Hypotension, Hypertension, Shock

In most cases of shock, circulatory failure is manifested by:

Which of the following best describes cardiogenic shock?

According to the 'Perfusion Triangle', what are the three critical components necessary to maintain adequate perfusion?

A patient presenting with a pulmonary embolism is most likely to experience which type of shock?

Which of the following conditions is NOT typically associated with cardiogenic shock?

In cardiogenic shock, what is the typical response of systemic vascular resistance (SVR)?

Which hemodynamic parameter is typically elevated in cardiogenic shock due to back up pressure in the left atrium?

A patient in shock presents with cool, clammy skin. This finding is most likely due to:

Which of the following is a common laboratory finding in cardiogenic shock, especially if it is caused by acute ischemia?

A patient is diagnosed with cardiogenic shock. Which of the following hemodynamic profiles is most consistent with this condition?

A patient in cardiogenic shock is being considered for mechanical support. Which of the following devices directly assists left ventricular function?

A patient in cardiogenic shock exhibits severe metabolic acidosis with an arterial pH of 7.05. Which of the following interventions might be considered?

A patient is hypotensive with a systolic blood pressure of 80 mmHg. Which represents the threshold for hypotension in shock?

Which of the following best explains why PCWP is elevated in cardiogenic shock?

Which of the following is the most appropriate initial intervention for a patient in cardiogenic shock secondary to acute myocardial infarction?

A patient in cardiogenic shock is receiving norepinephrine for refractory hypotension. Which of the following findings would warrant immediate discontinuation of norepinephrine?

Which of the following statements accurately describes the Frank-Starling mechanism's relevance to cardiogenic shock?

A patient with cardiogenic shock has a pulmonary artery catheter in place. Which set of hemodynamic values is MOST consistent with cardiogenic shock?

Which intervention would be MOST appropriate to improve cardiac output in a patient with cardiogenic shock?

Which of the following best describes a potential consequence of sympathetic overactivity in cardiogenic shock?

What is the primary purpose of inserting an intra-aortic balloon pump (IABP) in a patient with cardiogenic shock?

Which of the following is a typical sign or symptom of cardiogenic shock?

A 68-year-old male presents to the emergency department with acute dyspnea, chest pain, and a history of prior myocardial infarction. His blood pressure is 85/50 mmHg, heart rate is 110 bpm, and oxygen saturation is 88% on room air. Which of the following is the MOST likely underlying cause of this patient's presentation?

A physician is deciding between using dobutamine versus norepinephrine for a patient with cardiogenic shock. What is the MOST important factor that should influence this decision?

Which of the following is an absolute contraindication to the insertion of an intra-aortic balloon pump (IABP) in a patient with cardiogenic shock?

Which of the following is the MINIMUM reduction in systolic blood pressure that defines orthostatic hypotension?

A patient experiences lightheadedness upon standing. After how many minutes of standing should blood pressure be assessed to diagnose orthostatic hypotension?

Which of the following is a common symptom associated with orthostatic hypotension?

What is the underlying pathophysiology of orthostatic hypotension related to sympathetic response?

Which of the following medications is LEAST likely to contribute to orthostatic hypotension?

A patient with Postural Orthostatic Tachycardia Syndrome (POTS) and a heart rate greater than 120 bpm may benefit from which of the following medications?

What is the primary mechanism behind vasovagal syncope?

Which set of circumstances is MOST likely to provoke vasovagal syncope?

Which of the following is a non-pharmacological intervention for orthostatic hypotension?

A patient with recurrent vasovagal syncope despite lifestyle modifications may benefit from which intervention?

Which of the following blood pressure readings is indicative of Stage 1 hypertension?

A patient is diagnosed with elevated blood pressure. Which of the following readings aligns with this diagnosis?

What percentage of hypertensive individuals are estimated to have secondary hypertension?

Which of the following is NOT typically considered a risk factor for essential hypertension?

A 28-year-old patient is newly diagnosed with hypertension. Why is it particularly important to consider secondary causes in this patient?

Which of the following best explains the impact of increased systolic or diastolic blood pressure on cardiovascular risk?

