Hand findings in an elderly lady

77y, white woman, nursing home resident, PMH of HTN, DM, CHF, A fib and DJD, was hospitalized earlier this month for anorexia, diarrhea and weakness for the past several months. She is being treated with Lasix, Prevacid, Toprol, Oxycodone, Coumadin, L-thyroxine, Spironolactone, Glipizide, Effexor, Colchicine and Probenecid. On exam, she is dehydrated corroborated by a BP of 90/40 and pulse rate of 80 - 100/m. The following findings are noted on her hands.
What is the most likely diagnosis?

1. Heberden’s and Bouchard’s nodes
2. Rheumatoid nodulosis with possible “geodes”
3. A description by Dr. Thomas Syndenham in the 17th century- ANSWER (tophaceous gout).
4. Calcinosis cutis