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MSK clin Med > Lower extremity disorders > Flashcards

Lower extremity disorders Flashcards

1
Q

What is Avascular Necrosis (AVN)

A

Bone infarction, aseptic necrosis, osteonecrosis

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2
Q

What gender is effect by AVN most

A

Male

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3
Q

Which bones are primarily effected by AVN

A

Hip (Femoral head)
Knee (Condyles)
Shoulders (Humeral head)

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4
Q

What causes AVN

A

Interruption of blood supply
-trauma
-idiopathic

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5
Q

What causes AVN of the jaw

A

bisphosphonate use

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6
Q

What are the risk factors for AVN

A

Alcohol/AIDS
Sickle cell/SLE
Exogenous steroids
Pancreatitis
Trauma
Infection
Caisson disease

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7
Q

What is Caisson disease

A

Decompression sickness

An acute neuralogical emergency from a release of a nitrogen gas bubble that impinges the vessels and spinal cord

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8
Q

How does true hip pain manifest

A

groin pain

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9
Q

What are some symptoms of AVN

A

Insidious onset of joint pain
Six similar to OA

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10
Q

How do you diagnose AVN

A

Imaging
-> MRI is most sensitive

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11
Q

How do you treat AVN when there is no bone collapse

A

Osteoporosis drugs (Bisphosphonates)
Surgery to induce revascularization

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12
Q

How would you treat AVN when there is bone collapse or if the patient is older

A

Arthroplasty

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13
Q

What does SCFE stand for

A

Slipped Capital Femoral Epiphysis

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14
Q

What is a SCFE

A

Slippage of the epiphysis off the metaphysis

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15
Q

What is the most common adolescent hip disorder

A

SCFE

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16
Q

Which hip are SCFE most often seen in

A

Left

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17
Q

What is the most common presentation of a SCFE

A

Hip pain (groin and thigh)
Limp or external rotation of leg
primary knee pain
Reduced ROM on exam

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18
Q

What is the test of choice to diagnose SCFE

A

Xray

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19
Q

How are SCFE treated

A

Percutaneous fixation (pinning)
ORIF if severe

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20
Q

What is the most common orthopedic disorder in newborns

A

Developmental hip Dysplasia

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21
Q

Which gender is more effected by developmental hip dysplasia and which side is more effected

A

Females
Left (in utero positioning)

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22
Q

How does ethnicity contribute to developmental hip dysplasia

A

Because of how they swaddle

Native Americans do cradle boarding

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23
Q

What causes developmental hip dysplasia

A

Predisposed hip laxity
Intra-uterine or post natal malpositioning

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24
Q

Which newborns are at higher risk for having developmental hip dysplasia

A

First born
Breech
+ family history
Macrosomia
Oligohydramnios

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25
Q

If a newborn presents with developmental hip dysplasia, what else are you going to look for

A

Metatarsus adductus
Torticollis

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26
Q

A mother brings her newborn in who you suspect has developmental hip dysplasia, what are you going to do to test them?

A

Barlow and ortolani maneuvers

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27
Q

What does the Barlow test for

A

It will dislocate a dislocatable hip (Click on exit)

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28
Q

What does the ortolani test for

A

Reduces a dislocated hip (Clunk on entry)

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29
Q

What type of imaging would be done for developmental hip dysplasia on a baby 0-4 months

A

US

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30
Q

After 4 months of age, why do you switch to xray for developmental hip dysplasia

A

Ossification of the femoral head begins

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31
Q

What is the first line treatment for newborns <4months with a +ortolani

A

Pavlik harness
*keeps femoral head in acetabulum

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32
Q

How would a baby who has a failed pavlik harness or is 6-8 months of age be treated for developmental hip dysplasia

A

Spica cast

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33
Q

What is trochanteric bursitis

A

Inflammation of trochanteric bursa

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34
Q

Where is the great trochanteric bursa located

A

Between the greater troch and the IT band

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35
Q

A patient comes in with hip pain and point tenderness over their greater trochanter, what is their likely diagnosis

A

Trochanteric bursitis

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36
Q

What is the treatment for trochanteric bursitis

A

Rest / Ice
NSAIDs
PT
Intra-bursal corticosteroid
Bursectomy is last resort

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37
Q

What would be a likely cause for a native joint hip dislocation

A

High energy trauma
-MVC

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38
Q

What is the normal presentation of a hip dislocation

A

Acute pain
Deformity
inability to bear weight
Shortening and internal rotation of foot

