ABOS Part I Comprehensive Review - Batch 82

Question 1

A 48-year-old right-hand dominant male carpenter presents with a 6-month history of progressive left hand pain, cold intolerance, numbness, and episodic digital pallor and cyanosis primarily affecting the ring and small fingers. He frequently uses hi

Accepted Answer

Hypothenar Hammer Syndrome

Question 2

During the clinical examination, an Allen's test is performed on the patient's left hand. Occlusion of the ulnar artery and release results in significantly delayed reperfusion (> 15 seconds) or absent reperfusion in the ring and small fingers, while

Accepted Answer

There is significant compromise of the ulnar artery with inadequate collateral circulation from the radial artery to the ulnar digits.

Question 3

Following the clinical examination, a Duplex Ultrasound (DUS) with Doppler Flow Study is performed. Given the suspected diagnosis and clinical findings, which of the following findings would be most consistent with Hypothenar Hammer Syndrome?

Accepted Answer

A fusiform aneurysm of the ulnar artery within Guyon's canal with intraluminal thrombus and distal occlusion.

Question 4

A Computed Tomography Angiography (CTA) is performed for pre-operative planning. Which of the following findings from the CTA would be most critical for determining the surgical strategy for arterial reconstruction?

Accepted Answer

Precise delineation of the extent of the ulnar artery pathology (aneurysm and thrombotic occlusion) and assessment of collateral circulation.

Question 5

The patient's symptoms include both digital ischemia and mild ulnar nerve deficits. During the differential diagnosis process, it is crucial to distinguish Hypothenar Hammer Syndrome (HHS) from primary Ulnar Nerve Entrapment at Guyon's Canal. Which o

Accepted Answer

Digital pallor, cyanosis, cold intolerance, and a diminished ulnar pulse.

Question 6

The Nerve Conduction Studies (NCS) and Electromyography (EMG) findings indicate a mild ulnar neuropathy at the wrist, with mildly reduced sensory nerve action potential (SNAP) amplitudes and sparse positive sharp waves in intrinsic muscles. Based on

Accepted Answer

Secondary compression or irritation of the ulnar nerve by the adjacent ulnar artery aneurysm and surrounding edema.

Question 7

The patient is classified as Type II Hypothenar Hammer Syndrome based on diagnostic findings. The decision is made to proceed with surgical intervention. Which of the following is the most compelling indication for surgical management in this patient

Accepted Answer

Persistent and worsening digital ischemia, symptomatic ulnar artery aneurysm with thrombus, and inadequate collateral circulation.

Question 8

During the surgical procedure for this patient's Hypothenar Hammer Syndrome, the pathological ulnar artery segment (aneurysm and thrombotic occlusion) is resected. Given the length of the resected segment (approximately 3.5 cm) and the goal of restor

Accepted Answer

Reconstruction with an autogenous vein graft.

Question 9

Immediately post-operatively, the patient is in the recovery room. Which of the following is the most critical aspect of monitoring and management to ensure the success of the arterial reconstruction?

Accepted Answer

Continuous monitoring of digital perfusion (color, temperature, capillary refill) and Doppler auscultation of the graft site.

Question 10

The patient is progressing well in rehabilitation. As part of long-term management and prevention of recurrence, what is the most crucial advice to provide to this patient, particularly given his occupational history?

Accepted Answer

Reinforce avoidance of repetitive trauma to the hypothenar region and counsel on ergonomic modifications for work and hobbies.

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Key Takeaway