We have a Hypertensive Management case here! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-05-2011
USMLE Forums Newbie
 
Steps History: 1 + CK
Posts: 9
Threads: 3
Thanked 10 Times in 4 Posts
Reputation: 20
Sphygmomanometer We have a Hypertensive Management case here!

Your assistant alerts you that a patient in your clinic has severely elevated blood pressure. The patient is a 45-year-old man without other significant medical history. The patient's blood pressure is 220/125 mmHg; blood pressure measurements are essentially the same in both arms. The patient says that he is feeling fine. He has had no symptoms of flushing, sweating, or headache, nor has he had visual changes,focal weakness, numbness, chest pain, dyspnea, or decreased urine output. On examination, neurologic status is normal. An S4 gallop and trace pretibial edema are noted. The lungs are clear to auscultation.
An ECG shows sinus rhythm with LVH. There is no evidence of ischemia or infarction.

How should you manage this patient?

A. Administer sublingual nifedipine, 10 mg

B. Prescribe atenolol, 50 mg, and follow up in 1 week

C. Administer atenolol, 50 mg, and follow up in 24 hours

C. Prescribe atenolol, 50 mg, and follow up in 1 week

D. Admit him to the intensive care unit for cardiac and blood pressure
monitoring and intravenous nitroprusside therapy

Note:its a bit step 3 flavor qs but has a very good concept behind this.
Reply With Quote Quick reply to this message
The above post was thanked by:
1TA2B (04-05-2011), aktorque (04-05-2011), healer2b (04-05-2011), sinsinati (04-05-2011), us1us (04-05-2011), yarasara77 (08-07-2012)



  #2  
Old 04-05-2011
USMLE Forums Scout
 
Steps History: ---
Posts: 59
Threads: 12
Thanked 31 Times in 20 Posts
Cool

Admit to ICU.........................
i think that will be the correct approach.

Reply With Quote Quick reply to this message
  #3  
Old 04-05-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 184 Times in 70 Posts
Reputation: 194
Default

I would say C, "Administer atenolol, 50 mg, and follow up in 24 hours"

The pt is presenting with a hypertensive urgency (as opposed to hypertensive emergency) because there is no evidence of ischemia or end organ damage. Treatment with nifedipine and rapid reduction of BP are contraindicated as they can precipitate cerebral infarct or MI. BP should be reduced to ≤160/100 mmH with conventional antihypertensive therapy over several hours to days.
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (04-05-2011)
  #4  
Old 04-05-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 19
Threads: 4
Thanked 12 Times in 7 Posts
Default

D
FOLLOWUP IN 2WEEK OR 24H IS TOO LATE,HOWEVER IT IS HTN URGENCY AND NOT EMERGENCY BECAUASE SHE OR HE DOESNT HAVE ENDORGAN FAILURE
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (04-05-2011)
  #5  
Old 04-05-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
Default

Hi

Thanks. Great question!

I'm more in favour of-give him some b-blocker and see how it goes! I suppose fundoscopic exam did not reveal papilledema. There may be a component of white coat effect too.

Would go with C.
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (04-05-2011)
  #6  
Old 04-05-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow C Administer atenolol, 50 mg, and follow up in 24 hours

C) Administer atenolol, 50 mg, and follow up in 24 hours

Drug of choice for hypertensive urgency is Clonidine (Catapres). You can also tx a pt with betablocker.

Severe Hypertension (Urgency)

Asymptomatic pt (>180/110mmHg)
Observe 1-3 hr; initiate, resume medication; increase dosage of inadequate agent

Symptomatic pt (>180/110mmHg)
Observe 3-6 hr; lower BP with short-acting oral agent; adjust current therapy

Hypertensive Emergency

>220/140 mmHg

Immediate admission to ICU; treat to initial goal BP; additional diagnostic studies
Reply With Quote Quick reply to this message
The above post was thanked by:
vansha (04-08-2011)
  #7  
Old 04-05-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 184 Times in 70 Posts
Reputation: 194
Post

I found the following article to be helpful: http://www.turner-white.com/memberfi...pertensive.pdf
Reply With Quote Quick reply to this message
  #8  
Old 04-06-2011
USMLE Forums Scout
 
Steps History: ---
Posts: 59
Threads: 12
Thanked 31 Times in 20 Posts
Cool

This patient has very high blood pressure although he has no signs of end organ damage. Also he has S4 and pretibial edema and for these findings in such a patient, the rule is DO NOTHING BUT TREAT ONLY HYPERTENSION ! B BLOCKER WOULD BE A GOOD OPTION.
BUT THE PROBLEM IS , FOR THAT HIGH BP SHOULD WE CHANGE OUR APPROACH AND GO FOR CARDIAC MONITORING AND NITROPRUSSIDE OR WE JUST GO FOR ATENOLOL AND FOLLOW UP ?

I THINK CARDIAC MONITORING IS NECESSARY AS THIS PATIENT S HTN SHOWS CONDITION IS GETTING WORSE PLUS TREAT HTN.
Reply With Quote Quick reply to this message
  #9  
Old 04-06-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
Default useful message!

Quote:
Originally Posted by healer2b View Post
I found the following article to be helpful: http://www.turner-white.com/memberfi...pertensive.pdf
Thanks Healer2b

Yes. Very useful indeed. I just copied some important points from your article for others to have a quick look!



TAKE HOME POINTS

(http://www.turner-white.com/memberfi...pertensive.pdf)

• Distinguishing between hypertensive emergency (associated with acute target organ damage) and urgency (no target organ damage) is crucial to appropriate management.

• Diagnosis of hypertensive emergency requires a thorough history (evidence of target organ dam- age, illicit drug use, and medication compliance) as well as a complete physical examination, basic laboratory data, and electrocardiogram to assess for the presence of target organ damage and deter- mine its severity.

• In general, hypertensive urgency is managed using oral antihypertensive drugs in outpatient or same- day observational settings, while hypertensive emer- gency is managed in an intensive care unit or other monitored settings with parenteral drugs.

• The initial goal in hypertensive urgency is a reduc- tion in mean arterial pressure by no more than 25% within the first 24 hours using conventional oral therapy; in hypertensive emergency, mean arterial pressure should be reduced approximately 10% during the first hour and an additional 15% within the next 2 to 3 hours.

• Various medications are available for the treatment of hypertensive emergency; specific target organ involvement and underlying patient comorbidities dictate appropriate therapy.
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
healer2b (04-06-2011), vansha (04-08-2011), yarasara77 (08-07-2012)



Reply

Tags
Cardiology-, Internal-Medicine-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
What to do with this hypertensive patient? Hohepa USMLE Step 2 CK Forum 8 05-24-2011 02:18 PM
Management of hyponatremia Haisook USMLE Step 2 CK Forum 8 04-01-2011 03:55 PM
How to help a hypertensive decrease salt intake kemoo USMLE Step 1 Forum 2 01-18-2011 08:43 AM
Hypertensive Smoker Unwilling to Stop Smoking kemoo USMLE Step 1 Forum 1 01-17-2011 10:46 PM
Hypertensive diseases in pregnancy Question good_boy_1234 USMLE Step 1 Forum 7 06-11-2010 07:57 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)