ABFM HYPERTENSION EXAM Questions AND Correct Answers
A 14-year-old female is diagnosed with stage 1 hypertension. Her
previous medical history and family history are unremarkable. A
physical examination is notable for a height of 160 cm (63 in), a
weight of 75 kg (165 lb), a BMI of 29 kg/m2, and a blood pressure of
134/84 mm Hg.Which one of the following studies is not routinely
obtained in this situation?
A urinalysis
A fasting lipid profile
Serum creatinine
Hemoglobin A1c
Renal ultrasonography - ✔✔E
For children >13 years of age, the American Academy of Pediatrics
(AAP) defines stage 1 hypertension as a blood pressure of 130-139/80-
89 mm Hg and stage 2 hypertension as a blood pressure ≥140/90 mm
Hg. The AAP recommends that all pediatric patients with
hypertension be evaluated with a urinalysis, a chemistry panel
(including electrolyte, BUN, and creatinine levels), and a lipid
profile.Renal ultrasonography is recommended for patients <6 years
of age with hypertension, as well as those with abnormal findings on
a urinalysis or renal function studies. For adolescents and pediatric
patients who have obesity and hypertension, recommended tests also
include hemoglobin A1c, aspartate transaminase (AST) and alanine
transaminase (ALT), and a fasting lipid panel. Echocardiography is
recommended to assess for cardiac target organ damage if
pharmacologic treatment of hypertension is being considered.An
,extensive evaluation for secondary causes of hypertension is not
recommended for children older than 6 years if they have a family
history of hypertension, or if they are overweight or obese, and the
history and physical examination do not suggest a secondary cause for
their hypertension.
A 19-year-old male college student sees you for follow-up of an
emergency department (ED) visit. He says he was told that his
symptoms were due to a panic attack. His past medical history is
notable only for migraine headaches. On the day of his ED visit he was
started on propranolol for the headaches. The initial physical
examination in the ED was notable for a blood pressure of 198/114
mm Hg supine, dropping to 150/98 mm Hg on standing, and a heart
rate of 112 beats/min. He reports that his symptoms improved after a
couple hours in the ED and the record from the visit notes that his
blood pressure was 140/90 mm Hg at the time of discharge.The
patient says that he has always been an anxious person but has never
experienced a similar attack in the past. He notes that his blood
pressure has always been on the "high side" and his blood pressure in
your office today is 144/86 mm Hg.Which one of the following should
be c - ✔✔D
Pheochromocytomas are catecholamine-producing neuroendocrine
tumors, and the majority arise from the adrenal medulla. They are a
rare but important secondary cause of hypertension, whether
sustained or paroxysmal. Paroxysmal hypertension with sweating,
headaches, and palpitations is the usual presentation of
pheochromocytoma. Other clinical clues to its presence include
unexplained tachycardia, weight loss, episodic diaphoresis,
,unexplained orthostatic hypotension with a background of
paroxysmal or refractory hypertension, and feelings of anxiety or
panic attacks. β-Adrenergic blockers have been implicated in
precipitating adverse reactions in patients with pheochromocytoma.
The mechanism for β-blocker-associated adverse events is generally
ascribed to inhibition of β2-adrenoceptor-mediated vasodilation,
leaving adrenoceptor-mediated vasoconstriction unopposed. If a
hypertensive crisis occurs in a patient taking β-blockers, the presence
of a pheochromocytoma should be suspected. Furthermore, the
Hypertension Canada 2017 guidelines recommend that the possibility
of pheochromocytoma be considered in patients with hypertension
triggered by β-blockers as well by monoamine oxidase inhibitors,
micturition, changes in abdominal pressure, surgery, or anesthesia.
A 24-year-old male comes to the emergency department with chest
pain an hour after using cocaine. A physical examination is notable for
a blood pressure of 190/110 mm Hg and tachycardia. An EKG reveals
sinus tachycardia with a rate of 116 beats/min and nonspecific ST-
and T-wave changes.Which one of the following agents can be safely
prescribed?
