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PCM Exam 1 > Knee, Ankle, and Foot > Flashcards

Knee, Ankle, and Foot Flashcards

1
Q

What could the locking of the knee indicate?

A

A meniscal tear

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2
Q

What does a popping sensation at the knee indicate?

A

A ligamentous tear or rupture

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3
Q

What does a giving out sensation at the knee indicate?

A

A ligamentous rupture or patellar subluxation

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4
Q

What does a rapid onset of knee effusion indicate?

A

ACL rupture

Tibial plateau fracture

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5
Q

What does a slower onset of knee effusion indicate?

A

Meniscal tear or ligamentous sprain

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6
Q

What does recurrent knee effusion suggest?

A

A meniscal tear

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7
Q

What are 3 ways to test for knee effusion?

A
  1. Milking technique: down stroking of the knee
  2. Medial pressure technique: apply pressure to the medial aspect of the knee and look for lateral bulging
  3. Fluid wave technique: tap the lateral knee and feel for a fluid wave with the other hand
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8
Q

What are the neuromuscular knee exam components?

A

patellar reflex

sensation

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9
Q

Describe a valgus stress test

A

Patient is supine with the knee flexed to 30 degrees
Physician supports the lower leg and places the other hand on the lateral knee. A force is applied to the proximal tibia while abducting the lower leg (taking the lower leg out and the knee in)

Positive if increased laxity, pain, or absent end point

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10
Q

Describe a varus stress test

A

Patient is supine with the knee flexed to 30 degrees
Physician holds the lower leg and places the other hand on the medal side of the knee
A lateral force is applied at the proximal tibia which the lower leg is adducted (taking the lower leg in and the knee out)

Positive if increased laxity, pain, or absent end point

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11
Q

Describe an anterior drawer test

A

Patient is supine with the knee flexed to 90 degrees
examiner sits on the patients foot and grasps the proximal tibia with both hands, pulling anteriorly

a positive test would be excessive translation

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12
Q

Describe a posterior drawer test

A

Patient is supine with the knee flexed to 90 degrees.
Examiner sits on the patients foot, grasps the proximal tibia with both hands and pushes posteriorly

a positive test with excessive translation (moves too much)

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13
Q

Describe McMurrays test

A

Patient is supine with the hip and knee flexed
One hand placed on distal femur and the other controls the ankle

  1. Lateral meniscus: rotates tibia in internal rotation with e varus stress then continues into leg extension
  2. Medial meniscus: rotates tibia into external rotation and applies a valgus (inward) stress and continues into extension

positive test with pain or clicking

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14
Q

What is the Q angle? What is normal in men versus women

A

The Q angle is an extension of the “lines” drown from the ASIS and the tibial tubercle; the intersection of these lines will be the Q angle

In women the Q angle is about 17 degrees and in men its about 14 degrees

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15
Q

Describe tibial apophysitis (Osgood-Schlatter disease)

  1. Cause
  2. Classic presentation
  3. Diagnosis
  4. Treatment
A
  1. Repetitive strain and chronic avulsion of the secondary ossification center of the tibial tuberosity
  2. Typically seen in kids with a recent growth spurt or overuse (9-14 year olds in sports)
    - presents as gradually worsening anterior knee pain that worsens with movement
  3. Tenderness over the tibial tuberosity with a bony protuberance
  4. Ice, NSAIDS, Tylenol
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16
Q

Describe Pes Anserinus Pain Syndrome (PAPS)

  1. Define pes anserinus
  2. Classic presentation
  3. Diagnosis
  4. Treatments
A
  1. pes anserinus is the insertion site of the conjoined tendons of sartoris, gracilis, and semitendonosis
  2. Sudden onset of medial knee pain that is inferior to the medial joint line; worsened by repetitive knee flexion and extension; worsened pain at night
  3. Medial knee pain and tenderness over the proximal tibia
  4. Weight loss, Quad strengthening, NSAIDS
17
Q

Describe Iliotibial band Syndrome (ITBS)

