A 43-year-old man is evaluated for drug-resistant hypertension. Hypertension was diagnosed 1 year ago and has been difficult to control despite maximum dosages of lisinopril, metoprolol, and nifedipine. The patient reports feeling well, on physical examination, temperature is 36.5°C, blood pressure is 146/92 mm Hg, pulse rate is 88/min, and BMI is 27. Results of the general physical examination and funduscopic examination are unremarkable. Sodium 143 meg/L Potassium 3.3 meq/L Chloride 101 meq/L 33 meq/L 1.0 mg/dL Bicarbonate Creatinine Inappropriately High Spot urine potassium Urinalysis Normal. Which of the following is the most appropriate next diagnostic test?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Determination of serum aldosterone to plasma renin activity ratio
Drug-resistant hypertension with hypokalaemia (K 3.3), metabolic alkalosis (HCO3 33), high-normal Na and inappropriate urinary K loss = suspected primary hyperaldosteronism. The screening test is the plasma aldosterone : renin ratio. Adrenal CT comes only after biochemical confirmation; metanephrines are for phaeochromocytoma; renal angiography for renovascular disease.
ليش كل خيار صح أو غلط
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A
ليش غلط
Adrenal CT is used to find the cause once primary aldosteronism is diagnosed (adenoma versus hyperplasia), not as the first test.
✓ Step Up To Medicine 6th Edition 2024 (Adrenal).pdf · p. 8 -
B
ليش صح
Hypertension with hypokalemia is the listed indication for the plasma aldosterone to renin ratio, and metabolic alkalosis and drug-resistant hypertension are associated findings of primary hyperaldosteronism.
✓ Adrenal disorders (2).pdf · p. 12 -
C
ليش غلط
The aldosterone/renin ratio first separates primary hyperaldosteronism (high PAC, low renin) from secondary (high PAC and high renin); angiography is not the next step.
✓ Adrenal disorders (2).pdf · p. 12 -
D
ليش غلط
Metanephrines are the biochemical test for pheochromocytoma, whose classic triad is episodic: paroxysmal hypertension, pounding headache and sweating; he feels well and reports no such episodes.
✓ Adrenal summary.pdf · p. 7
- المصدر
- Adrenal disorders (2).pdf · p. 12
- المحاضرة
- Primary Hyperaldosteronism · Endocrinology · Module B
- ظهر في
- Endo bank