Problem: A patient experiencing chronically dry eyes reGuy is a 65 y/o male who comes to the clinic with the following chief complaint: "I have been feeling feverish, have chills, and am tired all the time. My heart also makes a funny sound. In the physical exam the NP auscultates a heart murmur, and notices that he patient has subungual hemorrhages, petechiae on the palate, violet colored nodes on the fingers and feet, and nontender red nodes on the palms and soles of his feet. The most likely diagnosis for Guy is:ports having a foreign body sensation, burning, and itching. A Schirmer test is abnormal. What is the suspected cause of this patient's symptoms based on this test finding?