WBR0309
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Renal |
| Prompt | [[Prompt::A 42 year old female patient presents to the physician's office for headache and blurry vision. On further questioning, she reports she is previously healthy, takes no medications, and has no allergies. She says that her blood pressure has been recently constantly elevated on several occasions during different times of the day. Her vital signs show a temperature of 36.1 degrees C (97 degrees F), a heart rate of 82 bpm, and a blood pressure measuring 170/90 mmHg. The remainder of her physical examination is unremarkable. Appropriate work-up is initiated; her abdominal computed tomography (CT) scan shows small stenoses along the left renal artery with areas of small aneurysms causing a "string of beads" appearance. An image of her CT scan is shown below. What is the most likely diagnosis of this patient's condition?
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| Answer A | AnswerA::Takayasu arteritis |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB::Renal artery stenosis |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Fibromuscular dysplasia |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD:: |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE:: |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer:: |
| Explanation | [[Explanation::Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease that most commonly involves the medium-size arteries, especially renal and carotid arteries. Nonetheless, the involvement of almost all arterial beds has been already described in the literature. Generally, it accounts for only 1% of cases of arterial stenosis.
FMD is caused by fibroplasia of any layer of the arterial wall. Most commonly,FMD is medial fibroplasia. Each of Intimal fibroplasia, which common in the pediatric population, and adventitial fibroplasia accounts for approximately only 10% of FMD cases. Medial fibroplasia is characterized by a "string of beads" appearance on CT scan. In the case of renal artery FMD, fibroplasia is typically in the mid to distal portion of the artery. |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
