Clinical Correlates: Exam 1

Question 1

Saphenous cutdown

Answer 1

Use the saphenous vein to insert a catheter near the medial malleolus of the foot

Question 2

Varicose veins

Answer 2

When valves of saphenous and perforating veins fail to function correctly, retrograde flow into superficial veins

Question 3

Femoral hernia

Answer 3

When the intestines push through a weakness in the femoral canal, resulting in a direct inguinal hernia

Question 4

Trendelenburg test

Answer 4

Injury to superior gluteal nerve - Gluteus medius/minimus work to pull hip down on supported side to lift leg off the ground. An abnormal case will not be able to pull hip up and leg will be dragging on unsupported side. Treat by giving a cane on the unaffected side.

Question 5

Piriformis syndrome

Answer 5

compression of sciatic nerve by the piriformis, pain extends along the sciatic nerve and is worse when sitting (aka fat wallet syndrome)

Question 6

Lumbar lordosis

Answer 6

hamstrings usually pull down on pelvis, tilting it superiorly to prevent it from falling forward, weak hamstrings allow hip flexors to pull pelvis anteriorly (tight hamstrings can cause flatback)

Question 7

Hamstring pull

Answer 7

avulsion of hamstring tendon from ischial tuberosity

Question 8

Iliotibial tract syndrome

Answer 8

inflammation of the IT tract causing pain on the lateral knee (from rubbing against lateral chondyle during flexion and extension)

also from excessive pronation that increases internal rotation of tibia, increasing friction

Question 9

Gluteal injections

Answer 9

Inject in area between ASIS and ilial crest to avoid hitting sciatic nerve (upper lateral quadrant)

Question 10

Sciatica

Answer 10

Lower back pain, with pain radiating down the leg and to the foot, from herniated disc, spinal stenosis, piriformis syndrome or hematoma

Question 11

Popliteal artery aneurysm

Answer 11

pain behind the knee, edema in lower leg and foot, foot pain, can cause embolism and occlusion

Question 12

Popliteal (Baker’s) cyst

Answer 12

herniation of synovial membrane of knee joint or distension of gastroc or semimembranosus bursae into popliteal fossa

Question 13

Compartment syndrome

Answer 13

Increased pressure in a compartment - causes pain, paresthesia, pallor, paralysis and pulselessness, treated by releasing the pressure quickly (fasciotomy)

Question 14

Achilles tendon rupture

Answer 14

Happens during dorsiflexion and extension of leg

Question 15

Calcaneal tendon reflex

Answer 15

If absent, injury to S1 or S2, also have decreased sensation and weak plantarflexion of foor

Question 16

Shin splints

Answer 16

microfractures in the tibia from extensor muscles of the anterior compartment

Question 17

Stress fracture of the tibia

Answer 17

overuse causes injuries on bone, load exceeds ability to repair bone

Question 18

Drop foot

Answer 18

damage to the deep peroneal nerve, results in inability to dorsiflex foot, loss of sensation in first web space, patients walk with high steppage gait

Question 19

Pes planus

Answer 19

flat foot, from posterior tibial tendon dysfunction of spring ligament laxity - overpronation (eversion) and abduction of feet

Question 20

High ankle sprain

Answer 20

sprain of the ligaments that join the tibia and fibula (anterior and posterior tibiofibular ligaments)

Question 21

Low ankle sprain

Answer 21

tearing of deltoid ligaments on medial side of ankle (occurs when foot is inverted and plantar flexed) - more here

Question 22

trimalleolar fracture

Answer 22

foot is everted and strong medial (deltoid) ligament breaks the medial malleolus - talus breaks free and breaks lateral malleolus - tibia breaks free and breaks at posterior distal end

Question 23

plantar fasciitis

Answer 23

results from shorted Achilles or hypermobile forefoot, pain at the insertion of the plantar fascia into the calcaneous with or without bony formation

Question 24

bunion (hallux valgus)

Answer 24

swollen bursal sac or bony anomaly of the metatarsophalangeal joint, cause by flat feet, excessive flexibility of ligaments, abnormal bone structure

