Pimp Interview Questions

Question 1

Fowler Phillip Angle (normal vs abnormal to ID what pathology)

Answer 1

• ID Haglund’s Deformity
• normal: 45-70 deg
• Haglunds > 75 deg

Question 2

Another name for “Total Angle”

Answer 2

Total angle “OF RUCH”

Question 3

Total Angle (abnormal to ID what pathology)

Answer 3

• ID Haglund’s Deformity

> 90 = pathologic

Question 4

What is “Peak of Lampiere”

Answer 4

1st met-cuneiform exostosis

Question 5

Another term for “Peak of Lampiere”

Answer 5

tarsal bossing

Question 6

What are 3 angles you want to examine for haglund’s deformity

Answer 6

1. Fowler-Phillip Angle
2. Total Angle (of Ruch)
3. Parallel Pitch Lines

Question 7

How much cartilage should be intact to 1st MTPJ for decision justified to do joint salvage px for hallux lim

Answer 7

> 50%

Question 8

For surgical correction of Haglunds deformity… you should consider using fixation (e.g., bone anchor) to secure it back in place if you have to resect what % of tendon?

Answer 8

50%

Question 9

Difference b/w Bruit and Thrill

Answer 9

• bruit : hear

- thrill: feel

Question 10

Allen Test

Answer 10

• performed in hand – test for radial or ulnar artery occlusion

Question 11

Pallor with Elevation, Rubor with Dependency – how long does it take normally for color to return? abnormal/diseased?

Answer 11

10 seconds = normal return

45-60 seconds = abnormal

Question 12

ABI necessary for healing?

Answer 12

DM: 0.45

Non-DM: 0.35

Question 13

When is TBI indicated?

Answer 13

• when ABI > 1.3

- i.e., when calcification of the vessels prohibits accurate ABI (doesn’t effect TBI b/c calcification rarely in digits)

Question 14

What TBI value is consistent with LEAD

Question 15

Toe pressure

Answer 15

TBI

Question 16

Interpretation of Segmental Pressures

Answer 16

• same leg: occlusion proximal if 30 mmHg decrease b/w 2 segments
• CL leg: occlusion on one limb if 20-30 mmHg difference from other side (occlusion in lower read)

Question 17

Transcutaneous Oxygen Pressure: when is it useful?

Answer 17

• useful when ABI and TBI do not provide useful information (i.e., compressible vessels and toes amputated)
• additional support for re-vasc sx
• indicate amputation level

Question 18

Interpretation of TcPO2

Answer 18

> 30 mmHg - normal (predictive of healing)

Question 19

When is Skin Perfusion Pressure Test done (SPP)

Answer 19

when there is excessive local edema/anemia (TcPO2 can give false reading)

> 30 mmHg - likely to heal wound

Question 20

IV contrast used in MRA

Answer 20

gadolinium

Question 21

Contraindications to MRA

Answer 21

• pacemaker
• implanted defibrillators
• other implanted electronic devices (cochlear implants)
• aneurysm clips
• pregnancy

relative contraindications: orthopedic hardware (creates artifacts on films), claustrophobia

Question 22

IV contrast used for CTA

Answer 22

iodinated contrast

Question 23

CTA vs MRA

Answer 23

• CTA: more image detail, useful in pts with CI to MRA
• • however, less accurate in extensive vessel occlusion, ionizing radiation +
• MRA: no ionizing radiation, more accurate with extensive vessel occlusion
• • however, many CI’s, less image detail, and pts may be claustrophobic b/c takes longer

Question 24

Foam Cells

Answer 24

lipid-laden macrophages

Question 25

Senile Medial Calcinosis

Answer 25

Monckeberg's Sclerosis

Question 26

Extensive skin necrosis following limb ischemia occurs within what amount of time

Answer 26

6 hrs

Question 27

Causes of Hypercoaguable State

Answer 27

- Protein C or S deficiency - Antithrombin III deficiency - Factor V Leiden deficiency - Antiphospholipid syndrome (associated with SLE)

