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NBME 24 Answers

nbme24/Block 2/Question#29 (40.9 difficulty score)
A 65-year-old woman with well-controlled type ...
Atherosclerosis🔍
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xxabi  Is there a situation where you would pick fibromuscular dysplasia over atherosclerosis if given both options? Thanks for your help! +5  
baconpies  Atherosclerosis affects PROXIMAL 1/3 of renal artery Fibromuscular dysplasia affects DISTAL 2/3 of renal artery +34  
gonyyong  Why is there ↓ size in both kidneys? This threw me off +2  
kateinwonderland  @gonyyong : Maybe because narrowed renal a. d/t atherosclerosis led to renal hypoperfusion and decrease in size? +1  
drdre  Fibromuscular dysplasia occurs in young females according to Sattar Pg 67, 2018. +6  
davidw  Normally you will see Fibromuscular dysplasia in a young female 18-35 with high or resistant hypertension. She is older has a history type II DM predispose you to vascular disease and normal to moderate elevation in BP +5  
suckitnbme  @gonyyong there's bilateral renal artery stenosis. The decrease in size of both kidneys should be from atrophy due to lack of renal blood flow. +2  
tyrionwill  1 year ago, she did not present any physical or Lab abnormalities. This means she must not suffer fibromuscular dysplasia, otherwise she must have presented renal abnormalities for a long long time, or even before DM-2. +  



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Main causes of renal artery stenosis:

  1. Atherosclerotic plaques—proximal 1/3 of renal artery, usually in older males, smokers.

  2. Fibromuscular dysplasia—distal 2/3 of renal artery or segmental branches, usually young or middle-aged females.




Pathoma Ch 1, of 3.

Slowly developing ischemia (ie atherosclerosis) leads to atrophy whereas, acute ischemia (ie renal artery embolus) results in injury.

usmlecrasherss  i picked fibromuscular dysplasia and have zero regret, i just did not pay attention toward the word of proximal.... +2  



Up to 80 percent of aortic aneurysms are caused by "hardening of the arteries" (atherosclerosis). Atherosclerosis can develop when cholesterol and fat build up inside the arteries. ... Elevated blood pressure through the aorta can then cause the aortic wall to expand and bulge.

https://www.uwhealth.org/heart-cardiovascular/aortic-aneurysm-causes-symptoms-and-concerns/10971

Also, FA 2019 pg300 says complications of atherosclerosis includes aneurysm

almondbreeze  I was dumb and went for marfan.. +1  
llamastep1  Wrong question lol +2