Print this Content

Week 28

 

Return to Image Quiz Archive

Quiz 28 Context:

A 55-year-old male presents for follow-up after being seen in the emergency room the previous week for minor trauma associated with a motor vehicle accident. He reports that there was mild pain in his hands at the time of the accident, and now the pain has worsened.

Notable medical history includes that the patient suffers from chronic kidney disease thought to result from hypertension, with a creatinine of 3.4 mg/dL baseline. He also reports a history of unspecified arthritis, hypertension, hyperlipidemia, and asthma/COPD.

Medications include metoprolol, furosemide, inhaled steroids, and lovastatin.

Physical examination reveals a male patient in no distress. Vital signs reveal a temperature of 37.4 degrees Celsius, heart rate 90 bpm, blood pressure 156/90 mmHg. The exam is most notable for asymmetric polyarticular involvement of the joints of the hands and feet. Involved joints are tender, warm and swollen. There is no rash.

As part of the evaluation, a plain film of the hands and feet is obtained. The key findings of the study are shown above.

This history, examination, and data are most consistent with which of the following possibilities as a cause for the symptoms:

  1. Gout
  2. Retained foreign object
  3. Osteoarthritis
  4. Rheumatoid arthritis
  5. Multiple fractures

 

Bookmark this Chapter
Copyright © 2000-2014 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195
Copyright © 2000-2011 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195