Practice Set 135 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.
A patient with severe cubital tunnel syndrome is undergoing an in situ ulnar nerve decompression. The floor of the cubital tunnel is formed by which of the following structures?
. Osborne's ligament
A patient presents with weakness in pinching the thumb and index finger, noting an inability to make an 'OK' sign. Electromyography confirms a compressive neuropathy of the anterior interosseous nerve (AIN). Which of the following anatomical structures is the most common cause of this specific nerve compression?
. Ligament of Struthers
A 45-year-old mechanic complains of a deep aching pain in the dorsal proximal forearm and an inability to extend the fingers at the MCP joints. Wrist extension is preserved but deviates radially. Where is the most likely site of nerve compression?
. Arcade of Struthers
A common anatomical variant involves a communicating neural branch between the median nerve and the ulnar nerve in the forearm. What is the name of this anomaly and what type of nerve fibers does it predominantly carry?
. Riche-Cannieu anastomosis; predominantly sensory
During surgical decompression of the ulnar nerve at the elbow (cubital tunnel release), the floor of the cubital tunnel is visualized. Which of the following structures primarily forms the floor of the cubital tunnel?
. Osborne's ligament
Compression of the ulnar nerve in Guyon's canal can present with mixed sensory and motor deficits or isolated deficits depending on the zone of compression. A ganglion cyst in Zone 2 of Guyon's canal will produce which of the following clinical pictures?
. Combined motor weakness of intrinsics and sensory loss over the volar little finger
A patient presents with aching pain in the proximal volar forearm and paresthesias in the thumb, index, and middle fingers. Symptoms worsen with resisted pronation. Examination reveals no weakness of the flexor pollicis longus. An anomalous ligament extending from a supracondylar process to the medial epicondyle is suspected. What structures are compressed by this ligament?
. Ulnar nerve and ulnar artery
A patient presents with volar forearm pain and paresthesias in the thumb, index, and middle fingers. Symptoms are exacerbated by resisted forearm pronation with the elbow extended. Which of the following structures is the most likely site of median nerve compression?
. Ligament of Struthers
A cyclist presents with intrinsic muscle weakness of the right hand but intact sensation over the volar hypothenar eminence and the dorsal ulnar aspect of the hand. In which zone of Guyon's canal is the ulnar nerve most likely compressed?
. Zone 1
A patient presents with an inability to form an OK sign with their thumb and index finger after a supracondylar humerus fracture. Sensation in the hand is completely normal. What is the most likely injured nerve and its primary origin?
. Anterior interosseous nerve; branch of the radial nerve
During an in situ ulnar nerve decompression at the cubital tunnel, several distinct anatomic structures can cause compression. Which of the following structures forms the roof of the cubital tunnel?
. Osborne's ligament
. Flexor carpi radialis
A 45-year-old mechanic presents with numbness in the small finger and weakness in grip strength. Nonoperative management has failed, and an in situ decompression of the ulnar nerve is planned. During the approach, the roof of the cubital tunnel must be divided. Which of the following structures constitutes the primary roof of this tunnel?
. Medial intermuscular septum
A patient presents with an inability to make an 'OK' sign, demonstrating loss of flexion at the thumb interphalangeal joint and index finger distal interphalangeal joint. Sensation in the hand is completely normal. Which of the following is LEAST likely to be the anatomical site of neural compression in this syndrome?
. Tendinous edge of the deep head of the pronator teres
A 25-year-old falls on an outstretched hand and sustains a scaphoid waist fracture. Which of the following best describes the predominant arterial supply to the proximal pole of the scaphoid?
. Volar radiocarpal branches entering distally
Tears of the triangular fibrocartilage complex (TFCC) often occur in conjunction with distal radius fractures. Which zone of the TFCC is considered avascular and therefore has the poorest healing potential?
. Peripheral dorsal
During an ulnar nerve transposition, the surgeon must release Osborne's ligament. This structure spans between the medial epicondyle and which other bony landmark?
. Coronoid process
During a carpal tunnel release, the recurrent motor branch of the median nerve is inadvertently injured. This will result in weakness of which of the following actions?
. Thumb adduction
A patient presents with the inability to cross their index and middle fingers. Which muscle group and nerve combination is primarily responsible for this specific action?
. Palmar interossei, Deep branch of the ulnar nerve
A patient exhibits an inability to extend their fingers at the metacarpophalangeal joints but has normal wrist extension following a proximal radius fracture. At what anatomical site is the involved nerve most likely compressed or injured?
. Arcade of Frohse