Hand Surgery Practice Questions

Q: Dupuytren's contracture is associated with which of the following conditions?

Peyronie's disease. **Explanation:** **Dupuytren’s contracture** is a benign fibroproliferative disorder of the palmar fascia. It results in the formation of nodules and cords, leading to progressive, permanent flexion contractures of the fingers (most commonly the ring and little fingers). **1. Why Peyronie’s Disease is Correct:** Dupuytren’s contracture is part of a systemic fibromatosis diathesis. It is strongly associated with other ectopic fibromatoses, most notably **Peyronie’s disease** (fibromatosis of the tunica albuginea of the penis). Both conditions involve abnormal collagen deposition (Type III collagen replacing Type I) and myofibroblast proliferation. Other associated conditions include **Ledderhose disease** (plantar fibromatosis) and **Garrod’s pads** (knuckle pads over the PIP joints). **2. Why the Other Options are Incorrect:** * **Hypospadias & Epispadias:** These are congenital anatomical malformations of the male urethra (abnormal location of the urethral meatus). They are developmental defects, not fibrotic disorders, and have no association with palmar fascia pathology. * **Exotropia:** This is a form of strabismus (eye misalignment) where one or both eyes turn outward. It is a neuromuscular or refractive issue of the extraocular muscles, unrelated to systemic fibromatosis. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Strong genetic predisposition (Autosomal Dominant with variable penetrance), male gender (older age), diabetes mellitus, chronic alcoholism, smoking, and epilepsy (associated with phenytoin use). * **Pathology:** Proliferation of **myofibroblasts** is the hallmark. * **Clinical Sign:** **Hueston’s Tabletop Test** is positive when the patient cannot flatten their palm against a flat surface. * **Management:** Surgical options include fasciectomy (gold standard) or needle aponeurotomy. Non-surgical treatment includes collagenase *Clostridium histolyticum* injections.

Q: Fracture shown in this radiograph is:

Bennett's fracture. ***Bennett's fracture*** - This is a **fracture-dislocation** of the **base of the first metacarpal** involving the **carpometacarpal (CMC) joint** of the thumb. - The **abductor pollicis longus (APL)** pulls the metacarpal **proximally and radially**, causing characteristic displacement with a small **ulnar fragment** remaining attached to the trapezium. *Colles' fracture* - This involves the **distal radius** with **dorsal angulation** and typically occurs after a fall on an outstretched hand. - It does not involve the **thumb metacarpal** or **CMC joint**, making it anatomically distinct from the fracture shown. *Smith's fracture* - This is a **reverse Colles' fracture** of the **distal radius** with **volar angulation** of the distal fragment. - Like Colles', it affects the **forearm bones**, not the **thumb metacarpal** as seen in this radiograph. *Rolando's fracture* - This is a **comminuted fracture** of the **base of the first metacarpal** with **multiple fragments** involving the CMC joint. - Unlike Bennett's fracture, it shows **Y-shaped** or **T-shaped** fracture lines with **three or more fragments**, not the simple two-part fracture pattern shown.

Q: Which of the following scaphoid fractures is most prone to develop avascular necrosis?

Fracture of the waist of the scaphoid. **Explanation:** The risk of **Avascular Necrosis (AVN)** in scaphoid fractures is primarily determined by its unique **retrograde blood supply**. 1. **Why the Waist is the Correct Answer:** The scaphoid receives approximately 70-80% of its blood supply from the **dorsal carpal branch of the radial artery**. These vessels enter the bone at the dorsal ridge (near the waist) and flow in a **retrograde (distal-to-proximal) direction**. When a fracture occurs at the **waist** or the **proximal pole**, it interrupts this blood flow to the proximal fragment. Since the proximal fragment is left without a direct blood supply, it is highly susceptible to ischemia and subsequent AVN. 2. **Why Other Options are Incorrect:** * **Fracture of the Tubercle:** The tubercle is located at the distal end and has an independent, rich blood supply. It heals well with conservative management and rarely develops AVN. * **Fracture of the Distal Pole:** Similar to the tubercle, the distal pole is closer to the entry points of the primary vessels. The blood supply remains intact or minimally disturbed, making AVN unlikely. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** The **waist** is the most common site of scaphoid fractures (approx. 70%). * **Most Common Complication:** **Non-union** is the most common complication, while AVN is the most serious. * **Radiology:** Fractures may not be visible on initial X-rays. If clinical suspicion exists (tenderness in the **Anatomical Snuffbox**), repeat X-rays in 10-14 days or perform an MRI (most sensitive). * **Preiser’s Disease:** Idiopathic avascular necrosis of the scaphoid (without a fracture).

