Orthopedics/Rheumatology Flashcards
What neurovascular injury is most commonly associated with knee dislocations?
Popliteal artery an peroneal nerve injuries
What is the most common type of knee dislocation?
Anterior knee dislocation
What physical exam finding is suspicious for a vascular injury in a knee dislocation?
What is the gold standard in diagnosing vascular injury?
Diminished or absent distal pulses
CT angiography
A 25-year-old male presents after a motor vehicle collision with severe knee pain and deformity. Physical exam reveals a visibly dislocated knee and absent dorsalis pedis pulse. What is the most appropriate next step in management?
A. Obtain X-rays before attempting reduction
B. Immediate closed reduction
C. Order CT angiography before reduction
D. Administer thrombolytics
Immediate closed reduction
Prompt reduction is critical to restore vascular flow and minimize ischemia. X-rays can be obtained after reduction if vascular compromise is suspected
A 40-year-old male presents with a knee dislocation that was successfully reduced in the ED. He complains of persistent numbness in the foot, and his dorsalis pedis pulse is weak. What is the most appropriate next diagnostic step?
A. Duplex ultrasound
B. CT angiography
C. MRI of the knee
D. Ankle-brachial index (ABI)
CT angiography
CT angiography is the gold standard for diagnosing vascular injuries, such as a popliteal artery injury, in knee dislocations
A 35-year-old male sustains a tibial plateau fracture after a skiing accident. He complains of worsening pain, even at rest, and has swelling and tense compartments in his leg. What is the most appropriate next step?
A. Elevate the leg and observe
B. Immediate fasciotomy
C. Immobilization with a long-leg cast
D. Initiate anticoagulation therapy
Immediate fasciotomy
A 45-year-old woman presents with a comminuted patellar fracture after a fall directly onto her knee. She is unable to perform a straight-leg raise. What is the next step in management?
A. Long-leg casting
B. Non-weight-bearing and follow-up in 1 week
C. Open reduction and internal fixation (ORIF)
D. Knee arthroscopy
Open reduction and internal fixation (ORIF)
Inability to perform a straight-leg raise indicates disruption of the extensor mechanism, necessitating surgical repair.
What is the hallmark symptom of cauda equina syndrome?
What reflex is typically diminished in cauda equina?
Saddle anesthesia
Ankle reflex
What type of incontinence is commonly associated with cauda equina syndrome?
Urinary retention or overflow incontinence
What is the first-line imaging study for diagnosing cauda equina syndrome?
MRI of the lumbosacral spine
A 50-year-old man presents with severe low back pain radiating to both legs, difficulty urinating, and numbness in his inner thighs. On exam, he has decreased rectal tone and diminished sensation in the perineal area. What is the most likely diagnosis?
A. Lumbar spinal stenosis
B. Sciatica
C. Cauda equina syndrome
D. Acute transverse myelitis
Cauda equina syndrome
Saddle anesthesia, decreased rectal tone, and urinary retention are hallmark findings of cauda equina syndrome
What bedside examinations can be done to evaluate for cauda equina?
- Sensation
- Rectal tone evaluation
- Post void bladder scan
What is the most common precipitating event leading to compartment syndrome?
What is the most common first sign of compartment syndrome?
Tibial Fracture
Pain
A 28-year-old male presents to the emergency department 6 hours after sustaining a tibial fracture from a motorcycle accident. He reports severe, worsening pain that is not relieved by opioid analgesics and is aggravated by passive movement of his toes. On examination, there is tense swelling in the lower leg. What is the next best step in management?
A) Supply compression via hard cast
B) Measure intracompartmental pressures
C) Repeat imaging
D) Fasciotomy
Measure intracompartmental pressures
Severe pain out of proportion and pain on passive stretching are key signs of compartment syndrome. Measurement of intracompartmental pressure is needed to confirm the diagnosis
A 40-year-old female who recently underwent a revascularization procedure for limb ischemia reports significant leg pain. The leg appears swollen, and her pain is out of proportion to the examination findings. What is the most likely diagnosis?
A) Deep venous thrombosis
B) Arterial stenosis
C) Compartment syndrome
D) Reperfusion injury
Compartment Syndrome
Post-revascularization can lead to increased blood flow into previously ischemic tissues, causing swelling and compartment syndrome. Immediate surgical decompression is necessary
A patient is found to have a compartment pressure of 35 mmHg after a crush injury to the forearm. What does this finding indicate, and what is the next step?
The pressure is high enough to compromise tissue perfusion; the next step is urgent fasciotomy.
What are the three physical exam maneuvers for an anterior cruciate ligament (ACL) tear?
- Lachman test
- Pivot shift
- Anterior drawer
Which ACL physical exam test provides the best sensitivity and specificity for ACL rupture?
Lachman test
A 55-year-old man presents to the emergency department with shoulder pain. He states the symptoms started 3 days ago. He reports no traumatic events leading up to his symptoms. Which positive physical exam finding is most consistent with supraspinatus tendonitis?
A) Hawkins-Kennedy test
B) Homans test
C) O’Brien test
D) Speed test
Hawkins-Kennedy test
Strength testing of supraspinatus is evaluated best with the “empty can” or Jobe strength test. This particular test is said to best isolate the supraspinatus from the other rotator cuff muscles. The Neer or Hawkins-Kennedy tests are the best tests for impingement, and in combination with the range of motion testing described above, they are highly suggestive of tendinitis.
Which rotator cuff muscle is most commonly injured, inflamed, or torn?
Supraspinatus muscle
Which nerve is most commonly injured in shoulder dislocations?
Axillary nerve
A 76-year-old man presents to the hospital with a hot, swollen, and painful right knee that appears to have an effusion. After your examination, you decide to perform an arthrocentesis. The fluid aspirate is turbid, cloudy, and most definitely looks like it is infectious material. Based on this clinical scenario, what would be most likely bacterial organism present in an elderly septic arthritis?
Staphylococcus aureus
What is the most likely causative agent of septic arthritis in a sexually active young adult?
Neisseria gonorrhoeae
A positive Finkelstein’s test indicates what diagnosis?
de Quervain’s tenosynovitis
