Final Flashcards
This is diffuse, shear + yellow
hyperkeratosis
This is a result of direct pressure and has a white diffuse rim
tyloma
How do you diagnose IPK + porokeratosis?
visually and through palpation
Diffuse maceration surround the keratosis and usually underlying a bony prominence?
a. hyperkeratosis
b. tyloma
c. IPK
d. porokeratosis
C. IPK
This is a translucent keratinous plue surrounded by a white rim of macerative tissue beleived to be the plugged rim of an eccrine sweat duct
a. hyperkeratosis
b. tyloma
c. IPK
d. porokeratosis
D. porokeratosis
How do you diagnosis verruca?
a. Loss of skin lines- DNA altered
b. Pinpoint black petechiae
c. Pain w radial compression
d. all
e. none - these are all ways of treating
D. all of hte above
Hoe do u confirm herpes zoster?
a. PAS stain
b. Biopsy
c. Visual
d. KOH stain
e. None of the above
B.
How do you diagnose a lipoma?
a. visually
b. palpation
c. biopsy
d. KOH stain
B. palpation
T/F you confirm a lipoma, ganglion & leiomyoma with an MRI
True
This is a palpable, painful and hard nodular lesion right below the skin that commonly presents w a history of trauma.
a. lipoma
b. ganglion cyst
c. bruise
d. inclusion cyst
e. leiomyoma
D
This is an acute inflammation and thrombosis of arteries and veins of the hands and feet
a. vasospastic disease
b. thromboangiitis onliterans
c. vasculitis
B. Thromboangiitis obliterans
How do u diagnose thromboangiitis obliterans?
H&P, smoking history!
How do you diagnose vasospastic disease?
H&P, occurs during cold temps!
When do you visually inspect the digits in order to make a diagnosis?
with vasculitis!
Small fiber neuropathy commonly presents with:
a. absent reflexes
b. loss of light touch
c. loss of proprioception
d. loss of vibratory sense
e. pain + burning of soles
E. pain burning soles
To make the DIAGNOSIS of this, you palpate to reproduce symptoms along the course of the nerve. A. tendonitis B. neuritis C. neuroma D. muscle atrophy
B. neuritis
What is the most common peripheral nerve tumor?
schwannoma
Positive mulder’s sign is seen in?
neuroma
Morton’s neuroma is:
a. commonly enlarged 4th common plantar digital nerve at the level of the met heads just plantar to the DTML
b. commonly enlarged 3rd common plantar digital nerve at the level of the met heads just plantar to the DTML
c. commonly enlarged 2nd common plantar digital nerve at the level of the met heads just plantar to the DTML
d. commonly enlarged 5th common plantar digital nerve at the level of the met heads just plantar to the DTML
e. none of hte above
B.
T/F Steroid injections are a good therapy for neuromas and provide relief in hte majority of patients.
False, poor therapeutic results with only relief in 14% of pts
How do you diagnose muscle spasm w contiguous MTPJ disease?
If there is pain on ROM while palpating muscle
This is a biomechanical abnormality that is commonly seen at the 2nd MPJ and is aggravated by weight bearing and end ROM restriction.
a. Tendonitis
b. Capsulitis
c. Bursitis
d. Synovitis
e. B and D
B. capsulitis
This is an inflammation of one or more small sacs of synovial fluid in the body
a. Tendonitis
b. Capsulitis
c. Bursitis
d. Synovitis
e. B and D
C
This is an inflammation of the joint fluid
a. Tendonitis
b. Capsulitis
c. Bursitis
d. Synovitis
e. B and D
D
A 35 y/o female patient comes into your office complaining of pain on the medial aspect of her foot, near the arch. You clinically describe it as a translucent keratinous plug surrounded by white rim of macerative tissue. It is unusual because it is not located in a weight bearing area of her foot. What is your diagnosis?
Porokeratosis!
