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USMLE (United States Medical Licensing Examination) Practice Exam 17

Practice exam for USMLE (United States Medical Licensing Examination).

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Question 1 of 1000%
Time remaining120:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 23-year-old woman comes to the clinic because of recurrent episodes of lightheadedness and muscle cramps for 6 months. She reports craving salty foods. She has no vomiting or diarrhea. Medications include an oral contraceptive only. Blood pressure is 92/58 mm Hg and pulse is 98/min. Physical examination shows mild orthostatic hypotension. Laboratory studies show: Na+ 130 mEq/L, K+ 5.8 mEq/L, HCO3− 18 mEq/L, glucose 62 mg/dL. Which of the following is the most likely acid–base disturbance and its primary renal mechanism?

Findings suggest primary adrenal insufficiency (Addison disease) with hypoaldosteronism causing type 4 RTA: hyperkalemia and non–anion gap metabolic acidosis from decreased H+ secretion (and decreased NH3 generation) in the collecting duct. Anion gap acidosis would suggest ketoacidosis, lactic acidosis, or toxins.

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