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