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Question 165 (of 179)

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The scaphoid articulates with which of the following bones?

AHamate
BRadiusCorrect Answer
CTriquetrum
DUlna

Correct Answer ( B )
Explanation:

The scaphoid bone is one of the eight carpal bones, which altogether with the distal radius and ulna, make up the bones of the wrist. The carpal bones are arranged in two
rows of four bones. The proximal row consists of the scaphoid, lunate, triquetrum, and pisiform, while the distal row consists of the trapezium, trapezoid, capitate, and
hamate. The wrist has many complex articulations which allow for complex movements, including the radiocarpal joint, the midcarpal joint, and the distal radioulnar
joint, which allow wrist flexion, extension, radial deviation (abduction), ulnar deviation (adduction), circumduction, pronation, and supination. The scaphoid and lunate
bones articulate proximally with the radius to form the radiocarpal joint. The radius also articulates with the ulna at the distal radioulnar joint. The ulna does not
directly articulate with the carpal bones, but rather has an interface with the triangular fibrocartilage complex, known as the articular disk, which binds together the distal
ends of the radius, ulna, lunate, and triquetrum. Scaphoid fractures can be radiographically difficult to detect. In 15% of cases, radiographs taken immediately after injury
fail to show a fracture line. Therefore, if a scaphoid fracture is suspected, the wrist should be immobilized in a thumb spica splint and follow-up should be arranged for
repeat clinical evaluation and radiographic imaging in seven to ten days.

The scaphoid bone does not articulate with the hamate (A), triquetrum (C), or ulna (D).

Question: Which nerve provides innervation to the ventral surface of the thumb, index, and long finger?

Reveal Answer: Median nerve.

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Scaphoid Fracture

History of fall on an outstretched hand (FOOSH)

Dorsal radial wrist pain with decreased range of motion
PE will show anatomical snuffbox tenderness
Confirm with imaging (X-ray, CT, bone scan, MRI most accurate)
Treatment is thumb spica splint

References:

1. 1. Williams DT, Kim HT. Wrist and forearm. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th
ed. St. Louis, MO: Mosby, Inc. 2010; (Ch) 51:570-595.

Reviewed August 2023

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Category: Traumatic Disorders

