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Podiatry part 3 exam > Part 3 Podiatry exam > Flashcards

Part 3 Podiatry exam Flashcards

1
Q

wound healing

A

Hemostasis Phase.- is the process of the wound being closed by clotting. …starts when blood leaks out of the body

Inflammatory Phase. …econd stage of wound healing and begins right after the injury when the injured blood vessels leak transudate (made of water, salt, and protein) causing localized swelling. Inflammation both controls blleding and prevents infections

Proliferative Phase. …wound healing is when the wound is rebuilt with new tissue made up of collagen and extracellular matrix. In the proliferative phase, the wound contracts as new tissues are built. In addition, a new network of blood vessels must be constructed so that the granulation tissue can be healthy and receive sufficient O2 and nutrients

Maturation Phase.the maturation phase is when collagen is remodeled from type III to type I and the wound fully closes. The cells that had been used to repair the wound but which are no longer needed are removed by apoptosis, or programmed cell death.

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2
Q

2 main approaches for fracture plate fixation

A

Interfragmentry compression and internal splinting

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3
Q

2 test to evaluate progression of OM

A

ESR

CBC

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4
Q

2nd layer muscle on the plantar foot

A

Quadratus Plantar (Lateral plantar Nerve)

1st Lumbricals Medial plantar branch nerve)

FHL and FDL run in this layer

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5
Q

3rd layer of the foot

A

Flexor Hallucis Brevis (Medial plantar nerve,proper digital N to hallux)

Adductor Hallucis(Lateral plantar nerve, deep branch)

Flexor digitii minimi brevis( Lateral plantar nerve, superficial)

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6
Q

4 stages of bone healing

A

Inflammation, soft callus, hard, callous, remodeling

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7
Q

4th layer

A

Interosseous

PAD

DAB

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8
Q

5 Minute reactive hyperemic test

A

Patient lies supine legs raided 30 degress

foot DF and PF several time to empty venous blood

Apply and inflate cuff to 100mm above ankle systolic

Place foot heart level

After 5 minutesquickly deflate cuff

Time the interval between cuff let down and color returns to foot

Normal= instant with max erythema t 1 minute

Vasospastic disease- Return of color is uniform slight delayed 5-8 seconds-max erythema 2 minutes

Organic Occlusive Disease-Return uniform requires 15 seconds to reach toes,erythema less then normal

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9
Q

5th ray runs at

A

proximal, lateral plantar, distal medial dorsal

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10
Q

;Conization

A

remove cone shape bone

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11
Q

A 2 agonst

A

reduce central and peripheral sympathetic overflow and via peripheral presynaptic receptors may reduce peripheral neurotransmitter release. Alpha 2 agonists lower blood pressure in many patients either alone or in combination with diuretics.

Drugs: Guanabenz, guanfacine, clonidine, tizanidine, medetomidine, and dexmedetomidine are all α-2 agonists that vary in their potency and affinities for the various α-2 receptor subtypes. Clonidine, tizanidine, and dexmedetomidine ha

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12
Q

A antagonist

A

Phentolamine

Phenoxybenzamine also use for pheochromocytoma

Will cause reflex tachycardia and 1st dose syncope

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13
Q

A farmer ran over his brother’s foot with a plow, causing
a degloving injury and comminuted fracture of the first
metatarsal. He makes it to the hospital within 1 hour

A

Take a culture. Start a cephalosporin,
aminoglycoside and Penicillin G. Surgical
repair.

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14
Q

A patient received an allograft bone graft while
undergoing surgical excision of active osteomyelitis. The
graft is rejected. Which type of hypersensitivity reaction

A

TYPE IV

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15
Q

A Type 4 Hawkins talar neck fracture represents:

A

displacement of the ankle joint
Displacement of the talar neck, subtalar
joint, ankle joint and talonavicular joint

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16
Q

Abduction test

A

supine, hips and knees flexed to 90 degrees

Abduct the knee to resistance

A dislocated hip will have limitation of abduction on affected side

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17
Q

Absorable sutures

A

Plain gut-natural multifilament-digested own enz, tensile strength maint 7-10 days–70 days complete

Chromic gut-natural multifilament- chromeic NacL solution resist body enz, prolong>>90 days]

Vicryl-Synthetic monofilament-75% of original tensile strength remains day 14, absorpt 56-60 days by hydrolysis

Monocryl- synthetic monofilament-tensile strength-60% at 7 day 30% 14 day, original strength lost 21 day absorbed at 91-119

PDS (polydiazone)-synthetic monofil-70% original strength at day 14, absorption minimal until 90 days and complete absorbed 6 months

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18
Q

Ace inhibitors

A

Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced

Benazepril (Lotensin) Side effects

Captopril. Cough and hyperkalemia by inhib of aldosterone

Enalapril (Vasotec)

Fosinopril.

Lisinopril (Prinivil, Zestril)

Moexipril.

Perindopril.

Quinapril (Accupr

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19
Q

acetabular index

A

angle greater then 30 is dislocated

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20
Q

Acrocyanosis

A

Acrocyanosis is persistent blue or cyanotic discoloration of the extremities, most commonly occurring in the hands, although it also occurs in the feet and distal parts of face.

Can mimic Raynauds contrictive S/S

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21
Q

adult range in malleolar position

A

13-18 degrees

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22
Q

Alcoholic Neuropathy

A

dAngthrapist

similiar to beri beri

Thiamine essential for CHO catabolism

Decrease Thiamine (B1)=CVD>>Wet beri beri

N Sys Dz>>Dry Beri beri

Dry Beri beri–Wernicke-Korsakoff Syndrome which alcohol related brain damage>>>language & thinking(xs alcohol consuption

TX-100mg IV Thiamine

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23
Q

Alkaline Phosphatase

A

30-85

Mainly in liver and bone

released by osteoblast when secreted into bone

Increased-Live/bone DZ,healing fracture &bone growth,hyperparathyroidism,obstructive biliary dz, Pagets,Sarcoma

Decreased-Hypothyroidism, malnutrition,scurvy, pernicous anema, Diabetes

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24
Q

Alkaline Phsphatase ALP

A

30-85

Liver-heat stable

Bone- heat labile

Most often measure bile duct obstruction

INCREASED- Liver DZ/Bone DZ/Hyperparathyroidism/Healing bone growth/Obstruction biliary DZ

Decreased- Hypothyroidism/Malnutrition/Pernicous anemia/

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25
Q

A Jones fracture occurs

A

Metaphyseal/diaphyseal junction

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26
Q

allodynia

A

r pain out of proportion

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27
Q

Allograft

A

a tissue graft from a donor of the same species as the recipient but not genetically identical.

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28
Q

Allografts

A

osteogenesis

osteoconduction

immogenicity

individual of same species but different genertic background

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29
Q

Dynamization of an external fixator

A

The process of making the fixator more
flexibleDyn

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30
Q

An axis is a straight line around which an object rotates. Movement at the joint takes place in a plane about an axis. There are three axes of rotation.

Name the 3 axises

A

Sagittal axis - passes horizontally from posterior to anterior and is formed by the intersection of the sagittal and transverse planes.

Frontal axis - passes horizontally from left to right and is formed by the intersection of the frontal and transverse planes.

Vertical axis - passes vertically from inferior to superior and is formed by the intersection of the sagittal and frontal planes.

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31
Q

Anatomy associated with Lisfranc complex

A
  • Complex composed of dorsal (weakest) Plantar (strongest) and interosseus ligaments
  • 2nd TMT joint is the keystone of the arch
  • No interosseus ligament between 1st and 2nd MT
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32
Q

Anatomy CT

A

High density to Low

Cortical

cancellous

muscle

nerve

tendon

ligament

fat

air

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33
Q

Anatomy of nerve

A

Perikarya

Axon

Dendrite

Oligodentrocytes

Schwann Cell

Myelin

Ganglia

Nuclei

Nissl bodies

Node of Ranvier

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34
Q

ANATOMY OF SCREW

A

Head

Land-underside of head

shank- only in cancellous screw

run out- weakest point of screw-starts at the beginning of the threads

pitch-distance between threads

rake angle- thread to axis angle

core diameter-diameter of the screw between the threads

thread diameter- describes the screw size(ie: 2.7mm has a2.7 mm thread diameter

tip angle- tip to axis

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35
Q

Anchor sign

A

baby prone, legs adducted and extended

look for asymmetry of thigh and gluteal fold

more fold on the dislocated side

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36
Q

Andersons disease

A

rare genetic disorder of glycogen metabolism. It is caused by the deficient activity of the glycogen-branching enzyme, resulting in accumulation of abnormal glycogen in the liver, muscle, and/or other tissues. The disease is inherited as an autosomal recessive trait.

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37
Q

Anesthesic Supplementary medication

A

1- Opoids-

Fentanyl- Short-term analgesia during anesthetic periods, premedication, induction and maintenance; and in the immediate postoperative periods as need arises.

Morphine- Serves to alleviate periop pain and decrease somatic and autonomic response to airway manipulation, improve hemopdynamic stability, lower req for inhales anes and decrease anxiety. Older

Demerol-(meperidine) Induces amnesia and controls post anesthetic shivering. Can casue tachycardia and caution with pts with heartt ireg. like narcotics SE: N&V, constipation (vistaril used in conjunction)

2- IV Pain management

1-Toradol NSAID reduce post op pain, however risk of bleed

2- Acetaminiophen (IV Ofirmev) deecrease risk of bleed

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38
Q

ANGINA PECTORIS

A

PRESSURE SQUEEZINF, IMPENDING DOOM

LOCATION- ARM AND JAW

TIME-15 MINUTES

CAUSE: CAD<<<

TREATMENT: NITROGLYCERIN

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39
Q

Anterior Motor Horn Disease

A

Diseases that cause selective damage that affect voluntary movement and rarely attack other path in S.C

Poliomyelitis

Symp: malaise & Myalgias- flu-like symptoms, low grade fever

muscle tightness in hamstring, thigh and back

LMN weakness or parylsis>>gradual tightening muscle spasm, muscle weakness

Amyotrophic Lateral Sclerosis (Lou Gerhigs )

Lateral colum and anterior gray matter which are close connect with SC

ALS involves voluntary motor system inv/ degeneration of corticospinal tracts and alpha motor neurons

Presents with both UMN and LMN

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40
Q

Anterior Spinalthalamic tract

A

information about pain and temperature.touch

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41
Q

Anti-Angina Meds

A

Nitrates-

CA+ channel blockers

B Blockers

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42
Q

Anticoagulant

A

Indication::Venous thrombosis, DVT/PE/A-FIB WITH EMBOLI/MI, SURGICAL PROPHYLAXIS

TYPES:HEPARIN:LMWH-ENOXAPRIN(LEVENOX =COUMADIN

Production Vit K dependent factors-II,VII,IX,X

Contraindication: Allergy//active bleed, CNS sx//eye ex//Severe HTN, Ulcer

Heparin-works faster then warfarin-injectable

Warfarin-Slows down process in liver that use Vit K to make certain Proteins (clotting factor) that causes clotting

Coumadin-oral outpatient-stop 5 days prior to Sx

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43
Q

Antidysrythmiacs

A

Class Ia NA channel blocker-Quinidine

Procainamide

Disopyramide

Class 1b Weak NA channel blockers-Lidocaine

Phenytoin

Class 2 Beta blockers vent arrhythmias

Class 3 K channel blocker Amiodarone Sotol

Btretylium

Class 4 L-type CA channel blocker Verapamil

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44
Q

Antiplatelet Types

A

ASA (-) Cox

2) PDEinhibitor

Persantine-PDE III inhibitor >>decrease cAMP>>decrease platelet aggregation

Pletal(clopidiel) PDE III inhibitor>>decreases cAMP>>decreases platelet aggregation

3)Ticlid-250Mg PO BID

4)Trental (pantoxyfilline) alters rheology RBC>>increase flexibility>>decrease blood viscosity by decrease RBC>>decrease elevated plasma level of fibrogen>>and release plasminogen activator thereby promoting fibrinolysis

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45
Q

Arterial and Venous testing

A

Duplex ultrasound-8-10 hx of U/S triphasic-faster Q wave form resemble a teepee

biphasic may be normal in patients with diabetes

monophasic-slow Q indicates signaficant abnormal

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46
Q

Arthrograms for ankle ligament injury

A

ruputure of C-F ligament is always associated with the ATFL with dye flowing into the anterior and lateral malleolus

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47
Q

ASA Classification Anesthesia

A

ASA-

PS1 Healthy non smoker

PS2-Mild dz without substantive func limits. ie: smoker, well controlled DM/HTN mild lung disease (30

PS3 Severe systemic dz with substantive functional limitation. 1 or more moderate to severe disease

ie: poor controleed dm, HTN,COPD (BMI>40), acute hepatitis, reduction of ejection fraction

PS4 Incapacitating Systemic dz-threat to life ie; < MI,CVA,TIA or CAD/stents, severe reduction ejection fraction

PS5 Moribund patient not expected to live ie; ruptured abdominal/thoracic aneuysm

PS6 Declared brain dead

PS7 If procedure is an emergency, physical status is followed by E

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48
Q

Assmann DZ

A

Osteochondritis of the 1st metatarsal

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49
Q

At what point during tendon healing can isometric
exercises begin?

A

3 weeks

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50
Q

Atropine Sulfate

Scopolamine

Glycopyrrolate

A

Reduce resp tract secretion

protect reflex bradycardia, decrease gastric secretion

Used gen+endotracheal tube insertion

SE​: Dry sore mouth, poor visual, relax lower spincter bofy temp rise

if use with preanesesthetic combo with atropine and meperidine

GLLCOPYRROLLATE-MORE POP BC NO CNS EFFECT

ANTODOTE:PHYSOSTIGMINE

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51
Q

Autogenerous bone graph has

A

a. osteoconduction
b. osteoinduction
c. viable osteocytes

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52
Q

Autogenous bone grafts have

A

oeteogenesis

osteoconduction

osteoinduction

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53
Q

Autograft

A

An autograft is a bone or tissue that is transferred from one spot to another on the patient’s body

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54
Q

Barlow sign

A

thumb on lesser trochanter and middle finger of the same hand is on the greater trochanter

The dislocated hio become displaced with a palpable clunk as the head slips over the posterior aspect of the acetabulum

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55
Q

Basal Ganglia Disorders

A

Huntingtons Chorea

Sydenhams Chorea (St Vitus Disease

Parkingtons Disease (PARK)
Wilson Disease
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56
Q

Basophilia

Bands

Platelet count

A

Basophilia- Polycythemia, chronic myelogenous leukemia

chicken pox- hypothyroid myxoderma Renal DZ

Bands increase-shift to the left– acute bacterial infection

Platelet Count- 140-340,000

Increased Vascular Dz, iron def, acute infection, cardiac Dz, malignancy, PCV, cancer, RA,

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57
Q

BEBAX SHOE

A

TREAT RF ABNORMALITIES (MET ADDUCTUS)

USE AFTER SERIAL CASTING FOR MET ADDUCTUS

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58
Q

Best meds for post op shivering

A

Demerol

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59
Q

Best treatment for osteochondral bone lesion

A

osteochongral autogenous graphs

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60
Q

Beta blockers

A

Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure.

atenolol (Tenormin) and metoprolol (Toprol,Lopressor)

Side effects—-

Dizziness.

Headaches.

Flushing of your face and neck.

Upset stomach or throwing up.

Low blood pressure (hypotension)

Irregular heart rhythms (arrhythmia

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61
Q

Bier Block

A

Intravenous reghional anesthesia

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62
Q

Bilirubin

A

.1-1.3

Is breakdown of HGB

Catabolism of HGB and breakdown myoglobin,cytochromes,catalose

Unconjugated (indirect) is lipid soluable and doesn’t spill into the urine

BREAKDOWN- occurs in Kupffer cells using cytochrome P450 to breakdown heme

INCREASED- Bile duct obstruction hemolytic anemia,hepatocellar damage, Crigler-Najjar Syndrome/Gilbets disease,XS destruction of RBC or Liver unable to excrete noram amt produced

DECREASED-MEDS:PENICILLIN/SULFONAMIDES

Conjugated (direct) increase is obstructive Jaundice

Increase in Unconjugates (indirect) destruction of RBC

>>3 jaundice

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63
Q

Bimalleolar equivalent

A

rupture of the deltoid ligament instead of medial malleolar fracture. More unstable than actual fracture of the medial malleolus

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64
Q

bioburden testing

A

is the measure of microbial contamination levels on or in a product. Bioburden can be introduced from the raw materials used in the manufacturing process, or be introduced via the workforce or manufacturing environment.

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65
Q

biological lock plates provide

A

indirect healing

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66
Q

Biomaterials suture

A

Nature and synthetic

absorable and non absorable

monofilament and multifilament

Synthetic materials cause less rxn with less inflam rxn

Absorable applies to a wound that heals quickly and need minimal temp support. ITS PURPOSE TO ALLEVIATE TENSION ON WOUND EDGES

New synthetic sutures retain their strength until the absorption process starts

Non-absorable sutures offer longer mechanical support

Mono-filament less drag thru tissue but susceptible to instrumentation damage.Infection is avoided unlike braided multifilimant can cause sustain bacterial inocula

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67
Q

biopsy of lesion <2 cm

A

b. Excisional biopsy using 2 semi-elliptical incisions
c. Dimensions should be 3 to 1 width of the lesion
d. Full thickness, including fat

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68
Q

Bleck classification of metatarsal adductus

A

bisect heel and extend line distally to see where it falls on the toes

Normal-2-3rd toe

Mild-line to 3rd toe

Moderate- line thru 3-4th toe

Severe-Line thru 4-5th toe

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69
Q

Bleeding time

INR

A

2-9 Minutes Bleeding Time

3 - 4 INR

measure the primary phase of hemostasis, the ineraction of the platelets with the blood vessel wall and the formation of the hemostatic plug

Forearm scratch

Increased–Von Willibrand,Thrombocytopenia

DIC Platelet dysfunction and ASA/ NAIAD therapy

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70
Q

Blood Gas coefficient for anesthesia(Ostswald)

A

Solubility of an agent, speed of induction

The blood:gas partition coefficient is an important determinant of the speed of anesthetic induction and recovery. It describes the partition of an agent between a gaseous phase, such as alveolar air, and the blood. The greater the blood:gas partition coefficient, the greater the solubility in blood.

