Question 1

A decrease in which one of the following would most likely result in chronic hypertension?

Accepted Answer

Nitric oxide is a potent vasodilator and plays a crucial role in the regulation of blood pressure. A decrease in nitric oxide production or activity would result in vasoconstriction, leading to an increase in blood pressure and possibly chronic hypertension. The other options (Angiotensin II, Renal sympathetic nerve activity, and Aldosterone) typically contribute to increasing blood pressure, so a decrease in any of these factors might actually improve blood pressure control.

Question 2

A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l } 
\text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \
\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \
\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \
\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \
\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \
\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \
\text { Urinalysis: } & 3 + \text { proteinuria }
\end{array}$$
-An angiotensin-converting enzyme inhibitor is administered to a 65-year-old man with a 20-year history of hypertension. The drug lowered arterial pressure and increased plasma levels of renin and bradykinin. An increase in which of the following would best explain the decline in blood pressure?

Accepted Answer

Angiotensin-converting enzyme inhibitors (ACE inhibitors) lower blood pressure primarily by inhibiting the conversion of angiotensin I to angiotensin II, leading to decreased vasoconstriction and aldosterone secretion. This results in increased renal sodium excretion, which is a key mechanism in reducing blood pressure. Additionally, ACE inhibitors increase bradykinin levels, which can further contribute to vasodilation, but the primary mechanism for the decline in blood pressure is the enhancement of renal sodium excretory function.

Question 3

A 65-year-old woman with a 10-year history of essential hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 2-3 times higher than normal. The patient is given a prescription for an angiotensin I receptor blocker (ARB). Which one of the following would you expect to occur in this patient following administration of the ARB?

Accepted Answer

Angiotensin I receptor blockers (ARBs) block the action of angiotensin II, leading to vasodilation and decreased aldosterone secretion. This results in a compensatory increase in plasma renin activity as the body attempts to counteract the effects of the ARB and maintain blood pressure.

Question 4

A decrease in which one of the following would best explain the increase in blood pressure in this patient?

Accepted Answer

A decrease in glomerular filtration rate (GFR) can lead to fluid retention, increasing blood volume and consequently raising blood pressure.

Question 5

Which of the following set of changes would be expected to increase sodium excretion by the kidney?

Accepted Answer

The answer of Which of the following set of changes...

Question 6

A 45-year-old woman was seen by her physician for an upper respiratory infection. Blood pressure on that visit was noted to be 158/94 mm Hg. She was asked to return for two other visits, separated by 1 week each, for measurement of blood pressure. Repeat measures were similar. She has no previous history of hypertension. She denies any previous significant medical problems. There is a positive family history for hypertension. The rest of her history is unremarkable. Other than moderate obesity and the elevated blood pressure, her physical examination was completely normal. All routine laboratory studies were normal. Which diagnosis would you predict for this woman?

Accepted Answer

The patient's presentation is consistent with essential hypertension, which is a diagnosis of exclusion. Other potential causes of hypertension would need to be ruled out through additional testing or imaging, but the presence of a positive family history and lack of other significant medical problems makes essential hypertension the most likely diagnosis.

Question 7

A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l } 
\text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \
\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \
\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \
\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \
\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \
\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \
\text { Urinalysis: } & 3 + \text { proteinuria }
\end{array}$$
-A 55-year-old man with a history of normal health visits his physician for a checkup. His blood pressure was 170/98 mm Hg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected in this man with renovascular hypertension?

Accepted Answer

The answer of A 40-year-old woman with a 16-year history...

Question 8

A 45-year-old man with a history of normal health visits his physician for a checkup. His blood pressure measured 170/98 mm Hg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected?

Accepted Answer

The answer of A 45-year-old man with a history of...

Question 9

A healthy 22-year-old female medical student with normal kidneys increases her sodium intake by 200% for a period of 2 months. A decrease in which of the following is expected to occur in response to the increase in sodium intake?

Accepted Answer

An increase in sodium intake leads to an increase in blood volume and blood pressure, which in turn decreases the need for the renin-angiotensin-aldosterone system to conserve sodium. As a result, plasma renin activity decreases.

Question 10

A 55-year-old woman is diagnosed with a juxtaglomerular cell rennin-secreting tumor. Lab tests reveal a plasma concentration of angiotensin II five times normal. Which of the following set of findings would be expected?

Accepted Answer

The answer of A 55-year-old woman is diagnosed with a...

Question 11

A 50-year-old man has a 3-year history of hypertension. He has taken several medications but has not achieved good blood pressure control. He has been off medications entirely for the last 6 months. He complains of fatigue and occasional muscle cramps. There is no family history of hypertension. The patient has not had any other significant medical problems. Examination reveals a blood pressure of 168/104 mm Hg. Additional laboratory tests indicate that he has primary hyperaldosteronism. Which of the following set of findings would be most likely expected?

Accepted Answer

The answer of A 50-year-old man has a 3-year history...

Question 12

A patient with which sodium intake (in mmol/day) will have the greatest reduction in blood pressure in response to an angiotensin converting enzyme inhibitor?

Accepted Answer

The answer of A patient with which sodium intake (in...

Question 13

A 55-year-old woman with a 5-year history of hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 3 to 4 times higher than normal. The patient is given a prescription for Capoten, an angiotensin II converting enzyme (ACE) inhibitor. An increase in which one of the following would you expect to occur in this patient following administration of the ACE inhibitor?

Accepted Answer

ACE inhibitors block the conversion of angiotensin I to angiotensin II. As a result, the level of angiotensin I increases because its conversion to angiotensin II is inhibited.

Quiz 19: Role of the Kidneys in Long-Term Control of Arterial Pressure and in Hypertension: the Integrated System for Arterial Pressure Regulation