Hypertension (OSCE)

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