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Old 12-21-2012
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Arrow Most appropriate course of action

A 55-year-old woman presents to her primary care physician with complaints of pain in her hands in the cold. On further questioning, she states that she notices that her hands have a bluish hue when she is outside, and that they become pale and then quite red when warm. Her physician, concerned that Raynaud’s phenomenon may indicate the presence of an autoimmune illness, initiates an autoimmune workup that is entirely negative. Three weeks later, the patient returns to the office with reports of visual “floaters.” She states that she feels fine otherwise. Her physical examination is negative aside from several large bruises on her legs. What is the most appropriate course of action to be taken by the physician?

(A) Begin a course of prednisone to alleviate the patient’s autoimmune symptoms in the absence of concrete diagnosis
(B) Discuss the possibility of domestic violence with the patient
(C) Order plasma electrophoresis
(D) Reassure the patient and reevaluate in 3 months
(E) Resend the patient’s serum for antinuclear antibody tests
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Old 12-21-2012
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(C) Order plasma electrophoresis--looks like hyperviscosity syndrome.
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Old 12-21-2012
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Raynaud + visual disturbances = Waldenstrom's macroglobulinemia's hyperviscosity = electrophoresis
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electrophorsis for walderstrom macroglobinemia
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Old 12-25-2012
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yup correct ans is (C) Order plasma electrophoresis
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