A 32-Year-Old Right-Hand-Dominant Woman Living in New Hampshire Comes to the Physician

question 327

Multiple Choice

A 32-year-old right-hand-dominant woman living in New Hampshire comes to the physician complaining of right wrist pain for the past 3 months.  She has no history of tick bites, recent travel, or illness in the family.  Review of systems is negative for fever, pain or swelling in any other joints, skin rash, or recent gastrointestinal or genitourinary infections.  The patient is sexually active in a monogamous relationship.  She delivered her first child 4 months ago.  She smokes marijuana occasionally.
Her temperature is 37.2° C (99° F) , blood pressure is 110/78 mm Hg, pulse is 78/min, and respirations are 12/min.  She weighs 80 kg (176 lb) .  There is a sharp tenderness on palpation of the radial styloid at the wrist.  The pain is aggravated on ulnar deviation of the wrist after she is asked to make a fist over the thumb.  There is no synovitis or tenderness noted on any other joints.  The right hand x-ray is shown below.

Which of the following is the most likely diagnosis?

• A)Carpal tunnel syndrome
• B)de Quervain's tenosynovitis
• C)Gonorrheal arthritis
• D)Lyme arthritis
• E)Osteoarthritis of the first carpometacarpal joint

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Definitions:

Corporate Deviance

Behaviors by companies or their representatives that do not conform to societal expectations or norms, often involving unethical or illegal activities.

High Position

A status or role that ranks above others in terms of authority, responsibility, or hierarchical order.

Prestige

A measure of high status or respect gained by achievements or quality of character, often associated with a certain position or profession.

Sky-high Compensation

Extremely high or excessive payment or remuneration, often discussed in the context of executive pay or legal settlements.