Board Review part II Flashcards
1
Q
Dupuytrens cords that cause contractures at the PIP joint
A
Central cord, Spiral cord, Lateral cord
2
Q
Dupuytrens cords that cause contractures at the DIP joint
A
Lateral cord, retrovascular cord
3
Q
Dupuytrens cords that cause contractures at the MCP joint
A
Preteninous cord
4
Q
Dupuytrens cord that prevents abduction of fingers
A
Natatory cord
5
Q
The nerve bifucates ____ to the artery in the palm
A
distal
6
Q
The digital nerve is ____ to the artery in the finger and ___ to the artery in the palm
A
volar to the artery in the palm and dorsal to the artery in the palm
7
Q
In the proximal forearm, the radial artery runs between the ___ and ___ muscles
A
brachioradialis and pronator teres
8
Q
At the wrist crease, the radial artery lies superficially between tendons ___ and ___
A
APL and FCR
9
Q
Thenar muscles
A
Median nerve innervated
Opponens pollicis
Abduction pollicis brevis
Flexor pollicis longus (deep is ulnar innervated)
10
Q
Methods for maintaining elbow extension in quadriplegia
A
- deltoid to triceps transfer with free graft
2. Biceps to triceps for C5-6 tetraplegia
11
Q
Treatment of thumb in palm deformity
A
associated with cerebral palsy: release spastic muscles and stabilization of the joint
- FPL abductoplasty (FPL to APB + fusion/tenodesis thumb IP)
- Flexor/pronator slide
12
Q
Treatment of wrist flexion contracture and clenched fist deformity in cerebral palsy and stroke
A
- botox injections
- Surgery if that doesn’t work- transfer flexors to different levels of forearm, fractional lengthening, FDS to FDP transfer
13
Q
Restore thumb key pinch in low level quads
A
thumb IP fusion with release of pulley and tenodesis of FPL to volar radius, tenodesis of EPL to dorsum of thumb metacarpal
14
Q
Where is parona’s space?
A
deep flexor compartment of the forearm - PQ, FPL, FDP
15
Q
AIN innervated hand
A
FPL, PQ, 2/3 FDP
16
Q
Median innervated hand
A
LOAF
17
Q
Ulnar innervated hand
A
- all intrinsics except radial 2 lumbricals
- deep head of FPB, hypothenars
- 4/5 FDP
18
Q
Radial innervated hand
A
ECRB/ECRL
19
Q
PIN innervated hand
A
All extensors except ECRB/ECRL
20
Q
what are the deep forearm extensors?
A
anconeus, supinator, EIP, EPL, EPB, APL
compartments 1, 3, 4
21
Q
What are the superficial forearm extensors?
A
ECU, EDM, EDC, ECRB, ECRL, BR
compartments 2, 4, 5, 6
22
Q
Treatment for volkmann’s contracture
- mild: FDP 3/4
- moderate: FDP and FPL
- severe: all flexors
A
Mild: excision of scar cord on muscle bellies
Moderate: decompress median and ulnar nerves, excision of cords, flexor-pronator slide, then tendon transfers (ECRB to FDP) (BR or ECU to FPL)
Severe: innervated gracilis free flap
23
Q
Proximodistal limb growth controlled by
A
AER (apical ectodermal ridge)
- dyfunction = short limb
24
Q
Radio-Ulnar limb growth controlled by
A
Zone of polarizing activity (sonic hedgehog protein)
25
Dorsal-ventral limb growth is controlled by
WNT7 signaling pathway which produces LMX1 (dorsal), EN1 blocks wnt (ventral)
26
Innervation to the lateral lower fat pad of the eye?
Zygomaticofacial nerve
27
Innervation to the upper lateral eyelid?
Lacrimal nerve via lateral palpebral branch
28
Innervation to the medial upper and lower eyelid
Infratrochlear nerve
29
4 stages of perilunate instability pattern
1. Scapholunate disruption (DISI)
2. Dorsal dislocation of capitate
3. Lunotriquetral disruption (VISI)
4. Volar dislocation of lunate
30
Normal scapholunate angle?
DISI?
VISI?
Normal is 30-60 degrees
DISI < 30 degrees
VISI > 60 degrees
31
Lateral calcaneal artery is the terminal branch of what artery?
lateral calcaneal artery is usually the terminal branch of the peroneal artery but occasionally may arise from the posterior tibial artery
32
Tendon transfer for foot drop
posterior tibial tendon to anterior tendon transfer
33
Genitofemoral nerve
proximal portion of the thigh about the femoral triangle just lateral to the skin that is innervated by the ilioinguinal nerve. Nerve injury may result from hernia repair, but injury to this nerve is rare
34
Ilioinguinal nerve
from the fusion of T12 and L1 nerve roots and pierces the transversus abdominis and internal oblique muscles.
