Hand infections: clenched fist injury: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Hand infections: clenched fist injury

Sample item

A man presents the day after punching someone in the mouth with a small wound over the third metacarpophalangeal joint. Which organism needs to be covered, and what is the management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Eikenella corrodens and other oral flora; exploration, washout and amoxicillin-clavulanate

A fight bite is a human bite injury to the metacarpophalangeal joint, which commonly penetrates the joint capsule. Oral flora including Eikenella corrodens, streptococci and anaerobes are involved, and a broad-spectrum antibiotic such as amoxicillin-clavulanate is used. The joint should be explored and washed out because septic arthritis and osteomyelitis are likely.

Option by option

  • A. Mycobacterium marinum; rifampicin

    Mycobacterium marinum follows aquarium and fish tank injuries.

  • B. Clostridium tetani only; no surgery

    Tetanus prophylaxis is given, but the infection is polymicrobial and surgery is needed.

  • C. Pseudomonas only; observation

    Observation risks septic arthritis and Pseudomonas is not the principal organism.

  • D. Eikenella corrodens and other oral flora; exploration, washout and amoxicillin-clavulanate (correct)

    Correct. Oral flora cover with joint exploration and washout is required.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Eikenella corrodens and other oral flora; exploration, washout and amoxicillin-clavulanate. A fight bite is a human bite injury to the metacarpophalangeal joint, which commonly penetrates the joint capsule.

Why is "Mycobacterium marinum; rifampicin" not the answer?

Mycobacterium marinum follows aquarium and fish tank injuries.

Why is "Clostridium tetani only; no surgery" not the answer?

Tetanus prophylaxis is given, but the infection is polymicrobial and surgery is needed.

Why is "Pseudomonas only; observation" not the answer?

Observation risks septic arthritis and Pseudomonas is not the principal organism.

What concept does this question test?

It tests Hand infections: clenched fist injury in Orthopaedics. Oral flora including Eikenella corrodens, streptococci and anaerobes are involved, and a broad-spectrum antibiotic such as amoxicillin-clavulanate is used. The joint should be explored and washed out because septic arthritis and osteomyelitis are likely.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hand infections: clenched fist injury?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.