Labetalol (Trandate)
Lorazepam (Ativan)
Metoprolol tartrate (Lopressor)
Short-acting nifedipine (Procardia)
Propranolol - ✔✔B
, In patients with cocaine-induced chest pain and hypertension, initial
management with an intravenous benzodiazepine can relieve chest
pain and produce beneficial cardiac hemodynamic effects. In addition,
by reducing the central stimulatory effects of cocaine,
benzodiazepines also reduce anxiety, which often leads to resolution
of the hypertension and tachycardia. Administration of sublingual or
intravenous nitroglycerin and intravenous or oral calcium channel
blockers is recommended for patients with ST-segment elevation or
depression that accompanies ischemic chest discomfort after cocaine
use.By blocking only β-receptors, resulting in an unopposed α-
adrenergic effect, β-blockers can exacerbate vasoconstriction and
should therefore be avoided. Although labetalol is both an α- and β-
blocker, because it blocks β-receptors substantially more it is thought
to offer no advantages over a β-blocker.
A 32-year-old female who works as an administrative assistant is
referred to you for evaluation of high blood pressure. Her past
medical history is unremarkable, and she does not take any
prescribed or over-the-counter medications. A review of systems
reveals only a chronic history of mild fatigue and episodic muscle
cramping. A physical examination is normal except for a blood
pressure of 156/100 mm Hg in both arms without significant
orthostatic changes.Laboratory
FindingsCBC............normalSodium............145 mEq/L (N 135-
145)Potassium............2.9 mEq/L (N 3.5-5.0)Chloride............100
mEq/L (N 100-108)Bicarbonate............25 mEq/L (N 22-
26)Creatinine............0.7 mg/dL (N 0.6-1.5)BUN............10 mg/dL (N 8-
25)Glucose............90 mg/dLUrinalysis............normalWhich one of the
following is the most likely cause of her hypertension?
A 14-year-old female is diagnosed with stage 1 hypertension. Her
previous medical history and family history are unremarkable. A
physical examination is notable for a height of 160 cm (63 in), a
weight of 75 kg (165 lb), a BMI of 29 kg/m2, and a blood pressure of
134/84 mm Hg.Which one of the following studies is not routinely
obtained in this situation?
A urinalysis
A fasting lipid profile
Serum creatinine
Hemoglobin A1c
Renal ultrasonography - ✔✔E
For children >13 years of age, the American Academy of Pediatrics
(AAP) defines stage 1 hypertension as a blood pressure of 130-139/80-
89 mm Hg and stage 2 hypertension as a blood pressure ≥140/90 mm
Hg. The AAP recommends that all pediatric patients with
hypertension be evaluated with a urinalysis, a chemistry panel
(including electrolyte, BUN, and creatinine levels), and a lipid
profile.Renal ultrasonography is recommended for patients <6 years
of age with hypertension, as well as those with abnormal findings on
a urinalysis or renal function studies. For adolescents and pediatric
patients who have obesity and hypertension, recommended tests also
include hemoglobin A1c, aspartate transaminase (AST) and alanine
transaminase (ALT), and a fasting lipid panel. Echocardiography is
recommended to assess for cardiac target organ damage if
pharmacologic treatment of hypertension is being considered.An
,extensive evaluation for secondary causes of hypertension is not
recommended for children older than 6 years if they have a family
history of hypertension, or if they are overweight or obese, and the
history and physical examination do not suggest a secondary cause for
their hypertension.
