BP and comprehensive versus focused exam

Question 1

What is the most critical part of the exam?

Answer 1

general appearance and vital signs

Question 2

What is true BP?

Answer 2

average BP measured over days and weeks

Question 3

Hypertension BP

Answer 3

140/90 or higher

Question 4

Pre-hypertension BP

Answer 4

135/90

Question 5

There is no consensus on what in terms of measuring BP and classifying patients?

Answer 5

Setting, timing and total number of measurement

Question 6

Two types of hypertension

Answer 6

White coat hypertension and masked hypertension

Question 7

White coat hypertension

Answer 7

In the office, BP is high but ambulatory is normal–> cardiovascular risk is low

Question 8

Masked hypertension

Answer 8

Office BP is normal but ambulatory is high–> high risk for cardiovascular disease

Question 9

Why don’t we roll up a patient sleeve when measuring BP?

Answer 9

Compresses brachial artery and causes a higher read

Question 10

Where is the arm positioned when doing a BP?

Answer 10

Brachial artery, at the antecubital crease, needs to be at heart level, which is the 4th interspace at the junction with the sternum

Question 11

Width of the inflatable bladder should be what % of the arm circumference

Answer 11

40%

Question 12

Length of the inflatable bladder should be what % of the arm circumference

Answer 12

80%

Question 13

What happens if the cuff is too small?

Answer 13

BP will be high

Question 14

What happens if the cuff is too big?

Answer 14

BP will be low

Question 15

Where should the lower border of the cuff be?

Answer 15

2.5cm above the antecubital crease

Question 16

How do you find a reference BP?

Answer 16

Feel the radial pulse with fingers of one hand, rapidly inflate the cuff until the radial pulse disappears. Read the pressure on the meter and add 30mmHg to it.

Question 17

Why do we need a reference BP?

Answer 17

To prevent discomfort from unnecessarily high cuff pressures and to avoid errors due to auscultatory gap

Question 18

What is the auscultatory gap?

Answer 18

Silent interval that may be present between the systolic and diastolic pressures

Question 19

What sounds are heard over the brachial artery?

Answer 19

Korotkoff sounds

Question 20

How do you hear systolic pressure?

Answer 20

Hear 2 consecutive beats

Question 21

How do you hear true diastolic pressure?

Answer 21

Last distinct sound before muffled/disappeared sound

Question 22

HR is with what and pulse is with what?

Answer 22

HR- stethoscope

Pulse- radial artery

Question 23

What do you compress radial artery with?

Answer 23

Pads of index and middle fingers

Question 24

What is the normal range for HR/pulse?

Answer 24

50-90beats/min

Question 25

What is the 5th vital sign?

Answer 25

pain

Question 26

What is a comprehensive exam?

Answer 26

Patients you are seeing for the first time; includes all teh elements of health history and the complete physical examination

Question 27

What is a focused (problem-oriented) assessment?

Answer 27

Patients you know well who are returning for routine care or patients with specific urgent care concerns