Foot - Medicine Flashcards
(131 cards)
1
Q
bone tumor
MC primary malignant bone tumor among children
A
osteoSARCOMA
2
Q
torsades de pointes;
associated with what medication
A
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.
3
Q
torsades de pointes:
tx
A
magnesium sulfate, and atropine
4
Q
A non-healing wound that has failed to respond to routine ulcer therapy is best treated with
A
punch biopsy and path evaluation.
In cases of non-healing wounds, melanoma must be a consideration
5
Q
anaplastic is thought to be:
A
malignant
*rapidly divide with minimal resemblance to normal, healthy cells.)
6
Q
melanoma:
most common
A
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
7
Q
what joint involves late state of the ankylosing spondylitis?
A
cervical spine
(earliest is SI joint, then lumbar spine)
8
Q
Most appropriate for management of intraoperative vasovagal hypotension, bradycardia, nausea?
A
atropine
treats bradycardia by increasing heart rate and improving AV conduction by blocking the parasympathetic.
9
Q
Which of the following forms of malignant melanoma is most often misdiagnosed as a pyogenic granuloma?
A
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.
10
Q
pulseless electrical activity:
tx
A
begin CPR
11
Q
wound healing: stages
A
- 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).
12
Q
osteomalacia
A
soft bone disease,” is a metabolic bone disorder characterized by the inadequate mineralization of bone tissue
deficiency of vitamin D, calcium, or phosphate
13
Q
osteopenia
A
decreased bone synthesis rate and reduced bone mass
14
Q
what deficiency is associated wtih periosteal hematomas and petechial hemorrhages?
A
SCURVY (Vitamin C deficiency)
15
Q
Rickets
A
Vitamin D deficiency
- inc risk of skeletal fx and bone deformities
- insufficient mineralization of newly formed osteoid
16
Q
huntingtons:
syndrome
A
symptoms include difficulty speaking, swallowing, or walking, emotional mood swings, hallucinations, and problems with balance and posture
17
Q
parkinsons:
sxs
A
tremors, slowness of movement, rigidity, and difficulty with balance.
18
Q
amyotrophic lateral sclerosis:
sxs
A
muscle weakness, muscle cramps, twitching, stiff muscles, speech challenges, and fatigue.
19
Q
Lesch-Nyhan syndrome
A
- 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.
20
Q
Reiter (reactive arthritis) syndrome:
mc affects
A
- Metatarsophalangeal joints
- calc
- ankle
- knee
21
Q
Resolute purulent discharge is seen MOST often in which type of osteomyelitis?
A
Resolute purulent discharge is seen most often in chronic osteomyelitis. Chronic osteomyelitis includes involucrum, cloaca and dead bone.
22
Q
Beriberi
A
B1 (thiamine) deficiency
- seen in alcoholism or poor diet
- sxs: generalized weakness, shortness of breath, lower extremity edema, and limb pain
23
Q
Pellagra
A
deficiency of B3 (Niacin)
sxs: inflamed skin, diarrhea, dementia, and sores in the mouth
tx: niacin or nicotinamide
24
Q
kwashiorkor
A
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
25
lyme disease:
tx of choice
doxyCYCLINe
26
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.
27
Digital edema with ivory phalanx radiographic appearance
psoriatic arthritis
28
systemic lupus erythematosus:
sxs
Malar rash, photosensitivity, and raynauds phenomenom
29
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.”
30
where are esther anesthetics metabolized?
plasma pseudocholinesterase
31
where are amide anesthetics metabolized?
liver
32
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
33
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.
34
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,
35
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.
36
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.
37
gustilo anderson:
type II
treatment
cephalosporin and aminoglycoside
38
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.
39
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)
40
eosinophilia is seen with:
* parasitic reaction,
* malignant disease,
* asthma,
* collagen vascular disease (SLE, rheumatoid arthritis), and
* allergies
41
brodie's abscess
bone abscess that develops during the **subacute** phase of osteomyelitis
42
for pediatric calcaneal ostemyelitis
tx with Ceftazidime or Cefepime
43
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.
44
ankle arthroplasty:
contraindications
* infection,
* peripheral vascular disease,
* neuropathic disease and
* inadequate soft tissue support.
45
45
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.
46
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.
