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Test your basic knowledge |
Emergency Medicine: Lower Extremity
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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. Vertical displacement of bones @ SI joint and mid-pubic rami - SI ligament may occur
Vertical Shear Pelvic Fracture Xray Findings
Reduction of dislocated patella
2nd Metatarsal / Lisfranc ligament injury
Causes of Compartment Syndrome
2. I&D - splint -> Xrays - Tetanus shot - parenteral Atbx - Cefazolin for open Fx - Measure pressures if Compartment suspected
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Immediate Ortho consults
ACL injury
Tibial fracture
3. 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
Patella Fx Treatment: Open fx
LCL PE findings
Causes of Compartment Syndrome
Quadriceps tendon rupture
4. Immediate reduction of a fracture / dislocation is needed if __________ suspected
Posterior hip dislocation treatment
Meniscal Tear Treatment
MRI
Vascular compromise (dusky foot - absent pulse)
5. 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
Compartment Syndrome
Physical Exam findings suspect of Hip Fracture
Patellar tendon rupture
Uncomplicated ankle fracture treatment
6. 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
2nd Metatarsal / Lisfranc ligament injury
Lisfranc ligament injury PE findings
Lachmans Test
Reduction of dislocated patella
7. 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
Meniscal Tear Treatment
Clinical History suspect of Hip Fracture
Vascular compromise (dusky foot - absent pulse)
Lateral Compression Pelvic Fracture
8. The _______ of the upper extremity is most likely to develop compartment syndrome - Tibia (Anterior - Posterior - Medial)
Lateral Compression Pelvic Fracture Xray Findings
Forearm (flexor - extensor - mobile wad)
Lateral Compression Pelvic Fracture
MRI
9. Hip flexed @ 45 degrees - knee flexed @ 90 degrees - Both hands @ tibia tubercle level -> anterior displacement foce applied - >6 mm movement = ligament tear
MCL PE findings
Achilles tendon rupture
Surgical management of dislocated patella
Anterior Drawer Test
10. 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
Posterior hip dislocation treatment
Achilles tendon rupture
Complications of Pelvic Fractures
Femoral shaft fracture
11. Recurrent lateral dislocation (15% of cases) - Superior - horizontal - intercondylar disolcations - Irreducible dislocations
Surgical management of dislocated patella
Lateral Compression Pelvic Fracture Xray Findings
Lisfranc ligament injury PE findings
Patella Fx Treatment: Severely comminuted
12. Open fractures - Fracture dislocations - Dislocations - Bimalleolar / Trimalleolar fractures - Unstable unimalleolar fractures - Mausonneuve fractures
Immediate Ortho consults
Nondisplaced Phalangeal fractures
Patella Fx treatment: Nondisplaced & intact extensors
Pivot Shift Test
13. Most common hip disolcation (90%) - Cause is secondary to force applied to a flexed knee - directed posteriorly - Common in MVC injuries
Patella Fx Treatment: Severely comminuted
Jones Fracture
Patella fracture presentation
Posterior hip dislocation
14. 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
Jones Fracture
Vascular compromise (dusky foot - absent pulse)
Posterior hip dislocation treatment
Non-displaced femoral neck fractures
15. Most sensitive imaging of occult hip fx
Immediate Ortho consults
Compartment Syndrome
MRI
Non-displaced metatarsal shaft fractures
16. Patient may be ambulatory - Physical exam findings: may be subtle - Xray findings: Normal Shenton's line - Treatment: Internal fixation
Vascular compromise (dusky foot - absent pulse)
Pivot Shift Test
Quadriceps tendon rupture
Non-displaced femoral neck fractures
17. 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
MCL PE findings
Posterior hip dislocation
Achilles tendon rupture
Pilon fractures
18. Lachmans Test (84% sensitivity) - Anterior Drawer Test (62% sensitivity) - Pivot shift Test
Anterior Drawer Test
Patella Fx treatment: Nondisplaced & intact extensors
Forearm (flexor - extensor - mobile wad)
ACL PE maneuvers
19. Treatment for posterior hip dislocation - downward traction placed on femur at the knee -> uther hand applies external and internal rotation
Stimpson maneuver
Pilon fractures
Patellar tendon rupture
Ottawa Knee Rules
20. Irrigation & antibiotics in ED - I&D in OR
Vertical Shear Pelvic Fracture
Causes of Compartment Syndrome
Ottowa Ankle Rules
Patella Fx Treatment: Open fx
21. Forceful contraction of ____ - Falling on flexed knee - Patients under 40 years w/ hx of tendinitis or past steroid injections
Patellar tendon rupture
Jones Fracture
AP Compression Pelvic Fracture Xray Findings
AP Compression Pelvic Fracture
22. 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
Tibial fracture complications
AP Compression Pelvic Fracture Xray Findings
Quadriceps tendon rupture
Compartment Syndrome
23. 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)
Displaced femoral neck fractures
ACL PE maneuvers
Calcaneal fractures
Femoral shaft fracture
24. Infection secondary to poor I&D - Compartment syndrome disabilities - Fx not adequately aligned
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Lateral Compression Pelvic Fracture Xray Findings
Tibial fracture complications
ACL injury
25. Surgical debridement - suturing of quadriceps and patellar tendons
Patella Fx Treatment: Severely comminuted
Posterior hip dislocation
Posterior hip dislocation treatment
LCL PE findings
26. 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
