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Quizzes > Health & Medicine > Diseases & Conditions

Secondary Hypertension Quiz: Identify the Root Causes

Think you can ace a secondary hypertension test? Dive in and prove your expertise!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art heart kidney artery on sky blue for 158 92 blood pressure secondary hypertension quiz

This 158/92 blood pressure quiz helps you spot secondary hypertension causes and clues - like renal disease, coarctation of the aorta, and pheochromocytoma - so you can think fast in clinic or on the floor. Use it to practice pattern recognition and check gaps before exams. When you finish, try the NCLEX hypertension practice or review meds in the antihypertensive drugs quiz.

What term describes hypertension with an identifiable underlying cause?
Primary hypertension
Gestational hypertension
Essential hypertension
Secondary hypertension
Secondary hypertension arises from a specific, identifiable cause - such as renal disease or endocrine disorders - unlike essential hypertension, which has no single cause. Recognizing secondary hypertension is vital because treating its root condition can lead to better blood pressure control. This distinction guides appropriate diagnostic and therapeutic strategies. Learn more at .
Which is the most common cause of secondary hypertension?
Renal parenchymal disease
Pheochromocytoma
Coarctation of the aorta
Primary hyperaldosteronism
Renal parenchymal disease - such as chronic glomerulonephritis or diabetic nephropathy - is the leading cause of secondary hypertension, accounting for the majority of cases. Damage to renal tissue impairs sodium and water excretion, elevating blood pressure. Identifying renal causes early can help prevent progression. See more at .
In primary hyperaldosteronism, which electrolyte disturbance is most commonly observed?
Hypermagnesemia
Hypokalemia
Hypercalcemia
Hyponatremia
Primary hyperaldosteronism causes excessive aldosterone secretion, leading to increased sodium reabsorption and potassium excretion. The resulting hypokalemia often presents with muscle weakness, cramps, and polyuria. Correct diagnosis hinges on recognizing this key electrolyte imbalance. Further details at .
Which noninvasive imaging modality is often used initially to evaluate suspected renal artery stenosis?
Plain abdominal X-ray
CT scan without contrast
Duplex ultrasound
MR angiography
Duplex ultrasound is a widely available, cost-effective first-line tool for detecting renal artery stenosis by measuring blood flow velocities. It avoids nephrotoxic contrast and radiation. Its sensitivity and specificity make it ideal for initial screening. More information at .
A classic triad of episodic headache, sweating, and tachycardia is most suggestive of which condition?
Cushing syndrome
Hyperaldosteronism
Coarctation of the aorta
Pheochromocytoma
Pheochromocytoma secretes excess catecholamines, causing paroxysmal headaches, diaphoresis, and tachycardia. Blood pressure can spike dramatically during these episodes. Recognizing this triad is critical for timely biochemical testing. See diagnostic guidance at .
Elevated renin levels are most characteristic of which cause of secondary hypertension?
Primary hyperaldosteronism
Cushing syndrome
Pheochromocytoma
Renal artery stenosis
Renal artery stenosis reduces renal perfusion, triggering increased renin release from the juxtaglomerular apparatus. This activates the renin-angiotensin-aldosterone system, raising blood pressure. Measuring renin can help distinguish stenosis from other causes. Review at .
Which medication is first-line treatment for primary hyperaldosteronism?
Furosemide
Metoprolol
Spironolactone
Hydrochlorothiazide
Spironolactone is a mineralocorticoid receptor antagonist that blocks aldosterone's effects, correcting hypertension and hypokalemia in primary hyperaldosteronism. It is typically more effective than other antihypertensive classes for this condition. Dosing is titrated based on blood pressure and potassium levels. More at .
Which endocrine disorder is characterized by chronic cortisol excess leading to hypertension?
Addison disease
Diabetes insipidus
Cushing syndrome
Sheehan syndrome
Cushing syndrome involves excessive cortisol production, which induces hypertension through various mechanisms including increased vascular sensitivity to catecholamines and sodium retention. Clinical features include central obesity, moon facies, and purple striae. Early recognition prevents complications. Learn more at .
