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Discussion Starter · #1 ·
A 32-year-old African American woman returns to the clinic for a follow-up visit. She was seen 2 weeks prior with complaints of dyspnea, dry cough, chest pain, and tightness of the chest. An electrocardiogram was within normal limits. A chest x-ray was performed a week later which showed bilateral hilar lymphadenopathy with pulmonary infiltrate. While in clinic now, she points out a rash on her nasal tip that has been present for a number of months. There is a 4 x 2 cm violaceous, indurated plaque involving the nasal tip extending to the bilateral ala. There are a few tiny button-like papules in the center of the plaque. In addition, there are waxy, translucent lesions with flat tops on the face, lids, around the orbits, and in the nasolabial folds. The most appropriate next step in evaluation is to

A. determine serum angiotensin-converting enzyme and serum calcium levels

B. determine serum CEA marker level

C. order a complete blood count

D. refer her for a bronchoscopy

E. send her for a lung biopsy
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