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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 3/Question#24 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Autonomous production of aldosterone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: endo

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submitted by โˆ—kingfriday(45)
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  • Catecholamine producing tumor -> not likely since the presentation would be more of an intemittent episode of HTN and other sympathetic symptoms
  • Decreased distensibility caused by atherosclerosis: could be describing RAS which is discounted by the lack of abdominal bruits
  • Execess production of ANP -> can be seen in volume overload states and would also result in a reduction of Na+ in the serum due to the actions of ANP- maximal point of impulse not displaced, no edema, low-normal resp.
  • Juxtaglomeular cell hypertrophy and sclerosis -> this would suggest findings of diabetic nephropathy. Patient doesnt have hx or HTN.
  • along with patients labs suggesting high aldosterone state - answer is most likely pointing toward autonomous production of aldosterone.
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305charlie94  if aldosterone is increased, and aldosterone increases NaCl retention, then why is the Cl low here? Wouldn't it have to be increased as well with the sodium? +



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