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NBME 22 Answers

nbme22/Block 4/Question#37 (40.1 difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophy🔍
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 +8 
submitted by haliburton(206),
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uormfrlibcaus adyalspis in eht lfet nlare a. ausesc olw lfow senluigtr in olw G.FR cChnior wol FRG sseauc ulatbur r.tpahyo cepterx( dan rfceernee lw)o.eb

blruTua htrypao is a rlagnee emrt hatt erdeicssb lravese ratestnp of chncoir rbuatlu nuyrji tiwh edinehckt tuubarl estnmbae mm,esnaebr adn calilnlcyi famsnitse sa orcinch neyikd sdiesae ithw rcesdeade glomulearr rioniattfl ater. dInsaecre exntet fo tuurlba harytpo dna yagccnnampoi iteritlsinat iforsbis srcoearetl thwi eorsw onsp.risog uiroPnirate is ,elrbavai gpinddene on scua.e

0.1a3th-tl/0/3cs/iorpedwf6rx2e3/t6(7S.0-6alt2u3w:j)8tgl6/wk




 +5 
submitted by lala123(5),
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odfnu the epanlnoxtia of oqtunesi di 345 in doulrw uellhpf


QID 453 renal artery stenosis is m/c d/t atherosclerosis. It can cause severe, refractory HTN d/t activation of the RAAS. over time, renal atrophy may occur d/t chronic O2 and nutrient deprivation. histologic examination may show crowded glomeruli, tubulointerstitial atrophy and fibrosis, and focal inflammatory infiltrates.

+6/- almondbreeze(80),


 +3 
submitted by keycompany(292),
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yWh dluow dnetiipsoo fo frbdoiiin ostepdsi (e.i. dioinbifr tsiaailr/sncmgnoen TNH) be wgr?on

amorah  Kidney is smaller than normal, suggesting less blood flow to it. Won't see shrunken kidney in the case of HTN. +1  
linwanrun1357  I have done so research showing that it should deposit collagen (see below). Anyway, fuck this question! http://www.pathologyoutlines.com/topic/heartfibromusculardysplasia.html +2  
shapeshifter51  I ruled out selection A since it is involving the interlobar artery. Renal artery stenosis involves the "renal artery" and the stem gives you fibromuscular dysplasia with renal artery stenosis. +3  



 +3 
submitted by makinallkindzofgainz(217),

Dr. Sattar says that decreased blood flow --> atrophy. Fibromuscular dysplasia of the left renal artery is essentially renal artery stenosis --> atrophy of the left kidney




 +1 
submitted by j000(4),

ch 1.2 pathoma cellular injury kidney will undergo ATROPHY due to slow, progressive ischemia because the blood supply is cut off. examples where blood supply is cut off to the kidney 1) atherosclerosis of renal artery 2) fibromuscular dysplasia of renal artery

fibrinoid deposits happen in PAN (vasculitis), hypertensive emergency, and pre eclampsia.

i can see why this is confusing because both PAN and fibromuscular dysplasia have that string of pearls appearance




 +0 
submitted by keycompany(292),
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ulntwod’ ohcrinc snohnrtpeeiy fo het -Lnrela yarret eudicn RSAA vaicattni,o nda ehecn taurulb yhrrpthpyoe iwht tlacciro aoytp?rh

fcambridge  I had a similar thought regarding mesangial hypercellularity. I missed a UW question on a similar topic. Unilateral renal artery stenosis results in hyperplasia of modified smooth muscle cells (JG cells) due to reduced RBF. The hyperplasia is intended to correct the supposed deficiency via increased production of renin. +  
paperbackwriter  Atrophy of the affected kidney (receiving less blood) and hypertrophy of the opposite kidney. +2