Under Pressure
Atherosclerotic renal lesions are most likely located here.
What is the ostium and proximal renal artery, often extending from the aortic wall?
FMD occurs far more commonly in this demographic group.
What is women (≈ 90 percent of adult cases)?
What is the gold standard imaging modality for diagnosing RAS?
What is digital subtraction angiography (DSA)?
What important structure must be avoided when dissecting the distal common iliac arteries?
What is the ureter?
This document lists patient preferences for CPR and other life sustaining treatments at the end of life.
what is a living will?
Explain how unilateral RAS produces renovascular hypertension.
What is hypoperfusion of the affected kidney activates RAAS → renin‑dependent systemic vasoconstriction and volume expansion → hypertension?
This layer of the arterial wall is primarily affected by the typical form of FMD.
What is the media of medium‑sized arteries?
CTA of renal arteries requires approximately how much iodinated contrast and has radiation equivalent to how many chest X‑rays?
What is 120–140 mL of contrast, ≈ 87–260 chest X‑rays or ~5.3 mSv?
The splenic artery runs along which surface of the pancreas?
What is the superior border?
What makes POLST/MOLST forms unique compared with other advance directives?
What is they are physician / clinician‑signed medical orders recognized across care facilities and emergency services?
Name four major risk factors for renal artery atherosclerosis (RAA).
What are age, hypertension (especially high systolic BP), diabetes mellitus, and reduced HDL cholesterol?
How can FMD be distinguished from large‑vessel vasculitis?
What is absence of systemic inflammation, anemia, or elevated acute‑phase reactants?
A 70‑year‑old man begins lisinopril and develops rapid creatinine rise and hyperkalemia. What diagnostic clue distinguishes RAS from intrinsic renal disease?
What is a bland urinalysis with minimal proteinuria (suggesting hemodynamic cause rather than parenchymal injury)?
You are performing a splenorenal bypass. Mid‑procedure, you realize the splenic artery does not reach the renal hilum. What intraoperative alternative maintains the bypass’s efficacy?
What is using a saphenous vein graft as an extension conduit?
A 78‑year‑old with a DNR order requires urgent laparotomy for ischemic bowel. The anesthesiologist asks to suspend the DNR automatically during surgery. What is the ethically correct plan?
A. Automatic suspension is acceptable during any operation.
B. The surgeon should confirm with the patient/surrogate whether temporary suspension aligns with their values.
C. Leave the decision solely to anesthesia.
D. Cancel surgery until ethics approves.
B. Professional societies emphasize required reconsideration — autonomy requires an explicit patient/surrogate discussion.
A patient with advanced RAA develops worsening cramping on ambulation and angina. You suspect he has diffuse systemic atherosclerotic disease and decide to evalute these three arterial beds.
What are coronary, carotid, and peripheral arterial beds?
What imaging modality is the gold standard for diagnosing renal artery FMD?
What is digital subtraction angiography (DSA)?
A 65‑year‑old with resistant hypertension undergoes a captopril renal scan showing delayed tracer excretion on the right and increased uptake on the left. What does this pattern indicate?
What is functionally significant right renal artery stenosis with compensatory contralateral hyperfiltration?
Following completion of your anastomoses, the attending insists on a final step “before we come off clamps” to ensure no debris exists in the graft.
What is flushing both the graft and native vessels before completion?
A divorced patient is incapacitated. Her ex‑husband claims she wanted “everything,” while her adult daughter presents a POLST indicating comfort‑only measures.
Which principle guides your next step?
A. Follow the statement of the former spouse, as next of kin.
B. Follow the POLST form —it is a licensed medical order representing the patient’s documented wishes.
C. Initiate life support until the conflict resolves.
D. Defer to state court for immediate adjudication.
B. Verifiable patient‑expressed wishes (POLST) ethically override surrogate claims — autonomy through prior directive.
A patient with long-standing unilateral RAS undergoes aortorenal bypass. Post-op, his systemic blood pressure normalizes, but creatinine rises slightly. Explain the likely cause of transient post op renal dysfunction?
What is ischemic-reperfusion injury from restoration of flow to a chronically hypoperfused kidney causing tubular dysfunction?
A 28‑year‑old woman successfully treated for renal FMD two years ago presents with recurrent hypertension. Duplex shows elevated velocities at the prior lesion. What is the most likely cause, and next step?
What is restenosis—repeat DSA with possible re‑angioplasty?
Which formula defines resistive index (RI)?
What is (PSV – EDV) / PSV?
During a transaortic endarterectomy for bilateral ostial disease, you extend the arteriotomy too far laterally and encounter brisk back‑bleeding from a short posterior branch—no distinct trunk identified. Which anatomic variant might explain this bleeding
What is a posterior accessory renal artery arising directly from the aorta or from a lumbar branch (present in ≈ 20% of cases)?
A patient’s spouse insists he is “a fighter” and would want CPR despite severe metastatic disease. Clinical team believes CPR would cause harm without benefit.
Ethically, what should guide your recommendation?
A. Respect for autonomy—perform CPR regardless of outcome.
B. Beneficence and nonmaleficence—recommend against CPR, supported by patient’s values if known.
C. Justice—resources should not be wasted.
D. Legal obligation—perform CPR until the code team stops.
B. Offer a professional recommendation grounded in beneficence and nonmaleficence, framed through the patient’s prior values (“He wanted comfort, not prolongation of dying”).