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62 Cards in this Set
- Front
- Back
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acceptable fracture position for long bones in hand
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50% apposition
30 degrees angulation 0 - rotation |
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tendon laceration not needing repair
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<90%
(insertional strength is 10% of cross sectional area of the tendon) |
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mallet finger
Rx |
splint (continuously) for 8 - 12 weeks
splinting is ok with less than 30% articular surface fracture |
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tendon rupture secondary to rheumatoid arthritis
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surgical urgency =
synovectomy to prevent other ruptures |
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how to determine if a peripheral nerve (mixed) is divided
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Tinel's sign
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test for ulnar intrinsic function
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"cross your fingers"
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syndrome
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a constellation of signs and sypmtoms which collectively describe or identify a condition or disorder
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carpal tunnel syndrome
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paresthesia, dysesthesia,or anesthesia in the radial 3 1/2 digits
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carpal tunnel syndrome
Dx |
Tinel's
Phalen's NCV |
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hand splint position
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intrinsic plus
wrist = neutral mp = 65 - 90 degrees ip = neutral |
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digit replantation
indications |
thumb
multiple digits single digit distal to superficialis insertion |
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replantation
contraindications |
absolute = patient condition
precludes surgery relative = 1. self mutilation 2. crush/avulsion 3. single digit proximal to superficialis insertion |
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compartment syndrome (forearm)
Dx |
pain on passive extension
confirm with compartment pressures (pulses present even with compartment syndrome) |
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finger tip injuries
Rx |
children = heal by secondary intent (except when part is available, then replant)
adult = controversial (test answer is flap cover of exposed bone) |
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burn
Dx of depth |
best method = length of time to healing
second best (best at injury) = history of the injury |
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escarotomy
when indicated |
circumferential deep burn to chest or extremity
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hydrofluroic acid burn
Rx |
calcium gluconate
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Electrical burns
Rx |
fasciotomy not escarotomy
0.9% NaCl not lactated ringers NaHCO3 |
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burn
admission criteria |
age 10 - 50 yrs. = >20% tbsa
under 10 over 50 yrs. = >10% tbsa circumferntial extremity perineal burn inhalation injury |
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melanoma
Dx |
Assymetry
Border irrregularity Color varigation Diameter > 6mm |
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melanoma
Dx |
excisional biopsy of lesions < 1.5cm
(incisional biopsy does not effect metastatic rate) |
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melanoma
RX margins |
insitu 5mm
0-1mm 1cm 1-2mm 1-2cm 2-4mm 2cm >4mm 2-3 cm |
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sentinel lymph node indications
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all patients breslow 1-3.99mm
male with trunk <0.76mm thin melanoma with regression ulceration, lymphocytic infiltrate,Clark level III |
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melanoma
recurrence and survival |
local recurrence = 20% 10ys
(better than with distant met) |
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melanoma
lymph node and survival |
posative metastatic lymph node disease severely impacts survival at all breslow levels
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basal cell carcinoma
Rx morpheaform (sclerosing) |
for the test - treatment is Moh's micrographic surgery
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basal cell carcinoma
Rx of involved margins |
for the test - treatment is re-excision
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squamous cell carcinoma of the skin
Rx margin |
for the test = 1 cm
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Marjolin's Ulcer (scar cancer)
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occurs 15-20 yrs. post injury
agressive tumor high met rate at presentation (approx. 50%) |
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actinic keratosis
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most consider precancerous
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keratoacanthoma and cutaneous horn
Rx |
complete excision with narrow margin
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DFSP (dermatofibrosarcoma protuberans)
Rx margins |
3 cm
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silicone
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dimethyl siloxane
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cause and effect between breast implants and collagen vascular disease and breast cancer
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none
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breast implant failure
Dx |
mri
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breast reconstruction in radiated post mastectomy patient
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autologous tissue
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optimal result in patient undergoing post mastectomy radiation
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delayed reconstruction
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breast reduction and mammograms
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intraparenchymal calcifications are stable after 6 months
(base line study at 6 months) |
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laceration closure
(my bias) |
steristrips in children
monocryl in deep dermis monofilament nylon in skin |
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hyperbaric oxygen
contraindications |
optic neuritis
acitve virus existing malignancy |
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facial fractures
indications for surgery |
mechanical diplopia
malocclusion visable deformity air way obstruction or septal hematoma |
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most common mandible fracture in child
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subcondylar
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most common orbit fracture in child
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superior orbital rim
(opposite of adult) |
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size of orbital floor defect requiring surgery
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2 cm
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incidence of associated cervical spine injuries with panfacial fracture
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10%
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when are skin flaps necessary
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exposed bone without periosteum, nerve, tendon, cartilage, joint, visera.
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Pierre Robin syndrome
acute problem = |
tongue based airway obstruction secondary
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Pierre Robin syndrome
Rx airway |
prone or side position
tongue lip adhesion tracheostomy |
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cutaneous hemangioma
% resolution |
50% by age 5
80% by age 8 |
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hemagioma
surgical indications |
1.uncontrolled bleeding
2.uncontrolled ulceration 3.threatening an orifice 4.Kasselbach Merrit syndrome (consumptive coagulopathy) 5."when it's easy" |
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selective embolism and vascular malformations
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valuable as a pre operative adjunct
(not therapeutically effective without surgery) |
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first Rx for rapidly growing hemangiomas
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systemic steroids
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lymangiomas and growth
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grow with the child
will enlarge with adjacent infections |
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posterior frontal sinus wall fracture
Rx |
cranialization
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risk factors melanoma
nevi |
more than 50
atypical mole syndrome <10% giant hairy nevi 5-10% |
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risk factors melanoma
hair color |
red hair = 3.6X (5%)
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risk factors melanoma
family history |
up to 8X higher risk, depending on number of family members
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risk factors melanoma
immunosuppression |
regardless of the reason immunosupression increases risk of all skin cancer including melanoma
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risk factors melanoma
gender |
males are at greater risk
male 1:57 female 1:81 |
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risk factors melanoma
atypical mole syndrome definition |
=> 100 nevi
one or more nevi => 8mm one or more nevus with atypical histologic features |
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xeroderma pigmentosa
risk of melanoma |
increased risk for all cutaneous malignancies including melanoma
60% dead bya ge 20yrs. |
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risk factors melanoma
age |
more than 50% of melanoma occur over the age of 50 yrs.
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