Clinical Boxes Flashcards
1
Q
Hip pointer is another name for contusion of what bony structure?
A
contusion of iliac crest
2
Q
What is the cause of Charley horse?
A
ischemia or contusion and rupture of blood vessles of a single muscle
3
Q
What is the most common site of THIGH hematoma ?
A
quadriceps
4
Q
What should ALWAYS be considered when a pt has edema in proximal part of the thigh?
A
psoas abscess (can be seen in lateral border of radiograph)
5
Q
Psoas abscess is often overlooked as what other conditions?
A
- indirect/direct hernia
- lymphadenopathy
- saphenous varix
6
Q
Softening of the patellar cartilage especially in marathon runners?
A
Chondromalacia Patellae
7
Q
When does the patella ossify? What can result if it fails to ossify?
A
- 3-6 years old
- can result in BIPARTITE or TRIPARTITE patella
(often confused for patellar fracture)
8
Q
Diminished patellar reflex could indicate?
A
decreased integrity of femoral nerve (L2-L4 nerve)
9
Q
What muscle is engaged in patellar reflex
A
quadriceps
10
Q
Between what 3 structures would you compress the femoral Artery?
A
Press POSTERIORLY on
- superior pubic ramus
- psoas major M.
- femoral head
11
Q
What structure is cannulated for LEFT cardio angiography? Where is it cannulated?
A
- Femoral Artery
2. inferior to inguinal ligament
12
Q
where would one feel the femoral pulse?
A
B/w the ASIS and pubic symphysis , about 3 cm below the inguinal ligament
13
Q
What would supply the lower leg if a patient had a laceration to the femoral artery?
A
Cruciate anastomosis
14
Q
What often results from a laceration to femoral artery?
A
and arteriovenous shunt , because the femoral VEIN is located very close to femoral ARTERY
15
Q
Edema of the femoral triangle can be caused by dilation of what structure?
A
Great Saphenous Vein
SAPHENIX VERIX
16
Q
What structure is used for RIGHT cardiac angiology?
A
Cannulation of femoral VEIN
17
Q
What is important to avoid during varicose vein operations?
A
Do NOT tie the Femoral VEIN (it has no tributaries at this level except the great saphenous v.)
18
Q
Describe the anatomical location of femoral hernias?
A
small intesting popping through the FEMORAL RING and into the FEMORAL CANAL
19
Q
What is the cause of transverse patellar fracture? What fragments result?
A
- blow to the knee or sudden contraction of quadriceps
2. proximal fragment and distal fragment
20
Q
Pt walking with forward lean and pressing on distal part of their thigh cannot perform what muscle function?
A
- extension of leg against resistance
(due to paralysis of quadriceps)
21
Q
What is the cause of psoas abscess?
A
pyogenic infection in the abdomen
22
Q
Lesion to innervation of quadriceps would result in ?
A
diminished patellar reflex
23
Q
A groin pull involves muscles with which function?
A
staring or stretching of thigh flexors and thigh adductors
24
Q
Where is the best site for gluteal IM injections?
A
superolateral quadrant of the buttocks
25
Pt is compensating for weakened abduction of the thigh by the gluteus medius and minimus.. what condition do they have?
What nerve is affected?
1. Gluteus medius limp
| 2. Injury to Superior Gluteal Nerve
26
Avulsion of the ischial tuberosity could result in injury to what muscles?
Hamstrings
27
What condition does a pt with localized point tenderness over the greater trochanter with pain along the IT band?
Trochanteric bursitis
28
What muscle from the leg, along with its nerve and blood vessels can be used to replace a damaged muscle in the hand?
Gracilis M.
29
Avulsion fractures of the hip bone occur at which bony projection?
Apophyses
30
What types of activities cause avulsion fractures at the hip bone?
sudden acceleration and deceleration
31
Angle DECREASED between of femoral neck and the femoral shaft?
```
Coxa VARA
(shaft of femur deformed toward midline)
```
32
Angle INCREASED between of femoral neck and the femoral shaft?
Coxa VALGA
| bow- legged
33
What types of femoral fractures can result in IMPACTION (overriding bones)?
1. spiral fracture
2. transcervical fracture
3. intertrochanteric fracture
34
Which femoral fracture can result in hemorrhage of popliteal artery?
Fracture of Distal or Inferior Femur
35
What is the cause of Osgood Schlatter disease?
*disrupted epiphyseal plate of tibial tuberosity*
| cause inflammation or chronic pain in adoloescents
36
Dislocation of epiphysis of femoral head is caused by ?
increased shearing stress on epiphysis with ABduction and lateral rotation
37
What bone is common for grafting? What bony structure must be grafted along with it?
1. Fibula
| 2. Nutrient Foramen
38
What leads to Compartment Syndrome?
inflammation of muscles, edema or hemorrhage due to STRONG nature of septa and deep fascia of leg forming the boundaries of the leg compartments
39
What procedure is used to relieve pressure of compartment syndrome?
