05-11-2010, 11:00 AM
There are 2 very similar case from UW Qbank, they are both related to renal artery stenosis:
1. A 65-yo man comes to your office for follow-up after his previous visits revealed inadequately controlled hypertension. He has no present complains except difficulty walking uphill or climbing stairs, because of the pain in the right thigh, which makes him stop and rest. His past medical history includes stable angina, requiring coronary angioplasty and stenting 2 years ago; hypercholesterolemia; a 2-year history of hypertension; and a 10-year history of diabetes mellitus, type 2. His current medications are aspirin, metoprolol, hydrochlorothiazide, enalapril, amlodipine, pravastatin and glyburide. He smokes 1 and 1/2 packs of cigarettes per day and does not consume alcohol. His BP is 160/100 mm Hg in his right arm and 180/110 mm Hg is his left arm. Which of the following findings will point to the potential cause of the resistant hypertension in this patient?
A. Increased pulsation of intercostal arteries
B. Continuous murmur in the paraumbilical area to the right
C. Increased urinal excretion of VMA
D. High aldosterone/renin ratio
2. A 67 yo man is evaluated for hypertension. He complains of occasional morning headaches. His past medical history is also significant for type 2 DM, coronary artery disease, and a stroke with residual left-sided weakness. He underwent coronary artery bypass surgery seven years ago and carotid endarterectomy 5 years ago. His current meidcation list includes lisinopril, hydrochlorothiazide, amlodipine, metoprolol, aspirin, metformin and glyburide. His BP is 190/120 mm Hg on the right arm and 170/110 mm Hg on the left arm. His HR is 65/mmin. Physical examination reveals a periumbilical systolic-diastolic bruit. the latter finding is best explained by which of the following?
A. Abdominal aortic aneurysm
B. Aortic dissection
C. Renal artery stenosis
D. Aortic coarctation
These two cases are NOT hard. But I found that in the above cases, both mentioned about the different BP in the left and right arm. My Question is: Are these symptoms must appear in renal artery stenosis?
1. A 65-yo man comes to your office for follow-up after his previous visits revealed inadequately controlled hypertension. He has no present complains except difficulty walking uphill or climbing stairs, because of the pain in the right thigh, which makes him stop and rest. His past medical history includes stable angina, requiring coronary angioplasty and stenting 2 years ago; hypercholesterolemia; a 2-year history of hypertension; and a 10-year history of diabetes mellitus, type 2. His current medications are aspirin, metoprolol, hydrochlorothiazide, enalapril, amlodipine, pravastatin and glyburide. He smokes 1 and 1/2 packs of cigarettes per day and does not consume alcohol. His BP is 160/100 mm Hg in his right arm and 180/110 mm Hg is his left arm. Which of the following findings will point to the potential cause of the resistant hypertension in this patient?
A. Increased pulsation of intercostal arteries
B. Continuous murmur in the paraumbilical area to the right
C. Increased urinal excretion of VMA
D. High aldosterone/renin ratio
2. A 67 yo man is evaluated for hypertension. He complains of occasional morning headaches. His past medical history is also significant for type 2 DM, coronary artery disease, and a stroke with residual left-sided weakness. He underwent coronary artery bypass surgery seven years ago and carotid endarterectomy 5 years ago. His current meidcation list includes lisinopril, hydrochlorothiazide, amlodipine, metoprolol, aspirin, metformin and glyburide. His BP is 190/120 mm Hg on the right arm and 170/110 mm Hg on the left arm. His HR is 65/mmin. Physical examination reveals a periumbilical systolic-diastolic bruit. the latter finding is best explained by which of the following?
A. Abdominal aortic aneurysm
B. Aortic dissection
C. Renal artery stenosis
D. Aortic coarctation
These two cases are NOT hard. But I found that in the above cases, both mentioned about the different BP in the left and right arm. My Question is: Are these symptoms must appear in renal artery stenosis?