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NBME 24 Answers

nbme24/Block 2/Question#29

A 65-year-old woman with well-controlled type 2 ...


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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).

xxabi  Is there a situation where you would pick fibromuscular dysplasia over atherosclerosis if given both options? Thanks for your help! +3  
baconpies  Atherosclerosis affects PROXIMAL 1/3 of renal artery Fibromuscular dysplasia affects DISTAL 2/3 of renal artery +13  
gonyyong  Why is there ↓ size in both kidneys? This threw me off +  
kateinwonderland  @gonyyong : Maybe because narrowed renal a. d/t atherosclerosis led to renal hypoperfusion and decrease in size? +  
drdre  Fibromuscular dysplasia occurs in young females according to Sattar Pg 67, 2018. +2  
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 +1  

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

Pathoma Ch 1, of 3.

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

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