Free Test MCQs/SBAs Hand Surgery

Best Answer: B .
An extensile incision should be chosen to approach the pediatric trigger finger as the pathology could lie at many sites. The ulnar FDS slip should be resected. If triggering persists, release of the A3 pulley may be performed, or release of the remaining FDS slip. In the pediatric population, trigger thumbs are 10 times more common than trigger fingers. Trigger thumb presents with flexion contracture, and is caused by constriction at the A1 pulley. Trigger fingers present with a palpable Notta's nodule proximal to the A1 pulley, flexion contracture, and triggering. Trigger fingers are caused by an abnormal relationship of the FDP and FDS tendons, a more proximal decussation of the FDS, nodules in either the FDS or FDP, a thickened A-2 pulley, or a tight A-3 pulley. Figure shows flexion contracture of the long finger of the left hand secondary to pediatric trigger finger.

Best answer: B
A mucous cyst is thought to be a ganglion arising from the DIP joint in patients with osteoarthritis. They are frequently associated with nail deformities. Treatment involves removal of the cyst with debridement of DIP joint osteophytes.

Best Answer: B
The lesion lies in zone II of the ulnar tunnel. In that zone the deep motor branch of the ulnar nerve is susceptible to compression. Distal to the hook of the hamate, the motor branch of the ulnar nerve dives deep to innervate the interossei as it begins to move from an ulnar to radial direction. Because of its course, it has little or no give in response to a mass effect from the floor of Guyon’s canal. Ganglions are the most common cause of ulnar nerve entrapment in the wrist. Lesions in zone I can affect both sensory and motor aspects of the ulnar nerve as well as the motor innervation of the hypothenar muscles. Lesions at the elbow or mid-to-proximal forearm are associated with dorsal hand numbness and tingling .

Best Answer: B
The clinical presentation is consistent with a SLAC wrist.The radioscaphoid joint is the first to be affected in this process.The radiographs of the right wrist demonstrate a scapholunate dissociation.

Best answer: E .
Excision of a fractured hook of hamate is the most appropriate management. The patient has a hook of hamate fracture with ulnar nerve compression and irritation of the flexor tendons by the fracture surfaces; this puts the tendons at risk for rupture. Cast treatment will most likely not gain union of the fracture and will not address the nerve or tendon problems. Decompression of Guyon's canal alone will not address the tendon issue.

Correct Answer: E .
Scaphoidectomy and 4-bone fusion is the most appropriate management based on the choices available. The patient has arthritic changes of SNAC (scaphoid nonunion advanced collapse) wrist, stage III. Stage I is at the radial styloid, stage II is at the radioscaphoid joint, and stage III is at the midcarpal joint. Arthroscopic debridement is not appropriate in patients with arthrosis. Attempting to achieve scaphoid union is only appropriate if there is no arthrosis or the changes are classified as stage I where radial styloidectomy can be performed.

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.