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Anatomy
Anesthesia
Orthopedics
Surgery
Perioperative
100
What is the thickness of plantar fascia in the normal adult without heel pain? (Be specific with cutoff value)
The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm
100
Overdose of what local anesthetic has been associated with cardiotoxicity?
Marcaine (Bupivacaine)
100
Why plantar fasciitis have pain with the first step in the morning?
Achilles tendon contracture at the night time due to the heel plantarflexion during sleep. The heel cord shortens, which pulls calcaneus upward and pulls plantar fascia. With the first step in the morning, the heel cord is still stiff with calcaneus up, and the plantar fascia stretches
100
What nonabsorbable suture material has the greatest tensile strength straight pull? Least?
Greatest tensile strength Stainless steel wire Polyester Monofilament Nylon Polybutester Braided Nylon Polypropylene Natural fiber (silk, cotton)
100
What vitamin supplement must be stopped prior to surgery according to McGlamry's?
Vitamin E supplements - hold 7 to 10 days prior to surgery due to a risk of bleeding
200
What structure surrounds popliteal fossa on inferolateral, inferomedial, superolateral, and superomedial?
Bicep femoris head - superolateral Semimembranosis and semitendinosis - superomedial Inferomedial - Medial head of gastroc Inferolateral - lateral head of gastroc
200
What local anesthetic (s) is associated with Methemoglobinemia?
Prilocaine
200
What clinical tests helps to rule out/evaluate superficial deltoid ligament? Deep deltoid ligament?
Eversion test - superficial deltoid ligament External rotation stress test - Deep deltoid ligament
200
What procedure is used to reduce the forefoot supinatus deformity?
Young tenosuspension. Kidner procedure. The Young's tenosuspension entails rerouting all or one-half of the tibialis anterior tendon through a slot fashioned in the navicular. The tendon is not detached from its insertion at the medial-plantar aspect of the medial cuneiform-first metatarsal base. Rather, it is slipped into the navicular keyhole slot by supinating the foot and stretching the tendon plantarly and posteriorly. The resulting position will create a new insertion for the tibialis anterior tendon into the dorsum of the navicular. This will accomplish four functions: 1. The tibialis anterior will continue to be capable of inverting the foot around the longitudinal axis of the midtarsal joint. 2. The tibialis anterior will continue to function as one of the primary dorsiflexors of the foot at the ankle joint. 3 The distal portion of the tendon will become a strong ligament in the medial arch, running from the plantar aspect of the first metatarsal to the plantar aspect of the navicular. 4. Finally, the procedure removes the dorsiflexory force of the tibialis anterior around the first ray axis. This allows a mechanical advantage to the plantarflexory force of the peroneus longus. More commonly today, the Young's suspension is utilized with the Kidner tibialis posterior advancement as part of the medial arch reconstruction, with more effective results.
200
Continuing this medication including the day of surgery will carry risk of rhabdomyolysis and myositis. What medication?
Cholesterol-lowering drugs - hold 1 day prior to surgery due to risk of rhabdomyolysis and myositis. Statins should be continued in the perioperative period as they have been shown to prevent cardiovascular events Niacin (nicotinic acid, vitamin B3), fibric acid derivatives (gemifibrozil, fenofibrate), cholestyramine and colestipol should be held at least 1 day before surgery
300
Xanthoma of the tendon is found common in what tendon?
Achilles tendon
300
Arrange these effects in order from the beginning to last of nerve function from local anesthetics: touch temperature proprioception pain
According to McGlamry's, Pain -> temperature -> touch -> proprioception
300
Wobble board is a balance boarding that is mostly used for what ankle instability? (Be specific)
Wobble board is a balance boarding that improves prioprioception, flexibility, balance, etc for functional ankle instablity. (Not mechanical instability). Functional instability is loss of proprioception, weakness of peroneal tendons
300
What is Lambrinudi procedure? For which deformity?
Lambrinudi - plantarflexory wedge osteotomy at the base of 1st metatarsal for hallux limitus
300
McGlamry's recommends smoking cessation for how many weeks before elective surgery has a significantly lower risk of postoperative pulmonary complications
Smoking cessation for at least 8 weeks before elective surgery has a significantly lower risk of postoperative pulmonary complications than those who continue to smoke or who stop smoking for less than 8 weeks before surgery
400
How many structures in the foot and ankle are associated with watershed area?
Posterior tibialis, Achilles tendon, 5th metatarsal diaphyseal metatarsal
400
EMLA (Eutectic mixture of local anesthetic) is a combination of what 2 local anesthetic?
Prilocaine and lidocaine
400
According to JAPAS classification, what is anterior caves and posterior caves deformity located at what apex?
Anterior caves - metatarsocuneiform joint Posterior cavus- proximal TNJ
400
According to McGlamry's, list these suture types from least relative soft tissue reaction to greatest soft tissue reaction: Silk, Polyester, Vicryl, Chromic gut, Polypropylene, Maxon
LEAST Synthetic monofilament nonabsorbables: steel, nylon, polypropylene, polybutester Synthetic multifilament nonabsorbables: steel, nylon, polyester (uncoated) Synthetic monofilament absorbables: PDS, Polyglyconate (Maxon) Synthetic multifilament absorbables: PGA, Polyglactin 910 (Vicryl) Natural nonabsorbable: uncoated silk, cotton Natural absorbable:plain catgut, plain gut, chromic gut Answer: Polypropylene, Polyester, Maxon,Vicryl, Silk, Chromic gut
400
Which of these medications must be continued throughout the surgery, which meds must be stopped prior to the surgery, which meds must be hold on the day of the surgery? (BE SPECIFIC including days) Acetaminophen, Aspirin, Naproxen, Digoxin, Albuterol, Levemir, Novolog, Metformin
Acetaminophen - continue use throughout sx NSAIDS - hold 3 days prior to sx due to reversible inhibior activity of platelet cyclooxygenase Aspirin - hold 7 d prior to sx due to irreversible inhibitor Digoxin, clonidine,BB, CCB - continue Diuretics, ACEi, ARB2 - hold on the morning of sx, especially in pts with hx of CHF bc there is an increased risk of hypotension during sx, may cause electrolyte imbalance Inhaled beta-agonist (Albuterol, Terbutaline), Inhaled ipratropium (Atrovent), Inhaled corticosteroid - continue Insulin - give long-acting insulin at 1/2 the normal dose, hold short-acting morning of surgery Metformin - hold 2 d prior to sx due to risk of lactic acidosis
500
How many bones are there in the foot?
26 bones
500
What is the most common complication after spinal anesthesia?
Headache
500
Highest ankle dorsiflexion is seen during which phase of gait?
Heel off
500
What additional procedure must be performed in conjunction with tibial sesamoid excision for hallux varus?
IPJ fusion
500
According to McGlamry's textbook, name as many contraindication for Epinephrine injection?
Pheochromocytoma Hyperthyroidism Severe HTN Severe PVD Pregnancy - relative contraindication