Question 28

CAVEMAN common etiologies for embolic source

Answer 28

``` Cardiac catheterization - iatrogenic A. Fib Valve Dz Endocarditis Myocardial Infarct/Mural Thrombus Aneurysm Nothing ```

Question 29

Virchow's Triad

Answer 29

- venous stasis - hypercoaguable state - endothelial damage

Question 30

R/o Test for DVT

Answer 30

d-dimer (fibrin degradation product)

Question 31

Tests for PE

Answer 31

- CT pulmonary angiography (gold standard) -- rule in - V/Q Scan - D-dimer (rule out)

Question 32

Pratts sign vs Pratts Test

Answer 32

Pratts sign: dilated pre-tibial vessels Pratts test: compressing popliteal veins; calf squeeze

Question 33

Reversal agent Heparin

Answer 33

protamine sulfate

Question 34

Reversal agent Coumadin

Answer 34

Vit K or FFP (faster)

Question 35

Heparin Induced Thrombocytopenia -- why is it bad?

Answer 35

antibodies activate platelets and cause arterial / venous thrombosis

Question 36

How to tx pt with HIT:

Answer 36

1. stop heparin 2. need anticoagulants due to incr risk of thrombosis 3. begin non-heparin anti-coagulant (e.g., argatroban - direct thrombin inhibitor, fondaparinux, apixiban, rivaroxiban) -ban's = Xa inhibitors ** don't use lovenox as supplement

Question 37

Pharmacologic Tx of DVT

Answer 37

1. initial (first 5 days): - Lovenox (1 mg/kg q 12 hrs = therapeutic dose) - Heparin so that PTT is 1.5 x normal - Apixiban or Rivaroxiban 2. Long Term (Start initially but not therapeutic at the onset) - Warfarin (Coumadin) INR 2-3 3. Other agents - Factor Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban) - Direct Thrombin Inhibitors (Dabigatran, Argatroban)

Question 38

myxedema - what is it and what is it hallmark for?

Answer 38

- mucopolysaccharide deposition in the dermis | - grave's disease

Question 39

+ stemmer sign

Answer 39

thickened skin fold at the base of the second toe or second finger that is a diagnostic sign for lymphedema. Stemmer Sign is positive when this tissue cannot be lifted but can only be grasped as a lump of tissue; it is negative when it is possible to lift the tissue normally.

Question 40

Atrophie Blanch

Answer 40

sign of impending ulceration w/ venous insufficiency

Question 41

Lipodermatosclerosis

Answer 41

sclerotic hardening of the underlying fat

Question 42

Contraindications to using TQ:

Answer 42

- PVD (h/o re-vasc px) - Traumatized limb - Severe infection in limb - DVT in limb - Peripheral neuropathy - Poor Skin Condition - AV fistula Relative CI: sickle cell disease

Question 43

Examples of Large vessel vasculitis

Answer 43

- giant cell (temporal) arteritis | - takayasu arteritis

Question 44

Examples of Medium Vessel Vasculitis

Answer 44

- Polyarteritis nodosa | - Kawasaki Dz

Question 45

Examples of Small Vessel Vasculitis

Answer 45

- Churg Strauss Syndrome (anti-neutrophil cytoplasmic Ab) - Wegener's Granulomatosis (anti-neutrophil cytoplasmic Ab) - Henoch-Schonlein Purpura (mostly in kids following strep pharyngitis)

Question 46

How to diagnose Compartment Syndrome

Answer 46

Wick/Stryker Catheter (>30 mmHg comp pressure) * note: normal Compartment Pressures: 0-5... capillary blood flow compromised at 10-30 mmHg... and pain develops when tissue pressures reach 20-30 mmHg

Question 47

most common cause endocarditis

Answer 47

S. viridans

Question 48

cause of endocarditis due to IVDA

Answer 48

s. aureus

Question 49

Haglund's DISEASE

Answer 49

osteochondrosis of accessory navicular

Question 50

Other names for Subtendinous/Retrocalcaneal Bursitis

Answer 50

- Achillodynia - Albert's disease - Anterior Achilles Bursitis

Question 51

Name for 1st TMTJ arthritis/exostosis

Answer 51

- Tarsometatarsal "Bossing" | - "Peak of Lampiere"