D'Antoni Case Studies- Lower Limb
A 22-year-old woman is admitted with high fever and vaginal discharge. Physical and laboratory examinations reveal gonorrheal infection. A series of intramuscular antibiotic injections are ordered. Into which of the following parts of the gluteal region should the antibiotic be injected to avoid nerve injury? A. Anterior and superior to a line between the posterior superior iliac spine and the greater trochanter B. In the middle of a line between the anterior superior iliac spine and the ischial tuberosity C. Inferolateral to a line between the posterior superior iliac spine and the greater trochanter D. Inferomedial to a line between the posterior superior iliac spine and the greater trochanter E. Halfway between the iliac tuberosity and the greater trochanter
A. Anterior and superior to a line between the posterior superior iliac spine and the greater trochanter
A 22-year-old male professional football player is admitted to the emergency department with acute right knee pain after sustaining a kick injury to an extended leg. A radiograph and a subsequent MRI revealed that the trauma caused anterior displacement of the tibia with respect to her femur. Which of the following ligaments was most likely injured? A. Fibular (lateral) collateral B. Tibial (medial) collateral C. Patellar D. Anterior cruciate E. Posterior cruciate F. Oblique popliteal
D. Anterior cruciate
In an accident during cleanup of an old residential area of the city, the Achilles tendon of a 32-year-old worker was cut through by the blade of a brush cutter. The patient is admitted to the hospital and a laceration of the Achilles tendon is diagnosed. Which of the following bones serves as an insertion for the Achilles tendon? A. Calcaneus B. Fibula C. Cuboid D. Talus E. Navicular
A. Calcaneus
A 55-year-old man visits the outpatient clinic complaining that he cannot walk more than 5 minutes without feeling severe pain in his feet. An image of the feet of this patient is shown in. What is the most common cause of this condition? A. Collapse of medial longitudinal arch, with eversion and abduction of the forefoot B. Exaggerated height of the medial longitudinal arch of the foot C. Collapse of long plantar ligament D. Collapse of deltoid ligament E. Collapse of plantar calcaneonavicular ligament
A. Collapse of medial longitudinal arch, with eversion and abduction of the forefoot
An 81-year-old man is admitted to the emergency department with severe pain in his knees. The patient has a long history of osteoarthritis. Radiologic examination reveals degeneration of the joints of his lower limbs. The degeneration is more severe on the medial side of the knees, which causes his knees to be bowed outward when he stands upright. Which of the following terms best describes the condition of his knees? A. Genu Varus B. Genu valgus C. Coxa Varus D. Coxa Valgus E. Hallus Valgus
A. Genu Varus
A lateral blow to the knee during a tackle in a football game injures a 24-year-old woman. Field examination reveals an "anterior drawer sign." An MRI demonstrates injury to several structures of the knee, including her medial meniscus. Which structure might also have been injured by the tackle? A. Medial collateral ligament B. Lateral collateral ligament C. Lateral meniscus D. Posterior cruciate ligament E. Tendon of the semitendinosus
A. Medial collateral ligament
A 55-year-old cowboy is admitted to the emergency department after he was knocked from his feet by a young longhorn steer. MRI examination reveals a large hematoma in the knee joint. Physical examination reveals that the patient suffers from the "unhappy triad" (of O'Donoghue). Which of the following structures are involved in such an injury? A. Medial collateral ligament, medial meniscus, and anterior cruciate ligament B. Lateral collateral ligament, lateral meniscus, and posterior cruciate ligament C. Medial collateral ligament, lateral meniscus, and anterior cruciate ligament D. Lateral collateral ligament, medial meniscus, and anterior cruciate ligament E. Medial collateral ligament, medial meniscus, and posterior cruciate ligament
A. Medial collateral ligament, medial meniscus, and anterior cruciate ligament
A 19-year-old football player was hit on the lateral side of his knee just as he put that foot on the ground. Unable to walk without assistance, he is taken to the hospital. An MRI examination reveals a torn medial collateral ligament. Which structure would most likely also be injured due to its attachment to this ligament? A. Medial meniscus B. Anterior cruciate ligament C. Lateral meniscus D. Posterior cruciate ligament E. Tendon of the semitendinosus less