47
erythropoeiten (epo)
mechanism
a hormone produced and secreted by the kidney via hypoxia, promotes increased red blood cell formation within the bone marrow
48
type IV collagen
a Type IV collagen is a type of collagen found primarily in the skin within the basement membrane zone.
49
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.
50
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.
51
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.
52
monosodium urate gout crystals
under polarizing light
Needle-shaped, NEGATIVELY birefringent crystals
53
marcaine toxic dose
Most consistent practice to date is with single doses of marcaine up to 225 mg with epinephrine 1:200,000
and 175 mg without epinephrine.
54
symptoms of rabies:
* first symptoms are similar to a flu-like illness—fever, headache, and general discomfort.
* Within days, the disease can progress to symptoms such as anxiety, confusion, agitation, abnormal behavior, delirium, and hallucinations
55
clean wound, unknown tetanus status
give toxoid (vaccine)
The patient has an incomplete tetanus status. Because the wound is clean, the toxoid would be given and the TIG (tetanus immunoglobulin) would be held.
If the wound is dirty and tetanus prone, then TIG and toxoid would be given.
56
acute charcot, with osseous fragmentation and joint dislocation that can be seen on radiograph
(eichenholtz)
eichenholz stage I
57
What is the targeted, thereaputic INR for anticoagulation?
2-3
58
for conscious sedation, rreferred drug choices for administering moderate intravenous (IV) sedation are:
midazolam (benzodiazepine sedative) and fentanyl (opioid analgesic) because their safety and efficacy have been well established.
59
when is a person diagnosed with AIDS
CD4 cells (also known as CD4+ T cells) are white blood cells that fight infection. These are the cells that the HIV virus kills. As HIV infection progresses, the number of these cells declines. When the **CD4 count drops below 200, a person is diagnosed with AIDS**. A normal range for CD4 cells is about 500-1,500.
60
61
hypothyroidism:
effect on TSH, T3, T4
TSH (thyroid-stimulating hormone) levels would be HIGH, as the pituitary gland produces more TSH in an effort to stimulate the thyroid gland to produce more thyroid hormones from the LOW levels of T3 and T4 in the blood.
62
Hyperparathyroidism
* excessive secretion of parathyroid hormone, causes
* hypercalcemia,
* hypophosphatemia, and
* hypermagnesemia.
It is likely the most common cause of hypercalcemia in otherwise healthy people
63
The green-colored interdigital maceration along with the green fluorescence on Wood's Lamp examination pictured indicates a superficial Pseudomonas aeruginosa infection; tx
mild and may be managed with oral antibiotics such as Ciprofloxacin
64
Dabigatran’s (Pradaxa) mechanism of action
an anticoagulant by directly inhibiting the enzyme thrombin (factor IIa).
*** Direct thrombin inhibitors.**
65
first symptoms of malignant hyperthermia
rise in end-tidal carbon dioxide concentration, muscle rigidity, and **tachycardia**.
66
Monckeberg's arteriosclerosis
occurs when calcium deposits are found in the muscular middle layer of the walls of arteries (the tunica **media**).
67
* chronic synovitis w/ pannus formation
* systemic disease
* Swan neck deformities
rheumatoid arthritis
68
sarcomas
cancers arising from transformed cells of mesenchymal (connective tissue) origin. Connective tissue broadly include: bone, cartilage, fat, vascular, or hematopoietic tissues, and sarcomas can arise in any of these types of tissues.
69
The malignant tumor pictured in the lower leg below is derived from mesenchymal tissue. Based upon its origin, which of the following cancers is presumed?
sarcomas
70
The probability of diabetic foot osteomyelitis increases with an erythrocyte sedimentation rate of:
efficiency of the hematological parameters in correctly diagnosing diabetic osteomyelitis from cellulitis was highest for ESR > 70 mm/hr (92%).
70
A 20 year old healthy, sexually active male presents with pain and burning in his right ankle joint that has worsened over the past 3 days. Past medical history reveals no prior hospitalizations and no history of bacterial infections. Joint aspiration demonstrates wbc’s. Gram stain and cultures are pending. Which of the following is the most likely organism?
Neisseria gonorrhea.
EXPLANATION: Untreated Neisseria gonorrhea may spread throughout the body (disseminated gonorrhea), and is especially common in joint infections.
