Pimp1000, Podiatry Interview/PIMP/Study questions, 4th year pimp ?s

What is the perioperative management for patients on long-term, high-dose steroids?

Peri-op IV steroid supplementation. Stress dosing.

Hydrocortisone 100 mg IV given the night before surgery, immediately prior to surgery, and then q8h until postoperative stress relieved

What is a Gustillo Anderson type 1?

Open fracture with Clean wound <1 cm

What is the Pigott Classification for and what are the stages?

Hallux Valgus Classifications (stages 1 - 4)

Stage 1

Excess pronation causes hypermobility of 1st ray. Tibial sesamoid ligament gets stretched

& fibular sesamoid ligament contracts.

Lateral subluxation of proximal phalanx occurs

Stage 2

Hallux abductus progresses, touches against 2nd digit

FHL & FHB gain lateral mechanical advantage

Crista starts to erode

Stage 3

Further subluxation at 1st MPJ, formation of IMA

IMA increases secondary to retrograde forces from abductor hallucis

Stage 4

Hallux subluxes & dislocates on 1st metatarsal

Increased crista erosion

What is the toxic dose of vicryl?(Prism pg27)

1-2 lbs

What is the Regnauld Classification for and its grades?

Hallux Limitus Classification

Grade 1 - functional hallux limitus with dorsal spurring

Intact sesamoids with no associated disease

Joint enlargement but joint space narrowing and arthrosis

<40° dorsiflexion and <20° plantarflexion

Grade 2 - broad flat metatarsal head with structural elevatus and significant spurring

Pain at rest

Osteochondral defects in metatarsal head and sesamoidal hypertrophy

Joint space hypertrophy and narrowing

75% decrease in total ROM

Grade 3 - ankylosis and articular hypertrophy with extensive peri-articular osteophytes

Osteochondral defect with joint mice and extensive 1st metatarsal-sesamoid disease

Severe loss of joint space or collapse of joint → bone on bone

FDL contracture

The "C" in CRP stands for what?

substance in serum that reacts with C- polysaccharide of pneumococcus

What is a Gustillo Anderson type 2?

Open Fx Wound 1-10 cm in diameter + soft tissue damage

What is the Jahss Classification for and its types? (Prism p48, Watkins p464)

1st Metatarsal Dislocations:

Type l - dorsal dislocation of proximal phalanx and sesamoids with intact intersesamoid ligament

Type 2 - dorsal dislocation of proximal phalanx and sesamoids

2A - intact sesamoids with ruptured of intersesamoid ligament

2B - transverse fracture of sesamoid with intact intersesamoid ligament

What is a Gustillo Anderson type 3 A?

Open Fx Wound >10 cm + Adequate soft tissue coverage

ACE stands for what?

all cotton elastic

What is the Stewart Classification used for and its types? (Prism p49)

5th Metatarsal Fractures

Type 1 - extra-articular fracture at metaphyseal-diaphyseal junction (true Jones fracture)

Type 2 - intra-articular avulsion fracture of 5th metatarsal base

Type 3 - extra-articular avulsion fracture of styloid process of 5th metatarsal base

Type 4 - intra-articular comminuted fracture of 5th metatarsal base

Type 5 - extra-articular avulsion of epiphysis in children

Warfarin came from what?

Originally used for rat poison

What is a Gustillo Anderson type 3 B?

Open Fx Wound >10 cm +Periosteal stripping

What is Rosenthal Classification used for and its zones? (Prism p47)

Nail Injury

Zone 1 - distal to bony phalanx

Zone 2 - distal to lunula

Tx: V-Y advancement

Zone 3 - proximal to distal end of lunula

If nail bed is lacerated, it is considered an open fracture

Tx: amputation

Who described >25% rule for posterior mall fx?

McDaniel- 1977

What is a Gustillo Anderson type 3C?

Open Fx Wound with arterial damage

What is a Resnick type 1?

Puncture wound. Superficial/Cutaneous w/o signs of infection

What is the Quenu & Kuss Classification used for and the three types? (Prism 49)

Lisfranc Dislocation

Convergent homolateral

All metatarsals subluxed laterally

All 5 metatarsals displaced laterally in the transverse plane

Isolateral

1st metatarsal subluxed medially or metatarsals 2-5 subluxed laterally

1 or 2 metatarsals displaced laterally in the transverse plane

Divergent

1st metatarsal subluxed medially and metatarsals 2-5 subluxed laterally

Displacement in both sagittal and transverse planes

What does TLS stand for and who invented it?

tiny little sucker

Stanley Kalish

What is the Hardcastle Classification used for and its types?

