A 60-year-old female complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes. There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On exam, the buccal mucosa appears dry and the salivary glands are enlarged bilaterally. The next step in evaluation is:

**Core Concept**
Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration and destruction of exocrine glands, particularly the salivary and lacrimal glands. This leads to symptoms of xerostomia (dry mouth) and xerophthalmia (dry eyes).

**Why the Correct Answer is Right**
The patient's presentation of dry mouth, gritty sensation in the eyes, and enlarged salivary glands is highly suggestive of Sjögren's syndrome. The absence of a history of diabetes mellitus or neurologic disease and the lack of medication use make this a primary Sjögren's syndrome diagnosis. The lymphocytic infiltration of the salivary glands can be confirmed through a minor salivary gland biopsy, which is the next step in evaluation.

**Why Each Wrong Option is Incorrect**
**Option A:** A thorough medical history and physical examination have already been performed, making further history taking unnecessary at this point.

**Option B:** While imaging studies may be useful in evaluating the salivary glands, a minor salivary gland biopsy is the most specific and sensitive test for diagnosing Sjögren's syndrome.

**Option C:** The patient's symptoms and physical examination findings do not suggest a primary neurologic disorder, making this option incorrect.

**Option D:** The patient's symptoms are not consistent with a viral or bacterial infection, making this option incorrect.

**Clinical Pearl / High-Yield Fact**
Sjögren's syndrome can be associated with other autoimmune disorders, such as rheumatoid arthritis and systemic lupus erythematosus. A minor salivary gland biopsy is a key diagnostic tool for Sjögren's syndrome and can be performed in the outpatient setting.

**Correct Answer:** B.

✓ Correct Answer: B. Schirmer test and measurement of autoantibodies