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7. Hand and Wrist MCQs

Practice Set 16 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 301

Topic: 7. Hand and Wrist

The most important requirement for a diagnostic magnetic resonance image (MRI) study in cases of scaphoid-lunate ligament injury is:

. 2 mm thin slices
. Tangential cuts
. Gallium-enhanced scan
. Dedicated wrist coil
. MRI in neutral, radial, and ulnar deviation

Correct Answer & Explanation

. Dedicated wrist coil

Explanation

MRI is not considered the technique of choice for the evaluation of the scaphoid-lunate ligament. Standard MRI coils are not adequate for the evaluation of the ligaments of the wrist. To maximize the yield from a wrist MRI, high-field strength and highresolution images must be obtained using dedicated wrist coils. Only with such dedicated coils can detailed information be derived regarding the continuity of the scapoid-lunate ligament. Physical examination and wrist arthroscopy remain the gold standards for the evaluation of a torn scaphoid-lunate ligament.

Question 302

Topic: 7. Hand and Wrist

Mallet finger injuries refer to:

. Fractures of the bony tuft
. Flexor tendon injuries
. Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint
. Fractures of the middle phalanx
. Intrinsic tightness

Correct Answer & Explanation

. Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint

Explanation

Mallet finger injuries may be associated with fractures of the bony tuft, fractures of the middle phalanx, flexor tendon injuries, and intrinsic tightness. However, mallet injuries refer to lack of continuity at the DIP joint.

Question 303

Topic: 7. Hand and Wrist
In mallet finger injuries, the distal phalanx posture is:
. Hyperextended
. Flexed
. Neutral
. Radially deviated
. Ulnarly deviated

Correct Answer & Explanation

. Flexed

Explanation

The characteristic deformity is โ€œdroopingโ€ at the distal interphalangeal (DIP) joint. The DIP is flexed. It is not hyperextended, neutral, or deviated.

Question 304

Topic: 7. Hand and Wrist

Mallet finger injuries are typically:

. Secondary to hyperextension injuries
. Secondary to forced flexion injuries
. Secondary to torsion injuries
. Secondary to fingertip amputations
. Asymptomatic

Correct Answer & Explanation

. Secondary to forced flexion injuries

Explanation

Mallet finger usually results from a blow to the tip of the extended finger. This forces distal phalanx flexion and disruption of the extensor mechanism at the distal interphalangeal joint. Open injuries to the extensor mechanism can also cause mallet finger.

Question 305

Topic: Nerve & Tendon

Treatment of a type I mallet finger is typically closed. This involves:

. C ast immobilization of the affected digit in extension
. Dorsal block splint of the affected digit
. Early active motion of the affected joint
. Splinting of the affected distal interphalangeal joint (DIP) joint in flexion
. Splinting of the affected DIP joint in extension

Correct Answer & Explanation

. Splinting of the affected DIP joint in extension

Explanation

Cast immobilization is excessive and will cause undue stiffness in the affected finger. Dorsal blocking splints, splinting in flexion, and early active motion are contraindicated in these injuries. Only the affected joint should be splinted in extension.

Question 306

Topic: Nerve & Tendon

Type I mallet finger injuries must be immobilized constantly for a minimum of:

. 4 weeks
. 5 weeks
. 6 weeks
. 7 weeks
. 8 weeks

Correct Answer & Explanation

. 8 weeks

Explanation

Eight weeks of immobilization is preferred. If the finger is immobilized for a shorter period of time, the clock is reset and immobilization is started again.

Question 307

Topic: Nerve & Tendon
The most common mallet finger injuries are:
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

Type I mallet injuries are by far the most common mallet injuries. There is no such classification as a type V injury.

Question 308

Topic: 7. Hand and Wrist

On physical examination, a mallet finger assumes a:

. Resting flexed posture with active and passive extension
. Resting flexed posture without passive extension
. Resting flexed posture without active extension
. Resting flexed posture without active or passive extension
. Resting flexed posture with active extension

Correct Answer & Explanation

. Resting flexed posture without active extension

Explanation

The distal phalanx assumes a resting flexed posture. The patient is not able to actively extend the fingertip, but it can be passively extended.

Question 309

Topic: Nerve & Tendon
The following mallet finger injuries always require tendon repair:
. Type I and type II
. Type II and type III
. Type III and type IV
. Type IV and type V
. Type I and type IV

Correct Answer & Explanation

. Type II and type III

Explanation

Type II and III injuries have absolute requirements for tendon repair as there is a laceration or loss of tendon substance.

Question 310

Topic: Nerve & Tendon

After placing a type I mallet finger in a splint at the initial visit, next follow- up should be:

. The following day
. In 1 week
. In 2 weeks
. In 1 month
. At the end of the 8-week regimen

Correct Answer & Explanation

. In 1 week

Explanation

After placement of the splint, the patient should follow-up in the next week to make sure the finger is still maintained in full extension. Loosening of the splint will occur as swelling decreases.

Question 311

Topic: 7. Hand and Wrist

Enchondromas are commonly involved in which of the following sites:

. Metacarpals
. C arpus
. Radius
. Ulna
. C lavicle

Correct Answer & Explanation

. Metacarpals

Explanation

Metacarpals and phalanges are the most common areas of hand involvement, and the hand is involved in 40% to 65% of cases. Enchondromas are also the most common primary benign bone tumor of the hand (90% cases).

Question 312

Topic: Nerve & Tendon
All of the following may be seen with preganglionic lesion except:
. Horner's syndrome
. Hemidiaphragmatic palsy
. Positive histamine test
. Tinel's sign
. Root avulsion sleeve on myelogram

Correct Answer & Explanation

. Tinel's sign

Explanation

Tinel's sign is seen with postganglionic lesions.

Question 313

Topic: 7. Hand and Wrist

A 1-year-old child presents with simple syndactyly of the middle and ring fingers. What is the most appropriate timing and rationale for surgical release?

. Before 6 months of age to prevent neurovascular compromise.
. Between 12 and 18 months of age to minimize scar contracture while allowing normal motor development.
. At 3 to 4 years of age when the child can comply with postoperative hand therapy.
. At 5 to 6 years of age immediately prior to starting school to avoid psychosocial stigma.

Correct Answer & Explanation

. Between 12 and 18 months of age to minimize scar contracture while allowing normal motor development.

Explanation

Simple syndactyly of the middle and ring fingers is optimally released between 12 and 18 months of age. Releasing earlier risks significant scar contracture, while later release may interfere with normal grasp and fine motor development.

Question 314

Topic: Nerve & Tendon

The Martin-Gruber anastomosis is a well-described anatomical variant in the upper extremity. It involves the anomalous crossing of nerve fibers in the forearm from the:

. Ulnar nerve to the Median nerve
. Median nerve (or anterior interosseous nerve) to the Ulnar nerve
. Radial nerve to the Ulnar nerve
. Ulnar nerve to the Radial nerve

Correct Answer & Explanation

. Median nerve (or anterior interosseous nerve) to the Ulnar nerve

Explanation

The Martin-Gruber anastomosis occurs in the forearm when motor fibers cross from the median nerve or anterior interosseous nerve to the ulnar nerve. These fibers typically go on to innervate intrinsic muscles of the hand.

Question 315

Topic: 7. Hand and Wrist

A 25-year-old male falls on an outstretched hand and sustains a proximal pole scaphoid fracture. What is the major arterial supply to the scaphoid that makes this specific fracture pattern highly prone to avascular necrosis?

. Volar carpal branch of the radial artery
. Dorsal carpal branch of the radial artery
. Deep palmar arch
. Ulnar artery recurrent branches
. Anterior interosseous artery

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The dorsal carpal branch of the radial artery enters the scaphoid at the dorsal ridge (distal to the waist) and supplies 70-80% of the bone via retrograde flow. Fractures at the proximal pole disrupt this retrograde supply, leading to high rates of avascular necrosis.

Question 316

Topic: 7. Hand and Wrist
According to the Wassel classification of thumb polydactyly, which type is the most common and involves duplication at the metacarpophalangeal joint?
. Type II
. Type III
. Type IV
. Type V
. Type VII

Correct Answer & Explanation

. Type IV

Explanation

Wassel Type IV, characterized by a bifid proximal phalanx and duplication of the distal phalanx, is the most common form of preaxial polydactyly. It accounts for approximately 40-50% of all thumb duplications.

Question 317

Topic: 7. Hand and Wrist

Dorsal wrist ganglions originate from the:

. Scapholunate ligament
. Dorsal capsule
. Extensor digitorum communis (EDC ) tendon
. Dorsal carpal ligament
. C apitolunate joint

Correct Answer & Explanation

. Scapholunate ligament

Explanation

Dorsal wrist ganglia do not arise from the dorsal capsule, EDC tendon, capitolunate joint, or dorsal intercarpal ligament. Dorsal wrist ganglia arise from the scapholunate ligament. Some surgeons advocate excising a small rim of the scapholunate ligament to avoid recurrence.C orrect Answer: Scapholunate ligament

Question 318

Topic: 7. Hand and Wrist

Ganglions of the distal interphalangeal (DIP) joints of the fingers are called:

. Mucous cysts
. Bouchard nodes
. Heberden nodes
. Inclusion cysts
. Retinacular cysts

Correct Answer & Explanation

. Mucous cysts

Explanation

Ganglions arising at the DIP joints are called mucous cysts and ganglions from the flexor tendon in the palm are called retinacular cysts. Bouchard nodes are osteophytes that develop at the proximal interphalangeal joint. Heberden nodes are bony spurs at the dorsal aspect of the DIP joint and are present in osteoarthritis. Inclusion cysts are mobile, nonadherent to skin, and can occur anywhere on a hand.

Question 319

Topic: Hand Trauma & Infection

Felon complications include all of the following except:

. Phalangeal osteomyelitis
. Suppurative flexor tenosynovitis
. C ollar button abscess
. Distal interphalangeal joint septic arthritis
. Nailbed deformity

Correct Answer & Explanation

. Phalangeal osteomyelitis

Explanation

Felons that are chronic or neglected may penetrate adjacent structures such as the distal phalanx, nailbed, or distal interphalangeal joint. They can also contribute to the formation of a pyogenic flexor tenosynovitis. C ollar button abscesses are localized to web space. They typically arise from direct inoculation, not from distant felons.

Question 320

Topic: Hand Trauma & Infection

Which of the following is not a classic Kanavel sign of flexor tenosynovitis:

. Pain on passive extension
. Flexion attitude of the finger
. Tenderness of flexor sheath
. Anesthesia of the fingertip
. Fusiform swelling of the entire finger

Correct Answer & Explanation

. Anesthesia of the fingertip

Explanation

The cardinal signs of flexor tenosynovitis described by Kanavel include pain on passive extension, flexion attitude of the finger, tenderness of flexor sheath, and swollen finger.

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