asmi
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middle aged women with presistently increasing blood pressure .H/O occasional headaches . H/O increased urine output since past 6 weeks .Blood pressure is measured was 168/115 mm Hg. Fundus examination showed arteriovenous nicking .
BUN is 20
Creatinine is 1.2
Serum Na + is 144
the cause of her HTN is :
A. JG cell hypertrophy and sclerosis
B autonomus production of aldosterone
c. excess ANP production
d. catecholamine producting tumor
E. decreased arteriolar distensibility caused by atherosclerosis .
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| tuesday
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answer; A
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| tasneembanu
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can it be D?
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| sar
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Answer: I think D :?:
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| bahaa
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I think it is E because:
1-the remarkable elevation in the diastolic press.
2-Arteriovenous nicking.
3-The choice d cause retension not increasing in the urine flow scince it causes renine production.
4-serum Na is normal
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| dr.shar
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A. JG cell hypertrophy and sclerosis
increased urine output might be due to renal failure.
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| asmi
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sorry guys i don't have the answer..but i was thinking in terms of E..since middle aged women with HTN ..renovascular HTN due to atherosclerosis .
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| lauxw
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I PREFER ANSWER E
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| drvic
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one important thing missing in this question is serum potassium levels. that would have made things easy (maybe that's why the question maker obliterated it...to make it difficult :wink: )... becuase serum potassium is a very integral component of the initial evaluation of hypertension... won't miss it out in real life though.
now let's look at the question in detail... its basically testing your concepts of endocrine causes of hypertension...
middle aged woman with increasing blood pressures of recent onset - secondary cause likely. headaches and retinal changes explainable simply by high BP(so these were just the distractors - we'll forget them for now because they don't help us any further in delineating the underlying probable endocrine cause). now increased urine output of 6 weeks' duration is an important hint because it helps you to narrow it down to two of the choices - ANP excess and primary hyperaldosteronism- both should cause polyuria.
now we go through the choices -
JG cell hypertrophy and sclerosis - seen in Bartter's Syndrome - but that will cause low to normal BP coz there is hyporesponsiveness to elevated renin levels seen in this condition - so this choice is out
autonomous prodn of aldosterone - that means primary hyperaldosteronism by definition - no role of renin here. hypokalemia and polyuria are the key to diagnosis. since there is no mention of potassium in the question here, we'll just keep this choice under consideration.
ANP excess- also explains everything but the normal Na levels. this is because excess of ANP will definitely cause Na wasting. so this choice may be out as well
Catecholamine - non-paroxysmal (presumably) HT, no sympathetic stimulation signs mentioned (flushing, pallor, tachycardia etc) - this one is clearly out of the window
Atherosclerosis - doesnt explain inc in urine output of 6 weeks' duration.
so i think aldosterone excess is the answer.
don't think this questioned can be reasoned out in a minute. took me quite a bit of time to analyse every aspect... hope these kinda questions don't come in my Step 2 exam!!!
waiting for your responses
drvic
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| mdwannabe
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exellent analysis. I agree K level would be absultely essential here, or Renin level. But polyuria with normal Na is ponting to that Dx anyway.
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| asmi
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I agree with you drvic and mdwannabe , but K levels were not given in Q.
:idea: Unfortunately we do get few of these kinda Q's in Ck.
Drvic , that was a very good analysis indeed .
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| webjeee
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this is a nbme question, moreover, actually they did give the level of K+ of 2.9mEq/L. didn't type them all.
drvic is right
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