Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Med - Musculoskeletal > Lower Extremity > Flashcards

Lower Extremity Flashcards

1
Q

A patient with multiple injuries to the same ankle will be more at risk for developing what condition later in life?

A

Arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is ankle arthritis more commonly unilateral or bilateral?

A

Unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What lifestyle modification can greatly improve ankle pain?

A

Weight Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the most common location of a condral injury in the ankle?

A

Talar Dome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

An osteocondral injury would be classified as an injury to the underlying ________ as well as to the cartilage surface.

A

Bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Osteocondritis Dessicans would result in injury to the bone and cartilage due to what?

A

Compromised blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Would you expect to see ligamentous instability in ankle chondral injuries?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most concerning disease process on your DDx when working up a possible ankle chondral injury?

A

Avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Can patients diagnosed with ankle chondral injuries be weight bearing?

A

No, they need to be NWB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: Ankle chondral injuries are more likely to be treated surgically, especially in older patients

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Are athletes more likely to have achilles tendonitis at it’s insertion or within the tendon?

Elderly?

Overweight?

A

Athletes: Tendon

Elderly: Insertion

Overweight: Insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is achilles tendonitis managed?

A 
Non-Operative
1. Rest 
2. PT
3 Heel Lift
4. NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Should corticosteriod injections be given to a patient with Achilles tendonitis (or any tendonitis)?

A

No! There is an increased risk for rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A 42 y.o. male presents to the ED with complaints of right ankle pain. He was playing basketball an hour ago when he went up for a rebound and heard a “pop” near his heel. He felt immediate pain and was unable to ambulate without significant pain. On examination you note significant swelling to the posterior right ankle.

Given the history what is your most concerning diagnosis?

What physical examination test would confirm this?

A

Achilles Tendon Rupture

Thompson’s Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A 42 y.o. male presents to the ED with complaints of right ankle pain. He was playing basketball an hour ago when he went up for a rebound and heard a “pop” near his heel. He felt immediate pain and was unable to ambulate without significant pain. On examination you note significant swelling to the posterior right ankle. When preforming a Thompson’s Test, there is no response in the foot, so you suspect an achilles tendon rupture.

What imaging modality is most diagnostic for this?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A 42 y.o. male presents to the ED with complaints of right ankle pain. He was playing basketball an hour ago when he went up for a rebound and heard a “pop” near his heel. He felt immediate pain and was unable to ambulate without significant pain. On examination you note significant swelling to the posterior right ankle. When preforming a Thompson’s Test, there is no response in the foot, so you suspect an achilles tendon rupture, which is confirmed on MRI.

Upon review of his chart you notice he was recently treated for PNA. What class of ABx was he likely treated with?

(HINT: An ADR of this class is an increased risk for tendon rupture)

A

Fluroquinolones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A 42 y.o. male presents to the ED with complaints of right ankle pain. He was playing basketball an hour ago when he went up for a rebound and heard a “pop” near his heel. He felt immediate pain and was unable to ambulate without significant pain. On examination you note significant swelling to the posterior right ankle. When preforming a Thompson’s Test, there is no response in the foot, so you suspect an achilles tendon rupture, which is confirmed on MRI.

How is this condition managed?

A

Splint
Crutches
Referral To Orthopedic Surgeon (likely surgical repair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which ligament is most commonly injured in ankle sprains?

A

Anterior Talofibular Ligament (ATFL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A high ankle sprain involves injury to what ligament?

A

Syndemosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Are ankle sprains more commonly the result of an eversion or inversion injury?

A

Inverson Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A positive anterior drawer of the ankle may indicate an injury to what ligament?

A

Anterior Talofibular Ligament (ATFL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A 56 y.o. female present to the ED with left ankle pain. She was coming downstairs with the laundry when she missed the last step and fell. She believes her left leg hit first and could hear a loud crack. She had immediate pain and swelling and noted a deformity which prompted her to call 911. She denied hitting her head or losing consciousness. On examination, you note an obvious deformity to the left ankle.