Which physical exam finding strongly suggests coarctation of the aorta?
Bounding carotid pulses
Delayed femoral pulses compared to brachial pulses
Continuous machinery murmur
Systolic click
Coarctation of the aorta narrows the descending thoracic aorta, causing delayed and diminished femoral pulses relative to brachial pulses (radio-femoral delay). Blood pressure is higher in the arms than legs. Recognizing this sign prompts imaging for confirmation. Details at .
What is the gold standard diagnostic test for renal artery stenosis?
MR angiography
Renal arteriography
CT scan without contrast
Duplex ultrasound
Renal arteriography, or digital subtraction angiography, provides high-resolution visualization of renal arteries and is considered the gold standard for diagnosing stenosis. It allows for simultaneous therapeutic intervention like angioplasty. Because it uses contrast and invasive catheters, it's reserved for when intervention is planned. See guidelines at .
Which hereditary syndrome is most commonly associated with pheochromocytoma?
Neurofibromatosis type 1
Von Hippel-Lindau disease
Li-Fraumeni syndrome
Multiple endocrine neoplasia type 2 (MEN2)
MEN2 (subtypes 2A and 2B) results from RET proto-oncogene mutations and commonly features pheochromocytoma, medullary thyroid carcinoma, and hyperparathyroidism. Genetic screening of RET mutations guides early diagnosis and management. Recognizing MEN2 is critical for screening at-risk family members. More at .
An aldosterone-renin ratio above which value strongly suggests primary hyperaldosteronism?
>10
>40
>20
>30
An aldosterone-to-renin ratio (ARR) greater than 20 (using ng/dL and ng/mL/hour units) is highly suggestive of primary hyperaldosteronism, prompting confirmatory testing. Elevated ARR reflects inappropriately high aldosterone relative to suppressed renin. Proper sampling conditions are essential for accuracy. Reference: .
Which imaging modality is preferred for initial localization of a suspected pheochromocytoma?
CT scan of the abdomen
Renal ultrasound
Echocardiogram
Chest X-ray
CT scanning of the abdomen provides detailed images of the adrenal glands and is the preferred initial modality to localize pheochromocytomas. It has high sensitivity and can detect extra-adrenal paragangliomas. MRI may be used if CT is contraindicated. See imaging recommendations at .
Which gene mutation is responsible for multiple endocrine neoplasia type 2?
RET proto-oncogene
RB1
BRCA1
PTEN
MEN2 is caused by germline mutations in the RET proto-oncogene, leading to medullary thyroid carcinoma, pheochromocytoma, and parathyroid hyperplasia. Detection of RET mutations guides early prophylactic surgery. Genetic counseling is recommended for affected families. Details at .
What is the best initial screening test for Cushing syndrome?
Plasma renin activity
24-hour urinary free cortisol
Low-dose dexamethasone suppression test
ACTH stimulation test
A 24-hour urinary free cortisol measurement is a first-line screening test for Cushing syndrome because it assesses cortisol over a full day, reducing false negatives. Elevated urinary cortisol confirms hypercortisolism, after which further testing distinguishes causes. Other screening options include late-night salivary cortisol. Guidelines at .
Which imaging modality provides the best anatomic detail for diagnosing coarctation of the aorta?
Chest X-ray
Abdominal ultrasound
Echocardiography
MRI angiography
MRI angiography offers high-resolution, three-dimensional images of the aorta without ionizing radiation or iodinated contrast. It accurately defines the location and severity of coarctation, aiding surgical planning. MRI is preferred over CT in younger patients to reduce radiation exposure. Learn more at .
What pathophysiologic change in renal parenchymal disease contributes most directly to hypertension?
Decreased sympathetic activity
Increased sodium and water retention due to nephron loss
Decreased renin release
Enhanced nitric oxide production
Loss of functional nephrons in renal parenchymal disease impairs sodium and water excretion, leading to volume expansion and hypertension. This volume overload activates neurohormonal pathways that further increase blood pressure. Controlling fluid balance is key in management. For more, see .
