Crozer- Clinical Podiatry

Question 1

clinical patterns of tinea pedis? common infecting org?

Answer 1

chronic (moccasin/papulosquamous-trichophyton rubrum
acute (interdigital/vasicular)-trichophyton mentagrophytes
Ulceration-trichophyton mentagrophytes w pseudomonas or proteus

Question 2

patterns of onychomycosis? infecting org?

Answer 2

Distal subungual onychomycosis (DSO) ~ 90%
 Most common
 Trichophyton rubrum
Proximal subungual onychomycosis (PSO) ~ 1%
 Seen in immunocompromised patients
 Trichophyton rubrum
Superficial white onychomycosis (SWO) ~ 10%
 Trichophyton mentagrophytes
Candidal onychomycosis
 Candida albicans

Question 3

what test confirms tinea pedis or onychomycosis

Answer 3

KOH prep of skin/nail. septate

Question 4

how does lamisil work

Answer 4

inhibits ergosterol syn

Question 5

whats phenol

Answer 5

carbolic acid

Question 6

if pt allergic to all locals what can you use during a nail avulsion?

Answer 6

Saline block (pressure block)
pressure cuff
benadryl block

Question 7

causes of hallux varus

Answer 7

Congenital
 Clubfoot
 Metatarsus adductus
Traumatic
 MPJ dislocation
 Fracture
Iatrogenic
 Overcorrection of intermetatarsal angle
 Excessive resection of medial eminence or staking the head
 Fibular sesamoidectomy
 Overaggressive capsulorrhaphy
 Bandaging too far into varus

Question 8

Staking the head

Answer 8

excessive resection of 1st met head-> varus

Question 9

flexor stabilization hammertoes

Answer 9

Most common
 Stance phase
 Flexors overpower interossei
 Pronated foot

Question 10

extensor substitution

Answer 10

Swing phase
 Extensors overpower lumbricals
 Anterior cavus, ankle equinus, anterior compartment muscle weakness

Question 11

Flexor substitution

Answer 11

Least common
 Stance phase
 Deep compartment muscles overpower interossei
 Supinated, high arch foot or weakened Achilles

Question 12

whats the silfverskiold test

Answer 12

Determines gastroc vs. gastroc-soleus
Positive test
 Dorsiflexion of the foot to neutral or beyond with the knee in flexion
 Gastroc equinus
Negative test
 Lack of dorsiflexion of the foot to neutral with knee in flexion and in extension
 Gastroc-soleus equinus

Question 13

Lachman test

Answer 13

Determines if there is a plantar plate tear or rupture. While stabilizing the metatarsal, a dorsal
translocation of the proximal phalanx greater than 2 mm is suggestive of rupture.

Question 14

Mulder sign

Answer 14

Identifies a Morton neuroma by a palpable click when compressing metatarsal heads and
palpating the interspace

Question 15

sullivan sign

Answer 15

separation of digits caused by a mass in the interspace

Question 16

q angle

Answer 16

btwn axis of the femur and the line between the patella and tibial tuberosity

Question 17

edema with a cast. when to worry?

Answer 17

if down in AM know it is gravity edema.

if doesn’t go down=abnormal

Question 18

Stages of raynauds?

Answer 18

white-> blue-> red
Pallor – spasm of digital arteries
Cyanosis – deoxygenation of blood pools
Rubor – hyperemia

Question 19

ABI normal?

Answer 19

Ankle Brachial Index – compares ankle to arm pressures
Normal 1
Intermittent claudication 0.6-0.8
Rest pain 0.4-0.6
Ischemic ulcerations <0.4

Question 20

what may falsely elevate the ABI?

Answer 20

Vessel calcification/non compressible vessels

Question 21

What other tests are typically performed with an ABI?

Answer 21

Segment pressures
 Measured at high thigh, above the knee, below the knee, ankle, midfoot, and toe
 Normal 70-120 mm Hg
 Drop between segments >30 mm Hg indicate disease in vessel above
Pulse volume recordings (PVRs)
 Normal waveforms are triphasic
 Waveforms are widened and blunted with severe disease

Question 22

most common skin cancer?

