WBR269

Author	[[PageAuthor::Sapan Patel M.B.B.S]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Cardiovascular, SubCategory::Preventive Medicine
Prompt	[[Prompt::A 42-year-old female presents to your office for elevated blood pressure (BP). She has been having headaches for the last 2 weeks. She checks her BP at pharmacy and she presents with readings ranging between 162/106 and 154/92. After some research she did on her own, she has been exercising and following the "DASH (Dietary Approaches to Stop Hypertension)" diet for the past 2 months. Her BP in the office after more than 10 minutes of resting was 152/88 in her left arm and 146/92 in her right. She tells you that both her mother and father have hypertension. She denies chest pain, shortness of breath, dizziness, or blurred vision. She denies tobacco use, drinks 3–4 beers on weekends, and uses no recreational drugs. Your physical examination should include documentation of which of these?]]
Answer A	AnswerA::Cranial nerve examination
Answer A Explanation	AnswerAExp::Incorrect- It is not an essential part of physical examination for a newly diagnosed patient with hypertension.
Answer B	AnswerB::Peripheral nerve examinations
Answer B Explanation	AnswerBExp::Incorrect- It is not an essential part of physical examination for a newly diagnosed patient with hypertension.
Answer C	AnswerC::Auscultation for carotid, abdominal, and femoral bruits
Answer C Explanation	AnswerCExp::Correct- See explanation
Answer D	AnswerD::Palpation of the abdomen for hepatosplenomegaly
Answer D Explanation	AnswerDExp::Incorrect- It is not an essential part of physical examination for a newly diagnosed patient with hypertension.
Answer E	AnswerE::Mental status examination
Answer E Explanation	AnswerEExp::Incorrect- It is not an essential part of physical examination for a newly diagnosed patient with hypertension.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The seventh report of the Joint National Committee on the prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) key recommendations classify this patient in hypertension stage 1, as most of her BP readings are systolic blood pressure (SBP) in the 140–159 range and diastolic blood pressure (DBP) between 90 and 99. Category: SBP and/or DBP Normal: <120 and <80 Prehypertension: 120–139 or 80–90 Hypertension stage 1: 140–159 or 90–99 Hypertension stage 2: >160 or >100 The primary purpose of the initial physical examination is to look for causes of secondary hypertension and for early organ damage due to untreated hypertension. In physical examination for a newly diagnosed patient with hypertension, there are recommendations to include BP measurement in both arms, examination of the optic fundi, BMI calculation, auscultation for carotid, abdominal and femoral bruits, palpation of the thyroid gland, examination of the heart and lungs, and examination of the abdomen for enlarged kidneys, masses, and abnormal aortic pulsation. Educational objective: The primary aim of the initial physical examination is to look for causes of secondary hypertension and for early organ damage due to untreated hypertension. Educational Objective: References: ]]
Approved	Approved::Yes
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