Question

Background Information

Initial history

- 50-year-old female, coming from work and told her blood pressure was high at a health fair

- Works at a legal clerk, secretary at a large law firm

Additional history

- No other health problems and medications

- Father and brother both have hypertension

History of MI and stroke in maternal grandparents

- Denies cardiac or neuro symptoms

Eats a relatively healthy diet

Not a smoker, 1-3 glasses of white wine, exercises every week

Has gained 5 pounds from a knee injury

Her cholesterol was just checked 8 years ago 218 milligrams per deciliter and was told to

watch her diet (when she was 42)

PHYSICAL EXAM

- An alert and oriented, mildly obese female in no distress

- Temp was 37 degrees (oral), 95 pulse rate (regular), 14 respiration, BP 156/98 in both arms, sitting

- Her head and neck exam was unremarkable; pharynx clear, subtle without bures or thyromegaly

- Lungs had good expansion bilaterally, breath sounds clear

- Cardiac – no murmurs, no pmi, 5 intercostal space, no S3’s

- Abdominal – mildly obese, no abdominal bures heard, nothing enlarged, no masses felt

- Extremines, no edema, pulses were full in all extremities

- Neuro exam – alert and oriented, gait was steady, proprioception was normal,

QUESTIONS

1. What are the pertinent positives and negatives on the physical exam and what might they mean?

2. What should be done now?

3. How should she prepare for her next visit?

Follow up number 2

- Feels well, 160/100 both arms sitting with arm elevated to heart level

- Rest of exam was unchanged

Question 4   What now?

Third visit - No complaints, BP 158/102

Question 5- What now? Would you order lab tests? If so, what would you order?

- All blood chemistries are normal, complete blood and bacterial count normal, urine – neg for glucose, for LDL elevated, HDL slightly low

Question 6 - What do the lab test mean?

Question 7 - How should this patient be managed?

Answer 1

1.The pertinent positive on the physical examination are

• Vitals :Temperature, pulse and respiration withing normal limits describes that the patient has no infection, normal heart beats with respiratory function.
• Auscultation of lungs is clear indicating no fluid retention or edema of the lungs thus having clear lung sounds
• The cardiac functions are within normal limits
• Neurological examination are within normal limits

The pertinent negative on the physical examination are

• Elevated blood pressure indicating there should be some constriction in the blood vessels due to increased cholesterol
• Mild obesity noted in the abdomen due to poor lifestyle

2.The following should be done

• Weight management
• Reduce or stop wine intake
• To reduce blood pressure and maintain it under normal limit

3.She can prepare herself for the follow up by

• Visiting the healthcare provider as per the schedule
• Medication adherence

4.The patient should be started with antihypertensive drugs as her blood pressure is too high which needs medication to be controlled.