Question of the Week # 58, 59

Q58) A 30 year old man comes to your office with complaints of pain in both the wrists and in the hands for the past two months. The pain is particularly worse in the nights and awakens him from sleep. It radiates to the forearms from the wrists.  Occassionally, the pain is associated with abnormal sensations in both hands.  He denies any pain or paresthesiae at this time. Upon further questioning, he also reports some mild stiffness & very mild pain in the neck in the past two weeks. Physical Examination is normal. The most appropriate initial investigation is:

A. Nerve conduction studies

B. Plain X-ray of the wrist

C. Plain X-ray of the cervical spine

D. Rheumatoid factor

E. MRI cervical spine

Q59) The most likely underlying etiology of this patient’s clinical features is :

A. Spinal cord compression

B. Brachial plexopathy

C. Rheumatoid arthritis

D. Hypothyroidism

E. Cervical Spondylosis

12 Responses

  1. answer is cand c

  2. hypothyroidism and nerve coduction study

  3. cande

  4. c
    c

  5. c and e

  6. c and a

  7. c and b

  8. e, b

  9. A, C

    A. Clinical features are consistent with Carpal tunnel syndrome (CTS)

    C. CTS can occur with RA. Stiffness in the neck will serve as a clue for possible early RA. Though Hypothyroidism can cause CTS, the patient in the question does not have any clinical history suggestive of Hypothyroidism.

    • I think that this clinical scenario –Dr you have a very good unrealistically uncommon presentation of CTS —

  10. A and C

  11. Wow, thought this was Rheumatoid for sure.

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