In polydactyly, the following is true except:

Reconstruction of the ulnar collateral ligament is necessary.

On the right is associated with Poland’s syndrome.

In carpal tunnel syndrome which is false?

Carpal tunnel decompression was first performed in 1896.

Toe-to-hand transfer in patients with bilateral hands affected with constriction ring syndrome:

Helps painful digit tips by adding padding and needed length.

How does pollicisation in older patients with traumatic thumb loss differ from that in children with congenital absence?

Older patients with trauma need flexor tendon shortening.

In Dupuytren’s disease:

Needle fasciotomy is as effective as fasciectomy for MCP contracture.

In rheumatoid arthritis:

Thumb surgery is considered a low-risk, high-benefit procedure.

The metacarpal head becomes the new trapezium.

In obstetrical brachial plexus palsy:

Differentials: shoulder injury, cord lesions, arthrogryposis.

The most appropriate angles for fusion of the digits are:

Index - 5° DIP joint, 40° PIP joint, 25° MCP joint.

Of the bones in the carpus:

Scapholunate dissociation causes scaphoid flexion.

DeQuervain’s stenosing tenosynovitis is most often clinically confused with:

Osteoarthritis of the CMC joint of the thumb.

Concerning carpal tunnel syndrome - all are true except:

The specificity of nerve conduction studies is less than 70%.

Hereditary neuropathy with liability to pressure palsies is associated with all, except:

Defect in gene for central nerve axonal transport.

Of the vascular organisation in the hand:

Digital arteries arise from the superficial palmar arch.

In the correction of a swan neck deformity by operative procedure, it is essential to:

Achieve slight flexion or a neutral position of the PIP joint.

2-week-old boy has complex complete thumb-index syndactyly. What is the best next step in management?

Taylor first described the free fibula osteocutaneous flap

In thumb duplication:

Always look for pollex abductus.

In obstetric brachial plexus palsy with C5–C6 avulsion, which nerve transfer restores elbow flexion without morbidity?

10% of ulnar nerve to musculocutaneous.

The initial event in the evolution of the development of a Boutonnière deformity is:

Loss of central slip insertion continuity at middle phalanx base.

Hypoplastic thumbs Type II of the Blauth classification can be treated successfully by:

Release web space, UCL repair, flap, FTSG, and opponensplasty.

Arthritis can be treated by all except:

Joint mobilisation under anaesthesia

In thumb hypoplasia, classified by Blauth, all these statements are true except:

Blauth 4 is treated by bone stabilisation and tendon transfer.

Presence of eyelid ptosis & pupillary miosis known (Horner syndr) is noted obstetric brachial plexus paralysis, suggests

Avulsion of the lower brachial plexus.

Radialisation uses radial tendon transfers to create ulnar balancing force.

In a typical cleft hand:

Is associated with autosomal dominant inheritance.

Regarding rehabilitation of tendon injuries:

The Belfast regime is a ‘CAM’ regime, i.e. controlled active motion.

Contraindications to early exploration in brachial plexus injury include:

Absence of a Tinel’s sign in the supraclavicular fossa.

In fixed PIP flexion contracture, which structure most contributes to the rigid flexed position?

The contracted proximal part of the volar plate.

The median artery can be persistent.

The apical ectodermal ridge secretes fibroblast derived growth factor 4.

In replantation of an avulsed thumb:

Vein graft from radial artery in anatomical snuffbox is often necessary

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Section 2: Hand Surgery

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Questions 83

Answers

1
In polydactyly, the following is true except:
Stelling Type A can be treated by ligation.
Ligation leaves a nubbin.
Can be hereditary.
Reconstruction of the ulnar collateral ligament is necessary.
2
Symbrachydactyly:
Can be treated by pollicisation.
Is rarely confused with constriction ring syndrome.
Often has transverse lying bones.
On the right is associated with Poland’s syndrome.
3
Which of the following are not differentials for nerve compression neuropathies?
Neuralgic amyotrophy.
Tomaculous neuropathy.
Charcot Marie Tooth.
Hereditary neuropathy with liability to pressure palsies.
4
In the proximal row of the carpus, radiological signs of a ruptured scapholunate ligament include all but:
An extended scaphoid.
A flexed scaphoid.
A wide gap between the scaphoid and lunate.
An extended lunate.
5
Thumb hypoplasias are frequently associated with:
First web space tightness.
Mandatory surgical reconstruction.
Weckesser’s classification.
Scaphoid anomalies.
6
In carpal tunnel syndrome which is false?
Motor branch may pass through TCL in 25%, making it vulnerable.
Carpal tunnel decompression was first performed in 1896.
It is commonly bilateral.
There is a 25% incidence in males.
7
The following is true of congenital upper limb anomalies except:
Swanson’s IFSSH classification links anomalies to embryological origin.
They are likely to be bilateral in 50%.
They occur in 1:150 births.
They are commonly sub-classified according to thumb status.
8
Toe-to-hand transfer in patients with bilateral hands affected with constriction ring syndrome:
Helps painful digit tips by adding padding and needed length.
Should not be done—no cortical map for missing part of hand.
Often fail due to poorly developed arterial supply.
Lack of motion makes them nonfunctional.
9
The middle finger extension test (active extension against resistance) is useful for all except:
Radial tunnel syndrome.
Multifocal motor neuropathy.
Posterior interosseous nerve palsy.
Intrinsic tightness.
10
Which limb allograft component triggers the strongest and weakest immune response after transplant?
Muscle and vessel.
Skin and muscle.
Muscle and bone.
Skin and subcutaneous tissue.
11
How does pollicisation in older patients with traumatic thumb loss differ from that in children with congenital absence?
Bone graft often needed to replace metacarpal in trauma.
Congenital cases always need full thickness skin graft.
Young patients may not need extensor tendon shortening.
Older patients with trauma need flexor tendon shortening.
12
In Dupuytren’s disease:
Splinting may prevent progression of the contracture.
Is more strongly associated with alcohol than smoking.
Needle fasciotomy is as effective as fasciectomy for MCP contracture.
Has a genetic basis linked to chromosome 17.
13
In rheumatoid arthritis:
Anti-TNF alpha prevents joint destruction and tendon rupture.
Response to DMARDs is one diagnostic feature of rheumatoid disease.
Thumb surgery is considered a low-risk, high-benefit procedure.
Rheumatoid nodules may respond to intra-lesional steroids.
14
In pollicisation:
The metacarpal head becomes the new trapezium.
The extensor tendon should not be split beyond the level of the MCP joint
The distal phalanx becomes the new proximal phalanx.
The first dorsal interosseous becomes a thumb adductor.
15
In obstetrical brachial plexus palsy:
Breech delivery is associated with a higher incidence.
Incidence has declined over 50 years due to better obstetric care.
Differentials: shoulder injury, cord lesions, arthrogryposis.
Shoulder dystocia is linked to more than 90% of these cases.
16
The most appropriate angles for fusion of the digits are:
Thumb - neutral IP joint, neutral MCP joint.
Index - 5° DIP joint, 40° PIP joint, 25° MCP joint.
Thumb - neutral IP joint, 45° MCP joint.
Index - 5° DIP joint, 40° PIP joint, 25° MCP joint.
17
Common locations for compression of the ulnar nerve include all except:
Medial intermuscular septum.
Osbourne’s canal.
Ligament of Struthers.
Between the two heads of flexor carpi ulnaris (FCU).
18
Of the bones in the carpus:
40% of scaphoid blood supply enters at the waist.
Scapholunate dissociation causes scaphoid flexion.
Carpal forces cause the scaphoid to extend.
Scaphoid is the largest carpal bone.
19
DeQuervain’s stenosing tenosynovitis is most often clinically confused with:
Dupuytren’s contracture.
An interosseous ganglion of the scaphoid.
