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Wrist & Carpus MCQs

Practice Set 33 of 33

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

Question 641

Topic: Wrist & Carpus

Regarding the clinical scenario of Complex Regional Pain Syndrome (Sudeck's atrophy) following a distal radius fracture, which of the following prophylactic therapies has been shown in clinical trials to reduce its incidence?

. Gabapentin 300mg TID for 4 weeks
. Vitamin C 500mg daily for 50 days
. Pregabalin 75mg BID for 6 weeks
. Oral bisphosphonates for 3 months post-injury
. Prophylactic stellate ganglion blocks

Correct Answer & Explanation

. Vitamin C 500mg daily for 50 days

Explanation

Daily supplementation with 500 mg of Vitamin C for 50 days following a distal radius fracture has been shown in prospective randomized trials to significantly reduce the risk of developing CRPS.

Question 642

Topic: Wrist & Carpus

A 55-year-old female sustains a distal radius fracture treated with open reduction and internal fixation. To prevent the development of the condition shown in the clinical image below, what pharmacological prophylaxis should be initiated?

. Gabapentin 300mg daily
. Vitamin C 500mg daily for 50 days
. Ibuprofen 400mg every 8 hours
. Prednisone 20mg daily for 14 days
. Amitriptyline 25mg nightly

Correct Answer & Explanation

. Vitamin C 500mg daily for 50 days

Explanation

The image demonstrates trophic skin changes and swelling consistent with Complex Regional Pain Syndrome (CRPS). Studies have shown that Vitamin C (500 mg daily for 50 days) significantly reduces the incidence of CRPS following distal radius fractures. Other medications listed are used for treatment, not proven primary prophylaxis.

Question 643

Topic: Wrist & Carpus

A 16-year-old boy with a known history of multiple hereditary exostoses (MHE) presents with worsening deformity of his left forearm and decreased range of motion. Radiographs reveal a characteristic forearm deformity associated with this condition. Which of the following best describes the typical pathoanatomy of the forearm in MHE?

. Radial shortening, ulnar bowing, and ulnar head dislocation
. Symmetric shortening of the radius and ulna with proximal radioulnar synostosis
. Ulnar shortening, secondary bowing of the radius, and radial head dislocation
. Overgrowth of the distal ulna leading to positive ulnar variance and TFCC tears
. Madelung deformity secondary to premature closure of the volar-ulnar distal radius physis

Correct Answer & Explanation

. Ulnar shortening, secondary bowing of the radius, and radial head dislocation

Explanation

Forearm deformity in MHE typically begins with relative shortening of the ulna due to osteochondroma formation. This tethering effect leads to secondary bowing of the radius and eventual dislocation of the radial head.

Question 644

Topic: Wrist & Carpus

A 55-year-old female undergoes open reduction and internal fixation of a distal radius fracture using a volar locking plate. Six months postoperatively, she presents with an inability to actively flex the interphalangeal joint of her thumb. Radiographs reveal the plate is positioned distally, over the watershed line. Which tendon is most likely ruptured?

. Extensor pollicis longus (EPL)
. Flexor pollicis longus (FPL)
. Flexor carpi radialis (FCR)
. Flexor digitorum profundus (FDP) to the index finger
. Flexor pollicis brevis (FPB)

Correct Answer & Explanation

. Flexor pollicis longus (FPL)

Explanation

Placement of a volar plate at or distal to the watershed line of the distal radius causes prominence of the hardware in the flexor compartment. This friction most commonly leads to attrition and subsequent rupture of the flexor pollicis longus (FPL) tendon.

Question 645

Topic: Wrist & Carpus

In idiopathic Madelung deformity, premature fusion of the volar-ulnar aspect of the distal radial physis occurs due to mechanical tethering. Which anomalous structure is responsible for this tether?

. Triangular fibrocartilage complex
. Brachioradialis tendon
. Short radiolunate ligament
. Pronator quadratus
. Extensor carpi ulnaris sheath

Correct Answer & Explanation

. Short radiolunate ligament

Explanation

Madelung deformity is characterized by an abnormal volar tether known as Vickers ligament. This structure is a thickened, dysplastic short radiolunate ligament that bridges the radius and lunate, restricting the growth of the volar-ulnar distal radius.

Question 646

Topic: Wrist & Carpus

What is the most common anatomic location for the presentation of a Chondromyxoid fibroma (CMF)?

. Distal radius epiphysis
. Proximal tibia metaphysis
. Proximal humerus diaphysis
. Vertebral body
. Calcaneus

Correct Answer & Explanation

. Proximal tibia metaphysis

Explanation

CMF most commonly occurs in the lower extremities, particularly around the knee. The proximal tibia metaphysis is the single most common location, accounting for a large percentage of cases.

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