7. Hand and Wrist MCQs

An infant is born with severe micromelia, a "hitchhiker" thumb, clubfeet, and cystic swelling of the external ears that later calcify. Radiographs show a shortened first metacarpal. What is the primary biochemical defect in this disorder?

A neonate presents with short limbs, postaxial polydactyly, severely hypoplastic nails, and a cardiac murmur. An echocardiogram confirms the presence of a common atrium. Which of the following diagnoses is most likely?

A 22-year-old sexually active female presents with a 3-day history of migratory polyarthralgia, now localized as a swollen right wrist. She has sparse, painless pustular skin lesions on her distal extremities. What is the most common finding on synovial fluid culture from the wrist?

A 42-year-old aquarium worker presents with a chronic, indolent, violaceous nodule on his dominant hand that has progressed to tenosynovitis over several months. Routine bacterial cultures are negative. What is the most likely causative organism?

A 55-year-old woman is evaluated for severe burning pain, stiffness, and skin color changes in her right hand following a distal radius fracture treated with a cast 8 weeks ago. Which of the following prophylactic measures has been shown to reduce the incidence of this condition following conservative or surgical management of distal radius fractures?

A 17-year-old female presents with diffuse, severe burning pain in her hand and hypersensitivity to light touch 3 months after a wrist sprain.

According to the Budapest Criteria, which of the following symptom categories is NOT strictly required to make the clinical diagnosis of Complex Regional Pain Syndrome?

A 65-year-old woman sustains a displaced distal radius fracture. To reduce the risk of developing the painful condition shown in the radiograph, which is characterized by periarticular patchy osteopenia, which of the following prophylactic measures is recommended?

A 45-year-old man develops severe, burning left hand pain 6 weeks after a crush injury. He exhibits skin color asymmetry, hyperhidrosis, and allodynia. According to the Budapest criteria for diagnosing Complex Regional Pain Syndrome (CRPS), which of the following conditions must be met?

A patient develops early-stage CRPS of the upper extremity following a distal radius fracture, presenting with severe sympathetically maintained pain. If conservative management fails, what is the primary sympathetic ganglion targeted for diagnostic and therapeutic nerve blocks?

A 45-year-old female sustains a minimally displaced distal radius fracture treated in a cast. Six weeks later, she presents with severe, burning pain out of proportion to her injury, alongside swelling, stiffness, and shiny skin.

Which of the following interventions at the time of injury has been shown to reduce the risk of developing this condition?

A 45-year-old woman presents with severe burning pain, swelling, and altered skin color in her right hand 6 weeks following a distal radius fracture. An image is provided.

According to the Budapest criteria, which of the following must be present for a clinical diagnosis of Complex Regional Pain Syndrome (CRPS)?

A 55-year-old woman is scheduled for closed reduction and casting of a Colles fracture.

What pharmacological agent, when given daily for 50 days post-injury, has been shown in some trials to reduce the incidence of CRPS in distal radius fractures?

A 40-year-old man with refractory CRPS type 1 of the right upper extremity continues to have severe pain despite aggressive physical therapy.

What is the most appropriate next step in interventional management?

A 45-year-old female typist presents with numbness and tingling in her thumb, index, and middle fingers, which frequently awakens her at night. Symptoms are reproduced by tapping over the volar aspect of the wrist. Which nerve is compressed in this condition?

A 45-year-old typist is scheduled for an open carpal tunnel release. During the surgical approach, the surgeon must be mindful of the contents of the carpal tunnel. Which of the following tendons is located within the carpal tunnel?

During an open carpal tunnel release, the surgeon must be careful to avoid injury to the recurrent motor branch of the median nerve. Which of the following muscles is primarily innervated by this specific branch?

Which of the following anatomical locations is considered extremely rare for the development of Dysplasia Epiphysealis Hemimelica (DEH)?

A 4-year-old boy presents with painless swelling of the medial ankle. Imaging shows irregular ossification centers adjacent to the medial malleolus. What is the classic eponymous name for this exact condition?

While Dysplasia Epiphysealis Hemimelica is most commonly found in the lower extremities, it can rarely involve the upper limb. When the upper limb is involved, which of the following areas is most frequently affected?

An adult patient with suspected dermatomyositis presents with profound proximal muscle weakness and interstitial lung disease. Which of the following autoantibodies is most highly associated with this specific clinical phenotype (antisynthetase syndrome)?