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ABFM HYPERTENSION exam with complete solutions 2024
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ABFM HYPERTENSION exam with complete solutions 2024
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ABFM HYPERTENSION exam withj j j
complete solutions 2024
j j j
A j39-year-old jmale jsees jyou jfor jevaluation jof jhigh jblood jpressure. jHis jpast
jmedical jhistory jis junremarkable. jOn jexamination jhe jhas ja jBMI jof j32 jkg/m2 jand
jyou jnote jthat jhe jhas ja jround jface jand ja jplethoric jcomplexion. jHis jblood
jpressure jis j150/98 jmm jHg, jhis jpulse jrate jis j88 jbeats/min, jand jhis jrespiratory
jrate jis j16/min. jOther jnotable jfindings jinclude ja jprominent jdorsal jcervical jfat
jpad jand jsupraclavicular jfat jpads, jas jwell jas jviolaceous jstriae jon jhis jtrunk.
jLaboratory jfindings jare jnotable jonly jfor ja jfasting jglucose jlevel jof j114
jmg/dL.Which jone jof jthe jfollowing jis jthe jmost jlikely jcause jof jhis jhypertension?
Addison's jdisease
Cushing jsyndrome
Hemochromatosis
Pheochromocytoma
Primary jhyperaldosteronism j- jANSWER✓✓-B
This jpatient's jclinical jfindings jare jconsistent jwith jCushing jsyndrome, jor
jhyperadrenocorticism. jThis jis ja jclinical jsyndrome jand jmetabolic jdisorder
jresulting jfrom jchronic jexcess jof jglucocorticoids. jThe jmost jcommon jcause jis
jcorticosteroid juse, jbut jadrenal jneoplasms jaccount jfor j20%-25% jof jcases.
jFindings jinclude jgeneral jweakness, josteoporosis, jmoon jfacies, jfacial jplethora,
jecchymoses, jtruncal jobesity, jviolaceous jstriae jof jthe jabdomen, jdeposition jof
jadipose jtissue jin jthe jinterscapular jarea j("buffalo jhump"), jand jglucose
jintolerance.
You jdiagnose jstage j2 jhypertension jin ja j54-year-old jmale. jHis jpast jmedical
jhistory jis jotherwise junremarkable jand ja jphysical jexamination jis jnotable jfor
jmild jAV jnicking jon jfunduscopic jexamination. jA jbaseline jEKG jreveals jevidence
jof jleft jventricular jhypertrophy.Which jone jof jthe jfollowing jclasses jof
jantihypertensive jagents jhas jNOT jbeen jshown jto jproduce ja jregression jof jleft
jventricular jhypertrophy?
ACE jinhibitors
β-Blockers
Calcium jchannel jblockers
Direct jvasodilators
,Thiazide jdiuretics j- jANSWER✓✓-D
In jpatients jwith jleft jventricular jhypertrophy, jstudies jhave jshown ja jreduction jin
jleft jventricular jmass jin jthose jtreated jwith jACE jinhibitors, jdiuretics, jcalcium
jchannel jblockers, jand jβ-blockers, jwith jthe jmost jconsistent jreduction jachieved
jwith jACE jinhibitors jand jthe jleast jwith jβ-blockers. jRegression jof jleft jventricular
jhypertrophy jhas jnot jbeen jdemonstrated jwith jdirect jvasodilators jsuch jas
jhydralazine jand jminoxidil.
According jto jcurrently jaccepted jcriteria, jhypertension jin jchildren jis jdefined jas
jrepeated jblood jpressure jmeasurements jat jor jabove ja jthreshold jof jwhich jone
jof jthe jfollowing jpercentiles jfor jage, jsex, jand jheight?
80th
85th
90th
95th
99th j- jANSWER✓✓-D
In jchildren jand jadolescents, jhypertension jis jdefined jas jblood jpressure jat jor
jabove jthe j95th jpercentile jfor jage, jsex, jand jheight, jon jrepeated jmeasurements.
Which jone jof jthe jfollowing jconditions jis jassociated jwith jisolated jsystolic
jhypertension?
Aortic jstenosis
Hypothyroidism
Paget's jdisease
Renovascular jhypertension
Severe josteoporosis j- jANSWER✓✓-C
Isolated jelevation jof jsystolic jblood jpressure jcan jbe jsecondary jto jconditions
jassociated jwith jelevated jcardiac joutput, jsuch jas janemia, jPaget's jdisease,
jhyperthyroidism, jarteriovenous jfistula, jand jaortic jinsufficiency.
