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1. General Principles & Basic Science MCQs

Practice Set 159 of 789

This practice set contains high-yield board review questions covering key concepts in 1. General Principles & Basic Science. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 3161

Topic: Infection, Pharmacology & VTE

A 70-year-old patient with a known history of severe tophaceous gout is scheduled for surgical debulking of a large, symptomatic tophus on the dorsal aspect of his wrist that is causing significant functional impairment. He is currently experiencing an acute gout flare in his knee, with severe pain and swelling, and his serum uric acid (SUA) is 11 mg/dL. He also has a history of poorly controlled diabetes and is on warfarin for atrial fibrillation. Which of the following factors represents the MOST significant contraindication to proceeding with elective surgical intervention at this time?

. A. History of poorly controlled diabetes
. B. Use of warfarin for atrial fibrillation
. C. Acute gout flare and uncontrolled hyperuricemia
. D. Age of the patient (70 years old)
. E. Location of the tophus on the dorsal wrist

Correct Answer & Explanation

. C. Acute gout flare and uncontrolled hyperuricemia

Explanation

Correct Answer: CThe teaching case explicitly lists 'Acute Gout Flare' and 'Uncontrolled Hyperuricemia' as contraindications for surgical intervention. 'Surgical intervention is generally contraindicated during an acute inflammatory flare. Surgery can exacerbate the inflammatory response and potentially trigger a new flare. Medical management (NSAIDs, colchicine, corticosteroids) should be optimized to quiescent the inflammation before elective surgery.' Additionally, 'elective surgical intervention should ideally be deferred until serum uric acid (SUA) levels are adequately controlled... High SUA levels increase the risk of post-operative flares and continued crystal deposition.' The patient's acute knee flare and SUA of 11 mg/dL clearly fall under these contraindications.Option A is incorrect:While poorly controlled diabetes is a significant medical comorbidity that increases surgical risk, it is listed as a 'Significant Medical Comorbidity' that requires thorough pre-operative workup and risk-benefit analysis, rather than an absolute contraindication that would immediately halt an elective procedure if other factors were optimized.Option B is incorrect:Warfarin use indicates a coagulopathy, which is a contraindication if uncorrected, due to increased risk of hematoma. However, coagulopathies can often be managed pre-operatively (e.g., bridging therapy) to mitigate risk. The acute flare and uncontrolled hyperuricemia are more direct and absolute contraindications for elective surgery in this context.Option D is incorrect:While advanced age (70 years old) is associated with increased comorbidities and surgical risk, it is not an absolute contraindication in itself. Many elderly patients undergo successful elective surgeries after appropriate medical clearance.Option E is incorrect:The location of the tophus on the dorsal wrist does not represent a contraindication to surgery; rather, it is the site of the pathology requiring intervention.

Question 3162

Topic: Infection, Pharmacology & VTE

A 78-year-old female with a history of chronic tophaceous gout in her hands undergoes surgical debulking of a large tophus on her left middle finger. The procedure is uneventful. Post-operatively, the patient is placed in a protective splint. During the rehabilitation phase, the hand therapist emphasizes early and aggressive mobilization. Which of the following is the MOST critical aspect of long-term post-operative management to prevent recurrence of tophi and progressive joint destruction?

. A. Prolonged immobilization to protect the surgical site
. B. High-dose NSAIDs for pain management
. C. Strict adherence to urate-lowering therapy (ULT)
. D. Aggressive passive range of motion exercises immediately post-op
. E. Surgical revision for any residual tophaceous material

Correct Answer & Explanation

. C. Strict adherence to urate-lowering therapy (ULT)

Explanation

Correct Answer: CThe teaching case explicitly states under 'Advanced Phase' of rehabilitation: 'Medical Management Reinforcement: Crucial to emphasize continued adherence to urate-lowering therapy and regular follow-up with the rheumatologist to prevent future flares and crystal deposition. This is paramount to surgical success and long-term joint health.' ULT is the cornerstone of preventing recurrence and progression of gout.Option A is incorrect:While initial protection with a splint is necessary, prolonged immobilization is a risk factor for joint stiffness and reduced range of motion, as mentioned in the complications section. Early, guided mobilization is crucial for rehabilitation.Option B is incorrect:High-dose NSAIDs are used for acute flare management, but their long-term use is often limited by side effects, especially in the elderly with comorbidities like renal impairment. They are not the primary strategy for preventing tophi recurrence.Option D is incorrect:Aggressive passive range of motion exercises immediately post-op can jeopardize wound healing and surgical repairs, especially if tendon or joint capsule repairs were performed. Rehabilitation progresses gradually from protected AROM to PROM.Option E is incorrect:While revision surgery for symptomatic residual tophi may be considered, it is not the primary long-term management strategy for prevention. The goal is to prevent new tophi formation and dissolve existing ones through medical management.

