52yo man comes to the physician for a f/up exam. he has a 4y hx of htn and a 1y hx of hypokalemia. current meds include labetolol, enalapril and kcl. his bp is 154/90. the remainder of the exam shows no abnormalities. his fasting serum aldosterone: renin ratio is increased. a ct scan shows a 1cm l adrenal mass. adrenal vein sampling before and after administration of acth shows b/l hypersecretion of aldosterone. which of the following is the most appropriate next step in management?
a. candesartan therapy
b. furosemide therapy
c. spironolactone therapy
d. b/l adrenalectomy
e. u/l adrenalectomy

Marijuana is an example of a(n) drug

A41-year-old man comes to the clinic complaining of a chronic cough over the past 4 months, which has now been accompanied by haemoptysis. he denies smoking or any past medical history. on physical examination, his head and neck examination is normal. his lungs have diffuse bilateral rales. cardiac examination is normal. laboratory findings reveal na 142 meq/l, k 4.2 meq/l, cl 110 meq/l, hco3 24 meq/l, bun (blood urea nitrogen) 39 mg/dl, creatinine 2.9 mg/dl. urinalysis reveals microscopic haematuria and 4+ proteinuria. which of the following serologic blood tests would most confirm the suspected diagnosis? - anti-glomerular basement membrane antibodies- anti-mitochondrial antibodies- anti-neutrophilic antibodies- anti-parietal cell antibodies- anti-smooth muscle antibodies

  when we experience conflict, it threatens our needs to feel