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7. Hand and Wrist MCQs

Practice Set 5 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 81

Topic: Nerve & Tendon

A 5-year-old child presents with an extension-type supracondylar humerus fracture. Examination reveals an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?

. Median nerve
. Anterior interosseous nerve
. Ulnar nerve
. Radial nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Median nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar fractures. It is a motor branch of the median nerve innervating the flexor pollicis longus and the flexor digitorum profundus to the index and middle fingers.

Question 82

Topic: Nerve & Tendon

A 5-year-old child sustains a displaced extension-type supracondylar humerus fracture. Examination reveals weakness in flexing the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Musculocutaneous nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. It innervates the flexor pollicis longus and flexor digitorum profundus to the index finger.

Question 83

Topic: 7. Hand and Wrist

A 7-year-old boy falls on an outstretched hand and sustains a widely displaced extension-type supracondylar fracture of the humerus. During assessment, he is unable to flex the interphalangeal joint of his thumb. Which nerve is most likely injured?

. Ulnar nerve
. Radial nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures.

Question 84

Topic: Nerve & Tendon

A radiograph

of a 10-year-old girl who sustained a lateral condyle fracture of the humerus 5 years ago shows an established nonunion. She now complains of clumsiness in her hand and numbness in her little finger. This complication is most directly related to:

. Progressive cubitus varus deformity
. Ischemia of the anterior interosseous nerve
. Cubitus valgus deformity causing ulnar nerve stretching
. Direct ulnar nerve injury sustained at the time of the initial fracture
. Overgrowth of the lateral condyle compressing the median nerve

Correct Answer & Explanation

. Cubitus valgus deformity causing ulnar nerve stretching

Explanation

Nonunion of a lateral condyle fracture typically results in a progressive cubitus valgus deformity. Over time, this valgus angulation stretches the ulnar nerve, leading to tardy ulnar nerve palsy.

Question 85

Topic: 7. Hand and Wrist

A newborn has an amputation of the right hand at the wrist and a deep, circumferential constriction band around the left lower leg. The left foot is swollen and cyanotic. What is the appropriate management for the left leg?

. Immediate Z-plasty excision of the entire band
. Observation until 6 months of age
. Serial casting to stretch the band
. Amputation at the level of the band
. Elective Z-plasty in 1 year

Correct Answer & Explanation

. Immediate Z-plasty excision of the entire band

Explanation

Amniotic band syndrome (Streeter dysplasia) can cause severe vascular compromise due to deep constriction rings. If the distal extremity is neurovascularly compromised, emergent surgical release of the band with Z-plasty is required to salvage the limb.

Question 86

Topic: 7. Hand and Wrist

A neonate presents with a markedly shortened lower leg, varus foot positioning, and an absent hallux. Radiographs reveal complete absence of the tibia but an intact fibula (Jones Type 1a). Which of the following inheritance patterns is associated with this condition when part of Werner syndrome?

. Autosomal dominant
. Autosomal recessive
. X-linked recessive
. X-linked dominant
. Mitochondrial

Correct Answer & Explanation

. Autosomal recessive

Explanation

While isolated tibial hemimelia is often sporadic, it can occur in Werner syndrome (tibial hemimelia-polydactyly syndrome), which has an autosomal recessive inheritance pattern. These patients typically present with absent tibiae and preaxial polydactyly.

Question 87

Topic: 7. Hand and Wrist

Which of the following is not a common feature of constriction band syndrome:

. Annular rings
. Fenestrated syndactyly
. Digital amputation
. Equinovarus foot
. Hip dislocation

Correct Answer & Explanation

. Hip dislocation

Explanation

Constriction band syndrome is not commonly associated with developmental dislocation of the hip. However, annular rings, fenestrated syndactyly, digital amputation, and equinovarus foot are often seen in patients with constriction band syndrome.

Question 88

Topic: 7. Hand and Wrist

A 5-year-old boy falls on an outstretched hand and sustains a widely displaced extension-type supracondylar humerus fracture. Which nerve is most commonly injured in this specific fracture pattern?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve (AIN)
. Posterior interosseous nerve (PIN)
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. Its function is assessed by asking the patient to make an 'OK' sign.

Question 89

Topic: 7. Hand and Wrist
A 3-year-old girl is diagnosed with congenital scoliosis due to a fully unsegmented bar with a contralateral hemivertebra. Which of the following is the most appropriate next step in evaluation to rule out associated anomalies?
. Renal ultrasound and echocardiogram
. Pulmonary function tests
. Ophthalmologic examination
. Brain MRI with contrast
. Dual-energy X-ray absorptiometry (DEXA)

Correct Answer & Explanation

. Renal ultrasound and echocardiogram

Explanation

Congenital scoliosis is highly associated with VACTERL anomalies. Routine screening must include a renal ultrasound (genitourinary anomalies in 20-30%) and an echocardiogram (cardiac anomalies in 10-15%).

Question 90

Topic: 7. Hand and Wrist

Which of the following symptoms is not characteristic of congenital constriction band syndrome:

. C ircular grooves in the limb
. C omplex complete syndactyly
. Terminal amputations
. C lubfoot
. Lymphedema

Correct Answer & Explanation

. C omplex complete syndactyly

Explanation

Syndactyly in constriction band syndrome is a fenestrated syndactyly, is incomplete, and has slits between the digits proximally. Syndactyly in constriction band syndrome is also not complex because the bones are not fused.

Question 91

Topic: Nerve & Tendon

A 6-year-old boy sustains an extension-type supracondylar humerus fracture. He is unable to flex the interphalangeal joint of his thumb. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. It innervates the FPL, responsible for thumb IP joint flexion.

