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NBME 20 Answers

nbme20/Block 1/Question#44 (33.3 difficulty score)
A 35-year-old woman with newly diagnosed ...
MR angiography of the renal arteries🔍,📺
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 +5 
submitted by hayayah(1081),
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uslme123  So both causes would result in increased aldo and MR is the only way to differentiate the two? +2  
hello  @USMLE123 I think both are causes of renal artery stenosis and that could be seen via MR angiography. It is asking what could help DIAGNOSE this patient -- and her most likely cause of the findings is fibromuscular dysplasia. So, yes, MR angiography would look different for the 2 different etiologies and thus could can be used to differentiate the two from one another. However, epidemiologically, we are looking to diagnose her with the suspected most probable cause. +8  
yotsubato  @USLME123 I think measuring Aldosterone is an incorrect answer because you already know its increased due to low K. Knowing she has high Aldosterone wouldnt provide you evidence for a final diagnosis. +4  



 +3 
submitted by waterloo(77),

The patient has a bruit which is turbulent blood flow due to something obstructing like stenosis causing renovascular HTN.

  • if you measure just aldo, what are you expecting? You heard the bruit, you know there's probably stenosis so does a high aldo tell you the cause? Typically the non-invasive approach to assessing renovascular HTN is checking plasma renin.

  • MR angiography can better explain if the bruit is the reason why the patient has renovascular HTN. We learned in my renal course, gold std is renal arteriography but you can use MRA.