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Retired NBME 18 Answers

nbme18/Block 4/Question#10 (reveal difficulty score)
A 4-year-old boy undergoes radiographic ...
Tubular atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +30  upvote downvote
submitted by โˆ—anechakfspb(77)
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Just a rant - i hate this f*cking picture it's been on 3 NBMEs now and every time I've gotten it wrong.

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cbreland  And it's a different answer every time +20
krukenberg  same +



 +8  upvote downvote
submitted by โˆ—faus305(39)
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I think @beastaran1 has the correct explanation but I just want to say his kidney is "abnormally small and nonfunctional" which means that it is not being used. When the body doesn't use something (like a muscle) it atrophies. So tubular atrophy makes sense.

Atrophy = gradual decline in effectiveness or vigor due to underuse or neglect.

When a question seems wildly complicated and you have no idea what's going on, take a deep breath and explain it to yourself like you're five.

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 +2  upvote downvote
submitted by โˆ—beastaran1(2)
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Believe this one is tubulointerstitial fibrosis of the kidney:

medullary cystic disease is characterized by autosomal dominant inheritance pattern progressive and slow impairment in renal function that ultimately results in end-stage renal disease no or minimal proteinuria with a bland urine sediment medullary cysts on renal ultrasound in most cases medullary cysts are not present can see shrunken kidneys on ultrasound

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makepoopinggreatagain  Tubular atrophy (hint: dilated ureter/calyx in image) โ†“ Posterior urethral valves is the 1 cause of bladder obstruction in males ...Diagnosed by hydronephrosis and thick walled bladder +
nbmeanswersownersucks  this can't be posterior urethral valve because then both kidneys would be effected. +9
j44n  I agree its the medullary cystic kindey disease-> FA19-592 talks about it +



 +1  upvote downvote
submitted by โˆ—overa(28)
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I think that this is a ureteric stricture or ureteropelvic junction obstruction (not sure if they are the same thing) but according to sketchy, it is the most common cause of unilateral fetal/congenital hydronephrosis and most commonly happens in those who Saturdays are for.. ;)

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dhpainte22  If only kidney was involved I would agree with you but the ureter also being involved equally as much as the kidney leads me towards cystic kidney. +1
utap2001  Hydronephrosis is associated with cortical atrophy and tubular atrophy. But atrophy is different from necrosis, atrophy is chronic fibrosis change, necrosis result from acute ischemia or inflammation. +



 +0  upvote downvote
submitted by โˆ—uasid(68)
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Hydronephrosis causes tubular atrophy from compression of the tubules by urine. Two common causes of hydronephrosis in infants and young children include pelvic-urethral obstruction and vesicourethral reflux.

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 +0  upvote downvote
submitted by โˆ—avatar(17)
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AD tubulointerstitial kidney disease: Also called medullary cystic kidney disease. Causes tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine. Medullary cysts usually not visualized; smaller kidneys on ultrasound. Poor prognosis. FA2020 page 602

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