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7. Hand and Wrist MCQs

Practice Set 19 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 361

Topic: Wrist & Carpus

A 62-year-old woman sustained a nondisplaced distal radius fracture treated in a cast for 4 weeks. Six weeks after cast removal, she reports a sudden inability to extend her thumb at the interphalangeal joint. What is the most appropriate definitive management for her current condition?

. Primary end-to-end tendon repair
. Extensor indicis proprius (EIP) to extensor pollicis longus (EPL) tendon transfer
. Tendon graft using palmaris longus
. Flexor carpi radialis (FCR) to EPL tendon transfer
. Corticosteroid injection and extension splinting

Correct Answer & Explanation

. Extensor indicis proprius (EIP) to extensor pollicis longus (EPL) tendon transfer

Explanation

Delayed extensor pollicis longus (EPL) rupture after a nondisplaced distal radius fracture is best treated with an extensor indicis proprius (EIP) to EPL tendon transfer. Primary repair is typically not feasible due to retracted and degenerated tendon ends.

Question 362

Topic: 7. Hand and Wrist

A 28-year-old male sustains a proximal pole scaphoid fracture. The high risk of nonunion and avascular necrosis in this region is due to its retrograde blood supply primarily derived from which vessel?

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

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The primary blood supply to the scaphoid enters distally via the dorsal carpal branch of the radial artery. This retrograde flow makes proximal pole fractures highly susceptible to avascular necrosis.

Question 363

Topic: 7. Hand and Wrist

A patient with severe carpal tunnel syndrome exhibits profound thenar atrophy. Which specific muscle, innervated by the recurrent motor branch of the median nerve, is primarily responsible for the bulk of the thenar eminence affected in this condition?

. Flexor pollicis brevis (deep head)
. Adductor pollicis
. Opponens pollicis
. Abductor pollicis longus
. Palmaris brevis

Correct Answer & Explanation

. Opponens pollicis

Explanation

The thenar eminence bulk is primarily composed of the opponens pollicis and abductor pollicis brevis. Severe median nerve compression causes denervation via the recurrent motor branch, leading to visible atrophy of these muscles.

Question 364

Topic: 7. Hand and Wrist

A 22-year-old male falls on an outstretched hand and sustains a proximal pole scaphoid fracture. Which of the following best describes the vascular supply to the proximal pole of the scaphoid and the implication for this fracture?

. It receives retrograde blood flow from the dorsal carpal branch of the radial artery, making it highly susceptible to avascular necrosis.
. It receives anterograde blood flow from the volar carpal branch, resulting in high healing rates.
. It receives dual blood supply from both the radial and ulnar arteries, ensuring rapid union.
. It relies entirely on intra-osseous circulation from the distal pole without direct capsular vessels.
. It receives blood via the interosseous ligament from the lunate, leading to frequent nonunions.

Correct Answer & Explanation

. It receives retrograde blood flow from the dorsal carpal branch of the radial artery, making it highly susceptible to avascular necrosis.

Explanation

The primary vascular supply to the scaphoid is retrograde via branches of the radial artery entering the dorsal ridge distally. This tenuous retrograde blood flow places proximal pole fractures at a significantly higher risk for avascular necrosis and nonunion.

Question 365

Topic: 7. Hand and Wrist

A patient sustains a proximal pole scaphoid fracture. The high risk of avascular necrosis (AVN) in this region is primarily due to the retrograde blood supply originating from which of the following vessels?

. Superficial palmar arch
. Ulnar artery
. Dorsal carpal branch of the radial artery
. Anterior interosseous artery
. Deep palmar arch

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The primary blood supply to the scaphoid is retrograde, entering distally and supplying the proximal pole. This supply originates almost entirely from the dorsal carpal branch of the radial artery, making proximal pole fractures highly susceptible to ischemic necrosis.

Question 366

Topic: 7. Hand and Wrist

A 40-year-old man has pain in his foot after minor trauma. A radiograph is shown in Slide 1 and biopsy specimens are shown in Slides 2 and 3. Which of the following would be the most appropriate treatment:

. Curettage and bone grafting
. Wide resection and allograft reconstruction
. Toe amputation
. External beam irradiation
. C urettage, cement augmentation, and external beam irradiation

Correct Answer & Explanation

. Curettage and bone grafting

Explanation

The radiograph shows a lucent lesion in the proximal phalanx of the second toe and expansion of the proximal phalanx. The bone is expanded with a thin periosteal rim. Faint calcifications are also seen within the medullary cavity. This radiographic appearance is fairly characteristic of an enchondroma. The low-power hematoxylin and eosin stain shows abundant blue hyaline matrix and a paucity of cells. The high-power hematoxylin and eosin stain shows the small dark and uniform nuclei present in enchondromas. No pleomorphism or nuclear atypia are present.

