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Test your basic knowledge |
Emergency Medicine: Lower Extremity
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Subjects
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health-sciences
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emergency-medicine
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Patient may be ambulatory - Physical exam findings: may be subtle - Xray findings: Normal Shenton's line - Treatment: Internal fixation
Meniscal Tear PE Maneuvers
Patella fracture presentation
Forearm (flexor - extensor - mobile wad)
Non-displaced femoral neck fractures
2. MOA: external rotational force applied to foot - starting medially and extending upward and laterally - Results in: - deltoid ligament rupture or medial malleolus injury - Interosseous tearing of distal tib/fib - Fx of proximal fibula
2nd Metatarsal / Lisfranc ligament injury
LCL PE findings
Maisonneuve fractures
Lateral Compression Pelvic Fracture Xray Findings
3. Painful to patient - Patient supine - hip internally rotated 45 degrees - force applied to fibular head - internally rotate ankle and knee - valgus force to knee - flex knee. - If anterior subluxation occurs = ligament tear
Vascular compromise (dusky foot - absent pulse)
AP Compression Pelvic Fracture
Patella Fx Treatment: Open fx
Pivot Shift Test
4. Conscious sedation - Hip flexed - knee hyperextended - ______ moved back in place - Immediate pain - long term relief from capsular injury
Reduction of dislocated patella
Fibula (Anterior - Lateral - superficial posterior - deep posterior)
Clinical History suspect of Hip Fracture
Jones Fracture
5. Knee in 30 degrees flexion - Stabalize femur above knee - anterior force applied behind tibia @ tubercle level -> attempt to displace tibia anteriorly - >5mm movement = ligament tear
Immediate Ortho consults
Lachmans Test
2nd Metatarsal / Lisfranc ligament injury
Non-displaced femoral neck fractures
6. Knee immoblizer & RICE
Achilles tendon rupture
ACL injury
Patella Fx treatment: Nondisplaced & intact extensors
ACL PE maneuvers
7. Early detection w/ high index of suspicion - Initially complain of severe pain - poorly controlled w/ analgesics - Pain starts few hours after injury - Swollen - firm - tender to squeeze by examiner
AP Compression Pelvic Fracture
Lisfranc ligament injury PE findings
Non-displaced metatarsal shaft fractures
Compartment Syndrome
8. Xray if one is present: - Patient age >55 years - tenderness @ head of fibula - isolated patellar tenderness - Inability to flex knee to 90 degrees - Inability to transfer weight for four steps both immediately after injury and in the ED
Ottawa Knee Rules
Ottowa Ankle Rules
Lachmans Test
MCL PE findings
9. Common in older adults - Women > Men - Usually secondary to osteoporosis - Fall is usually the cause
Pilon fractures
Femoral Neck Fractures
AP Compression Pelvic Fracture Xray Findings
Lisfranc ligament injury PE findings
10. Most common tarsal bone fx - 2 categories: Intra-Articular Fx - Extra-Articular Fx - Associated injuries are common
Achilles tendon rupture
Calcaneal fractures
Lateral Compression Pelvic Fracture Xray Findings
Meniscal Tear
11. Atrophy of quads / joint line tenderness - McMurray Test (50% positive) - Grind Test (50% positive)
MCL PE findings
Immediate Ortho consults
Meniscal Tear PE Maneuvers
Complications of Pelvic Fractures
12. Lachmans Test (84% sensitivity) - Anterior Drawer Test (62% sensitivity) - Pivot shift Test
Reduction of dislocated patella
ACL PE maneuvers
Maisonneuve fractures
Tibial fracture complications
13. Immediate reduction of a fracture / dislocation is needed if __________ suspected
Vascular compromise (dusky foot - absent pulse)
Maisoneuve fractures
ACL PE maneuvers
Tibial fracture
14. Occurs w/ cutting - squatting - or twisting maneuvers - Can occur independent or w/ ligament injury - Medial > Lateral frequency - 'Locking - popping - clicking - snapping' sensations - joint instability
Treatment of ALL knee ligament injuries
Patella Fx treatment: Nondisplaced & intact extensors
Non-displaced femoral neck fractures
Meniscal Tear
15. Forceful contraction of ____ - Falling on flexed knee - Patients over 40 years
Achilles tendon rupture
Achilles tendon rupture
Ottowa Ankle Rules
Quadriceps tendon rupture
16. Intra-Articular: immobilization w/ well padded posterior splint - strict elevation - non-weightbearing - analgesia - ortho f/you - Extra-Articular: Immobilization - analgesia - ortho f/you
Calcaneal fracture treatment
Meniscal Tear Treatment
