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7. Hand and Wrist MCQs

Practice Set 257 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 5121

Topic: 7. Hand and Wrist

The clinical photograph below shows the hands of a patient with achondroplasia. Which of the following statements best describes the hand manifestations in this specific dysplasia compared to other short-limb dwarfisms?



. The fingers are exceptionally short and completely fused (syndactyly)
. The fingers are not as short as in many other short-limb dwarfisms
. The hands exhibit severe ulnar deviation and joint subluxation
. The metacarpals are entirely absent
. The thumb is typically triphalangeal

Correct Answer & Explanation

. The fingers are not as short as in many other short-limb dwarfisms

Explanation

Correct Answer: The fingers are not as short as in many other short-limb dwarfismsAs shown in the clinical image and noted in the text, the fingers in achondroplasia are not as short as in many other forms of short-limb dwarfism. They often present with a 'trident' appearance, though their relative length is better preserved than in other severe dysplasias.

Question 5122

Topic: 7. Hand and Wrist

The hands of a patient with a skeletal dysplasia are shown below. In achondroplasia, how do the fingers typically present compared to many other short-limb dwarfisms?


. They are significantly shorter and more stubby.
. They are not as short as in many other short-limb dwarfisms.
. They exhibit severe syndactyly.
. They show marked ulnar deviation at the metacarpophalangeal joints.
. They are disproportionately long compared to the forearm.

Correct Answer & Explanation

. They are not as short as in many other short-limb dwarfisms.

Explanation

Correct Answer: They are not as short as in many other short-limb dwarfisms.While achondroplasia is a short-limb dwarfism, the fingers are characteristically not as short as those seen in many other forms of short-limb dwarfism.

Question 5123

Topic: 7. Hand and Wrist

The hands of a patient with a disproportionate short-limb dwarfism are shown below. According to the specific characteristics of this condition, how do these digits typically compare to other forms of short-limb dwarfism?


. They exhibit severe syndactyly requiring early release.
. They are significantly shorter than in all other forms of dwarfism.
. They are not as short as in many other short-limb dwarfisms.
. They present with severe preaxial polydactyly.

Correct Answer & Explanation

. They are not as short as in many other short-limb dwarfisms.

Explanation

Correct Answer: They are not as short as in many other short-limb dwarfisms.While achondroplasia is a short-limb dwarfism and features a characteristic 'trident hand' deformity, the fingers themselves are actually not as short as those seen in many other forms of short-limb dwarfism.

Question 5124

Topic: 7. Hand and Wrist

The clinical photograph below demonstrates the hands of a patient with the most common disproportionate short-limb dwarfism. Which of the following statements regarding the hand anatomy in this condition is true?


. The fingers are significantly shorter than in all other forms of short-limb dwarfism.
. The fingers are not as short as in many other short-limb dwarfisms.
. There is typically a severe complex syndactyly of the 3rd and 4th digits.
. The thumb is characteristically triphalangeal.

Correct Answer & Explanation

. The fingers are not as short as in many other short-limb dwarfisms.

Explanation

Correct Answer: The fingers are not as short as in many other short-limb dwarfisms.In achondroplasia, the hands often exhibit a 'trident' appearance due to the inability to approximate the tips of the middle and ring fingers. However, as noted in the clinical description, the fingers in achondroplasia are actually not as short as they are in many other forms of short-limb dwarfism. Syndactyly is characteristic of Apert syndrome, and triphalangeal thumbs are seen in conditions like Holt-Oram syndrome.

Question 5125

Topic: 7. Hand and Wrist

A clinical photograph of the hands of a patient with a skeletal dysplasia is shown below. In the context of achondroplasia, how do the fingers typically present compared to many other short-limb dwarfisms?


