CHS Diagnosis and Evaluation 2 — Questions and Answers
Question 1: A patient has BP readings of 148/92 mmHg on three separate clinic visits over 4 weeks. According to ACC/AHA 2017 guidelines, how is this classified?
- Stage 1 hypertension
- Stage 2 hypertension (Correct answer)
- Elevated blood pressure
- Hypertensive urgency
Correct answer: Stage 2 hypertension
Stage 2 hypertension is defined as systolic ≥140 mmHg or diastolic ≥90 mmHg on confirmed readings.
Question 2: Which ambulatory blood pressure monitoring (ABPM) threshold best defines daytime hypertension?
- ≥130/80 mmHg
- ≥135/85 mmHg (Correct answer)
- ≥140/90 mmHg
- ≥125/75 mmHg
Correct answer: ≥135/85 mmHg
Daytime (awake) ABPM hypertension threshold is ≥135/85 mmHg, which is lower than office BP thresholds.
Question 3: A 45-year-old presents with episodic headaches, diaphoresis, and palpitations. BP is 182/104 mmHg during symptoms. Which secondary cause should be ruled out first?
- Primary aldosteronism
- Pheochromocytoma (Correct answer)
- Renovascular hypertension
- Cushing syndrome
Correct answer: Pheochromocytoma
The triad of episodic headache, diaphoresis, and palpitations is classic for pheochromocytoma, a catecholamine-secreting tumor.
Question 4: When measuring clinic blood pressure, how long should the patient rest in a seated position before the first measurement?
- 1 minute
- 3 minutes
- 5 minutes (Correct answer)
- 10 minutes
Correct answer: 5 minutes
Guidelines recommend at least 5 minutes of quiet rest before BP measurement to minimize physiological reactivity.
Question 5: Home blood pressure monitoring (HBPM) average consistent with hypertension is:
- ≥130/80 mmHg
- ≥135/85 mmHg (Correct answer)
- ≥140/90 mmHg
- ≥125/75 mmHg
Correct answer: ≥135/85 mmHg
A home BP average ≥135/85 mmHg corresponds to hypertension, analogous to the ABPM daytime threshold.
Question 6: A 58-year-old woman has office BP of 158/96 mmHg but normal ABPM (average 122/78 mmHg). This pattern is best described as:
- Masked hypertension
- White-coat hypertension (Correct answer)
- Sustained hypertension
- Nocturnal hypertension
Correct answer: White-coat hypertension
White-coat hypertension is characterized by elevated office BP with normal out-of-office (ABPM or home) readings.
Question 7: Which finding on fundoscopic examination indicates hypertensive urgency or emergency?
- Arteriovenous nicking
- Copper wiring
- Flame-shaped hemorrhages and papilledema (Correct answer)
- Silver wiring
Correct answer: Flame-shaped hemorrhages and papilledema
Flame-shaped hemorrhages and papilledema represent grade III–IV hypertensive retinopathy and indicate severe end-organ damage.
CHS Diagnosis and Evaluation 2
A patient has BP readings of 148/92 mmHg on three separate clinic visits over 4 weeks.
According to ACC/AHA 2017 guidelines, how is this classified?