High BGC=more soluble=more agent needed in blood before equilibrium is met

High BGC=More potent, slower induction

MIC=amount of inhaled at 1 ATM that prevents movement and response to noxious stimulus in 5-% pts

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71
Q

Blood work muscle

A

Creatine kinase( CK or CPK) 6-30

Cardiac ezymes- CK-MB 20% Cardiac-hi during 48 hrs MI and flip LDH-DX made

CK-BB brain 90%

CK-MM-80% cardiac muscle, high in skeletal muscle injury

Myoglobin- sensitive indicator muscle injury

Troponin increase 3-12 hour after injury

Aldolase-glycolytic involved in metabolism of glucose

Increase AST and LDH w/n 1-2 days after episode chest apin=Pulmonary infact

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72
Q

BLOUNT DZ

A

OSTEOCHONDROSIS OF MEDIAL PORTION PROXIMAL EPIPHYSEAL OSSIFICATION CENTER IN TIBIA CAUSING BOWLING OF LEGS

SYMPTOMS INCLUDE LIMPING, LARERAL BOWING

RADIOGRAPH- SCLEROTIC MEDIAL CORTEX WITH SPURRING

BEFORE 6 YEARS OLD

CAUSE EARLY WALKING AND OBESITY

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73
Q

blount dz

A

true tibial varum

progressive tibial varum

disruption of the medial capital ephiphysis

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74
Q

BMI

A

BMI <25 Desirable

26-27 Mild obese

28-29 Moderately obese

>30 Morbid obese

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75
Q

Bone graphs

A

Autogenous bone grafts provide both
osteoconductive and osteoinductive properties

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76
Q

Bone metabolism

A

Alkaline Phosphatase 30-85

Calcium 8.5-11

Phosphous 3-4.5

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77
Q

Bone scan of reflex sympathetic dystrophy

A

Increased blood flow

3rd phase of affected limb reveals increased periarticular activity

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78
Q

Bone scan scintigraphy phases

A

technetium-99m (commonly Tc-99m-methylene diphosphonate (MDP)) as the active agent. The study has 4 phases which follow intravenous injection of the tracer. Sometimes a fourth (delayed/delayed) phase is performed.

The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time.

1st Phase ====Dynamic

2nd- Blood pool image and 5 minutes after injection

3rd- after 3 hours when urinary excretion has decreased the amount of the radionuclide in soft tissues.

4th- after 24 hours

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79
Q

Bone stimulaors good used

A

An oligotrophic nonunion.

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80
Q

Bosworth definition

A

avulsion fracture of the fibula from the PITFL

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81
Q

Brachymetatarsia

A

Type I=shortening of 1st metatarsal only

Type II-Shortening of 1 or 2 lesser metatarsal (usually 3rd or 4th)

Type III-Shortening of the 1st and one or more of the lesser metatarsals

Type IV-shortening of all the metatarsals

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82
Q

Broden view: position of foot and beam

A
  • Ankle is dorsiflexed, with leg internally rotated 30 degrees
  • X-ray beam is cephalic tilt of 10-40 degrees
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83
Q

Brodie Abscess

A

rare form of osteomyelitis. It involves a subacute or chronic infection of the bone with development of a localized abscess, usually within the metaphysis of long bones. The tibia is the most common bone involved and staphylococcus aureus is the most common organism identified.

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84
Q

Buchingham classification

A

Type A-Medial STJ disloc-AKA basket-ball or acquired clubfoot,calcaneus medial to talus

Type B-Lateral STJ dislocation,calcaneus lateral to talus

Type C- Anterior & posterior STJ dislocation

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85
Q

Buergers Disease

Thromboangiitis Obliterans

A

inflam changes small and medium vessels

20:1

Raynauds phenomenon common

Decrease pulse

Inflammatory occlusions more distal

Patient usually have HLA-A9,,HLA-B5

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86
Q

BUN

A

10-20%

End produce of amino group removal in degrdation of amino acids

Measure urea produce in liver

Measure of liver function and kidney excretion

INCREASED-Renal DZ/Dehydration/ High protein diet/DM

DECREASED-Severe Liver damage,ie: poison//hepatits

BUN alone not reliable indicator of renal function because it depends on many extra renal factos

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87
Q

Buschke DZ

A

Osteochondritis of the cuneiforms

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88
Q

c. Muscular dystrophy with a waddling gait.
d. Cerbral palsy with a scissoring GAIT

hemiphagia with circumductive gait

A
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89
Q

Calcaneal erosions on xray

A

R.A,

Reiters

Ankylosing Spondylitis

Psoriatic OA

Hyperparathyroidism

Lipid dermata OA

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90
Q

Calcaneonavicular Coalition CN

A

45 % extra articular

8-10 y.o

Pain localized to the area of coalition

decrease ROM STJ and MTJ

MEDIAL OBLIQUE- calc and nav are close proximity or connet

LATERAL VIEW shows classic elongated ant process of calc-ANTEATER SIGN

TX- Resection and place the EDB belly in void (Cowell procedure)

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91
Q

Calcium

A

8.5-11

98% stored in skeletal and teeth

acts main resevoir for maintaining blood levels needed for muscle contraction

kidney important regulation of calcium

Any condition causing bone deminerization or atrophy>>>increase Ca Level

Hypo-Hypoparthyroidism,Vit D dif, renal failure secondary alkalosis

Hyper-cancer,hyperparathyroidism,Iatrognic, multiple myeloma

parathyroidism,m sarcoidosis, acidosis(CHIMPS), Lymphoma

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92
Q

Cause of congenital flatfoot

A

Compensated FF varus and valgus

RF equinus

abducted and adducted foot

neutrophic feet

muscle imbalance

PTT rupture

Ligamentous laxity (ehler-danlos, Marfans, osteogenesis imperfecta)

Calcaneal valgus

Enlarged or accessory navicular

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93
Q

Cavus foot description

A

elevated arch

primary sagittal plane deformity

less surface area touching the ground

painful callous may develop under met heads

chronic ankle sprains

CIA-norm 20-25 in cavus->30 degrees

Angle od meary 0 in cavus >6

Angle of Hibbs 135-140 cavus >150

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94
Q

Cavus foot cause and types

A

usually congenitial

due to failure of segmentation of primitive mesenchyme

TYPES

1-Syndesmosis-fibrous

2-Synchondrosis-cartilaginous

3-Synostosis-osseous

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95
Q

Cavus foot causes

A

neuromuscular ie: spina bifida, CMT, Friedreich ataxia

polio, spinal cord tumors, myelomeningocele

CP, infection, stphillis, trauma and S.C. lesions

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96
Q

Cavus foot treatment osseous

A

Cole-DF osteotomy Cuneiform-Nav Jt

Japas- V osteotomy thru entire forefoot, apex usually at the navicular

Devries-DF fusion at MTJ

Dwyer- Lateral closing wedge or open medial wedge calcaneal

McElvenny-Caldwell Procedure- DF fusion 1st metatarsal-medial cuneiform JT, if severe

nav-cuneiform jt

DFWO- DF wedge osteotomy 1sr metatarsals or all of the metatarsals

Jahss- DF wedge osteotomy across tarsometatarsal joint

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97
Q

Cavus foot treatments surgical soft tissue

A

Plantar fasciotomy

Steindler Stripping- plantar fascia with long plantar lgt, abductor hallucis,FDB, abd digiti quinti are stripped

Jones tenosuspension

Heyman procedure- transfer all 4 extensor tendons to their met heads

Hibbs procedure

Splitt T.A..T (STATT)

Peroneus longus tendon transfer

TPT transfer

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98
Q

Cavus foot treatments conservative

A

Shoe modification

extra depth shoes with metatarsal abr

Young patient passive stretching, manipulation

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99
Q

CBC

A

Measure total # of White cells in blood

HGB–Male 13.5-17

female 12.5-16

HCT- Male 40-50

Femal 37-47

RBC Male 5.4-

Female-4.8

WBC 5,000-10,000

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100
Q

CBC Diff

A

WBC Granulocytes ( 5,000-10,000)

Neutrphils (40-60%)

Eosinphiles (1-5%)

Basophils( .1%)

Bands

Lymphocytes 20-40%

Monocytes 4-8%

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101
Q

Cefdinir

A

For type 1 DM toe infections

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102
Q

Cerebellar disorders

A

Cerebellar-smooth coordination of voluntary, skilled movements.

Helps maintain normal posture, balance and unconscience propioception

Contibutes to vestibular function>>>maintains equilibrium

Cerebellar lesion >>>awkwardness and uncoordination of voluntary movements

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103
Q

Cerebellar Disorders Test

A

PATTING TEST; ASSESES THE INTEGRITY OF EPS OR SPINOCEREBELLAR TRACT

Alternative tap the heel and toe and ask to maintain heel against floor and abduct, the adduct foot

Heel-Knee Test- Asses integrity of EPS or spinocerebellar tract**MOST RELIABLE OF CEREBELLAR FUNCTION OF LOWER EXTREMITY

Romberg’s Test-test propioception. ability sense where one is-propioception 2 tracts-

conscience proprioception on the dorsal column

unconscience propioception spinocerebellar

Cerebellar and dorsal column-Eyes open and eyes closed= sway

Cerebellar if Eyes open steady and eyes closed sway

Clinical Muscle testing-0=absent- no evidence of contractility

1=Trace-evidence of slight contracture-no joint motion

2=Poor-complete ROM w/ gravity eliminated

3-Fair-Complete ROM against gravity

4-Good-complete ROM vs gravity with some resistance

5=Normal ROM vs gravity with full resistance

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104
Q

Cerebellar Lesion movement disorders

A

Asthenia- muscle tiring easy

Hyporeflexia decease DTR

Dysmetria-loss of ability to gauge distance, speed, power or movements

Speech- slurred, jerky or explosive in nature

Intention tremor- with initiation of voluntary movement often intesifies as goal is neared

Nystagmus- dancing eye

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105
Q

Cerebral palsey

A

Non-progressive neuromuscular disorder from brain damage

Spastic CP- most common 25%

Athetoid CP-20%

Ataxic CP-10%

Rigidity CP

Tremor CP

Atonic CP

SCISSOR GAIT SECONDARY TO SPASTIC ADDUCTOR MUSCLES.

Speech defect, retardation, seizures, visual defects, ankle equinus

TX-PT-OT-Splinting-Bracing

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106
Q

Charcot Marie Tooth discription

A

cavus foot type, decreased distal sensation,
decreased distal muscle power and
decreased nerve conduction velocity

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107
Q

Charcot-Marie Tooth

A
  1. Signs of muscle weakness in your arms, legs, hands and feet 2. Decreased muscle bulk in your lower legs, resulting in an inverted champagne bottle appearance 3. Reduced reflexes 4. Sensory loss in your feet and hands 5. Foot deformities, such as high arches or hammertoes 6. Other orthopedic problems, such as mild scoliosis or hip dysplasia provide information about the ext…

PERIPHERAL NERVE DISORDER

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108
Q

Chemical matrixectomies application

A

Phenol- 89% X 3 for 30 seconds Sodium hydrozide-1980

no neutralizer>>>flush with alcohol 10% NaOH X 2 15 seconds each

longer shelf life neutralizer-5 % acetic acid

recurrence 5-10% d/t old phenol or inadeq application LOW

or not removing enoug nail-need to remove nail

matrix is integral to prevent recurrence

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109
Q

Chloride

A

98-109

major excellular

acid/base balance

depletes with massice loss of G.I, fluid

Hypo-N&V, Ulcerative colitis,severe burns heat exhaustion, DM ketoacidosis

Hyper-Dehydration,XS IV fluid, kidney disease

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110
Q

CHOLESTEROL

A

LESS THEN 180

L=LOUSY LDL= IF HIGH…BAD

HDL=

DIRTY======TRIGLYCERIDES-fat in blood from food we eat

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111
Q

Choreoathetosis

A

A rapid (chorea) or slow (athetosis) involuntary movements of the fingers or toes (flexion–extension, adduction–abduction, writhing, sometimes piano-playing movements) which are irregular, nonrhythmic, and purposeless (Fahn, 1997).

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112
Q

Classification of metatarsal adductus

A

TYPE 1

Flexible- FF will crrect past neutral into slight over correction

TYPE II

Partial Flexible (doesn’t correct to neutral actively, but does passively)

Type III

Rigid (doesn’t correct to neutral)

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113
Q

Classification of Syndactyly

A

Type 1-(MMost common)-Zyngodactyly- partial or complete webbing 2.3rd toes

Type II- Synpolydactyly- 1 soft tissue mass covering 4th, 5th and 6th toe

Type III_ass/ with metatarsal fusion

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114
Q

Claudication causes

A

1-ASO

2-Deep thrombophlebitis of tibial, popliteal or femoral veins

3-Popliteal entrapement

4-Sciatica

5-Femoral or popliteal arterial calcification

6-Anemia (hypochromic, microcytic, sickle cell, thalassemia

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115
Q

Clinical presentation of Calcaneal fracture

A

Mondors sign

back pain between T12 and L2

Compartment syndrome

Hoffa’s sign- less taut Achilles tendon

Lateral wall blowout

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116
Q

Clinical presentation of compartment syndrome

A

6p’s

Pain out of proportion
Paresthesia
Pallor
Pulselessness
Paresis
Paralysis
Pressure

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117
Q

Clinical presentation sign seen with posterior process fractures talus

A

Nutcracker sign: pain with forced ankle PF

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118
Q

Clinical signs present with Lisfranc injury

A

Plantar ecchymosis sign

Apprehension sign: with FF DF and abduction

Stress exam of midfoot: unstable TMTJ with pronation and eversion

RULE OUT COMPARTMENT SYNDROME

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119
Q

clinodactyly

A

the medical term for an abnormally bent or curved finger. The affected finger abnormally curves to the side and may overlap other fingers. While the condition is relatively rare among the general population (3 percent), it affects one in four children born with Down syndrome (trisomy 21).

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120
Q

Club foot evaluation

A

Normal Club foot

Kite angle 20-40 0-15

Calc Inclination angle 20-25 17

Talar neck Add 10-20 80-90

Plantarflex 25-30 45-65

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121
Q

CMT Foot

A

Active plantarflexion of the medial forefoot
by the peroneus longus in conjunction with
loss of strength in the anterior tibial muscle

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122
Q

CNS disorders

A

Progrfessive Multifocal Leukoencephalopathy

CMV

Cerebral Toxoplasmosis

Multiple Sclerosis

Tabes Dorsalis

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123
Q

Coagulation Cascade

A

Extrinsic Pathway- Activated by external trauma cause blood to escape from vascular system

Intrinsic Pathway- Activated by trauma inside vessel system and activated by plaelet, exposed endothelium,or chemical

Cell injury..Vessel constrict..platelet adhesion>>stabilization and reinforcement of plug by intrinsic and extrinsic system>>>>Fibrinolysis

Phase I Generation of tissue thromboplastin (factorIII) intrinsic

Phase II-Activation of thromplastin end product of intrinsic and extrinsic

FINAL COMMON ATHWAY BEGINS WITH ACTIVATION OF FACTOR X

Phase 3- Concersion prothrombin>>>thrombin by factor Xa

Phase 4- Conversion of fibrogen into fibrin by thrombin which stabilzed by factor XIII

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124
Q

Coagulation Pathway part 2

Coagulation factors

A

Intrinsic- III + VII + VIIa>>>>activates X>>>Xa

Extrinsic XII>>>XIIa by surface contact>> XI>XIa>IX>IXa>VIIIa>>X>>Xa

Factors require Vit K

Heparin intrinsic

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125
Q

Codman triangle

A

periosteal elevation and spicules

formation represents tumor extensions into the perisoteum and calcification

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126
Q

Cohort studies

A

Cohort studies are a type of medical research used to investigate the causes of disease and to establish links between risk factors and health outcomes. The word cohort means a group of people. These types of studies look at groups of people.

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127
Q

Collagen diseases that affect microcirculation

A

1-R.A. 6-Giants Cell Arteritis

2-SLE 7-Erythema nodosum

3-Systemic Sclerosis 8-Erythema Induratum

4-Polymyositis 9-Nodular Vasculitis

5-Polyarteritis nodosum 10-Nonsuppurative panniculitis

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128
Q

Color Changes to nail

A

Yellow-Addisonsdz- Diabetes

Blue-Cyanosis

Red-Cancer

Green-Pseudomonas-Candida

Black/brown-Normal-Addison Dz-Junctional nevi, melanoma-

White-heredity-anemia-fungal infection

White lines-Arsenic poison pr drug toxicity

White spots- Injury-psoriasis

White & Pink- Anemia of chronic dz-nephrotic syndrome

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129
Q

Common Peroneal N Injury

A

L4-L5-S1

Sensory & Muscular

Vulnerable to external compression injury–NEUROPRAXIA-crossing leg c/p paresthesia,hyperesthesia,

entrapement more unusual

Diagnosis: NC studies; radiculopathy L5>>EMG IN GLUTEAL AND PARASPINAL

Clinical signs>> weakness TA& EH muscles>>>>DROP FOOT

weakness of anrterior muscle group (NC Studies)

Radiculopathy-L5 EMG

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130
Q

Common site for OATS procedure

A

non-portion weight bearing of the knee

Restores hyaline cartilage

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131
Q

Compartment syndrome is best characterized

A

A predictable, recurrent, well-localized pain
relieved by rest.

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132
Q

Component of open chain pronation

A

dorsiflexion, adbuction, evrsion

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133
Q

Components to look for on X-ray with ankle injury (5). The measurements and which is most reliable

A

-Medial clear space: >4mm abnormal
-Tib fib clear space: greater than or equal to 6mm abnormal. MOST RELIABLE
- Inversion stress view
Talocrural angle

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134
Q

Congeniotal Vertical talus open reduction

A

3 months of age

most procedure posterior release and reduction of the talonavicular joint

3-6 years-extra articular arthrodesis (Green-Grice type)

>6 wait until 10-14 when bones mature

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135
Q

Congenital dislocated hip signs

A

females, usually occurs 2 weeks after birth

children with older siblings, breech, joint laxity, first born

Classic signs in older children– limited abduction

asymmetric thigh fold, (+) trendelenburg test, externaslly rotates foot

Waddling gait.

when dislocation occurs, femeral head posterior and superior to the acetabulum

Assc/ with met adductus, calcaneal valgus

gohydramnios, torticollis

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136
Q

Congenital Vertical talus

A

congenital covex pes planovalgus assoc wi arthrogyrosis, right foot more common

reverse clubfoot, persian slipper, rockerbottom flatfoot

The talus is perpendicular so severly the navicular dislocated dorsally ontot he talus neck, locking the talus

Forefoot is abducted and DF at the MTJ and Calc is in valgus

Rgidity is the hallmark of this

gastroc soleus is contracted, spring lgt is elongated

usually are B/L/STJ facet abnormal/

Talus –Anterior absent/middle hypoplastic, posterior malformed

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137
Q

Congestive Heart Failure

A

Inability of heart to pump blood throughout body orrequiring elevated filling pressure in oprder to pump effectively. The pooling of blood leads to congestion in body tissue

Cause-famaliar-infection, alcohol,anemia,thyrotoxicosis, arrhythmia and HTN

Plaque, stress, smoking, age. no exercise, overwork heart, obesity

S/S-Pulm edema,,peripheral edema, enlarged or pulsatile liver/ JVD(jugular vein distension)

NEVER USE PNEUMATIC COMPRESSION DEVICES

Treatment- maintaining a euvolemic state>>>diuretics>>vasodilator agents and positive inotropes

Delaying the progression>>>ACE inhibitors, beta blocker and aldosterone antagonist(diurectics)

Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced.

