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  #1  
Old 08-27-2012
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Sphygmomanometer Hypertension with Bruits!

A 64 yr old male comes to physician for general examination..he is in good health smokes half packet of cigarettes and has no associated problems...,but he tells the physician he was diagnosed with HTN in the past..on examination his BP is 160/100 mmhg and 1+ pitting edema to his knees...physician notes bilateral bruit heard best at costophrenic angle at T 11. which of the following is contraindicated?

a) smoking cessation
b) diuretics
c) ACEI
d) surgery
e) angioplasty
f) CCB
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  #2  
Old 08-27-2012
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I am so confused between C and F

But lets go with c)... ACEI

Last edited by Doc4Step1; 08-27-2012 at 07:50 AM.
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Old 08-27-2012
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C for sure
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  #4  
Old 08-27-2012
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Default my answer

c) ACEI
bilateral renal arteries stenosis
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Old 08-27-2012
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How did I miss this "physician notes bilateral bruit heard best at costophrenic angle at T 11".

My problem is I don't read the question carefully.

C is the right answer.Avoid ACE Inhibitors in renal stenosis.
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Old 08-27-2012
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yes,like all of them answered...the correct answer is C) ACEI

the pt. is sufeering from bilateral renal artery stenosis...stenosis lead to drop in intraglomerular pressure....GFR decreases gradually and filtration fraction..so, the underperfused kidneys activate RAA system...so, with ACEI ,filtration further decreases....so, they are avoided

other treatment options.....betablockers, calcium channel blockers, diuretics and finally surgery can be done....
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Cardiovascular-, Pathology-, Pharmacology-, Step-1-Questions

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