LE Clinical Notes

Question 1

Avulsion fractures of the __ ___ and ____ may occur as a result of sudden acceleration or deceleration

Answer 1

Hip bone and femur

Question 2

“Hip fractures” generally erroneously refer to fracture of the ___ ___

Answer 2

Femoral neck

Question 3

Increase in the angle of inclination of the femur is a condition known as ___ ___

Answer 3

Coxa Valga

Question 4

Decrease in the angle of inclination of the femur is a condition known as __ __

Answer 4

Coxa Varus

Question 5

Dislocation of the ___ of the __ __ typically occurs in older children and adolescents as a result of excessive shearing force on the ___ __ associated with the ___ ___

Answer 5

• Epiphysis of the femoral head
• Epiphyseal Plate associated with the femoral head

Question 6

Femoral fractures typically occur at the __ __ and the ___ of the femur despite the size and strength of the bone. Multiple varieties of femoral fractures can occur

Answer 6

Proximal end and body

Question 7

Overstressing the knee or a blow to the patella can result in ____ ____ (also known as __ ___ ), and results in soreness and aching around or deep to the patella.

Answer 7

Chondromalacia patella (runner’s knee)

Question 8

The patella ossifies between the __ and __ year of life. Occasionally the patella will fail to ossify into a single bone resulting in a ___ or ___ patella, which can be confused for a fracture patella on a radiograph

Answer 8

• 3rd and 6th
• Bipartite or Tripartite

Question 9

___ fractures may result from a variety of injuries: being hit by the bumper of a car (“___” fracture), excessive hiking (“___” fracture), extreme force (“___” fracture), and skiing falls (“__” fracture)

Answer 9

• Tibial
• Bumper
• March
• Diagonal
• Boot-top

Question 10

Fractures involving the ___ ___ can lead to a condition known as ____-___ disease, resulting in pain and an overly pronounced tibial tuberosity. (Common injury in children experiencing a growth spurt)

Answer 10

• Epiphyseal Plate
• Osgood-Schatter

Question 11

___ fractures are often the result of inversion and eversion injuries that lead to the ___ of the medial and lateral malleoli.

Answer 11

• Fibular
• Avulsion

Question 12

__ ___ ___ are common because the ___ is not primarily weight-bearing and is well vascularized so it can be harvested and used to replace bones that have experienced a debilitating injury

Answer 12

• Fibula Bone Grafts
• Fibula

Question 13

Fractures of the ___ ___ may result from extreme dorsiflexion as one might experience by pressing extremely hard on the brake pedal of a vehicle during a collision

Answer 13

Talar Neck

Question 14

A secondary ossification site exists between the __ ___ and the rest of the ___. Occasionally (14-25% of the time) the ___ __ will not properly untie with the ___, resulting in a loose bone posterior to the ___ called an os trigonum

Answer 14

• Lateral Tubercle
• Talus
• Lateral Tubercle
• Talus

Question 15

____ fractures may occur as a result of a hard fall onto the heel. These fractures are usually debilitating due to the disruption of the ____ Joint.

Answer 15

• Calcaneal
• Talocalcaneal

Question 16

Fractures of the __ bones can occur for a variety of reasons: a heavy object falling on the foot (__-___ fractures), losing one’s balance and putting the full body weight on the ___ (“dancer’s fracture), avulsion of the base of the __th ___ from rolling one’s ankle and fatigue fractures from prolonged walking.

Answer 16

• Metatarsals
• Blunt-force
• Metatarsals
• 5th Metatarsal

Question 17

A medial angulation of the leg and decreased Q-angle resulting from an unusually vertical femur is known as ___ __ or “___”

Answer 17

Genu Varum (Bowleg)

Question 18

Lateral angulation of the leg and increased Q-angle is known as __ __ or “__-__”

Answer 18

Genu Valgum (Knock-Knee)

Question 19

___ __ are abnormal herniations of the synovial membrane into the popliteal fossa

Answer 19

Popliteal Cysts

Question 20

___ of the hip joint can be severe enough to warrant replacing the __ __ and ___ with metal prosthesis, a procedure known as surgical hip replacement

Answer 20

• Osteoarthritis
• Proximal Femur and Acetabulum

Question 21

____ ___ of the hip is fairly common, with females being affected nearly eight times more than males. Acquired dislocation of the hip is uncommon given the stability of the joint, but can occur usually as a result of an automobile injury where the knee hits the dashboard and forces the ___ ___ out of the ___ posteriorly, rupturing the joint capsule.

