When talking about hypertension, we know that it can physiologically be caused by all of the following except

A. Is caused by hypertrophy and hyperplasia with associated fibrosis of the intima and media: While these changes can occur in the vascular walls over time due to hypertension, they are not the primary cause of primary hypertension itself. Primary hypertension is more complex and multifactorial.

B. Underactivity of the sympathetic nervous system and the RAAS: Primary hypertension is characterized by increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS), not underactivity. Increased activity of these systems contributes to elevated blood pressure.

C. Is caused by complicated interactions of genetics and the environment without evidence of a specific causative agent: This statement accurately describes primary hypertension, which results from a combination of genetic predisposition and environmental factors such as diet, physical activity, and stress. There is no single identifiable cause for primary hypertension, making this the correct answer.

D. Is caused by systemic disease that raises peripheral vascular resistance and/or cardiac output: This statement pertains more to secondary hypertension, which is due to identifiable causes such as kidney disease, endocrine disorders, or other systemic diseases. Primary hypertension does not arise from a specific systemic disease but rather from multifactorial influences.

A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.

B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.

C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.

D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.