Question 3163

Topic: Infection, Pharmacology & VTE
A 62-year-old male presents with acute, severe pain and swelling in his right wrist and multiple MCP joints. He has a history of hyperuricemia but has never been formally diagnosed with gout. His symptoms are accompanied by warmth and erythema. Given the inflammatory nature of his presentation, the orthopedic surgeon considers a differential diagnosis that includes septic arthritis, rheumatoid arthritis, and calcium pyrophosphate deposition disease (CPPD), in addition to gout. An arthrocentesis is performed on the most inflamed MCP joint. The synovial fluid analysis reveals a WBC count of 75,000 cells/mm³ with 92% neutrophils. Gram stain is negative. Which of the following additional findings from the synovial fluid analysis, as shown in the image, would definitively confirm a diagnosis of gout and rule out the other inflammatory conditions?
. A. Presence of positively birefringent, rhomboid-shaped crystals
. B. Identification of negatively birefringent, needle-shaped crystals
. C. Absence of bacteria on culture
. D. Low synovial fluid glucose level
. E. High synovial fluid lactate level

Correct Answer & Explanation

. B. Identification of negatively birefringent, needle-shaped crystals

Explanation

Synovial fluid analysis using polarized light microscopy is the gold standard for definitive diagnosis. Identification of negatively birefringent, needle-shaped MSU crystals definitively confirms gout and differentiates it from septic arthritis, CPPD (which has positively birefringent crystals), and rheumatoid arthritis.

Question 3164

Topic: 1. General Principles & Basic Science

A 60-year-old man presents with an acute, severely painful, erythematous, and swollen proximal interphalangeal (PIP) joint. Joint aspiration is performed. Under polarized light microscopy, which of the following findings is diagnostic of the most likely condition?

. Positively birefringent rhomboid-shaped crystals
. Negatively birefringent needle-shaped crystals
. Positively birefringent needle-shaped crystals
. Negatively birefringent rhomboid-shaped crystals
. Gram-negative diplococci

Correct Answer & Explanation

. Negatively birefringent needle-shaped crystals

Explanation

Gout is caused by monosodium urate crystal deposition, which appear as negatively birefringent needle-shaped crystals under polarized light. Pseudogout features positively birefringent rhomboid-shaped calcium pyrophosphate crystals.

Question 3165

Topic: Infection, Pharmacology & VTE

A 24-year-old male presents with a small laceration over the dorsum of the 3rd metacarpophalangeal (MCP) joint sustained during an altercation.

What is the most appropriate initial management and empiric antibiotic of choice?

. Primary closure and oral clindamycin
. Primary closure and oral ciprofloxacin
. Incision, drainage, wound left open, and amoxicillin-clavulanate
. Incision, drainage, delayed primary closure, and cephalexin
. Wound irrigation, primary closure, and IV vancomycin

Correct Answer & Explanation

. Incision, drainage, wound left open, and amoxicillin-clavulanate

Explanation

Human bite wounds ("fight bites") over the MCP joint carry a high risk of deep space infection and septic arthritis. They require formal surgical exploration, irrigation, being left open to heal by secondary intention, and amoxicillin-clavulanate to cover Eikenella corrodens and other oral flora.

Question 3166

Topic: 1. General Principles & Basic Science

A 60-year-old man with a history of hypertension presents with acute, severe, erythematous swelling of his right index proximal interphalangeal (PIP) joint. Aspiration of the joint is performed. Which of the following crystallographic findings on polarized light microscopy confirms the most likely diagnosis?

. Rhomboid-shaped, positively birefringent crystals
. Needle-shaped, positively birefringent crystals
. Needle-shaped, negatively birefringent crystals
. Rhomboid-shaped, negatively birefringent crystals
. Bipyramidal-shaped, non-birefringent crystals

Correct Answer & Explanation

. Needle-shaped, negatively birefringent crystals

Explanation

The patient is experiencing an acute gout flare. Monosodium urate crystals are classically needle-shaped and exhibit strong negative birefringence under polarized light microscopy.

Question 3167

Topic: Infection, Pharmacology & VTE

A 45-year-old avid aquarist presents with an indolent, slowly enlarging erythematous nodule on his hand. Biopsy reveals noncaseating granulomatous inflammation. Acid-fast bacilli cultures grown at 30 degrees Celsius (86 degrees Fahrenheit) are positive. Which of the following is the most appropriate initial treatment?

. Intravenous Vancomycin and Ceftriaxone
. Oral Amoxicillin-clavulanate
. Oral Clarithromycin and Ethambutol
. Topical Terbinafine
. Emergent surgical amputation of the digit

Correct Answer & Explanation

. Oral Clarithromycin and Ethambutol

Explanation

The clinical scenario is classic for Mycobacterium marinum (fish tank granuloma), which grows optimally at 30 degrees Celsius. Treatment involves prolonged dual antibiotic therapy, typically with clarithromycin and ethambutol, or rifampin.

Question 3168

Topic: Infection, Pharmacology & VTE

A 65-year-old man with end-stage renal disease on hemodialysis presents with an acute, excruciatingly painful, red, and swollen right thumb interphalangeal joint. Joint aspiration confirms the presence of negatively birefringent needle-shaped crystals. Given his comorbidities, which of the following is the safest and most appropriate acute pharmacologic management?

. Oral Indomethacin
. Oral Colchicine
. Intra-articular or systemic corticosteroids
. Initiation of oral Allopurinol
. Intravenous Ketorolac

Correct Answer & Explanation

. Intra-articular or systemic corticosteroids

Explanation

In a patient with severe renal impairment, NSAIDs and colchicine are heavily contraindicated due to the risk of toxicity and acute renal failure. Intra-articular or systemic corticosteroids are the safest treatment for an acute gout flare in this setting.

Question 3169

Topic: 1. General Principles & Basic Science
A 65-year-old male presents with acute, severe pain and swelling in his left index finger distal interphalangeal (DIP) joint. Aspiration yields cloudy fluid. Microscopic analysis under polarized light reveals needle-shaped crystals with strong negative birefringence. What is the primary molecular driver of the severe inflammatory response seen in this condition?
. Activation of the NLRP3 inflammasome by monosodium urate crystals
. Activation of the alternate complement pathway by calcium pyrophosphate
. Direct bacterial stimulation of Toll-like receptor 4
. Autoantibody deposition in the synovial membrane
. Deposition of basic calcium phosphate crystals leading to cartilage degradation

Correct Answer & Explanation

. Activation of the NLRP3 inflammasome by monosodium urate crystals

Explanation

The patient has acute gout (monosodium urate crystals). The crystals are phagocytized by macrophages, which triggers the NLRP3 inflammasome, leading to the activation and massive release of Interleukin-1 beta (IL-1β), causing severe acute inflammation.

Question 3170

Topic: Surgical Anatomy & Approaches

In the surgical treatment of a severe purulent infection of the radial bursa extending into the ulnar bursa, the surgeon must drain a 'horseshoe abscess.' Through which anatomical structure do these two bursae communicate in the distal forearm?

. Midpalmar space
. Thenar space
. Parona's space
. Space of Poirier
. Quadrangular space

Correct Answer & Explanation

. Parona's space

Explanation

The radial bursa (housing the FPL tendon) and the ulnar bursa (housing the flexor tendons of the small digit) communicate proximally in the distal forearm via Parona's space. This space is located deep to the flexor digitorum profundus tendons and superficial to the pronator quadratus.

Question 3171

Topic: Infection, Pharmacology & VTE

A 55-year-old male with chronic kidney disease stage IV presents with a swollen, erythematous, and exquisitely painful right thumb interphalangeal joint. Aspiration confirms acute gout. Which of the following is the most appropriate initial medical management?

. Oral indomethacin 50 mg TID
. Oral colchicine 1.2 mg followed by 0.6 mg in 1 hour
. Initiation of oral allopurinol 100 mg daily
. Intra-articular injection of a corticosteroid
. Intravenous vancomycin and ceftriaxone

Correct Answer & Explanation

. Intra-articular injection of a corticosteroid

Explanation

In a patient with severe chronic kidney disease, NSAIDs (indomethacin) and colchicine are contraindicated or carry high toxicity risks. An intra-articular corticosteroid injection (or systemic steroids if multiple joints are involved) is the safest and most effective acute treatment.

Question 3172

Topic: 1. General Principles & Basic Science

A 60-year-old male presents with an acutely painful, swollen right index finger distal interphalangeal (DIP) joint. Radiographs show periarticular punched-out erosions with overhanging edges. Aspiration of the joint reveals crystals. Under polarized light microscopy, what are the expected characteristics of these crystals?

. Rhomboid-shaped, positively birefringent
. Needle-shaped, negatively birefringent
. Bipyramidal-shaped, non-birefringent
. Rhomboid-shaped, negatively birefringent
. Needle-shaped, positively birefringent

Correct Answer & Explanation

. Needle-shaped, negatively birefringent

Explanation

The clinical and radiographic presentation (Martel sign) indicates an acute gout flare. Gout is caused by the deposition of monosodium urate crystals, which classically appear needle-shaped and strongly negatively birefringent under polarized light.

Question 3173

Topic: Infection, Pharmacology & VTE

A 65-year-old male with end-stage renal disease on hemodialysis presents with an acute, severe gout flare in his left wrist. He has a history of severe, recurrent peptic ulcer disease with gastrointestinal bleeding. Which of the following is the most appropriate initial pharmacological treatment?

. Oral indomethacin
. Oral colchicine
. Allopurinol
. Intra-articular corticosteroid injection
. Probenecid

Correct Answer & Explanation

. Intra-articular corticosteroid injection

Explanation

In patients with severe renal impairment (ESRD), systemic colchicine is contraindicated. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also contraindicated given his severe GI bleeding history. An intra-articular corticosteroid injection provides safe, targeted, and rapid relief.

Question 3174

Topic: Infection, Pharmacology & VTE

A 40-year-old aquarist presents with a 4-week history of multiple nodular, erythematous lesions ascending in a sporotrichoid pattern along the lymphatic drainage of his right forearm. The lesions began after a minor abrasion sustained while cleaning a fish tank and have been unresponsive to oral cephalexin. Which of the following organisms is the most likely etiology?

. Sporothrix schenckii
. Pasteurella multocida
. Staphylococcus aureus
. Mycobacterium marinum
. Vibrio vulnificus

Correct Answer & Explanation

. Mycobacterium marinum

Explanation

Mycobacterium marinum is an atypical mycobacterium found in fresh and saltwater environments, classically causing 'fish tank granuloma' with lymphatic spread. It is inherently resistant to typical beta-lactam antibiotics and is effectively treated with prolonged courses of clarithromycin, ethambutol, or rifampin.

Question 3175

Topic: Infection, Pharmacology & VTE

A 40-year-old patient presents with a lumbrical plus deformity of the ring finger, significantly impacting her ability to perform daily tasks. After a trial of hand therapy, the deformity persists. The surgeon is considering surgical intervention. According to the case, which of the following is an absolute contraindication to surgical intervention for this condition?

. Mild, intermittent pain that is managed with NSAIDs.
. The patient's desire for a non-invasive approach, despite significant functional impairment.
. A dynamic deformity that improves with active-assistive exercises.
. Active infection in the surgical field.
. Unrealistic patient expectations regarding the timeline for recovery.

Correct Answer & Explanation

. Active infection in the surgical field.

Explanation

Correct Answer: DExplanation:The case outlines both indications and contraindications for surgical intervention. Under 'Contraindications for Surgical Intervention', it explicitly states: 'Any active infection in the surgical field is an absolute contraindication to elective hand surgery until adequately treated.'Option A (Mild, intermittent pain): This falls under non-operative management criteria ('Mild to moderate pain managed with NSAIDs, activity modification, splinting') and is not an absolute contraindication.Option B (Patient's desire for non-invasive approach): While patient preference is a factor, it's listed as a reason for non-operative management, not an absolute contraindication. The question asks for anabsolutecontraindication.Option C (Dynamic deformity that improves with active-assistive exercises): This describes a mild deformity that is likely to respond to conservative management and would typically not warrant surgery, but it is not an absolute contraindication if surgery were otherwise indicated.Option E (Unrealistic patient expectations): This is listed as a contraindication, but it is generally considered a relative contraindication that can be addressed through thorough patient education, rather than an absolute one that completely precludes surgery.

Question 3176

Topic: Surgical Anatomy & Approaches

A 50-year-old patient presents with a recurrent lumbrical plus deformity after a previous lumbrical tenotomy. Intraoperative assessment confirms significant over-tensioning of the flexor digitorum profundus (FDP) tendon as the primary underlying cause. The surgeon decides to perform an FDP lengthening procedure. Which of the following statements accurately describes this technique and its implications?

. FDP lengthening is the primary surgical approach for all lumbrical plus deformities, as it directly addresses the FDP-lumbrical imbalance.
. The procedure involves a transverse incision of the FDP tendon, followed by direct end-to-end repair with a gap to achieve lengthening.
. FDP lengthening is typically performed via a Z-plasty in the mid-palmar or forearm region, aiming to achieve appropriate tension without causing a quadriga effect.
. This technique carries a lower risk of adhesions and a faster recovery compared to simple lumbrical tenotomy.
. The ideal tension for the lengthened FDP is achieved when the digit can passively extend completely, and the repaired FDP allows adjacent digits to flex prematurely.

Correct Answer & Explanation

. FDP lengthening is typically performed via a Z-plasty in the mid-palmar or forearm region, aiming to achieve appropriate tension without causing a quadriga effect.

Explanation

Correct Answer: CExplanation:The case provides specific details regarding FDP lengthening:Option C (Correct): The case states: 'Expose the FDP tendon well, typically in the mid-palmar or forearm region to gain sufficient length for a Z-plasty... Perform a Z-lengthening of the FDP tendon... The ideal tension is achieved when the affected digit can passively extend completely while maintaining a normal resting cascade, and can actively flex without paradoxical extension. A useful clinical test is to ensure the repaired FDP tendon allows the digit to passively extend fully without causing adjacent digits to flex prematurely (quadriga effect).' The image provided could represent such a Z-lengthening.Option A (Incorrect): The case states that 'simple lumbrical tenotomy... is the most effective and least morbid surgical intervention for established lumbrical plus deformity.' FDP lengthening is 'generally reserved for cases where... The primary etiology is clearly demonstrated to be iatrogenic overtensioning of the FDP tendon... or a simple lumbrical tenotomy has failed.'Option B (Incorrect): FDP lengthening is typically performed via a Z-plasty (longitudinal incision with a Z-shape or step-cut), not a simple transverse incision with a gap, which would be less stable and prone to gapping.Option D (Incorrect): The case explicitly states that FDP lengthening is 'More extensive surgery, longer recovery, higher risk of adhesions, and potential for flexor weakness if over-lengthened.' This contradicts the statement.Option E (Incorrect): The ideal tension ensures the digit can passively extend completelywithout causing adjacent digits to flex prematurely (quadriga effect). The option incorrectly states that it allows adjacent digits to flex prematurely.

Question 3177

Topic: Surgical Anatomy & Approaches

A hand surgeon is reviewing the literature on lumbrical plus deformity to prepare for a complex case. The literature consistently emphasizes the standard surgical approach and its rationale. Which of the following statements accurately reflects the consensus in current hand surgery literature regarding the primary surgical intervention for established lumbrical plus deformity?

. FDP lengthening via Z-plasty is the preferred initial procedure due to its ability to directly address the underlying tendon tension.
. Lumbrical advancement or recession is favored to preserve some lumbrical function, despite being technically more demanding.
. Simple lumbrical tenotomy at its origin from the FDP tendon is the most effective and least morbid intervention, with functional loss generally well-compensated.
. Extensor digitorum communis (EDC) tendon transfer to the FDP is the standard to rebalance the flexor-extensor mechanism.
. Arthrodesis of the PIP and DIP joints is often necessary to eliminate the paradoxical extension and restore functional stability.

Correct Answer & Explanation

. Simple lumbrical tenotomy at its origin from the FDP tendon is the most effective and least morbid intervention, with functional loss generally well-compensated.

Explanation

Correct Answer: CExplanation:The 'Summary of Key Literature / Guidelines' section clearly outlines the standard surgical approach:Option C (Correct): The case states: 'The overwhelming consensus in current hand surgery literature is that simple lumbrical tenotomy at its origin from the FDP tendon is the most effective and least morbid surgical intervention for established lumbrical plus deformity... The loss of a single lumbrical's specific function is generally well-compensated by other intrinsic muscles, and the functional gain from improved FDP excursion is significant.'Option A (Incorrect): FDP lengthening is described as 'a more involved procedure and is generally reserved for cases where... The primary etiology is clearly demonstrated to be iatrogenic overtensioning of the FDP tendon... or a simple lumbrical tenotomy has failed.' It is not the preferred initial procedure for all cases.Option B (Incorrect): Lumbrical advancement/recession is described as 'Less commonly performed as the primary solution for established lumbrical plus' and 'Technically more demanding, higher risk of recurrence.'Option D (Incorrect): EDC tendon transfer to the FDP is not mentioned as a standard treatment for lumbrical plus deformity.Option E (Incorrect): Arthrodesis is a joint fusion procedure, typically reserved for severe, painful arthritis or instability, not for correcting a dynamic tendon imbalance like lumbrical plus. The goal is to restore motion, not eliminate it.

Question 3178

Topic: 1. General Principles & Basic Science

Question 9

A hand surgeon is preparing to excise a small, deep-seated mass in the digital pulp, which is suspected to be an epidermal inclusion cyst. The area is densely packed with neurovascular structures. The case emphasizes specific tools and techniques for precise dissection. The use of surgical loupes (2.5x to 4.5x magnification) is highly recommended, if not mandatory, for all hand mass excisions primarily because it:

. A. Significantly reduces the overall operative time by speeding up dissection.
. B. Decreases the need for a bloodless surgical field, as structures are easier to see through blood.
. C. Enhances visualization of small nerves, vessels, and the true margins of the mass, significantly reducing iatrogenic injury.
. D. Allows for wider skin incisions, improving overall exposure without additional risk.
. E. Eliminates the need for a pneumatic tourniquet, improving patient comfort.

Correct Answer & Explanation

. C. Enhances visualization of small nerves, vessels, and the true margins of the mass, significantly reducing iatrogenic injury.

Explanation

Correct Answer: CThe case states under 'Patient Positioning and Setup': 'Magnification: Use of surgical loupes (2.5x to 4.5x magnification) is highly recommended, if not mandatory, for all hand mass excisions. This enhances visualization of small nerves, vessels, and the true margins of the mass, significantly reducing iatrogenic injury.'Option A is incorrect.While magnification can make dissection more efficient, its primary benefit is precision and safety, not necessarily a reduction in overall operative time, which can sometimes be longer due to meticulous dissection.Option B is incorrect.A bloodless field (achieved with a tourniquet) is still 'absolutely critical for meticulous dissection in the hand where small, vital structures are easily obscured by bleeding,' even with magnification. Magnification does not negate the need for a bloodless field.Option D is incorrect.Magnification allows for more precise dissection throughsmaller, well-planned incisions, rather than necessitating wider incisions. The goal is adequate exposure, not unnecessarily large incisions.Option E is incorrect.A pneumatic tourniquet is essential for a bloodless field, which is critical for hand surgery. Magnification complements, but does not replace, the need for a tourniquet.

Question 3179

Topic: Infection, Pharmacology & VTE

A 65-year-old woman presents with a slow-growing mass over the dorsal aspect of the distal interphalangeal (DIP) joint of her index finger. Examination reveals longitudinal grooving of the nail plate. Which underlying joint pathology is most universally associated with this soft tissue lesion?

. Rheumatoid arthritis
. Osteoarthritis
. Gouty arthropathy
. Psoriatic arthritis
. Septic arthritis

Correct Answer & Explanation

. Osteoarthritis

Explanation

Mucous cysts are ganglion cysts that arise from the DIP joint and are nearly universally associated with underlying osteoarthritis of the DIP joint (Heberden's nodes). Nail grooving occurs due to pressure on the germinal matrix.

Question 3180

Topic: 1. General Principles & Basic Science

A 60-year-old female presents with a soft, translucent mass on the dorsal aspect of her right index DIP joint, associated with longitudinal nail grooving. To minimize the risk of recurrence during surgical excision, which of the following must be performed?

. Excision of the cyst wall alone
. Excision of the associated underlying osteophyte
. Removal of the entire nail bed
. Tenodesis of the terminal extensor tendon
. Primary arthrodesis of the DIP joint

Correct Answer & Explanation

. Excision of the associated underlying osteophyte

Explanation

Mucous cysts are ganglion cysts arising from the DIP joint and are strongly associated with underlying osteoarthritis. Excision of the cyst along with debridement of the associated marginal osteophyte is crucial to minimize the risk of recurrence.

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