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39
Q

What is the study of choice to diagnose a hip dislocation

A

Xray

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40
Q

What are the risk factors for a femoral neck fracture

A

Old age
Osteoporosis
Hx of falls
Smokers
Prior trauma

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41
Q

What are the complications associated with hip fractures

A

High readmission rate
High mortality rate
High revision / conversion rate
Risk of functional impairment
Risk for osteonecrosis
Risk for non-union

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42
Q

How much blood can be stored in the thigh

A

About 1 liter

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43
Q

Why can patients become hemodynamically unstable with a femur fx

A

Due to the amount of blood in the thigh and great vessels

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44
Q

How are most femur fractures treated

A

Surgically with an intramedullary nail

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45
Q

What is the usual cause of IT band syndrome

A

Overuse -> causes friction between IT band and lateral condyle

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46
Q

What type of athletes typically get IT band syndrome

A

Runners
Cyclists
(repetitive knee flexion/extension)

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47
Q

What anatomically can cause IT band syndrome

A

Knees with varus alignment (bow legs)

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48
Q

A patient comes in who is training for a marathon and complain of lateral knee pain that gets worse with activity, what is their likely diagnosis

A

IT band syndrome

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49
Q

You diagnose a patient with IT band syndrome, how do you treat them

A

Rest/ice
NSAIDs
PT

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50
Q

When is surgery done for IT band syndrome

A

refractory cases

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51
Q

What is osgood schlatters disease

A

Apophysitis of the tibial tubercle

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52
Q

What type of patients are most susceptible to having osgood schlatters disease

A

Males and athletes (jumpers, runners)

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53
Q

A patient come is complaining of anterior knee pain, enlargement of tibial tubercle with point tenderness over the tibial tubercle with pain on extension with resistance… What is their probably diagnosis

A

Osgood Schlatters

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54
Q

What is the #1 indication for knee arthroscopy

A

Meniscal tears

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55
Q

What type of meniscal tear is most common

A

Medial

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56
Q

What is the presentation of a meniscal tear

A

Pain along the respective joint line, clicking and locking, +/- joint effusion

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57
Q

Where is the effusion seen with meniscal tears

A

Intraarticular

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58
Q

What tests can you do to check for meniscal tears

A

Apley’s
McMurray’s

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59
Q

What is the imaging modality of choice for meniscal tears

A

MRI

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60
Q

How do you treat a degenerative meniscal tear

A

rest
ice
NSAIDs
PT

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61
Q

When is surgery done with meniscal tears

A

Younger patients
traumatic injury
partial meniscectomy vs repair (location of tear important)

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62
Q

What makes up 50% of all knee injuries

A

ACL tears

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63
Q

Which gender is more likely to suffer from an ACL tear

A

Females

64
Q

Which gender is more likely to suffer from an ACL tear

A

Females

65
Q

What is the MOI for an ACL tear

A

Sudden stopping and pivoting
Direct lateral blow to knee

66
Q

A patient comes in with complaints of acute knee pain, difficulty bearing weight, complaining of knee instability and claims they heard a “pop” while playing volleyball. What is their most likely diagnosis?

A

ACL tear

67
Q

What are the special tests that can help determine an ACL tear

A

Lachmans
Anterior drawer
*if positive= laxity

68
Q

What is the treatment for most ACL tears?

A

Reconstruction

69
Q

Which ligament in the knee is stronger than the ACL

A

PCL

70
Q

What is a PCL tear often associated with

A

Other knee injuries

71
Q

What is the rarest of all knee ligament injuries

A

PCL

72
Q

What is the MOI for a PCL tear

A

Knee hitting dashboard in MVC
Fall directly on bent knee
Hyperextension

73
Q

A patient presents with posterior knee pain with a feeling of instability. They have a positive posterior drawer test and a positive sag sign. What is their likely diagnosis

A

PCL tear

74
Q

What does a positive posterior drawer test indicate

A

Laxity-> tibia moves away from examiner

75
Q

What is a positive sag sign indicative of

A

Tibia sinks towards patient/table

76
Q

How would you treat an ACL tear that does not have significant deformity

A

Restricted weight bearing +/- immobilization
non-operative

77
Q

How would you treat a PCL tear that is associated with other injuries

A

PCL repair/reconstruction

78
Q

What does the MCL do in the knee

A

Stabilizes valgus stress

79
Q

If a patient comes in with an ACL and meniscus injury, what other injury are you going to look for

