question: Q:A 32-year-old woman comes to the physician with increasing jaundice and fatigue for the past week. She has no history of a serious illness. She takes no medications and denies use of recreational drugs. She does not drink alcohol. Her vital signs are within normal limits. Her body mass index is 21 kg/m2. On physical examination, she has icteric sclera. Otherwise, her heart and lung sounds are within normal limits.
  Hemoglobin 15 g/dL
  Leukocyte count 6,000/mm3 with a normal differential
  Serum bilirubin  
  Total 6.5 mg/dL
  Direct 0.9 mg/dL
  Alkaline phosphatase 70 U/L
  Aspartate aminotransferase (AST, GOT) 430 U/L
  Alanine aminotransferase (ALT, GPT) 560 U/L
  γ-Glutamyltransferase (GGT) 43 U/L (N=5-50 U/L)
  Hepatitis A antibody Negative
  Hepatitis B surface antigen Negative
  Hepatitis C antibody Negative
  Rheumatoid factor 80 IU/mL (N=0-20 IU/mL)
  Antinuclear antibody (ANA) titer is 1:1280. Polyclonal immunoglobulin gamma is 5 g/dL. Which of the following antibodies is most likely to be positive in this patient?? 
  {'A': 'Anti-cyclic citrullinated peptide', 'B': 'Anti-double stranded DNA', 'C': 'Anti-liver kidney microsomal type 2', 'D': 'Anti-mitochondrial', 'E': 'Anti-smooth muscle'},