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62 Cards in this Set

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acceptable fracture position for long bones in hand
50% apposition
30 degrees angulation
0 - rotation
tendon laceration not needing repair
<90%

(insertional strength is 10% of cross sectional area of the tendon)
mallet finger

Rx
splint (continuously) for 8 - 12 weeks

splinting is ok with less than 30% articular surface fracture
tendon rupture secondary to rheumatoid arthritis
surgical urgency =
synovectomy to
prevent other ruptures
how to determine if a peripheral nerve (mixed) is divided
Tinel's sign
test for ulnar intrinsic function
"cross your fingers"
syndrome
a constellation of signs and sypmtoms which collectively describe or identify a condition or disorder
carpal tunnel syndrome
paresthesia, dysesthesia,or anesthesia in the radial 3 1/2 digits
carpal tunnel syndrome

Dx
Tinel's

Phalen's

NCV
hand splint position
intrinsic plus

wrist = neutral
mp = 65 - 90 degrees
ip = neutral
digit replantation

indications
thumb
multiple digits
single digit distal to
superficialis insertion
replantation

contraindications
absolute = patient condition
precludes surgery
relative = 1. self mutilation
2. crush/avulsion
3. single digit proximal to superficialis insertion
compartment syndrome (forearm)

Dx
pain on passive extension

confirm with compartment pressures
(pulses present even with compartment syndrome)
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)
burn

Dx of depth
best method = length of time to healing

second best (best at injury) = history of the injury
escarotomy

when indicated
circumferential deep burn to chest or extremity
hydrofluroic acid burn

Rx
calcium gluconate
Electrical burns

Rx
fasciotomy not escarotomy
0.9% NaCl not lactated ringers
NaHCO3
burn

admission criteria
age 10 - 50 yrs. = >20% tbsa
under 10 over 50 yrs. =
>10% tbsa
circumferntial extremity
perineal burn
inhalation injury
melanoma

Dx
Assymetry
Border irrregularity
Color varigation
Diameter > 6mm
melanoma

Dx
excisional biopsy of lesions < 1.5cm

(incisional biopsy does not effect metastatic rate)
melanoma

RX margins
insitu 5mm
0-1mm 1cm
1-2mm 1-2cm
2-4mm 2cm
>4mm 2-3 cm
sentinel lymph node indications
all patients breslow 1-3.99mm
male with trunk <0.76mm
thin melanoma with regression
ulceration, lymphocytic
infiltrate,Clark level III
melanoma

recurrence and survival
local recurrence = 20% 10ys

(better than with distant met)
melanoma

lymph node and survival
posative metastatic lymph node disease severely impacts survival at all breslow levels
basal cell carcinoma

Rx morpheaform (sclerosing)
for the test - treatment is Moh's micrographic surgery
basal cell carcinoma

Rx of involved margins
for the test - treatment is re-excision
squamous cell carcinoma of the skin


Rx margin
for the test = 1 cm
Marjolin's Ulcer (scar cancer)
occurs 15-20 yrs. post injury
agressive tumor
high met rate at presentation
(approx. 50%)
actinic keratosis
most consider precancerous
keratoacanthoma and cutaneous horn

Rx
complete excision with narrow margin
DFSP (dermatofibrosarcoma protuberans)

Rx margins
3 cm
silicone
dimethyl siloxane
cause and effect between breast implants and collagen vascular disease and breast cancer
none
breast implant failure

Dx
mri
breast reconstruction in radiated post mastectomy patient
autologous tissue
optimal result in patient undergoing post mastectomy radiation
delayed reconstruction
breast reduction and mammograms
intraparenchymal calcifications are stable after 6 months

(base line study at 6 months)
laceration closure

(my bias)
steristrips in children

monocryl in deep dermis
monofilament nylon in skin
hyperbaric oxygen

contraindications
optic neuritis

acitve virus

existing malignancy
facial fractures

indications for surgery
mechanical diplopia
malocclusion
visable deformity
air way obstruction or septal
hematoma
most common mandible fracture in child
subcondylar
most common orbit fracture in child
superior orbital rim

(opposite of adult)
size of orbital floor defect requiring surgery
2 cm
incidence of associated cervical spine injuries with panfacial fracture
10%
when are skin flaps necessary
exposed bone without periosteum, nerve, tendon, cartilage, joint, visera.
Pierre Robin syndrome

acute problem =
tongue based airway obstruction secondary
Pierre Robin syndrome

Rx airway
prone or side position
tongue lip adhesion
tracheostomy
cutaneous hemangioma

% resolution
50% by age 5

80% by age 8
hemagioma

surgical indications
1.uncontrolled bleeding
2.uncontrolled ulceration
3.threatening an orifice
4.Kasselbach Merrit syndrome
(consumptive coagulopathy)
5."when it's easy"
selective embolism and vascular malformations
valuable as a pre operative adjunct

(not therapeutically effective without surgery)
first Rx for rapidly growing hemangiomas
systemic steroids
lymangiomas and growth
grow with the child

will enlarge with adjacent infections
posterior frontal sinus wall fracture

Rx
cranialization
risk factors melanoma
nevi
more than 50
atypical mole syndrome <10%
giant hairy nevi 5-10%
risk factors melanoma

hair color
red hair = 3.6X (5%)
risk factors melanoma

family history
up to 8X higher risk, depending on number of family members
risk factors melanoma

immunosuppression
regardless of the reason immunosupression increases risk of all skin cancer including melanoma
risk factors melanoma

gender
males are at greater risk

male 1:57
female 1:81
risk factors melanoma

atypical mole syndrome
definition
=> 100 nevi
one or more nevi => 8mm
one or more nevus with
atypical histologic
features
xeroderma pigmentosa
risk of melanoma
increased risk for all cutaneous malignancies including melanoma

60% dead bya ge 20yrs.
risk factors melanoma

age
more than 50% of melanoma occur over the age of 50 yrs.