When a Low-Positive ANA Sends the Wrong Patient Down the Wrong Workup

A 74-year-old woman referred for “lupus workup” on a low-positive ANA. The prior chest radiograph was read as normal. A careful second look tells a different story — the findings are not autoimmune. They are DISH. This case asks the reader to do what the first reader did not: look again, and follow what is actually on the film rather than what the requisition suggests.

What is new in this release

• New Two-stage gameplay — Stage 1 asks what was missed on the prior read; Stage 2 surfaces false interpretations that would have cascaded into harm if they had been reported.
• New Eight languages with full parity: English, Russian, Spanish, Chinese, Portuguese, German, French, Italian.
• New Harm-cascade pedagogy — every false interpretation in Stage 2 carries an explicit downstream-consequence note (oncology workup, wrong immunosuppression, invasive biopsy).
• Improved Crisper imaging — 1080 px JPEG at quality 82, 4× lightbox zoom, edge-tap navigation.
• Improved Smarter retry alert that reports the actual caught-count from the prior attempt (stale-state bug resolved).
• Improved Direct link to the full RheumaView clinical report from both the final screen and the fail screen.
• Improved Clearer Stage 2 framing — an explicit two-line heading clarifies that the listed items are not in the report, and what would have happened if they had been.
• Improved Cleaner gameplay — internal category tags (“false pattern”, “diagnosis reframe”) stay hidden until the reveal phase, so they no longer spoil answers.

The Challenge