What is the first step in evaluating this injury?

A

Make sure the patient is neurovascularly intact distally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 56 y.o. female present to the ED with left ankle pain. She was coming downstairs with the laundry when she missed the last step and fell. She believes her left leg hit first and could hear a loud crack. She had immediate pain and swelling and noted a deformity which prompted her to call 911. She denied hitting her head or losing consciousness. On examination, you note an obvious deformity to the left ankle. There is obvious swelling and tenderness, but she is neurovasculairy intact distally. Interestingly, she has pain extending to the proximal fibula.

An XR of the Ankle, Tib/Fib, and knee reveal fracutres of the medial malleolus, lateral malleolus, and the proximal fibula.

this type of injury can be described as what type of fracture?

A

Tri-malleolar Fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Are ankle fractures a surgical emergency?

A

No

Most can be managed without surgery –> splint, crutches, elevation, etc…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the most common cause of inferior heel pain?

A

Plantar Fasciitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Would repetitive activity such as running be a risk factor for plantar fasciitis?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A 24 y.o. male presents to your office with left foot pain. He localizes the pain on the plantar aspect of his foot, particularly near his heel. The pain is significantly worse in the morning when he gets out of bed. He is an avid runner, but the pain has limited his ability to do just that. He denied any recent trauma or injuries to the feet. He has not had any fevers as well. On examination, there is tenderness over the plantar surface of the calcaneous, and pain is illicited with dorsiflexion of the foot.

What is the most likely diagnosis?

A

PLantar Fascitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A 24 y.o. male presents to your office with left foot pain. He localizes the pain on the plantar aspect of his foot, particularly near his heel. The pain is significantly worse in the morning when he gets out of bed. He is an avid running, but the pain has limited his ability to do just that. He denied any recent trauma or injuries to the feet. He has not had any fevers as well. On examination, there is tenderness over the plantar surface of the calcaneous, and pain is illicited with dorsiflexion of the foot. You feel this is consistent with plantar fasciitis.

What treatment recommendations would you make for this patient?

A

Physical Therapy
NSAIDs
Night Splints / Walking Boot
Activity Modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

________ __________ is a benign tumor or thickening of the plantar interdigital nerve typically in the 3rd webspace.

Sx include……

Burning sensation in the toes
Paresthesias
Pain in the webspace

A

Morton’s Neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How is a Morton’s Neuroma diagnosed?

A

MRI

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How is a Morton’s Neuroma managed?

A
  1. Shoe Modifications
  2. Metatarsal Pads
  3. Steroid Injections
  4. Surgical Removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Hallux Valgus is also referred to as a _______

A

Bunion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Stress fractures are often the result of what?

A

Overuse Injury

Ex:
Runner’s
Military Recruits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Are most stress fractures managed conservatively or with surgery?

A

Conservatively

Splint
Cast
Hard soled shoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Can patients with stress fractures of the foot be weight bearing?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which metatarsal is most commonly fractured?

A

5th Metatarsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A 61 y.o. women presents to the ED with complaints of left foot pain. She was walking down the street when she missed the curbed an “rolled her left ankle”. She was able to bear weight following the accident, but it was painful. She tried resting at home, but there continued to be significant pain and swelling. She denied any other injuries from the accident, and she never completely fell to the ground. On examination, the lateral aspect of her left foot with significantly swollen and there is tenderness over the 5th metatarsal.

What is a likely diagnosis, and what imaging modality would confirm this?

A

Fracture of the 5th Metatarsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

A 61 y.o. women presents to the ED with complaints of left foot pain. She was walking down the street when she missed the curbed an “rolled her left ankle”. She was able to bear weight following the accident, but it was painful. She tried resting at home, but there continued to be significant pain and swelling. She denied any other injuries from the accident, and she never completely fell to the ground. On examination, the lateral aspect of her left foot with significantly swollen and there is tenderness over the 5th metatarsal. You wisely order an XR which shows a non-displaced fracture of the 5th metatarsal.

