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Free Orthopedics Review | Dr Hutaif General Orthopedics -...

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FREE Orthopedics MCQS 2022 1501-1550

QUESTION 1
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
Diagnosis of the condition is:
1
Brachial plexus neuropraxia
2
Erbâs palsy
3
Brachial plexus neuritis
4
C 5, C 6 disk herniations
5
Klumpkeâs Palsy
QUESTION 2
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3-cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
The level of lesion is:
1
Postganglionic C 5, C 6
2
Preganglionic C 5, C 6
3
Posterior cord injury
4
Middle trunk
5
Spinal accessory paralysis
QUESTION 3
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
The least helpful test in further management of this patient is:
1
Magnetic resonance imaging (MRI)
2
C omputed tomography (C T) scan of the neck
3
Repeat electromyelogram (EMG) after 4 weeks
4
Somatosensory evoked potential (SSEP)
5
C areful neurological examination
QUESTION 4
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
The plan of management in this patient 5 months postinjury with no clinical improvement should be:
1
Neurotization
2
Exploration and nerve grafting
3
C ontinued observation
4
Tendon transfers
5
Shoulder arthrodesis
QUESTION 5
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
The most important indication for early exploration in this patient is:
1
Absence of biceps function at 3 months
2
Absence of biceps function with return of extensor carpi radialis longus (EC RL) power at 4 months
3
Presence of trick movements
4
Subluxation of humeral head on radiographs
5
Weakness of the supraspinatus
QUESTION 6
A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle eight weeks prior. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. C linical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could
grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3-cm wasting of his arm and 2 cm of the forearm. Tinelâs sign is positive around the clavicle. Hornerâs signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion.
The most important function that needs to be restored in this patient is:
1
Shoulder abduction
2
Shoulder elevation
3
Elbow flexion
4
Wrist extension
5
Elbow extension
QUESTION 7
An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of
5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patientâs right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Hornerâs syndrome and the grasp reflex is absent.
Diagnosis of this condition is:
1
Erbâs palsy
2
Klumpkeâs palsy
3
C erebrovascular accident
4
Ulnar and median combined nerve injury
5
Syringomyelia
QUESTION 8
An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of
5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patientâs right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Hornerâs syndrome and the grasp reflex is absent.
The level of the lesion in this patient is:
1
Preganglionic lesion
2
Postganglionic lesion
3
Lateral cord
4
Posterior cord
5
Upper trunk
QUESTION 9
An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of
5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patientâs right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Hornerâs syndrome and the grasp reflex is absent.
Appropriate surgical management in this case is:
1
Neurotization
2
Exploration and nerve grafting
3
Tendon transfers
4
Neurolysis
5
Vascularized nerve grafting
QUESTION 10
An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of
5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patientâs right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Hornerâs syndrome and the grasp reflex is absent.
Reconstructive surgery includes all of the following except:
1
Thumb opposition
2
Widening of first web space
3
Thumb adduction
4
Thumb metaphalangeal (MP) fusion
5
Thumb capsulodesis
QUESTION 11
Which mechanism and long-term deformity is most often associated with a dorsal avulsion fracture at the base of the middle phalanx:
1
Volar proximal interphalangeal (PIP) joint dislocation and swan-neck deformity
2
Dorsal PIP joint dislocation and swan-neck deformity
3
Volar PIP joint dislocation and boutonniere deformity
4
Dorsal PIP joint dislocation and boutonniere deformity
5
Dorsal PIP joint dislocation and mallet finger deformity
QUESTION 12
At what degree of flexion is ulnar collateral ligament injury tested:
1
0º of metacarpophalangeal (MC P) joint flexion
2
30º of MC P joint flexion
3
60º of MC P joint flexion
4
90º of MC P joint flexion
5
120º of MC P joint flexion
QUESTION 13
Which of the following structures are found within the first dorsal compartment:
1
Abductor pollicis longus and extensor indicis
2
Abductor pollicis longus and extensor pollicis longus
3
Abductor pollicis longus and extensor pollicis brevis
4
Abductor pollicis brevis and extensor pollicis longus
5
Extensor carpi radialis longus and extensor pollicis brevis
QUESTION 14
A 28-year-old man fell off his bike and sustained a fall onto his outstretched hand. He experiences thumb and index finger numbness. Attempts at reduction of his grade I open extra-articular distal radius fracture are unsuccessful. The next appropriate step of management is:
1
Incision and drainage, splint in functional position, and bone grafting
2
Incision and drainage, carpal tunnel release, and splint in functional position
3
Incision and drainage, open reduction with internal fixation
4
Incision and drainage, open reduction with internal fixation, and carpal tunnel release
