Rapid fire stuff that you got wrong Flashcards
What is the sign called when you cause bone bleeding?
Paprika sign
Name the avascular non unions
Torsion wedge
Cominuted
Defect
Atrophic
What is the name for the disease causing lymhadema in neonates?
Ven Watson syndrome
How long does it take for vicryl to be absorbed?
56 days to 120 days
What is ethibond made of?
Polyester
What is fiberwire made of?
Polyethylene jacketed in polyester
How many nerves cross the ankle joint?
6
What does the coleman block test check?
Checks for rearfoot flexibility!
What is the herx reaction
The dying off of bacteria secondary to antibiotic treatment.
Typically seen in the treatment of lymes disease
What is the dose for oral lamasil?
250 mg daily for 3 months
Order LFT beforehand
What is apligraft made of?
Neonatal foreskin
Normal peak and trough for vancomycin?
30-40 for peak
10-20 for trough
Peak is dose dependent trough is interval dependent
Clindamycin dose?
300 mg qid PO
or
900 mg IV
Normal size for an ankle tourniquette?
18 inches
When performing an austin, you determine the bone is too soft. What fixation should you use?
Crossing K-wires for static stability.
How long must you wait for an MRI after a new tattoo?
6 months.
What’s the score for newborn respirations?
APGAR
Osteochondrosis of the proximal fibular head?
Ritters disease
What is phlegmasia cerulea dolens?
venous gangrene common after DVT ischemic blockage
At what stage of pregnancy is a woman most at risk for a DVT?
Third trimester as the placenta separates.
What is the name for the RSD classigication?
Steinbroker
Acute, Dystrophic, Atrophic
Low calcium has what effect on the QRS wave?
Widens the wave form!!
Toxic dose of marcaine with and without epi
without 175
with 225
Blake orthotic?
Inverted rear post for rearfoot varus
How long can a ligament lengthen before being torn?
6-8%
Multiple enchondroma with and without hemangiomas?
Maffuci syndrome (hemangiomas)
Vs
Olliers disease (without)
What is Bowens disease?
squamous cell carcinoma in situ
Name the neuromas in proper order
1 joplin 2 Housers 3 Heuters 4 Mortons 5 Iselens
What genetic disease places a patient at risk for pseudomonal infection?
Cystic fibrosis
What is a normal NCV test speed?
Normally >40 mps
Immunosupressant drug used in transplant patients?
Tacrolimus
What proteins are broken down with gout?
Purines
What is used to test for Sjorgrens?
The Swermer test in which a piece of litmus paper is put into the eye to test for tears.
A true Limb Length Discrepancy requires a __mm deficit to cause significant biomechanical problems
5mm
What is the dose for oral vancomycin?
125 PO q6
Dose for bactrim single strength vs double?
160 TMP single strength
800 TMP double strength
What is the normal uric acid level?
2-7 in females
3-8 in males
These oral hypoglycemic agents work on decreasing insulin resistance at the peripheral receptor site of insulin.
Thiaglitazones
Give the dose of the following drugs Fortaz – Aztreonam – Timentin – Ciprofloxacin – Aminoglycosides Gentamicin & Tobramycin: Amikacin: Imipenem – Zosyn –
Fortaz – 2 g IV q12h Aztreonam – 1 g IV q8h Timentin – 3.1 g IV q4-6h Ciprofloxacin – 400 mg IV q12h or 250-750 mg PO BID Aminoglycosides Gentamicin & Tobramycin: 3-5 mg/kg q8h Amikacin: 15 mg/kg q8h Imipenem – 500 mg IV q8h Zosyn – 4.5 g IV q8h
Describe the resnik classification
I. Superficial/cutaneous, usually visible without signs of infection
II. Subcutaneous or articular without soi
IIIA. SubQ or articular with soi
IIIB. Bone penetration without soi
IV. Bone penetration with known osteomyelitis
Give the Patzaki classification and its corresponding risks of infection
Zone 1: met necks and distal risk of OM: 50%
Zone 2: Met necks to TMTJ Risk of OM: 17%
Zone 3: Calcaneus Risk of OM: 33%
What bar is used to correct club foot and what angle is it set at?