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138
Q

CONSERVATIVE TREATMENT CLUBFOOT

A

stretch and manipulation prior to casting

apply TOB to skin

2” cast applied, ussually long cast

correction n order

1-ADDUCTION (A.V.E)

2-VARUS

3-EQUINUS

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139
Q

Coonradd bugg trap

A

interposition of PTT prevents reduction of medial malleolar fragment

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140
Q

Correct sequence in soft tissue reliease in bunion surgery

A

adductor tendon, suspensory ligament,
tenotomy of the lateral head of FHB,
excision of the fibular sesamoid

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141
Q

Counter rotational system Langer

A

correct torsional abnormalities

several hinges allow greater frredom of motion

BEST TOLERATED SPLINT, ALLOW UNENCUMBERED CRAWLING

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142
Q

Creatinie Clearance

Ceatinine

A

140-Age x weight (kg)==male 97-137

72 X Serum= female 88-128

Creatinine found in muscle

increase in age up too 20 yo

CLINICAL MARKER FOR KIDNEY

MOST SENSITIVE MARKER OF GFR>>>DOSING MEDICATION

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143
Q

Cross sectional studies

A

involves looking at data from a population at one specific point in time. The participants in this type of study are selected based on particular variables of interest.

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144
Q

CT views for middle subtalar facet coalition

A

axial and coronal because facet lies at 45 degree and is equidistant from both planes

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145
Q

CVD MAJOR CARDIAC

A

ANGINA PECTORIS-

MYOCARDIAL INFARCTION

DISSECTING ANEURYSM

ESOPHAGITIS GERD

TIETZE’S

PERICARDITIS

GALLBLADDER CHOLECYSTITIS

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146
Q

Cyma line: pronation vs supination

A
  • Anterior break (pronated)- TN joint over CC
  • Posterior break (supinated)-TN joint posterior to CC
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147
Q

Davis and German classification

A

Incomplete-webbing doesn’t extend to the distal toes

Complete- extends to distal toes

Complicated-phalanges involved

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148
Q

DDX based on Jt Fluid Analysis Chart

A

Group 1-Non inflammatory

DJD,trauma,osteochondritis charcot,

hyperparathyroid Pulm OA,Pigmented villous nodular

Group 2-Inflammatory condition-RA-Gout-Pseudogout

Group 3-Septa OA secondary to Bacterial Infection

Hemathrosis-results in hemorrahgic Jt fliud speciman caused by hemophilia and other bleeding diathesis, lgt with and without FX, neuropathis arthropathy, Pigmented Syn, hemangioma

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149
Q

DEEP PERONEAL NERVE ENTRAPEMENT

A

Anterior tibial nerve` SENSORY AND MOTOR

Supplies TA,EDL,EHL,PT,EDB resonsible for DF and frontal plane movement

Innervates lateral halklux and medial aspect 2nd toe

Anterior Tarsal Tunnel Sdyndrome-BLUNT TRAUMA to ant ankle///entrapped under ext ret or irriated by superior edge of Inf ext Ret (tarsal spur) compresses the DPN over ankle (max point of contact)

Clinical Finding: paresthesia dorsum of foot with numbness 1st met space//nocturnal pain relieve by movement d/t motor innervation of EDB

DX- distal motor latencies woth NCS >7ms (5 norm)

also reproduce sym PF of ankle with ext toes>>palpate the N of the ant ankle medial to dorsalis pedis

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150
Q

Deep Tendon Reflex

A

4+ associated with clonus

3+ Hyper-reflexic

2+ average

1+ low normal-hypo-reflex’

0 Absent

Patella DTR-L3 & L4 knee slight extend

Achilles S1 & S2 foot plantarflex

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151
Q

Define dive punch piece

A
  • Triangular wedge of tibia that drives the rest of a pilon fracture
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152
Q

Defivitive treatment of atrophic non union

A

Decortication and stabilization of the
fragments

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153
Q

Delayed healing

A

2-6 months post

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154
Q

Dennis brown bar

A

treat met adductus

convex pes planovalgus

bar is screwed or riveted on shoes

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155
Q

Describe Amberry

McKeever

reverse Hohmann

long oblique distal osteotomy

A

Amberry-Davis+removal of base of proximal phalanx

McKeever-resection of 1/2-2/3 of 5th met

Reverse Hohmann-transverse osteotomy in neck

L. Oblique Distal -Weil osteotomy like cut at the MT neck

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156
Q

Describe DeVries 5th metatarsal

A

removal of lateral plantar condyle

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157
Q

Describe Hibbs tenosuspension

A

-EDL stlips combined and transferred to lateral cuneiform

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158
Q

Describe Jones tenosuspension procedure

A

transfer of EHL to 1st MT head

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159
Q

Describe Lawrence and Bott classification

A

1) Avulsion fracture due to lateral band of plantar fascia or PB contractures
2) Jones fracture due to ground reactive force with failure of the foot to evert
3) Diaphyseal fracture due to chronic stress, and repetitive distractive forces

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160
Q

Describe Steindler stripping procedure

A

-Sectioning of plantar fascia, 1st layer of plantar muscles, long plantar ligament

Disadvantage::::can active Charcot

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161
Q

Describe the Cobb procedure

A

-TA split proximally and rerouted through medial cuneiform. Tenodesed to PTT

Disadvantage-

sacrifices major inverter/adductor of the foot

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162
Q

Describe the Heyman tenosuspension procedure

A

transfer EDL to met necks

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163
Q

Describe the Stewart classification

A

1) Extra-articular Jones fracture
2) Intra-articular non comminuted fracture
3) Extra-articular avulsion fracture (PB)
4) Intra-articular comminuted fracture
5) Apophysis fracture

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164
Q

Describe the Young tenosuspension

A

-Reroute TA through Keyhole in the Navicular with insertion still intact

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165
Q

Describe Torg Classification

A

Type I: acute injury

Type 2: delayed union

Type 3: Nonunion

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166
Q

Diabetic Peripheral Neuropathy

A

1-Hyperglycemia and duration of disease

Small unmyelinated C fibers compose autonomic and sensory axons that transmit thermal perception and sympathetic function

-sensory changes do not correlate with N conduction deficits

2-presents prominent paresthesias and ANS with presence of orthostatic hypotension, resting tacycardia, and distal andydrosis

3-Large myelinated- (motor and sensory)- symptoms are tingling, burning, numbness, allodynia or deep lancinating pain

DTR attenuated or absent with possible distal motor wearkness

Neuopathy develps distal-proximal (Stocking & Glove) which is a cause of ulceration in 85%

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167
Q

Diabetic peripheral neuropathy TX

A

Capasaicin- to target P baciophen, muscle relax, TCA, anti-seizure meds

GAPAPENTIN-

Neurontin (900mg)initial,>>(1 tab)300mg>>(2 tbs)600mg>>900mg(3tabs)

Amytriptiline( 25mg @pm dose. if neurontin does work) +DOPA and NE receptor

OD-dizzy, drousy.. , Excrete unaltered>>no kidney stress

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168
Q

Gout Diagnosis

A

1-Light microscope-needle like crystal piercing WBC yellow needle crystals appear negatively birefrignant.Parallel to axis of lens and blue when perpendicular

2-X-Ray Rat bites, cloud sign, punched out lesions

3-Martel sign (overhanging margins)

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169
Q

diastematomyelia

A

more common in female

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170
Q

DIAZEPAM

LORAZEPAM

MIDAZOLAM

A

CNS DEPRESSES AND REDUCE ANXIETY

IV DIAZEPAM- PAIN BUT ORAL REACHES HIGHER BLD LEVEL

LORAZEPAM- 8 HR AMNESIA BC NO PRE-MED GIVEN TO OUT PT

VERSED= HIGHER % ANTEROGRADE AMNESIA-GREAT FOR ANXIOUS PT (POP)

KETAMINE DISSOCIATIVE SEDATION CAN BE COMBINE WITH VERSED OR VALIUM/ IF ADMIN ALONE-NIGHTMARES AND DELUSION

**MOA FACILITATES GABA ACTION BY INCREASE GREQ OF CL CHANNEL OPENING

ANTIDOTE: FLUMAZENZIL

DOPERIDOL+FENTANYL=NEUROLEPTIC ANESTHESIA=LIGHT GENERAL ANESTHESIA OR COGNATIVE DISS

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171
Q

Difference in shapes between medial and lateral OCD’s of the talus

A

medial: cup (PIMP CUP)
lateral: wafer

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172
Q

DISSECTING ANEURYSM

A

SHARP KNIFE LIKE SEVERE RIPPING

LOCATION-GENERALIZE

TIME->15 MIN

CAUSE-VARIES>>STROKE

TREATMENT-SURGERY AND PREVENTION

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173
Q

Distal Tarsal Tunnel Syndrome

A

Entrapment distal segments of the prox Tib N

Medial Plantar Nerve=JOGGERS FOOT SEONDARY TO COMPRESSION INTO THE PLANTAR B/C NAVICULAR TUBEROSITY AND ABDUCTOR HALLUC BELLY

Lateral plantar Nerve-1st branch to abductor digit M.Q. (BAXTERS NERVE) Enrtrap between quadratus plantar &Abductor Hallucis is accos with chronic heel spur synd and is MOST COMMON TYPE DISTAL TARSAL

TUNNEL SYNDROME

Give S/S post static dyskinesia and described as afterburn

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174
Q

DM Neuopathy Intrinsic muscle

A

Atrophy of intrinsic musculature>>> digit contracture

plantar prominence of metatarsal

abnormal distribution of the weight bearing load with ambulation

Advanced stages>>foot drop secondary gastroc complex lost its antagonist muscle group

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175
Q

DM neuropathy ANS

A

Profound vasodilation

presents::warm, erythematous and dry>>Increase blood flow

>>>>>deminerization of bone>>>>“wash away”

CHARCOT JOINT DISEASE

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176
Q

DM Neuropathy Sensory changes

A

Sensory doesn’t always correlate with Nerve conduction studies

DTR-attenuated or absent with possible distal motor weakness

Devlops in legth dependent fashion>>STOCKING GLOVE

Decrease sensory loss>>>ulceration or breakdown

LOSS OF VIBRATORY AND POSITION SENSE>>>Ulcer

CAUSE-Oxidative stress>>breakdown intraneural glucose

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177
Q

DM peripheral neuropathy pathology

A

Small ummyelinated C fibers composed autonomic & sensory axons that transmit thermal perception and sympathetic function SEEN EARLY

-Prominent paraesthesia + ANS dysfunction ie:orthostatic hypotension

resting tachycardia

distal anhidrosis

Large myelinated axons-both motor & sensory—conducts propioception, light touch & pain

Sensory does not correlate with nerve conduction deficit

Symptons:Tingling,burning, numbness, allodynia, deep lacinatying paon

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178
Q

Drugs for tubercolosis

A

Isoniazid-pyrodoxidine def is major side effect

Rifampin-cytoP50—will decrease effectiveness of co-administered drugs,::protein inhibitor, BCP, warfarin,quindine,zidovudine,itraconazole, lfluconazolw and ketakononazole

Pyrazinamide

Ethambutol or Streptomycin

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179
Q

Duchenne Muscular Dystrophy

A

DMD) is a severe type of muscular dystrophy that primarily affects boys. Muscle weakness usually begins around the age of four, and worsens quickly. Muscle loss typically occurs first in the thighs and pelvis followed by the arms.

GOWERS SIGNS-pathognomonic where child rises from sitting position by climbing on her legs

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180
Q

During which phase of Tendon healing do you start
cross training with lower impact exercises?

A

Phase 3

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181
Q

Ganleys closing abduccory cuboid calcaneal osteotomy

A
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182
Q

Dynamization

A

The process of making the fixator more
flexible

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183
Q

Electrolytes

A

Sodium (NA) 135-145

Potassium(3.5-5.5)

Chloride-(98-109)

CO2

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184
Q

Electromagnetic fields

A

low frequency magnetic fields.

Magnetic fields are created by electricity flowing through wires

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185
Q

Emollients

A

Aquaphor

Calamine

Cetaphil

Eucerin

Lac-Hydrin

Lanolin

Moisturel

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186
Q

Entrapement neuropathy

A

Definition-compression neuroapathy to gradual contriction anatomic structures about anerve

S/S- insidious & mil;d; motor and sensory changes painful

DX: EMG and NCV

TX Surgical decompression

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187
Q

Esses-Lopresti

A

Intra-articular calcaneal fracture

type 1-tongue fx d/t vertical fall primary line exist plantar secondary fx line exist posterior

Type 2-joint depression fx d/t posterior fall, primary line exist plantar and 2nd fx line posteriorsuperiorly(dorsally)

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188
Q

Etiology of Lisfranc fracture

A
  • most injuries in Dorsal direction
  • Forced abduction
  • Twisting with an axial loading of a PF foot
  • Motor vehicle accident
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189
Q

Etiology of posterior process fractures

A

-Shepard’s or cedell fractures occur with forced PF of the foot.

Steida process: intact medial tubercle

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190
Q

Evans procedure

A

procedure best treats a flat foot with a severe transverse plane abduction deformity

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191
Q

Exam that can be done in the OR for syndesmosis injury

A

Cotton test/hook test- best test for syndesmosis injury

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192
Q

Femur development infants

In Adults

A

135-155 infant

120-135 Adults

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193
Q

Fillauer Bar

A

Same as Denis-Browne Bar except the bar clamps to sole of pts shoes

Need rigid shoes

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194
Q

Flexible vs rigid pes planus foot

A

Flexible Rigid

+ Hubscher manuever (-)

+ Resupination test (-)

NOT PAINFUL PAINFUL

LA arch on weight bearing coalition, vertical talus

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195
Q

FRIEDMAN COUNTER SPLINT OF FLEXOSPLINT

A

DYNAMIC SPLINT CONSIST OF A BELT AROUND THE POSTERIOR HEEL

ALLOWING MOTION IN ALL PLANES EXCEPT INTERNAL ROTATION

INDICATED FOR INTERNAL TIBIAL TORSION

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196
Q

Frontal plane corection of flatfoot deformity

A

Chambers-raise the posterior facet of the STJ using a bone graph

Baker- Osteotomy inferior to the STJ post facet with bone graph

Selakovich- open wedge osteotomy of the sustentaculum tali with bone graph

which restricts abnormal STJ motion

Gleich- Oblique osteotomy displaced anterior- help to increase cal-inc.angle

Silver- Lateral opening wedge with graph

Koutsogiannis- Medial side calcaneal osteotomy

Triple Arthrodesis- reserved for salvage

Grice-Green Extra-articular Subtalar arthrodesis -bone graph inserted laterally in

sinus tarsi bewteen the talus and calc. good for children. Provides excellent stability

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197
Q

Galeazzi Sign

A

also known as Allis sign

hip and knees flexed, supine position

dislocated hip results in lower knee positiob on affected side

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198
Q

Galium 67

A

1/2 life 78.3 hours

diagnose if you have certain types of cancer, such as Hodgkin’s disease, lymphoma, or lung cancer.

identifies the cells that are dividing most quickly in your body. It can help detect some cancer cells. It can also help show cells that are rapidly reproducing or responding to an infection somewhere in your body. People with lymphoma (cancer of the lymph system) may need gallium scans.

principal organs that localize gallium are the liver, spleen, and bone marrow.

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199
Q

Ganley splint

A

1st splint to treat combo foot and leg disorders

Similiar to Denis-Browne

If treating internal rotation, bar placed bewteen RF plates

If treating external rotation, place bar forefoot plate

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200
Q

General anesthesia staging based on Guedel’s

Phases on anesthesia

A

1- Induction

Begins with induction agent and ends with loss of consciousness. The patient can still feel pain in this stage

Stage 2-Hyperexcitable state. The time where the patient looses consciousness and when they regain autonomic stability. The patient losses the ability to maintain temperature, blood pressure and may experience irregular breathing, uncontrolled movement, GI issues (vomiting). This stage last a very short amount of time.

2-Maintenace-

Stage 3-This is desirable state or target debt of anesthesia. Patient regains autonomic stability

Plane 1-eye rolling which progresses to eyeball centrally fixed

Plane 2- Loss of corneal and laryngeal

Plane 3- Pupils dilate and loss of light reflex

Plane 4-Intercostal paralysis, Short shallow abdominal respiration (diaphragmatic respiration)

Stage 4 Overdose. Autonomic instability will begin to reemerge. Loss of BP, decrease breathing, circ failure

Emergence-Starts at stage 3 surgical anaesthesia) thru stage 2>>> stage 1 conscience awake

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201
Q

General induction Anesthesia

A

A-IV short acting Other induction agents>>Fentanyl>>>Sulfematil>>>>Alfemtanil (uses narcotic as induction reduces need for pre-medication)—-SIDE EFFECT–RESP DEPRESSION>> USE NALOXONE

B-Barbituate- 1- Thiopental-(3-5MG)-short act depress. SE long recovery>metaboloze in liver, PORPHYRIA

2- Methohexital (Brevital)short acting, faster return to consc SE: cough/singultus/ PORPHYRIA/cardiac failure/ not used with recent MI or air obstruct or severe liver damage

3 Propofol(Diprivan)-** sedative-hypnotic- metabolized fast in liver. Rapid return to clear head

SE: cause greater CV and resp depression

4- Ketamine- IV/IM great for un coop Kids ( SE dissociative anesthesia- pt appears awake eyes open but pt is unaware of surrounding)

C- Benzodiazepine 1-Midazolam-No analgesia>>Resp depression>>decrease BP-shortest act

D- Butyrophenone 1-Droperidol -if combined with other narcotic like fentanyl>>Neuroleptic Anesthesia

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202
Q

Giant cell tumor

A

This tumor usually affects patients in their 2nd and 4th
decade of life. It has a predilection for the female
population. Symptoms are often a dull ache that is
intermittent in nature and may be accompanied by a
palpable mass. The areas most commonly affected are
the distal radius, proximal tibia and the distal femur.
Radiographically one may see an expansile lesion, a
central area of radiolucency, destructive, and can extend
to the articular surface of the bone. What is

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203
Q

Glide and thread hole

A

Insertion of a fully-threaded lag screw requires drilling a glide hole in the near cortex, on the same axis as the thread hole in the far cortex.

