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Pathology 34

A 45-year-old woman presents to her primary care physician for evaluation of joint pain and fatigue, which has been present over the past 6 months. She states that it takes her an hour to gain full mobility of her fingers in the morning, which makes it difficult to button her coat. Her past medical history is significant for atrial fibrillation, for which she takes flecainide. Vital signs are significant for a temperature of 99°F (37.2°C) and are otherwise within normal limits. Physical examination reveals bilateral swan neck deformities of the fingers, and serum studies indicate a positive rheumatoid factor.

Which of the following describes the most likely appearance of this patient’s affected joints?

  • A) Monosodium urate crystal deposition
  • B) Osteophyte formation with asymmetric joint space narrowing
  • C) Pencil-in-cup deformity with dactylitis
  • D) Purulent synovial fluid containing bacteria
  • E) Synovial hyperplasia with inflammatory pannus


Alexandra Conway


Dr. Ted O'Connell