Foot - Medicine Flashcards
bone tumor
MC primary malignant bone tumor among children
osteoSARCOMA
torsades de pointes;
associated with what medication
administration of ondansetron (Zofran) may increase the risk of QT interval prolongation on electrocardiogram. Torsades de pointes is a specific form of polymorphic ventricular tachycardia in those with a long QT interval.
torsades de pointes:
tx
magnesium sulfate, and atropine
A non-healing wound that has failed to respond to routine ulcer therapy is best treated with
punch biopsy and path evaluation.
In cases of non-healing wounds, melanoma must be a consideration
anaplastic is thought to be:
malignant
*rapidly divide with minimal resemblance to normal, healthy cells.)
melanoma:
most common
Superficial spreading melanoma
*first sign is appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat asymmetrical in form
what joint involves late state of the ankylosing spondylitis?
cervical spine
(earliest is SI joint, then lumbar spine)
Most appropriate for management of intraoperative vasovagal hypotension, bradycardia, nausea?
atropine
treats bradycardia by increasing heart rate and improving AV conduction by blocking the parasympathetic.
Which of the following forms of malignant melanoma is most often misdiagnosed as a pyogenic granuloma?
nodular melanoma
A pyogenic granuloma is a benign growth of skin and mucus membranes that can appear as a nodule or polyp that will bleed easily after trauma.
Nodular melanoma commonly presents in a similar appearance, underscoring the necessity of tissue biopsies.
pulseless electrical activity:
tx
begin CPR
wound healing: stages
- Inflammatory
- Proliferative: early wound contracture, collagen synthesis, neovascular formation, and re-epithelialization
- Maturation: the previously synthesized collagen bundles remodel, contracts, and wound increases in tensile through closure
- (some add “Hemostasis Phase,” making 4 stages).
osteomalacia
soft bone disease,” is a metabolic bone disorder characterized by the inadequate mineralization of bone tissue
deficiency of vitamin D, calcium, or phosphate
osteopenia
decreased bone synthesis rate and reduced bone mass
what deficiency is associated wtih periosteal hematomas and petechial hemorrhages?
SCURVY (Vitamin C deficiency)
Rickets
Vitamin D deficiency
- inc risk of skeletal fx and bone deformities
- insufficient mineralization of newly formed osteoid
huntingtons:
syndrome
symptoms include difficulty speaking, swallowing, or walking, emotional mood swings, hallucinations, and problems with balance and posture
parkinsons:
sxs
tremors, slowness of movement, rigidity, and difficulty with balance.
amyotrophic lateral sclerosis:
sxs
muscle weakness, muscle cramps, twitching, stiff muscles, speech challenges, and fatigue.
Lesch-Nyhan syndrome
- occur much more frequently in males
due to mutations in the HPRT1 gene located on the X chromosome (X-linked recessive) - caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT).
The HGPRT deficiency causes a build-up of large volumes of uric acid.
Reiter (reactive arthritis) syndrome:
mc affects
- Metatarsophalangeal joints
- calc
- ankle
- knee
Resolute purulent discharge is seen MOST often in which type of osteomyelitis?
Resolute purulent discharge is seen most often in chronic osteomyelitis. Chronic osteomyelitis includes involucrum, cloaca and dead bone.
Beriberi
B1 (thiamine) deficiency
- seen in alcoholism or poor diet
- sxs: generalized weakness, shortness of breath, lower extremity edema, and limb pain
Pellagra
deficiency of B3 (Niacin)
sxs: inflamed skin, diarrhea, dementia, and sores in the mouth
tx: niacin or nicotinamide
kwashiorkor
severe form of protein deficiency;
-sxs: Edema (swelling in the ankles, feet, and belly), enlarged liver, dry or brittle hair, loss of appetite, irritability, fatigue, and stunted growth in children
lyme disease:
tx of choice
doxyCYCLINe
reactive arthritis
a seronegative spondyloarthropathy that may occur after a gastrointestinal infection with campylobacter jejuni. It is characterized by oligio or polyarthititis which is aymmetrical in nature. Radiographic findings are not specific and are similar to other sero negative spondyloarthopathies. These include focal sclerosing sacroiliitis, floating osteophytes, juxta articular osteoporosis.
Digital edema with ivory phalanx radiographic appearance
psoriatic arthritis
systemic lupus erythematosus:
sxs
Malar rash, photosensitivity, and raynauds phenomenom
CRPS I vs II
Unlike CRPS type II, there is no known peripheral nerve injury associated with CRPS type I. “CRPS is an uncommon chronic condition that usually affects the extremities. Type, 1 previously known as regional sympathetic dystrophy, occurs after an illness or injury that did not directly damage the nerves in the affected limb. On the other hand, type 2 follows a distinct nerve injury. CRPS was first described during the civil war when soldiers continued to report excessive pain after wounds had healed.”
where are esther anesthetics metabolized?
plasma pseudocholinesterase
where are amide anesthetics metabolized?
liver
sxs include blue sclerae of the eyes, bone that easily fractures, short stature, curvature of the spine, joint deformities, hearing loss, respiratory problems, tooth development disorder called dentinogenesis imperfecta.
osteogenesis imperfecta
epoeitin alpha (PROCRIT)
commonly used to treat anemia in those undergoing cancer treatment (chemotherapy and radiation) and chronic kidney disease (but not on dialysis). For those who require dialysis iron should be given with erythropoietin.
