WBR0146

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	USMLE Step 2 CK
Main Category	Internal medicine
Sub Category	Cardiovascular
Prompt	A 46-year-old male Chinese patient presents to the physician for uncontrolled hypertension. The patient is completely asymptomatic and has detected high blood pressures incidentally on several occasions that prompted his medical visit. Patient has an unremarkable past medical history. He does not take any medication. Before the diagnosis of essential hypertension can be made, which of the following questions might be helpful to rule out secondary causes of hypertension?
Answer A	“Have you been exposed to shipyards for a long period of time?”
Answer A Explanation	This question is not implicated in defining risk factors or possible etiologies for hypertension.
Answer B	“Do you ingest licorice frequently”?
Answer B Explanation	Among the many causes of secondary hypertension, excessive ingestion of licorice can induce hypertension and hypokalemia by activating the renal mineralocorticoid receptors.
Answer C	“Do you get enough exposure to the sun every day?”
Answer C Explanation	This question is not implicated in defining risk factors or possible etiologies for hypertension.
Answer D	“What is the number of sexual partners you have had so far?”
Answer D Explanation	This question is not implicated in defining risk factors or possible etiologies for hypertension.
Answer E	“Have you had a recent bone fracture in your lower extremities?”
Answer E Explanation	This question is not implicated in defining risk factors or possible etiologies for hypertension.
Right Answer	B
Explanation	[[Explanation::Secondary hypertension can be caused by several mechanisms, one of which is excessive ingestion of licorice. It is important to rule out reversible causes of secondary hypertension. Educational objective: Among the many causes of secondary hypertension, excessive ingestion of licorice can induce hypertension and hypokalemia by activating the renal mineralocorticoid receptors. Educational Objective: References: ]]
Approved	No
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