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ABOS Part I > Hand > Flashcards

Hand Flashcards

1
Q

Contents of first dorsal wrist compartment.

A

APL/EPB

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2
Q

Contents of second dorsal wrist compartment.

A

ECRL/ECRB

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3
Q

Contents of third dorsal wrist compartment.

A

EPL

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4
Q

Content of fourth dorsal wrist compartment.

A

EDC/EIP

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5
Q

Contents of fifth dorsal wrist compartment.

A

EDM

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6
Q

Contents of sixth dorsal wrist compartment.

A

ECU

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7
Q

Location of sagittal bands.

A

MCP

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8
Q

Central slip inserts here.

A

Middle phalanx.

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9
Q

Eponym for oblique retinacular ligament.

A

Ligament of Landsmeer.

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10
Q

Prevents volar subluxation of the lateral bands.

A

Triangular ligament.

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11
Q

Prevents dorsal subluxation of the lateral bands.

A

Transverse retinacular ligament.

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12
Q

This helps link PIP and DIP joint extension.

A

Oblique retinacular ligament.

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13
Q

Action of FDS.

A

Flexes PIP.

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14
Q

Action of FDP.

A

Flexion DIP.

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15
Q

Each digit has ____ annular pulleys.

A

5

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16
Q

Each digit has ___ cruciate pulleys.

A

3

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17
Q

These pulleys prevent flexor tendon bowstringing.

A

A2 and A4

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18
Q

Most radial structure in the carpal tunnel.

A

FPL

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19
Q

Carpal tunnel contains these structures.

A

Median nerve, FDS x4, FDP x4, FPL.

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20
Q

Roof of Guyon canal.

A

Volar carpal ligament.

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21
Q

Prevalence of palmaris longus tendon.

A

80-85%

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22
Q

FCU inserts here.

A

Pisiform.

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23
Q

Number of dorsal interossei.

A

4

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24
Q

Number of palmar interossei

A

3

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25
Q

Interossei innvervation.

A

Ulnar.

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26
Q

Lumbrical muscles originate here.

A

Radial aspect of FDP tendons.

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27
Q

Radial two lumbricals innervated by this nerve.

A

Median.

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28
Q

Ulnar two lumbricals innervated by this nerve.

A

Ulnar.

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29
Q

Palmar cutaneous branch of median nerve between these two tendons.

A

Palmaris longus and FCR.

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30
Q

Crossover variations between median and ulnar nerves.

A

Martin-Gruber anastomoses.

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31
Q

Distal radius fracture morphology associated with scapholunate ligament disruption.

A

Isolated radial styloid fracture.

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32
Q

AAOS guidelines for non-op distal radius fx treatment.

A
  1. radial shortening less than 3mm
  2. dorsal articular tilt less than 10 deg.
  3. intra-articular step-off less than 2mm
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33
Q

Vitamin C dose of at least ____ mg/day may decrease CPRS after distal radius fx.

A

500 mg/day

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34
Q

Proximal row of carpus.

A

Scaphoid, lunate, triquetrum.

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35
Q

Distal row of carpus.

A

Trapezium, trapezoid, capitate, hamate.

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36
Q

Most common carpal fracture.

A

Scaphoid.

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37
Q

Blood supply to scaphoid.

A

Dorsal branch of radial artery.

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38
Q

Blood supply to scaphoid enters here.

A

Dorsal ridge just distal to waist.

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39
Q

Most commonly harvest vascularized bone grafting for scaphoid nonunion.

A

1,2 intercompartmental supraretinacular artery (a,2 ICSRA)

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40
Q

SNAC wrist stage I.

A

Radioscaphoid arthritis.

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41
Q

SNAC wrist stage II.

A

Scaphocapitate joint.

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42
Q

SNAC wrist stage III.

A

Lunocapitate joint.

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43
Q

Instability between individual carpal bones of single row.

A

Carpal instability dissociative (CID).

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44
Q

DISI and VISI are examples of this type of carpal instability.

A

CID

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45
Q

Instability between carpal rows.