Rocky Mountain spotted fever
- tick-borne disease caused by the bacterium Rickettsia rickettsii.
- Symptoms are typically nonspecific and include acute fever, headache, cough, gastrointestinal complaints, red eyes, and myalgia. Small, flat, pink, non-itchy macules without eschars on the wrists, forearms, and ankles may appear 2 days to 5 days after fever onset and spread to the palms or soles.
- Tx: Doxycycline is the drug of choice for everyone,
anklyosing spondylitis
a seronegative spondyloarthritis which is HLA-B 27 positive. It is more common in young and middle aged males. The most common findings in the axial skeleton of an AS patient include florid anterior spondylitis (Romanus lesions), florid discitis (Andersson lesions), insufficiency fractures of the ankylosed spine, syndesmophytes, enthesitis of the interspinal ligaments, ankylosis. Romanus lesion, are the lesions of disco-vertebral unit. The inflammatory changes result in the squaring of the verterbare with progessive loss of lumbar lordosis. Syndesmocytes are paravertebral ossifications that resemble an osteophyte, but run in the vertical rather than the horizontal plane.
Cushings syndrome
- cause: use of corticosteroid medication in high does for long periods of time.
- sxs: buffalo hump, significant weight gain, moon-shaped face, purple stretch marks to arms, legs and abdomen, fatigue, acne, weakness, and glucose intolerance.
gustilo anderson:
type II
treatment
cephalosporin and aminoglycoside
Madura foot
chronic skin and soft tissue infection caused by both bacteria (mycetoma and actinomycetomas) and fungi (eumycetomas or mycotic mycetoma). Mycetoma infections occur most likely in very rural areas, often infecting field or farm laborers.
sickle cell anemia is characterized as
chronic hemolytic anemia
(cells cause vaso-occlusion and are prone to hemolysis, leading to severe pain crises, organ ischemia, and other systemic complications)
eosinophilia is seen with:
- parasitic reaction,
- malignant disease,
- asthma,
- collagen vascular disease (SLE, rheumatoid arthritis), and
- allergies
brodie’s abscess
bone abscess that develops during the subacute phase of osteomyelitis
for pediatric calcaneal ostemyelitis
tx with Ceftazidime or Cefepime
aspirin is both anti-inflammatory and anti-platelet
spirin acts as both an antiplatelet and anti-inflammatory agent (Nonsteroidal anti-inflammatory drug). There are two classes of antithrombotic drugs: antiplatelets and anticoagulants. Anticoagulants like warfarin and elliquis slow down clotting, thereby reducing fibrin formation and clot prevention. Antiplatelets prevent platelet clumping. Both aspirin and prednisone are anti-inflammatory agents.
ankle arthroplasty:
contraindications
- infection,
- peripheral vascular disease,
- neuropathic disease and
- inadequate soft tissue support.
ehler’s danlos vs marfan
Ehlers-Danlos syndrome which is a defect in collagen. People are often tall and thin with long extremities toes and fingers.
Marfan syndrome affects males and females equally and is inherited autosomal dominant. A mutation to the gene that creates fibrillin results in abnormal connective tissue, which includes ocular, skeletal and cardiovascular abnormalities.
nec fasc
Type 1 forms are typically polymicrobil and occur in the immunocompromised. The most common form of Type 2 NF is haemolytic group A streptococcus, often resulting in toxic shock syndrome. BoardWizards Note Primary cause for microbial Type 2 NF varies in the literature (some sources say staph/strep), but for podiatric board preparation, we recommend: haemolytic group A streptococcus… NF is quickly developing and tissue palpation is POSITIVE for crepitus. CT demonstrates soft-tissue thickening and enhancemenet, with fluid collections within the deep fascia.
erythropoeiten (epo)
mechanism
a hormone produced and secreted by the kidney via hypoxia, promotes increased red blood cell formation within the bone marrow
type IV collagen
a Type IV collagen is a type of collagen found primarily in the skin within the basement membrane zone.
acute hematogenous osteomyelitis:
begins where
occurs in children with open growth plates. Blood flow slows as it passes through metaphyseal bones in growing children predisposing that region to infection.
positive babinski in adult
UMN lesion
The presence of the Babinski sign after 12 months is the sign of a non-specific upper motor neuron lesion. The Babinski reflex tests the integrity of the cortical spinal tract (CST). Stimulation of the lateral plantar aspect of the foot (S1 dermatome) normally leads to plantar flexion of the toes (due to stimulation of the S1 myotome). The descending fibers of the CST normally keep the ascending sensory stimulation from spreading to other nerve roots. When there is damage to the CST, nociceptive input spreads beyond S1 anterior horn cells. This leads to the L5/L4 anterior horn cells firing, which results in the contraction of toe extensors (extensor hallucis longus, extensor digitorum longus) via the deep peroneal nerve.
D dimer test
a small protein fragment present in the blood following a thrombus formation and its concentration may be easily obtained through a blood test.
