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Hand Trauma & Infection MCQs

Practice Set 8 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 141

Topic: Hand Trauma & Infection

A 32-year-old male presents with a swollen, erythematous, and exquisitely painful index finger after a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs of flexor tenosynovitis?

. Fusiform swelling of the digit
. Pain with active extension of the digit
. Flexed posture of the digit
. Pain with passive extension of the digit
. Tenderness along the flexor tendon sheath

Correct Answer & Explanation

. Fusiform swelling of the digit

Explanation

Kanavel's four cardinal signs are: fusiform swelling, flexed posture, exquisite pain with passive extension, and tenderness along the flexor sheath. Pain on active extension is not considered a cardinal sign.

Question 142

Topic: Hand Trauma & Infection

A 35-year-old mechanic sustains a small puncture wound to his volar right index finger. Two days later, he presents with severe pain and swelling. Which of the following is NOT one of Kanavel's cardinal signs of pyogenic flexor tenosynovitis?

. Fusiform swelling of the digit
. Digit held in a flexed posture
. Severe pain on passive extension of the digit
. Tenderness along the flexor tendon sheath
. Erythema tracking proximally into the palm

Correct Answer & Explanation

. Fusiform swelling of the digit

Explanation

Kanavel's four cardinal signs of pyogenic flexor tenosynovitis include: 1) Fusiform ('sausage') swelling of the entire digit, 2) The digit is held in resting flexion, 3) Exquisite pain with passive extension (often the earliest and most sensitive sign), and 4) Tenderness to palpation along the course of the flexor tendon sheath. Erythema tracking proximally (lymphangitis or palmar spread) is not one of the classic Kanavel's signs.

Question 143

Topic: Hand Trauma & Infection

A 28-year-old male presents 48 hours after a puncture wound to the volar aspect of his index finger.

His finger is erythematous, swollen, and held in a flexed posture. According to Kanavel's criteria for acute suppurative flexor tenosynovitis, which of the following signs is considered the earliest and most sensitive indicator of the infection?

. Fusiform (sausage-like) swelling of the digit
. Flexed resting posture of the digit
. Tenderness extending along the flexor tendon sheath
. Exquisite pain with passive extension of the digit
. Erythema tracking proximally into the palm

Correct Answer & Explanation

. Fusiform (sausage-like) swelling of the digit

Explanation

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

Question 144

Topic: Hand Trauma & Infection

A patient presents with a swollen, painful ring finger 3 days after sustaining a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs of pyogenic flexor tenosynovitis?

. Fusiform swelling of the digit
. Flexed resting posture of the digit
. Tenderness along the flexor tendon sheath
. Erythema extending to the palmar crease
. Pain on passive extension of the digit

Correct Answer & Explanation

. Fusiform swelling of the digit

Explanation

Kanavel's four cardinal signs of pyogenic flexor tenosynovitis include: 1) fusiform swelling of the digit, 2) flexed resting posture, 3) tenderness along the flexor tendon sheath, and 4) pain on passive extension. Erythema extending to the palmar crease is not one of Kanavel's specific signs.

Question 145

Topic: Hand Trauma & Infection

A 35-year-old skier falls while holding a ski pole and presents with thumb MCP joint pain. Examination reveals 40 degrees of radial deviation laxity in full extension with no solid endpoint. An MRI confirms a complete tear of the ulnar collateral ligament (UCL). Which anatomic structure prevents nonoperative healing of this lesion?

. Adductor pollicis aponeurosis
. Abductor pollicis brevis aponeurosis
. Extensor pollicis longus tendon
. Flexor pollicis brevis
. Volar plate

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the torn UCL of the thumb becomes displaced superficial to the adductor pollicis aponeurosis. This prevents the ligament from apposing its anatomical insertion, requiring surgical repair.

Question 146

Topic: Hand Trauma & Infection

A 24-year-old male presents with a swollen, erythematous MCP joint of his right ring finger after an altercation where he punched another individual in the mouth. What is the most appropriate empiric antibiotic regimen to cover the typical pathogens, including Eikenella corrodens?

. Clindamycin
. Cephalexin
. Amoxicillin-clavulanate
. Trimethoprim-sulfamethoxazole
. Erythromycin

Correct Answer & Explanation

. Clindamycin

Explanation

Human bites (fight bites) require coverage for staph, strep, anaerobes, and Eikenella corrodens. Amoxicillin-clavulanate (Augmentin) provides excellent empiric oral coverage.

Question 147

Topic: Hand Trauma & Infection

A 42-year-old male sustains a puncture wound to his index finger. Two days later, he presents with symmetric digit swelling, flexed resting posture, tenderness along the flexor sheath, and severe pain with passive extension. Which organism is the most common cause of this condition, and what is the definitive management?

. Streptococcus pyogenes / IV antibiotics alone
. Staphylococcus aureus / surgical irrigation and debridement
. Pasteurella multocida / amputation of the digit
. Pseudomonas aeruginosa / delayed primary closure
. Eikenella corrodens / outpatient oral antibiotics

Correct Answer & Explanation

. Streptococcus pyogenes / IV antibiotics alone

Explanation

The patient exhibits Kanavel's four cardinal signs of acute pyogenic flexor tenosynovitis. Staphylococcus aureus is the most common pathogen, and the presence of these signs dictates emergent surgical irrigation and debridement along with IV antibiotics.

Question 148

Topic: Hand Trauma & Infection

A 28-year-old skier falls while holding a ski pole, forcibly abducting his thumb. Examination shows gross laxity of the thumb MCP joint with valgus stress in 30 degrees of flexion. MRI confirms a Stener lesion. What anatomical structure is interposed between the ruptured ends of the ligament?

. Adductor pollicis aponeurosis
. Abductor pollicis brevis tendon
. Flexor pollicis brevis muscle belly
. Extensor pollicis brevis tendon
. Dorsal interosseous fascia

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the distally avulsed ulnar collateral ligament (UCL) retracts and displaces superficial to the adductor pollicis aponeurosis. This interposition prevents spontaneous anatomical healing and is an absolute indication for surgical repair.

Question 149

Topic: Hand Trauma & Infection

A 32-year-old mechanic presents with an infected index finger after a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs for acute pyogenic flexor tenosynovitis?

. Severe pain with passive extension of the digit
. Flexed resting posture of the digit
. Fusiform (sausage) swelling of the digit
. Tenderness along the entire flexor tendon sheath
. Erythema tracking proximally up the volar forearm

Correct Answer & Explanation

. Severe pain with passive extension of the digit

Explanation

Kanavel's signs include: flexed posture, fusiform swelling, tenderness over the flexor sheath, and pain with passive extension. Erythema tracking proximally indicates lymphangitis, not tenosynovitis.

Question 150

Topic: Hand Trauma & Infection

A 35-year-old skier falls while holding his pole, sustaining a hyperabduction injury to the thumb. Clinical examination reveals gross laxity of the metacarpophalangeal (MCP) joint to valgus stress. A Stener lesion is suspected. What anatomical structure prevents spontaneous healing of the torn ulnar collateral ligament (UCL) in this lesion?

. Extensor pollicis brevis tendon
. Adductor pollicis aponeurosis
. Abductor pollicis longus tendon
. Flexor pollicis longus tendon
. Volar plate

Correct Answer & Explanation

. Extensor pollicis brevis tendon

Explanation

A Stener lesion occurs when the torn UCL displaces superficial to the adductor pollicis aponeurosis. The aponeurosis physically blocks the ligament from returning to its insertion site, mandating surgical repair.

Question 151

Topic: Hand Trauma & Infection

A 30-year-old male sustains a forced hyperabduction injury to his thumb metacarpophalangeal (MCP) joint while skiing. MRI confirms a complete tear of the ulnar collateral ligament (UCL) with the adductor aponeurosis interposed between the ruptured ligament and its anatomical insertion. What is this lesion called, and what is the indicated management?

