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CABS - MSK > pathophysiology of lower extremity > Flashcards

pathophysiology of lower extremity Flashcards

1
Q

what DVT is most likely to embolize

A

proximal DVT; popliteal, femoral iliac

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2
Q

What is a common issue in the lower extremity

A

lymphedema

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3
Q

what is edema

A

excess lymph fluid collects in the 3rd space

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4
Q

what is excess lymph fluid called when it collects in the 3rd space

A

edema

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5
Q

What is the root for biceps tendon reflex

A

C5

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6
Q

what is the root for brachioradialis tendon reflex

A

C6

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7
Q

what is the root for triceps tendon reflex

A

C7

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8
Q

what is the root for the quadriceps tendon reflex

A

L3,4

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9
Q

what is the root for the achilles tendon reflex

A

L5, S1

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10
Q

What makes up the femoral triangle

A

inguinal ligament
Sartorius
adductor longus

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11
Q

what does the inguinal ligament, sartourus and adductor longus create

A

the femoral triangle

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12
Q

What makes up the pelvic girdle

A

right and left os coxae, sacrum and coccyx

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13
Q

what is the purpose of the pelvic girdle

A

supports trunk on legs and protects viscera

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14
Q

what are the anterior pubic bones joined with

A

fibrocartilage to form pubic symphysis

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15
Q

what is the iliopsoas responsible for

A

major hip flexor that assists with posture

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16
Q

where does the iliacus portion arise from for the iliopsoas

A

iliac fossa

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17
Q

where does the psoas portion arise from for the iliopsoas

A

lumbar vertebrae

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18
Q

what is the psoas sign used for

A

assessment of appendicitis

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19
Q

what is the MOA for a native hip dislocation

A

high mechanism of injury - posterior dislocation think dashboard injury

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20
Q

when shortening is mentioned, what bone are you instantly thinking of

A

femur

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21
Q

what are hip dislocations that are left untreated at risk for

A

AVN
>6 hours

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22
Q

what is a concern with capsular damage s/p hip disolcation

A

instability

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23
Q

what is the cause of AVN

A

disruption of blood supply to a section of bone leading to ischemia and cellular death

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24
Q

AVN in the hip is most likely associated with what other injury

A

femoral neck fracture
increased if the fracture is displaced

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25
Q

what is angiogenesis

A

remodeling

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26
Q

what is MOA for a native anterior hip dislocation

A

forced abduction with head of femur forced through anterior capsule (catching ski tip)

often associated with fracutre-dislocation (acetabular fracture) and labral displacement

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27
Q

where does the femoral head receive vascular supply from

A

femoral circumflex arteries

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28
Q

what type of femoral neck fracture does not disrupt the vasculature

A

intertrochanteric fracture

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29
Q

what is intertrochanteric fractures less likely to have

A

AVN of femoral head

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30
Q

what fractures are likely to lead to AVN

A

Femoral neck fracutre

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31
Q

what are greater trochanteric fractures associated with

A

avulsion of the gluteus medius

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32
Q

what are lesser trochanteric fracutres associated with

A

avulsion of the iliopsoas

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33
Q

what are intertrochanteric fractures associated with

A

osteoporosis and falls

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34
Q

what are subtrochanteric fractures associated with

A

significant trauma, osteoporosis with fall and pathologic fracture

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35
Q

what is dysplasia

A

atypical shape of the joint

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36
Q

what happens with developmental dysplasia

A

acetabulum does not develop appropriately and is more shallow, thus leading to hip instability

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37
Q

what can developmental dysplasia be associated with

A

Ehlers-danlos, down syndrome, spina bifida and cerebral palsy

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38
Q

what does a shallow acetabulum result in

A

labrum may evert and ligamentum teres can elongate and further propagates instability of the hip

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39
Q

what is a femoral shaft fracture associated with for MOA

A

high mechanism of action - direct trauma may cause transverse fracture, oblique fracture and comminuted fracture

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40
Q

what causes trochanteric bursitis

A

repetitive movements that involve glute max pulling tendon fibers over the bursa

typically from friction of the IT band

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41
Q

what is the IT band

A

connective tissue that runs from the iliac crest to the lateral tibia (aponeurosis)

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42
Q

what runs from the iliac crest to the lateral tibia

A

IT band

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43
Q

what does SCFE stand for

A

Slipped capital femoral epiphysis

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44
Q

what is the patient population we see SCFE

A

males 14-16 yo - typically overweight

45
Q

what is a SCFE

A

displaced capital femoral epiphysis from the femoral neck

46
Q

what is the pathophysiology of SCFE injury

A

Multifactorial: obesity, repeat traumas, hormonal/genetic links, endocrne

may be acute or acute on chronic

47
Q

were does chronic hip pain present

A

classically in the knee

48
Q

where does acute hip pain present

A

groin

49
Q

why do we see SCFE in adolescents

A

rapid growth at the metaphysis

50
Q

what stabilizes the knee from dislocation

A

patellar retinaculum (medial and lateral)

51
Q

what is the purpose of the ACL

A

stabilizes the femur on the tibia so that it is unable to shift posteriorly

52
Q

where does the ACL attach

A

anteriorly to the tibial plateau and posteriorly to the lateral femoral condyle

53
Q

where does the PCL attach

A

posterior and inferiorly to the tibia and superior anteriorly to the medial condyle