5
Incision and drainage, open reduction with internal fixation, carpal tunnel release, and bone grafting
QUESTION 15
Which of the following is not usually associated with radial deficiency:
1
Thrombocytopenia absent radii
2
Fanconi anemia
3
Holt-Oram syndrome
4
Larsen syndrome
5
C ardiac anomalies
QUESTION 16
Which of the following is the most common carpal coalition in the hand:
1
Lunotriquetral
2
Scapholunate
3
C apitohamate
4
Radioscaphoid
5
C apitolunate
QUESTION 17
A 6-year-old boy presents with a Salter-Harris II distal radius fracture 3 weeks after injury. He is nontender and neurologically intact. On radiographs, he has a 35º dorsal angulation. The appropriate course of treatment is:
1
Observe, cast, follow until healed
2
Observe, cast, follow with serial radiographs for at least 2 years
3
C lose reduction and casting
4
C lose reduction and pins
5
Open reduction
QUESTION 18
The oblique retinacular ligament connects with what two structures:
1
Flexor tendon to lateral extensor tendon
2
Flexor tendon to central slip
3
Flexor tendon sheath to lateral extensor tendon
4
Flexor tendon sheath to central slip
5
Flexor tendon sheath to head of middle phalanx
QUESTION 19
A patient presents with hand weakness. On examination, she has no sensory deficient, decreased strength with pronation, and her elbow is at 90º of flexion and pulp-to-pulp contact on key pinch. The most likely diagnosis is:
1
C arpal tunnel syndrome
2
Anterior interosseous nerve syndrome
3
Posterior interosseous nerve syndrome
4
C ubital tunnel syndrome
5
Martin-Gruber connection
QUESTION 20
Indications for operative treatment in an acute elbow dislocation include:
1
Instability to valgus stress
2
Recurrent dislocation with extension past 50º
3
Radial head fracture involving 30% of the radial head
4
Osteochondral lesions
5
Ulnar nerve parathesias
QUESTION 21
When performing open reduction and internal fixation of radial neck fractures, the plate should be placed:
1
In the "nonarticular safe-zone" comprising 120º of the 360º radial head circumference
2
Forearm in pronation with plate posterior
3
Forearm in supination with plate anterior
4
Forearm in supination with plate posterior
5
Forearm in neutral with plate anterior
QUESTION 22
Heterotopic ossification after elbow dislocations is not associated with which of the following:
1
Delay surgical intervention
2
C losed head injury
3
Aggressive passive range of motion after dislocation
4
Extensive surgical dissection
5
C oncomitant proximal humeral fracture
QUESTION 23
What is the order of joint destruction in a patient with scapholunate disassociation:
1
Radial styloid, proximal radioscaphoid, radiolunate, midcarpal
2
Radial styloid, proximal radioscaphoid, radiolunate
3
Proximal radioscaphoid, midcarpal, radiolunate
4
Proximal radioscaphoid, radial styloid, midcarpal, radiolunate
5
Radial styloid, proximal radioscaphoid, midcarpal
QUESTION 24
Which of the following is not characteristic of Dupuytrenâs disease:
1
Autosomal dominant trait
2
Irish and Scottish decent
3
Higher prevalence in men
4
Ring and small finger involvement first
5
Predictable progression of disease
QUESTION 25
Operative indications for Dupuytrenâs contracture include:
1
Metacarpophalangeal joint contraction of more than 25º to 30º
2
Proximal interphalangeal joint contracture of 30º or more
3
Palpable cords in the palm
4
Decreased light touch sensation to affected digits
5
Painful palmar nodule
QUESTION 26
Favorable indications for attempted replantation include:
1
Amputation of the thumb
2
Warm ischemia time of less than 16 hours
3
C rush injuries to the distal forearm
4
C old ischemia time of less than 20 hours
5
Sharp amputation proximal to the elbow
QUESTION 27
Injuries to the central articular disk portion of the triangular fibrocartilage complex are related to all of the following except:
1
Age
2
Positive ulnar variance
3
Ulnocarpal impingement
4
Scaphoid nonunion
5
Avulsion injuries from the dorsal ligamentous attachments
QUESTION 28
A patient reports that he felt a pop and immediate pain over the MP joint of his finger. Examination reveals tenderness on the dorsum of the joint and subluxation of the extensor tendon. Which of the following is the most common defect:
1
C entral slip
2
Lateral bands
3
Triangular ligament
4
Sagittal fibers
5
Extensor tendon
QUESTION 29
All of the following transfers may be used to improve function in a patient who has had radial nerve paralysis longer than 6 months, except:
1
Pronator to extensor carpi radialis brevis
2
Flexor carpi radialis extensors
3
Flexor digitorum superficialis of the ring finger to digital extensors
4
Flexor digitorum superficialis of the ring finger to brachioradialis
5
Flexor palmaris longus to extensor pollicis longus
QUESTION 30
Slide 1
A 24-year-old man presents with a short forearm and a hand deformity. The patient is otherwise healthy with no other congenital defects. The clinical appearance of his forearm is shown (Slide). Your diagnosis is:
1
Ulnar club hand
2
Preaxial longitudinal deficiency
3
Postaxial longitudinal deficiency
4
Thumb aplasia
5
Hypoplastic hand syndrome
QUESTION 31
Slide 1
A 24-year-old man presents with a short forearm and a hand deformity. The patient is otherwise healthy with no other
congenital defects. The clinical appearance of his forearm is shown (Slide). The patient has an elbow flexion contracture of 70°
and desires lengthening. Which of the following statements is not true regarding lengthening:
1
Nerve palsies may occur during lengthening.
