support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 

NBME 23 Answers

nbme23/Block 3/Question#26 (24.4 difficulty score)
A 27-year-old woman has headaches and blurred ...

Login to comment/vote.

 +13  upvote downvote
submitted by mcl(501),
unscramble the site ⋅ become a member ($36/month)

atteinP wthi aiertabll nlare teayrr uribts nad oirhestnynpe lwli ofr eurs ehva tnacitvaio fo SAR eymsst and rhftreoee crsnaeei ni oiesnnn.atig

luhgtAoh mcpaomrthehocoyo nda nequneotcs aveltede eolcnseahamtci can esnaeric doblo sper,uers typomsms era tllacpyyi psedicio nda anelr tbrusi era nto kielyl ot be rdae.h vetdleEa esvell of oonitnrse nca asol asuec ernt,hesnpoyi utb we owdul aslo tepecx ot ese luifgshn; as,lo eethr si hotgnni in teh emst ot tcdianie teintpa is ktgnai sSSIR ro tonsimhge lese thta loudc sopspeidre erh ot teleaevd lelvse fo nt.rnooies aetdvleE vselel of hrytodi mhrenoo ocudl oals igve nepiatt snt,pyoreinhe ubt ew olwdu sloa pxecte teroh signs of yrsoemyitdrihph (rermto,s ethigw sso,l )

I saw a liettl oedusfcn if OEP dwluo eb levdeeat -- fi teehr si siotssne fo nrlea rritease a(s danitdeci yb teh iubrst) teh iesnkdy uldco salo ecdtte stih sa iohxypa nda amrp up rtpooincud fo OPE. rHv,oeew I ndede pu noigg htwi ienotisnang scein it emseed emor oc"nr"eetc to me hatt RSA wuldo eb .pu esoD onyena nkow hyw its' ton ?POE

brise  Wouldn't that be more long term? +2  
sugaplum  I think Epo would indicate Rcc or renal failure, she seems like she has "just" refractory HTN, and no other sx to indicate anemia. +  
davidw  She has Fibromuscular dysplasia which should be in your differential for a young female with hypertension ( along with Conns syndrome and pheochromocytoma). it typically causes stenosis and aneurism formation of the renal arteries leading to elevated renin. +2  

 +0  upvote downvote
submitted by usmile1(72),

main points from this question:

  • bilateral renal bruits in a patient with HTN = Renal artery stenosis --> in a young woman, it's most likely Fibromuscular dysplasia

  • RAS can present in up to 1/3 of patients with malignant HTN or hypertensive emergency which is how this patient is presenting, evidenced by the HA, blurred vision, and papilledema.

  • renal artery stenosis → decreased renal perfusion → compensatory activation of the renin–angiotensin–aldosterone system → secondary hypertension