Welcome. My name is Divine. This is episode 645 of the Divine Intervention Life Lessons, I mean, Divine Intervention Podcasts.

In today's podcast, we're going to be continuing the 386 series. This is going to be series 7.

We're going to start from question 57. So a 28-year-old white woman returns to the office for full up of hypertension.

She says, my blood pressure keeps getting worse no matter what I do.

Her hypertension had been controlled with a diuretic and a bit of blocking medication for four years.

But her blood pressure has steadily increased in the past eight months, despite taking maximum doses of the medications.

She insists she takes her medications as directed.

Family history is negative for hypertension.

She does not smoke cigarettes.

High is 5 feet, 4 inches, that's 163 centimeters.

And weight is 75 kilograms, that's 165 pounds.

A BMI is 28 kilograms per meter squared.

Vital signs to their pulse of 96 per minute and blood pressure of 165 over 110 standing in both arms.

Examination of the retina shows EV-necking. Abdominal examination discloses a new epigastric

brewery. The remainder of the examination is normal.

Right. So we look at this question and we see this person. She's a young female, right? And she seems to have this resistant

hypertension. And it seems to have developed, you know, things seem to have been getting worse over the past

eight months, right? And she has this AV nicking, right? A tyrovenal snaking in the eye, we tend to see that in people that have really nasty hypertension. And we also see she has an epigastric brouye. So what condition should you be thinking about here? I really hope you're thinking about some kind of renal vascular disease like fibromuscular dysplasia, right? So now we just need to pick an answer choice that relates to fibromuscular dysplasia, right?

So question 57 says, which of the following is the most appropriate diagnostic study to order next? Option A says 24-hour urine collection for creatine clearance and protein excretion. No, right? We typically are going to do that for a nephrotic onephronex syndrome. Option B says 24-hour urinary collection collection for

vanilla mandelic acid metanephrine and kind of culmination. We're going to typically do that

for a few chromosome cytoma. That's not what's going on here. Option C says serum and urine

electron light concentrations. That's a very, very non-specific answer, right? Like, it's very nonspecific, right?

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