Question 25

Hip dislocation

Answer 25

femoral tears into the gluteal region, between iliofemoral and ischiofemoral ligaments, causing damage to sciatic nerve

Question 26

Developmental dysplasia of the hip

Answer 26

malformed socket, common in first born females (decrease amnionic fluid), requires hip replacement

Question 27

Coxa Vara/Valga

Answer 27

``` Vara = low angle of femoral neck to the acetabulum - shortening of limb and limp Valga = higher angle ```

Question 28

avascular necrosis of femoral head

Answer 28

blood supply gets disrupted, causes death to osteocytes

Question 29

femoral neck fractures

Answer 29

need to be repaired within 8 hours to prevent avascular necrosis, type 1 - crack, type 2 - fracture, type 3 - displacement, type 4 - full displacement concern is medial circumflex artery leg appears shortened and laterally rotated

Question 30

types of hip repair

Answer 30

dynamic compression screw and plate and bipolar hip prosthesis

Question 31

hip pain

Answer 31

referred pain - great trochanter is trochanteric bursitis - buttocks = sciatic causes = arthritis, bursitis, tendinitis, muscle strain, cancer, avascular necrosis

Question 32

Nursemaids knee

Answer 32

aseptic or septic prepatellar bursitis, swelling is more focal than effusion

Question 33

knee effusion

Answer 33

synovial fluid accumulation around knee joint

Question 34

Q-angle

Answer 34

angle that the femur makes relative to tibia

Question 35

Genu valgum/varum

Answer 35

Varum - low Q angle, stress on medial menisci and LCL Valgum - high Q angle, stress on lateral menisci, MCL

Question 36

testing collateral ligaments

Answer 36

varus stress test angles leg medially to test LCL and valgus stress test angles leg laterally to test MCL

Question 37

ACL tear

Answer 37

forces directed from posterior side of the leg 1. rapid cutting maneuver with foot on ground and knee flexed 2. knee hyperextension with internal tibial rotation

Question 38

PCL tear

Answer 38

forces directed from anterior side of the leg, or forced flexion of knee with external rotation

Question 39

test of ACL tear

Answer 39

Anterior drawer sign, flex knee to 90 and pull leg forward, more then 1cm anterior displacement = ACL tear

Question 40

test of PCL tear

Answer 40

sag of the tibia posterior

Question 41

meniscus injuries

Answer 41

medial side injured most (when medial meniscus is more secured and foot is planted with excessive rotation)

Question 42

unhappy triad

Answer 42

medial meniscus is attache to MCL and both are torn during ACL tear (not LCL because of popliteus)

Question 43

Shoulder separation

Answer 43

tearing of acromioclavicular and coracoclavicular ligaments, piano key deformity

Question 44

winged scapula

Answer 44

damage to long thoracic nerve, medial scapula freely moves posteriorly, especially when pressing against wall, person has difficultly raising hands above head

Question 45

breast cancer

Answer 45

lower medial quadrant is the most dangerous because it crosses the midline and because parasternal lymph nodes cant be palpated

Question 46

rotator cuff injuries

Answer 46

supraspinatus and infraspinatus

Question 47

frozen shoulder (adhesive capulisitis)

Answer 47

loss of range of motion from tendinitis, bursitis, rotator cuff injury, inflammation, treat with steriod and PT

Question 48

biceps tendon reflex

Answer 48

tests musculocutaneous nerve

Question 49

wrist drop

Answer 49

damage to radial nerve and deep brachial artery in the spiral groove, paralyze the extensor muscles

Question 50

Erb palsy

Answer 50

C5 and C6 brachial plexus injury, limb will be adducted, extended and medially rotated

Question 51

Klumpke's palsy

Answer 51

lower brachial plexus injury

Question 52

Nursemaids elbow

Answer 52

subluxation of the radial head

Question 53

Colles fracture

Answer 53

extension fracture of the radius (dinner fork)

Question 54

Smith fracture

Answer 54

flexion fracture of the radius

Question 55

nightstick fracture

Answer 55

ulna fracture

Question 56

scaphoid fracture

Answer 56

significant because of the limited blood supply

Question 57

carpal tunnel syndrome

Answer 57

compression of the median nerve, from inflammation of flexor tendons of digits