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Emergency Medicine: Lower Extremity

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. Most sensitive imaging of occult hip fx






2. 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






3. 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






4. 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






5. 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)






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






7. 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






8. Surgical debridement - suturing of quadriceps and patellar tendons






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






10. Common in older adults - Women > Men - Usually secondary to osteoporosis - Fall is usually the cause






11. The _______ of the upper extremity is most likely to develop compartment syndrome - Tibia (Anterior - Posterior - Medial)






12. 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






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






14. Noncontact injury - decelleration - hyperextension - or marked internal rotation of the tibia on the femur - 'Pop' -> swelling within hours






15. 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






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






17. 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






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






19. Immobilization by cast / surgery - Goal is to restore anatomical relationship of ____ - maintain reduction during healing - mobilize ankle early - Most ___ fx require ORIF






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






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






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






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






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






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






26. 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






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






28. 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 -






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






30. Infection secondary to poor I&D - Compartment syndrome disabilities - Fx not adequately aligned






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






32. Knee immoblizer & RICE






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






34. Knee immobilizer & RICE -> referral for ORIF






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






36. 'Open book fracture' - 25% of injuries - Head on MVC






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






38. Valgus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain






39. 5 P's of Compartment Syndrome






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






41. 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






42. 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






43. 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






44. 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






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






46. Varus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain






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






48. Transverse fx is most common - displacement & disrupted extensor mechanism likely






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






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