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Practice sessionHEALTHCARE & MEDICAL EXAMSMEDICAL LICENSING

USMLE (United States Medical Licensing Examination) Practice Exam 08

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

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Question 1 of 300%
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, he reports a persistent dry cough. Which change at the level of the renal efferent arteriole is most likely responsible for the initial decrease in glomerular filtration pressure after starting this medication?

ACE inhibitors reduce angiotensin II, which normally preferentially constricts the efferent arteriole to maintain intraglomerular pressure. Loss of this effect causes efferent dilation and can lower glomerular capillary hydrostatic pressure and GFR. A key distractor is reduced prostaglandins (choice E), which is the mechanism for NSAID-associated afferent constriction and decreased GFR, not ACE inhibitors.

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