This page is dedicated to organizing various examples of standardized exam questions whose answer is renal artery stenosis. While this may seem a odd practice, it is useful to see multiple examples of how renal artery stenosis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for renal artery stenosis.
- Hypertension that is often severe and treatment resistant.
- Abdominal bruit is a classic physical exam findings
Question # 1
An otherwise healthy 70 year old woman comes to the clinic for a follow up visit. She has a 10 year history of hypertension. She explains that during the past 6 months she has had blood pressure readings that range between 160/100 mm Hg and 180/120 mm Hg. In the past her PCP has controlled her blood pressure with atenolol. Her past medical history is otherwise unremarkable. A physical exam is notable for only a systolic-diastolic bruit that is heard over the abdomen. Lab values are shown below.
- Sodium: 138 mEq/L
- Potassium: 3.3 mEq/L
- Creatinine: 1.3 mg/dL
What is a likely diagnosis in this patient?
Explanation # 1
Hypertension + bruit over the abdomen = renal artery stenosis
Question # 2
A 70 year old woman comes to the clinic because she is worried about her hypertension. A few days ago she measured her pressures at home and got a rating of 200/100 mm Hg. She has a 15 year history of hypertension that has been well controlled with a thiazide diuretic until now. At her last visit 4 months ago her blood pressure was 140/80 mm Hg. Today in the clinic her pulse is 78/min, respirations are 13/min, and blood pressure is 210/110 mm Hg. A funduscopic exam shows arteriovenous nicking, and a right carotid bruit is heard. What is a possible diagnosis?
Explanation # 2
Hypertension + carotid bruit (sometimes associated with renal artery stenosis) = renal artery stenosis
Question # 3
A 69 year old man with long standing hypertension comes to the clinic for a follow up visit. His medical history is notable for angina pectoris and COPD. He has prescriptions for nitroglycerin and an albuterol inhaler. He also has a 100 pack year smoking history and his BMI is 22 kg/m2. His pulse is 75/min, respirations are 15/min, and his blood pressure is 170/110 mm Hg. A physical exam is unremarkable. Serum studies reveal a BUN of 38 mg/dL and a creatinine concentration of 2.0 mg/dL. A renal ultrasound shows a 13.5 cm left kidney and a 8 cm right kidney. What is the likely cause of this patient’s hypertension and renal atrophy?
Explanation # 3
Hypertension + one kidney smaller than the other (atrophied) = renal artery stenosis
Question # 4
A 25 year old woman is seen in the clinic for hypertension. She has been on two different anti-hypertensive medications for the past two year but still has not been able to bring her blood pressure into normal range. She is healthy and fit, and has a very strict diet low in salt/fats and high in fruits/vegetables. She has no history of smoking, alcohol usage, or illicit drug usage. Her vital are unremarkable, other then her blood pressure of 160/100 mm Hg. She states emphatically that she too her HCTZ and Amlodipine this morning, and that she never misses a dose. A physical exam reveals an abdominal bruit just to the right of the umbilicus. What is the diagnosis in this patient?
Explanation # 4
Treatment resistant hypertension + bruit over the abdomen = renal artery stenosis (likely secondary to fibromuscular dysplasia)
Question # 5
Explanation # 5
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 01.22.2017