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7. Hand and Wrist MCQs

Practice Set 136 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 2701

Topic: Nerve & Tendon

A runner complains of chronic medial heel and arch pain. Examination reveals a positive Tinel's sign posterior to the medial malleolus radiating to the plantar medial foot. Which muscle is innervated by the medial plantar nerve?

. Abductor hallucis
. Abductor digiti minimi
. Flexor digiti minimi brevis
. Adductor hallucis
. Quadratus plantae

Correct Answer & Explanation

. Abductor hallucis

Explanation

The medial plantar nerve innervates the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and the first lumbrical. The other listed muscles are innervated by the lateral plantar nerve.

Question 2702

Topic: 7. Hand and Wrist

A rock climber experiences a sudden "pop" in their ring finger, followed by bowstringing of the flexor tendons. Which annular pulley is located over the proximal phalanx and is considered the most biomechanically critical to prevent this bowstringing?

. A2
. A1
. A3
. A4
. A5

Correct Answer & Explanation

. A2

Explanation

The A2 pulley is located over the proximal phalanx and, along with the A4 pulley over the middle phalanx, is the most critical for preventing bowstringing. The A2 pulley withstands the highest forces during grip.

Question 2703

Topic: 7. Hand and Wrist

A patient complains of an inability to extend the fingers at the metacarpophalangeal joints but has preserved wrist extension with radial deviation. The sensory examination is completely normal. Compression of the involved nerve most commonly occurs between the two heads of which muscle?

. Pronator teres
. Supinator
. Flexor carpi ulnaris
. Extensor carpi radialis brevis
. Brachioradialis

Correct Answer & Explanation

. Pronator teres

Explanation

Posterior interosseous nerve (PIN) syndrome causes weakness of finger extensors and extensor carpi ulnaris, leading to radial deviation during wrist extension. The most common site of compression is the Arcade of Frohse, located at the proximal edge of the superficial head of the supinator.

Question 2704

Topic: 7. Hand and Wrist

During an open carpal tunnel release, the recurrent motor branch of the median nerve is inadvertently transected. Which of the following thumb movements will be most significantly impaired?

. Adduction
. Extension
. Palmar abduction
. Flexion of the interphalangeal joint
. Radial abduction

Correct Answer & Explanation

. Adduction

Explanation

The recurrent motor branch of the median nerve innervates the opponens pollicis, abductor pollicis brevis, and the superficial head of the flexor pollicis brevis. Denervation results in loss of palmar abduction and opposition of the thumb.

Question 2705

Topic: 7. Hand and Wrist

A patient sustains a laceration to the palmar aspect of the hand resulting in a "lumbrical plus" posture during attempted finger flexion. Which of the following describes the origin and insertion of the first lumbrical?

. Originates from the flexor digitorum superficialis tendon and inserts on the ulnar lateral band
. Originates from the flexor digitorum profundus tendon and inserts on the radial lateral band
. Originates from the metacarpal shaft and inserts on the radial lateral band
. Originates from the flexor digitorum profundus tendon and inserts on the central slip
. Originates from the metacarpophalangeal volar plate and inserts on the ulnar lateral band

Correct Answer & Explanation

. Originates from the flexor digitorum superficialis tendon and inserts on the ulnar lateral band

Explanation

The lumbricals originate from the flexor digitorum profundus tendons and insert into the extensor expansion (radial lateral band) of the corresponding digit. They flex the metacarpophalangeal joints and extend the interphalangeal joints.

Question 2706

Topic: Nerve & Tendon

A 6-year-old boy sustains a posterolateral displaced supracondylar fracture of the humerus. Which neurovascular structures are at the highest risk of being tethered or injured by the proximal fracture fragment?

. Radial nerve and profunda brachii artery
. Median nerve and brachial artery
. Ulnar nerve and superior ulnar collateral artery
. Anterior interosseous nerve and radial artery
. Musculocutaneous nerve and brachial artery

Correct Answer & Explanation

. Radial nerve and profunda brachii artery

Explanation

In a posterolateral displaced supracondylar humerus fracture, the proximal fragment displaces anteromedially. This places the brachial artery and the median nerve at greatest risk of direct injury or tethering.

Question 2707

Topic: Wrist & Carpus

A 22-year-old male sustains a proximal pole scaphoid fracture. The high risk of avascular necrosis in this fracture pattern is due to the retrograde intraosseous blood supply. The primary vascular inflow to the scaphoid enters at which location?

