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7. Hand and Wrist MCQs

Practice Set 105 of 266

This practice set contains high-yield board review questions covering key concepts in 7. Hand and Wrist. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2081

Topic: 7. Hand and Wrist

Which anatomical structure forms the roof of the carpal tunnel?

. Flexor Carpi Ulnaris tendon
. Palmaris Longus tendon
. Transverse Carpal Ligament
. Flexor Retinaculum of Guyon's Canal
. Deep palmar arch

Correct Answer & Explanation

. Transverse Carpal Ligament

Explanation

The transverse carpal ligament (also known as the flexor retinaculum) forms the robust fibrous roof of the carpal tunnel. The floor and walls are formed by the carpal bones. The structures within the carpal tunnel include the median nerve and nine flexor tendons. The Palmaris Longus tendon lies superficial to the transverse carpal ligament in many individuals. The flexor retinaculum of Guyon's canal is for the ulnar nerve and artery, not the carpal tunnel. The deep palmar arch is distal.

Question 2082

Topic: 7. Hand and Wrist

What is the most common site for an enchondroma in the hand?

. Metacarpal head
. Distal phalanx
. Proximal phalanx
. Carpal bones
. Distal radius

Correct Answer & Explanation

. Proximal phalanx

Explanation

Enchondromas are the most common benign bone tumors of the hand, and they most frequently occur in the proximal phalanges, followed by the metacarpals and middle phalanges. Distal phalanges and carpal bones are less common sites.

Question 2083

Topic: 7. Hand and Wrist

A 40-year-old patient presents with a history of recurrent episodes of white, then blue, then red discoloration of her fingers, particularly in cold weather or with stress. She denies joint pain or swelling. What is the most likely diagnosis?

. Carpal Tunnel Syndrome
. Vibration White Finger
. Hypothenar Hammer Syndrome
. Raynaud's Phenomenon
. Erythromelalgia

Correct Answer & Explanation

. Raynaud's Phenomenon

Explanation

The classic 'triphasic' color change (pallor, cyanosis, rubor) of the digits in response to cold or stress is pathognomonic for Raynaud's Phenomenon. This is a vasospastic disorder. Vibration white finger is a form of Raynaud's secondary to occupational exposure. Hypothenar Hammer Syndrome is an injury to the ulnar artery. Carpal Tunnel Syndrome involves nerve compression. Erythromelalgia is a rare condition causing burning pain and redness, typically in the feet.

Question 2084

Topic: 7. Hand and Wrist

What is the primary function of the extensor indicis proprius (EIP) muscle?

. Flexion of the index finger
. Extension of the ring finger
. Independent extension of the index finger
. Adduction of the thumb
. Extension of the wrist

Correct Answer & Explanation

. Independent extension of the index finger

Explanation

The Extensor Indicis Proprius (EIP) is an accessory extensor of the index finger, allowing for independent extension of the index finger apart from the other digits. It originates from the posterior aspect of the ulna and interosseous membrane and inserts into the extensor mechanism of the index finger, medial to the extensor digitorum communis (EDC) tendon.

Question 2085

Topic: 7. Hand and Wrist

A 50-year-old man presents with chronic pain and stiffness in his dominant wrist. X-rays show sclerosis, fragmentation, and collapse of the lunate bone. What is this condition called?

. Preiser's disease
. Kienbock's disease
. Madelung's deformity
. Distal Radioulnar Joint Arthritis
. SLAC wrist

Correct Answer & Explanation

. Kienbock's disease

Explanation

Kienbock's disease is avascular necrosis (osteonecrosis) of the lunate bone, leading to its collapse and fragmentation, and eventually carpal arthritis. Preiser's disease is avascular necrosis of the scaphoid. Madelung's deformity is a congenital malformation of the distal radius and ulna. DRUJ arthritis and SLAC wrist are types of arthritis but not primary avascular necrosis of the lunate.

Question 2086

Topic: Nerve & Tendon

A patient with a high median nerve injury (e.g., at the elbow) would typically present with a characteristic 'ape hand' deformity. Which muscle is primarily responsible for the thenar eminence wasting seen in this deformity?

