Question of the Week # 70

Q70) A 40-year-old man presents to your office for regular follow up. He has history of  hypertension  for which he has been on Hydrochlorthiazide and Lisinopril. Lately, his blood pressure has not been well controlled and this has been documented both in the office and outside during several visits. The patient says he has had increasing fatigue and irritability over the last few months and has difficulty concentrating at work. He  thinks his boss has never been supportive and he attributes his irritability to this. He has smoked 2 packs of cigarettes per day for the past 15 years. On physical examination he is a obese male with a neck circumference of 18 inches. He has a ruddy complexion. His vitals reveal a HR of 90 and a BP of 152/92.  Reminder of the physical exam is normal. EKG reveal changes consistent with long standing hypertension. A CBC, electrolyes and creatinine are normal. Which of the following is the most important investigation that can identify the cause of  his uncontrolled hypertension?

( A ) Ambulatory blood pressure monitoring

( B ) Pulmonary function studies

( C ) Polysomnography

( D ) Arterial blood gases

(E)  Urine drug screen

13 Responses

  1. a

  2. C b/c he’s fat, fatigued, irritable
    E second choice, cocaine

  3. obstuctive sleep apnea can cause pulmonary hypertension
    sleep study can be helpful

  4. C

  5. cccc

  6. C

  7. c

  8. why c?

  9. eee
    most common cause is that the patient do not follow thrapy

  10. I guess the neck circumference was meant to be in inches and not in cm, as a neck circumference greater than 16 inches in a woman or greater than 17 inches in a man correlates with an increased risk for obstructive sleep apnea.

  11. Why not ABG to differentiate OSA from Obesity Hypoventilation syndrome. thank you

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