APMLE Part III flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Wagner grade 3 ulcer

A diabetic foot ulcer that is deep and associated with abscess or osteomyelitis. Requires imaging, infection control, and often surgical debridement in addition to offloading.

Total contact cast

A molded, well-padded cast that redistributes plantar pressure and is the gold standard for offloading neuropathic plantar ulcers. Avoid with deep infection or severe ischemia.

Probe-to-bone test

A sterile blunt probe is advanced into an ulcer; contact with hard bone suggests osteomyelitis. It has high positive predictive value but lower sensitivity.

Eichenholtz stage I

The earliest Charcot neuroarthropathy stage, characterized by fragmentation, joint destruction, and edema. Treatment is non-weightbearing offloading with a total contact cast.

Ankle-brachial index

Ratio of ankle to brachial systolic pressure. Values of 0.90 or less indicate peripheral arterial disease; values above 1.3 suggest non-compressible calcified vessels.

Foot compartment syndrome

Elevated pressure within foot compartments causing ischemia. Pain out of proportion and pain with passive stretch are early signs; fasciotomy is indicated when pressures exceed 30 mmHg.

Jones fracture

A fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, in a vascular watershed area. High nonunion risk warrants non-weightbearing or surgical fixation.

Lisfranc injury

Disruption of the tarsometatarsal joint complex. Weightbearing radiographs showing more than 2 mm widening between the first and second metatarsal bases confirm the diagnosis.

Thompson test

Squeezing the calf while the patient is prone should plantarflex the foot. Absence of plantarflexion indicates Achilles tendon rupture.

Charcot neuroarthropathy

Progressive destructive joint disease of the foot in neuropathy, often presenting as a warm, swollen, erythematous foot without infection. Offloading prevents further deformity.

Plantar fasciitis

Medial heel pain worse with first steps in the morning. First-line treatment is stretching, orthoses, and activity modification; imaging is usually unnecessary.

Morton neuroma

A perineural fibrosis of an interdigital nerve, most commonly in the third web space. Presents with forefoot pain and a positive Mulder click.

Hallux valgus angle

The angle between the first metatarsal and proximal phalanx; normal is under 15 degrees. Larger angles with symptoms may warrant surgical correction.

Osteomyelitis diagnosis

Bone infection suggested by probe-to-bone, elevated inflammatory markers, and MRI. Plain radiographs may remain normal for the first 10 to 14 days.

Perioperative glucose target

For most hospitalized and surgical patients, target blood glucose of approximately 140 to 180 mg/dL. Tighter control below 110 mg/dL increases hypoglycemia risk without clear benefit.

Active cardiac conditions

Unstable angina, decompensated heart failure, severe valvular disease, and recent myocardial infarction. These warrant delay of elective surgery and cardiology evaluation.

Caprini score

A validated risk assessment tool for venous thromboembolism that guides choice of mechanical versus pharmacologic prophylaxis in surgical patients.

Prophylaxis timing

Surgical antibiotic prophylaxis should be given within 60 minutes before incision, or within 120 minutes for vancomycin or fluoroquinolones, to achieve peak tissue levels.

Warfarin bridging

Warfarin is typically stopped about 5 days before surgery. LMWH bridging is reserved for high thrombotic-risk patients such as those with a mechanical mitral valve.

Metformin perioperative hold

Metformin is held on the day of surgery and restarted after 48 hours once renal function is stable, reducing the risk of lactic acidosis.

Hypertensive emergency

Severe blood pressure elevation with acute end-organ damage such as encephalopathy, aortic dissection, or pulmonary edema. Requires controlled intravenous blood pressure reduction.

Smoking cessation timing

Stopping smoking at least 4 weeks before elective surgery reduces wound and pulmonary complications. Nicotine replacement therapy is acceptable during this period.

ASA physical status

A classification from I to VI that stratifies preoperative comorbidity and risk, guiding the intensity of preoperative testing and anesthesia planning.

Diabetic ketoacidosis

Hyperglycemia with ketosis and anion-gap metabolic acidosis. Treatment includes isotonic fluids, intravenous insulin, and potassium replacement once potassium is not elevated.

Anticoagulation reversal

For urgent surgery on warfarin, vitamin K plus four-factor prothrombin complex concentrate restores coagulation. Fresh frozen plasma is an alternative when PCC is unavailable.

Perioperative beta-blockade

Beta-blockers should generally be continued in patients already taking them. Starting them de novo on the day of surgery is not routinely recommended.

Surgical site infection

Infection within 30 days of surgery (or 90 days with implants). Superficial infections involve skin and subcutaneous tissue; deep infections involve fascia or muscle.

Contrast-induced nephropathy

Acute kidney injury after iodinated contrast exposure. Risk is reduced by adequate hydration and holding nephrotoxic agents, especially in patients with pre-existing renal disease.

Peripheral neuropathy screening

Annual 10-g monofilament and vibration testing in diabetic patients identifies loss of protective sensation, which guides foot care and ulcer prevention counseling.

Antibiotic stewardship

Selecting the narrowest effective agent, correct dose, and shortest adequate duration based on culture data reduces resistance and adverse effects.

Informed consent elements

Valid consent requires decision-making capacity, disclosure of risks, benefits, and alternatives, and voluntary agreement. Emergency exceptions apply when imminent harm exists.

Delirium versus dementia

Delirium is acute, fluctuating inattention with altered consciousness; dementia is chronic progressive cognitive decline. Delirium often signals underlying infection or metabolic derangement.