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NBME 23 Answers

nbme23/Block 3/Question#26 (24.4 difficulty score)
A 27-year-old woman has headaches and blurred ...
Angiotensin🔍
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 +13  upvote downvote
submitted by mcl(501),
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atteinP wthi aiertabll nlare teayrr uribts nad oirhestnynpe lwli ofr eurs ehva tnacitvaio fo SAR eymsst and rhftreoee crsnaeei ni oiesnnn.atig

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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