A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by

Choice A reason: Hepatomegaly is not a typical finding in early to moderate rheumatoid arthritis (RA). It may occur in advanced RA with systemic complications like Felty’s syndrome, but early RA focuses on joint inflammation. Expecting hepatomegaly misguides assessment, potentially overlooking RA’s articular signs critical for early diagnosis and DMARD therapy to prevent joint damage.

Choice B reason: Heberden’s nodes, bony growths at distal interphalangeal joints, are characteristic of osteoarthritis, not RA. RA involves synovial inflammation, causing soft tissue swelling, not bony nodes. Assuming nodes risks misdiagnosis, delaying RA-specific treatments like methotrexate, which target inflammation to prevent progressive joint erosion and deformity.

Choice C reason: Crepitus, a grating sound from joint movement, is more typical in osteoarthritis due to cartilage loss, not early RA, where synovial inflammation dominates. Expecting crepitus misaligns assessment, potentially missing RA’s soft tissue swelling and stiffness, delaying interventions like biologics critical for controlling inflammation and joint destruction.

Choice D reason: Spindle-shaped fingers, from synovial inflammation and swelling in proximal interphalangeal joints, are a classic early to moderate RA finding. This soft tissue swelling reflects autoimmune synovitis, aiding diagnosis. Recognizing this guides timely DMARD or corticosteroid use, reducing inflammation, preventing joint damage, and improving function in RA patients.

Choice A reason: An oblique fracture involves a diagonal break across the bone, typically from twisting forces, not splintering into multiple pieces. Comminuted fractures, as described, involve multiple fragments. Misidentifying as oblique risks inappropriate treatment, like simple casting instead of surgical fixation, delaying healing and increasing nonunion risk in complex tibial fractures.

Choice B reason: An impacted fracture occurs when bone ends are driven together, often in compression injuries, not splintered into pieces. The described tibial fracture with multiple fragments is comminuted. Assuming impacted misguides management, potentially overlooking the need for surgical stabilization, complicating recovery and alignment in severe fractures.

Choice C reason: A comminuted fracture, where the bone splinters into multiple fragments, matches the x-ray description. Common in high-energy trauma like falls, it requires surgical fixation to align fragments and ensure healing. Accurate identification guides appropriate intervention, preventing complications like malunion or infection in complex tibial fractures.

Choice D reason: A transverse fracture is a straight, horizontal break, not involving multiple fragments. The described splintered tibia indicates a comminuted fracture. Misdiagnosing as transverse risks inadequate treatment, like casting instead of surgery, leading to poor alignment, delayed healing, or chronic pain in severe tibial injuries.