Hypertension (OSCE)

Assessment of Hypertension

## Goals

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* identify end organ damage
* identify signs of secondary hypertension

## Differential

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* Medications
* Renal: vascular, parenchymal
* Endocrine: Cushing’s, pheochromocytoma, primary aldosteronism, hyperparathyroidism, thyroid
* Aortic dissection

## Vitals

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* standard vitals
* weight and height (BMI)

## Inspection

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* Neck:
* thyroid
* JVP
* Skin
* Cushing’s (striae, acne, hirsutism)
* pheochromocytoma (clammy, diaphoretic)
* arterial insufficiency (skin, hair changes)

## Palpation

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* Point of maximum impulse (PMI)- diffuse
* peripheral pulses (symmetric)
* radiofemoral delay

## Auscultation

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* carotid bruit
* pulmonary edema
* S4 gallop, murmurs
* bruits (abdominal, renal, femoral)

## Fundoscopic exam

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* Grade 1 - spasm of retinal vessels
* Grade 2 - constriction retinal arterioles, AV nicking
* Grade 3 - vascular changes, hemorrhage, exudates
* Grade 4 - papilledema

## External link

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* Auscultation of Carotid Bruit \- bruit audio, case studies and quiz

## Other OSCE modules

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* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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