48. A 58-year-old woman comes to the office because of a 1-month history of fatigue, fever, shortness of breath, and joint pain; she also has had a 3.2-kg (7-lb) weight loss during this period. Her temperature is 37.6°C (99.7°F), and respirations are 34/min. Physical examination shows tenderness to palpation over the maxillary sinus, nasal ulcerations, and a bulging, red left tympanic membrane. Laboratory studies show: Erythrocyte sedimentation rate Serum C-reactive protein 65 mm/h 8.2 mg/L (N=0.08-3.1) 2+ 2+ Urine Blood Protein Histologic examination of a biopsy specimen of affected lung tissue shows granulomata and vasculitis. An autoantibody is most likely directly binding which of the following cell types in this patient? OA) Basophils B) Endothelial cells C) Fibroblasts D) Neutrophils E) Plasma cells

Mr. JKL is a 69 yr old white male complaining of shortness of breath during activities and sometimes at rest. He does not report any myocardial ischemia symptoms and is treated for hypertension and prostate cancer (diagnosed 5 years prior). The patient quit smoking 3 years ago and smoked on average 2 packs per day for 51 years. He was admitted to the hospital 4 months ago due to respiratory symptoms. The patient is not on supplemental oxygen, his oxygen saturation is 95%, and he reports some shortness of breath with a dyspnea rating of 5 (1-7 scale). The patient is sedentary, rarely walks outside of his home, and does not engage in sports or recreational activities. Mr. JKL's preexercise medical exam results: BMI = 31.8 Resting heart rate = 85 Blood pressure = 144/98 Enlarged anteroposterior chest diameter and decreased breath sounds and prolonged exhalation Current medications: Atrovent inhaler 8 puffs twice per day Doxapram HCL, 50 mg 3 times daily Furosemide, 40 mg 4 times daily…