Fibromuscular dysplasia of the renal artery characteristically appears as which angiographic pattern?
Maltese cross
Picket-fence
Sawtooth
String of beads
Fibromuscular dysplasia causes alternating areas of arterial narrowing and dilatation, creating a 'string of beads' appearance on angiography. It predominantly affects young to middle-aged women. Recognizing this pattern guides percutaneous intervention. Read more at .
Spironolactone lowers blood pressure primarily by antagonizing which receptor?
Beta-1 adrenergic receptor
Mineralocorticoid receptor
Alpha-1 adrenergic receptor
Angiotensin II receptor
Spironolactone is an antagonist at the mineralocorticoid receptor in the distal nephron, blocking aldosterone's sodium-retaining and potassium-excreting actions. This leads to natriuresis and blood pressure reduction. It is particularly useful in hyperaldosteronism. More at .
Which laboratory finding helps distinguish Cushing syndrome from primary hyperaldosteronism?
Hypercalcemia
Elevated plasma cortisol leading to hyperglycemia
Elevated plasma renin
Suppressed plasma cortisol
Cushing syndrome features excessive cortisol secretion, often causing hyperglycemia, whereas primary hyperaldosteronism typically presents with normoglycemia and hypokalemia. Elevated cortisol levels with corresponding metabolic effects point toward Cushing. Differentiation guides appropriate endocrine work-up. See details at .
Why are plasma free metanephrines more sensitive than direct catecholamine measurements for diagnosing pheochromocytoma?
They are unaffected by medications
They reflect continuous intratumoral metabolism of catecholamines
They correlate with aldosterone levels
They are secreted by the pituitary
Pheochromocytomas continuously metabolize catecholamines to metanephrines within the tumor, resulting in elevated plasma free metanephrine levels even between symptomatic episodes. This makes metanephrines a more reliable and sensitive biomarker than episodic catecholamine measurements. Confirmatory testing follows positive screening. Learn more at .
What complication can occur when initiating ACE inhibitor therapy in a patient with bilateral renal artery stenosis?
Hypoglycemia
Metabolic alkalosis
Hyperkalemia without renal effects
Acute kidney injury due to decreased glomerular filtration pressure
In bilateral renal artery stenosis, angiotensin II helps maintain glomerular filtration pressure. ACE inhibitors reduce angiotensin II, dramatically lowering filtration pressure and potentially causing acute kidney injury. Monitoring renal function after initiation is crucial. See recommendations at .
Liddle syndrome mimics hyperaldosteronism but is characterized by which renin and aldosterone levels?
Low renin and high aldosterone
High renin and high aldosterone
Low renin and low aldosterone
High renin and low aldosterone
Liddle syndrome is caused by gain-of-function mutations in epithelial sodium channels, leading to sodium retention and hypertension. Feedback suppresses both renin and aldosterone, distinguishing it from primary hyperaldosteronism, which has low renin but high aldosterone. Genetic testing confirms the diagnosis. More at .
In adult patients with coarctation of the aorta, which less invasive treatment option may be preferred over open surgical repair?
Balloon valvuloplasty
Percutaneous coronary intervention
Endovascular stent placement
Thoracoscopic sympathectomy
Endovascular stent placement for aortic coarctation in adults offers a minimally invasive approach to relieve the narrowed segment. Compared to open surgery, it typically has shorter recovery and reduced morbidity. Not all anatomies are suitable, so imaging and patient factors guide selection. Review procedural outcomes at .
Which pharmacologic test can distinguish false-positive elevated metanephrine results from true pheochromocytoma?
Aldosterone suppression test
ACTH stimulation test
Clonidine suppression test
Low-dose dexamethasone suppression test
The clonidine suppression test helps differentiate true pheochromocytoma from stress or medication-related false positives by suppressing sympathetic tone and thus lowering catecholamine release. In true pheochromocytoma, metanephrine levels remain elevated despite clonidine. This test improves diagnostic specificity when plasma free metanephrines are borderline. More at .
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Study Outcomes

