Final Exam Flashcards by Frank Narcisi

includes 3 cuneiforms, navicular, cuboid

Midfoot

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includes phalanges, metatarsals, sesamoids

Forefoot

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includes talus and calcaneus

Rearfoot

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membranous protective covering of the body consisting of Epidermis and Derims

Skin

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sheet of fibrous tissue that envelops the body beneath the skin. It encloses muscles and groups of muscles, separating them into layers/groups

Fascia

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hard CT consisting of cells embedded in a matrix of mineralized ground substance and collagen fibers

Bones

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a band of sheet of fibrous tissue connecting two or more bones, cartilages, or other structures

Ligaments

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a primary tissue, consisting predominantly of highly contractile cells, which may be classified as skeletal, cardiac and smooth

Muscle

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a non-distensible fibrous cord, or band of variable length that is the part of the muscle which connects the fleshy part of the muscle with the bony attachment

Tendon

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a CT characterized by avascularity and firm consistency

Cartilage

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thick walled, muscular, pulsating blood vessel conveying blood away from the heart, usually oxygenated (one exception)

Artery

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vessel carrying blood toward the heart, usually deoxygenated (one exception)

Vein

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a vascular channel that transports lymph

Lymphatics

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circulation tissue of the body. Fluid and its suspended formed elements that are circulated through the heart, arteries, capillaries and veins

Blood

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relating to, containing, or consisting of synovium

Synovium

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white cordlike structure composed of one or more bundles of un/myelinated fibers, coursing outside the CNS

Nerve

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X-ray beam shot from anterior to posterior

AP projection (PA View)

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divides body into anterior and posterior, vertical plane

Frontal Plane

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divides body into superior and inferior

Transverse Plane

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divides body into medial and lateral

Sagittal Plane

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parallel to axis of structure (movement)

Longitudinal

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perpendicular to axis of structure (movement)

Transverse

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straign line, movement connecting two points

Linear

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one curve (movement)

Curvilinear

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two curves (movement)

Lazy S

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movement in sagittal plane, foot moves upward toward the tibia

Dorsiflexion

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movement in sagittal plane, foot moves downward away from the tibia

Plantarflexion

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movement in frontal plane, sole of foot is turned inward toward the midline

Inversion

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movement in frontal plane, sole of foot moves outward away from the midline

Eversion

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movement in the transverse plane, foot is turned laterally, away from the midline of the body

Abduction

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movements in transverse plane, foot turns medially, towards the midline of the body

Adduction

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triplanar movement, foot is simultaneously abducted, everted, and dorsiflexed

Pronation

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triplanar movement, foot is simultaneously adducted, inverted, and plantarflexed

Supination

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fusion/fixing

-desis

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puncture a joint

-centesis

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removal of excision of

-ectomy

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to free up

-lysis

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incision into

-otomy

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condition of

-osis

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to suture

-raphy

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surgical correction/plastic repair

-plasty

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crushing something or friction/rasping

-tripsy

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stiffening of a joint by operative means

Arthrodesis

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fusion of ankle joint

Triple Arthrodesis

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incision into a joint, expose interior of a joint

Arthrotomy

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excision or removal of a bunion

Bunionectomy

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to suture a capsule, usually refers to the repair of capsule after surgical incision

Capsulorraphy

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incision into the capsule, frequently used to gain access into a joint

Capsulotomy

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use of an agent to stop bleeding, may also be used for cutting (electric current, freezing, chemicals, silver nitrate)

Cauterize

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to clog blood, to change a liquid into a gel or solid

Coagulate

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freezing via liquid nitrogen or CO2, used for warts, tumors, etc

Cryosurgery

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trim away/remove, excision of devitalized tissue and foreign matter from a wound

Debride

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make incision deeper into subcutaneous tissue

Deepen

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removal of something

Excise

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removal of an exostosis, removal or a bony prominence, (under toenail)

Exostectomy (Subungual Exostosis)

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use of electric needle to control bleeding by desiccation blood at a vessel

Hyfrecate

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to cut with a knife

Incise

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fixation of a joint by using internal instrumentation/implants (uaually permanent)

Internal Fixation

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removal/excision of nerve

Neurectomy

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to free up a nerve from the surrounding scar tissue

Neurolysis

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incision into bone, usually by means of saw or osteome

Osteotomy

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crush/rasp bone

Osteotripsy

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to remove symptom without curing underlying disorder

Palliation

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stick out of skin, denoting the passage of substances though unbroken skin, as in absorption by ununction. Passage through the skin by needle puncture. Introduction of wired and catheters

Percutaneous

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removal of a digit of hand or foot

Phalangectomy

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removal of a tendon or part of tendon

Tenectomy

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fastening a tendon into place

Tenodesis

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incision into the tendon

Tenotomy

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to separate something into two distinct layers

Underscore

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absence of pain, neurologic or pharacologic state in which painful stimuli are moderated such that they are still perceived but no longer painful

Analgesia

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Reversal of differentiated states in cells, especially in the case of cancer or tumor

Anaplasia

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absence of sensation, from pharmacologic depression of nerve function or form neurogenic dysfunction

Anesthesia

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weakening and ballooning out of blood vessel wall

Aneurysm

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fusion of fixation of a joint, stiffening or fixation of joint as a result of disease process which causes any fibrous or bony union across a joint

Ankylosis

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hardening/stiffening of arteries, thickening of intima, loss of elasticity

Artheriosclerosis

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formation of a fatty plaque in the most proximal blood vessels

Atherosclerosis

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joint pain

Arthralgia

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inflammation of a joint

Arthritis

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x-ray of joint, may be with or without contrast

Arthrogram

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visualization of a joint, endoscope for examining the internal anatomy of a joint

Arthroscope

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due to cerebella syndrome. Broad based, oscillatory gait. Inability to coordinate muscle activity during voluntary movement

Ataxia

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mild, non-progressive sickness or condition (like a neoplasm)

Benign

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inflammation of bursa

Bursitis

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synonymous with malignant tumors

Cancer

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malignant tumor arising from epithelial cells

Carcinoma

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inflammation of joint cartilage

Chondritis

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blockage (usually of blood vessels), causes ischemia

Claudication

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pain disproportional to the procedure

Causalgia

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high arch

Cavoid

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grinding of joint surfaces

Crepitation

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inflammation of joint capsule

Capsulitis

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two joint surfaces crossing slightly out of the joint

Deviation

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metatarsal crossing into the hallux space

Subluxation

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metatarsal completely under the hallux

Luxation

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disease of carbohydrate intolerance due to relative or absolute insuline deficiency

Diabetes Mellitus

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test in which a microscope slide is pressed to skin, no blanching = ecchymosis, blanching = erythema

Diascopy

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bony projection (bone spur)

Exostosis

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swelling, note whether unilateral/bilateral, pitting or non-pitting

Edema

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redness or rubor, dialation of blood capillaries due to inflammation, blanches with diascopy test

