Do not seek to follow in the footsteps of the wise. Seek what they sought. Matsuo Basho
Idea Transcript
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In the two-incision approach for a biceps tendon repair following identification of the biceps tendon, the preferred interval for the second incision is: A. Trans-brachioradialis B. BR and ECRL C. ECRL and ECRB D. ECRB and EDC E. EDC and ECU Snapping triceps syndrome is commonly associated with which of the following clinical conditions? A. Triceps tendon rupture B. Posterolateral rotatory instability of the elbow C. Valgus instability of the elbow D. Posterior interosseous neuropathy E. Ulnar neuropathy A patient has dorsoradial wrist pain with positive Eichhoff test reproducing his pain. What is the next best step in management? A. Percutaneous tenotomy B. Wrist denervation C. EPL rerouting D. First dorsal compartment steroid injection E. Intersection area steroid injection Which of the following is most commonly associated with failure of conservative treatment of de Quervain’s tenosynovitis? A. Multiple slips of the APL B. Single compartment without septation C. Triggering D. Pregnancy E. Male gender In relationship to the APL within the first dorsal extensor compartment, a separate subcompartment containing the EPB is located: A. Volar-radial B. Dorsal-radial C. Volar-ulnar D. Dorsal-ulnar E. Directly radial A 25 year old competitive rower presents with radial side of the wrist pain. Finklestein’s test is negative but there is crepitus and bogginess near the musculotendinous junction of the APL and EPB where they cross over the radial-sided wrist extensors. What is the diagnosis? A. de Quervain’s syndrome B. Fibromyalgia
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A 25 year old competitive rower presents with radial side of the wrist pain. Finklestein’s test is negative but there is crepitus and bogginess near the musculotendinous junction of the APL and EPB where they cross over the radial-sided wrist extensors. What is the diagnosis? A. de Quervain’s syndrome B. Fibromyalgia C. Musculotendinous syndrome D. Intersection syndrome E. Radial styloid tenosynovitis A 45-year-old logger presents with crepitus and dorsal/radial wrist pain. Discomfort is reproduced with palpation over the outcroppers and on resisted wrist extension. Tendinopathy in which extensor tendon compartment would best explain the patient's symptoms? A. 1st B. 2nd C. 3rd D. 4th E. 6th A 68-year-old female presents with a one-week history of difficulty using her thumb. She has no recent history of injury and denies pain. She did have a non-displaced distal radius fracture eight months ago, treated uneventfully with a short arm cast. Physical exam reveals she is unable to raise her thumb off the table. Which of the following is the most likely diagnosis? A. Extensor pollicis brevis rupture B. Abductor pollicis longus rupture C. Radial nerve palsy D. Extensor pollicis longus rupture E. de Quervain’s stenosing tenosynovitis At the six week postoperative appointment after open reduction internal fixation of an intraarticular distal radius fracture, a loss of thumb extension was noted. The next phase of management would include: A. Revision internal fixation B. Extension thumb splint in therapy C. Extensor indicis proprius tendon transfer D. Metacarpal phalangeal joint arthrodesis E. Extensor tendon repair Which flexor tendon is at greatest risk of attritional rupture following volar plate fixation of distal radius fractures? A. Ring FDP B. Long FDS
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At the six week postoperative appointment after open reduction internal fixation of an intraarticular distal radius fracture, a loss of thumb extension was noted. The next phase of management would include: A. Revision internal fixation B. Extension thumb splint in therapy C. Extensor indicis proprius tendon transfer D. Metacarpal phalangeal joint arthrodesis E. Extensor tendon repair Which flexor tendon is at greatest risk of attritional rupture following volar plate fixation of distal radius fractures? A. Ring FDP B. Long FDS C. Long FDP D. Index FDS E. FPL In a patient with rheumatoid arthritis, which is the most common tendon ruptured within the carpal tunnel? A. FDS of the ring finger B. FDP of the long finger C. Flexor pollicis longus D. Flexor carpi radialis E. Palmaris longus A 52-year-old female had open reduction and internal fixation with volar plate and screws for a distal radius fracture one year ago. She had full use of the hand until a month ago when she noted inability to flex the index finger. The best treatment at this point is: A. Cast application with the wrist in flexion B. Steroid injection into the carpal tunnel C. Flexor tenolysis D. Hardware removal E. Occupational therapy for strengthening A young woman presents with vague forearm pain, for which she has been seen by multiple consultants without confirmatory diagnosis. She denies antecedent trauma. When asked to flex her thumb IPJ, she involuntarily flexes her index finger as well. The likely cause for this finding is: A. Accessory FPL B. Psychogenic C. Tendinous interconnections D. Pseudoneuroma of the median nerve E. Duplicate AIN Extension of the proximal phalanx at the metacarpophalangeal joint occurs through the function of the:
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A young woman presents with vague forearm pain, for which she has been seen by multiple consultants without confirmatory diagnosis. She denies antecedent trauma. When asked to flex her thumb IPJ, she involuntarily flexes her index finger as well. The likely cause for this finding is: A. Accessory FPL B. Psychogenic C. Tendinous interconnections D. Pseudoneuroma of the median nerve E. Duplicate AIN Extension of the proximal phalanx at the metacarpophalangeal joint occurs through the function of the: A. Transverse fibers of the extensor hood B. Oblique fibers of the extensor hood C. Medial tendon of the dorsal interosseus D. Sagittal bands E. Transverse retinacular ligament A 67-year-old female has a 2-week history of pain in her left hand following a minor injury. There is mild swelling over the dorsum of the middle finger MCP joint. Collateral ligament integrity is intact. Passive joint range of motion is full. There is a 20 degree extensor lag of the affected MCP joint, although full MCP extension can be maintained once the finger is passively extended. The most appropriate treatment at this point includes: A. Intrinsic tenotomy B. Functional MCPJ extension splinting of the middle finger C. Radial sagittal band reconstruction with extensor tendon loop D. Reconstruction of the extensor digitorum communis tendon E. Crossed intrinsic transfer A 72-year-old woman with rheumatoid arthritis complains about her inability to extend the fingers and thumb of her non-dominant left hand. The MCPJs can be extended passively, but she is unable to hold the fingers in extension after they are passively straightened. With passive wrist flexion, the MCPJs and PIPJs extend. Which of the following is the most likely cause of these findings? A. Arthritis of the MP joints B. Intrinsic tightness C. Posterior interosseous nerve palsy D. Rupture of the extensor tendons E. Subluxation of the extensor tendons A 24-year-old male sustains a dorsal laceration over the central aspect of the ring finger metacarpal shaft from a box cutter two weeks ago. He presents with weakness of ring finger MCP joint
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A 72-year-old woman with rheumatoid arthritis complains about her inability to extend the fingers and thumb of her non-dominant left hand. The MCPJs can be extended passively, but she is unable to hold the fingers in extension after they are passively straightened. With passive wrist flexion, the MCPJs and PIPJs extend. Which of the following is the most likely cause of these findings? A. Arthritis of the MP joints B. Intrinsic tightness C. Posterior interosseous nerve palsy D. Rupture of the extensor tendons E. Subluxation of the extensor tendons A 24-year-old male sustains a dorsal laceration over the central aspect of the ring finger metacarpal shaft from a box cutter two weeks ago. He presents with weakness of ring finger MCP joint extension and a 20-degree resting extensor lag. Which structure is responsible for MCP extension in the face of a complete tendon laceration? A. Junctura tendinae B. Sagittal band C. Lateral band D. Oblique retinacular ligament E. Transverse retinacular ligament Which structure is closest to the A1 pulley of the flexor tendon sheath of the thumb? A. A2 pulley B. Oblique pulley C. Radial digital nerve D. Ulnar digital nerve E. Motor branch of the median nerve Corticosteroid injection for trigger digits is most likely to be successful in the following clinical situation: A. Multiple digital involvement B. Associated type I diabetes mellitus C. Single digit in a patient over 50 years of age D. Tenosynovial tophaceous gout E. Associated with other upper extremity tendinopathy Long-standing trigger finger, refractory to non-surgical treatment, is often associated with which deformity? A. Boutonierre deformity B. Proximal interphalangeal joint flexion contracture C. Intrinsic tendon contracture D. Distal interphalangeal joint flexion contracture E. Metacarpal-phalangeal joint flexion contracture
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Corticosteroid injection for trigger digits is most likely to be successful in the following clinical situation: A. Multiple digital involvement B. Associated type I diabetes mellitus C. Single digit in a patient over 50 years of age D. Tenosynovial tophaceous gout E. Associated with other upper extremity tendinopathy Long-standing trigger finger, refractory to non-surgical treatment, is often associated with which deformity? A. Boutonierre deformity B. Proximal interphalangeal joint flexion contracture C. Intrinsic tendon contracture D. Distal interphalangeal joint flexion contracture E. Metacarpal-phalangeal joint flexion contracture Preferred Responses 1. E 6. D 11. C 16. C 2. E 7. B 12. D 17. A 3. D 8. D 13. C 18. C 4. C 9. C 14. D 19. C 5. D 10. E 15. B 20. B Test Taking Hints Pace yourself Skip difficult questions Record answers as you go Answer on basis of first impression unless you have misread the question Correct responses have “may” or “can”
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Test Taking Hints Incorrect responses have double negatives, sweeping generalizations (“always” or “never”) Eliminate the wrong answers Guess most conservative treatment or the longest answer Choose the completely correct answer Rest before the test!