Q: Which of the following statements is FALSE regarding radial club hand?

Hand is deviated to the ulnar side.. ***Hand is deviated to the ulnar side*** - This statement is **FALSE** - in radial club hand, the hand deviates toward the **radial side** (thumb side), not the ulnar side. - The deviation occurs due to **absent or hypoplastic radius**, causing the hand to bend toward the deficient radial side. *Caused by deficiency of the radius and thumb* - This statement is **TRUE** - radial club hand results from **congenital absence or hypoplasia** of the radius bone. - Often associated with **thumb aplasia or hypoplasia**, as the thumb development is closely linked to radial formation. *Associated conditions include Holt-Oram syndrome and VACTERL association* - This statement is **TRUE** - radial club hand is frequently seen with **Holt-Oram syndrome** (cardiac and upper limb defects). - Also associated with **VACTERL association**, **TAR syndrome**, and **Fanconi anemia**. *Preferred management includes pollicization and centralization of the ulna* - This statement is **TRUE** - **centralization** involves positioning the carpus over the distal ulna for better alignment. - **Pollicization** converts the index finger into a functional thumb when the thumb is absent or severely hypoplastic.

Q: Which of the following statements about nerve entrapment syndromes is FALSE?

Cheiralgia paresthetica involves the femoral nerve.. **Explanation:** The correct answer is **C** because **Cheiralgia paresthetica** involves the **superficial branch of the radial nerve**, not the femoral nerve. It is a sensory neuropathy characterized by pain or numbness over the dorsal-radial aspect of the wrist and hand, often caused by tight watchbands, handcuffs, or repetitive trauma. In contrast, entrapment of the lateral femoral cutaneous nerve is known as *Meralgia paresthetica*. **Analysis of other options:** * **Option A (Guyon’s Canal Syndrome):** This is a true statement. It involves compression of the **ulnar nerve** as it passes through the fibro-osseous tunnel (Guyon’s canal) at the wrist, often seen in long-distance cyclists. * **Option B (Cubital Tunnel Syndrome):** This is a true statement. It is the second most common compression neuropathy, involving the **ulnar nerve** at the elbow (medial epicondyle). * **Option D (Tarsal Tunnel Syndrome):** This is a true statement. It involves compression of the **posterior tibial nerve** (or its branches) as it passes behind the medial malleolus. **High-Yield Clinical Pearls for NEET-PG:** * **Wartenberg’s Syndrome:** Another name for Cheiralgia paresthetica (radial nerve). * **Meralgia Paresthetica:** Involves the **Lateral Femoral Cutaneous Nerve** (L2-L3); common in obesity or those wearing tight belts. * **Double Crush Syndrome:** When a nerve is compressed at two different levels (e.g., cervical radiculopathy and Carpal Tunnel). * **Froment’s Sign:** Positive in Ulnar nerve palsy (Cubital/Guyon’s canal) due to adductor pollicis weakness.

Q: Which of the following is NOT a cause of carpal tunnel syndrome?

Tuberculosis. **Explanation:** Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, caused by compression of the **median nerve** as it passes through the carpal tunnel beneath the flexor retinaculum. **Why Tuberculosis is the Correct Answer:** While chronic infections can theoretically cause swelling, **Tuberculosis (Option B)** is not a standard or recognized systemic cause of Carpal Tunnel Syndrome. In the context of NEET-PG, CTS is associated with systemic conditions that cause fluid retention, metabolic changes, or space-occupying lesions within the tunnel. TB typically presents as a "cold abscess" or dactylitis in the hand, but it is not a classic etiology for CTS. **Analysis of Incorrect Options:** * **Hypothyroidism (Option A):** Causes the accumulation of glycosaminoglycans (myxedematous tissue) in the carpal tunnel, increasing pressure on the nerve. * **Pregnancy (Option C):** A very common cause due to generalized **fluid retention** and hormonal changes, typically resolving postpartum. * **Acromegaly (Option D):** Excess growth hormone leads to the overgrowth of soft tissues and bone (synovial edema), narrowing the carpal tunnel space. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Idiopathic. * **Clinical Tests:** **Phalen’s test** (most sensitive) and **Tinel’s sign** (percussion over the nerve). * **Gold Standard Diagnosis:** Nerve Conduction Velocity (NCV) studies showing delayed conduction. * **Muscle Wasting:** Occurs in the **Thenar eminence** (L-O-A-F muscles: Lateral two Lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis). * **Sensory Sparing:** The palm's skin is often spared because the **palmar cutaneous branch** of the median nerve passes *superficial* to the flexor retinaculum.

