7. Hand and Wrist MCQs

A 35-year-old construction worker sustains a 'fight bite' over the dorsal aspect of his right 3rd metacarpophalangeal (MCP) joint. He presents 48 hours later with significant erythema, swelling, and purulent drainage. Which of the following organisms is a fastidious Gram-negative rod uniquely associated with this specific injury mechanism, and what is the optimal empiric oral antibiotic therapy?

A 24-year-old male sustains a closed fracture of the base of the first metacarpal with an intra-articular extension that separates a small volar-ulnar fragment from the remaining metacarpal shaft. Which of the following ligaments remains attached to the volar-ulnar fragment, preventing its displacement?

Which of the following clinical signs is considered the most sensitive and earliest indicator of acute pyogenic flexor tenosynovitis?

A 22-year-old male punches a wall and sustains a closed, isolated fracture of the 5th metacarpal neck (Boxer's fracture).

What is the maximum acceptable volar angulation for this fracture before reduction or surgical intervention is definitively indicated to prevent functional deficit?

When evaluating a closed metacarpal shaft fracture for rotational deformity, which of the following statements accurately describes the clinical consequence of malrotation?

A 45-year-old male sustains a base of the 5th metacarpal fracture with dorsal and proximal displacement of the metacarpal shaft. This 'reverse Bennett' fracture pattern is primarily driven by the deforming pull of which muscle?

A 30-year-old carpenter presents with a severe felon of the left index finger requiring incision and drainage. To minimize the risk of painful scarring and sensory loss on the primary pinch surfaces, what is the recommended location for a mid-axial longitudinal incision?

A patient presents with swelling and extreme tenderness localized to the central palm. The palm has lost its normal concavity and appears bulging, but there is no significant swelling of the thenar eminence. Which of the following boundaries accurately defines the involved deep palmar space?

Which of the following fracture patterns of the 1st metacarpal base is associated with the highest rate of post-traumatic arthrosis, although functional outcomes are often surprisingly well-tolerated?

A patient presents with a deep space infection of the hand characterized by a significantly swollen web space between the thumb and index finger, and the thumb is held in a resting posture of flexion and abduction. What is the most likely diagnosis?

Which of the following radiographic views is most sensitive for detecting a subtle intra-articular fracture of the metacarpal head or collateral ligament avulsion fracture?

A 30-year-old nurse presents with painful, grouped vesicles on an erythematous base near the eponychium of her right index finger. She describes a burning and tingling prodrome before the vesicles appeared. A Tzanck smear is positive for multinucleated giant cells. Which of the following treatments is strictly contraindicated?

A 60-year-old man presents with chronic, enlarging, nodular masses on the digits of both hands. He has a history of poor medical compliance.

Radiographs demonstrate well-defined periarticular erosions with sclerotic overhanging margins ('Martel sign') and preserved joint spaces. What is the most likely composition of these soft tissue masses?

A 45-year-old diabetic male develops pyogenic flexor tenosynovitis in his left thumb following a minor penetrating injury. If left untreated, the infection is most likely to spread to the flexor sheath of the small finger to form a 'horseshoe abscess' through which of the following anatomic structures?

A 22-year-old male presents with a 3-mm puncture wound over his right 3rd metacarpophalangeal (MCP) joint after striking another person in the mouth. He exhibits pain with passive motion and localized swelling. Radiographs show no fracture. In addition to surgical irrigation and debridement, empiric antibiotic therapy MUST cover which of the following organisms characteristic of this injury?

A 25-year-old laborer sustains a transverse fracture of the third metacarpal shaft. On lateral radiograph, the fracture demonstrates apex dorsal angulation. Which of the following muscle groups is primarily responsible for generating this characteristic deformity?

A 19-year-old male punches a wall and sustains a closed fifth metacarpal neck fracture (Boxer's fracture) without extensor lag or digit malrotation. Based on the compensatory mobility of the carpometacarpal (CMC) joints, what is the maximum acceptable volar angulation for this fracture to be managed nonoperatively?

A 34-year-old agricultural worker presents with a severely painful, swollen right hand. Examination reveals marked swelling of the first web space, forcing the thumb into an abducted and flexed posture. There is extreme tenderness over the palmar aspect of the thenar eminence. Which of the following best describes the anatomic boundaries of the involved deep fascial space?

A 28-year-old professional boxer sustains a fracture-dislocation of the base of the fifth metacarpal ('Baby Bennett' fracture). Radiographs reveal dorsal and proximal migration of the metacarpal shaft. Which of the following muscles is the primary deforming force responsible for this displacement?

A 32-year-old carpenter presents with progressive difficulty making a full fist with his right ring finger, particularly when attempting to grasp small objects. He reports a history of a 'Jersey finger' injury to the same digit 6 months prior, which was surgically repaired. On examination, when he attempts to actively flex his ring finger, his metacarpophalangeal (MCP) joint flexes, but his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints paradoxically extend. Passive range of motion of the PIP and DIP joints is full. Based on the epidemiology and pathophysiology described in the case, which of the following is the most likely underlying mechanism for this patient's current deformity?