How would you manage this patient?

A

Non-operatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Would a patient with a calcaneous fracture likely be able to bear weight?

A

No, it is unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Do calceneal fractures require surgical management?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What part of the body does gout typically present in?

A

The Foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Is gout more common in men or women?

A

Men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

On physical examination of a patient with gout…..

Which MTP joint in the foot is likely to be tender?

A

1st MTP Joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which NSAID is used in gout treatment?

A

Indomethacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

_________ ________ is described as a lack of blood supply which results in bone death.

A

Avascular Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Avascular necrosis can be a concerning complication of femoral neck fractures and hip dislocation due to injury of what artery?

A

Medial Femoral Circumflex artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are risk factors for avascular necrosis?

A 
Smoking
Steroids
Alcohol
HIV
Sickle Cell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe the pain pattern in avascular necrosis?

A

Insidious Onset
Anterior Hip
Worse with Flexion
Often Bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

In the moderate phase of avascular necrosis of the hip, patients will often notice decrease ROM in the hip. Which movement is often limited?

A. Internal Rotation
B. External Rotation
C. Flexion
D. Extension

A

A. Internal Rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What ‘sign’ on XR is consistent with avascular necrosis of the hip?

A

Crescent Sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the preferred imaging modality when evaluating a patient for avascular necrosis?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Is total hip arthroplasty a commonly used in management of avascular necrosis of the hip?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Discomfort on log rolling of the leg (particularly with internal rotation) in a 35 year female runner would must likely be indicative of a ______tear.

A

Labral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the most diagnositc imaging modality in a labral tear of the hip?

A

MRI Arthrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How is a labral tear treated non-operatively?

Operatively?

A

Non-Op:

NSAIDs +/- Injections
PT

Operatively:

Arthroscopic Debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the THREE types of Femoral Acetabular Impingement lesions?

Describe each….

A
  1. CAM (Flattening/Widening of the femoral neck)
  2. PINCER (Osteophyte on the superior acetabulum)
  3. MIXED (Combination of both)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Is femoral acetabular impingement more common in females or males?

A

Males

58
Q

T/F: Femoral Acetabular impingement is typically managed surgically?

A

True

59
Q

A patient with a femoral neck stress fracture should be NWB for how long?

A

4 weeks

60
Q

All hip fractures are surgical except for which type?

A

Femoral Neck Stress Fractures

61
Q

Femoral neck stress fractures are most commonly seen in what patient population?

A

Teenage female runners

62
Q

What is the classic TRIAD for femoral neck stress fractures?

A

Amenorrhea
Eating Disorder
Osteoporosis

63
Q

What is the most diagnostic imaging study for femoral neck stress fracture evaluation?

A

MRI (Repeat in 3 months after treatment)

64
Q

There are TWO types of femoral neck stress fractures….

What are they and which one is surgical?

A
  1. Tension (Surgical)

2. Compression (NWB)

65
Q

T/F: Femoral neck fractures are often pathological

A

True

Osteoporosis patient bends over and breaks their hip, resulting in a fall

66
Q

What restrictions are put in place following a femoral neck fracture with repair to prevent dislocation?

A

+/- Abduction Pillow

Limit Flexion, Adduction, and IR

67
Q

T/F: Hip fractures in the elderly have a mortality rate of 5% in the next 2 years

A

False

The mortality rate is about 95%!

68
Q

What percent of inter and subtrochanteric fractures require surgical fixation?

A

100%

69
Q

What physical examination finding is consistent with an inter or subtrochanteric fracture?

A

Shortened and externally rotated leg

70
Q

Subtrochanteric fractures are always considered pathological…..

What are some examples of these pathologies?

