32 - Lower Extremity

Question 1

What is transient synovitis of the hip caused by and who gets it?

Answer 1

Viral, post-vaccine or drug-induced synovitis of the hip.

Occurs in ages 3-10.

Question 2

What is seen on exam of someone with transient synovitis? How is it treated?

Answer 2

Any motion causes pain (+), refuses to bear weight. High sed rate and mild leukocytosis.

Treat with NSAIDs for 1-3 weeks.

Question 3

What is the history of someone with slipped capital femoral epiphysis (SCFE)? What causes it?

Answer 3

Clasically ocerweight early adolescent with history of groin or knee pain, which may be referred to anteromedial thigh.

Often occurs bilaterally, but not simultaneously.

Caused by repetitive overload - presents with vague symptoms that are worwse with acitivty.

Question 4

How would you treat a slipped capital femoral epiphysis? What is seen on exam? What test do you use for diagnosis?

Answer 4

Exam: limitation of hip internal rotation

Tests: plain exrays

Treatments: surgical fixation

Question 5

What is seen on exam of someone with a septic jont? What is the etiology?

Answer 5

Exam: swollen, etremely painful joint, passive and active ROM very painful. Red, hot joint. Usually symptomatic signs but may be absent in DB or immunocomp pts.

Etiology: gonorrhea or skin flora

Question 6

What is the treatment of a septic joint? What is a complication?

Answer 6

Treatment: surgical emergency, requires irrigation and drainage followed by IV abx.

Complcation: articular surface destruction

Question 7

What artery is often injured in a knee dislocation? What type arteries should be checked with a knee dislocation?

Answer 7

Popliteal artery: dorsalis pedis (lateral to tendon of extensor hallucis lungus), poterior tibial artery (by medial malleolus)

Question 8

What are the three articular surfaces of the knee?

Answer 8

1. Femoral condyles
2. Tibial plateau
3. Patella

Note: the patella does NOT articulate with the tibia

Question 9

What are the ligaments of the knee?

Answer 9

Medial meniscus: C-shaped

Lateral meniscus: O-shaped

Cruciates: anterior (ACL) and posterior (PCL)

Medial (tibial) collateral and Lateral (fibular) collateral

Question 10

What are the components of the unhappy triad?

Answer 10

Torn:

• ACL
• Medial collateral ligament
• Lateral meniscus

Question 11

What type of injury results in a postitive anterior drawer sign?

Answer 11

ACL tear - causes tibia to move forward in relation to the femur

Question 12

Varus and valgus stress testing tests which ligaments of the leg?

Answer 12

The lateral collateral ligament (LCL) and medical collateral ligament (MCL)

Question 13

What is the primary stabilizer of the knee in extension?

Answer 13

The ACL - strongest ligament of the knee itself; provides the most stability when leg is fulling extended at the knee.

Question 14

How would you radiographically assess ligament tears of the knee?

Answer 14

MRI - to see associated ligament injuries, menisci, articular cartilage, and “bone bruises”

Question 15

What are the structures denoted by each color?

Answer 15

Question 16

What knee injury can cause locking, pain with twisting, and mild swelling?

Answer 16

Meniscul tear - free flaps in the joint space cause the joint to freeze up and lock, this results in a loss of ROM.

Question 17

What is the McMurray and circumduction test?

Answer 17

Put load into knee joint and rotating it

-shift and load type test

Compress joint and then rotate to stress the structure in the middle of the joint

Question 18

A 35 yo runner with a foot drop that occurs when running sub-5min mile pace and great toe numbness. No problem at slower speeds or with ADLs. There’s been no recept chance in exercise regiment. What diagnosis do you suspect?

Answer 18

Exertional compartment syndrome - local swelling from exertion can compress the nerve resulting in foot drop and numbness.

Question 19

What are signs and sympoms of acute compartment syndrome?

Answer 19

P’s:

• poikilothermia - cool extremities often earliest sign
• pain - to passive motion, out of proportion to exam, and tense compartment on palpation
• parasthesias - tingling/pricking sensation
• pulselessness and pallor - rare

Question 20

What nerve innervates each location?

Answer 20

Question 21

Someone got a laceration to the bone on the posterior aspect of their medial malleolus. What nerve deficit would they likely have?

Answer 21

Medial plantar nerve injury - this is a branch of the tibial nerve.

The tibial nerve supplies the entire back of the leg and bottom of the foot. Any intrinsic foot problem will be associated with the tibial nerve.

Question 22

What compartment of the lower leg is least likely to get compartment syndrome? Why?

Answer 22

Superficial posterior: it’s completely encapsulated by skin which allows for greater elasticity. More space for swelling to occur in = less pressure.

Question 23

What is the function of the anterior, lateral, superficial posterior, and deep posterior compartment of the leg? How likely is exertional compartment syndrome in each?

Answer 23

Anterior: extensors - 40-50%

Lateral: eversion and external rotation - 20%

Superficial posterior: superficial flexors (gastroc, soleus, plantaris)-rare

Deep posterior: deep flexors - 30%

Question 24

How would you measure the pressure in each cmpartment of hte leg?

Answer 24

Slit catheter system - 18 gauage blunt needle

Question 25

Exertional compartment syndrome will show _____ pressure at rest.

Answer 25

Normal pressure at rest, high pressure after exercise.

Question 26

What does the femoral nerve innervate? what is the action?

Answer 26

IPSquad-iliacus, pectineus, sartorius, and quads.

Anterior compartment of the leg - helps extend the lower knee

Question 27

What does the obturator nerve innervate? what is the action?

Answer 27

Medial compartment of the thigh for leg adduction

POAAAS: pectineus, obturator externues, A add’s, gracillis

Question 28

What nerve inervates the gluteus medius, minimus, and tensor fascia lata? What happens when this nerve doesnt work?

Answer 28

Superior gluteal nerve.

Trandelenburg gait - when you stand on right left with R nerve damage, the L hip will drop. Pts tend to lean over their affected side causing this characteristic gait.

Question 29

What are the branches of the sciatic nerve?

Answer 29

Tibial nerve - posterior leg and foot; splits into medial and lateral plantar nerves

Common fibular (wraps around the head of the fibula and can get damaged here) - splits into superficial fibular nerve (lateral compartment), and deep fibular nerve (anterior compartment)

Question 30

Meniscal and labral patholgoy causes symptoms with _____ stress.

Answer 30

rotational

Question 31

What is apophysitis?

Answer 31

Pain at an open growth plate.

Question 32

What are the lab findins in someone with a compression fracture due to osteoporosis?

Answer 32

Normal calcium and phosphate

Alkaline phosphatase is normal

PTH is normal

Question 33

What illness shows pink, scaly, annular lesinos on sun-exposed areas?

Answer 33

Subacute cutaneous lupus erythematous

Question 34

WhatWhat disease is associated with the following signs: heliotrope rash, gottrons papules, capillary injury, and interstitial lung disease?

Answer 34

Dermatomyositis

Question 35

A child came in with her partents with short stature, bowed legs, and short arms. Genetic testing showed a mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. Which drug would be the best to help this child with her developmental disorder?

Answer 35

Somatotropin (recombinant human growth hormone)

Question 36

What genetic condition is associated with ewing’s sarcoma?

Answer 36

(11;22) translocation (looks onion-like on radiology)

Question 37

What syndrome is assocaited with severe scleroderma?

Answer 37

CREST syndrome.

Question 38

Someone with pagets disease would have a higher chance of developing what type of tumor?

Answer 38

Osteosarcoma.