Ortho
Surgery
Trauma
Medicine
Complications
100
Polydactyly is most commonly seen on which toe?
Hallux (Pre-axial) - 10%

5th toe (Post-axial) - 80% - most common

2nd, 3rd and 4th toe - rare (< 5%)

100

The first step in the open reduction and internal fixation of an ankle pilon fracture is?

Fixation of the fibula fracture
100
What is the most commonly fractured tarsal bone?
Calcaneus
100

A 54 year-old obese male with Type 2 DM presents for foot care. During the interview his eyes close, he abruptly stops talking and begins to snore. Finger stick glucose is 146mg/dL. BP is 145/89. What condition causes his problem?

Narcolepsy
100

What is the cut-off value of diastolic blood pressure for the hypertensive patient prior to cancelling the surgery?

Diastolic pressure < 100 mmHg is acceptable for the patient to proceed with the surgery as long as the intra-op and PACU BP is closely monitered

200
What clinical test helps confirm your suspicious for sustentaculum tali fracture in Rowe type 1B before ordering x-ray?

Clinical exam by flexing and extending hallux due to FHL

200
What is the hemoglobin minimum value for the patient to have elective surgery?
Hemoglobin of 8 g/dl or higher is okay for elective surgery??
200

The most common location of stress fractures in the lower extremity is:

80% of stress fractures occur in lower extremity. Tibia and fibula makes up 24%. 20% from metatarsals (11% 2nd metatarsal, 7% 3rd metatarsal, 2% from 1st,4th and 5th metatarsals). 2% from sesamoids, calcaneus, navicular, talus.


200
Identify the condition on EKG as shown in Figure 1

Atrial flutter. Individual flutter waves may be symmetrical, resembling p-waves, or may be asymmetrical with a "sawtooth" shape, rising gradually and falling abruptly or vice versa.

200
What complication the obese patient will get from the general anesthesia?
Cardiopulmonary failure in obese patients (>30% overweight) 3 times risk with anesthesia
300
Talar tilt test is contraindicated in the presence of what condition?

Caution: inversion stress views (talar tilt test) may further damage the ligamentous structures and is contraindicated in the presence of an ankle fracture!

300
When fixating a plate for Weber type B, what type of screw must be avoided to place distally to the fracture site?
Cortical screw. Use cancellous screw as it will not enter the ankle joint or damage the talus bone.
300

Place the following in the correct order in a patient who sustained polytrauma:

1. Hemorrhage

2. Sucking chest wound

3. Asphyxia

4. Splint fractures

5. Shock

During resuscitation phase, in order of urgency: Airway/Asphyxia, hemorrhage, sucking chest wound, shock, splint fractures
300
Identify the condition on EKG in figure 2

Atrial fibrillation.  Characteristic findings are the absence of P waves, with disorganized electrical activity in their place, and irregular R–R intervals due to irregular conduction of impulses to the ventricles

300
What effects does the penicillamine has on the patient who is scheduled for the foot surgery if she/he was to continue the medication and what is the treatment?

Penicillamine decreases wound healing through

collagen synthesis disruption. Use Vitamin C.

400

There are 4 methods to measure anterior ankle subluxation. Name 2 of them.

1) Mortensson method: Calculating the perpendicular distance between the vertical lines drawn through the posterior lip of the tibia and the posterior tubercle of the talus.

2) Kelikian method: Distance between the distal dorsal aspect of the talus at its articulation with the navicular and the anterior margin of the articular surface of the tibia.

3) Lindstrand method: Perpendicular distance between the centers of concentric circles of the joint surface of the tibia and the talar dome.

4) Perlman method: Measure distance between the posterior lip of the tibia and the nearest portion of the talar dome.

400
What is Grumbine procedure and for which deformity?
Grumbine procedure (1981) - opening wedge on medial cuneiform with cuboid closing wedge/decancellation to correct metatarsus adductus
400
What is non-union fracture according to FDA?

Food and Drug Administration (FDA) defines a non- union as a fracture that is at least 9 months old and has not shown any signs of healing for 3 consecutive months

400
Name at least 3 disinfectant/anti-septic agents that are known to be cytotoxic to tissue grafts
Dakin's solution, Povidone-iodine solution, chlorhexidine, scarlet red spray


FYI: additional medications that are known to be cytotoxic to tissue grafts: mefanide acetate, tincoban, zinc sulfate, and high silver concentrations

400
What medication has been associated with the cause of osteonecrosis? 
High dose/long term of steroids use - prednisone, glucocorticoid, corticosteroids

Biphosphonate if using to increase bone density with certain medical condition like cancer, not osteoporosis

DVA NY Harbor - failed the interview

500
What is the mechanism of the action for Rowe type 1C and what ligament is responsible for the injury?
Plantarflexion on a supinated foot which forces bifurcate ligament to avulse anterior calcaneus process fragment
500
Name 3 procedures that stabilize one ligament in lateral ankle. Name 2 procedures that stabilize 2 ligaments.

Procedures that stabilize one ligament

Lee , Evans, Watson-Jones, D. Nilson 

Procedures that stabilize two Ligaments:

Christman-Snook , Elmslie, Brostrum-Gould procedure

500
What vertebra is most commonly fractured in associated with calcaneal fracture?

Calcaneal fractures are associated with spinal fractures 20% of time, T12 - L2 area, L1 most common vertebrae fractured. Other associated fractures include femoral neck fractures and tibial plateau fractures.

500
What is the name of diagnostic maneuver/test that strongly suggests neurogenic origin to a patient's heel when placing his foot in plantarflexion and inversion which increases the pressure within the porta pedis?
Phalen's test
500
When is the critical period for both upper and lower limb development? (be specific with days or week)
First appearance of limb buds in 5th week intrauterine.

Between 24th day and 44th days after fertilization, cellular injury are most vulnerable to thalidimine, radiation, etc


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