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A 27-year-old woman presents to her primary care physician for a follow-up appointment. At her previous visit she had missed her previous two menses and also had a blood pressure of 147/100 mmHg. The patient has a past medical history of anxiety, depression, bulimia nervosa and irritable bowel syndrome. Her physician prescribed her an exercise program as well as started her on hydrochlorothiazide and ordered lab work. The results of the patient's lab work are below:Serum:Na+: 145 mEq/LK+: 2.9 mEq/LCl-: 100 mEq/LHCO3-: 30 mEq/LBUN: 18 mg/dLCa2+: 10.9 mg/dLMg2+: 2.0 mEq/LCreatinine: 1.2 mg/dLGlucose: 110 mg/dLThe patient's blood pressure at this visit is 145/100 mmHg and she has still not experienced her menses. Her cardiac, abdominal, and pulmonary exams are within normal limits. Inspection of the patient's oropharynx is unremarkable as is inspection of her extremities. The patient is started on furosemide and sent home. Which of the following is the most likely cause of this patient's presentation?
Increased mineralocorticoid production
Increased reabsorption at the collecting duct
Decreased renal artery blood flow
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A 44-year-old male presents to his primary care physician with complaints of fatigue, muscle weakness, cramps, and increased urination over the past several weeks. His past medical history is significant only for hypertension, for which he was started on hydrochlorothiazide (HCTZ) 4 weeks ago. Vital signs at today's visit are as follows: T 37.2, HR 88, BP 129/80, RR 14, and SpO2 99%. Physical examination does not reveal any abnormal findings. Serologic studies are significant for a serum potassium level of 2.1 mEq/L (normal range 3.5-5.0 mEq/L). Lab-work from his last visit showed a basic metabolic panel and complete blood count results to all be within normal limits. Which of the following underlying diseases most likely contributed to the development of this patient's presenting condition?
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
A 44-year-old female presents to her primary care physician with complaints of headache, fatigue, muscle weakness, and frequent urination. These issues have developed and worsened over the past month. She has no significant prior medical or surgical history other than cholecystitis managed with cholecystectomy 5 years ago. Her vital signs at today's visit are as follows: T 37.1 C, HR 77, BP 158/98, RR 12, and SpO2 99%. Physical examination is significant for tetany, mild abdominal distension, reduced bowel sounds, and hypertensive retinal changes on fundoscopic exam. The physician orders a laboratory and imaging work-up based on his suspected diagnosis. An abdominal CT scan shows an 8 cm unilateral left adrenal mass suggestive of an adrenal adenoma. Which of the following sets of laboratory findings would be most likely in this patient?
Metabolic acidosis, hypernatremia, hyperkalemia
Metabolic acidosis, hyponatremia, hyperkalemia
Metabolic acidosis, hypernatremia, hypokalemia
Metabolic alkalosis, hypernatremia, hyperkalemia
Metabolic alkalosis, hypernatremia, hypokalemia
A 56-year-old man with a history of hypertension presents to his physician with progressive fatigue and new onset muscle cramps. He has had no recent changes to his medication regimen, which includes hydrochlorothiazide, lisinopril, and amlodipine. His temperature is 98.0°F (36.7°C), blood pressure is 174/111 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. The patient's cardiopulmonary and abdominal exams are unremarkable. Laboratory values are ordered as seen below. Serum:Na+: 138 mEq/LCl-: 100 mEq/LK+: 3.3 mEq/LHCO3-: 33 mEq/LBUN: 20 mg/dLGlucose: 129 mg/dLWhat is the most likely underlying etiology of this patient's hypertension?
Impaired kidney perfusion
Increased peripheral vascular resistance