Multiple Choice Questions
Hands
Test your knowledge , learn more and get ready for your orthopaedic exam
30. A 38-year-old man caught his index finger in a volleyball net. He noted an angular deformity of the finger that was reduced when a teammate pulled on his finger. Three weeks later, he now reports trouble extending his finger. A clinical photograph is shown in Figure . What anatomic structure is most likely injured?
A) Spiral oblique retinacular ligament 2 Sagittal bands
B) Sagittal
C) Volar plate
D) Central slip of the extensor tendon
E) Terminal extensor tendon
29. A 26-year-old man presents with chronic hand weakness. The clinical appearance of his hand, and radiographs are shown in Figures. Surgical exploration and decompression is performed. Besides addressing thumb interphalangeal and index distal interphalangeal joint flexion, which is the most appropriate treatment to restore thumb opposition? 
A) Ring flexor digitorum superficialis transfer to the abductor pollicis brevis
B) Extensor indicis proprius transfer to the abductor pollicis brevis
C) Neurotization of thenar muscles
D) Camitz palmaris longus transfer to the abductor pollicis brevis
E) Thumb carpometacarpal joint arthrodesis
28. A 48-year-old hairdresser presents with pain and swelling of his ring finger for 4 days. On examination, there is generalized tenderness along the entire digit. Passive extension of the digit triggers excruciating pain. The clinical appearance of the digit is shown in Figure . What is the most appropriate next step in management? 
A) Acyclovir
B) Intravenous antibiotics, splinting and elevation
C) Closed tendon sheath irrigation from the level of the A1 pulley (proximal) to the distal interphalangeal joint (distal)
D) Continuous closed tendon sheath irrigation from the wrist (proximal) to the distal interphalangeal joint (distal)
E) Open irrigation and debridement
27. Figures show the radiographs of a 62-year-old man with severe radially sided wrist pain. Management has consisted of wrist splinting, nonsteroidal anti-inflammatory drugs, and activity modification, but he continues to have pain and reports difficulty sleeping. What is the most appropriate treatment for this patient?
A) Arthroscopic debridement
B) Open reduction and internal fixation
C) Scaphoid nonvascularized bone graft and screw fixation
D) Scaphoid vascularized bone graft and screw fixation
E) Scaphoid excision and 4-corner fusion
26. A 46-year-old man sustains an injury to his left index finger while cleaning his paint gun with paint thinner. Examination reveals a small puncture wound at the pulp. The finger is swollen. What is the next most appropriate step in management?
A) Elevation and observation
B) Surgical debridement and lavage
C) Infiltration with corticosteroids
D) Infiltration with a neutralizing agent
E) Administration of antibiotics
25. In obtaining informed consent for a percutaneous trigger finger release of the thumb, what structure is discussed as being most vulnerable to injury?
A) Radial digital sensory nerve to the index finger
B) Radial digital sensory nerve to the thumb
C) Median motor branch to the thenar muscles
D) Volar plate of the thumb metacarpophalangeal joint
E) Ulnar digital sensory nerve to the thumb
24. Ganglion cysts about the wrist most commonly arise from what structure?
A) First carpometacarpal joint
B) Second carpometacarpal joint
C) Scapholunate interosseous ligament
D) Radioscaphocapitate ligament
E) Capitohamate interosseous ligament
23. A patient sustained a sharp laceration to the base of his left, nondominant thumb 4 months ago. Examination reveals no active flexion but full passive motion of the interphalangeal joint. What is the best treatment option?
A) Interphalangeal joint fusion
B) Intercalary tendon graft
C) Silicone rod placement
D) Primary flexor pollicis longus repair
E) Flexor digitorum superficialis transfer
22. When evaluating a patient with suspected purulent flexor tenosynovitis in the thumb, the distal forearm and little finger are found to be swollen as well. The most likely anatomic explanation is the existence of a potential space in which of the following?
A) Through the carpal tunnel
B) Across the midpalmar space
C) Communicating with the subcutaneous tissue
D)Superficial to the distal antebrachial fascia
E) Between the fascia of the pronator quadratus and flexor digitorum profundus conjoined tendon sheaths
21. In the rheumatoid hand with an intact extensor tendon mechanism, replacement of the metacarpophalangeal joints might be considered if there is?
