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  #1  
Old 08-28-2013
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Kidney Nephrology Question

A 46 y/o woman who is a school bus driver by occupation presents to your office for regular follow up. She has a history of ADPKD. Her blood pressure is well controlled at 120/70 on enalapril. She has no other problems. She denies any headache. There is no family history of intracranial or subarachnoid hemorrhage. However, she is concerned that her head might explode because her sister who also has ADPKD was recently diagnosed of having a berry aneurysm. She wants to be screened for berry aneurysm as soon as possible. Her physical examination is benign and does not reveal any focal neurological deficits. Which of the following suggests the necessity for screening in her case?

A. Family history of berry aneurysm
B. Polycystic kidneys
C. School bus driving
D. Cysts in the liver
E. No screening necessary in her case
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  #2  
Old 08-28-2013
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B. Polycystic kidneys


It is a common extrarenal manifestation, the odds of she having berry aneurysm are even higher than the average ADPKD because of her sister's berry aneurysm
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Old 08-28-2013
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I think the answer is C
The patient is a bus driver and hence puts her and her passengers at risk.

From up to date:
The role for radiologic screening for cerebral aneurysm of asymptomatic patients with ADPKD is unsettled.
Routine screening is recommended only for high-risk patients:
such as those with a previous rupture
positive family history of an intracerebral bleed or intracranial aneurysm, warning symptoms
high-risk occupation in which loss of consciousness would place the patient or others at extreme risk
prior to surgery that is likely to be associated with hemodynamic instability with hypertension.
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  #4  
Old 08-28-2013
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The correct answer is:
B. Polycystic kidneys
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  #5  
Old 08-30-2013
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Answer is C
Revnair explanation is correct
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Old 07-12-2014
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Default C

from UPTODATE online : At present, routine screening is recommended only for high-risk patients, such as those with a previous rupture; a positive family history of a brain hemorrhage or stroke; warning symptoms (eg, unusual headaches); or a person with a high-risk occupation (eg, airline pilot), in whom a loss of consciousness would place the patient or others at extreme risk
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