A patient's blood pressure is particularly responsive to changes in sodium intake. This is best described as:

Which of the following is a potential characteristic of glucocorticoid-remediable hypertension?

A patient presents with hypertension and hypokalemia. Further workup reveals suppressed plasma renin activity and low aldosterone levels. Which of the following conditions is most likely?

Which of the following is a known mechanism by which hyperinsulinemia can increase arterial pressure?

A patient with hypertension is suspected of having renal artery stenosis. Which of the following physical exam findings would support this diagnosis?

A patient presents with hypertension, suggesting coarctation of the aorta. Which physical exam findings supports this suspicion?

A patient has recently started taking a medication and subsequently developed hypertension. Which of the following medications is LEAST likely to contribute to this new onset hypertension?

Which of the following target organ damage is LEAST likely to be caused by chronic hypertension?

Which of the following statements regarding symptoms of hypertension (HTN) is most accurate?

Which initial laboratory tests is MOST important to perform in a patient with documented hypertension?

A patient with hypertension has new onset atrial fibrillation. This new finding should prompt the clinician to consider which action?

Ambulatory blood pressure monitoring (ABPM) is MOST useful in which of the following scenarios?

Which of the following is the MOST appropriate initial diagnostic test for a patient suspected of having primary hyperaldosteronism?

A patient with poorly controlled hypertension experiences paroxysmal episodes of headache, sweating, and tachycardia. What condition should be suspected?

Which of the following symptoms is MOST suggestive of secondary hypertension due to primary aldosteronism?

A young female patient is diagnosed with hypertension. A renal ultrasound reveals fibromuscular dysplasia. Which of the following is the MOST likely cause of her hypertension?

Which of the following is a typical finding in secondary hypertension due to coarctation of the aorta?

What are the lifestyle modifications that will have the greatest SBP reduction?

A 55-year-old patient is diagnosed with hypertension and has no other comorbidities. According to the 2017 Hypertension Guidelines, when should pharmacological treatment be initiated?

According to guideline recommendations, what is the target blood pressure for most patients on antihypertensive treatment?

A 62-year-old African American patient with hypertension is started on a thiazide diuretic. What is the rationale for this choice of medication?

Which of the following drug classes is NOT considered as a first-line agent for the treatment of essential hypertension?

In the treatment of hypertension, which drug class would be MOST appropriate for a male patient with concomitant benign prostatic hyperplasia (BPH)?

A patient with hypertension also has a history of heart failure. Which of the following antihypertensive drug classes should be used with caution or avoided?

A patient with hypertension develops a persistent, dry cough after starting an antihypertensive medication. Which of the following medications is most likely responsible?

Which of the following antihypertensive medications is contraindicated in pregnancy?

An elderly patient with hypertension is being treated with multiple antihypertensive medications. Which of the following conditions is MOST important to monitor for in this patient population?

Following the initiation of antihypertensive therapy, how often should serum potassium and creatinine levels be checked?

What is the recommended alcohol intake for patients with hypertension?

A patient presents with a blood pressure of 220/120 mmHg, severe headache, and visual disturbances, but no evidence of end-organ damage. What is the MOST appropriate course of action?

A patient is started on hydrochlorothiazide for hypertension. Which of the following electrolyte abnormalities is MOST likely to occur?

The primary goal in treating a patient with hypertensive encephalopathy is to:

According to current hypertension guidelines, what blood pressure reading is classified as 'Elevated'?

A patient is diagnosed with Stage 2 hypertension. According to the guidelines, which of the following blood pressure readings would confirm this diagnosis?

What is the estimated prevalence of hypertension in African Americans?

Which of the following modifiable risk factors is most closely associated with the development of hypertension?

Which statement best summarizes the long-term impact of essential hypertension on cardiovascular health?

A patient's blood pressure is highly responsive to variations in their daily sodium intake. How would this patient's condition be best described?

In which scenario should a clinician be MOST suspicious of secondary hypertension?

During a physical examination, which finding would be MOST suggestive of secondary hypertension due to renal artery stenosis?

A patient presents with hypertension, muscle weakness, polyuria, and polydipsia. Which of the following conditions should be MOST suspected?

Which of the following physical exam findings is MOST specific for coarctation of the aorta as a cause of hypertension?

