A 65-year-old man presents to the emergency room complaining of shortness of breath and coughing frothy sputum for 5 days. Has uncontrolled hypertension despite being on 3 blood pressure medications. He is a heavy smoker. Vital signs showed: pulse rate 120 bpm, respiratory rate is 28/min, blood pressure 182/100 mmHg. Oxygen saturation 90% on room air. Physical examination revealed JVP 8 cm, coarse crackles up to midzones bilaterally on chest auscultation, and abdominal bruit. Blood work showed decreased kidney function. Chest X-ray is consistent with pulmonary edema. What is the most likely cause of hypertension in this patient?
سؤال مجاني 5 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Atherosclerotic renal artery stenosis
An older heavy smoker with resistant hypertension (on 3 drugs), an abdominal bruit, impaired renal function and flash pulmonary oedema fits atherosclerotic renal artery stenosis. Fibromuscular dysplasia is the renovascular cause in young women, not elderly smokers. Primary hyperaldosteronism presents with hypokalaemia/alkalosis and no bruit; renal failure here is a consequence of the stenosis rather than the primary cause.
ليش كل خيار صح أو غلط
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A
ليش صح
Key words for renal artery stenosis are an abdominal bruit, atherosclerotic stenosis and rapid worsening of renal function after ACEI or ARB use; this heavy smoker with resistant HTN, a bruit and impaired kidney function fits.
✓ Dr. Al-Ahmadi - HTN and Hypertensive Emergency✅.pdf · p. 5 -
B
ليش غلط
Conn's syndrome (primary hyperaldosteronism) comes with hypokalemia, metabolic alkalosis and muscle weakness, not an abdominal bruit.
✓ Dr. Al-Ahmadi - HTN and Hypertensive Emergency✅.pdf · p. 5 -
C
ليش غلط
Fibromuscular dysplasia causes renovascular HTN in younger patients; in older patients like this 65-year-old smoker the cause is atherosclerosis.
✓ CARDIOLOGY-HTN.pdf · p. 3 -
D
ليش غلط
Drug-induced HTN comes from agents such as sympathomimetics (cocaine, amphetamines), estrogen-containing OCPs or NSAIDs; none is mentioned in his history.
✓ (Y4)-(M B) Hypertension.pdf · p. 2 -
E
ليش غلط
An abdominal bruit in an atherosclerotic patient points to renal artery stenosis, in which renal function deteriorates (rapidly after ACEI or ARB use); the renal impairment is a consequence here rather than the primary cause.
✓ Dr. Al-Ahmadi - HTN and Hypertensive Emergency✅.pdf · p. 5
- المصدر
- Dr. Al-Ahmadi - HTN and Hypertensive Emergency✅.pdf · p. 5
(Y4)-(M B) Hypertension.pdf · p. 2 - المحاضرة
- Hypertension · Cardiology · Module B
- ظهر في
- Cardio bank