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7. Hand and Wrist MCQs

Practice Set 258 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 5141

Topic: Wrist & Carpus

A 40-year-old female presents with persistent pain, stiffness, and catching in her right wrist after a fall. Radiographs are normal. MRI reveals a tear of the triangular fibrocartilage complex (TFCC). Which part of the TFCC is most commonly involved in chronic mechanical symptoms?

. Articular disc
. Meniscus homologue
. Ulnolunate ligament
. Radioulnar ligaments (dorsal and volar)
. Extensor carpi ulnaris (ECU) subsheath

Correct Answer & Explanation

. Radioulnar ligaments (dorsal and volar)

Explanation

The triangular fibrocartilage complex (TFCC) is a critical stabilizer of the distal radioulnar joint (DRUJ) and acts as a cushion for the ulnar carpus. While all parts contribute, tears of the dorsal and volar radioulnar ligaments (RULs) are most commonly associated with instability and chronic mechanical symptoms such as pain, clicking, and reduced grip strength. The articular disc can tear, but the RULs are key for DRUJ stability. The meniscus homologue and ulnolunate ligament are components, but the RULs are paramount for DRUJ integrity. The ECU subsheath is adjacent but not part of the TFCC proper.

Question 5142

Topic: 7. Hand and Wrist

A 32-year-old female develops a sudden, painful, and complete loss of active finger extension at the metacarpophalangeal (MCP) joints, with intact wrist extension, after a fall onto her outstretched hand. Sensation is normal. What is the most likely nerve injury?

. Median nerve injury at the elbow
. Ulnar nerve injury at Guyon's canal
. Radial nerve injury at the spiral groove of the humerus
. Posterior interosseous nerve (PIN) injury
. Anterior interosseous nerve (AIN) injury

Correct Answer & Explanation

. Posterior interosseous nerve (PIN) injury

Explanation

A posterior interosseous nerve (PIN) injury, often due to trauma, fracture, or compression in the supinator muscle, specifically results in a loss of active finger and thumb extension at the MCP joints, and thumb IP joint extension. Wrist extension is preserved or only minimally weakened (due to preserved extensor carpi radialis longus/brevis, which are innervated proximally to the PIN). Sensation is typically spared, as PIN is purely motor. Radial nerve injury at the spiral groove would also involve wrist drop. Median nerve injury affects thumb opposition and sensation. Ulnar nerve injury affects intrinsic hand muscles and sensation. AIN injury affects flexor pollicis longus, profundus to index/middle fingers, and pronator quadratus.

Question 5143

Topic: Nerve & Tendon

What is the most critical anatomical structure to preserve during surgical repair of a mallet finger?

. Flexor digitorum profundus tendon.
. Flexor digitorum superficialis tendon.
. Extensor digitorum communis tendon.
. Germinal matrix of the nail.
. Central slip of the extensor mechanism.

Correct Answer & Explanation

. Germinal matrix of the nail.

Explanation

During surgical repair of a mallet finger, which involves rupture or avulsion of the extensor tendon at the distal interphalangeal (DIP) joint, it is absolutely critical to preserve the germinal matrix of the nail. The germinal matrix is responsible for nail growth. Damage to this structure can result in permanent nail deformity, which is a significant functional and cosmetic complication. The flexor tendons are on the opposite side. The central slip is involved in PIP extension. The extensor digitorum communis is the tendon that ruptures, but its overall preservation is not as critical as the germinal matrix for post-op function and appearance.

Question 5144

Topic: Wrist & Carpus

A 64-year-old woman sustains the wrist injury shown in the radiographs. The injury is a volar displaced intra-articular distal radius fracture. When utilizing a volar buttress plate for this specific fracture pattern, what is the primary biomechanical function of the plate?

. To provide dynamic compression across the articular surface
. To act as a tension band against dorsal bending forces
. To neutralize axial loading and volar shearing forces
. To bridge a comminuted metaphyseal defect
. To rigidly lock the radiocarpal joint

Correct Answer & Explanation

. To neutralize axial loading and volar shearing forces

Explanation

Correct Answer: CThe radiographs show a volar Barton's fracture (volar displaced intra-articular fracture of the distal radius). The primary deforming forces are axial loading and volar shear, which cause the carpus to subluxate volarly with the fracture fragment. A volar buttress plate is applied to physically block (buttress) this volar displacement, neutralizing the axial and shearing forces.