Erythema

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bleeding under the skin (bruise), skin won’t blanch with diascopy test

Ecchymosis

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clot breaks loose and travels, can be venous or arterial

Embolism

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like dermatitis, inflammation of the skin

Eczema

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inflammation/irritation of fascia (common with flat feet)

Fasciitis

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also called pes planis or pronation syndrome, depression of medial arch (rigid/flexible)

Flatfoot

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necrosis of tissue (wet = infected, dry = non-infected)

Gangrene

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disease of purine metabolism, produces uric acid crystals in kidneys and joints

Gout

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callus on top of foot

Heloma

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weakness on one half of the body

Hemiparesis

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full paralysis on one half of the body (common with stroke)

Hemiplegia

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increased blood sugar

Hyperglycemia

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increased uric acid in blood, may indicate preliminary stage of gout

Hyperuricemia

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increased number of cells

Hyperplasia

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increased cell size

Hypertrophy

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complete ischemia leading to tissue necrosis

Infarct

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to close a wound with suture/staples

Primary Intention

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wound is left open

Secondary Intention

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inadequate blood flow to a part of the body, may lead to infarct

Ischemia

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smooth muscle tumor

Leiomyoma

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fatty tumor

Lipoma

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progressive increase characterized by properties of anaplasia, metaplasia, etc

Malignancy

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fungus (in feet = Onychomycosis/tinea pedis

Mycosis

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cell type conversion, a tumor

Metaplasia

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new growth, uncoordinated with the surrounding cells, may become cancerous

Neoplasia

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nerve inflammation

Neuritis

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nerve tumor (Morton’s)

Neuroma

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group of diseases involving degeneration of the center of ossification in the bones of children and adolescents

Osteochondrosis

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nail fungus

Onychomycosis

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inflammation or infection of the inside of bone

Osteomyelitis

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softening of bone due to Ca2+ and Vit D deficiency (Rickets)

Osteomalacia

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Abnormal union of 2 bones in the rearfoot and midfoot. 3 Types.

Tarsal Coalition - Synostosis, synchondrosis, syndesmosis

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Chronic inversion and adduction when the foot is in the plntarflexed position.

Supination syndrome

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Inflammation of the vein (deep and superficial)

Phlebitis

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Foot with too high of n arch

Pes Cavus

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A triplanar deformity that is simultaneous eversion and abduction while the foot is dorsiflexed

Pronation syndrome

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Inflammation of the plantar aponeurosis

Plantar fasciitis

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Infracalcaneal exostosis.

Heel Spur

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A form of arthritis caused by deposits of needle-like crystals of uric acid.

Gouty Arthritis

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Breaking of a bone

Fracture

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A disease process that occurs at the sire of insertion of muscle tendons and ligaments into bones or a joint capsule

Enthesopathy

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3 Major types: Adduction of the forefoot, equinus of the rearfoot, and inversion of the rearfoot.A congenital deformity.

Club Foot (Talipes Equino Varus)

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Looks like calcaneovalgus but the bones do not realign when plantarflexed. Most commonly seen in the right foot.

Congenital vertical talus (AKA Convex pes valgo plantus)

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loss of bone tissue

Osteopenia

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organic matrix of bone laid down by osteoblasts (“bone-like”)

Osteoid

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inflammation of bone

Osteitis

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fibrous tissue around a nerve

Perineural Fibrosis

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increased urination

Polyuria

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increased thirst

Polydipsia

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increased appetite

Polyphagia

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inflammation of a vein (deep may form clot

Phlebitis

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growth that if untreated/watched may turn into cancer

Precancer

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striated muscle tumor

Rhabdomyoma

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inflammation of the nerve rots as they exit the spine, producing nerve pain up and down the foot and leg (L4-S2)

Radiculitis

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malignant tumor in the CT’s

Sarcoma

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blood clot

Thromus

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neurological defect that can lead to ulcerations of the skin, as the patient can’t feel anything

Trophic

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foot fungus (acute = wet, chronic = dried/scaly

Tinea Pedis

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crystallizations in a joint due to crystal deposits (gout)

Tophi

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callus on bottom of foot, hyperkeratosis

Tyloma

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dilation of veins leading to pooling of blood and clot formation, prone to phlebitis

Varicosity

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first and outer layer of skin

Epidermis

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second layer of skin (papillary/reticular)

Dermis

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bottom part of dermis, just above superficial fascia

Subcuticular

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subcutaneous fascia, subcutaneous layer, hypodermis

Superficial fascia

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investing fascia for muscles and tendons

Deep Fascia

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outer layer of bone

Periosteum

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clearing ou tthe area you will be working on in bone

Underscoring

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move away from the underlying tissue, ie bone

Underscoring the capsule/periosteum

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surgical removal of bone

Ostectomy/Osteotomy

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small, flat, non-palpable, colored area of skin (less than 10 mm), area of melanocyte putting out melanin

Macule

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a defined area of skin problem

Patch

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small, solid, rounded bump rising from the skin, usually inflammatory elevation of skin that doesn’t contain pus (smaller than 1 cm)

Papule

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small collection of tissue that is palpable and can be found in any skin layer, mass of tissue or aggregation of cells (larger than 1 cm)

Nodule

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dry, broad, raised area on the skin and can be palpated, plateau like

Plaque

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small blister on the skin or any small pouch (wet lesion filled with fluid)

Vesicle

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fluid-filled blister

Bulla

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collection of pus on the top layer of skin, small elevation of skin that is filled with pus

Pustule

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thick, leathery skin, resulting from scratching and rubbing, hyperkeratosis caused by chronic inflammation resulting from prolinged scratching or irritation

Lichenification

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crack in the skin, can be healed by TBC

Fissure

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self induced traumatized area (scratching) that bleeds

Excoriation

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light shined through a bag of proteins should transmit red and reflect blue

Tyndall Effect

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skin that looks red but is cool to touch, can result in gangrene

Cool Erythema

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skin pigmentation from Vit A, gives yellow color and is lipid soluble

Carotene

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darkens skin, produced by melanocytes

Melanin

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too many melanocytes

Melanoma

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hypertrophy of the stratum corneum from trauma

Hyperkeratosis

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corn on dorsum of foot

Heloma Durum

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Macerated corn, from sweat between toes

Heloma Molle

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keratosis formed over a previous ulcer, entraps capillaries and are prone to bleeding/rupture

Heloma Vascularis

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corn that entraps a nerve making trimming painful

Heloma Neurofibrosum

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multiple spotted tiny hyperkeratoses

Heloma Milliare

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occurs where a sweat gland becomes occluded, vasodialates with sweating, but very painful to walk on

Porokeratosis

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very deep, well-defined, hard central core of a callus that may go down to the bone

Intractable Plantar Keratosis (IPK)

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elongation of the papillary layer and thinning of the superpapillary layer, affect skin on elbows, knew, scalp, lumbosacral areas, intergluteal cleft

Psoriasis

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sign of psoriasis, bleeds easily