- sensory to the pubic symphysis, the femoral triangle, and either the root of the penis and anterior scrotum in the male or the mons pubis and labia majora in the female
- Symptoms include paresthesia of the skin along the inguinal ligament. The sensation may radiate to the lower abdomen. Pain may be localized to the medial groin, the labia majora or scrotum, and the inner thigh.
35
iliohypogastric
small region just superior to the pubis. Symptoms include burning pain into the inguinal and suprapubic region
36
Lateral femoral cutaneous nerve
anterior and lateral thigh burning, tingling, and/or numbness that increase with standing, walking, or hip extension.
37
Location of the medial plantar artery
between flexor digitorum brevis and abductor hallucis
38
Location of the lateral plantar artery
lateral plantar artery runs between the flexor digitorum brevis and abductor digiti minimi
39
Location of the dorsalis pedis
dorsalis pedis artery runs between the extensor hallucis longus and extensor digitorum longus tendons
40
Medial plantar artery comes off the ... artery
posterior tibial artery. Innervation through the medial plantar nerve
41
Margins for excision of high-risk SCC?
| What is a high-risk SCC?
- 6mm to 10mm
- larger than 2 cm, invasive to fat, or in high-risk locations (i.e., central face, ears, scalp, genitalia, hands, feet).
- 4-mm margin of healthy tissue is recommended for lower-risk lesions
- Frozen sections of margins are recommended for high-risk squamous cell carcinoma and basal cell carcinoma in high-risk areas, lesions more than 2 cm, and any morpheaform basal cell carcinoma.
42
areas of thickened skin involving the forearms and hands. Telangiectasias are seen on the face and oral cavity. A review of systems discloses symptoms of heartburn and dysphagia.
CREST
- calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasias
- ok to debride if needed (different from calciphylaxis)
43
Treatment of angiosarcoma (purple plaque) on the forehead
wide local excision with reconstruction
44
Treatment of kid with purpura fulminans with DIC
activated protein C
45
Treatment of Merkel cell carcinoma
WLE and radiation (it is a radio-sensitive tumor)
46
multiple ulcerative, nonhealing wounds on the left shoulder after MRM and radiation for breast cancer
Stewart treaves
| wide local excision with reconstruction
47
Indications for MOHS surgery for BCC?
1. Recurrent or incompletely excised BCC or squamous cell carcinoma (SCC)
2. Primary BCC or SCC with indistinct borders
3. Lesions located in high-risk areas (ie, eyelids, nose, ear, nasolabial folds, upper lip, vermillion border, columella, periorbital, temples, preauricular and postauricular areas, scalp)
4. Cosmetically and functionally important areas, including genital, anal, perianal, hand, foot, and nail units
5. Tumors with aggressive clinical behavior (ie, rapidly growing, greater than 2 cm in diameter)
6. Tumors with an aggressive histologic subtype (ie, morpheaform BCC) and/or those with perivascular invasion
7. SCCs ranging from undifferentiated to poorly differentiated, and SCCs that are adenoid (acantholytic), adenosquamous, desmoplastic, infiltrative, perineural, periadnexal, or perivascular
8. Tumors arising in sites of previous radiation therapy
9. Tumors arising in immunosuppressed patients
10. Basal cell nevus syndrome patients
48
Mechanism of topical 5-FU
topical chemotherapeutic agent that directly inhibits DNA synthesis
49
MOA of imiquod
stimulates host cytokine production and induces apoptosis of tumor cells. It has been used to treat actinic keratoses, viral warts, and nonmelanoma skin malignancy
50
Bazex syndrome
multiple BCCs of the face, follicular atrophoderma of the extremities, localized or generalized hypohidrosis, and hypotrichosis,
-like gorlin but no hand pits or molar pain
51
Erythroplasia of Queyrat
arises from the squamous epithelial cells of the glans penis. It is synonymous with Bowen disease of the glans penis, is seen mostly in uncircumcised men, and represents an in situ form of squamous cell carcinoma
52
excision margin for lentigo maligna
1cm
53
Melanoma excision based on depth
In situ = 0.5cm
<1mm = 1cm
1-4mm = 2cm
>4mm = 3cm
54
Treatment for radiation dermatitis
hydrocortisone
55
What is Type 1 hypersensitivity?
Type 1 (allergy) refers to immediate release of IgE, mediated release of histamine, and other vasoactive mediators resulting in manifestation within minutes. Examples include asthma or anaphylaxis.
56
What is Type 2 hypersensitivity?
Type 2 (cytotoxic-antibody dependent) refers to binding of IgM or IgG to the target cell, which in this case is a host cell. This results in the membrane attack complex (MAC) destruction of the targeted cell. Examples include thrombocytopenia, Goodpasture, and membranous nephropathy.
57
What is Type 3 hypersensitivity?
Type 3 (immune complex–mediated reaction) refers to IgG binding to circulating antigen resulting in formation of an immune complex. These complexes can end up collecting in the vasculature, joints, and kidneys resulting in local destruction. Examples include rheumatoid arthritis, systemic lupus erythematosus, and serum sickness.
58
What is Type 4 hypersensistivity?
