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NBME 24 Answers

nbme24/Block 1/Question#47 (19.7 difficulty score)
A 35-year-old man comes to the physician 1 ...
Increased serum angiotensin II concentration🔍

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submitted by xxabi(223),
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RsBA lsuter in eht flowigonl ec:aghns raedcines ern,in crisdeean gnA ,I neieacrsd ngA ,II asrceeedd leornetoasd adn hcuaegndn rdknybaini

famylife  ...and just to clarify, they directly inhibit the Ang II receptor (AT1) +2  
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... +2  

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submitted by aoa05(11),

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 Since AR1 is blocked by ARB, this negative feedback is no longer active, triggering an increase in renin and increasing Ang II production (correct answer).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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A good yaw ot hiknt obuat tish si thta iniasgtneon II is epenstr ta teh IANIG scertrp.eo If oyu veig na toginsnneia ecertpor cbeklor hcus as tsih lwli lpscaied the nngniaeisto II rptenes in het .corsetrep stuh nrsignecia het llesve fo stonaneiign II in .srmue