MCQs – Adult Pathology – Single Best Answer

A 68-year-old woman presents with a history of pain in the region of her thumb. This is her radiograph (Fig. 1). 1. Describe the radiograph. What is the diagnosis? Answer: The radiograph of the wrist shows evidence of decreased joint space and subchondral sclerosis of the joints between the scaphoid, the trapezium and the trapezoid. The diagnosis is arthritis of the scapho-trapezio-trapezoid (STT) joint. 2. What are the causes of this condition? Answer: The causes of STT arthritis are age-related osteoarthritis, post-traumatic arthritis (including STT arthritis post-scaphoid ORIF), abnormal trapezio-trapezoidal inclination, capitotrapezial ligament laxity and rotatory subluxation. 3. What is the treatment for this condition? Answer: Non-operative treatment options include rest, splinting, hand therapy, oral anti-inflammatory medication, and intra-articular steroid injection. Surgical options for ongoing symptoms will depend on the extent of symptoms, arthritis and the age and functional demands of the patient. The options include excision arthroplasty, interposition arthroplasty (using tendon or pyrocarbon implant) and arthrodesis. The latter is preferred in the young active patient as it is more likely to result in a stable thumb for high power manual work. Arthrodesis provides a stable column across the carpus and is a definitive operation to deal with 1. Which of the following statements regarding spinal tumours is false? Answer: a. About 15% of all bone tumours are primary spine tumours. Bone tumours can be benign or malignant. They can also be classified as primary (arising from the bone) or secondary (metastases from different sites). Secondary bone tumours make up the vast majority of all bone tumours. Therefore 15% is a significantly greater percentage than the expected figure for primary spinal tumours.1