. Distal pole via volar branches of the ulnar artery
. Dorsal ridge via branches of the radial artery
. Volar tubercle via the superficial palmar arch
. Scapholunate ligament attachments
. Radioscaphocapitate ligament attachments

Correct Answer & Explanation

. Distal pole via volar branches of the ulnar artery

Explanation

The major blood supply to the scaphoid enters distally along the dorsal ridge from branches of the radial artery, leaving the proximal pole dependent on tenuous retrograde flow.

Question 2708

Topic: Nerve & Tendon

A patient with De Quervain's tenosynovitis demonstrates a positive Finkelstein test. The involved tendons form the radial (anterior) border of the anatomical snuffbox. Which of the following tendons forms the ulnar (posterior) border of this space?

. Extensor pollicis brevis
. Abductor pollicis longus
. Extensor pollicis longus
. Extensor carpi radialis longus
. Extensor carpi radialis brevis

Correct Answer & Explanation

. Extensor pollicis brevis

Explanation

The anatomical snuffbox is bordered radially by the first extensor compartment tendons (APL and EPB) and ulnarly by the third extensor compartment tendon (EPL).

Question 2709

Topic: Nerve & Tendon

When utilizing the volar (Henry) approach to the proximal radius, the surgeon enters the internervous plane between the brachioradialis and the pronator teres. Which nerves supply these two muscles, respectively?

. Radial nerve and Median nerve
. Median nerve and Ulnar nerve
. Musculocutaneous nerve and Median nerve
. Radial nerve and Ulnar nerve
. Median nerve and Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve and Median nerve

Explanation

The brachioradialis is innervated by the radial nerve, while the pronator teres is innervated by the median nerve. This provides a safe, true internervous plane for exposing the proximal radius.

Question 2710

Topic: 7. Hand and Wrist

Avascular necrosis of the proximal pole of the scaphoid is a known complication of scaphoid waist fractures due to its retrograde blood supply. The primary blood supply to the proximal pole enters via which of the following vessels?

. Volar branch of the radial artery
. Dorsal carpal branch of the radial artery
. Anterior interosseous artery
. Ulnar artery
. Princeps pollicis artery

Correct Answer & Explanation

. Volar branch of the radial artery

Explanation

The dorsal carpal branch of the radial artery enters the distal pole of the scaphoid and provides retrograde flow to the proximal 80% of the bone. This unique vascular anatomy explains the high rate of proximal pole AVN following waist fractures.

Question 2711

Topic: Wrist & Carpus

During clinical assessment of the distal radioulnar joint (DRUJ) for instability, understanding the tensioning of the radioulnar ligaments is essential. Which ligamentous structure is under maximum tension when the forearm is placed in full supination?

. Dorsal radioulnar ligament
. Volar radioulnar ligament
. Ulnar collateral ligament
. Radioscaphocapitate ligament
. Lunotriquetral ligament

Correct Answer & Explanation

. Dorsal radioulnar ligament

Explanation

The volar (palmar) radioulnar ligament of the TFCC is tightest in full supination, preventing dorsal translation of the ulna. Conversely, the dorsal radioulnar ligament becomes tightest in full pronation.

Question 2712

Topic: Nerve & Tendon

The lumbrical muscles of the hand are unique in that they both originate from and insert onto tendons. Which of the following correctly describes the innervation of the lumbrical muscle associated with the ring finger?

. Deep branch of the ulnar nerve
. Superficial branch of the ulnar nerve
. Anterior interosseous nerve
. Recurrent motor branch of the median nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Deep branch of the ulnar nerve

Explanation

The third and fourth lumbricals (ring and small fingers) are innervated by the deep branch of the ulnar nerve. The first and second lumbricals (index and middle fingers) are innervated by the median nerve.

Question 2713

Topic: 7. Hand and Wrist

During a surgical release for a recalcitrant trigger finger, a specific annular pulley is incised. What is the location of this pulley relative to the digit's joints?

. Proximal to the metacarpophalangeal (MCP) joint
. At the level of the metacarpophalangeal (MCP) joint
. At the mid-substance of the proximal phalanx
. At the proximal interphalangeal (PIP) joint
. At the mid-substance of the middle phalanx

Correct Answer & Explanation

. Proximal to the metacarpophalangeal (MCP) joint

Explanation

Trigger finger release involves sectioning the A1 pulley, which overlies the metacarpophalangeal (MCP) joint. The A2 and A4 pulleys must be preserved to prevent flexor tendon bowstringing.

Question 2714

Topic: Nerve & Tendon

In the proximal forearm, the median nerve passes between the two heads of the pronator teres. Which of the following structures anatomically separates the median nerve from the ulnar artery at this level?

