Clinical Clues
A 68-year-old man with a long history of smoking and known coronary and peripheral artery disease presents with new-onset hypertension. Examination reveals diminished femoral pulses and an abdominal bruit. What is the most likely cause of his high blood pressure?
renal artery stenosis
In what cause of secondary hypertension would you see a string of pearls on CT angiography?
fibromuscular dysplasia
CKD (and most renal parenchymal diseases) can cause abnormal activation of which nervous system pathway, leading to secondary hypertension?
Sympathetic NS
This common OTC drug class raises blood pressure by inhibiting prostaglandins.
NSAIDs
In which type of renovascular hypertension are bruits not heard?
coarctation of the aorta
What exam finding would you see in someone with secondary hypertension due to coarctation of the aorta?
radial femoral delay
A 65-year-old man with a 40-pack-year smoking history presents with diminished pedal pulses and poorly controlled hypertension despite three antihypertensive medications. What type of blood flow occurs at the site where this patient likely has a blockage?
turbulent
A 42-year-old woman presents with progressive central weight gain, purple striae, and proximal muscle weakness, along with new-onset hypertension. She reports taking medication for a chronic inflammatory condition. Which of the following drugs could lead to this condition?
A. Spironolactone
B. Lisinopril
C. Dexamethasone
D. Propranolol
E. Chlorthalidone
dexamethasone
A 52-year-old non-obese man is brought to the ED for severe headache, tremor, and increased sweating. His BP is 220/140 mmHg with a heart rate of 128 BPM. What diagnosis is most likely in this patient?
pheochromocytoma
In assessing a patient with suspected primary hyperaldosteronism, what test should be ordered first?
Plasma aldosterone/renin ratio
Various causes of secondary hypertension can lead to hypokalemia and metabolic alkalosis. Abnormal signaling to which renal tubular cell(s) causes these effects?
principal and alpha-intercalated cells
What receptor is targeted by a common decongestant that can lead to secondary hypertension?
alpha 1 receptor
A 35 year old man with a family history of kidney disease presents with flank pain, hypertension, and bilaterally enlarged and nodular kidneys on exam. Increased levels of what hormone could be causing his hypertension?
renin
A 43-year-old male presents for his annual physical examination. Review of systems is negative except for occasional headaches. He is found to have a blood pressure of 150/95 in both arms. The remainder of the physical examination is normal. Lab values are as follows:
Na 140 mEq/L, K 3.0 mEq/L, Cl 100 mEq/L, Bicarb 29 mEq/L, Cr 1.1 mg/dL
What characteristic is most suggestive of a secondary cause of hypertension in this patient?
hypokalemia and/or metabolic alkalosis
In renal artery stenosis, a certain system is upregulated in the affected kidney. Why do patients with this condition have hypertension but do not experience volume overload?
Other kidney compensates and lowers RAAS, reducing water retention, but cannot fully counter renin
A child with low renin and low aldosterone levels, hypokalemia, and severe hypertension is evaluated in the clinic. What is the best drug of choice for the management of hypertension in this child with no Cushingoid features?
amiloride
A 28-year-old woman with no prior medical history is found to have new-onset hypertension and reports intermittent headaches. On exam, she has carotid, abdominal, and femoral bruits. What anatomical structure is likely affected in this patient (be specific!)?
tunica media of the distal ⅔ of renal artery
A 55-year-old man is experiencing episodic sweating and palpitations. His BP is 220/140 mmHg with a heart rate of 128 BPM. What test should be ordered to confirm the suspected diagnosis?
Plasma and 24hr urine collection for free metanephrine and normetanephrine
In glucocorticoid-remediable aldosteronism, aldosterone production is abnormally regulated by a certain hormone. What part of the adrenal cortex does this hormone normally stimulate?
zona fasciculata
A 77-year-old man with HTN for 2 years presents with a BP of 168/102 mmHg and a heart rate of 91 BPM. He is on HCTZ 25 mg, ramipril 10 mg, and metoprolol succinate 100 mg (all are once daily). His creatinine is 1.8 mg/dL (eGFR 42 mL/min), which increased from 1.2 mg/dL. Which drug caused his renal function to worsen, and what is the likely cause of his condition?
Ramipril, RAS