Subcategory: Extremity Trauma

Question: 515028

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Physician Task : Diagnosis

Age: Not Age Specific

Acuity : Lower acuity

Question Type: First order

Grade Exam

Pause Exam

Clear Answer

Peer Comparison
A. A 11%
B. B 73%
C. C 13%
D. D 3%

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Normal Lab Values

25-hydroxyvitamin D, serum 25–80 ng/mL 62–200 nmol/L
Activated partial thromboplastin time (APTT) 25–35 seconds 25–35 seconds
Adrenocorticotropic hormone (ACTH) 9–52 pg/mL 2–11 pmol/L
Alanine aminotransferase (ALT) 0–35 U/L 0–0.58 µkat/L
Albumin 3.5–5.5 g/dL 35–55 g/L
Alkaline phosphatase 45–115 U/L (men), 30–100 U/L (women) 0.75–1.92 µkat/L (men), 0.50–1.67 µkat/L (women)
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Ammonia 40–80 µg/dL 23–47 µmol/L
Amylase 0–130 U/L
Anion Gap 8–16 mEq/L 8–16 mmol/L
Aspartate aminotransferase (AST) 0–35 units/L 0–0.58 µkat/L
Bands < 1 x 10,000/µL < 1 x 10,000/mm3
Bicarbonate 23–28 mEq/L 23–28 mmol/L
Bilirubin, direct/conjugated 0–0.3 mg/dL 0–5.1 µmol/L
Bilirubin, total 0.3–1.2 mg/dL 5.1–20.5 µmol/L
Blood urea nitrogen (BUN) 8–20 mg/dL 2.9–7.1 mmol/L
B-type natriuretic peptide (BNP) <100 pg/mL < 100 ng/L
Calcium (ionized, adult) 4.5–5.6 mg/dL 1.05–1.3 mmol/L
Calcium (total) 9–10.5 mg/dL 2–2.6 mmol/L
Ceruloplasmin 16–31 mg/dL (men), 19–39 mg/dL (women)
Chloride 98–106 mEq/L 98–106 mmol/L
Cholesterol (Total: Adult) 150–199 mg/dL 3.88–5.15 mmol/L
COHb (%) Non Smoker: < 2% Smoker: <9% Non Smoker: < 2% Smoker: <9%
Copper 63.7–140.12 µg/dL 12–22 µmol/L
Cortisol (bedtime) 3–13 µg/dL 83–359 nmol/L
Cortisol (free, urine) < 50 µg/24 h 138 nmol/24 h
Cortisol (morning) 10–20 µg/dL 275.88–551.76 nmol/L
C-peptide - serum 0.5–2.0 ng/mL 0.17–0.66 nmol/L
C-reactive protein (CRP) < 5 mg/L
Creatine kinase (CK) 30–170 U/L 0.50–2.84 µkat/L
Creatinekinase – MB fraction (CK-MB) 0–7 ng/mL 0–7 µg/L
Creatinine 0.7–1.3 mg/dL 61.9–115 µmol/L
CSF Cell count 0-5 cells/µL 0-5 × 10⁶ cells/L
CSF Glucose 40–80 mg/dL 2.2–4.4 mmol/L
CSF Opening pressure 7-20 cm of H20
CSF Protein 15–50 mg/dL 150–500 mg/L
D-dimer < 0.5 µg/mL < 500 ng/mL
Erythrocyte sedimentation rate (ESR) 0–15 mm/hr (men) 0–20 mm/hr (women)
Estradiol (female, day 1-10) 14–27 pg/mL 50–100 pmol/L
Estradiol (female, day 11-20) 14–54 pg/mL 50–200 pmol/L
Estradiol (female, day 21-30) 19–41 pg/mL 70–150 pmol/L
Estradiol (male) 10–30 pg/mL 37–110 pmol/L
Ferritin, serum 15–200 ng/mL 15–200 µg/L
Fibrinogen, plasma 150–350 mg/dL 1.5–3.5 g/L
Follicle-stimulating hormone (female, follicular/luteal phase) 5–20 mU/mL 5–20 U/L
Follicle stimulating hormone (female, midcycle) 30–50 mU/mL 30–50 U/L
Follicle stimulating hormone (female, postmenopausal) > 35 mU/mL > 35 U/L
Follicle stimulating hormone (male) 5–15 mU/mL 5–15 U/L
Free Thyroxine (T4), serum 0.9–2.4 ng/dL 12–31 pmol/L
Free Triiodothyronine (T3), serum 0.2-0.5 ng/dL (260–480 pg/dL) 4-7.4 pmol/L
Gastrin 0–180 pg/mL 0–86.58 pmol/L
GGT level 0 to 30 IU/L
Glucose (fasting) 70–100 mg/dL 3.9–5.6 mmol/L
Glycosylated hemoglobin 4%–5.9% 4%–5.9%
Haptoglobin 50–150 mg/dL 500–1500 mg/L
HDL (Men) ≥ 40 mg/dL 1.0 mmol/dL
HDL (Women) ≥ 50 mg/dL 1.3 mmol/dL
Hematocrit (Hct) (Female) 36–47% 0.36–0.47
Hematocrit (Hct) (Male) 41–51% 0.41–0.51
Hemoglobin (Hgb) (Female) 12–16 g/dL 120–160 g/L
Hemoglobin (Hgb) (Male) 14–17 g/dL 140–170 g/L
Insulin - serum < 25 mU/L < 174 pmol/L
Iron 60–160 µg/dL 11–29 µmol/L
Lactate dehydrogenase (LDH) 60–100 units/L 1.00–1.67 µkat/L
Lactic acid 6–16 mg/dL 0.67–1.8 mmol/L
LDL < 100 mg/dL
Lipase < 95 U/L < 1.59 µkat/L
Luteinizing hormone (female, follicular/luteal phase) 5–22 mU/mL 5–22 units/L
Luteinizing hormone (female, midcycle) 30–250 mU/mL 30–250 units/L
Luteinizing hormone (female, postmenopausal) > 30 mU/mL > 30 units/L
Luteinizing hormone (male) 3–15 mU/mL 3–15 units/L
Lymphocytes 1,000–4,000/µL (20–40%) 1,000–4,000/mm3 (20–40%)
Magnesium 1.5–2.4 mg/dL 0.62–0.99 mmol/L
Mean corpuscular hemoglobin concentration (MCHC) 32–36 g/dL 320–360 g/L
Mean corpuscular hemoglobin (MCH) 28–32 pg 0.4–0.5 fmol/cell
Mean corpuscular volume (MCV) 80–100 fL/red cell
Metanephrines (urine) < 1.2 mg/24 hours < 6.1 mmol/24 hours
Monocytes 100–700/µL (2–8%) 100–700/mm3 (2–8%)
Neutrophils 2500–8000/µL (55–70%) 2500–8000/mm3 (55–70%)
Parathyroid hormone (PTH) 10–65 pg/mL 10–65 ng/L
PCO₂ 35–45 mm Hg 4.7–6 kPa
pH 7.35-7.45 7.35-7.45
Phosphorus 3–4.5 mg/dL 0.97–1.45 mmol/L
Platelets 150,000–350,000/µL 150–350 × 10⁹/L
PO₂ 80–100 mm Hg 10.6–13.3 kPa
Potassium 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Procalcitonin (adults and children > 72 hours old) < 0.15 ng/mL
Prolactin (Men) < 15 ng/mL < 15 µg/L

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Prolactin (Nonpregnant women) < 20 ng/mL < 20 µg/L
Prolactin (Pregnant women) 36–372 ng/mL 36–372 µg/L
Protein C 65 to 135 IU dL-1
Prothrombin time (PT) 11–13 seconds 11–13 seconds
Pyruvate 300–900 µg/dL 34068.00–102204.00 µmol/L
Red blood cells (RBC) 4.7–6.1 x 10⁶/µL (men), 4.2–5.4 x 10⁶/µL (women)
Red cell distribution width (RDW) 11.6–14.6% 11.6–14.6%
Reticulocytes 0.5%–1.5% 0.5%–1.5%
Reverse Triiodothyronine (T3), serum 10–24 ng/dL 10–24 ng/dL
Sodium 136–145 mEq/L 136–145 mmol/L
Testosterone (adult male) 300–1200 ng/dL 10–42 nmol/L
Testosterone (female) 20–75 ng/dL 0.7–2.6 nmol/L
Thyroid-stimulating hormone (TSH) 0.5–5.0 µU/mL 0.5–5.0 mU/L
Total iron-binding capacity (TIBC) 250–460 µg/dL 45–82 µmol/L
Total Serum Protein 6.0–7.8 g/dL 60–78 g/L
Total Thyroxine (T4), serum 5–12 µg/dL 64–155 nmol/L
Total Triiodothyronine (T3), serum 70–195 ng/dL 1.1–3.0 nmol/L
Transferrin 200–360 mg/dL 24.60–44.28 µmol/L
Transferrin saturation 20–50% 20–50%
Triglycerides <150 mg/dL < 1.69 mmol/L
Troponin I 0–0.5 ng/mL 0–0.5 μg/L
Troponin T 0–0.10 ng/mL 0–0.10 µg/L
Tryptase < 11.5 ng/mL < 11.5 ng/mL
Urea 17–43 mg/dL 2.8–7.2 mmol/L
Uric acid, serum 2.5–8 mg/dL 0.15–0.47 mmol/L
White blood cells (WBCs) 4,000–10,000/µL 4.0–10.0 x 10⁹/L

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