Final Exam

Question 1

Osteochondral dissecans (OCD)

Answer 1

a condition seen in older children, teenagers, and young adults, particularly those active in sports. Clinical signs include dull pain, subtle limp, mechanical symptoms (popping, locking), and joint effusion are exacerbated with weight-bearing activity.

Question 2

Osgood-Schlatter Disease

Answer 2

11-15 yo
Growth spurts
Male>female
Self Limiting

Question 3

Degenerative Joint Disease

Answer 3

pain worse with weight-bearing activities, intermittent joint effusions, in advanced stages, there is loss of function and varus or valgus deformations.

Question 4

The characteristic radiographic signs of degenerative joint disease at the knee may include the following…

Answer 4

1. Decreased radiographic joint space
2. Sclerosis of subchondral bone
3. Osteophyte formation at joint margins
4. Subchondral cyst formation
5. Varus or valgus joint deformity

Question 5

Fracture of the femur

Answer 5

pain, inability to bear weight, and swelling. Can be caused by high energy collision, MVA, or falls.

Question 6

Fracture of the tibial plateau

Answer 6

Traumatic fracture that can extend to the joint surface or exhibit articular depression that affects joint stability and function. Can be caused by valgus or varus force combined with axial loading, fracture can also occur in osteoporotic bone from low impact trauma

Question 7

Signs and symptoms of tibial plateau fracture

Answer 7

Pain, inability to bear weight or flex knee, knee joint effusion

Question 8

Peripheral arterial occlusive disease

Answer 8

Age >60, history of type 2 diabetes, ischemic heart disease, smoking, sedentary lifestyle, concurrent intermittent claudication

Question 9

Peripheral arterial occlusive disease symptoms

Answer 9

unilateral cool extremity (may be bilateral if aorta is site of occlusion), prolonged capillary refill time (>2 sec), decreased pulses in arteries below level of occlusion, prolonged vascular filling time, ankle-brachial index <0.90

Question 10

Deep vein thrombosis

Answer 10

Recent surgery, malignancy, pregnancy, trauma, or leg immobilization. symptoms include calf pain, edema, tenderness, and warmth

Question 11

Compartment syndrome

Answer 11

History of blunt trauma, crush injury, or unaccustomed exercise

Question 12

Compartment syndrome symptoms

Answer 12

severe, persistent leg pain that is intesified with stretch applied to involved muscles, swelling, tenderness and palpable tension/hardness of involved compartment, paresthesia, paresis, pallor, or pulselessness.

Question 13

Septic arthritis

Answer 13

History of recent infection, surgery, or injection, coexisting immunosuppressive disorder

Question 14

Septic arthritis symptoms

Answer 14

constant aching, or throbbing pain, joint swelling, tenderness, or warmth, May have elevated body temp

Question 15

Cellulitis

Answer 15

history of recent skin ulceration or abrasion, venous insufficiency, congestive heart failure, or cirrhosis

Question 16

Cellulitis symptoms

Answer 16

Pain, skin swelling, warmth, irregular margin of erythema/reddish streaks, fever chills, malaise, and weakness

Question 17

Radiologic signs of ankle instability following severe sprains are seen on the…

Answer 17

anteroposterior view as an abnormal position of the talus and increased width of the ankle mortise joint space, and positive anterior drawer test.

Question 18

ottowa ankle rule for trauma: Any pain in the malleolar zone AND any one of the following:

Answer 18

Bone tenderness along the distal 6 cm of the posterior edge of tibia or tip of medial malleolus OR

Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus OR

An inability to bear weight both immediately and in the emergency department for four steps

Question 19

Weber Classification system

Answer 19

1. Fracture below the ankle joint, usually stable but may require ORIF if medial malleolus is fractured.
2. Fracture at the level of the joint, with the tibiofibular ligaments intact, variable stability
3. Fracture above the joint level which tears the syndesmotic ligaments, unstable, required ORIF

Question 20

Maisonneuve fracture

Answer 20

refers to a combination of a fracture of the proximalfibulatogether with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distaltibiofibular syndesmosis,deltoid ligament) and/or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism.

Question 21

low-risk stress fracture areas

Answer 21

posteromedial tibia, 2nd/3rd metatarsals, calcaneous, distal fibula, cuboid, and cunieforms

Question 22

high-risk stress fracture areas

Answer 22

anterior tibial cortex, medial malleous, navicular, talus, base of 5th, base of 2nd metatarsal, and hallux sesamoids

Question 23

Tarsal coalition

Answer 23

Congenital bony or fibrocartilaginous union between two or more tarsal bones with talocalcaneal and calcaneonavicular being most common. S/x include painful ambulation and limit foot ROM, which becomes pronounced after bones are ossified in late childhood or early adolescence.

Question 24

Fracture of talar neck

Answer 24

Can be caused by hyperdorsiflexion which forces the talus against anterior tibia as seen in landing from height or MVA. Talus is predisposed of developing avascular necrosis after fracture

Question 25

Osteomyelitis in foot of diabetes patients

Answer 25

ulcers tend to be at weightbearing bones. Cellulitis and draining sinus tracts may be present. Pain is variable due to neuropathy

Question 26

Boehler’s angle

Answer 26

often used to evaluate the angular relationship of the talus and the calcaneus in the presence of trauma. This angle is determined by the intersection of lines drawn from the posterior aspect of the subtalar joint to the anterior process of the calcaneus (a) and across the posterior superior margin of the calcaneus (b). Normal values range from 25 to 40 degrees, and lesser values will be seen in the presence of impacted calcaneal fractures.

Question 27

Trauma: Ottawa Ankle Rule (Foot): Any pain in the midfoot zone and any one of the following:

Answer 27

Bone tenderness at the base of the fifth MT OR
Bone tenderness at the navicular bone OR
An inability to bear weight both immediately and in the emergency department for four steps.

Question 28

Lisfranc fracture-dislocations

Answer 28

the most common type of dislocation involving thefootand correspond to the dislocation of the articulation of the tarsus with the metatarsal bases. Look for medial plantar bruising which is considered to be a hallmark sign of a lisfranc injury

Question 29

Hallux valgus

Answer 29

deformity of the forefoot in which the first metatarsal is deviated medially and the great toe is deviated laterally.

Question 30

Pes cavus

Answer 30

abnormally high medial longitudinal arch of the foot, with a calcaneal inclination greater than 30 degrees as measured on the lateral view.

Question 31

Pes planus

Answer 31

an abnormally low medial longitudinal arch of the foot, the result of a developmental deformity, tarsal coalition, soft tissue injury or dysfunction, and neuromuscular conditions.

Question 32

Hallux Valgus degree angles

Answer 32

Normal: less than 15 degrees / 9 degrees
Mild: 15 to 30 degrees / 9 to 13 degrees
Moderate: 30 to 40 degrees / 13 to 20degrees
Severe: over 40 degrees / over 20 degrees

Question 33

Talipes Equinovarus

Answer 33

Club foot
Forefoot is in adduction relative to the hindfoot
Also equinus/PF position of the heel
Inversion of the subtalar joint with varus hindfoot

Question 34

Ottawa knee rules

Answer 34

Knee radiographs are indicated when patient presents with any of these:

Age >55 years
tenderness at head of fibula
isolated tenderness on patella
inability to flex knee to 90 degrees
inability to weightbear 4 steps both immediately and in the emergency department