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* nbme 1
 #615995  
  vishnuvardhan - 09/22/11 15:53
 
  34. A 42-year-old woman comes to the physician for evaluation of persistently increased blood pressures. At her last two office visits during the past 3 months, her blood pressure has ranged between 150–170/105–115 mm Hg. During this period, she has had occasional headaches. In addition, she has had an increased urine output over the past 6 weeks that she attributes to a diet high in sodium. She is otherwise healthy and takes no medications. Her blood pressure today is 168/115 mm Hg, pulse is 68/min, and respirations are 14/min. Funduscopic examination shows mild arteriovenous nicking. The point of maximal impulse is not displaced. There is no edema, abdominal bruits, or masses. Serum studies show:

Na+
144 mEq/L
Cl–
90 mEq/L
K+
2.9 mEq/L
HCO3–
32 mEq/L
Urea nitrogen (BUN)
20 mg/dL
Creatinine
1.2 mg/dL

Which of the following is the most likely underlying cause of this patient's hypertension?

A
) Autonomous production of aldosterone

B
) Catecholamine-producing tumor

C
) Decreased arterial distensibility caused by atherosclerosis

D
) Excess production of atrial natriuretic peptide

E
) Juxtaglomerular cell hypertrophy and sclerosis
what is the diagnosis?
 
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* Re:nbme 1
#2481924
  supercowbp - 09/22/11 16:05
 
  I picked A, just because of the low K and mildy high Na  
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* Re:nbme 1
#2482221
  sonia29 - 09/22/11 23:39
 
  aa hypertension,hypok, , metabolic alkalosis  
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* Re:nbme 1
#2565404
  drguirand - 01/14/12 13:38
 
  How can you be sure that the answer is A whithout renin level??...I picked Answer A like you guys but I am not able to rule out Answer C...Can you help, here ?  
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* Re:nbme 1
#2565408
  genewalking - 01/14/12 13:43
 
  A
Against C
decreased arterial distensibility due to atherosclerosis woud cause aneurysm not hypertension. Hypertension is a disease of resistant arteries and atherosclerosis doesn't affect those.
 
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* Re:nbme 1
#2565415
  genewalking - 01/14/12 13:46
 
  actually decreased arterial distensibility due to athero would cause isolated systolic hypertension: athero of aorta --> systolic hypertension  
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* Re:nbme 1
#2565432
  raheem - 01/14/12 13:59
 
  AA .... -HIGH ALDOSTERONE ...LOW K ..... NEPHROGENIC DI  
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