7. Hand and Wrist MCQs

A 32-year-old carpenter sustains a small puncture wound to his left index finger. Two days later, he presents with uniform swelling of the digit, flexed resting posture, and excruciating pain with passive extension.

Which of the following is the fourth Kanavel sign typically seen in this condition?

A patient sustains a severe laceration to the proximal forearm, completely transecting the median nerve. However, clinical examination reveals intact intrinsic function of the hand typically supplied by the ulnar nerve, and unexpectedly, intact thenar muscle function. Which of the following anatomical anomalies best explains this physical examination finding?

In the context of flexor tendon injuries of the hand, what anatomical landmarks define 'Zone II'?

A 65-year-old female presents with a dorsally displaced distal radius fracture. She is treated with open reduction and internal fixation utilizing a volar locking plate. What is the most common complication associated with this specific surgical approach and implant placement distal to the watershed line?

A patient is undergoing surgical exploration for a fight bite over the third MCP joint. To best expose potential joint capsule violation and aid in thorough debridement and irrigation, what position should the finger be held in during the initial assessment?

Following surgical debridement and intravenous antibiotics for a septic MCP joint secondary to a fight bite, which of the following splinting positions is most appropriate for initial immobilization?

A 22-year-old male presents with a persistent discharging sinus tract over the third metacarpal following a poorly managed fight bite 6 weeks ago. Plain radiographs reveal cortical irregularity and lucency of the metacarpal head. What is the most likely diagnosis?

A 25-year-old male presents with a painful, swollen, and red index finger following a fight bite 36 hours ago. The wound is over the MCP joint. During surgical exploration, the extensor digitorum communis tendon is found to be partially lacerated. What is the most appropriate management for the partially lacerated tendon in this acutely infected field?

A 40-year-old carpenter presents with a swollen, painful index finger 3 days after a penetrating injury from a splinter. Which of the following is considered the most sensitive and earliest clinical sign of pyogenic flexor tenosynovitis?

A 32-year-old mechanic presents with severe pain and swelling in his dominant right index finger 3 days after a puncture wound. Which of the following is NOT one of Kanavel's classic cardinal signs of acute suppurative flexor tenosynovitis?

A 22-year-old male presents with a painful, swollen, and erythematous wound over his right third metacarpophalangeal (MCP) joint after striking another individual in the mouth. In addition to Staphylococcus and Streptococcus species, empirical antibiotic therapy must primarily cover which of the following organisms?

A 34-year-old dental hygienist presents with severe, throbbing pain and grouped vesicular lesions on the volar pad of her left index finger. The area is erythematous but lacks fluctuance. A Tzanck smear reveals multinucleated giant cells. What is the most appropriate next step in management?

A 40-year-old woman presents to the clinic 24 hours after sustaining a deep puncture bite to her dominant hand from her domestic cat. The hand is edematous, erythematous, and exquisitely tender. Which of the following is the most appropriate primary antibiotic choice for this injury?

A patient presents with a painful, tense, erythematous volar pad of the distal thumb, diagnosed as a felon. The surgeon plans an incision and drainage. To minimize the risk of digital nerve injury, painful scarring, and functional impairment, which surgical incision is most currently recommended?

A 30-year-old construction worker presents with a "collar button" abscess of the hand. In understanding the pathophysiology and surgical approach to this infection, how does the purulence classically spread?

A 48-year-old diabetic male develops a severe deep space infection of the hand diagnosed as a "horseshoe abscess." This unique pattern of infection occurs due to direct communication between which two synovial spaces?

A 50-year-old bartender presents with bilateral swelling, induration, and loss of the cuticle around multiple fingernails, present for over 3 months. The condition is refractory to oral antibiotics. What is the most likely dominant pathogen responsible for this chronic paronychia?

A patient presents with swelling and severe tenderness over the central palm, with loss of the normal palmar concavity, indicative of a midpalmar space infection. What specific anatomical structure forms the radial border of the midpalmar space, separating it from the thenar space?

A 33-year-old carpenter presents with a swollen, painful index finger 3 days after a penetrating wood splinter injury. Examination reveals fusiform swelling, the finger held in slight flexion, pain on passive extension, and tenderness along the flexor tendon sheath. What is the standard, minimally invasive surgical approach for irrigation of this infection?

A 28-year-old male presents with a 1 cm laceration over the 3rd metacarpophalangeal joint. He admits to punching someone in the mouth 2 days ago. The joint is swollen and erythematous. What is the most likely associated responsible organism and the appropriate empiric outpatient oral antibiotic?