Multiple Choice Questions

Hands

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

20. Macrodactyly is associated with all of the following syndromes except:

Isolated Macrodactyly | Consultant360

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

 

19. A 16-year-old male high school football 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 football. 

Appropriate treatment includes surgical repair.

Author: Fouad Chaudhry

 

18. 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

 

17. A collegiate golfer sustained a hook of the hamate fracture . After 12 wks 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 diffi cult to perform because of the size of the bone; hardware prominence is common. Nerve defi cits 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

 

16. 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 fi nger 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 diffi cult with amputations distal to the nail fold because the digital vessels bifurcate or trifurcate at this level, and little functional benefi t 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

 

15.  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.

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

 Author :Firas Arnaout

 

14. 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 metacarprophalangeal and proximal interphalangeal 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 only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized. 

Author : Firas Arnaout

 

13.  A 55 -years-old man sustains an open fracture of the radius which was treated with open reduction and internal fixation. This operation was complicated with radial nerve injury which did not improve at follow up. 

Which of the following treatments will best restore function?

A)Transfer of pronator teres to extensor carpi radialis brevis
B)Transfer of deltoid to triceps
C)Transfer of the flexor carpi radialis to extensor digitorum and the palmaris longus to the extensor pollicis longus 
D)Transfer of pectoralis major to biceps
E)Transfer of common flexors tendon to the humerus

Best answer: C

 

For radial nerve palsy in the forearm palsy, the most beneficial transfers include transferring the flexor carpi radialis to the finger extensors (to restore finger extension) and palmaris longus to the extensor pollicis longus (to restore extension of the thumb).

In radial nerve palsy in the forearm, the patient has adequate wrist extension due to intact ECRL (providing radial wrist extension) supplied by the radial nerve proximal to the elbow.

Transfer of pronator teres to extensor carpi radialis brevis,and Transfer of deltoid to triceps are indicated in radial nerve palsy .

Transfer of pectoralis major to biceps and transfer of common flexors tendon to the humerus are both indicted in musculocutaneous nerve palsy. 

Ref:Ropars M, Dréano T, Siret P, Belot N, Langlais F. Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis. J Hand Surg Br. 2006 Oct; 31(5):502-6.

Author :Firas Arnaout

 

12. The anterior interosseous nerve innervate all of the following except:

A) The pronator quadratus
B) The abductor pollicis longus
C) The flexor pollicis longus
D) The radial half of the flexor digitorum profundus                                                                                                                                                   
E) The wrist capsule

Best answer: B

 

The abductor pollicis longus is innervated by the posterior interosseous nerve.

 

11. 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

 

 

10. In Wassel classification of thumb polydactyly.

Polydactyly of Hand - Hand - Orthobullets

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

 

 

9. Regarding polydactyly, all of the followings are wrong except:

A) The least common congenital abnormalities of the hand.
B) Ulnar (postaxial) polydactyly affects whites more than blacks.
C) Ulnar polydactyly is associated with a generalized syndrome.
D) The Bilhaut-Celoquet procedure entails excision of the least developed digit with reconstruction of the ipsilateral collateral ligament.
E) Polydactyly is more common in blacks than in whites.

Best answer: E

 

Author: Ahmed Eltanboly

 

 

8. What is the most common organism responsible for hand infection in human bite?

A)Eikenella corrodens
B) Bacteroides fragilis
C) Fungus.
D) Staphylococcus aureus
E) Pasteurella multocida

Best answer: D

 

Staphylococcus aureus is the most common pathogen in hand infections. 

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

Author: Ahmed Eltanboly

 

 

7.  Regarding the biomechanics of flexor tendons, all of the following statements are correct except:

A) As a tendon passes farther from a joint’s axis of rotation, it will create more motion at that joint per unit of muscle contraction.
B) Passive metacarpophalangeal motion produces no differential excursion between the FDP & FDS tendons.
C) Pulley system controls the flexor tendon moment arms.
D) As a tendon passes farther from a joint’s axis of rotation, the tendon has a greater moment arm across that joint.
E) They are viscoelastic structures.

Best answer: A

 

Author: Ahmed Eltanboly

 

 

6. The most common malignant tumor of the hand is:

A) Chondrosarcoma
B) Epithelioid sarcoma
C) Squamous cell carcinoma
D) Basal cell carcinoma
E) Osteosarcoma

Best answer: C

 

Regional LN should be examined, as it tends to spread through it.

Author: Ahmed Eltanboly

 

 

5. The most common soft tissue sarcoma of the hand is:

A) Epithelioid sarcoma
B) Malignant fibrous histiocytoma
C) Soft tissue osteosarcoma
D) Synovial sarcoma
E) Alveolar rhabdomyosarcoma

Best answer: A

 

Better to be treated by wide resection or amputation.

Author: Ahmed Eltanboly

 

 

4. Regarding wrist arthroscopy, The Lister tubercle lies between two dorsal wrist compartments .

What are they and their contents?

A) 2 (ECRL), 3 (extensor digitorum communis)
B) 1 (APL), 2 (ECRB)
C) 1 (EPB), 2 (ECRL)
D) 3 (EPL), 4 (extensor indicis proprius)
E) 2 (ECRB), 3 (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

 

 

3.  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

Explanation: The most common site is proximal phalanx. The most common soft tissue tumour is Ganglion.

Author: Ahmed Eltanboly

 

 

2. In this figure, flexor bullae of a finger. What two structures are the most important for maintaining the integrity of finger flexion?

Pulley Injuries Explained – Part 1 – The Climbing Doctor

A)  A1 and A2
B) A1 and A3
C) A1 and A4
D) A2 and A4
E) A2 and A5

Best answer: D

 

If A2 or A4 pulleys were cut bowstringing will happen

Author: Ahmed Eltanboly

 


1. 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 fi nger 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

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