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A 60-Year-Old Woman Is Being Evaluated for Headache and Hypertension

question 761

Multiple Choice

A 60-year-old woman is being evaluated for headache and hypertension. For the past week, she has felt tired and has had a progressive, generalized headache. She denies fever, chills, photophobia, or neck stiffness. Her general health has been good with the exception of 6 months of persistent pains and swelling in both hands. During this time, her fingers felt puffy and she recently noted some tiny pits appearing on her finger tips. She is also troubled by heartburn and mild dyspnea with exertion. She does not smoke or drink alcohol. She takes calcium, vitamin D, and a multivitamin. Over the past few days, she has also been taking acetaminophen and ibuprofen.
Her blood pressure is 210/111 mm Hg, pulse is 90/min, and respirations are 16/min. She looks her stated age and appears uncomfortable. Her ocular fundi reveal no papilledema. Her neck is supple. Cardiac and abdominal exams are within normal limits. She has bibasilar fine end-inspiratory crackles on pulmonary exam. There are a few small digital fingertip pits.
Her laboratory studies are shown below.

Her chest-x ray shows bibasilar reticular fibrosis. Her peripheral blood smear reveals schistocytes.
Which of the following is the best initial treatment for this patient?

Definitions:

Avoidance Goals

Targets aimed at preventing undesirable outcomes, as opposed to pursuing positive outcomes.

Achievement Goal Theory

A framework in psychology that focuses on how individuals' goals, both competence-based and achievement-based, motivate their behaviors and learning approaches.

Peer-assisted Learning

An educational approach where peers engage in collaborative learning activities together, often involving students tutoring each other in their areas of strength.

Acquiring Knowledge

The process of obtaining information, understanding, and skills through experience, education, or being taught.