***NBME2:will u plz explain? - john2007

[ArchivalUser]

A healthy 27-year-old woman comes for a routine health maintenance examination. Her blood pressure is 185/90 mm Hg. Examination shows no other abnormalities except for hypertensive retinopathy. Serum studies show a sodium level of 140 mEq/L, potassium level of 4 mEq/L, and creatinine level of 1.1 mg/dL. A complete blood count, serum catecholamine levels, and urinalysis are within normal limits. At two subsequent visits, her blood pressure is 190/100 mm Hg and 182/96 mm Hg, respectively. Which of the following is the most appropriate next step in diagnosis?
A) 24-Hour urine collection for measurement of creatinine clearance
B) 24-Hour urine collection for measurement of 17-hydroxycorticosteroid and total 17-ketosteroid levels
C) Measurement of serum aldosterone level
D) Magnetic resonance angiography of renal vessels

[ArchivalUser]

i think A: inc of cr==>check kidney

all the rest cause electrolyte disturbance, while we dont have any here. plz correct me ?

[ArchivalUser]

AA

[ArchivalUser]

will u plz explain?

[ArchivalUser]

Another thought, is DD

[ArchivalUser]

any explanations for D?

[ArchivalUser]

DD: hypertension in young female usually cause by OCTs, and Renal A.stenosis..rite?, this girl no mention about OCTs. ..so rule out OCTs cause. in Renal A.stenosis the best dx.is captopril renogram or MRA. and i think, you shold do MRA once creatinine > 2mg/dl, and renography if creatinine

[ArchivalUser]

i think, you missed another option for this qs. is EE?, where is that EE?

[ArchivalUser]

sorry, one option was missing, thanks for ur attention:

A healthy 27-year-old woman comes for a routine health maintenance examination. Her blood pressure is 185/90 mm Hg. Examination shows no other abnormalities except for hypertensive retinopathy. Serum studies show a sodium level of 140 mEq/L, potassium level of 4 mEq/L, and creatinine level of 1.1 mg/dL. A complete blood count, serum catecholamine levels, and urinalysis are within normal limits. At two subsequent visits, her blood pressure is 190/100 mm Hg and 182/96 mm Hg, respectively. Which of the following is the most appropriate next step in diagnosis?
A) 24-Hour urine collection for measurement of creatinine clearance
B) 24-Hour urine collection for measurement of 17-hydroxycorticosteroid and total 17-ketosteroid levels
C) Measurement of serum aldosterone level
D) Magnetic resonance angiography of renal vessels
E) CT of abdomen

i found dif answ for this q:a, d,e ???i am not sure why?

[ArchivalUser]

Dont u fidn it really time killer to go true nbme qs with all discrepancies?
here is another one :

http://www.usmleforum.com/showthread.php?tid=325152