7. Hand and Wrist MCQs

A 40-year-old female complains of burning pain, swelling, and color changes in her right hand 6 weeks after cast removal for a distal radius fracture. Radiographs reveal patchy osteopenia. What is the most effective initial intervention to prevent progression of this condition?

A 32-year-old woman is admitted to the Emergency Department with a severe cough and shortness of breath. She has been unwell for a few days with a cough and sore throat and now says she is coughing purulent sputum which is rust-coloured and blood-stained. She has a history of asthma which is usually managed with a Seretide inhaler. On examination, she is pyrexial (38.2 °C) and has a blood pressure of 110/82 mmHg. Her pulse is 95 bpm and regular. She has a respiratory rate of 30/min and coarse inspiratory crackles to the mid-zone on the right-hand side. There are marked cold sores affecting her upper lip. Investigation: Hb 12.1 g/dl, WCC 14.3 x 10^9/l, PLT 202 x 10^9/l, Sodium 139 mmol/l, Potassium 4.5 mmol/l, Creatinine 179 µmol/l, CRP 170 mg/l, PO2 9.1 kPa, PCO2 4.3 kPa. Which of the following is the most likely cause of her underlying pneumonia?

A 30-year-old woman presents with persistent radial-sided wrist pain two weeks after a FOOSH injury. Initial and repeat radiographs are entirely normal. Which magnetic resonance imaging (MRI) sequence is most sensitive for detecting early, radiographically occult bone marrow edema indicative of a scaphoid fracture?

A 60-year-old woman sustains a distal radius fracture treated with closed reduction and casting. Which of the following daily oral supplements has the highest level of evidence for reducing her risk of developing Complex Regional Pain Syndrome (CRPS)?

A 6-year-old boy who is treated for a type III supracondylar fracture has no neurovascular deficit on initial examination. His fracture is treated by anatomic closed reduction and percutaneous fixation with medial and lateral pins. A partial deficit in ulnar motor and sensory function is noted after surgery. The next step in treatment should be:

The primary blood supply to the proximal pole of the scaphoid is derived from which of the following vessels?

A rupture of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint primarily leads to instability when which of the following forces is applied?

A positive Finkelstein's test in a patient with De Quervain's tenosynovitis is caused by irritation of which of the following tendon groups as they pass through the first dorsal compartment?

A 25-year-old rugby player sustains a flexor digitorum profundus (FDP) avulsion from the distal phalanx of the ring finger. Radiographs show a large bony fragment retracted to the level of the A4 pulley. What is the Leddy and Packer classification of this injury?

A 35-year-old carpenter sustains a puncture wound to his index finger. He presents 48 hours later with severe pain and swelling. Which of the following Kanavel signs is generally considered the most reliable and earliest indicator of acute suppurative flexor tenosynovitis?

A 22-year-old man presents with anatomic snuffbox tenderness after a fall onto an outstretched hand. Initial radiographs are negative. An MRI obtained 1 week later confirms an undisplaced fracture of the proximal pole of the scaphoid. What is the blood supply most relevant to the high nonunion risk of this fracture?

A 28-year-old man presents with chronic wrist pain. Radiographs show a scaphoid waist nonunion with a "humpback" deformity and dorsal intercalated segment instability (DISI). What is the recommended surgical management?

A 30-year-old carpenter lacerates the volar aspect of his index finger between the distal palmar crease and the proximal interphalangeal joint, transecting the FDS and FDP tendons. This injury is located in which flexor tendon zone?

In the rehabilitation following a primary Zone II flexor tendon repair, which of the following postoperative protocols has been shown to result in the strongest tendon healing and the fewest adhesions?

A 45-year-old manual laborer presents with advanced Scaphoid Nonunion Advanced Collapse (SNAC) stage III wrist arthritis. The radiocarpal and midcarpal joints are arthritic, but the radiolunate articulation is spared. Which salvage procedure is most appropriate?

A 28-year-old male sustains a proximal pole scaphoid fracture. Eight weeks later, radiographs demonstrate a lack of healing and nonunion. The high rate of nonunion in proximal pole scaphoid fractures is primarily due to the retrograde blood supply. Which vessel provides the primary blood supply to the proximal pole of the scaphoid?

A 40-year-old female complains of sudden loss of active thumb interphalangeal joint flexion 6 months after open reduction and internal fixation of a distal radius fracture with a volar locking plate. Radiographs show the plate is positioned distally, crossing the watershed line. Which tendon is most likely ruptured?

During surgical repair of a zone II flexor tendon laceration, a surgeon must carefully manage the flexor tendon sheath to prevent bowstringing of the repaired tendons. Preservation of which two annular pulleys is most critical for maintaining the biomechanical integrity of the digit?

A 22-year-old man sustains a proximal pole scaphoid fracture. The high rate of avascular necrosis associated with this specific fracture pattern is primarily due to the retrograde blood supply originating from which of the following arteries?

A patient sustains a laceration to the volar aspect of the hand, severing the flexor digitorum superficialis and profundus tendons in the region historically known as "no man's land." This anatomic area (Zone II) is defined by which of the following boundaries?