A patient with long-standing hypertension is found to have left ventricular hypertrophy (LVH) on an ECG. What is the clinical significance of this finding?

According to the 2017 Hypertension Guidelines, what is the blood pressure target for most patients on antihypertensive treatment?

Which of the following lifestyle modifications is expected to result in the GREATEST reduction in systolic blood pressure?

A 65-year-old patient with a history of hypertension is being evaluated for suspected secondary hypertension. Which of the following historical clues would be MOST indicative of primary aldosteronism?

In managing hypertension, a clinician is considering initiating a thiazide diuretic. In which patient would this medication be MOST appropriate as a first-line agent?

A patient with essential hypertension develops a persistent, dry cough soon after starting treatment. Which antihypertensive medication is MOST likely responsible for this adverse effect?

When treating hypertension in older adults, which condition is MOST important to monitor closely to avoid adverse outcomes?

What is the MOST appropriate initial blood pressure target in a patient presenting with hypertensive encephalopathy?

After initiating antihypertensive therapy, how often should serum potassium and creatinine levels be checked?

According to current guidelines concerning treatment of HTN, what is the target BP for elderly (>70 years) patients?

A 26 year old female presents with hypertension on routine evaluation. Which of the following historical clues is MOST indicative of renal artery stenosis?

A 57 year old male presents to the clinic with hypertension. You begin to suspect Hyperaldosteronism. Which of the following symptoms is MOST suggestive of this condition?

An 18-year-old female is diagnosed with hypertension. A renal ultrasound reveals fibromuscular dysplasia. Which of the following is the MOST likely cause of her hypertension?

A 72 year old male presents to the clinic with hypertension. Which medication is contraindicated due to the patient also having gout?

A patient's blood pressure persistently remains above goal despite adherence to three antihypertensive medications. Which of the following should be the NEXT step in management?

A 45-year-old man with hypertension has been experiencing erectile dysfunction since starting antihypertensive medication therapy six months ago. Which of the following medications is MOST likely contributing to this side effect?

A 60-year-old patient with a history of poorly controlled hypertension presents with a blood pressure of 220/120 mmHg and papilledema on funduscopic examination. He denies any chest pain, shortness of breath, or neurologic deficits. Which of the following is the MOST appropriate initial course of action?

A patient in hypertensive emergency requires a continuous intravenous infusion for blood pressure control. Which of the following agents requires cyanide toxicity monitoring, especially with prolonged use or in patients with renal insufficiency?

A 75-year-old patient with known hypertension presents with dizziness upon standing. Blood pressure readings are 150/80 mmHg supine and 120/65 mmHg standing. What change in drug regimen is most appropriate?

A 50-year-old male with a history of hypertension and benign prostatic hyperplasia (BPH) presents for a routine follow-up. Which of the following antihypertensive medications would be MOST appropriate for treating both conditions concurrently?

A 32-year-old pregnant patient is diagnosed with gestational hypertension. Which of the following antihypertensive medications is generally considered safe for use during pregnancy?

In a patient with hypertension and known renovascular disease, initiation of which antihypertensive drug class requires careful monitoring due to the risk of acute kidney injury?

Which of the following initial diagnostic test is MOST specific for diagnosing the common causes of Cushing's syndrome?

Among the following antihypertensive medications, which one exhibits the LEAST versatility in managing diverse conditions?

A patient with a history of hypertension and end-stage renal disease presents with a BP of 180/110 mmHg which diuretic is the LEAST effective in these patients?

In an elderly hypertensive patient taking diuretics, beta-blockers and ACE-inhibitors, what laboratory finding is the MOST likely precipitant of postural hypotension?

According to the 2017 Hypertension Guidelines, at what blood pressure level should antihypertensive drug therapy be initiated for primary prevention?

What is the on-treatment blood pressure goal for most patients on antihypertensive treatment?

An African American patient with hypertension is started on a thiazide diuretic. What is the rationale for this choice of medication?

What drug class should be used with caution or avoided in a patient with hypertension and a history of heart failure?

A patient develops a persistent, dry cough after starting an antihypertensive medication. Which medication side effect is MOST likely responsible?

