Case 205

Medical history

62 year-old male patient seeks medical care complaining that his hand is "becoming bent". He states that the process has started over 10 years ago, with the appearance of some lumps in his palm, and that he does not feel pain, only a slight itch. He has hypertension, taking 50 mg of losartan a day, drinks alcohol frequently, is a chronic smoker and has worked as a drover for 50 years. Upon physical examination, his fourth and fifth fingers were rigid and incapable of complete extension.

Based on the history and the image, which of the following are the observed alteration and possible risk factor, respectively?

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