A

Carpal instability non-dissociative (CIND).

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46
Q

Type of carpal instability secondary to perilunate dislocations.

A

Carpal instability complex.

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47
Q

Most common form of carpal instability.

A

DISI (CID).

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48
Q

Scaphoid and lunate deformities in DISI.

A

Scaphoid flexed, lunate extended.

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49
Q

Second most common form of carpal instability.

A

VISI.

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50
Q

Mayfield stages of perilunar disruption.

A
  1. Scapholunate disruption
  2. Scaphocapitate disruption
  3. Lunotriquetral disruption
  4. Circumferential disruption
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51
Q

Major deforming force of small finger CMC fracture-dislocation.

A

ECU

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52
Q

Deforming force of Bennett fractures.

A

APL and adductor pollicis.

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53
Q

This fragment is characteristically kept reduced to trapezium in Bennett fractures.

A

Volar-ulnar base.

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54
Q

This ligament keeps the volar-ulnar thumb MC base reduced to trapezium in Bennett fractures.

A

Anterior oblique or beak ligament.

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55
Q

Gamekeeper’s thumb.

A

Chronic thumb MCP joint ulnar collateral ligament injury.

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56
Q

Competent thumb ulnar collateral ligament needed for this.

A

Pinch.

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57
Q

In a Stener lesion, this is interposed between avulsed MCP joint UCL and its insertion site on base of proximal phalanx.

A

Adductor pollicis aponeurosis.

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58
Q

Dorsal PIP joint dislocation may injure this.

A

Volar plate.

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59
Q

Volar PIP joint dislocation may injure this.

A

Central slip.

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60
Q

Inadequately treated central slip injury will lead to this.

A

Boutonniere deformity.

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61
Q

Splint in this position after PIP joint volar dislocation.

A

Full extension.

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62
Q

Irreducible DIP dislocation are due to interposition of this.

A

Volar plate.

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63
Q

Chronic mallet finger may lead to this deformity

A

Swan neck.

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64
Q

This epynonymous test for acute central slip rupture.

A

Elson’s test.

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65
Q

In boutonneire’s deformity, these sublux volarly.

A

Lateral bands.

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66
Q

Extensor zone V injury here.

A

Over MCP joint.

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67
Q

Extensor Zone IV injury here.

A

Over proximal phalanx.

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68
Q

Extensor zone III injury here.

A

Over PIP joint.

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69
Q

Extensor Zone VI injury here.

A

Over metacarpal.

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70
Q

Extensor Zone VII injury here.

A

Over wrist joint.

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71
Q

Risk of repaired tendon rupture greatest at this time.

A

3 weeks post repair.

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72
Q

Failure of tendon repair generally occurs here.

A

At suture knots.

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73
Q

Zone I flexor tendon injury.

A

FDP avulsion distal to FDS insertion.

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74
Q

Classification of FDP avulsion injuries.

A

Leddy and Packer.
Type I – retraction into palm
Type II – remains in digital sheath, implication that supporting vincula intact
Type III – bony fragment attached to tendon stump stopped at A4 pulley

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75
Q

Location of Zone II flexor tendon injury.

A

Between FDS insertion and distal palmar crease.

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76
Q

location of Zone III flexor tendon injuries.

A

Between distal palmar crease and distal end of carpal tunnel.

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77
Q

Location of Zone IV flexor tendon injuries.

A

Carpal tunnel.

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78
Q

Trigger finger at this pulley.

A

A1.

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79
Q

First line of trigger finger treatment.

A

Corticosteroid injection into A1 pulley.

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80
Q

This first dorsal compartment tendon may have multiple slips.

A

APL

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81
Q

This first dorsal compartment tendon may have its own separate compartment.

A

EPB

82
Q

Intersection syndrome symptoms occur here.

A

4-5 cm proximal to radiocarpal joint.

83
Q

Intersection syndrome occurs at the junction of tendons in these compartments.

A

First (APL/EPB) and second (ECRL/ECRB).

84
Q

Nail plate originates from this.

A

Germinal matrix.

