A 38-Year-Old Puerto Rican Woman Comes to the Physician Because

question 494

Multiple Choice

A 38-year-old Puerto Rican woman comes to the physician because of fever and fatigue for the last two weeks.  Over the past few days, she has developed bilateral pedal edema, ankle pain with walking, and painful bruises on her shins without any trauma.  She denies diarrhea, vaginal discharge, or lower abdominal pain.  Her weight has been stable.  She has no travel history within the past year.  She denies tobacco, alcohol, or illicit drug use.  She is in a monogamous relationship with her long-standing, live-in boyfriend and uses oral contraceptives.
Her temperature is 38.1 C (100.5 F) , blood pressure is 122/70 mm Hg, and pulse is 86/min.  Chest examination is unremarkable.  The liver span is 11 cm and the tip of the spleen is not palpable.  There are several violaceous, tender, raised lesions over both pretibial areas and 1+ pretibial edema.  Both ankles are warm to the touch with some discomfort on passive movement.
Complete blood count, comprehensive metabolic panel, and urinalysis are all within normal limits.
Which of the following would be most useful in establishing the diagnosis in this patient?

• A)Chest imaging
• B)HIV testing
• C)Rheumatoid factor and anti-CCP antibodies
• D)Tuberculin skin testing
• E)Urethral and cervical cultures

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