pathophysiology of lower extremity Flashcards
1
Q
what DVT is most likely to embolize
A
proximal DVT; popliteal, femoral iliac
2
Q
What is a common issue in the lower extremity
A
lymphedema
3
Q
what is edema
A
excess lymph fluid collects in the 3rd space
4
Q
what is excess lymph fluid called when it collects in the 3rd space
A
edema
5
Q
What is the root for biceps tendon reflex
A
C5
6
Q
what is the root for brachioradialis tendon reflex
A
C6
7
Q
what is the root for triceps tendon reflex
A
C7
8
Q
what is the root for the quadriceps tendon reflex
A
L3,4
9
Q
what is the root for the achilles tendon reflex
A
L5, S1
10
Q
What makes up the femoral triangle
A
inguinal ligament
Sartorius
adductor longus
11
Q
what does the inguinal ligament, sartourus and adductor longus create
A
the femoral triangle
12
Q
What makes up the pelvic girdle
A
right and left os coxae, sacrum and coccyx
13
Q
what is the purpose of the pelvic girdle
A
supports trunk on legs and protects viscera
14
Q
what are the anterior pubic bones joined with
A
fibrocartilage to form pubic symphysis
15
Q
what is the iliopsoas responsible for
A
major hip flexor that assists with posture
16
Q
where does the iliacus portion arise from for the iliopsoas
A
iliac fossa
17
Q
where does the psoas portion arise from for the iliopsoas
A
lumbar vertebrae
18
Q
what is the psoas sign used for
A
assessment of appendicitis
19
Q
what is the MOA for a native hip dislocation
A
high mechanism of injury - posterior dislocation think dashboard injury
20
Q
when shortening is mentioned, what bone are you instantly thinking of
A
femur
21
Q
what are hip dislocations that are left untreated at risk for
A
AVN
>6 hours
22
Q
what is a concern with capsular damage s/p hip disolcation
A
instability
23
Q
what is the cause of AVN
A
disruption of blood supply to a section of bone leading to ischemia and cellular death
24
Q
AVN in the hip is most likely associated with what other injury
A
femoral neck fracture
increased if the fracture is displaced
25
what is angiogenesis
remodeling
26
what is MOA for a native anterior hip dislocation
forced abduction with head of femur forced through anterior capsule (catching ski tip)
often associated with fracutre-dislocation (acetabular fracture) and labral displacement
27
where does the femoral head receive vascular supply from
femoral circumflex arteries
28
what type of femoral neck fracture does not disrupt the vasculature
intertrochanteric fracture
29
what is intertrochanteric fractures less likely to have
AVN of femoral head
30
what fractures are likely to lead to AVN
Femoral neck fracutre
31
what are greater trochanteric fractures associated with
avulsion of the gluteus medius
32
what are lesser trochanteric fracutres associated with
avulsion of the iliopsoas
33
what are intertrochanteric fractures associated with
osteoporosis and falls
34
what are subtrochanteric fractures associated with
significant trauma, osteoporosis with fall and pathologic fracture
35
what is dysplasia
atypical shape of the joint
36
what happens with developmental dysplasia
acetabulum does not develop appropriately and is more shallow, thus leading to hip instability
37
what can developmental dysplasia be associated with
Ehlers-danlos, down syndrome, spina bifida and cerebral palsy
38
what does a shallow acetabulum result in
labrum may evert and ligamentum teres can elongate and further propagates instability of the hip
39
what is a femoral shaft fracture associated with for MOA
high mechanism of action - direct trauma may cause transverse fracture, oblique fracture and comminuted fracture
40
what causes trochanteric bursitis
repetitive movements that involve glute max pulling tendon fibers over the bursa
typically from friction of the IT band
41
what is the IT band
connective tissue that runs from the iliac crest to the lateral tibia (aponeurosis)
42
what runs from the iliac crest to the lateral tibia
IT band
43
what does SCFE stand for
Slipped capital femoral epiphysis
44
what is the patient population we see SCFE
males 14-16 yo - typically overweight
45
what is a SCFE
displaced capital femoral epiphysis from the femoral neck
46
what is the pathophysiology of SCFE injury
Multifactorial: obesity, repeat traumas, hormonal/genetic links, endocrne
may be acute or acute on chronic
47
were does chronic hip pain present
classically in the knee
48
where does acute hip pain present
groin
49
why do we see SCFE in adolescents
rapid growth at the metaphysis
50
what stabilizes the knee from dislocation
patellar retinaculum (medial and lateral)
51
what is the purpose of the ACL
stabilizes the femur on the tibia so that it is unable to shift posteriorly
52
where does the ACL attach
anteriorly to the tibial plateau and posteriorly to the lateral femoral condyle
53
where does the PCL attach
posterior and inferiorly to the tibia and superior anteriorly to the medial condyle
54
