<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 47-year-old Caucasian woman presents with a 2-month history of general fatigue, slight jaundice, and mild itching. She has also noticed that her urine has been darker and stools have been lighter in color recently. She denies any fevers, chills, or alcohol use. She has no significant past medical or surgical history and is not taking any medications. She recalls that her mother saw a doctor for eye and mouth dryness but cannot remember the name of her diagnosis. She denies any illicit drug use, recent change in diet, or recent travel. On physical exam, her abdomen is soft and non-distended. There is right upper quadrant tenderness to deep palpation but a negative Murphys sign. Her laboratory findings were significant for increased liver enzymes, direct bilirubin, and alkaline phosphatase with normal levels of iron and ceruloplasmin. Ultrasound revealed no stones in the gallbladder or common bile duct and endoscopic retrograde cholangiopancreatography ERCP revealed normal extrahepatic biliary ducts. Which of the following findings is most likely to also be found in this patient?? A: Anti-neutrophilic cytoplasmic antibodies ANCA, B: Rheumatoid factor, C: Anti-gliadin antibody, D: Anti-centromere antibody, E: Anti-mitochondrial antibody,  <response>: This is a clinical vignette describing a 47-year-old woman with a 2-month history of fatigue, jaundice, itching, dark urine, and light stools. She has a family history of an autoimmune condition affecting the eyes and mouth. On exam she has right upper quadrant tenderness but no Murphys sign. Labs show elevated liver enzymes, direct bilirubin, and alkaline phosphatase. Imaging reveals no biliary obstruction. The history, exam, and lab findings are consistent with cholestatic liver disease. The differential diagnosis includes primary biliary cholangitis PBC, primary sclerosing cholangitis PSC, drug-induced cholestasis, and other autoimmune and infectious causes. The key finding in the question stem is the family history of an autoimmune condition affecting the eyes and mouth, which is most consistent with Sjogrens syndrome. PBC is frequently associated with other autoimmune diseases like Sjogrens. Therefore, the most likely additional finding in this patient would be a positive anti-mitochondrial antibody, which is present in up to 95 of patients with PBC.E: Anti-mitochondrial antibody 