Hall: Guyton and Hall Textbook of Medical Physiology, 12th Edition

Chapter 19: Role of the Kidneys in Long-Term Control of Arterial Pressure and in
Hypertension: The Integrated System for Arterial Pressure Regulation

Test Bank

1. A 65-year-old female with a 10-year history of essential hypertension visits her physician
for an examination. Laboratory test results indicate that the patient has a plasma rennin
activity 2-3 times higher than normal. The patient is given a prescription for an
angiotensin type 1 receptor blocker (ARB). Which one of the following would you
expect to occur in this patient following administration of the ARB?
A. Increase in total peripheral resistance
B. Increase in arterial pressure
C. Increase in plasma renin activity
D. Increase in aldosterone
E. Decrease in kidneys ability to excrete sodium

ANS: C

2. A 55-year-old female with a five year history of hypertension visits her physician for an
examination. Laboratory test results indicate that the patient has a plasma rennin activity
3-4 times higher than normal. The patient is given a prescription for Captopen, an
angiotensin II converting enzyme (ACE) inhibitor. An increase in which one of the
following would you expect to occur in this patient following administration of the ACE
inhibitor?
A. Total peripheral resistance
B. Arterial pressure
C. Angiotensin I
D. Aldosterone
E. Atrial natriuretic peptide

ANS: C

3. Which of the following set of changes would be expected to decrease sodium excretion
by the kidney?
0 Nitric Oxide Renal Sympathetic Angiotensin II

1 Nerve Activity

A.

B.

C.

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.

Test Bank 19-2

D.

E.

F.

G.

H.

ANS: G

4. A healthy 22-year-old female medical student with normal kidneys increases her sodium
intake by 300% for a period of two months. Which of the following is expected to occur
in response to the increase in sodium intake?
A. A decrease in arterial pressure
B. A decrease in plasma renin activity
C. A decrease in sodium excretion
D. A decrease in nitric oxide
E. A decrease in atrial natriuretic peptide

ANS: B
2

3 5. A 55-year-old female is diagnosed with a juxtaglomerular cell rennin-secreting tumor.

Lab tests reveal a plasma concentration of angiotensin II five times above normal. Which

of the following set of findings would be expected in this man?

Blood Pressure Blood Volume Renal Blood Flow

A.

B.

C.

D.

E.

F.

G.

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.

Test Bank 19-3

H.

ANS: C

6. A 45-year-old male with a history of normal health visits his physician for a check up.
During his physical exam, it was revealed that his blood pressure was 170/98 mmHg.
Further tests indicated that he had renovascular hypertension as a result of a stenosis in
the left kidney. Which of the following set of findings would be most likely expected in
this man with renovascular hypertension?
Renal Bood Flow Plasma Renin Aldosterone

A.

B.

C.

D.

E.

F.

G.

H.

ANS: G

7. A 50-year-old male has a three year history of hypertension. He has been on several
medications without ever having good blood pressure control. He has been off
medications entirely for the last six months. He complains of fatigue and occasional
muscle cramps. There is no family history of hypertension. The patient has not had any
other significant medical problems in the past. Examination reveals a blood pressure of
168/104 mmHg. Additional laboratory tests indicate that the patient has primary
hyperaldosteronism. Which of the following set of findings would be most likely
expected in this man with primary hyperaldosteronism?
4 Extracellular Fluid Plasma Renin Activity Plasma K

Volume Concentration

A.

B.

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.

Test Bank 19-4

C.

D.

E.

F.

G.

H.

ANS: C
4.
5. Questions 8-9: A 40-year-old female with a history of diabetes mellitus for 16 years
visited the emergency room with a blood pressure of 270/110. She had her blood pressure
measured many times in the past and has never been noted to be hypertensive. She also
complains of pedal edema which has been gradually progressive. She denies polyuria,
polydypsia or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the
morning and 10 units in the afternoon. Laboratory tests revealed the following values (range
of normal values in parentheses):
BUN 33 (9-20 mg/dl)
Creatinine 2.7 (0.7-1.4 mg/dl)
Glucose 296 (74-106 mg/dl)
Total protein 6.2 (6.3-8.2 g/dl)
Albumin 3.0 (3.5-5.1 g/dl)
Cholesterol 320 (120-199 mg/dl)
Urinalysis 3+ proteinuria

8. A decrease in which one of the following would best explain the increase in blood
pressure in this patient?
A. Angiotensin II
B. Aldosterone
C. Sympathetic nerve activity
D. Glomerular filtration rate
E. Endothelin

ANS: D
5
9. An increase in which one of the following would most likely result in chronic
hypertension?
A. Dopamine
B. Senal sympathetic nerve activity
C. Bradykinin
D. Nitric oxide

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.

Test Bank 19-5

ANS: B
6
7 10. A 45-year-old female was seen by her physician for an upper respiratory infection.
Blood pressure on that visit was noted to be 158/94 mmHg. She was asked to return for
two other visits, separated by one week each, for measurement of blood pressure. Repeat
measures were similar. She has no previous history of hypertension. She denies any
previous significant medical problems. There is a positive family history for
hypertension. The rest of her history is unremarkable. Other than moderate obesity and
the elevated blood pressure, her physical examination was completely normal. All routine
laboratory studies were normal. Which of the following diagnoses would you predict for
this woman?
A. Renovascular hypertension
B. Primary hyperaldosteronism
C. Essential hypertension
D. Pheochromocytoma
E. Moderate aortic valve regurgitation

ANS: C

11. A 55-year-old male with a history of normal health visits his physician for a check up.
During his physical exam, it was revealed that his blood pressure was 170/98 mmHg.
Further tests indicated that he had renovascular hypertension as a result of a stenosis in
the left kidney. Which of the following set of findings would be most likely expected in
this man with renovascular hypertension?
8 Total peripheral resistance Plasma Renin Aldosterone

A.

B.

C.

D.

E.

F.

G.

H.

ANS: A

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.

Test Bank 19-6

12. An angiotensin-converting enzyme inhibitor (CEI) is administered to a 65-year-old male

with a 20-year history of hypertension. The drug lowered arterial pressure and increased
plasma levels of renin and bradykinin. An increase in which of the following would best
explain the decline in blood pressure?
A. Preprobradykinin
B. Conversion of angiotensin I to angiotensin II
C. Angiotensin II
D. Kallikrein
E. Renal sodium excretory function

ANS: E

13. A healthy 22-year-old female medical student with normal kidneys increases her sodium
intake by 200% for a period of two months. A decrease in which of the following is
expected to occur in response to the increase in sodium intake?
A. Arterial pressure
B. Plasma renin activity
C. Sodium excretion
D. Nitric oxide
E. Atrial natriuretic peptide

ANS: B

Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc.