All of the following are common characteristic bone deformities that can occur in the hands of a patient with rheumatoid arthritis, EXCEPT:

1. A

   Boutonniere Deformity

2. B

   Swan Neck Deformity

3. C

   Ulnar Drift

4. D

   Tophi Crystal Deposition

Appeared in: PGICH Noida NO-2025

Explanation

• Tophi are hard nodules formed by the deposition of monosodium urate (uric acid) crystals under the skin, in, or around joints.
• They are a hallmark feature of chronic tophaceous gout, which is a type of metabolic arthritis caused by hyperuricemia.
• Rheumatoid arthritis is an autoimmune disease characterized by synovial inflammation leading to joint erosion and specific deformities, but it does not involve uric acid crystal deposition.

Why Other Options Were Wrong

• Option A: Boutonniere deformity is a classic hand deformity seen in rheumatoid arthritis.
• Option B: Swan neck deformity is another classic hand deformity characteristic of rheumatoid arthritis.
• Option C: Ulnar drift, or ulnar deviation, is a common deformity in long-standing rheumatoid arthritis due to subluxation at the MCP joints.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of hand deformities in inflammatory arthritis to guide bedside assessment, documentation, and the next nursing action.
• Accurate identification of joint deformities is crucial for nurses to differentiate between types of arthritis (e.g., RA, gout, osteoarthritis), which guides appropriate patient education and management.
• Nursing care for RA focuses on pain management, joint protection, and promoting mobility through physical therapy. In contrast, care for gout also involves dietary modifications (low-purine diet) and medications to lower uric acid levels.
• What if? If the patient presented with hard, bony nodules on the distal interphalangeal (DIP) joints, the most likely diagnosis would be osteoarthritis (Heberden's nodes), not RA or gout.

How to Approach the Question

• This is a negative-lead question using the word 'EXCEPT'. The goal is to find the option that does not belong to the group.
• First, identify the central concept in the question stem: 'common characteristic bone deformities... in a patient with rheumatoid arthritis'.
• Review each option to determine if it is a known deformity of RA.
• Recall or look up the classic hand deformities of RA: Boutonniere deformity, Swan Neck deformity, and Ulnar drift are all correct examples.
• Identify the option that is not associated with RA. Tophi are characteristic of gout.
• Therefore, Tophi Crystal Deposition is the correct answer because it is the exception.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of hand deformities in inflammatory arthritis
• Stem keywords: rheumatoid arthritis, hand deformities, characteristic
• Lead-in keywords: EXCEPT
• Negative lead-in flag: Question asks for the EXCEPTION

Question ID

Qc9DuAsaakBGn5XBx_3Cot

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 pp. 744-746, 847-849

E6 Medicine Macleod Clinical Examination 15e p. 307-309