Glide hole: The cortex under the screw head is drilled to the size of thread diameter so that the thread gets no purchase.
Thread hole: A drill hole which is the same diameter as the core of the screw is drilled, and a tap is used to cut the spiral groove that receives the thread of the screw. The result is a thread hole.

One can drill both cortices with the thread hole sized drill and then overdrill the near cortex. Alternatively, the gliding hole is drilled first, and a drill sleeve is placed within it to direct the drill bit for the thread hole in the far cortex

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204
Q

Goals of AO

A

The first screw should be placed centrally
and perpendicular to the long axis of the
bone. The secondary screw should be
placed perpendicular to the fracture line and
placed on either side of the first screw

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205
Q

GOUT

A

Affect peripheral joints, esp 1st MPJ

Monosodium crystals forms

Supersatuated hyperuricemic body fluid crytalizes

UA Crystals in joints from xs breakdown or overproduction of purines

CLASSIC BEGINS: evening or early morning

S/S=Asymmetrical monarticular OA

Sudden onset: red hot swollen with possible low fever

Joint sparing, but in chronic, joint destructive

Usually 1st attacks 1st MPJ

Crunchy tophi in ears

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206
Q

Ground reactve force peak in which 2 phases of gait cycle

A

contact, prolpulsion

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207
Q

GTT

A

Present in renal tubular epithelium and in liver

sensitive to detect chronic alcohol consumption

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208
Q

Guillame Barre Syndrome Landry’s Ascending Paralysis

A

danGthrapist

sysmetrical motor and sensory paresis

Schwann cell surface membrane targeted

frequest infection organism—Camphlobacter jejuni

Pathology Edema of nerve–degeneration of nerve and myelin sheath

S/S=distal limb first (weakness)>>decrease tednon reflex>>inv ANS>>motor and sensory weakness

TX- Plamsa phoresis with immunomodulation via infusion IgG shortens DZ

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209
Q

hallus abducto valgus and associated complications

A

prominent metatarsal head
*hypermobility of the 1st ray ( usually insufficient)
* callus
hammer toe on 2nd digit
*rearfoot valgus deformity
*gait evaluation- overpronation
arch collapse (VERY MUCH SO) {*the peroneus longus tendon is stretched with collapsed arch. }
*1st MTPJ: 60 degree ROM, 45/15 ( should be under 25 and 15)
may also see ingrown nail.

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210
Q

Hallux limitus and rigidus destructive procedure

A

Keller

Implant arthroplasty

Stone-oblique osteotomy resects 1/4 of met head leaves plantar condyle

Mayo-excise 5mm met head

Mckeever=1st MPJ arthrodesis-df 5-10 degrees

Valenti-V shape osteotomy

Lapidus-fusion of the MC joint

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211
Q

1st MPJ Joint preserving procedures

A

Cheilectomy

kessel & Bonney

Regnauld-Mexican hat prox phalanx- shorten 1st ray

Waterman

Waterman-Green-shorten and PF met head

Youngswick

Van-Ness-PF wedge base 1st met

Cotton-Open base wedge

Labrinudi-PF wedge correct met primus elevatus

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212
Q

Hansen’s disease (leprosy)

A

Leprosy is caused by infection with the bacterium Mycobacterium leprae. It mainly affects the skin, eyes, nose and peripheral nerves.

Symptoms include light colored or red skin patches with reduced sensation, numbness and weakness in hands and feet.

Leprosy can be cured with 6-12 months of multi-drug therapy. Early treatment avoids disability.

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213
Q

Harris Beath view :

A

views medial and posterior STJ facets

-great for coalitions

214
Q

Hawkins Classification Type 1

20%

A

Non displace vertical fracture talar neck

1 of the3 bllod supplies is disrupted

artery of the sinus tarsi

15% avascular necrosis

215
Q

Hawkins Classification 2

A

Displaced vertical fracture of the talar neck with dislocation of the STJ

2 out of 3 main blood supplies to the talar body is disrupted

AA sinus tarsi and tarsal canal

AVN 15-50%

216
Q

Hawkins Class Type 3

A

Displaced vertical fracture talar neck with STJ and ankle joint dislocation

All 3 main blood supplied to the talar body is disrupted

AA sinus tarsi, tarsal canal and deltoid artery

AVN 91%

217
Q

Hawkins Class Type 4

A

Displaced vertical fracture of the talar neck with dislocation of the STJ, AJ and TNJ

All main blood supply to the talar body is disrupted

AA sinus tarsi, tarsal canal and deltoid artery

100% AVN

218
Q

HGB

A

Indices of RBC info of size and HGB content of RBC

MCHC-is the average concentration of hemoglobin in your red blood cells.

Protein in RBC help carry O2 throught the body

>>18-Polycythemia, increase Bld viscosity>>>hi risk of thrombosis

<<<<11 anema

219
Q

HCT

A

Male 40-50

Female 37-47

Integral part of persons CBC

Is the % Volume of RBC in a sample of anticoagulated whole blood

High-Packed cells vol, PCV, CHF COMA Dehydration/ shocl

Low-Anemia and blood loss

220
Q

Hematoma >25 % of nail bed, consider

A

nail bed laceration and distal phalanx FX

221
Q

Hereditary Motor and Sensory Neuropathies

A

DangtHrapist

Type I CMT segental demyelination

Type II-Neuronal degeneration and onset distal limb weakness

Type III-Dejerine Sottas DZ-hypertrophic neuropathy>>onion bulb- affect ability to move

Type IV-Refsum Disease-lipid storage disorder with increase excretion of phytanic acid, connect to CMT overlap sensory and spinal path

Symptoms-repeat attacks and remisiion distal motor and sensory loss hands and feet, absent pain and Temp sense

Clinical: enlarged nerve sheath resembles Dejerine-DSottas DZ

Type V-spastic paraplegia

Type VI optic atrophy and hyperthrophic neuropathy type I

Type VII- clinical picture type I with complication retinitis pigmentosum

222
Q

Hilgenreiner line (Y line)

Ombredanne (Perkins vertical line)

A

dislocated hip will be femoral head outer upper quadrant

223
Q

Hindfoot alignment view: position of beam and what is measured

A
  • beam at 10 degrees
  • to measure RF coronal plane axis
224
Q

How long do you brace with the Ponsetti method? and follow with?

A

recommended for 2-4 years, then dennis brown bar for 2 years

225
Q

How many days sutures left in

A

face and neck 2-5 days

dorsum foot-7 days

plantar 10-14

retention site 3 weeks-6 weeks

226
Q

How many incisions are used with Lisfranc surgery and what structures are fixated

A

3 incisions are used.

  • medial to 1st met
  • in 2nd interspace
  • in 4th interspace

ORIF used to achieve arthrodesis of 1st-3rd TMTJ

Do not fuse 4 and 5 because they are essential joints.

227
Q

HTN Pathology

A

Over time collagen fibers in aa and arteriole wall increase>>bld vessels stiffer and with reduced elasticity>> Arterial BP

Path-Inability of kidney to excrete sodium

An overactive renin/angiotension system leads to vasoconstriction and retension of sodium and water

Overactive sympathetic NS>>>increased stress response

Complication- CVA MI

Cardiomyopathy Hypertensive retinopathy

Accelerated HTN-SBP >>240 without signs of end organ damage

Hypertensive emergencies- when end organ damage is ongoing without intracaniel pp

Malignant hypertension-late phase with headaches, blurred vision, increased intracraniel pressure

Diagnostic Evaluation-**KIDNEY FUNCTION: SERUM CREATININE AND BUN ARE ELEVATED

PROTEINURIA, ELEVATED K+, EKG AND CXR

228
Q

Huntington Chorea

A

BASAL GANGLIA DISORDER

Degenerativr CNS by involuntary movement,

progressive dementia, psychiatric and behavior distubances

Associated chromosone 4

Autosomal dominant pattern—Men=Women

Athetosis usually freq in hands and feet

Athetosis is a symptom characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue. Movements typical of athetosis are sometimes called athetoid movements.

Hemmiballism characterized by violent involuntary limb movements, on one side of the body, and can cause significant disability.

Essential tremor and choreoathetotic gait

Choreoathetotic gait- as rapid (chorea) or slow (athetosis) involuntary movements of the fingers or toes (flexion–extension, adduction–abduction, writhing, sometimes piano-playing movements) which are irregular, nonrhythmic, and purposeless

Treatment-Haloperidol and phenothiazine suppress the chorea

229
Q

Hydrogenated fluourocarbons

HISMDEs

A

Halothane- .75 MAC///BGC= 2.3. Most potent rapid smooth induction and recovery. low irritability to resp tract

non emetic, non flammable, BRONCHODILATOR EXCELLENT PEDS> asthmatic

Disadvantage:: Decrease BP by reduce cardiac contract//sensitize myocardium ot catecholamine>>dysrhymias

myocardium depression>Halothane hepaitis> postop shiver decreases HR>>hepatic necrosis]

DON’T ADMIN W/N 3 MONTHS BECAUSE SLOW LIVER METAB>>HALOTHANE HEPATIC NECROSIS

Isoflurance-BGC 1.4 MAC=1.5 low bld solub so fastest response and recovery, bronchodilator non flam,

good muscle relax, maintains cardian rhym, compatible with epi, doesn’t sensitize heart to catecholamine

Disadv: depress CVS, shiver post op, poss acute or delayed lover injury

ENFLURANE- BGC 1.7 MAC Pleasant smell> rapid induction/recovery, non-irriate/ bronchodilator,Maintain CVS, non-emetic. comp with epi>>skeletal muscles> enhances nondepolorizing NM blocking agent

Disadv:Cardiac depresses..metabolize renal (caution) less potent then halothan

Methoxyfluranne- MOST POTENT- least volatile. great margin of safety, good relax, non inflam NEPROTOXIC

SEVOFLURANE- BGC=.65 MAC 1.7-CAN be deep sedative with local or general

Desflurance-BGC .45- MAC 6- good for same day out pt sx

230
Q

Hyperlipidemia

A

Cholesterol turns into plaque

NORMAL FLOW-Lamina flow>>bullet shape, its is concentric layers of blood in parallel down length of blood vessels

Blood flow–hits a curve(bifurcationor trifurcation)…turbulent flow and shacks out the solid element ( lipid-plaque)>>>>lamina flow

STENTS>>>go around curve

231
Q

Hypertension Charting

A

>>>>140/90

if DM or kidney dz>>130/80 considered a risk

Systolic Diastolic

Stage 1 140-159 90-99

Stage 2 160-179 100-109

Stage 3 180-209 110-119

Stage 4 >>210 >>129

232
Q

Ilizarov divides the postoperative period after corticotomy

A

Latency period, Distraction period,
Consolidation period

233
Q

Ill defines erosions on X-ray

A

Psoriatic OA

hyperparathyroidism ( hi calcium)

R.A.

Reiters

Ankylosing Spondylitis

234
Q

In the Lauge Hansen classification of ankle fractures,
what would be a short oblique fracture with rupture of the deltoid

235
Q

Indium 111

A

An indium-111 WBC scan is used to look for a suspected infection. The scan involves the injection of radioactive white blood cells into the vein through a small needle, followed by a gamma camera scan to confirm or exclude a clinically suspected infection.

In can be used as a label for red cells, platelets, and leukocytes.

1/2 life is 67.2 hours

236
Q

Infectious Neuropathy

DANGTHRAPIST

A

Infectious

TB Leprosy- multiple nerve palsies

Neurosyphillis T Pallidum 25% with 3rd syphilis

Poliomyelitis-RNS virus starts as flu–meningitis>>faccid paraysis Tx Vaccine

Herpes Zoster-vessicles, segmental weakness

Lyme disease-meningeal distribution with cranial neuritis, motor or sensory radiculoneuritis

237
Q

Inhalational Agents

A

A-Gaseous

Nitrous oxide- least potent and common for sedation.

B- Volatile Liquids

Halothane (fluothane)-rarely used.SE irreg heartbeat, resp depression liver problems. Dont use if PORPHYRIA OR MALIGNANT HYPERTHERMIA

Isoflurance (forane) SE resp depression, similar to halothane. Can cause coronary aa vasodilation>>Coronary artery steal syndrome. Decrease BP

Desflurane (Suprane) same as Sevoflurane/MOST RAPID ONSET AND OFFSET. Contra for arrhythmia can trigger malignant hyerthermia

Previous MI < 6 months perioperative re-infarction 10X if older then 6 months

238
Q

Intrinsic Muscle Nerve Innervation`

A

Deep peroneal N-–EDB & EHB

Medial plantar Nerve-Abductor hallucis & FDB &FHB

Medial plantar nerve, proper digital branch to the hallux- FHB

Medial plantar nerve, first common digital branch 1st Lumbricals

Lateral plantar nerve, trunk Quadratus Plantaw & Abductor digiti minimi

Lateral Plantar Nerve,superficial—Flexir digiti minimi brevis 3rd plantar interosseus 4th dorsal interosseous

Lateral plantar Nerve, deep- 2nd, 3rd,4th Lumbricals &Adductor halluxis (both heads) 1st & 2nd inerossei & 1st,2nd and 3rd dorsal interossei

239
Q

IPOS

A

ANTI-ADDUCTUS ORTHOTIS TYPE 2

INDICATED METATARSAL ADDUCTUS

240
Q

Internal fixation plates, examples

A

b. A dynamic compression plate has oblong holes with
sloped slots.
c. In a long bone, the convex side is the tension side,
and the concave side is the compression side.
d. Examples of dynamic compression implants are
tension band plate, dynamic compression plate, and
circlage wiring.
e. In tension band wiring, the band is place on the
concave, or compression side, of the fracture.

241
Q

Jackson–Weiss syndrome (JWS)

A

is a genetic disorder characterized by foot abnormalities and the premature fusion of certain bones of the skull (craniosynostosis), which prevents further growth of the skull and affects the shape of the head and face.

242
Q

Jendrassik Maneuver

A

The most common method of reinforcing reflexes is the Jendrassik maneuver. In 1885, Erno Jendrassik reported that having the patient “hook together the flexed fingers of his right and left hands and pull them apart as strongly as possible” while the clinician taps on the tendon enhances the reflexes of normal patients.

243
Q

Joint ROM-STJ/ Ankle and Midtarsal joint

A

b. Subtalar joint ROM is about 16 degrees in the sagittal
and 42 degrees in the transverse plane.
c. The oblique midtarsal joint has nearly equal ROM in
the transverse and sagittal plane.
d. Ankle ROM is about 82 degrees in the sagittal and 30 degrees in the frontal plane

244
Q

Joplins neuroma

A

benign enlargement medil plantar digital nerve located medial aspect of the 1st MPJ hallux

Cause biomechanical

245
Q

JOPLINS NEUROMA

A

Compression or entrapement medial plantar digitial proper Nerve

Symptoms-Numbness & Pain infer-medial 1st metatarsal-phalangeal joint

Etiology: pronation>>>apropulsive gait with medial roll-off

246
Q

Kirby’s sign

A
  • posterior facet of talus abuts calcaneal floor and occludes sinus tarsi
  • sign of maximum pronation
  • opposite of bullet hole sinus tarsi

Kirby sign. parallel pitch line. tests for HAglunds deformity. fowler phillp angle. normal is between 44 and 69. chauveaux- liet angle. calcaneal pitch minus the angle of the most posterior point of the greater tuberosity and the apex of the postero=ior superior crest angled to a vertical line. normal is 0-12, greater than 12 is abnormal=haglunds deformity from radiopaedia online.

247
Q

knee joint doing during midstance?

248
Q

KOHLERS DZ

A

BOYS<<

NAV BECOMES SCLEROTIC AND FLATTENED (COIN ON EDGE OR SILVER DOLLAR SIGN)

SELF LIMITING

249
Q

Kulgerberg-Welander

A

mild form of spinal muscular dystrophy

250
Q

Lachmans test

A

predislocation sysndrome

251
Q

Lag Screw definition

A

A lag screw is used to compress fracture fragments. It is threaded into the opposite cortex, and slides through a hole in the near cortex. Tightening the screw presses the screw head against the near cortex, compressing the fracture fragments. Optimally, a lag screw should be perpendicular to the fracture plane.

Some screws are designed as lag screws. They are partially threaded so this screw threads into the far cortex, and the smooth shaft slides in the near cortex. The result is the same as if the near cortex were overdrilled.

Partially threaded lag screws are often used to compress fractures in cancellous bone. Their threads must lie completely beyond the fracture line to achieve good interfragmentary compression.

Allows compression across the osteotomy site. the head

IE: 2.7mm into cortical bone
drill thread hole (2.0mm bit) near near and far cortex

drill glide hole-2.7mm drill bit–near cortex

counter sink

measure

tap using 2.7mm

flush

insert 2.7 mm screw

252
Q

Lag screw principle

A

Screws positioned perpendicular to the long
axis of the bone functions to provide
resistance to axial loading.

253
Q

Lance DZ

A

Osteochondritis of the cuboid

254
Q

Lange Hansen(SER)

A

Supination External Rotation

1-AITFL syndesmotic rupture or avulsion of it insertion

2-the talus dispaces and fractures the fibula oblique or Sprial fracture(weber b) long,

posterior spike on lateral x-ray

3-PITFL syndesmoptic rupture or avulsion of its insertion

or fracture posterior malleolus

4-tear of Deltoid ligament or transverse avulsion fracture of medial malleolus

255
Q

Lange Hansen

PAB

A

Pronation Abduction

1-Transverse avulsion FX medial malleolus/deltoid rupture

2-AITFL syndesmotic rupture or avulsion of its insertion//or WF fracture

3-Short oblique lateral malleolus fracture (DWB Butterfly fragment)

transverse X-ray

256
Q

PER

A

PER
1-Transverse avulsion FX medial malleolus/ deltoid rupture

2-AITFL syndesmotic rupturer avulsion of its insertion

3-Oblique or spiral fibular fracture above the talotibial joint (Weber C)

4-Involement of the PITFLor Posterior malleolus fracture

257
Q

Lange Hansen Classification

A

Supination Adduction

1-LRupture of the AITF/PITF lgt tear,or avulsion fibular fracture(weberA)

2-Spiral fracture of the fibula DWB POSTERIOR SPIKE ON LATERAL XRAY

3- Volkmans fracture or PITF rupture

4- Rupture of the deltoid lgt/ transverse fracture of the medial malleolus

258
Q

Lateral ankle artery supply

259
Q

Lateral column

A

lateral cortical motor pathway include spastic paresis and hyperreflexia.