Auspitz sign

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sign of psoriasis, new lesions form due to irritation

Koebner phenomenon

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serous or pustular developments in addition to flaking (type of psoriasis)

Pustular Psoriasis

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flexor surfaces of knees or extensor surfaces of elbows are the most common areas (type of psoriasis)

Psoriasis Vulgaris

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pencil and cup deformities of joint (type of psoriasis)

Psoriatic Arthritis

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extensor surfaces of lower extremity, flexor surfaces of upper extremities (type of psoriasis)

Inverse Psoriasis

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epidermal/dermal destrucition causes this, inflammatory response with itching

Lichen Planus

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Lichen Planus on anterior tibia

Violaceous Lesion

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itching sensation

Pruritis

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warts, increased number of rete pegs under hyperkeratosis, painful to squeeze, not to press

Verucae

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common vart, bottom of foot

Verrucae Vulgaris

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wart on face

Filiform wart

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wart on plantar surface of the foot, more keratin on top

Verrucae Plantaris

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wart on or near genitalia (caused by papillary virus)

Venereal warts

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wart, usually seen on face and possibly on foot

Juvenile Warts

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pale warts on the skin or mucous membrane

Molluscum Contagiosum

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crop of warts together, may form into one huge lesion

Mosaic wart

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forms blood blister within the wart and the wart usually falls off later

Pulse Dye Laser

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freezes the wart

Liquid Nitrogen

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used on warts instead of salicylic acid, paste that can be taped over the wart, debride a week later and repeat if not deep enough to remove

60% Selenicaine

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burning the wart with electric spark

Hyfrecation

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electric needle used on wart

Electrolysis

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symptom, not a disease. Vasodilation of the papillary layer

Eczema

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first contact causes reaction in patient (type of dermatitis)

Primary Irritant Contact Dermatitis

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type of primary contact dermatitis, acid burns, poison ivy

Direct Etiology

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type of primary contact dermatitis, skin dries out from washing dishes too often (soap)

Indirect Etiology

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allergic reaction to whatever substance is touching the skin, first exposure nothing happend, second exposure causes a reaction

Allergic contact dermatitis

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hives, superficial blood vessel inflammation

Uretecaria

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hives with deep blood vessels inflammation

Angioedema

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when a scratch causes inflammation and itch, itch/scratch cycle

Neurodermatitis (Lichen Simplex Chronicus)

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fluid-filled vesicles, positive Nikolski sign = skin readily peels off if scratched

Pemphigus

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bleeding when scratched, sign for psoriasis

Auspitz Sign

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skin disease that give golden fluoresce under Wood’s lamp, caused by tinea versicola

Vitiligo

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bacterial infection, occurs between the toes, bright red look, coral-red color under Wood’s lamp (pitted keratolysis)

Intertrigo

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increase in number of melanocytes, clump together and can be raised, circumscribed lesion (moles)

Nevi

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connective tissue surrounded by epidermal folds, treated by clipping or burning off

Skin Tags

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Ulcer caused by pressure (decubitis) or insult (traumatic)

External Ulcer

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ulcer caused by imbalance in blood sugar

Diabetic Ulcer

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Ulcer caused by no blood flow or neurosensory deficit

Internal Ulcer

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nail forms from the proximal part of the floor extending from the junction of floor and roof up to the anterior margin of the lunula (theory)

Traditional Theory

nail forms in three layers, dorsal, intermediate, ventral (theory)

Lewis Theory

exposed nail bed is sterile except for a small portion close to the point of separation of the nail from its bed (solehorn)(theory)

Boas Theory

fungal infection of the nail

Onychomycosis

three classes of dermatophytes

Tricophyton, Epidermophyton, Microsporum

most common saprophytic yeast infection

Candida Albicans

ingrown toenail

Onychocryptosis

wearing down of the cartilage due to age, wear and tear, and/or possible trauma

Degenerative Joint Disease

many joints involved, unknown etiologies, seropositive/negative forms, metabolic or endocrine (gout/pseudogout)

Polyarthidities (Inflammatory)

abnormal enlargement of the medial aspect of the metatarsophalangeal joint at base of hallux

Bunion

condition where one of the metatarsals are short, causing a short toe

Brachymetatarsia

frequent manifestation of tissue ischemia which is caused by occlusion of small vessels and usually occurs in elderly male who undergoes an invasive vascular procedure

Blue Toe Syndrome

toe contracted at DIP and PIP joints, often result of nerve damage

Claw Toe

Arthridities

non-inflammatory: degenerative joint disease

inflammatory: poly-arthridities of unknown etiology; metabolic, endocrine arthridities

Bunion

abnormal enlargement of the joint (MTP) at the base of the hallux; caused by inflammation

Brachymetatarsia

condition in which one of five metatarsals is abnormally short; brachymetapody (affecting more than one toe)

Blue Toe Syndrome

(arterial embolic disorder); frequent manifestation of tissue ischemia which is caused by occlusion of small vessels; occurs when “shower” a little emboli into one of the digits

Claw Toe

toe that is contracted at PIP and DIP joints, which leads to severe pressure and pain; often result of nerve damage caused by diseases like diabetes or alcoholism

Capsulitis

inflammation of capsule; most frequently affects the forefoot, specifically head of 2nd metatarsal

Diabetic Osteolysis

bone disappears; increase in osteoclast activity, causing demineralization

Digiti Minimi Varus

the phalanx is turned toward the midline

Dislocation

no connection at the MPJ; luxation

Fracture

to break bone or cartilage; can occur via traumatic, surgical, or pathological means

Forefoot Varus

a constant structural inversion of the forefoot with respect to a bisection of the posterior of the calcaneus when the subtalar joint is in a neutral position; causes severe pronation problems

Uncompensated: rearfoot is rigid and cannot compensate; will try to compensate in the midtarsal joint
Partially compensated: degree of forefoot varus is greater than the available degree of calcaneal eversion
Compensated: when degree of forefoot varus is equal to or less than the degree of calcaneal eversion

Forefoot Valgus

most common deformity; everted position of the forefoot relative to the rearfoot at the level of the midtarsal joint; inversion of the lateral column must occur to allow the forefoot to purchase the supporting surface during midstance and propulsive phases of gait

Flexible Forefoot Valgus: sufficient flexibility in the midtarsal joint to allow the lateral column of the foot to reach the supportive surface; leads to unstable gait; causes flatfoot
Rigid Forefoot Valgus: when range of motion in midtarsal joint is not enough to allow the lateral column of foot to touch ground; rearfoot supination/compensation required; causes high arch

Gouty Arthritis

arthritis caused by deposits of uric acid crystals

Gangrene

most commonly occurs on limb which has lost blood supply and undergoes coagulative necrosis

Dry: tissue leads to dessication and mummification
Wet: caused by bacterial infection

Hallux Abducto Valgus

progressive degeneration of 1st MPJ; demonstrates classic features of osteoarthritis; hallux is abducted and everted (patient usually has bunion)

