RAAS Practice Questions

Question 1

A 75 year-old gentleman presents to his general practitioner. He is currently being treated for hypertension and is on a multi-drug regimen. His current blood pressure is 180/100. The physician would like to begin treatment with minoxidil or hydralazine. Which of the following side effects is associated with administration of these drugs?

Accepted Answer

Reflex tachycardia

Answer

Persistent cough

Answer

Cyanosis in extremities

Answer

Fetal renal toxicity

Answer

Systemic volume loss

Question 2

A 32-year-old African American man presents to the office for a routine examination. He has no complaints at this time. Records show that his systolic blood pressure was in the 130–138 range and diastolic blood pressure in the 88–95 range despite counseling on lifestyle modification. He admits that he was not compliant with this advice. He takes no medications and works at home as a web designer. He does not drink alcohol but smokes marijuana on a weekly basis. Temperature is 37°C (98.6°F), blood pressure is 138/90 mm Hg, pulse is 76/min, and respirations are 12/min. BMI is 29.8 kg/m2. Physical examination is normal except for truncal obesity, with a waist circumference of 44 inches. Fasting laboratory results are as follows:
Blood glucose 117 mg/dL
Total cholesterol 210 mg/dL
LDL cholesterol  120 mg/dL
HDL cholesterol  38 mg/dL
Triglycerides  240 mg/dL
 Which of the following mechanisms contribute to this patient’s condition?

Accepted Answer

Insulin receptor resistance

Answer

Excessive cortisol secretion and activity

Answer

Granulomatous inflammation in medium-sized vessels

Answer

LDL receptor gene mutation

Answer

Autoimmune destruction of pancreatic beta cells

Question 3

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?

Accepted Answer

Primary hyperaldosteronism

Answer

Benign essential hypertension

Answer

Pheochromocytoma

Answer

Cushing syndrome

Answer

Narrowing of the renal arteries

Question 4

A 55-year-old woman comes to the physician because of involuntary hand movements that improve with alcohol consumption. Physical examination shows bilateral hand tremors that worsen when the patient is asked to extend her arms out in front of her. The physician prescribes a medication that is associated with an increased risk of bronchospasms. This drug has which of the following immediate effects on the cardiovascular system?

Stroke volume | Heart rate | Peripheral vascular resistance

Accepted Answer

↓ ↓ ↑

Answer

↓ ↓ ↓

Answer

↓ ↑ ↑

Answer

↑ ↑ ↑

Answer

↑ ↑ ↓

Question 5

A 32-year-old man presents with hypertension that has been difficult to control with medications. His symptoms include fatigue, frequent waking at night for voiding, and pins and needles in the legs. His symptoms started 2 years ago. Family history is positive for hypertension in his mother. His blood pressure is 160/100 mm Hg in the right arm and 165/107 mm Hg in the left arm, pulse is 85/min, and temperature is 36.5°C (97.7°F). Physical examination reveals global hyporeflexia and muscular weakness. Lab studies are shown:
Serum sodium 147 mEq/L
Serum creatinine 0.7 mg/dL
Serum potassium 2.3 mEq/L
Serum bicarbonate 34 mEq/L
Plasma renin activity low
Which of the following is the most likely diagnosis?

Accepted Answer

Primary aldosteronism

Answer

Renal artery stenosis

Answer

Coarctation of aorta

Answer

Cushing syndrome

Answer

Essential hypertension

Question 6

A newborn female is found to have ambiguous genitalia and hypotension. Laboratory workup reveals hyperkalemia, hyperreninemia, and elevated levels of 17-hydroxyprogesterone in the patient's urine. Which of the following enzymes would you expect to be deficient in this patient?