260
Q

LDH

A

Catalyses lactic acid to pyruvic acid in the citric acid cyscle(Glycolytic Cycle)

Many in tissue, liver kidney myocardium and muscle

Inceeased 12-24 hrs after MI

Increased in CVA//Hepatitis?CA/Hemolytic anemia/skeletal muscle necrosis

FALSE FLIPS-LDH1>>LDH2>>>>>MI

LDH3 Pulmonary

LDH4-Liver disease

261
Q

LEGG-CALVE-PERTHES-DZ

A

Osteochondrosis of the femoral head

Males>>>females Limping, pain to groin with stiffnes

3-12 years of age

MOST COMON FORM OF OSTEOCHONDRITIS

SYMPTOMS-INSIDIOUS ONSET, LIMPING, GROIN PAIN REFERRED PAIN TO KNEE

childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die. This weakened bone gradually breaks apart and can lose its round shape.

262
Q

Lepow Technique

A

take perpendicular of a line passing thru lateral base of 5th and medial base of the 1st metatarsal and compare with the 2nd

263
Q

Lewin DZ

A

Osteochondritis of the distal tibia

264
Q

Lichtblau for clubfoot up to 4 years old

A

Lateral closing wedge anterior osteotmy calcaneal

265
Q

LIMB LENGTHENING LENGTHENING

A

a. The Wagner frame
b. The Ilizarov frame
c. The Oxford frame
d. The Orthofix frame

266
Q

Liver Blood Work

A

LDH-38-62

SGOT/AST-10-50

SGPT/ALT-10-50

GTT-2-65

Alkaline Phosphatase/ ALP (30-85)

Bilirubin (.1-1.2)

Cholesterol

267
Q

Locations of bone lesions

A

Epiphysis

Chrondroblastoma, Giant cell tumor post growth plate

Metaphysis

Osteogenic sarcoma fibrosarcoma

unicarmeral bone cyst giant cell tumor non ossifying fibroma

Diaphysis

myeloma, ewing tumor, reticulum cell sarcoma

268
Q

Loop of Henle

A

1) Reabsorption of 15% of filtered water and 25% of the filtered load of Na+
2) Production of a dilute (hypo-osmotic) filtrate entering the distal tubule
3) Development of a hypertonic interstitum in the medullary regions of the kidney (via Countercurrent Multiplication)

4) Recovery of H20 & NACL from urine

269
Q

Loss of blood supply to the head of the femur in a 6 year
old male would likely lead

A

Calve-Legg Perthes Disease

270
Q

ANTITHYPERTENSIVE MEDS

A

MANNITOL,CARBONIC INHIBITORS

LOOP DIURETIC- TYPES-FURSOSEMIDE-LASIX

ADVERSE EFFECT-CAUSES INCREASE IN K+ LOSS

THIAZIDES DIURETICS-ADVERSE EFFECTS

K SPARING DIURETICS- SPIRINOLACTONE, AMIODARONE Adverse effects

Beta Blockers-decrease HR, CO and SBP>>>>hypoglucose,hyper TG’s and ppt CHF and angina

A2 agonst- Clonidine>>>not cause reflex tachycardia

A antagonist- Phentolamine and Phenoxybenzamine

Post-ganglionic sympatholytics- Reserpine, Guanadrel

Direct vasodilators-Apresozide, hydralazioine, Minoxidil, Diozozide,Nanitroprusside, Nitroglycerin infusion

Ace inhibotors-PRILS->cough and hyperkalemia via its inhibition of aldoserone that cause hypoK+ & hyper NA

Angiotensin receptor antag-artans–blocks the angiotensin 2 receptors, has no cough

271
Q

LOWER MOTOR NEURONS

A

LMN lesions present with muscle atrophy, fasciculations (muscle twitching), decreased reflexes, decreased tone, negative Babinsky sign, and flaccid paralysis.

ORIGNATE SPINAL CORD

ANTERIOR HORNS

WEAKNESS

amyotrophic lateral sclerosis,// progressive bulbar palsy, //primary lateral sclerosis,// progressive muscular atrophy, spinal muscular atrophy,// Kennedy’s disease, and post-polio syndrome.

Guillame Barre Syndrome

272
Q

Lyme disease

A

Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans.

Lyme disease causes a rash, often in a bull’s-eye pattern, and flu-like symptoms. Joint pain and weakness in the limbs also can occur.

Most people with Lyme disease recover completely with appropriate antibiotic treatment. For those who develop syndromes after their infection is treated, pain medications may provide symptomatic relief.

273
Q

Magnesium

A

2nd greatest intracellular cation

deficiency can cause leg muscle fatigue

274
Q

Maisonneuve fracture definition

Treatment

A

fracture of the proximal fibula corresponding with PER III

syndesmotic screw at distal fibula will reduce proximal fibular fracture

275
Q

Malignant bone lesion on xray

A

ill defined or absent margins

cortical erosion

onion peeling

codman triange

276
Q

McArdle disease

A

rare muscle disorder. In this disease, the muscle cells can’t break down a complex sugar called glycogen. It is part of a group of diseases called glycogen storage diseases. Another name for McArdle disease is glycogen storage disease type 5 (GSD 5 or GSD V).

277
Q

Mearys angle

A

talo-first metatarsal angle) was measured as the angle between the line originating from the center of the body of the talus, bisecting the talar neck and head, and the line through the longitudinal axis of 1st metatarsal.

278
Q

Measuring for metatarsal adductus angle

A

line drawn medial proximal aspect of the 1st metatarsal base and medial distal aspect of T-N articulation

2nd line-between lateral prox asp 4th metatarsal base and lateral distal aspect of the C-C joint

3rd Line- between the bisection to 2 lines

4-perpendicular line to the 3rd line down the shaft of the 2nd metatarsal

Metatarsal adductus angle a>>20 is adducted

MTA at birth 25-30 degree

279
Q

Ankle blood supply

280
Q

Medial Calcaneal Nerve entrapment

A

associated with infra-calcaneal heel spur syndrome

281
Q

Medial view of ankle soft tissue

282
Q

Meningitis

A

Bacterial- H.flu, meningitides//DX lumbar puncture

TX PCN G or Ampicillin

Coccidioidomycosis-

Cryptococcus Neoformans-pigeons—dissemination to CNS-menigitis

Brudzinski’s sign is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed. Indicates meningeal irritation

Kernig Sign people with meningitis weren’t able to extend their knees past a 90˚ angle without pain.

283
Q

Meta-analysis

A

examination of data from a number of independent studies of the same subject, in order to determine overall trends:

284
Q

Metatarsal adductus

A

adductus of the FF at the TMJ

affects 1 in 1,000 male=females

55% are B/L

CAUSE

Intrauterine position

Tight abductor hallucis muscle

Absent or hypoplastic medial cuneiform

Abnormal insertion of anterior tibial tendon

285
Q

Metatarsal adductus osseous procedure

A

8 y.o and older

Berman and Gartland-crescentric osteotomy 1-5

Lepird-closing wedge 1-5 base

Johnson Osteochondrotomy-closing abductory-Closing abductory base wedge

1st met 2.5mm from the lesser metatarsals

Fowler-Opening wedge osteotomy of medial cuneiform with insertion bone graph

Peabody-Muro-Excise base metatarsal 2,3,4 with osteotomy 5th metatarsal

mobilize 1st met-cun joint

Steytlier and Van Der Walt-Oblique osteotomies all metatarsals

McCormick and Blount-Arthrodesis of 1st metatarsal-cuneiform joint

286
Q

Metatarsal adductus soft tissue procedures

A

Heyman, hernon,Strong- release all soft tissue at lis franc except plantar lateral lgt

Thompson Procedure- Resection of abductor hallucis and release medial head FHB

Lange- Capsulotomy of 1sr met-cuneiform joint/ division of the abductor hallucis

Licthlau- Sectioning of hyperactive abductor hallucis

287
Q

MI

A

N/V DIAPHORESES

LOCATION SIMILAR TO ANIGINA

TIME>>15 MINUTES

CAUSE–ANGINA MAY PRECEDE

TREATMENT: NITRATES,ASA, B-BLOCKERS,

CA+ ANTAGONIST, HEPARIN, THROMBOLYTIC TX, PCTA

288
Q

Minimum Alveolar Concentration

A

The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients.

A lower MAC value represents a more potent volatile anesthetic.

289
Q

Mockenberg Medial Calcific

A
  • is a form of arteriosclerosis or vessel hardening, where calcium deposits are found in the muscular middle layer of the walls of arteries (the tunica media).
  • results in increase ankle ischemic indices
290
Q

Moncheberg Disease

A

benign arteriosclerosis results in extensive calcium deposits in tunica media layer of medium size arteries

291
Q

Monocytosis

Eosinophilia

Eosinophenia

A

Monocytosis Leukemia Hodgkins Bacterial Endocarditis

Collagen Vascular disease, sarcoidosis

Eosinophilia- Allergy, asthma, eczema parasitic inf, scarlet fever, Pernicious Anemia

Eosinophenia- Cushing DZ, XS ACTH, chronic steroid post opstate, shock labot

292
Q

monofilament polypropylene

A

Least reactive

293
Q

MORPHINE

MEPERIDINE (DEMEROL 1/10) MORPHINE

FENTANYL (100XPOTENT MORHINE)

A

ADJUNCT MINIMIZE PAIN

NOT FOR OUT PT SX\

ADR-Prolong analgesia

Hypotension, Res depression, pruritis N&V

ANTIDOTE :NALOXONE(NARCAN) OR NALMEFENE)

SULFENTANIL AND ALFENTANIL-SYNTHETIC ANALOG OF FENTANYL MORE POTENT

REMIFENTANIL-NEW AND VERY FAST ACTING OPOID FOR MINOR PROCEDURE

294
Q

MRI for OM

A

Cortical bone destruction

bone marrow edema low signal T1

Reactive surface

well defined

Adjacent rim, well define

T2 increased signal

295
Q

What does the MRI reveal in a stress fracture

A

Low intensity T1 linear zone poorly defined

T2 linear is dark

296
Q

Mulders sign

A

silent palpable click that patient feels while squuzing metatarsal heads together

297
Q

MUSCLE RELXANTS SURGERY

A

1-SUCCINYLCHOLINE (ANECTINE)-RAPID ONSET DEPOLARIZING MR WITH STRONG EFFECT, RAPID ONSET

PREVENT ASPIRATION

SE: POST MYALGIA UP TO 4 DAYS POST OP

RAPID INJECTION>>CARDIAC ARRYTHMIA

ANTIDOTE: ANTICHOLINESTERASE AGENTS-NEOSTIGMINE (PROSTIGMIN)

PYRIDOSTIGMINE(MESTINON

2-ATRACURIUM(TRACRIUM)

3-VECURONIUM (NORCURON)

BOTH non-depolaring interm. Acting MR>>slower onset then Succiny

50-75 minutes DOA Atracurium

20-30 Min DOA Vecuronium

298
Q

Muscular dystrophies

A

progressive weaknes and degeneration of sketetal muscles

Symtoms-progressive weakness, atrophy, loss of DTR, secondary contracture and deformities

1-Duchennes-2-5 yo- most rapid progression- toe walk, diff climbing stairs, waddling gait, gower sign

2-Becker’s-5-25

3-Emery-Dreifuss-5-15

4-Facioscapulohumeral-7-20

5-Limb-Girdle-10-30

299
Q

MYASTHENIA GRAVIS

A

AUTOIMMUNE DISORDER CAUSED BY PRODUCTION OF AUTOANTIBODIES TO ACH RECEPTOR ON MOTOR END PLATE

ASSOCIATED WITH THYMIC HYPERPLASIA OR THYMONA

neuromuscular disorder that causes weakness in the skeletal muscles, which are the muscles your body uses for movement. It occurs when communication between nerve cells and muscles becomes impaired.

300
Q

Nail patholgy

A

Anonychia-no nail, congenital-ischemia-toxins raynauds, darier dz-lichen planus

Paronychia-infection+IGTM-staph-candida

Beau’s Line-transverse ridges .1-.5mm widex1mm deep d/t sudden arrestin Fx of nail plate-inf-typhus-syphyllis

leprosy-DM-psoriasis-vasc dz ACTH, hyperthyroidism, alopecia, exf dermatatis

Clubbed-bulbous deformity—Lovibond angle>>160 degrees-CH defects, resp, lung ca SBE

Darier White Dz-red and white longitudinal streak on nail

Mee’s lines- Horizontal striation on nail d/t arsenic & thallium poisoning

Eczema-atrophic and contact dermatitis nail colour yellow,green, gray or black

Glomus tumor-Neoplasm or AV shunts in nail beds (glomus bodies) purplish tumor & pain

Keratocantoma-subungual ulcerated lesion resembles SCC

Leukonychia- white Transverse striation, spots or total nail psoriasis, toxic metal poison, scleroderma, leprosy-anemia-cancer, hodgkins dz- darrier dz

Malignant melanoma-acral lentiginous melanoma most dreadful, MELANOTIC WHITLOW-elevation of nail

Atrophy-Lichen planus

Periungal fibroma-acq or congenital ass/ tuberous sclerosis, mental retard-seizure-adenomasebaceum

301
Q

Nail procedures

A

Cold steel indicated for chronic reoccuring IGTN, failed chemical procedures

Frost- inverse L shape-nail, matrix and hypertrophic ungual labia: suture

Whitney-B/L frost; Mendelsohn & smith suturing

Winograd 1/4 of nail edge is removed along with matrrix and bed: snip nail fold wedge to the bone; suture

Zadik-remove nail plate & matrix c/o shortening: forced on nail matrixl; excised skin over base of nail bed prox to lunula & matrix; skin flap advanced & suture to distal nail bed

Terminal Symes-Removal entire nail plate, bed and matrix, resect 1/2 distal phalnx & close defect with plantar skin flap DISADV: shortens digit, bulbous terminal stub, slough of flap, scar, nail depth

Kaplan-stressed removal of both nails matrix and bed, H incision carried out at 2 depth

Suppan-free the eponychial fold & remove the nail, allow visual of prox nail matrix, cut lateral & ant border and remove prox attachment

Plastic lip-excise pie shape wedge of tissue from side of toe, use for hypertrophy of ungualabia

complication -recurrenc4, xs drain & bleeding, infection, exuberant granulation tissue, insuff amt removed

soft tissue migration up to dorsum of toe

302
Q

Nelaton line

A

good for b/l dislocation

imaginary line connect the A.I. Spine to tuberosity of the ischium

if tip of the greater trochanter is palpable distal to this line>>>hip is dislocated

303
Q

Neuroimaging studies

A

most important initial studies for children with chronic progressive ataxia

used changes in blood flow or chemistry to examine parts of the brain active while normal adults perform tasks. These studies have provided a general picture of where cognitive and emotional processing is carried out by the brain

304
Q

Neuromas

A

Houser Neuroma 1st plantar intermetatarsal nerve

Morton Neuroma- 3rd IMS

Heuters Neurom-2nd IM nerve

Islen’s Neuroma- 4th plantar IM nerve

305
Q

Neuropraxia

Radiculopathy

A

Neuropraxia is the mildest form of traumatic peripheral nerve injury. It is characterized by focal segmental demyelination at the site of injury without disruption of axon continuity and its surrounding connective tissues. This condition results in blockage of nerve conduction and transient weakness or paresthesia.

Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column. The pinched nerve can occur at different areas along the spine (cervical, thoracic or lumbar). Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.

306
Q

Neutrophils

Lymphocytosis

A

Neutrophilia-Bacterial infection, necrosis Pain

acute infection, rigious exercise post convulsion

Neutrophenia-Overwhelming infection marrow depression

autoimmunity antimetabolite

Lymphocytosis-Viral inf, measles, hepatitis, chronic TB, Lymphocytic leukemia

307
Q

Non absorable sutures

A

Ethilon-monofil nylon-low tissue reactivity-more plaible when wet 9-0 10-0 microsx

Nerolon-braided nylon- coated to improve handling

Mersilene-multifilament polyester-minimal tissue rxn, MOST ACEPTABLE FOR VASC SYN PROCESSES

Ethibond excel-polyester braid- coated with polybutalate

prolene-relatively biolically inert, use minimal suture sx (ie:infection)

Dermabond- sterile liquid- in 3 minutes provides the same strength as healed tissue at 7 days

Steri-strips- hypoallergenic

Staples-fast method and least tissue reaction

308
Q

Non Halogenated Agents

A

Nitrous Oxide-BGC .47

MAC 1.6

30X more soluble then NO in blood

More beneficial if used with volatile agent like halothane, enflurane ETC

MUST GIVE 100% O2 END OF SX TO PREVENT DIFFUSION HYPOXIA

CAN CAUSE CARDIA DEPRESSION

OVER LONG PERIOD>>BONE MARROW DEPRESSION

309
Q

Non-invasive test to asses normal pulsation, pressure and flow for suspicion of arterial lesion

A

1-1Segmental pneumatic plethysmography (large vessel wall reactivwly ro pulsa)

2-Segmental pressure (indicated presence of normal to decreased heads of pressure, depending on the degree of stenosis)

3-Doppler isolation of arteries (demonstrate normal dynamic flow VS aberrant eddy current ditsal to thrombic lesions)

4-Digital photocell plethysmohraphy (demonstates pulsatility of end arteriole comprimising the glomus in the pulp of the toe)

5-Digitial pressure (asses the head of pressure in the digital arteries)

6-Thermography, skin thermometry and percutaneous oximetry (reflecs the degree of cutaneous perfusion

310
Q

normal malleolar position at birth?

311
Q

Normal metatarsal adductus at birth

A

22-25 degrees

312
Q

Nutritional Neuropathy

A

daNgthrapist

Restless leh syndrome”Ekbom’s Syndrome

Decrease Zinc and folate, Vit B12 neuropathy

Clinical-persistant urge to wiggle and associated with fibromyalgia

Uncomfortable, crawling, painful grabbing sensation–Primary in L.E.

Can also have PLMS- painful limb movement sleep

TX-Dopamine agonst Pergolide (antiparkinson drug)

BZD (valium)/anticonvulsabt/opoids/dopaminergic that work on cns may help

313
Q

OATS Definition

A

osteochondral autograft transfer system

314
Q

Oral or IV anti-fungals

A

Itraconazole (sporanox)

Ketoconazole(Nizoral)

Amphorericin B (Abelcet, Fungizone)

Terbinafine (Lamisil)

Griseofulvin

Gentain Violet

315
Q

Ortolani Sign

A

1-baby supine, hips and knees flexed at 90 degrees

2-grap baby thigh with middle finger over greater trochanter

and lifting and abducting the thigh while stabilizing the pelvis and opposite leg witht he other hand

+ when a palpable click is felt as the femoral head is made to enter the acetabalum

316
Q

OSGOOD-SCHLATTER

A

OSTEOCHONDROSIS OF THE TIBIAL TUBEROSITY

CAUSES BY EXCESSIVE TRACTION OF THE PATELLAR LIGAMENT

SELF-LIMITING

317
Q

Osteochondritis dissecans

A

s a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply

**most comon femoral condyle

318
Q

Other hereditary Disorders

A

1- Riley-Day Syndrome AKA Familail Dysautonomia- indifference to pain

Ashkenazi jews, high breech presentation//weak absent suck and poor tone

emotional, self mutilation, absent or hyporeflex DTR

2-Rousy-Levy Syndrome-Hereditary arcreflex dystasia

form of frust CMT- pes cavus, Absent DTR,POSITIVE ROMBERG SIGN-(balance with eyes closed)

3-Friedreich Ataxia AKA Spinocerebellar Ataxia- most common inherited ataxias, involving, spinocerebellar and corticospinal tract, post column

D/T protein Frataxin decreased (CNS,heart,pancrease) have abnormal high iron in cardiac tissue>> react with O2 to produce free radicals

Slowly progressive scoliosis in thoracic region

LE Finding- feet cavus, wide unsteady gait..absent DTR, +romberg sign

shin ataxia>>Cardiac failure

4-Dejerine-Sottas-Progressive hypertrophic polyneuritis

paresthersia and lightning-like pain in extremities>>>>wheelchair confined

Clincical-all sensory modalities affected, stocking glove distribution ie: light touch & pinprick>>+Romberg//like CMT slow progressive weakness

reflex diminished

TX-Accomodative

319
Q

Parkinson Gait

A

Shuffling with short, hurried steps

320
Q

Parkinson’s disease

A

Loss pf dopamine neurons from substantia nigra

55-60 Yo

Classic=rigidity, bradykinesia and disturbance in gait

PILL ROLLING RESTING TREMOR

AKINESIA- LACK OF POVERTY OF MOVEMENT AND COGWHEEL RIGIDITY

FESTINATING GAIT

BRADYKINSIA-SLOWNESS AND FATIGUING OF VOLUNTARY MOVEMENT

ALL SYMPTOMS PROGRESS TO MASKED FACIES

TREATMENT:LEVODOPA COMBO LEVODOPA & CARBIDOPA (Sinemet)

Dopamine agonist, AMANTADIN, Anticholinergics

COMT inhibitor which inc/ entacapone & tolcapone>>breaksdown levodopa in periphery and may increase CNS delivery of dopamine

321
Q

PASA Corrections

A

Austin

Reverdin

Reverdin Green

Reverdin Laird

Reverdin Todd

Peabody

Hohman

Drato

Ludloff

322
Q

Pathologic Reflex responses elucidates

A

Babinski sign- <2 yo, stropke lateral prox to distal>>>+ extension/dorsiflex of great toe with flex fanning toes

Normal>>In adults the hallux moves up

slow response plantar withdrawal response to that of tickling

Chaddocks Sign_ stroke lateral foot about lateral malleoli moving distally>>extension of hallux

Oppenheim Sign- use thumb and index finger as caliper to squeeze tibial creat>>hallux extends if deficit cause pyramidial tract

Gordon Sign- squeeze posterior calf>>hallux extends and dorsiflexs

Rossolimos Sign- tap balls or distal pulp of toes>>++ if toes Plantar flex

323
Q

Pedal antiperspirants

A

Ostiderm roll on

Xerac

Drysol

Bromi-lotion

Dr Scholl’s antiperspirant

324
Q

Pedricarditis

A

Sharp and generalized

Varies

Inflammation between the visceral and pericardium

Treatment-Sitting up and forwrd

325
Q

Pentobarbital

Secobarbital

A

Sedation>>no analgesia>>RELIEVE APPREHENSION

MINIMAL RESP DEPRESISON

CAUSTION IF PT HAS PORPHYRIA (DECREASE HEME)

326
Q

Performing a calcaneal osteotomy for PTTD how much translation should occur

A

1-1.5cm medially

327
Q

peripheral neuropathies

A

DANGTHRAPIST

1-Diabetic peripheral neuropathy

2-Alcoholic

3-Nutrional

4-Guillame-Barre Barre

5-Toxic

6-Herditary

7-Reccurrent

8-Amyloidosis

9-Porphyria

10-Infections

11-Systemic

12-Tumors

328
Q

Peroneal Muscular Atrophy Charcot Marie Tooth Disease

A

CMT 1- demyelination form, degeneration of post colunm of spinal cord

loss anterior horns and degeneration spinocerebellar tract

Slow nerve conduction velocities

CMT 2-neuronal form by axonal degeneration of peripheral nerve

Male>>>female

Clinical-muscle atrophy symtrical and distal: peroneals and intrinsic muscles of the feet 1st>>lose ability to evert becasue invertors mechanical advantage. Cavus type foot

Early sym varus and high arch with atrophy TA,EHL,EDL>>cavus& clawing

Finding: plumb thigh, slender legs “ostrich or stork” Inverted chanpagne bottle

329
Q

Perthes Test

A

Detect deep vein valvular incompetence

Place tounaquet mid thighelevated leg 60mm to occlude superficial venous flow

patient walks to asses muscle pumping function of deep veins

Competent valves- blood flows thru deep veins back to heart

Valve incompetence- blood reflx thru incompetent commicators to superficial and enlarges below tournaquet

If patient feels pain on walking, could be deep venous claudication

330
Q

Pes planus deformity

A

Transverse plane-abduction FF on RF

Frontal Plane=RF eversion with decrease 1st met declination angle

Sagittal plane-sagging midfoot-Nav-cuneiform breech//TDA increase

331
Q

Phases of a 3-phase bone scan

A

1st immediate and seen in a few seconds

2nd is blood pool phase 2-5 minutes and represents regional blood flow

3rd delayed or static and can take 2-3 hours and represents bone uptake and urinary excretion

332
Q

Phosphorus

A

3-4.5

controlled by parathyroid hormone

intracellular

PTH>>Increase Ca>>increae resorption Ca from bone>>suppress loss into urine

Hyper-Tissue trauma(hemolysis), burns, renal failure, healing bone

Hypo-Vomit N&D, Diuretic, starvation

Serum calcium and phosphorus>>>dependant greatly level of PTH

333
Q

Planal dominence in the STJ

A

frontal and transverse

334
Q

1st Plantar layer

A

Abductor hallucis( medial plantar Nerve)

Flexor digitorum brevis( Medial plantar nerve)

Abductor digital minimi(Lateral plantar nerve)

335
Q

PLEURISY

A

Sharp pain associated with respiration

Location-Generalized

Time>15 minutes

Causes-can be seen-pneumonia

Treatment-Control infection

336
Q

Polyarteritis Nodosa

A

Polyarteritis nodosa (PAN), is a systemic necrotizing inflammation of blood vessels (vasculitis) affecting medium-sized muscular arteries, typically involving the arteries of the kidneys and other internal organs but generally sparing the lungs’ circulation

337
Q

Polymyositis

A

Polymyositis is a type of muscle disease called an inflammatory myopathy. It inflames your muscles and their related tissues, like the blood vessels that supply them. It can cause muscle weakness

Eventually, people with polymyositis have trouble when rising from a sitting position, climbing stairs, lifting objects, or reaching overhead.

338
Q

PONSETI SERIAL CASTING

A

serial casting weekly

percutaneous tendoachiles tenotomy

once corrected abduction foot orthotics 12 weeks

then at night until age 4

Complication= metatarsal adductus

heel varus

pes plano-valgus

rockerbottom foot

AVN or talar head flatening because infant connetive tissue stronger then bone

Navicular subluxation

339
Q

post op complication using autologous iliac bone graph

A

pain

hemorrahage

hernia

340
Q

Posterior column

A

Vibratory

sensation

proprioception

341
Q

Posterior, medial and lateral release for club foot 1 year

A

POSTERIOR

reflic origin abductor hallacis and plantar fascia

z-plasty achilles tendon

release posterior , medial and lateral ankle joint

release posterior, medial and lateral STJ,–posterior talofib and calcfib lgts are severed

MEDIAL RELIEASE

Z-PLASTY OF PTT, SO SPRING LGY AND HENRY KNOT IS SEVERED

release entire medial STJ, inc/ superficial deltoid

Lateral release thruSTJ

release interosseous talocalc lgt

release bifurcate lgt and release lateral STJ

342
Q

Posterior shin splint cause pain

A

3-12 cm above the medial malleolus

343
Q

Potassium

A

3.5-5.5

Major intracellular and only 2% total body K is extracellular

Decreased--lead to arrythemia, depressed T wave

High-N&V, dehydration, Mulpiple myeloma and malignancy

Increased and decrease>>profound effect NMS>>apathy, weakness,paralysis,MI

When hypo>> exam serum bicarbonate

344
Q

Pre albulmin

A

Distinct marker for protein synthesis

345
Q

Pre empative analgesia involves preventing spinal cord windup by

A

using pain killers and nerve blocks pre-op to decrease pain post op

346
Q

Pre op medication Class

A

Barbituates- Pentobarbital(nembutal)

Secobarbital (seconal)

Benzodiazpines/Sedative hynotic Diazepam (valium)

Lorazepam(ativan)

Midazolam (versed)

Narcotic/Opiods Morphine

Meperidine (demerol) 1/10morphine

Fentanyl (100x more potent then morphine

Anticholinergic(belladona derivative) Atrophine sulfate

(inhib parasympath-blocks ACY) Scopolamine

Glycopyrrolate

347
Q

Pre-anesthesthic Medication

A

1-Sedatives- (anti-anxiety/hyponotic)

Diazepams (valium)–sedation and amnesia. Can be given PO 1-2 hr before Sx(5-10mg)

Lorazepam (ativan) 1-2 hours pre surgery 2-4mg

Midazolam (versed) pre-op +/or induction agent. Rapid onset with short duration

when IV works w/n 5 minutes. effect last between 1-6 hours

Hydroxyzine (vistaril) sedative primary, also anti-histaminic, antiemetic and bronchodilator. Good premed

2-Anticholinergic (Belladonna)-

Atropine-before anesthesia to decrease resperation secretion. Keep heart rate normal during.

prevents asystolic and bradycardia in presence of halothane and vagolytic agents

Scopolamine-Used as a preanesthetic because it produces mild respiratory stimulation and it inhibits salivary secretion. In reversing paralysis it is used to reduce parasympathetic hyperactivity.

348
Q

Preanesthetic Agents principle

A

Purpose:

1-Reduce anxiety

2-Produce some sedation/amnesia

3- Reduce gastric PH as well as volume

4-Reduce bronchial secretion

5-Prevent N&V

349
Q

Principles Lower Extremity Nerves Lower Plexus

A

1-Lateral fenoral cutaneous nerve L2,L3 SENSORY

1st sensory nerve of lumar plexus- supplies skin lateral/anterior thigh, Posterior branch>>lat/posterior thigh

2-Femoral Nerve L2, L3 &L4 SENSORY AND MUSCULAR-exitsvertebral canal>>inervates psoas & iliacus

Sensory branches>>ant/medial thigh medial calf

Muscular branch>>pectineus,sartarius and quad femoris

Movements:Iliopsoas>>hip flexion>>flexion of thigh:quad femoris>>>extend of leg at knee

3-Saphenous N- largest and longest sensory branch femoral nerve>>innervate skin medial thigh, leg and foot

course>>accompanies femoral AA in femoral triangle, descends and divides medially under sartorius muscle>>terminal with greater saphenous VV>>medial calf at medial malleolus to medial foot>>1st MPJ

Entrapped as it exit subsartorial canal (Hunter’s canal) proximal to knee>>no motor weakness b/c its sensory

4-Obturator Nerve (L2,L3,L4) SENSORY AND MOTOR

Anterior branch>adductor longus, brevis and greacilis

Posterior branch-obturator externus and 1/2 adductus magnus

Sensory fibers-cutaneous sensation upper medial thigh & anastomose with Saphenous N

Movement>>adductor longus,brevis and gracilis (INTERNAL ROTATES LEG>>>adduct thigh

Obturator externus>>external rotates thigh & 1/2 adductor magnus muscle>>adduct, flex&extend thigh

350
Q

Proper treatment of a stage 3 PTTD would be:

A

Triple Arthrodesis

351
Q

Protein

A

6-8

Albumin is a protein in liver that halps maintain normal distribution of water in body and transport blood constituents

Total blood mostly refers to Albumin 50-60%

Non-Albumins is referred to a globulin

A/G ratio diagnosis condition multiple myeloma (Bence-Jones Pr)

Increased= elevation of globulins as collagen Vascular DZ

Total Protein= 3gm globulin + 4gm Albumin====7 gm total protein

352
Q

Proximal Tarsal Tunnel syndrome

A

Entrapment medial and lateral branch ribial N, under lacinate Lgt (flex retinaculum)

Anatomy NVS passes thru lacinate lgt

Vascular-med & post tibial N well supplied with AA. Regenerate well and susceptible ischemic injuryor aa insuffiiency>>>TARSAL TUNNEL SYNDROME

BIOMECHANICAL-compression medial & lateral plantar Nas they enter foot/seen with enlarged ABH bellies or osteophytic spurring of medial arch>>pronation syndrome>>extreme PF & adduction of talus during ambulation

enlarged navicular tuberosities D/T osseous impingement of insertion PTT

Clinical_ Buring, tireness in foot, pain totates proximally==VALLEIX PHENOMENON

REPRODUCEWITH PERCUSSION OF PTT NERVE AT LEVEL OF LACINATE LGT

DX: ELECTRO-DX distal latency (millisec) greater latency value

distal latency medial N abnormal>>6.1

lateral plantar nerve abnormal>>6.7

PTN stim just proximal to lacinate lgt

ABH muscle for Medial plantar Nerve and Abductor digit quinti to test Lateral PLantar N

353
Q

PT

A

11-16 seconds

measure extrinsic

Increased Vit K def//Biliary obstruction//Liver disease//Coumadin tx//deficiency in extrinsic or common pathway factors

354
Q

PTT

A

25-35 # of seconds to clot

Intrinsic pathway–M

3 stages of coagulation except factor VII

Increased- Hemophilia A factor VIII

Hemophilia B Christmas tree ( Factor IX

Von Willebrand DZ

DIC Deficiency in intrinsic pr common pathway factors

Liver DZ Heparin TX

355
Q

RADICULOPATHY

A

PATHWAY TO SPINAL NERVE ROOTS AS EXIT SPINAL SOLUMN THRU VERTEBRAL FORAMINA

DISC HERNIATION, DEGENERATIVE JOINT DISEASE AND OTHER ARTHRITIEED AFFECTING THE SPINE

ACUTE TRAUMA

356
Q

Radio Frequency

A

high frequency electromagnetic radiation due to the use of wireless equipment, devices and data transmission.

357
Q

Radiograph congrenital vertical talus

A

Lateral view-witha second the foot plantarflexed showing the talo-navicular relationship doesn’t change

Navicular not evident on x-ray until age 3

line bisecting the talus is parrallet to the tibia

TC angle on A/P is increased to >>40 degrees

Talar neck hypoplastic may have hourglass shape and flat surface

Navicular articulates witht he dorsal talus

Negative hubscher maneuver

358
Q

Raynauds phenomenon VS Syndrome VS Disease

A

Phenomenon is episodic digial palloring with paresthesias, followed by cyanosis and finally presenting with rubor and warmth with thrombing sensation

Syndrome- repeated presentation of phenomenon under coldness or anxiety and associated with collagen disorder

Disease-trilogy of colors ass/ symptoms noted for 2 years without definition of underlying collagen disease

359
Q

RBC

A

Male 5.4-

Female 4.8

Provides info about HGB content and size of RBC

​Mean Corpuscular Vol= Normocytic -82-92//Macrocytic//95-150//Miccocytic-50-80

Mean Corpuscular HGB= Normocytic-25-30//Macrocytic//30-50//Microcytic 12-25

Mean Corpuscular HGB Concentration= Normcytic 32-36/Macrocytic-32-36//Microcytic 25-30

Microcytic Anemia<<<<80 is iron deficiency, Thalasemia, blood loss, poisoning

Normocytic Anemia-(80-100) isChronic DZ, Bone marrow failure,,hemolysis

Macrocytic Anemia(>>>100 is Folate acid & Vit B12 def, Liver DZ, drugs like phenytoin

360
Q

Red man syndrome

A

infusion-related reaction peculiar to vancomycin [3]. It typically consists of pruritus, an erythematous rash that involves the face, neck, and upper torso. Less frequently, hypotension and angioedema can occur.

361
Q

Refsum’s disease:

A

(hereditary motor sensory neuropathy type IV, heredopathia atactica polyneuritiformis) is an autosomal recessive disorder the clinical features of which include retinitis pigmentosa, blindness, anosmia, deafness, sensory neuropathy, ataxia and accumulation of phytanic acid in plasma- and lipid-

362
Q

Renandier DZ

A

Osteochondritis of the tibia sesamoid

363
Q

Reynaulds Number

A

Diameter X VelocityXDensity/Viscosity

is the ratio of inertial forces to viscous forces within a fluid which is subjected to relative internal movement due to different fluid velocities. A region where these forces change behavior is known as a boundary layer, such as the bounding surface in the interior of a pipe.

364
Q

Rheumatoid Disease Labs

ESR

CRP

ANA

Uric acid

A

ErythrocyteSedimentation Rate ESR

RBC settle out of unclotted bld

Increased>>> Infection, R.A Maignancy..A.S.Acute gout

Inflammation, Septic OA metastasis

C-Reactive Protein <

Rises before ESR and normal after NSAID,ASA Steroid

produced during acute imflam phase

Increased RA, Strep Infection

ANA

appears month after connective tissue DZ

More accurate then LE Cell test>>unaffected by steroids

Lupus.99///Scleroderma>>73 RZ>>60…Sjogrens.43

Uric acid 7-9 males

Increased in gout, malignancy, renal DZ, familial hyperuricemia

MARTINI SIGN–MONOSODIUM URATE CRYTALS NEEDLE SHAPE

365
Q

Ritter DZ

A

osteochondritis of the fibular head

366
Q

Rowe Calcaneal Type 1

A

1A- Fx of the medial tuberosity

1b-Fx of the sustentaculum tali

1C-Fx of the anterior process -mc of avulsion fx of the bificate ligament

367
Q

Rowe Type 2

A

2A- Beak fx no ACH involvement

2B-Avulsion tx of Tendo achilles

NO INVOLDE THE STJ

368
Q

Rowe 3

A

Type 3-extraarticular oblique fx of calcaneal body not involving STJ

369
Q

Rowe classification 4

A

Type 4-Fx involving STJ w/o joint depression or comminution

370
Q

Rowe Class Type 5

A

Type 5-comminuted fx of STJ w/ central or severe depression

371
Q

Rowe Classification 1-II

A

Type Ia - tuberosity fx; beak/medial avulsion fx, vertical/horizontal body fx. (Rowe types I and II) Type Ib - calcaneo-cuboid joint involvement Type IIa - undisplaced STJ fx, secondary fx line exits posteriorly through calcaneus. Type IIb - displaced STJ fx, secondary fx line exits dorsally through calcaneus and a fragment dislocates.

