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#2 BOARDS > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Etiologies of hammer toes

A
  • Flexor stabilization
  • Flexor substitution
  • Extensor substitution
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2
Q

Flexor stabilization

A

MOST COMMON
o Pronation of STJ leads to unlocked/hypermobile foot and therefore excessive “gripping”
o Flexors (FDL, FDB) fire earlier and stay contracted longer to stabilize the foot, but end up overpowering the interosseous muscles
o STJ pronation also leads to forefoot abduction making the QP muscle weak, allowing adductovarus rotation of 5th digit

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3
Q

Flexor substitution

A

LEAST COMMON
o Supinated foot type with weak gastro-soleal complex (Achilles rupture, Achilles surgery)
o Flexors gain advantage over interosseous due to weak gastro-soleal complex, they try to “substitute” for the weak muscle group
o Deep posterior and lateral muscles attempt to make up for weak gastro-soleal complex

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4
Q

Extensor substitution

A

o Pes cavus, neuromuscular contracture, equinus (these need to be corrected as well)
o Extensor digitorum longus gains advantage over the lumbricals, bowstringing of EDL
o Initially only swing phase hammering which will partially resolve during weight bearing
o Orthotics will not work due to the deformity predominating during swing phase

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5
Q

Virchow’s triad

A

Three factors that are commonly associated with the formation of thrombi

  • Stasis
  • Blood vessel injury
  • Hypercoagulability
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6
Q

Stasis

A

Reasons for stasis

  • Arrhythmias
  • MI
  • CHF
  • Heart failure
  • Immobilization
  • Obesity
  • Varicose veins
  • Dehydration
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7
Q

Blood vessel injury

A

Reasons for blood vessel injury

  • Trauma
  • Fracture
  • IV
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8
Q

Hypercoagulability

A

Reasons for hypercoagulability

  • Neoplasm
  • Oral contraceptives
  • Pregnancy
  • Surgery
  • Polycythemia
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9
Q

Calculate ABI

A
  • Determine brachial systolic pressure
  • Determine ankle systolic pressure
  • Ankle pressure divided by brachial pressure
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10
Q

Ranges of ABIs

A 
1 = normal 
0.5-0.8 = intermittent claudication 
<0.5 = rest pain, ulcers
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11
Q

Toe pressures in diabetics

A

> 55 mmHg = healing
45-55 mmHg = uncertain healing
<45 = no healing

At least 30 mmHg required for healing a wound on the digits

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12
Q

Seddon classification for nerve injury

A
  • Neurapraxia
  • Axonotmesis
  • Neurotmesis
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13
Q

Neurapraxia

A

Bruised nerve - results in numbness that is reversible

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14
Q

Axonotmesis

A

Injury to axon that results in Wallerian degeneration, will regenerate over several months as long as gap is not too big

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15
Q

Neurotmesis

A

Complete severance of the nerve resulting in irreversible numbness

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16
Q

Sunderland’s classification for nerve injury

A
  • First degree
  • Second degree
  • Third degree
  • Fourth degree
  • Fifth degree
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17
Q

First degree

A

A conduction deficit without axonal destruction

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18
Q

Second degree

A

Axon is severed without reaching the neural tube. Wallerian degeneration with regeneration. Regeneration is likely (axonotmesis)

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19
Q

Third degree

A

Degeneration of axon with destruction of fascicle with irregular regeneration

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20
Q

Fourth degree

A

Destruction of axon and fascicle and no destruction of nerve trunk, but a neuroma-in-continuity exists

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21
Q

Fifth degree

A

Complete loss - neuroma is likely and spontaneous nerve recovery is rare

22
Q

Sullivan’s sign

A

Toes adjacent to Morton’s neuroma splay apart on weight bearing

23
Q

Joplin’s neuroma

A

Similar to Morton’s neuroma but affecting the medial plantar digital nerve on the medial aspect of the first MPJ of the hallux

Similar symptoms to Morton’s neuroma - paresthesia and burning with pain at point of entrapment

Biomechanical etiology - caused by pronation or hallux limitus

24
Q

Another name for flexor retinaculum

A

Lacinate ligament

This is the tarsal tunnel (where tarsal tunnel syndrome exists)

25
Q

Types of anemia

A
  • Microcytic
  • Normocytic
  • Macrocytic
26
Q

Mnemonic to remember types of anemia

A

Microcytic: “I SAT”
Normocytic: “IN A HAM”
Macrocytic: “DAMN”

