Peripheral Nerve Injuries MCQs

Orthopedics · 44 free questions with answers & explanations.

1. A 25-year-old with a stab wound to the axilla presents with inability to abduct the shoulder beyond 30°, loss of sensation over the lateral aspect of the upper arm, and weakness of deltoid. The nerve injured is:
2. A nerve injury in which the axon and myelin sheath are disrupted but the endoneurium is intact is classified by Seddon's classification as:
3. Seddon classified peripheral nerve injuries into three types. A Sunderland Grade 4 injury is equivalent to which Seddon classification and has what surgical implication?
4. A 35-year-old presents with wrist drop, inability to extend fingers, and loss of sensation over the first dorsal web space. Radial nerve palsy at the spiral groove (Saturday night palsy) typically spares which muscle, distinguishing it from a higher radial nerve lesion?
5. A 30-year-old sustains an injury to the median nerve at the wrist (carpal tunnel level). Which muscle is NOT affected in a pure median nerve lesion at the wrist (as opposed to the elbow)?
6. In a tibial nerve injury at the ankle (tarsal tunnel syndrome), the characteristic sensory loss is in the:
7. In Sunderland's classification of nerve injuries, the distinction between Grade III and Grade IV injury is:
8. A patient with a posterior interosseous nerve (PIN) palsy will have which clinical pattern?
9. Tinel's sign, used in monitoring nerve regeneration after injury, represents:
10. In Sunderland classification of nerve injuries, the key distinction between Grade 3 (neurotmesis of endoneurium) and Grade 4 (damage to perineurium) injuries is:
11. A 30-year-old man sustains a humeral shaft fracture and develops wrist drop. At 3 months, nerve conduction studies show no fibrillation potentials and nascent motor units are beginning to appear on EMG. This suggests:
12. Wartenberg's sign is a clinical test associated with which nerve injury, and what does it indicate?
13. A 25-year-old man has a complete radial nerve injury at the spiral groove of the humerus following a humeral shaft fracture. After 18 months, there is no recovery. Electromyography shows denervation potentials with no reinnervation in the extensor digitorum communis. Nerve grafting is no longer feasible. Which is the MOST appropriate reconstructive option to restore wrist and digit extension?
14. A 30-year-old man has cubital tunnel syndrome with clawing of the ring and little fingers. On examination, there is loss of the first web space bulk (first dorsal interosseous wasting), positive Froment's sign, and sensory loss over the medial one and a half fingers. Which test specifically demonstrates the inability to extend the ring and little finger PIP joints when MCP joints are held extended (Bouvier's test negative)?
15. In Sunderland's classification of nerve injuries, a Grade 4 injury is characterised by which pathological finding and expected clinical outcome?
16. A patient with anterior hip dislocation presents with weakness of hip flexion and inability to extend the knee, with sensory loss over the anterior thigh and medial leg. Which nerve injury does this pattern suggest?
17. Tinel's sign in the assessment of peripheral nerve regeneration is interpreted in which specific manner to track regenerating axons?
18. In Sunderland's classification of nerve injuries, Grade IV injury is characterized by:
19. A patient with radial nerve palsy following a Holstein-Lewis fracture (middle-third/distal-third humeral shaft junction spiral fracture) is most likely to have which nerve involvement?
20. A 25-year-old sustains a deep laceration at the wrist and is unable to flex the interphalangeal joint of the thumb (FPL) and the distal phalanx of the index and middle fingers (FDP to index). Which nerve is injured and at which fascicular zone?
21. Sunderland's classification of nerve injuries has five grades. Which grade corresponds to disruption of axon and endoneurium but intact perineurium, and what is the expected recovery pattern?
22. A 35-year-old sustains a posterior dislocation of the hip in an RTA. Immediately after reduction, he develops wasting of the gluteus maximus, sensory loss over the posterior thigh, and inability to dorsiflex the ankle. Which nerve is injured and what is the most likely mechanism?
