Final Exam Flashcards
What are the cardinal signs of infection?
- Redness
- Erythema
- Increase in pain
- Odor
- Increase in warmth
- Purulence of staph
Purulence of staph
- Consistency is whitish-yellow and chalky
- Classic of staph aureus
Pseudonomas
- Greenish discoloration
- Another common bacteria that affects the foot, especially in diabetic patients
- Much longer incubation period (usually 7 days or more for a good response)
Osteomyelitis
- Bacteria begins to effect bone
- Diagnosed with an x-ray
Classic infection signs of bone (osteomyelitis)
- Erosion
- Osteolucent/osteolytic types of irregularities in the bone
How do diagnose osteomyelitis on x-ray
- Subjective findings
- Typically includes osteolytic appearance or erosion of bone
- Takes about 2-3 weeks for you to be able to see osteolytic erosions on an x-ray
Perinicea
- Infection of soft tissue surrounding ingrown toenail
Treatment of perinicea
- Put patients on Keflex or BSI and pain does not get better
- If toenail is not removed, it will not resolve
- If infection gets worse, it can seed the bone underneath the toe (phalanx)
Ingrown toenails often have _____
- Associated infection with it
Ingrown toenail infection usually results from _____
- Chronic irritation of impinged nail plate that causes localized redness, pain, etc.
- Not necessarily true infection
For ingrown toenail infection to resolve itself _____
- Ingrown toenail must be removed
What is the most common puncture wound?
- Staph aureus
- Staph organism enters the body, then enough to cause infection can spread
Staph aureus typically requires an incubation period of _____
- 3 days/72 hours
If a patient is going to develop an infection from a staph organism _____
- It will typically begin to show cardinal signs of infection
One of the immediate things to do for staph infection that allows bacteria to escape is _____
- Incision and drainage
- Flush it out, then decrease bacteria count to a number in which body can fight effectively
- Augment fighting with oral antibiotics
Drug of choice/oral antibiotic for staph
- 1st generation cephalosporin like Keflex
Diabetic patients (immune compromised) cannot _____
- Fight infection without antibiotic
Culturing bacteria determines _____
- How antibiotic inhibits future growth
Strong bacterial killing agent may effect culture, so you must _____
- Rinse with saline to get rid of surface contamination
Nail puncture wounds _____
- May lead to septic arthritis (3 days)
- Superficial, visible entry site
If an infection is in the joint, it can be devastating to _____
- Cartilage of the joint
Catrilage is avascular, so it _____
- Does not respond well to oral or IV antibiotics
Infections in joints are considered _____
- Surgical emergencies
- Requires aggressive incision and drainage to ensure joint is not damaged to the point of non-functional
Gout tophi may result from _____
- Patients that have long-term untreated gout
Gout tophi characteristics
- Crystals that deposit themselves not just in joint, but soft tissue around joint
- Fill these masses called tophi
- X-ray may even look like a bone tumor
- Can be surgically resected
A non resolving scrape on the skin may be a result of _____
- High BSL
Unresolved wounds may create _____
- Infections
- May lead to non-healing wound and continued spread of infection
- May lead to amputation later (especially if patient has poor circulation)
Important notes for patients with wounds
- Make sure they are metabolically optimized to heal from that wound
- Requires normal blood sugar and good circulation
- Patient requires treatment with primary care, endocrinologist, vascular surgeon, etc.
Many studies show presence/development of bunions are a result of these aggravating factors
- Shoes
- High heels/shoes putting pressure on forefoot area will more commonly come in complaining of a bunion deformity
Bunion deformities develop from _____
- The way we walk
- Inherited biomechanical function creates these deformities, and they develop over time
- Pronation causes this biomechanical fault
What is the most common etiology of bunions and hammertoes?
