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clinical medicine exam 3 > the lower extremity > Flashcards

the lower extremity Flashcards

1
Q

what is femoroacetabular impingement (FAI)

A
  • bone overgrowth or abnormality in bone development that changes function of hip joint
    • can tear labrum
    • destruct articular cartilage
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2
Q

what are the two types of femoroacetabular impingement (FAI)

A
  • pincer (acetabular involvement)
  • Cam (femoral head involvement)
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3
Q

clinical presentation

  • groin pain and/or lateral hip pain
  • pain may be described as sharp, stabbing, or deep dull ache
  • pain aggravated with turning, twisting, prolonged standing or squatting
    • FADIR test
A

femoroacetabular impingement (FAI)

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4
Q

FADIR test

A
  • impingement test
  • knee/hip flexion with adduction and internal rotation of the hip
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5
Q

FABER test

A
  • flexion
  • abduction
  • external rotation

*figure of four test

note: place counter pressure on opposite hip

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6
Q

Clinical presentation

  • dull or sharp groin pain
  • often radiates to lateral hip, anterior thigh, or buttock
  • insidious onset vs acute trauma
  • catching, clicking that may cause pain
A

Labral tear of the hip

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7
Q

what causes snapping hip syndrome

A

muscle or tendon sliding over bony prominence, which can lead to bursitis

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8
Q

what are the two main anatomical causes of snapping hip syndrome

A
  • external: IT band over greater trochanter
  • internal: iliopsoas tendon over iliopectineal eminence or femoral head
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9
Q

clinical presentation

  • snapping or popping sensation in hip with walking, getting up from chair, or swinging leg
    • may be painful or painless
  • pseudosubluxation (sensation of hip subluxation or dislocation)
A

snapping hip syndrome

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10
Q

physical exam for snapping hip syndrome

A
  • do faber test (flex, abduct and externally rotate), then test snapping by extending hip
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11
Q

what patient population is associated with snapping hip syndrome

A
  • dancers
  • adolescents
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12
Q

what is the most common cause of lateral hip pain in adults

A

greater trochanteric pain syndrome

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13
Q

what is greater trochanteric pain syndrome

A
  • repetitive overload tendinopathy (gluteal medius and minimus)
  • trouble with hip abduction and pelvic stability
  • bursa may become inflamed
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14
Q

clinical presentation

  • Lateral hip pain with localized pain to greater trochanter
  • pain increased with pressure over greater trochanter (lying on side)
  • pain increases with walking, stairs, inclines, and prolonged standing
A

greater trochanteric pain syndrome

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15
Q

physical exam for greater trochanteric pain syndrome

A
  • TTP over greater trochanter
  • pain with resisted abduction
  • Trendelenburg sign (difficulty maintain standing on one foot)
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16
Q

What is the Triad of O’Donoghue (unhappy triad)

A
  • ACL
  • MCL
  • medial meniscus
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17
Q

most common mechanism of injury for medial collateral ligament (MCL) sprain

A
  • knee flexion + foot planted AND
  • lateral impact causing vlagus stress + rotation
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18
Q

mechanism of injury for lateral collateral ligament sprain

A
  • rare
  • tibial internal rotation
  • medial impact
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19
Q

valgus stress

A
  • assess the integrity of the medial collateral ligament
  • valgus = foot pulled laterally
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20
Q

varus stress

A
  • used to assess the lateral collateral ligament
  • Varus = return foot to body
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21
Q

what is the most common ligament in the knee to by injured

A

anterior cruciate ligament (ACL)

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22
Q

function of anterior cruciate ligament (ACL)

A

prevents anterior translation of the tibia

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23
Q

noncontact mechanism of injury: anterior cruciate ligament (ACL)

A
  • quick position change with cutting/pivoting
    • lateral bend (valgus stress)
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24
Q

contact mechanism of injury: anterior cruciate ligament (ACL)

A

direct blow causing hyperextension or valgus deformity with lateral impact

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25
Q

is ACL injury more common in males or females

A

females

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26
Q

clinical presentation

  • feeling or hearing a “pop”
  • immediate pain and swelling
  • report feeling of instability
  • guarding
  • often able to bear weight
  • laxity
A

anterior cruciate ligament (ACL)

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27
Q

specialized tests for anterior cruciate ligament (ACL)

A
  • Lachman
  • anterior drawer
  • pivot shift

*pt needs to be cooperative and relaxed

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28
Q

treatment for anterior cruciate ligament (ACL)

A
  • RICE
  • refer to ortho
    • surgery: younger patients and atheletes
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29
Q

function of posterior translation of tibia

A

prevents posterior translation of tibia

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30
Q

what is the largest and strongest ligament of the knee

A

posterior cruciate ligament

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31
Q

clinical presentation

  • varies based on MOI (MVA, soccer..etc)
  • mild to moderate knee effusion/hemarthrosis
  • generalized knee pain, feeling “something isn’t right”
  • limp
A

posterior cruciate ligament

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32
Q

specialized testing for PCL injury

A
  • posterior drawer sign
  • posterior sag sign (pictured)
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33
Q

function of menisci

A
  • increase contact area for articulation
  • increase joint stability, facilitate lubrication and shock absorption
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34
Q

MOI: meniscus injury

A

excessive rotational force (femur on tibia)

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35
Q

which meniscus is more susceptible to injury

A

medial meniscus

  • greater forces medially
  • less mobile structure than lateral meniscus
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36
Q

clinical presentation

  • joint line pain
  • inability to fully extend knee, described as “locking” or “catching”
  • walking up and down stairs and squatting is difficult and painful
A

meniscus injury

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37
Q

specialized testing for meniscus injury

A
  • McMurray’s
  • Apley’s compression/distraction
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38
Q

imaging for Meniscus injury

A

MRI (don’t need arthrogram)

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39
Q

what is a Grade I knee sprain

A

mild stretch

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40
Q

treatment for a Grade I knee sprain

A
  • RICE
  • WB as tolerated
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41
Q

What is a Grade II knee sprain

A

partial tear

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42
Q

Treatment for a Grade II knee sprain

A
  • RICE
  • Brace immobilization
  • +/- crutches
  • PT
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43
Q

what is a Grade III knee sprain

A

complete tear

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44
Q

treatment for Grade III knee sprain

A
  • REFER to ortho
  • surgical repair
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45
Q

what is patellofemoral pain syndrome

A
  • malalignment, patellar tracking concerns
  • most common knee complaints in primary care medicine
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46
Q

clinical presentation

  • anterior pain under the patella (involves retinaculum)
  • pain worse with going up and down stairs
  • positive theater sign or long car ride sign
  • usually see crepitus, popping, feelings of joint instability
A

patellofemoral pain syndrome

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47
Q

specialized testing for patellofemoral pain syndrome

A
  • patellar glide
  • apprehension test
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48
Q

recovery/prevention for patellofemoral pain syndrome

A
  • PT
    • strengthen hip abductors and quads, stretch hamstrings, core stabilization
    • taping or patellar stabilizing brace
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49
Q

what is a baker’s cyst (popliteal cyst)

A
  • accumulation of joint fluid in the popliteal fossa
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50
Q

treatment for baker’s cyst

A
  • NSAIDs
  • aspiration/injection
  • compressive neoprene brace
  • surgery rarely indicated
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51
Q

What is patellar tendonitis (jumper’s knee)

A
  • patellar tendon inflammation from repetitive trauma
52
Q

treatment for patellar tendonitis (jumper’s knee)

A
  • Ice, NSAIDs, bracing
  • steroid injection is NOT recommended
53
Q

clinical presentation

  • pinpoint pain inferior to patella
  • found in athletes involved in running, jumping, kicking sports
  • age 16-40
  • excessive foot pronation and running hills can exacerbate these symptoms
A

Patellar tendonitis

54
Q

what patient population is iliotibial band syndrome (ITBS) most associated with

A
  • runners
  • cyclists
55
Q

clinical presentation

  • gradual onset of localized pain
    • initially sharp/burning pain during activities
    • may develop into constant deep ache
  • PE: localized tenderness and reproducible with ROM and compression to iliotibial band region
A

iliotibial band syndrome (ITBS)

56
Q

treatment for iliotibial band syndrome (ITBS)

A
  • conservative
  • RICE
  • NSAIDs
  • PT
57
Q

in knee bursitis, what bursa are most commonly affected

A
  • prepatellar
  • pes anserine
58
Q

a patient with knee bursitis will present with pain, swelling, and tenderness. what condition do you need to rule out?

A

infection

59
Q

treatment for knee bursitis

A
  • avoid precipitating factors
  • NSAIDs
  • aspiration/steroid injection
  • bracing
60
Q

what is osteochondritis Dissecans (OCD)

A
  • lesion of cartilage and underlying bone that results in necrosis and possible displacement (stable vs unstable)
  • unknown etiology
61
Q

what are the most common locations affected by osteochondritis Dissecans (OCD)

A
  • knee
  • ankle
  • elbow
62
Q

treatment for osteochondritis Dissecans (OCD)

A
  • long term bracing
  • PT
  • surgery?
63
Q

if a patient presents with medial knee pain, what is your differential diagnosis

A
  • MCL
  • medial meniscus
  • pes anserine bursitis
64
Q

if a patient presents with lateral knee pain, what is your differential diagnosis?

A
  • LCL
  • IT band syndrome
  • lateral meniscus
65
Q

if a patient presents with posterior knee pain, what is your differential diagnosis?

A
  • baker’s cyst
  • DVT
66
Q

if a patient presents with anterior knee pain, what is your differential diagnosis?

A
  • quadriceps/patellar tendons
  • patellofemoral pain syndrome
  • bursitis
  • patellar fx or dislocation
  • Osgood-schlatter disease
67
Q

what ligaments are included in the lateral ligament complex

A
  • anterior talofibular ligament
  • calcaneofibular ligament (CFL)
  • posterior talofibular ligament
68
Q

what ankle injury is most common

A

lateral ankle: injury to the lateral ligament complex

  • inversion injury with plantar flexion
69
Q

what specialized test is for lateral ankle sprain

A

anterior drawer test

70
Q

what ligaments are located on the medial aspect of the ankle

A

deltoid ligament complex

71
Q

what is a syndesmotic ankle sprain

A

high ankle sprain

72
Q

what ligaments are involved in a high ankle sprain (syndesmotic)

A
  • anterior tibiofibular
  • posterior tibiofibular
  • transverse tibiofibular ligaments
  • interosseous membrane
73
Q

what specialized test is for high ankle sprain (syndesmotic)

A
  • squeeze test
74
Q

Grade I ankle sprain: typical findings

A
  • minimal pain and swelling
  • able to bear weight/stand
75
Q

Grade 2 ankle sprain: typical findings

A
  • moderate pain, swelling, and bruising
  • difficulty weight bearing
76
Q

grade 3 ankle sprain: typical findings

A
  • severe pain, swelling, and bruising
  • inability to bear weight w/o significant pain
77
Q

Grade I ankle sprain: damage to ligament

A
  • microscopic tears
  • majority of ligament remains intact
78
Q

Grade 2 ankle sprain: damage to ligament

A
  • complete tear of some, but not all ligament fibers
79
Q

Grade 3 ankle sprain: damage to ligament

A
  • complete rupture of ligament, or avulsion fracture
80
Q

treatment for ankle sprain

A
  • RICE, NSAIDs
  • +/- short immobilization for grade 2 and 3
  • PT to prevent repeat injuries
  • bracing, taping
81
Q

what is the achilles tendon? function?

A
  • common insertion of the gastrocnemius/soleus
  • function: plantar flexion
82
Q

if a pediatric patient c/o pain to the heel/inferior posterior leg, what condition must you exclude?

A

calcaneal apophysitis (Sever’s disease)

83
Q

clinical presentation

  • recent increase in training regimen
  • burning pain to heel/inferior posterior leg that increases with activity
A

achilles tendon tendinopathy

84
Q

MOI of a achilles tendon rupture

A
  • sudden pivoting or rapid acceleration
  • sensation of violet hit or pop
85
Q

physical exam for achilles tendon

A
  • examine lying prone
  • palpate along tendon for pain, edema, and/or defect
    • palpate in both plantarflexion and dorsiflexion
86
Q

specialized test for achilles tendon rupture

A

Thompson test

87
Q

treatment for achilles tendon rupture

A
  • ortho referral
  • immobilization
    • equinus splinting
    • boot allowing for continued plantar flexed position
88
Q

what is plantar fasciitis commonly due to

A
  • activity
  • heel spurs
  • pes planus/cavus
  • ankle pronation
  • poor shoe wear
89
Q

clinical presentation

  • pain commonly on the plantar aspect of the heel
  • pain with onset of walking (first step in the morning)
  • PE: point tenderness at insertion of fascia at calcaneus or along entire arch
  • pain aggravated by ROM (dorsiflexion of toes or ankle)
A

plantar fasciitis

90
Q

if a patient comes in c/o pain to the dorsum of their foot, what condition must you rule out