A
  1. Osteoporosis
  2. Carcinoma
  3. Fosamax
71
Q

A 85 y.o. female presents to your clinic with complaints of left hip pain. She has had lateral hip pain over the last few months that she described as a dull ache. Her daughter noted that the patient used to be fairly active but now she can’t even get up from a chair without using her hands or assistance. She denied any trauma or injury prior to the onset of pain. She has had no previous injuries to her hips in her lifetime. She denied any history of osteoporosis or arthritis. On examination, she is point tender of the greater trochanter with mild swelling present but no erythema or warmth. When asked to stand she bears most her weight on the right hip (+ Trendelenburg). You order an XR which does not show any fractures or arthritic changes.

What is your suspected diagnosis?

A

Greater Trochanteric Bursitis

(Clinical Pearls:

Elderly Females 
Acute vs Chronic 
Lateral Hip Pain
Can no get up from a chair without assistance 
\+ Trendelenburg on exmination
r/o fracture & infection)
72
Q

A 85 y.o. female presents to your clinic with complaints of left hip pain. She has had lateral hip pain over the last few months that she described as a dull ache. Her daughter noted that the patient used to be fairly active but now she can’t even get up from a chair without using her hands or assistance. She denied any trauma or injury prior to the onset of pain. She has had no previous injuries to her hips in her lifetime. She denied any history of osteoporosis or arthritis. On examination, she is point tender of the greater trochanter with mild swelling present but no erythema or warmth. When asked to stand she bears most her weight on the right hip (+ Trendelenburg). You order an XR which does not show any fractures or arthritic changes.You suspect greater trochanteric bursitis.

What management options could you recommend for this patient?

Could you perform a joint aspiration on this patient?

A

Steroid Injections
NSAIDs
PT

No, do not aspirate this in the office or clinic

73
Q

This syndrome is commonly seen in patients who are s/p ACL repair, runners, and is more common in females than in males

A

Iliotibial band syndrome

74
Q

What physical examination test is consistent with IT band syndrome?

A

+ FABER’s

75
Q

How is IT band syndrome managed?

A
  1. NSAIDs
  2. PT
  3. Foam Roll
76
Q

In osteoarthritis of the hip, which ROM test would be most diminished to due lack of joint space?

A

Internal Rotation

77
Q

What is the gold standard imaging modality for diagnosing osteoarthritis?

What would you seen on this?

A

X-Ray

  1. Decreased Joint Space
  2. Osteophytes
  3. Subchondral Cysts
  4. Acetabular Sclerosing
78
Q

What medication administered during pre-op of hip replacements significantly cuts down on bleeding?

A

Transexamic Acid (TXA)

79
Q

This pediatric disease of the hip is described as an idiopathic transient lack of blood supply to the hip

A

Legg Calve Oerthes

80
Q

T/F: ADHD is seen in about 1.3rd of patients with Legg Calve Perthes

A

True

81
Q

Is Legg Calve Perthes an emergency?

How is it managed?

A

No

Supportive
Serial XRs

82
Q

A 10 y.o. obese african american male presents to your clinic with complaints of right knee and thigh pain. He has noticed this over the last few days increasing in pain. He denied any injuries or trauma prior to the onset, and his mother noted his is fairly sedentary. He denied any fevers or history of juvenile arthritis. On examination, he has painful and limited ROM of the right hip, no swelling, and no ligamentous laxity.

Given the history what is his most prominent risk factor for a Slip Capital Femoral Epiphyseal Fracture?

A

Obesity

83
Q

A 10 y.o. obese african american male presents to your clinic with complaints of right knee and thigh pain. He has noticed this over the last few days increasing in pain. He denied any injuries or trauma prior to the onset, and his mother noted his is fairly sedentary. He denied any fevers or history of juvenile arthritis. On examination, he has painful and limited ROM of the right hip, no swelling, and no ligamentous laxity. You are most concerned for a SCFE, so you get an XR.

What TWO views must you obtain?

What ‘line’ is measured on the XR to determine management?

A

AP
Frog Lateral

Klein’s Line (Line from femoral neck to ASIS, which NEEDS to pass through femoral head)

84
Q

How is SCFE managed?

