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Refer patient to cardiologist
0%
0/8
Treat with thiazide diuretic
Repeat the blood pressure measurement
100%
8/8
Obtained computed tomagraphy scan
Provide reassurance
Select Answer to see Preferred Response
Diagnosis of hypertension is made after measuring BP > 140 / 90 at least three times in at least two separate clinical visits. The BP measurement must be repeated, ideally with one measurement outside the clinic setting. Hypertension needs to occur multiple times in order to rule out other potential causes such as white coat hypertension and defective blood pressure measurements. Hypertension is more common in older adults and African Americans. 95% of hypertension is idiopathic. Hypertension is usually asymptomatic in its early stages, but complications can develop including shortness of breath, chest tightness, headache, and vision changes. Changes to the physical exam can include a displaced PMI, retinal changes, papilledema, and systolic ejection click. Ebell et al writes that the assessment of a patient for hypertension begins with focused history to assess for cardiac risk factors, target-organ damage, and secondary causes of hypertension. Other reasons for hypertension such as renovascular disease, heart failure, and Cushing's disease should be probed. Invasive testing should only occur if initial evaluation raises suspicion for secondary causes, if the hypertension is difficulty to control, occurs suddenly, or responds poorly to drug therapy. Siu et al writes the U.S. Preventative Services Task Force Recommendation statement for screening for hypertension. After reviewing evidence, it is recommended that adults aged 18 years or older be screened. It is also recommended that a BP measure outside of the clinical setting be used for diagnostic confirmation before starting treatment. Incorrect answers: Answer 1: There is no reason to refer to cardiology at this time, particularly as there is no history or concerning symptoms. Answer 2: The diagnosis must be made before starting any treatments. Answer 4: CT scan is not warranted at this time, particularly without any symptoms or physical exam signs of hypertension. Answer 5: Reassurance is not warranted, as changes in blood pressure can be a sign of underlying illness.
3.9
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