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163380 Pathology

A 29-year-old man has developed marked joint pain beginning 12 days after receiving snake antivenom injection. On physical examination, there is diffuse joint pain with movement. The stool is negative for occult blood. Laboratory studies show a serum creatinine level of 4.4 mg/dL and urea nitrogen level of 42 mg/dL. Microscopic examination of a renal biopsy specimen shows focal fibrinoid necrosis of the small arterial and arteriolar vascular media and intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. Which of the following laboratory findings in the blood is most likely present in this patient?

ACD4+ lymphocytosis
BHypocomplementemia
CIncreased IgE
DNeutropenia
Pathology
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163384 Medicine

A 21-year-old man has a nonproductive cough, shortness of breath, and chest pain, which changes with breathing. He also has pain in the left arm. On examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middles lobes (Figure given below). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test?

Alung biopsy
Bhumerus bone biopsy
CCT scan of chest
DBronchoscopy
Medicine
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