NBME Step 2 CK Form 7 Decreased renal blood flow (NBME Answers)

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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 4/Question#13 (reveal difficulty score)
An 82-year-old man with congestive heart ...
Decreased renal blood flow 🔍 / 📺 / 🌳 / 📖
tags: renal

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submitted by ∗saffronshawty(30)

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How is this due to decreased renal blood flow when the BUN/Cr is <20 ?

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gh889 ischemia of the kidneys can cause intrinsic renal failure - w/ a BUN/Cr <15 +6

step_prep5 for more, see comment: https://nbmeanswers.com/exam/step2ck_form7/1977#5900 +2

merpaperple I was really confused by this too. There's a good explanation here: https://www.thehymedicine.com/post/step-2-ck-ccssa-nbme-form-7. • Patient has CKD so his BUN/Cr ratio is showing an intrinsic kidney problem • Patient then has furosemide added changing the ratio from 8.3 to 10.4 - this increase in ratio could suggest CKD with superimposed prerenal azotemia • Glomerulonephritis would show RBC casts • Interstitial nephritis would show WBC casts & eosinophils • Tubular Necrosis would show granular casts +2

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submitted by ∗step_prep5(246)

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CHF patient with increased diuretic dosage –> Too much fluid is pulled off –> Decreased effective circulating volume –> AKI (pre-renal, acute tubular necrosis)
Key idea: When taking care of a patient with decompensated heart failure, important to balance correcting volume overload with risk of causing an AKI

https://step-prep.org/tutoring/

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submitted by ∗charcot_bouchard(574)

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If its intrinsic defect HTF urinalysis is normal with no casts?

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