23. A 28-year-old man sustains a mid-shaft humeral fracture and presents with wrist drop. Radial nerve injury is suspected. The fracture is managed conservatively. At 8 weeks follow-up, electromyography (EMG) shows fibrillation potentials and positive sharp waves in brachioradialis and extensor carpi radialis longus but no voluntary motor units. What is the most likely Seddon classification of this injury and the expected prognosis?
24. In a Wallerian degeneration injury, which histological change occurs in the proximal nerve stump that is essential for successful nerve regeneration?
25. Sunderland's classification of peripheral nerve injuries divides injuries into 5 degrees. A Sunderland Grade III injury involves:
26. Tinel's sign in nerve regeneration progresses distally at approximately 1 mm per day. If a radial nerve injury occurs at the spiral groove (15 cm proximal to the extensor digitorum communis motor end-plate), the minimum expected time to appearance of early voluntary reinnervation of EDC (ignoring neuromuscular junction reformation time) is approximately:
27. A 22-year-old man sustains a deep laceration at the wrist dividing the median nerve. At 6 weeks post-repair, which electrodiagnostic finding would MOST reliably indicate early axonal regeneration?
28. Following a humeral shaft fracture, a patient develops wrist drop and loss of finger extension. Sensation is intact over the dorsum of the hand. The nerve injured and its expected prognosis by Sunderland classification are:
29. Wartenberg's sign, Froment's sign, and a positive intrinsic tightness test are all positive in a patient with ulnar nerve palsy at the elbow. Which specific test differentiates intrinsic tightness from extrinsic (FDP/joint capsule) tightness in the ring finger?
30. A Seddon-classified neurapraxia (Sunderland Grade I) differs from axonotmesis (Sunderland Grade II) in which critical aspect that determines clinical management?
31. A patient with a radial nerve palsy after a mid-shaft humeral fracture managed conservatively is assessed at 12 weeks. Motor assessment uses the MRC scale. An MRC grade 3 for wrist extension indicates:
32. Following a closed humeral shaft fracture, a patient develops wrist drop (radial nerve palsy). The clinical feature that most strongly indicates the nerve injury is a neurapraxia (Sunderland grade I) rather than a more severe axonotmesis or neurotmesis is:
33. In a patient with high median nerve injury at the elbow level (e.g., after a supracondylar fracture), the classic deformity of the hand includes inability to flex the index and middle fingers at the DIP joints, with flexion preserved at ring and little fingers. This deformity is called:
34. According to Sunderland's classification of peripheral nerve injuries, a Grade 4 injury is distinguished from Grade 3 by:
35. A patient undergoes nerve repair 2 months after a sharp median nerve laceration at the wrist. The expected rate of nerve regeneration distally, and the clinical test to assess recovery progress is:
36. A 28-year-old man sustains a gunshot wound to the axilla. EMG at 4 weeks shows fibrillations in the biceps but normal SNAP (sensory nerve action potential) in the musculocutaneous nerve territory. The Seddon/Sunderland classification implied is:
37. A 20-year-old woman with anterior shoulder dislocation has persistent wasting and weakness of the deltoid and loss of sensation over the 'regimental badge' area 6 weeks post reduction. The nerve injured is:
38. A 28-year-old sustains a mid-shaft humerus fracture in a road traffic accident. One month later, electrodiagnostic studies show absent sensory nerve action potentials and fibrillation potentials in the radial nerve territory. What is the Seddon classification of this injury and what does the electrodiagnostic pattern indicate?
39. Tinel's sign in peripheral nerve injuries is defined as tingling sensations elicited by tapping along the course of a regenerating nerve. Its progressive distal migration after nerve injury or repair indicates:
40. A patient with a radial nerve injury at the spiral groove of the humerus will have loss of:
41. Sunderland Grade V nerve injury is equivalent to Seddon's classification of neurotmesis. What histologically defines it?
42. Tinel's sign is used clinically to track nerve regeneration. It is elicited by:
43. A 25-year-old man sustains a mid-shaft humeral fracture and develops radial nerve palsy. At 3 months, there is no clinical recovery and nerve conduction studies show absent voluntary motor units in the extensor compartment. The most appropriate next step is:
44. In Seddon's classification of nerve injuries, the term 'axonotmesis' is characterized by which features?