A 42-Year-Old Woman Comes to the Physician with 6 Months

question 364

Multiple Choice

A 42-year-old woman comes to the physician with 6 months of progressively worsening exertional dyspnea.  She is unable to climb two flights of stairs without becoming short of breath.  She also complains of dry cough, weight loss, and fatigue.  She describes finger tingling and numbness when exposed to colder temperatures.  Her past medical history is significant for acid reflux disease and diabetes mellitus.  Her medications include metformin and omeprazole.  She does not smoke cigarettes.
Her blood pressure is 155/80 mm Hg and her pulse is 86/min.  Oxygen saturation is 94% on room air.  Small ulcers are seen at the fingertips bilaterally.  Jugular venous pressure is estimated at 6 mm H₂O.  There are no heart murmurs.  Inspiratory fine crackles are heard on auscultation at lung bases.  There is no organomegaly.
Laboratory results are as follows:

Chest x-ray shows bilateral reticular opacities.
Which of the following antibodies is most likely to be positive in this patient?

• A)Anticitrullinated peptide antibodies
• B)Anti-DNA topoisomerase I antibodies
• C)Antimitochondrial antibodies
• D)Antineutrophil cytoplasmic antibodies
• E)Antisynthetase antibodies

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Definitions:

Neural Activity

The functioning and communication processes of neurons, including the transmission of electrical and chemical signals within the brain and nervous system.

Visual-Discrimination Task

A task designed to assess the ability to differentiate between objects or symbols based on visual characteristics.

REM Sleep

Rapid Eye Movement Sleep, a unique phase of sleep characterized by fast movements of the eyes, dreaming, and increased brain activity.

Narcolepsy

A continuous sleep issue characterized by intense sleepiness throughout the day and sudden sleep occurrences.