USMLE Forum Archives - USMLE Step 2 CS - A Case of Hypertension For Step-2CS Exam
A Case of Hypertension For Step-2CS Exam
vishalsheth - 09-03-10 09:20
A 46-year-old white female presents to your office with
concerns about her diagnosis of hypertension 1 month
previously. She asks you about her likelihood of developing
complications of hypertension, including renal failure
and stroke. She denies any past medical history other than
hypertension and has no symptoms that suggest secondary
causes. She currently is taking hydrochlorothiazide 25
mg/d. She smokes half a pack of cigarettes daily and drinks
alcohol no more than once per week. Her family history is
significant for hypertension in both parents. Her mother
died of a cerebrovascular accident. Her father is alive but
has coronary artery disease and is on hemodialysis. Her
blood pressure is 138/90. Body mass index is 23. She has
no retinal exudates or other signs of hypertensive retinopathy.
Her point of maximal cardiac impulse is not displaced
but is sustained. Her rate and rhythm are regular
and without gallops. She has good peripheral pulses. An
electrocardiogram reveals an axis of –30 degrees with
borderline voltage criteria for left ventricular hypertrophy.
Creatinine is 1.0 mg/dL. Which of the following items in
her history and physical examination is a risk factor for a
poor prognosis in a patient with hypertension?
vishalsheth - 09-03-10 09:20
A 46-year-old white female presents to your office with
concerns about her diagnosis of hypertension 1 month
previously. She asks you about her likelihood of developing
complications of hypertension, including renal failure
and stroke. She denies any past medical history other than
hypertension and has no symptoms that suggest secondary
causes. She currently is taking hydrochlorothiazide 25
mg/d. She smokes half a pack of cigarettes daily and drinks
alcohol no more than once per week. Her family history is
significant for hypertension in both parents. Her mother
died of a cerebrovascular accident. Her father is alive but
has coronary artery disease and is on hemodialysis. Her
blood pressure is 138/90. Body mass index is 23. She has
no retinal exudates or other signs of hypertensive retinopathy.
Her point of maximal cardiac impulse is not displaced
but is sustained. Her rate and rhythm are regular
and without gallops. She has good peripheral pulses. An
electrocardiogram reveals an axis of –30 degrees with
borderline voltage criteria for left ventricular hypertrophy.
Creatinine is 1.0 mg/dL. Which of the following items in
her history and physical examination is a risk factor for a
poor prognosis in a patient with hypertension?
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#1
Re: A Case of Hypertension For Step-2CS adonis123 - 09-04-10 00:05 This case is open to discussion.
#3
Re: A Case of Hypertension For Step-2CS dell22 - 11-29-10 14:33 History of smoking
Uncontrolled BP
Voltage criteria for LVH
Positive family history
#4
Re: A Case of Hypertension For Step-2CS babbu5508 - 12-08-10 01:31 risk factor for a poor prognosis in a patient with hypertension
smoking history,
family history in both parents with severe oucome of htn,
left ventricular hypertrophy..................
#5
Re: A Case of Hypertension For Step-2CS drbasim - 12-09-10 16:00 I think once both parents have HT she might have some of AD dislipidemeima syndromes is highly recoomended to check her serum Cholesterol and triglycerides + check if she drinking any Caffeinated beverages also they mention that father on hemodialysis it might be Congenital polysystic kidneys so base line CR+BUN and somking is not really a high factor for Hypertension and of course the Left ventricular hyperophy that there is strain on the cardiac muscle and an omminoiuns sign for the heart is about to fail soon she might need an additional drug do not forget to check For Diabetes as there what is called * Meatabolic syndrome which is maily hypertesion and impaired glucose tolerance and even good Body index that case is for BROAD DIFF and do not forget Hypercortosilism too so many ------
#6
Re: A Case of Hypertension For Step-2CS sudha2015 - 12-26-10 16:42 smoking
+ve family h/o
left ventricular hypertrophy.
dont forgot to ask patiet diet n sedientry life style.
ask her abt thyroid h/o even family h/o for thyroid
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