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Test your basic knowledge |
Emergency Medicine: Lower Extremity
Start Test
Study First
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
.
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. Knee immobilizer & RICE -> referral for ORIF
Surgical management of dislocated patella
AP Compression Pelvic Fracture Xray Findings
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Physical Exam findings suspect of Hip Fracture
2. Most common tarsal bone fx - 2 categories: Intra-Articular Fx - Extra-Articular Fx - Associated injuries are common
Patella fracture presentation
Calcaneal fractures
Posterior hip dislocation
Vascular compromise (dusky foot - absent pulse)
3. Valgus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain
Femoral shaft fracture
Stimpson maneuver
Non-displaced metatarsal shaft fractures
MCL PE findings
4. Patient may be ambulatory - Physical exam findings: may be subtle - Xray findings: Normal Shenton's line - Treatment: Internal fixation
Calcaneal fractures
Non-displaced femoral neck fractures
Lisfranc ligament injury PE findings
Meniscal Tear
5. The ______ level of the lower extremity is most likely to develop compartment syndrome
Meniscal Tear
Vertical Shear Pelvic Fracture
Fibula (Anterior - Lateral - superficial posterior - deep posterior)
Lachmans Test
6. Occurs w/ cutting - squatting - or twisting maneuvers - Can occur independent or w/ ligament injury - Medial > Lateral frequency - 'Locking - popping - clicking - snapping' sensations - joint instability
MCL PE findings
ACL PE maneuvers
Meniscal Tear
Ottawa Knee Rules
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
Lateral Compression Pelvic Fracture
Compartment Syndrome
Reduction of dislocated patella
Clinical History suspect of Hip Fracture
8. Knee immoblizer & RICE
LCL PE findings
Tibial fracture complications
Patella fracture presentation
Patella Fx treatment: Nondisplaced & intact extensors
9. Infection secondary to poor I&D - Compartment syndrome disabilities - Fx not adequately aligned
Femoral shaft fracture
Achilles tendon rupture
Fibula (Anterior - Lateral - superficial posterior - deep posterior)
Tibial fracture complications
10. Noncontact injury - decelleration - hyperextension - or marked internal rotation of the tibia on the femur - 'Pop' -> swelling within hours
Tibial fracture
Non-displaced metatarsal shaft fractures
Complications of Pelvic Fractures
ACL injury
11. Most sensitive imaging of occult hip fx
Lisfranc ligament injury PE findings
MRI
Immediate Ortho consults
AP Compression Pelvic Fracture
12. Most common mechanism of pelvic fracture (50%) - occurs when pedestrians are broad-sided by car
Lateral Compression Pelvic Fracture
Lisfranc ligament injury PE findings
Femoral Neck Fractures
Patellar tendon rupture
13. Most common fracture of foot - MOA: stubbing mechanism - crush injury - Dx: Xrays - Tx: Buddy taping - hard soled shoes
Reduction of dislocated patella
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Nondisplaced Phalangeal fractures
14. Forceful contraction of ____ - Falling on flexed knee - Patients under 40 years w/ hx of tendinitis or past steroid injections
Treatment of ALL knee ligament injuries
Forearm (flexor - extensor - mobile wad)
Patellar tendon rupture
MRI
15. Forceful contraction of ____ - Falling on flexed knee - Patients over 40 years
Quadriceps tendon rupture
Reduction of dislocated patella
Dislocated patella
Jones Fracture
16. May be ambulatory - focal patellar tenderness - swelling - effusion - potential for poplitieal artery injury - check distal pulses
Patella fracture presentation
Patella Fx treatment: Nondisplaced & intact extensors
Meniscal Tear
Compartment Syndrome
17. Presentation: fibula may be fx at head -> 6 cm above ankle joint - Tx: Reduce / stabalize fractured medial malleolus - secure fibula to distal tibia
Displaced femoral neck fractures
Immediate Ortho consults
Maisoneuve fractures
Ottawa Knee Rules
18. 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
Lachmans Test
Patella fracture presentation
Femoral Neck Fractures
Clinical History suspect of Hip Fracture
19. Occurs with fall / jump from a height - 5% of injuries
Calcaneal fractures
Tibial fracture
Vertical Shear Pelvic Fracture
Posterior hip dislocation
20. Immobilization by cast / surgery - Goal is to restore anatomical relationship of ____ - maintain reduction during healing - mobilize ankle early - Most ___ fx require ORIF
Ottawa Knee Rules
Patella Fx Treatment: Severely comminuted
Uncomplicated ankle fracture treatment
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
21. I&D - splint -> Xrays - Tetanus shot - parenteral Atbx - Cefazolin for open Fx - Measure pressures if Compartment suspected
Tibial fracture
Immediate Ortho consults
Femoral shaft fracture
Anterior Drawer Test
22. Conscious sedation - Hip flexed - knee hyperextended - ______ moved back in place - Immediate pain - long term relief from capsular injury
Tibial fracture complications
Pivot Shift Test
Calcaneal fractures
Reduction of dislocated patella
23. Atrophy of quads / joint line tenderness - McMurray Test (50% positive) - Grind Test (50% positive)
Posterior hip dislocation treatment
LCL PE findings
2nd Metatarsal / Lisfranc ligament injury
Meniscal Tear PE Maneuvers
24. MOI: high energy trauma (MVC - direct blows) - PE findings: shortening of leg - deformity - swelling - pain - hemorrhage
Causes of Compartment Syndrome
Femoral shaft fracture
Femoral Neck Fractures
