subs shelf study 2/8/17 Flashcards
(107 cards)
1
Q
define open fracture
A
communicates with outside world
bone can break skin…
or can get bullet shot…
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
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
4
Q
bending with compression causes what kind of fracture
A
oblique fracture
5
Q
define segmental fracture
A
several large bone fragments separate from the main body of a fractured bon
6
Q
compartment syndrome = no blood in or no blood out?
A
no blood out
-veins compress first
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
8
Q
common fracture locations causing vascular injury
A
clavicle - subclavian
supracondylar (peds) - brachia
knee dislocation - popliteal
9
Q
which is more common in ortho fx / disloc… vascular or nerve inj
A
nerve
10
Q
nerve injury = physiologic disruption called
A
neuropraxia
11
Q
nerve injury w axonal disruption but intact epineurium called
A
axonotmesis
12
Q
nerve transection called
A
neurotmesis
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
14
Q
common sites of heterotopic ossification in ortho
A
brachialis - distal humerus fracture
quadriceps - contusion
hip abductors - surgical dissection
15
Q
weakest structures most prone to ortho injury according to age
A
peds - physes
adults - ligaments
elderly - bone
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
17
Q
define mechanism of stress fracture
A
Repetitive loading below endurance limit
18
Q
additional injury to rule out if scapular fracture from big fall
A
pneumothorax
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)
20
Q
orthopedic emergencies
A
Compartment syndrome
Dislocations of major joints
Fractures with vascular injury
Open fractures
21
Q
class of drugs that most commonly contributes to fracture nonunion
A
nsaids
need inflammation to heal…
22
Q
why ortho traction after trauma
A
to keep muscles from shortening and making reduction difficult
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
24
Q
when does ligamentum teres stop supplying blood to femoral head
A
about age 4
according to Dr. Kessler
25
why fix clavicle fracture with tibial fracture
for crutch use
| otherwise in most cases clavicle fractures are not fixed
26
"shoulder separation" refers to what joint
glycocalyx
27
conoid and trapezoid ligaments attach...
clavicle to coracoid
28
Distal humerus fracture risk this nerve
ulnar nerve palsy w Distal humerus fx
(radial with humeral shaft,
axillary with humeral neck)
29
dinner fork deformity aka
colles fx
| (distal forearm
30
bones predisposed to avn
femoral neck fx
talar neck fx
proximal humerus fx
31
ortho treatment for complex regional pain syndrome
extensive physical therapy...
32
tf
| swelling and erythema can be symptoms of complex regional pain syndrom
```
t
Abnormal sympathetic tone
Pain
Stiffness
Swelling
Erythema
etc...
```
33
when to sling vs fix shoulder disloc
usually sling
| fix wide displacement, open fx, associated fx (ipsilateral or lower extremity... crutches)
34
manage proximal humerus fx
sling rom if simple minimal displacement
orif if displaced
hemiarthroplasty if comminuted
35
ligaments of clavicle shoulder joint
acromioclavicular ligament
| conoid and trapezoid ligaments (coraco-clavicular ligaments)
36
treat shoulder dislocation
closed reduction
2-3 weeks immobilized
early rehab
surgery for athletes / high demand young pts
37
nerves at risk in supracondylar humerus fracture
AIN
| Ulnar
38
manage supracondylar humerus fracture
immediate referral to orthopod (neurovascular risk)
| -for closed reduction, percutaneous pinning, and 4-6 wks casting
39
3 phases of wound healing
```
few days (inflammation 4-6 days)
few weeks (proliferation 4-24 days)
few months-years (remodeling 21 days - 2 years)
```
40
bacterial load of wound infection
10^5
| less than that just contamination
41
why not do elevtive surgery on a smoker
impaired wound healing (nicotine vasoconstricts and CO... poisons... reduced oxygen)
eg nose job will just necrose their face
42
tf
| keloid = hypertrophic scar
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
43
healing by primary vs secondary intention
primary (closed) - edges brought together, no tissue loss
secondary (open)- edges not brought together, left open
44
cover cat or dog bite for infection
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
treat dog vs cat bite
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
best finger to lose
actually index finger
| ... just for pointing... don't want to lose thumb... ring and pinkie for power grip...
47
what is an unna boot
4 layer dressing for compression
48
bug in human bites
| eg fight bight from punching teeth
```
eikinella corrodens (anaerobic)
-need to be washed out
```
49
what limbs can you replant vs not
can replant UE forearm and below
| NEVER lower extremity...
50
which needs debridemnt, wet or dry gangrene`
wet
| dry is stable... needs vascular surgery to get flow back to it...
