Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5211_Библиотеки_им_академика_М_И_Перельмана
.pdf
Hand I Structured SBA
B. Fibroblasts, coagulation, macrophages, cross-
linked collagen
C. Granulocytes, macrophages, fibroblasts, col-
lagen, cross-linked extracellular matrix
D. Macrophages, granulocytes, collagen,
fibroblasts
E. Neutrophils, extracellular matrix cross-
linking, granulocytes, macrophages
24. A 76-year-old female patient sustained a closed
distal radius fracture, which was treated conservatively in a cast for 4 weeks. She presents to her
GP complaining of an inability to use her thumb
properly and with a reduced range of movement
of her thumb. Her GP refers her back to the
fracture clinic for review.
Which of the following thumb movements is
most likely to be impaired in this patient?
A. Abduction
B. Adduction
C. Flexion
D. Opposition
E. Retropulsion
25. A 26-year-old falls and injures her right hand.
There is no bony injury identified on X-ray, but
she is noted to have a lytic lesion at the base of
her middle finger proximal phalanx. The lesion
demonstrates geographic bone destruction, bony
expansion and cortical thinning. The lesion is
asymptomatic.
What is the most appropriate management
plan for this patient?
A. CT scan
B. MRI scan and review
C. Reassurance and discharge
D. Reassurance and observation with serial
radiographs
E. Screening blood tests and chest X-ray
26. You have just repaired a zone II flexor tendon
injury involving both flexor digitorum superficialis and flexor digitorum profundus. You are
now filling in the hand therapy request form
after applying a dorsal splint.
Which of the following post-operative rehabilitation regimens is most appropriate?
A. Early combined passive and active motion at
days 3–5
B. Early full range active flexion
C. Early passive motion at days 3–5
D. Place and hold at 1 week
E. Splint 7 days, then combined passive and
active motion
27. A patient sustained a proximal humeral fracture
that was treated with plating while she was on
holiday in Egypt. Six months later, she now presents with an inability to extend her wrist, fingers
or thumb. Nerve conduction tests have alre ady
been organised by her GP and show no evidence
of function of the affected nerve. She has read on
the Internet about tendon transfers.
Which of the following tendon transfers would
be most app ropriate in this patient?
A. Brachioradialis to flexor pollicis longus
B. Flexor digitorum superficialis to adductor
pollicis
C. Latissimus dorsi to triceps
D. Pronator teres to extensor carpi radialis
brevis
E. Pronator teres to extensor carpi radialis
longus
28. A 36-year-old rugby player sustained a forced
abduction injury to his right dominant thumb
during a match. He attends hand trauma clinic
24 hours later with a bruised and swollen right
thumb, he is tender over the ulnar border of the
MCPJ with a palpable lump over the ulnar side of
the joint. On examining the joint, there is no
firm end point to radial deviation in either full
extension or 20° of flexion.
Which of the following most accurately
describes the most likely anatomical injury?
A. Avulsion of ulnar collateral ligament from
distal insertion
B. Midsubstance ulnar collateral ligament injury
C. Stener lesion
D. Ulnar collateral ligament and volar plate
injury
E.
Volar plate injury
29. You are asked to assess a motorcyclist who was
involved in a serious RTA 2 weeks ago. He has
open fractures to both lower limbs which have
been nailed. He complains of weakness in his left
upper limb. When you examine him, he has
385
Emma Reay
weakness of flexion and extension of his wrist
and fingers including his thumb. He is also
unable to actively pull his arm into his side
against r esistance. He cannot cross his fingers
when asked.
Which is the most likely level of brachial plexus
injury based on the above clinical examination?
A. C5, C6
B. C5, C6, C7
C. C7
D. C7, C8, T1
E. C8, T1
30. A patient presents with a pattern of upper limb
injury suggestive of brachial plexus damage. You
notice that he is unable to fully open his eye on
the ipsilateral side.
At what level within the brachial plexus is this
lesion?
A. Root level
B. Trunk level
C. Division level
D. Cord level
E. Nerve level
31. You are asked to assess a pedal cyclist who fell off
his bicycle 2 weeks ago. At that time, he was
diagnosed with a lower brachial plexus injury
resulting in weakness of his left upper limb. He
has now returned to clinic with pain on active
and passive movement of his shoulder.
What is the most appropriate next step for this
patient?