. Segond lesion, indicating conservative management
. Stener lesion, indicating the need for surgical repair
. Stener lesion, indicating successful conservative management in a thumb spica cast
. Gamekeeper's lesion, requiring immediate MCP joint arthrodesis
. Volar plate avulsion, necessitating a dorsal blocking splint

Correct Answer & Explanation

. Segond lesion, indicating conservative management

Explanation

A Stener lesion occurs when the torn UCL displaces superficial to the adductor aponeurosis, preventing anatomical healing. It is an absolute indication for surgical repair.

Question 152

Topic: Hand Trauma & Infection

In a complete tear of the ulnar collateral ligament (UCL) of the thumb (Skier's thumb), a Stener lesion may occur. This lesion is characterized by the proximal stump of the torn UCL displacing superficial to which of the following structures?

. Adductor pollicis aponeurosis
. Abductor pollicis brevis tendon
. Extensor pollicis longus tendon
. Flexor pollicis longus tendon
. Extensor pollicis brevis tendon

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the distal attachment of the thumb UCL avulses and gets flipped proximally and superficial to the adductor aponeurosis. The aponeurosis interposes between the torn ligament ends, preventing spontaneous healing and thus necessitating surgical repair.

Question 153

Topic: Hand Trauma & Infection

A 35-year-old skier falls while gripping his ski pole and presents with weakness in thumb pinch and pain over the ulnar aspect of the thumb MCP joint. MRI reveals a complete rupture of the ulnar collateral ligament (UCL). The distal end of the torn ligament is displaced, preventing spontaneous healing. Which structure is the torn UCL typically displaced superficial to in this classic lesion?

. Adductor pollicis aponeurosis
. Abductor pollicis brevis
. Extensor pollicis longus
. Flexor pollicis longus
. Volar plate

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

The patient has a Stener lesion, a common complication of a complete thumb UCL rupture (Skier's/Gamekeeper's thumb). In a Stener lesion, the distal end of the completely torn UCL flips back and becomes trapped superficial to the adductor pollicis aponeurosis. Because the aponeurosis interposes between the torn ligament and its insertion on the proximal phalanx, anatomic healing cannot occur without surgical intervention.

Question 154

Topic: Hand Trauma & Infection
A 35-year-old diabetic patient presents to the emergency department with a swollen, throbbing index finger 3 days after sustaining a puncture wound. The physician suspects acute purulent flexor tenosynovitis. Which of the following is NOT one of Kanavel's cardinal signs for this condition?
. Fusiform swelling of the entire digit
. Digit held in a posture of slight extension
. Tenderness along the course of the flexor tendon sheath
. Severe pain on passive extension of the digit
. All of the above are cardinal signs

Correct Answer & Explanation

. Digit held in a posture of slight extension

Explanation

Kanavel's four cardinal signs of acute flexor tenosynovitis are: 1) Fusiform (sausage-like) swelling of the digit. 2) The digit is held in a posture of slight FLEXION (not extension) to minimize tension on the inflamed sheath. 3) Tenderness along the entire course of the flexor tendon sheath. 4) Disproportionate, severe pain with passive extension of the digit.

Question 155

Topic: Hand Trauma & Infection

A 40-year-old diabetic male presents with an exquisitely tender, swollen index finger held in slight flexion. Passive extension of the digit elicits extreme pain extending into the palm. What is the most appropriate next step in management?

. Oral antibiotics and outpatient physical therapy
. Splinting, NSAIDs, and elevation
. Urgent incision and drainage with intravenous antibiotics
. Corticosteroid injection into the flexor sheath
. EMG and nerve conduction studies

Correct Answer & Explanation

. Oral antibiotics and outpatient physical therapy

Explanation

This presentation describes Kanavel's cardinal signs of acute pyogenic flexor tenosynovitis. This is an orthopedic surgical emergency requiring prompt incision, irrigation, drainage, and broad-spectrum IV antibiotics to prevent tendon necrosis.

