{"knowledge_schema": {"broad_category": "Medicine \u2192 Neurology \u2192 Peripheral Nerve Disorders", "refinement": "This problem involves identifying a specific anatomical abnormality based on clinical presentation and imaging findings in a patient with a history of gout and neurological symptoms.", "specific_scope": "The focus is on the relationship between the patient's gouty tophi and the resulting neurological symptoms, particularly in the context of hand anatomy and potential nerve compression.", "goal": "Determine the anatomical abnormality that correlates with the patient's symptoms and imaging findings."}, "summary": "In this clinical scenario, the 78-year-old farmer presents with bilateral numbness and muscle weakness, alongside gouty tophi in both hands. The imaging studies reveal masses consistent with gouty tophi, which can lead to nerve compression. The goal is to identify the anatomical abnormality that explains the neurological symptoms. Given the presence of gouty tophi, the most likely anatomical abnormality is ulnar neuropathy, as the tophi can compress the ulnar nerve, leading to the observed symptoms."}