Pimp Interview Questions Flashcards
Fowler Phillip Angle (normal vs abnormal to ID what pathology)
- ID Haglund’s Deformity
- normal: 45-70 deg
- Haglunds > 75 deg
Another name for “Total Angle”
Total angle “OF RUCH”
Total Angle (abnormal to ID what pathology)
- ID Haglund’s Deformity
> 90 = pathologic
What is “Peak of Lampiere”
1st met-cuneiform exostosis
Another term for “Peak of Lampiere”
tarsal bossing
What are 3 angles you want to examine for haglund’s deformity
- Fowler-Phillip Angle
- Total Angle (of Ruch)
- Parallel Pitch Lines
How much cartilage should be intact to 1st MTPJ for decision justified to do joint salvage px for hallux lim
> 50%
For surgical correction of Haglunds deformity… you should consider using fixation (e.g., bone anchor) to secure it back in place if you have to resect what % of tendon?
50%
Difference b/w Bruit and Thrill
- bruit : hear
- thrill: feel
Allen Test
- performed in hand – test for radial or ulnar artery occlusion
Pallor with Elevation, Rubor with Dependency – how long does it take normally for color to return? abnormal/diseased?
10 seconds = normal return
45-60 seconds = abnormal
ABI necessary for healing?
DM: 0.45
Non-DM: 0.35
When is TBI indicated?
- when ABI > 1.3
- i.e., when calcification of the vessels prohibits accurate ABI (doesn’t effect TBI b/c calcification rarely in digits)
What TBI value is consistent with LEAD
Toe pressure
TBI
Interpretation of Segmental Pressures
- same leg: occlusion proximal if 30 mmHg decrease b/w 2 segments
- CL leg: occlusion on one limb if 20-30 mmHg difference from other side (occlusion in lower read)
Transcutaneous Oxygen Pressure: when is it useful?
- useful when ABI and TBI do not provide useful information (i.e., compressible vessels and toes amputated)
- additional support for re-vasc sx
- indicate amputation level
Interpretation of TcPO2
> 30 mmHg - normal (predictive of healing)
When is Skin Perfusion Pressure Test done (SPP)
when there is excessive local edema/anemia (TcPO2 can give false reading)
> 30 mmHg - likely to heal wound
IV contrast used in MRA
gadolinium
Contraindications to MRA
- pacemaker
- implanted defibrillators
- other implanted electronic devices (cochlear implants)
- aneurysm clips
- pregnancy
relative contraindications: orthopedic hardware (creates artifacts on films), claustrophobia
IV contrast used for CTA
iodinated contrast
CTA vs MRA
- CTA: more image detail, useful in pts with CI to MRA
- however, less accurate in extensive vessel occlusion, ionizing radiation +
- MRA: no ionizing radiation, more accurate with extensive vessel occlusion
- however, many CI’s, less image detail, and pts may be claustrophobic b/c takes longer
Foam Cells
lipid-laden macrophages
Senile Medial Calcinosis
Monckeberg’s Sclerosis
Extensive skin necrosis following limb ischemia occurs within what amount of time
6 hrs
Causes of Hypercoaguable State
- Protein C or S deficiency
- Antithrombin III deficiency
- Factor V Leiden deficiency
- Antiphospholipid syndrome (associated with SLE)
CAVEMAN common etiologies for embolic source
Cardiac catheterization - iatrogenic A. Fib Valve Dz Endocarditis Myocardial Infarct/Mural Thrombus Aneurysm Nothing
Virchow’s Triad
- venous stasis
- hypercoaguable state
- endothelial damage
R/o Test for DVT
d-dimer (fibrin degradation product)
Tests for PE
- CT pulmonary angiography (gold standard) – rule in
- V/Q Scan
- D-dimer (rule out)
Pratts sign vs Pratts Test
Pratts sign: dilated pre-tibial vessels
Pratts test: compressing popliteal veins; calf squeeze
Reversal agent Heparin
protamine sulfate
Reversal agent Coumadin
Vit K or FFP (faster)
Heparin Induced Thrombocytopenia – why is it bad?
antibodies activate platelets and cause arterial / venous thrombosis
How to tx pt with HIT:
- stop heparin
- need anticoagulants due to incr risk of thrombosis
- begin non-heparin anti-coagulant (e.g., argatroban - direct thrombin inhibitor, fondaparinux, apixiban, rivaroxiban) -ban’s = Xa inhibitors
** don’t use lovenox as supplement
Pharmacologic Tx of DVT
- initial (first 5 days):
- Lovenox (1 mg/kg q 12 hrs = therapeutic dose)
- Heparin so that PTT is 1.5 x normal
- Apixiban or Rivaroxiban - Long Term (Start initially but not therapeutic at the onset)
- Warfarin (Coumadin) INR 2-3 - Other agents
- Factor Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban)
- Direct Thrombin Inhibitors (Dabigatran, Argatroban)
myxedema - what is it and what is it hallmark for?
- mucopolysaccharide deposition in the dermis
- grave’s disease
+ stemmer sign
thickened skin fold at the base of the second toe or second finger that is a diagnostic sign for lymphedema. Stemmer Sign is positive when this tissue cannot be lifted but can only be grasped as a lump of tissue; it is negative when it is possible to lift the tissue normally.
Atrophie Blanch
sign of impending ulceration w/ venous insufficiency
Lipodermatosclerosis
sclerotic hardening of the underlying fat
Contraindications to using TQ:
- PVD (h/o re-vasc px)
- Traumatized limb
- Severe infection in limb
- DVT in limb
- Peripheral neuropathy
- Poor Skin Condition
- AV fistula
Relative CI: sickle cell disease
Examples of Large vessel vasculitis
- giant cell (temporal) arteritis
- takayasu arteritis
Examples of Medium Vessel Vasculitis
- Polyarteritis nodosa
- Kawasaki Dz
Examples of Small Vessel Vasculitis
- Churg Strauss Syndrome (anti-neutrophil cytoplasmic Ab)
- Wegener’s Granulomatosis (anti-neutrophil cytoplasmic Ab)
- Henoch-Schonlein Purpura (mostly in kids following strep pharyngitis)
How to diagnose Compartment Syndrome
Wick/Stryker Catheter (>30 mmHg comp pressure)
- note: normal Compartment Pressures: 0-5… capillary blood flow compromised at 10-30 mmHg… and pain develops when tissue pressures reach 20-30 mmHg
most common cause endocarditis
S. viridans
cause of endocarditis due to IVDA
s. aureus
Haglund’s DISEASE
osteochondrosis of accessory navicular
Other names for Subtendinous/Retrocalcaneal Bursitis
- Achillodynia
- Albert’s disease
- Anterior Achilles Bursitis
Name for 1st TMTJ arthritis/exostosis
- Tarsometatarsal “Bossing”
- “Peak of Lampiere”
