204 Questions
What are common symptoms of cellulitis?
Erythema, edema, warmth, tenderness
Which of the following is NOT a common symptom of cellulitis?
Cold and numb feeling in the infected area
Which organisms are most commonly identified as the pathogens causing cellulitis?
Streptococci and S.aureus
What is a typical treatment for cellulitis?
Outpatient oral antibiotics covering Gram-positive organisms
Which type of infection is characterized by a localized collection of purulent material encapsulated by inflammation?
Abscess
Which condition involves rapid destruction of tissue and if untreated can result in systemic toxicity and death?
Necrotizing fasciitis
Which of the following diagnostic methods is NOT typically used for diagnosing cellulitis?
Blood culture
What is a common risk factor for developing gangrene?
Vascular disease
Which of the following is NOT a typical treatment option for osteomyelitis as per the text?
Crystal analysis
What is a common feature of necrotizing fasciitis?
High mortality rate
What is a key factor in the diagnosis of an abscess?
$50,000 and 90% neutrophils predominance
Why should nonunion be considered infected until proven otherwise?
$4x greater risk when infected
What is the main difference between cellulitis and necrotizing fasciitis?
Cellulitis is a superficial skin infection, while necrotizing fasciitis is a deep-seated infection that rapidly progresses and causes tissue death
Which of the following is a common characteristic of gangrene?
Gangrene involves the death and decay of body tissues due to lack of blood supply
Which of the following infections is most likely to require surgical intervention?
Osteomyelitis
What distinguishes an abscess from cellulitis?
An abscess is a deep pocket of infection with pus, while cellulitis is a superficial skin infection without pus collection
What differentiates osteomyelitis from gangrene?
Osteomyelitis is an infection specifically affecting bone, while gangrene affects soft tissues due to lack of blood supply
What is the primary reason for maintaining intrinsic muscle stability around the metatarsal phalangeal joint?
To prevent Charcot foot complications
In what scenario would a Ray resection typically be performed?
To manage gangrene of a toe and its metatarsal
What is the main difference between a Ray resection and transmetatarsal amputation?
Ray resection involves amputation of a digit and its associated metatarsal, while transmetatarsal amputation involves only partial removal of the metatarsal.
Which condition would necessitate a transmetatarsal amputation?
Gangrene involving multiple toes and metatarsals
Why are skin incisions made with medial and lateral flaps during a Ray resection?
To obtain viable skin for closure over raw bone
What distinguishes a Transmetatarsal Amputation from other toe-related procedures?
It involves complete removal of all metatarsals and toes
Why is it essential to stabilize hindfoot fusions for long-term success?
To prevent chronic ulcers and osteomyelitis
What is a common indication for the insertion of antibioti-contaminated tissue according to the text?
Charcot arthropathy
Why is fusing the ankle and subtalar joint considered essential for stability and function?
To avoid Charcot arthropathy
According to Boyd, H.R.'s study, what surgical procedure involves amputation of the foot with calcaneotibial arthrodesis?
Choparts amputation
In what context would the use of an IM (intramedullary) rod be considered appropriate?
In cases of Charcot arthropathy
What ASA physical status class would a patient with stable diabetes fall into?
Class 2
Which level of amputation involves removal of the entire foot up to the ankle joint?
Hindfoot
What is the term used for a toe amputation performed through the base of the proximal phalanx?
Complete Rays
Which type of amputation involves removing part of the metatarsal bones but not the entire foot?
Partial Rays
In amputation levels, which level involves removal of the heel bone specifically?
Calcanectomy
Which type of amputation involves removing part of the foot and part of the lower leg?
Below Knee (BKA)
What defines infection as per the text?
Pathological presence of bacteria in a site
What is an essential clinical parameter for diagnosing infections?
White blood cell count
Why is the identification of SIRS criteria important in infections?
To understand the severity of the patient's immune response
What distinguishes sepsis from other lower extremity infections?
Presence of bacteria in the blood
Why is it important to differentiate between various types of lower extremity infections?
To provide appropriate medical and surgical management
What is the most common presenting symptom for pulmonary embolism?
Dyspnea
In diagnosing deep vein thrombosis, what is the sensitivity and specificity reported for noninvasive duplex ultrasound?
Sensitivity of 95% and specificity of 90%
What is the timing to the diagnosis of venous thromboembolism (VTE) on average as per Saragas et al?
33.1 days
Which diagnostic method is mostly reserved for patients in whom computed tomography pulmonary angiogram (CTPA) is contraindicated or inconclusive?
Ventilation perfusion scan
What is the initial peak timing for deep vein thrombosis postoperatively according to Forsh et al?
Day 4
What symptom, when present with ankle dorsiflexion and knee flexion, can be positive in up to half of patients with or without a DVT?
Calf pain
What is the basic science behind electrical stimulation (e-stim) in bone healing?
Tension in e-stim generates electronegative potentials for bone formation.
What is the primary goal of applying a Posterior Splint?
To immobilize the foot and ankle following injury or surgery
What is the main purpose of extracorporeal Shock Wave Therapy (ESWT) in bone healing?
To stimulate neovascularization and cell differentiation through microtrauma.
When is a Sugar-Tong Splint typically indicated post-operatively?
In cases of ankle sprains and stable fibular fractures
Which material is commonly used for Post-Operative Casts and allows for weight bearing sooner?
Fiberglass
Which of the following is a contraindication for using Electrical Stimulation in bone healing?
Synovial pseudoarthrosis.
What is a critical characteristic of Autologous Bone Grafts?
Autologous Bone Grafts are osteoconductive due to the presence of viable osteoblasts.
What is the main purpose of a Controlled Ankle Motion (CAM) Boot post-operatively?
To control foot and ankle motion for specific injuries
What should be considered in determining the Operative Strategy for nonunion treatment?
Nonunion location – metaphysis vs diaphysis doesn't affect treatment options.
Why should Post-Operative Shoes have a stiff sole?
To prevent contralateral hip and knee pain
What is one of the main functions of Platelet Concentrates in operative treatment?
Releasing growth factors and cytokines to aid in healing and tissue regeneration.
What is the primary function of Incisional Wound Vacs in post-operative care?
To draw moisture towards the incision site
What distinguishes Jones Compressive Dressing from other dressing options?
It is designed to control edema in post-operative or trauma patients
What is the key feature of a multi-layer compressive wrap like the Jones Compressive Dressing?
It helps control edema in post-operative or trauma patients
What is the primary role of Xeroform in Post-Operative Dressings?
To prevent adhesion to the incision site
What distinguishes Plaster from Fiberglass materials used in Post-Operative Casts?
Fiberglass allows for quick weight-bearing compared to Plaster
Which of the following is NOT a clinical feature of Malignant Hyperthermia?
Hypotension
What is the mechanism that leads to increased muscle contraction in Malignant Hyperthermia?
Depletion of ATP
Which muscle relaxant is MOST commonly associated with triggering Malignant Hyperthermia?
Succinylcholine
What is the proposed treatment for Post-Operative Fever associated with a deep venous thrombosis/pulmonary embolism?
Anticoagulants
Which of the following is NOT a symptom typically associated with pneumonia/atelectasis in the context of Post-Operative Fever?
Flank pain
What is a key distinguishing factor between wound infection and urinary tract infection in the context of Post-Operative Fever?
Pain upon urination
In DVT management, which option is rarely indicated?
Thrombectomy
For acute isolated distal DVT without severe symptoms, what does the ACCP 2012 guidelines recommend?
Perform serial imaging
What is the main purpose of LMWH in the context of VTE treatment?
Decrease risk of PE
In the context of DVT management, which option is usually not used as a treatment choice?
Thrombectomy
Which type of DVT would likely warrant in-hospital care according to the text?
Massive DVT
What is typically recommended for acute isolated distal DVT with severe symptoms or risk factors?
Initiate anticoagulation
What is the potential complication of DVT following foot and ankle surgery?
Pulmonary Embolism
Which condition is characterized by edema, pain, induration, pigment change, and ulceration?
Postphlebitic Syndrome
What is the most common presentation of venous thromboembolism (VTE)?
Deep Venous Thrombosis
Which component of Virchow’s Triad refers to alterations in the constituents of the blood?
Blood hypercoagulability
What is the primary distinguishing feature between superficial venous thrombosis and deep venous thrombosis?
Location in the vascular system
What is the potentially fatal consequence of a thrombus in the pulmonary artery?
Pulmonary Embolism
What is the primary mechanism through which blood passes from superficial to deep veins in the context of deep venous thrombosis (DVT)?
