Lower Extremity

Question 1

What is avascular necrosis of hip called in kids?

Answer 1

Legg-Calve Perthes Dz

Question 2

Tx of avascular necrosis

Answer 2

Conservative, may eventually need hip replacement

Question 3

Labral tear of hip, occurs in what pop?

Answer 3

Men 30-40 due to wear and tear

Question 4

Sx of labral tear of hip

Answer 4

Groin pain

“Locks”, limits exercise

Question 5

Femoroacetabular Impingement

Answer 5

Early osteoarthritis w/ labral tear

Question 6

Types of Femoroacetabular Impingement (3)

Answer 6

CAM–young active males, flattening/widening of femoral neck
Pincer–females, osteophyte formation on superior acetabulum
Blended–some flattening w/ osteophytes

Question 7

Hip dislocation–what does leg look like? (position)

Answer 7

Shortened, adducted, internally rotated

Question 8

Is posterior or anterior hip dislocation more common?

Answer 8

Posterior

Question 9

Femoral neck fx–what does leg look like? (position)

Answer 9

Shortened, abducted, externally rotated

Question 10

Femoral neck fx has high risk of what?

Answer 10

AVN

Question 11

Triad of RF for femoral neck fx

Answer 11

Amenorrhea, eating disorder, osteoporosis (teen female runner)

Question 12

Types of femoral neck fx (2) and tx

Answer 12

Tension: fx along superior lateral neck
- Surg
Compression: fx along inferior medial neck
- Non-op, NWB

Question 13

Intertrochanteric and subtrochanteric fx–what does leg look like? (position)

Answer 13

Shortened, externally rotated

Question 14

Intertrochanteric and subtrochanteric tx

Answer 14

100% are surgical (ORIF)

Question 15

All subtrochanteric fx are considered ______ until proven otherwise

Answer 15

Pathologic

Question 16

Greater trochanteric bursitis is inflam bt _____ and _____

Answer 16

Inflam bt gluteus medius and IT band

Question 17

What type of gait do kids w/ Legg-Calve Perthes have?

Answer 17

Trendelenburg gait, painless limp

Question 18

1 RF of slipped capital femoral epiphysis

Answer 18

Obese

Question 19

Sx of slipped capital femoral epiphysis

Answer 19

Painful limp, knee/thigh pain

Question 20

What pop typically gets slipped capital femoral epiphysis?

Answer 20

10-14 y/o during growth spurts or jumping activities

Question 21

Tx for slipped capital femoral epiphysis

Answer 21

ORIF, NWB (wheelchair)

Question 22

1 complication of slipped capital femoral epiphysis

Answer 22

Osteonecrosis

Question 23

Most common orthopedic disorder of newborns

Answer 23

Developmental dysplasia of hip

Question 24

Developmental dysplasia of hip: Barlows vs. Ortolani

Answer 24

• Barlows: hip flexion and adduction

- Ortolani: hip elevation and abduction

Question 25

Diagnosing developmental dysplasia of hip

Answer 25

Initially: US | At 4-6 months: xray

Question 26

Developmental dysplasia can lead to...

Answer 26

Premature osteoarthritis

Question 27

Xray views of knee to order

Answer 27

Standing AP Standing lateral Sunrise view

Question 28

Is knee dislocation an emergency?

Answer 28

YES--early reduction is essential

Question 29

What must you check on pt w/ knee dislocation?

Answer 29

Distal pulses and peroneal nerve fxn

Question 30

Osgood-Schlatter Dz

Answer 30

Pronounced tibial tubercle

Question 31

Pop that presents w/ Osgood-Schlatter Dz

Answer 31

Kids w/ rapid growth spurt and running sports (or obese kids)

Question 32

Patella alta vs. Patella baja

Answer 32

Alta=above (patellar tendon tear) | Baja=below (quad tendon tear)

Question 33

How to tx patellar fx

Answer 33

Knee immobilizer for 6-8 wks UNLESS displaced fx (ORIF)

Question 34

Common mechanism for meniscal injuries

Answer 34

Plant and twist

Question 35

Tests for meniscal tears

Answer 35

McMurray's and Apley

Question 36

Common mechanism for ACL tear

Answer 36

Quickly stop moving and change direction while running, HEAR POP

Question 37

Tests for ACL tear

Answer 37

Lachman's and Anterior drawer

Question 38

Is an MCL tear is caused by valgus or varus stress?

Answer 38

Valgus

Question 39

Is a LCL tear is caused by valgus or varus stress?

Answer 39

Varus

Question 40

Common mechanism for PCL tear

Answer 40

"Dashboard" injury--blow to knee while it is bent

Question 41

Tests for PCL tear

Answer 41

[+] Posterior drawer | [+] sag sign--tibia sags posteriorly

Question 42

Tx for MCL, LCL, and PCL tears

Answer 42

Brace

Question 43

Gold standard for diagnosing knee osteoarthritis

Answer 43

Xray

Question 44

Xray views of ankle to order

Answer 44

AP Lateral Mortise view

Question 45

Ottawa ankle rules: order xray if either of the following are true...

Answer 45

- Navicular or malleolar pain | - Unable to take 4 steps

Question 46

Most common metatarsal fx

Answer 46

5th Metatarsal (Jones) fx

Question 47

Why would you be concerned about a 5th metatarsal diaphysis fx?

Answer 47

Poor blood supply

Question 48

Most commonly injured tarsal bone

Answer 48

Calcaneus

Question 49

Ankle arthritis is often a result of...

Answer 49

Past trauma (primary is rare)

Question 50

Is ankle arthritis usually bilateral or unilateral?

Answer 50

Unilateral

Question 51

Which ligament is most commonly injured in ankle sprain?

Answer 51

Anterior talofibular ligament (ATFL)--main stabilizer during inversion

Question 52

Syndesmosis sprain AKA...

Answer 52

High ankle sprain

Question 53

3 Grades of Ligament Injuries

Answer 53

1: stretching w/ microscopic damage 2: partial disruption 3: complete disruption

Question 54

Test for ankle sprain

Answer 54

Ankle drawer test: [+] = anterior translation of foot

Question 55

Cause of achilles tendinitis

Answer 55

Overuse

Question 56

What tx to avoid in achilles tendinitis?

Answer 56

Steroid injection --> tendon rupture

Question 57

Which class of meds put pt at risk for achilles tendon rupture?

Answer 57

Fluoroquinolones

Question 58

What test is used for achilles tendon rupture?

Answer 58

Thompson's test: weak/absent plantar flexion when gastrocnemius is squeezed

Question 59

Most common cause of inferior heel pain

Answer 59

Plantar fasciitis

Question 60

When does someone w/ plantar fasciitis experience pain the most?

Answer 60

- 1st thing in morning - Initiation of walking after resting - Running/high impact

Question 61

Hallmark of Morton's neuroma (tumor of plantar interdigital nerve)

Answer 61

Pain and tenderness in involved webspace

Question 62

Hallux Valgus AKA...

Answer 62

Bunion

Question 63

Hallux Valgus can be caused by...

Answer 63

- Constrictive footwear - Genes - Foot malalignment

Question 64

Most common cause of onychomycosis

Answer 64

- Dermatophyte (fungus)