Fasciotomy
40
How can DVT result in death?
large thrombus breaks free and travels to the lungs
41
Which vein is most associated with varicose veins?
Great saphenous V and its tributaries
42
What is the difference between normal and varicose veins?
varicose veins have INCOMPETENT valves
43
Venus stasis is a big cause of thrombus formation. What causes venus stasis?
1. muscular inactivity
2. external pressure on veins
3. loose fascia
44
Which vein is best grafted for coronary bypass?
Saphenous vein
45
What are 3 reasons for grafting the saphenous vein?
1. accessible
2. wall is muscular more elastic than superficial veins
3. distance between tributaries and perforating vs, is sufficient allowing to harvest more length
46
What must doctors consider when assessing abnormalities in peripheral sensory function?
major cutaneous nerves must be seen as anatomically different from dermatome maps
47
What procedure is done for prolong administration of blood, electrolytes or drugs?
Saphenous Cutdown (anterior to medial malleolus)
48
What nerve do you target for REGIONAL nerve block of lower limb?
Femoral nerve (L2-L4)
49
What muscle commonly compresses the Sciatic N?
Piriformis M.
50
Pt with (+) Trendelenburg sign would have what injury?
Injury to Superior Gluteal N.
51
What injuries could have (+) Trendelenburg SIgn?
1. injury to superior gluteal N.
2. hip dislocation
3. avulsion of greater trochanter
52
Where would anesthetic block of sciatic nerve would cause paresthesia?
all the way to the foot
| sciatic N --> tibial N---> medial and lateral plantar ns.
53
Ischial bursitis involves excessive friction between ischial bursa and what bony structure?
ischial tuberosity
54
This type of strain is most common in athletes who run or kick hard?
hamstring injury
55
What are the arteries involved in cruciate anastomosis?
1. inferior gluteal A.
2. medial femoral circumflex A
3. lateral femoral cicumflex A
4. 1st perforating branch of deep femoral branch
56
When ligating the femoral A. the anastomosis functions to?
prevent NECROSIS of the femoral head
57
Complete tear of hamstring with loss of motor function is ?
Grade 3 hamstring tear
58
Hamstring tendonapathy is often associated with ?
avulsion of ischial tuberosity
59
Mild tear of hamstring with minor swelling?
Grade 1 hamstring tear
60
Partial hamstring tear with loss of strength ?
Grade 2 Hamstring Tear
61
Which bony structure is susceptible to avulsion by the hamstrings?
ischial tuberosity
62
What part of the tibia is most susceptible to COMPOUND fractures? Why?
Tibial shaft because of its POOR blood supply
63
This type of fracture is common in pple who take long hikes before they are conditioned?
Transverse march (stress) fractures
64
Common fracture with skiing?
Diagonal fracture of tibia
| " BOOT top Fracture"
65
Fibular fractures are commonly associated with what other injury?
fx or dislocations of ankle joint
66
What joint is damaged as a result of a Calcaneal Fracture?
Talocalneal Joint
67
A hard fall on the heel can result in?
calcaneal fracture
68
Fracture of this structure via crush injury could affect weight bearing on the foot ?
fracture of sesamoid bones
69
What two events could result in formation of Os Trigonum? Where does it form?
1. failure of secondary ossification center to fuse
2. fracture of ossified center
behind the talus
70
How do popliteal abscesses spread?
Tend to spread superior and inferiorly because of the toughness of the popliteal fascia
71
Weakening of popliteal pulse indicates?
femoral artery obstruction
72
How do you palpate for popliteal pulse?
prone position, with knee flexed
| relax popliteal ossa and hamstrings
73
What unique characteristics distinguish a popliteal aneurysm from other masses?
thrills and bruits audible via stethoscope
74
What nerve is susceptible to compression by popliteal aneurysm?
tibial N.
75
Severing the tibial N. would affect what functions?
1. paralysis of plantarflexion and flexing of the toes
2. loss of sensation in the sole of the foot
( TIbial N. supplies Posterior leg and Plantar Ns in the feet)
76
infection in anterior or posterior leg spread ? In Lateral leg?
1. Distally
| 2. Proximally into popliteal fossa via femoral N.
77
Shin splints are caused by ?
microtrauma to TIBIALIS ANTERIOR leading to small tears in the periosteum
78
What two structures contribute to the unique Everted (pronated) position of the HUMAN foot?
1. fibularis longus across the sole of the foot
| 2. fibularis tertius at 5th metatarsal
79
Most injured Nerve of the lower limb?
common fibular N.
| b/c wraps around fibular head
80
Severance of the Common fibular N. would result in what deficits?
1. loss of dorsiflexion and eversion
2. loss of sensation of anterolateral leg and dorsum of foot
3. difficult HEEL STRIKE
81
Foot drop is caused by?
injury to common fibular N.