372
Q

Rule of Simon

A

Talo–1st met angle> 15 & talo-calc angle < 15= TN dislocation

373
Q

Ryders test

A

a femoral torsion angle of 10 degree in a 6
year old female.

374
Q

Sacral Plexus Nerves

A

Superior L4,L5, S1 (Muscular)- innervate gluteus medius, minimus and TFL

Inferior Gluteal L5,S1,S2-gluteus maximus

Superior gluteal Abducts and internal rotation thigh

Inferior N>>extension,abduction and external rotation of thigh

Sciatic Nerve-L4,L5,S1,S2> MOTOR>>peroneal component short head bicep femoris and portion add magnus, tibial branch to post thigh, hamstrings>>>>SCIATICA>>>PAIN DOWN LOWER LIMB

TIBIAL NERVE-(POST TIBIAL) sensory & motor- bifurcates w/n popliteal fossa>>medial popliteal N>>tibial

motor innerv muscle superficial/deep sural muscle (grastroc/soleus) superior 1/2 motor to deep post group :ie Tibial posterior, FHL,FDL enters foot between medial malleolus and flex retinaculum under the reticulum splits to>>>medial and lateral plantar Nerves after giving off 1st small calcenal branch

Medial Plantar N>>with medial plantar AA>>motor 4 muscles (LAFF), ANH,FDB,FHB,1st Lumbrical

Cutaneous innv medial distal 2/3 plantar foot, plantar digits 1-3 & medial 4th digit

Lateral plantar Nerve- lateral to heel and lateral plantar surface

innerv>>all other intrinsics &motor innerv sensory lateral aspect of sole & lateral 4th & entire 5th toe

375
Q

Sagittal plane 1st MPJ motion occurs about which axis

A

transverse

376
Q

Sagittal Plane correction for FF deformity

377
Q

Sagittal plane correction for Pes planus

A

Lowman- Plantarflex T-N wedge arthrodesis with TAL

and TA tendon rerouted under the navicular

Cotton-Open dorsal wedge 1st cuneiform

transplanting TPT under the navicular

Hoke-Plantar based wedge arthrdesis of the nav-& medial cuneiform

perform TAL

Miller-Nav-1st cuneiform and 1st metarsal fusion

PTT and spring Lgt advanced using an odteoperiosteal flap

Young (keyhole technique)- reroute the TA tendon thu keyhole in the navicular

378
Q

Salter Harris

A

S.A.L.T. ER

379
Q

Salter Harris Functure

A

S.A.L.T.ER

380
Q

Samuels Test

A

Elevate LE, arteriole rubor to palor pedal skin, while venogenic dependent rubor convert to normal coloration

381
Q

Sanders CT classification of calcaneal fracture is bases on

A

number and position of the posterior facet fracture line on a coronal section

382
Q

Saphenous Nerve

A

Branch of the femoral

Parallels the great saphaneous vein

Gives off branches to the medial crural nerve

383
Q

Saphenous nerve

A

from the femoral and it is the only branch

branches to the medial crural nerves’

384
Q

Screws

A

Cortical-fully threaded

fine threads with small pitch to anchor the cortical bone

cancellous-partially threaded (historically), usually lag. threads are coarser with hugh pitch inted to engage medullary bone

385
Q

Rheumatoid Labs continue

Serum Compliment

Anti-Streptilysin ASO

HL A-B27

HL A-B15

Calcium Pyrophosphate

A

Series of enzymatic protein cobine antigen-antibody complex and effect lysis when antigen is an intact cell

ASO-Anti-streptilysin-AB against streptolysin O and group A Strep

80% acuteR>F> or other strep infection

HL-A_B27-90% A.S>//Reiters 75%//P.A &Juveline RA

HL.A B15-33%. in SLE

Calcium Pyrophosphate- crystals are rhomboid

386
Q

Sever DZ

A

Osteochondrosis of the calcaneus

cause by excellive traction of the achilles tendon

6-12 years old

more common with equinus

radiograph are difficult

TX- Rice NSAIDS, eliminate sports, heel lift, achilles stretch exercise

387
Q

SGOT/AST

A

10-50

When heart or liver damage, SGOT spills into blood and the amount is directly related to the damage cells

More specific for cardiac necrosis

INCREASED- MI,Liver(HEPATITIS) disease DZ, Skeltetal muscle, after strenous exercise

DECREASED-Uncontrolled DM, Beriberi

Bone disease wont cause elevation AST

388
Q

SGPT/ALT

A

10-50mu

High in hepatitis and after strenous exercise

Found high concentration in liver>kidney.>heart

catylyzes amino group between alanine & alpha ketoglut

Bone disease wont cause elevated levels of ALT

389
Q

Shenton curved line

A

line from femeral neck to obturator foramen

witrh hip dislocation, obturator foramen is too low

390
Q

shoe anatomy

391
Q

Silk

392
Q

Simons Assesment Method

A

Simon rule of 15

talus, calcaneus and 1st metatarsal longitudinallt bisect on A/P xray in max corrected position

clubfoot talo-calc angle <<15

Talo-1st metatarsal angle >>15

393
Q

Skewfoot

A

1-Adducted forefoot

2-normal midfoot

3-valgus hindfoot

4-Increase calc-cuboid angle (norm 0-5)

usually acquired from comp of a metatarsal varus, develops with wt. bearing or

inproper manipulation and casting

394
Q

slipped capital femoral epiphysis

A

A 12 year old obese male who was sitting with his left
leg externally rotated rises and begins to walk. His gait
remains severely externally rotated on the left side with a
trunk-shift limp to the right side.

395
Q

Snappen Fracture 1

A

group 1-

Transchondral or compression FX to talar dome including osteochondritis dessicans

396
Q

Sneppen Fracture Group 2 Talus

A

Coronal, sagital or horizontal shearing fracture of entire talar body

Cause-severe DF with compression forces when talus is sandwiched b/t tibia & calcaneus

Type 1 Coronal or sagittal fx-

1a-non-displaced

1B-displace of trochlear articular surface

1C-displacement of trochlear art surface with STJ discloca

1D-total displacement of talar body with Displace STJ/AJ

TYPE 2 horizontal FX

2a-non-displaced fx dividing talar body into sup/inf halve

2b-displaced fx superior portion shifts on inf halve

397
Q

Sneppen 3

A

fracture posterior tubercle(most common)

d/t severe plantarflex force (DDX steida process or shepaers fx, os trigonum)

pain posterior ankle causes limited rom

reproduced on FHL movement

398
Q

Sneppen group 4

A

Fx lateral process of talus

2nd most common talar body fracture

AKA Snowboard FX eversion injury with lateral process caught b/t fibula and calcaneus

399
Q

Sneppen Fracture 5

A

Crush Fx

Comminuted of talar body

400
Q

Sodium

A

NA 135-145

Major cation in extracellular fluid

maintains osmotic PP in acid-base balance

Low-Dehydration, cushings Dz

High-Severe burns, N&V, excess IV, Addison DZ/ CHF

Convulsion&seizures>>Traid of low NA, Low HCT, Low BUN

ADH-Arginine vasopressin-tells kidneys how much water to conserve

401
Q

Soft tissue lateral view of ankle

402
Q

sphenoid bone shape

A

wedge shape

403
Q

Spinal anesthesia

A

Both, requires lower volume of anesthetic agent than epidural anesthesia and difficult to control the level of anesthesia are correct.

404
Q

Spinal Bifida Occulta

A

Incomplete closure of 1 or more vertebral arches only

L5 &S1

405
Q

SPINAL CORD EVUALTION OF RADICUPATHY

A

NERI’S SIGN-TAKES SMALL STEPS WITH KNEE SEMI-FLEX TO PREVENT STRETCHING OF N ROOT

Minors Sign- patient rises from seated position, pt places wt on unaffected side with one hand on his back

Lumbar lordosis or thopracic kyphosis

Pseudoclaudication-relieved by flexing spine

Straight leg raise test- supine and hip passively flex with knee in full extension, should be non painful

Lasegues Test-reproduce pain when patinet leg is elevated less then 30 degree and foot DF

Bowstring-to differentiate lumbosacral ilian pain–patient supine in full extension, if nerve pain when knee is flexed pain goes away

Gaenslens Test- DDX lumbosacral from sacral ilian pain- patient supine with 1 leg in full extension and the other is lowered off the sideof the table, the twisting of the pelvis causes sacro-iliac pain

Valsalva Manuever-DDX space occupying lesion or herniated disc; b/l compression of jujular vn results in increase intra spinal PP and reproduces radicular pain

EMG Studies

406
Q

STANDARD AFO

A

Ankle set 90 degree

various neuromuscular disorder may cause equinus

407
Q

STJ AXIS ROM

A

Avg axis position to sagittal plane= 16 degrees

Avg axis position to the transverse plane = 42 degrees

408
Q

summary sequence of ischemic necrosis

A

infARCTION

resorption

revascularization

remodeling

409
Q

Sunderland Classification

A

1-Conduction eficit without axonal destruction

2- Axon is severed without reaching neural tube.(Wallerian degeneration) with regeneration

3-Degeneration of axon with destruction of fascicle with irregular regeneration

4-Destruction of axon and fascicle and no destruction of nerve truck

5- Complete loss, neuroma likely and spontaneous recovery is rare

410
Q

Superficial Nerve

A

Common peroneal nerve within the tunnel of the P.L and neck of the fibula

upper part innervate the P.L. and PB

supplies most of anterior skin to ankle and dorsum

411
Q

SUPERFICIAL PERONEAL

A

AKA Musclulo-cutaneous N (SENSORY. MUSCULAR

INNERVATED PL AND PB>>EVERT AND PF

DESCENDS INF BETWEEN PERONEAL MUSCLES>>INFERIOR INTO MEDIAl and INTERMEDIATE DORSAL CUTANEOUS NERVE (SENSORY BRANCHES>>ANT AND EXT RETINCULUM SUPPLY ANT-LAT ASPECT OF LOWER 1/2 LEG AND DORSUM OF FOOT & TOE MOST COMMON NERVE INJURY TO FOOT

injury and entrapement-exits the fascia w/c the calf approx 10cm about the lateral malleolus. Intermediate dorsal cutaneous N (LAMONTS N) couring just medial to the sinus tarsi; severe inversion injuries>>>>stretched Nerve & injury

DX-1- LOCAL INFILTRATE REPRODUCES TO CONFIRM WITH FOOT DORSAL FLEX AND EVERT AGAINST RESISTANT

DX 2- PASSIVE FOOT PF ABND INVERSION PLACING NERVE ON STRETCH

DX 3- DIRECT PERCUSSION FOOT HELP PF AND INVERSION

2-

412
Q

Superficial Peroneal Nerve

A

Divides into (2)medial and intermediate (1) dorsal cutaneous nerve

medial dorsal cutaneous nerve divides into 2 dorsal digital Nerve-1-Medial proper dorsal digital nerve to the hallux(skin)

2-Common dorsal digital nerve-innervates skin 2nd & 3rd toe

3-Intermediate dorsal cutaneous nerve-splits into 2 digits nerve 3rd & 4th IDS

413
Q

SURAL NERVE

sensory

A

From medial sural nerve (tibial) and sural commincating branch (common peroneal)

orgnates from ​inferior popliteal fossa b/t bellies gatroc>>inf & distally,post fibular malleolus

Cutaneous Innervation>>post-lateral distal leg/ lateral aspect of foot

Terminal branches..divides lateral and medial>medial supplies cutaneous innervation to dorsal skin of base 4th metatarsal; communicated with intermediate dorsal cutaneous nerve

Terminal branch of the sural nerve most accessible sensory nerve of the foot and NERVE OF CHOICE>BIOPSY

INJURY AND ENTRAPMENT-ANKLE IS MINIMAL SENSORY DEFICIT

414
Q

Sural Nerve Anatomy

A

Strictly cutaneous

Forms in leg by combining branches tibial and common peroneal Nerve

Medial sural cutaneous branch is branch of tibial nerve

Sural comminicating branchof the peroneal N at fibula head

As Sural enter the foot>>lateral dorsal cuntaneous nerve0

415
Q

surgical treatment club foot children 3-12 months

A

1- Medial hockey stick

2-Cincinnati incision

416
Q

suture materials is the most
reactive

A

natural fibers

417
Q

Sydenham’s Chorea

A

BASAL GANGLIA DISORDER

Major Dx R.F.

Can occur up to 6 months following Group A beta-hemolytic strep infection

Indication to intiate prophylactic antibiotic therapy to prevent subq development of other manisfestation of RF

Clinical-aimless involuntary movement, impaired coordination and muscular weakness with reduced muscle tone. Movements are worse when trying to repress

Treatment-Phenothiazine or haloperidol can control the chorea

anti-microbial tx Penicillin or erythromycin if pen allergy

Usually resolves 3-6 weeks

418
Q

Syndesmotic screw: For fracture

  • Material
  • Size
  • number of cortices
  • When to remove
  • Side effects
A
  • Material: no difference between stainless steel and titanium
  • Size: No difference between 3.5 and 4.5. 4.5 easier to remove but also causes greater irritation
  • number of cortices: 1 screw across 4 cortices will have higher chance of fracture. 2 screws across 3 cortices have better stability, better physiological movement
  • When to remove: at 3-4 months
  • Side effects: limitation of ankle ROM, broken screw, pain , screw removal, syndesmosis diastasis.
419
Q

talar neck fracture most stable in vitro using

A

6.5 mm screw & K-wire posterior to anterior

420
Q

Talipes Equinus varus can be subdivided

A

Idiopathic, Positional, Syndromic,Terotologic

421
Q

Talo-navicular coalition

A

2%

usally asyptomatic

if painful usually around 3-5 y.o.

CC: bump pain from shoe pressure

Lateral x-ray shows absence of Cyma line

TX- correct medial prominence

422
Q

Talocalcaneal Coalition

A

45% and almost all the middle facet

starts around 12-14 y.o.

pain usually over the sinus tarsi

decrease ROM STJ and MTJ

X-RAY- Lateral and Harris-beath best views

TC on lateral C sign or halo sign

(this C chape is a line formed from medial outline of talar dome and inf outline of Sust tali.

thiis C shape is specific

May be absent STJ middle facet and diminished facet

Talar beaking

Medial oblique- shortening talar neck/ dysmorphic sust tali (or ovoid shape)

Talus in ankle mortise more rounded (ball and socket)

423
Q

Tarsal Coalition

A

abnormal bridge bewteen tarsal bones

1% AND 50% ARE BILATERAL

most common cause of peroneal spastic flatfoot, secondary to spasm of STJ

Males>>>females

TC=CN and account for over 90%

CT scan is gold standard

TX- conservative by decrease motion of inv/ joints with shoe modification or braces,

casting , splints, RICE & NSAIDS

424
Q

Tarsal tunnel

A

Flexor retinaculum medial/posterior

calcaneus and posterior aspect of the talus

Distal tibia and medial malleolus-anteriorly

425
Q

Tc-99m scans HMPAO

A

used to detect a wide range of conditions including injuries, infections, tumours, heart disease, thyroid abnormalities, kidney conditions and also to guide some cancer procedures.

HMPAO-hexylmethyl propylene amids Oxide

1/2 life is 6 hours

426
Q

Tendon healing

A

Week one is characterized by edema, erythema, and
callus formation.
b. During week two, vascularity and fibroblastic
proliferation continue.
c. Gentle range of motion exercises starting in week 3
will lead to increased strength of the tendon.
d. Passive range of motion exercises during week 4
helps realign the collagen fibers to allow optimum strength

427
Q

Test determine flexible Flatfoot

A

Hubcheur Manuever-PF 1st ray will cause STJ to supinate and re-create arch if flex

Trunk Twist- STJ flexibility for supination and pronation

Jack test-Pt on heels, heels will invert, check the PT tendon

428
Q

Tetanus

A

caused by toxin Clostridium tetani–affect CNS

Spore>>release bacteria>>multiply and produce>>neurotin>> Tetanospasmin

429
Q

The achilles tendon consist of

A

paratenon, epitenon

430
Q

The first ray is

A

Uniaxial, triplanar not pronatory/supinatory

431
Q

The research design

A

is a broad framework that describes how the entire research project is carried out. Basically, there can be three types of research designs – exploratory research design, descriptive research design, and experimental (or causal) research design.

