NBME 19 Renal artery stenosis (NBME Answers)

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Retired NBME 19 Answers

nbme19/Block 3/Question#27 (reveal difficulty score)
74 yo man; continuous systolic-diastolic ...
Renal artery stenosis 🔍 / 📺 / 🌳 / 📖
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submitted by ∗yotsubato(1208)

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What was confusing for me in this question was that he has an acute presentation. That didnt make sense to me... He lived 74 years with renal artery stenosis and now has hypertension because of it!?

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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). +1

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submitted by ∗okokok1(38)

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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."

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