Hypertension (OSCE)
Assessment of Hypertension
Goals
[edit | edit source]- identify end organ damage
- identify signs of secondary hypertension
Differential
[edit | edit source]- Medications
- Renal: vascular, parenchymal
- Endocrine: Cushing’s, pheochromocytoma, primary aldosteronism, hyperparathyroidism, thyroid
- Aortic dissection
Vitals
[edit | edit source]- standard vitals
- weight and height (BMI)
Inspection
[edit | edit source]- Neck:
- thyroid
- JVP
- Skin
- Cushing’s (striae, acne, hirsutism)
- pheochromocytoma (clammy, diaphoretic)
- arterial insufficiency (skin, hair changes)
Palpation
[edit | edit source]- Point of maximum impulse (PMI)- diffuse
- peripheral pulses (symmetric)
- radiofemoral delay
Auscultation
[edit | edit source]- carotid bruit
- pulmonary edema
- S4 gallop, murmurs
- bruits (abdominal, renal, femoral)
Fundoscopic exam
[edit | edit source]- Grade 1 - spasm of retinal vessels
- Grade 2 - constriction retinal arterioles, AV nicking
- Grade 3 - vascular changes, hemorrhage, exudates
- Grade 4 - papilledema
External link
[edit | edit source]- Auscultation of Carotid Bruit - bruit audio, case studies and quiz