Question 367

Topic: 7. Hand and Wrist

A 22-year-old male presents with a proximal pole scaphoid fracture. The high risk of avascular necrosis in this region is primarily due to the retrograde blood supply from which vessel?

. Volar carpal branch of the radial artery
. Dorsal carpal branch of the radial artery
. Superficial palmar arch
. Deep palmar arch
. Anterior interosseous artery

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The scaphoid receives its primary blood supply from the dorsal carpal branch of the radial artery, which enters distally and flows retrograde to the proximal pole, making proximal fractures prone to AVN.

Question 368

Topic: Nerve & Tendon

A 6-year-old child sustains a severely displaced extension-type supracondylar fracture of the humerus. Which nerve is most commonly injured in this specific fracture pattern?

. Median nerve (main trunk)
. Anterior interosseous nerve
. Ulnar nerve
. Radial nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures due to the anterior displacement of the proximal fracture fragment.

Question 369

Topic: 7. Hand and Wrist

A patient presents with a vague proximal forearm ache and weakness in the hand. The surgeon suspects anterior interosseous nerve (AIN) syndrome. Which of the following physical examination findings is most specific for this diagnosis?

. Inability to cross the index and middle fingers
. Inability to make an "OK" sign due to weakness of the FPL and FDP to the index finger
. Numbness and tingling over the volar aspect of the small finger
. Weakness of the flexor carpi ulnaris during wrist flexion
. Winging of the scapula with forward elevation of the arm

Correct Answer & Explanation

. Inability to make an "OK" sign due to weakness of the FPL and FDP to the index finger

Explanation

AIN syndrome results in motor weakness of the flexor pollicis longus (FPL), the flexor digitorum profundus (FDP) to the index/middle fingers, and the pronator quadratus. This classically presents as the inability to form an "OK" sign.

Question 370

Topic: 7. Hand and Wrist
A 24-year-old athlete presents with chronic radial-sided wrist pain. Radiographs reveal a scaphoid nonunion advanced collapse (SNAC) pattern with arthritis involving the radioscaphoid and capitolunate joints, but sparing the radiolunate joint. What is the most appropriate surgical treatment?
. Proximal row carpectomy (PRC)
. Scaphoid excision and four-corner fusion
. Total wrist arthrodesis
. Radial styloidectomy
. Dorsal capsulodesis

Correct Answer & Explanation

. Scaphoid excision and four-corner fusion

Explanation

In stage II or III SNAC/SLAC wrist, the capitolunate joint is arthritic, making a proximal row carpectomy contraindicated since it relies on a healthy capitate articular surface. Scaphoid excision with four-corner fusion preserves the healthy radiolunate joint while effectively addressing the arthritic midcarpal segments.

Question 371

Topic: 7. Hand and Wrist
A 32-year-old manual laborer presents with dorsal wrist pain and decreased grip strength. Radiographs reveal sclerosis and early fragmentation of the lunate, with negative ulnar variance, but no carpal collapse. What is the most appropriate surgical intervention?
. Proximal row carpectomy
. Radial shortening osteotomy
. Ulnar shortening osteotomy
. Scaphoid-Trapezium-Trapezoid (STT) arthrodesis
. Total wrist arthrodesis

Correct Answer & Explanation

. Radial shortening osteotomy

Explanation

In Lichtman Stage II or IIIA Kienbock's disease with negative ulnar variance, a joint-leveling procedure such as a radial shortening osteotomy is indicated. This unloads the lunate and helps prevent further carpal collapse.

Question 372

Topic: 7. Hand and Wrist
A 24-year-old carpenter suffers a laceration over the volar aspect of his proximal phalanx of the index finger, resulting in an inability to flex both the PIP and DIP joints. Which of the following accurately describes the anatomical flexor tendon zone of this injury?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Flexor tendon Zone II (historically known as 'no man's land') extends from the A1 pulley (distal palmar crease) to the insertion of the FDS at the middle phalanx. Lacerations here typically involve both the FDS and FDP tendons.

Question 373

Topic: 7. Hand and Wrist
A 25-year-old carpenter lacerates his volar index finger at the level of the proximal phalanx, cutting both the FDS and FDP tendons. This injury corresponds to which flexor tendon zone?
. Zone II
. Zone I
. Zone III
. Zone IV

Correct Answer & Explanation

. Zone II

Explanation

Zone II, historically known as "no man's land," extends from the A1 pulley to the distal insertion of the FDS. Injuries here are notoriously difficult to treat due to the risk of adhesions between the closely opposed FDS and FDP tendons.

Question 374

Topic: 7. Hand and Wrist

A patient complains of numbness in the thumb, index, and middle fingers. Symptoms are exacerbated by tapping over the volar wrist. Which nerve is compressed, and in which anatomical space?

. Ulnar nerve in Guyon's canal
. Median nerve in the carpal tunnel
. Median nerve between the heads of the pronator teres
. Radial nerve in the spiral groove

Correct Answer & Explanation

. Median nerve in the carpal tunnel

Explanation

Carpal tunnel syndrome results from compression of the median nerve within the carpal tunnel. It presents with sensory changes in the radial three and a half digits and a positive Tinel's sign at the wrist.

