#march2020mccqe1
A 55-year-old man is evaluated for fatigue that has been present for more than 1 year. He feels tired on awakening and requires at least one nap daily to accomplish his work tasks. He reports no other changes in his sleep pattern or symptoms of depression. He does not smoke cigarettes, drink alcohol, or take illicit drugs. His only other medical problem is a 2-year history of difficult-to-control hypertension. Medications are lisinopril, hydrochlorothiazide, and amlodipine. On physical examination, temperature is normal, blood pressure is 140/92 mm Hg, pulse rate is 78/min, and respiration rate is 14/min. BMI is 36. The cardiopulmonary examination is normal. The vascular examination is normal without evidence of carotid, abdominal, or femoral bruits. The remainder of the physical examination is unremarkable.
Routine laboratory testing, including fasting blood glucose, serum electrolytes, and kidney function tests are normal. Which of the following diagnostic tests should be done next?
(A) 24-Hour urine free cortisol measurement
(B) Percutaneous renal artery angiography
(C) Plasma aldosterone-renin activity ratio
(D) Polysomnography
A 55-year-old man is evaluated for fatigue that has been present for more than 1 year. He feels tired on awakening and requires at least one nap daily to accomplish his work tasks. He reports no other changes in his sleep pattern or symptoms of depression. He does not smoke cigarettes, drink alcohol, or take illicit drugs. His only other medical problem is a 2-year history of difficult-to-control hypertension. Medications are lisinopril, hydrochlorothiazide, and amlodipine. On physical examination, temperature is normal, blood pressure is 140/92 mm Hg, pulse rate is 78/min, and respiration rate is 14/min. BMI is 36. The cardiopulmonary examination is normal. The vascular examination is normal without evidence of carotid, abdominal, or femoral bruits. The remainder of the physical examination is unremarkable.
Routine laboratory testing, including fasting blood glucose, serum electrolytes, and kidney function tests are normal. Which of the following diagnostic tests should be done next?
(A) 24-Hour urine free cortisol measurement
(B) Percutaneous renal artery angiography
(C) Plasma aldosterone-renin activity ratio
(D) Polysomnography
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