Renal tubular defects Quiz: Ace Your Exams

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A 58-year-old woman comes to the clinic complaining of headaches, palpitations, and muscle pain for the last 2 months. The patient’s medical history is non-contributory, and she is not currently taking any medications. The patient’s temperature is 37°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 186/92 mmHg. The physician prescribes lisinopril 10 mg and recommends a follow up in one month. One month later, the patient returns to the clinic with persistent symptoms. Upon further questioning, the patient admits to consumption of five cups of Egpytian licorice tea daily for the past six months. Laboratory tests are obtained, and the results are shown below:  
 
Laboratory value  Result 
Blood, serum, plasma 
Potassium   3.2 mEq/L 
 Bicarbonate  44 mEq/L 
 Aldosterone  decreased 
 Renin  decreased 
Which of the following enzymes is most likely inhibited in this patient?

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