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You are working in a busy outpatient client and performing assessment on a new patient. The patient reports pain and morning stiffness in the bilateral hands. You see what looks like large nodules on the knuckles, swan-neck deformity of the fingers, and ulnar deviation of the fingers as well. What is your patient's MOST LIKELY diagnosis?

A.

Osteoarthritis

B.

Rheumatoid arthritis

C.

Lupus arthritis

D.

Gouty Arthritis

Answer and Explanation

The Correct Answer is B

A.    Osteoarthritis (OA) typically presents with joint pain and stiffness, but it is usually unilateral and does not cause the same types of deformities seen in RA. OA also tends to develop over time without the systemic symptoms associated with RA.
B.    The combination of bilateral pain and morning stiffness in the hands, along with the presence of large nodules (likely rheumatoid nodules), swan-neck deformities, and ulnar deviation, is characteristic of rheumatoid arthritis (RA). RA is an autoimmune disorder that affects joints symmetrically and commonly leads to these specific deformities.
C.    Lupus arthritis can cause joint pain and swelling, but it is often accompanied by other systemic symptoms like skin rashes (butterfly rash), fatigue, and organ involvement. The specific deformities noted (swan-neck and ulnar deviation) are more closely aligned with RA than lupus.
D.    Gout is characterized by sudden, severe attacks of pain, often in the big toe or foot, and is caused by the deposition of urate crystals in the joints. It does not typically present with the deformities or patterns seen in the described patient.
 


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Related Questions

Correct Answer is D

Explanation

A. Neutropenia refers to an abnormally low level of neutrophils in the blood. This condition can result from various factors, including severe infections, bone marrow issues, or certain medications. However, in the context of a severe bacterial infection, you would expect an increase in neutrophils, not a decrease.
B. Anemia is a condition characterized by a lack of healthy red blood cells to carry adequate oxygen to the body’s tissues. While infections can lead to anemia, it is not a direct indicator of white blood cell production or response to a bacterial infection.
C. Leukopenia refers to a decrease in the overall white blood cell count. Like neutropenia, it indicates a reduced ability to fight infection, which is not consistent with a severe bacterial infection where the body is actively trying to produce more white blood cells.
D. A "left shift" indicates the presence of increased immature neutrophils (such as band cells) in the blood, which occurs when the bone marrow releases these cells into circulation in response to a severe infection. This reflects the body’s effort to combat an infection, typically seen in bacterial infections.

Correct Answer is B

Explanation

A. A positive ketone result indicates the presence of ketones in the urine, which can occur in conditions such as diabetes, fasting, or starvation. It is not indicative of a UTI.
B. A positive leukocyte esterase test indicates the presence of white blood cells (WBCs) in the urine, suggesting inflammation or infection, commonly associated with a UTI. This enzyme is released by WBCs, making it a key marker for infections.
C. The presence of crystals in the urine can indicate various conditions, including kidney stones or metabolic disorders, but it is not a specific marker for a UTI.
D. Hyaline casts may appear in the urine in response to dehydration or concentrated urine but are not specific to urinary tract infections. They can be seen in various renal conditions and do not indicate infection.

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