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Externship questions
| Question | Answer |
|---|---|
| If the patient is allergic to penicillin? | Clindamycin Dose: 600 mg or 900 mg IV 30 minutes before surgery |
| What is the DOC for surgical prophylaxis? | Ancef (Cephalexin) Dose: 1g IV 30 minutes before surgery |
| What is the advantage of daptomycin (Cubicin) over vancomycin? | Both drugs are used to treat MRSA, but daptomycin is rapidly bactericidal compared to vancomycin, kills more effectively and rapidly and may have better penetration. Class of cubicin : cyclic lipopeptides (new class) |
| What are the toxic doses for lidocaine and marcaine? | Lido: 300 mg Lido + epi: 500 mg Bupivicaine: 175 mg Bupivicaine + epi: 225 mg |
| Why should you not use bupivicaine in children? | Half-life is normally 2.7 hours, but in children it is from 6-22 hours, so may cause seizures |
| What is a venous tourniquet? | Uses in presence of calcified vessels that are non-compressible. It will not compress the arteries. It will compress the veins not allowing blood to escape. Surgical field will be very wet and adjusting the tourniquet or cauterizing will not help. |
| What are the different sizes of K-wires? | 0.028 (0.7 mm) 0.035 (0.9 mm) 0.045 (1.14 mm) 0.054 (1.4 mm) 0.062 (1.6 mm) |
| What is Dakin's solution? | Hypochlorite based solution. Used in dressings or irrigation to prevent bacterial growth |
| How do you calculate HbA1c from glucose values? | Normality: 4-7% Reflects the average blood sugar level for the 2-3 months period before the test 4%: 3.3 mmol/L or 60 mg/dl 5%: 5.0 mmol/L or 90 mg/dl 6%: 6.7 mmol/L or 120 mg/dl |
| What is the classification for isolated medial malleolar fracture? | Mueller classification A: Tip avulsion (avulsion of the anterior colliculus) - Associated with tear of the superficial deltoid ligaments B: Intermediate. C: Fracture at the level of the plafond (oblique).D: Above the level of the plafond. |
| What are the 4 principles when fixating a pilon fracture? | 1- Restore the length of the fibula 2- Reconstruct the tibia articulation (Use the key fragment and the talus as a guide) 3- Fill in defects with cancellous bone grafts 4- Buttress the medial malleolus (tibia) to prevent tibial varum |
| What is Meperegan Fortis? | Meperidine and promethazine (pain killer and antiemetic) |
| What is dilaudid? | Hydromorphone |
| What is vicodin? | Hydrocodone and acetaminophen (5/500) 1-2 tabs PO q4-6 hrs ES: 7.5/750 HP: 10/660 |
| What is lortab? | Hydrocodone and acetaminophen (2.5/500, 5/500 or 7.5/500 1-2 tabs PO q4-6h or elixir (2.5/167 per 5 ml) 15 ml PO q4-6h |
| What is percocet? | Oxycodone and acetaminophen (5mg-325mg) |
| What is bactroban? | Topical antibiotic ointment (muciprocin) Active against MRSA |
| What formula is used to determine how much insulin should be given on a sliding scale? | (Glucose-100) / 30 |
| What is Virchow's triad? | Hypercoagulability Endothelial damage Stasis |
| What are the key risk factors of DVT? | I- Immobilization A- arrhythmias M- Myocardial infarction C- Contraceptives L- Laiden (mutation of coagulation factor V) O- Obesity T- Trauma T- Tumor T- Tobacco E- Elderly D- DVT history / DM |
| What are the normal values of PT and PTT? | -PTT: 25-35secs. Monitors heparin anticoagulation therapy. Prolonged (1,2,5,8,9,10,11,12) -PT: 11-16 secs. Monitors long term warfarin therapy. Prolonged (1,2,5,7,10). -INR: International normalized ratio. Normal = 1. <1 = hyper-coagulable. >1 = hypo |
| What is the therapeutic INR? | Between 2-3 (Patient will bleed a great deal) If patient is going to surgery, the INR should be between 1 and 1.5 |
| How long before surgeries you should stop: | Coumadin? 4 days Heparin? 6 hours Aspirin? 5 days (Some studies say you should continue taking aspirin before surgery (lower mortality rate (circulation 2005) Plavix (clopidogrel) 7 days |
| How long does it take for Coumadin to take effect? What is the initial effect? | Warfarin initially decreases protein C levels (anticoagulant) faster than coagulation factors, so can cause hyper coagulability at the beginning. Can give heparin at the same time at the beginning to offset this initial effect. Can take 4-7 days to effect |
| Why does urinary retention occurs after surgery? | can be a direct result of the anesthetic or type of operation. Relative immobility after a surgery can also contribute to urinary retention. General anesthesia affects brain function and inhibits the autonomic (involuntary) nervous system that controls bl |
| What is dilated cardiomyopathy? | The heart cavity is enlarged. The muscles become weak at pumping blood. Fluid starts to compile in the lungs.Results in CHF. Tachypnea, tachycardia, HTN.Venous distension, pulmonary edema/congestion .Hepatojugular reflex, enlarged liver, peripheral edema. |
