Lower Limb Coretext

Question 1

Where does hip pathology typically produce pain?

Answer 1

Groin

buttock

Knee

Question 2

What range of motion is usually reduced first in hip pathology?

Answer 2

Internal Rotation

Question 3

What does a positive trandellenburg test suggest?

Answer 3

Abductor weakness

Question 4

What muscles are tested in the Trendellenburg test?

Answer 4

Gluteus Medius and Gluteus minimus

Abductors of the hip

Question 5

How long do total hip replacements usually last?

Answer 5

15 - 20 years

Question 6

What is Avascular Necrosis?

Answer 6

Poor blod suplly leading to cell death , common in the hip joint

Question 7

How do people with Avascular Necrosis of the hip present ?

Answer 7

Groin pain

Question 8

What happens if Avascuar Necrosis is left unoticed?

Answer 8

Patchy sclerosis of femoral head

Lytic sones resulting in “hanging rope sign” on xray

Femoral head collapse

Question 9

What does sclerosis mean?

Answer 9

Abnormal hardening

Question 10

What are the treatment options for Avascular Necrosis of the hip?

Answer 10

Pre collapse- drill holes can be made in an attempt to releive pressure and promote healing

Post collapse- total hip replacement

Question 11

What is Trochanteric bursitis?

Answer 11

inflamation of the trochanteric bursa

Question 12

What do people with trochanteric bursitis present with?

Answer 12

Pain and tenderness in the region of the greater trochanter with pain on resisted abduction

Question 13

How do you treat Trochanteric Bursitis?

Answer 13

Analgesic

NSAIDs

Physiotherapy

Steroid injections

No surgical treatment has proven benefit

Question 14

What are the four main ligaments in the knee joint?

Answer 14

ACL - anterior crustiate ligament

PCL - posterior crusiate ligament

MCL- Medial collateral ligament

LCL - lateral collateral ligament

Question 15

What is the principle role of the ACL?

Answer 15

To prevent abnormal internal rotation of the tibia

Question 16

What is the main function of the PCL?

Answer 16

Prevents hyperextension and anterior translation of the femur.

Question 17

How do Meniscal Injuries usually occur?

Answer 17

twisting force on a loaded knee

Question 18

Where will people with meniscal injuries feel the pain?

Answer 18

Medial or lateral joint line

Usually medial

Question 19

What are common mechanical symptoms of meniscal tears?

Answer 19

Catching sensation

or

“Locking”

Question 20

What is true knee locking ?

Answer 20

Mechanical block to full extension causes by a torn meniscus flipping over and being stuck in the joint line

Question 21

What will the patient feel if they rupture their ACL?

Answer 21

Immediatly

Rotational force

they will hear a “POP”

Haemarthrosis

Chronically

Rotatory instability

Question 22

What parts of the meniscur are supllied by blood?

Answer 22

Outer 1/3

Question 23

What is more common, medial or lateral meniscal tears?

Answer 23

Medial

Question 24

Which special physical examination test can be preformed to diagnose ACL rupture?

Answer 24

Anterior draw test

and

Lachmans test

Question 25

What is the 1/3 rule for ACL ruptures?

Answer 25

1/3 have no problems 1/3 manage by avoiding certain movements 1/3 will do poorly with frequent giving away

Question 26

What percentage of patients with a torn ACL will end up having reconstruction

Answer 26

4

Question 27

How are acute MCL tears usually treated?

Answer 27

Hinged knee brace

Question 28

How can chronic MCL instability be treated?

Answer 28

MCL tightening or with reconstruction with a tendon graft

Question 29

What is the usual treatment for LCL ruptures?

Answer 29

surgical Early repair or late reconstruction with tendon graft

Question 30

What must you be aware of during reperfusion of a leg?

Answer 30

compartment syndrome

Question 31

what are osteochondral and chondral injuries?

Answer 31

Occour due to impaction or shearing of articular surfaces due to a direct blow

Question 32

What are the characterisitc symptoms of osteochondral and chondral injuries?

Answer 32

Ongoing pain and effusion after a knee injury

Question 33

What investigations would you consider in osteochonfral injuries?

Answer 33

MRI Arthroscopy X ray

Question 34

What structures are invloved in the extensor mechanisim of the knee?

Answer 34

quadriceps muscle quadriceps tendon patella patellar tendon tibial tuberosity

Question 35

How do you treat a extensor mechanism rupture?

Answer 35

Surgical repair

Question 36

what physcial examination is most useful in extensor mechanism ruptures?

Answer 36

Straight leg raise

Question 37

What is Patellofemoral dysfunction?

Answer 37

Disorders of the patellofemoral articulation resulting in anterior knee pain

Question 38

Which way does the patella usually dislocate?

Answer 38

Laterally

Question 39

What are the two surgical options for patients with advanced ankle osteoarthritis?

Answer 39

Arthrodesis Ankle replacement

Question 40

What is hallux valgus also known as ?

Answer 40

Bunion

Question 41

What is a cheilectomy?

Answer 41

Removal of oesteophytes in the foot

Question 42

What is the gold standard surgical treatment for hallux rigidus?

Answer 42

Arthrodesis

Question 43

What is Morton's Neuroma?

Answer 43

Neuroma forming from plantar interdigital nerves

Question 44

What is this?

Answer 44

Morton's neuroma

Question 45

What would a patient with morton's neuroma experiance?

Answer 45

tingiling and burning pain in affected toes

Question 46

What investigation is used to diagnose Mortons neuroma?

Answer 46

ultrasound looking for the swollen nerve

Question 47

What are the management options for morton's neuroma?

Answer 47

Conservative insoles Steroids and anaesthetic Surgical Neurom can be excsied - patients may continue to feel pain

Question 48

What are the most common metatarsals to stress fracture?

Answer 48

2nd metatarsal followed by the 3rd metatarsal

Question 49

What is the treatment for metatarsal stressfractures?

Answer 49

prolonged rest for 6-12 weeks while wearing a rigid solid boot

Question 50

Why should steriod injection around the achillies tendon in achillies tendonitis be avoided?

Answer 50

Risk of tendon rupture

Question 51

what is simmonds test?

Answer 51

Plantar flexsion upon squeezing of the calf muscles

Question 52

What is plantar fasciitis?

Answer 52

Self-limiting repetative strain injury chracterised by pin with walking felt on the instep of the foot.

Question 53

What is pes planus ?

Answer 53

Flat feet

Question 54

Where does the tibialis posterior tendon attatch on to ?

Answer 54

Medial navicular

Question 55

How should Tibialis posterior tendonitis be treated?

Answer 55

a splint with a media arch support to avoid rupture

Question 56

What happens if the tibialis posterior tendon ruptures?

Answer 56

loss of the medial arch of the foot

Question 57

What is Pes cavus?

Answer 57

Abdnormally high arch of the foot