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BOF:3

A 32 year old female presents with a history of pain and swelling of her joints. She has not had any serious illness in the past and is not on any medications .

On examination you note that she has swelling, of the distal interphalangeal joints of the index and middle fingers of her right hand and swelling of the distal interphalangeal joints of the 4^th and 5^th fingers of her left hand .

Investigations reveal elevated inflammatory markers.

You do a careful examination to look for:

a)      Malar rash

b)      Nodules over her elbows

c)      Iritis

d)     Pitting of her nails

e)      Heberden’s nodes

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