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