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Surgery > subs shelf study 2/8/17 > Flashcards

subs shelf study 2/8/17 Flashcards

1
Q

define open fracture

A

communicates with outside world
bone can break skin…
or can get bullet shot…

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2
Q

fracture patterns from low to high energy

and mechanism

A 
Avulsion – tensile
Spiral – torsion
Transverse – bending
Oblique – bending with compression
Segmental/Comminuted – combined
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3
Q

define segond fracture

A

Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently (~75% of cases) associated with disruption of the anterior cruciate ligament (ACL

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4
Q

bending with compression causes what kind of fracture

A

oblique fracture

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5
Q

define segmental fracture

A

several large bone fragments separate from the main body of a fractured bon

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6
Q

compartment syndrome = no blood in or no blood out?

A

no blood out

-veins compress first

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7
Q

most sensitive exam finding for compartment syndrome

A

pain out of proportion for exam
and pain w PASSIVE STRETCH
-less sensitive are pallor pulseless poikilothermia paresthesias

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8
Q

common fracture locations causing vascular injury

A

clavicle - subclavian
supracondylar (peds) - brachia
knee dislocation - popliteal

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9
Q

which is more common in ortho fx / disloc… vascular or nerve inj

A

nerve

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10
Q

nerve injury = physiologic disruption called

A

neuropraxia

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11
Q

nerve injury w axonal disruption but intact epineurium called

A

axonotmesis

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12
Q

nerve transection called

A

neurotmesis

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13
Q

common nerve injuries in ortho

A
  • humeral shaft fracture - radial nerve - wrist drop
  • knee dislocation - peroneal nerve - foot drop
  • hip dislocation - sciatic nerve, peroneal division
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14
Q

common sites of heterotopic ossification in ortho

A

brachialis - distal humerus fracture
quadriceps - contusion
hip abductors - surgical dissection

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15
Q

weakest structures most prone to ortho injury according to age

A

peds - physes
adults - ligaments
elderly - bone

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16
Q

define degloving

A

A degloving injury is a type of avulsion in which an extensive section of skin is completely torn off the underlying tissue, severing its blood supply

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17
Q

define mechanism of stress fracture

A

Repetitive loading below endurance limit

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18
Q

additional injury to rule out if scapular fracture from big fall

A

pneumothorax

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19
Q

phases of bone healing

A

vascular
metabolic (4-6 wks post fx)
mechanical (remodeling under stress…bone needs Some stress to heal… don’t give Too much stability)

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20
Q

orthopedic emergencies

A

Compartment syndrome
Dislocations of major joints
Fractures with vascular injury
Open fractures

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21
Q

class of drugs that most commonly contributes to fracture nonunion

A

nsaids

need inflammation to heal…

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22
Q

why ortho traction after trauma

A

to keep muscles from shortening and making reduction difficult

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23
Q

how to treat infected hardware once glycocalyx forms

A

id org and give approp abx

REMOVE hardawre when fx healed… once glycocalyx forms you will never be rid of it so take it out

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24
Q

when does ligamentum teres stop supplying blood to femoral head

A

about age 4

according to Dr. Kessler

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25
Q

why fix clavicle fracture with tibial fracture

A

for crutch use

otherwise in most cases clavicle fractures are not fixed

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26
Q

“shoulder separation” refers to what joint

A

glycocalyx

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27
Q

conoid and trapezoid ligaments attach…

A

clavicle to coracoid

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28
Q

Distal humerus fracture risk this nerve

A

ulnar nerve palsy w Distal humerus fx
(radial with humeral shaft,
axillary with humeral neck)

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29
Q

dinner fork deformity aka

A

colles fx

(distal forearm

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30
Q

bones predisposed to avn

A

femoral neck fx
talar neck fx
proximal humerus fx

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31
Q

ortho treatment for complex regional pain syndrome

A

extensive physical therapy…

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32
Q

tf

swelling and erythema can be symptoms of complex regional pain syndrom

A 
t
Abnormal sympathetic tone
Pain
Stiffness
Swelling
Erythema
etc...
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33
Q

when to sling vs fix shoulder disloc

A

usually sling

fix wide displacement, open fx, associated fx (ipsilateral or lower extremity… crutches)

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34
Q

manage proximal humerus fx

A

sling rom if simple minimal displacement

orif if displaced

hemiarthroplasty if comminuted

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35
Q

ligaments of clavicle shoulder joint

A

acromioclavicular ligament

conoid and trapezoid ligaments (coraco-clavicular ligaments)

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36
Q

treat shoulder dislocation

A

closed reduction
2-3 weeks immobilized
early rehab
surgery for athletes / high demand young pts

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37
Q

nerves at risk in supracondylar humerus fracture

A

AIN

Ulnar

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38
Q

manage supracondylar humerus fracture

A

immediate referral to orthopod (neurovascular risk)

