A 37-year-old man has headache and transient visual loss. He has not seen a physician in more than 10 years and takes no medication. He was told many years ago that he had high blood pressure but did not follow up with a health care provider. Initial physical examination shows him to be awake but slightly confused and irritable. He is afebrile, HR is 72 /min, and BP Is 268/176 mmHg, Fundoscopy exam reveals arteriovenous crossing changes and several hemorrhages, but no papilledema. Cardiac examination shows an S4 gallop; the lungs are clear. There is no peripheral edema. Which of the following is the best treatment option for this patient?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: B. Nitroprusside, intravenously
BP 268/176 with confusion (hypertensive encephalopathy) and retinal haemorrhages = hypertensive emergency → ICU and IV therapy such as nitroprusside, lowering MAP by no more than ~25% in the first hour. Oral regimens (oral labetalol, oral nifedipine + furosemide) are for hypertensive urgency, and sublingual nifedipine causes uncontrolled BP drops.
ليش كل خيار صح أو غلط
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A
ليش غلط
Hypertensive emergency (end-organ damage, here encephalopathy) is treated with IV medications; sublingual nifedipine is not among the listed agents (esmolol, nitroprusside, labetalol, nitroglycerin).
✓ Step Up To Medicine 6th(Aortic dissection ).pdf · p. 1 -
B
ليش صح
With hypertensive encephalopathy, IV agents such as esmolol, nitroprusside, labetalol or nitroglycerin are appropriate.
✓ Step Up To Medicine 6th(Aortic dissection ).pdf · p. 1 -
C
ليش غلط
Oral agents are for hypertensive urgency (no end-organ damage); this patient has confusion and visual loss, so he has an emergency needing IV treatment.
✓ Step Up To Medicine 6th(Aortic dissection ).pdf · p. 1 -
D
ليش غلط
Labetalol is appropriate in emergencies when given IV; oral agents are for hypertensive urgencies, where BP is lowered within 24 hours.
✓ Step Up To Medicine 6th(Aortic dissection ).pdf · p. 1
- المصدر
- Step Up To Medicine 6th(Aortic dissection ).pdf · p. 1
CARDIOLOGY-HTN.pdf · p. 12 - المحاضرة
- Hypertensive Crisis & Aortic Dissection · Cardiology · Module B
- ظهر في
- Cardio bank