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EMERGENCY HIGH YIELD REVISION
Describe a Mayo black. - ANSWER -Local "ring" block of the 1st MTPJ. Describe MAC anesthesia. - ANSWER -IV sedation with a local anesthesia block. How does local anesthesia provide pain relief? - ANSWER - Prevents sodium migration through the nerve membrane, which prevents depolarization and causes inhibition of nerve conduction. What is the basic treatment of shock? - ANSWER -Fluids, ABCs, monitor vitals. The ASA surgical risk classification system classifies "A healthy patient" as what class? - ANSWER -Class 1 List the complications associated with TQ use. - ANSWER -Tissue necrosis, inflammation, paralysis, thrombosis, circulatory overload. A contraindication to TQ use would be? - ANSWER -Previous popliteal-dorsalis pedis bypass grafting, sickle cell disease. TQ use causes low oxygen tension, which could cause cells to sickle.
List the potential complications of endotracheal intubation. - ANSWER -Sore throat, tracheal edema, croup, laceration, pneumothorax. When positioning a patient in the supine position during general anesthesia, the most common complication is? - ANSWER -Ulnar nerve neuropathy. When positioning a patient in the prone position during general anesthesia, the most common complication is? - ANSWER - Pressure on the orbit, as well as the dorsum of the foot. During spinal anesthesia, the space in the lumbar area fo the spine into which the anesthetic is placed is the? - ANSWER - Subarachnoid space, deep to the dura. Complications of spinal anesthesia include? - ANSWER - Headache, hypotension, cauda equina syndrome, infection. Which stage of anesthesia is considered surgical anesthesia? - ANSWER -Stage 3 There are four reflexes progressively lost in level 3 anesthesia. The third reflex lost in the progression is? - ANSWER -Thoracic musculature. While performing an Austin bunionectomy under general anesthesia, you overhear the anesthesiologist mention that he is administering Reglan (metoclopramide). What is this for? - ANSWER -Reduce gastric motility.
What medication is used to treat malignant hyperthermia? - ANSWER -Dantrium (dantrolene) IV. What type of allergic reaction is anaphylaxis? - ANSWER -A type 1 IgE antibody mediated hypersensitivity reaction, seen immediately. What are early signs of anaphylaxis? - ANSWER -Flush, difficulty in breathing, wheezing, stridor, laryngeal edema. What is the treatment for anaphylaxis? - ANSWER -Epinephrine 0.3-0.5 mL SQ of a 1:1000 solution, along with antihistamines. Describe the MOA of local anesthetics. - ANSWER -Local anesthetics prevent conduction of the nerve by decreasing sodium permeability, thus increasing the excitation threshold. What is the toxic dose of Xylocaine (lidocaine) 1% plain? - ANSWER -300 mg (30 mL) What is the toxic dose of Xylocaine (lidocaine) 1% with epinephrine? - ANSWER -500 mg (50 mL) What is the toxic dose of Marcaine (bupivacaine) 0.25% plain? - ANSWER -175 mg (70 mL) What is the toxic dose of Marcaine (bupivacaine) 0.25% with epinephrine? - ANSWER -225 mg (90 mL)
List four common amide-based local anesthetics. - ANSWER - Lidocaine, bupivacaine, mepivacaine, ropivacaine. List four common ester-based local anesthetics. - ANSWER - Benzocaine, procaine, tetracaine, chloroprocaine. When performing tendon transfer-type procedures, list the type of potential anesthesia that may be used. - ANSWER -General, spinal, epidural. Each of these modalities will temporarily eliminate lower extremity muscular activity. What type of local block is most widely accepted when performing HAV surgery in a healthy patient? - ANSWER -MAC with local Mayo block. What nerve lies within the 1st IM space? - ANSWER -Deep peroneal nerve. What nerves lies anterior to the medial malleolus? - ANSWER - Saphenous nerve. Cervical spine radiographs should be obtained on a patient with a history of? - ANSWER -RA. When using a high thigh TQ, which types of anesthesia would be unwise? - ANSWER -MAC and local types.
Anesthesia is defined as? - ANSWER -Loss of sensation with or without loss of consciousness. Factors that affect the concentration of a drug at a site of action, as a function of time is referred to as? - ANSWER - Pharmacokinetics. Succinylcholine is primarily used to achieve? - ANSWER -Muscle relaxation through depolarization. Succinylcholine can cause what adverse reactions? - ANSWER - Fasciculations, hyperkalemia, hypotension. List a potential adverse reaction caused by the drug Toradol (ketorolac). - ANSWER -Formation of a peptic ulcer. Do ester-type anesthetics have a higher or lower allergic potential than amides? - ANSWER -Higher. The protein binding characteristic of a drug will affect what? - ANSWER -Direction of action. Is eating within 6 hours prior to a general anesthetic a cause to cancel the surgery? - ANSWER -Yes, due to the risk of regurgitation and aspiration. During a local field bock what sensation(s) is lost first? - ANSWER -Pain and temperature, followed by touch and motor.
A local field block injected into an infected area is less active because of what? - ANSWER -The acidic area of the infection converts the anesthetic chemically from an ionized form to a non- ionized form, thus decreasing penetration into the cell membrane. When performing an ankle block which nerves are blocked? - ANSWER -Saphenous, tibial, sural, superifical peroneal, and deep peroneal nerves. When performing various types of anesthesia on pediatric patients, what is the common concern during anesthesia? - ANSWER -Hypothermia. What is DOC to increase the threshold of convulsions during the intraoperative period? - ANSWER -Valium (diazepam). What are the initial steps to perform once it is determined that a patient is having a syncope reaction? - ANSWER -Oxygen, Trendelenburg position, monitor vitals. Wydase (hyaluronidase) works by what action? - ANSWER - Permitting a more rapid spread of solution into the area. When using halothane, what vasoconstrictive drug is contraindicated? - ANSWER -Epinephrine. What are the adverse effects of narcotics? - ANSWER -Respiratory depression, emesis, constipation, dependence.
What are the hallmark signs of the third stage of anesthesia? - ANSWER -Ceased eye movements and respiratory depression. Which stage of anesthesia can lead to patient death? - ANSWER - Stage 4. In which stage of anesthesia is the patient relaxed and fully conscious? - ANSWER -Stage 1. Which type of anesthesia always requires airway support? - ANSWER -General anesthesia. Stage 3 of anesthesia is further broken down into four phases. Which phase is considered "deep anesthesia"? - ANSWER -Phase
This is desired level of anesthesia for painful surgery. What is the ASA classification system? - ANSWER -A system for assessing the fitness of a patient prior to surgery. Describe the ASA classification system. - ANSWER -ASA 1: normal healthy patient ASA 2: patient with mild systemic disease ASA 3: patient with severe systemic disease ASA 4: patient with severe systemic disease that is a constant threat to life
ASA 5: moribound patient who is not expected to survive without an operation ASA 6: declared brain-dead patient whose organs are being removed for donor purposes The addition of "E" denotes emergency surgery. An emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part. Scope portals should be separated as widely as possible, consistent with the anatomy, to avoid what? - ANSWER -Skin necrosis. If an arthroscopic instrument fails or breaks within the joint, what should be done immediately? - ANSWER -Outflow of saline should be shut down, but inflow should be left open. This keeps the joint distended to help with retrieval of the broken piece. What anatomical structures should be considered when making an anterolateral scope portal? - ANSWER -EDL tendon and superifical peroneal nerve. When is a transmalleolar scope approach for lesions of the talus contraindicated? - ANSWER -In children with open physes. What anatomical structures should be considered when making an anteromedial scope portal? - ANSWER -TA tendon and great saphenous vein.
Prior to beginning arthroscopy, which portal is developed first? - ANSWER -Anteromedial portal. What are the contraindications for manual distraction and/or gravity distraction in ankle arthroscopy? - ANSWER -Tight ankles, pathology that is not easily accessible, prolonged procedures. What are the contraindications to the use of non-invasive distraction in ankle arthroscopy? - ANSWER -Impaired circulatory status, diabetes, generalized medical conditions, ankle edema, fragile skin. What are the contraindications to the use of skeletal distraction in ankle arthroscopy? - ANSWER -Local or generalized infections, osteopenia, open physes, lax ligaments. What are the indications for the use of single heavy pin (3/16 in) distraction in ankle arthroscopy? - ANSWER -Large bone structure in males, long cases, difficult pathology, very tight ankles, ankle arthrodesis. What are the advantages of double pin (7/64 in) distraction in ankle arthroscopy? - ANSWER -Better control, less stress riser, less chance of pin tract infection. What are the recommended parameters of force and duration for non-invasive distraction in ankle arthroscopy? - ANSWER -20- lbs of force for 30-45 minutes.