A) Gross joint destruction
B) Palmar and proximal dislocation of the base of the phalanx
C) Marked ulnar drift combined with (A) and (B)
D) All of these
E) None of these
20. Which of the following muscles is not located in the thenar group of muscles?
A) Abductor pollicis brevis
B) Opponens pollicis
C) Opponens digiti minimi
D) Flexor pollicis brevis
E) Adductor pollicis
19. Patient is seen post op after their wrist arthroscopy and is concerned about a firm lump just proximal to one of their portal sites .
What injury should you check for?
A) Nerve injury
B) Ganglion
C) Loose Body
D) retropulsion of thumb fracture
E) Extending the little finger
18. A patient presents to your clinic with both hands in this position.
What medications might they be on?
A) none
B) Beta blocker’s
C) Simvastatin
D) Metformin
E) Hydrazine
17. An amateur boxer presents to your clinic, she is worried as after her most recent match she cannot extend her finger.
If she straightens with her other hand she can hold it straight and it stays up
This is because:
A) partial tendon tear
B) posterior interosseous nerve compression from the fight
C) complete tendon rupture
D) saggittal band rupture
E) MCP subluxation
16. The ulnar paradox relates to:
A) Cubital tunnel syndrome is rarely associated with carpal tunnel syndrome
B) A proximal compression of the nerve leads to a worse deformity
C) After cubital tunnel release the deformity gets worse before it gets better
D)Cubital tunnel syndrome is always bilateral
E) Double pinch syndrome has a far worse outcome
15. Nail bed injury in the adult might be associated with which of the following:
A) Seymour fracture
B) Tuft fracture
C) Fracture of middle phalanx
D)Proximal phalanx fracture
E) Avulsion of central slip
14. A 19-year-old volleyball player injured her right thumb during a game.
A magnetic resonance image (MRI) through the metacarpophalangeal joint is shown .
What is the diagnosis:
A) Extensor tendon disruption
B) Complete ulnar collateral ligment tear
C) Volar plate disruption
D) Incomplete ulnar collateral ligament tear
E) Ulnar collateral
ligament sprain
13. When applying a POSI splint, which of the following is true?
A) The wrist should be extended 10-45 degrees
B) PIPJ flexed to 90 degrees
C) DIPJ flexed to 30 degrees
D) Thumb in maximum abduction
E) MCPJ full extension
12. Macrodactyly is associated with all of the following syndromes except:
A) Neurofibromatosis
B) Proteus syndrome
C) Klippel-Trenaunay syndrome
D) Marfan syndrome
E) Multiple enchondromatosis
11. A 16-year-old male high school rugby player was making a tackle when he felt sudden pain in his right long finger.
He has swelling and tenderness along the volar aspect of the injured digit. He is unable to actively flex the distal interphalangeal joint of the injured digit.
Radiographs are negative for fracture.
Recommended treatment should include:
A) Observation
B) Splinting of the distal interphalangeal joint in extension
C) Splinting of the distal interphalangeal joint in flexion
D) Immediate active range of motion exercises
E) Surgical repair
10. During a wrist arthroscopy in a basketball player who has ulnar-sided wrist pain, the articular disk of the triangular fibrocartilage complex is observed.
A probe is inserted and the disk is free floating without tension, a negative “trampoline test”.
What does this signify:
A) Flexor carpi ulnaris subluxation
B) Distal radioulnar joint disruption
C) Scapholunate instability
D) Tear in either the central or peripheral portion of the TFCC
E) Ulnar abutment syndrome
9. A golfer sustained a hook of the hamate fracture .
After 12 weeks of splinting and therapy, the hand is still symptomatic.
What is the most appropriate management to allow return to competitive activity?
A) Continued observation
B) Open reduction and internal fi xation of the fracture
C) Excision of the hook of the hamate
D) Carpal tunnel release
E) Guyon canal release
8. What is the most appropriate indication for replantation in an otherwise healthy 35y old man?
A) Isolated transverse amputation of the thumb through the middle of the nail bed
B) Isolated transverse amputation of the index fi nger through the proximal phalanx
C) Isolated transverse amputation of the ring finger through the proximal phalanx
D) Isolated transverse amputation of the hand at the level of the wrist
E) Forearm amputation with a 10-hour warm ischemia time
7. A 59 years old man attended A&E with hand infection. Blood culture grow Eikonella Corrodens .
Which injury is associated with this organism?