85
Q

Lies directly beneath nail plate and contributes keratin to increase plate thickness.

A

Sterile matrix.

86
Q

Crescent-shaped white structure at junction of sterile and germinal matrices.

A

Lunula.

87
Q

Lies between distal nail bed and skin of fingertip.

A

Hyponichium.

88
Q

Distal margin of the proximal nail fold.

A

Eponychium (cuticle).

89
Q

Lateral margins of the nail fold.

A

Paronychium.

90
Q

2-octylcyanoacrylate.

A

Dermabond.

91
Q

Fingertip injuries without exposed bone.

A

Heal by secondary intention.

92
Q

Dorsal thumb injury best covered with.

A

First dorsal metacarpal artery kite flap.

93
Q

Degree of lengthening from Z-plasty (a) 30 deg, (b) 45 deg, (c) 60 deg.

A

25%, 50%, 75%

94
Q

Viable warm ischemia time for amputated digit.

A

12 hours.

95
Q

Viable cold ischemia time for amputated digit.

A

24 hours.

96
Q

Viable warm ischemia time for amputation proximal to carpus.

A

6 hours.

97
Q

Viable cold ischemia time for amputation proximal to carpus.

A

12 hours.

98
Q

Contraindications to digit replantation (5).

A
  1. Single digit (esp index)
  2. Crush injury
  3. Prolonged ischemia
  4. Segmental amputation
  5. Level of amp within flexor zone II
99
Q

Most common cause of early (12 hrs) replantation failure.

A

Arterial thrombosis from persistent vasospasm.

100
Q

Most common cause of failure after 12 hrs of replant.

A

Venous congestion or thrombosis.

101
Q

Medicinal leeches technical name.

A

Hirudo medicinalis.

102
Q

Medicinal leeches produce this.

A

Hirudin.

103
Q

Leech therapy infection with this.

A

Aeromonas hydorphila.

104
Q

Prophylactic abx with leech therapy.

A

Ceftriaxone or ciprofloxacin.

105
Q

Factor most predictive of digit survival after replantation.

A

Mechanism of injury.

106
Q

Main contributor to superficial palmar arch.

A

Ulnar artery.

107
Q

Main contributor to deep palmar arch.

A

Radial artery.

108
Q

Initial treatment of frostbite.

A

Rapid rewarming in water bath at 40-42 deg C.

109
Q

Surgical debridement or amputation after frostbite done at this time.

A

Delayed.

110
Q

Inability to discern two-point greater than ___ mm is considered abnormal.

A

6 mm

111
Q

Most sensitive carpal tunnel syndrome provacative test.

A

Carpal tunnel compression test.

112
Q

Abnormal distal sensory latencies.

A

More than 3.5 msec

113
Q

Abnormal motor latencies.

A

More than 4.5 msec

114
Q

Courses between the supracondylar process and the medial epicondyle.

A

Ligament of struthers.

115
Q

Supracondylar process best seen on this x-ray.

A

Lateral or elbow or humerus.

116
Q

Differentiates pronator teres syndrome from AIN syndrome.

A

AIN syndrome has no sensory component.

117
Q

Floor of cubital tunnel.

A

MCL and elbow joint capsule.

118
Q

Walls of cubital tunnel.

A

Medial epicondyle and olecranon.

119
Q

Roof of cubital tunnel made up of these (2).

A
  1. FCU fascia

2. Arcuate ligament of osborne

120
Q

Most common cause of ulnar tunnel syndrome.

A

Ganglion cyst.

121
Q

Roof of Guyon canal.

A

Volar carpal ligament.

122
Q

Floor of Guyon canal.

A

Transverse carpal ligament.

123
Q

Radial border of Guyon canal.

A

Hook of hamate.

124
Q

Ulnar border of Guyon canal.

A

Pisiform and abductor digit minimi.

125
Q

Zones of the Ulnar tunnel (3).

A

Zone 1 – proximal to bifurcation of ulnar nerve. Mixed motor/sensory
Zone 2 – deep motor branch. Pure motor symptoms
Zone 3 – distal sensory branches. Pure sensory

126
Q

Sites of compression in PIN compression syndrome (5).

