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NBME 20 Answers

nbme20/Block 1/Question#49 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Fibromuscular hyperplasia of arterioles🔍,📺

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submitted by hayayah(1128),
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eCas of tosri.lesolrscaoeir

iypslrpcaHte srcoirtloeslsrioae niovvesl ntehkgnici of esvsel alwl yb lraspeaypih of sohmot lcuesm n-n'os(ikion )'enapacepar

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  • ayM aled ot inifidrob oernissc fo eht sveles lwla whti aermregohh; lacaliscsyl csesau tceau lerna laiuefr (FR)A hitw a tiascerhritcca t'nlaefb-eti' epapacnrae
masonkingcobra  From Robbin's: Fibromuscular dysplasia is a focal irregular thickening of the walls of medium-sized and large muscular arteries due to a combination of medial and intimal hyperplasia and fibrosis. It can manifest at any age but occurs most frequently in young women. The focal wall thickening results in luminal stenosis or can be associated with abnormal vessel spasm that reduces vascular flow; in the renal arteries, it can lead to renovascular hypertension. Between the focal segments of thickened wall, the artery often also exhibits medial attenuation; vascular outpouchings can develop in these portions of the vessel and sometimes rupture. +  
asapdoc  I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +20  
uslme123  I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +  
hello  The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +29  
yotsubato  hello is right. Fibromuscular hyperplasia is thickening of the muscular layer of the arteriole in response to chronic hypertension (as the question stem implies) +8  
smc213  Fibromuscular Hyperplasia vs Dysplasia...... are supposedly the SAME thing with multiple names. Fibromuscular dysplasia, also known as fibromuscular hyperplasia, medial hyperplasia, or arterial dysplasia, is a relatively uncommon multifocal arterial disease of unknown cause, characterized by nonatherosclerotic abnormalities involving the smooth muscle, fibrous and elastic tissue, of small- to medium-sized arterial walls. +1  
smc213  *sorry I had to post this because it was confusing!!!*Fibromuscular dysplasia is most common in women between the ages of 40 of and 60, but the condition can also occur in children and the elderly. The majority (more than 90%) of patients with FMD are women. However, men can also have FMD, and those who do have a higher risk of complications such as aneurysms (bulging) or dissections (tears) in the arteries. +1  
momina_amjad  These questions are driving me crazy- fibromuscular dysplasia/hyperplasia is the same thing, and it is NOT this presentation and it doesn't refer to arteriolosclerosis seen in malignant HTN! Is the HTN a cause, or a consequence? I read it as being the cause (uncontrolled HTN for many years) If it was the consequence, the presentation is still not classical! -_- +1  
charcot_bouchard  Poor controlled HTN is the cause here +  
charcot_bouchard  Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +  

It is worth clarifying that all the comments are wayyyy off, since Hyperplastic Arteriolosclerosis has nothing to do with Fibromuscular Dysplasia. Note that arteri-ol-osclerosis is exclusively referring to pathology of Arterioles. There are 2 subtypes of arteriolosclerosis, Hyperplastic Arteriolosclerosis is often due to Hypertensive Emergency (as seen in this patient). The other subtype is Hyaline Arteriolosclerosis, often associated with Diabetes Mellitus.

The correct answer choice says "Fibromuscular hyperplasia of arterioles" which is simply a description of what occurs in Hyperplastic Arteriolosclerosis (onion-skinning due to smooth muscle hyperplasia)

+50/- msyrett(55),

submitted by chandlerbas(108),
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eerevs hornetnespyi eadls to prlhcsaiepty tolrirocerisessola nlgeadi to esoooicrsparrolleternhis A1F'(8 -pg- )927

submitted by cry2mucheveryday(18),
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oFcmsuuablrri lyarpeiapsh lwli cesau pre alner azt.omiea S. NBC/Ur is &2g0;t in per ralen ozeaamti but ni teh outnseiq tsi eavlu is itcievnadi fo ircisnnti enlra ur.aflei very ionnfs!!ucg

charcot_bouchard  Not really, Hypotension cause pre renal azotemia. Here long standing HTN resulting in end organ damage so intrinsic renal failure +2  
cry2mucheveryday  ugh! i just noticed there's a fairly long h/o of poorly controlled HTN which makes this question simpler now. Thanks!! +  
j44n  arterioles are in the kidney.... ya know like afferent/efferent ARTERIOLE @ the glom. if this was in the renal artery he'd have pre renal azotemia +  

submitted by athenathefirst(8),
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owH do yuo nokw the swenra is otn ?E I osceh E uecaebs I uhgthto of NTA :( oemSeno hple eelaps

submitted by j44n(110),
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I daeth vnryeeihtg ouatb ehest nrwase ccesiho

submitted by lickmyass(0),
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yhW not etMuilpl anerl reatyr nry?usaesm I asw hrntwo off yb het cesditrpino of tysilhppecra osolraestilesciorr and os I newt thiw hsit ceoic.h I utghoth cpsialehytpr eooolcslrrrsetsaii amy elda to iibrofidn ricossne of eth sleves wall tihw

hiroshimi  I think hyperplastic arteriosclerosis meaning that the wall of the artery is thicker, and that narrows the lumen, making it more "stiff" and reduce compliance. It's exactly what you see in patient with HTN. Think about pt with aortic stenosis, it's similar. In contrast, in aneurysm, the wall of the artery is actually thinner, the wall is weakened, that's why it's easier to rupture, think about the aortic aneurysm, it's more likely to rupture if's not treated. +