WGU D118 Adult Primary Care: Questions & Answers:
Complete Solution
Best lab test to rule out MI - ANSWERCardiac-specific troponin I and T (rise within
the first 2-4 hrs after MI and remain elevated for 7-10 days)
What should you do for the patient experiencing ACS? - ANSWERASA, nitroglycerin
and transfer to ED (preferably at a hospital with a cath lab)
Number one symptom of CAD - ANSWERAngina
Characteristics of metabolic syndrome - ANSWER1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors - ANSWER1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? - ANSWERMercury bulb (if using digital, make sure they
are periodically recalibrated)
What are you listening for when measuring BP? - ANSWER1st and 5th Korotkoff
sound
What factors can transiently elevate BP? - ANSWER1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors - ANSWER1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in conjunction
with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN - ANSWERIncreased CO which results in
increased peripheral arterial resistance
,Typical presentation of secondary HTN - ANSWER-Presentation is usually abrupt and
severe
-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN - ANSWERRenal artery stenosis
Other causes of secondary HTN - ANSWERPheochromocytoma, primary
hyperaldosteronism, coarctation of the aorta, Cushing's, Renal Parenchymal Disease,
alcohol, medication
How would you diagnose Cushing's? - ANSWER24 urine to see if cortisol levels are
elevated
Questions to ask about HTN - ANSWER1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes, why did
they stop taking them?)
Factors from chest pain article - ANSWER1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange for ED
transport)
What medications should you ask about when concerned about HTN? - ANSWER1)
NSAIDs
2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? - ANSWERLicorice
What are abnormal fundoscopic findings that are possible w/HTN? - ANSWER1)
Abnormal blood vessels
2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
, Why would you draw a CBC w/HTN? - ANSWERHTN drugs can cause
anemia/polycythemia
Why would you draw a uric acid level w/HTN? - ANSWERThiazide diuretics can
increase uric acid levels
Why would you draw a calcium level w/HTN? - ANSWERLow calcium intake in the
diet can increase BP
HTN differentials - ANSWER1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN - ANSWER1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
What is the DASH diet? - ANSWERHigh fruits/vegetables, low-fat diet
Thresholds for initiating HTN treatment - ANSWER1) >= 60 yrs old >150 SBP or >90
DBP
2) <60 yrs old >140/90
First line HTN pharmacological agents - ANSWER1) Thiazide diuretic
2) ACEI
3) ARBs
4) CCB
What HTN drug should be used with diabetics? - ANSWERACEI (possible caution in
African-Americans?)
When to refer w/HTN - ANSWER1) Unresponsive to usual therapy
2) Suspected secondary HTN
3) Those w/sign of renal failure or other target organ damage
When should you schedule follow up when a patient is started on an anti-
hypertensive? - ANSWERMonthly visits until goal is reached; then see q3-6 months
(more frequent for its with elevated BP or co-morbid conditions)
Metabolic risk factors - ANSWER1) Abdominal obesity
2) Glucose intolerance (fasting glucose >110)
3) BP >130/85
4) High triglycerides (>150)
5) Low HDL
Complete Solution
Best lab test to rule out MI - ANSWERCardiac-specific troponin I and T (rise within
the first 2-4 hrs after MI and remain elevated for 7-10 days)
What should you do for the patient experiencing ACS? - ANSWERASA, nitroglycerin
and transfer to ED (preferably at a hospital with a cath lab)
Number one symptom of CAD - ANSWERAngina
Characteristics of metabolic syndrome - ANSWER1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors - ANSWER1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? - ANSWERMercury bulb (if using digital, make sure they
are periodically recalibrated)
What are you listening for when measuring BP? - ANSWER1st and 5th Korotkoff
sound
What factors can transiently elevate BP? - ANSWER1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors - ANSWER1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in conjunction
with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN - ANSWERIncreased CO which results in
increased peripheral arterial resistance
,Typical presentation of secondary HTN - ANSWER-Presentation is usually abrupt and
severe
-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN - ANSWERRenal artery stenosis
Other causes of secondary HTN - ANSWERPheochromocytoma, primary
hyperaldosteronism, coarctation of the aorta, Cushing's, Renal Parenchymal Disease,
alcohol, medication
How would you diagnose Cushing's? - ANSWER24 urine to see if cortisol levels are
elevated
Questions to ask about HTN - ANSWER1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes, why did
they stop taking them?)
Factors from chest pain article - ANSWER1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange for ED
transport)
What medications should you ask about when concerned about HTN? - ANSWER1)
NSAIDs
2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? - ANSWERLicorice
What are abnormal fundoscopic findings that are possible w/HTN? - ANSWER1)
Abnormal blood vessels
2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
, Why would you draw a CBC w/HTN? - ANSWERHTN drugs can cause
anemia/polycythemia
Why would you draw a uric acid level w/HTN? - ANSWERThiazide diuretics can
increase uric acid levels
Why would you draw a calcium level w/HTN? - ANSWERLow calcium intake in the
diet can increase BP
HTN differentials - ANSWER1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN - ANSWER1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
What is the DASH diet? - ANSWERHigh fruits/vegetables, low-fat diet
Thresholds for initiating HTN treatment - ANSWER1) >= 60 yrs old >150 SBP or >90
DBP
2) <60 yrs old >140/90
First line HTN pharmacological agents - ANSWER1) Thiazide diuretic
2) ACEI
3) ARBs
4) CCB
What HTN drug should be used with diabetics? - ANSWERACEI (possible caution in
African-Americans?)
When to refer w/HTN - ANSWER1) Unresponsive to usual therapy
2) Suspected secondary HTN
3) Those w/sign of renal failure or other target organ damage
When should you schedule follow up when a patient is started on an anti-
hypertensive? - ANSWERMonthly visits until goal is reached; then see q3-6 months
(more frequent for its with elevated BP or co-morbid conditions)
Metabolic risk factors - ANSWER1) Abdominal obesity
2) Glucose intolerance (fasting glucose >110)
3) BP >130/85
4) High triglycerides (>150)
5) Low HDL