Whcih type of porokeratosis do we worry about most? Why?
a. Classic porokeratosis of mibellis (PM)
b. Linear porokeratosis
c. Disseminated superficial actinic porokeratosis (DSAP)
d. Porokeratosis palmaris et plantaris dissesminata (PPPD)
e. Punctuate porokeratosis keratoderma
e. Punctuate porokeratosis keratoderma
because these are more commonly only seen on the hands and the feet while the others are seen all over the body!
How do you diagnose tinea + verruca?
a. visual
b. PAS
c. KOH
d. biopsy
e. X-ray
A.
How do you diagnose a stress fracture?
H&P
POP to met shaft
Tuning fork to area
X-rays
What are the three MOST COMMON soft tissue tumors in the forefoot?
a. lipoma
b. ganglion
c. inclusion cyst
d. leiomyoma
NOT D.
What is the most common lipoma of the foot/ankle?
Juxtamalleolar lipoma!
- fat pad in front of the ankle “cankles”
A pt comes into clinic w a ganglion cyst on the plantar lateral surface of her foot. You decide to aspirate it. What do you tell teh patient?
a. The chances of it coming back are slim-none and she does not have to worry about it ever coming back
b. The chances of it coming back are high and she may need to return to get it aspirated again
c. It will definitely never come back
d. It will definitely come back
B
How do you diagnose a freiberg’s infraction?
H&P, palpation to the tip of the met head vs shaft, but difficult
What is the recurrence rate of an inclusion cyst?
a. quite low
b. quite high
c.
A. quite low
What is the most common cause of fat pad insufficiency?
atrophy due to age
The acute inflammation and thrombosis of arteries and veins of hte hands and feet is what?
a. vasospastic disease (raynaud’s)
b. thromboangiitis obliterans (beurger’s disease)
c. vasculitis
d. all of the above
e. none of hte above
B
In this disease you see pinpoint erythmatous macules on the digits
a. vasospastic disease (raynaud’s)
b. thromboangiitis obliterans (beurger’s disease)
c. vasculitis
d. all of the above
e. none of hte above
C vasculitis
T/F Vasculitis is a disease of only veins
FALSE, includes arterieis, capillaries as well
How do you diagnose OA?
expose the joint via flexion/extension + palpate
Pt comes into your office complaining of BURNING PAIN in the forefoot of their L foot. This is most commonly due to:
a. large fiber neuropathy
b. small fiber neuropathy
c. not enough information is given
d. both large + small fiber
B. small
Small = burning Large = loss of sensation- dont feel anything!
What is Tinel?
when you palpate the nerve in the forefoot, the pain is electrically stimulated DISTALLY.
TD bank
What is valleix
when you palpate the nerve in the forefoot, the pain is radiated PROXIMALLY
VP- VICE PRESIDENT
WHAT IS THE most common nerve tumor?
schwannoma
All of hte following are considered zebras except?
a. CMT disease
b. Chronic relapsing polyneuritis
c. Amyloidosis
d. Schwanomma
e. Neurofibroma
f. Acromegaly
D. schwanomma
This is a hypertrophy of hte PERINEURAL + ENDONEURIUM of the nerve
neuroma
A positive mulder’s sign is?
a. an audible click that is heard when palpating for a neuroma
b. an audible click that is heard when you are palpating for neuritis
c. A palpable click that is felt when you are palpatig for neurtiis
d. A palpable click that is felt when you are palpating for a neuroma
D. a PALPABLE click
T/F Conservative treatment of neuromas showed promising results with about 80% of patients reporting relief after 1 month.
False!
Which has the better results of conservative treatment?
a. steroid injection
b. sclerosing injections
c. wider shoes
d. orthoses
e. metatarsal pads
B. sclerosing
When doing surgical treatment on neuromas, what is best to do?
reposition it into muscle for best results!! + to prevent wallarian degeneration
capsulitis is commonly seen at what joint?
a. 1st mpj
b. 2nd mpj
c. 3rd mpj
d. 4th mpj
B. 2nd MPJ
What are the normal metatarsal parabolas?
2 3 1 4 5
2 1 3 4 5
T/F Brachymetatarsia is seen much more commonly in females rather than males
True
Pt presents w freiberg’s infraction. what should u tel them to do to treat it conservatively?
a. Use shoes that have no heel to take pressure off
b. Use shoes that have a low heel to take pressure off
c. Do a shortening wedge osteotomy
d. Do a met head resection
B.
Which layer do ganglions arise in?
a. skin
b. vasculature
c. bone
d. adipose tissue
e. muscle
D. adipose!
A neuroma found in the arch of the foot has pain that radiates
a. proximally
b. distally
c. both proximally + distally
d. neither distally nor proximally
B
When would the pain radiate distally in regards to a neuroma
a. tinel sign forefoot
b. valleix sign forefoot
c. arch
d. rearfoot
e. calf
A and C
Fibromas are commonly seen in which layer
a. skin
b. adipose
c. plantar fascia
d. bone
e. muscle
C
MOst of hte time, fibromas are found in the:
a. medial 1/3 of foot
b. lateral 1/3 of foot
c. middle of foot
A. medial
When you have arch pain WHAT IS THE FIRST THING YOU THINK OF?
Plantarfibromatosis
Posterior tibial tendonitis is commonly associated with:
a. weakness on inversion of foot
b. weakness on eversion of foot
c. weakness of plantarflexion
d. weakness on dorsiflexion
A.
When should you engage the single/ double raise test
When diagnosing for posterior tibial tendonitisi
When talking about arch pain, where do you most commonly see pain?
a. skin
b. vasculature
c. nerves
d. adipose
e. bone
E. bone
Primary stability of the 1st and 2nd mets come from:
a. lisfranc ligament
b. 2nd met mortise
c. plantar soft tissue
d. ligaments + tendons in the arch
e. A and B
E
Wick’s catheter is used to:
asses whether or not a patient has compartment syndrome by measuring pressure
If you get widening of more than how many mm should u be thinking about Lis Francs?
4mm or 2mm greater than contralateral foot
What is Fleck sign?
A small avulsion fracture usually off hte medial cuneiform or 2nd MT seen w a Lis Francs injury
nutcracker injury
navicular fracture
Name the fractures of the 5th met, distal to proximal
Stress
Jones
Avulsion
Stop Jumping Around
Which of the fractures of hte 5th met is a watershed area?
Jones
What is the most common cause of OA?
a. when normal stress is placed on an abnormal joint
b. due to systeic conditions that cause breakdown of a joint
c. When abnormal stress is placed on a normal joint
d. idiopathic
e. secondary
C! abnormal stress normal joint!
OA is characterized by:
chronic low grade inflammation even thought it is not caused by an inflammatory process
What is the most common pathogenesis of OA?
a. defective cartilage initially fails under normal joint loading
b. damage to normal cartilage by physical forces - either macrotrauma or repetitive microtrauma
B.
What is a common cause of midfoot pain, dorsally?
an exostosis or osteophye= rubbing = pain
Most common site of charcot foot?
a. Forefoot
b. ankle/subtalar
c. midtarsal
d. lisfrancs
D. Lisfranc’s
What is the equation for midfoot breakdown?
neuropathy + elevated forefoot pressure + achiless tendon structural problem = midfoot breakdown
What type of pain do pts w charcot complain of?
a. excruciating pain
b. dull aching pain
c. sharp pinpoint pain
d. burning pain
e. shooting radiating pain
B. dull aching
When using a dermal thermometer, what is the degree in which you should start thinking charcot?
a. 2
b. 3
c. 4
d. 5
e. 6
C. 4 degree difference in limbs = sign of charcot
What time of day do you commonly see pain w plantar fasciitis vs medial posterior heel pain, respectively?
a. worse in morning, worse at night
b. worse in morning, worse in morning
c. worse at night, worse in morning
d. worse at nigh, worse at night
e. always hurts, always hurts
A
When would u use an EMG to test for tarsal tunnel syndrome?
a. early stages of disease
b. late stages of disease
c. middle stages of disease
d. you would not use EMG to test for TTS
B. late
If your patient has impingement of the medial calcaneal branch of the tibial nerve, what is most likely the cause?
a. tarsal tunnel syndrome
b. porta pedis
c. neuropathy
d. neurodynia
D. neurodynia
Porta pedis is further down in the foot!!! Tarsal tunnel is higher! neurodynia happens below porta pedis!
