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Category: Critical Care Medicine-Endocrine Disorders--->Renin-Angiotensin-Aldosterone System
Page: 1

Question 1# Print Question

An 18-year-old male with a history of headaches presents to the emergency department with complaints of severe headache. His vitals are:

  • HR of 112 beats/min
  • BP 215/125 mm Hg
  • respiratory rate 14 breaths/min
  • temperature 36.9°C

CT scan of the brain showed diffuse cerebral edema but no acute intracranial bleed. ECG demonstrates sinus tachycardia but is otherwise normal. Despite multiple administrations of antihypertensives, his blood pressure is still 194/110, and he is admitted for hypertensive crisis. Workup demonstrates mild hypokalemia. Hormonal studies were significant for elevated plasma renin and aldosterone levels, but normal renin/aldosterone ratio. Plasma metanephrines, thyroid-stimulating hormone, T3, T4, and free T4 are normal. Imaging shows a juxtaglomerular mass on the right kidney and no evidence of renal artery stenosis.

Which of the following regarding his diagnosis is correct?

A. Patients often present with concurrent metabolic acidosis
B. Renal ultrasound is the diagnostic modality of choice
C. The patient should undergo alpha-blockade prior to beta-blockade
D. Blood pressure is often difficult to control before resection

Question 2# Print Question

A 68-year-old male with a history of coronary artery disease/myocardial infarction treated with a drug-eluting stent and controlled hypertension develops microscopic hematuria and is scheduled for cystoscopy. His medication list includes metoprolol XL 100 mg daily, losartan 50 mg daily, atorvastatin 80 mg daily, and aspirin 81 mg. His preoperative examination is unremarkable, and patient reports exercise capacity >4 METs. Per his instructions from his surgeon, he has continued taking all his medications except for holding his lisinopril and metformin the night before. After an uneventful induction and intubation, the patient’s blood pressure drops from 132/68 to 70/42 mm Hg, with pulse continuing at 66 beats/min. The patient’s five-lead electrocardiogram demonstrates sinus rhythm but with new 1 mm ST depressions in his precordial leads. End-tidal CO2 and pulse oximetry are unchanged. The blood pressure does not improve with repeated boluses of phenylephrine and ephedrine, or with a fluid bolus of 500 mL, necessitating vasopressin and epinephrine boluses. Bedside transthoracic echocardiogram demonstrates a hyperdynamic and collapsed LV, no wall motion abnormalities, no valvular lesions, and no pericardial effusion. Decision is made to postpone the patient’s elective surgery and awaken him. Upon emergence, the patient’s blood pressure recovers to 124/62 mm Hg and pulse 60 beats/min. The patient is extubated successfully with no neurological sequelae.

Which of the following is the most likely etiology of the patient’s hypotension?

A. Hypovolemia
B. Medication effect
C. Acute myocardial infarction
D. Pulmonary embolism

Question 3# Print Question

An 18-year-old male with multiple stab wounds to his abdomen is brought by ambulance to the trauma bay. He is bleeding profusely, with HR 128 beats/min, BP 72/41 mm Hg, SpO2 92% on 15 L oxygen via nonrebreathing face mask. Of the following statements regarding this patient’s renin-angiotensin-aldosterone system (RAAS), which is FALSE? 

A. Decreased oxygenation in the macula densa activates the RAAS
B. Increased conversion of angiotensin I to II via renin results in angiotensin (AT1)-receptor–mediated vasoconstriction of arteriolar smooth muscle
C. Angiotensin II has a greater effect on efferent glomerular arterioles than afferent, preserving glomerular pressure
D. Aldosterone release promotes sodium and water retention in the kidneys leading to greater volume retention

Question 4# Print Question

Which of the following lab results is most consistent with isolated hypoaldosteronism?

A. A
B. B
C. C
D. D

Category: Critical Care Medicine-Endocrine Disorders--->Renin-Angiotensin-Aldosterone System
Page: 1 of 1