Through venous perforators
Which of the following is a common presenting symptom shared by both deep venous thrombosis (DVT) and pulmonary embolism (PE)?
Shortness of breath
In the context of deep venous thrombosis (DVT), what is the significance of calf DVT compared to thigh DVT?
Thigh DVT has a higher likelihood of propagating to pulmonary embolism (PE)
What is the main function of valves in the context of deep venous thrombosis (DVT)?
To prevent retrograde blood flow
Which component primarily keeps blood from retrograding in the context of deep venous thrombosis (DVT)?
Valves
What differentiates proximal deep venous thrombosis (DVT) from distal DVT?
The location within the leg
Which factor is a significant risk for developing nonunion?
Regular use of NSAIDs
What is a common complication associated with deep infections and nonunion?
Need for frequent debridement procedures
What is a key factor to consider when diagnosing an infection post-operatively?
The presence of leukocytosis
What is the primary function of incisional wound dressings?
To provide protection from external contaminants
Why should nonunion be considered infected until proven otherwise?
Due to the associated risks with deep infections
What is typically recommended for acute isolated distal deep venous thrombosis (DVT) with severe symptoms or risk factors?
Early anticoagulant therapy
What is a potential complication related to hardware concerns post-operatively?
Infection
Which post-operative approach involves taking into consideration the possibility of R.I.C.E.?
Managing post-operative pain
What is a key consideration for identifying post-operative infection requiring immediate action?
Clinical findings
What is the primary purpose of acetaminophen in post-operative treatment?
Managing post-operative pain
In the context of bone healing, which material is commonly utilized for local wound care?
Xeroform dressing
What is a primary factor contributing to the faster healing seen in fresh fractures with Ultrasound therapy?
Acoustic pressure waves
In the context of Electrical Stimulation, what is one of the main reasons why it is not suitable for addressing problems of angulation, malrotation, and shortening?
Deformity
Which of the following bone graft materials is considered the 'gold standard' due to its multiple factors promoting vascular ingrowth, healing, and new bone growth?
Autologous Bone Graft
What is one of the key distinguishing characteristics of Extracorporeal Shock Wave Therapy (ESWT) in bone healing?
Microtrauma induced in bone
Why is Electrical Stimulation contraindicated in cases of synovial pseudoarthrosis?
Deformity concerns
What is a key difference between Autogenous Bone Grafts and Platelet concentrates in operative treatment?
Osteoinduction potential
What is one crucial component that should be included in a discharge summary according to the text?
Home medications
Which of the following is NOT typically part of the post-operative discharge instructions as per the text?
Medication reconciliation
What specific detail should be outlined in the discharge instructions to address post-operative complications?
Medication management guidance
In the context of post-operative discharge, what is a common reason for patients to hear from their healthcare providers?
Bleeding in dressing ('strike-through')
What is a key difference between an inpatient and outpatient post-operative discharge order as mentioned in the text?
Level of detail in discharge summary
Why is nonunion often considered infected until proven otherwise as per the text?
Higher likelihood of surgical site infection
What is the main factor that makes Electrical Stimulation contraindicated for addressing problems of angulation, malrotation, and shortening?
It does not address deformity
What is the primary reason why Electrical Stimulation should not be used for synovial pseudoarthrosis?
It does not address structural issues
Why is an Autologous Bone Graft considered the 'gold standard'?
It contains viable osteoblasts
Which factor plays a significant role in deciding the Operative Strategy for nonunion treatment?
Deformity type
In treating infected bones, why is stability crucial to resolve the infection?
To prevent further infection spread
What distinguishes nonunion location in the decision between Operative and Non-operative Treatment?
Infection status at the location
What is the primary purpose of a Jones Compressive Dressing?
To immobilize the foot and ankle following injury or surgery
Which of the following is a primary indication for using a Sugar-Tong Splint post-operatively?
High-grade ankle sprain
What is the main goal of applying a Posterior Splint?
To immobilize the foot and ankle following injury or surgery
What are CAM Boots primarily used for in post-operative care?
To control foot and ankle motion
In post-operative management, what is the primary function of a Flat Surgical Shoe?
To stabilize structures of the foot following injury or surgery
Which material is commonly used for Post-Operative Casts to allow for earlier weight-bearing?
Fiberglass
For which patient type is a Post-Op Shoe most beneficial following surgery?
Patients with ankle sprains
Which clinical sign is NOT a part of the SIRS criteria?
Erythema
What diagnostic imaging modality is NOT commonly used for diagnosing an abscess?
X-ray
Which factor is NOT a risk factor for septic arthritis?
Inflammatory bowel disease
What is a common treatment approach for sepsis following joint drainage?
Arthroscopy
What is the primary diagnostic method for confirming septic arthritis?
Crystal analysis
What defines sepsis as per the text?
The presence of systemic inflammatory response syndrome (SIRS) alongside an infection
Which of the following imaging techniques is commonly used to help diagnose septic conditions?
CT scan
What is the primary distinguishing feature between fever due to an infection and fever due to sepsis?
The presence of SIRS criteria in sepsis-related fever
How does systemic inflammatory response syndrome (SIRS) differ from sepsis?
Sepsis can exist without meeting SIRS criteria, but not vice versa
When diagnosing a post-operative fever, what crucial factor should be considered to differentiate sepsis from a non-septic cause?
The presence or absence of SIRS criteria
Which of the following is NOT a typical symptom seen in patients with Malignant Hyperthermia?
Hypokalemia
What is the most common trigger for Malignant Hyperthermia according to the text?
Nitrous oxide
Which of the following is a potential treatment for Post-Operative Fever associated with urinary tract infections?
Nitrofurantoin
What is a primary diagnostic method for identifying Deep Venous Thrombosis/Pulmonary Embolism?
Venous duplex ultrasound
Which drug is associated with causing Drug Fever in the post-operative period?
Opioids
Which symptom is typically NOT associated with Wound Infection in the post-operative period?
Myoglobinuria
What is a common diagnostic tool used in identifying Pneumonia/atelectasis in the post-operative period?
'Wells Score'
'Suprapubic pain' is most likely a symptom associated with which post-operative condition?
'Water' stage complication
'Flank pain' would most likely be a symptom seen in which stage of Post-Operative Fever?
'Water' (POD 2-3)
'Post-Operative Fever >7 days' could be most likely attributed to which condition?
'Wonder Drug'
How many angiosomes does the posterior tibial artery feed in the foot?
3
What is the total number of angiosomes in the entire body?
40
How many angiosomes does the peroneal artery feed in the foot?
2
How many angiosomes does the anterior tibial artery feed in the foot?
1
Which vessel supplies the lateral forefoot, plantar midfoot, and entire plantar forefoot?
Posterior tibial artery
In limb salvage surgeries, what major factor should be considered regarding ambulatory status?
Maintaining limb for transfers
What factor can help predict the success of healing after an amputation?
Ankle Brachial Index
Which technology is used for intraoperative evaluation with dye and imaging for determining amputation level?
Spy technology
What emerging concept is used to evaluate the healing potential of flaps based on composite vascular territories?
Angiosomes
When should surgery typically be scheduled after a vascular intervention according to Attinger et al?
4-10 days
Which medication is typically recommended to be continued before limb surgery for successful outcomes?
Plavix
What concept is used to predict the healing potential of different body tissues supplied by specific blood vessels?
Angiosomes
What is one key consideration for successful limb salvage?
Ensuring optimal blood flow
Which factor is essential for a successful amputation regarding the vascular status?
Adequate blood supply at the amputation level
What is a common indication for distal limb salvage procedures?
Enhancing lifestyle
Which factor does NOT contribute to a successful amputation procedure?
Presence of gangrene
What needs to be considered for a successful distal limb salvage?
Vascular sufficiency at the surgical site
Which of the following is crucial during a limb salvage procedure?
Establishing a stable soft tissue envelope
What is the primary goal of Electrical Stimulation in bone healing?
To stimulate neovascularization
What is a common contraindication for using Ultrasound in bone healing?
Synovial pseudoarthrosis
Which factor is NOT considered when defining Operative Strategy in nonunion treatment?
Infection status
What distinguishes Autogenous Bone Graft as the 'gold standard' in bone healing?
Excessive cost
Why is it important to differentiate between Hyper-, Oligo-, Atrophic, or Pseudarthrosis nonunion types?
To guide operative strategy
What is the main function of Extracorporeal Shock Wave Therapy in bone healing?
To stimulate neovascularization and cell differentiation
What is a crucial aspect to consider for long-term success in stabilizing hindfoot fusions?
Utilizing Steinman pin or K-wires
What is a common risk factor associated with Nonunion?
