Hand Infections — MCQs
Which of the following is true about tenosynovitis of the finger?
Which of the following disorders would be more likely associated with Staphylococcus saprophyticus rather than Staphylococcus aureus?
What specific hand abnormalities are associated with Marfan syndrome?
Test for De-quervain's tenovaginitis -
Most common route of infection in pasteurella cellulitis -
A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
Erysipeloid is transmitted by which route?
Most common mode of transmission of nosocomial infection is -
What is the most common complication of a felon?
What is the most common route of transmission for Toxoplasma gondii in adults?
Hand Infections Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is true about tenosynovitis of the finger?
- A. Treatment is conservative.
- B. Fingers held in mild extension / Extension deformity at the involved fingers.
- C. With involvement of little finger the infection can spread to the ring finger.
- D. Tenosynovitis of little finger will spread to thumb rather than ring finger. (Correct Answer)
Explanation: ***Tenosynovitis of little finger will spread to thumb rather than ring finger.*** - The **little finger's flexor tendon sheath** connects directly to the **ulnar bursa**, which communicates with the **radial bursa** (thumb's sheath) in approximately **80% of individuals** through the space of Parona. - This **bursal communication** creates a direct pathway for infection spread from the little finger to the thumb, making it the most common route of propagation in flexor tenosynovitis. *With involvement of little finger the infection can spread to the ring finger.* - While anatomically possible through **fascial plane connections**, direct spread to the ring finger is **less common** than spread to the thumb via established bursal pathways. - The **ulnar bursa-radial bursa connection** provides a more direct and frequently utilized route for infection propagation than lateral spread to adjacent digits. *Treatment is conservative.* - **Purulent flexor tenosynovitis** requires urgent **surgical incision and drainage** to prevent irreversible tendon damage and loss of function. - Conservative treatment with antibiotics alone is inadequate for established infections and may lead to **tendon necrosis** and permanent disability. *Fingers held in mild extension / Extension deformity at the involved fingers.* - Patients with tenosynovitis characteristically hold the affected finger in **mild flexion** as part of **Kanavel's four cardinal signs**. - **Extension** of the finger causes severe pain due to stretching of the inflamed tendon sheath, so patients avoid this position naturally.
Question 2: Which of the following disorders would be more likely associated with Staphylococcus saprophyticus rather than Staphylococcus aureus?
- A. Burns
- B. Tension pneumothorax
- C. Osteomyelitis
- D. Acute cystitis (Correct Answer)
Explanation: ***Acute cystitis*** - **Staphylococcus saprophyticus** is a common cause of **urinary tract infections (UTIs)**, particularly acute cystitis, in young sexually active women. - This bacterium has a high affinity for **uroepithelial cells**, facilitating its colonization and subsequent infection of the bladder. *Tension pneumothorax* - A **tension pneumothorax** is a medical emergency characterized by air accumulation in the pleural space, leading to lung collapse and mediastinal shift. - It is typically caused by trauma or iatrogenic factors, not directly by bacterial infection from either *Staphylococcus saprophyticus* or *Staphylococcus aureus*. *Burns* - Burn wounds are highly susceptible to bacterial colonization and infection, with **Staphylococcus aureus** being a primary pathogen in this context. - *Staphylococcus saprophyticus* is rarely associated with burn wound infections. *Osteomyelitis* - **Osteomyelitis**, an infection of the bone, is most frequently caused by **Staphylococcus aureus** via hematogenous spread or direct inoculation. - *Staphylococcus saprophyticus* is not a common pathogen in osteomyelitis.
Question 3: What specific hand abnormalities are associated with Marfan syndrome?
- A. Brachydactyly
- B. Clinodactyly
- C. Syndactyly
- D. Arachnodactyly (Correct Answer)
Explanation: ***Arachnodactyly*** - This term refers to **long, slender fingers and toes**, resembling a spider's appendages, which is a classic musculoskeletal manifestation of **Marfan syndrome**. - It results from the generalized connective tissue disorder affecting the deposition of **fibrillin-1**, leading to excessive bone growth. *Syndactyly* - This condition involves the **fusion of adjacent digits**, either soft tissue or bone, rather than unusually long fingers. - It is typically a congenital anomaly not specifically associated with Marfan syndrome. *Clinodactyly* - This describes the **curving or deviation of a digit**, usually the fifth finger, due to an abnormally shaped bone [1]. - While a digital anomaly, it is not a hallmark feature of Marfan syndrome, which is characterized by digit length. *Brachydactyly* - This condition is characterized by **unusually short fingers and toes**, which is the opposite of the digital characteristic seen in Marfan syndrome. - It can be a feature of various genetic disorders but not Marfan syndrome.
