1
Q
What are the cardinal signs of infection?
A
- Redness
- Erythema
- Increase in pain
- Odor
- Increase in warmth
- Purulence of staph
2
Q
Purulence of staph
A
- Consistency is whitish-yellow and chalky
- Classic of staph aureus
3
Q
Pseudonomas
A
- Greenish discoloration
- Another common bacteria that affects the foot, especially in diabetic patients
- Much longer incubation period (usually 7 days or more for a good response)
4
Q
Osteomyelitis
A
- Bacteria begins to effect bone
- Diagnosed with an x-ray
5
Q
Classic infection signs of bone (osteomyelitis)
A
- Erosion
- Osteolucent/osteolytic types of irregularities in the bone
6
Q
How do diagnose osteomyelitis on x-ray
A
- Subjective findings
- Typically includes osteolytic appearance or erosion of bone
- Takes about 2-3 weeks for you to be able to see osteolytic erosions on an x-ray
7
Q
Perinicea
A
- Infection of soft tissue surrounding ingrown toenail
8
Q
Treatment of perinicea
A
- Put patients on Keflex or BSI and pain does not get better
- If toenail is not removed, it will not resolve
- If infection gets worse, it can seed the bone underneath the toe (phalanx)
9
Q
Ingrown toenails often have _____
A
- Associated infection with it
10
Q
Ingrown toenail infection usually results from _____
A
- Chronic irritation of impinged nail plate that causes localized redness, pain, etc.
- Not necessarily true infection
11
Q
For ingrown toenail infection to resolve itself _____
A
- Ingrown toenail must be removed
12
Q
What is the most common puncture wound?
A
- Staph aureus
- Staph organism enters the body, then enough to cause infection can spread
13
Q
Staph aureus typically requires an incubation period of _____
A
- 3 days/72 hours
14
Q
If a patient is going to develop an infection from a staph organism _____
A
- It will typically begin to show cardinal signs of infection
15
Q
One of the immediate things to do for staph infection that allows bacteria to escape is _____
A
- Incision and drainage
- Flush it out, then decrease bacteria count to a number in which body can fight effectively
- Augment fighting with oral antibiotics
16
Q
Drug of choice/oral antibiotic for staph
A
- 1st generation cephalosporin like Keflex
17
Q
Diabetic patients (immune compromised) cannot _____
A
- Fight infection without antibiotic
18
Q
Culturing bacteria determines _____
A
- How antibiotic inhibits future growth
19
Q
Strong bacterial killing agent may effect culture, so you must _____
A
- Rinse with saline to get rid of surface contamination
20
Q
Nail puncture wounds _____
A
- May lead to septic arthritis (3 days)
- Superficial, visible entry site
21
Q
If an infection is in the joint, it can be devastating to _____
A
- Cartilage of the joint
22
Q
Catrilage is avascular, so it _____
A
- Does not respond well to oral or IV antibiotics
23
Q
Infections in joints are considered _____
A
- Surgical emergencies
- Requires aggressive incision and drainage to ensure joint is not damaged to the point of non-functional
24
Q
Gout tophi may result from _____
A
- Patients that have long-term untreated gout
25
Gout tophi characteristics
- Crystals that deposit themselves not just in joint, but soft tissue around joint
- Fill these masses called tophi
- X-ray may even look like a bone tumor
- Can be surgically resected
26
A non resolving scrape on the skin may be a result of _____
- High BSL
27
Unresolved wounds may create _____
- Infections
- May lead to non-healing wound and continued spread of infection
- May lead to amputation later (especially if patient has poor circulation)
28
Important notes for patients with wounds
- Make sure they are metabolically optimized to heal from that wound
- Requires normal blood sugar and good circulation
- Patient requires treatment with primary care, endocrinologist, vascular surgeon, etc.
29
Many studies show presence/development of bunions are a result of these aggravating factors
- Shoes
| - High heels/shoes putting pressure on forefoot area will more commonly come in complaining of a bunion deformity
30
Bunion deformities develop from _____
- The way we walk
- Inherited biomechanical function creates these deformities, and they develop over time
- Pronation causes this biomechanical fault
31
What is the most common etiology of bunions and hammertoes?
