10 exam-style questions with answers and explanations, straight from our 1,050-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The HSE exam has 175 questions and runs 4 hours.
These 10 free HSE questions are organized by exam domain, so you can see how each part of the Hand Surgery Exam blueprint is tested. Reveal the answer and explanation under each question.
A 4-year-old catches his fingertip in a door. Radiographs show a transverse fracture through the physis of the distal phalanx with slight dorsal angulation. The nail plate is avulsed and sitting on top of the eponychial fold, and the DIP rests in flexion with no active extension of the tip. What is the MOST appropriate management?
Correct answer: A - Operative irrigation, removal of interposed matrix, and nail bed repair
Four hours after closed reduction and splinting of a displaced distal radius fracture, a 58-year-old woman reports numbness in the thumb, index, and long fingers that has become progressively worse since the reduction. She now describes severe, burning pain unrelieved by elevation. What is the MOST appropriate next step?
Correct answer: A - Urgent carpal tunnel release with stabilization of the fracture
A 24-year-old man falls on an outstretched hand. CT confirms a nondisplaced scaphoid fracture. Which fracture location carries the HIGHEST risk of avascular necrosis, and why?
Correct answer: A - The proximal pole, because its intraosseous blood supply runs retrograde
A 27-year-old laborer has a spiral fracture of the ring finger metacarpal shaft. Radiographs show 3 mm of shortening and 8 degrees of apex-dorsal angulation. On composite flexion, the ring finger crosses over the long finger. Which finding MOST strongly indicates operative fixation?
Correct answer: D - The scissoring of the digit demonstrated on composite flexion
A 31-year-old skier has pain and instability at the thumb MCP joint. Stress testing in 30 degrees of flexion shows 40 degrees of radial deviation with no firm endpoint. A small, mobile mass is palpable at the proximal ulnar aspect of the joint. Why does this injury require operative repair rather than immobilization?
Correct answer: D - The adductor aponeurosis has become interposed at the ligament insertion
A 62-year-old man has Stage III scapholunate advanced collapse (SLAC) wrist with pain and preserved motion. He wishes to retain wrist motion. Which finding on preoperative assessment would MOST strongly contraindicate proximal row carpectomy?
Correct answer: D - Full-thickness cartilage loss on the proximal capitate head
A 29-year-old man dislocates his index finger MCP joint. The digit rests in slight extension with radial deviation, and there is puckering of the palmar skin at the distal palmar crease. Two attempts at longitudinal traction in the emergency department have failed. What accounts for the irreducibility?
Correct answer: B - The volar plate has become interposed within the MCP joint space
A 35-year-old falls from a ladder. PA radiographs of the wrist show disruption of Gilula's arcs and a triangular lunate. The lateral view shows the lunate rotated volarly and displaced out of the radial fossa, with the capitate lying dorsally. He reports worsening numbness across the volar thumb and index finger. Which stage of progressive perilunar instability is this, and what is the urgent concern?
Correct answer: B - Stage IV; lunate dislocation with acute median nerve compression
Two patients have ulnar nerve compression. Patient A has a lesion at the cubital tunnel; Patient B has a lesion within Guyon's canal at the wrist. Both have intrinsic weakness. Compared with Patient B, Patient A's ring and small fingers demonstrate LESS clawing. What explains this?
Correct answer: B - Proximal lesions also denervate the FDP to the ring and small fingers
A 46-year-old has hand numbness. Nerve conduction studies show an unexpectedly high compound muscle action potential amplitude when stimulating the median nerve at the elbow compared with the wrist, alongside apparent ulnar findings that do not fit the clinical picture. Which anatomic variant MOST likely accounts for this discrepancy?
Correct answer: A - Martin-Gruber anastomosis in the proximal forearm
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