Jeopardy SBH Pod

Medical Imaging

100

What is the ALARA principle? What does it stand for

As Low As Reasonably Achievable 

a radiation safety concept focused on minimizing exposure to ionizing radiation

200

Best view for CN coalition? TC Coalition ? 

CN - medial oblique

TC - Harris beath. Waiters signs. Most common is middle facet. 

300

Describe the Cyma line and findings for pronated vs supinated foot 

Relationship between TN and CC, generally a Lazy S 

Supinated: posterior break

Pronated: anterior break 

400

Epiphyseal lesion with soap bubble appearance in mature bone

Giant Cell tumor

500

Phases of Bone Scan 

Flow Phase:This early phase, captured immediately after injection, assesses blood flow to the area of interest. 

2. Blood Pool Phase:This phase, acquired shortly after the flow phase (within 5-10 minutes), evaluates blood pooling and soft tissue involvement. 

3. Delayed Phase:This phase, acquired 2-4 hours after injection, reflects bone turnover and osteoblastic activity (bone formation).

Extra:

Fourth Phase (24-hour static image): This optional phase, acquired 24 hours after the injection, can be helpful in diagnosing osteomyelitis and other conditions

Surgery

100

Strength of vicryl sutures at 2 weeks 

75%

200

In what position do you fuse the 1st MPJ? 

10 degrees of dorsiflexion and 10-15 degree of Adduction 

300

What does Reverdin correct? 

PASA and IM 

400

What is the location for Evans Osteotomy? Why? 

1-1.5cm proximal to CC joint in order to avoid the anterior and medial facets 

500

What is the angle of cut for Austin Bunionectomy? 

60 degrees chevron 

Anesthesia

100

What nerves are blocked for a Mayo Block? 

Saphenous Nerve

Dorsal Medial Cutaneous Nerve 

Deep Peroneal Nerve 

Medial Plantar Nerve 

200

ASA Classification Stage for a patient that has HTN and poorly controlled Diabetes 

What is ASA Classification for a patient that has HTN and poorly controlled diabetes? 

3 

• ASA I: A healthy patient with no systemic disease.
• ASA II: A patient with mild systemic disease. This may include well-controlled conditions like mild asthma, well-managed hypertension, or mild obesity.
• ASA III: A patient with severe systemic disease that is not life-threatening. Examples include poorly controlled hypertension, severe lung disease, or diabetes with complications.
• ASA IV: A patient with severe systemic disease that is a constant threat to life. This could be a patient with unstable angina, severe heart failure, or end-stage renal disease. 
• ASA V: A moribund patient who is not expected to survive with or without surgery. 

  
  

• ASA VI: A brain-dead patient being maintained for organ donation. 

  
  

  
  

  
  

300

Nerves that are blocked for ankle block?

Saphenous N

Sural N

Superficial Fibular 

Tibial N

Deep Fibular N

400

What nerve is not blocked during popliteal block 

Saphenous nerve 

Popliteal block targets the Sciatic branches

500

Max dose of Lidocaine with and without Epi? Max dose of Marcaine with and without epi? 

Lido (plain) - 4-4.5 mg/kg (cannot exceed 300mg) 

Lido (w/epi) - 7 mg/kg (cannot exceed 500mg) 

Bupivicaine - 2.5 mg/kg (cannot exceed 175mg/dL) 

Bupivicaine (w/ epi) - 3 mg/kg (cannot exceed 225 mg/dL)

Wound Care and Antibiotics

100

What is Wagner Classification? What are the Stages 

The Wagner classification system is a tool used to categorize the severity of diabetic foot ulcers, ranging from 0 to 5, based on depth and presence of infection or gangrene.

• Grade 0: Intact skin. Can be pre-ulcerative area or high risk foot 
• Grade 1: Superficial ulcer, involving only the skin. 
• Grade 2: Deeper ulcer extending to tendon, bone, or joint capsule. 
• Grade 3: Deeper ulcer with abscess, osteomyelitis, or tendonitis. 
• Grade 4: Gangrene of the forefoot. 
• Grade 5: Gangrene of the entire foot.

200

Antibiotic with coverage for Pseudomonas. Name at least 3

Zosyn (pipercillin/tazobactam) 

Carbapenam 

ceftazidime, cefepime

Ciprofloxacin 

Aminoglycosides

Aztreonam

300

Describe SIRS, Sepsis, Septic Shock and MODS

SIRS : It's characterized by at least two of the following: 

• Fever (temperature >38°C or <36°C). 
• Heart rate >90 bpm. 
• Respiratory rate >20 breaths per minute or PaCO2 <32 mm Hg. 
• White blood cell count >12,000/mm³ or <4,000/mm³ or >10% band forms  
• Sepsis: SIRS + source of infection 
• Septic Shock: persistent hypotension (despite adequate fluid resuscitation) and impaired tissue perfusion, signs of end organ damage, or LDH elevated 
• MODS :dysfunction of two or more organ systems in an acutely ill patien

400

What is scoring system for necrotising fasciitis? What variables are included?

CRP

Hemoglobin

WBC

Blood glucose

Sodium 

Creatinine 

a score of 6 is considered positive for nec fasciitis 

500

Antibiotics based off of Gustillo Anderson Classification 

• Gustillo type I and II

  • 1st generation cephalosporin

• Gustillo type III

  • 1st generation cephalosporin + aminoglycoside

• With farm injury / bowel contamination

  • 1st generation cephalosporin + aminoglycoside + PCN

  • add PCN for clostridia 

     

• Type I

  • wound ≤1 cm, minimal contamination or muscle damage

    
    

• Type II

  • wound 1-10 cm, moderate soft tissue injury

    
    

• Type IIIA

  • wound usually >10 cm, high energy, extensive soft-tissue damage, contaminated

    
    

  • adequate tissue for flap coverage

    
    

  • farm injuries are automatically at least Gustillo IIIA

    
    

• Type IIIB

  • extensive periosteal stripping, wound requires soft tissue coverage (rotational or free flap)

     

    
    

• Type IIIC

  • vascular injury requiring vascular repair, regardless of degree of soft tissue injury

Trauma

100

What is the most commonly experienced Lauge Hansen Classification? 

SER

200

Name a classification system used for Lisfranc Injuries 

Hardcastle/Myerson 

• Type A: Complete incongruity of the TMT joint, with all metatarsal bases displaced in the same direction.
• Type B: Partial incongruity, further divided into: 
• 
  
  • B1: Medial displacement of the first metatarsal. 
  • B2: Lateral displacement of the lesser metatarsals.
• Type C: Divergent displacement, with medial displacement of the first metatarsal and lateral displacement of the lesser metatarsals, further divided into: 
  • C1: Partial. 
  • C2: Complete.

Quenu and Kuss classification (Early)

300

What classification system is used for talar osteochondral lesion and what are the stages?

Berndt and Hardy 

Stage I

Subchondral compression fracture

Stage II

Incomplete avulsion of fragment

Stage III

Complete avulsion of fragment without displacement

Stage IV

Complete avulsion with displacement

Stage V*

Subchondral cyst

*Stage V added by Loomer and collegues. 29

400

Salter Harris that is most likely to cause growth arrest. The one that exhibits the Thurston-Holland sign  

Salter Harris V

Salter Harris II - Flag sign 

1. Type I: Fracture through the physis (growth plate) only. 
2. Type II: Fracture through the physis and metaphysis (most common). 
3. Type III: Fracture through the physis and epiphysis (intra-articular). 
4. Type IV: Fracture through all three (epiphysis, physis, and metaphysis). 
5. Type V: Crush injury of the physis

500

Name and describe the ankle fracture that cannot be close reduced. 

Bosworth fracture, displacement and entrapment of fractured fibular fragment into posterior distal tibia