432
Q

The windlass effect refers to

A

Plantarflexion of the 1st metatarsal during 1st MTP dorsiflexion

433
Q

durometric Thickness of plastozoate

434
Q

Thiemann DZ

A

Osteochondritis epiphyseal ossification center of the phalanges

435
Q

Thompson Test

A

Rupture of the Achilles tendon

436
Q

Tietze

A

Sharp, Costochondritis, tender at pressure points

Location-Chest wall

Time>days to weeks

Causes>Inflam of costoconfral joints

Treatment-Benign, assoc with aniety

437
Q

Tillaux-Chaput definition

A

avulsion fracture of the tibia from the AITFL

438
Q

Toe pressure diabetic healing

A

>55mm Hg Healing

45-55 Hg Range of uncertainty

<45 No wound healing

NEED AT LEAST 30MM HG REQUIRED FOR HEALINH OF A WOUND ON THE DIGIT

439
Q

Topical Fungals for nails

A

Efinaconazle (jublia)

tavaborale (Kerydin)

Ciclopirox (penlac)

Tolfanate (Formula 3)

Underclenic (Tineacide)

Tolcylen

440
Q

Torus fracture

A

Common pediatric fracture at the transitional zone between the metaphysis and diaphysis

441
Q

TOTAL SERUM PROTEIN

A

6-8

Formed in liver to maintain normal distribution of water ( colloidal osmotic pp) and transport bld constiuent

Usually referred to Albumin because bld protein 60% albumin

Non-albulmin referred to a globulin A?G ratio

A/G ratio diagnosis multiple myeloma/(Bence-Jones protein is a globulin)

Increased-Hyperproteinmia,N&V,Mutiple myeloma/Malignancy

Decreased-Hypoproteinemia//chronic liver DZ//Severe burns

Total protein=3 gram%globulin+4gm%albumin===7gm total

442
Q

Toxic neuropathy (drugs)

A

dangThrapist

Heart and HBP-Amiodarone Hydralazine perhexilline

Fight cancer: Vincristine, Cisplatin

Infetions:Metronidazole (flagyl) Nitrifurantoin, Thalidomide (leprosy)

IND (isoniazid),(TB)

Skin conditions-Dapsone

Antoconvulsants -Phenytoin

Anti drugs and alcohol-Disulfram

Fight HIV-Zisovudine(retrovir,AZT),Didanosine (Videx) Stavudine (Zerit)

Zalcitabine (Hivid) Ritonavir (norvir), Amprenavir (agenerase)

443
Q

Toxic neuropathy Environment

A

1-Arsenic-cause whitr striae on nail>>Mees band

TX-BAL chelating agent

2-Barium-can lower lserum K>>clinical paraylsis

3-Lead-vasculopathy-edematous fluid surrounds abnorm permeable capillary

S/S convulsice seizures

4-Mercury-3 forms 1- Inorganic salts and 2 metallic>> S/S=neurological comp Mad Hatter Syndrome include tremors, personality tremor of the limb

3-Organomercurial exposure>>paresthesia limbs, visual, dysarthria tremor, incordination large expsure could be permanent

TX:BAL and EDTA for chelation

5-Lithium

6-Manganese - rigidity and hypokinsia can manage with L-dopa

7-Urate

444
Q

Transverse plane correction of flatfoot

A

Evans-open osteotomy of calc 1.5cm to CCjoint with insertion of bone graph

Kidner-remove prominent nav tuberosity and transplant TPT underside of navicular

445
Q

Transverse plane correction of pes planus

A

Evan’s-calcaneal osteotomy 1.5cm proximal to the C-C jt with insert bone graph to lengthen lateral column and put PT on stretch to increease supinatory motion

Kidner-removal prominant tuberosity(acc navicular) transpose PT plantar

C-C Joint distraction arthrodesis

446
Q

transyndesmotic screw is:

A

Inserted posterior lateral to anterior medial,
inserted 2-3 cm above the syndesmosis,
and inserted with the foot neutral to slightly
dorsiflexed

447
Q

Treatment of choice for type II-IV talar neck FX

A

Immediate ORIF and Closed reduction followed by
ORIF when patient is stable

448
Q

Treatment of dislocated 5th digit

A

Increase the deformity, distract the toe, then
reduce the deformity.

449
Q

Treatment of DM Neuropathy

A

Rigid glucose control

Superfical Nerve pain-Capaicin

Deep Nerve pain-tricyclic anti depressants (amytriptyllene) or anti seizure (gabapentin)

Tegretol (anti-seizure)

Gabapentin-(post-herpectic neuroligia req titration)

OD- dizzyness and Drousy

Neurontin-900mg///300mg//600>>>900mg

Amytrptiline if neurontin doesn’t work

450
Q

Treatment of pilon fracture

A

a. Restoration of fibula length
b. Anatomic reduction of articular defect
c. Bone grafting of metaphyseal defect
d. Medial tibial buttress plating
e. All of the answers are correct

451
Q

Trendelenburg Maneuver

A

DDX deep and superficial venous incompetence

Elevate leg to empty venous

Tounaquet upper thigh 30-60mm Hg to occlude superficial venous flow

Then stand-if varicosities fill within 20-30 seconds>>deep and perforation disease is present

If varicositie promp return>>>superficial system

452
Q

Treve DZ

A

Osteochondritis of the fibular sesamoid

453
Q

tumor of the bone marrow

454
Q

Twister cables

A

cables around waist

inside pant leg

CONTROLS DEGREE OF ABDUCTION AT HEEL CONTACT

TREAT SCISSOR GAIT OF CP PATIENTS

455
Q

Type II navicular body fracture

A

Axial compression fracture with an oblique
pattern from dorsal-lateral to plantar-medial

456
Q

Types of Anestheisa Inhalation

A

Inhalation agents

Chloroform-rapaid induction/recovery, nonflammable, good muscle relaxation

Disadvant>not in use, myocardial depresion, hepatoxic

Diethyl ether- reliable anesthesia depth-resp stimulated, bronchodilator, circ not depressed, goof muscle relax

Disadv>not in use-prolonged induction, flammable and explosive

N.O.- little effect of HR myocardial contractility,resp,BP, liver or kidney metabolism

VERY HIGH MAC

DISADV> LEAST POTENT 100%> MUST BE GIVEN AT ERMINATION OF SX TO PREVENT DIFFUSION HYPOXIA> no muscle relaxation, ?? bone marrow depression, fatal agranulocytosis

457
Q

Unibar

A

Same as denis brown bar except has ball and socket joint beneath each foot

tighten for varus position (preventing STJ and MTJ subluxation) elimninating the need to bend the bar

458
Q

UPPER MOTOR NEURONS

A

BRAIN

MOTOR COMPONANT OF CNS

PYRAMIDAL AND EXTRAPYRAMDIAL

SYMPTOMS USUALLY RIGID

muscle hypotonia and flaccid

Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS)

Primary lateral sclerosis (PLS)

Traumatic brain injury.

Spinal cord injury.

Multiple sclerosis.

Stroke.

Huntington’s disease.

459
Q

URIC ACID

A

1.5-7mg

End product of purine-not useful indicator of renal failure

U.A levels most common used to evaluate renal fsilure, gout and leukemia

ELEVATED-Renal failure

Gout

Leukemia

Alcoholism

Lead Poisoning

Decreased-uricosuric agents, Fanconi sign/ Wlson DZ

460
Q

Uric Acid Gout

A

Mostly in males

During a gouty attack levels are normal

90% acute gout>>>>>>1st MPJ (Podagra)

2) Soft tissue
3) Ankle joint

Tophi in ears>>B/C lowerTemp>>>UA less soluable

Solubility of UA= 37C -6.8>>30% 4.5>>Ankle Jt 29C Crystalization

461
Q

Virchow Triad

A

1-Stasis (arrythmias, MI,CHF,heart failure, immobiliation, besity , varicose veins, dehydration

2-Blood vessel injury (trauma, fractures)

3-Hypercoagulability (neoplasm, oral contraceptives,pregnancy,surgery,polycythemia

these are the 3 stages of formation of thombi

462
Q

Volkmann definition

A

avulsion fracture of the tibia from the PITFL

463
Q

Von Gierke disease

A

condition in which the body cannot break down glycogen. Glycogen is a form of sugar (glucose) that is stored in the liver and muscles. It is normally broken down into glucose to give you more energy when you need it. Von Gierke disease is also called Type I glycogen storage disease (GSD I).

464
Q

Von Rosen View (frog leg view)

A

dislocated hip, the line bisects the ASIS

465
Q

Wagstaffe definition

A

avulsion fracture of the fibula from the AITFL

466
Q

Watson & Jones type 2

A

Dorsal avulsion lip fracture (most common) 40%

Plantarflexion & forced inversions causes avulsion

Fx via dorsal TN lgt

plantarflexion-eversion causes avulsion via dorsal TN LGT

TX short leg cast immboile 6-8 weeks

467
Q

Watson & Jones 3

A

Transverse tracture of body (29%) with dorsal fragment dislocation vertical or horizontal

from fall from height

longitudinal force along the ray when ankle PF

Horizontal plane FX-long dorsal deformity

468
Q

Watson & Jones 4

A

Stress FX of middle 1/3 in young atheletes

Differentiate from overuse syndrome

469
Q

Watson & Jones Type 1

A

Tuberosity fracture (24%) forceful eversion

avulsion fracture from the PT tendon

R/O tibiale externumor MTJ subluxation

TX short leg cast NWB 4-6 weeks

470
Q

WBC

A

5,000-10,000

Leukocytosis in acute infection, metabolic acidosis, gout, heavy metal toxin, tissue necrosis, burns gangrene and inflammation

Leukopenia- decrease reduction of W.C in blood>>>various DZ,, adverse RX to druga and certain severe infection

471
Q

What antibiotic is contraindicated in pts with CHF

472
Q

What antibiotic results in increased CPK levels

A

Daptomycin

473
Q

What antibiotics should be used to treat MRSA

A
  • Clindamycin
  • Bactrim
  • Linezolid
  • Tetracycline
474
Q

What antibiotics should be used to treat pseudomonas

A
  • Fortaz
  • Aminoglycosides
  • Timentin
  • Ciprofloxacin
  • Imipenem
  • Atreonam
  • Zosyn
475
Q

What are hammertoe soft tissue procedures (4)

A
  • Flexor or extensor percutaneous tenotomy
  • Extensor tendon lengthening, Z-lengthening
  • Capsulotomy
  • Flexor tendon transfer
476
Q

What are some distal metatarsal procedures that can be done for metatarsalgia

A

Weil-cut distal dorsal to proximal plantar

Complications of Weil-

  • Transfer lesions
  • –recurrence
  • –floating toe/flail toe
  • –Dorsal contracture
  • *Weil+plantar plate repair**
  • Jacoby-V cut to PF or DF
  • Duvries- Plantar condylectomy on both sides of the joint
  • Chevron-removal of bone to shorten the met
  • DFWO-same as the waterman
477
Q

What are some of the soft tissue procedures that can be done for overlapping 5th toe

A
  • Incision from Distal Medial to Proximal Laterl
  • Z-plasty or V-Y pasty
  • tendon lengthening
478
Q

What are the 3 axis of motion

A

Just as there are three planes of motion, there are three axes of rotation: the anterior-posterior axis, the mediolateral axis, and the longitudinal axis. Joints rotate in these axes, allowing movement to occur in the planes.

479
Q

What are the 3 phases of soft tissue healing?
When do they occur?
Lasts until when?

A
  1. Inflammatory – first 48-72 hours (up to 10 days)
  2. Proliferative – from ~day 3 (lasts 3 - 6 wks)
  3. Remodeling – from ~day 9 (lasts 6 wks to 12 mths)
480
Q

What are the 3 ways that a wound vac works

A

1) To get rid of stagnant bacteria
2) Promote new blood flow to the area with growth factors and neutrophils
3) Allows for even growth of the wound bed, and keeps callouses from forming

481
Q

What are the 4 different responses in the inflammatory phase?

A

It begins with disruption of normal tissue physiology

It ends with complete removal of the wound debris

Initial Vasoconstriction – with the role of limiting blood loss
Followed by vasodilation

–Hemostatic response
–Vascular response
–Cellular response
–Immune response

482
Q

What are the arteries that provide intraosseous circulation 5th metatarsal

A

1) periosteal plexus
2) nutrient artery
3) metaphyseal/epiphyseal arteries

483
Q

What are the classification systems for pilon fractures

A

Ruedi and Allgower. AO classification

484
Q

What are the classification systems to describe 5th metatarsal fractures

A
  • Stewart classification
  • Torg classification
  • Lawrence and Bott classification
485
Q

What are the classification systems used to describe Lisfranc injuries

A

Harcastle

  • Quenu and Kuss
  • Nunley
486
Q

What are the compartment pressures during a compartment syndrome

A

Intra-compartmental : >30mmhg
Extra-compartmental: within 10-30mmHg of diastolic BP

487
Q

What are the different names for proliferative phase?

A

Physiological: Proliferative, granulation, fibroblastic or repair phase
Clinical: Subacute phase
Management: Controlled motion phase

•It ends when
–Fibroblasts activity / collagen production returns to baseline levels
–Fibroblast-rich granulation tissue is replaced by scar tissue

488
Q

What are the different names for remodeling phase?

A

Physiological: Remodeling phase
Clinical: Chronic phase
Management: Return-to-Function phase

–The ends point for this phase is unclear as the rate of tissue remodeling may return to baseline before biomechanical properties are recovered.

489
Q

What are the side effects of steroid use

A
  • Leukocytosis
  • increased wound healing time
  • hyperglycemia
  • hypopigmentation
490
Q

What are the three Flexor tendon transfers

A
  • *-Girdlestone Taylor**- bisect the tendon
  • flexor reattached dorsally and sutured together to make a sling over proximal phalan

-Kuwada/Dockery-reroute the tendon to the distal drill hole

-Schuberth-reroute the tendon thru the proximal drill hole

491
Q

What bacteria is incorporated into Santyl

A

Chlostridium histolytica

492
Q

What classification system is used for open fractures

A

Gustilo and Anderson-

1- Opening in the skin <1cm
2- Opening in the skin between 1-5cm

3A: Greater than 5 cm with great soft tissue coverage
3B: Greater than 5cm with periosteal stripping
3C: Greater than 5 cm with arterial damage3

493
Q

What is a locking plate and when is the best time to use it

A

A locking plate provides no compression of any sort

-great for osteoporosis, bone deficits and comminution

494
Q

What is a strain

What’s a sprain?

A

Strain-used to describe physical damage to “active” soft tissues (muscle, tendon, myofascia). Usually tear of muscle or tendon

Sprain: Term used to describe physical damage to “passive” soft tissues (esp. ligament and joint capsule).

495
Q

What is extensor substitution and during what phase of gait

A
  • Weak anterior muscles: EDL/EHL overpowers intrinsics during swing phase of gait
  • Cavus foot- EDL in position to overpower lumbricals just by passive stretch
  • Equinus: extensors overworked to prevent tripping on forefoot

During the Swing phase of gait

496
Q

What is flexor stabilization and during what phase of gait does it occur

A
  • Failure of PTT to resupinate the foot results in overpronation.
  • Extrinsics (FHL/FDL) fire earlier/longer/stronger to grasp ground during midstance

Midstance phase of gait

497
Q

What is flexor substitution and during what phase of gait?

A

Supinated foot with weak posterior muscle (achilles tendon) unable to PF foot during propulsion.

PT, FHL, FDL overpower to lumbricals

Propulsive phase of gait

498
Q

What is the angle formed by the metatarsal parabola

A

142 degrees

499
Q

What is the blair procedure and what should it be used for

A

When the body of the talus is removed, the foot is fused in 15 degrees dorsiflexion. This procedure is used for AVN of the talus

500
Q

What is the definition of osteoarthritis?

A

progressive loss of articular cartilage

accompanied by

  • attempted repair of articular cartilage,
  • remodelling, and
  • sclerosis of subchondral bone, and

in many instances the formation of

  • subchondral bone cysts and
  • marginal osteophytes.
501
Q

What is the depth of 1st met-cuneiform joint

502
Q

What is the etiology of talar neck fracture and what xray view is used

A

Etiology: axial load+ hyper dorsiflexion. Aviators Astralagus

-Canale X-ray view-AP view with foot PF, pronated 15 degrees to view angular deformity of talar neck

503
Q

What is the function of plantar plate and what is its healing potential

A

Plantar plate serves as a stabilizer during WB and has very poor healing potential

504
Q

What is the medical term for rolled edges along wound bed

505
Q

What is the most senitive and specific signs on a peripheral blood smear for megaloblastic anemia

A

Hypersegmented neutrophils

506
Q

what is the relationship of motion to axis at a hinge joint?

A

perpendicular

507
Q

What is the sequential release of MTPJ for hammertoe repair

A

1) Arthroplasty
2) Extensor tenotomy
3) Extensor hood release
4) Extensor Tendon lengthening
5) Flexor tendon transfer

508
Q

What is Volkman’s contracture

A

ischemic necrosis causes muscular contracture

509
Q

What layer of the nerve does a Morton’s neuroma usually develop in

A

in the epineurium

510
Q

What normally occurs 2-5 cm superior to the insertion of
the Achilles tendon?

A

Tendon twist 90 degrees lateral

511
Q

What oral meds are okay to give during Charcot Neuropathy

A

bisphosphonates

512
Q

What sign presents to the medial calcaneus in flatfeet

A

Pizogenic sign which is fat papule herniations

513
Q

What test differentiates between FF and RF cavus foot

A

Coleman block test

514
Q

Wheaton Brace

A

used for metatatsal adductus

alternative to serial casting

515
Q

Wheaton Brace System

A

Additional AK piece is design to lock into BK component

Knee flexed at 90 degrees prevent twisting of femur or hip and allowing isolated unilateral tx of tibial torsion

516
Q

when casting infant for clubfoot

A

forefoot adductus

rearfoot varus

equinus

517
Q

Where in the LE do atheromatous plaques tend to develop

A

Sites of bifurcation

1-Distal abdominal aorta

2-Common iliac

3-Common fermerol

4-Popliteal

5-Trifurcation into tibial and peroneal trunks

518
Q

Which anesthesthetic should be evaluate for malgnant hyperthermia

A

Elevation of creatine Kinase

519
Q

Which of the following are the two types of limb length
discrepancies?

A

Structural

Functional

520
Q

Which of the following is a lower motor neuron disorder?

A

achilles tendon over taking the degenerative PTT

521
Q

If the DTML is severed

A

develops hammertoes

522
Q

While performing the vertical stress test for 2nd MTPJ
dislocation, which stage would you find the phalangeal
base can be subluxed but not dislocated?

523
Q

Why are 5th met fractures hard to heal

A
  • Watershed area of inraosseous blood supply to the metaphyseal region
  • Mechanical pull of PB
524
Q

Why is FDL used as a tendon transfer with PTTD

A

because it is in direct opposition to PB, expendable, and proximity to PTT

525
Q

Wiberg CE Angle

A

if femoral head is inadequately, wil develop DJD

this test reveals how much DJD will develop

treatment: aligning the femoral head in the actabulum and holding it there

526
Q

Wilson Disease

A

BASAL CELL DISORDER

Juvenile patient, symp to parkinsons

cooper-binding ceriloplasmin leading to accumulation of cooper in tissue

KAYSER-FLEISCHER RINGS-PATHOGNOMONIC OF APPEAR COOPER

CHILDREN EXHIBIT SCHIZOPHRENIC BEHAVIOR, MULTIPLE MOVEMENT DISORDER

TREATMENT-D PENICILLSMINE

527
Q

X-Ray difference Normal to Flatfoot

A

Normal Flatfoot

Meary’s angle 0 degree 1-15 and >>15 severe

CIA 20-25 degrees <15 degrees

A/P T/C angle <25 >25 degrees

T-N angle <50 60-70 degrees

528
Q

X-ray findings associated with Lisfranc injury

A

Space between 1st and 2nd MT should be equal inspace with medial and intermediate cuneiform

  • Drop in arch
  • Fleck sign
529
Q

X-ray findings to confer fibular length (2).

A

Shenton’s lines: line continues with spur of lateral malleolus with tibial plafond

Dime sign: assesses fibular length and talocrural angle

530
Q

Diathermy

A

use of electric current to coaguate vessels

531
Q

hinge-axis
concept?

A

To lengthen the metatarsal, the cut should
be proximal-medial to distal-lateral.

532
Q

Sniffin Position

A

extend head and flex the neck for anesthesia

Podiatry part 3 exam (2 decks)

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