INI-CET EXAM -2025: A patient with rheumatoid arthritis (RA) presents with the deformity shown. What is the correct name of defor…

INI-CET EXAM -2025

Medical & Surgical Nursing

Medium

Appeared in: INI-CET EXAM -2025

Explanation

A Swan neck deformity is defined by a specific pattern: hyperextension of the proximal interphalangeal (PIP) joint.
This is coupled with a compensatory flexion of the distal interphalangeal (DIP) joint.
This deformity arises from damage and inflammation of the ligaments and tendons supporting the finger joints, which is a hallmark of advanced rheumatoid arthritis.
The appearance in the provided image perfectly matches the clinical description of a Swan neck deformity.

Option A: The Piano key sign is not a finger deformity. It describes instability of the distal radioulnar joint at the wrist, where the ulnar styloid can be depressed and rebounds like a piano key.
Option B: The Z deformity, or Z-thumb deformity, specifically affects the thumb. It involves flexion of the metacarpophalangeal (MCP) joint and hyperextension of the interphalangeal (IP) joint. The image shows a deformity of a finger, not the thumb.
Option C: A Boutonniere deformity is the opposite of a Swan neck deformity. It consists of flexion at the PIP joint and hyperextension at the DIP joint. The image clearly shows hyperextension at the PIP joint.

Visual 1: Diagram - A side-by-side comparison diagram illustrating the joint positions in a Swan neck deformity versus a Boutonniere deformity. This helps clarify the opposing nature of the two conditions.
Visual 2: Illustration - An anatomical drawing showing the damaged tendons and ligaments (specifically the volar plate and extensor mechanism) that lead to the development of a Swan neck deformity.
Visual 3: Photograph - A clinical photograph showing a Z-deformity of the thumb to differentiate it from finger deformities.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of specific hand deformities associated with rheumatoid arthritis to guide bedside assessment, documentation, and the next nursing action.
Hand deformities in RA, such as the Swan neck deformity, can severely impair a patient's ability to perform activities of daily living (ADLs), such as gripping objects, writing, or buttoning clothes.
Nurses play a key role in assessing the functional impact of these deformities, providing patient education on joint protection techniques, and introducing assistive devices to maintain independence.
What if? If the patient also complained of wrist pain and a clicking sensation, the nurse should assess for a 'piano key sign' in addition to the finger deformities, as multiple deformities can coexist in RA.

How to Approach the Question

Step 1: Analyze the question stem to identify the context, which is a deformity in a patient with rheumatoid arthritis.
Step 2: Carefully examine the provided image. Focus on the specific joints of the affected finger, namely the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints.
Step 3: Characterize the position of each joint. Note that the PIP joint is bent backward (hyperextended) and the DIP joint is bent forward (flexed).
Step 4: Recall or look up the definitions of the deformities listed in the options.
Step 5: Compare your observation from the image with the definitions. Eliminate options that affect different joints (Piano key sign - wrist; Z deformity - thumb) or show the opposite pattern (Boutonniere deformity).
Step 6: Select the option that perfectly matches the visual evidence. The pattern of PIP hyperextension and DIP flexion is the definition of a Swan neck deformity.

Concept Tested & Keywords

Concept Tested: Identification of specific hand deformities associated with rheumatoid arthritis.
Stem keywords: rheumatoid arthritis, deformity, hand
Lead-in keywords: What is the correct name
Clinical cues: The visual presentation of the finger deformity is the primary clinical cue.

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