ABFM KSA HYPERTENSION Latest Update -

ABFM KSA HYPERTENSION Latest Update - 60 Questions and 100% Verified Detailed Correct Answers Guaranteed A+ Approved by Professor

A 14-year-old female is diagnosed with stage 1 hypertension. Her previous medical history and family history are unremarkable. A physical examination is notable for a height of 160 cm (63 in), a weight of 75 kg (165 lb), a BMI of 29 kg/m2, and a blood pressure of 134/84 mm Hg.Which one of the following studies is not routinely obtained in this situation?A urinalysis A fasting lipid profile Serum creatinine Hemoglobin A1c

Renal ultrasonography - CORRECT ANSWER: E

For children >13 years of age, the American Academy of Pediatrics (AAP) defines stage

• hypertension as a blood pressure of 130-139/80-89 mm Hg and stage 2 hypertension

as a blood pressure ≥140/90 mm Hg. The AAP recommends that all pediatric patients with hypertension be evaluated with a urinalysis, a chemistry panel (including electrolyte, BUN, and creatinine levels), and a lipid profile.Renal ultrasonography is recommended for patients <6 years of age with hypertension, as well as those with abnormal findings on a urinalysis or renal function studies. For adolescents and pediatric patients who have obesity and hypertension, recommended tests also include hemoglobin A1c, aspartate transaminase (AST) and alanine transaminase (ALT), and a fasting lipid panel. Echocardiography is recommended to assess for cardiac target organ damage if pharmacologic treatment of hypertension is being considered.An extensive evaluation for secondary causes of hypertension is not recommended for children older than 6 years if they have a family history of hypertension, or if they are overweight or obese, and the history and physical examination do not suggest a secondary cause for their hypertension.

A 19-year-old male college student sees you for follow-up of an emergency department (ED) visit. He says he was told that his symptoms were due to a panic attack. His past medical history is notable only for migraine headaches. On the day of his ED visit he 1 / 4

was started on propranolol for the headaches. The initial physical examination in the ED was notable for a blood pressure of 198/114 mm Hg supine, dropping to 150/98 mm Hg on standing, and a heart rate of 112 beats/min. He reports that his symptoms improved after a couple hours in the ED and the record from the visit notes that his blood pressure was 140/90 mm Hg at the time of discharge.The patient says that he has always been an anxious person but has never experienced a similar attack in the past.He notes that his blood pressure has always been on the "high side" and his blood pressure in your office today is 144/86 mm Hg.Which one of the following should be c -

CORRECT ANSWER: D

Pheochromocytomas are catecholamine-producing neuroendocrine tumors, and the majority arise from the adrenal medulla. They are a rare but important secondary cause of hypertension, whether sustained or paroxysmal. Paroxysmal hypertension with sweating, headaches, and palpitations is the usual presentation of pheochromocytoma.Other clinical clues to its presence include unexplained tachycardia, weight loss, episodic diaphoresis, unexplained orthostatic hypotension with a background of paroxysmal or refractory hypertension, and feelings of anxiety or panic attacks. β- Adrenergic blockers have been implicated in precipitating adverse reactions in patients with pheochromocytoma. The mechanism for β-blocker-associated adverse events is generally ascribed to inhibition of β2-adrenoceptor-mediated vasodilation, leaving adrenoceptor-mediated vasoconstriction unopposed. If a hypertensive crisis occurs in a patient taking β-blockers, the presence of a pheochromocytoma should be suspected.Furthermore, the Hypertension Canada 2017 guidelines recommend that the possibility of pheochromocytoma be considered in patients with hypertension triggered by β- blockers as well by monoamine oxidase inhibitors, micturition, changes in abdominal pressure, surgery, or anesthesia.

A 24-year-old male comes to the emergency department with chest pain an hour after using cocaine. A physical examination is notable for a blood pressure of 190/110 mm Hg and tachycardia. An EKG reveals sinus tachycardia with a rate of 116 beats/min and nonspecific ST- and T-wave changes.Which one of the following agents can be safely prescribed?Labetalol (Trandate) Lorazepam (Ativan) Metoprolol tartrate (Lopressor) Short-acting nifedipine (Procardia)

Propranolol - CORRECT ANSWER: B

• / 4

In patients with cocaine-induced chest pain and hypertension, initial management with an intravenous benzodiazepine can relieve chest pain and produce beneficial cardiac hemodynamic effects. In addition, by reducing the central stimulatory effects of cocaine, benzodiazepines also reduce anxiety, which often leads to resolution of the hypertension and tachycardia. Administration of sublingual or intravenous nitroglycerin and intravenous or oral calcium channel blockers is recommended for patients with ST- segment elevation or depression that accompanies ischemic chest discomfort after cocaine use.By blocking only β-receptors, resulting in an unopposed α-adrenergic effect, β-blockers can exacerbate vasoconstriction and should therefore be avoided.Although labetalol is both an α- and β-blocker, because it blocks β-receptors substantially more it is thought to offer no advantages over a β-blocker.

A 32-year-old female who works as an administrative assistant is referred to you for evaluation of high blood pressure. Her past medical history is unremarkable, and she does not take any prescribed or over-the-counter medications. A review of systems reveals only a chronic history of mild fatigue and episodic muscle cramping. A physical examination is normal except for a blood pressure of 156/100 mm Hg in both arms without significant orthostatic changes.Laboratory FindingsCBC............normalSodium............145 mEq/L (N 135-145)Potassium............2.9 mEq/L (N 3.5-5.0)Chloride............100 mEq/L (N 100-108)Bicarbonate............25 mEq/L (N 22-26)Creatinine............0.7 mg/dL (N 0.6-1.5)BUN............10 mg/dL (N 8- 25)Glucose............90 mg/dLUrinalysis............normalWhich one of the following is the most likely cause of her hypertension?Addison's disease Bartter syndrome Chronic licorice ingestion

Pr - CORRECT ANSWER: D

Primary hyperaldosteronism, also known as Conn's syndrome, is associated with hypersecretion of aldosterone, a mineralocorticoid. It is twice as common in women as in men, and usually occurs between 30 and 50 years of age. In the past, it was estimated that approximately 1% of unselected hypertensive patients had hyperaldosteronism, but more recent data indicates that the prevalence is around 6% in patients with uncomplicated hypertension and as high as 20% in those with resistant hypertension. Symptoms are largely related to the associated hypertension, hypokalemia, or alkalosis, and include headaches, polyuria, polydipsia, muscle weakness and fatigue, and intermittent paresthesias.

• / 4

A 38-year-old male with a chronic history of nocturia sees you for a 2-day history of gross hematuria. His past medical history is unremarkable. His father is on hemodialysis for an unknown kidney problem and he believes his brother has kidney problems as well. A physical examination reveals a blood pressure of 150/102 mm Hg. His serum creatinine level is 2.4 mg/dL (N 0.6-1.2).Which one of the following is the most likely diagnosis?Chronic glomerulonephritis Chronic pyelonephritis Membranous nephropathy Medullary sponge kidney

Polycystic kidney disease - CORRECT ANSWER: E

Autosomal polycystic kidney disease has a prevalence of 1:300 to 1:1000 and accounts for approximately 10% of end-stage renal disease in the United States. Significant findings include renal pain, enlarged kidneys, nocturia, gross and microscopic hematuria, elevated serum creatinine, and low urine specific gravity. The disease can present at any age, but most frequently causes symptoms in the third or fourth decade of life.

A 39-year-old male sees you for evaluation of high blood pressure. His past medical history is unremarkable. On examination he has a BMI of 32 kg/m2 and you note that he has a round face and a plethoric complexion. His blood pressure is 150/98 mm Hg, his pulse rate is 88 beats/min, and his respiratory rate is 16/min. Other notable findings include a prominent dorsal cervical fat pad and supraclavicular fat pads, as well as violaceous striae on his trunk. Laboratory findings are notable only for a fasting glucose level of 114 mg/dL.Which one of the following is the most likely cause of his hypertension?Addison's disease Cushing syndrome Hemochromatosis Pheochromocytoma

Primary hyperaldosteronism - CORRECT ANSWER: B

• / 4