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Question 4. What is the association between the “fixed nodule(s) at pressure point(s)” on the left wrist/right elbow and a diagnosis of rheumatoid arthritis?
Patient Case Question 5. Why is it reasonable that this patient has no stiffness, pain, or swelling in the DIP joints of the fingers?
Laboratory Blood Test Results
Na 140 meq/L
ANA Negative
Hct 43%
Uric acid 2.9 mg/dL
K 3.7 meq/L
ESR 38 mm/hr
WBC 15,100/mm3
Cholesterol 189 mg/dL
Cl104 meq/L Cr 1.0 mg/dL
Plt 270,000/mm3 Albumin 4.0 g/dL
HCO3 23 meq/L
Glucose, fasting 94 mg/dL
RBC 4.7 million/mm3
TSH 1.7 μU/mL
BUN 18 mg/dL Hb 14.9 g/dL
Ca2 8.8 mg/dL
RF Positive
Patient Case Question 6. Identify three abnormal laboratory tests in Table 80.1 that are consistent with a diagnosis of rheumatoid arthritis.
Patient Case Question 7. Why is it entirely appropriate that the PCP has ordered a TSH test for this patient?
Patient Case Question 8. Provide a reasonable explanation for the serum uric acid test result shown in
Table 80.1.
Patient Case Question 9. What is probably the first class of drugs that the PCP will prescribe for this patient?
Urinalysis Normal with no RBC, WBC, or protein
Chest X-Ray No fluid, masses, infection, or cardiomegaly
Hand X-Ray Soft tissue swelling and bone demineralization; no erosions
Synovial Fluid Analysis (Left Knee) • 7.4 mL volume • Cloudy and yellow in appearance • 14,000
WBC/mm3, primarily neutrophils • Glucose: 60 mg/dL
Patient Case Question 10. In terms of the progression of the disease, what do the results of the hand x-ray suggest?
Patient Case Question 11. Which findings in the examination of the synovial fluid are consistent with a diagnosis of rheumatoid arthritis?
Patient Case Question 12. What causes limitation of joint motion that occurs early in the clinical course of rheumatoid arthritis?
Patient Case Question 13. What causes limitation of joint motion that occurs late in the clinical course of rheumatoid arthritis?
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