27
Q

Microcytic

A

I = iron deficiency

S = sideroblastic anemia 
A = anemia of chronic disease 
T = thalassemia
28
Q

Normocytic

A 
I = infiltrative bone marrow disorder
N = nutritional anemia

A = anemia of chronic disorder

H = hemolytic anemia 
A = anemia of renal insufficiency 
M = myelodysplastic anemia
29
Q

Macrocytic

A 
D = drugs (metformin) 
A = alcohol 
M = malabsorption syndromes 
N = nutritional anemias
30
Q

Concepts of skin plasty

A
  • Stress
  • Strain
  • Creep
  • Stress relaxation
31
Q

Stress

A

The force on the skin per cross sectional area

32
Q

Strain

A

The change in length divided by the original length of the given tissue to which a force is applied

33
Q

Creep

A

The increase in strain seen when skin is under constant stress

This occurs in a matter of minutes and is due to an extrusion of fluid from the dermis and a breakdown of the dermal framework

34
Q

Stress relaxation

A

The decrease in stress when the skin is held in tension at a constant strain for a given time

This occurs over a matter of days to weeks and is due to an increase in skin cellularity and the permanent stretching of skin components

35
Q

What concentration of phenol is most commonly used?

A

89%

36
Q

Thick vs thin skin graft

A
  • The thinner the graft the better the take

- The thicker the graft the better the function

37
Q

Full thickness skin grafts

A
  • Epidermis and all of the dermis
  • Take is not as good
  • Infection rate is higher
  • Grafts do not shrink or change color
  • Hair follicles preserved
38
Q

Partial thickness (split thickness) grafts

A
  • Epidermis and varying amount of dermis
  • The thinner the graft, the more likely it will take because a higher number of blood vessels are transected and there is more opportunity for revascularization
  • Grafts tend to shrink 50-70% and become hyperpigmented
39
Q

Graft meshing

A
  • A process by which multiple staggered rows of full thickness incisions are placed in a graft before application to the recipient site
40
Q

Advantages of meshing

A
  • Expands tissue allowing smaller graft to cover larger site
  • Allows drainage of hematoma/seroma through graft
  • Allows graft to drape well around irregular surfaces
41
Q

Disadvantages of meshing

A
  • Inferior aesthetic appearance after healing
  • Graft becomes very delicate
  • Easily torn
42
Q

Graft donor site

A

Full thickness

  • Flexor surface, especially groin
  • Close primarily with 3:1 ratio

Partial-thickness

  • Anterior/lateral thigh, upper inner arm, gluteal region, dorsum of foot
  • Heal by secondary intention, control bleeding with thrombin/epinephrine/cautery and dress with tegaderm
43
Q

Reasons for graft failure

A
  • Hematoma (most common)
  • Infection (second most common)
  • Seroma
  • Shearing forces
  • Improper preparation of recipient site
44
Q

Z plasty

A
  • Angles permissible for Z-plasties are 45-60 degrees
  • 60 degrees gives the greatest lengthening
  • Angles less than 45 degrees result in impaired blood flow to the flaps and angles greater than 60 result in severe tension
  • Particularly useful in treating linear scar contractures
45
Q

V-Y plasty

A
  • Skin lengthening technique

- The apex of the “V” can point distally or proximally

46
Q

Derotational skin plasty for 5th digits

A
  • Done in conjunction with an arthroplasty
  • Acts to correct for the varus (frontal) and hammering (sagittal) of the digit
  • Incision made from distal medial to proximal lateral
47
Q

Most common sources of metastatic tumors

A
  • Breast
  • Lung
  • Prostate
  • Kidney
  • Multiple myeloma
48
Q

Most common benign primary bone tumor

A

Osteochondroma

49
Q

Most common malignant primary bone tumor

A

Multiple myeloma

50
Q

Malignant bone tumors

A
  • Osteosarcoma
  • Chondrosarcoma
  • Fibrosarcoma
  • Ewing’s sarcoma
  • Multiple myeloma
51
Q

Benign bone tumors

A
  • Osteoma
  • Osteochondroma
  • Enchondroma
  • Chondroblastoma
  • Chondromyxoid fibroma
  • Osteoid osteoma
  • Osteoblastoma
  • Non-ossifying fibroma
  • Intraosseous lipoma
  • Giant cell tumor (locally malignant)
  • Unicameral bone cyst
  • Enostosis
  • Ossifying fibroma
  • Aneurysmal bone cyst
  • Chondroblastoma

#2 BOARDS (14 decks)

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