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NBME 19 Answers

nbme19/Block 3/Question#27 (8.4 difficulty score)
74 yo man; continuous systolic-diastolic ...
Renal artery stenosisπŸ”,πŸ“Ί
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 +2 
submitted by yotsubato(1036),
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aWht wsa fnncougsi rfo em ni ihts tisuqoen wsa ttah eh has an eauct orinnp.sattee Thta dnitd maek eenss ot ..e.m He dilve 74 yersa htwi eanrl rearty sisntoes dan wno sah isnhtnopryee besucea of !i?t

an_improved_me  Its hard to say when he had a clinically significant stenosis of the renal artery. He clearly has evidence of atherosclerotic CV disease, (MI 5 years ago), and so it's not necessarily suprising that he gets atherosclerosis elsewhere. Also not sure if the hypothyroidismis a clue to a risk factor for elevated LDL / Cholesterol, since thyroid is important for that (although he has been treated for it). +  



 +0 
submitted by okokok1(13),

With the question stem saying "bruit over right posterior flank" that was the clue I used to pick renal artery stenosis. First Aid defines it as the following:

"Renal Artery Stenosis: Clinically, patients can have refractory HTN with negative family history of HTN, asymmetric renal size, epigastric/flank bruits."