Question 5145

Topic: 7. Hand and Wrist

A 64-year-old woman sustains the wrist injury shown in the radiographs after a fall on an outstretched hand. The fracture pattern involves a volar displaced intra-articular fragment. What is the primary biomechanical rationale for utilizing a volar buttress plate in the surgical management of this specific injury?

. It provides dynamic compression across the articular surface.
. It neutralizes axial loading forces on the fractured volar fragment.
. It acts as a tension band construct during wrist flexion.
. It prevents dorsal comminution from collapsing.
. It allows for rigid fixation of the distal radioulnar joint.

Correct Answer & Explanation

. It neutralizes axial loading forces on the fractured volar fragment.

Explanation

Correct Answer: It neutralizes axial loading forces on the fractured volar fragment.The radiographs demonstrate a volar Barton's fracture, which is a volar displaced intra-articular fracture-dislocation of the distal radius. The volar carpal ligaments remain attached to the volar fragment, pulling the carpus volarly. A volar buttress plate is biomechanically ideal for this injury because it acts as an anti-glide plate, neutralizing the axial loading and shear forces that drive the fragment proximally and volarly. A dorsal plate would not provide this buttress effect and would make maintaining the reduction difficult.

Question 5146

Topic: Wrist & Carpus

A 64-year-old woman sustains a wrist injury after a fall. Radiographs demonstrate a volar displaced, intra-articular distal radius fracture-dislocation. Which of the following surgical approaches and fixation methods is most appropriate to neutralize the axial loading forces on the fractured fragment?

. Dorsal approach with an angular stable plate
. Volar approach with a buttress plate
. Closed reduction and percutaneous pinning
. Spanning external fixation alone
. Volar approach with headless compression screws only

Correct Answer & Explanation

. Volar approach with a buttress plate

Explanation

Correct Answer: BThe radiographs show a volar Barton's fracture (volar displaced intra-articular distal radius fracture-dislocation). The most biomechanically sound treatment is an open reduction through a volar approach and stabilization with a volar buttress plate. The buttress plate effectively neutralizes the axial loading and shear forces that drive the volar fragment proximally. A dorsal plate cannot provide this buttress effect for a volar shear fracture.

Question 5147

Topic: 7. Hand and Wrist

A 28-year-old male presents with 6 months of radial-sided wrist pain after falling on an outstretched hand. Radiographs reveal a scaphoid proximal pole nonunion. The blood supply to the proximal pole of the scaphoid is primarily derived from which of the following vessels?

. Palmar carpal branch of the radial artery
. Dorsal carpal branch of the radial artery
. Superficial palmar arch
. 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, arising from the dorsal carpal branch of the radial artery. It enters at the dorsal ridge near the waist and supplies the proximal pole, making proximal fractures highly susceptible to avascular necrosis and nonunion.

Question 5148

Topic: 7. Hand and Wrist

An asymptomatic 30-year-old woman undergoes hand radiography following minor trauma, revealing a well-circumscribed, 1 cm central lytic lesion with stippled calcifications in the proximal phalanx.

There is no cortical breakthrough. What is the most appropriate management?

. Immediate wide excision
. Curettage and bone grafting
. Observation with serial radiographs
. Neoadjuvant chemotherapy
. Ray amputation

Correct Answer & Explanation

. Observation with serial radiographs

Explanation

The classic radiographic appearance of an asymptomatic enchondroma in the hand requires only observation. Surgical intervention (curettage) is reserved for symptomatic lesions, impending fractures, or documented rapid enlargement.

Question 5149

Topic: 7. Hand and Wrist

A 32-year-old female presents with an incidental finding on a hand radiograph taken after mild trauma. The image shows a well-defined lucency with stippled calcification in the proximal phalanx, with no cortical breakthrough or soft tissue mass. What is the most appropriate next step in management?

. Curettage and bone grafting
. Ray amputation
. Observation and reassurance
. Wide local excision
. Neoadjuvant chemotherapy

Correct Answer & Explanation

. Observation and reassurance

Explanation

This is a classic presentation of an asymptomatic enchondroma of the hand. In the absence of pathologic fracture or significant pain, observation and reassurance is the standard of care.

Question 5150

Topic: 7. Hand and Wrist

A 45-year-old male sustains a minor twisting injury to his hand. Radiographs show a well-circumscribed, lucent lesion with central stippled calcifications in the proximal phalanx of the ring finger.

There is no cortical breakthrough. Which of the following mutations is most frequently associated with the development of multiple such lesions in a mostly unilateral or asymmetric distribution?

. EXT1
. IDH1
. GNAS
. RUNX2
. P53

Correct Answer & Explanation

. IDH1

Explanation

The patient has an enchondroma. Multiple enchondromas with a unilateral or asymmetric distribution characterize Ollier disease, which is driven by somatic mosaic mutations in the IDH1 or IDH2 genes. EXT1 mutations are associated with multiple hereditary exostoses, not enchondromatosis.

Question 5151

Topic: 7. Hand and Wrist

A 10-year-old girl with Hereditary Multiple Exostoses (HME) presents for evaluation of forearm deformity.

Which of the following patterns of forearm deformity is most characteristic of this condition?

. Relative lengthening of the ulna with radial deviation of the wrist
. Relative shortening of the ulna with ulnar deviation of the wrist and radial bowing
. Proximal radioulnar synostosis
. Dorsal subluxation of the distal radioulnar joint with a positive ulnar variance
. Madelung deformity with volar subluxation of the carpus

Correct Answer & Explanation

. Relative shortening of the ulna with ulnar deviation of the wrist and radial bowing

Explanation

The classic forearm deformity in HME is caused by tethering and slower growth of the distal ulna, resulting in a relatively short ulna. This leads to ulnar deviation of the hand, radial bowing, and potential subluxation or dislocation of the radial head.

Question 5152

Topic: Wrist & Carpus

A 9-year-old girl with Hereditary Multiple Exostoses presents with a progressive forearm deformity. Which of the following best describes the classic deformity pattern seen in this condition?

. Relative radial shortening with ulnar bowing and distal radioulnar joint (DRUJ) dislocation
. Relative ulnar shortening with radial bowing and radial head dislocation
. Isolated proximal radioulnar synostosis
. Volar subluxation of the carpus with excessive radial length
. Symmetric growth arrest of both the radius and ulna

Correct Answer & Explanation

. Relative ulnar shortening with radial bowing and radial head dislocation

Explanation

The classic forearm deformity in HME consists of relative ulnar shortening (due to growth arrest from distal ulnar osteochondromas), secondary bowing of the radius, increased ulnar tilt of the distal radius, and progressive radial head dislocation.

Question 5153

Topic: Wrist & Carpus

A 14-year-old male with Hereditary Multiple Exostoses (HME) presents with progressive deformity and limited pronation/supination of his left forearm. Radiographs typically demonstrate which of the following patterns in this condition?

. Relative shortening of the radius with radial bowing
. Relative shortening of the ulna with ulnar deviation of the carpus and bowing of the radius
. Dorsal subluxation of the distal radioulnar joint with a lengthened ulna
. Overgrowth of the radius resulting in a positive ulnar variance
. Premature closure of the proximal radial physis

Correct Answer & Explanation

. Relative shortening of the ulna with ulnar deviation of the carpus and bowing of the radius

Explanation

The classic forearm deformity in HME results from a disproportionately short ulna, which tethers the radius. This causes radial bowing, radial articular angle tilting, and ulnar deviation of the carpus, potentially leading to radial head subluxation.

Question 5154

Topic: 7. Hand and Wrist

A 56-year-old woman undergoes excision of a painful, firm nodule contiguous with the plantar fascia. Histologic examination of the excised tissue would most likely reveal an abundance of which of the following cell types?

. Multinucleated giant cells
. Fibromyoblasts
. Synovial cells
. Lipoblasts
. Chondrocytes

Correct Answer & Explanation

. Fibromyoblasts

Explanation

Correct Answer: BThe clinical presentation is consistent with plantar fibromatosis (Ledderhose disease), a benign fibroproliferative disorder of the plantar fascia. Histologically, it consists chiefly of fibromyoblasts (myofibroblasts) that produce excessive collagen. This condition is pathophysiologically similar to Dupuytren's contracture in the hand and Peyronie's disease.

Question 5155

Topic: 7. Hand and Wrist

During an open carpal tunnel release, the transverse carpal ligament is divided. Which of the following pairs of carpal bones serve as the radial attachments for this ligament?