  1. Identify Major Causes of Secondary Hypertension -

    Readers will be able to list key secondary hypertension causes - including renal disease, aortic coarctation, and pheochromocytoma - relevant to a 158/92 blood pressure reading.

  2. Analyze Renal Hypertension Mechanisms -

    Readers will examine how renal artery stenosis and parenchymal kidney conditions lead to sustained blood pressure elevations and distinguish them in a clinical quiz setting.

  3. Interpret Diagnostic Clues -

    Readers will interpret symptoms and lab findings that point toward secondary hypertension causes, refining their ability to recognize when a 158/92 reading indicates an underlying disorder.

  4. Differentiate Secondary Hypertension Causes -

    Readers will compare and contrast the pathophysiology of coarctation of the aorta, pheochromocytoma, and other renal hypertension causes to improve diagnostic accuracy.

  5. Apply Clinical Reasoning -

    Readers will apply their knowledge to quiz scenarios, selecting appropriate diagnostic tests and management strategies for patients presenting with a 158/92 blood pressure.

Cheat Sheet

  1. Recognizing Red Flags for Secondary Hypertension -

    A sustained reading like 158/92 blood pressure in a person under 30 or someone with resistant hypertension should prompt evaluation for secondary hypertension causes. Look for atypical onset, sudden worsening, or signs of end-organ damage (e.g., elevated creatinine) as highlighted by the American Heart Association. A quick mnemonic "YOUNG RESIST" (Young, Resistant, End-organ signs, Sudden onset, Tumor, etc.) can help you recall key screening criteria.

  2. Renal Hypertension and the RAS Pathway -

    Renal hypertension causes quiz often focuses on renovascular (renal artery stenosis) vs parenchymal disease; both elevate renin, driving the renin-angiotensin-aldosterone system (RAS). Remember the formula ΔBP ≈ PR×CO where RAS increases peripheral resistance (PR) via angiotensin II. An easy mnemonic is "RAS = Renin Activates System" to recall the cascade up to aldosterone-mediated sodium retention.

  3. Coarctation of the Aorta Clinical Clues -

    In a coarctation of the aorta hypertension test, you'll find higher blood pressure in arms than legs, often >20 mm Hg difference, along with weak femoral pulses. The classic "3 sign" on chest X-ray and rib notching from collateral vessels confirm the diagnosis, as outlined in pediatric cardiology guidelines. Spot this defect early by comparing bilateral limb pressures during physical exam.

  4. Pheochromocytoma and the 5 Ps Mnemonic -

    Pheochromocytoma causes quiz questions focus on episodic hypertension, headaches, sweating, tachycardia and pallor - summarized by the "5 Ps": Pressure (high), Pain (headache), Perspiration, Palpitations, Pallor. Biochemical confirmation uses 24-hour urinary metanephrines with >2× upper normal limit being suspicious per Endocrine Society recommendations. Recognizing the pattern of spells is crucial for timely localization by CT or MRI.

  5. Primary Aldosteronism: PAC/PRA Screening -

    Primary aldosteronism is a top secondary hypertension cause, especially when hypokalemia accompanies elevated blood pressure. The screening ratio of plasma aldosterone concentration (PAC) to plasma renin activity (PRA) >20 suggests aldosterone excess, as detailed by clinical endocrinology consensus. A useful memory aid is "Conn's = Conned Renin Nearly Zero" to recall suppressed renin in aldosterone-producing adenomas.

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