Compartment Syndrome
Forearm (flexor - extensor - mobile wad)
17. Hx of recent fall or MVC - Prolonged steroid use - Hx cancer - CKD - Metabolic disorders -> Pathalogic Fx - Pain @ site of injury - Pain @ knee - groin - other injured sites
Posterior hip dislocation treatment
Clinical History suspect of Hip Fracture
Causes of Compartment Syndrome
Femoral shaft fracture
18. Ortho referral - NSAIDs and partial weightbearing - Difinintive Dx by MRI & arthroscopy
Patella Fx treatment: Nondisplaced & intact extensors
Meniscal Tear Treatment
Ottawa Knee Rules
Femoral shaft fracture
19. Most sensitive imaging of occult hip fx
AP Compression Pelvic Fracture Xray Findings
MRI
Femoral Neck Fractures
Non-displaced femoral neck fractures
20. PE: Thompson test - Tx: in ED - short leg cast in slight plantar flexion. Heals well w/ conservative tx or surgery
MCL PE findings
Maisonneuve fractures
Lachmans Test
Achilles tendon rupture
21. 'Open book fracture' - 25% of injuries - Head on MVC
Complications of Pelvic Fractures
MRI
Achilles tendon rupture
AP Compression Pelvic Fracture
22. Treatment for posterior hip dislocation - downward traction placed on femur at the knee -> uther hand applies external and internal rotation
Patella Fx Treatment: Open fx
Vascular compromise (dusky foot - absent pulse)
Physical Exam findings suspect of Hip Fracture
Stimpson maneuver
23. 5 P's of Compartment Syndrome
Patella Fx Treatment: Severely comminuted
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Patellar tendon rupture
LCL PE findings
24. Transverse fx is most common - displacement & disrupted extensor mechanism likely
MRI
Maisonneuve fractures
Patella fracture
Patellar tendon rupture
25. Strain: knee immobilizer - ROM exercises - ice/elevation - NSAIDS - ambulation ASAP - f/you w/ ortho/PCP <1 week - Rupture: Same above - functional bracing - immediate ortho consult for difinitive surgery
ACL injury
Displaced femoral neck fractures
Pivot Shift Test
Treatment of ALL knee ligament injuries
26. Pain elicited by torsion of the midfoot - Injuries about the tarsometatarsal joint - with pain on passive dorsi/plantar flexion of foot - Bony displacement > 1mm between bases of 1st-2nd metatarsal
Posterior hip dislocation treatment
Lisfranc ligament injury PE findings
Femoral Neck Fractures
Surgical management of dislocated patella
27. Shortening / rotation of lower extremities - Lacerations - bruising - tenderness - crepitence @ site - Instability of extremities - Limited ROM - Pain w/ motion - Significant pain w/ weight bearing - even if Xrays show no fx (Suspect for femoral neck
Femoral shaft fracture
Physical Exam findings suspect of Hip Fracture
2nd Metatarsal / Lisfranc ligament injury
AP Compression Pelvic Fracture Xray Findings
28. Most common hip disolcation (90%) - Cause is secondary to force applied to a flexed knee - directed posteriorly - Common in MVC injuries
Stimpson maneuver
AP Compression Pelvic Fracture
Posterior hip dislocation
Jones Fracture
29. May be ambulatory - focal patellar tenderness - swelling - effusion - potential for poplitieal artery injury - check distal pulses
Patella fracture
Calcaneal fracture treatment
Vertical Shear Pelvic Fracture
Patella fracture presentation
30. MOA: Acute direct blow or twisting force - Dx: Typically seen in oblique or lateral foot films - Tx: Posterior splint or Orthopedic shoe/boot
Displaced femoral neck fractures
MRI
Treatment of ALL knee ligament injuries
Non-displaced metatarsal shaft fractures
31. Patients typically unable to bear weight - Physical exam findings: external rotation - abduction - and shortening - Xray findings: disruption of Shenton's line + 'it don't look right' - Treatment: emergency surgery (fixation)
Uncomplicated ankle fracture treatment
Clinical History suspect of Hip Fracture
Displaced femoral neck fractures
Patella fracture
32. The ______ level of the lower extremity is most likely to develop compartment syndrome
Compartment Syndrome
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Fibula (Anterior - Lateral - superficial posterior - deep posterior)
Physical Exam findings suspect of Hip Fracture
33. Presentation: fibula may be fx at head -> 6 cm above ankle joint - Tx: Reduce / stabalize fractured medial malleolus - secure fibula to distal tibia
Maisoneuve fractures
Posterior hip dislocation treatment
Reduction of dislocated patella
Ottawa Knee Rules
34. French for 'pestle' - May be accompanied by compartment syndrome or vertebral body fx (L1) - MOA: grinding of the talus into the distal tibia - Presentation: high energy mechanism -> ST damage and extensive bone fragmentation - Tx: Reduction of fx -