A

S1 radiculopathy

  • weakness with dorsiflexion of great toe
  • SLR and achilles tendon reflex
91
Q

diagnostics of plantar fasciitis

A
  • radiographs of foot: AP, lateral, and weight bearing
    • assess for bony abnormalities
92
Q

treatment for plantar fasciitis

A
  • ice, NSAIDs, rest
  • prevention
    • improve shoe wear
    • achilles stretching exercises
93
Q

what is osteoporosis

A

progressive bone loss with increased risk of fracture

94
Q

prevention of osteoporosis

A
  • calcium
  • vitamin D
  • exercise
95
Q

evaluation for osteoporosis

A

DEXA scan

96
Q

treatment for osteoporosis

A
  • estrogen replacement therapy
  • calcitonin
  • bisphosphonates
97
Q

treatment for septic arthritis

A
  • surgical emergency
  • IV abx; I&D
98
Q

evaluation of septic arthritis

A
  • joint aspiration
    • gram stain
  • labs
    • CBC, ESR, CRP, blood cultures
99
Q

what is the most common benign tumor

A

unicameral bone cyst (simple bone cyst)

100
Q

what is a unicameral bone cyst

A
  • fluid filled cavity in the bone
  • usually seen in long bones
  • cortex is intact but thinned
101
Q

treatment for unicameral bone cyst

A
  • may resolve spontaneously: OBSERVE
  • consider surgery for recurrent pathologic features
    • in peds: avoid tx if near physis under older (high recurrence rate)
102
Q

what is an Aneurysmal bone cyst (ABC)

A
  • blood filled cyst in the bone
    • seen in spine and extremities
  • BENIGN but aggressive
103
Q

treatment of Aneurysmal bone cyst

A

refer to ortho for surgery

104
Q

what is a Non-ossifying Fibroma (NOF)

A
  • benign lesion
  • think MES: Metaphyseal, Eccentric, Sclerotic border
    • eccentric (on the edge of the bone)
    • sclerotic: has a good border around it
105
Q

clinical presentation of non-ossifying fibroma

A

asymptomatic or pain associated with pathologic fx

106
Q

treatment for non-ossifying fibroma

A
  • observe with serial radiographs
  • ortho referral if lesion is greater than 50% diameter of the bone
107
Q

what is a giant cell tumor (GCT)

A
  • Benign, aggressive tumor
  • may develop as growth plate closes: metaphyseal/epiphyseal
  • early adulthood
108
Q

clinical presentation of giant cell tumor

A
  • localized pain
  • possible weakness
109
Q

treatment for giant cell tumor

A
  • refer to ortho
  • radiation and surgery
  • high reoccurrence rate
110
Q

what is an Osteoid Osteoma

A
  • small benign bone tumor
  • seen in children and adults
  • Nidus-center of growing cells surrounded by thickened bone
111
Q

clinical presentation

  • dull aching pain
  • severe night pain
  • NSAIDs relieve pain
A

Osteoid Osteoma

112
Q

treatment of Osteoid Osteoma

A
  • refer to ortho or interventional radiology
  • CT guided radiofrequency ablation
113
Q

what is osteochondroma (exostosis)

A

abnormal growth of bone and cartilage along surface of the bone

114
Q

what is the most common benign bone tumor

A

osteochondroma

115
Q

clinical presentation

  • fixed, non-mobile mass near joints
  • may be painful with activity
  • tingling or numbness if near nerve
A

osteochondroma

116
Q

if you see a osteochondroma, why should you check for more?

A
  • multiple hereditary exostosis
  • small malignant potential for an osteochondroma to become a chondrosarcoma
117
Q

treatment for osteochondroma

A
  • observation
  • refer if painful
118
Q

what is the most common bone tumor in children

A

osteosarcoma

119
Q

what is an osteosarcoma

A

malignant primary bone tumor

120
Q

what is chondrosarcoma

A

bone tumor composed of cartilage-producing cells

121
Q

treatment for chondrosarcoma

A
  • refer to ortho
  • +/- radiation, chemotherapy
122
Q

clinical presentation

  • fatigue, fever, night sweats
  • diffuse bone tenderness
  • pathologic fractures
A

multiple myeloma

123
Q

what is multiple myeloma

A
  • malignant bone tumor
  • involves entire skeleton
124
Q

if considering multiple myeloma, what would you look for in the urine

A

bence-jones proteins

125
Q

imaging: punched out appearance on radiographs

A

multiple myeloma

126
Q

what cancers most frequently cause metastatic bone cancer

A

think Lead Kettle (PB-KTL)

  • prostate, breast, kidney, thyroid, lung

clinical medicine exam 3 (7 decks)

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