Station - Instructions for candidate
You are a junior doctor working in a general practice in Perth.
My Tran, a 28-year-old primary school teacher, has come back for the results of blood and urine tests you ordered three weeks ago for four months of painful hands and tiredness. The results are printed below. At that visit she was told the tests would look for an immune cause, and she has been told nothing since.
Bloods and urine from three weeks ago
| Item | Value | Reference range |
|---|---|---|
| Antinuclear antibody (ANA) | Positive, titre 1:640, homogeneous pattern | Negative (<1:80) |
| Anti-dsDNA antibody | 185 IU/mL | <30 IU/mL |
| Extractable nuclear antigen antibodies | Anti-Sm positive; Ro, La and RNP negative | Negative |
| Complement C3 | 0.62 g/L | 0.90-1.80 g/L |
| Complement C4 | 0.08 g/L | 0.16-0.47 g/L |
| Haemoglobin | 108 g/L (MCV 88 fL) | 115-165 g/L |
| White cell count | 3.1 x10^9/L (lymphocytes 0.8) | 4.0-11.0 x10^9/L (lymphocytes 1.0-4.0) |
| Platelets | 128 x10^9/L | 150-400 x10^9/L |
| ESR | 48 mm/h | <20 mm/h |
| CRP | 4 mg/L | <5 mg/L |
| Creatinine | 62 umol/L | 45-90 umol/L |
| eGFR | >90 mL/min/1.73m2 | >90 mL/min/1.73m2 |
| Urine albumin-creatinine ratio | 1.4 mg/mmol | <3.5 mg/mmol |
| Antiphospholipid antibodies | Negative (lupus anticoagulant, anticardiolipin, anti-beta2 glycoprotein I) | Negative |
Rheumatoid factor and anti-CCP antibodies negative. Thyroid function, liver function and creatine kinase normal. Urine dipstick: no blood, no protein.
Your tasks are to:
- Take a focused history.
- Explain the results and what they mean to Ms Tran.
- Counsel her on starting hydroxychloroquine.
- You do NOT need to examine the patient.
- You do NOT need to summarise your findings to the examiner.
- You do not need to write a prescription or a referral letter in this station.
This is a 10-minute station, with 2 minutes of reading time.