A. Medial meniscus
A 37-year-old man is admitted to the hospital after an injury to his foot while playing flag football with friends on a Saturday morning. A series of radiographs demonstrates a fracture involving the talocrural (tibiotalar, ankle) joint. Which movements are the major ones to be affected by this injury? A. Plantar flexion and dorsiflexion B. Inversion and eversion C. Plantar flexion, dorsiflexion, inversion, and eversion D. Plantar flexion and inversion E. Dorsiflexion and eversion
A. Plantar flexion and dorsiflexion
A 69-year-old woman, who fell down the stairs, presents to the emergency department. Radiologic imaging reveals a fracture of the talocrural (tibiotalar) joint. Which movements take place at this joint? A. Plantar flexion and dorsiflexion B. Inversion and eversion C. Plantar flexion, dorsiflexion, inversion, and eversion D. Plantar flexion and inversion E. Dorsiflexion and eversion
A. Plantar flexion and dorsiflexion
A 58-year-old man visited his physician for his annual check-up. Physical examination reveals a hyper reflexive patellar reflex. Which muscle(s) contribute(s) to the tendon that is struck when testing this reflex? A. Quadriceps femoris B. Quadratus femoris C. Sartorius D. Pectineus E. Biceps femoris
A. Quadriceps femoris
A 43-year-old woman receives deep intramuscular injections for the past week for treatment of a sexually transmitted disease. She complains to her doctor that she has difficulty walking. During physical examination her right hip drops every time she raises her right foot. Which of the following injection locations will most likely correspond with the clinical presentation of this patient? A. Superomedial quadrant of the buttock B. Superolateral quadrant of the buttock C. Inferomedial quadrant of the buttock D. Inferolateral quadrant of the buttock E. Posterior thigh
A. Superomedial quadrant of the buttock
A 19-year-old patient is admitted to the orthopedic service with a complaint of severe pain in his very swollen and discolored foot. He states that he hurt the foot when jumping from his girlfriend's bedroom window to the concrete driveway below. Plain film radiographic studies reveal that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What would be the most likely, serious problem in such a case? A. Tearing of the plantar calcaneonavicular (spring) ligament B. Fracture of the cuboid bone C. Interruption of the plantar aponeurosis D. Sprain of the anterior talofibular ligament E. Disruption of the distal tibiofibular ligament
A. Tearing of the plantar calcaneonavicular (spring) ligament
A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiologic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What would be the most likely cause in this case? A. Tearing of the plantar calcaneonavicular (spring) ligament B. Fracture of the cuboid bone C. Interruption of the plantar aponeurosis D. Sprain of the anterior talofibular ligament E. Sprain of the deltoid ligament
A. Tearing of the plantar calcaneonavicular (spring) ligament
A 50-year-old man is admitted to the emergency department after a car crash. An MRI examination reveals an injured anterior cruciate ligament. Physical examination reveals a positive drawer sign. Which of the following signs is expected to be present during physical examination? A. The tibia can be slightly displaced anteriorly B. The tibia can be slightly displaced posteriorly C. The fibula can be slightly displaced posteriorly D. The fibula can be slightly displaced anteriorly E. The tibia and fibula can be slightly displaced anteriorly
A. The tibia can be slightly displaced anteriorly
During a football game a 21 year old wide receiver was illegally blocked by a linebacker, who threw himself against the posterolateral aspect of the rubber's left knee. As he lay on the ground, the wide receiver grasped his knee in obvious pain. Which of the following structures is frequently subject to injury from this type of force against the knee. A. Fibular collateral ligament B. Anterior cruciate ligament C. Lateral meniscus and posterior cruciate ligament D. Fibular collateral and posterior cruciate ligament E. All the ligaments of the knee will be affected
B. Anterior cruciate ligament
