A 66-year-old female presents with severe pain in her knees and hips. Examination reveals firm, non-tender bony enlargements over the distal interphalangeal (DIP) joints and proximal interphalangeal (PIP) joints of both hands, without warmth or erythema. What are the clinical names of these respective joint swellings, and what is the diagnosis?

Answer and explanation

Correct answer: D. Heberden nodes at DIP and Bouchard nodes at PIP; Osteoarthritis

  1. Step 1: Osteoarthritis of the hand classic findings include osteophyte bony enlargements: Heberden nodes located at the Distal Interphalangeal (DIP) joints and Bouchard nodes located at the Proximal Interphalangeal (PIP) joints.
  2. Step 2: They represent primary non-inflammatory degenerative osteophytic remodeling.
Answer
Heberden nodes at DIP and Bouchard nodes at PIP; Osteoarthritis.
Why not the others: 'Bouchard at DIP and Heberden at PIP' inverts the anatomical locations; 'Osler nodes and Janeway lesions' are immunologic and vascular phenomena of bacterial endocarditis; 'Tophi' are urate crystal deposits with inflammatory erythema seen in chronic tophaceous gout.

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