7. Hand and Wrist MCQs

A 22-year-old male presents with persistent wrist pain 4 months after a fall onto an outstretched hand. Radiographs reveal a nonunion of the proximal pole of the scaphoid. Which of the following accurately describes the primary blood supply to this region, explaining the high rate of nonunion?

A 19-year-old male presents with a swollen, erythematous right hand 48 hours after punching another individual in the mouth, sustaining a small laceration over the third metacarpophalangeal (MCP) joint. In addition to Staphylococcus and Streptococcus species, which of the following organisms must be empirically covered?

A 45-year-old diabetic female presents with a 2-day history of right index finger pain and swelling. Which of the following is NOT one of Kanavel's four cardinal signs of flexor tenosynovitis?

A 22-year-old rugby player felt a "pop" in his right ring finger while grabbing an opponent's jersey. He cannot actively flex the distal interphalangeal (DIP) joint. Imaging reveals a small bony avulsion retracted into the palm. What is the optimal timing for surgical intervention?

During surgical planning for a highly comminuted intra-articular distal radius fracture, the surgeon notes a displaced volar ulnar corner (lunate facet) fragment. Fixation of this specific fragment is critical to prevent carpal subluxation due to the attachment of which ligament?

A patient presents with a thumb injury after a skiing accident. Examination reveals gross instability with valgus stress at the thumb MCP joint. An MRI confirms a complete rupture of the ulnar collateral ligament (UCL) with the torn edge displaced superficial to an aponeurosis. Which structure prevents anatomic healing in this Stener lesion?

A patient presents with sudden onset of weakness in the forearm and hand. When asked to make an "OK" sign, the patient instead demonstrates a "flat pinch" with the index finger and thumb. Which combination of muscles is affected in this specific nerve entrapment syndrome?

A 25-year-old male punches a wall and sustains a closed, displaced fracture of the 5th metacarpal neck (Boxer's fracture). The fracture demonstrates apex dorsal angulation. Which muscle group is primarily responsible for deforming the distal fracture fragment volarly?

A 32-year-old female presents after a fall onto an outstretched hand. Radiographs reveal a volar shear fracture of the distal radius with subluxation of the carpus (volar Barton's fracture). What is the optimal biomechanical fixation method for this specific fracture pattern?

A 65-year-old female undergoes volar locked plating of a distal radius fracture. Four weeks postoperatively, she suddenly loses the ability to actively extend her thumb interphalangeal joint. What is the most likely cause?

A 24-year-old male falls on an outstretched hand. Initial radiographs are negative, but repeat imaging at 3 weeks reveals a displaced proximal pole scaphoid fracture. What is the primary blood supply to the proximal pole of the scaphoid?

A 40-year-old female, 3 months postpartum, presents with pain and swelling at the radial side of her dominant wrist. The pain is exacerbated by lifting her infant and by activities involving grasping and pinching. Physical examination reveals tenderness over the radial styloid and a positive Finkelstein's test (pain with ulnar deviation of the wrist while the thumb is flexed into the palm). What is the most likely diagnosis?

During an open carpal tunnel release, the longitudinal incision should be made in line with the radial border of the ring finger. Making the incision significantly radial to this axis most increases the risk of injuring which structure?

While enchondromas can occur in any bone, they are most frequently found in which anatomical location?

A 22-year-old male sustains a proximal pole scaphoid fracture. What anatomical characteristic of the scaphoid's blood supply places him at a high risk for avascular necrosis?

A 60-year-old female undergoes volar locking plate fixation for a distal radius fracture. Six months later, she presents with an inability to flex her thumb interphalangeal joint. Plate prominence at which anatomical landmark is most responsible for this complication?

A 60-year-old female undergoes open reduction and internal fixation of a distal radius fracture using a volar locking plate. Four months postoperatively, she presents unable to actively flex the interphalangeal (IP) joint of her thumb. Which tendon has most likely ruptured, and what surgical technical error primarily increases the risk of this complication?