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Cardiology USMLE Step 3 > Section 7: Hypertension > Flashcards

Section 7: Hypertension Flashcards

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USMLE® Step 1 flashcards
1
Q

A man comes to the office for a routine visit. He is found to have a blood pressure of 145/ 95. What is the next best step in management?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8219-8221). . Kindle Edition.

A

Repeat the blood pressure measurement in 1– 2 weeks.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8219-8221). . Kindle Edition.

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2
Q

True or False

It may take 3– 6 measurements to get an accurate assessment of blood pressure.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8223-8224). . Kindle Edition.

A

True

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3
Q

List the routine tests for hypertension cases on CCS

A
  • Urinalysis
  • EKG
  • Eye exam for retinopathy
  • Cardiac exam for murmur and S4 gallop

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8229-8231). . Kindle Edition.

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4
Q

List the life style modifications for repeatedly abnormal blood pressure

A
  • Sodium restriction
  • Weight loss
  • Dietary modification
  • Exercise
  • Relaxation techniques

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8234-8236). . Kindle Edition.

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5
Q

What is the most effective lifestyle modification for hypertension?

A

Weight loss

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8237-8239). . Kindle Edition.

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6
Q

First line Rx for hypertension

A
  • Thiazide diuretic, such as:
    • hydrochlorothiazide
    • chlorthalidone
  • In diabetics, however, use ACEI/ ARB

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8241-8243). . Kindle Edition.

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7
Q

About 70 percent of patients will be controlled with a diuretic alone. If pressure control is not achieved with a diuretic alone, a second drug added. List them

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8244-8248). . Kindle Edition.

A
  • Beta blocker
    • atenolol
    • metoprolol
  • ACE inhibitor
  • Angiotensin receptor blocker (ARB)
  • Calcium channel blocker (CCB)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8244-8248). . Kindle Edition.

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8
Q

For each of the conditions listed below name the specific first line anti-hypertensive:

  1. Coronary artery disease
  2. Congestive heart failure
  3. Migraine
  4. Hyperthyroidism
  5. Osteoporosis
  6. Depression
  7. Asthma
  8. Pregnancy
  9. BPH
  10. Diabetes

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8270-8280). . Kindle Edition.

A
  1. Beta blocker
  2. Beta blocker, ACEI, or ARB
  3. Beta blocker, CCB
  4. Beta blocker
  5. Thiazide
  6. No beta blockers
  7. No beta blockers
  8. Alpha methyldopa
  9. Alpha blockers
  10. ACEI/ARB

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8270-8280). . Kindle Edition.

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9
Q

List basis for investigating for secondary hypertension

A
  • Young (< 30) or old (> 60) patient
  • Failure to control pressure with 2 medications

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8284-8285). . Kindle Edition.

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10
Q

List the likely diagnosis based on finding in a patient with hypertension

  1. Bruit
  2. Episodic hypertension
  3. Hypokalemia
  4. Buffalo hump, truncal obesity, striae
  5. Upper extremity > lower extremity pressure
  6. Hirsutism

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8291-8306). . Kindle Edition.

A
  1. Closure of renal artery (stenosis)
  2. Pheochromocytoma
  3. Conn syndrome
  4. Cushing syndrome
  5. Coarctation of the aorta
  6. Congenital adrenal hyperplasia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 8291-8306). . Kindle Edition.

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11
Q

Define hypertensive crisis

A

High blood pressure in association with:

  • Confusion
  • Blurry vision
  • Dyspnea
  • Chest pain
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12
Q

Best initial therapy for hypertensive crisis

A
  • Labetolol
  • Nitroprusside

Nitroprusside needs monitoring with an arterial line

Other equally acceptable medications are:

Enalapril

CCBs: Diltiazem. Verapamil

Esmolol

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13
Q

Emergency orders on CCS for hypertensive encephalopathy

A
  • I.V access
  • Oxygen
  • Pulse oximetry
  • Cardiac monitor
  • BP monitor
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14
Q

Diagnostic tests to order on CCS for hypertensive encephalopathy

A
  • 12 lead ECG
  • Head CT without contrast
  • CBC
  • BMP
  • CXR
  • Urinalysis
  • Lipid profile
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15
Q

Therapy for hypertensive encephalopathy

A
  • NPO
  • Complete bed rest
  • IV antihypertensive
  • Counseling
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16
Q

Monitoring in hypertensive encephalopathy

A
  • Arterial line
  • Cardiac monitor
  • Pulse oximetry
17
Q
  1. Drug of choice for hypertensive patients who have hyperuricemia
  2. Antihypertensive drugs contraindicated in a patient with HTN and hyperuricemia
A
  1. Losartan (ARB)
  2. Contraindicated
    • Thiazides
    • Loop diuretics

Also avoid aspirin

Losartan has a mild uricosuric effect

Cardiology USMLE Step 3 (12 decks)

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