Question 375

Topic: 7. Hand and Wrist

A 24-year-old male falls on an outstretched hand and presents with anatomic snuffbox tenderness. Initial standard radiographs of the wrist are negative for fracture. What is the most appropriate next step in management to definitively rule out a fracture?

. CT scan of the wrist
. MRI of the wrist
. Technetium bone scan
. Diagnostic wrist arthroscopy
. Ultrasound of the anatomic snuffbox

Correct Answer & Explanation

. MRI of the wrist

Explanation

In cases of suspected scaphoid fractures with negative initial radiographs, MRI is highly sensitive and specific for detecting occult fractures. Alternatively, immobilization and repeat radiographs at 10-14 days can be performed.

Question 376

Topic: 7. Hand and Wrist
A 28-year-old carpenter sustains a laceration over the volar aspect of the proximal phalanx of his index finger. Examination reveals the inability to actively flex the proximal and distal interphalangeal joints. This injury occurred in which flexor tendon zone, and what is the optimal timing for primary repair?
. Zone I; within 24 hours
. Zone II; within 1 to 2 weeks
. Zone III; within 4 weeks
. Zone IV; delayed primary repair at 6 weeks
. Zone V; immediate single-stage grafting

Correct Answer & Explanation

. Zone II; within 1 to 2 weeks

Explanation

Lacerations over the proximal phalanx fall within Zone II ('No Man's Land'), involving both FDS and FDP tendons. Primary repair is typically indicated within the first 1 to 2 weeks to optimize functional outcomes and prevent tendon retraction.

Question 377

Topic: 7. Hand and Wrist

A 24-year-old man falls onto an outstretched hand and complains of anatomic snuffbox tenderness. MRI confirms a nondisplaced fracture of the proximal pole of the scaphoid. What is the primary arterial supply to the proximal pole of the scaphoid that places it at high risk for nonunion and avascular necrosis?

. Volar carpal branch of the radial artery entering proximally
. Dorsal carpal branch of the radial artery entering distally
. Ulnar artery via the deep palmar arch
. Anterior interosseous artery
. Superficial palmar branch of the radial artery

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery entering distally

Explanation

The scaphoid has a retrograde blood supply. The dorsal carpal branch of the radial artery enters the dorsal ridge at the distal pole and waist, leaving the proximal pole entirely dependent on this retrograde flow.

Question 378

Topic: 7. Hand and Wrist

A 22-year-old man falls on an outstretched hand and complains of severe radial-sided wrist pain. Examination reveals marked tenderness within the anatomic snuffbox.

Initial PA and lateral radiographs are interpreted as negative. What is the most appropriate initial management?

. Discharge with an elastic compression bandage
. Thumb spica splinting and repeat radiographs in 10 to 14 days
. Immediate open reduction and internal fixation
. Corticosteroid injection into the first dorsal compartment
. Rigid short arm cast for 6 weeks

Correct Answer & Explanation

. Thumb spica splinting and repeat radiographs in 10 to 14 days

Explanation

Occult scaphoid fractures may not be visible on initial plain radiographs immediately following an injury. Applying a thumb spica splint and reassessing with follow-up radiographs or an MRI in 10-14 days prevents displaced nonunions of potentially hidden fractures.

Question 379

Topic: 7. Hand and Wrist
A 35-year-old carpenter sustains a volar laceration over the proximal phalanx of his index finger, resulting in an inability to flex both the DIP and PIP joints. This injury is classified as occurring in which flexor tendon zone?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Zone II extends from the A1 pulley to the insertion of the flexor digitorum superficialis (FDS). Injuries here often involve both the FDP and FDS tendons within the tight fibro-osseous sheath.

Question 380

Topic: 7. Hand and Wrist

A 22-year-old male falls on an outstretched hand and presents with anatomic snuffbox tenderness. Radiographs show a displaced fracture of the proximal pole of the scaphoid.

If left untreated, which of the following represents the typical progression of arthritic changes in the wrist?

. Radioscaphoid joint, then capitolunate joint, then scaphocapitate joint
. Radioscaphoid joint, then scaphocapitate joint, then capitolunate joint
. Capitolunate joint, then radioscaphoid joint, then radiolunate joint
. Radiolunate joint, then capitolunate joint, then radioscaphoid joint
. Scaphotrapezial joint, then radioscaphoid joint, then capitolunate joint

Correct Answer & Explanation

. Radioscaphoid joint, then scaphocapitate joint, then capitolunate joint

Explanation

Scaphoid nonunion advanced collapse (SNAC) begins with arthritis at the radial styloid-scaphoid articulation. It then progresses to the scaphocapitate joint, and finally the capitolunate joint, characteristically sparing the radiolunate joint.

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