During a gymnastic session, a 24-year-old woman suddenly developed pain and swelling on the right buttock. This happened following a forceful thigh movement. There is severe weakness of right hip extension and knee flexion. Adduction of the thigh is also slightly weak. An avulsion fracture of the ischial tuberosity is found on a radiograph. Which of the following group of muscles has most likely involved in this process? A. Adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis B. Biceps femoris, semimembranosus, semitendinosus, and adductor magnus C. Iliacus and psoas major D. Gluteus medius and gluteus minimus E. Gluteus maximus and adductor magnus F. Iliacus, psoas major, rectus femoris and sartorius
B. Biceps femoris, semimembranosus, semitendinosus, and adductor magnus
A 16-year-old teenage girl suffered an inversion sprain of her ankle during dance class. Physical examination in the clinic most likely reveals severe tenderness over which ligament? A. Calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid
B. Calcaneofibular
A 22-year-old football player is admitted to the hospital with pain and swelling over the lateral aspect of the ankle. The emergency department doctor diagnoses an inversion sprain. Which ligament was most likely injured? A. Plantar calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid
B. Calcaneofibular
A 32-year-old male basketball player comes down hard on his ankle. He is admitted to the outpatient clinic, and radiologic examination reveals a Pott's fracture. What ligament is most likely injured? A. Calcaneofibular ligament B. Deltoid ligament C. Spring ligament D. Plantar ligament E. Long plantar ligament
B. Deltoid ligament
A 49-year-old male worker fell from a ladder, with his weight impacting on the heels of his feet. Radiologic examination reveals comminuted calcaneal fractures. After the injury the contraction of which one of the following muscles could most likely increase the pain in the injured foot? A. Flexor digitorum profundus B. Gastrocnemius C. Tibialis posterior D. Tibialis anterior E. Fibularis (peroneus) longus
B. Gastrocnemius
A 45 year old is admitted to the hospital after his left leg impacted a fence post when he was thrown form apowerful four-wheel all-terrain vehicle. Radiologic examination reveals posterior dispaclement of the tibia upon the femur. Which of the following structuers was most likely injured? A. Anterior cruciate ligament B. Posterior cruciate ligament C. Lateral collateral ligament D. Lateral meniscus ligament E. Patellar ligament
B. Posterior cruciate ligament
A 53-year-old woman reports difficulty in walking. Physical examination showed a positive Trendelenburg sign when she is asked to stand on her right leg. Which nerve has been compromised to produce the positive sign? A. Sciatic B. Right superior gluteal C. Left inferior gluteal D. Left superior gluteal E. Right inferior gluteal
B. Right superior gluteal
During an interview, a 30-year-old man who is a psychiatric patient suddenly becomes aggressive. In order to calm him down, the patient is given an intramuscular injection in the upper lateral quadrant of the buttock. The injection is given at this specific location to prevent damage to which of the following nerves? A. Lateral femoral cutaneous B. Sciatic C. Superior gluteal D. Obturator E. Inferior gluteal
B. Sciatic
A 5-month-old baby boy is admitted to the pediatric orthopedic clinic. During physical examination it is noted that the baby has inversion and adduction of the forefoot relative to the hindfoot and plantar flexion. Which of the following terms is diagnostic for the signs observed on physical examination? A. Coxa vara B. Talipes equinovarus C. Hallux valgus D. Hallux varus E. Plantar fasciitis
B. Talipes equinovarus
A 34-year-old woman has a direct blow to the patella by the dashboard of the vehicle during an automobile crash. The woman is admitted to the emergency department and radiologic examination reveals patellofemoral syndrome. This type of syndrome is characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening by physical rehabilitation to prevent future dislocation of the patella? A. Vastus lateralis B. Vastus medialis C. Vastus intermedius D. Rectus femoris E. Patellar ligament
B. Vastus medialis
A 27-year-old female tennis pro injured her ankle during the quarterfinal match. A physical examination at the outpatient clinic revealed a severe inversion sprain of the ankle. Which of the following structures is most commonly damaged in such injuries? A. Medial plantar nerve B. Tibial nerve C. Anterior talofibular ligament D. Posterior talofibular ligament E. Deltoid ligament
C. Anterior talofibular ligament