54
Q

what is stronger the ACL or PCL

A

PCL

55
Q

what is the purpose of the PCL

A

keeps the femur from shifting anteriorly or the tibia from shifting posteriorly in reference to one another

56
Q

if a patient sustains a valgus producing force, what are you concerned about

A

MCL injury

57
Q

if a patient sustains a varus producing force, what are you concerned about

A

LCL injury

58
Q

what is the MCL attached to other than the femur and the tibia

A

meniscus

59
Q

what collateral ligament has better vasculature

A

MCL

60
Q

what is varus

A

bowed legs

61
Q

what is valgus

A

knock kneed

62
Q

is a patient presents with a proximally located patella what is that called and what is injured

A

patella alta
patellar ligament rupture

63
Q

what does the IT band connect with

A

tensor fascia lata, gluteus maximus and medius, vastus lateralis

64
Q

what is osgood-schlatter disease

A

traction apophysitis of the tibial tubercle

65
Q

what is the typical MOA for osgood-schlatters

A

repeat stress with pulling of the patellar tendon insertion site, chronic microavulsions at the ossification center

66
Q

what part of the meniscus has the most vasculature

A

medial meniscus

67
Q

what is the MOA of ACL tear

A

valgus movement of the knee and adduction of hip when striking down
- tibia will shift anteriorly and the ACL helps to control this - should resist rotation

68
Q

what is the MOA for PCL tear

A

anterior to posterior force against the tibia (dashboard)

69
Q

what location do patellas dislocate

A

laterally

70
Q

what is a knee dislocation

A

femoral tibial dislocation
MEDICAL EMERGENCY due to vasculature

71
Q

what is important to assess with knee dislocations

A

neuro and vascular exams

72
Q

what is compartment syndrome

A

increased pressure within the define fascial compartments. the pressure causes compression to veins and arteries leading to hypoxic injury

73
Q

what is normal compartment pressure

A

-10 mmHg

74
Q

what is a critical compartment pressure

A

10-30 mmHg

75
Q

what does POOP stand for

A

pain out of proportion

76
Q

what does a patient with compartment syndrome present with

A

POOP
pain with passive stretch of compartment
weakness and sensory changes to suggest ischemic event

77
Q

how many hours would compartment syndrome be considered irreversible level of damage

A

8 hours

78
Q

what is exertional compartment syndrome

A

increased pressures during exercise

79
Q

what is one of the longest tendons within the body

A

Achilles tendon

80
Q

where is the typical rupture of the achilles tendon

A

typcially rupture 2-6cm proximal to the calcaneous insertion secondary to blood supply

81
Q

what is the MOA for achilles ruptures

A

sudden force with foot in dorsiflexed position

82
Q

what medications risk tendon rupture

A

fluoroquinolones

83
Q

how do fluoroquinolone damage tendon and increase risk of ruptures

A

cause alteration of tendon matrix thus weakening the tendon and causing tendinopathy

84
Q

what is retrocalcaneal bursitis

A

also known as achilles tendon bursitis

85
Q

what ligaments are we worried about on the lateral aspect of the ankle

A

ATFL
PTFL
CFL

86
Q

what is the MOA for ankle fracutres

A

typically due to rotational injuries

87
Q

what is the syndesmosis

A

articulation between tibia and fibula

88
Q

what is a maisonneuve fracture

A

proximal fibular fracture and syndesmosis tear - unstable fibular fracture

89
Q

what is the first thing to assess during an ankle dislocation evaluation

A

vasculature - check for a pulse

90
Q

what is plantar fascia

A

aponeurosis along plantar surface of the foot
thickest area attaches to the medial aspect of the calc
support structure of the foot as toes spread forward when weight bearing

91
Q

what is the cause of plantar fascitis

A

multifactorial:
obesity, jumping, prolonged periods of standing, running

92
Q

what can develop secondary to long term plantar fascitis

A

bone spurs off the calcareous

93
Q

what is a neuroma

A

benign overgrowth or tumor of neuronal tissues

94
Q

where is morton neuromas located

A

bifurcation of the nerve in the 3rd web space

95
Q

what is Mortons neuroma associated with

A

associated with local irritation over chronic period, typically shoes that are too tight
can be repetitive microtrauma

96
Q

what does the 5th metatarsal assist with

A

assists as a level during push off of ambulation

97
Q

what is a jones fracture

A

fracture at zone 2 which is avascular watershed area

98
Q

what are 5th metatarsal fractures associated with

A

higher risk of AVN because of limited blood supply

99
Q

what is the MOA for a 5th metatarsal fracture

A

plantar flexion with hindfoot inversion and/or repetitive trauma

100
Q

where is the lisfranc ligament located

A

between the lateral base of the medial cuneiform and medial aspect of the 2nd met - made up of 3 ligaments

101
Q

what is the keystone of the foot

A

2nd metatarsal

102
Q

how are lis franc injuries diagnosed

A

non-weight bearing and weight bearing xrays of the foot

103
Q

what injury should be considered with midfoot pain

A

lisfranc injury

104
Q

what is pes planus

A

flat foot

105
Q

what are the two types of pes planus

A

congenital or acquired

106
Q

is pes planus normal or abnormal in children

A

normal in children - arch develops at 5-6 yo

107
Q

what is charcots foot

A

midfoot injury that is not treated
flat foot

108
Q

what patients are at an increased risk of developing charcots foot

A

diabetics

CABS - MSK (12 decks)

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