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Emergency Medicine: Lower Extremity

Instructions:
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. Most common hip disolcation (90%) - Cause is secondary to force applied to a flexed knee - directed posteriorly - Common in MVC injuries






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






3. 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






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






6. 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






7. Knee immoblizer & RICE






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






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






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






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






12. 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






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






14. 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






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






16. 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






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






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






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






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






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






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






23. 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






24. 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






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






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






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






28. Knee immobilizer & RICE -> referral for ORIF






29. 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






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






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






32. Most sensitive imaging of occult hip fx






33. 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






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






35. 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






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






37. 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






38. 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






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






40. 5 P's of Compartment Syndrome






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






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






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






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






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






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






47. 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






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






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






50. 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







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