The Correct Answer is C!

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A 26-year-old woman comes to the office for evaluation of hand pain. For the past year, she has been bothered by discomfort and color change in her fingers on cold exposure. Typically the tips of her second, third, and fourth fingers turn pale and then blue when they are cold. Her fingers often feel numb and painful when they are blue. She has also been bothered by achiness in muscles and joints. She feels that her hands swell in the mornings. She has had increasing fatigue. All of these symptoms started after the birth of her first child a year ago. She has had mouth sores intermittently for several years and has a foreign body sensation in her eyes. She states that she has had no rash, photosensitive eruptions, dyspnea, chest pain, edema, or fever. She takes no medications other than an oral contraceptive. Her past medical history is negative.

On physical examination vital signs are normal. The fingers are slightly cool but have no color change. The fingertips have no active ulcers or scars. The skin over the fingers is normal. There are tender points at the trapezii, sternal margins, buttocks, and greater trochanters. The examination is otherwise normal.

The last laboratory studies available are from the time of her delivery a year ago and these showed normocytic anemia with hemoglobin of 11.1.

Which of the following tests will be most helpful in determining whether she has secondary Raynaud phenomenon?

  1. Noninvasive vascular studies
  2. Anti-nuclear antibody testing
  3. Nail fold capillary microscopy
  4. Selective angiography of the arms

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1. Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.