According to a study done by Louisia in 1999, the medial calcaneal nerve:
a. lies between deep fascia + abductor hallucis
b. lies superficial to abductor hallucis
c. 46% of the time originates from the medial plantar nerve
d. none of the above
B.
All of the following are tendons on the medial aspect of the foot that can cause tendonitis, EXCEPT?
a. PT
b. FDL
c. FHL
d. EHL
d. EHL
Where do you commonly see a Haglund’s deformity?
On the lateral aspects of hte heels, lateral to achilles
• Directly centered will be Achilles Tendinitis- Retrocalcaneal
What is the most common site for a retrocalcaneal bursa?
A. between achilles tendon + skin
b. between achilles + calcaneus
c. between calcaneus +bursa
B. between calcaneus + achilles
When do you elicit pain with a retrocalcaneal bursitis?
With direct palpation BEHIND the achilles tendon
Lateral heel pain is MOST LIKEY due to:
a. nerve impingement
b. peroneus longus tendinitis
c. peroneus brevis tendinitis
d. ATF ligament
e. CF ligament
C- becuase of its insertion!
Which of the following is a cause of lateral plantar heel pain?
a. nerve impingement
b. fat pad atrophy
c. fracture
d. tumor
e. all of hte above
E.
T/F An endochondroma is a zebra of heel pain
True
T/F RA usually presents bilaterally
True
With RA you will see that changes occurring in what areas of heel ?
1,2,3,4
With ankylosing spondylitis, where do you see changes occuring in the heel?
2.3.4.5
With reiters syndrome, where do you see spurs?
1,2,4
Where do you more commonly see pencil in cup deformities?
in the metatarsals, not he calcaneus
With psoriatic arthritis, where do you commonly see heel changes?
2,3,4,5
Pts with sarcoidosis most commonly present with waht as the initial disease feature?
a. forefoot pain
b. arch pain
c. heel pain
d. burning pain
e. calf pain
C. heel pain
• A traction apophysitis of the Achilles tendon insertion
Severs disease
In Sever’s disease, where does the pain most commonly present?
a. medial heel
b. lateral heel
c. posterior heel
d. plantar heel
C. posterior heel
With what fracture is Fleck's sign MOST commonly seen? A. Jones Fracture B. Lis Franc Fracture C. Navicular Fracture D. Stress fracture of 2nd met
B Lis Franc
What is Turk’s test?
used to CONFIRM the diagnosis of TTS: pump up a blood pressure cuff + if it exascerabtes the symptoms of pain = TTS.
Dont want to pump it up too high. pump up to half of their SYSTOLIC!
Venous comitantes become engorged and blood cant get out but keeps coming in
Where do you find an achilles bursa?
between skin + posterior aspect of distal achilles tendon
T/F Plantar fasciitis has been found to be linked to a biomechanical abnormality (abnomral foot posture)
False
Has to do with weight, occupation, or bilateral heel pain
T/F An increase in temperature gradient is indicative of plantar fasciitis
True
What is the most common inflammatory disease seen in america?
Rheumatoid arthritis
Why do patients w RA have heel pain?
Rheumatoid related laxity causes pes valgus = rear foot malaignment
T/F Seronegative Spondyloarthropathies have no RF factor but do have a strong association with HLA-B27
True
What parts of the heel are reiters syndroem associated with? A. 1,2,3,4 B. 2,3,4,5 C. 1,2,4,5 D. 1,2,4 E. 1,2,5
D. 1,2,4
This is a multiple, focal microscopic inflammatory lesions localized to the ligamentous + tendinous attachements
Psoriatic arthritis
T/F Venous stasis dermatitis commonly presents bilateral vs unilateral
True
Refers to the skin induration and hyperpigmentation of the legs that often occurs in patients who have chronic venous insufficiency.
Lipodermatosclerosis
Reverse champagne bottle + stork leg are commonly seen with what diseas?