Compartment Syndrome
Pilon fractures
Lateral Compression Pelvic Fracture
Femoral shaft fracture
35. MOA: vertical or mediolateral forces exerted on base 5th metatarsal while heal is raised and foot plantar flexed - Or significant adduction force applied to forefoot - while ankle is plantarflexed - Sudden change in direction w/ heel off ground in sp
Patella Fx Treatment: Severely comminuted
Achilles tendon rupture
Jones Fracture
Patella Fx treatment: Nondisplaced & intact extensors
36. Infection secondary to poor I&D - Compartment syndrome disabilities - Fx not adequately aligned
ACL injury
Tibial fracture
Tibial fracture complications
Achilles tendon rupture
37. Occurs with fall / jump from a height - 5% of injuries
ACL PE maneuvers
Tibial fracture
Vertical Shear Pelvic Fracture
Lisfranc ligament injury PE findings
38. MOI: high energy trauma (MVC - direct blows) - PE findings: shortening of leg - deformity - swelling - pain - hemorrhage
Complications of Pelvic Fractures
Displaced femoral neck fractures
Femoral shaft fracture
Patella Fx Treatment: Severely comminuted
39. Orthopedic (Tibial / Forearm Fx) - Vascular (Ischemic-reperfusion injury - hemorrhage) - Iatrogenic (Vascular puncture in anticoagulated patients - IV/intra-arterial drug injection - constrictive casts) - Soft Tissue Injury (Prolonged limb compressio
Vascular compromise (dusky foot - absent pulse)
ACL injury
Nondisplaced Phalangeal fractures
Causes of Compartment Syndrome
40. MOA: eccenric force applied to dorsiflexed foot - Presentation: 30-50 yr old weekend warrior - sudden severe pain - can't run - stand on toes - swollen calf - palpable gap 2-6 cm from calcaneus - Fluoroquinolones & Corticosteroids increase risk
Lachmans Test
Achilles tendon rupture
Displaced femoral neck fractures
Surgical management of dislocated patella
41. Most common fracture of foot - MOA: stubbing mechanism - crush injury - Dx: Xrays - Tx: Buddy taping - hard soled shoes
AP Compression Pelvic Fracture
Nondisplaced Phalangeal fractures
Vascular compromise (dusky foot - absent pulse)
Maisoneuve fractures
42. Hip flexed @ 45 degrees - knee flexed @ 90 degrees - Both hands @ tibia tubercle level -> anterior displacement foce applied - >6 mm movement = ligament tear
Physical Exam findings suspect of Hip Fracture
Non-displaced femoral neck fractures
Anterior Drawer Test
Compartment Syndrome
43. Retroperitoneal bleeding (can hold 4 L) - Sciatic nerve injury - Urogynecologic injury - Rectal injury - Ruptured diaphragm - Nerve root injury - Long term effects - Chronic pain - sexual dysfunction
Pivot Shift Test
Physical Exam findings suspect of Hip Fracture
Stimpson maneuver
Complications of Pelvic Fractures
44. The _______ of the upper extremity is most likely to develop compartment syndrome - Tibia (Anterior - Posterior - Medial)
Forearm (flexor - extensor - mobile wad)
Physical Exam findings suspect of Hip Fracture
Nondisplaced Phalangeal fractures
Posterior hip dislocation treatment
45. Vertical displacement of bones @ SI joint and mid-pubic rami - SI ligament may occur
MRI
Vertical Shear Pelvic Fracture Xray Findings
Surgical management of dislocated patella
Tibial fracture complications
46. Noncontact injury - decelleration - hyperextension - or marked internal rotation of the tibia on the femur - 'Pop' -> swelling within hours
ACL injury
Anterior Drawer Test
Non-displaced femoral neck fractures
Patella Fx Treatment: Open fx
47. Forceful contraction of ____ - Falling on flexed knee - Patients under 40 years w/ hx of tendinitis or past steroid injections
ACL PE maneuvers
Patellar tendon rupture
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Patella Fx treatment: Nondisplaced & intact extensors
48. Widening of Pubic Symphysis - Disruption of SI Joint - Sacral ligament injuries
Non-displaced femoral neck fractures
AP Compression Pelvic Fracture Xray Findings
Ottowa Ankle Rules
Immediate Ortho consults
49. Immobilization by cast / surgery - Goal is to restore anatomical relationship of ____ - maintain reduction during healing - mobilize ankle early - Most ___ fx require ORIF
Surgical management of dislocated patella
Pilon fractures
Immediate Ortho consults
Uncomplicated ankle fracture treatment
50. I&D - splint -> Xrays - Tetanus shot - parenteral Atbx - Cefazolin for open Fx - Measure pressures if Compartment suspected
Tibial fracture
MRI
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Uncomplicated ankle fracture treatment