Lisfranc Dislocation

A1 - homolateral

A2 - homomedial Type B - partial incongruity

Bl - partial medial displacement

1st metatarsal displaced medially and/or in combination with metatarsals 2-4

B2 - partial lateral displacement

Lateral displacement of one or more lesser metatarsals

Type C - divergent

Cl - partial displacement

1st metatarsal displaced medially with any combination of metatarsals 2-4 displaced laterally

C2 - total displacement

1st metatarsal displaced medially with metatarsals 2-5 displaced laterally

What is a Resnick type 2?

Puncture wound. Subcutaneous or articular w/o signs of infection

Name Lisfranc, treatment, Reduction Sequence, Post-op Care

and Complications (Prism p49, Watkins 483)

Treatment Options

Cast immobilization (sprains 3-5 weeks)

Closed reduction and percutaneous pinning

ORIF

Reduction Sequence

1. First realign 2nd metatarsal on middle cuneiform. Once stabilized, lesser metatarsals will

follow.

2. Next stabilize 1st metatarsal and then lateral metatarsals

Post-op Care

BK casting for 6 to 12 weeks

Initial NWB for 6-8 weeks

Partial WB approximately 6 weeks

Begin ambulation in stiff-soled shoe

PT ASAP

Accommodative orthotics

Complications

Majority - post-op DJD

Serious - circulatory compromise

What is the device for measuring compartment syndrome?

Wick Catheter or Slit Catheter, Stryker Intra-Compartmental Pressure Monitor

What is a Resnick type 3-A?

Puncture wound. Subcutaneous or articular with signs of infection

What is the Watson-Jones classification used for and its types? (Prism p50, Watkins p485)

Navicular Fractures

Type 1 - navicular tuberosity fracture

Type 2 - dorsal lip fracture

Type 3 - transverse body fracture

3A - fracture of body without displacement

3B - fracture of body with displacement

Type 4 - stress fracture

What is a Resnick type 3-B?

Puncture wound. Bone penetration w/o signs of infection

What is the Rowe Classification used for and its types? (Prism p52, Watkins p475)

Calcaneal fx

Type 1 -

1A - fracture of plantar tuberosity 1B - fracture of sustentaculum tali 1C - fracture of anterior process

Type 2

2A - ―beak fracture‖

2B - avulsion fracture of Achilles insertion

Type 3

3A - simple oblique fracture of body not involving STJ

3B - comminuted oblique fracture of body not involving STJ

Type 4 - intra-articular fracture involving STJ

Type 5 - intra-articular, comminuted, depression fracture with STJ involvement

Note: Rowe is primarily used for extra-articular fractures. Intra-articular fractures (Rowe 4 & 5)

are usually replaced by Essex & Lopresti.

What must ABX be if used in PMMA (polymethylmethacrylate)?

Heat-labile: Gentamycin, Tobramycin, Vancomycin, Ticarcillin, Cefazolin, Moxalactam, Cefotaxime

What is a Resnick type 4?

Puncture wound. Bone Penetration with osteomyelitis

What is a Patzakis type 1?

Wound location. Toe to met head. 50% incidence of osteomyelitis

What are the 2 layers of periosteum?

outer fibrous layer

inner cambium osteogenic layer (connected to cortex via Sharpey's fibers)

What is the Essex-Lopresti used for and its types? (Prism p52, Watkins p476)

ESSEX-LOPRESTI - Calcaneal fx

Type 1 - tongue fracture (vertical fracture line) without STJ involvement

Type 2 - joint depression fracture (horizontal fracture line) with STJ involvement

What is a Patzakis type 2?

Wound location=Midfoot. 17% incidence of osteomyelitis

What is the Degan Classification used for and its types?

DEGAN - Calcaneal Ant Process fx

Type 1 - non-displaced fracture of the anterior process

Type 2 - extra-articular, displaced fracture of the anterior process

Type 3 - intra-articular, displaced fracture of the anterior process involving C-C joint

Name of the venous plexus deep to the EHB and EDB muscle bellies

Ruch's Plexus

What is the Sanders classification used for and its types? (Prism p52, Watkins p477)

SANDERS - Calcaneal fx

Used for CT evaluation from coronal and axial views

Classified by number of pieces

Lines A and B divide the inferior portion of the posterior talar facet into 3 equal portions.

Line C separates the medial and posterior facets.

