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Orthopedics > 4 - Knee > Flashcards

4 - Knee Flashcards

1
Q

What is the main difference between the Lachman’s test and anterior drawer test for assessing the ACL ligament?

A

Lachman’s test = knee is flexed to 30 degrees

anterior drawer = knee is flexed to 90 degrees

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2
Q

What are the 2 tests used to assess the integrity of the PCL ligament?

A
  • posterior drawer

- posterior sag test

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3
Q

What are the 2 tests used to assess the integrity of the meniscus?

A
  • McMurray test

- Apley compression

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4
Q

What is a positive finding for the patellar apprehension test?

A

Lateral stress to patella results in pain, apprehension, or quadriceps contraction

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5
Q

To test the integrity of the MCL you apply _____ stress.

To test the integrity of the LCL you apply _____ stress.

A 
MCL = valgus stress
LCL = varus stress
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6
Q

What are the 5 Ottawa Knee rules?

don’t use in intoxicated patients

A
  • For an acute knee injury you should obtain imaging if the patient has ANY ONE of these:
  • age >55
  • isolated tenderness of the patella
  • tenderness at the head of the fibula
  • inability to flex to 90 degrees
  • inability to weight bear both immediately and in the ER for four steps
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7
Q

The Ottawa Knee rules has very high _______, but very low _______. It is used to rule ______.

A
  • very high sensitivity
  • very low specificity
  • it is used to rule OUT
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8
Q

The McMurray’s test has very high ______. It is a good test to rule _____.

A
  • very high specificity

- it is used to rule IN

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9
Q

A 66 year old presents with progressive bilateral medial knee pain. On PE you notice crepitus with ROM and the patient is tender along the medial joint line. What is the diagnosis?

A

osteoarthritis

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10
Q

What are the 2 bursa most likely to become inflamed in bursitis?

A
  • pre-patellar

- infra-patellar

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11
Q

What antibiotics would you want to use in an uncomplicated bursitis caused by infection?

A

Keflex

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12
Q

A 26 year old avid runner presents with lateral left knee pain. The pain was initially sharp that has now progressed to a constant, deep pain. On physical exam the patient is tender over the lateral femoral epicondyle. What is the diagnosis?

A

IT band syndrome

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13
Q

What are the treatment options for IT band syndrome?

A
  • NSAIDs, RICE
  • Foam rolling
  • Physical therapy
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14
Q

A synovial cyst of the popliteal fossa is also called a ______ cyst.

A

Baker’s cyst

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15
Q

A 46 year old presents with a palpable fullness in the popliteal area. It is more prominent when the patient stands and the knee is extended. The patient is asymptomatic. What is the most likely diagnoses?

A
  • Popliteal cyst (Baker’s cyst)

* treatment is self-limiting and resolve without intervention; if refractory = steroid injections + aspiration*

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16
Q

What is the best way to diagnose a Baker’s cyst?

A

ultrasound

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17
Q

A 22 year college volleyball player presents with insidious, aching, anterior knee pain. On PE the patient is tender over the proximal patellar tendon. He also has pain with knee extension. What is the diagnosis?

A

Patellar tendonitis (Jumper’s knee)

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18
Q

How is patellofemoral syndrome (Runner’s knee) diagnosed?

A

diagnosis of exclusion

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19
Q

Achy pain around or under patella worse after squatting, running, prolonged sitting (theatre sign) is consistent with this diagnosis.

A

patellofemoral syndrome (Runner’s knee)

20
Q

T/F: A wider Q angle is NOT a factor in patellofemoral syndrome.

A

True

21
Q

A patient who recently began training for the boston marathon presents with pain in the middle and distal third of the posteromedial tibia. The patient is diffusely tender over the anterior shin. What is the diagnosis?

A

medial tibial stress syndrome aka “shin splints”

stress fracture would be longer time frame and pain would be focal

22
Q

What is the difference in treatment management for MTSS vs. stress fracture?

