Test your basic knowledge |

Emergency Medicine: Lower Extremity

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. Open fractures - Fracture dislocations - Dislocations - Bimalleolar / Trimalleolar fractures - Unstable unimalleolar fractures - Mausonneuve fractures






2. Surgical debridement - suturing of quadriceps and patellar tendons






3. 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






4. Valgus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain






5. 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






6. Most sensitive imaging of occult hip fx






7. W/o fracture-> closed reduction under procedural/GA sedation -> within 6 HOURS - Stimpson Maneuver






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






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






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






11. Treatment for posterior hip dislocation - downward traction placed on femur at the knee -> uther hand applies external and internal rotation






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






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






14. 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






15. Occurs w/ cutting - squatting - or twisting maneuvers - Can occur independent or w/ ligament injury - Medial > Lateral frequency - 'Locking - popping - clicking - snapping' sensations - joint instability






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






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






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






19. 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






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






21. 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






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






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






24. Varus deformity w/ flexion - Laxity >1cm w/o endpoint: complete rupture - Laxity <1cm w/ endpont: incomplete/partial tear - no laxity but pain: ligament strain






25. Presentation: fibula may be fx at head -> 6 cm above ankle joint - Tx: Reduce / stabalize fractured medial malleolus - secure fibula to distal tibia






26. 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






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






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






29. 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






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






31. 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






32. 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






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






34. 5 P's of Compartment Syndrome






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






36. 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)






37. 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






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






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






40. Intra-Articular: immobilization w/ well padded posterior splint - strict elevation - non-weightbearing - analgesia - ortho f/you - Extra-Articular: Immobilization - analgesia - ortho f/you






41. Recurrent lateral dislocation (15% of cases) - Superior - horizontal - intercondylar disolcations - Irreducible dislocations






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






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






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






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






46. Knee immoblizer & RICE






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






48. 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






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






50. Occurs from a twisting injury to extended knee - Women > men - Lateral displacement common - Tearing of medial knee joint capsule occurs