  1. Cause
  2. Presentation
  3. diagnosis
  4. Treatment
A
  1. overuse
  2. Slow onset diffuse lateral knee pain
  3. Noble test: patient lateral decubitus with knee flexed to 60 degrees, if they are tender over the lateral femoral epicondyle then the test is positive; localized tenderness to the lateral femoral condyle
  4. Rest, Ice, NSAIDS, ITB stretching
18
Q

Describe Popliteal cysts (Bakers cysts)

  1. Cause
  2. Classic presentation
  3. Diagnosis
  4. Treatment
A
  1. Gastrocnemius-semimembranous bursa secondary to joint disease or trauma
  2. most are asymptomatic; posterior knee pain, stiffness, feeling of a mass behind the knee
  3. knee mass that is most prominent in full extension and standing
    Fouchers sign: mass disappears with flexion of about 45 degrees
  4. treat underlying joint disorder IF symptomatic
19
Q

Define metarsalagia

A

Plantar surface pain from the head of the metatarsals (usually the 2nd and 3rd toe; from collages of the transverse foot arch

20
Q

Define Hallux Rigidus

A

first metatarsophalangea joint (MTP) that shows unusual stiffness that causes limited great toe extension

21
Q

Describe a Morton neuroma

A

Collapse of the transverse arch which puts increased pressure on the interdigital nerve; usually between the 3rd and 4th metatarsal

22
Q

Describe Charcot foot

A

Chronic, progressive, and destructive arthropathy that is related to neuropathy (rocker bottom foot)

23
Q

Describe plantar fasciitis

  1. Cause
  2. Presentation
  3. Diagnosis
  4. Treatment
A
  1. Microtears in the plantar fascia
  2. Sharp stabbing medial plantar heel pain; worse with prolonged standing and worse with the first few steps
  3. Tenderness to palpation over the medial plantar calcanea region; pain worse with dorsiflexion
  4. Rest, Ice, NSAIDS, stretching
24
Q

Describe a lateral ankle sprain

A

Lateral anke ligaments (anterior talofibular or calcaneofibular ligaments) injury secondary to foot inversion and plantar flexion

25
Q

Describe a medial ankle sprain

A

medial ankle ligament injury secondary to forced eversion

26
Q

Describe a syndesmotic sprain (high ankle sprain)

A

Dorsiflexion and or eversion with external rotation that sprains the distal tubular syndesmosis

27
Q

What is the presentation of an ankle sprain?

A

Ecchymosis (bruising) and swelling)

28
Q

What are the clinical diagnosis tests for a

  1. Lateral ankle sprain
  2. Medial ankle sprain
  3. Syndesmotic spain
A
  1. Anterior drawer test and talar tilt test
  2. Eversion test
  3. Squeeze test
29
Q

Describe the ottawa ankle rules

A

Tenderness over the medial or lateral malleolus or inability to bear weight after the injury

Tendereness to the base of the 5th metatarsal or navicular or inability to bear weight after the injury

30
Q

Describe a gout flare

  1. Cause
  2. Presentation
  3. Diagnosis
  4. Treatment
A
  1. precipitation of monosodium rate crystals in a joint space
  2. sudden onset, monoarticular joint pain with swelling and redness
  3. Arthocentesis; serum uric levels, gouty tophi
  4. NSAIDS, glucocorticoids, allopurinol for prevention
31
Q

What does a positive Valgus test indicate?

A

Medial collateral ligament (MCL) disruption

32
Q

What does a positive varus test indicate?

A

Lateral collateral ligament disruption (LCL)

33
Q

What does a positive anterior drawer test indicate?

A

ACL insufficiency (injury/tear)

34
Q

What does a positive posterior drawer test indicate?

A

PCL insufficiency

35
Q

What does a positive Lachmans test indicate?

A

ACL insufficiency

36
Q

What does a positive McMurray’s test indicate?

A

Medial or lateral meniscus tears

PCM Exam 1 (10 decks)

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