A

MCL

80
Q

What is the MOI for an MCL injury

A

Blow to lateral knee with planted foot
-Excessive valgus force

81
Q

A patient comes in with complaints of medial knee pain, feeling unstable, having trouble bearing weight, and recalls a popping sound when tackled in football the day prior. What is their likely diagnosis

A

MCL injury

82
Q

What might you see on an exam for an MCL injury

A

Ecchymosis
Effusion
Medial tenderness
+valgus stress test

83
Q

What is the diagnostic test of choice to diagnose an MCL injury

A

MRI

84
Q

How would you treat a partial tear or stable complete tear of an MCL

A

Rest, Ice, NSAIDS, PT, bracing

85
Q

How would you treat a multilligament knee injury or a severe complete tear of the MCL

A

Surgical repair or reconstruction

86
Q

What does the LCL do in the knee

A

Stabilizes varus movement

87
Q

What is the MOI for an LCL injury

A

Direct blow to the medial knee

88
Q

What is the imaging test of choice for LCL injury diagnosis

A

MRI

89
Q

What will you find on exam for a positive LCL injury

A

Lateral knee pain
Instability with stairs
Joint effusion / ecchymosis
Tenderness on lateral joint line
Laxity with varus stress test

90
Q

What mechanism are the quad and patellar tendon apart of

A

Extensor mechanism

91
Q

What age group is at high risk for a quad tendon rupture

A

> 40

92
Q

What is the MOI for a quad/patellar tendon rupture

A

Forceful quad contraction or fall on flexed knee

93
Q

What is the diagnostic test of choice for a quad or tendon rupture

A

MRI

94
Q

What may be seen in an xray when there is a patellar tendon rupture

A

Patella alta

95
Q

What is the treatment for a quad or patellar tendon rupture

A

urgent surgical repair

96
Q

What is patellar tendonitis known as

A

jumpers knee

97
Q

A patient comes in with complaint of insidious onset knee pain, pain while at high jump practice and had tenderness to palpation just inferior to the patella. What is their likely diagnosis and what test will you order to confirm your suspicion?

A

Patellar tendonitis

MRI

98
Q

What is the MOI for a knee injury

A

high energy traum-> knee hitting dashboard in MVC

99
Q

What is important to do before getting any imaging in knee dislocations

A

Reduction

100
Q

What is important to assess post reduction

A

Neuromuscular status of the leg

101
Q

If there is vascular injury that occurs with a knee dislocation, what imaging should be ordered

A

CT angio

102
Q

Once the knee is reduced, what are you looking for on Xray

A

Avulsion fx
other associated fx
Joint space irregularities

103
Q

Which gender is at higher risk of a patellar dislocation

A

Women

104
Q

Why are women more susceptible to patellar dislocations

A

Q-angle
higher baseline laxity

105
Q

Which direction does the patella most often dislocate

A

Laterally

106
Q

What is the MOI for a patellar dislocation

A

Blow to the lateral knee
Twisting w/ foot planted in external rotation

107
Q

What is the first line imaging for a patellar fx

A

Xray

108
Q

What is the MOI for distal femur fx

A

Axial load with rotational force

109
Q

What is the treatment for a distal femur fx

A

Splint until ORIF

110
Q

When is ORIF used in a patellar fx

A

Severely comminuted
Extensor mechanism defect
Open fx
Displaced fx

111
Q

What is the MOI for a tibial plateau fx

A

Axial load with varus or valgus stress

112
Q

If a patient has a tibial plateau fx, what are they at high risk for

A

Neuromuscular injury
compartment syndrome

113
Q

What are the most common long bone fractures

A

Tibia/fibula

114
Q

If a patient has a tibial shaft fracture, what are you also concerned about

A

Compartment syndrome

115
Q

What is the likely MOI for a transverse, comminuted, or displaced tibial/fibular fx

