knee, foot, ankle ppt

Question 1

What type of joint is the knee?

Answer 1

hinge joint

Question 2

Genu varus
causes
normal?
Q angle

Answer 2

bow legs
blount’s disease, rickets, skeletal dysplasia, asymmetric growth due to trauma, infection, neoplasia
normal until age 2
decreased Q angle

Question 3

Genu valgum
causes
normal?
Q angle

Answer 3

knock knees
intrauterine molding, genetic, Cozen fracture, obesity, obesity, trauma
4-7 yo
increased Q angle

Question 4

anterior cruciate ligament injury/tear

causes

Answer 4

more common in females than males

noncontact sports

Question 5

PE findings ACL injury/tear

Answer 5

injury with popping sounds with subsequent pain and swelling at the knee, feeling instable
+ anterior drawer test and Lachman test

Question 6

imaging and treatment ACL injury/tear

Answer 6

MRI

RICE, physical therapy, surgery

Question 7

PCL injury/tear

cause

Answer 7

uncommon injury

combination with other bulk ligament injury due to trauma

Question 8

PE findings PCL injury/tear

Answer 8

setting of MVA with multiple injuries, complete dislocation of knee
+ posterior drawer test
+ sag sign

Question 9

imaging and treatment PCL injury

Answer 9

XR, MRI

RICE, hinge bracing immobilizer, PT, ortho referral

Question 10

medial collateral ligament injury

Answer 10

most common ligament injury

athletes in sports that involve sudden change in direction

Question 11

PE findings for MCL injury

Answer 11

pain and swelling of knee, laxity with valgus stress test

Question 12

treatment of MCL injury

Answer 12

RICE, PT

Question 13

LCL injury

causes

Answer 13

least common injury

joint struck from medial side (varus stress)

Question 14

PE findings for LCL injury

Answer 14

blow to medial or anteromedial aspect of leg with resulting lateral or posterolateral knee pain. swelling, locking, and knee giving out under stress.
+ varus test
+ posterior drawer test
+ dial test

Question 15

treatment for LCL injury

Answer 15

low grade: PT and crutches

high grade: immobilization

Question 16

meniscal injury

causes

Answer 16

common
twisting injuries (sports), chronic degenerative tears of meniscus or cartilage in older patients

Question 17

PE findings of meniscal injury

Answer 17

joint line tenderness, joint effusion/swelling, catching, pain with certain movements, inability to squat/kneel
+McMurray test
+ Apley grind test

Question 18

imaging and treatment of meniscal injury

Answer 18

XR, US, MRI

RICE, crutches, PT, ortho referral

Question 19

patellofemoral pain
other name
causes

Answer 19

Retropatellar pain syndrome, runner’s knee, lateral facet compression syndrome, idiopathic anterior knee pain
overuse disorder, biomechanical abnormalities, dynamic biomechanical abnormalities

Question 20

PE findings for patellofemoral pain

Answer 20

anterior knee pain around or behind patella, pain aggravated activity or weight bearing
+squatting
+ patellar glide

Question 21

treatment for patellofemoral pain

Answer 21

modify activity, NSAID, PT, steroids, biomechanical abnormality bracing and orthodontics

Question 22

What type of pain worsens as day progresses?

Answer 22

osteoarthritis

Question 23

Osgood schlatter
other name
causes

Answer 23

osteochondritis of tibial tubercle
repetitive strain and tearing of the secondary ossification center on tibial tubercle, over time causes callous that appears as swelling of the tibial tubercle where the patellar tendon inserts

Question 24

PE findings osgood schlatter

Answer 24

13-14 yo boy or 11-12 yo girl wtih pain and swelling of anterior knee
no imaging needed

Question 25

osgood schlatter treatment

Answer 25

self limiting NSAID PT

Question 26

Ottawa knee rules - radiograph after trauma

Answer 26

``` age 55 or older tenderness at head of fibula isolated tenderness of patella inability to flex 90 degrees inability to walk four weightbearing steps after injury or in ED ```

Question 27

Pittsburgh decision rules - blunt trauma or fall to knee

Answer 27

age younger than 12 yo or older than 50 yo | inability to walk 4 weight bearing steps in ED

Question 28

diabetic neuropathy test

Answer 28

pressure sensation using monofilament testing vibration sensation using tuning fork superficial pain using pinprick

Question 29

ankle sprain common ligaments risk factors/causes

Answer 29

one of the most common visit to PCP or ED calcaneofibular ligament, anterior talofibular ligament sports or nonsports related, female>male, children and adolescent>adult

Question 30

PE findings ankle sprain

Answer 30

tenderness, swelling, and ecchymosis of ankle mechanism of injury + anterior drawer test +inversion stress/talar tilt test

Question 31

treatment of ankle sprain

Answer 31

RICE, bear weight as tolerated, splint or bracing, NSAID, PT

Question 32

Ottawa ankle and foot rules

Answer 32

pt has pain in malleolar zone AND any of the following: inability to perform 4 weight bearing steps bone tenderness at posterior edge or tip of lateral malleolus bone tenderness of 5th metatarsal pain in midfoot zone AND any of the findings: bone tenderness at posterior edge or tip of medial malleolus bone tenderness at navicular bone inability to take 4 weight bearing steps

Question 33

syndesmotic ankle injury other name cause

Answer 33

high ankle sprain injury to one or more of the ligaments including the distal tibiofibular syndesmosis high intensity sports

Question 34

PE findings of syndesmotic ankle injury

Answer 34

tenderness, swelling, ecchymosis of ankle high impact injury mechanism + squeeze test

Question 35

imaging and treatment of syndesmotic ankle injury

Answer 35

XR, MRI | RICE, immobilization, rehab, surgery

Question 36

plantar fasciitis | causes

Answer 36

heel pain in adults | biomechanical overuse, flat feet, high arch, prolonged walking or standing on hard surface, excessive training

Question 37

PE findings plantar faciitis

Answer 37

plantar or calcaneal pain on walking or hard surfaces pain with first steps in the morning or after period of inactivity pain with passive dorsiflexion

Question 38

treatment of plantar faciitis

Answer 38

modify activity, orthodontics, exercises, steroid injections, surgery

Question 39

morton neuroma | causes

Answer 39

pain between the metatarsal heads from the plantar digital nerve, most commonly 3rd web space chronic trauma or repeated stress due to tight fitting shoes, high heels

Question 40

PE findings of morton neuroma

Answer 40

burning pain 3rd metatarsal space most common that radiates to toes numbness of toes + Mulder's sign

Question 41

gout | risk factors

Answer 41

precipitation of monosodium urate crystals in a joint space | genetics, age, sex, diet, trauma, foods

Question 42

PE findings of gout

Answer 42

swollen erythematous tender joint on exam (bedsheet cause extreme pain) serum uric acid levels >8

Question 43

tendinopathy PE findings and specialty tets

Answer 43

swelling, warmth, pain | +squeeze test (gastrocnemius m)

Question 44

hallux rigidus

Answer 44

stiffness of the great toe, most often due to osteoarthritis

Question 45

hallus valgus

Answer 45

valgus malformation of great toe

Question 46

plantar warts

Answer 46

plantar warts most often due to HPV1

Question 47

corns and calluses

Answer 47

caused by abnormal pressure over the skin and bony prominences from shoes on foot

Question 48

metatarsalgia

Answer 48

pain on plantar surface second and third metatarsal

Question 49

tinea pedis

Answer 49

fungal infection of the foot dry, scaling skin, itching treat - topical fungi creams

Question 50

onychomycosis

Answer 50

fungal infection of the nail thickened discolored nail oral antifungal meds