A. Angiogram left arm
B. CT myelogram
C. MRI cervical spine
D. Nerve conduction testing
E. Shoulder and chest X-rays
32. A 55-year-old male patient presents to your outpa-
tient clinic complaining of pain, swelling and
restricted range of movement of his right dominant wrist. The painoccasionallyoccurs at night and
it is affecting his ability to do his job. He remembers an injury to his wrist as a young man. X-rays
show osteoarthritic change in the radioscaphoid
articulation and the capitoscaphoid articulations.
What is the most appropriate next course of
management?
A. CT scan
B. Four corner fusion
C. Proximal row carpectomy
D. Steroid injection and CT scan
E. Total wrist fusion
33. A 27-year-old cleaner presents to the hand clinic
with an inability to actively extend the distal
interphalangeal joint (DIPJ) of her right middle
finger after changi ng a bed. On examination, she
has mild swelling and bruising over the dorsum
of the DIPJ and an extensor lag of 30°. X-rays
show no bony injury.
What is the most appropriate management
plan in this patient?
A. DIPJ splinting for 4 weeks in extension
B. DIPJ splinting for 6 weeks in extension,
followed by plain radiographs
C. Surgical repair
D. Percutaneous K-wire fixation
E. DIPJ splinting for 6 weeks in extension, then
2 weeks at night only
34. A 30-year-old builder presents with fractures to
the shafts of his 3rd, 4th and 5th metacarpals,
which are closed injuries. There is no rotational
deformity, although it is difficult to examine him
because of pain on flexion of his digits. The
fractures are oblique midshaft comminuted
fractures.
What is the most appropriate management
plan for this patient?
A. Buddy taping and mobilisation
B. Cast immobilisation
C. Moulded thermoplastic splinting
D. MUA and cast immobilisation
E. Operative fixation
35. After sustaining an axial load type injury to their
right ring finger, a 22-year-old factory worker
attends the hand trauma clinic with a painful
proximal interphalangeal joint (PIPJ), and Xrays show a comminuted intra-articular fracture
to the base of their middle phalanx and confirm a
dorsal triangle sign.
What is the most appropriate management for
this patient?
A. Dynamic external fixation
B. Open reduction and internal fixation
386
Hand I Structured SBA
C. Non-operative management with buddy
taping
D. Splinting in flexion
E. Static external fixation
36. A 76-year-old female patient complains of pain
over the radial side of her hand and around her
thumb with an inability to open her hand fully
and decreased grip strength because of pain. She
is unable to knit for more than 10 minutes. Xrays show grade IV changes at both the thumb
CMC joint and the STT joint.
Which other anatomical structure should be
examined during the consultation?
A. IPJ of the thumb
B. Median nerve
C. Radial artery
D. Superficial radial nerve
E. Ulnar nerve
37. A patient returns to clinic 6 months after carpal
tunnel decompression complaining that they
have not felt any improvement in their symptoms post-operatively. They are 89 years old and
had preoperative nerve conduction testing,
which showed severe compression of the median
nerve. They also have evidence of abductor pollicis brevis wasting.
Which is the most important prognostic indicator following carpal tunnel decompression?
A. Age
B. Comorbidities
C. Duration of symptoms
D. Presence of muscle wasting
E. Severity of compression on NCT
38. A 43-year-old sustained a twisting injury to her
wrist when picking up a heavy suitcase while on
holiday 2 weeks ago. She attends the hand trauma
clinic with a painful wrist, and on examination
she has tenderness over the fovea of her ulnar
head and her distal radioulnar joint appears lax.
Which anatomical structure provides most stability to the distal radioulnar joint?
A. Bony anatomy
B. Deep head of pronator quadratus
C. Extensor carpi ulnaris
D. Intraosseous membrane of forearm
E. Triangular fibrocartilage complex
39. A patient presents with functional problems in
her hand after repair of a flexor digitorum profundus avulsion injury of her left middle finger.
She describes being unable to fully flex her index
and ring fingers when she flexes her repaired
middle finger into her palm.
What is the anatomical basis for this
problem?
A. Adhesions within flexor sheath of repaired
middle finger
B. Damage to nerve supply to flexor digitorum
profundus
C. Rupture of flexor digitorum profundus
tendons to index and ring fingers
D. Shared muscle belly of all four flexor digi-
torum profundus tendons
E. Tethering of flexor digitorum profundus
tendons in forearm
40. A 45-year-old factory worker presents with a
long-standing history of a painful wrist that she
localises to the dorsum, worse on extension. Xrays show sclerosis of the lunate, and an MRI
organised by the musculoskeletal service shows
proximal lunate collapse.
