Abstract
Hand II Structured SBA Questions
Hand II Structured SBA Questions
1. A 29-year-old butcher presents after sustaining a palmar knife laceration over the proximal phalanx. He is unable to flex his non-dominant index finger. Neurovascular examination is unremarkable.
What is the most appropriate management plan?
2. A 37-year-old chef sustains a laceration to his non-dominant thumb on the palmar aspect overlying the proximal phalanx. Active thumb flexion is painful. There is no neurovascular compromise.
How would you manage this patient?
3. A 57-year-old cabinet maker undergoes flexor tendon repairs of their non-dominant index, middle and ring fingers.
Which of the following postoperative management plans is most appropriate?
4. A 39-year-old bricklayer presents with dorsal wrist pain on exertion. No injury is recalled. Radiographs demonstrate a scapholunate angle of 70 degrees and no degenerative change. Grip strength is reduced.
Which is the most appropriate management option?
5. A 69-year-old retired grocer presents with ulnar-sided wrist pain and evidence of a TFCC lesion.
Which of the following is true regarding the TFCC?
6. An 18-year-old courier falls from his motorbike and presents 4 weeks later with dorsal wrist pain. Radiographs demonstrate an increased capitolunate angle, a scapholunate angle of 25 degrees and no associated fractures.
Which is most accurate regarding this injury?
7. A 24-year-old snowboarder presents with wrist pain. The scaphoid shift test is positive. Plain radiographs are unremarkable.
Which of the following is considered the gold standard to confirm the diagnosis?
8. A 30-year-old financier sustains closed mallet injuries to their dominant index and middle fingers while skiing. The fractures involve 30% and 20% of the distal phalanx articular surfaces, respectively. There is slight subluxation of the index finger distal phalanx.
How would you manage these injuries initially?
9. An 18-year-old gymnast sustains a closed fracture-subluxation of his ring finger PIPJ. The AP radiograph demonstrates satisfactory alignment; however, the lateral radiograph shows an intra-articular volar base fracture with dorsal subluxation of the middle phalanx. The fracture involves 30% of the articular surface.
How would you manage this case initially?
10. A 26-year-old mechanic presents with radial-sided wrist pain 7 months after a fall. Plain radiographs demonstrate a scaphoid fracture non-union of the proximal pole. There is sclerosis of the proximal fragment. Carpal height and alignment are well-maintained.
What is the most appropriate management?
11. A 30-year-old tree surgeon accidentally amputates his non-dominant thumb through the proximal phalanx with a circular saw. Three hours later he arrives at the emergency department with the digit held in a bag.
What is the preferred definitive management?
12. A 39-year-old lawyer presents with pain over his middle finger 2 weeks following a closed injury while playing football. His PIPJ is swollen but stable. Elson’s test is positive.
How would you manage this patient?
13. A 55-year-old woman presents with pain and altered sensation in the median nerve distribution following volar plate fixation of a distal radius fracture. Autonomic function remains intact. She describes no sensory impairment prior to surgery. Electromyography completed 6 weeks following surgery demonstrates fibrillations and positive sharp waves in the abductor pollicis brevis. A Tinel is elicited over the scar.
Which pair represents the most likely nerve injury and most appropriate management plan?
14. A 42-year-old cyclist presents 3 months following a radial head replacement, which was complicated by a nerve palsy. He is now able to weakly extend the index, middle, ring and little fingers. Thumb retropulsion is not seen. A Tinel is present in the midforearm.
What is the most appropriate next step in management?
15. A 5-year-old girl presents with a unilateral small thumb. The thenar eminence is hypoplastic, and the MCP joint ulnar collateral ligament is lax. Plain radiographs demonstrate intact MCP and CMC joints.
What is the most appropriate management plan?
16. A 43-year-old woman presents with a progressive flexion contracture of her right index finger. She states that her father has a similar problem. She underwent corrective surgery 5 years ago. On examination, there are flexion contractures of the MCPJ (70 degrees, uncorrectable) and PIPJ (10 degrees, passively correctable). A mature scar is visible.
What is the most appropriate management plan in the first instance?
17. An 80-year-old man presents with an enlarging mass on the volar aspect of his forearm. It measures 5.5cm in maximal diameter. He denies a history of trauma. Plain radiographs are unremarkable.
What investigation should be performed next?
18. A 53-year-old architect presents with a 4-month history of a mildly tender palmar nodule in line with the little finger at the level of the distal palmar crease. His father had a similar condition. Full digital extension is observed.
Which of the following is most accurate?
19. A 35-year-old chemist presents with a chronic radial nerve palsy following a humeral fracture sustained 18 months ago. His hand function is compromised.
What is the most appropriate definitive management plan?
20. A 24-year-old engineer falls while skiing and sustains a displaced proximal pole scaphoid fracture.
What is the most appropriate management option?