- Abnormal excessive pronation
- Try to correct with orthotics before surgery
Two very common types of ulcers that are vascular related are those that form because of _____
- Venous incompetency
- Arterial insufficiency
Ulcer located proximal to medial malleolus (on the inside) typically is a _____
- Venous ulcer
- Usually not painful
- Red and healthy looking tissue (granulation tissue)
Ulcer located lateral to medial malleolus usually indicates _____
- Arterial ulcer
- Usually excruciatingly painful
- Very necrotic in appearance
A uniform border usually indicates _____ ulcer
- Arterial ulcer
Patients with arterial ulcers need _____
- Vascular intervention
- Need to reestablish blood flow to the extremity before any attempts at debridement
- Then debridement is done every day in office with 15 blade or tissue nipper
_____ is typically the antibiotic of choice for injuries obtained from salt water because of the pathogens that tend to grow in there
- Augmentin
Jellyfish stings typically require _____
- Supportive treatment
- Want to minimize the effects of the toxin
Typical medications effective in reducing effects of jellyfish toxin
- Nitroglycerin patch
- Topical steroid
- Oral analgesics
- Oral steroids
Neurofibroma (neurofibromatosis)
- Soft tissue pathology
- May be related to other issues
Most common tumor in the body
- Lipoma
Characteristics of Lipomas
- Benign mass, soft tissue growth
- Common in lower extremity
- Tumors tend to be very well encapsulated and vascularized
- Classic signs of benign soft tissue mass
Malignant melanoma
- Very fast-growing soft tissue tumor
- Invading of surrounding tissues and very destructive
- Can be life-threatening
Calcification in a soft tissue mass requires _____
- Surgical resection with biopsy
- It is a potential malignant marker
Liposarcoma
- Fast growth and out grows its blood supply
- Necrotic
- Has same stem cells as lipoma, but unlike lipoma is highly malignant
Characteristics of Liposarcomas
- Lobulated
- Not well encapsulated
- No apparent supporting vascular structure
Cavus foot, CMTD
- Genetic disorder (result of neurological condition)
- Commonly develop high arched foot
- Many ways to surgically stabilize to create better weight bearing status
- Least common type of foot pathology
Treatment for cavus foot
- Typically combination of osteotomies, fusions, and tendon transfers performed to address deformity
- Staging can be used
- Tendon transfers first to rebalance, then more bony procedures to address bony pathology
2nd toe very often involved with pathology of _____
- Bunions
- As patients develop bunions, first metatarsal will deviate from natural position
When first metatarsal deviates (in multiple planes/transvers and frontal plane rotation) it puts a lot of stress underneath _____
- 2nd metatarsal
- Complain about pain under 2nd metatarsal, not bunion
Bunion/toe correction must be addressed in a specific order
- Cannot put toe in correct position until bunion deformity is addressed first
- Bunion > corrective position > then 2nd toe into stable position
- Needs soft tissue work to re-stabilize structures so toe does not continue to dislocate post-operatively
_____ makes the repair site heal more efficiently in an achilles tendon rupture
- Augmentation of tendon with collagen graft
Calcaneal fracture contour plates are utilized to _____
- Reconstruct calcaneal fracture
- Calcaneal fractures usually show multiple fragments, so plates are needed to get bones back together
- Bone replacement products may be used with bone deficit
Calcaneal fractures are typically _____
- Interarticular
- Results in arthritis post-operatively
Developing arthritis following calcaneal fracture reconstruction is often seen developing in _____
- Subtalar joint
- Usually will need secondary surgery for arthritic complications
Flatfoot/Charcot joint mid-food collapse
- Common diabetic complication
- Patients that are neuropathic may commonly undergo this bone-breakdown process in the foot
- Seen most commonly in diabetics
- Midfoot looks like it fuses into one block of bone
Diabetic Charcot joint usually results from/in
- No traumatic injury
- Foot gets red, hot and swollen
- Continues to walk on it (bones are very brittle during this acute charcot)
- Bones begin to break down
What foot type do diabetics with Charcot develop?
- Rocker bottom foot
Common issues associated with rocker bottom foot
- Cannot feel bottom of foot
- Do not adjust to pressures
- Constantly come down on foot, creating ulcers/soft tissue ulceration
- Ulcers commonly infected and lead to osteomyelitis
Brachymetatarsia is _____
- Early growth plate closure, most commonly the 4th metatarsal
- No known etiology as to why this has happened
Osteotomy
- Create a cut in the bone in an area of high cell turnover
_____ area of bone has the best vascularity compared to the _____ area of bone
- Metaphyseal
- Diaphyseal
- Better vascularity means better healing potential
Callous distraction lengthening
- Cut bone
- Insert external fixator
- Place pins
- Patient turns periodically
Bandage scissors
- Flat part against the patient’s skin
* You need to wash and clean the bandage scissors with disinfectant every time you use it*
Two most common people you are cutting bandages off are _____
- Post-ops
- Wound care
Stethoscope
- Single barrel stethoscope with one large aperture
- Smaller one and bigger one (smaller for pediatric patients)
Auscultate lungs at _____
- 10th Thoracic Vertebra
Heart Sounds during auscultation
- Lub (blood moves from atria to ventricles)
- Dub (ventricles expel blood from the heart)
Blood Pressure Cuff/Sphygmomanometer
- Also use stethoscope when taking blood pressure
- Listening to brachial artery
- Pump cuff above 120 (because 120 is normal)
- First sound is the shutting off of the artery (gives first number)
- Second noise is when you release the cuff, and start to hear blood flow again (gives second number, 80 is normal)
- Systole over diastole
Petechiae
- Little red splotches if cuff is not released or left on for too long
Systole/Diastole
- Systole (ventricular shortening and emptying)
- Diastole (ventricular elongation and filling)
- 120/80 mm Hg within normal limits
Goniometer or Tractograph used most often in
- Biomechanics
One of the angles to look at when evaluating for a bunion repair is the _____
- Intermetatarsal angle
- Angle between the two metatarsals
Goniometer or Tractograph used may also commonly be used in
- Physical therapy
- Tendon surgery
- Shows the degree of flexion that you can get after the surgery