What are the parameters for proximal pin placement in skeletal distraction in ankle arthroscopy? - ANSWER -2.25, up to 4, inches above the ankle joint, usually on the lateral side. What are the three insertion sites for distal pin placement in skeletal distraction in ankle arthroscopy? - ANSWER -Two in the calcaneus and one in the talus. How is the distal pin in skeletal distraction in ankle arthroscopy inserted in the calcaneus? - ANSWER -It is inserted at a 20-25º downward slope so that when distraction occurs the pin will become parallel with the proximal pin. What size of pin is used in light double distraction in ankle arthroscopy? - ANSWER -7/64 in smooth pin. What size of pain is used in heavy single or double distraction ankle arthroscopy? - ANSWER -3/16 in threaded pin. When a 3/16 in pin for invasive distraction is used in ankle arthroscopy, how long postoperatively should a patient avoid athletic activity or heavy work? - ANSWER -8-10 weeks. When a 7/64 in pin for invasive distraction is used in ankle arthroscopy, when can a patient RTA? - ANSWER -4-6 weeks. What type of specific synovitis occurs in three stages? - ANSWER -Chronic synovial chrondomatosis.
What are the advantages of the arthroscopic approach to ankle fusion over the open method? - ANSWER -Less surgical morbidity, improved cosmesis. What is a disadvantage of the arthroscopic approach to ankle fusion? - ANSWER -Severe varus/valgus malalignment is difficult to correct arthroscopically. What is a contraindication to doing an arthroscopic ankle fusion? - ANSWER -A varus/valgus malalignment >15º. What type and size of screw is used in arthroscopic ankle fusion? - ANSWER -Cannulated 6.5 mm cancellous screw. What are considered abnormal values in the anterior drawer stress test? - ANSWER -Abnormal: 5-10 mm of anterior displacement of the talus on the distal tibia Grossly abnormal: >10 mm of anterior displacement of the talus on the distal tibia In comparison to the unaffected extremity, the injured ankle should have an anterior drawer test result of 3 mm or more to be considered significant. Name the arthroscopic technique that involves insertion of another object, such as a probe, beside a target structure into the field of view of the scope in order to better conceptualize the relative position of these objects to one another or adjacent structures. - ANSWER -Triangulation.
According to R.W. Jackson (1982), is more relief of symptoms achieved with diagnostic arthroscopy attributable to joint lavage or lysis of adhesions? - ANSWER -Joint lavage (21%) >> lysis of adhesions (4%) What does the Berndt and Hardy classification system classify. Describe it. - ANSWER -Transchondral fractures. Stage 1: compression of the articular cartilage Stage 2: incomplete fracture Stage 3: non-displaced complete fracture Stage 3: displaced complete fracture Which side of the anterior half of the talar dome usually produces a shallow, wafer-shaped lesion? - ANSWER -Lateral. Which side of the posterior half of the talar dome usually produces a deep, cup-shaped lesion? - ANSWER -Medial. What is the procedure for sterilization of an arthroscope? - ANSWER -1st case: ethylene oxide gas Additional cases: activated glutaraldehyde solution Arthroscopes cannot be autoclaved. What is the probable diagnosis if only 10-12 mL of saline can be injected into the ankle joint capsule of a normal sized adult? - ANSWER -Capsular adhesions or fibrosis.
Prevents cartilaginous damage. Arthroscope are available in what sizes? - ANSWER -1.7 mm to 8.0 mm What is used to distend the ankle joint and maintain a clean field for the scope camera? - ANSWER -Normal saline via an irrigation system. For chondromalacia, osteochondral defects, and OA, burrs are used to abrade articular defects to what level? - ANSWER -Viable bleeding bone. What structure is the landmark for locating the proper site for an anteromedial portal approach for an ankle arthroscopy? - ANSWER -TA tendon. Must go medial to it. An anterocentral scope portal is always located lateral to what structure? - ANSWER -EHL tendon. What nerves are at risk of being injured with the five different scope portals of entry into the ankle joint? - ANSWER - Anteromedial: saphenous nerve Anterocentral: deep peroneal nerve Anterolateral: superifical peroneal nerve
Posteromedial: tibial nerve Posterolateral: sural nerve What is the purpose of a stopcock on the sidearm of a cannula? - ANSWER -Can ingress or egress fluids. What are the three types of light sources used in arthroscopy? - ANSWER -Xenon, quartz halogen, incandescent (tungsten halogen). The three main types of motorized shower tips that attach to hand engines of power arthroscopy instrumentation are the open- ended, side-cutter, and full-radius. Which tip contains a normal rotating blade that prevents inadvertent damage to cartilage? Which tip is most aggressive? - ANSWER -Full-radius: rotating blade Open-ended: most aggressive Are the flutes in the sphere of an abrader more aggressive in cutting in a forward or reverse direction? - ANSWER -Forward. How does the force of suction affect the aggressiveness of a shaver? An abrader? - ANSWER -Increases the aggressiveness of both by aspirating more tissue into the openings at the end of the instruments. How does the speed of rotations of its blades affect a shaver? An abrader? - ANSWER -The slower a shaver rotates, the more aggressively it cuts. The faster an abrader rotates, the more aggressively in cuts.