21. A 15-year-old presents with bilateral wrist deformities and limited forearm rotation. The ulnar heads are especially prominent. She is noted to be of short stature. Plain radiographs demonstrate increased radial inclination.
What is the likely diagnosis?
22. A 55-year-old florist presents with a scaphoid wrist fracture following a high-energy injury. Radiographs demonstrate a 1mm cortical step on the radial cortex.
What is the most appropriate management plan?
23. A 19-year-old falls onto his outstretched hand while snowboarding. He has a suspected scaphoid fracture.
Which plain radiographic view is least helpful?
24. A 31-year-old mechanic accidentally injects the tip of his non-dominant index finger with a high-power grease gun.
What is the most appropriate first step in the management of this patient?
25. A patient presents with a flexion contracture of their ring finger secondary to Dupuytren’s disease. The MCPJ is flexed to 40° and the PIPJ is flexed to 20°.
Which of the following structures is least likely to be affected?
26. A 42-year-old marine biologist presents with a displaced intra-articular fracture of the thumb metacarpal base. Plain radiographs demonstrate a two-part fracture.
Which is true regarding the management of such fractures?
27. A 53-year-old librarian presents with a long history of morning stiffness and a symmetric polyarthropathy of the hands. She is positive for serum anti-CCP antibodies.
Which of the following clinical findings would not be expected?
28. A 17-year-old cyclist falls from his bike and sustains a deep defect over his dominant thenar eminence. Tissue loss measures 4 x 3 cm, and the underlying muscle and fascia are exposed.
What is the most appropriate definitive management plan for this patient?
29. A 24-year-old amateur tennis player presents with chronic dominant wrist pain. Examination reveals a painful ‘catch-up’ clunk as the wrist is moved from radial to ulnar deviation. No history of trauma is recalled. She has Ehlers–Danlos syndrome.
What is the most likely diagnosis?
30. A 45-year-old undergoes carpal tunnel decompression under local anaesthetic.
Which local anaesthetic option would you choose?
31. A 59-year-old carpenter sustains a transverse amputation through the tip of his non-dominant index finger while using a circular saw. The tip of the distal phalanx is exposed, and the defect cannot be closed primarily.
What reconstruction technique would be preferred?
32. A 19-year-old student presents with a painful ‘snapping’ sensation along their middle finger after punching a wall 3 months ago. Plain radiographs are unremarkable.
How would you manage this patient?
33. A 65-year-old retired baker presents with an inability to extend her thumb. Three months ago, she sustained a distal radius fracture that was managed non-operatively.
How would you manage this patient?
34. A 75-year-old female presents with dominant radial-sided wrist pain of 8 months’ duration. Thumb movements and ulnar deviation of the wrist are particularly uncomfortable. On examination, she has a positive Finkelstein’s test.
Which of the following is correct?
35. A 25-year-old personal trainer presents with a 6-month history of central wrist pain and stiffness. Plain radiographs are unremarkable except for ulnar negative variance of 3mm. He recalls no history of trauma and is a non-smoker. He has been treated with a period of immobilisation in a cast but remains in pain.
How would you manage this patient?
36. A 35-year old manual labourer presents with a 12-month history of worsening wrist pain. He fractured the ipsilateral distal radius 6 years ago. There is pain on ulnar deviation during power grip. Plain radiographs demonstrate ulnar positive variance of 3mm and 10 degrees of distal radius dorsal angulation. The TFCC is intact but attenuated.
How would you manage this patient?
37. A 19-year-old shop assistant presents 10 hours after a dog bite to their dominant index finger. The digit is painful, erythematous and held semi-flexed. They take no regular medications.
What is the preferred initial management of this patient?
38. A 38-year-old woman with rheumatoid arthritis presents with a correctable deformity of her middle finger. Pain is not a feature, and there is no history of trauma. There is resting hyperextension of the PIPJ and flexion of the DIPJ and full active range of movement. Plain radiographs demonstrate moderate erosive changes. Conservative measures have failed.
What is the most appropriate definitive management?
39. A 74-year-old retired caretaker is referred with digital clawing. On examination there is altered sensation in his little finger.
Which of the following statements is correct?
40. A 25-year-old professional swimmer presents with altered sensation in the radial three digits of his dominant hand. Sensation over the thenar eminence is reduced. Night symptoms are not a particular feature, but certain movements bring on paraesthesia. Provocative tests over the carpal tunnel, neurophysiological testing and magnetic resonance imaging are all unremarkable.
What is the most likely diagnosis?
41. A 20-year-old man presents with an apex dorsal fracture of his right little finger metacarpal neck.
Which is true regarding management of these fractures?
Related posts:
Chapter 6 – Knee II Structured SBA
Chapter 7 – Foot and Ankle Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 24 – Prosthetics and Orthotics Structured SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
