Learning through Problem Solving

A Kaplan Problem-Based Learning Initiative

Small Group Session: Hypertension

*** Student Handout ***

1. A 35-year-old woman involved in an automobile accident is admitted as an

emergency patient. A major artery severed in her leg caused an estimated 700 mL
blood to be lost. Her blood pressure is 90/60 mm Hg. Which of the following would
be expected to increase in response to hemorrhage?
A. Arteriolar diameter in skeletal muscle
B. Sodium excretion
C. Sympathetic nerve activity
D. Vagal nerve activity
E. Water excretion

2. A healthy 18-year-old male law student has an exercise stress test at a local health
club. Which of the following is most likely to decrease in his skeletal muscles during
exercise?
A. Arteriolar resistance
B. Carbon dioxide concentration
C. Lactic acid concentration
D. Sympathetic nervous activity
E. Vascular conductance

3. A patient with long-standing hypertension dies in a motor vehicle accident. At

autopsy, multiple small, cavitary lesions are observed in the basal ganglia. Which of
the following blood vessels most likely resulted in this pathology?
A. Anterior cerebral
B. Lateral striate
C. Posterior cerebral
D. Superior cerebellar
E. Vertebral
4. A 28-year-old man comes for a routine physical examination. His blood pressure
is 160/100 mm Hg. The measurement is repeated 40 minutes later, and is 161/102
mm Hg. The physician asks the patient to return the next week and the week
following, and each time repeats the evaluation yielding the following results:
172/100, 178/107, 173/106, 167/102 mm Hg. Which of the following cardiac
complications is most likely to be seen in this patient?
A. Large vegetations on cardiac valves
B. Left ventricular hypertrophy
C. Patent foramen ovale
D. Pericarditis
E. Pulmonary stenosis

5. A 24-year-old woman presents to her primary care for a wellness examination.

She has been healthy and is currently doing well without complaints. She is a
nonsmoker with no significant past medical or family history. The patient is afebrile,
her BP is 160/90 mm Hg, pulse is 88/min, and respirations are 17/min. Her pulses
are symmetric and equal, her cardiac and pulmonary examinations are normal, and
there is an abdominal bruit with a systolic and diastolic component. Serum
chemistry shows:
Sodium 145 mEq/L

Potassium 3.1 mEq/L

Chloride 102 mEq/L

Bicarbonate 28 mEq/L

Blood urea nitrogen 14 mg/dL

Creatinine 1.0 mg/dL

Glucose 80 mg/dL

Which of the following would explain all of her findings?

A. Bilateral Renal artery stenosis
B. Coarctation of the aorta
C. Cushing syndrome
D. Pheochromocytoma
E. Thyrotoxicosis
6. On a routine annual examination, a previously healthy 63-year-old man is found
to have elevated blood pressure. His high blood pressure is confirmed on three
subsequent visits. He is advised on how to manage his diet and exercise, but 1 year
later it is still elevated, so he is prescribed a diuretic. He returns for a follow-up visit,
and lab studies show an elevation of his potassium levels. Which of the following
diuretics was he most likely prescribed?
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Metolazone
E. Triamterene

7. A 40-year-old woman comes to the office complaining that she feels "a bit tired
lately.” She has started a new job as an executive assistant at a prestigious law firm.
Since beginning her new job, she has had a hard time keeping up with all of her
activities. She has failed to regularly exercise and her eating habits have revolved
around pizza and chocolate bars. She admits to having restarted smoking again. She
has not been sexually active for the past 3 months. Her last Pap smear was 6 months
ago and was normal, and has been at every screening. Her temperature is 37ºC, and
blood pressure is 148/96 mm Hg supine and 144/90 mm Hg standing. BP remains
elevated 40 minutes later. Her physical examination is unremarkable. Which of the
following is the most appropriate next step?
A. Ambulatory blood pressure monitoring
B. Order a chest x-ray
C. Perform a pap smear
D. Prescribe the nicotine patch
E. Schedule her for a mammogram

8. A medical student presents a case to the attending physician of a 55-year-old man

with polyuria, hesitancy, nocturia, and incomplete emptying of the bladder. He has a
past medical history of stage 1 hypertension that has failed to be controlled with
diet and exercise. His blood pressure reading has been consistently around 150/90
mm Hg for 3 months. On physical examination he has an enlarged, symmetric, and
non-nodular prostate. Which of the following pharmacotherapies should be
administered to this patient?
A. Atenolol
B. Doxazosin
C. Felodipine
D. Finasteride
E. Hydrochlorothiazide
9. A 65-year-old Caucasian man with a long-standing history of essential
hypertension presents to the emergency department because of palpitations and a
headache. He has been on a variety of antihypertensive drugs to control his
hypertension. He claims that he ran out of some of them yesterday. His BP is
210/120 mm Hg. Ophthalmoscopic examination shows arteriovenous (AV) nicking,
papilledema, and dot blot hemorrhages. Urine dipstick shows 2+ proteinuria. His
home systolic blood pressure readings have always averaged around 160 mm Hg.
Cautioning on abrupt stoppage of which of the following medications could have
prevented this patient’s presentation?
A. Atenolol
B. Clonidine
C. Felodipine
D. Hydrochlorothiazide
E. Lisinopril

10. A 25-year-old woman comes to the physician complaining of excessive weight

loss and menstrual irregularities for the past 3 months. Her last menstrual period
was 2 months ago. She has a remote history of anemia. She is a nonsmoker and has
no significant family history. Her temperature is 36.9ºC, BP is 160/90 mm Hg (in all
extremities), pulse is 106/min, and respirations are 16/min. Her pulses are
symmetric and equal. Cardiac, pulmonary, and abdominal examinations are
unremarkable. Urine pregnancy test is negative. Which of the following is the most
likely cause of her elevated blood pressure?
A. Coarctation of the aorta
B. Cushing syndrome
C. Pheochromocytoma
D. Renal artery stenosis
E. Thyrotoxicosis