springbird
Forum Newbie
Topics: 6
Posts: 33
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Anybody can tell me the correct answer? thank you in advance.
17.
A 42-year-old woman comes for a follow-up examination.
Two weeks ago,
her blood pressure was 152/94 mm Hg during a routine
visit. Her blood
pressure today is 150/94 mm Hg, pulse is 76/min, and
respirations are
14/min. Examination shows no other abnormalities.
Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following
is the most
appropriate next step in management?
A
) Measurement of plasma renin activity
B
) Serum lipid studies
C
) 24-Hour urine collection for measurement of
metanephrine level
D
) Echocardiography
E
) Captopril renal scan
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| drdg
Forum Senior
Topics: 31
Posts: 176
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This patient only have high blood pressure. Serum studies are nornal. especially K+ is normal, her hypertension is not due to renal artery stenosis. Therefore, A and E can be rule out.
She may have essential hypertension. Therefore, she should have some basic studies such as
1.urinalysis for protein, glucose.
2. EKG to evaluate for LVH.
3. Serum BUN/Cr.
4. blood glucose and plasma lipid analysis as an indicator of atherosclerotic risk.
Now you should know the best answer is serum lipid studies.
Hopefully I answer your question right.
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| springbird
Forum Newbie
Topics: 6
Posts: 33
|
I got it, thank you drdg.
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| springbird
Forum Newbie
Topics: 6
Posts: 33
|
here is another question, also NBME2, please explain why D is the correct answer?
A 55-year-old man is admitted to the hospital because of progressive shortness of
breath for 10 days. He has a history of chronic venous stasis and deep venous
thrombosis. He has been treated with warfarin since he had several pulmonary
emboli 2 years ago; he takes no other medication. He has smoked two packs of
Cigarettes daily for 30 years. He weighs 109 kg (240 lb) and is 165 cm (65 in) tall.
Examination shows jugular venous distention. Echocardiography is most likely to
show which of the following?
A) Left ventricular dilation
B) Mitral stenosis
C) Pericardial thickening and tamponade
D) Right ventricular hypertrophy and dilation
E) Tricuspid stenosis
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| drdg
Forum Senior
Topics: 31
Posts: 176
|
Yes, the correct answer for this question is D. Right ventricular hypertrophy and dilation.
He had several PEs and his high BMI ( obesity) indicate he may have pulmonary artery hypertension. In addition, He has JVD indicate he has right ventricular dysfunction. Therefore, Right ventricular hypertrophy will be manifested in his echocardiography.
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| springbird
Forum Newbie
Topics: 6
Posts: 33
|
Hi drdg, thank you for your answer. I understand now, but how obesity relates to pulmonary HTN?
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| springbird
Forum Newbie
Topics: 6
Posts: 33
|
Hi drdg, please parden me for my pesty, but here is another NBME2 question which I have no idea.
A 27-year-old woman comes to the physician because of muscle weakness and
cramps for 2 weeks. She has been taking a ß-adrenergic blocking agent for
hypertension for 2 years. She had chronic lymphocytic thyroiditis (Hashimoto's
disease) 1 year ago. Her blood pressure is 160/108 mm Hg, and pulse is 60/min.
Serum studies show:
Na+ 140 mEq/L
Cl– 110 mEq/L
K+ 2.2 mEq/L
HCO3– 30 mEq/L
Urea nitrogen (BUN) 20 mg/dL
Creatinine 1 mg/dL
Magnetic resonance angiography of the abdomen shows normal findings.
A) Adrenal cortex
B) Adrenal medulla
C) Aorta
D) Renal arteries
E) Renal glomeruli
F) Thyroid gland
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| drdg
Forum Senior
Topics: 31
Posts: 176
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This young woman has low K, HCo3- 30, upper limit of Na and HPT indicate she may have Conn's syndrom, whihc is due to adrenal cortex hyperplasia. I guess the question ask where is site of her problem.
I will select A as the answer.
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| springbird
Forum Newbie
Topics: 6
Posts: 33
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thanks drdg, but one question, why she is resistant to the medication and still has HTN?
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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adrenal hyperplasia not conn's
conn's=adrenal adenoma
daignosis by measure plasma aldosterone/plasma renin
treatemt spironolactone as aldesterone antagoinst +- ACEI
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