input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 38-year-old woman with a history of systemic lupus erythematosus, obesity, and hyperlipidemia presents to her primary care physician for evaluation of new bilateral blisters on her hands. She says that she first noticed these blisters shortly after returning from a weekend trip to the beach two weeks prior. She denies any fevers, joint pains, or other skin rash during this period. The patient works in the adult entertainment industry. On examination, there are multiple flaccid blisters of the bilateral dorsal hands with hemorrhagic crusts, mild scarring, and hyperpigmentation. In addition, increased hair growth is noted on the bilateral malar cheeks. Her temperature is 99.1° F (37.3° C), pulse is 95/min, blood pressure is 130/87 mmHg, respirations are 13/min, and oxygen saturation is 98% on room air. Her laboratory results are:  Serum: Na+: 140 mEq/L K+: 4.5 mEq/L Cl-: 100 mEq/L HCO3-: 21 mEq/L BUN: 20 mg/dL Creatinine: 1.1 mg/dL Glucose: 104 mg/dL  Leukocyte count: 9,000/mm^3 Hemoglobin: 12.4 g/dL Platelets: 400,000/mm^3  Anti-nuclear antibody titer 1:320  Which of the following would confirm the diagnosis in this patient?   (A) Anti dsDNA titers   (B) Anti-hemidesmosome titers   (C) Urine porphyrin levels   (D) Tzanck smear
output: ['(C) Urine porphyrin levels <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Anti dsDNA titers  (B) Anti-hemidesmosome titers  (C) Urine porphyrin levels  (D) Tzanck smear <> possible answers', '  A 38-year-old woman with a history of systemic lupus erythematosus, obesity, and hyperlipidemia presents to her primary care physician for evaluation of new bilateral blisters on her hands. She says that she first noticed these blisters shortly after returning from a weekend trip to the beach two weeks prior. She denies any fevers, joint pains, or other skin rash during this period. The patient works in the adult entertainment industry. On examination, there are multiple flaccid blisters of the bilateral dorsal hands with hemorrhagic crusts, mild scarring, and hyperpigmentation. In addition, increased hair growth is noted on the bilateral malar cheeks. Her temperature is 99.1° F (37.3° C), pulse is 95/min, blood pressure is 130/87 mmHg, respirations are 13/min, and oxygen saturation is 98% on room air. Her laboratory results are:\n\nSerum:\nNa+: 140 mEq/L\nK+: 4.5 mEq/L\nCl-: 100 mEq/L\nHCO3-: 21 mEq/L\nBUN: 20 mg/dL\nCreatinine: 1.1 mg/dL\nGlucose: 104 mg/dL\n\nLeukocyte count: 9,000/mm^3\nHemoglobin: 12.4 g/dL\nPlatelets: 400,000/mm^3\n\nAnti-nuclear antibody titer 1:320\n\nWhich of the following would confirm the diagnosis in this patient? <> context']