A 19-year-old male college student sees you for follow-up of an
emergency department (ED) visit. He says he was told that his
symptoms were due to a panic attack. His past medical history is
notable only for migraine headaches. On the day of his ED visit he was
started on propranolol for the headaches. The initial physical
examination in the ED was notable for a blood pressure of 198/114
mm Hg supine, dropping to 150/98 mm Hg on standing, and a heart
rate of 112 beats/min. He reports that his symptoms improved after a
couple hours in the ED and the record from the visit notes that his
blood pressure was 140/90 mm Hg at the time of discharge.The
patient says that he has always been an anxious person but has never
experienced a similar attack in the past. He notes that his blood
pressure has always been on the "high side" and his blood pressure in
your office today is 144/86 mm Hg.Which one of the following should
be c - ✔✔D
Pheochromocytomas are catecholamine-producing neuroendocrine
tumors, and the majority arise from the adrenal medulla. They are a
rare but important secondary cause of hypertension, whether
sustained or paroxysmal. Paroxysmal hypertension with sweating,
headaches, and palpitations is the usual presentation of
pheochromocytoma. Other clinical clues to its presence include
unexplained tachycardia, weight loss, episodic diaphoresis,
,unexplained orthostatic hypotension with a background of
paroxysmal or refractory hypertension, and feelings of anxiety or
panic attacks. β-Adrenergic blockers have been implicated in
precipitating adverse reactions in patients with pheochromocytoma.
The mechanism for β-blocker-associated adverse events is generally
ascribed to inhibition of β2-adrenoceptor-mediated vasodilation,
leaving adrenoceptor-mediated vasoconstriction unopposed. If a
hypertensive crisis occurs in a patient taking β-blockers, the presence
of a pheochromocytoma should be suspected. Furthermore, the
Hypertension Canada 2017 guidelines recommend that the possibility
of pheochromocytoma be considered in patients with hypertension
triggered by β-blockers as well by monoamine oxidase inhibitors,
micturition, changes in abdominal pressure, surgery, or anesthesia.
A 24-year-old male comes to the emergency department with chest
pain an hour after using cocaine. A physical examination is notable for
a blood pressure of 190/110 mm Hg and tachycardia. An EKG reveals
sinus tachycardia with a rate of 116 beats/min and nonspecific ST-
and T-wave changes.Which one of the following agents can be safely
prescribed?
Labetalol (Trandate)
Lorazepam (Ativan)
Metoprolol tartrate (Lopressor)
Short-acting nifedipine (Procardia)
Propranolol - ✔✔B
, In patients with cocaine-induced chest pain and hypertension, initial
management with an intravenous benzodiazepine can relieve chest
pain and produce beneficial cardiac hemodynamic effects. In addition,
by reducing the central stimulatory effects of cocaine,
benzodiazepines also reduce anxiety, which often leads to resolution
of the hypertension and tachycardia. Administration of sublingual or
intravenous nitroglycerin and intravenous or oral calcium channel
blockers is recommended for patients with ST-segment elevation or
depression that accompanies ischemic chest discomfort after cocaine
use.By blocking only β-receptors, resulting in an unopposed α-
adrenergic effect, β-blockers can exacerbate vasoconstriction and
should therefore be avoided. Although labetalol is both an α- and β-
blocker, because it blocks β-receptors substantially more it is thought
to offer no advantages over a β-blocker.
A 32-year-old female who works as an administrative assistant is
referred to you for evaluation of high blood pressure. Her past
medical history is unremarkable, and she does not take any
prescribed or over-the-counter medications. A review of systems
reveals only a chronic history of mild fatigue and episodic muscle
cramping. A physical examination is normal except for a blood
pressure of 156/100 mm Hg in both arms without significant
orthostatic changes.Laboratory
FindingsCBC............normalSodium............145 mEq/L (N 135-
145)Potassium............2.9 mEq/L (N 3.5-5.0)Chloride............100
mEq/L (N 100-108)Bicarbonate............25 mEq/L (N 22-
26)Creatinine............0.7 mg/dL (N 0.6-1.5)BUN............10 mg/dL (N 8-
25)Glucose............90 mg/dLUrinalysis............normalWhich one of the
following is the most likely cause of her hypertension?
