11-22-2007, 01:21 PM
34. A 42-year-old woman comes to the physician for evaluation of persistently increased blood pressures. At her last two office visits during the past 3 months, her blood pressure has ranged between 150“170/105“115 mm Hg. During this period, she has had occasional headaches. In addition, she has had an increased urine output over the past 6 weeks that she attributes to a diet high in sodium. She is otherwise healthy and takes no medications. Her blood pressure today is 168/115 mm Hg, pulse is 68/min, and respirations are 14/min. Funduscopic examination shows mild arteriovenous nicking. The point of maximal impulse is not displaced. There is no edema, abdominal bruits, or masses. Serum studies show:
Na+
144 mEq/L
Cl“
90 mEq/L
K+
2.9 mEq/L
HCO3“
32 mEq/L
Urea nitrogen (BUN)
20 mg/dL
Creatinine
1.2 mg/dL
Which of the following is the most likely underlying cause of this patient's hypertension?
A
) Autonomous production of aldosterone
B
) Catecholamine-producing tumor
C
) Decreased arterial distensibility caused by atherosclerosis
D
) Excess production of atrial natriuretic peptide
E
) Juxtaglomerular cell hypertrophy and sclerosis
Na+
144 mEq/L
Cl“
90 mEq/L
K+
2.9 mEq/L
HCO3“
32 mEq/L
Urea nitrogen (BUN)
20 mg/dL
Creatinine
1.2 mg/dL
Which of the following is the most likely underlying cause of this patient's hypertension?
A
) Autonomous production of aldosterone
B
) Catecholamine-producing tumor
C
) Decreased arterial distensibility caused by atherosclerosis
D
) Excess production of atrial natriuretic peptide
E
) Juxtaglomerular cell hypertrophy and sclerosis