Hallux Extensus

deformity where hallux is held rigidly in extended position, causing too much force on metatarsal head

Hallux Interphalangeus

abduction deformity of IPJ of hallux; distal phalanx abducted to side

Hallux Limitus

limited amount of dorsiflexion at MPJ

Hallux Rigidus

condition where stiffness occurs in 1st MPJ; usually associated with development of bone spurs on dorsal surface

Hallux Varus

deviation of hallux at MPJ; hallux is inverted

Hammertoe

deformed toe with contraction at the PIP joint; dorsiflexion at the PIP and plantarflexion of DIP joint

Heloma

corn or callosity on foot

Heloma Molle

corn formed by pressure between two toes; surface is macerated and yellowish in color; soft corn; (heloma durum is a hard corn)

Hypertrophy

increase in size of metatarsal head

Intractable Plantar Keratosis

discrete callus, about 1cm, directly under a metatarsal head; feels like “pebble” in ball of foot

Intermetatarsal Neuroma

tumor on nerve in metatarsal or between metatarsals (e.g. Morton’s Neuroma)

Mallet Toe

occurs when joint at the end of toe cannot straighten; tip of toe is turned down against top of shoe; plantarflexion of DIP joint

Metatarsalgia

painful foot condition in the metatarsal region of the foot; caused by extensor muscles pulling too hard

Metatarsus Adductus

adduction of metatarsus from midline

Morton’s Neuroma

occurs in the 3rd interspace between metatarsal heads

Onychauxis

thickened nail

Onychocryptosis

ingrown nail

Onychpgryphosis

long curved nail

Onchomycosis

nail fungus

Paronychia

suppurative inflammation of the nail fold surrounding the nail plate

Plantarflexed Metatarsal

plantarflexion of a metatarsal

Sprain

stretch, partial tear, total tear of a ligament

Splay Foot

widen metatarsal angles; very flexible foot

Subungual Exostosis

prominence of distal phalanx of a hallux; boney growth beneath nail

Subungual Hematoma

blood under nail

Tailor’s Bunion

lateral aspect of 5th metatarsal head

Verrucae

flesh-colored growth characterized by circumscribed hypertrophy of the papillae of the corium

Anterior Equinas

horse shaped

Cellulitis

infection of the skin and underlying tissues that can affect any area of the body

Charcot Foot

progressive degeneration that affects joints of the foot; associated with nerve damage that decreases ability to sense stimuli; joints of feet are subjected to repeated trauma

Dorsal Exostosis

plantarflexion of forefoot area; boney prominence at tarsometatarsal joint

Ganglionic Cyst

synovial membrane that has out pockets and filled with synovial fluid

Kohler’s Disease

avascular necrosis of bone (navicular)

LisFranc’s Fracture/Dislocation

dislocation of 1st cuneiform to 2nd metatarsal base

Lymphangitis

inflammation of lymphocytes

Ulcer

lesion through the skin or mucous membrane resulting from loss of tissue, usually with inflammation

Ischemic: no blood supply
Neurotrophic: no filling to area
Decubitis: bedsore
Venousstasis: poor venous return to heart

Ankle Equinas

horse shape (rearfoot pathology)

Calcaneovalgus

flexible deformity of foot in dorsiflexed position and touches talus; bones align with forced plantarflexion

Congenital Vertical Talus

same as calcaneovalgus except much more rigid; forced plantarflexion will not realign bones

Club Foot

(Talipes Equino Varus); deformity of ankle; inversion, plantarflexion, adducted (supination); metatarsal abduction foot to leg

Enthesopathy

a disease process occurring at the site of insertion of muscle tendons and ligaments into bones or joint capsules

Heel Spur Syndrome

exostosis, periostitis, plantar fascitis, or heel neuroma; causes abnormal walking style; spur itself does not cause pain but may be caused by inflammation in the area

Periostitis

inflammation involving the periosteum; may result in new bone formation

Plantar Fascitis

inflammation of central portion of plantar aponeurosis; common cause is a flat heel; associated with heel spurs

Pronation Syndrome

eversion, abduction, dorsiflexion (pronation); type of flatfoot, triplane deformity

Pes Cavus

high arch

Supination Syndrome

inversion, adduction, plantarflexion (supination)

Tarsal Coalition

abnormal union of two or more bones in the rearfoot and midfoot; complete or incomplete; congenital or acquired; can be bony (synostosis), catilaginous (synchondrosis), or fibrous (syndesmosis)

Deformity of MPJ, PIP

Hammertoe

Deformity of DIP, PIP

Claw Toe

Deformity of DIP

Mallet toe

When toes are curled and inverted towards the body

Varus deformity

Deviation of the digits medial towards the 2nd toe

Adduction deformity

Deviation of the digits outward/away from the body. Heloma molle may result.

Digital Abductus

-metatarsal abductus is the entire forefoot being bent outward from the body

Corn between toes

Heloma molle

Etiologies of Hammertoes

Extensor substitution
Flexor substitution
Flexor stabilization

weak tibialis anterior m. causes other extensors to fire harder, which upsets the dynamics b/w other extensors (and gives one hammertoes) EDL in particular can pull toes back (swing-phase formation of hammertoes – allows toes to clear in swing but causes hammertoe formation)

Extensor substitution

weak soleus muscle causes other posterior muscles to fire stronger than normal to prevent excessive ankle dorsiflexion in midstance. Flexor substitution occurs: FDL will upset dynamic by firing stronger than normal and will cause toes to buckle proximally.

Flexor substitution

when intrinsic muscles (lumbricals or interossiae) are weak, FDL becomes a deforming force, which causes hammer toes. Over time, the contracted extensor hood becomes a “holding force” maintaining the toes in their contracted position.

Flexor stabilization

Name other factors that affect the formation of hammertoes

Hallux abducto valgus
Tight shoes
High heels
Congenital deformity

Name other factors that affect the formation of hammertoes

Hallux abducto valgus
Tight shoes
High heels
Congenital deformity

Ways to evaluate hammer toes

Flexible vs. Rigid Hammertoes
Push-up test - push up on metatarsal base. If toes straighten, it is a flexible hammertoe.
Stand on floor - same principle – toes will straighten out if flexible

Flexible vs. Rigid Hammertoes

If it is a flexible hammer toe, surgeon can do capsular and tendon work

If a semi-rigid or rigid, surgeon will have to do bone work

Conservative Treatment of Hammertoes

Debridement of hyperkeratosis
Accommodative padding around prominences
Modification of foot gear
Local steroid injection
Oral NSAIDs
Topical keratolytics
Patient education
Orthotic control

Surgical Treatment of Flexible Hammer Toes

Flexor tenotomy
Extensor tenoromy
Extensor hood release

Surgical Treatment of Rigid Hammer Toes

Arthroplasty at PIPJ
PIPJ fusion
Digital joint implant
Middle phalangectomy
Diaphysectomy
Resection of base of proximal phalanx with syndactylization (joining of 2 toes surgically)

Surgical Treatment of Mallet Toes

Arthroplasty of DIPJ

Treatment of Heloma Molle

Exostectomy, arthroplasty, of syndactylization, since it is caused by the rubbing of head of proximal phalanx on the base of the middle phalanx of an adjacent toe

Prominence on the medial aspect of the 1st metatarsal head

Bunion

Promineneve on the lateral aspect of the 5th metatarsal head

Tailor’s Bunion

3 stages of healing process

Inflammation, Proliferation, Remodeling

0-4 days. Vascular, cellular, hemostatic event (lag/substrate phase)

Inflammation stage of healing process

5-20 days. Collagen fibers get laid down by fibroblasts (stage of healing)

Proliferation stage of healing

21+ days. Stage of healing process. Begins at 3 weeks for tendons

Remodeling stage of healing

What are the major areas to ask about for a physical?