A

MTSS = can continue exercise

Stress fracture = non weight-bearing in aircast boot

23
Q

Which of the following is an appropriate management option for medial tibial stress syndrome?

a. NSAIDs
b. shock absorbing insoles
c. vitamin D
d. all of the above are good management options

A

d. all of the above are good management options

24
Q

If you see an anterior lucency on XR in the setting of a stress fracture what should you do?

A

refer to specialist

25
Q

A 14 year old presents with pain and swelling at the insertion of the patellar tendon at the tibial tubercle. What is the diagnosis?

A

osgood-schlatter disease (tibial tubercle apophysitis)

treatment is self-limiting, resolves when growth plate closes

26
Q

A 45 year old presents with knee pain. He was playing basketball when he felt a pop while landing from a jump. On physical exam you notice an INFERIORLY displaced patella and a palpable defect SUPERIOR to the patella. The patient is unable to bear weight. What is the diagnosis?

A

quadriceps tendon rupture

27
Q
  • quadriceps tendon rupture = patella _____

- patella tendon rupture = patella _____

A
  • quadriceps tendon rupture = patella baja

- patella tendon rupture = patella alta

28
Q

What is the immediate and definitive treatment for a quadriceps tendon rupture OR a patellar tendon rupture?

A
  • immediate = NWB with knee immobilizer

- definitive - surgical repair

29
Q

A 25 year old presents with knee pain. He was playing basketball when he felt a pop while landing from a jump. On physical exam you notice a SUPERIORLY displaced patella and a palpable defect INFERIOR to the patella. The patient is unable to bear weight. What is the diagnosis?

A

patellar tendon rupture

30
Q

A 18 year old soccer player presents to the ED with knee pain. He says he was running when he decelerated to change direction and he felt a “pop”. On PE you notice severe swelling and a + anterior drawer test. What is the diagnosis?

A

ACL tear

31
Q

What is the best preventative activity for ACL prevention?

A

neuromuscular training

32
Q

Why would you get a plain film for an ACL tear?

A

to assess for a tibial avulsion fracture OR “Segond fracture”

33
Q

what is the test of choice for an ACL injury?

A

MRI

34
Q

Which of the following is the largest and strongest of knee ligaments?

a. MCL
b. LCL
c. ACL
d. PCL

A

d. PCL

35
Q

A patient presents to the ED with left knee pain following an MVA. She said she struck her knee off the dashboard. On PE you notice a positive posterior drawer test. What is the diagnosis?

A

PCL tear

36
Q

MCL tear is caused by ______ stress. LCL tear is caused by ______ stress.

A
  • MCL = valgus stress

- LCL = varus stress

37
Q

A patient presents with insidious left knee pain. He also notes recurrent episodes of popping, catching, and locking of the knee. Deep squats worsen his pain. On PE you note joint line tenderness and a + McMurray’s test. What is the diagnoses?

A

Meniscus injury

38
Q

A patient presents with severely deformed knee. The patient reported the knee “giving away” and when he looked down he saw his “knee was dislocated”. What is the diagnoses?

A

Patellar dislocation

39
Q

What is the best method to reduce a patellar dislocation?

A

extend knee while applying gentle medial pressure to patella

40
Q

A tibiofemoral dislocation is a true:

1.
2.
3.

A
  1. true knee dislocation
  2. true surgically emergency
  3. true limb threatening injury
41
Q

Which artery do you worry about with a tibiofemoral dislocation?

A

popliteal artery

42
Q

Which nerve do you worry about with a tibiofemoral dislocation?

A

peroneal nerve injury

43
Q

What imaging study do you want to get to assess for vascular injury in a tibiofemoral dislocation?

A

CTA

44
Q

What is the best treatment option for a non-displaced vs. displaced patella fracture?

A
  • non-displaced = knee immobilizer 6-8 weeks

- displaced = surgical repair - figure 8

45
Q

What is the “unhappy” triad?

A

The “unhappy triad” refers to a sprain injury that involves three structures of the knee. These structures are the medial collateral ligament, anterior cruciate ligament, and the medial meniscus.

Orthopedics (5 decks)

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