2
Lengthening must be done gradually.
3
Lengthening usually equalizes limb length.
4
Lengthening helps improve function by extending the reach.
5
Lengthening leads to recurrence of the deformity.
QUESTION 32
Slide 1
A 24-year-old man presents with a short forearm and a hand deformity. The patient is otherwise healthy with no other congenital defects. The clinical appearance of his forearm is shown (Slide). The potential complications of lengthening are discussed, and the patient is advised against it. However, the elbow flexion contracture is corrected by gradual distraction. One year postoperatively, the patient has attained a 30° correction of the flexion deformity, which remains mobile. Now, he desires that his wrist deformity be corrected. The procedure of choice is:
1
Arthrodesis
2
Radialization
3
C entralization
4
Proximal row carpectomy
5
Tendon transfers
QUESTION 33
Slide 1
A 24-year-old man presents with a short forearm and a hand deformity. The patient is otherwise healthy with no other congenital defects. The clinical appearance of his forearm is shown (Slide). Although the patient has a thumb, it is in an abnormal position. Any attempt to make his thumb more functional will be influenced by:
1
Index finger camptodactyly
2
Presence of a side-to-side finger grip
3
Stiff fingers
4
Recurrence of radial club hand
5
Radial bowing
QUESTION 34
Slide 1
A radial club hand is the result of an insult during which phase of the gestation period:
1
Weeks 1 to 4
2
Weeks 4 to 7
3
Weeks 8 to 12
4
Weeks 12 to 16
5
Anytime during gestation
QUESTION 35
A 15-day-old boy presents with deformity of the right hand. The boy was delivered prematurely and underwent an urgent arterial switch for transposition of great vessels. The patient is in stable condition. He has a radial club hand, and because the radial head cannot be palpated, total absence of radius is suspected. The thumb is absent and the index finger has camptodactyly. The forearm is short compared to the left side, and the patient flexes his elbow upon stimulation. Spontaneous finger motion is also present. A thorough physical examination is performed and a set of investigations is ordered. The results are as follows: complete blood count 10,000 mcu/L; platelet 254 254×103 mcu/L; neutophils 50%; Hb 14.2 mg/dL; lymphocytes
40%; Hct 45; and monocytes 10%. No renal abnormalities were noted on ultrasonogram of the abdomen. A radiograph of the spine is normal.
Diagnosis is:
1
Vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and radial and renal anomalies (VATER)
2
Abnormalities of vertebrae, anus, cardiovascular tree, trachea, esophagus, renal system, and limb buds (VAC TERL)
3
Thrombocytopenia absent radii (TAR) syndrome
4
Holt-Oram syndrome
5
Fanconiâs anemia
QUESTION 36
The principal abnormality associated with Holt-Oram syndrome is:
1
Platelet deficiency
2
C ardiac defects
3
Pancytopenia
4
Malignancy
5
Vertebral defects
QUESTION 37
The hereditary pattern for Holt-Oram syndrome is:
1
Autosomal recessive
2
Autosomal dominant
3
Sex-linked recessive
4
Sex-linked dominant
5
Sporadic
QUESTION 38
A 15-day-old boy presents with deformity of the right hand. The boy was delivered prematurely and underwent an urgent arterial switch for transposition of great vessels. The patient is in stable condition. He has a radial club hand, and because the radial head cannot be palpated, total absence of radius is suspected. The thumb is absent and the index finger has camptodactyly. The forearm is short compared to the left side, and the patient flexes his elbow upon stimulation. Spontaneous finger motion is also present. A thorough physical examination is performed and a set of investigations is ordered. The results are as follows: complete blood count 10,000 mcu/L; 254×103 mcu/L; neutophils 50%; Hb 14.2 mg/dL; lymphocytes 40%; Hct
45; and monocytes 10%. No renal abnormalities were noted on ultrasonogram of the abdomen. A radiograph of the spine is normal.
