Primary Aldosteronism: ABFM practice questions

4 board-style questions on primary aldosteronism in the PulseMD family medicine question bank — physician-reviewed, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 54-year-old man has persistently elevated blood pressure (158/96 mmHg) despite adherence to amlodipine 10 mg, lisinopril 40 mg, and chlorthalidone 25 mg. His serum potassium is 3.2 mEq/L and serum bicarbonate is 29 mEq/L. Adherence is confirmed by pharmacy refill records and direct questioning. What is the most appropriate next step in evaluation?

1. Obtain a 24-hour urine cortisol to evaluate for Cushing syndrome
2. Add spironolactone 25 mg daily as a fourth agent
3. Order renal artery duplex ultrasound to evaluate for renovascular hypertension
4. Measure plasma aldosterone concentration and plasma renin activity

Sample question 2

A 42-year-old woman with resistant hypertension and hypokalemia has a confirmed diagnosis of primary aldosteronism (positive ARR and saline infusion test). Adrenal CT shows a 1.2-cm left adrenal nodule and normal right adrenal gland. She is interested in surgical management. Which of the following is the most appropriate next step before recommending adrenalectomy?

1. Perform adrenal venous sampling to confirm lateralization
2. Start spironolactone and repeat imaging in 6 months
3. Proceed directly to left laparoscopic adrenalectomy based on CT findings
4. Obtain an I-131 NP-59 adrenal scintigraphy scan

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