71
hypoglyecmia
sxs: lethargy, diaphoresis, confusion, and tachycardia.
A blood glucose should be immediately obtained, and after IV access is obtained, she should be given glucose (D10W, D50W).
72
schwannoma
tumors of the nerve sheath. They are the most common type of benign peripheral nerve tumors in adults. During surgical excision, the surgeons gentle dissection along the tumor capsule from the epineurial layers usually allows the tumor to be shelled out as a whole without disturbing the nerve fascicles.
73
zinc deficiency
symptoms of: decreased appetite, growth retardation, diarrhea, hair and nail loss, and skin and eye lesions.
74
pernicious anemia
lack of vitamin b12
75
ABI
below 0.4 is indicative of severe peripheral arterial disease.
76
Which stage of syphilis is charcot neuroarthropathy typically seen?
TERTIARY syphyilis
77
charcot neuropathy:
risk factors
reported following syringomyelia, exposure to toxins, poliomyelitis, rheumatoid arthritis, multiple sclerosis, neuropathy, and TERTIARY syphilis
78
CPR principles
Begin CPR. If a pulse is not identified within 10 seconds, immediately beginadministering CPR, starting with chest compressions. Compressions should occur at a rate of 100 to 120 compressions per minute, with a depth of 2 inches. Use a compression-to-ventilation ratio of 30 compressions to 2 breaths
79
An 18-year-old sexually active female presents with migratory arthritis of 3 days duration, and reports severe pain in her left first metatarsal phalangeal joint. Based on the information given, which is the most likely offending organism?
Neisseria gonorrhoeae.
EXPLANATION: “Gonococcal arthritis results from blood dissemination of Neisseria gonorrhoeae from primary sexually acquired mucosal infection. Clinical features include polyarthralgia, sometimes migratory, tenosynovitis, arthritis, constitutional symptoms and skin lesions, which are mild and easily unnoticed.
80
guillain-barre
acute inflammatory disease affecting the **peripheral nerves**. An autoimmune attack on the **myelin** directly results in demyelination.
81
multiple sclerosis
characterized by demyelination in the central nervous system.
82
rhabdomyosarcoma
most common soft-tissue sarcoma in children.
83
syphilis:
sxs
* 1st sign: chancre is often the first sign of syphilis. It appears as a sore at the site of inoculation.
* Alopecia, rash, and fatigue are all common finding of secondary syphilis occurring several weeks following initial inoculation.
84
Kaposi sarcoma treatment
retroviral therapy and referral to radiation/oncology for chemotherapy treatment
85
frostbite sxs progression
* Initial symptoms of frostbite generally involve pale colored skin, cold sensitivity and numbness.
* Upon warming the skin may become to appear mottled, erythematous and fluid-filled blisters.
* Hyperhidrosis and hair loss are reported long term findings along with patchy skin lesions and distal tuft necrosis.
86
von willebrand's disease:
initial treatment
Desmopressin (DDAVP) is a synthetic antidiuretic hormone analogue which also induces a release of vWF and factor VIII from endothelial cells.
87
Subcutaneous nodules are most characteristic in which of the following diseases?
rheumatoid arthritis
Rheumatoid nodules are firm lumps that appear subcutaneously in approximately 20% of patients with rheumatoid arthritis. These nodules often occur over exposed joints that are subject to trauma, such as the digital joints and elbows. The insertional of the posterior achilles tendon is an occasional location in the lower extremity.
88
Which is the antibiotic of choice for a Gram positive, catalase positive, cocci in clusters, with PCN allergy?
vancomycin
89
HIV diagnosis is established utilizing which initial test?
ELISA
90
A rigid Morton's extension is used to treat which of the following?
is a continuation of the polypropylene orthotic shell that extends both underneath and past the first metatarsophalangeal joint, extending to distal end of the hallux. The function of the extension is to treat hallux rigidus, minimizing any remaining first MTP joint motion and limiting pain.
91
Which of the following is used to diagnose congenital hip dysplasia?
Barlow’s test, or maneuver, is used to diagnose congenital hip dysplasia. It is performed by adducting the hip with pressure is placed on the knee.
92
At what level glomerular filtration rate (GFR) does contrast enhanced CT scan begin to pose a threat for acute kidney injury (AKI)?
30 mL/min.
