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Self-Assessment Questions

Orthopaedic Surgery

Evaluation and Management of the Hand and Wrist: Review Questions

Francis H. Shen, MD, and Anjan P. Kaushik, BS

Dr. Shen is an assistant professor, Department of Orthopaedic Surgery, and Mr. Kaushik is a medical student; both are at the University of Virginia School of Medicine, Charlottesville, VA.

Choose the single best answer for each question.

1. A 23-year-old left-handed woman presents with a recurrent dorsal ganglion cyst on her right wrist that has returned several times despite splinting and aspiration. It is 1.5 cm in size and bulges near the scapholunate ligament between the third and fourth extensor compartment. The patient has come primarily for cosmetic reasons and reports no pain but has discomfort while her hand is at rest. What is the treatment method for this patientıs recurrent ganglion cyst?
  1. Aspiration followed by addition of sclerosing agents
  2. Continue serial aspirations using multiple needle punctures of the cyst site
  3. Superficial surgical excision of the ganglion cyst sac
  4. Surgical excision of the cyst by cutting the cyst stalk at the dorsal scapholunate ligament
  5. Traumatic rupture of the cyst with a direct blow
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2. A 43-year-old woman presents with an extremely tender tip of her right index finger. The fingernail bed appears bluish, and she does not tolerate cold temperature (assessed by using an ice pack) during physical examination. She experiences pinpoint pain over the underlying mass that is well localized to the tip and does not radiate to joints. She also experiences sudden spasms of sharp pain at the site. She does not remember any penetrating injury to the finger. What is the most probable diagnosis for this patientıs finger injury?

  1. Enchondroma
  2. Glomus tumor
  3. Hemangioma
  4. Pyogenic granuloma
  5. Schwannoma
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3. A 22-year-old tennis player slips and falls awkwardly on her left wrist during a match. Plain radiographs taken in the emergency department on the day of the injury show a nondisplaced fracture in the middle third of the scaphoid bone. All of the following statements regarding management methods for successful union after a nondisplaced scaphoid fracture are correct except:
  1. Closed reduction and percutaneous fixation offers a relatively short healing time of 8 to 12 weeks
  2. Middle third scaphoid fractures have better prognosis for healing than proximal pole fractures because of the vascular anatomy
  3. Partial removal of the scaphoid is only used as a last resort in select conditions because of resultant mechanical imbalances
  4. Radiographs are the primary resource for assessing union within the first 12 weeks
  5. The average postsurgical union rate after closed reduction for nondisplaced scaphoid fractures is approximately 90%
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4. A 2-year-old child is brought to his pediatrician by his mother to have his fingertips examined. His right thumb appears red and swollen at the perionychium and seems to bother the child slightly. The pad of his thumb is neither swollen nor red, and there are no visible breaks in the skin. The child does not cry from pain when the thumb is palpated. While questioning the mother, the child sucks on the same thumb, and the mother admits he does this often. The redness and edema have appeared only over the last 4 days. Which of the following is the most likely cause of this patientıs red, swollen thumb?

  1. Bacterial paronychia
  2. Felon
  3. Fungal paronychia
  4. Herpetic whitlow
  5. Tumor of the perionychium
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