MRCP part 2 question

44 year old man complians of, cough, shortness of breathing; painful joints and stiffness of the hands, for one year duration, no past history of hospitalisation or medical condition

Examination of the hands reavealed painful tender joints and swelling of metacarpophalangeal joints of both  hands and reduced flextion and extension of the fingers, chest examination showed bilateral wheezing and dullness mainly on the bases,  6 month before he was working as a coalminer abroad

CXR revealed bilateral scattered nodules varying in size

What is the most likely Diagnosis ?

What investigations necessary to confirm this condition ?

Source: Doc2Doc BMJ Cardiology - March 8, 2016 Category: Cardiology Authors: alaminium Source Type: forums