Question 156

Topic: Hand Trauma & Infection

A 35-year-old construction worker presents with a swollen, painful index finger 3 days after a puncture wound. Which of the following represents the four classic Kanavel signs of pyogenic flexor tenosynovitis?

. Flexed resting posture, fusiform swelling, pain on passive extension, tenderness along the flexor sheath
. Extended resting posture, localized fluctuance, pain on active flexion, erythema
. Flexed resting posture, crepitus on motion, numbness of the fingertip, pain on passive flexion
. Dorsal swelling, pain on passive extension, normal resting posture, absent radial pulse
. Fusiform swelling, fluctuance at the DIP joint, pain on active extension, ascending lymphangitis

Correct Answer & Explanation

. Flexed resting posture, fusiform swelling, pain on passive extension, tenderness along the flexor sheath

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis are a flexed resting posture of the digit, fusiform (sausage-like) swelling, exquisite pain on passive extension, and tenderness along the entire course of the flexor tendon sheath.

Question 157

Topic: Hand Trauma & Infection

A 24-year-old manual laborer presents with acute swelling, severe pain, and a flexed posture of his dominant index finger after a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs of flexor tendon sheath infection?

. Fusiform swelling of the digit
. Severe pain with passive extension of the digit
. Tenderness along the course of the flexor tendon sheath
. Pain with active flexion of the digit
. Flexed resting posture of the digit

Correct Answer & Explanation

. Fusiform swelling of the digit

Explanation

Kanavel's four cardinal signs of purulent flexor tenosynovitis are: fusiform swelling, flexed posture, pain with passive extension, and tenderness along the flexor sheath. Pain with active flexion is not considered one of the specific cardinal signs.

Question 158

Topic: Hand Trauma & Infection

A 35-year-old carpenter presents with a painful, swollen index finger following a minor puncture wound. Which of the following is NOT one of Kanavel's four cardinal signs of acute pyogenic flexor tenosynovitis?

. Fusiform swelling of the entire digit
. Tenderness specifically along the flexor tendon sheath
. Digit held in a rigidly extended posture
. Pain elicited by passive extension of the digit
. Flexed resting posture of the digit

Correct Answer & Explanation

. Fusiform swelling of the entire digit

Explanation

Kanavel's four cardinal signs include fusiform swelling, flexed resting posture (NOT rigidly extended), tenderness along the flexor sheath, and pain on passive extension. A resting extended posture contradicts these criteria.

Question 159

Topic: Hand Trauma & Infection

A 32-year-old carpenter presents with a swollen, painful index finger 3 days after a puncture wound. Suspecting pyogenic flexor tenosynovitis, the examining physician assesses for Kanavel's cardinal signs. Which of the following is one of these classic signs?

. Extension of the digit is painless
. The finger is held in a rigidly extended resting posture
. Fusiform swelling of the entire digit
. Tenderness strictly localized to the distal interphalangeal joint
. Erythema tracking proximally into the forearm

Correct Answer & Explanation

. Extension of the digit is painless

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis include fusiform (sausage-like) swelling of the digit, a flexed resting posture, severe pain with passive extension, and tenderness along the entire flexor tendon sheath.

Question 160

Topic: Hand Trauma & Infection

A 40-year-old mechanic presents with a swollen, erythematous right index finger after sustaining a puncture wound 3 days ago. Which of Kanavel's four cardinal signs of flexor tenosynovitis is typically considered the earliest and most sensitive indicator of the infection?

. Pain with passive extension of the digit
. Fusiform swelling of the entire digit
. Flexed resting posture of the digit
. Tenderness along the course of the flexor tendon sheath
. Erythema tracking proximally into the palm

Correct Answer & Explanation

. Pain with passive extension of the digit

Explanation

Pain with passive extension of the affected digit is considered the earliest and most sensitive sign of pyogenic flexor tenosynovitis. The other cardinal signs include fusiform swelling, resting in a flexed posture, and exquisite tenderness along the flexor sheath.

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