Lipodermatosclerosis
The area above the ankle below the calf is known as what & what disease is it associated with?
Gaiter distribution
Lipodermatosclerosis
Your patient presents with an ulcer on the medial side of their leg. it is superficial, and filled w red irregular granular tissue. What type of ulcer are you most commonly seeing?
Venous ulcer
Venous stasis dermatitis, lipodermatosclerosis, venous ulcers + arterial ulcers are all components of which part of the body?
a. Skin
b. Adipose
c. Vasculature
d. Bone
A. skin
TRICKY!
What are the two most important factors of Virchow’s triad
a. changes in blood flow
b. changes in vessel wall
c. alterations of coagulability
A and C
blood flow + coagulability
What is the pneumonic for DVT?
I am clotted Immobilization Arrhythmia MI HyperCoagulability Longevity Obesity Trauma Tobacco Estrogen previous DVT
What is Homans sign?
A test for DVT in which DF of the foot elicits pain in the POSTERIOR calf
What is Pratt’s sign?
A test for DVT in which squeezing of the posterior calf elicits pain
What does the Wells score estimate?
The probability of DVT
>3 - high
1-2 : intermediate
<0: low
T/F it is easier to make a diagnosis on deep veins vs superficial veins
False
T/F thrombophlebitis presents with blanching
False - negative bc clot - no blanching
If lesions dont blanch, what should be in your differential?
a. cellulitis
b. thrombophlebitis
c. phlebitis
d. phlebothrombosis
e. all except C
E.
What is the definition of claudication?
When pain goes away when you stop activity
Pts with PVD more commonly have leg pain at what time of the day?
a. morning
b. night
c. mid afternoon
d. all times of day
e. pts w PVD dont commonly have leg pain
B. night because legs are elevated in bed- less blood getting to them = painful. once they put feet down = pain stops
T/F Diabetics are more likely to report symptoms of intermittent claudication vs non-diabetics
FALSE! have neuropathy- cant feel pain= keep walking = bad
Claudication is most commonly assocaited with?
a. DVT
b. Thrombophlebitis
c. PVD
d. A and C
e. A and B
c. PVD- dull cramping pain in muscle
Distinguish between charlie horse + claudciation
both are pain in muscle
CH: at night and pain relieved when activating muscle
Claudication: during day pain relieved when resting muscle
What is the Thompson Test?
Thompson Test:
if i squeeze on the back of your leg, you should plantarflex your foot slightly
w patients with achilles rupture, there is NO plantarflexion! bc its ruptured
thompson= lookng for plantarflexion!
What are the 6 Ps of compartment syndrome?
Pain out of proportion Paresthesia Pallor Pulselessness Paralysis Pressure on passive extension of the compartment
This is defined as periostitis of the tibia due to tibial strain when under a load
Medial tibial stress syndrome
What is the other term for subtendinous calcaneal bursa?
a. subcutaneous calcaneal bursa
b. retrocalcaneal bursa
c. achilles bursa
d. infracalcaneal bursa
e. all of hte above are synonymous
B. retrocalcaneal
T/F Plantar fasciitis is commonly associated w an increase in temperature gradient
True
T/F A calcaneal spur is a cause of heel pain
False
Fat pad atrophy is most commonly seen in what type of heel pain?
Lateral PLANTAR heel pain
What are the 4 SNS’s?
Ankylosing Spondylitis
Reiter’s Syndrome
Psoriatic Arthritis
Enteropathic Arthritis (Crohn’s Dx)
What are the systemic inflammatory disorders?
Rheumatoid Arthritis Anklyosing Spondylitis Reiter’s Syndrome Psoriatic Syndrome Gout
What is the most common benign tumor in the body?
a. fibroma
b. lipoma
c. sarcoma
d. chondroma
B. lipoma
T/F you need a radiograph to diagnose neuroma
FALSE- just to rule out the neuroma. you use a H&P and reproducible pain to diagnose neuroma
A benign cutaneous fibrous histocytoma is AKA?
dermatofibroma
