#february2020mccqe1
A 60-year-old woman is evaluated for wrist pain of 6 months' duration. The pain is located at the base of the right thumb at the wrist. She is a watercolor artist and a graphic designer and is right handed. The pain is described as a persistent ache for which she takes acetaminophen, which provides moderate relief. She has 20 minutes of morning stiffness in the right thumb that improves with a hot shower. On physical examination, vital signs are normal. Examination of her hands shows no soft tissue swelling, warmth, or redness of any hand or wrist joints. Bilateral boney hypertrophy of the proximal interphalangeal joints is present bilaterally. Range of motion of the right thumb is limited by pain. Point tenderness is elicited at the base of the right thumb at the first carpometacarpal joint. Circular movement of her right thumb exacerbates the pain. Tapping the flexor retinaculum does not reproduce or aggravate the pain nor does passively stretching the tendons over the radial styloid. Which of the following is the most likely diagnosis?
(A) Carpal tunnel syndrome
(B) Crystal-induced arthritis
(C) de Quervain tenosynovitis
(D) Osteoarthritis
(E) Rheumatoid arthritis
A 60-year-old woman is evaluated for wrist pain of 6 months' duration. The pain is located at the base of the right thumb at the wrist. She is a watercolor artist and a graphic designer and is right handed. The pain is described as a persistent ache for which she takes acetaminophen, which provides moderate relief. She has 20 minutes of morning stiffness in the right thumb that improves with a hot shower. On physical examination, vital signs are normal. Examination of her hands shows no soft tissue swelling, warmth, or redness of any hand or wrist joints. Bilateral boney hypertrophy of the proximal interphalangeal joints is present bilaterally. Range of motion of the right thumb is limited by pain. Point tenderness is elicited at the base of the right thumb at the first carpometacarpal joint. Circular movement of her right thumb exacerbates the pain. Tapping the flexor retinaculum does not reproduce or aggravate the pain nor does passively stretching the tendons over the radial styloid. Which of the following is the most likely diagnosis?
(A) Carpal tunnel syndrome
(B) Crystal-induced arthritis
(C) de Quervain tenosynovitis
(D) Osteoarthritis
(E) Rheumatoid arthritis
Last edited by a moderator: