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