**Question:** A 20 year old female presents with a blood pressure of 160/110 mm Hg. Clinical examination reveals a bruit in both flanks. Which of the following statements about this patient is not true

A. The patient is likely suffering from hypertension.
B. The bruit indicates a turbulent blood flow, which may be due to renal artery stenosis.
C. The patient's hypertension is primarily due to essential hypertension.
D. The patient's hypertension is due to primary aldosteronism.

**Correct Answer:** C. The patient's hypertension is primarily due to essential hypertension.

**Core Concept:**
Hypertension, especially in young patients, should raise suspicion for secondary causes rather than primary essential hypertension. Secondary hypertension can be due to various conditions, such as renal artery stenosis (option B), primary aldosteronism (option D), orpheumatic heart disease (not discussed here). Essential hypertension is a primary cause of hypertension without identifiable secondary causes.

**Why the Correct Answer is Right:**

In this case, the patient's blood pressure is significantly elevated (160/110 mmHg), and the presence of a bruit (abnormally increased turbulent blood flow) in the flanks indicates a turbulent flow in the kidneys due to renal artery stenosis (option B). This is not consistent with essential hypertension, which is typically characterized by a slow and steady increase in blood pressure over time.

**Why Each Wrong Option is Incorrect:**

A. Hypertension is indeed present in the patient, but the primary cause is not essential hypertension.
B. The presence of a bruit is supportive evidence for renal artery stenosis, not essential hypertension.
D. Primary aldosteronism is a condition characterized by excessive aldosterone production, which would lead to hypokalemia and volume overload, not the elevated blood pressure found in this case.

**Why the Correct Answer is Right:**

Primary aldosteronism (option D) is a rare cause of hypertension in young adults. Essential hypertension (option C) is more common in this age group and is typically characterized by a slow and steady increase in blood pressure over time. Additionally, primary aldosteronism is associated with hypokalemia and volume overload, which is not the case in this scenario.

**Why Each Wrong Option is Incorrect:**

A. Hypertension is indeed present in the patient, but the primary cause is not essential hypertension. In this case, the elevated blood pressure is more consistent with renal artery stenosis (option B) or secondary causes of hypertension.
B. The presence of a bruit is supportive evidence for renal artery stenosis, not essential hypertension. A bruit is a sound produced by turbulent blood flow, which is more indicative of renal artery stenosis than essential hypertension.
D. Primary aldosteronism is characterized by hypokalemia and volume overload, which are not the presenting symptoms in this case. The patient has hypertension, but essential hypertension would be more consistent with the patient's age and the absence of hypokalemia and