Extremities Red Flags

Question 1

positioning/purpose of the olecranon-manubrium percussion test

Answer 1

elbows flexed at 90 across the chest
stethoscope over manubrium
olecranon percussed

UE fx

Question 2

findings associated with radial head fx

Answer 2

elbow jt effusion
tender to palpation
elbow in loose packed position (70° flex and 10° supination)
restricted, painful supination/pronation

Question 3

what are the amsterdam wrist rules

Answer 3

determines a pt’s need for radiographs

Question 4

characteristics of a distal radius fx

Answer 4

increased age
swelling in wrist
visible deformation
painful to palpation
pain on ballottement test

Question 5

what decreases the likelihood of a distal radius fx

Answer 5

pain in ulnar deviation

Question 6

what is the ballottement test

Answer 6

stabilization of either the radius or ulna
moving the other bone

Question 7

what are characteristics of a wrist fx

Answer 7

increased age
male
swelling of wrist / snuffbox
tender palpation
pain on radial deviation

Question 8

carpal bone most often fx

Answer 8

scaphoid

Question 9

imaging for carpal bone fx

Answer 9

radiographs - can miss 5-20%
MRI - hidden fx or avascular necrosis
CT

Question 10

what is a big concern for scaphoid fxs

Answer 10

avascular necrosis due to the retrograde nature of blood supply

Question 11

who is most at risk for a pancoast tumor

Answer 11

males over 50 who smoke

Question 12

findings of a pancoast tumor

Answer 12

horner’s
shoulder/scapula pain
– may radiate into head, neck, chest
mimicking thoracic outlet syndrome
weakness/atrophy of hand muscle

Question 13

what can cause Horner’s syndrome

Answer 13

carotid artery dissection
pancoast tumor
cervical spine injury

Question 14

signs of horner’s

Answer 14

ptosis - drooped eyelid
miosis - pupil constriction
anhidrosis - no sweating
enophthalmos - sinking of eyeball

Question 16

what causes CRPS-1? what type of pain is present?

Answer 16

injury w/o nerve involvement
after MI, CVA, disease of abdominal or thoracic viscera
nocioceptive pain

Question 17

what causes CRPS-2? what type of pain will be present?

Answer 17

after injury with nerve involvement
neuropathic pain

Question 18

sensory changes associated with CRPS1

Answer 18

allodynia
hypo/hyperalgesia
hypo/hyperesthesia

Question 19

trophic changes from CRPS

Answer 19

changes to the
skin
hair
nail

Question 20

autonomic changes due to CRPS

Answer 20

swelling
edema
sweating

Question 21

motor changes due to CRPS

Answer 21

weakness
contractures
atrophy

Question 22

causes of acute compartment syndrome

Answer 22

trauma or exertional

Question 23

what can acute compartment syndrome lead to

Answer 23

permanent muscle / nerve damage

Question 24

findings of acute compartment syndrome

Answer 24

palpable tenderness/tension
severe pain out of proportion
paresthesia, paralysis, pulselessness
– more later

Question 25

history of septic arthritis

Answer 25

insidious onset of pain localized at a joint IV drug use / infection diabetes trauma

Question 26

findings of septic arthritis

Answer 26

tenderness over jt limited mvmt at jt swelling at jt fever

Question 27

symptoms of periprosthetic infection

Answer 27

local erythema intense, persistent pain non-healing incision sudden change in pain

Question 28

is a referral warranted for septic arthritis periprosthetic infection

Answer 28

yes - immediate

Question 29

what is the female athlete triad

Answer 29

changes in energy levels w or w/o ED changes in menstrual cycle osteoporosis

Question 30

history of femoral head osteonecrosis

Answer 30

long-term corticosteroid use hx of avascular necrosis in contra hip hx of trauma

Question 31

findings of femoral head osteonecrosis? what motions would be restricted?

Answer 31

gradual onset of pain that is worse with weight bearing restrictions of IR, Flex, add @ hip

Question 32

typical pt hx of femoral neck fx

Answer 32

older females (>70) female athletes

Question 33

findings of femoral neck fx

Answer 33

severe, constant pain / > mvmt stress fx displaced fx

Question 34

what would make you suspect a femoral neck fx to be a stress fx

Answer 34

- discomfort with hip A/PROM - pain with percussion over greater trochanter

Question 35

what would make you suspect a femoral neck fx to be a displaced fx

Answer 35

leg held in abduction and ER with shortening

Question 36

types of stress fx

Answer 36

insufficiency fx fatigue fx

Question 37

what is an insufficiency fx

Answer 37

abnormal bone broken under normal force

Question 38

what is a fatigue fx

Answer 38

normal bone put under extreme force

Question 39

difference in populations when comparing insufficiency and fatigue fx?

Answer 39

insufficiency - older people fatigue - those partaking in high intensity activities

Question 40

common sites for stress fx

Answer 40

tibia femur pelvis

Question 41

tests for femoral stress fx

Answer 41

fulcrum test patellar pubic percussion

Question 42

characteristics of legg-calve perthes disease

Answer 42

5-8 y/o male > female insidious onset of hip, groin, thigh pain antalgic gait decreased abduction, IR

Question 43

what causes legg-calve perthes

Answer 43

avascular necrosis

Question 44

characteristics of a SCFE

Answer 44

10-16 y/o male > female obese antalgic gait leg held in ER, prefer to sit with affected limb across the other

Question 45

what is SCFE

Answer 45

slipped capital femoral epiphysis

Question 46

what is a klein line

Answer 46

line drawn along the superior edge of femoral neck should intersect the lateral aspect of superior femoral epiphysis

Question 47

how does the energy of trauma effect imaging in those with pelvis/hip fx

Answer 47

high - CT low - routine radiograph with advanced imaging

Question 48

what are the names of the knee fx rules

Answer 48

ottawa pittsburgh

Question 49

ankle portion of the ottawa foot and ankle rules

Answer 49

bone tenderness at posterior edge of lateral and/or medial malleolus

Question 50

foot portion of the ottawa foot and ankle rules

Answer 50

bone tenderness at either: base of 5th metatarsal navicular

Question 51

what is used to assess DVT

Answer 51

Well's Test

Question 52

gold standard of DVT diagnosis

Answer 52

contrast venography