nbme form 2 block 2 question 2 - medik9

[ArchivalUser]

2. A 15-year-old girl is brought to the physician 3
months after she
had a blood pressure of 150/95 mm Hg at a routine
examination prior to
participation in school sports. She is asymptomatic
and has no history
of serious illness. Twelve months ago, she was
diagnosed with a
urinary tract infection and treated with oral
trimethoprim-sulfamethoxazole.
She currently takes no medications. Subsequent blood
pressure
measurements on three separate occasions since the
last visit have been: 155/94
mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the
50th percentile
for height and 95th percentile for weight. Her blood
pressure today is
150/90 mm Hg confirmed by a second measurement, pulse
is 80/min, and
respirations are 12/min. Examination shows no other
abnormalities. Her
hematocrit is 40%. Urinalysis is within normal limits.
Cardiac and
renal ultrasonography shows no abnormalities. Which
of the following is
the most appropriate next step in management?

A
) Exercise and weight reduction program

B
) Measurement of urine catecholamine levels

C
) Measurement of urine corticosteroid levels

D
) Captopril therapy

E
) Hydrochlorothiazide therapy

[ArchivalUser]

A) Exercise and weight reduction program

[ArchivalUser]

Hello dream88, but the key given C, I dont understand,,

can any one give explaination plss,,,

[ArchivalUser]

Difficult Q...
1 st option: She is She is at the 50th percentile for height and 95th percentile for weight. means that she is overweight first measure in this case is Diet+ losing weight
"Losing 1 kg leads to a 1.6 reduction in systolic pressure and 1.1 reduction in diastolic pressure. Regular exercise is a good way to lose weight. It lowers high blood pressure and helps you lose weight. A study found that regular aerobic exercise decreased systolic pressure by 3.84 mmHg and diastolic pressure by 2.58 mmHg in inactive adults over 2 weeks.

Option C . Cushing? the problem is that PE is Normal ( absence of moon facies buffalo bump etc etc, prox muscle weakness).
the problem is that she has urinary infection which may be explained by increase Cortisol ( immunodepressed) and may explain her obesity too ( but with normal Physical exam and without other abnormalities first Option seems correct ).

[ArchivalUser]

My choice goes to D,

HT is caused by UTI, secondary, The first choice in this catagory is to use ACEI.

Obesity usually causes primary HT, treatment is to reduce weight first

[ArchivalUser]

aaa