Vasculature, Derm, Neuro, Musculoskeletal, Vital signs (temp, BP, respirations)

What are the 6 basic rules of infection?

Recognition, ID of infecting organisms, diagnostic testing, decompression/debridement, antibiosis, follow-up

when a drug inhibits growth

bacteriostatic

antibiotic for soft tissue infection, if patient is allergic to penicillin, metabolized by liver

erythromycin

antibiotic goes through barrier, metabolized by liver

clindamycin

antibiotic not used often, metabolized by kidney

tetracycline

antibiotic for burn patients

sulfonamides

destroys cell at or near the m.i.c.

bacteriocidal

always used the drug with the lowest m.i.c., the smaller the dosage the better

minimum inhibitory concentration

type of antibiotic most often used in podiatry

bacteriocidal

penicillins, cephalosporins, aminoglycosides, and vancomycin all metabolized by kidney

bacteriocidal

using two drugs of the same class, i.e. giving a bacteriostatic drug with another bacteriostatic drug or a bactericidal drug with another bacteriocidal drug

agonist

using one drug from each of the two classes (bacteriocidal and bacteriostatic); try to avoid this option

antagonist

try to avoid antagonistic relationship; exception to the rule is using bacteriostatic Clindamycin with bacteriocidal drug

cuts through extra-capsular polysaccharide glycolate slime coat secreted by some bacteria

sensitivity to medication

medication resistance

organism can successfully resist medication (antibiotic won’t work against organism)

organism resistance

bacteriocidal drugs (penicillin, vancomycin, cephalosporin, aminoglycosides, tetracyclines, quinolones) excreted by ___

kidney

bacteriostatic drugs (erythromycin, clindamycin) excreted by ___

liver

1st generation cephalosporin; 80% excretion via kidney and 20% via liver (good for those with liver problems)

cefazolin (ancef)

3rd generation cephalosporin, 20% excretion via kidney and 80% via liver; “pre-op” antibiotic

cefaperazone (cefobid)

what to look for at infection site

Cellulitis, Lymphangitis, Abscess

aerobic bacteria, staph (clusters), strep (chains), pneumo

gram(+) cocci

aerobic bacteria, Listeria, Clostridia, Dipthroides (LCD)

gram(+) rods

aerobic bacteria, Genococcus, Meningitis (GM)

gram(-) cocci

aerobic bacteria, Enterobacteriaceae, Pseudomonas - smelly infections (do NOT confused with enterococcus)

gram(-) rods

anaerobic bacteria, oral, gut, and vaginal

Bacteroides, Fragilis

penicillins, 1st generation cephalosporins treat:

gram(+) aerobes

aminoglycosides, 2nd and 3rd generation cephalosporins (strongest) treat:

gram(-) aerobes

1) quinolones if not resistant

2) otherwise anti-pseudomonal penicillin/cephalosporin PLUS anti-pseudomonal aminoglycoside COMBO are treatments for ___

pseudomonas

penicillins treat:

anaerobes

clindamycin or metronidazole treat:

bacteroides fragilis

complication of clindamycin is known as ___; the life-threatening diarrhea is treated by oral vancomycin which stays in the gut a long time to clean it because it has poor gut absorption

pseudo-membranous colitis

treatment for everything but pseudomonas; does not come in oral form [intravenous]

Unasyn

treatment with good aerobic coverage only

quinolones

treatment with excellent broad spectrum, aerobic and anaerobic coverage; augmentin is the oral form and timentin is the parentral form (intravenous, intramuscular)

clavulonates

treatment does not work well against Staph. Aureus; Keflex is a 1st generation cephalosporin that is effective because it is very resistance to degradation by beta-lactamase

penicillins

route of administration for minor infections in general; can be as strong as intravenous (IV)

oral

route of administration that is intravenous, intramuscular; for deep wound infections, potential bone involvement, constitutional symptoms

parentral

for dosage of children:

weight in pounds/150 = % of adult dose

Clark’s rule

1) situations where dire consequences could occur (ex: joint replacement) 2) situations where infection is common/possible (ex: prolonged wound exposure, extensive surgical trauma, contamination during surgery) 3) compromised immunological system

indications of prophylaxis

antibiotics that have beta-lactam rings in their structure; penicillins, cephalosporins, carbopenims, monobactams, cephamycins

beta-lactams

PenVK (oral) and PenG (IV, for surgery)

natural penicillins

ampicillin is twice as strong as amoxicillin (so you use half as much)

aminopenicillins

Cloxacillin, Oxacillin, Naphcillin, Dicloxacillin, Methacillin (CONDM)

penicillin-resistant penicillins

an enzyme secreted by some bacteria that breaks down penicillin molecules

penicillinase

type of penicillinase that acts on beta-lactam ring

beta-lactamase

Azlocillin, Pipercillin, Mezlocillin, Carbenicillin, Ticracillin

Acylureido Penicillins

carbenicillin, ticarcillin

carboxypenicillins

beta-lactamase inhibitors; penicillinase-resistant

clavulonates

amoxicillin + clavulonate

Augmentin

Ticarcillin + Clavulonate; intravenous/intramuscular

Timentin

Sulbactam + Ampicillin; intravenous/intramuscular

Unasyn (not for Pseudomonas)

Deformity of MPJ, PIP

Hammertoe

Deformity of DIP, PIP

Claw Toe

Deformity of DIP

Mallet toe

When toes are curled and inverted towards the body

Varus deformity

Deviation of the digits medial towards the 2nd toe

Adduction deformity

Deviation of the digits outward/away from the body. Heloma molle may result

Digital Abductus

Corn between toes

Heloma molle

Etiologies of Hammertoes

Extensor substitution
Flexor substitution
Flexor stabilization

Extensor substitution

Flexor substitution

Flexor stabilization

Name other factors that affect the formation of hammertoes

Hallux abducto valgus
Tight shoes
High heels
Congenital deformity

Ways to evaluate hammer toes

Flexible vs. Rigid Hammertoes
Push-up test - push up on metatarsal base. If toes straighten, it is a flexible hammertoe.
Stand on floor - same principle – toes will straighten out if flexible

