The Quizzes about Musculoskeletal Injuries

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Musculoskeletal Injuries

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Question 1

A 47-year-old man presents to the ED complaining of knee pain after slipping on ice on his way to On examination, you note significant swelling to his knee and palpate a large effusion. The patient has limited range of motion because of the swelling. You perform a palliative arthro- centesis and note blood and fat globules in the syringe. Which of the fol- lowing findings is the presence of fat globules most suggestive of?

A	ACL tear
B	PCL tear
C	Medial meniscus tear
D	Fracture
E	Vascular injury

Question 1 Explanation:

Frequently, there is a fracture to account for the presence of fat within the joint because the fat has entered from the bone marrow cavity. The presence of fat globules may be seen in the joint aspirate and even on the radiograph of the knee showing a joint effusion with a fat-fluid level. (a and b) Cruciate ligament tears are associated with early hemarthrosis. (c) Meniscal tears are associated with effusions that develop gradually over 6 to 24 hours postinjury. (e) Vascular injuries of the knee occur with fractures and dislocations and are a medical emergency.

Question 2

A 76-year-old woman is brought into the ED complaining of hip pain after a motor vehicle She states that her knee slammed into the dashboard after her car struck another vehicle. On examination you note her right leg appears shortened, adducted, internally rotated, and flexed. She has no other injuries. The radiograph of her hip confirms your diag- nosis of a hip dislocation. Which of the following statements regarding this type of injury is true?

A	The most common presentation of this injury is an abducted, externally rotated, and flexed lower extremity.
B	This type of injury accounts for 5% to 10% of all hip dislocations.
C	The injury is commonly caused by a direct force applied to a flexed knee.
D	The most common complication is injury to the femoral artery.
E	The femoral nerve is almost always injured in this type of dislocation.

Question 2 Explanation:

The patient sustained a posterior hip dislocation. The most common mechanism for this to occur is during a motor vehicle collision in which a direct force is applied to the flexed knee (eg, the patient’s knee hits the dashboard at high velocity). The limb appears shortened, adducted, internally rotated, and flexed. Because of the strong forces needed to cause such an injury, hip dislocations rarely occur in isolation. Life-threatening injuries should always be addressed first, prior to treating hip dislocations. Nonetheless, early reduction is required because the likelihood of avascular necrosis of the femoral head increases in direct proportion to a delay in reduction. Early complications of posterior dislocations include sciatic nerve injury. Late complications include avascular necrosis of the femoral head, as mentioned above. (a) This is the most common presentation of an anterior hip dislocation. (b) Posterior hip dislocations account for approximately 80% of hip dislocations. (d) The most common complication is avascular necrosis. (e) The sciatic nerve is at risk for injury.

Question 3

A 33-year-old carpenter was working on a construction project to build a new When using a high-pressure paint gun, he inadver- tently injected his left index finger. On arrival to the ED, he complains of intense hand pain. On examination, you note a 2-mm wound over the second proximal phalange. He has full range of motion and brisk capillary refill. Radiographs of the finger show soft tissue swelling, a small amount of subcutaneous air, but no fracture. His tetanus is up to date. Which of the following is the most appropriate disposition for this patient?

A	Place the hand in a radial gutter splint and have the patient follow up with an orthopedic surgeon in 1 week.
B	Discharge home with pain medication and have the patient return for repeat radiographs in 1 week.
C	Order a CT scan of the finger to confirm that there is no occult fracture before discharging the patient home.
D	Place the hand in a radial gutter splint, prescribe a 10-day course of antibiotics, and have the patient follow up with an orthopedic surgeon in 1 week.
E	Place the hand in a radial gutter splint, administer broad-spectrum antibiotics, and admit the orthopedic service for operative debridement.

Question 3 Explanation:

The patient sustained a high-pressure injection injury of his finger—this is a surgical emergency. These injuries may involve extensive tissue loss and are associated with a high infection rate. Most of these injuries involve grease, paint, or other industrial toxins. Paint generates a large, early inflammatory response, resulting in a high percentage of amputations. Within several hours after the digit has been injected, the extremity becomes painful and swollen. Initially, there may be anesthesia and even vascular insufficiency of the extremity. In the late stages, marked breakdown of the skin occurs, resulting in ulcers and draining sinuses. If the material injected into the extremity is radiopaque, it is possible to determine its degree of spread.Musculoskeletal Injuries Answers 315 Management involves splinting and elevating the extremity, administration of antibiotics, tetanus prophylaxis updated as indicated, analgesia, and immediate orthopedic consultation.

Question 4

A 29-year-old man is 10 ft up on a ladder, painting his barn ceiling when he loses his balance and falls off the ladder, landing on both of his feet and then falling to the He is brought to the ED by emergency medical services (EMS). On examination there are no obvious deformities, but you note swelling, tenderness, and ecchymosis of the right hindfoot. He has full range of motion at the ankle, knee, and hip. There is mild ten- derness over his lumbar spine. Hs neurovascular status is normal. Radio- graphs confirm the diagnosis. Which of the following statements regarding this type of injury is true?

A	This injury is the second most commonly fractured tarsal bone.
B	10% are associated with compression fractures of the dorsolumbar spine.
C	90% are bilateral.
D	The mechanism of injury is usually secondary to rotational force at the subtalar joint.
E	These fractures require operative repair to avoid gait defects.

Question 4 Explanation:

This individual sustained a calcaneal fracture of the right foot. The calcaneus is the most commonly fractured tarsal bone (a); the talus is the second most commonly injured tarsal bone. A calcaneal fracture is usually caused by a compression injury (d), such as a fall from a height with the patient landing on his or her feet. The examination reveals swelling, tenderness, and ecchymosis of the hindfoot and the inability to bear weight on the fracture. Ten percent are bilateral (c) and 10% are associated with compression fractures of the dorsolumbar spine. Therefore, it is important to examine the patient’s entire spine. Treatment varies depending on the extent of injury. In general, nondisplaced or minor extra-articular fractures only require supportive care with immobilization in a posterior splint and follow-up with an orthopedic surgeon (e). The management of intra-articular or displaced calcaneal fractures remains controversial regarding nonoperative versus immediate surgical reduction.

Question 5

A 39-year-old woman is brought to the ED by EMS on a backboard and cervical collar after being involved in a motor vehicle The primary survey is unremarkable. However, the secondary survey reveals a deformity of the right arm involving the upper arm and elbow. Which of the following associations are paired incorrectly?

A	Olecranon fracture and ulnar nerve injury
B	Posterior elbow dislocation and ulnar and median nerve injury
C	Anterior elbow dislocation and brachial artery injury
D	Supracondylar fracture and brachial artery and median nerve injury
E	Humeral shaft fracture and axillary nerve injury

Question 5 Explanation:

Humeral shaft fractures most commonly occur from a direct blow to the mid-upper arm. The fracture usually involves the middle third of the humeral shaft. The most common associated injury is damage to the radial nerve that causes wrist drop and loss of sensation in the first dorsal web space. Ulnar and median nerve injuries may also occur but are much less common. Olecranon fractures (a) are associated with injury to the ulnar nerve. Individuals may experience paresthesias and numbness in the ulnar nerve distribution or weakness of the interossei muscles. Posterior elbow dislocations (b) are associated with injuries to the ulnar and median nerves. Anterior elbow dislocations (c), although uncommon, have a much higher incidence of vascular injuries than posterior dislocations. It is important to evaluate for a brachial artery injury. Supracondylar fractures (d), common in young individuals, are associated with injuries to the brachial artery and median nerve as the distal humeral fragment is displaced posteriorly, thus placing the sharp fracture fragments anteriorly.

Question 6

A 31-year-old man is riding his mountain bicycle down a steep hill when he hits a rock in the path and is thrown off the In the ED, the individual complains only of left arm pain. Your primary survey is unremarkable. After administering medication for pain control, you send the patient for a radiograph of his arm. Which of the following injuries is consistent with this patient’s radiograph as seen below?

A	Monteggia fracture
B	Galeazzi fracture
C	Nightstick fracture
D	Colles fracture
E	Smith fracture

Question 6 Explanation:

The patient has a herpetic whitlow, a viral infection of the distal finger. It is caused by the herpes simplex virus type I or II. This condition typically occurs in health care providers with exposure to oral secretions and in patients with coexistent herpes infections. It generally presents with a prodrome period of fever and malaise. Subsequently, there is localized burning, itching, and pain that precede the development of the classic clear herpetic vesicles. Typically, only one finger is involved. The diagnosis is usually made clinically, but, if doubt remains or if the presentation is atypical, it can be confirmed with a Tzanck smear or viral culture. When managing this condition, it is important to note that surgical drainage is contraindicated. It can result in secondary infection and delayed healing. All of the other answer choices (b, c, d, and e) are acceptable management options.

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II. Preview all questions below

1. A 47-year-old man presents to the ED complaining of knee pain after slipping on ice on his way to On examination, you note significant swelling to his knee and palpate a large effusion. The patient has limited range of motion because of the swelling. You perform a palliative arthro- centesis and note blood and fat globules in the syringe. Which of the fol- lowing findings is the presence of fat globules most suggestive of?

ACL tear
PCL tear
Medial meniscus tear
Fracture
Vascular injury

2. A 76-year-old woman is brought into the ED complaining of hip pain after a motor vehicle She states that her knee slammed into the dashboard after her car struck another vehicle. On examination you note her right leg appears shortened, adducted, internally rotated, and flexed. She has no other injuries. The radiograph of her hip confirms your diag- nosis of a hip dislocation. Which of the following statements regarding this type of injury is true?

The most common presentation of this injury is an abducted, externally rotated, and flexed lower extremity.
This type of injury accounts for 5% to 10% of all hip dislocations.
The injury is commonly caused by a direct force applied to a flexed knee.
The most common complication is injury to the femoral artery.
The femoral nerve is almost always injured in this type of dislocation.

3. A 33-year-old carpenter was working on a construction project to build a new When using a high-pressure paint gun, he inadver- tently injected his left index finger. On arrival to the ED, he complains of intense hand pain. On examination, you note a 2-mm wound over the second proximal phalange. He has full range of motion and brisk capillary refill. Radiographs of the finger show soft tissue swelling, a small amount of subcutaneous air, but no fracture. His tetanus is up to date. Which of the following is the most appropriate disposition for this patient?

Place the hand in a radial gutter splint and have the patient follow up with an orthopedic surgeon in 1 week.
Discharge home with pain medication and have the patient return for repeat radiographs in 1 week.
Order a CT scan of the finger to confirm that there is no occult fracture before discharging the patient home.
Place the hand in a radial gutter splint, prescribe a 10-day course of antibiotics, and have the patient follow up with an orthopedic surgeon in 1 week.
Place the hand in a radial gutter splint, administer broad-spectrum antibiotics, and admit the orthopedic service for operative debridement.

4. A 29-year-old man is 10 ft up on a ladder, painting his barn ceiling when he loses his balance and falls off the ladder, landing on both of his feet and then falling to the He is brought to the ED by emergency medical services (EMS). On examination there are no obvious deformities, but you note swelling, tenderness, and ecchymosis of the right hindfoot. He has full range of motion at the ankle, knee, and hip. There is mild ten- derness over his lumbar spine. Hs neurovascular status is normal. Radio- graphs confirm the diagnosis. Which of the following statements regarding this type of injury is true?

This injury is the second most commonly fractured tarsal bone.
10% are associated with compression fractures of the dorsolumbar spine.
90% are bilateral.
The mechanism of injury is usually secondary to rotational force at the subtalar joint.
These fractures require operative repair to avoid gait defects.

5. A 39-year-old woman is brought to the ED by EMS on a backboard and cervical collar after being involved in a motor vehicle The primary survey is unremarkable. However, the secondary survey reveals a deformity of the right arm involving the upper arm and elbow. Which of the following associations are paired incorrectly?

Olecranon fracture and ulnar nerve injury
Posterior elbow dislocation and ulnar and median nerve injury
Anterior elbow dislocation and brachial artery injury
Supracondylar fracture and brachial artery and median nerve injury
Humeral shaft fracture and axillary nerve injury

6. A 31-year-old man is riding his mountain bicycle down a steep hill when he hits a rock in the path and is thrown off the In the ED, the individual complains only of left arm pain. Your primary survey is unremarkable. After administering medication for pain control, you send the patient for a radiograph of his arm. Which of the following injuries is consistent with this patient’s radiograph as seen below?

Monteggia fracture
Galeazzi fracture
Nightstick fracture
Colles fracture
Smith fracture

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The Quizzes about Musculoskeletal Injuries

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Musculoskeletal Injuries

II. Preview all questions below

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