Which patient could be expected to have the highest systolic blood pressure?
A 21-year-old male
A 50-year-old perimenopausal female
A 35-year-old patient with Type 2 diabetes
A 75-year-old male
D.
Nearly 25% of the US population has hypertension. The greatest incidence is in older adults
because of changes in the intima of vessels as aging and calcium deposition occur. Males of any
age are more likely to be hypertensive than females of the same age. African American adults
have the highest incidence in the general population. Among adolescents, African Americans and
Hispanics have the highest rates. Hypertension occurs in 5-10% of pregnancies.
Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT
need to be stopped prior to her catheterization?
Naproxen
Furosemide
Metformin
Losartan
D.
Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin
should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it
contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on
renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined
with contrast dye in an impaired kidney.
In older adults, the three most common ailments are:
hearing loss, vision loss, hypertension.
hearing loss, hypertension, arthritis.
depression, vision loss, hypertension.
arthritis, hearing loss, depression.
B.
Hypertension and arthritis are the two most common ailments in older adults. Hearing loss
occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis.
There is no consensus for the frequency of screening for hearing loss in older patients, but
minimally, it should be grossly evaluated at each visit and screened more thoroughly if deficits
are observed. Blood pressure should be screened annually, but it is usually screened at each visit.
Arthritis is not routinely screened.
,Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He has come
in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and
has a near-normal BMI. On examination, the patient is noted to have an absence of hair growth
on his lower legs. Which statement is true regarding this patient?
This is a normal consequence of aging.
This might indicate disease in the lower extremities.
It might be from exercise initiation.
This is secondary to long-term smoking.
B.
An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of
normal changes of aging that hair growth will diminish, but not become absent. His lower
extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for
years), and he should be questioned about leg pain when he walks. An ankle-brachial index
could be measured. If < 0.9, further assessment should be done. A normal ankle-brachial index
should be greater than 0.9. Less than 0.4 is considered critical.
The usual clinical course of mitral valve prolapse:
is benign.
results in sudden cardiac death.
results in chronic heart failure.
is associated with multiple episodes of emboli.
A.
The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP
are asymptomatic. A murmur may be present and is best auscultated with the diaphragm of the
stethoscope over the cardiac apex. In a minority of patients, symptoms of heart failure or sudden
death may occur. When heart failure results, it is usually a result of mitral regurgitation.
Embolization may occur, but, this is not common or usual in the majority of patients.
, An ACE inhibitor is specifically indicated in patients who have:
hypertension, diabetes with proteinuria, and heart failure.
diabetes, hypertension, hyperlipidemia.
asthma, hypertension, diabetes.
renal nephropathy, heart failure, hyperlipidemia.
A.
ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE inhibitors
are also indicated in patients who have renal insufficiency. However, ACE inhibitors can worsen
renal insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and
potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though
they are used by some healthcare providers in this way. This is an off-label use
An older adult who has hypertension and angina takes multiple medications. Which one of the
following decreases the likelihood of his having angina?
ACE inhibitor
Beta blocker
Diuretic
Angiotensin receptor blocker
B.
The beta blocker slows down heart rate, depresses myocardial contractility, and decreases
sympathetic stimulation. These decrease myocardial oxygen demand and improve angina
symptoms. It is an excellent drug class to use to prevent symptoms of angina in patients who
have underlying coronary artery disease. Calcium channel blockers are another class of
medications that could be used to improve symptoms of angina.
, Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure
decreases:
more than 20 points anytime after rising.
more than 20 points within 3 minutes after rising.
more than 20 points within 1 minute after rising.
any degree drop if the patient becomes weak or dizzy.
B.
Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the
systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to a more upright
position. Systolic blood pressure can be expected to decrease within one minute of moving to an
upright position. Normally, the blood pressure returns to baseline within one minute of a position
change and orthostatic hypotension does not occur. It is always abnormal when blood pressure
decreases beyond one minute of moving to an upright position. Orthostatic hypotension can then
be diagnosed. Moving to an upright position may be 1) lying to sitting or 2) sitting to standing.
Additionally, if the systolic blood pressure does not meet these criteria, but the diastolic drops by
10 mm Hg or more with a position change, orthostatic hypotension can be diagnosed. Patients
