questions 2

Renal Artery Stenosis

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Topic updated on 11/07/16 7:17am

Introduction
  • renal artery stenosisHypertension as a result of an altered renal artery presenting the kidney with perceived hypotension 
  • Etiologies
    • atherosclerosis plaques
      • seen in the elderly
    • fibromuscular dysplasia
      • seen in young adults
Presentation
  • Symptoms
    • headache
  • Physical exam
    • sudden onset hypertension
    • renal bruit
Evaluation
  • Labs
    • hypokalemia
  • Screening test with oral captopril
    • induces increased renin
  • Diagnosis confirmed with angiography, but MRA preferred if poor renal function 
Treatment
  • Surgical
    • angioplasty with stenting


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Qbank (1 Questions)

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(M2.RL.174) A 69-year-old man with a 55-pack-year smoking history, diabetes type II, and hyperlipidemia presents to his primary care clinic for an annual exam. He has no complaints. He reports that his blood glucose has been under tight control and that he has not smoked a cigarette for the past 5 months. Vital signs are HR 69 bpm, BP 180/100 mm Hg, RR 12/min, and O2 saturation 99% on room air. Physical examination is notable for bruits bilaterally just lateral of midline near his umbilicus. You initiate an anti-hypertensive medication, but his blood pressure continues to be suboptimal. Creatinine is 3.5. Regarding this patient's disease, which of the following is the best initial step in management? Topic Review Topic

1. Reassure the patient that his high blood pressure is to be expected as he ages
2. Perform a renal angiogram
3. Renal ultrasound with Doppler
4. Perform revascularization with percutaneous transluminal angioplasty
5. Begin treatment with ACE inhibitors prior to any other workup

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