MSFinals-1576

MSFinals-1576

A young couple presents for infertility assessment. The man, a 22-year-old barman, has a history of recurrent upper and lower respiratory tract infections. Review of systems is remarkable for cough and shortness of breath on exertion. He often has copious, foul-smelling sputum, which is occasionally blood-tinged. His bowel habits are normal, except for intermittent constipation for a year. He has been diagnosed with irritable bowel syndrome. He has never smoked and drinks alcohol occasionally, on weekends. His vital signs are within normal limits. His nasal mucosa appears congested. There is mild maxillary sinus tenderness on palpation. Scattered wheezing and crackles are noted on lung auscultation. Neurologic and abdominal examinations are otherwise normal. Semen analysis reveals abnormal sperm motility.
What is the most likely additional finding in this patient?