A) Human bites
B) Cat bites
C) Dog bites
D) Pyogenic flexor tenosynovitis
E) Paronychia
6. The following statements about Dupuytren’s contracture are true except that:
A) It is due to contraction of the palmar fascia which starts as an indurated nodule on the ulnar border of the hand.
B) The ring and little fingers are severely affected.
C) The deformity consists of flexion of the MCP and PIP joints with extension of the terminal joint.
D) The skin overlying the indurated fascia is often puckered and immobile.
E) The joint capsules and flexor tendons are not affected.
5. During replantation of a digit; what is the sequence of repairing structures:
A) Bone; Extensor tendon; Flexor tendons; Arteries; Veins; Nerves
B) Nerves; Arteries; Bone; Veins; Extensor tendon; Flexor tendons
C) Arteries; Bone; Flexor tendons; Extensor tendon; Veins; Nerves
D) Bone; Arteries; Nerves; Veins; Flexor tendons; Extensor tendon
E) Bone; Extensor tendon; Flexor tendons; Arteries; Nerves; Veins
4. In Wassel classification of thumb polydactyly.
What is the most common type?
A) Type I
B) Type II
C) Type III
D) Type IV
E) Type V
3. Regarding wrist arthroscopy, The Lister tubercle lies between two dorsal wrist compartments .
What are they and their contents?
A) ECRL and EDC
B) APL and ECRB
C) EPB and ECRL
D) EPL and extensor indicis proprius
E) ECRB and EPL
2. Which of the following is considered the most common primary bone tumor that occurs in the bones of the hand?
A) Giant cell tumor
B) Epithelioid sarcoma
C) Intraosseous ganglion
D) Enchondroma
E) Chondrosarcoma
1.What two flexor pulleysthat are the most important for maintaining the integrity of finger flexion?
A) A1 and A2
B) A1 and A3
C) A1 and A4
D) A2 and A4
E) A2 and A5
5. A 48-year-old hairdresser presents with pain and swelling of his ring finger for 4 days.
On examination, there is generalized tenderness along the entire digit. Passive extension of the digit triggers excruciating pain. The clinical appearance of the digit is shown in Figure .
What is the most appropriate next step in management?
A) Acyclovir
B) Intravenous antibiotics, splinting and elevation
C) Closed tendon sheath irrigation from the level of the A1 pulley (proximal) to the distal interphalangeal joint (distal)
D) Continuous closed tendon sheath irrigation from the wrist (proximal) to the distal interphalangeal joint (distal)
E) Open irrigation and debridement
4. During a wrist arthroscopy in a basketball player who has ulnar-sided wrist pain, the articular disk of the triangular fibrocartilage complex is observed.
A probe is inserted and the disk is free floating without tension, a negative “trampoline test”.
What does this signify:
A) Flexor carpi ulnaris subluxation
B) Distal radioulnar joint disruption
C) Scapholunate instability
D) Tear in either the central or peripheral portion of the TFCC
E) Ulnar abutment syndrome
3. A golfer sustained a hook of the hamate fracture .
After 12 weeks of splinting and therapy, the hand is still symptomatic.
What is the most appropriate management to allow return to competitive activity?
A) Continued observation
B) Open reduction and internal fi xation of the fracture
C) Excision of the hook of the hamate
D) Carpal tunnel release
E) Guyon canal release
2. In Wassel classification of thumb polydactyly.
What is the most common type?
A) Type I
B) Type II
C) Type III
D) Type IV
E) Type V
1. Figures show the radiographs of a 62-year-old man with severe radially sided wrist pain. Management has consisted of wrist splinting, nonsteroidal anti-inflammatory drugs, and activity modification, but he continues to have pain and reports difficulty sleeping.
What is the most appropriate treatment for this patient?
A) Arthroscopic debridement
B) Open reduction and internal fixation
C) Scaphoid nonvascularized bone graft and screw fixation
D) Scaphoid vascularized bone graft and screw fixation
E) Scaphoid excision and 4-corner fusion