Physical Exam findings suspect of Hip Fracture
Nondisplaced Phalangeal fractures
Maisoneuve fractures
Treatment of ALL knee ligament injuries
27. MOA: Acute direct blow or twisting force - Dx: Typically seen in oblique or lateral foot films - Tx: Posterior splint or Orthopedic shoe/boot
Non-displaced metatarsal shaft fractures
Non-displaced femoral neck fractures
ACL injury
Posterior hip dislocation
28. Noncontact injury - decelleration - hyperextension - or marked internal rotation of the tibia on the femur - 'Pop' -> swelling within hours
2nd Metatarsal / Lisfranc ligament injury
Patella fracture
ACL injury
Complications of Pelvic Fractures
29. Common in older adults - Women > Men - Usually secondary to osteoporosis - Fall is usually the cause
Femoral shaft fracture
Immediate Ortho consults
Complications of Pelvic Fractures
Femoral Neck Fractures
30. 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
Quadriceps tendon rupture
Tibial fracture complications
Lachmans Test
Ottowa Ankle Rules
31. Occurs w/ cutting - squatting - or twisting maneuvers - Can occur independent or w/ ligament injury - Medial > Lateral frequency - 'Locking - popping - clicking - snapping' sensations - joint instability
Non-displaced femoral neck fractures
Surgical management of dislocated patella
Meniscal Tear
MCL PE findings
32. SI crush injury may occur - Fracture and horizontal counterclockwise rotation of pelvis on the coronal plane - Ligament injuries may occur
Femoral Neck Fractures
Vascular compromise (dusky foot - absent pulse)
Patella fracture presentation
Lateral Compression Pelvic Fracture Xray Findings
33. 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
Ottowa Ankle Rules
Vertical Shear Pelvic Fracture
Tibial fracture complications
Maisonneuve fractures
34. 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
Femoral shaft fracture
Vertical Shear Pelvic Fracture
Ottowa Ankle Rules
Achilles tendon rupture
35. PE: Thompson test - Tx: in ED - short leg cast in slight plantar flexion. Heals well w/ conservative tx or surgery
Patella Fx Treatment: Severely comminuted
Achilles tendon rupture
Jones Fracture
Treatment of ALL knee ligament injuries
36. Knee immobilizer & RICE -> referral for ORIF
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Displaced femoral neck fractures
Reduction of dislocated patella
Achilles tendon rupture
37. Conscious sedation - Hip flexed - knee hyperextended - ______ moved back in place - Immediate pain - long term relief from capsular injury
Anterior Drawer Test
Lateral Compression Pelvic Fracture
Reduction of dislocated patella
Clinical History suspect of Hip Fracture
38. Ortho referral - NSAIDs and partial weightbearing - Difinintive Dx by MRI & arthroscopy
Meniscal Tear Treatment
Meniscal Tear PE Maneuvers
Immediate Ortho consults
Jones Fracture
39. Most common mechanism of pelvic fracture (50%) - occurs when pedestrians are broad-sided by car
Stimpson maneuver
Patella fracture presentation
Ottawa Knee Rules
Lateral Compression Pelvic Fracture
40. May be ambulatory - focal patellar tenderness - swelling - effusion - potential for poplitieal artery injury - check distal pulses
Vascular compromise (dusky foot - absent pulse)
Meniscal Tear PE Maneuvers
Patella fracture presentation
2nd Metatarsal / Lisfranc ligament injury
41. Most common tarsal bone fx - 2 categories: Intra-Articular Fx - Extra-Articular Fx - Associated injuries are common
Calcaneal fractures
MCL PE findings
Non-displaced metatarsal shaft fractures
MRI
42. Immobilization by cast / surgery - Goal is to restore anatomical relationship of ____ - maintain reduction during healing - mobilize ankle early - Most ___ fx require ORIF
Achilles tendon rupture
Posterior hip dislocation
Uncomplicated ankle fracture treatment
Nondisplaced Phalangeal fractures
43. 5 P's of Compartment Syndrome
Nondisplaced Phalangeal fractures
Pain - Parasthesia - Pallor - Pulselessness - Poikilothermia
Maisoneuve fractures
Achilles tendon rupture
44. Valgus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain
MCL PE findings
Forearm (flexor - extensor - mobile wad)
Treatment of ALL knee ligament injuries
Dislocated patella
45. 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 -
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Clinical History suspect of Hip Fracture
Pilon fractures
Surgical management of dislocated patella
46. Occurs from a twisting injury to extended knee - Women > men - Lateral displacement common - Tearing of medial knee joint capsule occurs
Uncomplicated ankle fracture treatment
Clinical History suspect of Hip Fracture
Dislocated patella
Meniscal Tear Treatment
47. Forceful contraction of ____ - Falling on flexed knee - Patients over 40 years
Meniscal Tear Treatment
Patella fracture
Tibial fracture complications
Quadriceps tendon rupture
48. W/o fracture-> closed reduction under procedural/GA sedation -> within 6 HOURS - Stimpson Maneuver
Vertical Shear Pelvic Fracture
ACL PE maneuvers
Posterior hip dislocation treatment
Uncomplicated ankle fracture treatment
49. Occurs with fall / jump from a height - 5% of injuries
Vertical Shear Pelvic Fracture
Patella Fx Treatment: Severely comminuted
Calcaneal fracture treatment
2nd Metatarsal / Lisfranc ligament injury
50. Presentation: fibula may be fx at head -> 6 cm above ankle joint - Tx: Reduce / stabalize fractured medial malleolus - secure fibula to distal tibia
Patella Fx treatment: Displaced >3mm &/or disrupted extensors
Patella Fx Treatment: Severely comminuted
Maisoneuve fractures
Dislocated patella