what is stronger the ACL or PCL
PCL
55
what is the purpose of the PCL
keeps the femur from shifting anteriorly or the tibia from shifting posteriorly in reference to one another
56
if a patient sustains a valgus producing force, what are you concerned about
MCL injury
57
if a patient sustains a varus producing force, what are you concerned about
LCL injury
58
what is the MCL attached to other than the femur and the tibia
meniscus
59
what collateral ligament has better vasculature
MCL
60
what is varus
bowed legs
61
what is valgus
knock kneed
62
is a patient presents with a proximally located patella what is that called and what is injured
patella alta
patellar ligament rupture
63
what does the IT band connect with
tensor fascia lata, gluteus maximus and medius, vastus lateralis
64
what is osgood-schlatter disease
traction apophysitis of the tibial tubercle
65
what is the typical MOA for osgood-schlatters
repeat stress with pulling of the patellar tendon insertion site, chronic microavulsions at the ossification center
66
what part of the meniscus has the most vasculature
medial meniscus
67
what is the MOA of ACL tear
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
what is the MOA for PCL tear
anterior to posterior force against the tibia (dashboard)
69
what location do patellas dislocate
laterally
70
what is a knee dislocation
femoral tibial dislocation
MEDICAL EMERGENCY due to vasculature
71
what is important to assess with knee dislocations
neuro and vascular exams
72
what is compartment syndrome
increased pressure within the define fascial compartments. the pressure causes compression to veins and arteries leading to hypoxic injury
73
what is normal compartment pressure
-10 mmHg
74
what is a critical compartment pressure
10-30 mmHg
75
what does POOP stand for
pain out of proportion
76
what does a patient with compartment syndrome present with
POOP
pain with passive stretch of compartment
weakness and sensory changes to suggest ischemic event
77
how many hours would compartment syndrome be considered irreversible level of damage
8 hours
78
what is exertional compartment syndrome
increased pressures during exercise
79
what is one of the longest tendons within the body
Achilles tendon
80
where is the typical rupture of the achilles tendon
typcially rupture 2-6cm proximal to the calcaneous insertion secondary to blood supply
81
what is the MOA for achilles ruptures
sudden force with foot in dorsiflexed position
82
what medications risk tendon rupture
fluoroquinolones
83
how do fluoroquinolone damage tendon and increase risk of ruptures
cause alteration of tendon matrix thus weakening the tendon and causing tendinopathy
84
what is retrocalcaneal bursitis
also known as achilles tendon bursitis
85
what ligaments are we worried about on the lateral aspect of the ankle
ATFL
PTFL
CFL
86
what is the MOA for ankle fracutres
typically due to rotational injuries
87
what is the syndesmosis
articulation between tibia and fibula
88
what is a maisonneuve fracture
proximal fibular fracture and syndesmosis tear - unstable fibular fracture
89
what is the first thing to assess during an ankle dislocation evaluation
vasculature - check for a pulse
90
what is plantar fascia
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
what is the cause of plantar fascitis
multifactorial:
obesity, jumping, prolonged periods of standing, running
92
what can develop secondary to long term plantar fascitis
bone spurs off the calcareous
93
what is a neuroma
benign overgrowth or tumor of neuronal tissues
94
where is morton neuromas located
bifurcation of the nerve in the 3rd web space
95
what is Mortons neuroma associated with
associated with local irritation over chronic period, typically shoes that are too tight
can be repetitive microtrauma
96
what does the 5th metatarsal assist with
assists as a level during push off of ambulation
97
what is a jones fracture
fracture at zone 2 which is avascular watershed area
98
what are 5th metatarsal fractures associated with
higher risk of AVN because of limited blood supply
99
what is the MOA for a 5th metatarsal fracture
plantar flexion with hindfoot inversion and/or repetitive trauma
100
where is the lisfranc ligament located
between the lateral base of the medial cuneiform and medial aspect of the 2nd met - made up of 3 ligaments
101
what is the keystone of the foot
2nd metatarsal
102
how are lis franc injuries diagnosed
non-weight bearing and weight bearing xrays of the foot
103
what injury should be considered with midfoot pain
lisfranc injury
104
what is pes planus
flat foot
105
what are the two types of pes planus
congenital or acquired
106
is pes planus normal or abnormal in children
normal in children - arch develops at 5-6 yo
107
what is charcots foot
midfoot injury that is not treated
flat foot
108
what patients are at an increased risk of developing charcots foot
diabetics