Flexible vs. Rigid Hammertoes

If it is a flexible hammer toe, surgeon can do capsular and tendon work

If a semi-rigid or rigid, surgeon will have to do bone work

Conservative Treatment of Hammertoes

Debridement of hyperkeratosis
Accommodative padding around prominences
Modification of foot gear
Local steroid injection
Oral NSAIDs
Topical keratolytics
Patient education
Orthotic control

Surgical Treatment of Flexible Hammer Toes

Flexor tenotomy
Extensor tenoromy
Extensor hood release

Surgical Treatment of Rigid Hammer Toes

Arthroplasty at PIPJ
PIPJ fusion
Digital joint implant
Middle phalangectomy
Diaphysectomy
Resection of base of proximal phalanx with syndactylization (joining of 2 toes surgically)

Surgical Treatment of Mallet Toes

Arthroplasty of DIPJ

Treatment of Heloma Molle

Exostectomy, arthroplasty, of syndactylization, since it is caused by the rubbing of head of proximal phalanx on the base of the middle phalanx of an adjacent toe

Prominence on the medial aspect of the 1st metatarsal head

Bunion

Promineneve on the lateral aspect of the 5th metatarsal head

Tailor’s Bunion

3 stages of healing process

Inflammation, Proliferation, Remodeling

0-4 days. Vascular, cellular, hemostatic event (lag/substrate phase)

Inflammation stage of healing process

5-20 days. Collagen fibers get laid down by fibroblasts (stage of healing)

Proliferation stage of healing

21+ days. Stage of healing process. Begins at 3 weeks for tendons

Remodeling stage of healing

What are the major areas to ask about for a physical?

Vasculature, Derm, Neuro, Musculoskeletal, Vital signs (temp, BP, respirations)

What are the 6 basic rules of infection?

Recognition, ID of infecting organisms, diagnostic testing, decompression/debridement, antibiosis, follow-up

when a drug inhibits growth

bacteriostatic

antibiotic for soft tissue infection, if patient is allergic to penicillin, metabolized by liver

erythromycin

antibiotic goes through barrier, metabolized by liver

clindamycin

antibiotic not used often, metabolized by kidney

tetracycline

antibiotic for burn patients

sulfonamides

destroys cell at or near the m.i.c.

bacteriocidal

always used the drug with the lowest m.i.c., the smaller the dosage the better

minimum inhibitory concentration

type of antibiotic most often used in podiatry

bacteriocidal

penicillins, cephalosporins, aminoglycosides, and vancomycin all metabolized by kidney

bacteriocidal

using two drugs of the same class, i.e. giving a bacteriostatic drug with another bacteriostatic drug or a bactericidal drug with another bacteriocidal drug

agonist

using one drug from each of the two classes (bacteriocidal and bacteriostatic); try to avoid this option

antagonist

try to avoid antagonistic relationship; exception to the rule is using bacteriostatic Clindamycin with bacteriocidal drug

cuts through extra-capsular polysaccharide glycolate slime coat secreted by some bacteria

sensitivity to medication

medication resistance

organism can successfully resist medication (antibiotic won’t work against organism)

organism resistance

bacteriocidal drugs (penicillin, vancomycin, cephalosporin, aminoglycosides, tetracyclines, quinolones) excreted by ___

kidney

bacteriostatic drugs (erythromycin, clindamycin) excreted by ___

liver

1st generation cephalosporin; 80% excretion via kidney and 20% via liver (good for those with liver problems)

cefazolin (ancef)

3rd generation cephalosporin, 20% excretion via kidney and 80% via liver; “pre-op” antibiotic

cefaperazone (cefobid)

what to look for at infection site

Cellulitis, Lymphangitis, Abscess

aerobic bacteria, staph (clusters), strep (chains), pneumo

gram(+) cocci

aerobic bacteria, Listeria, Clostridia, Dipthroides (LCD)

gram(+) rods

aerobic bacteria, Genococcus, Meningitis (GM)

gram(-) cocci

aerobic bacteria, Enterobacteriaceae, Pseudomonas - smelly infections (do NOT confused with enterococcus)

gram(-) rods

anaerobic bacteria, oral, gut, and vaginal

Bacteroides, Fragilis

penicillins, 1st generation cephalosporins treat:

gram(+) aerobes

aminoglycosides, 2nd and 3rd generation cephalosporins (strongest) treat:

gram(-) aerobes

1) quinolones if not resistant

2) otherwise anti-pseudomonal penicillin/cephalosporin PLUS anti-pseudomonal aminoglycoside COMBO are treatments for ___

pseudomonas

penicillins treat:

anaerobes

clindamycin or metronidazole treat:

bacteroides fragilis

complication of clindamycin is known as ___; the life-threatening diarrhea is treated by oral vancomycin which stays in the gut a long time to clean it because it has poor gut absorption

pseudo-membranous colitis

treatment for everything but pseudomonas; does not come in oral form [intravenous]

Unasyn

treatment with good aerobic coverage only

quinolones

treatment with excellent broad spectrum, aerobic and anaerobic coverage; augmentin is the oral form and timentin is the parentral form (intravenous, intramuscular)

clavulonates

treatment does not work well against Staph. Aureus; Keflex is a 1st generation cephalosporin that is effective because it is very resistance to degradation by beta-lactamase

penicillins

route of administration for minor infections in general; can be as strong as intravenous (IV)

oral

route of administration that is intravenous, intramuscular; for deep wound infections, potential bone involvement, constitutional symptoms

parentral

for dosage of children:

weight in pounds/150 = % of adult dose

Clark’s rule

anti-pseudomonal penicillins: Azlocillin, Pipercillin, Mexlocillin, Carbenicillin, Ticarcillin (A PM CTI)

acylureido penicillins

antipseudomonal penicillins: Carbenicillin and Ticarcillin

carboxypenicillins

K ↓, Na↑, PT↑, platelet dysfunction

carbenicillin

Tobramycin, Amikacin, Netalmycin, Gentamycin (TANG)

aminoglycosides

___ are based on peak/trough and kidney function

adjustments of dose/interval

blood drawn before each dose; lowest point in blood

trough

blood drawn after each dose, highest point in blood

peak

Penicillin allergic patient
Aerobic Gram (+) only
Drug of choice for MRSA infection
Parenteral (IV) → means it enters the body in a manner other than through the digestive tract, like by intravenous or intramuscular injection
Adjust administration of this drug for renal function

vancomycin

Bacteriostatic
Liver excreted
Penicillin allergic patient with soft tissue infections →esp. Erythromycin!
i.e., Erythromycin, Azithromycin (long acting)

macrolides

Gram (+) Aerobes, Most Anaerobes
Bacteroides Fragilis → (Metranidazole-Flagyl is also effective)
Gets thru extracapsular polysaccharide glycolate slime coat secreted by some bacteria
Side effect → Pseudomembranous Colitis
and Treatment → Oral Vancomycin

clindamycin

indications of prophylaxis

Oral or IV
Broad Spectrum
Aerobic only
Oral serum levels equivalent to IV antibiotics allow more outpatient therapy flexability
i.e., Ciprofloxacin, Levoflaxacin (expands Gram +)

quinolones

different organisms and patterns of lacerations for human, dogs, cats, spiders, snakes, ticks, etc.

bite wounds

consider: 1) electrolytes like K+ and Na+ 2) fluid loading i.e. congestive heart failure 3) drug interactions/kidney function

geriatric considerations

specific issues in an infection H&P

increased pain, rubor, temp, edema, past
past illness/infections, diabetes, PVD
current meds, kidney/liver function
allergies - especially to drugs
family hx - diabetes, vascular disorders
social hx - alcohol, smoking, drugs

Examination of Infection Site

cellulitis, lymphangitis, abscess

- get deep culture if possible (surface cultures are contaminated)

tell you which specific drug will work on which specific organism, need to be sent to the lab immediately

Cultures

What are the signs of anaerobic organism infection?

black areas in x-rays of soft tissues = gas
foul smell
area exposed to fecal matter
septic patient
necrotic tissue
thrombophlebitis

test to check for bone infection vs soft tissue infection

X-ray

shows slices of tissue

CT scan

“complete blood count”

-watch lymphocytes in WBC number

CBC test

Means of tracking inflammation (ESR)

Erythrosedimentation Rate

sensitive means of tracking inflammation (more precise than ESR)

C-Reactive Protein

tracks kidney function, should be about 1

if value is 2, 50% kidney function
if value is high, get GFR to see what amount going through kidney

Creatinine test

shows sugar levels, increased = decreased immune function

Blood Glucose test

measure of blood clotting compared to normal

PT (PTT)

checks for cardiac problems

EKG

performed if you suspect an infection, make sure to now go through an abscess while performing this test of it will precipitate an infection

Bone Biopsy

What are the effects of infection on the healing process?

Provocation without resolution
stop the impediment to the healing process
Drainage
use of antiboitics

what are the 6 basic rules of infection?

1) Recognition
2) Identification of infecting organisms
3) Diagnostic testing
4) Decompression and debridement
5) Antibiosis
6) Follow up

go through each rule of infection

or you die

what are the 6 types of Osteomyelitis

1) Acute Hematogenous Osteomyelitis
2) Contiguous (direct extension) Osteomyelitis
3) Osteomyelitis associated with PVD
4) Chronic Osteomyelitis
5) Brodie’s Abscess
6) Septic Arthritis

blood infection that gets into bone, from oral surgery with an abscess in the mouth,

Acute Hematogenous Osteomyelitis

intramembranous bone growth

causes bone to grow in width

endochondral bone growth

causes bone to grow in length

what are the four major blood supplies to long bones (areas)

Epiphyseal, Metaphyseal, Diaphyseal, Periosteal

infection begins in sinusoids at limits of circulation/sinusoid lakes due to sluggish blood flow, no epiphyseal plate so infection can spread to joint (staph aureus mostly)

Infant-AHO

what is the main infector of bone

Staph Aureus

epiphyseal plate present, secondary center of ossification present, sluggish blood flow under epiphyseal plate, blood infection spreading to bone

child AHO at 14 months

slow metaphyseal blood flow, no epiphyseal plate (infection can spread to entire bone), no more low O2 environment, no more bone growth (only replacement), weak point still sinusoid lakes

Adult AHO

what is the treatment for osteomyelitis?

After debridement in all cases is 4-6 weeks IV antibiotics followed by 4-6 months of oral antibiotics
must give long-term antibiotics→ have to be very aggressive

osteomyelitis secondary to ulceration or puncture wounds

Contiguous (direct extension) Osteomyelitis

Wound: >6 hours old, stellate/angular configuration, >1cm depth, necrotic/dying tissue, dirty/contaminated (from bullet, crush, burn, frostbite)

Tetanus prone wound of contiguous osteomyelitis

Wound: <1cm depth, no necrotic/dying tissue, no contaminants/dirt in wound (from sharp puncture, glass, knife)

Non-tetanus prone wound of contiguous osteomyelitis

A substance that has been treated to destroy its toxic properties but retains the capacity to stimulate production of antitoxins

Toxoid

antibody with the ability to neutralize a specific toxin

Antitoxin

when administering both a toxoid and an antitoxin, can you inject them both in the same arm?

No, you must administer them in separate arms. Otherwise the antitoxin will neutralize the toxoid

would you need to give a patient with a tetanus prone wound a toxoid if they have had 3 doses of toxoid immunization and it has been less than 5 years since last booster?

No toxoid would be needed even if the wound is “dirty.” Only given if less than 3 doses OR more than 5 years since booster

given for tetanus prone wound if unknown or less than 3 doses immunization. Not needed for non-tetanus prone wound

Antitoxin

given if unknown or less than 3 doses of toxoid immunization or more than 10 years since last booster

Toxoid

type of osteomyelitis common in diabetics, polymicrobic

Osteomyelitis Associated with Peripheral Vascular Disease

periosteal formation of new bone

Involucrum

1 cause of chronic osteomyelitis

Staph Aureus

long standing infection where acute fever/swelling seems to have gone away and suddenly reappears again. Type of osteomyelitis

Chronic Osteomyelitis

perforations in the cortex, get soft abscesses around the bone, patient can get infections through this all the way to the periosteum. If it gets all the way to the skin, a sinus tract may form all the way to the skin

Cloacae (involved with chronic osteomyelitis)

infection under periosteum that lifts it away

Subperiosteal Superation

subacute hematogenous osteomyelitis (not chronic). Site of healed osteomyelitis filled with infected granulation tissue. Treated by scraping out material

Brodie’s Abscess

diagnosis of Septic Arthritis

sterile aspiration of joint

antibiotics that have beta-lactam rings in their structure; penicillins, cephalosporins, carbopenims, monobactams, cephamycins

beta-lactams

PenVK (oral) and PenG (IV, for surgery)

natural penicillins

ampicillin is twice as strong as amoxicillin (so you use half as much)

aminopenicillins

Cloxacillin, Oxacillin, Naphcillin, Dicloxacillin, Methacillin (CONDM)

penicillin-resistant penicillins

an enzyme secreted by some bacteria that breaks down penicillin molecules

penicillinase

type of penicillinase that acts on beta-lactam ring

beta-lactamase

Azlocillin, Pipercillin, Mezlocillin, Carbenicillin, Ticracillin

Acylureido Penicillins

carbenicillin, ticarcillin

carboxypenicillins

beta-lactamase inhibitors; penicillinase-resistant

clavulonates

amoxicillin + clavulonate

Augmentin

Ticarcillin + Clavulonate; intravenous/intramuscular

Timentin

Sulbactam + Ampicillin; intravenous/intramuscular

Unasyn (not for Pseudomonas)

Hey there sexy

No not you

different organisms and patterns of lacerations for human, dogs, cats, spiders, snakes, ticks, etc.