What is the most appropriate management
option to discuss with the patient?
A. Immobilisation and rehabilitation
B. Lunate replacement
C. Proximal row carpectomy
D. Radial shortening
E. Vascularised bone graft to lunate
41. A 52-year-old manual worker presents to the ED
after amputating part of his little finger with a
circular saw. On examination, he has a jagged,
dirty wound at the level of the PIPJ. He hand s
you the amputated digit, which he recovered
from the scene. The amputated digit has no
evidence of vessels or nerves on inspection. Xrays show severe comminution of the middle and
distal phalanges of the amputate.
What advice are you going to give him when he
asks what can be done for his finger?
A. Amputation at the level of the MCPJ
B. Ray amputation
C. Replantation
D. Terminalisation
E. Wound debridement and closure in the ED
387
Emma Reay
42. A 52-year-old manual worker presents to the ED
after amputating part of his dominant thumb with
a circular saw. On examination, he has a jagged,
dirty wound at the level of the MCPJ. He hands
you the amputated digit which he recovered from
the scene. The amputated digit has no obvious
vessels or nerves on examination. X-rays show
severe comminution of the proximal and distal
phalanges of the amputated thumb.
What is the most appropriate management of
this patient?
A. Amputation at the level of the MCPJ
B. Ray amputation
C. Replantation
D. Terminalisation
E. Wound debridement and closure in the ED
43. A 45-year-old female patient presents with a
recent history of pain at the tip of her right
middle finger. She als o complains of hypersensitivity to cold stimulus at the tip of the finger. On
examination, a small mass lesion is palpated in
the tip and there is slight discolouration of the
nailbed.
What is the most likely diagnosis?
A. Glomus tumour
B. Malignant melanoma of the nailbed
C. Mucous cyst
D. Osteoid osteoma
E. Pulp abscess
44. A patient who is studying biology at university is
about to undergo carpal tunnel decompression.
They ask you to describe to them the anatomical
structures that can be encountered during the
operation.
Which of the following structures is most at
risk during a carpal tunnel decompression?
A. Deep palmar arch
B. Extra-ligamentous recurrent motor branch of
the median nerve
C. Flexor digitorum superficialis tendons
D. Palmar cutaneous branch of the median
nerve
E. Superficial recurrent motor branch of the
median nerve
little and ring fingers. He has guttering of the
small muscles of the hand and a mild flexible
claw deformity of his little and ring fingers.
Where is the most likely nerve pathology in his
case?
A. Arcade of Struthers
B. Cubital tunnel
C. Exit from flexor carpi ulnaris
D. Guyon’s canal
E. Midforearm
46. An elderly patient undergoes treatment for her
pantrapezial osteoarthritis with a trapeziectomy
through a dorsal approach.
Which anatomical structure is not at risk
through this approach?
A. ECRB tendon
B. EPB tendon
C. Flexor carpi radialis tendon
D. Radial artery
E. Superficial radial nerve branches
47. A patient presents to hand trauma clinic with
pain in his palm after using his palm to knock
down some tent pegs during a recent camping
trip. He has tenderness over his hypothenar eminence and weakness of abductor digiti minimi
and first dorsal interosseous muscle but no sensory loss.
What imaging would be most appropriate?
A. Angiography
B. MRI wrist
C. Nerve conduction testing
D. Ultrasound scan
E. X-ray
48. You have been asked to perform a diagnostic
wrist arthroscopy and are being quizzed about
the best port sites to use.
Which of the following portal sites is the best
for accessing the wrist?
A. 3–4
B. 4–5
C. 6R
D. 6U
E. Radial midcarpal
45. A 76-year-old male patient presents with weak-
ness in his left hand and altered sensation in the
388
49. A chef has sustained a laceration to the dorsum
of her right index finger at the MCPJ level.
Hand I Structured SBA
Which zone of extensor tendon injury is this?
A. Zone I
B. Zone III
C. Zone V
D. Zone VI
E. Zone VIII
50. A 55-year-old patient with severe rheumatoid
deformities in her hands, wrists and elbows has
asked for your advice regarding her surgical
options to improve her function. She has severe
pain in her right elbow and wrist and her right
hand MCP joints.
Which procedure should be performed first in
the sequence of management for her joint
pathology?
A. Elbow replacement
B. Finger MCP joint replacements
C. PIPJ fusions
D. Thumb MCP joint fusion
E. Wrist fusion
51. You are asked to describe the anatomy of the
forearm.
