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