Meniscal Tear Treatment
25. MOA: Acute direct blow or twisting force - Dx: Typically seen in oblique or lateral foot films - Tx: Posterior splint or Orthopedic shoe/boot
Dislocated patella
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Non-displaced metatarsal shaft fractures
Treatment of ALL knee ligament injuries
26. 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
Causes of Compartment Syndrome
Achilles tendon rupture
Surgical management of dislocated patella
Achilles tendon rupture
27. Transverse fx is most common - displacement & disrupted extensor mechanism likely
Patella fracture
Reduction of dislocated patella
ACL PE maneuvers
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
28. Open fractures - Fracture dislocations - Dislocations - Bimalleolar / Trimalleolar fractures - Unstable unimalleolar fractures - Mausonneuve fractures
Femoral Neck Fractures
ACL PE maneuvers
Uncomplicated ankle fracture treatment
Immediate Ortho consults
29. 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
Patellar tendon rupture
Complications of Pelvic Fractures
Stimpson maneuver
Vertical Shear Pelvic Fracture
30. 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
Anterior Drawer Test
Treatment of ALL knee ligament injuries
Calcaneal fracture treatment
Femoral shaft fracture
31. Vertical displacement of bones @ SI joint and mid-pubic rami - SI ligament may occur
Immediate Ortho consults
Maisonneuve fractures
Lateral Compression Pelvic Fracture Xray Findings
Vertical Shear Pelvic Fracture Xray Findings
32. 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
Immediate Ortho consults
Ottawa Knee Rules
Physical Exam findings suspect of Hip Fracture
Pilon fractures
33. 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
Meniscal Tear
Lisfranc ligament injury PE findings
Immediate Ortho consults
Lachmans Test
34. Common in older adults - Women > Men - Usually secondary to osteoporosis - Fall is usually the cause
Femoral Neck Fractures
2nd Metatarsal / Lisfranc ligament injury
Maisoneuve fractures
Jones Fracture
35. Radiographs required if pain in malleolar zone plus:- Tenderness at base of 5th metatarsal - posterior medial / lateral malleolus - navicular - can NOT take 4 steps immediately and in ED
Posterior hip dislocation treatment
Reduction of dislocated patella
AP Compression Pelvic Fracture
Ottowa Ankle Rules
36. Surgical debridement - suturing of quadriceps and patellar tendons
Patella Fx treatment: Nondisplaced & intact extensors
Ottowa Ankle Rules
Patella Fx Treatment: Severely comminuted
Maisonneuve fractures
37. 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
Maisonneuve fractures
Calcaneal fractures
Patella fracture presentation
Compartment Syndrome
38. Lachmans Test (84% sensitivity) - Anterior Drawer Test (62% sensitivity) - Pivot shift Test
AP Compression Pelvic Fracture
ACL PE maneuvers
Achilles tendon rupture
Lisfranc ligament injury PE findings
39. 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
Pivot Shift Test
Treatment of ALL knee ligament injuries
Jones Fracture
Causes of Compartment Syndrome
40. 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)
Achilles tendon rupture
Uncomplicated ankle fracture treatment
Vertical Shear Pelvic Fracture
Displaced femoral neck fractures
41. 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
Tibial fracture
Tibial fracture complications
Patellar tendon rupture
Pivot Shift Test
42. W/o fracture-> closed reduction under procedural/GA sedation -> within 6 HOURS - Stimpson Maneuver
Femoral shaft fracture
Posterior hip dislocation treatment
Displaced femoral neck fractures
Vertical Shear Pelvic Fracture
43. SI crush injury may occur - Fracture and horizontal counterclockwise rotation of pelvis on the coronal plane - Ligament injuries may occur
Meniscal Tear Treatment
Ottawa Knee Rules
Treatment of ALL knee ligament injuries
Lateral Compression Pelvic Fracture Xray Findings
44. Recurrent lateral dislocation (15% of cases) - Superior - horizontal - intercondylar disolcations - Irreducible dislocations
Patella Fx Treatment: Severely comminuted
AP Compression Pelvic Fracture
Surgical management of dislocated patella
Patella fracture
45. Treatment for posterior hip dislocation - downward traction placed on femur at the knee -> uther hand applies external and internal rotation
Posterior hip dislocation
Ottowa Ankle Rules
Stimpson maneuver
Pivot Shift Test
46. Irrigation & antibiotics in ED - I&D in OR
Fibula (Anterior - Lateral - superficial posterior - deep posterior)
Patella Fx Treatment: Open fx
Meniscal Tear Treatment
Meniscal Tear
47. Hip flexed @ 45 degrees - knee flexed @ 90 degrees - Both hands @ tibia tubercle level -> anterior displacement foce applied - >6 mm movement = ligament tear
Patella Fx Treatment: Open fx
Anterior Drawer Test
Displaced femoral neck fractures
Calcaneal fracture treatment
48. Varus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain
LCL PE findings
Meniscal Tear Treatment
Forearm (flexor - extensor - mobile wad)
AP Compression Pelvic Fracture Xray Findings
49. Widening of Pubic Symphysis - Disruption of SI Joint - Sacral ligament injuries
Complications of Pelvic Fractures
AP Compression Pelvic Fracture Xray Findings
LCL PE findings
Femoral shaft fracture
50. Occurs from a twisting injury to extended knee - Women > men - Lateral displacement common - Tearing of medial knee joint capsule occurs
Lateral Compression Pelvic Fracture
Dislocated patella
Patellar tendon rupture
Maisoneuve fractures