Immunocompromised patients
Which factor is NOT typically a risk factor for Nonunion following surgery?
Leukocytosis
In what scenario is fusing the ankle and subtalar joint deemed important?
For stability and function in the foot
What condition is NOT listed as an indication for insertion of antibioti-contaminated tissue?
Non-infected arthroplasty
What is a common modality for the treatment of Nonunion?
Autologous bone grafts
What technique is emphasized to maintain stability for ten years in a case involving Choparts amputation?
Utilizing JP-7 drain
Which of the following is a known risk factor for Nonunion in the context of bone healing?
Diabetes
According to Boyd, H.R.'s study, what procedure involves amputation of the foot coupled with calcaneotibial arthrodesis?
Lisfranc's calcanectomy
What type of bone surgery is often employed in the treatment of Nonunion?
Debridement
Which condition is strongly associated with an increased risk of Nonunion?
Skin or soft tissue infection
What is the primary reason for making skin incisions with medial and lateral flaps during a Ray resection?
To obtain adequate viable skin for closure
In the context of metatarsal amputation, what is a common indication for considering stabilization of the infection or open wound in the distal portion of the foot?
Non-vascular complications after surgery
When is a transmetatarsal amputation typically recommended?
When gangrene has stabilized and does not involve the plantar aspect of the foot
What distinguishes a ray resection from a transmetatarsal amputation?
The level of amputation performed on the metatarsal
What condition is usually present when considering a ray resection procedure?
Acute infection with soft tissue involvement
Which aspect influences the decision to perform metatarsal amputation?
Stabilization and non-involvement of gangrene in specific foot areas
How many angiosomes does the anterior tibial artery feed in the foot?
One
Which artery feeds the lateral ankle and plantar heel via the calcaneal branch?
Peroneal artery
In limb salvage procedures, what is a key factor regarding the vascular status?
Ambulation potential
What is a major factor to consider for amputation level decision-making when the patient is not ambulatory?
Maintaining limb advantage
Which artery gives rise to a branch supplying the medial ankle and lateral plantar heel?
Posterior tibial artery
What branch of the posterior tibial artery feeds the lateral forefoot?
Lateral branch
What is the main indication for performing a lisFranc’s disarticulation?
Failure of a transmetatarsal amputation
What adjunct procedure is mentioned in the text for transmetatarsal amputation?
TAL or gastric recession
What should be preserved during a transmetatarsal amputation to prevent an equinus deformity?
Tendons insertion
What surgical consideration is emphasized regarding blood availability during surgery?
Having at least 2 units of blood available at surgery
What is a recognized advantage of Syme's Amputation over other amputations?
Syme's Amputation provides a single-stage procedure for amputation
What is a distinctive feature of Calcanectomy for patients with heel ulcers and osteomyelitis?
Calcanectomy can be partial or complete depending on the patient's condition
What is a controversial aspect related to Syme's Amputation that concerns prosthetic construction?
Syme's Amputation causes difficulties in prosthetic construction due to ankle fusion
In what scenario would Partial Calcanectomy be considered a good alternative to below-knee amputation (BKA) or above-knee amputation (AKA)?
When the patient has a stable midfoot and forefoot
What is a potential advantage of Boyd Amputation over Syme's Amputation for certain patients?
Boyd Amputation allows for easier prosthetic attachment than Syme's Amputation
Why is Calcanectomy particularly advantageous for patients with large heel ulcers?
Calcanectomy provides better stability in the heel region
What is the most common presenting symptom for pulmonary embolism (PE)?
Chest pain
What is the timing to the diagnosis of venous thromboembolism (VTE) on average?
33.1 days
What imaging technique is mostly reserved for patients in whom CTPA is contraindicated or inconclusive?
Ventilation perfusion scan
What is a potential differential diagnosis for a positive Homan sign, other than DVT?
Ruptured Achilles tendon
In the context of postoperative fever, what crucial factor should be considered to differentiate sepsis from a non-septic cause?
Time of fever onset
Which test has reported sensitivity and specificity of more than 90% in diagnosing deep vein thrombosis (DVT)?
Duplex ultrasound
Test your knowledge on cellulitis, a bacterial skin and soft tissue infection characterized by symptoms like erythema, edema, warmth, and tenderness. Understand the pathogenesis, common symptoms, and factors contributing to cellulitis recurrence.
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