+967-774203774 [email protected]
Partner Portal Staff Login
العربية
Part of the Master Guide

Orthopedic Prometric Exam Preparation MCQs - Part 1

Orthopedic Prometric Exam Preparation MCQs - Part 9

25 Apr 2026 55 min read 1 Views
Orthopedic Prometric Exam Preparation MCQs - Part 9

Prometric Exam Simulator


00:00

Start Quiz

Question 1

Which of the following statements regarding ganglions is false:





Explanation

Transillumination is a hallmark of ganglions. Because of the location from which ganglia arise and the dissection performed during resection, a decrease in range of motion can be seen postoperatively. Needle aspiration is diagnostic and can be therapeutic, however, recurrence rates as high as 95% have been reported. Volar ganglia can often be intimately associated with the radial artery. Ganglia may often be multilobulated.

Question 2

Dorsal wrist ganglions originate from the:





Explanation

Dorsal wrist ganglia do not arise from the dorsal capsule, EDC tendon, capitolunate joint, or dorsal intercarpal ligament. Dorsal wrist ganglia arise from the scapholunate ligament. Some surgeons advocate excising a small rim of the scapholunate ligament to avoid recurrence.C orrect Answer: Scapholunate ligament

Question 3

Ganglions of the distal interphalangeal (DIP) joints of the fingers are called:





Explanation

Ganglions arising at the DIP joints are called mucous cysts and ganglions from the flexor tendon in the palm are called retinacular cysts. Bouchard nodes are osteophytes that develop at the proximal interphalangeal joint. Heberden nodes are bony spurs at the dorsal aspect of the DIP joint and are present in osteoarthritis. Inclusion cysts are mobile, nonadherent to skin, and can occur anywhere on a hand.

Question 4

Management of a mucous cyst entails:





Explanation

Treatment of mucous cysts, which are ganglions of the distal interphalangeal joint associated with osteoarthritic changes, entails excision of the cyst and osteophyte resection of fusion. Aspiration only or aspiration of the cyst with injection of hyaluronidase is not indicated or efficacious in the treatment of mucous cysts because the osteophyte must be addressed. Injection of steroids also fails to address the underlying cause of these cysts. Arthrodesis of the distal interphalangeal joint is not necessary in the treatment of typical mucous cysts.C orrect Answer: Excision and resection of osteophytes

Question 5

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. The most likely diagnosis is:





Explanation

This patient presents with the classic triad of glomus tumor: sharp lancinating pain, point tenderness, and cold sensitivity. Localized bluish discoloration is also strongly suggestive of a glomus tumor. Giant cell tumors can be found on the fingertip, however, a presentation of a giant cell tumor with these symptoms would be unusual. Mucous cysts would be part of the differential but does not cause a bluish discoloration or cold insensitivity. An acute paronychia would be painful and erythematous is infectious. A mucous cyst is not infectious. This classic triad does not describe a turret exotosis.

Question 6

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. The next step in management includes:





Explanation

This is a classic case of a glomus tumor with cold intolerance and nail deformity. Imaging studies often are inconclusive, although computed tomography scans may show cortical reaction. This patient is symptomatic and should receive definitive treatment. It should be noted that magnetic resonance imaging is increasingly helpful for nonclassical presentations of finger pain.

Question 7

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. Based on your clinical diagnoses, the histological findings will include which of the following:





Explanation

Glomus tumors consist of well-formed vascular channels with nonmyelinated nerve endings. Glomus tumors are not associated with mucous islands or giant cells. Negatively birefringent crystals are found in patients with gout. The presentation of this patient does not suggest gout. Amorphous calcium in a pseudocapsule is diagnostic of calcinosis. C alcinosis occurs intracutaneoulsy or subcutaneously. These deposits can be tender but are not effected by changes in weather, as are glomus tumors.

Question 8

Glomus tumors are characterized by all of the following except:





Explanation

Glomera are neuromyoarterial apparatuses that regulate temperature.

Question 9

All of the following are characteristic of hemangiomas except:





Explanation

Cavernous hemangiomas are noninvoluting hemangiomas and require surgical excision.

Question 10

Pseudoaneurysms differ from true aneurysms in that:




Explanation

Pseudoaneurysms occur secondary to penetrating trauma and have a fibrous wall, compared to true aneurysms that have all the elements of an arterial wall.

Question 11

Neurofibromas are characterized by all of the following except:





Explanation

Neurofibromas are benign tumors of neural origin that are transmitted as an autosomal dominant trait with variable penetrance. Neurofibromas are associated with cutaneous manifestations like cafe-au-lait spots and axillary freckles. They may be dumbbell shaped and can be identified with magnetic resonance imaging, which is especially helpful for deeper multiple lesions. They are infiltrative, making excision with preservation of peripheral nerve function difficult thus requiring bridge grafting for significant motor or sensory funtional requirements.