Which antihypertensive medications are typically contraindicated in pregnancy?

An elderly patient with hypertension is being treated with multiple antihypertensive medications. What is MOST important to monitor for in this patient population?

A patient is started on hydrochlorothiazide for hypertension. Which electrolyte abnormalities are MOST likely to occur?

What is the primary goal in treating a patient with hypertensive encephalopathy?

During a physical examination for hypertension, which finding would be MOST suggestive of secondary hypertension due to renal artery stenosis?

What historical clue suggests that a 65-year-old patient being evaluated for suspected secondary hypertension may have primary aldosteronism?

What lifestyle modification, will have the greatest impact on reducing systolic blood pressure?

According to the provided information, which of the following best describes how essential hypertension affects cardiovascular risk?

Which of the following signs or symptoms should prompt a high index of suspicion for secondary hypertension?

Which of the following clinical manifestations would be anticipated in a patient with a long history of poorly controlled hypertension?

A patient reports non-compliance, excess salt intake and is found to have resistant hypertension. Given this scenario, what medication class would best address the blood pressure and dietary non-compliance?

A 62-year-old African-American male is seen for his yearly PE. He has no complaints. He denies any current medications or medical problems, but the occupational medicine nurse has taken his BP several times in the past year and told him it was high. He denies any tobacco or alcohol use. His BP is 156/92 today. What is the most likely cause of his elevated BP?

A 24-year-old male seeks medical attention for the recent onset of headaches. The headaches are described as 'pounding' and occur during the day and night. He has had minimal relief with acetaminophen. Review of symptoms is positive only for leg fatigue with exertion. PE is notable for a BP of 185/115 mmHg in the right arm, a HR of 70/min, AV nicking on fundiscopic examination, normal jugular veins and carotid arteries, a pressure-loaded PMI with an apical S4, no abdominal bruits, and reduced pulses in both lower extremities. Additional measurement of BP reveals the following: Right arm 185/115 Left arm 188/113 Right thigh 100/60 Left thigh 102/58. What is the most likely cause of this patient's hypertension?

A 12-year-old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. BP obtained in both arms is elevated. Chest x-ray reveals rib notching. Which of the following is the most likely diagnosis?

A 48-year-old male presents to the emergency department with an alteration in consciousness after cocaine ingestion. On presentation, BP is 254/162, with an O2 sat of 83% on RA PE is notable for depressed consciousness. The patient does not follow commands but purposely withdraws from pain in all extremities. His pupils are equal and reactive. The cardiovascular exam is notable for a hyperdynamic precordium with a loud S4 gallop. There are no murmurs. Crackles are heard diffusely in both lung fields. The CXR is consistent with pulmonary edema. CT scan of the head reveals diffuse cerebral edema without hemorrhage. EKG shows LVH with T-wave inversions in V3 to V6. UA shows 1+ proteinuria with 25 to 50 RBC's/HPF. Creatinine is 2.6 mg/dL. What is the most appropriate management for this patient?

A 46-year-old female is being evaluated for a new-onset HTN that was discovered on screening at her workplace. The patient had several readings revealing systolic and diastolic HTN. Patient is currently on no medications. PE is unremarkable. A complete laboratory evaluation revealed hypokalemia as the only abnormality. Which of the following is the most likely diagnosis for this patient?

A 56-year-old male came to the ER with complaints of palpitations and shortness of breath for 1 week ago. He has a longstanding history of poorly controlled HTN PE reveals an elevated blood pressure of 190/98 mm Hg, elevated JVP, mild hepatomegaly, bilateral pedal edema, and rales at the lung bases. Diagnostic studies reveal concentric LVH without significant valvular abnormalities on echocardiogram. Which of the following drugs is beneficial in the treatment of the patient's condition by virtue of both afterload and preload reduction?

Which type of anti-hypertensive agent is NEVER recommended in pregnancy?

A 58-year-old male presents with chest pain. VS include BP of 210/175, pulse 80, RR 20. Which of the following would you expect to find on PE?

An ambulance transports a patient to your facility from the nursing home with anuria and diminished level of consciousness. Paramedics report a BP of 225/130 mm Hg. Which of the following medications is most appropriate for this patient?

