7. Hand and Wrist MCQs

A 55-year-old woman with advanced Rheumatoid Arthritis suddenly loses the ability to actively extend her small and ring fingers at the metacarpophalangeal joints. The tenodesis effect is absent for these digits. Radiographs demonstrate dorsal prominence of the distal ulna. The rupture of these tendons most likely occurred due to attrition over which of the following structures?

A 45-year-old construction worker complains of progressive cold intolerance, pain, and a bluish discoloration in his right ring and small fingers. The Allen test demonstrates sluggish blood return to the hand when the ulnar artery is released. Angiography shows 'corkscrew' tortuosity and an occlusion of the ulnar artery at the level of the wrist. This pathology is most strongly associated with repetitive trauma against which of the following carpal structures?

A 28-year-old chef sustains a volar oblique amputation of his left index fingertip, resulting in a 1.5 cm soft tissue defect with exposed distal phalanx bone. The dorsal nail bed is largely intact. Which of the following local flap options is best suited to provide durable, sensate coverage for this specific defect?

A 22-year-old male sustains a comminuted, Y-shaped intra-articular fracture of the base of his right thumb metacarpal after a fist fight. There are three large osseous fragments. What is the most widely accepted surgical management to restore joint congruity and stability in this classic Rolando fracture?

A patient suffers a severe laceration of the median nerve at the antecubital fossa. During physical examination 3 months later, the patient unexpectedly demonstrates preserved function of several intrinsic hand muscles normally innervated by the ulnar nerve. This phenomenon is best explained by a Martin-Gruber anastomosis, which consists of motor nerve fibers crossing in which specific pattern?

A 24-year-old male presents with wrist pain 3 weeks after a fall onto an outstretched hand. Radiographs demonstrate a scapholunate angle of 75 degrees. The scaphoid appears volarly flexed (signet ring sign), and the lunate is dorsally angulated. Which of the following is the most accurate diagnosis?

A 40-year-old diabetic patient presents to the emergency department with a swollen, painful index finger 3 days after sustaining a puncture wound. You suspect pyogenic flexor tenosynovitis. Of Kanavel's four cardinal signs, which is generally considered the earliest and most sensitive indicator of this infection?

A 35-year-old woman complains of excruciating, sharp pain in her right ring fingertip, which is markedly exacerbated by cold weather. On exam, there is exquisite point tenderness over the nail matrix and a faint bluish hue beneath the nail plate. Application of a proximal tourniquet to the arm significantly relieves the patient's fingertip pain. What is the name of this diagnostic test?

A 50-year-old patient sustains a volar Barton's fracture, which is an intra-articular fracture-subluxation involving the volar rim of the distal radius. The carpus displaces volarly with the fracture fragment. The carpus remains securely tethered to this volar distal radius fragment primarily due to the intact attachment of which of the following ligaments?

A neonate is born following a difficult shoulder dystocia delivery requiring hyperabduction of the arm. The infant demonstrates a claw hand deformity, absent grasp reflex, and unilateral miosis, ptosis, and anhidrosis. This presentation (Klumpke's palsy) is primarily caused by an injury to which nerve roots of the brachial plexus?

During a primary repair of a lacerated flexor tendon in Zone II, the surgeon visualizes the intricate relationship between the Flexor Digitorum Superficialis (FDS) and the Flexor Digitorum Profundus (FDP). The anatomic region where the FDS tendon splits and its slips decussate to allow the FDP tendon to pass superficially is known as:

In the pathoanatomy of Dupuytren's disease, the pathologic central cord is primarily responsible for causing flexion contractures at the metacarpophalangeal (MCP) joint. This cord develops from the disease-induced thickening and shortening of which normal fascial structure?

A 55-year-old male presents with advanced Scapholunate Advanced Collapse (SLAC) wrist arthritis. Radiographs demonstrate severe degenerative changes throughout the carpus. Which of the following articulations is classically spared from osteoarthritis in a SLAC wrist, even in late stages?

When performing open reduction and internal fixation of a distal radius fracture using a volar locking plate, placing the plate distal to the 'watershed line' significantly increases the risk of which of the following complications?

A 40-year-old carpenter presents with volar forearm and hand pain, along with paresthesia in the thumb, index, and middle fingers. Which of the following physical examination findings is most specific for differentiating Pronator Syndrome from Carpal Tunnel Syndrome?

A 22-year-old rugby player sustains an avulsion of the flexor digitorum profundus (FDP) tendon of the ring finger. Imaging and physical exam suggest a Leddy-Packer Type I injury. What is the defining anatomical characteristic and recommended timeframe for management of this specific injury type?

A 35-year-old mechanic sustains a puncture wound to the volar index finger. Two days later, he presents with a suspected pyogenic flexor tenosynovitis. Which of Kanavel's four cardinal signs is generally considered the most sensitive and earliest indicator of this infection?