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A 32-Year-Old Woman Comes to the Physician Because of Hand

question 805

Multiple Choice

A 32-year-old woman comes to the physician because of hand pain and swelling that lasts several hours every morning. She has not felt well since "getting the flu" two weeks ago from her two children (ages 4 and 6) . She initially had a sore throat and fever without rash, cough, dysuria, or diarrhea. She works as a flight attendant and travels extensively, but has been on medical leave for the past two weeks due to her illness. She is in a monogamous relationship and uses a barrier method for contraception. She does not smoke, but she drinks alcohol occasionally.
Her vital signs are within normal limits. There are no skin rashes. Oropharyngeal examination shows mild tonsillar swelling and normal appearing pharyngeal mucosa. Several 0.5 cm non-tender lymph nodes are palpable in the anterior cervical region. Auscultation of the heart and lungs is normal. There is no hepatosplenomegaly. The small joints of her hands and wrists are swollen and tender. She is unable to flex or extend her wrists or make a fist due to the pain and swelling. She has normal range of motion without swelling in both knees, ankles, shoulders, and feet.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

Definitions:

OID Instruments

Debt instruments issued at a discount from their face value, with the difference treated as interest for tax purposes.

Interest Income

Interest Income is the earnings an individual receives from depositing funds in interest-bearing accounts, such as savings accounts or investments in bonds.

Taxpayers

Individuals or entities that are obligated to pay taxes to a federal, state, or local government.

Employee Discounts

Reduced prices offered to workers of a company for its products or services.