<prompt> A 36-yrs-old woman presents with increased trouble swallowing. Physical examination finds hypeension and sclerodactyly. Lab tests find Anti- Scl- 70. Which of the following biopsies is most characteristic of this disorder?A conjunctival biopsy that reveals noncaseating granulomasA peripheral nerve biopsy that reveals rare acid- fast bacteriaA skin biopsy that reveals dermal fibrosis with an absence of adnexal structuresA subcutaneous fat biopsy that reveals an infiltrate of plasma cells and eosinophils  <response>: A skin biopsy that reveals dermal fibrosis with an absence of adnexal structures The combination of trouble swallowing, hypeension, and sclerosis of the skin should raise the possibility of progressive systemic sclerosis scleroderma, a multisystem disease that involves the cardiovascular, a peripheral nerve biopsy that reveals rare acid-fast bacteria is diagnostic of leprosy; and a temporal aery biopsy that reveals fragmentation of the internal elastic lamina is characteristic of ternporal aeritis. 