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USMLE (United States Medical Licensing Examination) Practice Exam 02

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

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Question 1 of 1000%
Time remaining180:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 62-year-old man with long-standing hypertension is started on a medication that lowers blood pressure by decreasing angiotensin II formation. Two weeks later, laboratory studies show an increase in serum potassium. Which change in renal tubular transport most directly explains this finding?

ACE inhibition lowers angiotensin II and thereby decreases aldosterone secretion. Lower aldosterone reduces ENaC expression/activity in principal cells, decreasing lumen-negative potential and reducing K+ secretion, causing hyperkalemia. A key distractor is decreased Na+-K+-2Cl− cotransporter activity (loop diuretics), which typically increases K+ loss (hypokalemia), not hyperkalemia.

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