Surgery

Question 1

Suture with most ST reaction

Answer 1

plain catgut

Question 2

hemostasis for sickle cell patients

Answer 2

AVOID TOURNIQUETS as much as possible → hypoxia and increased sickling

try local anesthetic (least invasive)

Question 3

sickle cell risk of complications

Answer 3

sickle cell patients are at higher risk than general population for intra-op and post-op surgical complication

Question 4

OM cause in sickle cell patients

Answer 4

SALMONELLA

Question 5

common complication of PIP RESECTION

Answer 5

Flail toe → toe instability and catching on socks or shoes

Question 6

MC complication following preaxial polydactyly repair

Answer 6

hallux varus

(usually w/ short 1st met)

Question 7

ankle tourniquets (vs thigh)

Answer 7

• greater NV damage
  
  • (bc of less ST and adipose tissue around NV structures)
• requires shorter duration than thigh tourniquet

Question 8

ankle tourniquet pressure:

rule of thumb

Answer 8

should be set ~100 mmHg higher than systolic BP;

BUT should NOT exceed 250 in adults, or 150 in a child

Question 9

thigh tourniquet pressure:

rule of thumb

Answer 9

may be elevated to 300-350 mmHg in adults due to greater ST coverage and larger girth of the limb

Question 10

maximal stress a material can undergo w/o permanent deformation

Answer 10

elastic limit

Question 11

process of a solid material to slowly and permanently migrate or deform while mechanical stresses that are below yield strength for the material

Answer 11

creep

Question 12

production of corrosion resistance by a surface of reaction products (this layer is normally an oxide layer, which is impervious to gas and water)

Answer 12

passivation

Question 13

amount of deformation that a tensile stress or load will produce

Answer 13

elongation

Question 14

force that attempts to pull apart or stretch a material

Answer 14

tensile stress

Question 15

measure of stiffness of a substance along its elastic range;

(stress load / amount of strain or deformation)

Answer 15

modulus elasticity

Question 16

ratio of change in dimension that takes place in a material under stress

Answer 16

strain

Question 17

3 phases of wound healing

Answer 17

1. inflammatory or substrate
2. proliferative or fibroblastic
3. remodeling or maturation

Question 18

vimentin:

what is it and when is it secreted

Answer 18

structural filament protein involved in wound healing (inflammatory phase)

Question 19

wallerian degeneration:

phase of nerve lesion

Answer 19

an active process of degeneration that results when the nerve fiber is cut or crushed and the part of the axon distal to the injury degenerates

occurs during AXONOTMESIS stage;

Question 20

best sx for CP patient w/ HAV

Answer 20

1st MPTJ fusion (McKeever);

due to equinus, poor toe clearance during swing; stiff-knee gait 2° to rectus femoris dysfunction → toe drag at initial point of stance

Question 21

ligation method:

small blood vessels during debridement of SubQ tissue

Answer 21

cauterized by bipolar cautery

Question 22

ligation method for vessels larger than 2-3 mm

Answer 22

ligated with liga-clips

liga-clips are least reactive foreign body material to accomplish this; if suture is used, should be small diameter monofilament

Question 23

best method to evaluate for equinus in cerebral palsy (CP) patients

Answer 23

qwith patient under general anesthesia;

(is the best way)

Question 24

following successful callous distraction w/ an ex-fix,

how long should frame be kept on to ensure complete ossification?

Answer 24

2-4x the time it took to complete the lengthening

patient is encouraged to weight bear to stimulate bone healing, as after the distraction period has been completed, the distraction gap is ossified incompletely

Question 25

5 modes of plate functions

Answer 25

• compression
• protection
• buttress
• tension band
• bridging

Question 26

mechanism of variable pitch compression screws

Answer 26

wider pitched threads distally entering the bone faster than the trailing threads →

providing gradual compression as the screw is advanced

Question 27

MOI: of lateral talar process fracture

(snowboarder’s fracture)

Answer 27

Dorsiflexion and External Rotation

sudden axial force traveling through the foot when the foot is dorsiflexed and externally rotated →