Question 92

Topic: Nerve & Tendon

The most common neural injury after a supracondylar fracture of the distal humerus is:

. Anterior interosseous nerve
. Median nerve
. Posterior interosseous nerve
. Radial nerve
. Ulnar nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The most commonly injured nerve after a supracondylar fracture of the distal humerus is the anterior interosseous nerve. An injury to this nerve results in the inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger.

Question 93

Topic: 7. Hand and Wrist

Which of the following best describes the primary vascular supply to the proximal pole of the scaphoid?

. Volar carpal branch of the radial artery entering distally
. Dorsal carpal branch of the radial artery entering through the dorsal ridge
. Superficial palmar arch entering the volar tubercle
. Anterior interosseous artery entering the waist
. Ulnar artery branches entering through the scapholunate ligament

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery entering through the dorsal ridge

Explanation

The primary blood supply to the scaphoid is retrograde, originating from the dorsal carpal branch of the radial artery, which enters the dorsal ridge at the waist and supplies the proximal pole. This retrograde flow is why proximal pole fractures have a high risk of avascular necrosis and nonunion.

Question 94

Topic: Wrist & Carpus

Failure to stabilize the volar lunate facet fragment in a distal radius fracture most commonly leads to subluxation of the carpus in which direction?

. Dorsal
. Volar
. Ulnar
. Radial
. Proximal

Correct Answer & Explanation

. Volar

Explanation

The volar lunate facet is critical for the stability of the radiocarpal joint due to the attachment of the short radiolunate ligament. Failure to capture this fragment often results in volar subluxation of the carpus and catastrophic joint failure.

Question 95

Topic: 7. Hand and Wrist
A 28-year-old manual laborer presents with Lichtman Stage IIIA Kienbock's disease and ulnar minus variance. Which of the following is the most appropriate surgical intervention?
. Proximal row carpectomy
. Radial shortening osteotomy
. Total wrist arthrodesis
. Lunate excision and silastic replacement
. Ulnar shortening osteotomy

Correct Answer & Explanation

. Radial shortening osteotomy

Explanation

In Kienbock's disease with ulnar minus variance and no carpal collapse (Stage IIIA), joint leveling procedures such as a radial shortening osteotomy are indicated. This unloads the lunate and can arrest disease progression.

Question 96

Topic: Nerve & Tendon

Which of the following is the most proximal potential site of ulnar nerve compression in cubital tunnel syndrome?

. Arcade of Struthers
. Medial intermuscular septum
. Osborne's ligament
. Aponeurosis of the flexor carpi ulnaris
. Deep flexor pronator aponeurosis

Correct Answer & Explanation

. Arcade of Struthers

Explanation

The Arcade of Struthers is a fascial band located about 8 cm proximal to the medial epicondyle and represents the most proximal potential site for ulnar nerve compression. Other sites include the medial intermuscular septum, Osborne's ligament, and the FCU aponeurosis.

Question 97

Topic: Nerve & Tendon

In radial tunnel syndrome, compression of the posterior interosseous nerve most frequently occurs at which of the following structures?

. Fibrous bands anterior to the radiocapitellar joint
. Vascular leash of Henry
. Leading edge of the extensor carpi radialis brevis
. Arcade of Frohse
. Distal edge of the supinator

Correct Answer & Explanation

. Arcade of Frohse

Explanation

While compression can occur at multiple sites within the radial tunnel, the most common site of compression for the posterior interosseous nerve is the Arcade of Frohse. This is the thickened proximal aponeurotic edge of the superficial supinator muscle.

Question 98

Topic: Wrist & Carpus

In the management of a Galeazzi fracture, which of the following radiographic signs most strongly indicates gross instability of the distal radioulnar joint (DRUJ) requiring operative stabilization?

. Fracture of the radial shaft greater than 7.5 cm from the articular surface
. Volar apex angulation of the radius
. Widening of the DRUJ on the true PA radiograph
. Fracture at the base of the ulnar styloid
. Dorsal comminution of the radius

Correct Answer & Explanation

. Fracture at the base of the ulnar styloid

Explanation

A basilar ulnar styloid fracture in the setting of a Galeazzi fracture frequently signifies complete detachment of the triangular fibrocartilage complex (TFCC) from its foveal insertion. This indicates severe DRUJ instability that often requires pinning or direct repair.

Question 99

Topic: Nerve & Tendon

During a single-incision anterior approach for repairing an acute distal biceps tendon rupture, which nerve is most frequently injured or irritated due to its superficial location and proximity to the cephalic vein?

. Lateral antebrachial cutaneous nerve (LABCN)
. Posterior interosseous nerve (PIN)
. Superficial radial nerve
. Ulnar nerve
. Median nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) runs closely with the cephalic vein and the distal biceps tendon, making it the most commonly injured nerve during a single-incision anterior approach. Injury results in lateral forearm paresthesias.

Question 100

Topic: 7. Hand and Wrist

A 65-year-old male with pre-existing cervical spondylosis sustains a hyperextension injury to his neck in a motor vehicle accident. He presents with Central Cord Syndrome. Which of the following best describes his expected pattern of motor deficit?

. Lower extremities are significantly more affected than upper extremities
. Upper extremities (particularly the hands) are significantly more affected than lower extremities
. Isolated dense hemiparesis on the dominant side
. Distal sensory loss only with normal motor strength
. Lower cranial nerve deficits with ascending paralysis

Correct Answer & Explanation

. Upper extremities (particularly the hands) are significantly more affected than lower extremities

Explanation

Central Cord Syndrome typically results from hyperextension injuries compressing the spinal cord in a narrowed canal. Because the cervical motor tracts controlling the upper extremities are located more centrally, patients present with profound upper extremity weakness (especially hands) while retaining better lower extremity function.

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