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A 37-Year-Old Woman Comes to the Emergency Department Due to Joint

question 143

Multiple Choice

A 37-year-old woman comes to the emergency department due to joint pain for the past 3 weeks. The pain is primarily in the lower extremities and is not associated with joint swelling or redness. She has had no skin rashes, chest pain, or urinary symptoms but has had malaise, profound fatigue, and decreased appetite. The patient's symptoms began after she visited her family in Connecticut. She has a history of mitral valve prolapse, and her current medications include oral contraceptives and a multivitamin. The patient works as a paralegal. She does not use tobacco or illicit drugs and drinks alcohol occasionally. Her mother has rheumatoid arthritis.
Temperature is 38 C (100.4 F) , blood pressure is 105/70 mm Hg, pulse is 89/min, and respirations are 18/min. BMI is 23 kg/m². The patient is mildly ill-appearing but in no acute distress. Dental hygiene is poor. Cardiopulmonary auscultation reveals clear lung fields and a 3/6 holosystolic murmur at the cardiac apex that radiates to the axillae. There is tenderness to palpation in the left upper quadrant with an enlarged spleen. No joint swelling or erythema is present, and there is no skin rash or lymphadenopathy.
Laboratory results are as follows:
Which of the following is most likely to establish the diagnosis in this patient?

Definitions:

Work Product Doctrine

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Case Preparation

The process of organizing facts, evidence, and legal arguments prior to presenting a case in court or to another decision-making body.

Trial

A formal examination of evidence before a judge, and possibly a jury, in order to decide guilt in a case of criminal or civil proceedings.

Attorney-Client Privilege

A legal principle that ensures communications between a lawyer and their client are confidential.