A 32-year-old man is admitted to the emergency department after an injury to his foot while playing football with his college friends. An MRI examination reveals multiple tendinous tears. Which of the following bones is associated with the muscle tears? A. Navicular B. Cuboid C. Calcaneus D. Sustentaculum tali E. Talus
C. Calcaneus
A 72-year-old woman suffered a hip dislocation when she fell down the steps to her garage. Which of the following is most significant in resisting hyperextension of the hip joint? A. Pubofemoral ligament B. Ischiofemoral ligament C. Iliofemoral ligament D. Negative pressure in the acetabular fossa E. Gluteus maximus muscle
C. Iliofemoral ligament
A 75-year-old man is transported to the emergency department with severe pain of his right hip and thigh. A radiologic examination reveals avascular necrosis of the femoral head (Fig. 5-2). Which of the following conditions most likely occurred to produce avascular necrosis in this patient? A. Dislocation of the hip with tearing of the ligament of the head of the femur B. Intertrochanteric fracture of the femur C. Intracapsular femoral neck fracture D. Thrombosis of the obturator artery E. Comminuted fracture of the extracapsular femoral neck
C. Intracapsular femoral neck fracture
A 34 year old male powerlifter visits the outpatient clinic because he has difficulty walking. During physical examination it is observed that the patient has a problem unlocking the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged? A. Biceps femoris B. Gastrocnemius C. Popliteus D. Semimembranosus E. Rectus femoris
C. Popliteus
A 75-year-old woman is admitted to the hospital after falling in her bathroom. Radiologic examination reveals an extracapsular fracture of the femoral neck. Which artery is most likely at risk for injury? A. Inferior gluteal B. First perforating branch of deep femoral C.Medial circumflex femoral D. Obturator E. Superior gluteal
C.Medial circumflex femoral
A 23-year-old man is admitted to the emergency department after injuring his knee while playing football. During physical examination there is pain and swelling of the knee, in addition to locking of the knee in full extension. Radiologic examination reveals a bucket handle meniscal tear (Fig. 5-12). Which of the following ligaments is most likely injured? A. Posterior cruciate B. Medial collateral C. Lateral collateral D. Anterior cruciate E. Coronary
D. Anterior cruciate
A 34-year-old man visits the outpatient clinic for an annual checkup. A radiographic examination of his knees is shown in Fig. 5-11. Physical examination reveals no pathology or pain to his knees. The patient has no past history of any knee problems. What is the most likely diagnosis? A. Enlarged prepatellar bursa B. Osgood-Schlatter disease C. Normal intercondylar eminence D. Bipartite patella E. Injury to lateral meniscus
D. Bipartite patella
During a battle, a 19-year-old soldier is shot in the lateral aspect of the right foot by a bullet that ricocheted off a building. The soldier is taken to a field hospital. A radiograph of the foot reveals that the base of the fifth metatarsal was completely obliterated. Which of the following muscles is most likely affected by this injury? A. Tibialis anterior B. Fibularis (peroneus) longus C. Gastrocnemius D. Fibularis (peroneus) brevis E. Extensor hallucis longus
D. Fibularis (peroneus) brevis
A 22-year-old woman is admitted to the emergency department after another vehicle collided with the passenger side of the convertible in which she was riding. Radiologic examination reveals an avulsion fracture of the greater trochanter. Which of the following muscles would continue to function normally if such an injury was incurred? A. Piriformis B. Obturator internus C. Gluteus medius D. Gluteus maximus E. Gluteus minimus
D. Gluteus maximus
A 42-year-old mother of three children visits the outpatient clinic complaining that her youngest son cannot walk yet even though he is 4 years old. Radiologic and physical examinations reveal an unstable hip joint. Which of the following ligaments is responsible for stabilization of the hip joint in childhood? A. Iliofemoral B. Pubofemoral C. Ischiofemoral D. Ligament of the head of the femur E. Transverse acetabular ligament
D. Ligament of the head of the femur
A 34-year-old male runner visits the outpatient clinic complaining of pain in his foot for the past week. Physical examination reveals inflammation of the tough band of tissue stretching from the calcaneus to the ball of the foot. Which of the following conditions is characteristic of these symptoms? A. Pott's fracture B. Dupuytren fracture C. Tarsal tunnel D. Plantar fasciitis E. Rupture of spring element
