ABFM HYPERTENSION EXAM
WITH CORRECT ANSWERS
2025
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
Pheochromocyto
ma
Primary
hyperaldosteroni
sm ( Correct
answers ) 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
fl -Blockers
Calcium channel
blockers Direct
vasodilators
Thiazide diuretics
( Correct answers ) D
In patients with left ventricular hypertrophy, studies have shown a
reduction in left ventricular mass in those treated with ACE inhibitors,
,inkibitors an» tke least witk fl -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?
80t
h
85t
h
90t
h
95t
h
99t
h
( Co
rrec
t
ans
wer
s )
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
Hypothyroidis
m Paget's
disease
Renovascular
hypertension
Severe
osteoporosis
( Correct
answers ) 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
,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 fi rst-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)
Felodipine
(Plendil) ( Correct
answers ) A
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal
Endpoints) was a randomized, double-blind, placebo-controlled international
multicenter trial undertaken to determine whether the addition of the direct
renin inhibitor aliskiren to standard therapy with renin-angiotensin system
blockade would be beneficial for patients with type 2 diabetes who are at
high risk for cardiovascular and renal events. The study was terminated
prematurely after a median follow-up of 27 months when no benefit was
apparent, and a higher risk of hyperkalemia and hypotension was seen in
patients receiving aliskiren. Based on this study, the FDA issued a drug
safety warning in 2012 that announced two additions to the drug labeling of
aliskiren-containing products. The first addition was a contraindication to
the use of aliskiren in patients with diabetes mellitus who are taking
angiotensin receptor blockers (ARBs) or ACE inhibitors, because of an
increased risk of renal impairment, hypotension, and hyperkalemia. The
second addition was a warning to avoid the use of aliskiren with ARBs or ACE
inhibitors in patients with moderate to severe renal impairment (ylomerular
riltration rate <60 mḺ/min/1.73 m2).Tke use or 6CE inkibitors, 6RBs, fl-
blockers, diuretics, and calcium channel blockers has been shown to be
effective in reducing cardiovascular events in patients with diabetes
, A 44-year-old male has a 1-week history of generalized headaches and
nonspecific dizziness. His past medical history is notable only for a 3-year
history of hypertension, which has been poorly controlled because of a lack
of adherence to his drug regimen. His renal status was normal 1 month ago.
On examination his blood pressure is 250/150 mm Hg, and you note cotton-
wool exudates on funduscopic examination.
Laboratory evaluation reveals normal serum electrolytes, a serum
creatinine level of
3.8 mg/dL (N 0.7-1.3), and a BUN level of 60 mg/dL (N 6-20). A urinalysis
shows gross hematuria and 3+ proteinuria.Which one of the following will
rapidly lower his blood pressure and increase renal blood flow?
Diazoxide
(Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam
(Corlopam)
Nitroprusside
(Nitropress) ( Correct
answers ) D
Fenoldopam is a selective peripheral dopamine-receptor agonist used for
the treatment of severe hypertension. In studies investigating fenoldopam
use in severe hypertension, its efficacy in lowering blood pressure was
found to be comparable to that of nitroprusside. It is FDA-approved for the
in-hospital management of severe hypertension when rapid but quickly
reversible reduction of blood pressure is required, such as in a patient with
malignant hypertension who has deteriorating end- organ function. By
virtue of its actions on peripheral dopamine receptors, fenoldopam
produces renal arterial vasodilation and natriuresis, and thus can provide a
renal protective effect in clinical situations associated with impaired renal
function. In addition, there is evidence that it may improve creatinine
clearance and urine flow rates in severely hypertensive patients with either
normal or impaired renal function. The 2017 American College of
Cardiology/American Heart Association (ACC/AHA) hypertension guidelines
include fenoldopam as a preferred agent for treating hypertensive
emergencies associated with acute renal failure. Other options include
nicardipine and clevidipine.
Compared to the typical American diet, the Dietary Approaches to Stop
Hypertension (DASH) diet includes reduced consumption of which one of
the following?