Osteoarthritis of the CMC joint of the thumb.
Osteoarthritis of the CMC joint of the thumb.
20
Concerning carpal tunnel syndrome - all are true except:
The specificity of nerve conduction studies is less than 70%.
The specificity of nerve conduction studies is less than 70%.
The sensitivity of nerve conduction studies is over 80%.
The ulnar border is the hook of the hamate and the pisiform bone.
21
Hereditary neuropathy with liability to pressure palsies is associated with all, except:
Defect in gene for central nerve axonal transport.
Spontaneous recovery.
Interstitial deletion in chromosome 17p11.2-12.
Familial predisposition.
22
Correction of radial hand deformity is not indicated in patients that present:
As well-adapted adults.
With thrombocytopenia with absent radius (TAR) syndrome.
With Holt-Oram syndrome.
With Fanconi’s anaemia.
23
In the finger, what is the usual relationship of the digital nerve to the digital artery?
Proximal
Distal
Volar
Dorsal
24
Of the vascular organisation in the hand:
Superficial arch is usually complete, fed by ulnar & radial.
Digital arteries arise from the deep palmar arch.
Deep arch lies just beneath the palmar aponeurosis.
Digital arteries arise from the superficial palmar arch.
25
In the correction of a swan neck deformity by operative procedure, it is essential to:
Repair the extensor mechanism on the dorsum of the PIP joint.
Divide the extensor mechanism distal to the PIP joint.
Release the volar plate.
Achieve slight flexion or a neutral position of the PIP joint.
26
The following are infectious causes of mono-neuropathies except:
Lyme disease.
Herpes zoster.
Leprosy
Bilharzia (schistosomiasis).
27
2-week-old boy has complex complete thumb-index syndactyly. What is the best next step in management?
Taylor first described the free fibula osteocutaneous flap
Supramicrosurgery = <0.5mm anastomosis
Jacobson & Suarez performed 0.9mm microvascular anastomosis
First successful free tissue transfer in humans was in America
28
The following is the commonest cause of distal interphalangeal joint contracture in Dupuytren’s disease:
Spiral cord.
Lateral digital sheet.
Retrovascular cord of Thomine.
Pre-tendinous cord.
29
Fanconi pancytopenia includes:
All of the above.
Brown pigment of the skin.
Short stature.
Mental retardation.
30
In thumb duplication:
Always needs treatment.
Always look for pollex abductus.
Always excise the triphalangeal thumb.
Always reconstruct the ulnar collateral ligament of the MCP joint.
31
In obstetric brachial plexus palsy with C5–C6 avulsion, which nerve transfer restores elbow flexion without morbidity?
10% of ulnar nerve to musculocutaneous.
10% of radial nerve to musculocutaneous.
10% axillary nerve to musculocutaneous.
10% lateral cord to musculocutaneous.
32
The initial event in the evolution of the development of a Boutonnière deformity is:
Laxity or rupture of PIP joint volar plate.
Hyperextension of the DIP joint.
Lateral and palmar migration of extensor lateral bands.
Loss of central slip insertion continuity at middle phalanx base.
33
Hypoplastic thumbs Type II of the Blauth classification can be treated successfully by:
Release web space, RCL repair, flap, FTSG, and opponensplasty.
Thumb amputation, small finger pollicisation, STSG used.
Thumb amputation, index pollicisation, FTSG used.
Release web space, UCL repair, flap, FTSG, and opponensplasty.
34
Arthritis can be treated by all except:
Joint excision.
Joint osteotomy.
Joint mobilisation under anaesthesia
Joint fusion.
35
Which is not a test for thoracic outlet syndrome?
Adson’s.
Sunderland’s.
Morley’s.
Roo’s.
36
In thumb hypoplasia, classified by Blauth, all these statements are true except:
Blauth 3 treatment depends on carpometacarpal joint development.
Blauth 4 is treated by bone stabilisation and tendon transfer.
Blauth 1 needs no treatment except possibly an opponensplasty.
Surgery for Blauth 2 may need metacarpophalangeal joint support.
37
Giant cell tumours are associated with all except:
Exclusively synovial origins.
Pigmented villonodular synovioma.
Localised or diffuse presentations.
Pigmentation
38
Presence of eyelid ptosis & pupillary miosis known (Horner syndr) is noted obstetric brachial plexus paralysis, suggests
Avulsion of the lower brachial plexus.
Phrenic nerve palsy.
Upper trunk rupture.
All of the above.
39
In radial dysplasia:
Radialisation involves resection of a portion of the carpus.
Radialisation uses radial tendon transfers to create ulnar balancing force.
Redistribution of the skin can be done by Z-plasties.
Release of the ulnar anlage may prevent deterioration.
40
In a typical cleft hand:
Is associated with autosomal dominant inheritance.
