7. Hand and Wrist MCQs

Which of the following prophylactic regimens is supported by prospective randomized controlled trials to reduce the risk of Complex Regional Pain Syndrome (Algodystrophy) following a distal radius fracture?

A 45-year-old female presents 6 weeks after non-operative management of a distal radius fracture. She describes severe burning pain out of proportion to the injury, alongside stiffness and shiny skin changes.

Which of the following prophylactic medications, if given at the time of injury, has been shown to reduce the incidence of this condition?

A 45-year-old female sustained a minor crush injury to her hand three months ago. She now presents with severe, burning pain that is disproportionate to the inciting event, significant allodynia, altered skin color, and asymmetric sweating.

She is diagnosed with Complex Regional Pain Syndrome (CRPS). Which of the following clinical features explicitly differentiates CRPS Type II from CRPS Type I?

A 35-year-old asymptomatic female is found to have an incidental well-circumscribed, purely radiolucent lesion with internal stippled calcification in the proximal phalanx of her ring finger following a radiograph taken for a minor sprain. There is no cortical breakthrough or soft tissue extension. What is the most appropriate management?

A 55-year-old woman presents 6 weeks post-distal radius fracture with severe, disproportionate hand pain, diffuse swelling, and shiny, hypersensitive skin.

Which of the following is an evidence-based pharmacologic prophylactic measure that has been shown to reduce the incidence of this specific syndrome following distal radius fractures?

A 52-year-old female presents with severe, burning hand pain, swelling, and shiny skin 10 weeks after open reduction and internal fixation of a distal radius fracture.

According to the Budapest Criteria, which of the following is an absolute requirement for the clinical diagnosis of Complex Regional Pain Syndrome (CRPS)?

A 45-year-old woman presents 3 months after a conservatively managed distal radius fracture with severe hand pain, hyperalgesia, swelling, and shiny skin.

A triple-phase bone scan is ordered to aid in the diagnosis of Complex Regional Pain Syndrome (CRPS). Which of the following bone scan findings is most characteristic of this condition?

A patient presents with a soft tissue mass in the popliteal fossa. Palpation of the mass elicits paresthesias radiating to the plantar aspect of the foot. Which of the following signs is being demonstrated, indicating a neural origin of the tumor?

A clinical trial comparing two internal fixation methods for distal radius fractures concludes there is no statistically significant difference in functional outcomes (p = 0.15). However, a true clinical difference does exist in the population. What type of statistical error has occurred, and what parameter is directly responsible for it?

Following a traumatic median nerve transection, Wallerian degeneration occurs distal to the injury site. Which cell type is primarily responsible for clearing the myelin debris in the peripheral nervous system to allow for subsequent axonal regeneration?

A randomized controlled trial comparing two surgical techniques for distal radius fractures finds no statistically significant difference in grip strength at 1 year (p = 0.15). However, a true difference actually exists in the population. Which of the following concepts describes this study's failure to detect the true difference?

In Zone II flexor tendon repairs of the hand, preservation of the vincula is heavily emphasized to optimize intrinsic healing. The vincula brevia to the flexor digitorum profundus (FDP) is located near which of the following anatomical structures?

A 55-year-old female with severe, long-standing carpal tunnel syndrome undergoes electromyography (EMG) and nerve conduction studies (NCS). Which of the following specific findings on EMG confirms active axonal loss and ongoing muscle denervation rather than simple demyelination?

A 22-year-old carpenter lacerates his index finger at the level of the proximal phalanx, resulting in both flexor digitorum superficialis (FDS) and profundus (FDP) transection (Zone II injury). Primary repair is planned. Blood supply to the flexor tendons within this specific zone is primarily provided by which of the following structures?

A 25-year-old rugby player presents with an inability to actively flex the distal interphalangeal (DIP) joint of his ring finger after grabbing an opponent's jersey. Radiographs

reveal a large bony avulsion fragment located at the level of the A4 pulley. Based on the Leddy-Packer classification, what type of flexor digitorum profundus (FDP) avulsion is this?

A 40-year-old clerical worker is diagnosed with severe, recalcitrant cubital tunnel syndrome

. Intraoperatively, the ulnar nerve is found to be compressed precisely where it passes between the two heads of the flexor carpi ulnaris (FCU). What is the specific eponymous anatomical structure that forms the roof of this compression site?

A 24-year-old carpenter sustains a laceration over the volar aspect of his proximal phalanx, resulting in a Zone II flexor tendon injury. What is the primary source of nutrition to the flexor tendons in this specific zone?

During an open carpal tunnel release, the surgeon must be careful to avoid injuring the recurrent motor branch of the median nerve. What is the most common anatomical variation of this branch?

During an extensile posterior approach utilizing an olecranon osteotomy for a comminuted distal humerus fracture (AO/OTA 13C3), the surgeon isolates the ulnar nerve. Which vascular structure typically accompanies the ulnar nerve as it passes posterior to the medial epicondyle?