Question 4: Test for De-quervain's tenovaginitis -
- A. Phalen test
- B. Cozen test
- C. Kanavel's sign
- D. Finkelstein test (Correct Answer)
Explanation: ***Finkelstein test*** - The **Finkelstein test** is performed to diagnose **De Quervain's tenosynovitis**, which involves inflammation of the **abductor pollicis longus** and **extensor pollicis brevis** tendons. - The test involves making a fist with the thumb tucked inside the fingers, followed by **ulnar deviation** of the wrist. Pain along the **radial styloid** is a positive sign. *Phalen test* - The **Phalen test** is used to diagnose **carpal tunnel syndrome**, which is compression of the **median nerve**. - This test involves holding the wrists in maximal **flexion** for 30-60 seconds, which exacerbates median nerve symptoms like **numbness** and **tingling**. *Cozen test* - The **Cozen test** is used to diagnose **lateral epicondylitis**, also known as "tennis elbow." - It involves resisted **wrist extension** and **radial deviation** with the elbow extended, causing pain at the **lateral epicondyle**. *Kanavel's sign* - **Kanavel's signs** (pain on passive extension, uniform swelling, flexed posture of digit, tenderness along the tendon sheath) are clinical indicators for **flexor tenosynovitis** in the hand. - These signs suggest a severe infection of the **flexor tendon sheath**, requiring urgent surgical intervention.
Question 5: Most common route of infection in pasteurella cellulitis -
- A. Animal bites or scratches (Correct Answer)
- B. Aerosols or dust
- C. Contaminated tissue
- D. Human to human
Explanation: ***Animal bites or scratches*** - *Pasteurella multocida* is a common commensal bacterium in the oral flora of **cats and dogs**. - **Animal bites or scratches** are the primary mode of transmission for *Pasteurella* infections, particularly cellulitis, due to direct inoculation. *Aerosols or dust* - Transmission via **aerosols or dust** is rare for *Pasteurella* infections, which typically require direct contact or inoculation. - While other bacteria can spread this way, *Pasteurella* cellulitis is not commonly acquired through airborne routes. *Contaminated tissue* - While possible in some contexts, **contaminated tissue** is not the most common route of infection for *Pasteurella* cellulitis. - Direct inoculation from an **animal's oral flora** is far more frequent than contact with contaminated environmental tissues. *Human to human* - *Pasteurella* infections are generally **not transmissible from human to human**. - The organism is primarily associated with animals and their bites or scratches.
Question 6: A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?
- A. Azithromycin 1g orally as single dose
- B. Benzathine penicillin G 2.4 million units IM
- C. Acyclovir 400mg orally TID for 7-10 days (Correct Answer)
- D. Doxycycline 100mg orally BID for 14 days
Explanation: Acyclovir 400mg orally TID for 7-10 days - The patient's presentation with painful genital ulcers and vesicles, fever, malaise, and tender inguinal lymphadenopathy is highly suggestive of primary herpes simplex virus (HSV) infection [1]. - Acyclovir is an antiviral medication that effectively reduces the duration and severity of symptoms in primary HSV outbreaks [1]. Azithromycin 1g orally as single dose - Azithromycin is primarily used to treat bacterial infections, particularly chlamydia and gonorrhea, which typically present with urethritis or cervicitis, not painful vesicles. - It is ineffective against viral infections such as HSV. Benzathine penicillin G 2.4 million units IM - Benzathine penicillin G is the treatment of choice for syphilis, which causes a painless chancre in its primary stage, not painful vesicles. - This antibiotic has no efficacy against HSV. Doxycycline 100mg orally BID for 14 days - Doxycycline is an antibiotic used for various bacterial infections, including chlamydia, lymphogranuloma venereum, and granuloma inguinale [1]. - These conditions typically present with different clinical features (e.g., painless ulcers, buboes) and not the vesicular rash seen in HSV.
