A 32-year-old woman comes to the office for a regular follow-up. She was diagnosed with type 2 diabetes mellitus 4 years ago. Her last blood test showed a fasting blood glucose level of 6.6 mmol/L (118.9 mg/dL) and HbA1c of 5.1%. No other significant past medical history. Current medications are metformin and a daily multivitamin. No significant family history. The physician wants to take her blood pressure measurements, but the patient states that she measures it every day in the morning and in the evening and even shows him a blood pressure diary with all the measurements being within normal limits. Which of the following statements is correct?
AThe physician has to measure the patient’s blood pressure because it is a standard of care for any person with diabetes mellitus who presents for a check-up.
BAssessment of blood pressure only needs to be done at the initial visit; it is not necessary to measure blood pressure in this patient at any follow-up appointments.
CThe physician should not measure the blood pressure in this patient and should simply make a note in a record showing the results from the patient’s diary.
DThe physician should not measure the blood pressure in this patient because she does not have hypertension or risk factors for hypertension.
EThe physician should not measure the blood pressure in this patient because the local standards of care in the physician's office differ from the national standards of care so measurements of this patient's blood pressure cannot be compared to diabetes care guidelines.
A 49-year-old man is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case?
AAmlodipine
BHydrochlorothiazide (HCT)
CEnalapril
DSpironolactone
EPropranolol
A 32-year-old man presents with hypertension that has been difficult to control with medications. His symptoms include fatigue, frequent waking at night for voiding, and pins and needles in the legs. His symptoms started 2 years ago. Family history is positive for hypertension in his mother. His blood pressure is 160/100 mm Hg in the right arm and 165/107 mm Hg in the left arm, pulse is 85/min, and temperature is 36.5°C (97.7°F). Physical examination reveals global hyporeflexia and muscular weakness. Lab studies are shown: Serum sodium 147 mEq/L Serum creatinine 0.7 mg/dL Serum potassium 2.3 mEq/L Serum bicarbonate 34 mEq/L Plasma renin activity low Which of the following is the most likely diagnosis?
ARenal artery stenosis
BCoarctation of aorta
CCushing syndrome
DPrimary aldosteronism
EEssential hypertension
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