A

NWB
Wheelchair
Percutaneous pinning until growth plates close

85
Q

What is the most common orthopedic disorder of newborns?

A

Developmental Dysplasia

86
Q

What is the first line and most beneficial treatment of developmental dyplasia?

A

Pavlik Harness

87
Q

T/F: Hip synovitis is a diagnosis of exclusion

A

True

88
Q

What imaging modality is needed in the work up of hip synovitis?

A

MRI

89
Q

What procedure should be done to diagnosis hip synovitis or an infected joint?

A

Aspiration

90
Q

How is hip synovitis treated?

A

ABx

91
Q

Which bursae of the knee is typically effected in housemaid’s knee?

A

Prepatellar

92
Q

T/F: Prepatella bursitis is an effusion

A

False it is NOT an effusion

93
Q

Should you aspirate prepatellar bursitis?

A

NOOOOOOO

94
Q

How is prepatellar bursitis typically managed?

A

NSAIDs
Ice
Rest

95
Q

Which ligament of the knee is commonly injury or torn in a patella dislocation?

A

Medial Patella Femoral Ligament

96
Q

Are patella dislocations more common laterally or medially?

A

Lateral (95%)

97
Q

Which physical examination test will be positive in patients with patella dislocations and medial patella femoral ligament injuries?

A

Apprehension Test

Push patella laterally andin a positive test it’ll incite pain

98
Q

Avulsion fractures of the patella on XR following dislocations is consistent with an injury to what ligament?

How is this injury definitively diagnosed?

A

Medial Patella Femoral Ligament

MRI

99
Q

How is a patella dislocation managed?

A

Closed Reduction
Brace
PT for strengthening

100
Q

When would surgery be indicated in a patient with a patella dislocation?

A

Recurrent Dislocations
Osteochondritis Dissecans (OCD)
Present

101
Q

A 60 y.o. male presents to the ED with complaints of knee pain. He was walking his dog 45 minutes ago when he tripped over the leash and fell to his knee. He believes his right knee took the brunt of the impact. He felt immediate pain to the anterior knee and was unable to flex his leg to walk. He denied hitting his head or any additional injuries from the fall. On examination, there is an obvious effusion present to the right knee, and his patella is diffusely tender. He is unable to preform active of passive flexion. He has a positive SLR to only 10 degrees.

What is your suspected diagnosis and what imaging modality is most diagnostic?

A

Patella Fracture

XR

102
Q

A 60 y.o. male presents to the ED with complaints of knee pain. He was walking his dog 45 minutes ago when he tripped over the leash and fell to his knee. He believes his right knee took the brunt of the impact. He felt immediate pain to the anterior knee and was unable to flex his leg to walk. He denied hitting his head or any additional injuries from the fall. On examination, there is an obvious effusion present to the rightt knee, and his patella is diffusely tender. He is unable to preform active of passive flexion. He has a positive SLR to only 10 degrees. XR confirms your suspected diagnosis of patella fracture without significant displacement or presence of OCD.

What is your recommended course of management?

A

Knee Immobilizer
Weight Bearing as tolerated
Referral to ED

103
Q

What surgical procedure can be done to repair a patella fracture?

A

ORIF

Tension band wiring

104
Q

A 51 y.o. obese male presents to the office with complaints of right knee pain. He noted that about an hour ago, he was walking down the stairs when he missed the last step. He felt his ‘thigh muscles’ get tight and then heard what he though to be a pop. He was is significant pain following this incident and was unable to ambulate due to the pain. He denied any additional injuries from the fall, and he did not strike his head. On examination, you note a major effusion over the right knee, he is unable to preform passive flexion of the knee, and there is a positive SLR to 10 degrees. Interestingly, you also feel a palpable deformity in the suprapatellar region.

Being a smart PA, you suspect a tendon rupture….which do you think is involved in the above case?

A

Qudriceps Tendon

105
Q

Which tendon of the knee would be ruptured if an XR showed a Patella Alta?

