MSK

Question 1

Indications for lower extremity amputation

Answer 1

1. Critical limb ischemia without ability to perform revascularization
2. Unsalvageable lower extremity soft tissue
3. Life-threatening infection

Question 2

What can neck manipulation (i.e. extension + torsion) inadvertently cause?

Answer 2

Vertebral artery dissection –> posterior circulation stroke –> lateral medullary (Wallenberg) syndrome)

1. Pain/temperature loss in ipsilateral face (spinal trigeminal) and contralateral trunk/limbs (spinothalamic)
2. Ataxia (inferior cerebellar peduncle) and nystagmus (vestibular nucleus)
3. Dysphagia, dysphonia - due to bulbar muscle weakness (nucleus ambiguus)
4. Ipsilateral Horner syndrome (sympathetic tract)

Question 3

Most reliable exam maneuver for checking complete Achilles tendon rupture

Answer 3

Calf squeeze test/Thompson test - patient is prone with feet off table, squeeze calf to shorten gastrocnemius - expect passive plantarflexion if normal

Also, impaired ability to walk on tips of toes

Question 4

Heel walking test

Answer 4

Sensitive for impaired dorsiflexion (e.g. footdrop)

Question 5

Traumatic hyphema

Answer 5

Can lead to intraocular hypertension

Treat with:
Eye shield, bed rest (head elevation)
Glucocorticoid eye drops to prevent rebleeding
Monitor intraocular pressure

Question 6

Traumatic cataract

Answer 6

Can develop after open globe injury
Eccentric or teardrop-shaped pupil

Question 7

What can lead to corneal neovascularization?

Answer 7

Keratitis/corneal infection, other causes of corneal ischemia

Question 8

Fat embolism syndrome - triad

Answer 8

1. Respiratory distress
2. Neurologic dysfunction
3. Rash

Question 9

Severe complications of heat stroke

Answer 9

Rhabdomyolysis
DIC
Pulmonary edema
End-organ damage (hepatic, renal)

Question 10

Purpose of pelvic binders

Answer 10

Minimize bleeding in preparation for surgery for unstable pelvic fracture