| What is hypertrophic cardiomyopathy? | - Heart muscle thickens - Left ventricle is the most affected, often enlargement of the inter ventricular septum, which will affect the outflow tract - Volume of the left ventricle decreases |
| What is a restrictive cardiomyopathy? | Heart muscle is unable to relax between heartbeats, so it is difficult for the heart to fill up - There is little time for the heart to refill with blood - Least common of the cardiomyopathies |
| What is the mechanism of action of daptomycin? | Disruption of bacterial membrane through formation of transmembrane channels Dissipation of bacterial membrane potential Inhibition of lipotheoic acid synthesis |
| Who first described the triple arthrodesis? | Edwin Ryerson (1923) added the calcaneocuboid joint - Hoke (1921) fusion for paralysis - Eduard Albert- described fusion for paralytic deformity (knee) |
| What are the stages of a skin graft healing? | 1- Plasmatic imbibition: graft is nourished through plasma 2- Inosculation: blood vessels start to grow in the graft 3- Revascularization 4- Remodeling |
| What are the sizes for split thickness skin grafts? | 0.008-0.012 inches (thin) (0.2 – 0.3 mm) 0.013-0.016 inches (intermediate) (0.3 – 0.4 mm) 0.017-0.020 inches (thick) (0.4 – 0.5 mm) |
| What is dilaudid? | Hydromorphone hypo chloride (hydrogenated ketone of morphine) - Either 1 mg, 2 mg or 4mg for mL (parenteral) - Either 2mg (orange) or 4mg (yellow) tablets. Dose: 1-2 mg SC or IM every 4-6 hour |
| What is Demerol? | Meperidine hydrochloride.effects similar to morphine (rapid onset of action n shorter duration). Should not be given to pregnant women, can cross the placental barrier, baby may have dependence and respiratory depression.Dosage: 50–150 mg PO q3-4 hrs |
| What is toradol? | Ketorolac trometamol - NSAID (pyrolo-pyrrole group) - IM injection (10 mg/ml and 30 mg/ml) completely absorbed Peak plasma = 1 hour - PO 10 mg tablets Peak plasma 35 minutes - Inhibits COX system (peripherally acting analgesic) |
| What are the normal hematologic values? | WBC: 5000 – 10000 cells / uL Hb: female: 14 Male: 16 Hct: 45% (40-50% males, 37-47% females) Platelets: 150 000 – 300 000 Neutrophils: 2500-7000/ uL |
| Which patients should be tested for pituitary-adrenal suppression? | Patients on 7.5 mg of corticosteroids a day or more |
| What are the five W’s? | Wind (Atelectasis, aspiration pneumonia, PE) - Wound (Infection, thrombophlebitis (IV site), pain) - Water (UTI, dehydration, constipation) - Walking (DVT) - Wonder drugs (patient appears less ill than fever suggests) |
| What is the clinical presentation is PVNS? | It is a benign tumor of the synovium often found in the digits. Seen in young people. Very aggressive, can erode the bone. It looks malignant. On MRI, on TI it is dark, T2 darker and T2 fat suppression it is very black! |
| How does OM looks on MRI? | Low signal intensity in T1. High signal intensity in T2 Even higher signal intensity in T2.If we suspect post-operative OM, Indium is the good modality, because it will have high signal intensity on MRI because of the trauma of the surgery. |
| In young people, where does the PT tendon generally tears? | At its insertion, in contrary of old people where it is at the watershed area. |
| What is a ddx of Ewing’s sarcoma? | Since Ewing sarcoma is a tumor that causes systemic symptoms (fever, chills, nausea), a ddx would be hematogenous OM. (Hematogenous OM is usually in the metaphyseal region of the bone and Ewing’s sarcoma is metaphysis and metadiaphyseal regions) |
| What is the oral glucose test? | Give 100 g bottle of glucose to the patient and than take the blood sugar values: 1- Fasting (65-110) 2- 30 minutes (< 160) 3- 1 hour (< ) 4- 2 hours (<125) 5- 3 hours (back to fasting levels 65-110) |
| What is the small layer of soft tissue directly on top of the extensor hallucis longus? | The extensor aponeurosis |
| - Antiemetics | Dimenhydrinate(Dramamine):50mg PO/IM/IV q4h. for nausea + vomiting assoc w/ motion sickness Odansetron (Zofran):32mg infused over 15min or three 0.15 mg/kg IV doses, 8-10mg PO bid or solution 4mg/5ml Promethazine(Phenergan): 25-50mg PO/IM/PR q 4-6hrs |
| What is the action of the adductor hallucis in the HAV deformity? | Deforming force my laterally pulling the proximal phalanx, it subluxes the head of the metatarsal medially. For that reason, it is important to release the adductor tendon |
| What are the steps of the lateral release? | 1- Cut the DTML 2- Cut the adductor tendon 3- Release the fibular sesamoid (release suspensory ligament) 4- Cut the EHB 5- Remove the fibular sesamoid In between these steps, check if the dorsiflexion of the hallux is in the right plane) |
| Which procedure would you do on a kid with an enormous IM angle, Lapidus or base wedge? | Base wedge for joint salvage and growth plates. |
| Why would you do an Austin with a long plantar arm? | Because it gives more contact surface with the ground forces and less chances to break. |
| What is the particularity of the possible fixation of an Austin Kalish? | It can be bicortical and away from the joint. The screws have to be perpendicular to the dorsal cut. |
| After a lateral release, which complication could happen? | A hematoma (collection of blood where the release was made) |
| What can happen if you overcorrect a HAV deformity? | A Hallux varus can occur. (Abductor tendon pulls on the proximal phalanx and creates this deformity) Especially if you have disrupted the sagittal groove |
| When you make a single cut with a sagittal saw, how much shortening of the bone will you get? | 2mm |
| What is the function of an apical axis guide? | To make the cut in function of the correction we want. (PF, DF, elongate, shorten) The guide is located at the apex of the osteotomy in an Austin. |
| What is a lock pin? | It is when you fixate with a k-wire and bend it close to the bone and leave it there. Doesn’t provide compression. |
| For maximal compression, where should be the threads of the screws? | Distal to the osteotomy site. |
| What is concentric drilling? | In a neutralization plate, you put the screws in the center of the holes if you don’t want compression. |
| Where do you transfer the adductor tendon in an adductor tendon transfer? | Laterally to EHL at the level of the neck of the first metatarsal sutured with horizontal mattress with the capsule. |
| What are the types of corrosion? | - Chemical corrosion - Crevice and pitting corrosion - Galvanic corrosion - Fretting: Chemical and mechanical corrosion between 2 mating surfaces in micromotion. |
| Which material is good for nickel allergies? | Titanium Ti-6Al-4V is a highly biocompatible alloy. Has a passivation layer that stabilizes it. Be careful of scratches, because crevice and pitting corrosion can occur. |
| What important principle should be followed when implanting devices? | The more similar a material’s mechanical properties are to bone, the less stress shielding is created. |
| When should you coagulate a bleeder (Bovi) or tie it? | If you can see the lumen of the vessel, you have to tie it. If you don’t, you can Bovi it. |
| What is decadron? | It is dexamethasone |
| In order to make a fusion, what part of the bone do you have to curette? | take off all of the articular cartilage and the subchondal plate until you see a nice bleeding. This is called the paprika sign, first described in surgeries of OM in which you had to take off the ‘’infected and dead’’ bone until the paprika sign. |
| What is the fibers that attach periosteum to bone at the level of the articular capsule? | Sharpy’s fibers attach periosteum to the bone at the articular capsule. They aren’t at the level of the cortical bone. when you strip off the periosteum, start at the shaft of the bone (easier) and finish at the level of the capsule (resistance) |
| What are Charnley principles? | It is a sequence of closed reduction: 1- Increase the deformity 2- Distract 3- Reverse the deformity and realign 4- Maintain correction with immobilization |
| What do you do if intraoperative edema occurs? | You elevate and compress the leg intra-op. |
| What was the joint that has the highest rate of non-union is a triple arthrodesis historically? | The talo-navicular joint, because since the approach (incision) was only lateral, it was more difficult to take off all of the cartilage from the articulation, resulting in non-union. |
| What is the joint that has the highest rate of non-union in a triple arthrodesis at the moment? | The calcaneo-cuboid joint, because patients walk before they are supposed to! |
| In a Jones fracture, what would be 3 good reasons to fixate? | Athletes - Displaced fracture - Non-union |
| What is the screw sequence to put a 6.5 mm screw? | 1- Predrill (3,2 mm) 2- Overdrill (4,5 mm) 3- Countersink (4,5 m) 4- Depth gauge (measure) 5- Tap (6,5 mm cancellous tap) 6- Screw insertion (6,5 mm) |
| What are the antibiotics that cover pseudomonas? | Fortaz (ceftazidime) Aztreonam Ticarcillin Ciprofloxacin Imipenem Aminoglyxosides (not pediatric approved) Pipercillin (Zosyn = piperacillin + tazobactam) |
| What are the antibiotics that cover the MRSA drugs? | Vancomycin (IV) Synercid (IV) Zyvox (Linezolid) (IV or PO) Bactrim / Rifampin (IV or PO) Minocycline (IV or PO) Cipro / Rifampin (IV or PO) Gentamycin (peds) (IV or IM) *? Cubicin (Daptomycin) (IV) |
| Why do end-stage renal disease patients tend to have calcifications of the arteries? | Because they tend to have hyperphosphatemia, which brings hypercalcemia and created deposits of calcium pyrophosphate in the vessels. A patient on dialysis has a low phosphate and potassium diet. (Because they have hyperphosphatemia and hyperkalemia.) |
| What is the DOC for afib? | Diltiazem |
| What is the procedure ‘’OATS’’ | Osteoarticular transfer replace of hyaline cartilage to a joint |
| What are 3 etiologies of renal disease? | Prerenal (not enough blood flow going to the kidneys) Intrarenal (Glomerular problems) Postrenal (Calcifications) |
| What is the best diagnostic test for bacterial endocarditis? | Transesophageal echo, detects more than 90% of heart valve infections. |
| When you want to plantarflex and elongate the first metatarsal while doing an Austin, why should we put the apical axis guide in a more dorsal position? | Because if we don’t, the k-wire will go through the 1st met head cartilage. |
| Why should we use a smaller screw that what was measured in an Austin? | Because we want the screw to be a little shorter so it doesn’t go into the joint. (Oriented that direction!) |
| What is the medication phoslo? | Phoslo is a medication often given to patients on dialysis. It is composed of calcium acetate that binds to dietary phosphate and that makes you excrete it in your feces. It is used to avoid the risk of hyperphosphatemia in dialysis patients |
| What would be the symptoms of hyperphosphatemia? | Unsafe buildup of minerals in you body (calcifications) - Heart strokes - Secondary hyperparathyroidism - Renal osteodystrophy |
| What are the ddx of neuropathy? | Diabetes Amyloidosis Nutritionnal (B12) Guillain Barré Toxic Herediary Endocrine Recurring (radiculopathy) Alcohol Pb Idiopathic Sarcoid Thyroid |
| - How does the injection of one unit of packed RBC changes the Hb and Hct? | - Increases the HB of 1% - Increases Hct of 3% |
| What are the 6 D’s of Charcot on X-ray? | Destruction Disorganization Increased density Debris Dislocation Distention |
| What is the formula to know how much fluids to give to a patient? | Add 40 to the weight of the patient in Kg. The number you will have is the number of ml / hour you have to give to your patient. |
| Which one between dilaudid and morphine is the strongest? | Dilaudid is 7x stronger than morphine |
| In which value of creatinine should metformin be avoided? | When creatinine is > 1.2 |
| - Should lovenox be administered in patients with renal problems? | The dose should be decreased by half if the GFR is < 58. |
| What is meralgia paresthetica? | A mononeuropathy of the lateral femoral cutaneous nerve that can be caused by a thigh tourniquet. |
| What are the signs of an anesthesiant overdose? (Lidocaine) | - CNS toxicity - Metallic taste - Numbness of tongue and lips To reverse, give versed and oxygen. |
| What is the dosage of prophylaxis antibiotherapy of ancef? | 1g IV 30 minutes before surgery if the patients weights less than 75 Kg. If the patient is heavier, give 2g IV. |
| What is the type of suture that keeps the best cutaneous blood flow? | Modified Allgower Denotti ( one side subcute and the other horizontal mattress) |
| What is the most common virus that causes arthritis? | Hepatitis B |
| What is the most commun fungus that causes arthritis | Sporothrix chinekii |
| When does the tarsal coalitions occur? | Talo-calcaneal : 8- 16 years old Calcaneo-navicular: 8 – 10 years old Talo-navicular: 3 – 5 years old (less common) If there is < 50% of involvement, resect it. If there is > than 50% of involvement, fuse it. |
| What can be seen in skin after corticosteroid injections? | - Thinning - Discoloration - Cristals |
| What are the indications for treatment of onychomycosis with formula 3 antifungal? | Apply BID / 6 weeks |
| What test should you do before doing a surgery for non-union? | You should do a bone scan to see if there is still activity in bone, if there is you can try bone stimulation 6-8 weeks before doing surgery. |
| What is primaxim? | Imipenem and cilastatin (500mg q6h) |
| What is Mobic (Meloxicam)? | It is an NSAID used to treat arthritic pain |
| What is toradol? | Its is ketorolac (NSAID) used to relieve moderately severe pain, usually after surgery. |
| - What agent can neutralize Phenol? | Betadine |
| - What is tramadol (ultram)? | Pain med (opiate agonist). Long acting, PO. |
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sfayed
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