. They are significantly shorter and completely fused (syndactyly)
. They are disproportionately long and arachnodactylic
. They are not as short as in many other short-limb dwarfisms
. They exhibit severe ulnar deviation and subluxation

Correct Answer & Explanation

. They are not as short as in many other short-limb dwarfisms

Explanation

Correct Answer: They are not as short as in many other short-limb dwarfismsAs noted in the text accompanying the clinical image, the fingers in achondroplasia are not as short as in many other forms of short-limb dwarfism, often presenting with a characteristic 'trident' appearance (though the relative length is the key distinguishing feature mentioned).

Question 5126

Topic: 7. Hand and Wrist

Which of the following hand deformities is considered a hallmark clinical finding in patients with achondroplasia?

. Ulnar deviation of the metacarpophalangeal joints
. Syndactyly of the second and third digits
. A 'trident' configuration with divergent fingers
. Camptodactyly of the little finger
. Preaxial polydactyly

Correct Answer & Explanation

. A 'trident' configuration with divergent fingers

Explanation

The 'trident hand' is a classic feature of achondroplasia. It is characterized by short, stubby fingers with a widened space between the third and fourth digits.

Question 5127

Topic: 7. Hand and Wrist



A patient with achondroplasia demonstrates a classic hand deformity. Which of the following describes the typical hand appearance in these patients?

. Arachnodactyly with a positive thumb (Steinberg) sign
. Trident hand with inability to approximate the tips of the middle and ring fingers
. Complex syndactyly of the middle and ring fingers
. Severe ulnar deviation of the metacarpophalangeal joints
. Short thumb with marked thenar hypoplasia

Correct Answer & Explanation

. Trident hand with inability to approximate the tips of the middle and ring fingers

Explanation

Achondroplasia is classically characterized by a 'trident hand' deformity. This consists of short, stubby fingers with an abnormally wide separation between the middle and ring fingers, making the patient unable to approximate those fingertips.

Question 5128

Topic: 7. Hand and Wrist
A 32-year-old manual laborer presents with chronic, progressive dorsal wrist pain and decreased grip strength. He denies any specific acute trauma. Radiographs reveal sclerosis and fragmentation of the lunate. Which of the following anatomical variants is most frequently associated with the development of this condition?
. Positive ulnar variance
. Negative ulnar variance
. Scapholunate dissociation
. Madelung deformity
. Carpal coalition

Correct Answer & Explanation

. Negative ulnar variance

Explanation

Kienböck's disease is the eponym for avascular necrosis of the lunate. It is strongly associated with negative ulnar variance, a condition where the distal ulna is abnormally short relative to the distal radius. This anatomical variant alters the biomechanics of the radiocarpal joint, leading to increased shear forces and mechanical loading specifically on the lunate, predisposing it to microfracture and subsequent vascular compromise.

Question 5129

Topic: 7. Hand and Wrist

A 22-year-old male falls onto an outstretched hand and sustains a proximal pole scaphoid fracture. He is counseled that he is at high risk for avascular necrosis (AVN) and nonunion. Which of the following best describes the primary arterial supply to the scaphoid that explains this risk?

. Blood supply enters distally via branches of the radial artery and flows in a retrograde fashion to the proximal pole
. Blood supply enters proximally via branches of the ulnar artery and flows distally
. Blood supply enters the waist via the anterior interosseous artery
. Blood supply enters the distal pole via the deep palmar arch
. Blood supply is segmental with independent vessels to the proximal, waist, and distal poles

Correct Answer & Explanation

. Blood supply enters distally via branches of the radial artery and flows in a retrograde fashion to the proximal pole

Explanation

Correct Answer: Blood supply enters distally via branches of the radial artery and flows in a retrograde fashion to the proximal poleThe scaphoid receives its primary blood supply (70-80%) from the dorsal carpal branch of the radial artery, which enters the bone distally at the dorsal ridge and flows in a retrograde fashion to supply the proximal pole. Fractures at the waist or proximal pole disrupt this retrograde flow, isolating the proximal fragment from its blood supply. This places the proximal pole at a high risk for avascular necrosis and nonunion, often necessitating surgical intervention.

