HISTORY

A 14 year old black male presents to your office with a history of recurrent episodes of abdominal pain and swelling of both wrists and the finger joints. A physical examination reveals a slender tall adolescent with slight pallor of mucous membranes. Other significant physical findings include frontal bossing, scleral icterus, and tortuosity of retinal vessels. There is a skin ulcer on the left ankle. You perform indicated laboratory tests.