ABSTRACT
You are reviewing patients in the medical outpatient clinic. Your next patient has been referred by her general practitioner with the following letter. Please read the letter and then review the patient.
Dear Doctor,
Re: Mrs Sally O’Sullivan
Age: 32 years
Please advise on the management of this young woman who has developed pain in her hands. There is clear tenderness when examining her hands but there are no convincing features of an arthropathy. The only other abnormalities on clinical inspection are a facial flush and a soft systolic murmur. She has a past history of thrombosis and has previously been on warfarin.
I would therefore greatly value your opinion on how to proceed. Best wishes.
Yours sincerely