Which of the following descriptions most
accurately describes the forearm musculature?
A. Flexor pollicis longus muscle takes its origin
from the mid ulnar shaft
B. Flexor digitorum profundus muscle is sup-
plied in part by the radial nerve
C. Flexor digitorum superficialis muscle has two
heads
D. Flexor digitorum superficialis tendons to the
index and middle finger are deep to the ring
and little finger tendons
E. Pronator quadratus is supplied by the poster-
ior interosseous nerve
52. A patient presents with painful swollen deformed
distal interphalangeal joints (DIP joint) of both
of his hands with shortened digits. He has pitting
and onycholysis of his nails.
What finding would you not expect to see at Xray?
A. Chondrocalcinosis
B. Interphalangeal ankylosis
C. Joint subluxation
D. ‘Pencil in cup’ appearance of joints
E. Resorption of bone
53. A patient presents to the ED after being bitten by
her cat 3 days ago. She has erythema and swelling
over the palmar surface of her hand and over the
thumb. She has multiple small, healing puncture
wounds. You take her to the operating theatre
and wash the wounds out. Intraoperative microbiology swabs are taken.
What is the most likely organism cultured from
the swabs?
A. Corynebacterium
B. Neisseria
C. Pasteurella
D.
E. Streptococcus
54. A 45-year-old patient presents with altered sen-
sation and tingling in the radial three digits of
her right dominant hand, which she says intermittently also affects the ulnar two digits particularly when she is driving. She is Phalen’s positive
at the wrist and provocation testing for cubital
tunnel syndrome is grossly negative.
What is the most likely explanation for her
symptoms?
A. Diabetes
B. Hypothyroidism
C. Martin–Gruber anastomosis
D. Peripheral neuropathy
E. Ulnar nerve entrapment at elbow
55. A 3-year-old patient comes into clinic after
having a set of scaphoid X-rays performed.
Their mother asks why there aren’
bones on the 3-year-old’s X-rays as there were
on her own scaphoid X-ray.
Which is the last carpal bone to ossify?
A. Capitate
B. Hamate
C. Lunate
D. Pisiform
E. Trapezium
56. A 53-year-old female patient with a history of
diabetes presents with pain over the radial border
of her right dominant wrist. On examination, she
has tender nodularity over her radial styloid and
pain on ulnar deviation of her wrist with her
thumb flexed.
What is the most likely diagnosis?
t as many
389
Emma Reay
A. Base of thumb arthritis
B. De Quervain’s tenosynovitis
C. Flexor carpi radialis tendonitis
D. Intersection syndrome
E. Superficial radial nerve neuroma
57. A 3-year-old child is brought to the hand clinic
after her parents noticed she was unable to fully
extend the IPJ of her left thumb. There has been
no history of injury and she is functioning normally. On exami nation, the IPJ of her left thumb
is fixed in 30° of flexion and you palpate a nodule
in her palm at the base of the digit. What management should you propose?
A. Observation
B. Observation and splinting
C. Thumb A1 pulley release
D. Ultrasound scan of flexor sheath
E. X-ray of thumb
58. A 21-year-old football player has been diagnosed
with an undisplaced scaphoid waist fracture. He
wants to get back to training as soon as possible
and asks for your advice regarding management.
What management option would you suggest?
A. Cast for 6 weeks and CT scan to assess union
B. Cast for 6 weeks and X-ray again
C. Open reduction and internal fixation with
headless compression screw
D. Percutaneous fixation with headless compres-
sion screw
E. Scaphoid plate
60. A 56-year-old female patient prese nts to the
hand clinic with a painful, swollen right ring
finger proximal interphalangeal joint (PIP joint).
The pain occurs at rest and at night, requiring
regular analgesia. On examination, she has an arc
of movement of 10–80°at the PIP joint, and her
radial collateral ligament is lax. She expresses a
wish to maintain as mu ch movement at the joint
as possible to allow her to continue her hobbies.
Radiographs show complete loss of joint space at
the PIPJ level.
What is the most appropriate management
option for this patient?
A. PIP joint fusion
B. PIP joint injection
C. PIP joint pyrocarbon replacement
D. PIP joint silastic replacement
E. Watchful waiting
61. A family is referred to your hand clinic by the
paediatric team. Their baby was born yesterday
with the upper limb difference illustrated in
Figure 18.1. This is their first child and they are
planning to have more children.