A - lateral

B - midline

C - medial (at sustentaculum tali)

1 - any number of fracture lines

- All non-displaced, extra-articular fractures

2 - one fracture line

Two-part fracture of posterior facet

Use one letter (2A, 2B, or 2C)

3 - two fracture lines

Three-part, intra-articular fracture of posterior facet with depressed central fragment

Use two letters (3AB, 3AC, or 3BC)

4 - three fracture lines

Four-part, intra-articular fracture of posterior facet and sustentaculum fragment with high degree of comminution

Incidences of peroneus tertius, plntaris, and peroneus quartus

PT 93%, PL 90%, PQ 7%

What is a Patzakis type 3?

Wound Location= Calcaneus. 33% incidence of osteomyelitis

What is the Hawkins Classification used for and its Types? (Prism p51, Watkins p480)

HAWKINS - Talar neck fx

Type 1 - vertical fracture of talar neck that is nondisplaced

Type 2 - vertical fracture of talar neck with STJ dislocation/subluxation

Type 3 - vertical fracture of talar neck with STJ and ankle dislocation/subluxation

Type 4 - vertical fracture of talar neck with STJ, ankle, and T-N dislocation/subluxation

What is an Orr and Fainer stage one?

Frostbite. Erythema, Edema, White Plaque

What is the Sneppen Classification used for and its types?

SNEPPEN - Talar Body Fractures

Type 1 - compressive fracture of the talar dome usually involving medial or lateral aspect Type 2 - shearing fracture of the talar body

2A - coronal shearing force 2B - sagittal shearing force 2C - horizontal shearing force

Type 3 - fracture of the posterior tubercle

Type 4 - fracture of the lateral process

Type 5 - crush fracture

Danger of rapid correction of hyponatremia?

demyelinating syndrome

What is an Orr and Fainer stage 2?

Frostbite. Blister or bleb formation

What is the Berndt & Hardy classification used for and its types? (Watkins p479)

BERNDT & HARDY - Talar dome fracture

Stage 1 - nondisplaced compression of talar dome

Stage 2 - partially detached osteochondral lesion

Stage 3 - completely detached, nondisplaced osteochondral lesion

Stage 4 - completely detached, displaced osteochondral lesion

How can a patient with a DVT develop a CVA if the occlusion is venous origin?

paradoxical embolus secondary to cardiac septal defect

What is an Orr and Fainer stage 3?

Frostbite. Full thickness w/ hemorrhagic blister + some necrosis

What is a Orr and Fainer stage 4?

Frostbite. Complete necrosis. Needs amputation

What is the Downey classification used for and its Types? (Prism p38)

DOWNEY - Tarsal Coalitions

Juvenile (Osseous Immature)

Type 1 - extra-articular coalition

A - no secondary arthritis

Tx: Badgley procedure

B - secondary arthritis

Tx: resection or triple

Type 2 - intra-articular

A - no secondary arthritis

Tx: resection, isolated arthrodesis, or triple B - secondary arthritis

Tx: triple

Adult (Osseous Mature)

Type 1 - extra-articular

A - no secondary arthritis

Tx: resection or triple

B - secondary arthritis

Tx: triple

Type 2 - intra-articular

A - no secondary arthritis

Tx: isolated or triple B - secondary arthritis

Tx: triple

Formula for calculating blood sugar from HBA1C?

6%= 110, then add 30 for each %

What is stages of Lauge-Hansen SAD?

Supination-Adduction (SAD) - No tib-fib diastasis

Stage l - rupture of lateral collaterals or * transverse fracture of lateral malleous below level of ankle joint (WEBER A)

Stage 2 - * vertical fracture of medial malleolus

What Abx is ineffective for pulmonary infections?

Daptomycin (inactivated by lung surfactant)

What is a Salter Harris type 1?

Epiphyseal Fx. Epiphysis seperated from the metaphysis w/o boney fracture

What are the stages of Lauge-Hansen PAB?

Pronation-Abduction (PAB)

Stage 1 - rupture or deltoid ligament or transverse avulsion fracture of medial malleolus

Stage 2 - rupture of anterior and/or posterior distal tib-fib ligaments

Stage 3 - * short fibular fracture (oblique on AP, trans, on lateral) at level of ankle joint

Critical lab to order for patient on Linezolid

CBC (risk of thrombocytopenia)

What is a Salter-Harris type 2?

Epiphyseal Fx. "Thurston Holland" fx through the epiphysis transversly going through the metaphysis. Most common.

What are the stages of Lauge-Hansen SER? (Prism p52)

Supination-Eversion (SER) - most common

Stage 1 - disruption of anterior tib-fib ligament with either a tibial avulsion (Tillaux-Chaput) or a fibular avulsion (Wagstaffe)

Stage 2 - * spiral oblique fracture of the fibula at level of ankle joint

Stage 3 - rupture of posterior tib-fib ligament or tibial avulsion (Volkmann)

Stage 4 - ruptured of deltoid or transverse fracture of medial malleolus (WEBER B)

Who first described the triple arthrodesis?

Ryerson 1928

What is a Salter-Harris type 3?

Epiphyseal Fx. Intraarticular fx from joint though the epiphysis, then extending along the plate to the periphery

What are the stages of Lauge-Hansen PER? (Prism p52)

Pronation-External Rotation (PER)

Stage 1 - rupture of deltoid ligament or transverse avulsion of med malleolus

Stage 2 - disruption of anterior tib-fib ligament with rupture of interosseous ligament and

Tillaux-Chaput or Wagstaffe avulsions

Stage 3 - * high fibular fracture above level of ankle joint (Maisonneuve fracture) - (WEBER C)

Stage 4 - Posterior tib-fib ligament or Volkmann fracture

Common complication of iliac bone graft harvesting?

meralgia paresthetica: lateral femoral cutaneous nerve entrapment

What is a Salter Harris type 4?

Epiphyseal Fx. Intraarticular fx from the joint through the epiphysis and physeal plate and through the metaphysis

What is a Salter Harris type 5?

Epiphyseal Fx. Compression of plate due to crushing injury

What is bone wax made of?

bees wax and paraffin

What is Danis Weber and which Lauge Hansen corresponds with which type? (Prism p52)

DANIS WEBER - Describes location of fibular fracture.

Type A - transverse avulsion fracture below the level of the ankle joint

(corresponds with Lauge-Hansen SAD)

Type B - spiral or oblique fracture at the level of the ankle joint

(corresponds with Lauge-Hansen SER and PAB)

Type C - fracture above the level of the ankle joint (Maisonneuve fracture)

(corresponds with Lauge-Hansen PER)

Why doesn't Apligraf come pre-fenestrated?

It is living tissue and will heal before application

What is a Salter Harris type 6?

Epiphyseal Fx. Peripheral bruise to Zone of Ranvier leading to angular deformity

What Ruedi & Allgower classification and its types? (Prism p55)

RUEDI & ALLGOWER - Pilon fractures - distal tibial metaphyseal fracture.

Type 1 - non-displaced tibial fragments

Type 2 - intra-articular tibial fracture without comminution

Type 3 - comminution and disruption of tibial articular surface

What is a Reudi-Allgower type 1?

Tibial Plafond Fx. Minimal displacement.

What are the components of Virchows triad?

Hypercoagulable State, Endothelial Damage, Stasis

What is the Salter-Harris classification used for and its types? (Prism p61)

SALTER-HARRIS - Physeal Injuries

(SMACK - Same, Metaphysis, Articulation, Continuous, Krush) (SALTR - Same, Above, Lower, Through, Really bad)

1 - fracture through physis

2 - fracture through physis into metaphysis

3 - intra-articular fracture through physis into epiphysis

4 - intra-articular fracture through epiphysis, physis, and metaphysis 5 - crush injury

How can you tell if abx are in the pulse lavage?

bubbles/foams

What is a Reudi-Allgower type 2?

Tibial Plafound Fx. Significant Displacement

What is CONTI Classification used for and its stages?

CONTI - PTTD - MRI rapture

Stage 1 - 1-2 fine, longitudinal tears

Stage 2 - intramural degeneration, variable diameter

Stage 3 - diffuse swelling

What is a Reudi-Allgower type 3?

Tibial Plafound Fx. Impaction and comminution.

Incidence of vertebral fx with calc fx

10% L1

What is the Kuwada Classification for and its Types? (Prism p55)

KUWADA - Achilles Tendon Ruptures

Type 1 - partial tear <50%

Tx: cast with foot plantarflexed

Type 2 - complete tear with <3 cm defect after debridement

Tx: end-to-end attachment

Type 3 - complete tear with 3-6 cm defect after debridement

Tx: end-to-end attachment and tendon flap

Type 4 - complete tear with >6 cm defect after debridement

Tx: end-to-end attachment, recession, or graft

What bugs do quinolones not cover?

enterococcus

What is the AO-OTA classifications 4 elements?

Pilon Fx. Bone, Segment, Articular, Complexity

What is the Mueller classification used for an its types?

MUELLER - Post Tib Tendon Inury

1 - direct injury

2 - pathologic rupture (RA)

3 - idiopathic

4 - functional abnormality

What is Danis-Weber AO classification Type A?

Ankle Fx. Fibular fx below the level of the syndesmosis

How much STJ motion do you lose with a TN joint fusion?

91%

What is the Gustilo & Anderson Classification used for and its types? (Prism p47)

Open Fractures GUSTILLO & ANDERSON

Type 1 - wound l cm without extensive soft tissue damage

Type 3 - extensive skin, soft tissue, muscle, and neurovascular damage

- 3A - adequate tissue coverage, high energy trauma

- 3B - periosteal stripping, massive comminution

- 3C - arterial injury

What is Danis-Weber AO classification Type B?

Ankle Fx. Fx at level of syndesmosis

What is the Weber and Cech classification used for? (Prism p34)

WEBER & CECH- Non-Union of Fractures

Hypertrophic - hypervascular (90%)

Elephant foot

Horse hoof

Oligotrophic

Atrophic - avascular (10%)

Torsion wedge

Comminuted

Defect

Atrophic

Concerns with prone surgery?

retinal detachment and peri-orbital edema

What is Danis-Weber AO classification Type C?

Ankle Fx. Fibula Fx above the level of the syndesmosis

What is the Wagner Classification used for and its grades? (Prism p9)

Ulcers

Grade 0 - no open lesions but bony prominence and/or structural deformity present

Grade 1 - superficial ulcer without penetration to the deep layers

Grade 2 - deep ulcer penetrating to tendon, joint capsule, or bone

Grade 3 - Grade 2 depth with the presence of infection

Grade 4 - gangrene of the forefoot

Grade 5 - gangrene of the entire foot

First person to describe charcot?

Musgrave 1703- venereal disease

What is a SAD 1?

Ankle Fx. Transverse fx of the lateral mal or CFL

What is the UT Wound system used for an its grades? (Prism p9)

University of Texas at San Antonio - UTSA (J Foot Ankle Surg, 35:528-531, 1996)

Grade 0 - completely epithelialized pre- or post-ulcerative lesion

Grade 1 - superficial wound not involving tendon, capsule, or bone

Grade 2 - wound penetrating to tendon or capsule

Grade 3 - wound penetrating to bone or joint

Within each grade, there are 4 subtypes:

A - non-ischemic, clean wound

B - infected wound

C - ischemic wound

D - infected and ischemic wound

What is a SAD 2?

Ankle Fx. Type 1 + Vertical Fx of the medial mal/ Deltoid

First person to describe Charcot in diabetics?

Jordan in 1936

What is the Drago Oloff Jacobs classification used for an its stages?

MPJ Joint Degeneration

Stage I: "Functional limitus" - MPJ unable to fully dorsiflex

during gait. NO radiographic changes yet.

Stage II: "Joint Adaptation" - small dorsal exostosis and

met head flattening. Pain at end ROM.

Stage III: Asymmetric joint space narrowing, large dorsal

spurring, severe met head flattening. Pain and crepitus w

full ROM, OA well established now.

Stage IV: Anklyosis of joint. Severe osteophytes and joint

mice present. Pain usually from skin irritation due to

friction from rubbing over large osteophytes. Less pain

from ROM at this stage as joint has no motion.

What does V.A.C stand for?

vacuum assisted closure

What is a SER 1?

Ankle Fx. ATFL Rupture

What is the Kellgren and Lawrence classification used for and its grades?

Classification for Osteoarthritis

Grade I: Doubtful narrowing of joint space with possible osteophytic lipping.

Grade II: Definite osteophytes with possible narrowing of joint space.

Grade III: Multiple osteophytes, definite jt. space narrowing, sclerosis, possible deformity of bone contour.

Grade IV: Large osteophytes, significant jt space narrowing, severe sclerosis, definite deformity of bone contour.

How does a wound V.A.C work?

creates a negative pressure environment which stimulates mitosis and angiogenesis of granulation tissue

What is an SER 2?

Ankle Fx. SER 1 + SO lateral mal Fx . Posterior Spike.

What is the Fallat & Buckholts Classification used for and its types? (Prism p31)

Classification for: Tailor's Bunionette

Type 1: enlarged lateral 5th metatarsal head (hypertrophy) Type 2: lateral bowing of 5th metatarsal (IM= normal, no hypertrophy)

Type 3: Increased IM angle (lateral deviation angle is normal)

Type 4: combo

What is an SER 3?

Ankle Fx. SER 2 + PITFl rupture or post mal FX