A j59-year-old jAfrican-American jmale jwith ja jhistory jof jhypercholesterolemia jand
jgout jsees jyou jfor ja jhealth jmaintenance jvisit. jA jphysical jexamination jis jnotable
jonly jfor ja jblood jpressure jof j144/85 jmm jHg.Laboratory jFindingsLDL-
cholesterol............82 jmg/dLHDL-cholesterol............47 jmg/dLSerum
jtriglycerides............134 jmg/dLLiver jpanel............normalSerum
jcreatinine............1.7 jmg/dL j(N j0.7-1.3)Estimated jglomerular jfiltration
,jrate............56 jmL/min/1.73 jm2Which jone jof jthe jfollowing jdoes jthe jJNC j8 jpanel
jrecommend jas jinitial jmanagement jof jthis jpatient's jblood jpressure jelevation?
Lifestyle jmeasures jonly
An jACE jinhibitor
A jcalcium jchannel jblocker
Hydralazine
Hydrochlorothiazide j- jANSWER✓✓-B
The jJNC j8 jpanel jrecommends jthe jinitiation jof jpharmacologic jtreatment jto
jlower jblood jpressure jin jpatients j≥18 jyears jof jage jwith ja jsystolic jblood
jpressure j≥140 jmm jHg jor ja jdiastolic jblood jpressure j≥90 jmm jHg jif jthey jhave
jchronic jkidney jdisease j(CKD), jdefined jas jan jestimated jor jmeasured jglomerular
jfiltration jrate j(GFR) j<60 jmL/min/1.73 jm2. jTreatment jis jrecommended jfor
jpatients jof jany jage jwith jthese jblood jpressure jvalues jwho jalso jhave
jalbuminuria, jdefined jas j>30 jmg jof jalbumin/g jof jcreatinine jregardless jof jGFR
j(SOR jC).Although ja jthiazide jdiuretic jor ja jcalcium jchannel jblocker jis jgenerally
jrecommended jas jfirst-line jantihypertensive jtherapy jin jAfrican-Americans, jfor
jpatients j≥18 jyears jof jage jwho jhave jCKD, jthe jJNC j8 jpanel jrecommends jinitial
j(or jadd-on) jantihypertensive jtreatment jwith jan jACE jinhibitor jor jangiotensin
jreceptor jblocker jto jimprove jkidney joutcomes, jregardless jof jethnicity jor
jdiabetes jstatus j(SOR jB).The j2017 jAmerican jCollege jof jCardiology/American
jHeart jAssociation jhypertension jguidelines jsimilarly jrecommend juse jof jan jACE
jinhibitor jin jpatients jwith jstage j3 jCKD, jas jwell jas jin jpatients jwho jhave jstages j1
jor j2 jCKD jwith jalbuminuria j>300 jmg/day.
A j67-year-old jmale jwith ja jhistory jof jhypertension jand jtype j2 jdiabetes jhas
jinadequately jcontrolled jblood jpressure. jHis jcurrent jmedications jare jlisinopril
j(Prinivil, jZestril), j40 jmg jdaily; jhydrochlorothiazide, j25 jmg jdaily; jand jextended-
release jmetformin j(Glucophage jXR), j1500 jmg jdaily. jLaboratory jtesting jreveals ja
jhemoglobin jA1c jof j6.8%, jnormal jserum jelectrolytes, ja jserum jcreatinine jlevel jof
j1.0 jmg/dL j(N j0.6-1.5), jand ja jurinary jalbumin/creatinine jratio jof j80 jmg/g j(N
j<30).Which jone jof jthe jfollowing jagents jshould jbe jAVOIDED jin jthis jpatient?
