Chapter 19

Hall: Guyton and Hall Textbook of Medical Physiology, 12th Edition Chapte 1!: "ole of the #idneys in $ong%Te& Contol of 'teial Pessue and in Hypetension: The (ntegated )yste& fo 'teial Pessue "egulation Test *ank

1. A 65-year 65-year-old -old female female with a 10-year history history of essential essential hypertensio hypertension n visits her physician physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 2- times hi!her than normal. "he patient is !iven a prescription for an an!iotensin type 1 receptor bloc#er $A%&'. (hich one o f the followin! would you expect to occur in this patient followin! administration of the A%&) A. *ncre ncreas asee in in tot total al peri periph pher eral al res resista istanc ncee &. *ncrease in in ar arterial pr pressure +. *ncrease in pl plasma re renin acti ctivit vity ,. *ncrease in aldosterone . ,ecr ,ecrea ease se in #idn #idney eys abil abilit ity y to excr excret etee sodi sodium um A/ + 2. A 55-year 55-year-old -old female female with a five five year history history of hypertension hypertension visits visits her physici physician an for an examination. Laboratory test results indicate that the patient has a plasma rennin activity - times hi!her than normal. "he patient is !iven a prescription for +aptopen3 an an!iotensin ** convertin! en4yme $A+' inhibitor. inhibitor. An increase in which one o ne of the followin! would you expect to occur occu r in this patient followin! administration of the A+ inhibitor) A. "otal pe peripheral re resistance &. Arterial pr pressure +. An!iotensin * ,. Aldosterone . Atrial natriuretic peptide A/ + . (hich of the followin followin! ! set of chan!es chan!es would would be expected to to decrease decrease sodium excreti excretion on by the #idney) 0 /itric xide %enal ympathetic An!iotensin ** 1

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A/ 8 . A healthy 22-year-old female medical student with normal #idneys increases her sodium inta#e by 00: for a period of two months. (hich of the followin! is expected to occur in response to the increase in sodium inta#e) A. A decrease in arterial pressure &. A decrease in plasma renin activity +. A decrease in sodium excretion ,. A decrease in nitric oxide . A decrease in atrial natriuretic peptide A/ & 2 

5. A 55-year-old female is dia!nosed with a ;uxta!lomerular cell rennin-secretin! tumor. Lab tests reveal a plasma concentration of an!iotensin ** five times above normal. (hich of the followin! set of findin!s would be expe cted in this man) &lood
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A/ + 6. A 5-year-old male with a history of normal health visits his physician for a chec# up. ,urin! his physical exam3 it was revealed that h is blood pressure was 1?0@> mm9!. 7urther tests indicated that he had renovascular hypertension as a result of a stenosis in the left #idney. (hich of the followin! set of findin!s would be most li#ely expected in this man with renovascular hypertension) %enal &ood 7low
A/ 8 ?. A 50-year-old male has a three year history of hypertension. 9e has been on several medications without ever havin! !ood blood pressure control. 9e has been off medications entirely for the last six months. 9e complains of fati!ue and occasional muscle cramps. "here is no family history of hypertension. "he patient has not had any other si!nificant medical problems in the past. xamination reveals a blood pressure of 16@10 mm9!. Additional laboratory tests indicate that the patient has primary hyperaldosteronism. (hich of the followin! set of findin!s would be most li#ely expected in this man with primary hyperaldosteronism)  xtracellular 7luid
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+. ,. . 7. 8. 9. A/ + . Cuestions -> A 0-year-old female with a history of diabetes mellitus for 16 years 5. visited the emer!ency room with a blood pressure of 2?0@110. he had her blood pressure measured many times in the past and has never been noted to be hypertensive. he also complains of pedal edema which has been !radually pro!ressive. he denies polyuria3 polydypsia or symptoms of hypo!lycemia. 9er insulin re!imen is 9umulin3 20 units in the mornin! and 10 units in the afternoon. Laboratory tests revealed the followin! values $ran!e of normal values in parentheses' &D/  $>-20 m!@dl' +reatinine 2.? $0.?-1. m!@dl' 8lucose 2>6 $?-106 m!@dl' "otal protein 6.2 $6.-.2 !@dl' Albumin .0 $.5-5.1 !@dl' +holesterol 20 $120-1>> m!@dl' Drinalysis E proteinuria . A decrease in which one of the followin! would best explain the increase in blood pressure in this patient) A. An!iotensin ** &. Aldosterone +. ympathetic nerve activity ,. 8lomerular filtration rate . ndothelin A/ , 5 >. An increase in which one of the followin! would most li#ely result in chronic hypertension) A. ,opamine &. enal sympathetic nerve activity +. &rady#inin ,. /itric oxide


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A/ & 6 7 10. A 5-year-old female was seen by her physician for an upper respiratory infection. &lood pressure on that visit was noted to be 15@> mm9!. he was as#ed to return for two other visits3 separated by one wee# each3 for measurement of blood pressure. %epeat measures were similar. he has no previous history of hypertension. he denies any previous si!nificant medical problems. "here is a positive family history for hypertension. "he rest of her history is unremar#able. ther than moderate obesity and the elevated blood pressure3 her physical exa mination was completely normal. All routine laboratory studies were normal. (hich of the followin! dia!noses would you predict for this woman) A. %enovascular hypertension &.  mm9!. 7urther tests indicated that he had renovascular hypertension as a result of a stenosis in the left #idney. (hich of the followin! set of findin!s would be most li#ely expected in this man with renovascular hypertension)  "otal peripheral resistance

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12. An an!iotensin-convertin! en4yme inhibitor $+*' is administered to a 65-year-old male with a 20-year history of hypertension. "he dru! lowered arterial pressure and increased plasma levels of renin and brady#inin. An increase in which of the followin! would best explain the decline in blood pressure) A.

Chapter 19

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