The dennis brown bare set at a 70 degree angle
What are the indications for a TTC nail?
Talar AVN STJ and Ankle arthritis Pantalar fusion Failed TAR Trauma
What is the working length of a TTC nail?
The working length of an IM nail is that length of the nail that transmits the loads from the proximal to the distal segments of the bone. In a locked nail, with no friction between the nail and the bone, the working length of the nail is the distance between the proximal and distal locking bolts.
Classification for Friebergs Infarction?
Smilies
Stage 1: epiphyseal fracture that is typically not visualized on radiograph; with or without joint space widening
Stage 2: metatarsal head begins to flatten as the dorsal aspect of the joint continues to deteriorate. This is the hallmark characteristic of Freiberg’s which can be seen on x-ray.
Stage 3: structural compromise of the metatarsal head resulting in central joint depression from subchondral bone collapse.
Stage 4: loose bodies can be seen around the periphery of the joint; these represent the fracturing of the medial and lateral projections.
Stage 5: complete degeneration (arthrosis) of the MPTJ representing the end point of the condition
What is Felty Syndrome?
A childhood form of severe rheumatoid arthritis, splenomegaly, and leukopenia
What is mycosis fungiodes?
A cutaneous T cell lymphoma that resembles eczema or psoriasis
DOC for human/dog/cat bites?
Augmentin
Describe the treatment plans for a superficial infection
Mild
Moderate
Severe
Mild: >0.5cm but < 2cm of erythema very superficial treat with 2-4 weeks of oral abx
Moderate: >2cm of erythema and containing the subq layers. Treat with 2-4 weeks of oral abx
Severe: +2 signs of SIRS with a localized infection treat with 2-4 weeks of parenteral or oral abx.
Describe the abx regimine IDSA for bone infections
No bony infection 4-6 days of PO abx
Mild bony infection 2-4 weeks PO or IV
Osteomyelitis with viable bone 2-4 weeks IV then switch to PO
Osteomyelitis with nonviable bone 4-6 weeks abx starting parenteral
Brodsky classification with the most common form?
1: Lis franc variant most common 27-60% prevelance
2: Chopart 30-35% prevelant
3: Ankle joint 9% prevelance
4: Multiple combinations
Type 5: Forefoot
Name some anaerobic bacteria
Clostridium
Peptostreptococcus
Bacteroides
Antibiotic reccomendations for an IDSA mildly infected wound
Mild: 2+ manifestations of infx with >.5cm but <2cm of erythema.
Limited to skin and sub q
Treat with: oxacillin, nafcillin, clindamycin, keflex, bactrim, augmentin, levo
Antibiotic treatment for a moderately IDSA infected wound
+2 signs of infection
>2cm of erythema or cellulitis involving the deep structures.
Bactrim, Augmentin, Levo, or levo/clinda
cephuroxime, zyvox + aztreoam, levo
Antibiotic treatment for a severely infected wound IDSA
Patient with SIRS and infx site Primaxin Zosyn Cipro+clinda Vanco + fortaz
Which three abx can be used to cover all bases?
Vanco
Aztreonam
Flagyl
What type of bacillis is clostridium tetani?
A gram positive raquet shaped bacillus.
Releases exotoxin causing a pre-sympathetic blockade.
Triad of tetanus?
Aphagia
Risus Sardonicus
Trismus
Dose for the tetanus toxoid and immunoglobulin?
The toxoid is 0.5 mL
The immunoglobulin is 250-300 units
What is the mangled extremity score based on?
Skeletal/Soft tissue injury
Shock
Limb ischemia
Age
If >7 then one must consider an increased likelihood of amputation.
What’s the mechanism of action for a Stewart I injury?
Internal rotation of the forefoot while the fifth metatarsal remains on the ground.
Creates a fracture at the metataphyseal diaphyseal junction.
What is the mechanism of injury for a Stewart 2 injury?
Internal rotation of the forefoot with a hypertonicity or flexure of the peroneus brevis resulting in an intrarticular avulsion fx.
