History and Physical Examination
Ms. A.A., a 25-year-old complaining of joint pain, fatigue, and significant weight loss, was seen by her primary care provider. Physical examination demonstrated a maculopapular rash on her face (Figure 1) and chest. Several joints in her hands were swollen. Her temperature was 37.8° C.
Laboratory Data
Assay Patientâs Result Reference Values
Complete blood count
Hemoglobin 10.5 mg/dL 12.0-16.0
Hematocrit 32% 35%-45%
Total WBC 9.5 Ã 109/L 4.5-10.3
Platelet count 190 Ã 109/L 150-450
Sedimentation rate 45 mm/hr 0-20
Urinalysis
Color Red-brown straw-yellow
Protein 4+ 0-trace
RBCs Large Negative
Microscopic examination
Many RBCs/hpf, few granular casts, moderate number of RBC and granular casts.
Antinuclear antibody (ANA): positive (a speckled nuclear staining pattern without staining of the nucleoli)
Questions:
1. The patientâs urinalysis results suggest: (5 pts)
a. urinary infection.
b. nephritic condition.
c. renal insufficiency.
d. No significant abnormalities.
2. What rheumatologic disorder is suggested by the patientâs laboratory findings? (5 pts)
3. The speckled antinuclear antibody staining pattern is associated with the following antibody (antibodies): (5 pts)
4. What type(s) of serum antibody (antibodies) can be significant in establishing a diagnosis of a specific rheumatoid disorder? (5 pts)