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NBME 18 Answers

nbme18/Block 1/Question#18 (reveal difficulty score)
68 yo man, chronically increased hydrostatic ...
Benign prostatic hyperplasia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: renal

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 +9  upvote downvote
submitted by โˆ—adong(144)

Increased pressure is in the Bowman space (NOT the glomerular capillaries) so the only pathology listed that would cause backward build up of pressure is BPH

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peyerpatchkids6  Does anyone know why its not diabetes? +1
michaelshain2  because the NBME said so, obvs! +3
cbreland  Diabetes would have non-enzymatic glycosylation causing increased GFR and hyperfiltation. The stem is referring to increased back pressure (Inc hydrostatic at bowmans space) which alludes to decreased GFR +1
victorlt14  @peyerpatchkids6 that's because NEG of the efferent arterioles could increase GLOMERULAR pressure; No increase in BOWMAN'S space pressure; That would have to be due to one of those post renal azotemia causes. Made the same mistake. +

 +0  upvote downvote
submitted by โˆ—breis(56)

I put CHF, still not sure why it is wrong over BPH, but my reasoning is that BPH causes obstructive urine flow --> Hydronephrosis and once the urine has been made it can't be redone and is like filling up a damn with water. Straight Stasis. vs CHF there is protective mechanisms in place for a while until frank CKD.

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pfebo  This is a case of postrenal azotemia. BPH is the only available option tbat causes it +1

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