CHS Diagnosis and Evaluation 3 — Questions and Answers
Question 1: Which test is the preferred initial screening for primary aldosteronism in a hypertensive patient?
- 24-hour urine aldosterone
- Plasma aldosterone-to-renin ratio (ARR) (Correct answer)
- Serum potassium level
- CT scan of adrenal glands
Correct answer: Plasma aldosterone-to-renin ratio (ARR)
The plasma aldosterone-to-renin ratio (ARR) is the recommended first-line screening test for primary aldosteronism.
Question 2: A 35-year-old man has severe hypertension, hypokalemia, and metabolic alkalosis. Serum aldosterone is elevated and plasma renin activity is suppressed. The most likely diagnosis is:
- Renovascular hypertension
- Pheochromocytoma
- Primary aldosteronism (Correct answer)
- Liddle syndrome
Correct answer: Primary aldosteronism
Primary aldosteronism presents with high aldosterone, suppressed renin, hypokalemia, and metabolic alkalosis.
Question 3: Which renal artery imaging modality is preferred for screening renovascular hypertension in a patient with normal renal function?
- Conventional angiography
- CT angiography
- Duplex ultrasound (Correct answer)
- MR angiography
Correct answer: Duplex ultrasound
Renal duplex Doppler ultrasound is the preferred non-invasive, radiation-free initial screen for renovascular hypertension.
Question 4: A 62-year-old diabetic with BP 145/88 mmHg has a urine albumin-to-creatinine ratio of 180 mg/g. This finding signifies:
- Normal kidney function
- Microalbuminuria indicating early kidney damage (Correct answer)
- Macroalbuminuria indicating advanced nephropathy
- Glomerulonephritis
Correct answer: Microalbuminuria indicating early kidney damage
A urine ACR of 30–300 mg/g defines moderately increased albuminuria (formerly microalbuminuria), indicating early hypertensive or diabetic kidney damage.
Question 5: The ankle-brachial index (ABI) is used in hypertension evaluation primarily to assess:
- Renal perfusion
- Peripheral arterial disease and atherosclerotic burden (Correct answer)
- Aortic stiffness
- Venous insufficiency
Correct answer: Peripheral arterial disease and atherosclerotic burden
ABI detects peripheral arterial disease, which reflects systemic atherosclerosis and elevates cardiovascular risk in hypertensive patients.
Question 6: Which ECG finding is the most specific marker of left ventricular hypertrophy (LVH) in hypertension?
- Left axis deviation
- Sokolow-Lyon voltage criteria (Correct answer)
- ST-segment depression in V4-V6
- PR interval prolongation
Correct answer: Sokolow-Lyon voltage criteria
The Sokolow-Lyon criteria (SV1 + RV5 or RV6 ≥35 mm) are widely used ECG voltage criteria for detecting LVH.
Question 7: Pulse pressure, calculated as systolic minus diastolic BP, is a marker of:
- Cardiac output
- Arterial stiffness (Correct answer)
- Peripheral vascular resistance
- Stroke volume index
Correct answer: Arterial stiffness
A widened pulse pressure reflects increased arterial stiffness, particularly in older adults with isolated systolic hypertension.
CHS Diagnosis and Evaluation 3
Which test is the preferred initial screening for primary aldosteronism in a hypertensive patient?