Type 4 (delayed type hypersensitivity) refers to the activation of TH1 helper T cells by an antigen-presenting cell. This establishes an immune response memory and when activated again, the TH1 cells activate a macrophage-mediated response resulting in cellular damage. Examples include chronic transplant rejection, contact dermatitis, and multiple sclerosis.
59
What type of hypersensitivity is immunosuppression of transplant patients trying to prevent?
Transplant patients require immunosuppression to avoid a type 4 hypersensitivity.
60
Briefly describe the 4 types of hypersensitivity:
Type 1: immediate release of IgE, mediated release of histamine, and other vasoactive mediators resulting in manifestation within minutes (asthma or anaphylaxis)
Type 2: IgM or IgM bind to host cell, cytotoxic antibody dependent
Type 3: immune complex-mediated reaction - IgG binding to circulating antigen (RA, SLE)
Type 4: delayed type; activation of Th1 helper T cells
61
order that cells show up in a wound
platelets, neutrophils, macrophages, lymphocytes, and fibroblasts
62
Describe the wound healing process
The appearance of cell types in an acute wound occurs in the following order: platelets, neutrophils, macrophages, lymphocytes, and fibroblasts, during the inflammatory phase.
- The ensuing phases of wound healing consist of inflammation, collagen synthesis, angiogenesis, epithelialization, and remodeling.
- after platelet aggregation and degranulation, chemoattractants, activation factors, and vasoconstrictors are released. An efflux of neutrophils occurs at the wound site to primarily sterilize the wound. Within 2 to 3 days, the inflammatory cell population shifts to monocytes that differentiate into macrophages, which orchestrate the repair process. Collagen synthesis occurs as circulating bone marrow-derived cells migrate into the wound and develop a fibroblastic cell function. These cells and local, activated fibroblasts synthesize and secrete the replacement collagen scar. Fibroblasts become the predominant cell type by 3 to 5 days in clean, noninfected wounds. As fibroplasia progresses, granulation tissue forms as a consequence of neoangiogenesis and the directed growth of vascular endothelial cells stimulated by platelet and activated macrophage and fibroblast products. Wound reepithelialization occurs as keratinocytes at the wound margins migrate and proliferate once epidermal continuity is reestablished. Remodeling of the resultant scar is a dynamic process that occurs slowly over months to years. Collagen deposition and degradation occur to yield a mature scar; however, maximum tensile strength of a wound reaches only approximately 80% of noninjured skin.
63
Tx bulbous tip
cephalic trim, transdomal sutures, lateral crural sutures
64
Tx boxy tip
Transdomal sutures
65
How long after isotretinoin treatment before pursuing cosmetic procedures?
6 months to 1 year
66
Mechanism of retinoids
- decrease corneocyte adhesion in the stratum corneum, resulting in reduced follicular occlusion and comedone formation.
- increases dermal collagen production and decreases degradation over 6 to 12 months of treatment.
67
Mechanism of hydroquinone
Suppresses metabolic processes of the melanocyte, specifically the inhibition of the oxidation of tyrosine to 3,4-dihydroxyphenylalanine (DOPA)
68
When to give radiation to epithelioid sarcoma of the forearm
Preoperative radiation should be administered for epithelioid sarcomas, as it will help decrease tumor size and local recurrence rates.
- Postoperative chemotherapy is appropriate for tumors that are high grade, greater than 10 cm in diameter, involve the lymph node, or are metastatic.
- Epithelioid sarcomas are usually high grade, so excisional biopsy would not be appropriate. Forearm amputation should be considered if negative margins cannot be achieved. Wide excision with negative margins is a mainstay of surgical treatment.
69
Mechanism of action of Botox
inhibits release of acetylcholine at the neuromuscular junction. may inhibit neuropeptide neurotransmitter release
70
Describe the depressor muscles of the brow
1. corrugator supercilii
2. Procerus
3. orbital portion of the orbicularis oculi
4. depressor supercilii
71
Elevator muscles of the eyelid
1. levator palpebrae muscle (parasympathetic)
2. Mueller's muscle (sympathetic)
both insert onto the tarsal plate
72
What muscles are responsible for bunny lines?
1. Levator labii superioris alaeque nasi
| 2. Nasalis
73
What are the retaining ligaments of the brow and temple?
1. Supraorbital ligamentous adhesions
2. temporal ligamentous adhesion
3. Superior temporal septum
4. interior temporal septum
74
What are the layers of the temple?
1. scalp
2. Superficial temporal fascia AKA TPF
3. Superficial DTF
4. Deep DTF
5. Temporalis
75
What structure in the temple is contiguous with the galea and the SMAS?
Superficial temporal fascia
76
What nerves supply sensation to the ear?
1. Auriculotemporal nerve (V3)
2. Great auricular nerve
3. Lesser occipital nerve
4. vagus nerve
5. Glossopharyngeal nerve
77
What is the vascular supply of the ear
1. Posterior auricular (dominant)
| 2. Superficial temporal