Figure 18.1
Clinical picture
hand (Photograph
courtesy of Shriners
Hospital for
Children,
Philadelphia, PA)
59. A 65-year-old patient presents to the fracture clinic
12 weeks after her cast was removed following
conservative treatment of her right distal radius
fracture. Check radiographs show a healing fracture that is well aligned. She is complaining of a
constant burning pain in her wrist. She describes
the skin over her wrist being very sensitive and
swollen. On examination, her wrist is swollen and
red and her skin appears thin and shiny.
What is the most likely incidence of the above
condition, following distal radius fracture?
A. 1%
B. 5%
C. 10%
D. 20%
E. 40%
390
Choose the most appropriate initial management plan from the option s below.
A. Consent for surgical correction
B. Genetic testing
C. Renal ultrasound, echocardiogram and full
blood count
D. Serial splintage and stretching
E. Skeletal survey
Hand I Structured SBA
62. A 2-year-old child is brought to the trauma clinic
having trapped their middle finger in a door.
Their mother is concerned about the fact they
are unable to fully straighten the finger. X-ray
findings are shown in Figure 18.2.
Figure 18.2 Lateral
radiograph middle finger
Involvement of which anatomical structure
must be assumed with this X-ray appearance?
A. Epiphysis of distal phalanx
B. Nail bed
C. Nail plate
D. Terminal extensor tendon
E. Triangular ligament
63. A window cleaner falls from their ladder onto an
outstretched left wrist sustaining the following
injury (Figure 18.3).
Which surgical approach will give you th e best
exposure to repair the damaged structures?
A. 2nd and 3rd extensor compartment splitting
approach
B. 3rd and 4th extensor compartment splitting
approach
C. Radial approach
D. Ulnar approach
E. Volar approach through carpal tunnel
Figure 18.3
Anteroposterior
(AP) radiograph
wrist
thumb base and an adducted thumb metacarpal
with tender thumb carpo-metacarpal joint and
scaphotrapeziotrapezoidal joint (STTJ). You
choose to perform the gold-standard surgery
for this pathology.
To prevent the most common cause of persistent post-operative pain, which of these manoeuvres should be performed intraoperatively?
A. Excise the scaphotrapezoidal joint
B. Perform a metacarpal suspension-plasty
C. Perform a tendon interposition
D. Stabilise the thumb metacarpophalangeal joint
E. Use a volar approach
65. A patient presents with a long-standing history
of the lesion pictured (Figure 18.4). Pressure to
the area elicits exquisite pain.
Which of the following statements is correct?
A. Marginal excision is curative
B. Mean age at presentation is 60 years
C. The patient is likely to have presented with
heat intolerance
D. The recurrence rate following surgical exci-
sion is 50%
E. Tourniquet inflation increases pain
64. A 65-year-old recently retired lecturer presents
to your clinic with pain at the thumb base and
reduced grip strength. They have squaring of the
66. A 47-year-old scaffolder presents with an 8month history of wrist pain which is not relieved
with painkillers and is now keeping them awake
391
Emma Reay
Figure 18.4 Photograph of left index finger
at night. On examination there is swelling over
the dorsum of the wrist with restricted extension
but preserved flexion. Radiographs are shown in
Figure 18.5.
What is the most appropriate surgical treatment option?
A. Proximal row carpectomy
B. Radial shortening
C. Radiocarpal fusion
D. Ulnar lengthening
E. Vascularised bone grafting
67. A 69-year-old alcoholic patient presents with
problems related to their right hand. On examination, there is a thickening and pitting of the
skin, and the little finger is held in an adducted
position.
The structure most likely to be involved is:
A. Commissural band
B. Grayson ligament
C. Lateral digital sheet
D. Natatory band
E. Pretendinous band
Figure 18.5 (a) AP radiograph and (b) lateral radiograph wrist
392
Hand I Structured SBA
68. A patient with anterior interosseous nerve
(AIN) palsy due to entrapment at the tendinous
edge of the deep head of pronator teres will
have all the following except:
A. Intact sensation at base of thenar eminence
B. Normal pronation strength with the elbows
fully flexed
C. Weakness of flexion to the index finger DIPJ
D. Weakness of flexion of the DIPJ of the
middle/long finger
E. Weakness of flexion of the IPJ of the thumb
69. A 72-year-old patient caught the tip of the right
middle finger in a circular saw sustaining loss of
the tip of the volar surface of the finger with a
1cm skin defect without expos ed bone.
Which of the following treatments is most
appropriate?
