A 37-year-old man comes to the physician for a follow-up examination. He is being evaluated for high blood pressure readings that were incidentally recorded at a routine health maintenance examination 1 month ago. He has no history of serious illness and takes no medications. His pulse is 88/min and blood pressure is 165/98 mm Hg. Physical examination shows no abnormalities. Serum studies show: Na+ 146 mEq/L K+ 3.0 mEq/L Cl- 98 mEq/L Glucose 77 mg/dL Creatinine 0.8 mg/dL His plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is 36 (N = < 10). A saline infusion test fails to suppress aldosterone secretion. A CT scan of the adrenal glands shows bilateral adrenal abnormalities. An adrenal venous sampling shows elevated PACs from bilateral adrenal veins. Which of the following is the most appropriate next step in management?
APropranolol therapy
BUnilateral adrenalectomy
CAmiloride therapy
DBilateral adrenalectomy
EEplerenone therapy
An investigator is studying patients with acute decompensated congestive heart failure. He takes measurements of a hormone released from atrial myocytes, as well as serial measurements of left atrial and left ventricular pressures. The investigator observes a positive correlation between left atrial pressures and the serum level of this hormone. Which of the following is most likely the mechanism of action of this hormone?
AIncreases potassium excretion at the collecting ducts
BConstricts afferent renal arteriole
CDecreases sodium reabsorption at the collecting tubules
DDecreases reabsorption of bicarbonate in the proximal convoluted tubules
EIncreases free water reabsorption from the distal tubules
A 64-year-old African American female comes to the physician's office for a routine check-up. The patient's past medical history is significant for hypertension, diabetes, and osteoarthritis in her right knee. Her medications include metformin, glimepiride, lisinopril, metoprolol, hydrochlorothiazide, and ibuprofen as needed. Her only complaint is an unremitting cough that started about 3 weeks ago and she has noticed some swelling around her mouth. The drug most likely responsible for her recent symptoms causes its primary renal hemodynamic effect on which part of the kidney?
ACollecting duct
BDistal convoluted tubule
CJuxtaglomerular cells
DEfferent arteriole
EAfferent arteriole
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