Clinical Medical Sciences (CMS)

Question 1

Blood pressure why is it important to use the right size cuff

Answer 1

• Use a blood pressure cuff that is of proper size to minimize errors in blood pressure determinations. The arm cuff should be at least 10cm wide; for the thigh, a width of 18cm is preferable. The length of the blood pressure cuff’s bladder (the inflatable part) should encircle at least 80% of the arm’s circumference.

Incomplete Occlusion: A small cuff may not fully occlude (block) the artery during measurement. This can result in some blood continuing to flow through the partially compressed artery, leading to a falsely high reading.

**If the clamp (cuff) is too small, you’d need to apply more pressure to stop the flow of water (blood). This excessive pressure can lead to inaccurately high readings because it compresses the artery too much.

If the clamp is just the right size, you’d apply the correct amount of pressure to stop the flow without squeezing the hose too tightly or leaving it too loose. This is analogous to using a properly sized cuff for blood pressure measurement, which gives accurate readings.

Conversely, if the clamp is too big, you wouldn’t need to apply much pressure because it naturally fits around the hose without squeezing it much. However, this can also lead to inaccurate readings because the cuff might not fully occlude the artery.

Question 2

Blood pressure what to screen for before taking

Answer 2

Screen the patient to identify if patient has avoided caffeine and smoking 30 minutes prior to measurement. Also be aware that anxiety, “white coat syndrome”, rushing to make the appointment on time, bladder distension, chronic alcoholism, recent cigarette smoking and caffeine consumption can contribute to temporarily raised blood pressure in the absence of disease.

• The patient’s arm should be bare, free of clothing, and have no scarring, lymphedema, or arteriovenous (AV) fistulas. Keep the patients arm at the level of the heart.

Question 3

Easy to remember if you understand to double for hypertension

Blood pressure what is normal, what are the different stages

Answer 3

Hypotension = low blood pressure (> 90/60 mm Hg)

Notice how elevated goes up by 10 mm Hg, then stage 2 is 20 above stage 1, and stage 3/Hypertensive crisis if 40 above stage 2. But Diastolic is 9/10/30 respectively above the normal 80 **Also 130/85 suggest NAFLD (Non Alcoholic Fatty Liver Disease)

Question 4

Common Causes of hypo/hypertension

Answer 4

Clinical manifestations of low blood pressure can include fatigue, shortness of breath (SOB)/dyspnea on exertion (DOE), and light-headedness, especially on assuming an upright posture (orthostatic hypotension).

• The most common causes of low blood pressure are dehydration or decreased cardiac output.
• In patients with acute illness, hypotension with a systolic BP of <90 mm Hg can predict death in hospitalized patients in the intensive care unit (ICU) (LR+ 3.1) and in patients with bacteremia (LR+ 4.9) and pneumonia (LR+ 7.6); with a systolic BP of <80 mm Hg it can predict death in patients with myocardial infarction (LR+ 15.5). The APACHE (Acute Physiology and Chronic Health Evaluation) scoring system, which predicts the risk of hospital mortality among patients in the ICU, assigns more points (and thus a higher risk) to severe hypotension than to any other vital sign or laboratory variable.
• Hypotension also predicts other adverse outcomes. In patients with myocardial infarction, a systolic blood pressure less than 80 mm Hg predicts a much higher incidence of congestive heart failure (CHF), ventricular tachycardia and fibrillation, and complete heart block. In hospitalized patients, hypotension greatly increases the risk of serious adverse outcomes in the next 24 hours (≤90 mm Hg, LR+ 4.7; ≤85 mm Hg, LR+ 9; ≤80 mm Hg, LR+ 16.7)

HYPERTENSION = High Blood Pressure (>130 / 80)

• Blood pressures that are too high may cause end-organ damage with equally disastrous consequences. Heart attack, stroke, hypertensive renal failure, and retinopathy are all too familiar in the hypertensive population.
• Essential hypertension is defined as three or more blood pressure readings taken over three visits separated by weeks
• Blood pressure should be measured in every person, even when asymptomatic, because essential hypertension is common and treatable and because treatment reduces cardiovascular morbidity and overall mortality rates.

Question 5

For Patient Health Questionaire (PHQ-2) and (General Anxiety Disorder (GAD-2) remember the system is 0-3

The options for answering the following questions are:
Not at all - for a score of 0
Several days - for a score of 1
More than half the days - for a score of 2
Nearly every day - for a score of 3

FYI: It starts by asking, over the past/last 2 weeks… (It keeps up with the notion of of 2’s)

But what is the cutoff that lets you know to ask the rest of the questions?

Answer 5

3 is the cut off

PHQ-2
“Over the past 2 weeks, how often have you been bothered by the following problems?”
1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless

GAD 2
“Over the last 2 weeks, how often have you been bothered by the following problems? “
1. Feeling nervous, anxious or on edge.
2. Not being able to stop or control worrying