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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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Well, the answer key shows A) & E), so it is quite confusing...
Why do you think B) would be the answer, dreamdr?
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pt with HTN,no other abnoormality,so I think it's b
his se.Na and K is normal,so noneed to do renin test,
Symptom not suggest pheochromocytoma,so ni nee for 24 hr metanephrin
ECG can be done not Echo.
in my opinion 1st choice is B
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only poit for a and e option is to rule out renovascular hypertension,,,,,,which occure in very young female(less than 35)or very old.........also this patient has normal renal functions so no need to suspect renovascular hypertension..........i will go with B too
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damnit how hard is it to let ppl know this is NBME !
my answer is ECHO , its essential HT , we need to test end organ damage (heart, eye, kidney)
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It could be essential HTN, but to assess degree of end-organ damage is with ECG, CXR, creatinine, not Echo.
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I go with Echocardiography.
It's essential HTN and one should determine the status of other organ.
for example essential HTN with no other abnormality should be treated with Hydrochlorthiazide. and if left ventricle hypertrophy is there then beta blocker will be the Rx of choice.
Hey, echocardiography is more sensitive than ECG to detect LVH.
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