bite wounds

consider: 1) electrolytes like K+ and Na+ 2) fluid loading i.e. congestive heart failure 3) drug interactions/kidney function

geriatric considerations

specific issues in an infection H&P

increased pain, rubor, temp, edema, past
past illness/infections, diabetes, PVD
current meds, kidney/liver function
allergies - especially to drugs
family hx - diabetes, vascular disorders
social hx - alcohol, smoking, drugs

Examination of Infection Site

cellulitis, lymphangitis, abscess

- get deep culture if possible (surface cultures are contaminated)

tell you which specific drug will work on which specific organism, need to be sent to the lab immediately

Cultures

What are the signs of anaerobic organism infection?

black areas in x-rays of soft tissues = gas
foul smell
area exposed to fecal matter
septic patient
necrotic tissue
thrombophlebitis

test to check for bone infection vs soft tissue infection

X-ray

shows slices of tissue

CT scan

“complete blood count”

-watch lymphocytes in WBC number

CBC test

Means of tracking inflammation (ESR)

Erythrosedimentation Rate

sensitive means of tracking inflammation (more precise than ESR)

C-Reactive Protein

tracks kidney function, should be about 1

if value is 2, 50% kidney function
if value is high, get GFR to see what amount going through kidney

Creatinine test

shows sugar levels, increased = decreased immune function

Blood Glucose test

measure of blood clotting compared to normal

PT (PTT)

checks for cardiac problems

EKG

performed if you suspect an infection, make sure to now go through an abscess while performing this test of it will precipitate an infection

Bone Biopsy

What are the effects of infection on the healing process?

Provocation without resolution
stop the impediment to the healing process
Drainage
use of antiboitics

what are the 6 basic rules of infection?

1) Recognition
2) Identification of infecting organisms
3) Diagnostic testing
4) Decompression and debridement
5) Antibiosis
6) Follow up

go through each rule of infection

or you die

what are the 6 types of Osteomyelitis

1) Acute Hematogenous Osteomyelitis
2) Contiguous (direct extension) Osteomyelitis
3) Osteomyelitis associated with PVD
4) Chronic Osteomyelitis
5) Brodie’s Abscess
6) Septic Arthritis

blood infection that gets into bone, from oral surgery with an abscess in the mouth,

Acute Hematogenous Osteomyelitis

intramembranous bone growth

causes bone to grow in width

endochondral bone growth

causes bone to grow in length

what are the four major blood supplies to long bones (areas)

Epiphyseal, Metaphyseal, Diaphyseal, Periosteal

infection begins in sinusoids at limits of circulation/sinusoid lakes due to sluggish blood flow, no epiphyseal plate so infection can spread to joint (staph aureus mostly)

Infant-AHO

what is the main infector of bone

Staph Aureus

epiphyseal plate present, secondary center of ossification present, sluggish blood flow under epiphyseal plate, blood infection spreading to bone

child AHO at 14 months

slow metaphyseal blood flow, no epiphyseal plate (infection can spread to entire bone), no more low O2 environment, no more bone growth (only replacement), weak point still sinusoid lakes

Adult AHO

what is the treatment for osteomyelitis?

After debridement in all cases is 4-6 weeks IV antibiotics followed by 4-6 months of oral antibiotics
must give long-term antibiotics→ have to be very aggressive

osteomyelitis secondary to ulceration or puncture wounds

Contiguous (direct extension) Osteomyelitis

Wound: >6 hours old, stellate/angular configuration, >1cm depth, necrotic/dying tissue, dirty/contaminated (from bullet, crush, burn, frostbite)

Tetanus prone wound of contiguous osteomyelitis

Wound: <1cm depth, no necrotic/dying tissue, no contaminants/dirt in wound (from sharp puncture, glass, knife)

Non-tetanus prone wound of contiguous osteomyelitis

A substance that has been treated to destroy its toxic properties but retains the capacity to stimulate production of antitoxins

Toxoid

antibody with the ability to neutralize a specific toxin

Antitoxin

when administering both a toxoid and an antitoxin, can you inject them both in the same arm?

No, you must administer them in separate arms. Otherwise the antitoxin will neutralize the toxoid

would you need to give a patient with a tetanus prone wound a toxoid if they have had 3 doses of toxoid immunization and it has been less than 5 years since last booster?

No toxoid would be needed even if the wound is “dirty.” Only given if less than 3 doses OR more than 5 years since booster

given for tetanus prone wound if unknown or less than 3 doses immunization. Not needed for non-tetanus prone wound

Antitoxin

given if unknown or less than 3 doses of toxoid immunization or more than 10 years since last booster

Toxoid

type of osteomyelitis common in diabetics, polymicrobic

Osteomyelitis Associated with Peripheral Vascular Disease

periosteal formation of new bone

Involucrum

1 cause of chronic osteomyelitis

Staph Aureus

long standing infection where acute fever/swelling seems to have gone away and suddenly reappears again. Type of osteomyelitis

Chronic Osteomyelitis

Cloacae (involved with chronic osteomyelitis)

infection under periosteum that lifts it away

Subperiosteal Superation

subacute hematogenous osteomyelitis (not chronic). Site of healed osteomyelitis filled with infected granulation tissue. Treated by scraping out material

Brodie’s Abscess

diagnosis of Septic Arthritis

sterile aspiration of joint

organisms of Septic Arthritis

staph aureus

treatment of Septic Arthritis

antibiotics, open surgery, opening up of entire joint

organisms of Septic Arthritis

staph aureus

treatment of Septic Arthritis

antibiotics, open surgery, opening up of entire joint

anti-pseudomonal penicillins: Azlocillin, Pipercillin, Mexlocillin, Carbenicillin, Ticarcillin (A PM CTI)

acylureido penicillins

antipseudomonal penicillins: Carbenicillin and Ticarcillin

carboxypenicillins

K ↓, Na↑, PT↑, platelet dysfunction

carbenicillin

Tobramycin, Amikacin, Netalmycin, Gentamycin (TANG)

aminoglycosides

___ are based on peak/trough and kidney function

adjustments of dose/interval

blood drawn before each dose; lowest point in blood

trough

blood drawn after each dose, highest point in blood

peak

Penicillin allergic patient
Aerobic Gram (+) only
Drug of choice for MRSA infection
Parenteral (IV) → means it enters the body in a manner other than through the digestive tract, like by intravenous or intramuscular injection
Adjust administration of this drug for renal function

vancomycin

Bacteriostatic
Liver excreted
Penicillin allergic patient with soft tissue infections →esp. Erythromycin!
i.e., Erythromycin, Azithromycin (long acting)

macrolides

Gram (+) Aerobes, Most Anaerobes
Bacteroides Fragilis → (Metranidazole-Flagyl is also effective)
Gets thru extracapsular polysaccharide glycolate slime coat secreted by some bacteria
Side effect → Pseudomembranous Colitis
and Treatment → Oral Vancomycin

clindamycin

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