A. Advancement flap
B. Pedicled flap
C. Primary closure
D. Split skin grafting
E. Toilet and dressing
70. A farmer presents to hand trauma clin ic with a
painful blister on the right index finger. There is
no history of injury but they have been very busy
with lambing season. The clinical picture of the
finger is illustrated in Figure 18.6.
Which of the following management plans is
most appropriate for this condition?
A. Acyclovir
B. Biopsy
C. Flucloxacillin
D. Surgical excision
E. Watchful waiting
71. An otherwise healthy 50-year-old left hand-
dominant man has a fixed deformity as is shown
in Figure 18.7. Examination reveals a thickened
cord.
Figure 18.7 Clinical picture hand
Which of the following would be the procedure
of choice with regards to treatment?
A. Dermofasciectomy and skin graft
B. Fusion of the PIP joint
C. Needle fasciotomy
D. No treatment is necessary
E. Partial fasciectomy
Figure 18.6 Photograph of right index finger
393
Emma Reay
HAND I STRUCTURED SBA ANSWERS
1. Answer C. Perform urgent fasciotomies of the
hand
Compartment syndrome of the hand is a rare but
functionally devastating condition and is often
more difficult to diagnose in the hand because
of the number of differential diagnoses that can
cause similar symptoms. The history suggests a
prolonged period of compression on the left
upper limb combined with the clin ical findings
of pain not controlled with adequate analgesia
and pain on passive stretch of the tendons passing through the hand. Emergent treatment in the
form of formal hand fasciotomies is required to
preserve muscle tissue.
2. Answer D. Fusiform swelling, flexor surface
tenderness, pain on passive extension and semi
flexed position
The clinical pictu re points to a diagnosis of flexor
sheath infection (pyogenic flexor tenosynovitis);
the four signs described in the correct answer are
collectively known as Kanavel’s signs and indicate the need for emergency treatment. The findings described in answer E suggest a potential
deep space infection rather than pyogenic flexor
tenosynovitis.
3. Answer D. Flucloxacillin
The most common organism isolated in flexor
sheath infection is Staphylococcus aureus, which
will respond well to flucloxacillin.
4. Answer A. MUA and carpal tunnel decompres-
sion on next available list
A perilunate dislocation must be reduced emergently in the presence of carpal tunnel symptoms. The ideal situation would be an MUA in
theatre to reduce the perilunate dislocation and
to allow for carpal tunnel decompression.
Scaphoid fixation can be performed on a less
emergent basis if the skill set of the admitting
general trauma team allows. The Tavernier
closed technique for reducing a perilunate dislocation involves hyper-extending the wrist to
accentuate the deformity while applying traction
to the hand. Place the thumb on the lunate to
stabilise it and then bring the hand into flexion.
This will allow the capitate head to seat itself
back into the lunate. Closed reduction of a perilunate dislocation often fails, as the lunate has
breached the volar wrist capsular structures and
is unreducible without opening the carpal tunnel.
5. Answer A. Flexor digitorum profundus tendons
and pronator quadratus
A flexor sheath infection within the flexor pollicis longus bursa can communicate proximally
into the potential space of Parona. The potential
space of Parona occurs in the palm between the
FDP sheath and pronator quadratus muscle.
6. Answer D. Peak latency delay of median nerve
sensory nerve action potential (SNAP)
Nerve conduction testing in mild carpal tunnel
syndrome, as described by the clinical scenario in
the question, is controversial. When reviewing
nerve conduction results for mild to moderate
compression, often the only finding is a slight
delay in the peak latency of the sensory nerve
action potential. The motor parameters are not
usually affected in mild to moderate compression, and needle EMG is rarely performed. If
needle EMG is performed, fibrillation potentials
and positive sharp waves are late signs. In 25% of
those presenting with mild carpal tunnel symptoms and signs, the study is normal.
7. Answer C. The condition occurs sporadically
with no known cause
This is an example of a severe radial longitudinal
deficiency, which can be associated with a
number of other syndromes such as TAR,
VACTERL or VATER. As yet, we do not know
the cause, and in the majority of cases there is no
genetic predisposition. It is believed to be an
abnormality of the sonic hedgehog protein or
an abnormality within the zone of polarising
activity (ZPA) which causes the underdevelopment of the radial side of the hand and forearm.
In some rare cases, it has been passed genetically
in autosomal recessive or autosomal dominant
forms.
8. Answer C. The symptoms are due to nerve
compression by the tendinous edge of pronator
teres
394
Соседние файлы в папке Библиотека им академика М.И. Перельмана