Assessment of Hypertension

Goals

• identify end organ damage
• identify signs of secondary hypertension

Differential

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

Vitals

• standard vitals
• weight and height (BMI)

Inspection

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

Palpation

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

Auscultation

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

Fundoscopic exam

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

External link

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

Other OSCE modules