Aliskiren j(Tekturna)
Atenolol j(Tenormin)
Diltiazem j(Cardizem)
Doxazosin j(Cardura)
Felodipine j(Plendil) j- jANSWER✓✓-A
The jALTITUDE jstudy j(Aliskiren jTrial jin jType j2 jDiabetes jUsing jCardiorenal
jEndpoints) jwas ja jrandomized, jdouble-blind, jplacebo-controlled jinternational
jmulticenter jtrial jundertaken jto jdetermine jwhether jthe jaddition jof jthe jdirect
, jrenin jinhibitor jaliskiren jto jstandard jtherapy jwith jrenin-angiotensin jsystem
jblockade jwould jbe jbeneficial jfor jpatients jwith jtype j2 jdiabetes jwho jare jat jhigh
jrisk jfor jcardiovascular jand jrenal jevents. jThe jstudy jwas jterminated jprematurely
jafter ja jmedian jfollow-up jof j27 jmonths jwhen jno jbenefit jwas japparent, jand ja
jhigher jrisk jof jhyperkalemia jand jhypotension jwas jseen jin jpatients jreceiving
jaliskiren. jBased jon jthis jstudy, jthe jFDA jissued ja jdrug jsafety jwarning jin j2012
jthat jannounced jtwo jadditions jto jthe jdrug jlabeling jof jaliskiren-containing
jproducts. jThe jfirst jaddition jwas ja jcontraindication jto jthe juse jof jaliskiren jin
jpatients jwith jdiabetes jmellitus jwho jare jtaking jangiotensin jreceptor jblockers
j(ARBs) jor jACE jinhibitors, jbecause jof jan jincreased jrisk jof jrenal jimpairment,
jhypotension, jand jhyperkalemia. jThe jsecond jaddition jwas ja jwarning jto javoid
jthe juse jof jaliskiren jwith jARBs jor jACE jinhibitors jin jpatients jwith jmoderate jto
jsevere jrenal jimpairment j(glomerular jfiltration jrate j<60 jmL/min/1.73 jm2).The juse
jof jACE jinhibitors, jARBs, jβ-blockers, jdiuretics, jand jcalcium jchannel jblockers
jhas jbeen jshown jto jbe jeffective jin jreducing jcardiovascular jevents jin jpatients
jwith jdiabetes jmellitus. jAlthough jno jsuch jbenefit jhas jbeen jseen jwith
jdoxazosin, jthere jis jno jcontraindication jto jits juse jin jpatients jwith jdiabetes.
A j44-year-old jmale jhas ja j1-week jhistory jof jgeneralized jheadaches jand
jnonspecific jdizziness. jHis jpast jmedical jhistory jis jnotable jonly jfor ja j3-year
jhistory jof jhypertension, jwhich jhas jbeen jpoorly jcontrolled jbecause jof ja jlack jof
jadherence jto jhis jdrug jregimen. jHis jrenal jstatus jwas jnormal j1 jmonth jago. jOn
jexamination jhis jblood jpressure jis j250/150 jmm jHg, jand jyou jnote jcotton-wool
jexudates jon jfunduscopic jexamination. jLaboratory jevaluation jreveals jnormal
jserum jelectrolytes, ja jserum jcreatinine jlevel jof j3.8 jmg/dL j(N j0.7-1.3), jand ja jBUN
jlevel jof j60 jmg/dL j(N j6-20). jA jurinalysis jshows jgross jhematuria jand j3+
jproteinuria.Which jone jof jthe jfollowing jwill jrapidly jlower jhis jblood jpressure
jand jincrease jrenal jblood jflow?
Diazoxide j(Proglycem)
Enalaprilat j(Vasotec)
Esmolol j(Brevibloc)
Fenoldopam j(Corlopam)
Nitroprusside j(Nitropress) j- jANSWER✓✓-D
Fenoldopam jis ja jselective jperipheral jdopamine-receptor jagonist jused jfor jthe
jtreatment jof jsevere jhypertension. jIn jstudies jinvestigating jfenoldopam juse jin
jsevere jhypertension, jits jefficacy jin jlowering jblood jpressure jwas jfound jto jbe
jcomparable jto jthat jof jnitroprusside. jIt jis jFDA-approved jfor jthe jin-hospital
jmanagement jof jsevere jhypertension jwhen jrapid jbut jquickly jreversible
jreduction jof jblood jpressure jis jrequired, jsuch jas jin ja jpatient jwith jmalignant
jhypertension jwho jhas jdeteriorating jend-organ jfunction. jBy jvirtue jof jits jactions
jon jperipheral jdopamine jreceptors, jfenoldopam jproduces jrenal jarterial
jvasodilation jand jnatriuresis, jand jthus jcan jprovide ja jrenal jprotective jeffect jin
jclinical jsituations jassociated jwith jimpaired jrenal jfunction. jIn jaddition, jthere jis
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