You are called to the ER to see one of your patients w/ hypertension, diabetes and chronic hepatitis C. He appears septic w/o an obvious focus. He was just in New Orleans for Mardi Gras. A most important question to ask:

Correct Answer: D

Rationale: Asking about food consumption can help identify potential sources of infection such as contaminated food or water.

Correct Answer: B

Rationale: Anti-CCP (ACPA) is highly specific for rheumatoid arthritis and strongly associated with aggressive, erosive joint disease, unlike ANA (nonspecific), ANCA (vasculitis), or Anti-SSA (Sjogren's), per rheumatology literature.

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.