. Ulnar head of the pronator teres
. Humeral head of the pronator teres
. Flexor digitorum superficialis
. Bicipital aponeurosis
. Brachioradialis

Correct Answer & Explanation

. Ulnar head of the pronator teres

Explanation

The deep (ulnar) head of the pronator teres separates the median nerve from the underlying ulnar artery. The median nerve passes deep to the humeral head but superficial to the ulnar head.

Question 2715

Topic: 7. Hand and Wrist

In the hand, the lumbrical muscles flex the metacarpophalangeal joints and extend the interphalangeal joints. What is the origin of the third lumbrical?

. Radial side of the flexor digitorum profundus (FDP) tendon to the middle finger
. Adjacent sides of the FDP tendons to the middle and ring fingers
. Adjacent sides of the FDS tendons to the middle and ring fingers
. Ulnar side of the FDP tendon to the ring finger
. Transverse metacarpal ligament

Correct Answer & Explanation

. Radial side of the flexor digitorum profundus (FDP) tendon to the middle finger

Explanation

The first and second lumbricals are unipennate, originating from the radial side of their respective FDP tendons. The third and fourth are bipennate, originating from the adjacent sides of the FDP tendons.

Question 2716

Topic: Wrist & Carpus

The central band of the forearm interosseous membrane is essential for longitudinal load transfer. What is the anatomical orientation of its fibers?

. Proximal radius to distal ulna
. Proximal ulna to distal radius
. Transverse from radius to ulna
. Proximal radius to proximal ulna
. Distal radius to distal ulna

Correct Answer & Explanation

. Proximal radius to distal ulna

Explanation

The central band of the interosseous membrane runs obliquely from the proximal radius to the distal ulna. This orientation facilitates the transfer of axial loads from the radius to the ulna.

Question 2717

Topic: Wrist & Carpus

The triangular fibrocartilage complex (TFCC) stabilizes the distal radioulnar joint (DRUJ). Which component is the primary restraint to dorsal translation of the distal ulna when the forearm is in pronation?

. Volar radioulnar ligament
. Dorsal radioulnar ligament
. Ulnocarpal meniscus
. Ulnolunate ligament
. Extensor carpi ulnaris subsheath

Correct Answer & Explanation

. Volar radioulnar ligament

Explanation

During forearm pronation, the dorsal radioulnar ligament becomes taut and acts as the primary restraint against dorsal translation of the distal ulna. Conversely, the volar radioulnar ligament tightens in supination.

Question 2718

Topic: 7. Hand and Wrist

The recurrent motor branch of the median nerve (the "million dollar nerve") provides critical motor function to the hand. Which of the following muscle combinations does it innervate?

. Adductor pollicis, abductor pollicis brevis, and opponens pollicis
. Opponens pollicis, abductor pollicis brevis, and superficial head of flexor pollicis brevis
. Deep head of flexor pollicis brevis, adductor pollicis, and first dorsal interosseous
. Abductor pollicis longus, extensor pollicis brevis, and opponens pollicis
. First and second lumbricals only

Correct Answer & Explanation

. Adductor pollicis, abductor pollicis brevis, and opponens pollicis

Explanation

The recurrent motor branch of the median nerve innervates the thenar eminence musculature. This includes the abductor pollicis brevis, opponens pollicis, and the superficial head of the flexor pollicis brevis.

Question 2719

Topic: Nerve & Tendon

Which of the following describes the typical motor innervation of the lumbrical muscles of the hand?

. All four by the median nerve
. All four by the ulnar nerve
. Radial two by the ulnar nerve, ulnar two by the median nerve
. Radial two by the median nerve, ulnar two by the ulnar nerve
. Radial two by the radial nerve, ulnar two by the median nerve

Correct Answer & Explanation

. All four by the median nerve

Explanation

The first and second lumbricals are unipennate and innervated by the median nerve. The third and fourth lumbricals are bipennate and innervated by the deep branch of the ulnar nerve.

Question 2720

Topic: Nerve & Tendon

Surgical decompression of the ulnar nerve at the elbow requires an understanding of the cubital tunnel boundaries. Which structure forms the true floor of the cubital tunnel?

. Anterior bundle of the medial collateral ligament (MCL)
. Posterior bundle of the medial collateral ligament (MCL)
. Annular ligament
. Brachialis muscle fascia
. Osborne's ligament

Correct Answer & Explanation

. Anterior bundle of the medial collateral ligament (MCL)

Explanation

The floor of the cubital tunnel is formed by the elbow joint capsule and the posterior bundle of the medial collateral ligament (MCL). Osborne's ligament and the FCU aponeurosis form the roof.

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