. Adductor Pollicis
. Flexor Pollicis Longus
. Abductor Pollicis Brevis
. First Dorsal Interosseous
. Extensor Pollicis Brevis

Correct Answer & Explanation

. Abductor Pollicis Brevis

Explanation

The 'ape hand' deformity, characterized by the inability to abduct and oppose the thumb and wasting of the thenar eminence, results from median nerve palsy. The abductor pollicis brevis (APB) is the most superficial and often the first thenar muscle to show atrophy due to median nerve compression, playing a crucial role in thumb abduction and opposition. Adductor Pollicis is ulnar nerve innervated. FPL is median nerve (AIN branch) but less related to thenar bulk. Interossei are ulnar nerve. EPB is radial nerve.

Question 2087

Topic: Nerve & Tendon

Which of the following describes a typical finding of a 'Swan Neck' deformity of a finger?

. Flexion of the PIP joint and hyperextension of the DIP joint
. Hyperextension of the MCP joint and flexion of the PIP joint
. Hyperextension of the PIP joint and flexion of the DIP joint
. Flexion of the MCP, PIP, and DIP joints
. Fixed abduction of the thumb

Correct Answer & Explanation

. Hyperextension of the PIP joint and flexion of the DIP joint

Explanation

A Swan Neck deformity is characterized by hyperextension of the proximal interphalangeal (PIP) joint and compensatory flexion of the distal interphalangeal (DIP) joint. This deformity is often seen in rheumatoid arthritis due to imbalances in the extensor mechanism. The boutonniere deformity has the opposite PIP/DIP joint positions.

Question 2088

Topic: 7. Hand and Wrist

A 20-year-old male sustains a fall directly onto his palm with the wrist extended. He presents with pain and swelling at the base of the thumb. Radiographs show an intra-articular fracture of the base of the first metacarpal with subluxation of the carpometacarpal (CMC) joint. What is this fracture called?

. Boxer's fracture
. Rolando's fracture
. Bennett's fracture
. Barton's fracture
. Smith's fracture

Correct Answer & Explanation

. Bennett's fracture

Explanation

Bennett's fracture is an intra-articular fracture-dislocation of the base of the first metacarpal. It is an oblique fracture that separates a small palmar-ulnar fragment, which remains attached to the anterior oblique ligament, from the rest of the metacarpal base, which subluxates radially and dorsally. Rolando's fracture is a comminuted intra-articular fracture of the first metacarpal base. Boxer's fracture is a neck fracture of the 5th metacarpal. Barton's and Smith's fractures are distal radius fractures.

Question 2089

Topic: 7. Hand and Wrist

A patient presents with a crush injury to the hand. Examination reveals complete loss of sensation over the ulnar half of the ring finger and the entire small finger, and weakness in finger abduction and adduction. There is also marked wasting of the hypothenar eminence. Which nerve is most likely injured?

. Median nerve
. Radial nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Ulnar nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

This clinical picture is classic for an ulnar nerve injury. The ulnar nerve innervates the hypothenar muscles (causing wasting), all interossei (responsible for finger abduction/adduction), the medial two lumbricals, and provides sensation to the ulnar half of the ring finger and the entire small finger. Median nerve injury affects the radial three digits and thenar muscles. Radial nerve injury affects wrist/finger extensors and dorsum of hand sensation. AIN is a motor branch of the median nerve. PIN is a motor branch of the radial nerve.

Question 2090

Topic: 7. Hand and Wrist

Which of the following statements regarding a Ganglion Cyst of the wrist is FALSE?

. They are typically filled with synovial fluid.
. They are the most common soft tissue tumor of the hand and wrist.
. Dorsal wrist ganglions are more common than volar wrist ganglions.
. Excision is always required for symptomatic relief.
. They commonly arise from joint capsules or tendon sheaths.

Correct Answer & Explanation

. Excision is always required for symptomatic relief.

Explanation

While excision can provide symptomatic relief and is often performed for cosmetic or persistent symptoms, it is not always required. Aspiration is a common non-surgical treatment, and many ganglions can spontaneously resolve. The other statements are true: they are typically filled with mucinous, jelly-like fluid (similar to synovial fluid), are the most common soft tissue tumor, dorsal are more common, and they arise from synovial linings.

