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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.
  • 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






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






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






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






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






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






7. Most common hip disolcation (90%) - Cause is secondary to force applied to a flexed knee - directed posteriorly - Common in MVC injuries






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






9. 'Open book fracture' - 25% of injuries - Head on MVC






10. Noncontact injury - decelleration - hyperextension - or marked internal rotation of the tibia on the femur - 'Pop' -> swelling within hours






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






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






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






14. Surgical debridement - suturing of quadriceps and patellar tendons






15. Knee immobilizer & RICE -> referral for ORIF






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






17. Knee immoblizer & RICE






18. SI crush injury may occur - Fracture and horizontal counterclockwise rotation of pelvis on the coronal plane - Ligament injuries may occur






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






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






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






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






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






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






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






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






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






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






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






30. Ortho referral - NSAIDs and partial weightbearing - Difinintive Dx by MRI & arthroscopy






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






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






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






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 -






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






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






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






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






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






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






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






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






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






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






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






47. The _______ of the upper extremity is most likely to develop compartment syndrome - Tibia (Anterior - Posterior - Medial)






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






49. Widening of Pubic Symphysis - Disruption of SI Joint - Sacral ligament injuries






50. Most sensitive imaging of occult hip fx







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