Question 5130

Topic: Wrist & Carpus
A 35-year-old manual laborer presents with chronic dorsal wrist pain. Radiographs reveal sclerosis and fragmentation of the lunate, with proximal migration of the capitate and a negative ulnar variance. This represents Lichtman Stage IIIb Kienböck's disease. Which of the following biomechanical factors is most strongly associated with the development of this condition?
. Positive ulnar variance
. Negative ulnar variance
. Scapholunate ligament dissociation
. Distal radioulnar joint instability
. Volar intercalated segment instability (VISI)

Correct Answer & Explanation

. Negative ulnar variance

Explanation

Kienböck's disease is avascular necrosis of the lunate. It is strongly associated with negative ulnar variance (where the ulna is shorter than the radius at the distal articular surface). This anatomic variant leads to increased shear and compressive forces transmitted from the radius directly to the lunate, predisposing it to microfracture, vascular compromise, and subsequent osteonecrosis. Joint leveling procedures (e.g., radial shortening osteotomy) are often utilized to offload the lunate in early stages.

Question 5131

Topic: Nerve & Tendon

A 5-year-old boy is brought to the emergency department after falling from monkey bars. He sustained a completely displaced extension-type supracondylar humerus fracture. His hand is pink and well-perfused, but he is unable to make an "OK" sign with his thumb and index finger. Which of the following structures is most likely injured, and what is its typical anatomical course at the elbow?

. Anterior interosseous nerve; passes between the two heads of the pronator teres.
. Radial nerve; passes anterior to the lateral epicondyle between the brachialis and brachioradialis.
. Ulnar nerve; passes posterior to the medial epicondyle through the cubital tunnel.
. Median nerve; passes superficial to the bicipital aponeurosis.
. Posterior interosseous nerve; passes through the arcade of Frohse.

Correct Answer & Explanation

. Anterior interosseous nerve; passes between the two heads of the pronator teres.

Explanation

Correct Answer: AThe inability to make an "OK" sign indicates an injury to the anterior interosseous nerve (AIN), which innervates the flexor pollicis longus and the flexor digitorum profundus to the index finger. AIN neuropraxia is the most common nerve injury associated with extension-type supracondylar humerus fractures. The AIN is a motor branch of the median nerve, which passes between the humeral and ulnar heads of the pronator teres muscle in the proximal forearm.

Question 5132

Topic: 7. Hand and Wrist

A 55-year-old female presents with severe, long-standing carpal tunnel syndrome. She has profound thenar atrophy. During an open carpal tunnel release, the surgeon must be careful to avoid injuring the recurrent motor branch of the median nerve. Which of the following muscles is innervated by this specific branch?

. Adductor pollicis.
. Deep head of the flexor pollicis brevis.
. Opponens pollicis.
. First dorsal interosseous.
. Palmaris brevis.

Correct Answer & Explanation

. Opponens pollicis.

Explanation

Correct Answer: CThe recurrent motor branch of the median nerve, often referred to as the "million dollar nerve," innervates the three thenar muscles: the opponens pollicis, the abductor pollicis brevis (APB), and the superficial head of the flexor pollicis brevis (FPB). The adductor pollicis, deep head of the FPB, and interossei are innervated by the deep branch of the ulnar nerve.

Question 5133

Topic: 7. Hand and Wrist
A 35-year-old carpenter presents with insidious onset of dorsal wrist pain, swelling, and decreased grip strength. Radiographs demonstrate sclerosis and collapse of the lunate. Which of the following radiographic anatomic variants is most classically associated with the pathogenesis of this condition?
. Positive ulnar variance
. Negative ulnar variance
. Volar intercalated segment instability (VISI)
. Dorsal intercalated segment instability (DISI)
. Carpal coalition

Correct Answer & Explanation

. Negative ulnar variance

Explanation

The patient's presentation and radiographic findings are diagnostic of Kienböck's disease, which is avascular necrosis (osteonecrosis) of the lunate. The etiology is multifactorial, involving both vascular and mechanical factors. Mechanically, negative ulnar variance (where the distal ulna is shorter than the distal radius) is classically associated with Kienböck's disease. This anatomic variant leads to increased shear forces and abnormal load transmission across the radiolunate joint, predisposing the lunate to microtrauma, vascular compromise, and subsequent osteonecrosis. Joint leveling procedures, such as a radial shortening osteotomy, are often utilized in early stages to unload the lunate.

Question 5134

Topic: Wrist & Carpus
A 35-year-old manual laborer presents with chronic, progressive dorsal wrist pain and decreased grip strength. Radiographs reveal sclerosis and fragmentation of the lunate, consistent with Kienböck's disease. Which of the following anatomical variants is most strongly associated with the development of this condition?
. Positive ulnar variance
. Negative ulnar variance
. Scapholunate coalition
. Madelung deformity
. Triquetral hypoplasia

Correct Answer & Explanation

. Negative ulnar variance

Explanation

Kienböck's disease is avascular necrosis of the lunate. While the exact etiology is multifactorial (involving vascular anatomy and trauma), it is strongly associated with negative ulnar variance. Negative ulnar variance occurs when the distal ulna is shorter than the distal radius. This anatomical configuration alters the biomechanics of the wrist, leading to increased shear stress and load transmission directly across the radiolunate joint. Over time, this repetitive microtrauma can compromise the tenuous blood supply to the lunate, precipitating osteonecrosis. Joint leveling procedures (e.g., radial shortening osteotomy) are often performed to unload the lunate in early stages of the disease.

Question 5135

Topic: 7. Hand and Wrist

During an open carpal tunnel release, the surgeon must be careful to avoid injury to the recurrent motor branch of the median nerve. In the classic extraligamentous anatomical variant (found in roughly 50% of patients), where does this nerve branch typically arise in relation to the transverse carpal ligament?

. Proximal to the ligament
. Distal to the ligament
. Directly through the substance of the ligament
. Ulnar to the hook of the hamate
. Dorsal to the flexor tendons

Correct Answer & Explanation

. Distal to the ligament

Explanation

The most common anatomical variant is the extraligamentous type, where the recurrent motor branch arises distal to the transverse carpal ligament and curls back to innervate the thenar musculature.

Question 5136

Topic: 7. Hand and Wrist

A 22-year-old male falls onto an outstretched hand and sustains a proximal pole scaphoid fracture. Which of the following anatomical characteristics of the scaphoid is the primary reason this specific fracture pattern carries a high risk for nonunion and avascular necrosis?

. Blood supply enters distally and flows in a retrograde fashion
. Complete lack of any strong interosseous ligament attachments
. A very high ratio of cortical to cancellous bone
. Poor vascularity of the palmar radiocarpal ligaments
. Presence of a strong volar intrinsic ligament that acts as a deforming force

Correct Answer & Explanation

. Blood supply enters distally and flows in a retrograde fashion

Explanation

The major blood supply to the scaphoid is derived from the dorsal carpal branch of the radial artery, which enters the distal pole and flows retrograde. Consequently, proximal pole fractures interrupt this retrograde blood supply, significantly increasing the risk of avascular necrosis.

Question 5137

Topic: Wrist & Carpus

A 45-year-old female underwent volar locked plating for a displaced distal radius fracture six weeks ago. She now presents with a sudden inability to actively extend her thumb interphalangeal joint. Radiographs confirm anatomic alignment with prominent screw tips projecting past the dorsal cortex. Rupture of the involved tendon typically occurs at the level of which anatomical landmark?

. First dorsal compartment
. Lister's tubercle
. Distal radioulnar joint
. Ulnar styloid process
. Scaphoid tubercle

Correct Answer & Explanation

. Lister's tubercle

Explanation

The extensor pollicis longus (EPL) tendon travels through the third dorsal compartment and uses Lister's tubercle as a pulley. It is highly susceptible to attrition and rupture at this site due to either mechanical friction from prominent dorsal screws or ischemia following a distal radius fracture.

