Morning Quiz 107

☕️ Which of the following is the most likely additional finding in this patient?

Dr. Shoaib Ahmad Baig
February 28, 2025

Morning Quiz ☕️

A 24-year-old woman presents to ER with:

Presenting Complaint: Sudden-onset, severe headache.

Medical History: Recently diagnosed with hypertension. No other medical problems.

Social History: Lifetime nonsmoker, no illicit drug use.

1 week later later she dies.

Autopsy Findings:

Evidence of intracranial hemorrhage.
Both carotid arteries appear tortuous distally with alternating areas of fibrotic webs and aneurysmal dilation.
Microscopic examination: Aneurysmal segments of the carotid arteries lack an internal elastic lamina.

Question

Which of the following is the most likely additional finding in this patient?

Options:
A. Adrenal tumor
B. Coarctation of the aorta
C. Hypertrophic cardiomyopathy
D. Renal artery stenosis
E. Thyroid follicular hyperplasia

Correct Answer 🎯: D. Renal Artery Stenosis

Recent Hypertension + Young Patient: suggests secondary hypertension, often caused by renal artery stenosis.

Carotid Artery Findings → indicates fibromuscular dysplasia (FMD)→ commonly affects renal arteries.

⚙️

Renal Artery Stenosis

⬇

Narrowing of renal artery (like a clogged pipe 🚰) → ↓ Blood flow to kidneys.

⬇
Kidneys perceive this as low blood volume

⬇

↑ Renin secretion. (Renin-Angiotensin System Activation)

⬇

Converts angiotensinogen to angiotensin I → Angiotensin II (via ACE).
⬇
Vasoconstriction (narrowing blood vessels 🎗️) + ↑ Aldosterone → Sodium and water retention.

⬇

Hypertension Diagnosis
⬇
↑ Blood Pressure (Chronic) 🩺
⬇
Chronic hypertension acts like a constant hammer 🛠️ on blood vessels, causing structural damage.
⬇
Vascular remodeling → ↑ Wall stress in arteries (like overstretching a rubber band 🎗️)

⬇
Tortuosity and fibrotic webs in carotid arteries

⬇
Alternating areas of fibrotic webs and aneurysmal dilation

(ballooning 🎈 in weak spots).

⬇

Loss of internal elastic lamina in aneurysmal segments

⬇
Weakening of arterial wall → ↑ Risk of rupture (bursting tire 🎈💥).
⬇
Rupture of weakened carotid artery ( Intracranial Hemorrhage)→ Bleeding into intracranial space.
⬇
Sudden-onset severe headache

⬇

Death.

Differential Table ⚖️

Differential ⚖️	Mechanism ⚙️	Why Incorrect? 🔴
Adrenal Tumor	Adrenal tumor → Episodic catecholamine release → Episodic hypertension.	No episodic symptoms (e.g., palpitations, sweating).
Coarctation of the Aorta	Aortic narrowing → ↑ BP proximal to coarctation → Differential BP in limbs.	No differential BP or rib notching on imaging.
Hypertrophic Cardiomyopathy	Heart muscle thickening → Obstructed blood flow → Cardiac symptoms (e.g., chest pain).	No cardiac symptoms or evidence of heart disease.
Thyroid Follicular Hyperplasia	Thyroid overactivity → Hyperthyroidism (e.g., weight loss, heat intolerance).	No thyroid-related symptoms or hormonal imbalance.

Practice Questions ⏳️

Most Importantly Solve UWorld Questions with IDs:

695, 832, 7569, 15247, 15273

Stay Hungry, Stay Curious!

Your Brother in This Struggle

Dr. Shoaib Ahmad