Usually has a good thumb.
Usually involves the left hand.
There are finger nubbins.
41
Regarding rehabilitation of tendon injuries:
The Belfast regime is a ‘CAM’ regime, i.e. controlled active motion.
Klienert traction is reserved for thumb injuries.
A volar slab is best for flexor tendon injuries.
A dorsal slab in extension is best for flexor tendon injuries.
42
The following are primary causes of mono-neuropathy except:
Ischaemia
Entrapment
Osteoarthritis
Hypothyroidism
43
Bilateral radial dysplasia with present thumbs of relative normal size is seen in association with:
Du Pan syndrome.
TAR syndrome.
Holt-Oram syndrome.
Fanconi’s anaemia.
44
Contraindications to early exploration in brachial plexus injury include:
Presence of Horner’s syndrome.
Absence of a Tinel’s sign in the supraclavicular fossa.
Presence of a separate skeletal injury.
Presence of root avulsion on MRI.
45
In fixed PIP flexion contracture, which structure most contributes to the rigid flexed position?
The collateral ligament.
The rigid distal part of the volar plate.
The contracted proximal part of the volar plate.
The accessory collateral ligament.
46
In radial dysplasia:
The median artery can be persistent.
The ECRB/L are available for transfer.
The extensor carpi ulnaris (ECU) is shortened.
The radial nerve can be large.
47
Signs or tests associated with glomus tumours include the following except:
Soucquet-Hoyer.
Hildreth
Love
Cherry red mass.
48
In hand embryology:
Wnt-7a is expressed by the apical ectodermal ridge.
The apical ectodermal ridge governs thumb development.
The apical ectodermal ridge influences the sonic hedgehog gene.
The apical ectodermal ridge secretes fibroblast derived growth factor 4.
49
A 43-year-old woman has cold-sensitive nail base pain and nail deformity. What is the most likely diagnosis?
Glomus tumour.
Epidermal inclusion cyst.
Giant cell tumour.
Ganglion cyst.
50
In replantation of an avulsed thumb:
Flexor pollicis longus (FPL) function should be restored.
Vein graft from radial artery in anatomical snuffbox is often necessary
Avoid shortening the bone.
The thumb should be supinated rather than pronated.
51
The treatment of choice for a Blauth grade 3b hypoplastic thumb would be:
Reconstruction of CMC and tendon transfers.
Toe transfer.
Huber-Nicolayasen transfer.
Pollicisation
52
In nerve transfer for brachial plexus injury:
The intercostal nerves are often transferred to the median nerve.
Phrenic nerve is avoided due to respiratory risk.
The axillary nerve can be innervated by the nerves to triceps.
The contralateral plexus is never used.
53
Which of the following is a diagnostic criterion for rheumatoid arthritis per the American Academy of Rheumatology?
Typical ocular changes (scleritis, episcleritis).
Arthritis of the hand for >6 weeks.
Positive pANCA or cANCA antibodies.
Morning stiffness for 2 weeks.
54
Regarding tumours in the hand:
Hildreth’s test helps distinguish glomus tumours from others.
Giant cell tumours of tendon sheath recur commonly and are usually benign.
Melorheostosis is a lymphoma.
Melanoma does not occur on the hand.
55
The least common sarcoma in the hand:
Fibrosarcoma
Chondrosarcoma
Liposarcoma.
Synovial sarcoma.
56
The most frequent lesion found in obstetrical brachial plexus injuries involves:
Only C8 and T1.
Upper plexus C5, C6 and C7.
Only C6 and C7.
All cervical roots.
57
The commonest inheritance pattern for Dupuytren’s disease is:
Autosomal recessive.
Autosomal dominant.
Sporadic
Sex-linked dominant.
58
Amniotic Band syndrome is associated with all except:
Peripheral neuropathy.
Patterson’s classification.
Constriction rings.
Ectodermal necrosis aetiological theory.
59
Of the major nerves in the forearm:
The posterior interosseous nerve remains motor, not cutaneous.
The median nerve enters the forearm between heads of pronator teres.
The posterior interosseous nerve enters between brachioradialis and ECRL.
The anterior interosseous nerve runs between FPL and FDP on the membrane.
60
In Dupuytren’s disease:
There is an increased ratio of Type II to Type III collagen.
There is an increased ratio of Type I to Type III collagen.
There is an increased ratio of Type II to Type I collagen.
There is an increased ratio of Type III to Type I collagen.
61
In radial dysplasia - utilizing the Ilizarov system, limb lengthening is associated with:
Night pain and delayed union of the callus.
All of the above.
Elbow pain and stiffness of all digits.
Pin tract infection
62
The most common form of carpal instability is:
Midcarpal instability.
Lunotriquetral instability.
Scapholunate instability.
Transtrapezial instability.