Question 7: Erysipeloid is transmitted by which route?
- A. Droplet
- B. Mosquito bite
- C. Fecal-oral
- D. Direct contact (Correct Answer)
Explanation: ***Direct contact*** - Erysipeloid, caused by *Erysipelothrix rhusiopathiae*, is transmitted through direct contact with **infected animal products**, especially fish, shellfish, and raw meat. - The bacteria typically enter through a **break in the skin**, such as a cut or abrasion, making occupational exposure common among butchers and fishmongers. *Droplet* - **Droplet transmission** involves the spread of respiratory droplets through coughing or sneezing, which is characteristic of airborne diseases like influenza. - Erysipeloid is primarily a **skin infection** and is not transmitted via the respiratory route. *Mosquito bite* - **Mosquito bites** are vectors for diseases like malaria, dengue, and West Nile virus, where the pathogen is injected directly into the bloodstream. - Erysipeloid is a bacterial infection acquired through **skin contact with contaminated materials**, not insect vectors. *Fecal-oral* - The **fecal-oral route** involves ingesting pathogens from contaminated food or water, often associated with gastrointestinal infections like cholera or giardiasis. - Erysipeloid is a **cutaneous infection** and does not involve the gastrointestinal tract as its primary mode of transmission.
Question 8: Most common mode of transmission of nosocomial infection is -
- A. Hand contact (Correct Answer)
- B. Droplet infection
- C. Blood and blood products
- D. Contaminated water
Explanation: ***Hand contact*** - **Direct contact** with healthcare workers' contaminated hands is the primary way pathogens are transferred between patients in a healthcare setting. - Failure to perform adequate **hand hygiene** between patient contacts is the single most important factor contributing to nosocomial infection transmission. *Droplet infection* - While droplet transmission can cause nosocomial infections, especially for respiratory viruses, it is not the most common mode of transmission for the overall burden of healthcare-associated infections. - **Droplets** usually travel short distances and deposit on mucous membranes of the nose, mouth, or eyes of a susceptible host. *Blood and blood products* - Transmission through **blood and blood products** is a significant concern for specific infections (e.g., HIV, hepatitis B/C), but the incidence is relatively low due to stringent screening and safety protocols. - This mode accounts for a small fraction of overall nosocomial infections compared to contact transmission. *Contaminated water* - **Contaminated water** can lead to outbreaks (e.g., *Legionella*, *Pseudomonas*), especially in immunocompromised patients, but it is not the most frequent mode of transmission on a day-to-day basis across all types of nosocomial infections. - Healthcare facilities implement measures to ensure water safety, limiting this as the primary route.
Question 9: What is the most common complication of a felon?
- A. Osteomyelitis (Correct Answer)
- B. Subungual hematoma
- C. Infective arthritis
- D. No complications
Explanation: ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.
Question 10: What is the most common route of transmission for Toxoplasma gondii in adults?
- A. Transmission through blood transfusion
- B. Ingestion of undercooked meat containing tissue cysts (Correct Answer)
- C. Congenital transmission from mother to fetus
- D. Fecal-oral transmission via contaminated cat feces
Explanation: ***Ingestion of undercooked meat containing tissue cysts*** - Consuming **undercooked or raw meat** (especially pork and lamb) containing **tissue cysts (bradyzoites)** is the **most common route** of *Toxoplasma gondii* transmission in adults in most countries - These cysts are highly resistant and survive digestion, releasing bradyzoites that cause systemic infection - This accounts for **30-63%** of infections in various populations *Fecal-oral transmission via contaminated cat feces* - Contact with **oocysts** from cat feces (in litter boxes, contaminated soil/water) is an important route - However, it's less common than meat consumption in most developed countries - Oocysts require 1-5 days to sporulate and become infective *Transmission through blood transfusion* - **Rare route** - tachyzoites have short survival in stored blood - Modern screening practices have made this extremely uncommon - Not a significant transmission route in general populations *Congenital transmission from mother to fetus* - Occurs when **primary maternal infection** happens during pregnancy - Important clinically but represents a small proportion of total infections - Does not apply to adult acquisition of infection
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free