Dietary fiber
Dietary
protein
Low-fat dairy
products Nuts and
whole grains
Fats and sweets
( Correct answers )
E
WITH CORRECT ANSWERS
2025
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
Pheochromocyto
ma
Primary
hyperaldosteroni
sm ( Correct
answers ) 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
fl -Blockers
Calcium channel
blockers Direct
vasodilators
Thiazide diuretics
( Correct answers ) D
In patients with left ventricular hypertrophy, studies have shown a
reduction in left ventricular mass in those treated with ACE inhibitors,
,inkibitors an» tke least witk fl -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?
80t
h
85t
h
90t
h
95t
h
99t
h
( Co
rrec
t
ans
wer
s )
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
Hypothyroidis
m Paget's
disease
Renovascular
hypertension
Severe
osteoporosis
( Correct
answers ) 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
,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 fi rst-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)
Felodipine
(Plendil) ( Correct
answers ) A
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal
Endpoints) was a randomized, double-blind, placebo-controlled international
multicenter trial undertaken to determine whether the addition of the direct
renin inhibitor aliskiren to standard therapy with renin-angiotensin system
blockade would be beneficial for patients with type 2 diabetes who are at
high risk for cardiovascular and renal events. The study was terminated
prematurely after a median follow-up of 27 months when no benefit was
apparent, and a higher risk of hyperkalemia and hypotension was seen in
patients receiving aliskiren. Based on this study, the FDA issued a drug
safety warning in 2012 that announced two additions to the drug labeling of
aliskiren-containing products. The first addition was a contraindication to
the use of aliskiren in patients with diabetes mellitus who are taking
angiotensin receptor blockers (ARBs) or ACE inhibitors, because of an
increased risk of renal impairment, hypotension, and hyperkalemia. The
second addition was a warning to avoid the use of aliskiren with ARBs or ACE
inhibitors in patients with moderate to severe renal impairment (ylomerular
riltration rate <60 mḺ/min/1.73 m2).Tke use or 6CE inkibitors, 6RBs, fl-
blockers, diuretics, and calcium channel blockers has been shown to be
effective in reducing cardiovascular events in patients with diabetes
, A 44-year-old male has a 1-week history of generalized headaches and
nonspecific dizziness. His past medical history is notable only for a 3-year
history of hypertension, which has been poorly controlled because of a lack
of adherence to his drug regimen. His renal status was normal 1 month ago.
On examination his blood pressure is 250/150 mm Hg, and you note cotton-
wool exudates on funduscopic examination.
Laboratory evaluation reveals normal serum electrolytes, a serum
creatinine level of
3.8 mg/dL (N 0.7-1.3), and a BUN level of 60 mg/dL (N 6-20). A urinalysis
shows gross hematuria and 3+ proteinuria.Which one of the following will
rapidly lower his blood pressure and increase renal blood flow?
Diazoxide
(Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam
(Corlopam)
Nitroprusside
(Nitropress) ( Correct
answers ) D
Fenoldopam is a selective peripheral dopamine-receptor agonist used for
the treatment of severe hypertension. In studies investigating fenoldopam
use in severe hypertension, its efficacy in lowering blood pressure was
found to be comparable to that of nitroprusside. It is FDA-approved for the
in-hospital management of severe hypertension when rapid but quickly
reversible reduction of blood pressure is required, such as in a patient with
malignant hypertension who has deteriorating end- organ function. By
virtue of its actions on peripheral dopamine receptors, fenoldopam
produces renal arterial vasodilation and natriuresis, and thus can provide a
renal protective effect in clinical situations associated with impaired renal
function. In addition, there is evidence that it may improve creatinine
clearance and urine flow rates in severely hypertensive patients with either
normal or impaired renal function. The 2017 American College of
Cardiology/American Heart Association (ACC/AHA) hypertension guidelines
include fenoldopam as a preferred agent for treating hypertensive
emergencies associated with acute renal failure. Other options include
nicardipine and clevidipine.
Compared to the typical American diet, the Dietary Approaches to Stop
Hypertension (DASH) diet includes reduced consumption of which one of
the following?
Dietary fiber
Dietary
protein
Low-fat dairy
products Nuts and
whole grains
Fats and sweets
( Correct answers )
E