63
Which is correct in relation to replantation of a digit?
Is not successful when cold ischaemia exceeds 24 hours.
Not usually advised for proximal Urbaniak III ring avulsion injuries.
Is not advisable at the DIP joint level.
Should only be considered with guillotine injuries.
64
A contraindication to centralisation or radialisation of radial dysplasia is:
Stiff elbow
Single extremity involvement.
Stiff fingers.
Stiff shoulder.
65
In De Quervain’s tenosynovitis (tenovaginitis) all are true except:
Radial neuritis may give false positive results.
Steroid plus splinting works better than either treatment alone.
Finkelstein’s test can be used for assessment.
Multiple APL and EPB tendon slips may be present in some patients.
66
Rupture of the C5 and C6 roots will paralyze which group of muscles?
All of the above
Subclavius and infraspinatus.
Biceps brachii and brachialis.
Deltoid and teres minor.
67
The carpal tunnel:
Contains the flexor carpi ulnaris (FCU).
Contains the flexor carpi radialis (FCR).
Is formed by proximal and distal carpal rows and the flexor retinaculum.
Contains the ulnar artery.
68
Of the extensor tendon compartments on the dorsum of the wrist:
1st compartment contains APL and EPB, not ECRL/ECRB.
EDM and ECU are in separate compartments, not the 5th together.
EIP shares its compartment with the extensor digitorum communis.
EPL changes direction around Lister’s tubercle, not ulnar styloid.
69
The following is true of epithelioid sarcoma except:
May mimic melanoma.
May mimic infection.
May present as Dupuytren’s disease.
Sentinel lymph node biopsy confers staging benefit.
70
In the surgical treatment of trigger finger, what structure is incised?
The A2 pulley.
The A1 pulley alone.
Both the A1 pulley and usually (not intentionally) the C2 pulley
The A4 pulley.
71
Which nerve is not commonly used as a source of donor action in nerve transfer for treatment of brachial plexus injury?
Ulnar nerve
Median nerve.
Accessory nerve.
Hypoglossal nerve.
72
The ‘safe’ position of splintage of the hand includes:
Proximal interphalangeal (PIP) joints flexed to approximately 90°.
Metacarpophalangeal (MCP) joints straight.
PIP joints flexed to approximately 60°.
MCP joints flexed to approximately 60°.
73
Infection can be mimicked by all except:
Epithelioid sarcoma.
Pigmented villonodular synovioma.
Osteoid osteoma.
Calcific tendonitis.
74
In arthrogryphosis:
The arms may benefit from internal rotation osteotomies
Intelligence is often sub-normal.
The arms should be positioned one up and one down.
Wedge osteotomy of the carpus can improve the hand position.
75
The palmar aponeurosis:
Covers palm incl. central, thenar & hypothenar regions.
Mainly inserts into proximal phalanx bases & flexor sheaths.
Inserts into flexor digitorum profundus tendons.
Lies just deep to the palm’s neurovascular structures.
76
Poor results in the treatment of radial club hand are due to:
Inadequate pre-operative stretching.
Improper surgical technique.
No compliance with postoperative bracing.
All of the above.
77
In radial dysplasia:
The ulna is usually affected.
Recurrence is rare if radialisation is done correctly.
The ulna physis can tolerate degloving and devascularisation.
The ulna is fused to the carpus in centralisation.
78
One of the following is not an accepted theory of the aetiology of ganglia:
Neurovascular channels.
Embryonic rest.
Traumatic perforation.
Myxoid degeneration.
79
Absolute indications for surgery in Dupuytren’s disease include:
None of the above
Painless Garrod’s pads.
Any contracture of the PIP joint.
Any contracture of the MCP joint.
80
The following is true of the ulnar nerve in Guyon’s canal except:
Compression in the third part results in sensory symptoms only.
Can cause Ramsay Hunt syndrome.
Compression in part 1 of part 2 causes motor symptoms only.
Compression in the first part results in sensory and motor palsy.
81
Of the lumbrical muscle, all statements are true except:
It extends the PIP joint.
It flexes the MCP joint.
It has no attachment to bone.
It is an abductor of the digit.
82
A Stener lesion occurs when:
Ulnar collateral ligament is obstructed by abductor pollicis brevis (APB)
Ulnar collateral ligament is obstructed by extensor pollicis longus (EPL).
Ulnar collateral ligament is obstructed by adductor pollicis aponeurosis.
Ulnar collateral ligament is obstructed by extensor pollicis brevis (EPB)
83
Regarding syndactyly:
Causes no functional problems.
Classification includes shovel hand.
Is associated with maternal diabetes.
Web creep is less likely to occur if separation is performed after age 2.

Section 2: Hand Surgery Flashcards | StudBud