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Old 05-15-2014
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Question Cardiology case. Need help understanding the answer.



Hi everyone,
When I tried to answer this question on my own, I chose "E" as the answer cuz I thought it was PAN. However, the answer turned out to be "C" indicating malignant hypertension hyperplastic arteriolosclerosis. I understand that malignant hypertension causes hyperplastic arteriolosclerosis, which is characterized by onion-like concentric thickening of arteriolar walls, and I know this information by heart since it's high-yield.
As far as I know, PAN may affect renal arterioles which would cause renal artery stenosis which in turn would activate the very famous renovascular hypertension pathway which gives signs & symptoms consistent with this patient's presentation (Headache, Oliguria, High blood pressure, Papilledema).

Although even in PAN-induced hypertension the onion-like concentric thickening would be present as a result of the hypertensive crisis, why isn't "E" a possible correct answer ?
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Old 05-15-2014
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I wonder, what made you think of PAN? Go cheap for boards
I mean there is no catch in the q , its simple straight forward question testing knowledge on whether we can identify histologic changes in Malignant HTN or not.
For answer to be of PAN in mind- In q step, there would have been given any constitutional signs or symptoms like weight loss,fever, young age,previous HBV infection,p-ANCA, sort of associations.
So i think you should not get confused with PAN vs M.HTN.
One more thing- In PAN, there maybe HTN but not malignant hypertension(in question) i suppose.

Hope this helps you.

If i am wrong please correct me.
Thank you.

Last edited by Redmoon; 05-15-2014 at 07:32 AM.
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Old 05-15-2014
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Redmoon,
I agree with your analysis.

Dr. Awaheed, the definition of hyperplastic arteriosclerosis is onion like layers of concentric thickening. The onion skin layers are the hyperplastic (divided) layers of smooth muscle that are protecting the vessel from bursting. Since it is hyperplastic, the cells themselves are in good shape and reacting. Hyaline arteriosclerosis is deposition of hyaline (acellular) junk in the walls of the arterioles. For this, think about systemic disorders like diabetes, ageing, PAN. The cells are damaged and can't respond properly.

Last edited by monkeymind90; 05-15-2014 at 09:35 AM. Reason: grammar
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Old 05-16-2014
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Quote:
Originally Posted by Redmoon View Post
I wonder, what made you think of PAN? Go cheap for boards
I mean there is no catch in the q , its simple straight forward question testing knowledge on whether we can identify histologic changes in Malignant HTN or not.
For answer to be of PAN in mind- In q step, there would have been given any constitutional signs or symptoms like weight loss,fever, young age,previous HBV infection,p-ANCA, sort of associations.
So i think you should not get confused with PAN vs M.HTN.
One more thing- In PAN, there maybe HTN but not malignant hypertension(in question) i suppose.

Hope this helps you.

If i am wrong please correct me.
Thank you.
I think you are correct. I tried unconsciously to complicate the question & made an assumption that the question can't be so straightforward. That's a lesson to learn however.
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