EXPLANATION: Radiographic contrasts are nephrogenic and pose a great risk of injury to the kidneys. atients with an eGFR lower than 30 mL/min are at very high risk of contrast-induced AKI; for these patients, all recommended prophylactic strategies should be used, as guided by a consultant nephrologist, and alternatives to the administration of iodinated contrast medium should be considered. Intravenous volume expansion is considered a requirement for patients with an eGFR lower than 60 mL/min and is generally considered good practice for other patients.
93
What is the most common form of melanoma found on palms and nail beds?
Acral lentiginous melanoma
94
A 46-year-old with history of DM is scheduled for an MRI with contrast regarding a questionable bone tumor. Which of the following medications should be discontinued to limit nephrotoxicity?
METFORMIN
**renally excreted** and several studies report an increased incidence of lactic acidosis with the use of metformin during procedures that utilize contrast. There is a high mortality rate in patients who do develop lactic acidosis. Metformin should be discontinued before the procedure and withheld for 48 hours after. It is only restarted after labwork confirms renal function to be normal.
95
XR gout
early signs, late sign
* early gout: Periarticular erosions, punched out lytic bone lesions, and increased soft tissue density
* Joint space is preserved until the very late, advanced stages of gout.
96
disseminated intravascular coagulation:
causes
1. inflammation,
2. infection, or
3. malignancy.
also occurs in obstetrics such as placental abruption and amniotic fluid emboli.
97
CRP
* activates complement system
* exercises LOWERS levels
* increases in concentration with age
* returns to normal levels faster than ESR
98
gustilo anderson:
tx
Type I and II open fractures should be treated with first-generation cephalosporin and
type III should also have aminoglycoside. If associated with soil or feces contamination penicillin is also added.
99
most sensitive and specific for Rheumatoid arthritis diagnosis
Anti-CCP (anti-cyclic citrullinated peptide).
EXPLANATION: Testing of anti-cyclic citrullinated peptide antibodies (anti-CCP) is commonly used as a marker for the diagnosis and prediction of this arthritis
100
A malnourished 4-year-old male with **bowed legs and a deformed chest (pigeon chest) **presents for evaluation. There is decreased bone density noted radiographically. He is most likely suffering from which of the following disorders?
rickets
(vitamin D deficiency)
101
Which of the following is the most common site for acute hematogenous osteomyelitis in children?
femur or tibia
102
A 38-year-old male presents to the ED with an acute, dirty open ankle fracture following a MVA. He relates a completed tetanus/diphtheria series and a booster dose received 2 years ago. What should be administered for tetanus prophylaxis?
Hold toxoid, Hold TIG.
EXPLANATION: The patient has a completed tetanus status and recent booster dose received within the past 5 years. Despite the dirty wound and the patients need for a skilled podiatric surgeon, neither the toxoid nor the TIG would need to be given.
103
A 9-year-old girl presents with her mother for evaluation of a 2 week-old green rash to her right foot and toenails as seen below. It has failed to respond to topical antibiotics and topical antifungals. Rash has worsened despite oral Keflex. What is the most appropriate next treatment?
**Ciprofloxacin** would be the most appropriate antibiotic listed for the safe treatment of this patients bacterial infection.
(Pseudomonas aeruginosa infection of the nail plate and skin. )
104
* can lead to ulnar deviation deformity of MTC and MTP
* IL-1 and TNF-alpha are part of cascade that leads to joint damage
* mononuclear cells are primary cellular mediator of tissue destruction
rheumatoid arthritis
105
what is rheumatoid factor
is itself an IgM antibody that is directed against the Fc portion of IgG antibody.
106
Which organism is the causative agent of gas gangrene?
Clostridium perfringens.
EXPLANATION: "Gas gangrene is synonymous with myonecrosis and is a highly lethal infection of deep soft tissue, caused by Clostridium species, with Clostridium perfringens being the most common
107
Which of the following nerves is most vulnerable during compartment syndrome in the anterior compartment of the leg?
Deep peroneal nerve.
EXPLANATION: The deep peroneal nerve supplies the anterior compartment of the leg and is most at risk
108
Remodeling of collagen bundles, wound contraction, and increased tensile strength are a part of which phase/stage of wound healing?
Maturation
(stage 3)
109
Bone disease caused by a dietary calcium insufficiency or vitamin D deficiency that causes poor bone mineralization and soft, weakend bones?
osteomalacia
110
* bamboo spine
* bilateral grade 2 sacroilitis
* squaring and erosion of the vertebrae
ankylosing spondylitis
111
A 39-year-old male who recently suffered an open traumatic inury to his left great toe is hospitalized with diarrhea of unknown origin. You discover he is currently being treated with a PICC line for concerning osteomyelitis. What is the most effective antibiotic in treating this patient?
Metronidazole 500 mg PO TID for 10 days.
EXPLANATION: Clostridium difficile is an anaerbic, toxin producing gram positive rod that is most commonly associated with nosocomial diarrhea. Prolong use of antibiotics kill the normal microbiota of gastrointestinal tract and results in colonization of Clostridium difficile infection. Toxin A, causes increased intestinal permeability and fluid secretion. Toxin B, leads to intense colonic inflammation. Three or more watery, nonbloody stools per 24-h period are characteristic of the disease. Mild disease is characterized by diarrhea in the absence of signs and symptoms of colitis whereas moderate disease is characterized by moderate diarrhea with colitis manifested by fever, abdominal cramps and discomfort, usually in the lower quadrants. Severe disease is characterized by white blood cell count of >15,000 cells/μL, serum albumin <3 g/dL, and/or a serum creatinine level ≥1.5 times the premorbid level. It produces yellowish white plaques in the large intestine which is known as pseudomembrane colitis. The treatment of choice for mild to moderate disease is per oral metronidazole, 500 mgthree times a day for 10 days, or 250 mg orally four times per day. Metronidazole is effective against anaerboes and it acts by interacting with the DNA and inhibiting the protein synthesis. Failure to respond to metronidazole therapy within 5-7 days requires a change in therapy to standard dose of vancomycin (125 mg orally q.i.d.) for 10 days. Please note that Vancomycin is given orally when treating Clostridium difficile.
112
A 3-year-old African-American boy presents with severe pain and swelling in his hands and feet. Lab studies showed hemolysis and abnormal red blood cells. Which of the following is the patient at a highest risk of having?
S. pneumoniae pneumonia.
EXPLANATION: Sickle cell disease is the most common autosomal recessive disorder in African-Americans. Patients are predisposed to infections with capsulated organisms (S pneumoniae >> H influenzae type b > N meningitidis) dues to functional asplenia from consecutive splenic infarcts. Cardiac complication due to ischemic events typically happen later in life.
113
Which of the following is the most common cause for anemia?
** Chronic blood loss **(often in the gastrointestinal tract) is the most common cause for anemia. -- Iron deficiency anaemia.
114
What is the MOST important initial treatment for a patient in septic shock from a diabetic foot infection?
IV Crystalloid fluids. EXPLANATION: Crystalloids (normal saline and lactated ringer’s) are recommended as the initial fluid choice in septic shock. These are crucial because in septic shock, the lowered blood pressure contributes to poor tissue perfusion and crystalloids increase blood volume.
115
A 51-year-old patient with a history of a previous MRSA infection and true penicillin allergy is scheduled for a total ankle replacement, which medication would serve as the best prophylaxis?
Vancomycin.
EXPLANATION: Vancomycin is indicated in surgical prophylaxis involving joint implants with a history of MRSA. Despite new acquired resistance strains, Vancomycin continues to be the drug of choice for treating most MRSA infection.
116
A 25 year old sustains a puncture injury to his right foot after having stepped on a nail. He reports fever, pain, and has a WBC of 16. A one week treatment of amoxicillin-clavulanic acid has resulted in no improvement of his symptoms. What additional antibiotic should be considered?
Ciprofloxacin.
EXPLANATION: Pseudomonas aeruginosa is the most commonly implicated organism to cause osteomyelitis as a result of a nail puncture injury. The most likely organism to cause a soft tissue infection with a puncture injury would be Staph aureus. In the event of a puncture injury into the the foot, a tetanus booster should be considered, and coverage of Pseudomonas should be provided for. Flouroquinolones are the only class of antibiotics that have an oral formulation that is active against Pseudomonas.
117
Which of the following medications should be held prior to contrast angiography?
Metformin.
EXPLANATION: Metformin is renally excreted and several studies report an increased incidence of lactic acidosis with use of metformin during contrast angiography. There is a high mortality rate in patients who do develop lactic acidosis. Metformin should be discontinued before the procedure and withheld for 48 hours after. It is only restarted after lab work confirms renal function to be normal.
118
The presence of many **target cells** in the peripheral blood smear, indicates which of the following form of inherited anemia?
**Thalassemia**.
EXPLANATION: Target cells are red blood cells that have the generalized appearance of a **shooting target with a bullseye**. Thalassemia is an inherited-blood disorder, characterized by diminished hemoglobin and fewer red blood cells in the body than normal. Target cells appear in conditions that cause the surface of the red cell to increase disproportionately to its volume.
119
Which of the following organisms is the MOST frequent in osteomyelitis following nail puncture through shoe?
| ****
Psudomonas aeruginosa.
EXPLANATION: “The management of puncture wounds of the foot should include routine wound care, tetanus prophylaxis and warnings of what to look for and expect. Pseudomonas aeruginosa is the most commonly recovered organism in puncture wounds.” *BoardWizards* note: While some argue that staph infections are in fact more common, pseudomonas infections are historically recognized as a common cause of **osteomyelitis** following puncture wounds.
120
Common antibiotics that cover pseudomonas:
* aminoglycosides (gentamicin, amikacin, tobramycin; not kanamycin)
* quinolones (ciprofloxacin, levofloxacin, not moxifloxacin), and
* cephalosporins (CEFEPIME, and ceftazidime).
121
talipes equinovarus:
hindfoot position
Adduction, Varus, Equinus.
EXPLANATION: Adduction, Varus, Equinus.
Talipes equinovarus (club foot) deformity is characterized by: adduction at the midtarsal joint, cavus and internal tibial torsion, and equinus at the ankle.
122
most effective antibiotics for:
pseudomonas aeruginosa
Carbapenems, aminoglycosides, cephalosporins, floroquinolones, penicillin with beta lactamase inhibitors, fosfomyin, monobactams and polymyxins. Imipenem, doripenem, and meropenem (Carbapenems) exhibit good activity against most strains
123
what types of foods increase blood clotting?
Vitamin K is essential in blood clotting. Foods high in Vitamin K will decrease the effectiveness of warfarin (Coumadin). Vitamin K is found in green-leafy vegetables including: spinach, lettuce, broccoli, and cabbage.
124
What is the most benign form of melanoma?
Lentigo maligna melanoma.
EXPLANATION: “Lentigo maligna melanoma is the first presentation of melanoma in which the cancerous cells are limited to the tissue of origin, the epidermis. Therefore, it is often reported as "in situ’" melanoma. It is the slowest growing and the least common type of melanoma.
125
Purulent discharge passes through which of the following?
Cloaca.
EXPLANATION: Common features of chronic osteomyelitis include involucrum (reactive bony encasement of the sequestrum). The cloaca is an opening within the involucrum that allows drainage of purulent/dead material out of the dead bone.
126
gustilo anderson: type II
amount of irrigation
6 L
Increasing volume removes more particulate matter and bacteria but the effect plateaus at a level dependent of the system. Bacterial loads drop logarithmically with increasing volumes of 1, 3, 6, and 9 liters of irrigation. The current recommendations are as follows: 1-3 liters for small volume wounds, 4-8 liters for moderate wounds, and 9 or more liters for large wounds or wounds with evidence of heavy contamination.
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What is the earliest sign of Volkmann’s ischemia contracture in an untreated compartment syndrome of the arm?
Pain upon passive extension.
EXPLANATION: Volkmann’s contracture is compartment syndrome of the forearm. Much like the lower leg, symptoms include: 5 P’s of compartment syndrome: pain, pallor, pulselessness, paresthesias, and paralysis. Of these, pain is the earliest sign. Pain is expressed with passive extension.
128
dog bite wound
Augmentin.
EXPLANATION: In animal bite wounds the treatment of choice is Augmentin unless the patient has an allergy to penicillin. Animal bite wounds are polymicrobial. Choose an antibiotic that will cover gram-positive, gram- negative, and anaerobic bacteria. Because of the bacterial contamination of these wounds, these injuries are considered infected at the time of presentation. Antibiotics are considered more therapeutic rather than prophylactic.
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