A 66-year-old female with a history of diabetes and hypertension presents for routine evaluation. Since beginning her ACE inhibitor and diuretic therapy her BPs have averaged 138/85 mmHg. Which of the following is the next best step in the management of this patient?

Which of the following antihypertensive drugs is incorrectly matched with the indication for therapy?

While in the clinic, the nurse measures the BP of a 61-year-old male and finds that it is 183/100 mmHg sitting and 190/105 standing. He has a HR of 81/minute, with an irregularly irregular rhythm. Which of the following pathologic findings is most likely to be present:

A 50-year-old construction worker continues to have an elevated BP of 160/95 even after a third agent is added to his antihypertensive regimen. PE is normal, electrolytes are normal, and the patient is taking no over-the-counter medications. The next helpful step for this patient is to:

All the following statements about severe hypertension are true EXCEPT

A 68-year-old man presents with chest pain, dyspnea, hypotension (BP 78/50), elevated JVP, and crackles. Echo shows EF 20%. Swan-Ganz catheter reveals ↓ CO, ↑ PCWP, and ↑ SVR. What is the most likely diagnosis?

Which of the following hemodynamic changes is most characteristic of cardiogenic shock?

A 73-year-old woman is hypotensive (BP 88/58) and develops syncope after standing. Her HR increases from 68 to 94. Which condition does this most likely indicate?

A 60-year-old male has episodic palpitations, sweating, and headaches. BP is 190/115 during episodes. Plasma metanephrines are elevated. What is the most likely diagnosis?

A 58-year-old man presents with blurry vision and BP of 220/130. He is confused and has papilledema on fundoscopy. What is the most appropriate immediate intervention?

A patient presents with refractory hypertension. Exam reveals abdominal bruit. Labs show hypokalemia and elevated renin. Which of the following is the most likely diagnosis?

A 76-year-old woman has a BP of 182/78. Her PP is elevated. Which of the following is the best explanation?

Which of the following antihypertensives is contraindicated in pregnancy?

A 61-year-old male with a history of HTN presents with severe chest pain radiating to his back. BP is 210/120 in both arms. CT shows a Stanford Type B aortic dissection. Which medication should be administered first?

A 74-year-old woman presents with acute mental status changes. BP is 245/130. She has headache, visual disturbances, and confusion. What is the most appropriate next step?

A 66-year-old male is hypotensive after massive upper GI bleed. He is cold, clammy, and tachycardic. Which of the following is most consistent with his hemodynamic profile?

A 68-year-old female presents with repeated fainting episodes. BP falls from 125/80 to 98/65 after 3 minutes of standing. HR goes from 68 → 70 bpm. Which mechanism is most likely?

A 26-year-old female has dizziness and palpitations upon standing. Tilt table test shows HR of 130 bpm with minimal BP drop. What is the diagnosis?

A 35-year-old male faints during blood donation. Witnesses report he was pale and sweating before collapse. He regains consciousness quickly. What's the best diagnosis?

Which of the following is the most appropriate initial BP reduction target in hypertensive emergency?

A 59-year-old male presents with dyspnea, chest pain, and hypotension. His extremities are cold and clammy. Echo shows EF 20%. Swan-Ganz reveals ↑ PCWP, ↓ CO, ↑ SVR. Which drug is appropriate for short-term inotropic support?

A 45-year-old woman presents with BP 185/120 and papilledema. She is admitted to ICU for hypertensive emergency. What's the maximum rate her BP should be lowered?

Which of the following findings is most consistent with distributive shock (e.g., sepsis)?

Which of the following antihypertensives is most appropriate for pregnant patients with hypertensive crisis?

A 70-year-old woman presents with blurry vision and BP 240/130. Fundus exam reveals hemorrhages and papilledema. What is this condition?

A 75-year-old male experiences lightheadedness when standing. BP drops from 132/76 → 106/60. HR remains 72. What does this indicate?

A patient with cardiogenic shock has persistent hypotension despite inotropes. Which device can mechanically improve perfusion and reduce afterload?

Which of the following best describes the pathophysiology of vasovagal syncope?

Which of the following drugs is most likely to cause reflex tachycardia and flushing when used to manage severe hypertension?