-for closed reduction, percutaneous pinning, and 4-6 wks casting

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39
Q

3 phases of wound healing

A 
few days (inflammation 4-6 days)
few weeks (proliferation 4-24 days)
few months-years (remodeling 21 days - 2 years)
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40
Q

bacterial load of wound infection

A

10^5

less than that just contamination

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41
Q

why not do elevtive surgery on a smoker

A

impaired wound healing (nicotine vasoconstricts and CO… poisons… reduced oxygen)
eg nose job will just necrose their face

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42
Q

tf

keloid = hypertrophic scar

A

FFFF
keloid is Outside borders or original injury, w preference for darker skin, usualy recur if excised (excision typically deferred for 12-24 mos)

-hypertrophic scar is Within borders of orignial injury w no skin preference, usually improve with excision if pain or contractures (excision typically deferred for 12-24 mos)

(both from excessive inflammation, disorganized collagen deposition, too much tension, secondary intension

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43
Q

healing by primary vs secondary intention

A

primary (closed) - edges brought together, no tissue loss

secondary (open)- edges not brought together, left open

44
Q

cover cat or dog bite for infection

A

augmentin (amox clav)
for pasteurella multocida
BUT coag neg staph (epi, saphro) still most likely to cause infection of any skin wound
*can close dog bite, abx optional
*never close cat bite, always abx (deeper puncture)

45
Q

treat dog vs cat bite

A

dog - can loosely close, abx optional

cat - Never close (deep puncture, can heal superficially and not deep and more likely to get infected), Always abx (augmentin to cover pasteurella multocida… and coag neg staph skin)

46
Q

best finger to lose

A

actually index finger

… just for pointing… don’t want to lose thumb… ring and pinkie for power grip…

47
Q

what is an unna boot

A

4 layer dressing for compression

48
Q

bug in human bites

eg fight bight from punching teeth

A 
eikinella corrodens (anaerobic)
-need to be washed out
49
Q

what limbs can you replant vs not

A

can replant UE forearm and below

NEVER lower extremity…

50
Q

which needs debridemnt, wet or dry gangrene`

A

wet

dry is stable… needs vascular surgery to get flow back to it…

51
Q

common site for venous stasis ulcer

what venous problems involved

A

medial malleolus

-venous htn and venous valvular incompetence

52
Q

reconstructive ladder

A 
secondary intention
primary closure
skin graft
local flap
regional flap
free flap (not local, completely disconnected / transplanted)
53
Q

difference graft vs flap

A

graft has no blood supply

flap does

54
Q

acetic acid household item

A

vinegar

55
Q

how are resting tension lines oriented compared to muscles

A

perpendicular to contraction
so perpendicular to fibers

e.g. crows feet orbicularis oris

56
Q

what is a wet to dry dressing

A

moist gauze applied - saline, acetic acid (vinegar) for contaminated wound or clean, dakins solution (bleach) for necrotic or infected

allowed to dry and then changed

57
Q

stages of skin graft incorporation

A

day 1-2 plasmatic imbibition - drinking plasma by passive absorption
day 3-4 inosculation - cut capillaries in graft find recipient bed vessels
day 5 - capillary ingrowth

58
Q

major risks to grafts

A

fluid - hematoma/seroma
infection
shear force

59
Q

full thickness skin graft donor sites

A

supraclavicular - for face grafts
groin - for most other full thickness grafts
forearm…

60
Q 
full versus split skin graft
dermis
primary contraction
secondary contraction
take rate
cosmesis
A

full - all epidermis and Dermis, more primary contraction (as soon as removed - has all dermal elements / myofibroblasts, more elastin), less secondary contraction (as graft heals), lower take rate, better cosmesis (better for face)

split - some dermis, less primary, more secondary, higher take, worse cosmesis

61
Q

split thickness skin graft donor sites

A

thigh buttock back

62
Q

best cartilage graft donor sites

A

ear (concha - hollow next to canal)
rib
nasal septum

63
Q

why do fat transplants work

A

aspirated fat has stem cells that allow transfer and take in new recipient site

64
Q

primary vs secondary skin graft contraction

A

primary - as soon as taken out of body (full thickness with dermis - more elastin and myofibroblasts…)

secondary - occurs as graft heals in new site (split thickness, less thick more secondary contraction…)

65
Q

best mgmt of pressure ulcers

A

PREVENTION

66
Q

duration of sustained pressure for pressure ulcer to develop

A

2 hours sustained pressure

67
Q

flap classification

A 
based on blood supply
type 1 - single vascular pedicle
type 2 - dominant and minor pedicles
type 3 - 2 dominant pedicles
type 4 - segmental
type 5 - segmental and dominant
68
Q

golden rule of LE wound reconstruction

A

upper 1/3 - gastroc flap
middle 1/3 - soleus flap
lower 1/3 (ankle) - free flap

69
Q

best cream for simple burns

A

silvadene

70
Q

erythema without skin breaks is what type of burn

A

first degree

71
Q

burn eschar around chest causes what? requires what?

A

respiratory distress

escharotomy

72
Q

total body surface area risk for burn wound infection

A

^30% tbsa

73
Q

primary blood supply to breast

A

internal mammary artery perforators

IMA perforators

74
Q

benign skin lesions

A
  • seborrheic keratosis - most common benign epithelial tumor, “stuck on”
  • keratocanthoma - umbilicated dome-shaped red-tan nudule rapidly growing to average 2.5 cm within weeks
75
Q

breslow depth

A

melanoma staging
v.75mm in situ

.76-1.5mm through bm into papillary dermis

1.6-4mm into reticular dermis

^4mm into subq

76
Q

liposuction is for treatment of…

A

LOCALIZED adiposity

–pannus abdominoplasty for improvement of hygeine…

77
Q

most common skin cancer

A

BCC

78
Q

best way to determine tx for melanoma

A

FULL excisional bx to determine depth

79
Q

most common benign skin tumor

A

sborrheic keratosis

80
Q

when to repair a lip
goals
when to repair a palate

A

lip - 3 mos
goals - restore
palate - 9 mos
orthognathic surgery (eg of mandible to catch up after palate repair slowed growth) - 15yo ish

81
Q

sensation to doral aspect of tip of index finger

A

median n

82
Q

what should be ruled out before surgical tx of mandible fracture?

A

c-spine injury

83
Q

check what physical exam finding when evaluating zygomatic fracture

A

eom - check for entrapment

84
Q

what is important in repairing orbital floor fractures

A

reconstruct floor and walls to prevent exopthalmos

85
Q

most important function of facial nerve

A

close eyelids

86
Q

fever in viral vs bacterial pharyngitis

A

viral v101 not too high

^101 think bacterial

87
Q

where to place needle/incision to tx peritonsiallar abscess

A

superior and medial to abscess, in bulge of soft palate superior and medial to abscess… toward uvula

88
Q

tf

mediastinitis is a complication of bacterial tonsilitis

A

t

down fascial plane…

89
Q

bugs in epiglottitis

A

BACTERIAL
H flu B HiB
(down w vaccine… but other bugs can still cause…)

90
Q

function of pterygoids

A

open jaw

91
Q

neck cyst by location

A

midline - thyroglossal duct cyst
(remnant from foramen cecum, near/through hyoid)

lateral - branchial cleft cyst (2nd cleft is most common)
-or salivary gland infection (Staph aureus)

92
Q

malocclusionin head trauma refers to

A

misalignment of mandible / maxilla to one another

aka misalignment of bite

93
Q

lefort fracturs are fractures of…

A 
the maxilla
(various types)
94
Q

advantages vs disadvantages of cricothyrotomy for tx of airway emergency… vs tracheotomy?

A

hemorrhage less common
easier to identify prominent cartilage
less risk of esophageal injury

but higher risk of subglottic stenosis

95
Q

which comes first, rhinitis or sinusitis

A

rhinitis (inflammation of nasal passageways)

then suniusitis - sinuses

96
Q

ostiomeatal complex

A

links the frontal sinus, anterior and middle ethmoid sinuses, and the maxillary sinus to the middle meatus that allows air flow and mucociliary drainage

97
Q

tf

reactive airway dz = asthma

A

f
reactive aireway dizease = exacerbation of lower airway problem (eg asthma) when chronic rhinosinusitis worsens… can treat by relief of rhinosinusitis to some degree instead of just treating asthma…

98
Q

what bug infects w kartagener’s

A

pseudomonas

99
Q

bugs in nose

A

coag neg staph
then staph a
then much less anaerobes, step pneumo, mixed

100
Q

person choking, what to do

person found down, what to do

A

heimlich, back blow, finger sweep

jaw thrust, gauze to pull tongue forward

101
Q

rinne and weber

A 
Rinne test (mastoid process)
Normal or positive if AC > BC
Abnormal or negative if AC ≤ BC
Weber test (forehead)
If SNHL, lateralized to better hearing ear
If CHL, lateralized to worse hearing ear
102
Q

number 1 pathogen in otitis externa

A

pseudomonas

103
Q

otitis media bugs

A 
same as sinusitis bugs
step pneumo
hflu
m catarrhalis
gas
(staph a rare)
104
Q

kidney stone compositionby most frequent

A 
calcium oxalate
struvite
calcium phosphate
uric acid
cysteine
miscellaneous
105
Q

treat kidney stone

A
  • medical mgmt (80% will pass spontaneously with support)
    • metabolic (urate or cysteine) stones always deserve a medical attempt
  • lithotripsy, endoscope, laser are all surgical options…
106
Q

lumbosacral myotomes

A 
L2 - hip flexors
L3L4 - knee extensors
L4L5 - ankle dorsiflexors
S1 - big toe extensor
S4-5 ankle plantarflexor
anal sphincter
107
Q

key sensory dermatomes

A

c5 - shoulder
c6 - thumb/index
c7 - middle finger
c8 - small finger

t4 - nipple
t10 - umbilicus

l3 - medial thigh
l4 - knee
l5 - big toe
s1 - lateral foot
s4-5 perianal

Surgery (22 decks)

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