Answer 21

• Congenital Dislocation
• Femoral Head
• Acetabulum

Question 22

The ___ Bursa and the ___ Bursa are susceptible to bursitis. ___ Bursa is a frictional bursitis that results from repeated stress such as cycling, pain is localized over the bursa and increases with movement of the ___ ___ muscle. ___ Bursitis is also a frictional bursitis that results from repeated activity like climbing stairs, pain is deep and diffuse and extends down the lateral thigh.

Answer 22

• Ischial
• Trochanteric
• Ischial
• Gluteus Maximus
• Trochanteric

Question 23

___ of the knee joint can be severe enough to warrant replacement of the ___ ___ and __ __ with corresponding metal and plastic prosthesis, a procedure known as Total Knee Replacement Arthroplasty.

Answer 23

• Osteoarthritis
• Distal Femur
• Proximal Tibia

Question 24

Tapping the __ Ligament (tendon) with a reflex hammer elicits contraction of the ___ __ muscles resulting in a brief extension of the leg at the knee. Failure of this response could suggest peripheral nerve injury to the ___ muscles.

Answer 24

• Patellar
• Quadriceps Femoral
• Quadriceps

*Tests L2, L3, and L4 segments of the spinal cord; esp L4

Question 25

Excessive running can produce a pain deep to the ___ that results from abnormal tracking of the ___ relative to the __ __ of the femur, and is known as ____ Syndrome or "___ knee".

Answer 25

- Patella - Patella - Patellar Surface - Patellofemoral - "Runners knee"

Question 26

Patellar dislocation typically occurs ___ due to the shape of the distal end of the femur, the angle of pull of the quadriceps musculature and the angle of the femur relative to the patella.

Answer 26

Laterally

Question 27

The ___ ___ __ is susceptible to tear and strain when the knee is extended and the foot is immobile. Because of its attachment to the __ __ it is likely to tear as well.

Answer 27

- Tibial Collateral Ligament - Medial Meniscus

Question 28

The __ ___ ___ is also susceptible to injury if the Tibia is forced ___ while flexed on the femur, such as in an automobile accident or when locking the knee.

Answer 28

- Posterior Cruciate Ligament - Posteriorly

Question 29

Blunt trauma or excessive friction between the skin and prepatellar bursa can produce ___ ___ or "___ ___"

Answer 29

Prepatellar Bursitis (Housemaids Knee)

Question 30

Excessive friction between the Tibial Tuberosity and the skin can produce ____ ____ ___ or "____ ___".

Answer 30

Subcutaneous Infrapatellar Bursitis (Clergyman's Knee)

Question 31

Sprains

Answer 31

torn fibers of a ligament

Question 32

Strains

Answer 32

torn fibers of a muscle

Question 33

Ankle sprains are almost always the result of excessive inversion of the ___ Joint, resulting in tearing of the ___ __ ligament and the ___ ___ ligament, and in extreme cases can involve tearing of the ____ ligament and avulsion of the ___ ___.

Answer 33

- Talocrural - Lateral Collateral - Anterior Talofibular - Calcaneofibular - Lateral Malleolus * LCL consists of the Posterior Talofibular L, Anterior Talofibular L, and the Calcaneofibular L

Question 34

Forced eversion of the ____ Joint can result in Pott Fracture-dislocation of the ankle, including avulsion of the __ __, fracturing of the __ __ and tearing of the ___ ___ ligament.

Answer 34

- Talocrural - Medial Malleolus - Distal Fibula - Anterior Tibiofibular

Question 35

The Clinical Subtalar Joint includes the ____ Joint in conjunction with the anatomical ___ (___) joint which is appropriate since the two joints are incapable of moving independent of each other.

Answer 35

- Talocalcaneonavicular - Subtalar (Talocalcaneal)

Question 36

___ (__) is a congenital condition that refers to a foot that is inverted with a plantarflexed ankle. There are multiple varieties of ___ and it is typically corrected early in the child's life.

Answer 36

- Talipes (Clubfoot) - Clubfoot

Question 37

The absence of the Longitudinal Arch can manifest in 3 ways: ___ __ __ (___), ___ __, and ___ ___.

Answer 37

Flexible Pes Planus (Flatfeet), Rigid Flatfeed, Acquired Flatfeet

Question 38

___ flatfeet appear normal when not bearing weight but flat when bearing weight, and is common in children but usually resolves by adulthood

Answer 38

Flexible Flatfeet

Question 39

___ flatfeet are flat even when not bearing weight and usually are the result of a bone deformity

Answer 39

Rigid Flatfeet

Question 40

___ Flatfeet (___ __) are usually secondary to some injury to the Tibialis Posterior muscle.

Answer 40

Acquired Flatfeet (Fallen Arches)

Question 41

___ __ (__-__) refers to feet that have exaggerated longitudinal arches as a result of ligamentous or muscular contributions.

Answer 41

Pex Cavus (High-Arches)

Question 42

Lateral deviation of the distal aspect of the __st ___ caused by poor footwear and degenerative joint disease is called ___ __ and is often accompanied by tender inflamed subcutaneous bursa called a ___.

Answer 42

- 1st Metatarsal - Hallux Valgus - Bunion

Question 43

Permanent dorsiflexion of the proximal phalanx at the metatarsophalangeal joint in conjunction with a strong plantar flexion of the proximal interphalangeal joint is a condition known as:

Answer 43

Hammer Toe

Question 44

Dorsiflexion of the proximal phalanges of the lateral four toes in conjunction with flexion of all the interphalangeal joints is a condition known as:

Answer 44

Claw Toes

Question 45

If only the Distal interphalangeal joint is plantarflexed this is known as:

Answer 45

Mallet Toe

Question 46

___ __ is herniation of abdominal wall or intestine through the femoral ring into the femoral canal, it appears as a tender mass over the ___ __ on the __ __.

Answer 46

- Femoral Hernia - Femoral Triangle - Anterior thigh

Question 47

The compartments of the leg are typically closed systems, therefore the accumulation of pus or inflammation of the musculature combined with very strong fascia surrounding the structures can compress the musculature and the vasculature leading to __ __. This is typically treated with a ___.

Answer 47

- Compartment Syndrome - Fasciotomy

Question 48

Strain or inflammation of the ___ ___ is called Plantar Fascitis, often a result of running with improper footwear. Pain is produced in the heel and medial aspect of the plantar foot when first walking after a period of rest.

Answer 48

Plantar Aponeurosis

Question 49

Contusion of the Iliac Crest as the result of collision can result in avulsion of the ___ and __ __ muscles from the ___ __ spines. Contusions of the __ __ musculature can also result from these collision injuries that can result in the formation of a _____.

Answer 49

- Sartorius - Rectus Femoris - Anterior Iliac - Anterior Thigh - Hematoma

Question 50

Paralysis of the __ results in the inability to extend at the knee against resistance and can be the result of weakness of the Vastus ___ and ___ muscles due to arthritis or trauma to the knee.

Answer 50

- Quadriceps - Vastus Medialis and Lateralis

Question 51

Due to the excessive adduction of horseback riders to keep from falling off of the horse, the __ __ muscle can strain. This is referred to as the "___ ___". This condition can progress to ossification of the ___ ___ resulting in "___ ___".

Answer 51

- Adductor Longus - "Riders Strain" - Adductor tendons - "Riders Bones"

Question 52

Straining, stretching or tearing of the ___ attachment of either the main ___ __ or ___ __ is often referred to as a "Groin pull".

Answer 52

- Proximal - Thigh Flexors - Thigh Adductors

Question 53

Since the ___ muscle is a relatively weak member of the Adductor musculature it can be harvested with little effect on the LE. Transplantation of the whole or part of the muscle and its neurovasculature has been performed to restore flexion and extension in the extremities, muscles of facial expression, and the external anal sphincter muscle.

Answer 53

Gracilis

Question 54

Strains to the muscles of the posterior thigh ("___ ___") usually involve contusion and tearing of the muscle fibers. Avulsion of the ___ __ occurs when a small piece of bone is avulsed away from the ___ __ with the tendon of the __ ___ of the Biceps Femoris M, ___ M, or __ M.

Answer 54

- Hamstring Strains - Ischial Tuberosity - Ischial Tuberosity - Long Head - Semitendinosus - Semimembranosus

Question 55

Tibialis Anterior Strain (Shin Splints) is the result of repetitive trauma to the __ __ muscle, causing tears in the ___ of the ___ and/or ___ ___ of the leg, usually brought about by overexertion by sedentary individuals.

Answer 55

- Tibialis Anterior - Periosteum of the Tibia - Deep Fascia

Question 56

Overstretching the ___ ___ of the ___ muscle can result in tearing of that muscle, this condition is known as Gastrocnemius Strain or "__ __".

Answer 56

- Medial Head of the Gastrocnemius - "Tennis Leg"

Question 57

Running injuries can inflame the Calcaneal tendon producing ___ ___, further aggravation of this condition can result in a ___ ___ ___.

Answer 57

- Calcaneal Tendonitis - Ruptured Calcaneal Tendon

Question 58

Infections of the ___ are more common in cultures where shoes are not worn. Puncture wounds can lead to infections in the ___ __, typically between layers of the foot musculature.

Answer 58

- Foot - Deep Foot

Question 59

Approximately 20% of the time a branch of the ___ ___ artery can travel over the superior pubic ramus to join an existing or completely replace the __ artery.

Answer 59

- Inferior Epigastric - Obturator

Question 60

The superficial position of the __ artery makes it readily accessible and useful for clinical procedures.

Answer 60

Femoral

Question 61

Compression of the ___ artery immediately distal to the __ ligament can reduce the flow of blood into the LE. The __ artery can also be cannulated at this location for cardiac procedures.

Answer 61

- Femoral - Inguinal - Femoral

Question 62

The superficial position of the __ artery makes it vulnerable to traumatic injury, especially laceration. When the __ artery is ligated the rest of the LE may still receive blood due to extensive anastomoses with other vessels crossing the hip joint.

Answer 62

- Femoral - Femoral

Question 63

The ___ artery is capable of aneurysm, which can result in edema, pain, or even compression of the ___ nerve in the popliteal fossa.

Answer 63

- Popliteal - Tibial

Question 64

The pulse of the ___ __ artery is usually palpated bilaterally during a physical exam to evaluate the peripheral vascular system.

Answer 64

Dorsalis Pedis

Question 65

The pulse of the __ __ artery is usually palpated bilaterally, posterior to the medial malleolus during physical exam to evaluate the peripheral vascular system.

Answer 65

Posterior Tibial

Question 66

The __ ___ vein and its tributaries are prone to becoming varicose, which means the valves that normally prevent blood from flowing in the wrong direction fail, resulting in enlarged, tortuous superficial veins that can cause discomfort.

Answer 66

Great Saphenous

Question 67

The veins of the LE are prone to formation of ___ (__ ___) following a bone fracture or as a result of venous stasis (stagnation) which can be the result of immobility of a limb.

Answer 67

- Clots - Venous Thromboses

Question 68

Venous Thrombophlebitis: Inflammation surrounding a __ ___ can cause the clot to break free of the vein and travel to the lungs causing a __ ___

Answer 68

- Venous Thrombosis - Pulmonary Embolism

Question 69

The ___ __ vein is often used in coronary artery bypasss grafts given its accessibility, its distance between communicating branches, and the greater presence of muscular and elastic fibers in the wall compared to other superficial veins. The large number of deep veins in the LE compensates for the loss of the ___ __ vein.

Answer 69

- Great Saphenous - Great Saphenous

Question 70

What vein can be used to insert a cannula for the administration of blood and medication due to its size and positional reliability?

Answer 70

Great Saphenous Vein (the process is often called Saphenous Cutdown)

Question 71

____ ___: A localized dilation of the Great Saphenous Vein in the femoral triangle that can lead to edema in the femoral triangle and be confused for Psoas Abscess or femoral hernia

Answer 71

Saphenous Varix

Question 72

What is a Saphenous Varix often confused for?

Answer 72

Psoas Abscess or Femoral Hernia

Question 73

A long catheter can be inserted into the ___ vein and guided to the right side of the heart for diagnostic purposes.

Answer 73

Femoral Vein (the process is often called Cannulation of the Femoral Vein)

Question 74

Enlarged ___ ___ __: Infections, minor sepsis, and abrasions can cause lymphadenopathy here. The superficial nature of the __ __ __ make them a good diagnostic tool for the lower trunk, perineum, LE as well as __ cancer in females.

Answer 74

- Inguinal Lymph Nodes - Inguinal Lymph Nodes - Uterine

Question 75

Regional Anesthetic Nerve Blocks of the LE: The __ and ___ nerves can be blocked with a local anesthetic injection near the Anterior Superior Iliac Spine. The ___ nerve can be blocked with an anesthetic injection in the ___ ___. This can result in paresthesia all the way down the medial leg if the ___ nerve is affected.

Answer 75

- Ilioinguinal and Iliohypogastric - Femoral - Femoral Triangle - Saphenous

Question 76

Variations of the __ nerves are common, whereby the ___ and ___ nerves originate as a common trunk. Furthermore, if the cutaneous branch of the ___ nerve is variably large, then the anterior femoral cutaneous nerve will be correspondingly small.

Answer 76

- Cutaneous - Ilioinguinal and Iliohypogastric - Obturator

Question 77

Injury to the ___ __ nerve results in motor loss to the gluteus medius and minimus muscles. When a patient is asked to stand on one leg the pelvis tilts away from the unsupported side, this is clinically referred to as a positive ___ test. (positive test is one in which the pelvis drops on the contralateral side during a single leg stand on the affected side)

Answer 77

- Superior Gluteal - Trendelenburg

Question 78

Anesthetic block of the ___ nerve can be achieved with an anesthetic injection near the Posterior Superior Iliac Spine. Paresthesia radiates all the way down to the __ foot.

Answer 78

- Sciatic - Plantar

Question 79

Pain in the gluteal region may result from compression of the ____ nerve by the ____ muscle, a condition known as ___ ___. Athletes that repeatedly use the gluteal muscles are predisposed to this condition. 50% of cases indicated trauma to the buttocks. 12% of cases show that the ____ ___ nerve passes through the Piriformis muscle.

Answer 79

- Sciatic - Piriformis - Piriformis Syndrome - Common Fibular

Question 80

___ Injection: The ___ region is a common site for intramuscular injection because of the large thick nature of the musculature. A safe zone can be determined by characteristically placing the hand over the injection site.

Answer 80

- Intragluteal - Gluteal

Question 81

Injury to the __ nerve rarely occurs due to its deep location in the posterior leg, but can occur as a result of deep lacerations, tibial fxs, and extreme dislocation of the knee. The result is a loss of the ability to ____.

Answer 81

- Tibial - Plantarflex

Question 82

___ Nerve Grafts: The __ nerve can be harvested and grafted to repair a nerve deficit.

Answer 82

- Sural - Sural

Question 83

Compression of the ___ ___ nerve as it passes under the flexor retinaculum can cause pain and numbness on the __ aspect of the plantar foot. This condition is called ___ ___ Nerve Entrapment and due to its frequency in runners it is sometimes called "___ ___".

Answer 83

- Medial Plantar - Medial - Medial Plantar - Joggers Foot

Question 84

Firmly stroking the __ surface of the foot with a blunt object should result in flexion of the toes, which is called the __ Reflex. If this test results in fanning and extension of the toes, it is called a ____ ___ and is indicative of brain injury or cerebral disease.

Answer 84

- Plantar - Plantar - Babinski Sign

Question 85

Injury to the ___ ___ nerve is common due to its superficial course around the fibular neck. Injury can result in paralysis of the muscles of the anterior and lateral compartments of the leg producing "___".

Answer 85

- Common Fibular - "Footdrop"

Question 86

Compression of the ___ __ nerve as it passes under the inferior extensor retinaculum can result from muscular edema and injury. Compression of this nerve is known as ___ ___ ___ ___. This condition will produce pain on the dorsum of the foot that radiates to the 1st interdigital space. Since ski boots and tight-fitting shoes are often a cause of this disorder, it is sometimes called "___ ___ ___".

Answer 86

- Deep Fibular - Deep Fibular Nerve Entrapment - "Ski Boot Syndrome"

Question 87

Where is pain located when someone has a compressed deep fibular nerve? Where does this pain radiate to?

Answer 87

Pain on the dorsum of the foot that radiates to the 1st interdigital space

Question 88

___ ___ ___ ___: This condition can result from the stretching of the ___ ___ nerve due to chronic ankle sprains. This can lead to pain and paresthesia along the lateral leg and dorsal lateral foot.

Answer 88

- Superficial Fibular Nerve Entrapment - Superficial Fibular

Question 89

Where does a person experience pain/paresthesia if they have Superficial Fibular Nerve Entrapment?

Answer 89

Along the lateral leg and dorsal lateral foot

Question 90

The __ ___ Ligament is susceptible to injury because it is a pivot for rotation of the knee. Injury to this ligament in conjugation with tearing of the ___ __ ligament and ___ ___ is often referred to as the "unhappy triad" of knee injuries.

Answer 90

- Anterior Cruciate - Tibial Collateral - Medial Meniscus

Question 91

Meralgia paresthetica is a condition characterized by tingling, numbness, and burning pain in your outer/lateral thigh. It's caused by compression of the ___ ___ ___ nerve, which often happens in individuals who carry a heavy toolbelt around their waist.

Answer 91

Lateral Femoral Cutaneous