This page is dedicated to organizing various examples of standardized exam questions whose answer is compartment syndrome. While this may seem a odd practice, it is useful to see multiple examples of how compartment syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for compartment syndrome.
- Severe pain in a compartment of the body.
- Numbness can also be present in a distribution associated with a compartment of the body.
- Trauma to compartment of body: this can be a car accident, gunshot, etc.
- Recent procedure/intervention: this can be a procedure or surgery involving a compartment of the body.
- Tense compartment: can be visible/palpated on the exam.
- Loss of sensation: in a distribution associated with a compartment of the body.
- Pain to passive movement: this is pretty specific to this condition (pain with moving fingers/toes passively by the examiner)
- Loss of pulses: in areas related to the compartment (later stage finding)
Question # 1
A 25 year old male is brought to the hospital after he is shot with a gun in his left calf. When he is brought to the hospital he is substantial visible pain. His temperature is 98.7°F, pulse is 101/min, respirations are 18/min, and blood pressure is 110/70 mm Hg. A physical exam is remarkable for a gunshot entrance wound on the medial aspect of the posterior left calf with no exit wound visualized. The calf is tense and tender to palpation. Passive movement of the great toe on left side also increase the patient’s calf pain. What condition might this patient have?
Trauma to compartment of body (posterior lower limb) + tense compartment (calf) + pain to passive movement = compartment syndrome
Question # 2
A 4o year old homeless man is brought to the hospital because of very severe pain in his forearm. He had a long night of drinking, and passed out on a park bench for around 14 hours before awaking. There are no signs of trauma to the forearm, but the muscles are very firm and tender to palpation. Passive motion of the fingers and wrist elicits severe pain. Pulses at the wrist are normal.
Tense compartment + pain to passive movement = compartment syndrome
Question # 3
A 90 year old male complains of severe right calf pain a few hours after undergoing a right femoral artery embolectomy. He complains of feeling a burning sensation in the back of this right leg. His past medical history is notable for atrial fibrillation and hypertension. A physical exam reveals a blood pressure of 160/70 mm Hg, heart rate of 95/min, and he is afebrile. His right calf is swollen, tense, and incredibly tender. The pain in his calf is worsened by passive extension of the right knee. His dorsalis pedis pulses are palpable bilaterally. What is the likely cause of this patient’s presentation?
Tense compartment + pain to passive movement = compartment syndrome
Question # 4
A 30 year old woman comes to the hospital because she spilled hot tea on her right forearm. Her current medications only include an oral contraceptive, and she has no other medical issues. A physical exam reveals a full-thickness burn, and she is discharged later with analgesics, topical antibiotics, and clear instructions regards wound care. 4 days later, the patient returns because she has experienced worsening pain and swelling in her right hand. She explains that the pain is very severe in her hand and that it is aching. Another physical exam reveals that the previous burn injury has healed with a circumferential eschar formation. The right hand is tense and tender. What is the likely diagnosis in this patient?
Circumferential scar around compartment + tense compartment + severe pain (out of proportion) = compartment syndrome (scar has caused decreased venous/lymphatic drainage)
Question # 5
A 25 year old man is involved in a motor vehicle collision and undergoes a prolonged orthopedic surgery to repair a right tibia fracture. On postoperative day 1 he has increasing pain in his right leg and is treated with IV fluids and morphine. Two hours later the patient continues to complain of pain that worsens with passive movement, and notes an altered sensation in his right leg. A physical exam is notable for a tense, tender swelling of the right calf. There is a sensory loss between the great and second toe. Dorsalis pedis pulses are palpated bilaterally. What is the suspected diagnosis in this patient?
Recent trauma to compartment + tense compartment + pain to passive movement = compartment syndrome
Question # 6
A 78 year old woman comes to the ED because she has been suffering from leg pain and numbness of the past day. Her past medical history is notable for atrial fibrillation and also hypertension. A physical exam shows that her right limb is cold and pale below the level of the knee. A ultrasound study reveals that she has an occluding thrombus in her in her right femoral artery, and a embolectomy is performed. The procedure is uncomplicated, and the patient has strong pulses return to her lower limb after. Later in the recovery unit, the patient begins to experience severe right calf pain that is unlike anything she has ever experienced. Her right calf is visibly swollen, and is tense and tender to palpation. Her pain worsens with dorsiflexion of the right foot. Her dorsalis pedis pulse is now absent on the right foot. What is the likely diagnosis in this patient?
Explanation # 6
Recent operation in compartment/trauma to compartment + severe pain + tense compartment + loss of pulses = compartment syndrome
Question # 7
A 22 year old female is brought to the ER right after she is stuck by a car when crossing the street. On arrival she complains of leg pain. Her vital signs are all unremarkable, and a physical exam shows that her sensory and motor function are intact in the right foot. Her lower extremity pulses are present bilaterally. An X-ray of the right lower leg shows a displaced comminuted fracture of the tibia. The patient’s broken limb is splinted in the ED, and the patent is admitted so that she can be observed. A few hours after this, she complains of numbness in her right foot, and starts to develop increasing pain in this lower extremity. Examination of the foot reveals that now she has decreased sensation to pinprick over the foot, and also has severe pain with passive extension of the toes. What is the diagnosis in this patent?
Explanation # 7
Trauma to compartment (car accident resulting in broken bone) + pain in compartment + numbness + loss of sensation + pain with passive extension = compartment syndrome
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Further diagnostic tests:
- Measurement of compartment pressure: this can be done to assess if the patient needs surgery (often not done and patients sent directly to surgery ).
- Surgical decompression (fasciotomy) is the only effective treatment for this condition (pressure needs to be reduced).
Page Updated: 01.22.2017