1
ABFM Hypertension Exam (Board Review)
Questions with Complete Verified Answers
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 - ANS:--B
This patient’s clinical findings are consistent with Cushing syndrome, or hyperadrenocorticism.
This is a clinical syndrome and metabolic disorder resulting from chronic excess of
glucocorticoids. The most common cause is corticosteroid use, but adrenal neoplasms account
for 20%-25% of cases. Findings include general weakness, osteoporosis, moon facies, facial
plethora, ecchymoses, truncal obesity, violaceous striae of the abdomen, deposition of adipose
tissue in the interscapular area ("buffalo hump"), and glucose intolerance.
pg. 1
,2
You diagnose stage 2 hypertension in a 54-year-old male. His past medical history is otherwise
unremarkable and a physical examination is notable for mild AV nicking on funduscopic
examination. A baseline EKG reveals evidence of left ventricular hypertrophy.Which one of the
following classes of antihypertensive agents has NOT been shown to produce a regression of left
ventricular hypertrophy? ACE inhibitors β-Blockers
Calcium channel blockers
Direct vasodilators
Thiazide diuretics - ANS:--D
In patients with left ventricular hypertrophy, studies have shown a reduction in left ventricular
mass in those treated with ACE inhibitors, diuretics, calcium channel blockers, and β-blockers,
with the most consistent reduction achieved with ACE inhibitors and the least with βblockers.
Regression of left ventricular hypertrophy has not been demonstrated with direct vasodilators
such as hydralazine and minoxidil. According to currently accepted criteria, hypertension in
children is defined as repeated blood pressure measurements at or above a threshold of which
one of the following percentiles for age, sex, and height?
80th
85th
90th
95th
99th - ANS:--D
pg. 2
, 3
In children and adolescents, hypertension is defined as blood pressure at or above the 95th
percentile for age, sex, and height, on repeated measurements.
Which one of the following conditions is associated with isolated systolic hypertension?
Aortic stenosis
Hypothyroidism
Paget’s disease
Renovascular hypertension
Severe osteoporosis - ANS:--C
Isolated elevation of systolic blood pressure can be secondary to conditions associated with
elevated cardiac output, such as anemia, Paget’s disease, hyperthyroidism, arteriovenous fistula,
and aortic insufficiency.
A 59-year-old African-American male with a history of hypercholesterolemia and gout sees you
for a health maintenance visit. A physical examination is notable only for a blood pressure of
144/85 mm Hg.Laboratory FindingsLDLcholesterol............82 mg/dLHDL-cholesterol............47
mg/dLSerum triglycerides............134 mg/dLLiver panel............normalSerum
creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular filtration rate............56
mL/min/1.73 m2Which one of the following does the JNC 8 panel recommend as initial
management of this patient’s blood pressure elevation?
Lifestyle measures only
An ACE inhibitor
A calcium channel blocker
pg. 3
, 4
Hydralazine
Hydrochlorothiazide - ANS:--B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood pressure
in patients ≥ 8 years of age with a systolic blood pressure ≥ 40 mm Hg or a diastolic blood
pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined as an estimated or
measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Treatment is recommended for
patients of any age with these blood pressure values who also have albuminuria, defined as >30
mg of albumin/g of creatinine regardless of GFR (SOR C).Although a thiazide diuretic or a
calcium channel blocker is generally recommended as first-line antihypertensive therapy in
African-Americans, for patients ≥ 8 years of age who have CKD, the JNC 8 panel recommends
initial (or add-on) antihypertensive treatment with an ACE inhibitor or angiotensin receptor
blocker to improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The
2017 American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in patients
who have stages 1 or 2 CKD with albuminuria >300 mg/day.
A 67-year-old male with a history of hypertension and type 2 diabetes has inadequately
controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril), 40 mg daily;
hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage XR), 1500 mg
daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal serum electrolytes, a serum
creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary albumin/creatinine ratio of 80 mg/g (N
<30).Which one of the following agents should be AVOIDED in this patient?