A

MVC, GSW

116
Q

What is the MOI for an oblique or transverse fx of the tibia/fibula

A

Bending

117
Q

What type of tibial/fibular fx are seen in ballet dancers/military

A

Stress fx

118
Q

What is compartment syndrome

A

Bleeding/swelling in a given compartment -> compression of nerves, vasculature and the fascia does not stress in response to swelling

119
Q

Where are the most common locations for compartment syndrome

A

Lower leg
thigh
forearm
hand
foot
buttocks
shoulder
paraspinals

120
Q

What is the traditional diagnosis for compartment syndrome

A

The 6P’s
*If most are present, damage has already occurred

121
Q

What are the 6Ps

A

Pain
Pallor
Pulselessness
Paresthesia
paralysis
pressure (<30)

122
Q

What is pes planus

A

flat foot

123
Q

What is hallux valgus

A

Bunions
*Progressive deformity of the 1st MTP joint

124
Q

Which gender is more likely to have bunions and why

A

women because of high heels with narrow toes

125
Q

What is the cause of hallux varus

A

Overcorrection of hallux valgus

126
Q

What is Mortons neuroma

A

Compressive neuropathy inter digitally

127
Q

Where is Mortons neuroma most common and in which gender

A

females
3rd interwed space

128
Q

MOI for Mortons neuroma

A

Friction from 3rd/4th MT head
traction from inter metatarsal ligament

129
Q

A patient complains of feeling like there’s a pebble in their shoe whenever they are walking, specifically around the 3rd interweb space. What is their likely diagnosis

A

Mortons neuroma

130
Q

What is the definitive treatment for Mortons neuroma

A

Surgical removal

131
Q

What is plantar fasciitis

A

Inflammation of the plantar fascia

132
Q

When is the pain from plantar fasciitis worse

A

In the AM
Walking barefoot
Walking up stares

133
Q

Where does achilles tendonitis generally occur

A

At the insertion site

134
Q

What is the MOI for achilles tendonitis

A

Repetitive ankle motion (common in runners)

135
Q

What kind of deformity will be seen on xray with achilles tendonitis

A

Haglund deformity

136
Q

What is often associated with achilles tendonitis

A

Retrocalcaneal bursitis

137
Q

What do you want to avoid with treating retrocalcaneal bursitis

A

Intra-bursal corticosteroids because of the risk of tendon rupture

138
Q

What will you see on a physical exam in someone with an achilles tendon rupture

A

positive thompson test

139
Q

What is one of the most common ankle injuries

A

Ankle sprain

140
Q

What is the MOI for an ankle sprain

A

Ankle inversion

141
Q

What is seen with a grade 1 ankle sprain

A

minimal functional loss
No limp
Minimal / no swelling
Mild point tenderness

142
Q

What is seen with a grade 2 ankle sprain

A

Moderate functional loss
limp
localized swelling
moderate point tenderness

143
Q

What is a grade 3 ankle sprain

A

Severe function loss
inability to bear weight
diffuse swelling
diffuse ankle tenderness

144
Q

What are the special tests you can do to test for an ankle sprain

A

Anterior drawer test: tests integrity of talofibular ligament

Talar tilt: tests integrity of calcaneofibular joint

145
Q

What is a syndesmotic injury

A

High ankle sprain

146
Q

What is the MOI for a high ankle sprain

A

Eversion of the ankle

147
Q

What might you see on an xray with a high ankle sprain

A

Widening of the syndesmosis

148
Q

Who are ankle fractures most commonly seen in

A

elderly women

149
Q

What are the three most common ankle fracture patterns

A

Isolated malleolar (66%)
bimalleolar
trimalleolar

150
Q

What is a pilot fx

A

An ankle fx that involves both the distal tibia and fibula

151
Q

What is the most commonly fractured tarsal bone

A

Calcaneous

152
Q

A patient comes in with tenderness to palpation on the calcaneous, widening or shortening of the heel, and ecchymosis about the heel that extends into the arch, what is their likely diagnosis

A

Calcaneal fx

153
Q

What type of splint would you place on a simple calcanea fx

A

Bulky jones

154
Q

What is a jones fx

A

FX of the proximal 5th MT (high rate of non-union)

*Different from psuedojones which is just the tip

155
Q

What is the most common forefoot injury

A

Phalangeal fx
-5th phalanx in particular

156
Q

What is the MOI for phalangeal fx

A

Dropping something on foot or stubbing toe

MSK clin Med (12 decks)

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