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Hand Trauma & Infection MCQs

Practice Set 10 of 10

This practice set contains high-yield board review questions covering key concepts in Hand Trauma & Infection. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 181

Topic: Hand Trauma & Infection

A 35-year-old carpenter presents with swelling, erythema, and severe pain along the volar aspect of his index finger. According to Kanavel's criteria for pyogenic flexor tenosynovitis, which of the following is considered the most specific and earliest clinical sign?

. Symmetrical fusiform swelling of the digit
. Flexed resting posture of the digit
. Tenderness along the entire flexor tendon sheath
. Pain with passive extension of the digit
. Erythema extending past the metacarpophalangeal joint

Correct Answer & Explanation

. Pain with passive extension of the digit

Explanation

Kanavel's four cardinal signs of pyogenic flexor tenosynovitis are: 1) fusiform swelling, 2) flexed resting posture, 3) tenderness along the tendon sheath, and 4) pain with passive extension. Pain with passive extension is considered the earliest and most sensitive/specific sign of the condition.

Question 182

Topic: Hand Trauma & Infection
A 35-year-old mechanic presents with a swollen, painful index finger 3 days after a puncture wound. Examination raises suspicion for pyogenic flexor tenosynovitis. Kanavel's cardinal signs for this condition include all of the following EXCEPT:
. Flexed resting posture of the digit
. Fusiform swelling of the entire digit
. Tenderness along the course of the flexor tendon sheath
. Severe pain elicited by passive flexion of the digit
. Severe pain elicited by passive extension of the digit

Correct Answer & Explanation

. Severe pain elicited by passive flexion of the digit

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis are: 1) flexed resting posture, 2) fusiform (sausage-like) swelling, 3) tenderness along the flexor sheath, and 4) excruciating pain on passive EXTENSION (not flexion), which stretches the inflamed tendon sheath.

Question 183

Topic: Hand Trauma & Infection

Which of the following physical examination findings is NOT considered one of Kanavel's four classic cardinal signs of pyogenic flexor tenosynovitis?

. Fusiform, symmetric swelling of the entire digit
. Erythema extending proximally beyond the wrist crease
. Exquisite tenderness along the course of the flexor tendon sheath
. Severe pain elicited with passive extension of the affected digit
. A flexed resting posture of the involved digit

Correct Answer & Explanation

. Erythema extending proximally beyond the wrist crease

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis are: fusiform swelling, severe tenderness along the flexor sheath, excruciating pain with passive extension, and a semi-flexed resting posture. Proximal spreading erythema suggests cellulitis or lymphangitis, not a strict Kanavel sign.

Question 184

Topic: Hand Trauma & Infection

A 28-year-old carpenter presents with a swollen, erythematous, and exquisitely tender left index finger 2 days after a wood splinter puncture. The finger is held in slight flexion, and there is severe pain with passive extension. What is the most appropriate management?

. Oral antibiotics and outpatient follow-up in 48 hours
. Incision and drainage in the operating room with systemic antibiotics
. Corticosteroid injection into the tendon sheath
. Splinting in extension and close observation
. Needle aspiration of the distal interphalangeal joint

Correct Answer & Explanation

. Incision and drainage in the operating room with systemic antibiotics

Explanation

The patient has Kanavel's four cardinal signs of acute suppurative flexor tenosynovitis (fusiform swelling, flexed posture, tenderness along the sheath, and pain on passive extension). This is a surgical emergency requiring prompt incision and drainage combined with systemic antibiotics to prevent tendon necrosis.

Question 185

Topic: Hand Trauma & Infection

A 30-year-old carpenter presents with a swollen, throbbing index finger two days after a minor puncture wound. Of Kanavel's four cardinal signs for acute pyogenic flexor tenosynovitis, which clinical finding is generally considered the earliest and most sensitive indicator?

. Fusiform swelling of the entire digit
. A resting flexed posture of the digit
. Tenderness to palpation along the flexor tendon sheath
. Severe pain elicited by passive extension of the digit
. Erythema extending into the palm

Correct Answer & Explanation

. Severe pain elicited by passive extension of the digit

Explanation

Pain with passive extension is widely regarded as the earliest and most sensitive of Kanavel's four cardinal signs for pyogenic flexor tenosynovitis. The other signs are fusiform (sausage) swelling, a flexed resting posture, and tenderness over the flexor sheath.

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