Accepted Answer

21-hydroxylase

Answer

11-hydroxylase

Answer

3β-hydroxysteroid dehydrogenase

Answer

11β-hydroxysteroid dehydrogenase

Answer

17-hydroxylase

Question 7

A 35-year-old African American woman comes to the physician because of intermittent palpitations over the past 2 weeks. During this period she has also had constipation and has felt more tired than usual. She was diagnosed with hypertension 4 weeks ago and treatment with chlorthalidone was begun. Her temperature is 36.5°C (97.7°F), pulse is 75/min, and blood pressure is 158/97 mm Hg. Physical examination shows a soft and nontender abdomen. There is mild weakness of the upper and lower extremities. Deep tendon reflexes are 1+ bilaterally. Laboratory studies show:
Hemoglobin 13.5 g/dL
Leukocyte count 5,000/mm3
Serum
Na+ 146 mEq/L
Cl− 100 mEq/L
K+ 2.8 mEq/L
HCO3− 30 mEq/L
Glucose 97 mg/dL
Urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Test of the stool for occult blood is negative. An ECG shows premature atrial complexes. Chlorthalidone is discontinued and oral potassium chloride therapy is begun. One week later, the patient's plasma aldosterone concentration is 26 ng/dL (N=3.6 to 24.0 ng/dL) and plasma renin activity is 0.8 ng/mL/h (N=0.3 to 4.2 ng/mL/h). Which of the following is the most appropriate next step in management?

Accepted Answer

Perform saline infusion test

Answer

Perform adrenalectomy

Answer

Measure urine pH and anion gap

Answer

Perform CT scan of the abdomen

Answer

Perform dexamethasone suppression test

Question 8

A 42-year-old man comes to the physician for a health maintenance examination. He has had generalized fatigue and muscle aches since his previous visit 6 months ago. He has hypertension and gastroesophageal reflux disease. Current medications include amlodipine and omeprazole. His temperature is 37.1°C (98.1°F), pulse is 88/min and blood pressure is 156/102 mm Hg. Physical examination shows no abnormalities. Serum studies show:
Na+ 143 mEq/L
K+ 2.3 mEq/L
Cl- 100 mEq/L
HCO3- 31 mEq/L
Urea nitrogen 14 mg/dL
Creatinine 1 mg/dL
His blood pressure medication is discontinued. One week later his plasma aldosterone concentration is 35 ng/dL (N=3.6 - 24.0 ng/dL) and plasma renin activity is 0.4 ng/mL/h (N=0.3 to 4.2 ng/mL/h). An oral sodium loading test over 3 days fails to reduce aldosterone. A contrast-enhanced CT scan of the abdomen and pelvis shows a 3-cm, homogenous, right-sided adrenal mass with rapid contrast washout. He is counseled about his treatment options and chooses to pursue surgery. Which of the following is the most appropriate next step in management?

Accepted Answer

Adrenal vein sampling

Answer

Right adrenalectomy

Answer

Fludrocortisone suppression test

Answer

Spironolactone therapy

Answer

Bilateral adrenalectomy

Question 9

A researcher is studying receptors that respond to epinephrine in the body and discovers a particular subset that is expressed in presynaptic adrenergic nerve terminals. She discovers that upon activation, these receptors will lead to decreased sympathetic nervous system activity. She then studies the intracellular second messenger changes that occur when this receptor is activated. She records these changes and begins searching for analogous receptor pathways. Which of the following receptors would cause the most similar set of intracellular second messenger changes?

Accepted Answer

Dopamine receptors in the brain

Answer

Muscarinic cholinoreceptors in the gastrointestinal tract

Answer

Growth hormone receptors in the musculoskeletal system

Answer

Vasopressin receptors in the kidney

Answer

Aldosterone receptors in the kidney

Question 10

Which mechanism primarily regulates sodium reabsorption in the collecting duct?

Accepted Answer

Aldosterone

Answer

Glomerulotubular balance

Answer

Atrial natriuretic peptide

Answer

Antidiuretic hormone

RAAS

Study Resources

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Questions

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Lessons

Renin production and regulation

Angiotensinogen to angiotensin I conversion

Angiotensin converting enzyme function

Angiotensin II receptors and actions

Aldosterone synthesis and release

Aldosterone actions on distal tubule

Sodium and potassium handling in RAAS

Negative feedback mechanisms

RAAS in volume regulation

RAAS in blood pressure control

Non-classical RAAS components

RAAS in pathophysiological states

Pharmacological targeting of RAAS

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