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ADULT HEALTH I EXAM I OUTLINEBe sure to review guidelines for diseases and conditionsPresenting signs and symptomsThink about your case studiesDiagnostic testingDifferential Diagnosis for common HEEENT and Cardiovascular conditionsTreatment regimens utilizing updated guidelines found in your readings for common disorders and diseases seen in clinic.JNC- 8, USPSTF Guidelines, AHA/ACC guidelines, to name a few.Review patient education, esp. about medication side effects, when to report back to the clinic, what to watch out for, other non-pharmacological modalities.Know the different stages of Hypertension and be aware of the criteria for each stage, for example Stage 1 SBP 140–159 mm Hg, DBP 90–99 mm HgReview the JNC-8 guidelines for HTNThink back to the Case Studies and how you gave you rationale and were ableto use updated guidelines and diagnostic criteria for those. 12 Lead EKG, ie LVH what would you see on an EKG? What symptoms might the pt present with for this condition.Funduscopic exam, esp. for RetinopathyCholesterol panel normal and abnormal ranges, remember recommended guidelines for initial treatment. What is best to target LDL and or Triglycerides. Be able to recognize signs of target organ damage ie Renal, cardiac muscle, ocular, cerebrovascular, etc. Review pharmacologic management of HTN as per the JNC 8 guidelines iee CCB, ACE, and Beta Blockers
CARDIACHypertensionoRisk FactorsAge, gender, race, obestity, fam hx, excess ETOH, sedentary life, Cig smoking, psych stressoMost common condition in primary care (50mill deaths annually)oEssential HTN has no identifiable causeInbalance between vasodilative and vasoconstrictive substancesRenin lvl can be abnormalincreased BP and blood volumeLow renninNa sensitive HTN ptsoMalignant HTNSeverely elevated BP > or = to 180/110 w/ evidence of acute organ damageHYPERTENSIVE EMERGENCYHypertensive URGENCYHTN w/o organ damageoDiff Dx (workup ruleouts)Obesitysleep apneadrug induced/relatedCushings24 hour urinary free cortisolCKDPrimary hyperaldosteronismK+ levelPlasma aldosterone and reninrenovascular dzrenal arteriogramUltrasoundMRI angioCoarctation of aortaCXR- rib notchingPheochromocytomaPlasma and 24 hr urine for catecholamineCT scan of adrenal glandsThyroid/parathyroid dzoWorkupHxPhysical examLabsCBC, UA, CMP, TSH, Lipid profileoDiagnosis2 separate readings
No caffeine or nicotine for 30 minutes priorSit for 5 minutes before checkoLifestyle ChangesWeight loss (BMI 18.5-24.9 is goal)DASH diet (fruits and veggies)Low sodium (2.4g/day)30+min per day most days of the week for activityLimit ETOH to less than 2/dayoTreatment RecsGoalsAdults >60150/90Adults <60140/90NONBLACK w or wo DMInitialThiazide diuretic, CCB, ACEI, or ARBBLACK w or wo DMInitial