A
  1. fascial band at radial head
  2. recurrent leash of henry
  3. edge of ECRB
  4. arcade of Frohse (proximal edge of supinator)
  5. distal edge of supinator
127
Q

Broad types of thoracic outlet syndrome (2).

A
  1. Vascular

2. Neurogenic

128
Q

Adson test for thoracic outlet syndrome.

A

Patient arm at side, hyperextension of neck, rotate head to affected side. Results in diminished radial artery pulse.

129
Q

Vascular thoracic outet syndrome caused by this.

A

Subclavian vessel compression or aneurysm.

130
Q

Neurogenic thoracic outlet syndrome described as this.

A

Entrapment neuropathy of lower trunk of brachial plexus.

131
Q

Essential for work up of neurogenic thoraic outlet syndrome.

A

Cervical and chest radiographs.

132
Q

Most important prognostic factor for nerve recovery.

A

Age.

133
Q

Wallerian degeneration in these two types of nerve injuries.

A

Axonotmesis and neurotmesis.

134
Q

Brachial plexus injuries at this location have worst prognosis.

A

Preganglionic (nerve root).

135
Q

Most reliable clinical sign of nerve regeneration and recovery after brachial plexus injury.

A

Advancing Tinel sign.

136
Q

Oberlin nerve transfer.

A

Ulnar nerve branch to FCU transfer to musculocutaneous nerve to help restore elbow flexion.

137
Q

Most important predictor of success in upper extremity surgery for CP spasticity.

A

Voluntary muscle control.

138
Q

Thumb in palm deformity in CP is corrected with this (3).

A
  1. Release/lengthening of adductor pollicis, first dorsal interosseous, flexor pollicis brevis, FPL
  2. First webbed space Z-plasty
  3. Tendon transfer to augment thumb extension/abduction
139
Q

Amplitude or muscle excursion is proportional to this when doing tendon transfers.

A

Length of the muscle.

140
Q

These types of muscle transfers are easiest to rehabilitate.

A

Synergistic.

141
Q

This amount of motor strength lost after transfer.

A

One grade of motor strength.

142
Q

Vaughan-Jackson syndrome.

A

Extensor tendon rupture in RA, starting with EDM.

143
Q

Carpus subluxes in these directions in RA (2).

A

Volarly and ulnarly

144
Q

Difference in MCP deformity in juvenile versus adult RA.

A

Adult MCP ulnar deviation. Juvenile RA MCP radial deviation.

145
Q

Eponym for systemic juvenile RA.

A

Still disease.

146
Q

Nail pitting and sausage digits.

A

Psoriatic arthritis.

147
Q

Pencil-in-cup deformity.

A

Psoriatic arthritis.

148
Q

Kienbock disease.

A

Idiopathic osteonecrosis of the lunate.

149
Q

First line of surgical treatment for Kienbock disease.

A

Joint leveling procedure (radial shortening to neutral or ulnar positive).

150
Q

Association exits between Dupuytren’s diseaes and occupation. True or false?

A

False.

151
Q

Predominant cell type in Dupuytren’s fascia.

A

Myofibroblasts.

152
Q

These ligaments are not involved in Dupuytren’s.

A

Cleland.

153
Q

This structure leads to PIP contracture in Dupuytren’s disease.

A

Spiral cord.

154
Q

In Dupuytren’s, the spiral cord puts the neurovascular bundle at risk by displacing it in this direction.

A

Centrally and superficially.

155
Q

Dupuytren’s of the plantar fascia of foot.

A

Ledderhose disease.

156
Q

Dupuytren’s of the penis.

A

Peyronie’s disease.

157
Q

Procedure of choice for Dupuytren’s.

A

Open limited fasciectomy.

158
Q

Hueston test for Dupuytren’s.

A

Inability to place hand flat on tabletop.

159
Q

This procedure for Dupuytren’s no longer favored due to high complication rate.

A

Total palmar fasciectomy.