Question 12

Recklinghausens disease is associated with all of the following except:





Explanation

Diffuse neurofibromatosis is a separate clinical presentation and is not associated with Recklinghausenâ s disease.

Question 13

Schwannomas are differentiated from neurofibromas by all of the following except:





Explanation

Schwann cells contribute to schwannoma and neurofibroma.

Question 14

All of the following are true for infantile digital fibroma except:





Explanation

Eighty percent of infantile digital fibromata appear before a child's first birthday. They are exclusive to the fingers and toes and are usually painless. Infantile digital fibromata are often small and the same color as the skin. On histological examination, intracytoplasmic inclusion bodies are present. Although benign, the fibromata are locally aggressive. They do not metastaaize, but recurrences after wide local excision are common. Surgery is indicated when deformity or contracture is imminent.

Question 15

Felon complications include all of the following except:





Explanation

Felons that are chronic or neglected may penetrate adjacent structures such as the distal phalanx, nailbed, or distal interphalangeal joint. They can also contribute to the formation of a pyogenic flexor tenosynovitis. C ollar button abscesses are localized to web space. They typically arise from direct inoculation, not from distant felons.

Question 16

Which of the following is not a classic Kanavel sign of flexor tenosynovitis:





Explanation

The cardinal signs of flexor tenosynovitis described by Kanavel include pain on passive extension, flexion attitude of the finger, tenderness of flexor sheath, and swollen finger.

Question 17

Septic flexor tenosynovitis may involve all of the following areas except the:





Explanation

The radial and ulnar bursae are extensions of the tendon sheaths of the flexor pollicis longus and the flexor digitorum profundus of the small fingers. They can easily be involved in a case of pyogenic flexor tenosynovitis. Although not direct extensions of the flexor sheaths, the thenar space and Parona's space are adjacent to the flexor sheaths and can be involved in suppurative conditions. The snuffbox, however, does not have any contributions from the flexor system and is not usually involved in cases of pyogenic flexor tenosynovitis.

Question 18

Regarding the management of web space abscess, which of the following statements is not true:





Explanation

Transverse incisions can lead to contractures that limit finger abduction. Leaving wounds open allow for continued drainage. If preferred, closed suction drains can be used after closure of the wound. All devitalized tissue must be debrided and all signs of infection removed and irrigated copiously. Early motion is encouraged to prevent stiffness.

Question 19

Meleneyâ s infection is a:





Explanation

Found in necrotizing fasciitis, Meleneyâ s infection is a spreading ulcer rimmed with gangrenous skin. The affected area must be debrided immediately. Cultures are taken at the time of surgery to tailor antibiotic coverage. Amputation is not unusual to control the spread of the gangrenous infection.

Question 20

Meleneyâ s infection is caused by:





Explanation

Aerobic hemolytic staphylococci and microaerophyllic non-hemolytic streptococci synergistically act to produce Meleneys infection. Meleney's infection is a gangrenous infection that often results after a small injury. The infection is characterized by significant, rapid swelling with gangrenous changes.

Question 21

The most common pathogen for osteomyelitis of phalanges is:





Explanation

Staphylococcus aureus is the most common pathogen that causes osteomyelitis in the hand. Most cases of osteomyelitis in the hand are due to direct extension. Other pathogens can be found if there is a contaminated injury that penetrates directly into the bone. H. infuenza , mixed pathogens, and Pasturella multocida are less likely causes of osteomyelitis and are often caused by direct inoculation injuries or bites.

Question 22

The most common pathogen causing septic arthritis in the hand is:





Explanation

Staphylococcus aureus is the most common pathogen that causes septic arthritis in the hand. The second most common pathogen is streptococcus species infections, which are often the result of trauma. Treatment includes incision and drainage with copius irrigation.

Question 23

"C ollar button" abscess refers to:





Explanation

Collar button abscess is an infection of web space and is usually a result of penetrating trauma. Treatment of such abscesses requires incision and drainage through dorsal and palmar incisions. Care must be taken to avoid the neurovascular bundles. Finger pulp infections are known as felon. Infections involving Parona's space is typically involved in a horseshoe abscess. Eponychial infections are limited to the nail fold. C ollar button abscesses do not include joint involvement.C orrect Answer: Web space infection

Question 24

A 35-year-old woman is bitten on her left index finger by a snake in her backyard. Management of snake bites includes all of the following except:





Explanation

There are different snake bite protocols depending on the species of snake. However, common steps in all snake bite protocols include keeping the patient emotionally and physically still, calling for help immediately, applying a moderately tight tourniquet proximally to prevent further spread of venom, and capture or identification of the snake. Local injection of the antivenin in the fingers or toes is contraindicated.C orrect Answer: Injecting antivenin locally based on recommended guidelines

Question 25

C ardinal signs of evenomation include all of the following except:





Explanation

The cardinal signs of evenomation appear between 10 minutes and 4 hours after a person is bitten. The signs include fang marks, pain, swelling, and local necrosis. Cyanosis is not considered a cardinal sign of evenomation.

