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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 πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—mcl(645),
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iedtlDo is ideenrnvta by arlxliay n,reev cwhih msceo rmof ootrs 5/CC6. oAsicnt fo the idlodte idnuecl bnadouict fo het rupep .itermetxy

submitted by βˆ—hayayah(1169),
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eCsa fo iososorreselltr.aic

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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. +1  
asapdoc  I thought this was a weirdly worded answer. I immediately ( stupidly) crossed of fibromuscular dysplasia since it wasnt a younger women =/ +22  
uslme123  I was thinking malignant nephrosclerosis ... but I guess you'd get hyperplastic arteries first -_- +1  
hello  The answer choice is fibromuscular HYPERplasia - I think this is different from fibromuscular DYSplasia (seen in young women); +31  
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) +10  
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. +2  
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. +2  
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! -_- +2  
charcot_bouchard  Poor controlled HTN is the cause here +1  
charcot_bouchard  Also guys if u take it as Fibromuscular dysplasia resulting in RAS none of the answer choice matches +1  

submitted by βˆ—chandlerbas(113),
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eevers ehyentrnosip lades to reapptilychs oraelloirctssisreo dlginae ot sorretlrhsneiorocpoiaesl 'AF81( -gp- 279)

submitted by βˆ—cry2mucheveryday(19),
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lFarrmiusocub rpsaieyhapl illw uacse rpe nelra taa.eozmi .S CNBUr/ si &t0g;2 ni per anlre atiezamo tub ni eht qnsuiote sit avlue si iecvnidtia of iiisntcrn rneal flie.aur eyrv uf!nsocngi!

charcot_bouchard  Not really, Hypotension cause pre renal azotemia. Here long standing HTN resulting in end organ damage so intrinsic renal failure +3  
cry2mucheveryday  ugh! i just noticed there's a fairly long h/o of poorly controlled HTN which makes this question simpler now. Thanks!! +1  
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 +1  

submitted by βˆ—athenathefirst(4),
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woH od you wonk het nwresa is otn ?E I heosc E scaeebu I tgthohu fo ANT :( noemeSo elph speeal

lovebug  I am not sure. but I thought E) multiple wedge-shaped cortical infarct . could be induced by multiple embolism of artery. or complete blocks of small artery junctions..(blockage of blood junction) but this case was hyperplastic arterioloscelrosis. +  

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I death eitvrgehny ouatb eehst wraesn checsio

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yhW otn Mutlipel lenar yerrta ens?uymras I swa rnhwot ffo by the iprdentocsi of seryithlpcap lslcieeoistorraosr nda os I etwn ithw hsti o.ciech I hgohutt pcpasilthyre rserloercossiiotla amy aeld to nbifriiod nricesso of teh velsse wall whit raomr.hgehe

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. +1  

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