D. Plantar fasciitis
A 10-year-old girl is admitted to the emergency department after falling from a tree in which she was playing with her friends. Radiologic and physical examinations reveal Osgood-Schlatter disease. Which of the following bony structures is chiefly affected? A. Medial condyle of tibia B. Posterior intercondylar area C. Intercondylar eminence D. Tibial tuberosity E. Anterolateral tibial tubercle (Gerdy's tubercle)
D. Tibial tuberosity
The swollen and painful left foot of a 23-year-old female long distance runner is examined in the university orthopedic clinic. She states that she stepped on an unseen sharp object while running through the park several days earlier. Emergency surgery is ordered to deal with her tarsal tunnel syndrome. The tarsal tunnel is occupied normally by tendons, vessels, and nerves that pass beneath a very strong band of tissue (flexor retinaculum) on the medial side of the ankle. What is the most anterior of the structures that pass through this tunnel? A. Flexor hallucis longus tendon B. Plantaris tendon C. Tibialis anterior tendon D. Tibialis posterior tendon E. Tibial nerve
D. Tibialis posterior tendon
A 23-year-old male basketball player injured his foot during training and is admitted to the emergency department. An MRI examination reveals a hematoma around the medial malleolus. Upon physical examination the patient shows excessive eversion of his foot. Which of the following ligaments most likely has a tear? A. Plantar calcaneonavicular (spring) B. Calcaneofibular C. Long plantar D. Short plantar E. Deltoid
E. Deltoid
A 72-year-old man visits the outpatient clinic with a complaint of severe pain when walking. Physical examination reveals the problems in his feet as shown in the figure. What is the most likely diagnosis? A. Coxa varus B. Coxa valgus C. Genu valgus D. Genu vara E. Hallux valgus
E. Hallux valgus
A 22-year-old soccer player collides with one of her teammates. During examination on the field, the posterior drawer test was performed and the tibia moved backward in relation to her femur. Injury to which structure is confirmed by performing this test? A. Anterior cruciate ligament B. Lateral collateral ligament C. Medial collateral ligament D. Medial meniscus E. Posterior cruciate ligament
E. Posterior cruciate ligament
Following an injury suffered in a soccer match, a 32 year old woman is examined in a seated position in the orthopedic clinic. Holding the right tibia with both hands, the clinician can press the tibia backward under the distal part of her femur. The left tibia cannot be displaced in this way. Which structure was most likely damaged in the right knee. A. Anterior cruciate ligament B. Lateral collateral ligament C. Medial collateral ligament D. Medial meniscus E. Posterior cruciate ligament
E. Posterior cruciate ligament
A 52-year-old woman is admitted to the emergency department after severely injuring her right lower limb when she fell from a trampoline. Radiologic examination reveals a trimalleolar fracture of the ankle involving the lateral malleolus, medial malleolus, and the posterior process of the tibia. Which of the following bones will also most likely be affected? A. Navicular B. Calcaneus C. Cuneiform D. Cuboid E. Talus
E. Talus
A 60-year-old retired male marathon runner complains to his primary care physician that during his daily morning jog he experiences bouts of numbness and tingling on the medial aspect of his heel. Upon further examination the doctor discovers the patient has trouble tiptoeing and shows a positive Tinel's sign. Which of the following conditions is most characteristic of these symptoms? A. Plantar fasciitis B. Ankle inversion sprain C. Morton's neuroma D. Lateral ligament E. Tarsal tunnel syndrome
E. Tarsal tunnel syndrome
A 43-year-old man visits the outpatient clinic with a painful, swollen knee joint. The patient's history reveals chronic gonococcal arthritis. A knee aspiration is ordered for bacterial culture of the synovial fluid. A standard suprapatellar approach is used, and the needle passes from the lateral aspect of the thigh into the region immediately proximal to and deep to the patella. Through which of the following muscles would the needle pass? A. Adductor magnus B. Short head of biceps femoris C. Rectus femoris D. Sartorius E. Vastus lateralis
E. Vastus lateralis
