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