ABFM HYPERTENSION 2026/2027 |
COMPLETE EXAM PREP | PRACTICE
QUESTIONS & STUDY GUIDE
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 - correct answer-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.
,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 - correct answer-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 β-blockers. 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 - correct answer-D
,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 - correct answer-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 FindingsLDL-
cholesterol............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
, Hydralazine
Hydrochlorothiazide - correct answer-B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower
blood pressure in patients ≥18 years of age with a systolic blood pressure ≥140
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 ≥18 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)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
COMPLETE EXAM PREP | PRACTICE
QUESTIONS & STUDY GUIDE
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 - correct answer-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.
,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 - correct answer-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 β-blockers. 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 - correct answer-D
,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 - correct answer-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 FindingsLDL-
cholesterol............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
, Hydralazine
Hydrochlorothiazide - correct answer-B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower
blood pressure in patients ≥18 years of age with a systolic blood pressure ≥140
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 ≥18 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)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