160
Q

Most common complication after fasciectomy for Dupuytren’s is this.

A

Recurrence.

161
Q

Most common soft tissue mass of the hand and wrist.

A

Ganglion.

162
Q

Most wrist ganglion’s originate from this articulation.

A

Scapholunate.

163
Q

These occur at dorsum of DIP joint in patients with osteoarthritis.

A

Mucous cysts.

164
Q

Second most common soft tissue mass of the hand.

A

Giant cell tumor of tendon sheath.

165
Q

Treatment of giant cell tumor of tendon sheath.

A

Marginal excision.

166
Q

Slow-growing, nontender, multilobulated mass on volar aspect of a digit.

A

Giant cell tumor of tendon sheath.

167
Q

Smooth muscle tumor in finger characterized by pain and cold intolerance.

A

Glomus tumor.

168
Q

Treatment of glomus tumor.

A

Marginal excision.

169
Q

Most common malignancy of the hand.

A

Squamous cell carcinoma.

170
Q

Most common subungual malignancy.

A

Squamous cell carcinoma.

171
Q

Most common metastatic cancer to hand.

A

Lung.

172
Q

Location of paronychia.

A

Eponychium.

173
Q

Location of felon.

A

Pulp space.

174
Q

Herpetic whitlow caused by this.

A

HSV 1

175
Q

Horseshoe abscess is based on communication between flexor tendon sheaths of these fingers.

A

Thumb and small finger.

176
Q

Most common organism in necrotizing fasciitis.

A

Group A beta-hemolytic strep.

177
Q

Limb bud appears during this week of gestation.

A

4th

178
Q

Most congential anomalies occur by this time.

A

The end of embyrogenesis at 8 weeks.

179
Q

This structure mediates proximal to distal growth of limb.

A

Apical ectodermal ridge.

180
Q

This structure mediates anterior to posterior growth of limb.

A

Zone of polarizing activity.

181
Q

Pathway important for anterior to posterior growth.

A

Sonic hedgehog gene.

182
Q

Pathway important for dorsoventral axis growth.

A

Wnt signalling.

183
Q

Most common congenital hand anomaly.

A

Polydactyly.

184
Q

Syndactyly results from failure of this.

A

Apoptosis to separate digits.

185
Q

Pure syndactyly has this inheritance pattern.

A

Autosomal dominant.

186
Q

Most common preaxial polydactyl thumb type.

A

Type IV – duplicated proximal phalanx

187
Q

If duplicate thumbs of equal size, preserve this side.

A

Ulnar thumb to retain ulnar collateral ligament for pinch.

188
Q

Critical structure when evaluating thumb hypoplasia.

A

CMC joint.

189
Q

Determines whether hypoplastic thumb can be reconstructed or requires poliicization.

A

CMC joint.

190
Q

Disruption of the volar ulnar physis of distal radius.

A

Madelung deformity.

191
Q

Implicated tether structure in Madelung deformity.

A

Vickers ligament.

192
Q

Primary restraint to valgus stress within functional elbow ROM.

A

Anterior bundle of medial collateral ligament.

193
Q

Histologic finding in lateral epicondylitis.

A

Angiofibroblastic hyperplasia.

194
Q

Location of partial distal biceps tears.

A

Radial side of tuberosity footprint.

195
Q

Technique for superior strength for distal biceps repair.

A

Endobutton.

196
Q

Risk of single incision technique for distal biceps repair.

A

Neurologic injury (PIN and LABCN).

197
Q

Risk of two incision technique for distal biceps repair.

A

Radioulnar synostosis.

198
Q

Anterior bundle of MCL of elbow inserts here.

A

Sublime tubercle on ulna.

199
Q

Posterolateral elbow rotatory instability caused by this.

A

Incompetence of lateral UCL.

200
Q

Highest stress of elbow MCL on this phase of throwing.

A

Late cocking.

201
Q

Osteophytes here block fulle xtension with valgus extension overload of elbow.

A

Posteromedial olecranon process.

ABOS Part I (16 decks)

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