A 23-Year-Old Man Comes to the Physician Because of a 6

question 623

Multiple Choice

A 23-year-old man comes to the physician because of a 6 month history of weight loss and poor energy.  He also complains of vague abdominal discomfort, soft stools, and chronic back pain.  He has had frequent episodes of bronchitis, which he attributes to smoking since an early age.  He has had several male sexual partners over the past 3 years and has used condoms inconsistently.  He was diagnosed with HIV infection six months ago, and his CD4 count at that time was 650 cells/µL.
On physical examination, scattered rhonchi are heard over the right upper lung.  The abdomen is mildly tender in the epigastrium.  There is no hepatomegaly and the spleen is not palpable.  There are no skin rashes.
Laboratory results are as follows:
CT scan of the chest and abdomen demonstrates right upper lobe bronchiectasis with some surrounding fibrotic changes and pancreatic calcifications with atrophy.
Which of the following is most likely to establish the diagnosis in this patient?

• A)Bone marrow biopsy
• B)Immediate skin test reactivity to Aspergillus antigens
• C)Serum immunoglobulin quantification
• D)Sputum smears with acid-fast staining
• E)Sweat chloride test