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