Question 2091

Topic: 7. Hand and Wrist

A 3-year-old child presents with a congenital hand anomaly characterized by a permanently bent little finger, usually at the PIP joint, with radial deviation. The finger cannot be fully straightened passively or actively. What is this condition called?

. Polydactyly
. Syndactyly
. Clinodactyly
. Camptodactyly
. Macrodactyly

Correct Answer & Explanation

. Camptodactyly

Explanation

The description perfectly matches Camptodactyly, a congenital flexion contracture of the PIP joint, most commonly affecting the little finger. It is often non-progressive or slowly progressive. Clinodactyly is angular deviation of a digit in the radioulnar plane (often radial deviation of the small finger due to an abnormally shaped middle phalanx). Polydactyly is extra digits. Syndactyly is fused digits. Macrodactyly is enlarged digits.

Question 2092

Topic: Nerve & Tendon

In a patient presenting with a fractured hook of the hamate, which of the following nerves is at greatest risk of injury?

. Radial nerve
. Median nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

The ulnar nerve and artery pass through Guyon's canal, which is bounded radially by the hook of the hamate. Fractures of the hook of the hamate can directly injure or cause compression of the ulnar nerve, leading to symptoms such as paresthesias in the small finger and ulnar half of the ring finger, and weakness of ulnar-innervated intrinsic muscles. Median and radial nerves are not in direct proximity.

Question 2093

Topic: 7. Hand and Wrist

A 30-year-old presents with a 'clenched fist injury' after punching someone in the mouth. Examination reveals swelling, pain, and a laceration over the dorsum of the MCP joint of the index finger. What is the most critical immediate concern in management?

. Fracture of the metacarpal head
. Ligamentous injury of the MCP joint
. Retained foreign body (tooth fragment) and septic arthritis
. Tendon rupture of the extensor digitorum communis
. Neurovascular injury

Correct Answer & Explanation

. Retained foreign body (tooth fragment) and septic arthritis

Explanation

Clenched fist injuries, also known as 'fight bites,' are notorious for high rates of infection, particularly septic arthritis of the MCP joint, due to inoculation of oral flora into the joint or tendon sheath through the small puncture wound. Retained tooth fragments are also common. Therefore, meticulous wound debridement, irrigation, antibiotics, and surgical exploration to rule out joint capsule violation and foreign bodies are crucial. While fractures, ligamentous injuries, and tendon ruptures can occur, the immediate priority is to prevent and treat potentially devastating infection.

Question 2094

Topic: 7. Hand and Wrist

Which of the following ligaments is primarily responsible for preventing dorsal intercalated segment instability (DISI) of the carpus?

. Lunotriquetral ligament
. Scaphotrapeziotrapezoid ligament
. Radioscaphocapitate ligament
. Scapholunate interosseous ligament
. Ulnar collateral ligament of wrist

Correct Answer & Explanation

. Scapholunate interosseous ligament

Explanation

The scapholunate interosseous ligament (SLIL) is the most important stabilizer of the scaphoid and lunate. A tear of the SLIL allows the scaphoid to flex and the lunate to extend, resulting in dorsal intercalated segment instability (DISI), where the lunate extends dorsally. The lunotriquetral ligament prevents volar intercalated segment instability (VISI). The other ligaments have different stabilizing roles.

Question 2095

Topic: 7. Hand and Wrist

A patient with a radial nerve injury at the spiral groove would typically exhibit which of the following deficits?

. Inability to flex the wrist
. Weakness in finger abduction/adduction
. Loss of sensation over the ulnar side of the hand
. Wrist drop with inability to extend MCP joints
. Thenar atrophy

Correct Answer & Explanation

. Wrist drop with inability to extend MCP joints

Explanation

A radial nerve injury at the spiral groove (mid-humerus) typically spares the triceps but affects the extensor muscles of the wrist and fingers, leading to a characteristic 'wrist drop' and inability to extend the metacarpophalangeal (MCP) joints. Sensation over the dorsum of the hand and radial aspect of the thumb is also affected. Inability to flex the wrist is typically median or ulnar nerve. Weakness in finger abduction/adduction and ulnar hand sensation loss are ulnar nerve. Thenar atrophy is median nerve.

Question 2096

Topic: 7. Hand and Wrist

What is the primary anatomical difference between Polydactyly and Syndactyly?