Patella Baja?

A

Alta: Patella Tendon tear

Baja: Quadriceps Tendon Tear

106
Q

How are quadricep or patella tendon ruptures managed?

A

Surgical Repair
PT
WBAT with Brace

107
Q

_________ ______ syndrome is described as a thickening of synovial fluid along the knee which rubs against the condyle causing pain.

This is common in teenage runners

A

Synovial Plica Syndrome

108
Q

T/F: Synovial Plica Syndrome is a diagnosis of exclusion

A

True

Remember this is a working diagnosis, and is common in patients who continue to fail conservative management

109
Q

What is the most common orthopedic procedure preformed?

A

Arthroscopic Menisectomy

110
Q

A 17 y.o. female presents to your office for evaluation of right knee pain. She was playing soccer when she tried to stop while sprinting and twisted her knee awkwardly. She believed she may have heard a strange popping noise at that time. Since then, she has felt like her knee has been “locking up” and it is difficult to flex and bear weight at times. On examination there is medial joint line tenderness and a mild effusion.

Which physical examination finding would be consistent with a meniscus tear?

A

+ McMurrays

111
Q

A 17 y.o. female presents to your office for evaluation of right knee pain. She was playing soccer when she tried to stop while sprinting and twisted her knee awkwardly. She believed she may have heard a strange popping noise at that time. Since then, she has felt like her knee has been “locking up” and it is difficult to flex and bear weight at times. On examination there is medial joint line tenderness and a mild effusion. There is a positive McMurrays without any other evidence of ligamentous laxity. Her exam is otherwise unremarkable.

What is the most diagnostic imaging modality in this case?

A

MRI

112
Q

A 17 y.o. female presents to your office for evaluation of right knee pain. She was playing soccer when she tried to stop while sprinting and twisted her knee awkwardly. She believed she may have heard a strange popping noise at that time. Since then, she has felt like her knee has been “locking up” and it is difficult to flex and bear weight at times. On examination there is medial joint line tenderness and a mild effusion. There is a positive McMurrays without any other evidence of ligamentous laxity. Her exam is otherwise unremarkable. MRI confirms a meniscal tear.

How would you recommend treating this injury?

A

Surgical Repair (Arthroscopic Menisectomy)

113
Q

What is the terrible triad (O’Donoghue’s) for ligamentous injuries in the knee?

A

ACL
MCL
Medial Mensicus

114
Q

Which physical examination finding would be the most sensitive and specific for an injury to the ACL?

Other than the above, what are TWO additional physical examination findings that would be concerning for an ACL injury?

A

Lachman’s

Anterior Drawer
Pivot Shift

115
Q

What is the study of choice for evaluating a suspected ACL injury?

A

MRI

116
Q

How is an ACL injury managed?

A

Surgical repair most commonly with a graft

117
Q

Hearing a ‘pop’ in the knee after a valgus stress would arise concern for injury to what ligament?

A

MCL

118
Q

Are MCL injuries typically managed surgically?

A

No

Usually conservatively….
Brace
PT (Quad Strengthening)

119
Q

Varus stress on the knee would be concerning for injury to what ligament?

A

LCL

120
Q

In LCL and PLC (Postior Lateral Corner) injuries, it is important to assess the function of what nerve?

What condition by be present if this nerve is damaged?

A

Peroneal (Fibular) Nerve

Foot Drop

121
Q

Which ligament of the knee is commonly injured through a “dashboard” mechanism of injury?

A

PCL

122
Q

What TWO physical examination findings would be concerning for a PCL injury?

A

Sag Sign

Posterior Drawer

123
Q

If you suspect a possible tibial plateau fracture is a CT or MRI more diagnostic?

A

CT (With thin 1 mm cuts)

124
Q

Would you expect a patient with a tibial plateau fracture to bear able to bear weight?

A

No!

The examine is often difficult

125
Q

Are lateral or medial tibial plateau fractures more common?

