Review Question - QID 109883

A 63-year-old man presents to his primary care provider for difficulty hearing. He reports developing significantly decreased hearing over the past 3-4 months that is worse in his right ear. He previously had good hearing and did not require a hearing aid. He is otherwise healthy and swims 1-2 miles per day. He has a distant history of multiple ear infections as a child. His temperature is 98.6°F (37°C), blood pressure is 140/85 mmHg, pulse is 82/min, and respirations are 19/min. Physical examination demonstrates a well-appearing male in no acute distress. He has no focal tenderness. Audiological examination demonstrates bilateral decreased hearing that is worse on the right. A radiograph of the patient’s skull demonstrates multiple lytic and sclerotic lesions with cortical thickening and bony expansion. Serological analysis in this patient would likely reveal which of the following in Figure A?