MCQ bank · 10 questions · free
Orthopaedics & hand MCQs with answers
10 single-best-answer questions on hip fracture, scaphoid, septic arthritis, hand infections and children’s fractures. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
An 84-year-old has a hip fracture after a fall. When should surgery be performed?
- On the day of admission or the day after (within about 36 hours), with orthogeriatric care
- Only if pain persists after 2 weeks
- Conservative management for all patients over 80
- After 1 week of bed rest
- After 6 weeks
Show the answer and explanation
Answer: A. On the day of admission or the day after (within about 36 hours), with orthogeriatric care. Early surgery for hip fracture reduces complications and mortality and allows early mobilisation. Delays should be only for correctable medical problems. Orthogeriatric input, nerve blocks for pain, and early mobilisation are key parts of care.
Why not the others? Prolonged bed rest causes pneumonia, pressure ulcers, VTE and loss of independence.
References
A 79-year-old who walks independently with no cognitive impairment has a displaced intracapsular (subcapital) fracture of the femoral neck. What is the recommended operation?
- Conservative treatment
- Arthroplasty (total hip replacement for suitable, active patients, or hemiarthroplasty)
- Intramedullary nail
- Plaster cast
- Internal fixation with screws
Show the answer and explanation
Answer: B. Arthroplasty (total hip replacement for suitable, active patients, or hemiarthroplasty). Displaced intracapsular fractures disrupt the blood supply to the femoral head, leading to avascular necrosis and non-union after fixation. Arthroplasty is recommended; total hip replacement is offered to patients who were independently mobile and are fit. Extracapsular fractures are fixed instead.
Why not the others? Undisplaced intracapsular fractures may be fixed.
References
After a fall onto an outstretched hand, a 22-year-old has tenderness in the anatomical snuffbox. Wrist and scaphoid X-rays are normal. What is the next step?
- Repeat X-ray in 6 months
- Steroid injection
- Physiotherapy only
- Immobilise the wrist and arrange MRI (or CT if MRI is not available)
- Reassure and discharge without follow-up
Show the answer and explanation
Answer: D. Immobilise the wrist and arrange MRI (or CT if MRI is not available). Scaphoid fractures are often not visible on initial X-rays. Missed fractures can lead to non-union and avascular necrosis because the blood supply enters distally. NICE recommends MRI as first-line further imaging if the X-ray is normal and suspicion remains.
Why not the others? Untreated scaphoid fractures can cause long-term wrist arthritis.
References
A 65-year-old has an acutely hot, swollen, painful knee with fever and cannot bear weight. What is the most important first step?
- Physiotherapy
- Antibiotics first without any samples
- Aspirate the joint for Gram stain, culture and crystals before starting antibiotics, take blood cultures, then start intravenous antibiotics and arrange washout if septic
- Steroid injection into the joint
- NSAIDs and review next week
Show the answer and explanation
Answer: C. Aspirate the joint for Gram stain, culture and crystals before starting antibiotics, take blood cultures, then start intravenous antibiotics and arrange washout if septic. A hot, swollen joint is septic arthritis until proven otherwise, because it can destroy cartilage within days. Joint aspiration before antibiotics confirms the organism. Septic joints need repeated aspiration or surgical washout. Gout and pseudogout can mimic it and can coexist.
Why not the others? Injecting steroid into an infected joint is dangerous.
References
Two days after a small puncture wound, a man’s index finger is uniformly swollen, held slightly flexed, tender along the flexor sheath, and very painful on passive extension. What is the diagnosis and treatment?
- Gout; colchicine
- Sprain; strapping
- Simple cellulitis; oral antibiotics at home
- Ganglion; reassurance
- Pyogenic flexor tenosynovitis (Kanavel’s signs); urgent hand surgery review for washout of the sheath, with intravenous antibiotics
Show the answer and explanation
Answer: E. Pyogenic flexor tenosynovitis (Kanavel’s signs); urgent hand surgery review for washout of the sheath, with intravenous antibiotics. Kanavel’s signs (fusiform swelling, flexed posture, tenderness along the sheath, pain on passive extension) indicate infection within the tendon sheath. Without urgent drainage, the tendon can necrose and the infection can spread to the palm and forearm, causing permanent stiffness.
