A pregnant woman feels tingling numbness and pain in the thumb and fingers during night. This condition is kn… - IGNOU Post B. SC. Nursing entrance -2021

IGNOU Post B. SC. Nursing entrance -2021

Obstetrics & Gynaecology

Medium

Appeared in: IGNOU Post B. SC. Nursing entrance -2021

Explanation

Carpal Tunnel Syndrome (CTS), a condition caused by the compression of the median nerve within the carpal tunnel at the wrist.
During pregnancy, increased fluid retention (edema) causes swelling in the tissues, which can narrow the carpal tunnel and compress the median nerve.
Symptoms include pain, numbness, and tingling in the distribution of the median nerve: the thumb, index, middle, and the radial half of the ring finger.
These symptoms are characteristically worse at night, often due to prolonged wrist flexion during sleep, which further increases pressure on the nerve.

Option A: Neuritis is a general term for inflammation of a nerve. While CTS involves nerve irritation, 'neuritis' is not specific enough to describe the mechanical compression mechanism seen in this pregnancy-related condition.
Option C: Korsakoff's syndrome is a chronic memory disorder caused by severe thiamine (vitamin B1) deficiency, most commonly associated with chronic alcohol abuse. Its symptoms are primarily neurological (amnesia, confabulation) and not related to peripheral nerve compression in the wrist.
Option D: Down's syndrome is a congenital genetic disorder caused by the presence of an extra copy of chromosome 21 (Trisomy 21). It is a lifelong condition characterized by distinct facial features, intellectual disability, and other developmental issues, not a transient condition of pregnancy causing hand numbness.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Carpal Tunnel Syndrome in Pregnancy as background academic context rather than a clinical decision trigger.
Nurses play a key role in educating pregnant patients about common discomforts like CTS. Reassurance that it is usually temporary and resolves after delivery is important.
Nursing interventions focus on non-pharmacological pain relief, such as teaching the patient to wear a neutral wrist splint at night, avoiding repetitive hand movements, and elevating the hands to reduce edema.
It is crucial to differentiate CTS from more serious conditions. If weakness (e.g., dropping objects) or muscle wasting in the thumb occurs, the patient should be referred for further evaluation.

How to Approach the Question

First, analyze the patient profile: a pregnant woman. This immediately suggests looking for conditions common in or exacerbated by pregnancy.
Next, identify the key symptoms: tingling, numbness, and pain in the thumb and fingers, which are worse at night. This points to a specific nerve distribution.
Evaluate the options based on this clinical picture. Carpal Tunnel Syndrome specifically involves the median nerve, which supplies the thumb and first few fingers, and is known to be aggravated by fluid retention in pregnancy and wrist position at night.
Rule out the other options. Neuritis is too general. Korsakoff's syndrome and Down's syndrome have completely different etiologies and clinical presentations (memory disorder and genetic condition, respectively) that do not match the patient's symptoms.

Concept Tested & Keywords

Concept Tested: Carpal Tunnel Syndrome in Pregnancy
Stem keywords: pregnant woman, tingling numbness, pain, thumb and fingers, night
Lead-in keywords: known as
Clinical cues: The combination of pregnancy, specific sensory symptoms in the hand (thumb and fingers), and worsening at night strongly points to a compression neuropathy.

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E6 Medicine Harrison 22e Part 2 pp. 1807-1809, 1517-1519

E6 Anatomy BDChaurasia V1 10e p. 130-132