Question 5138

Topic: Wrist & Carpus

A 72-year-old female presents with severe pain and instability after falling onto her outstretched hand. Radiographs show a comminuted intra-articular fracture of the distal radius with significant dorsal displacement, ulnar positive variance, and disruption of the distal radioulnar joint (DRUJ). Which classification is most appropriate for this injury, and what is its significance?

. Frykman classification; distinguishes between intra- and extra-articular fractures and associated ulnar styloid fractures.
. Fernandez classification; focuses on fracture mechanism and is useful for surgical planning.
. Universal classification; broadly categorizes based on articular involvement and stability.
. AO/OTA classification; describes fracture morphology based on alpha-numeric codes, highly detailed for research and complex cases.
. Gartland classification; primarily used for supracondylar humerus fractures in children.

Correct Answer & Explanation

. AO/OTA classification; describes fracture morphology based on alpha-numeric codes, highly detailed for research and complex cases.

Explanation

The AO/OTA classification is a comprehensive system that uses alphanumeric codes to describe fracture morphology (e.g., location, articular involvement, comminution) in great detail. For a complex, comminuted intra-articular distal radius fracture with DRUJ disruption, this system provides the most specific and reproducible description for surgical planning, research, and communication among surgeons. While Frykman classifies based on intra/extra-articular involvement and associated ulnar fractures, and Fernandez focuses on mechanism, the AO/OTA provides the highest level of detail for such a complex injury, which is critical for understanding the exact nature of the injury and guiding advanced surgical treatment. The Gartland classification is for pediatric elbow fractures.

Question 5139

Topic: Nerve & Tendon

A 48-year-old construction worker presents with insidious onset of unilateral elbow pain and weakness, primarily affecting grip strength. He describes pain exacerbated by pronation and resisted wrist flexion. Tenderness is noted over the pronator teres muscle belly and the origin of the flexor carpi radialis. Compression of the median nerve in the proximal forearm reproduces symptoms. What is the most likely diagnosis?

. Medial epicondylitis (golfer's elbow)
. Lateral epicondylitis (tennis elbow)
. Cubital tunnel syndrome
. Pronator teres syndrome
. Radial tunnel syndrome

Correct Answer & Explanation

. Pronator teres syndrome

Explanation

The symptoms of unilateral elbow pain, weakness, pain with pronation and resisted wrist flexion, tenderness over the pronator teres/flexor carpi radialis origin, and reproduction of symptoms with median nerve compression in the proximal forearm are highly suggestive of Pronator Teres Syndrome. This is a median nerve entrapment neuropathy in the proximal forearm, typically at the level of the pronator teres. Medial epicondylitis involves the common flexor origin but typically without neurological symptoms. Lateral epicondylitis involves the common extensor origin. Cubital tunnel syndrome is ulnar nerve entrapment at the elbow. Radial tunnel syndrome involves the posterior interosseous nerve (PIN), causing pain without motor weakness or sensory deficits initially.

Question 5140

Topic: 7. Hand and Wrist

A 55-year-old female presents with chronic wrist pain and weakness, particularly with pinch and grip. Examination reveals tenderness over the radial styloid and pain with active wrist ulnar deviation and passive wrist radial deviation, while the thumb is flexed into the palm (Finkelstein's test). What is the most likely diagnosis?

. Carpal tunnel syndrome
. De Quervain's tenosynovitis
. Intersection syndrome
. Trigger finger
. Basal joint arthritis of the thumb

Correct Answer & Explanation

. De Quervain's tenosynovitis

Explanation

The patient's symptoms of chronic wrist pain over the radial styloid, weakness with pinch and grip, and a positive Finkelstein's test (pain with passive ulnar deviation of the wrist while the thumb is flexed into the palm) are pathognomonic for De Quervain's tenosynovitis. This condition involves stenosing tenosynovitis of the first dorsal compartment of the wrist, affecting the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Carpal tunnel syndrome involves median nerve compression. Intersection syndrome involves the tendons of the first and second dorsal compartments crossing. Trigger finger is stenosing tenosynovitis of a flexor tendon. Basal joint arthritis affects the trapeziometacarpal joint.

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