Why not the others? Early cases may be managed with intravenous antibiotics under close hand surgery review.
References
A 7-year-old has a displaced supracondylar fracture of the humerus after a fall. The hand is warm and pink, but the radial pulse cannot be felt. What is the management?
- Discharge home
- Elevate the arm above the head for 2 days
- Leave in a cast and review in 2 weeks
- Wait for the pulse to return before any treatment
- Urgent closed reduction and stabilisation (usually K-wires), then reassess perfusion; explore the artery if the hand remains poorly perfused
Show the answer and explanation
Answer: E. Urgent closed reduction and stabilisation (usually K-wires), then reassess perfusion; explore the artery if the hand remains poorly perfused. Supracondylar fractures can injure the brachial artery and median, radial or ulnar nerves. A pink pulseless hand needs urgent reduction, which often restores the pulse. A white pulseless hand is an emergency needing immediate reduction and vascular exploration. Neurovascular status must be recorded before and after.
Why not the others? Missed compartment syndrome can lead to Volkmann’s ischaemic contracture.
References
A 30-year-old twisted his ankle playing football. Which finding means an ankle X-ray is needed under the Ottawa ankle rules?
- Any bruising
- All ankle injuries need X-ray
- Bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps both immediately and in the emergency department
- Pain on the top of the foot only, with normal walking
- Any swelling at all
Show the answer and explanation
Answer: C. Bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps both immediately and in the emergency department. The Ottawa ankle rules identify patients who need X-rays, reducing unnecessary imaging while maintaining high sensitivity for fractures. Separate criteria apply to the midfoot (tenderness at the base of the fifth metatarsal or the navicular).
Why not the others? Swelling and bruising alone are not part of the rules.
References
A 42-year-old felt a “kick” in the back of the heel while playing football. Squeezing the calf with the patient prone does not plantarflex the foot. Which statement about treatment is correct?
- Immobilise in full dorsiflexion
- Surgery is always mandatory
- Achilles tendon rupture: non-operative treatment with functional rehabilitation gives outcomes similar to surgery for many patients, with fewer wound complications
- Steroid injection into the tendon
- No treatment needed
Show the answer and explanation
Answer: C. Achilles tendon rupture: non-operative treatment with functional rehabilitation gives outcomes similar to surgery for many patients, with fewer wound complications. A positive Simmonds (Thompson) test suggests Achilles rupture. Recent trials found similar functional results with non-operative treatment (equinus boot and early functional rehabilitation) and surgery. Surgery has a slightly lower re-rupture risk but more complications; the choice is shared.
Why not the others? Steroid injections into the tendon increase rupture risk.
References
A painter accidentally injected paint into his index finger with a high-pressure spray gun. The finger has only a small puncture wound and mild pain. What is the management?
- Elevation and review in 1 week
- Apply ice and discharge
- Clean and dress the wound and discharge
- Urgent referral for surgical exploration and debridement, despite the small wound
- Oral antibiotics only
Show the answer and explanation
Answer: D. Urgent referral for surgical exploration and debridement, despite the small wound. High-pressure injection injuries look trivial but force material along tissue planes, causing chemical inflammation, ischaemia and infection. Delay increases the risk of amputation, especially with oil-based paints and solvents. Urgent surgical debridement is needed.
Why not the others? The small entry wound is misleading.
References
A 6-year-old has fever, refuses to bear weight and has point tenderness over the distal femur. X-ray is normal. What is the management?
- Physiotherapy
- Wait for X-ray changes before treating
- Suspected acute haematogenous osteomyelitis: blood cultures, inflammatory markers, MRI, and prompt intravenous antibiotics covering Staphylococcus aureus (and Kingella in young children)
- Steroids
- Discharge with analgesia
Show the answer and explanation
Answer: C. Suspected acute haematogenous osteomyelitis: blood cultures, inflammatory markers, MRI, and prompt intravenous antibiotics covering Staphylococcus aureus (and Kingella in young children). X-ray changes appear only after 10–14 days, so a normal X-ray does not exclude osteomyelitis. MRI is the most sensitive test. Early antibiotics often avoid surgery; abscesses or associated septic arthritis need drainage. Short intravenous courses followed by oral antibiotics are usual.
Why not the others? Waiting for X-ray changes allows bone destruction.
References