Q: Which of the following diagnostic studies is NOT useful in the evaluation of upper-extremity pain?

Adson's test. **Explanation:** The correct answer is **Adson’s test**. While it is a classic physical examination maneuver used to assess for Thoracic Outlet Syndrome (TOS), it is **not a diagnostic study** (imaging or electrodiagnostic test) [1]. Furthermore, its clinical utility is highly debated because it has a high false-positive rate (up to 20% in healthy individuals), making it unreliable for a definitive diagnosis of upper-extremity pain. **Analysis of Options:** * **Cervical spine x-ray:** Essential to rule out cervical spondylosis, disc herniation, or a **cervical rib**, all of which are common causes of referred pain to the upper limb. * **Chest x-ray:** Crucial for identifying a **Pancoast tumor** (superior sulcus tumor) or apical lung pathologies that can compress the brachial plexus, causing radiating arm pain. * **Neural conduction studies (NCS):** The gold standard for diagnosing peripheral nerve entrapments, such as **Carpal Tunnel Syndrome** (median nerve) or Ulnar nerve compression at the elbow. **Clinical Pearls for NEET-PG:** * **Adson’s Test:** Performed by extending the patient's neck and rotating the head toward the affected side while taking a deep breath. A positive result is the **diminution or loss of the radial pulse**. * **Thoracic Outlet Syndrome (TOS):** Most commonly caused by compression in the scalene triangle [1]. * **Pancoast Tumor:** Often presents with **Horner’s Syndrome** (miosis, ptosis, anhidrosis) and ulnar distribution pain due to involvement of the C8-T1 nerve roots. * **Differential Diagnosis:** Always differentiate between radiculopathy (nerve root) and neuropathy (peripheral nerve) using NCS and EMG.

Question 1

Dupuytren's contracture is associated with which of the following conditions?

Accepted Answer

Peyronie's disease

Answer

Hypospadias

Answer

Epispadias

Answer

Exotropia

Question 2

Fracture shown in this radiograph is:

Accepted Answer

Bennett's fracture

Answer

Colles' fracture

Answer

Smith's fracture

Answer

Rolando's fracture

Question 3

Which of the following scaphoid fractures is most prone to develop avascular necrosis?

Accepted Answer

Fracture of the waist of the scaphoid

Answer

Fracture of the tubercle

Answer

Fracture of the distal pole

Answer

All of the above

Question 4

Which of the following statements is FALSE regarding radial club hand?

Accepted Answer

Hand is deviated to the ulnar side.

Answer

Caused by deficiency of the radius and thumb.

Answer

Associated conditions include Holt-Oram syndrome and VACTERL association.

Answer

Preferred management includes pollicization and centralization of the ulna.

Question 5

A 19-year-old boy has a history of falling on an outstretched hand while playing. He developed slight radial side pain and tenderness. On examination, pressure along the axis of the thumb is painful, and X-rays are normal. What is the most likely diagnosis?

Accepted Answer

Scaphoid fracture

Answer

Fracture of the lower end of the radius

Answer

Wrist sprain

Answer

Perilunate dislocation

Question 6

Dupuytren's contracture commonly affects which finger?

Accepted Answer

Ring finger

Answer

Little finger

Answer

Middle finger

Answer

Index finger

Question 7

Which of the following statements about nerve entrapment syndromes is FALSE?

Accepted Answer

Cheiralgia paresthetica involves the femoral nerve.

Answer

Guyon's canal syndrome involves the ulnar nerve.

Answer

Cubital tunnel syndrome involves the ulnar nerve.

Answer

Tarsal tunnel syndrome involves the posterior tibial nerve.

Question 8

Which of the following tests is known for assessing De Quervain's tenosynovitis?

Accepted Answer

Finkelstein Test

Answer

Tinel's sign

Answer

Phalen's test

Answer

Cozen's test

Question 9

Which of the following is NOT a cause of carpal tunnel syndrome?

Accepted Answer

Tuberculosis

Answer

Hypothyroidism

Answer

Pregnancy

Answer

Acromegaly

Question 10

Which of the following diagnostic studies is NOT useful in the evaluation of upper-extremity pain?

Accepted Answer

Adson's test

Answer

Cervical spine x-ray

Answer

Chest x-ray

Answer

Neural conduction studies of the median nerve

Hand Surgery — MCQs

Hand Surgery — MCQs

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