DSSSB 12 August 2024
Medical & Surgical Nursing
Easy
Which of the following are the hard nodules or enlargements of the distal interphalangeal joints of the fingers?
Appeared in: DSSSB 12 August 2024
Explanation
- Heberden's nodes are bony swellings or osteophytes that develop on the distal interphalangeal (DIP) joints, the joints nearest to the fingertips.
- These nodules are a characteristic clinical sign of osteoarthritis (OA), a degenerative joint disease.
- The specific location on the distal joint is the primary feature that distinguishes Heberden's nodes from other joint abnormalities.
Why Other Options Were Wrong
- Option B: Boutonniere deformity is a specific finger posture (flexion of the PIP joint and hyperextension of the DIP joint), not a nodule. It is typically caused by inflammation from rheumatoid arthritis.
- Option C: Tophi are not bony growths but are deposits of uric acid crystals that form in and around joints in individuals with chronic gout. They have a chalky appearance and are not specific to the DIP joint.
- Option D: Bouchard's nodes are also bony enlargements seen in osteoarthritis, but they are located on the proximal interphalangeal (PIP) joints (the middle joints of the fingers), not the distal joints.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of Joint Deformities in Osteoarthritis as background academic context rather than a clinical decision trigger.
- Identifying the location of these nodes is a key diagnostic clue for osteoarthritis and helps nurses and doctors differentiate it from other conditions like rheumatoid arthritis or gout.
- Nurses play a crucial role in educating patients that these nodes are part of the degenerative process of OA and discussing management strategies for pain, stiffness, and maintaining hand function.
- What if? If the nodules were soft, warm, and located over the metacarpophalangeal (MCP) joints (the knuckles), the nurse should suspect an inflammatory arthritis like RA, not OA, prompting further investigation for systemic disease.
How to Approach the Question
- First, identify the key anatomical location specified in the question: 'distal interphalangeal joints'.
- Next, recognize the term 'hard nodules', which points towards a bony growth, characteristic of osteoarthritis.
- Recall the specific terminology for osteoarthritic nodules in the fingers.
- Associate 'distal' joints with Heberden's nodes and 'proximal' joints with Bouchard's nodes.
- A helpful mnemonic is that 'H' (Heberden) is further down the alphabet than 'B' (Bouchard), just as the distal joint is further down the finger than the proximal joint.
- Eliminate the other options by definition: Boutonniere is a deformity (not a nodule) and Tophi are related to gout (not osteoarthritis).
Concept Tested & Keywords
- Concept Tested: Assessment of Joint Deformities in Osteoarthritis
- Stem keywords: hard nodules, enlargements, distal interphalangeal joints, fingers
- Lead-in keywords: Which of the following
- Negative lead-in flag: false
Question ID
QvUbaG5rCAcjkGXBN4BJ27
Reference Book
E6 Medicine Harrison 22e Part 2 p. 847-849
E6 Medicine Macleod Clinical Examination 15e p. 307-309
Practise the full DSSSB 12 August 2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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