- Abnormal excessive pronation
| - Try to correct with orthotics before surgery
32
Two very common types of ulcers that are vascular related are those that form because of _____
- Venous incompetency
| - Arterial insufficiency
33
Ulcer located proximal to medial malleolus (on the inside) typically is a _____
- Venous ulcer
- Usually not painful
- Red and healthy looking tissue (granulation tissue)
34
Ulcer located lateral to medial malleolus usually indicates _____
- Arterial ulcer
- Usually excruciatingly painful
- Very necrotic in appearance
35
A uniform border usually indicates _____ ulcer
- Arterial ulcer
36
Patients with arterial ulcers need _____
- Vascular intervention
- Need to reestablish blood flow to the extremity before any attempts at debridement
- Then debridement is done every day in office with 15 blade or tissue nipper
37
_____ is typically the antibiotic of choice for injuries obtained from salt water because of the pathogens that tend to grow in there
- Augmentin
38
Jellyfish stings typically require _____
- Supportive treatment
| - Want to minimize the effects of the toxin
39
Typical medications effective in reducing effects of jellyfish toxin
- Nitroglycerin patch
- Topical steroid
- Oral analgesics
- Oral steroids
40
Neurofibroma (neurofibromatosis)
- Soft tissue pathology
| - May be related to other issues
41
Most common tumor in the body
- Lipoma
42
Characteristics of Lipomas
- Benign mass, soft tissue growth
- Common in lower extremity
- Tumors tend to be very well encapsulated and vascularized
- Classic signs of benign soft tissue mass
43
Malignant melanoma
- Very fast-growing soft tissue tumor
- Invading of surrounding tissues and very destructive
- Can be life-threatening
44
Calcification in a soft tissue mass requires _____
- Surgical resection with biopsy
| - It is a potential malignant marker
45
Liposarcoma
- Fast growth and out grows its blood supply
- Necrotic
- Has same stem cells as lipoma, but unlike lipoma is highly malignant
46
Characteristics of Liposarcomas
- Lobulated
- Not well encapsulated
- No apparent supporting vascular structure
47
Cavus foot, CMTD
- Genetic disorder (result of neurological condition)
- Commonly develop high arched foot
- Many ways to surgically stabilize to create better weight bearing status
- Least common type of foot pathology
48
Treatment for cavus foot
- Typically combination of osteotomies, fusions, and tendon transfers performed to address deformity
- Staging can be used
- Tendon transfers first to rebalance, then more bony procedures to address bony pathology
49
2nd toe very often involved with pathology of _____
- Bunions
| - As patients develop bunions, first metatarsal will deviate from natural position
50
When first metatarsal deviates (in multiple planes/transvers and frontal plane rotation) it puts a lot of stress underneath _____
- 2nd metatarsal
| - Complain about pain under 2nd metatarsal, not bunion
51
Bunion/toe correction must be addressed in a specific order
- Cannot put toe in correct position until bunion deformity is addressed first
- Bunion > corrective position > then 2nd toe into stable position
- Needs soft tissue work to re-stabilize structures so toe does not continue to dislocate post-operatively
52
_____ makes the repair site heal more efficiently in an achilles tendon rupture
- Augmentation of tendon with collagen graft
53
Calcaneal fracture contour plates are utilized to _____
- Reconstruct calcaneal fracture
- Calcaneal fractures usually show multiple fragments, so plates are needed to get bones back together
- Bone replacement products may be used with bone deficit
54
Calcaneal fractures are typically _____
- Interarticular
| - Results in arthritis post-operatively
55
Developing arthritis following calcaneal fracture reconstruction is often seen developing in _____
- Subtalar joint
| - Usually will need secondary surgery for arthritic complications
56
Flatfoot/Charcot joint mid-food collapse
- Common diabetic complication
- Patients that are neuropathic may commonly undergo this bone-breakdown process in the foot
- Seen most commonly in diabetics
- Midfoot looks like it fuses into one block of bone
57
Diabetic Charcot joint usually results from/in
- No traumatic injury
- Foot gets red, hot and swollen
- Continues to walk on it (bones are very brittle during this acute charcot)
- Bones begin to break down
58
What foot type do diabetics with Charcot develop?
- Rocker bottom foot
59
Common issues associated with rocker bottom foot
- Cannot feel bottom of foot
- Do not adjust to pressures
- Constantly come down on foot, creating ulcers/soft tissue ulceration
- Ulcers commonly infected and lead to osteomyelitis
60
Brachymetatarsia is _____
- Early growth plate closure, most commonly the 4th metatarsal
- No known etiology as to why this has happened
61
Osteotomy
- Create a cut in the bone in an area of high cell turnover
62
_____ area of bone has the best vascularity compared to the _____ area of bone
- Metaphyseal
- Diaphyseal
- Better vascularity means better healing potential
63
Callous distraction lengthening
- Cut bone
- Insert external fixator
- Place pins
- Patient turns periodically
64
Bandage scissors
- Flat part against the patient’s skin
| * **You need to wash and clean the bandage scissors with disinfectant every time you use it***
65
Two most common people you are cutting bandages off are _____
- Post-ops
| - Wound care
66
Stethoscope
- Single barrel stethoscope with one large aperture
| - Smaller one and bigger one (smaller for pediatric patients)
67
Auscultate lungs at _____
- 10th Thoracic Vertebra
68
Heart Sounds during auscultation
- Lub (blood moves from atria to ventricles)
| - Dub (ventricles expel blood from the heart)
69
Blood Pressure Cuff/Sphygmomanometer
- Also use stethoscope when taking blood pressure
- Listening to brachial artery
- Pump cuff above 120 (because 120 is normal)
- First sound is the shutting off of the artery (gives first number)
- Second noise is when you release the cuff, and start to hear blood flow again (gives second number, 80 is normal)
- Systole over diastole
70
Petechiae
- Little red splotches if cuff is not released or left on for too long
71
Systole/Diastole
- Systole (ventricular shortening and emptying)
- Diastole (ventricular elongation and filling)
- 120/80 mm Hg within normal limits
72
Goniometer or Tractograph used most often in
- Biomechanics
73
One of the angles to look at when evaluating for a bunion repair is the _____
- Intermetatarsal angle
| - Angle between the two metatarsals
74
Goniometer or Tractograph used may also commonly be used in
- Physical therapy
- Tendon surgery
- Shows the degree of flexion that you can get after the surgery
Intro to Pod
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