skip to main content

Carpal tunnel syndrome — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardOsteoarthritis and soft tissue rheumatologyCarpal tunnel syndromeSCE Rheumatology

A 63-year-old man has nocturnal hand paraesthesia affecting thumb, index and middle fingers. Examination shows Tinel and Phalen tests reproduce symptoms. Investigations show thenar strength is mildly reduced. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Nerve conduction studies

The best answer is “Nerve conduction studies”. Nerve conduction studies most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Vitamin D level, after safety review”, “Thyroid function testing, after specialist assessment”, “CT angiography, with clinical reassessment”, “Urinalysis, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations