A 95-year-old female presents to the emergency department with painful joints. Upon examination, you notice bumps and lumps all over her hands. What are these likely to be?
Gout tophi
Rheumatoid nodules
Osteoarthritis nodes
Carpal tunnel syndrome
The Correct Answer is C
Choice A reason: Gout tophi are urate crystal deposits, typically on joints like the big toe, not widespread on hands. Osteoarthritis nodes (Heberden’s/Bouchard’s) are more common in elderly hands, so this is incorrect.
Choice B reason: Rheumatoid nodules occur in rheumatoid arthritis, usually near elbows, not diffusely on hands. Osteoarthritis nodes are bony growths on finger joints, more likely in this patient, so this is incorrect.
Choice C reason: Osteoarthritis nodes (Heberden’s and Bouchard’s) are bony lumps on finger joints, common in elderly women with joint pain. This matches the hand findings, making it the correct diagnosis.
Choice D reason: Carpal tunnel syndrome causes wrist pain and numbness, not joint lumps. Osteoarthritis nodes explain the hand bumps in this elderly patient, so this is incorrect.
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Correct Answer is D
Explanation
Choice A reason: Nerve damage from the prosthetic may cause local discomfort, but pain in the entire absent arm suggests phantom limb pain. This is less likely than neural misfiring, so it’s incorrect.
Choice B reason: Heart attack referred pain typically affects the left arm but is unlikely in a prosthetic limb. Phantom limb pain explains pain in the absent arm, so this is incorrect.
Choice C reason: Muscle strain affects existing muscles, not a prosthetic arm. Phantom limb pain, from neural signals in the brain, explains pain in the missing limb, so this is incorrect.
Choice D reason: Phantom limb pain occurs when the brain perceives pain in an amputated limb, common in prosthetic users. This matches Mr. Jones’s pain in his prosthetic arm, making it correct.
Correct Answer is C
Explanation
Choice A reason: A fracture is a break in the bone, as seen in the patient, but osteosarcoma is the underlying tumor causing the pathological fracture. Defining osteosarcoma as a fracture ignores its neoplastic nature, making this incorrect.
Choice B reason: A bone infection, or osteomyelitis, involves bacterial or fungal invasion, causing pain and inflammation. Osteosarcoma is a primary bone cancer, not an infection, with distinct histopathological features, making this an incorrect definition.
Choice C reason: Osteosarcoma is a malignant bone tumor, typically arising in long bones like the humerus, often causing pain, swelling, and pathological fractures. This matches the patient’s imaging findings and clinical presentation, making this the correct definition.
Choice D reason: A benign bone tumor, like an osteoma, does not metastasize or cause aggressive destruction. Osteosarcoma’s malignant nature leads to local invasion and potential metastasis, as implied by the fracture, making this incorrect.
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