. Polydactyly is an extra finger, Syndactyly is a missing finger.
. Polydactyly is fused fingers, Syndactyly is an extra finger.
. Polydactyly is an extra finger, Syndactyly is fused fingers.
. Polydactyly affects only the thumb, Syndactyly affects only the small finger.
. Polydactyly is a bent finger, Syndactyly is an oversized finger.

Correct Answer & Explanation

. Polydactyly is an extra finger, Syndactyly is fused fingers.

Explanation

Polydactyly refers to the presence of extra digits (supernumerary fingers or toes). Syndactyly refers to the fusion or webbing between adjacent digits. These are distinct congenital hand anomalies. The other options describe incorrect definitions.

Question 2097

Topic: 7. Hand and Wrist

Which anatomical structure is responsible for stabilizing the first carpometacarpal (CMC) joint of the thumb, preventing dorsal and radial subluxation?

. Ulnar collateral ligament
. Radial collateral ligament
. Dorsal radiocarpal ligament
. Anterior oblique ligament (Beak ligament)
. Adductor pollicis tendon

Correct Answer & Explanation

. Anterior oblique ligament (Beak ligament)

Explanation

The anterior oblique ligament (often called the 'Beak ligament') is the primary stabilizer of the thumb CMC joint, resisting dorsal and radial subluxation. It originates from the palmar aspect of the trapezium and inserts onto the palmar-ulnar aspect of the first metacarpal base. Its integrity is crucial for the stability of the thumb CMC joint, and it is often disrupted in Bennett's fractures. The UCL and RCL of the thumb are MCP joint ligaments.

Question 2098

Topic: 7. Hand and Wrist

What is the most common carpal instability pattern?

. Volar Intercalated Segment Instability (VISI)
. Dorsal Intercalated Segment Instability (DISI)
. Midcarpal Instability
. Perilunate Dislocation
. Scaphotrapeziotrapezoid Instability

Correct Answer & Explanation

. Dorsal Intercalated Segment Instability (DISI)

Explanation

Dorsal Intercalated Segment Instability (DISI) is the most common carpal instability pattern. It is typically caused by a disruption of the scapholunate interosseous ligament, allowing the scaphoid to flex and the lunate to extend dorsally. VISI is less common and results from lunotriquetral ligament disruption. Perilunate dislocation is an acute, traumatic event, not an instability pattern itself but a severe form of carpal disruption that can lead to DISI if not reduced correctly.

Question 2099

Topic: Nerve & Tendon

A patient is unable to make an 'OK' sign, with compensatory hyperextension of the MCP joint of the thumb and index finger. This is indicative of a lesion to which nerve branch?

. Ulnar nerve
. Median nerve at the wrist
. Anterior interosseous nerve (AIN)
. Radial nerve
. Posterior interosseous nerve (PIN)

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

Explanation

Inability to make a proper 'OK' sign (often appearing as a flattened or 'pincer' grasp, not a true circle) with compensatory hyperextension of the MCP joints of the thumb and index finger suggests weakness of the flexor pollicis longus (FPL) and the flexor digitorum profundus (FDP) to the index finger. Both of these muscles are innervated by the Anterior Interosseous Nerve (AIN), a pure motor branch of the median nerve. A high median nerve injury would also cause this, but the AIN syndrome specifically refers to this isolated motor deficit without sensory loss.

Question 2100

Topic: 7. Hand and Wrist

A 6-year-old child presents with a 'delta phalanx' of the small finger. This anomaly is characterized by which of the following?

. An extra digit attached to the small finger.
. A missing phalanx in the small finger.
. A triangularly shaped phalanx causing angular deformity.
. Fusion of two phalanges in the small finger.
. An abnormally long small finger.

Correct Answer & Explanation

. A triangularly shaped phalanx causing angular deformity.

Explanation

A delta phalanx is a congenital bone anomaly characterized by a triangularly shaped phalanx that has a C-shaped epiphysis (or bar of bone) that extends longitudinally, preventing normal growth and leading to angular deformity (clinodactyly) of the affected digit. It is commonly associated with polydactyly or syndactyly, often affecting the middle phalanx of the small finger or the proximal phalanx of the thumb.

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