ORIF if over 5 mm
What is the normal Hibbs angle?
135-140 degrees
What is the PO dose for vancomycin?
125 q6
How do miglitol and acarbose work?
Prevent sugar uptake by competing with amylase in the pancrease.
How do thiazolidenaids work?
These work by increasing peripheral sensitivity to insulin.
Known as rosaglitazone.
What causes reiters syndrome?
Chlamydia!
Most common causes of viral arthritis?
hepatitis B
Rubella
Mono
Most common cause of a haglunds deformity?
Rearfoot varus
This is a talonavicular wedge arthrodesis. The TA is routed under the navicular and attached to the spring ligament. Name
Lowman procedure
What do you give a patient that is constipated?
Docolax, or Colase 50mg
Mattles test
Foot should be plantarflexed with patient prone and knee at 90 degrees
Simmonds test?
Foot should be plantarflexed with patient laying prone
Toygars skin angle?
Normally should be 110-125 degrees.
Increases to 130-150 with a rupture.
NAme the five augmented open repair types for achilles tendon ruptures
Lynn: Fanned out plantars
Silverskold: 1 strip of gastrocnemius aponeurosis brought down and rotated.
Lindholm: Two strips of gastroc brought down and rotated.
Bug and Boyd: Utilizes the fascia lata
V-Y lengthening of the gastroc with FHL reinforcement and possible graftjacket/pegasus.
ADC VANDLMAX
Admission Diagnosis Condition Vitals Ambulatory Status Nursing orders Diet Labs Medications Ancillary X-ray/imaging.
Normal BMP
Na: 135-145 Cl: 95-105 BUN:5-20 Glucose: 120 K: 3.5-5 CO: 28-32 Creat: .5-1.5
CMP adds ALT,AST, Calcium, procalcitonin,
What needs to be taken into consideration when correcting hyper or hyponatremia?
Both of these conditions require care as rapid correction of either can lead to brain injury.
How can one lower potassium levels?
May see peaked T waves on EKG with prolongation of the PR interval.
Increase the cellular uptake via:
- Insulin 10-20 units + glucose 50g IV
- IV sodium bicorbonate (3 ampules in 5% dextrose)
- Albuterol (5-10mg nebulized over 30-60 minutes)
Increase potassium excretion:
- Loop diuretics
- Thiazide diuretics
Dialysis
Calcium gluconate
What GFR indicates chronic kidney disease?
Which indicates failure?
GFR <60 is chronic kidney disease
GFR < 15 indicated kidney failure
Which two bacteria can cause a fever shortly after surgery?
Group A strep
Clostridium
Why must one be careful to diagnose fever in dialysis patients?
They tend to run one degrree cooler
A fever in them is 100.5 degrees instead of 101.5
Diagnostic tests for DVT?
Duplex ultrasound
Contrast venography
D-dimer >500
Impedence plethesmography
Dose for unfractionated heparin?
LAw of 80-18
80mg/kg bolus
18 mg/kg per hour until PTT is >45 <70
PTT q6h
What is the dose for enoxaparin?
1mg/kg q12 subq
What is the warfarin dose?
10mg or 7.5 mg PO q24h
INR 2.5 and maintain for 3-12 months following DVT.
Diagnostic tests for PE?
Pulmonary angiography
Spiral CT
VQ scan
CXR
Treatment for PE?
Urokinase 4,400 units/kg IV then 4,400 units/kg/hr for 12 hours.
Streptokinase 1.5 million units IV over 60 minutes.
Tensile strength of vicryl at 14 days?
65%!
What type of foot is related to edwards syndrome?
A flat foot
AKA pes planus
What bacteria causes rheumatic fever?
Strep Pyogenes
Defined by the JONES criteria
What type of hypersensitivity is RA related to?
A type III hypersensitivity
AKA an immune complex disorder
Earliest sign of sepsis?
cutaneous vasodilation
When would a bone scan be falsely positive?
In peripheral vascular disease
strawberry allergies are most closley related to what drug?
Codeine
Treatment mnemonic for acute MI
MONAB Morphine Oxygen NO Aspirin Beta blockers
