NBME 24 Atherosclerosis (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 2/Question#29 (reveal difficulty score)
A 65-year-old woman with well-controlled type ...
Atherosclerosis 🔍 / 📺 / 🌳 / 📖
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+8 upvote downvote
submitted by ∗ameanolacid(29)

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Atherosclerosis is the MOST common cause of renal artery stenosis...with fibromuscular dysplasia being the SECOND most common cause (even though it is tempting to choose this option considering the patient's demographic).

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xxabi Is there a situation where you would pick fibromuscular dysplasia over atherosclerosis if given both options? Thanks for your help! +6

baconpies Atherosclerosis affects PROXIMAL 1/3 of renal artery Fibromuscular dysplasia affects DISTAL 2/3 of renal artery +65

gonyyong Why is there ↓ size in both kidneys? This threw me off +3

kateinwonderland @gonyyong : Maybe because narrowed renal a. d/t atherosclerosis led to renal hypoperfusion and decrease in size? +1

drdre Fibromuscular dysplasia occurs in young females according to Sattar Pg 67, 2018. +12

davidw Normally you will see Fibromuscular dysplasia in a young female 18-35 with high or resistant hypertension. She is older has a history type II DM predispose you to vascular disease and normal to moderate elevation in BP +9

suckitnbme @gonyyong there's bilateral renal artery stenosis. The decrease in size of both kidneys should be from atrophy due to lack of renal blood flow. +5

tyrionwill 1 year ago, she did not present any physical or Lab abnormalities. This means she must not suffer fibromuscular dysplasia, otherwise she must have presented renal abnormalities for a long long time, or even before DM-2. +2

rockodude a little surprised that atherosclerosis leading to bilateral renal artery stenosis and shrunken kidneys could happen that quickly after everything was A okay the year prior +1

+6 upvote downvote
submitted by ∗abhishek021196(119)

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Main causes of renal artery stenosis:

Atherosclerotic plaques—proximal 1/3 of renal artery, usually in older males, smokers.
Fibromuscular dysplasia—distal 2/3 of renal artery or segmental branches, usually young or middle-aged females.

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+1 upvote downvote
submitted by ∗fenestrated(32)

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My reasoning was 135/80 BP relatively normal.. in fibromuscular dysplasia I believe it would be higher due to increase in renin. Her hx of diabetes + low hemoglobin (damage to renal peritubular capillaries) also pushed me towards atherosclerosis.

also per FA2019 p298--> "usually seen in women of child-bearing age" this pt was 65

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+0 upvote downvote
submitted by ∗ih8payingfordis(34)

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One thing that threw me off about this question is that with decreased blood flow to kidneys (ie renal artery stenoses), you would expect to find BUN:Cr ratio > 15 according to pathoma (>20 in some sources). In this case the ratio is 30/2.1 which is slightly less. Very frustrating!

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-2 upvote downvote
submitted by ∗almondbreeze(110)

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Up to 80 percent of aortic aneurysms are caused by "hardening of the arteries" (atherosclerosis). Atherosclerosis can develop when cholesterol and fat build up inside the arteries. ... Elevated blood pressure through the aorta can then cause the aortic wall to expand and bulge.

https://www.uwhealth.org/heart-cardiovascular/aortic-aneurysm-causes-symptoms-and-concerns/10971

Also, FA 2019 pg300 says complications of atherosclerosis includes aneurysm

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almondbreeze I was dumb and went for marfan.. +1

llamastep1 Wrong question lol +4

-2 upvote downvote
submitted by ∗cathartic_medstu(37)

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Pathoma Ch 1, of 3.

Slowly developing ischemia (ie atherosclerosis) leads to atrophy whereas, acute ischemia (ie renal artery embolus) results in injury.

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usmlecrasherss i picked fibromuscular dysplasia and have zero regret, i just did not pay attention toward the word of proximal.... +3

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