Adult Primary Care Exam
#2 | Study Guide, Practice
Questions & Exam
Review
|Guaranteed success|
,Characteristics of metabolic syndrome 1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors 1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? Mercury bulb (if using digital, make sure they are periodically recalibrated)
What are you listening for when measuring BP? 1st and 5th Korotkoff sound
What factors can transiently elevate BP? 1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors 1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in
conjunction with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN Increased CO which results in increased peripheral arterial resistance
Typical presentation of secondary HTN -Presentation is usually abrupt and severe
-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN Renal artery stenosis
Other causes of secondary HTN Pheochromocytoma, primary hyperaldosteronism, coarctation of the aorta,
Cushing's, Renal Parenchymal Disease, alcohol, medication
How would you diagnose Cushing's? 24 urine to see if cortisol levels are elevated
, Questions to ask about HTN 1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes,
why did they stop taking them?)
Factors from chest pain article 1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange
for ED transport)
What medications should you ask about when 1) NSAIDs
concerned about HTN? 2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? Licorice
What are abnormal fundoscopic findings that are 1) Abnormal blood vessels
possible w/HTN? 2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
Why would you draw a CBC w/HTN? HTN drugs can cause anemia/polycythemia
Why would you draw a uric acid level w/HTN? Thiazide diuretics can increase uric acid levels
Why would you draw a calcium level w/HTN? Low calcium intake in the diet can increase BP
HTN differentials 1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN 1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
#2 | Study Guide, Practice
Questions & Exam
Review
|Guaranteed success|
,Characteristics of metabolic syndrome 1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors 1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? Mercury bulb (if using digital, make sure they are periodically recalibrated)
What are you listening for when measuring BP? 1st and 5th Korotkoff sound
What factors can transiently elevate BP? 1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors 1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in
conjunction with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN Increased CO which results in increased peripheral arterial resistance
Typical presentation of secondary HTN -Presentation is usually abrupt and severe
-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN Renal artery stenosis
Other causes of secondary HTN Pheochromocytoma, primary hyperaldosteronism, coarctation of the aorta,
Cushing's, Renal Parenchymal Disease, alcohol, medication
How would you diagnose Cushing's? 24 urine to see if cortisol levels are elevated
, Questions to ask about HTN 1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes,
why did they stop taking them?)
Factors from chest pain article 1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange
for ED transport)
What medications should you ask about when 1) NSAIDs
concerned about HTN? 2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? Licorice
What are abnormal fundoscopic findings that are 1) Abnormal blood vessels
possible w/HTN? 2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
Why would you draw a CBC w/HTN? HTN drugs can cause anemia/polycythemia
Why would you draw a uric acid level w/HTN? Thiazide diuretics can increase uric acid levels
Why would you draw a calcium level w/HTN? Low calcium intake in the diet can increase BP
HTN differentials 1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN 1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