Answer 22

basal cell carcinoma

Question 23

what skin cancer is cauliflower like

Answer 23

Squamous cell carcinoma

Question 24

most common melanoma

Answer 24

superficial spreading melanoma- any part of body

Question 25

most malignant melanoma

Answer 25

nodular melanoma- misdiagnosed as pyogenic granuloma

Question 26

most benign melanoma

Answer 26

lentigo melanoma

Question 27

type of melanoma of palms soles and nail beds

Answer 27

acral lentiginous melanoma

Question 28

hutchinson sign

Answer 28

pigment changes in the eponychium seen w subungual melanoma

Question 29

what conditions associated w plantar fibromatosis

Answer 29

ledderhose disease, dupuytren contraction, peyronie disease

Question 30

another name for congenital convex pes valgus

Answer 30

vertical talus

Question 31

radiographic findings of CCPV

Answer 31

calc in equinus, plantarflexed talus, dorsally dislocated navicular, increased TC angle

Question 32

what additional radiographs for neonates with ccpv

Answer 32

lumbosacral films

Question 33

What are three coalitions of the rearfoot?

Answer 33

talocal, calcnav, talonav

Question 34

percent tarsal coalitions bilateral

Answer 34

50%

Question 35

what coalliton is most symptomatic

Answer 35

CN

Question 36

what coalliton is most asymptomatic

Answer 36

TN

Question 37

what coalliton is most common

Answer 37

TC> CN>TN

Question 38

which TC facet is most commonly fused

Answer 38

Medial > anterior > posterior

Question 39

what are ages of fusion

Answer 39

T-N (3-5 years) C-N (8-12 years) T-C (12-16 years)

Question 40

What are radiographic findings of tarsal coalitions? | 

Answer 40

 Rounding of lateral talar process  Talar beaking due to increased stress on talonavicular ligament  Asymmetry of anterior subtalar facet  Narrowing or absence of middle and posterior subtalar facets  Halo sign – circular ring of increased trabecular pattern due to altered compressive forces  Anteater sign – C-N coalition in which calcaneus has elongated process on lateral view  Putter sign – T-N coalition in which neck of talus unites with broad expansion of navicular

Question 41

The anterior facet is best seen by which radiographic views?

Answer 41

med oblique, ischerwood

Question 42

The middle and posterior facets are best seen by which radiographic view?

Answer 42

harris beath

Question 43

what are tx for symptomatic tarsal coalitions

Answer 43

``` Orthotics or supportive therapy  Immobilization  NSAIDs  Badgley – surgical resection of coalition or bar with interposition of muscle belly  Isolated fusion or triple arthrodesis ```

Question 44

What are the 3 components of clubfoot?

Answer 44

FF add, RF varus, ankle equinus

Question 45

clubfoot what ligaments contracted?

Answer 45

``` Posterior  Posterior tib-fib  Posterior talo-fib  Lateral calcaneofibular  Syndesmosis Medial  Superficial deltoid  Tibionavicular  Calcaneonavicular  Talo-Navic, Navic-Cunei, and Cunei-1st MT joints  Spring ligament ```

Question 46

clubfoot What muscles/tendons are contracted?

Answer 46

``` Posterior  Achilles tendon  Plantaris tendon Medially  PT, FDL, and FHL  Abductor hallucis Anteriorly  Tibialis anterior ```

Question 47

what is technique for correcting clubfoot called

Answer 47

Ponseti technique  Serial casting  First correct the FF and RF deformities, and then correct ankle equinus  During manipulation, pressure is applied to the head of the talus (not the calcaneus)  4-8 casts, percutaneous Achilles tenotomy (last cast for 3 weeks), occasional TA transfer, and D-B bar brace until age 3 y/o to prevent relapse

Question 48

accepted theory about clubfoot

Answer 48

Germ plasma defect-malposition of head/neck of talus

Question 49

simon rule of 15

Answer 49

For clubfoot, children <3 years → talo-navicular subluxation | T-C angle is <15° and talo-1st metatarsal angle is >15°