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Emergency Medicine: Lower Extremity

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  • Answer 50 questions in 15 minutes.
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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. 5 P's of Compartment Syndrome






2. Most common tarsal bone fx - 2 categories: Intra-Articular Fx - Extra-Articular Fx - Associated injuries are common






3. May be ambulatory - focal patellar tenderness - swelling - effusion - potential for poplitieal artery injury - check distal pulses






4. Occurs w/ cutting - squatting - or twisting maneuvers - Can occur independent or w/ ligament injury - Medial > Lateral frequency - 'Locking - popping - clicking - snapping' sensations - joint instability






5. Ligament runs between lateral base of medial cuneiform and medial base of 2nd metatarsal - Ranges from sprains -> fracture-dislocations - Concurrent fx of hind - forefoot - 2nd metatarsal






6. Occurs from a twisting injury to extended knee - Women > men - Lateral displacement common - Tearing of medial knee joint capsule occurs






7. Knee immobilizer & RICE -> referral for ORIF






8. 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






9. PE: Thompson test - Tx: in ED - short leg cast in slight plantar flexion. Heals well w/ conservative tx or surgery






10. MOA: Acute direct blow or twisting force - Dx: Typically seen in oblique or lateral foot films - Tx: Posterior splint or Orthopedic shoe/boot






11. SI crush injury may occur - Fracture and horizontal counterclockwise rotation of pelvis on the coronal plane - Ligament injuries may occur






12. Hip flexed @ 45 degrees - knee flexed @ 90 degrees - Both hands @ tibia tubercle level -> anterior displacement foce applied - >6 mm movement = ligament tear






13. Lachmans Test (84% sensitivity) - Anterior Drawer Test (62% sensitivity) - Pivot shift Test






14. Forceful contraction of ____ - Falling on flexed knee - Patients under 40 years w/ hx of tendinitis or past steroid injections






15. W/o fracture-> closed reduction under procedural/GA sedation -> within 6 HOURS - Stimpson Maneuver






16. Forceful contraction of ____ - Falling on flexed knee - Patients over 40 years






17. Treatment for posterior hip dislocation - downward traction placed on femur at the knee -> uther hand applies external and internal rotation






18. Conscious sedation - Hip flexed - knee hyperextended - ______ moved back in place - Immediate pain - long term relief from capsular injury






19. Immediate reduction of a fracture / dislocation is needed if __________ suspected






20. 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






21. 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






22. Vertical displacement of bones @ SI joint and mid-pubic rami - SI ligament may occur






23. 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






24. Most common fracture of foot - MOA: stubbing mechanism - crush injury - Dx: Xrays - Tx: Buddy taping - hard soled shoes






25. I&D - splint -> Xrays - Tetanus shot - parenteral Atbx - Cefazolin for open Fx - Measure pressures if Compartment suspected






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






27. Occurs with fall / jump from a height - 5% of injuries






28. MOI: high energy trauma (MVC - direct blows) - PE findings: shortening of leg - deformity - swelling - pain - hemorrhage






29. Potential complications: overal prognosis very good - potential for limb shortening -> limp - arthritis - delayed/non-union - pain w/ ortho hardware - Treatment: initial traction splint - intermedullary nailing - ex-fix






30. Widening of Pubic Symphysis - Disruption of SI Joint - Sacral ligament injuries






31. 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






32. 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






33. Open fractures - Fracture dislocations - Dislocations - Bimalleolar / Trimalleolar fractures - Unstable unimalleolar fractures - Mausonneuve fractures






34. Patient may be ambulatory - Physical exam findings: may be subtle - Xray findings: Normal Shenton's line - Treatment: Internal fixation






35. Irrigation & antibiotics in ED - I&D in OR






36. Most common hip disolcation (90%) - Cause is secondary to force applied to a flexed knee - directed posteriorly - Common in MVC injuries






37. 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






38. Recurrent lateral dislocation (15% of cases) - Superior - horizontal - intercondylar disolcations - Irreducible dislocations






39. Most common mechanism of pelvic fracture (50%) - occurs when pedestrians are broad-sided by car






40. Surgical debridement - suturing of quadriceps and patellar tendons






41. Atrophy of quads / joint line tenderness - McMurray Test (50% positive) - Grind Test (50% positive)






42. 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






43. Intra-Articular: immobilization w/ well padded posterior splint - strict elevation - non-weightbearing - analgesia - ortho f/you - Extra-Articular: Immobilization - analgesia - ortho f/you






44. Knee immoblizer & RICE






45. Presentation: fibula may be fx at head -> 6 cm above ankle joint - Tx: Reduce / stabalize fractured medial malleolus - secure fibula to distal tibia






46. Most sensitive imaging of occult hip fx






47. 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






48. Ortho referral - NSAIDs and partial weightbearing - Difinintive Dx by MRI & arthroscopy






49. 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 -






50. The ______ level of the lower extremity is most likely to develop compartment syndrome







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