vascular, dupuytrens, compartment syndrome

Question 1

normal DBI

Answer 1

> 0.7 should have sufficient flow to heal

Question 2

thrombolytics

Answer 2

may help within 3 days of thrombotic event

Question 3

raynauds definition

Answer 3

disease - no other disease process

phenomenon - associated with another disease

Question 4

raynauds treatment

Answer 4

calcium channel blocker
second line tricyclic antidepressant (amitriptyline)
botox blocks release of neurotransmitters (acetylcholine)
sympathectomy (strip vessel adventitia)

Question 5

Leriche sympathectomy

Answer 5

ligate and excise section of ulnar artery in hypothenar hammer syndrome
- removes nidus of clots

Question 6

aneuryms

Answer 6

true contain all layers of wall and result from blunt damage

false involve portion of wall from sharp/penetrating trauma

Question 7

arterial vs vein grafts

Answer 7

arterial grafts have endothelial function and produce NO and PDI1 to relax the wall
long term patency vein grafts 80%, must reverse, most common are cephalic and saphenous

Question 8

buergers disease (thromboangiitis obliterans)

Answer 8

• autoimmune
• associated with smoking
• males <40 years
• more common in middle eastern ethnicity
• prostacyclin or sympathectomy

Question 9

steal syndrome from AV fistula

Answer 9

• can be painful
• vascular surgeon can band to decrease flow through fistula or distal revascularization via arterial bypass (DRIL)
• on exam when push on fistula the blood flow improves

Question 10

etiology of dupuytrens

Answer 10

myofibroblasts and TGFb cause proliferation of more type III collagen (normally mostly type 1)

• autosomal dominant with variable penetrance
• trauma, age, smoking, DM, alcohol, phenobarbitone may induce
• free radicles -> increase IL-1 -> increase TGF-b

Question 11

bands around the neurvascular bundle

Answer 11

• graysons (ground)
• clelands (ceiling)
• lateral digital sheath (lateral)

Question 12

pretendinous cord

Answer 12

• most common
• causes skin pitting
• MCP flexion

Question 13

natatory

Answer 13

webspace contracture

Question 14

spiral cord

Answer 14

pretendinous band, spiral band, lateral digital sheath, graysons ligament.

• displace neurvascular bundle volar and midline
• flexion of the PIP joint

Question 15

ADM band

Answer 15

superficial to NVB so not displace

Question 16

retrovascular cord

Answer 16

DIP contracture

Question 17

dupuytren prevelence

Answer 17

RF>SF>MF>IF>thumb

Question 18

garrod node

Answer 18

dorsal kuckle pad node in duputryens diathesis

Question 19

treatment indication dupuytrens

Answer 19

MCP >30 degree contracture

PIP >15 degree contracture

Question 20

xiaflex

Answer 20

collagenase from clostridium histolyticum

• catalytic activity against collagen I and III mostly but not type IV (basement membrane and perineurium)
• can manipulate 1-7 days after injection

Question 21

CORD study

Answer 21

64-70% improved
at 5 years 50% recurrence (comparable to surgery) (recurrence defined as >20 degree worsening)
recurrence 66% PIP and 39% MCP
>95% adverse events (edema, lymphadenopathy, skin tears)
85-93% develop anticollagenase antibodies
at 2 years needle aponeurotomy better recurrence than collagenase

Question 22

fasciectomy for dupuytrens

Answer 22

• recurrence (more than 20 degrees worsening) 50% at 5 years
• primary surgery 2-3% NVB injury
• ## secondary surgery 10x risk NVB injury

Question 23

hypoxia

Answer 23

4 hrs - nerve death
4-8 hrs - muscle death
>8-10 hrs compartment syndrome too late to salvage with fasciotomies and end up with nonhealing wound

Question 24

volkmans ischemic contracture

Answer 24

• intrinsic minus deformity
• need radical tenolysis
• extensor may be spared for transfer
• free gracilis is an option

Question 25

high pressure injection injury

Answer 25

• tetanus, antibiotics, irrigation and debridement
• injected material with track down the NVB
• plan repeat look at 48 hours
• 30-50% amputation rate
• worse outcomes if longer than 6 hours to OR
• worst organic solvents (paint thinner, diesel, gasoline, oil)
• oil based pain worse than latex

Question 26

snake family

Answer 26

Elapids = coral. cobra, mamba, marine
Crotalinae = vipers, rattlesnakes, cottonmouth, copperhead

Question 27

crotalinae snakes

Answer 27

• most snake bites in US
• venom has hemotoxin, neurotoxin, venotoxin, cardiotoxin and necrotizing factors
• onset within 10 minutes of bite
• may require fasciotomy

Question 28

CroFab

Answer 28

polyvalent antivenin manufactured using venom from four types of pit vipers found in North America: cottonmouth, Mojave rattlesnake, Eastern rattlesnake, and Western rattlesnake (which is responsible for 98% of the venomous snake bites reported in the United States)

Question 29

coral snake markings

Answer 29

Coral snakes have adjacent red and yellow bands and can be distinguished from similarly appearing non-venomous snakes by the following useful saying: “Red touches black, safe for Jack. Red touches yellow, kills a fellow.” The Eastern coral snake, which is endemic to the southeastern United States, can be treated by a recently developed antivenin specific to coral snakes.

Question 30

stonefish

Answer 30

• Carribbean and Florida, Indo-Pacific
• spine stings
• severe pain and swelling up the limb, sweating nausea, syncope
• immersion 40-42 degree water to denature venom