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A 35-Year-Old Immigrant from Eastern Europe Comes to the Office

Question 205

Multiple Choice

A 35-year-old immigrant from Eastern Europe comes to the office due to dry cough, malaise, and fatigue.  He has had joint aches and involuntary weight loss over the past 3 months.  His other medical problems include severe allergies that manifest as nasal stuffiness, headache, and ear pain.  He takes over-the-counter decongestants.  He is a construction worker, smokes a pack of cigarettes a day, and drinks 6 cans of beer once a week.  His mother suffers from severe rheumatoid arthritis.
His temperature is 37.2 C (99 F) , blood pressure is 122/70 mm Hg, and pulse is 89/min.  He has tenderness on palpation of bilateral maxillary sinuses.  Tympanic membranes are full and bulging bilaterally.  Pulmonary auscultation reveals occasional rhonchi.  There are no heart murmurs.  The tip of the spleen is not palpable.  There are no skin rashes or joint swelling.
Laboratory results are as follows:
A 35-year-old immigrant from Eastern Europe comes to the office due to dry cough, malaise, and fatigue.  He has had joint aches and involuntary weight loss over the past 3 months.  His other medical problems include severe allergies that manifest as nasal stuffiness, headache, and ear pain.  He takes over-the-counter decongestants.  He is a construction worker, smokes a pack of cigarettes a day, and drinks 6 cans of beer once a week.  His mother suffers from severe rheumatoid arthritis. His temperature is 37.2 C (99 F) , blood pressure is 122/70 mm Hg, and pulse is 89/min.  He has tenderness on palpation of bilateral maxillary sinuses.  Tympanic membranes are full and bulging bilaterally.  Pulmonary auscultation reveals occasional rhonchi.  There are no heart murmurs.  The tip of the spleen is not palpable.  There are no skin rashes or joint swelling. Laboratory results are as follows: Liver panel is unremarkable.  Urinalysis is positive for blood and protein, and urine sediment analysis reveals multiple red blood cells casts.  Chest x-ray is shown below. Which of the following is most likely to establish this patient's diagnosis? A) Anti-double-stranded DNA antibodies B) Anti-myeloperoxidase antibodies C) Anti-proteinase 3 antibodies D) Bone marrow biopsy E) Tuberculin skin testing
Liver panel is unremarkable.  Urinalysis is positive for blood and protein, and urine sediment analysis reveals multiple red blood cells casts.  Chest x-ray is shown below.
A 35-year-old immigrant from Eastern Europe comes to the office due to dry cough, malaise, and fatigue.  He has had joint aches and involuntary weight loss over the past 3 months.  His other medical problems include severe allergies that manifest as nasal stuffiness, headache, and ear pain.  He takes over-the-counter decongestants.  He is a construction worker, smokes a pack of cigarettes a day, and drinks 6 cans of beer once a week.  His mother suffers from severe rheumatoid arthritis. His temperature is 37.2 C (99 F) , blood pressure is 122/70 mm Hg, and pulse is 89/min.  He has tenderness on palpation of bilateral maxillary sinuses.  Tympanic membranes are full and bulging bilaterally.  Pulmonary auscultation reveals occasional rhonchi.  There are no heart murmurs.  The tip of the spleen is not palpable.  There are no skin rashes or joint swelling. Laboratory results are as follows: Liver panel is unremarkable.  Urinalysis is positive for blood and protein, and urine sediment analysis reveals multiple red blood cells casts.  Chest x-ray is shown below. Which of the following is most likely to establish this patient's diagnosis? A) Anti-double-stranded DNA antibodies B) Anti-myeloperoxidase antibodies C) Anti-proteinase 3 antibodies D) Bone marrow biopsy E) Tuberculin skin testing
Which of the following is most likely to establish this patient's diagnosis?


A) Anti-double-stranded DNA antibodies
B) Anti-myeloperoxidase antibodies
C) Anti-proteinase 3 antibodies
D) Bone marrow biopsy
E) Tuberculin skin testing

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