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NBME 23 Answers

nbme23/Block 2/Question#26

A 36-year-old woman comes to the physician for a ...

Fibromuscular dysplasia

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submitted by vshummy(83),

Page 592 on First Aid 2019 under Renovascular Disease. Main causes of renal artery stenosis: Fibromuscular dysplasia in the distal 2/3rd of renal artery or segmental branches, usually young or middle-aged females.

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submitted by mousie(127),

I chose PAN for this one, saw the renal a. aneurysms and went right for it but PAN would have more systemic findings (fever, weight loss, head ache) and usually effects middle age MEN vs Women in FMD.

Pathologically characterized by: loss of internal elastic lamina. which can lead to the formation of anuerysms due to weakening of the wall

Case = Middle-aged female with severe hypertension (180/120 mmHg), and an aneurysm.

(1) Main cause of renovascular diseae in middle-aged females = fibromuscular dysplasia (FA2019 pg. 592).

(2) Also notice the -classic- 'string-of-beads' appearance of the artery: EXAMPLE