Aliskiren (Tekturna)
pg. 4
ABFM Hypertension Exam (Board Review)
Questions with Complete Verified Answers
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 - ANS:--B
This patient’s clinical findings are consistent with Cushing syndrome, or hyperadrenocorticism.
This is a clinical syndrome and metabolic disorder resulting from chronic excess of
glucocorticoids. The most common cause is corticosteroid use, but adrenal neoplasms account
for 20%-25% of cases. Findings include general weakness, osteoporosis, moon facies, facial
plethora, ecchymoses, truncal obesity, violaceous striae of the abdomen, deposition of adipose
tissue in the interscapular area ("buffalo hump"), and glucose intolerance.
pg. 1
,2
You diagnose stage 2 hypertension in a 54-year-old male. His past medical history is otherwise
unremarkable and a physical examination is notable for mild AV nicking on funduscopic
examination. A baseline EKG reveals evidence of left ventricular hypertrophy.Which one of the
following classes of antihypertensive agents has NOT been shown to produce a regression of left
ventricular hypertrophy? ACE inhibitors β-Blockers
Calcium channel blockers
Direct vasodilators
Thiazide diuretics - ANS:--D
In patients with left ventricular hypertrophy, studies have shown a reduction in left ventricular
mass in those treated with ACE inhibitors, diuretics, calcium channel blockers, and β-blockers,
with the most consistent reduction achieved with ACE inhibitors and the least with βblockers.
Regression of left ventricular hypertrophy has not been demonstrated with direct vasodilators
such as hydralazine and minoxidil. According to currently accepted criteria, hypertension in
children is defined as repeated blood pressure measurements at or above a threshold of which
one of the following percentiles for age, sex, and height?
80th
85th
90th
95th
99th - ANS:--D
pg. 2
, 3
In children and adolescents, hypertension is defined as blood pressure at or above the 95th
percentile for age, sex, and height, on repeated measurements.
Which one of the following conditions is associated with isolated systolic hypertension?
Aortic stenosis
Hypothyroidism
Paget’s disease
Renovascular hypertension
Severe osteoporosis - ANS:--C
Isolated elevation of systolic blood pressure can be secondary to conditions associated with
elevated cardiac output, such as anemia, Paget’s disease, hyperthyroidism, arteriovenous fistula,
and aortic insufficiency.
A 59-year-old African-American male with a history of hypercholesterolemia and gout sees you
for a health maintenance visit. A physical examination is notable only for a blood pressure of
144/85 mm Hg.Laboratory FindingsLDLcholesterol............82 mg/dLHDL-cholesterol............47
mg/dLSerum triglycerides............134 mg/dLLiver panel............normalSerum
creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular filtration rate............56
mL/min/1.73 m2Which one of the following does the JNC 8 panel recommend as initial
management of this patient’s blood pressure elevation?
Lifestyle measures only
An ACE inhibitor
A calcium channel blocker
pg. 3
, 4
Hydralazine
Hydrochlorothiazide - ANS:--B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood pressure
in patients ≥ 8 years of age with a systolic blood pressure ≥ 40 mm Hg or a diastolic blood
pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined as an estimated or
measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Treatment is recommended for
patients of any age with these blood pressure values who also have albuminuria, defined as >30
mg of albumin/g of creatinine regardless of GFR (SOR C).Although a thiazide diuretic or a
calcium channel blocker is generally recommended as first-line antihypertensive therapy in
African-Americans, for patients ≥ 8 years of age who have CKD, the JNC 8 panel recommends
initial (or add-on) antihypertensive treatment with an ACE inhibitor or angiotensin receptor
blocker to improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The
2017 American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in patients
who have stages 1 or 2 CKD with albuminuria >300 mg/day.
A 67-year-old male with a history of hypertension and type 2 diabetes has inadequately
controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril), 40 mg daily;
hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage XR), 1500 mg
daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal serum electrolytes, a serum
creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary albumin/creatinine ratio of 80 mg/g (N
<30).Which one of the following agents should be AVOIDED in this patient?
Aliskiren (Tekturna)
pg. 4