Question 26

All of the following nerves are involved in infection with Mycobacterium leprae except the:





Explanation

Mycobacterium leprae causes skin, nerve, and tendon sheath infections. M leprae commonly affects the hands because it has a predilection for cool parts of the body. M leprae causes neuropathy, which frequently involves the ulnar nerve at the elbow and the median nerve at the wrist. The resulting limb deformities require various surgical procedures. C ranial nerves and autonomic nerves are not affected.

Question 27

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal air in the joint but no joint dislocation or fracture, and there is no neurovascular deficit. All of the following are appropriate steps in the management of this patient except:





Explanation

Human bite wounds on the hand are typically found over the MP joint. The mechanism of injury is a clenched-fist blow to the mouth. Oral flora enters the wound, which often communicates with the joint. Eikenella corrodens is frequently cultured from human bite wounds, but the most common pathogen is staphylococcus aureus. Appropriate treatment includes the administration of tetanus toxoid, exploration if there is air in the joint or frank infection, observation, intravenous antibiotics, arm elevation, and splinting. All bites over joints should be assumed to penetrate and require formal incision and drainage.

Question 28

A 24-year-old man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. An important step in assessment of human bites is:





Explanation

Evaluation for tendon injury in a clenched-fist position is essential because tendons slide proximally in the open-hand position. Involvement of tendon or joint usually necessitates surgical debridement.C orrect Answer: Evaluation for tendon injury in clenched-fist position

Question 29

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. After cultures are taken, the next important step in treatment is:





Explanation

A patient with a human bite must be admitted for IV antibiotics and observation. If left untreated, human bites are commonly infected by a mixed flora of organisms. Therefore, they must be treated diligently.C orrect Answer: Admit and administer IV antibiotics

Question 30

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. The most appropriate antibiotic treatment includes:





Explanation

Imipenam and ciprofloxacin provide treatment for gram-negative and gram- positive organisms.C orrect Answer: Imipenam and ciprofloxacin

Question 31

Which of the following organisms is most likely found in a cat bite:





Explanation

Pasteurella multocida is the most common organism found in animal bites.

Question 32

Which of the following is the atypical mycobacterium that infects a penetrating wound sustained in an aquatic environment:





Explanation

Tuberculosis is the most common chronic infection found in the hand. Mycobacterium marinum is the atypical mycobacterium that can infect a wound sustained in a marine environment, freshwater lake, or tropical fish tanks. It is also called swimming pool granuloma or fish tank granuloma.

Question 33

Which of the following is not true for infections caused by Mycobacterium marinum:





Explanation

Tuberculous infections are chronic infections and do not produce acute signs of inflammation. Therefore, pain and tenderness are present in these infections but warmth and redness are absent. Abscesses produced in tuberculous infections are termed "cold abcesses."

Question 34

Which of the following fascial structures does not contribute to the formation of the spiral cord:





Explanation

The pretendinous band, spiral band, lateral digital sheet, and Grayson's ligament are all parts of the normal fascia that contribute to the formation of the spiral cord. C leland's ligament is not involved at all in the disease process.

Question 35

Which of the following structures contribute to the formation of the spiral cord:





Explanation

The spiral cord is formed from the pretendinous band, spiral band, Grayson's ligament, and lateral digital sheet. Cleland's ligament is not affected in Dupuytren's contracture. Remember that bands and ligaments give rise to cords, which are the diseased state.

Question 36

Surgical release in Dupuytrenâ s disease is indicated in which of the following:





Explanation

The indication for surgery in Dupuytrenâ s disease is MP joint contracture larger than 30° and any degree of PIP joint deformity. The other answers are incorrect because they are subjective descriptions and do not necessarily indicate joint involvement.

Question 37

Skin pits in Dupuytrenâ s disease are caused by:





Explanation

The longitudinal fibers forming layer 1 of the palmar aponeurosis insert into the dermis and, when contracted, give rise to skin pits. The pretendinous bands give rise to the central cord. C ontractures of the natatory ligament give rise to the natatory cord. Vertical fibers and septae do not give rise to pits.C orrect Answer: Longitudinal fibers of palmar aponeurosis inserting into the skin

Question 38

An otherwise healthy man has Dupuytrenâ s disease, which involves his small finger with 40° proximal interphalangeal joint involvement. The preferred surgery in this patient is:





Explanation

A partial fasciectomy is the preferred surgery in this situation. It is recommended that involved fascial cords be resected rather than performing prophylactic fasciectomies. C are must be taken to preserve the neurovascular bundles. Arthrodesis, arthroplasty, and osteotomies are salvage procedures meant for recurrent disease. Fasciotomy has been recommended for elderly patients who cannot tolerate a long operation.

Question 39

Marjolins ulcers are risk factors for which of the following tumors:





Explanation

Marjolins ulcers are malignant degenerations in chronic skin ulcers, sinuses, and burn scars and are risk factors for squamous cell carcinoma. Any patient with chronic, nonhealing ulcers should undergo biopsy for malignant degeneration. Basal cell carcinoma, malignant melanoma, synovial sarcoma, and osteosarcoma are not commonly associated with Marjolin's ulcer.

Question 40

Which of the following tumors rarely metastasizes:





Explanation

Dermatofibrosarcoma protuberans presents as a variably colored, slow- growing nodule involving the subcutaneous tissue. This tumor has a low incidence of metastasis; however, the recurrence rate is high even with wide local excision.

Question 41

Lymph node involvement is common in all of the following tumors except:





Explanation

Basal cell carcinomas rarely metastasize. Malignant sweat gland tumors, malignant melanoma, and Merkel's cell carcinoma are aggressive. Treatment usually includes regional lymphadenectomy. Squamous cell carcinoma is one of the most common hand malignancies and has the capacity to metastasize via the lymphatics.

Question 42

Which of the following is not a characteristic of an acrolentiginous melanoma:





Explanation

Acrolentiginous melanomas are usually flat, pigmented lesions. These melanomas often occur in older patients, affecting the palm and nail bed. At the time of presentation, acrolentiginous melanomas are frequently metastasized.

Question 43

Nevi at greatest risk for malignant degeneration are:





Explanation

Giant congenital hairy nevi, dysplastic nevi, senile lentigo, and congenital melanocytic nevi have significant risk for malignant degeneration. Nevus sebaceous is present at birth in the head and neck region and has a 10% incidence of malignant transformation. Blue nevi, junctional nevi, and compound nevi have lower risks for transformation.

Question 44

All of the following are risk factors for malignant melanoma except:





Explanation

Sun exposure is the most important risk factor for melanoma. Family history, atypical nevi, and an immunosuppressive state increases an individual's risk for developing melanoma. It is unknown if tanning lotions cause malignant melanomas.

Question 45

Which of the following statements is true regarding soft tissue sarcomas:





Explanation

Soft tissue sarcomas in the hand present as painless lesions, do not metastasize to bone, and although local control is better with radical resection, there is no improvement in overall survival when compared to wide excision. Soft tissue sarcomas should not be "shelled out."C orrect Answer: Patients with soft tissue sarcomas of the hand have worse prognosis than patients with similar tumors in other extremities.

Question 46

Which of the following tumor metastasizes to lungs:





Explanation

Squamous cell carcinoma and basal cell carcinoma do not commonly metastasize to the lungs. Actinic keratoses are premalignant lesions that progress into squamous cell carcinomas. Schwannomas are common benign nerve tumors.

Question 47

Which of the following is not a characteristic of synovial sarcomas:





Explanation

Synovial sarcomas are high grade malignant soft tissue sarcomas, in which metastases can occur years after surgery. Long term followup is necessary. They arise close to joints, tendons or bursa and lymphatic spred is common. Histology reveals spindle and epithelial type cells with menophasic or biphasic pattern. Treatment includes wide resection and radiation, chemotherapy is not usually used.

Question 48

C haracteristic histological features of malignant schwannoma are best described as:





Explanation

The histological features of malignant schwannoma have characteristic fusiform cells with neoplastic schwann cells and nerve fascicles.

Question 49

Which of the following terms is not used in reference to macrodactyly:





Explanation

Symbrachydactyly is a term that encompasses all variations of shortened digits. Symbrachydactyly may be associated with syndactylies, but it is not a term used in reference to macrodactyly.

Question 50

Most cases of macrodactyly are:





Explanation

The majority of patients (90%) present with unilateral macrodactyly, and men are more often affected than women. Macrodactyly is most frequently found in the index finger, followed by the long finger, thumb, ring, and little fingers. Typically, two digits are affected â most commonly the thumb and index or the index and long.C orrect Answer: Unilateral and affect men more often than women

You Might Also Like

Orthopedic Prometric MCQs - Chapter 3 Part 49
Orthopedic Prometric MCQs - Chapter 3 Part 49
Orthopedic Prometric MCQs - Chapter 3 Part 48
Orthopedic Prometric MCQs - Chapter 3 Part 48
Dr. Mohammed Hutaif
Medically Verified Content by
Prof. Dr. Mohammed Hutaif
Consultant Orthopedic & Spine Surgeon
Chapter Index
    Back to Master Guide