08-10-2009, 02:30 PM
A 59-year-old woman comes to the clinic complaining of
pain in her hands. She states that her fingers are often
numb and tingling, particularly along her thumb and first
three fingers. The pain sometimes wakes her from her
sleep and requires her to shake her hands until normal
sensation returns. The pain, described as sharp tingling
preceded by numbness, is often worse after knitting, a
hobby she pursues with great vigor. Aside from this pain,
she complains only of mild fatigue and being overweight.
She denies any fevers, chills, visual changes, polyphagia/
polydipsia/polyuria, or other systemic symptoms. Past
medical history is remarkable only for depression, irritable
bowel syndrome (constipation dominant), and high
blood pressure treated with a thiazide diuretic. Physical
examination shows mild wasting of the bilateral thenar
eminences of her palms. Tapping on her wrist increases
the pain, as does prolonged flexion of her wrists. Given
this patient™s presentation, an appropriate test to order
when working up the primary cause of her hand pain is
(A) antinuclear antibody titer
(B) hemoglobin A1c level
© no additional testing necessary
(D) thyroid-stimulating hormone
(E) urine pregnancy test
easy one.........
pain in her hands. She states that her fingers are often
numb and tingling, particularly along her thumb and first
three fingers. The pain sometimes wakes her from her
sleep and requires her to shake her hands until normal
sensation returns. The pain, described as sharp tingling
preceded by numbness, is often worse after knitting, a
hobby she pursues with great vigor. Aside from this pain,
she complains only of mild fatigue and being overweight.
She denies any fevers, chills, visual changes, polyphagia/
polydipsia/polyuria, or other systemic symptoms. Past
medical history is remarkable only for depression, irritable
bowel syndrome (constipation dominant), and high
blood pressure treated with a thiazide diuretic. Physical
examination shows mild wasting of the bilateral thenar
eminences of her palms. Tapping on her wrist increases
the pain, as does prolonged flexion of her wrists. Given
this patient™s presentation, an appropriate test to order
when working up the primary cause of her hand pain is
(A) antinuclear antibody titer
(B) hemoglobin A1c level
© no additional testing necessary
(D) thyroid-stimulating hormone
(E) urine pregnancy test
easy one.........