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Topic: Cardiology Record # 28 Question/Fact: A 25-year-old white woman comes to your office today to meet you for the first time. Her only complaint is of headaches. Her blood pressure is 160/105 mm Hg in both arms. She is obese and otherwise has a normal physical examination with no bruits in her abdomen. Two weeks and three weeks later, her blood pressure remains elevated at 155/107 and 157/105 mm Hg, respectively. She smokes but does not drink alcohol. 8 mg/dL. Urinalysis reveals +1 protein, with no red or white cells.

A) It is not indicated in this patient (B) It is mandatory in a patient with positive lupus serology to rule out lupus nephritis (C) Biopsy is used to determine the need for cyclophosphamide (D) It is indicated only in relapse patients (E) It is indicated in drug-induced lupus Answer: (C) Biopsy is used to determine the need for cyclophosphamide Explanation: Clinical lupus nephritis is seen in 50% of SLE patients and is characterized by either urinary abnormalities or a rising creatinine. Establishing a specific diagnosis of renal lupus is important, as each class may need a different form of therapy.

He has had hypertension for the last 10 years, which has been controlled on medication. On examination, he is found to have an irregularly irregular pulse of 120/min and a blood pressure of 98/70 mm Hg. The rest of the examination is normal. 3 mg/dL. An EKG shows a rate of 132/minute with an irregularly irregular rhythm. The QRS is 90 milliseconds in duration. The ST segments and T waves are normal. Which of the following is the most appropriate initial therapeutic option? (A) Electrical cardioversion (B) Ibutilide (C) Metoprolol (D) Amiodarone (E) Low-molecular-weight heparin Answer: (C) Metoprolol Explanation: The patient presents with a narrow complex tachycardia and a rapid ventricular rate.

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