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