question: Q:A 50-year-old woman comes to the emergency department because of fever and productive cough with blood in the sputum for 1 day. She also reports a sharp pain under her ribs that is worsened on taking deep breaths. Over the past 2 years, she has had repeated episodes of sinusitis, for which she used over the counter medication. She has recently started a new job at a wire-mesh factory. Her temperature is 38.3°C (100.9 °F), pulse is 72/min, respirations are 16/min, and blood pressure is 120/80 mm Hg. Physical examination shows palpable nonblanching skin lesions over her hands and feet. Examination of the nasal cavity shows ulcerations of the nasopharyngeal mucosa and a small septal perforation. Pulmonary examination shows stridor on inspiration. Laboratory studies show:
  Hemoglobin 13.2 g/dL
  Leukocyte count 10,300/mm3
  Platelet count 205,000/mm3
  Serum
  Urea nitrogen 24 mg/dL
  Creatinine 2.4 mg/dL
  Urine
  Protein 2+
  RBC 70/hpf
  RBC casts numerous
  WBC 1–2/hpf
  A chest x-ray shows multiple cavitating, nodular lesions bilaterally. Which of the following additional findings is most likely to be present in this patient?"? 
  {'A': 'Increased c-ANCA titers', 'B': 'Decreased ADAMTS13 activity', 'C': 'Increased p-ANCA titers', 'D': 'Increased anti-GBM titers', 'E': 'Increased anti-Smith titers'},