A previously healthy 61-year-old man comes to the physician because of a 6-month history of morning headaches. He also has fatigue and trouble concentrating on his daily tasks at work. He sleeps for 8 hours every night; his wife reports that he sometimes stops breathing for a few seconds while sleeping. His pulse is 71/min and blood pressure is 158/96 mm Hg. He is 178 cm (5 ft 10 in) tall and weighs 100 kg (220 lb); BMI is 31.6 kg/m2 . Which of the following is the most likely cause of this patient's hypertension?
AProliferation of adrenal chromaffin cells
BOverproduction of cortisol
CHypophyseal neoplasm
DNocturnal upper airway obstruction
EHypersecretion of aldosterone
During exercise, what is the primary mechanism for increased oxygen delivery to active muscles?
ADecreased blood viscosity
BIncreased cardiac output
CIncreased hemoglobin affinity
DEnhanced oxygen diffusion
A 33-year-old woman presents to her primary care physician for a wellness check-up. She states that recently she has been feeling well other than headaches that occur occasionally, which improve with ibuprofen and rest. She has a past medical history of hypertension and headaches and is currently taking hydrochlorothiazide. Her temperature is 99.2°F (37.3°C), blood pressure is 157/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman who appears healthy. A normal S1 and S2 are auscultated on cardiac exam, and her lungs are clear with good air movement bilaterally. From her previous visit, it was determined that she has an elevated aldosterone and low renin level. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 3.7 mEq/L HCO3-: 29 mEq/L BUN: 20 mg/dL Creatinine: 1.1 mg/dL Which of the following is the most likely diagnosis?
ABenign essential hypertension
BPheochromocytoma
CCushing syndrome
DNarrowing of the renal arteries
EPrimary hyperaldosteronism
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