A 75 yo woman admitted with 3 month hx of progressive fatigue, edema, mild hemoptysis and dyspnea. CXR bilateral infiltrates, CRE 4.1, BUN 55. UA+3 blood and protein. UAC 2300, UPC 4300. C3 and C4 are low. Which is the most likely diagnosis?

Correct Answer: C

Rationale: Low complement levels (C3 and C4) along with significant proteinuria and hematuria indicate systemic lupus erythematosus. Lupus nephritis often presents with these laboratory abnormalities.

Correct Answer: B

Rationale: Beta-blockers are advocated in the management of heart failure to inhibit the cardiac effects of sympathetic activation. These drugs are negative inotropes and have the potential to reduce cardiac output. The goal with the use of beta-blockers in heart failure is to reduce cardiac output. Beta-blockers do not affect sodium reabsorption. Angiotensin II and aldosterone enhance sodium and water reabsorption by the kidney, contributing to an elevated blood volume.

Correct Answer: D

Rationale: Holter monitoring (D) assesses arrhythmias over time but is not a primary diagnostic tool for heart failure. Echocardiogram (A), BNP (B), and nuclear stress tests (C) directly evaluate heart function or failure markers.

Correct Answer: B

Rationale: Angioedema occurring with angiotensin-converting enzyme(ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

Correct Answer: B

Rationale: The aortic valve allows blood to exit the left ventricle into the aorta, initiating the systemic circuit.