ABFM KSA (HYPERTENSION) EXAM |
NEWEST ACTUAL ACCURATE EXAM
COMPLETE QUESTIONS AND DETAILED
VERIFIED ANSWERS GRADED A+ | 100%
VERIFIED | 2024 UPDATE!!!
A 19-year-old male college student sees you for follow-up of an
emergency department (ED) visit. He says he was told that his
symptoms were due to a panic attack. His past medical history is
notable only for migraine headaches. On the day of his ED visit he was
started on propranolol for the headaches. The initial physical
examination in the ED was notable for a blood pressure of 198/114 Hg
supine, dropping to 150/98 mm Hg on standing, and a heart rate of 112
beats/min. He reports that his symptoms improved after a couple hours
in the ED and the record from the visit notes that his blood pressure
was 140/90 mm Hg at the time of discharge.In your office the patient
says that he has always been an anxious person but has never
experienced a similar attack in the past. He notes that his blood
pressure has always been on the “high side” and his blood pressure in
your office today is 144/86 mm Hg.Which one of the following is the
most likely cause of his blood pressure elevations?
Primary hyperaldosteronism
,Hyperthyroidism
Pheochromocytoma
Carcinoid syndrome
Panic disorder
Critique:
Pheochromocytomas are catecholamine-producing neuroendocrine
tumors, and the majority arise from the adrenal medulla. They are a
rare but important secondary cause of hypertension, whether
sustained or paroxysmal. Paroxysmal hypertension with sweating,
headaches, and palpitations is the usual presentation of
pheochromocytoma. Other clinical clues to its presence include
unexplained tachycardia, weight loss, episodic diaphoresis,
unexplained orthostatic hypotension on a background of paroxysmal
or refractory hypertension, and feelings of anxiety or panic attacks. β-
adrenergic blockers have been implicated in precipitating adverse
reactions in patients with pheochromocytoma. The mechanism for β-
blocker-associated adverse events is generally ascribed to inhibition
of β2-adrenoceptor-mediated vasodilation, leaving adrenoceptor-
mediated vasoconstriction unopposed. If a hypertensive crisis occurs
in a patient on β-blockers, the presence of a pheochromocytoma
should be suspected. Furthermore, the Hypertension Canada 2017
guidelines recommend that the possibility of pheochromocytoma be
,considered in patients with hypertension triggered by β-blockers as
well by monoamine oxidase inhibitors, micturition, changes in
abdominal pressure, surgery, or anesthesia.
A 38-year-old Asian male with a chronic history of nocturia sees you for
a 2-day history of gross hematuria. His past medical history is
unremarkable. His father is on hemodialysis for an unknown kidney
problem and he believes his brother has kidney problems as well. A
physical examination reveals a blood pressure of 150/102 mm Hg. His
serum creatinine level is 2.4 mg/dL.Which one of the following is the
most likely diagnosis?
Chronic glomerulonephritis
Medullary sponge kidney
Polycystic kidney disease
Chronic pyelonephritis
Membranous nephropathy
, Critique:
Autosomal polycystic kidney disease has a prevalence of 1:300 to
1:1000 and accounts for approximately 10% of end-stage renal
disease in the United States. Significant findings include renal pain,
enlarged kidneys, nocturia, gross and microscopic hematuria, elevated
serum creatinine, and low urine specific gravity. The disease can
present at any age, but most frequently causes symptoms in the third
or fourth decade of life.
A 22-year-old secretary is referred to you for evaluation of high blood
pressure. Her past medical history is unremarkable and she is on no
prescriptions or over-the-counter medications. Her review of systems
reveals only a chronic history of mild fatigue and episodic muscle
cramping. Her physical examination is normal except for a blood
pressure of 156/100 mm Hg in both arms without significant orthostatic
changes. Laboratory Findings
CBC............normal
Urinalysis............normal
Serum sodium............145 mEq/L (N 135–145)
NEWEST ACTUAL ACCURATE EXAM
COMPLETE QUESTIONS AND DETAILED
VERIFIED ANSWERS GRADED A+ | 100%
VERIFIED | 2024 UPDATE!!!
A 19-year-old male college student sees you for follow-up of an
emergency department (ED) visit. He says he was told that his
symptoms were due to a panic attack. His past medical history is
notable only for migraine headaches. On the day of his ED visit he was
started on propranolol for the headaches. The initial physical
examination in the ED was notable for a blood pressure of 198/114 Hg
supine, dropping to 150/98 mm Hg on standing, and a heart rate of 112
beats/min. He reports that his symptoms improved after a couple hours
in the ED and the record from the visit notes that his blood pressure
was 140/90 mm Hg at the time of discharge.In your office the patient
says that he has always been an anxious person but has never
experienced a similar attack in the past. He notes that his blood
pressure has always been on the “high side” and his blood pressure in
your office today is 144/86 mm Hg.Which one of the following is the
most likely cause of his blood pressure elevations?
Primary hyperaldosteronism
,Hyperthyroidism
Pheochromocytoma
Carcinoid syndrome
Panic disorder
Critique:
Pheochromocytomas are catecholamine-producing neuroendocrine
tumors, and the majority arise from the adrenal medulla. They are a
rare but important secondary cause of hypertension, whether
sustained or paroxysmal. Paroxysmal hypertension with sweating,
headaches, and palpitations is the usual presentation of
pheochromocytoma. Other clinical clues to its presence include
unexplained tachycardia, weight loss, episodic diaphoresis,
unexplained orthostatic hypotension on a background of paroxysmal
or refractory hypertension, and feelings of anxiety or panic attacks. β-
adrenergic blockers have been implicated in precipitating adverse
reactions in patients with pheochromocytoma. The mechanism for β-
blocker-associated adverse events is generally ascribed to inhibition
of β2-adrenoceptor-mediated vasodilation, leaving adrenoceptor-
mediated vasoconstriction unopposed. If a hypertensive crisis occurs
in a patient on β-blockers, the presence of a pheochromocytoma
should be suspected. Furthermore, the Hypertension Canada 2017
guidelines recommend that the possibility of pheochromocytoma be
,considered in patients with hypertension triggered by β-blockers as
well by monoamine oxidase inhibitors, micturition, changes in
abdominal pressure, surgery, or anesthesia.
A 38-year-old Asian male with a chronic history of nocturia sees you for
a 2-day history of gross hematuria. His past medical history is
unremarkable. His father is on hemodialysis for an unknown kidney
problem and he believes his brother has kidney problems as well. A
physical examination reveals a blood pressure of 150/102 mm Hg. His
serum creatinine level is 2.4 mg/dL.Which one of the following is the
most likely diagnosis?
Chronic glomerulonephritis
Medullary sponge kidney
Polycystic kidney disease
Chronic pyelonephritis
Membranous nephropathy
, Critique:
Autosomal polycystic kidney disease has a prevalence of 1:300 to
1:1000 and accounts for approximately 10% of end-stage renal
disease in the United States. Significant findings include renal pain,
enlarged kidneys, nocturia, gross and microscopic hematuria, elevated
serum creatinine, and low urine specific gravity. The disease can
present at any age, but most frequently causes symptoms in the third
or fourth decade of life.
A 22-year-old secretary is referred to you for evaluation of high blood
pressure. Her past medical history is unremarkable and she is on no
prescriptions or over-the-counter medications. Her review of systems
reveals only a chronic history of mild fatigue and episodic muscle
cramping. Her physical examination is normal except for a blood
pressure of 156/100 mm Hg in both arms without significant orthostatic
changes. Laboratory Findings
CBC............normal
Urinalysis............normal
Serum sodium............145 mEq/L (N 135–145)
