NBME 2: 15-year-old girl is brought - khushigrover - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: NBME 2: 15-year-old girl is brought - khushigrover (/showthread.php?tid=246222) |
NBME 2: 15-year-old girl is brought - khushigrover - ArchivalUser - 11-25-2007 2. A 15-year-old girl is brought to the physician 3 months after she had a blood pressure of 150/95 mm Hg at a routine examination prior to participation in school sports. She is asymptomatic and has no history of serious illness. Twelve months ago, she was diagnosed with a urinary tract infection and treated with oral trimethoprim-sulfamethoxazole. She currently takes no medications. Subsequent blood pressure measurements on three separate occasions since the last visit have been: 155/94 mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the 50th percentile for height and 95th percentile for weight. Her blood pressure today is 150/90 mm Hg confirmed by a second measurement, pulse is 80/min, and respirations are 12/min. Examination shows no other abnormalities. Her hematocrit is 40%. Urinalysis is within normal limits. Cardiac and renal ultrasonography shows no abnormalities. Which of the following is the most appropriate next step in management? A ) Exercise and weight reduction program B ) Measurement of urine catecholamine levels C ) Measurement of urine corticosteroid levels D ) Captopril therapy E ) Hydrochlorothiazide therapy CAN anybody plz explain this......... 0 - ArchivalUser - 11-25-2007 why a 14 Y/O has high BP????? the next step in managements would be AAA???? we have rule out ALL the posibilities..so i would go for AAAAA, cause this girl is otherwise asyntomatic, her only issue is obesity and i think that the antecedent of previous UTI is a distractor in the question, happen 1 year ago and was succesfull treated 0 - ArchivalUser - 11-25-2007 I agree that UTI is a distractor , but I wouldn't start treatment yet. we need to find out why she has High BP . I think B looking fopr a Pheochromocytoma? 0 - ArchivalUser - 11-25-2007 I would go for D The most common cause of increased blood pressure in a child is renal. This child had UTI 1 year ago. Each episode of UTI puts kidneys at increased risk of scarring.In practice, if renal ultrasound is negative and the blood presssure is high, we should do DMSA scan to see any scarring of the kidneys and also doppler to r/o renal artery stenosis. But as those tests are not given in choices , we should always treat this child's HTN . The most frequently used medication is Captopril/ ENALAPRIL Just obesity on 95th centile is very unlikely to cause persistent HTN and moreover, we should treat it to prevent end organ damage. other comments welcome 0 - ArchivalUser - 11-25-2007 ok-- elisue but tell me what signs of phechromocytoma this patient has????? the blood pressure even is high it is not as higher as in pheochromosytoma,, so I am 100% agree with you and then also could be CCC she is obese so she could have coushing syndrome, obese and hypertensive....but my point is thar this patient is ASYNTOMATIC she has no any symtoms that make us think in BBB or CCCC 0 - ArchivalUser - 11-25-2007 I wud go with C.....before labelling a ptt essentialy hypertensive...rule out sec causes....cushings cud present with obesity 0 - ArchivalUser - 11-25-2007 Hi, It's really interesting question. If we have to choose between B and C, C is the better option I think as Cushings syndrome can present with Obesity and HTN or she could be using steroids for the sports camp(!!!) I hope someone will come with more convincing explanation!! 0 - ArchivalUser - 11-25-2007 A. 0 - ArchivalUser - 11-25-2007 hi darkhorse whats up?? cud u pls explain.. 0 - ArchivalUser - 11-25-2007 hi ronaldo....nice to see u....have u finished all ur steps....? |