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A 45-Year-Old Woman Is Evaluated in the Jail Clinic for Pain

question 785

Multiple Choice

A 45-year-old woman is evaluated in the jail clinic for pain and swelling of her right knee. The pain started 2 weeks ago without any associated trauma. She has no fever, dysuria, vaginal discharge, or history of arthritis. She has had fatigue, poor appetite, and an unintentional weight loss of 9 kg (20 lb) over the past 6 months. Several scaly and erythematous skin lesions have also appeared during this time. She takes ibuprofen as needed. She has a 30-pack-year history of smoking, used to drink occasionally, and does not use illicit drugs. She has been in jail for 3 years.
Her vitals signs are normal. She has several white-to-yellowish flaky scales on the scalp and in the nasolabial folds. No scleral injection or oral ulcers are noted. The right knee joint has moderate-size effusion. The second toe of the left foot appears swollen with slight bluish discoloration and is slightly tender. There is a lesion on the left knee (shown below) and similar lesions on the extensor aspect of the elbows, chest, and upper back. The remainder of the physical examination is within normal limits.

The right knee is aspirated, and synovial fluid analysis is as follows:

Which of the following is most likely worsening this patient's illness?

Definitions:

Joiners

Individuals or entities that become part of a group, organization, or partnership.

Social Technographics

A classification of individuals based on their participation in technology-related social activities, such as content creation, sharing, and networking.