82
Identify the gait: individual leans to side opposite long limb
Waddling gait
83
Identify the gait: long limb is abducted to allow toes to clear
Swing out gait
84
Identify gait: extra flexion of the thigh to raise knee as high as necessary
Steppage gait
85
Ski boot syndrome is caused . y ?
Deep fibular Nerve entrapment
| cause pain in ANTERIOR compartment
86
Chronic ankle sprains can cause ?
entrapment of superficial fibular N.
87
What structure is occasionally found in the LATERAL head of the gastrocnemius M. ?
Fabella
88
Pt recently state they picked up running after being inactive for 6 months, and pain in her heel. What may this patient have?
Calcaneal Tendonitis
| usually occurs with sudden onset of training
89
An audible snap, immediate pain over the calf and loss of plantar flexion describe what injury?
Rupture of Calcaneal Tendon
90
Calcaneal Reflex tests which nerve roots?
S1 and S2
91
In the absence of plantar flexion a person will ?
rotate the foot EXTERNALLy during the stance phase to disable passive dorsiflexion
92
What is calcaneal bursitis?
infllammation of deep bursa in the calcaneal tendon
93
severe dorsiflexion of the ankle can result in ?
Fractures of neck of the talus
94
Cause of fracture of metatarsals?
heavy objects falling on foot
95
Pt with abrasions and minor sepsis caused by pathogenic microorganisms will have what on physical exam?
enlared inguinal lymph nodes
96
What muscles contibutes most to venous return of the leg?
triceps surae
97
A distal belly medial to the calcaneal tendon present in 3% people
Accessory soleus
98
What is important to examin in pts with occlusive peripheral arterial disease?
Posterior tibial pulse
99
Hematoma with edema anteromedial to the lateral malleolus could indicate?
Contusion of Extensor Digitorum Brevis
100
To numb the skin on the dorsum of the foot (except the flip flop zone), where would you administer an anesthetic block ?
Superficial Fibular N.
101
Plantar Reflex tests which nerve roots?
L4. L5. S1, S2
102
What does a babinski reflex indicate after the age of 4?
potential brain injury
103
Joggers foot is a result of ?
Medial Plantar N compression
| tingling on the medial side of the sole of the foot
104
Enlargement of popliteal lymph nodes indicates?
infection of LATERAL side of foot
105
Inguinal lymphadenopathy without popliteal lymphadenopathy sometimes indicates?
infection of MEDIAL side of foot
106
Pes planus is caused by ?
inability of spring Ligament supporting talar head
107
Potts Fracture - Dislocation is caused by?
eversion of the foot resulting in displacement of medial malleolus due to pulling on medial collateral ligament
108
Most common ankle injury ?
inversion injury
109
What ligament is involved in Lateral ankle Sprain?
Anterior talofibular Ligament
| common in jumping activities
110
What warrants a hip replacement? What is replaced?
OSteoarthritis of hip joint
| Femoral head and neck
111
What nerve can be injured with hip dislocation?
Sciatic N
112
increased Q angle indicates?
Genu Valgum (knock knees)
113
decreased Q angle indicates?
Genu Varum (bow leg)
114
What direction does patella dislocate ? Why?
Laterally b/c of vastus medialis
115
REpetitive microtrauma caused by running downhill , from friction between patella and patellar surface of femur is ?
Patellofemoral syndrome
116
Tearing of the Medial collateral ligament (Tibial collateral ligament) results in tearing of ? (2)
medial meniscus or ACL
117
ACL rupture would have which positive tests?
Lachmans
| Anterior Drawer
118
Pt lands on knee with flexed knee what injury is this?
PCL tear
119
Pain with lateral rotation of tibia indicates ?
Lateral meniscal tear
120
Pain with medial rotation of tibia indicates ?
medial meniscus tear
121
What examination is best for debridement or removal of torn menisci?
Arthroscopy
122
What makes up the triangular area for knee joint aspiration?
1. gerdy tubercle
2. lateral epicondyle of femur
3. apex of patella
123
Pt complains of knee pain, state he KNEELS alot at work ?
Prepatellar bursitis
124
Friction between skin and tibial tuberosity with edema?
subcutaneous infrapatellar bursitis
125
Edema between the patellar ligament and tibia?
Deep infrapatellar bursitis
126
abrasion or penetrating wounds to the knee can lead to?
Suprapatellar Bursitis
127
Herniation of gastrocnemius or semimembranous bursa into the joint capsule of the knee?
Popliteal cyst
128
Foot deformity caused by pressure from footwear and degenerative joint disease, characterized by lateral deviation of the great toe?
hallux valgus
129
tender and inflamed Subcutaneous bursa of the toe?
bunion
130
inflammmation and thickened skin over PIP of toes ?
corns
131
Mallet toe?
flexion at DIP
132
Hammer toe?
extension MP
| flexion PIP
133
Claw toe?
extension MP
flexion PIP
Flexion DIP
134
Trigger toe?
extension of MP and Flexion of IP of big toe
135
Inverted, plantarflexed and adducted Foot with weightbearing mostly on the lateral side?
Club foot
