Deck 60: Hypertension

Question 1

Elevated diastolic BP is a stronger risk factor for cardiovascular disease than elevated systolic BP.

Answer 1

False

Question 2

At her first visit with you, Ms. Ryan, a 55-year-old school teacher, is checked in by the medical assistant with a blood pressure of 155/92. Ms. Ryan reports no history of HTN or CVR disease and is asymptomatic. Repeat BP performed by you gives a reading of 148/85. In addition to ordering labwork and an ECG, you :

A) Suggest lifestyle modifications such as weight loss, stress reduction, and a DASH diet, and start Ms. Ryan on hydrochlorothiazide (HCTZ) 12.5 mg daily
B) Suggest lifestyle modifications (as above), refer Ms. Ryan for an exercise stress test, and start a beta blocker daily
C) Suggest lifestyle modifications and start an ACEI
D) Discuss lifestyle modifications and schedule Ms. Ryan back for repeat BP readings in 2-4 weeks

Answer 2

D

Question 3

Your patient, an asymptomatic 80-year-old receiving treatment for HTN (and reporting no adverse effects ) consistently presents with BPs > 140/80 but less than 150/90. According to the Joint National Committee (JNC) 8 recommendations, what approach to her HTN management would you have (in addition to reviewing compliance and diet)?

A) Add another antihypertensive medication to lower BP to < 140/90.
B) Add no antihypertensives at this time.
C) Order labwork and radiology to screen for secondary causes of HTN.
D) Recommend the patient lower sodium intake to less than 1,500 mg a day.

Answer 3

B

Question 4

Which of the following over-the-counter products (taken regularly) should be considered as a possible factor in elevating BP ?

A) Melatonin
B) Licorice tea
C) Diphenhydramine
D) Peppermint tea

Question 5

Your patient, Mr. Smith, is a 56-year-old moderately overweight African American hospital administrator with HTN. He has a FHx of DM but has had consistently negative screening labs for DM. He has been exercising regularly, is a nonsmoker, and has lost 10 lb over the past 6 months. Until recently, he has maintained a BP < 140/90 on HCTZ 25 mg daily.
The past 3 months his BP has been creeping upward and at his current visit is 160/94. In addition to checking labs and discussing his diet and stress, you decide to alter his medication regimen by:

A) Adding an angiotensin converting enzyme inhibitor
B) Increasing the HCTZ to 50 mg daily
C) Adding a calcium channel blocker
D) a or c
E) None of the above; advise on lifestyle only till next visit

Question 6

Mrs. Taylor is a 79-year-old widowed white woman who lives alone and whom you have been treating for HTN, kneedegenerative joint disease, and depression for 5 years. She is taking a diuretic, an ACEI, and a low dose of a beta blocker, all started by her former primary care physician before she transferred care to you. At this visit her BP has risen to 170/80, checked twice by you during the visit. Which of the following is not necessary to include in the history portion of the exam today:

A) Explore her compliance with taking her prescribed medications.
B) Discuss her diet.
C) Inquire about social support and spirituality.
D) Ask about her knee pain and how she is managing it.

Question 7

Abruptly discontinuing an alpha2 agonist such as clonidine can cause rebound hypotension.

Question 8

A 65-year-old woman presents to you for her first visit because she needs dental work and was found to have elevated BP when she saw the dentist. She tells you that she has never been to a doctor in her life, except when she had her two children over 40 years ago. Possible physical findings related to long-standing untreated HTN in this patient might include which of these findings?

A) Cardiac exam: S4
B) Fundoscopic exam: Arteriolar nicking
C) Abdominal exam: umbilical hernia
D) Extremity exam: Varicose veins
E) a and b

Question 9

According to JNC 8 recommendations, at which BP level do you initiate pharmacologic treatment for HTN in a 19-year-old diabetic male?

A) Greater than or equal to 125/80
B) Greater than or equal to 140/90
C) Greater than or equal to 130/90
D) Greater than 135/85

Question 10

A 45-year-old otherwise healthy Latina woman patient has had four BP readings in the past 6 months ranging from 145-155/79-82. What treatment do you recommend at this time?

A) Advise to try lifestyle modifications for 6 months and then reassess.
B) Ask her to check BPs at home for 6 months and return to clinic with these values.
C) Advise on lifestyle modifications and start a low dose of an antihypertensive such as an ACEI or diuretic.
D) Screen for white coat hypertension.