A 55-Year-Old Man Comes to the Physician Due to Myalgias

question 221

Multiple Choice

A 55-year-old man comes to the physician due to myalgias, arthralgias, and weight loss.  He has not felt well for 2 years.  Over that time, he has experienced 4 episodes of sinusitis that responded poorly to treatment and required prolonged courses of antibiotics for symptom resolution.  During the last 6 months, the patient has experienced diffuse aches.  He has pain that migrates from his knees to his shoulders and wrists and has also lost 4.5 kg (10 lb) .  He has no history of hypertension, diabetes mellitus, or chronic kidney disease.
His blood pressure is 138/90 mm Hg.  A small amount of crusted blood is present in one nostril.  There are no other significant physical findings.
Laboratory results are as follows:

Chest CT reveals two 2-3 cm nodules in the left upper lobe.  Serum anti-neutrophil cytoplasmic antibodies are negative.
Which of the following would be the best method to establish the diagnosis?

• A)Blood cultures
• B)Bronchoscopy with nodule biopsy
• C)Kidney biopsy
• D)Nasal biopsy
• E)Urine eosinophils

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Definitions:

Simultaneously Equilibrium

A condition in which demand and supply are balanced at the same time across multiple markets or within a complex system.

Capital Flow

The movement of money for the purpose of investment, trade, or business production between countries.

Excess Profits

Profits that exceed what is considered normal or expected, often realized in favorable market conditions or through monopolistic practices.

Free Markets

An economic system in which prices are determined by unrestricted competition between privately owned businesses, without government intervention.