Phaeochromocytoma — ESENeph MCQ
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Correct answer: A — Refer for specialist assessment of resistant hypertension and secondary causes
The best answer is “Refer for specialist assessment of resistant hypertension and secondary causes”. NICE lists hypertension remaining above target despite at least four agents at therapeutic doses as a specialist-referral criterion. Adherence, standardized measurement, volume status and secondary causes are assessed. “Add three further medicines without checking adherence or measurement technique” is less appropriate because apparent resistance requires systematic confirmation and specialist assessment rather than uncontrolled polypharmacy “Stop antihypertensive treatment because CKD makes control unattainable” is less appropriate because blood-pressure control remains central to cardiovascular and kidney risk reduction “Attribute the result to CKD without assessing secondary causes” is less appropriate because renovascular, endocrine, medication and sleep-related causes may be actionable “Refer after kidney replacement therapy starts” is less appropriate because poor control on four agents is itself a current referral criterion
Reference: NICE NG203: CKD assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations