Q1. A 35-yo Asian male presents with 5-month history of progressive dyspnea, cough and right knee pain. For the past week, he has been severely dyspneic and has no exercise endurance. He was born in Cambodia and denies use of alcohol, tobacco or illicit drugs. He did not see a doctor because of lack of insurance and he has been self medicating himself with over the counter meds to no avail. He is afebrile and hemodynamically stable. As you start to examine him, you note his elbow. The lesions appear to firm, painless and located below the skin in the dermis-see below. At this point, what is your preliminary diagnosis?
a. Gout
b. Lyme disease
c. Rheumatoid arthritis
d. Sarcoidosis
e. Rheumatic fever
f. Lupus
