Home measurement with a verified Blood pressure meter. (Read | Figure 1

kurthelgerson

Family Medicine

Home measurement with a verified Blood pressure meter. (Reads the same as the office readings when the patient is at the office.) ever see "White coat hypertension " this exciting?

Why you should join Figure 1

A 55 year old man case

A 55 year old man comes to see the first time for review of his blood pressure. His BMI is 28. He claims to have no other known medical history of note. He is currently on losartan 50mg daily, atenolol 50mg daily and amlodipine 5mg daily dosage. I have measured his BP in the clinic 30minutes apart and the readings are 192/113mmHg and 187/111mmHg respectively. The patient is otherwise asymptomatic with normal chest auscultation. His optic appears normal on inspection. Which of the following is the LEAST APPROPRIATE next step ?
A. A short acting anti hypertensive medication like captopril should be given to the patient to bring down the blood pressure within 12-24hours
B. The patient should be screened for hyperlipidaemia and diabetes
C. Do thyroid function test and do a more detailed history taking to exclude OSA
D. Replace atenolol with hydrochlorothiazide and check the BP again in 1 week
E. Advise the patient to do home BP monitoring in the morning and evening over the next 1 week and check the average of the readings

A 60-year-old female patient case

A 60-year-old asymptomatic female patient comes to the office for a medical checkup. Tmax: 36.7 C (98.1 F); P: 76 irregular; R: 20; BP: 130/90. PMHx Hypertension, Hypothyroidism.

A 52-year-old man case

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman case

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant case

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens case

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?