Multiple Choice Questions

Hands

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Please use the comments section at the bottom of the page if you have any query or feedback about any of the questions.

 

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

Correct Answer: D

EPL can be commonly injured with placement of the portal between the 3rd and 4th extensor compartments. Ganglion typical is distal or over the portal site

Author: David Hughes

 

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

Correct Answer: E

This is an intrinsic plus hand associated with neurological conditions such as Parkinson’s .

Hydrazine is a Monamine inhibitor used in the treatment of Parkinson’s.

Author: David Hughes

 

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

Correct Answer: D

saggital band rupture, leading to extensor tendon subluxation ulnarily  leading inability to extend at the MCP joint, but once in full extension passively can hold it.

Author: David Hughes

 

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

Correct Answer: C

Ffter surgery nerves recover proximal to distal so the proximal extrinsic muscles recover first, over powering the intrinsic muscle of the hand causing clawing of the ring and little finger.

Author: David Hughes

 

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

Correct Answer: B

Nailbed Injury is associated with tuft fracture in adults and Seymour fracture in children.

Author: S Kamat

 

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

Correct Answer: B

The MRI reveals a complete disruption of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

Author: Rajesh Bahadur Lakhey.

 

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

Correct Answer: A

POSI = Position of safety of intrinsics

Author: Fouad Chaudery

 

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

Correct Answer: D

Macrodactyly is an increase in length and width of a digit or two adjacent digits. It may be associated with all of the above syndromes except for Marfan syndrome. 

Macrodactyly is also a common isolated condition.

Author: Fouad Chaudery

 

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

Correct Answer: E

Avulsion of the flexor digitorum profundus, or "jersey finger," is a common injury in contact sports. 

Appropriate treatment includes surgical repair.

Author: Fouad Chaudhry

 

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”. 

Trampoline test is an arthroscopic evaluation of tension of triangular... | Download Scientific Diagram

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 

Correct Answer: D

A probe should be used to test the integrity of the articular disc of the TFCC. This disk should be fairly taught, similar to a trampoline. 

When the articular disk is floppy and floating without tension, a tear in either the central or peripheral portion must be suspected.

Author: Fouad Chaudhry

 

9. A golfer sustained a hook of the hamate fracture . 

After 12 weeks of splinting and therapy, the hand is still symptomatic. 

RiT radiology: Hook of Hamate Fracture

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

Correct Answer: C

Excision of the fracture fragment typically leads to rapid return to function. 

Fixation techniques are difficult to perform because of the size of the bone; hardware prominence is common. 

Nerve deficits are not typically noted in this injury. 

The motor branch of the ulnar nerve in Guyon canal must be protected during the surgical approach.

Author: Salam Al-Abayachi

 

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

Correct Answer: D

Vascular anastomoses are exceedingly difficult with amputations distal to the nail fold because the digital vessels bifurcate or trifurcate at this level, and little functional benefit is gained compared to other means of soft-tissue coverage. 

Single-digit amputations, other than the thumb, are a relative contraindication for replantation. 

Replantations at the level of the proximal phalanx lead to poor motion of the proximal interphalangeal joint. 

In a healthy, active adult, an amputation through the wrist is an appropriate situation to proceed with a replantation. 

A transverse forearm amputation is a good indication with a warm ischemia time of less than 6 hours.

Author: Salam Al-Abayachi

 

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

Best answer:  A

Staph aureus is the most common causing organism in all the above infections.However, Eikonella Corrodens is characteristic of human bites.

Hand infections are potentially serious. Treatment is with antibiotics and incision & drainage of any collection.

 

Pasteurella multocida is  common pathogen in cats and dogs scratches and bites.

 

 Ref: http://www.orthobullets.com/hand/6104/human-bite

 Author :Firas Arnaout

 

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.

Correct Answer is : E

Dupuytren's contracture usually affects the ring and little finger. 

The contracture spreads to the joints of the finger, which can become permanently immobilized. 

Author : Firas Arnaout

 

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

Best answer: E

 

BE a FAN of V (BEFANV)

Secured bone fixation should be done before starting any repair. 

Author: Ahmed Eltanboly

 

 

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

Best answer: D

 

Wassel is the most common classification system for thumb polydactyly:
I: bifid distal phalanx
II: duplicated distal phalanx
III: bifid proximal phalanx
IV: duplicated proximal phalanx
V: bifid metacarpal
VI: duplicated metacarpal
VII: triphalangism.

Author: Ahmed Eltanboly

 

 

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

Best answer: E

 

There are six extensor tendon compartments and the Lister's tubercle is the border between the second and third one.

Author: Ahmed Eltanboly

 

 

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

Best answer: D

The most common site is proximal phalanx. 

The most common soft tissue tumour is Ganglion.

Bone: Enchondroma

Author: Ahmed Eltanboly

 

 

1.What two flexor pulleysthat  are the most important for maintaining the integrity of finger flexion?