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Retired NBME 24 Answers

nbme24/Block 1/Question#47 (reveal difficulty score)
A 35-year-old man comes to the physician 1 ...
Increased serum angiotensin II concentration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—xxabi(293)
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ARBs result in the following changes: increased renin, increased Ang I, increased Ang II, decreased aldosterone and unchanged bradykinin

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famylife  ...and just to clarify, they directly inhibit the Ang II receptor (AT1) https://www.drugs.com/mmx/losartan-potassium.html +3
kpjk  I had a doubt- that wouldnt increased RAA lead to increased serum aldosterone as well. Now I understand that since the receptors are blocked- even the receptors to increase aldosterone secretion by Ang II would also get blocked... +3



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submitted by โˆ—aoa05(34)
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Renin concentration will be increased because feedback mechanism of renin release is due to angiotensis II (Ang II) on angiotensin type 1 receptor (AR1). That is, Ang II acting on AR1 will cause a negative feedback on the RAAS pathway. Since AR1 is blocked by ARB, this negative feedback is no longer active, triggering an increase in renin and increasing Ang II production (correct answer). Blocking AR1 will inhibit downstream actions (release of aldosterone and Ang II-mediated increase in sympathetic activation, triggering norepinephrine). Therefore, aldosterone and norepinephrine will be reduced.

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submitted by jotajota94(14)
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A good way to think about this is that angiotensin II is present at the ANGII receptors. If you give an angiotensin receptor blocker such as losartan. this will displace the angiotensin II present in the receptors. thus increasing the levels of angiotensin II in serum.

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