A

Lateral

126
Q

How are tibial plateau fractures managed?

A

These are most commonly surgically repaired (ORIF or EX-FIX)

127
Q

What is the most common complication of tibial plateau fracture repair?

A

Compartment Syndrome

128
Q

What is the ‘gold standard’ imaging modality for working up osteoarthritis of the knee?

A

XR

129
Q

A knee XR shows sclerosing of the joint surface…..

This should arise suspicion for what arthritic condition?

A

Rheumatoid Arthritis

130
Q

How is osteoarthritis of the knee managed non-operatively?

Operatively?

A

Non-Op:

NSAIDs
PT

Operatively:

Partial vs Total Knee Arthroplasty

131
Q

In order to undergo a knee arthroplasty, patients must have a BMI under what?

A

40

132
Q

A ______ _____ is described as a painful fluid collection in the posterior knee due to intra-articular anatomy defects leading to a build up of synovial fluid.

A

Baker’s Cyst

133
Q

What imaging modality is useful in evaluating for a Baker’s Cyst and why?

A

US

Because these can present similar to DVTs

134
Q

How are Baker’s Cysts commonly treated?

A

Warm Compress
NSAIDs
Cortisone Injection

Possible aspiration

135
Q

A teenage runner with worsening pain over the tibial tuberosity which is tender to palpation would be consistent with what disease of the knee?

A

Osgood Schlatters

136
Q

Why should you always obtain an XR when working up Osgood Schlatters?

A

To rule out occult fractures

137
Q

How is Osgood Schlatter’s managed?

A

Cho-Pat Strap
Rest

+/- NSAIDs

138
Q

How would an unstable osteochondral lesion be treated?

A

Surgical Fixation

139
Q

60 year old white male presents with spontaneous onset of knee pain and swelling x 2 days, pain is rated 8/10. He states he went to bed after a barbecue and had 3 beers. He woke up the next morning and felt his knee was stiff and difficult to bend. He denies any injuries or systemic complaints. He has tried advil, and tylenol with no improvement in symptoms. X-rays are WNL. PE reveals afebrile, mild erythema about the knee, 2+ effusion with limited ROM with painful passive flexion.

The most appropriate next treatment would be?

A. MRI (No traumatic injury)
B. CBC with diff ESR, CRP (Unlikely to be an infection)
C. Aspiration
D. Contact surgeon for immediate I&D

A

C. Aspiration

140
Q

18 year old female presents to the clinic 1 day after suffering an acute soccer injury. She was running planted her foot and fell to the ground. She was unable to continue playing. She locates the pain along the medial aspect of the knee, rates the pain a 9/10, and is unable to bear weight. PE reveals skin intact, a large effusion, she’s able to perform a SLR, and has limited ROM 0-90. She has discomfort to palpation along the medial aspect of the knee, pain reproduced with apprehensions test, lachmans is negative, no varus/valgus instability, mcmurrays reproduces pain. X-rays reveal small medial ossification seen on the sunrise view.

You want to order an MRI scan and tell your attending physician you believe her diagnosis is?

A. ACL tear
B. Medial meniscus tear
C. MCL tear
D. Patella dislocation

A

D. Patella dislocation

141
Q

19 year old female presents to the clinic 1 day after suffering an acute soccer injury. She was running planted her foot and fell to the ground. She was unable to continue playing. She locates the pain along the medial aspect of the knee, rates the pain a 9/10, and is unable to bear weight. PE reveals skin intact, a large effusion, she’s able to perform a SLR, and has limited ROM 0-90. She has discomfort to palpation along the medial aspect of the knee, apprehensions test is negative, lachmans is positive, pain with valgus stress test, mcmurrays reproduces pain. X-rays reveal are WNL,

You want to order an MRI scan and tell your attending physician you believe her most concerning injury is for?

A. ACL tear
B. Medial meniscus tear
C. MCL tear
D. Patella dislocation

A

A. ACL tear

Clinical Med - Musculoskeletal (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions