question: Q:A 53-year-old man comes to the emergency department because of a 1-month history of cough productive of small amounts of blood-tinged sputum. During this time, he has also developed fatigue, myalgia, and shortness of breath on exertion. He has had a 4-lb (2-kg) weight loss over the past 2 months. He has no personal history of serious illness. His mother has systemic lupus erythematosus. His temperature is 37.2°C (99.0 °F), pulse is 98/min, respirations are 22/min, and blood pressure is 152/98 mm Hg. Diffuse rhonchi are heard on auscultation of the chest bilaterally. There are multiple palpable, erythematous, nonblanching lesions on the lower extremities bilaterally. Laboratory studies show:
  Leukocyte count 12,300 cells/mm3
  Platelet count 400,000 cells/mm3
  Erythrocyte sedimentation rate 83 mm/hr
  Serum
  Creatinine 2.1 mg/dL
  Antinuclear antibody 1:40
  Urine
  Protein 3+
  Blood 2+
  RBC casts numerous
  A biopsy specimen of the skin shows inflammation of the arterioles and capillaries without granuloma formation. Further evaluation of this patient is most likely to show which of the following findings?"? 
  {'A': 'Anti-glomerular basement membrane antibodies', 'B': 'Increased serum cryoglobulins', 'C': 'Anti-double stranded DNA antibodies', 'D': 'Myeloperoxidase antineutrophil cytoplasmic antibody', 'E': 'Hepatitis B surface antigen'},