The next step in the management of the radial club hand is:
1
Stretching
2
Soft-tissue distraction
3
Radialization
4
C entralization
5
Pollicization
QUESTION 39
A 15-day-old boy presents with deformity of the right hand. The boy was delivered prematurely and underwent an urgent arterial switch for transposition of great vessels. The patient is in stable condition. He has a radial club hand, and because the radial head cannot be palpated, total absence of radius is suspected. The thumb is absent and the index finger has camptodactyly. The forearm is short compared to the left side, and the patient flexes his elbow upon stimulation. Spontaneous finger motion is also present. A thorough physical examination is performed and a set of investigations is ordered. The results are as follows: complete blood count 10,000 mcu/L; platelet 254×103 mcu/L; neutophils 50%; Hb 14.2 mg/dL; lymphocytes
40%; Hct 45; and monocytes 10%. No renal abnormalities were noted on ultrasonogram of the abdomen. A radiograph of the spine is normal.
C entralization will be performed on the patient. All of the following statements are true about centralization except:
1
It is necessary to make a notch in the carpus when performing centralization.
2
The forearm must be aligned with the second metacarpal.
3
Preoperative soft tissue distraction can be useful.
4
Transfer of tendons from the radial to ulnar side provides additional stability.
5
Ulnocarpal fusion is a known outcome.
QUESTION 40
A 15-day-old boy presents with deformity of the right hand. The boy was delivered prematurely and underwent an urgent arterial switch for transposition of great vessels. The patient is in stable condition. He has a radial club hand, and because the radial head cannot be palpated, total absence of radius is suspected. The thumb is absent and the index finger has camptodactyly. The forearm is short compared to the left side, and the patient flexes his elbow upon stimulation. Spontaneous finger motion is also present. A thorough physical examination is performed and a set of investigations is ordered. The results are as follows: complete blood count 10,000 mcu/L; 254Ã103 mcu/L; neutophils 50%; Hb 14.2 mg/dL; lymphocytes 40%; Hct
45; and monocytes 10%. No renal abnormalities were noted on ultrasonogram of the abdomen. A radiograph of the spine is normal.
When the patient is 10 years old, he is not satisfied with the length of his forearm and wishes to lengthen it. Which of the following is not a satisfactory recommendation:
1
Acute lengthening with bone graft
2
C ircular ring fixator and gradual distraction
3
Hybrid frame and distraction using the Ilizarov method
4
External frame and distraction using De Bastianiâs principles
5
Lengthening
QUESTION 41
Which of the following conditions is present in patients with radial club hand but not in patients with ulnar club hand:
1
Thumb hypoplasia
2
Thumb aplasia
3
Short forearm
4
Renal malformations
5
Bowing of the forearm
QUESTION 42
All of the following developmental anomalies are associated with ulnar club hand except:
1
Atrial septal defects
2
Proximal focal femoral deficiencies
3
Fibular agenesis
4
Mental retardation
5
Radial ray defects
QUESTION 43
Which of the following syndromes is associated with ulnar club hand:
1
Vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and radial and renal anomalies (VATER)
2
Abnormalities of vertebrae, anus, cardiovascular tree, trachea, esophagus, renal system, and limb buds (VAC TERL)
3
Holt-Oram syndrome
4
Thrombocytopenia absent radii (TAR) syndrome
5
Femur-fibular-ulnar syndrome
QUESTION 44
Which of the following areas is not involved in ulnar club hand:
1
Thumb
2
Elbow
3
Shoulder
4
Femur
5
Vertebra
QUESTION 45
All of the following are true statements regarding elbow involvement in ulnar club hand except:
1
Fifty percent of patients have radial head dislocation.
2
Nearly 50% of aplasia patients have radiohumeral synostosis.
3
Elbow instability worsens with the severity on involvement.
4
The anlage causes radial head dislocation or subluxation.
5
The elbow is usually normal in all hypoplastic patients.
QUESTION 46
All of the following statements are true regarding the carpal bones in patients with ulnar club hand except:
1
Involvement of carpus is severe in type III.
2
The pisiform is the most common missing carpus.
3
C arpal coalition is present in approximately 25% of patients.
4
Making a notch in the carpus provides stability at the wrist joint.
5
The extent of ulnar deformity does not correlate with deformities in the hand.
QUESTION 47
All of the following anomalies are present in patients with ulnar club hand except:
1
Phocomelia
2
Transverse arrest
3
Humeral aplasia
4
Humeral hypoplasia
5
Vertebral dysplasia
Dr. Mohammed Hutaif
Written & Medically Reviewed by
Consultant Orthopedic & Spine Surgeon