. Scaphoid and trapezium
. Scaphoid and trapezoid
. Trapezium and capitate
. Pisiform and hook of hamate
. Triquetrum and lunate

Correct Answer & Explanation

. Scaphoid and trapezium

Explanation

Correct Answer: AThe transverse carpal ligament (flexor retinaculum) forms the volar roof of the carpal tunnel. It attaches radially to the scaphoid tuberosity and the crest of the trapezium. Ulnarly, it attaches to the pisiform and the hook of the hamate. The trapezoid, capitate, triquetrum, and lunate do not serve as direct attachment sites for the transverse carpal ligament.

Question 5156

Topic: 7. Hand and Wrist

A 56-year-old woman undergoes resection of a painful, firm nodule contiguous with the plantar fascia, as shown in the clinical photograph. Histologic examination of this lesion would most likely reveal a proliferation of which of the following cell types?

. Multinucleated giant cells and hemosiderin-laden macrophages
. Fibromyoblasts producing excessive collagen
. Atypical lipoblasts with hyperchromatic nuclei
. Synovial cells forming villous projections
. Chondroblasts with areas of 'chicken-wire' calcification

Correct Answer & Explanation

. Fibromyoblasts producing excessive collagen

Explanation

Correct Answer: B. Fibromyoblasts producing excessive collagenThe clinical presentation and image are consistent with plantar fibromatosis (Ledderhose disease). This benign condition is characterized by a proliferation of fibromyoblasts that produce excessive collagen, which is histologically and pathophysiologically similar to Dupuytren's contracture in the palmar fascia of the hand.

Question 5157

Topic: 7. Hand and Wrist

The transverse carpal ligament forms the roof of the carpal tunnel. Which of the following pairs of carpal bones serve as the radial attachments for this ligament?

. Scaphoid and trapezium
. Trapezium and trapezoid
. Scaphoid and lunate
. Pisiform and hook of the hamate
. Triquetrum and pisiform

Correct Answer & Explanation

. Scaphoid and trapezium

Explanation

Correct Answer: A. Scaphoid and trapeziumThe transverse carpal ligament attaches radially to the tuberosity of the scaphoid and the crest of the trapezium. Ulnarly, it attaches to the pisiform and the hook of the hamate. It serves as the volar boundary of the carpal tunnel.

Question 5158

Topic: 7. Hand and Wrist

During an open carpal tunnel release, the surgeon carefully divides the transverse carpal ligament to decompress the median nerve. Which of the following carpal bones serves as an ulnar attachment site for this ligament?

. Scaphoid
. Trapezium
. Trapezoid
. Hook of the hamate
. Triquetrum

Correct Answer & Explanation

. Hook of the hamate

Explanation

Correct Answer: DThe transverse carpal ligament forms the volar boundary of the carpal tunnel. It attaches radially to the scaphoid tuberosity and the crest of the trapezium, and ulnarly to the pisiform and the hook of the hamate. The trapezoid and triquetrum do not serve as attachment points for the transverse carpal ligament.

Question 5159

Topic: 7. Hand and Wrist

A 50-year-old man presents with a painful, firm nodule on the plantar aspect of his foot. MRI confirms a lesion contiguous with the plantar fascia. Surgical resection is performed as shown in the clinical photograph. The predominant cell type in this lesion is most similar to the cells found in which of the following conditions?

. De Quervain's tenosynovitis
. Trigger finger
. Dupuytren's contracture
. Plantar fasciitis
. Morton's neuroma

Correct Answer & Explanation

. Dupuytren's contracture

Explanation

Correct Answer: CThe history, examination, and surgical findings are most consistent with plantar fibromatosis. Plantar fibromatosis is a benign tumor of the plantar fascia that consists chiefly of fibromyoblasts. These cells produce excessive collagen and are histologically and pathophysiologically similar to the cells found in the palmar fascia of patients with Dupuytren's contracture of the hand.

Question 5160

Topic: 7. Hand and Wrist

The transverse carpal ligament forms the volar boundary of the carpal tunnel. Which of the following carpal bones serves as a radial attachment site for this ligament?

. Trapezoid
. Capitate
. Scaphoid
. Triquetrum
. Lunate

Correct Answer & Explanation

. Scaphoid

Explanation

Correct Answer: CThe transverse carpal ligament is the volar boundary of the carpal tunnel. It attaches to the scaphoid and trapezium radially, and the pisiform and the hook of the hamate ulnarly. The ulna, trapezoid, capitate, and lunate do not receive attachments of the transverse carpal ligament.

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