51
common site for venous stasis ulcer
| what venous problems involved
medial malleolus
| -venous htn and venous valvular incompetence
52
reconstructive ladder
```
secondary intention
primary closure
skin graft
local flap
regional flap
free flap (not local, completely disconnected / transplanted)
```
53
difference graft vs flap
graft has no blood supply
| flap does
54
acetic acid household item
vinegar
55
how are resting tension lines oriented compared to muscles
perpendicular to contraction
so perpendicular to fibers
e.g. crows feet orbicularis oris
56
what is a wet to dry dressing
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
stages of skin graft incorporation
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
major risks to grafts
fluid - hematoma/seroma
infection
shear force
59
full thickness skin graft donor sites
supraclavicular - for face grafts
groin - for most other full thickness grafts
forearm...
60
```
full versus split skin graft
dermis
primary contraction
secondary contraction
take rate
cosmesis
```
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
split thickness skin graft donor sites
thigh buttock back
62
best cartilage graft donor sites
ear (concha - hollow next to canal)
rib
nasal septum
63
why do fat transplants work
aspirated fat has stem cells that allow transfer and take in new recipient site
64
primary vs secondary skin graft contraction
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
best mgmt of pressure ulcers
PREVENTION
66
duration of sustained pressure for pressure ulcer to develop
2 hours sustained pressure
67
flap classification
```
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
golden rule of LE wound reconstruction
upper 1/3 - gastroc flap
middle 1/3 - soleus flap
lower 1/3 (ankle) - free flap
69
best cream for simple burns
silvadene
70
erythema without skin breaks is what type of burn
first degree
71
burn eschar around chest causes what? requires what?
respiratory distress
| escharotomy
72
total body surface area risk for burn wound infection
^30% tbsa
73
primary blood supply to breast
internal mammary artery perforators
| IMA perforators
74
benign skin lesions
- 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
breslow depth
melanoma staging
v.75mm in situ
.76-1.5mm through bm into papillary dermis
1.6-4mm into reticular dermis
^4mm into subq
76
liposuction is for treatment of...
LOCALIZED adiposity
| --pannus abdominoplasty for improvement of hygeine...
77
most common skin cancer
BCC
78
best way to determine tx for melanoma
FULL excisional bx to determine depth
79
most common benign skin tumor
sborrheic keratosis
80
when to repair a lip
goals
when to repair a palate
lip - 3 mos
goals - restore
palate - 9 mos
orthognathic surgery (eg of mandible to catch up after palate repair slowed growth) - 15yo ish
81
sensation to doral aspect of tip of index finger
median n
82
what should be ruled out before surgical tx of mandible fracture?
c-spine injury
83
check what physical exam finding when evaluating zygomatic fracture
eom - check for entrapment
84
what is important in repairing orbital floor fractures
reconstruct floor and walls to prevent exopthalmos
85
most important function of facial nerve
close eyelids
86
fever in viral vs bacterial pharyngitis
viral v101 not too high
| ^101 think bacterial
87
where to place needle/incision to tx peritonsiallar abscess
superior and medial to abscess, in bulge of soft palate superior and medial to abscess... toward uvula
88
tf
| mediastinitis is a complication of bacterial tonsilitis
t
| down fascial plane...
89
bugs in epiglottitis
BACTERIAL
H flu B HiB
(down w vaccine... but other bugs can still cause...)
90
function of pterygoids
open jaw
91
neck cyst by location
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
malocclusionin head trauma refers to
misalignment of mandible / maxilla to one another
aka misalignment of bite
93
lefort fracturs are fractures of...
```
the maxilla
(various types)
```
94
advantages vs disadvantages of cricothyrotomy for tx of airway emergency... vs tracheotomy?
hemorrhage less common
easier to identify prominent cartilage
less risk of esophageal injury
but higher risk of subglottic stenosis
95
which comes first, rhinitis or sinusitis
rhinitis (inflammation of nasal passageways)
then suniusitis - sinuses
96
ostiomeatal complex
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
tf
| reactive airway dz = asthma
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
what bug infects w kartagener's
pseudomonas
99
bugs in nose
coag neg staph
then staph a
then much less anaerobes, step pneumo, mixed
100
person choking, what to do
person found down, what to do
heimlich, back blow, finger sweep
jaw thrust, gauze to pull tongue forward
101
rinne and weber
```
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
number 1 pathogen in otitis externa
pseudomonas
103
otitis media bugs
```
same as sinusitis bugs
step pneumo
hflu
m catarrhalis
gas
(staph a rare)
```
104
kidney stone compositionby most frequent
```
calcium oxalate
struvite
calcium phosphate
uric acid
cysteine
miscellaneous
```
105
treat kidney stone
- 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
lumbosacral myotomes
```
L2 - hip flexors
L3L4 - knee extensors
L4L5 - ankle dorsiflexors
S1 - big toe extensor
S4-5 ankle plantarflexor
anal sphincter
```
107
key sensory dermatomes
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
```
