Question

Mr. L, a 48-year-old Aboriginal man with previous history of hypertension. At the screening clinic, his BP was found to be 180/120 mmHg. His familial history is as follows: Father died of stroke at age 60 and mother is alive but has Diabetes type 2. He was also diagnosed with Diabetes Type 2 five years ago and non-compliant with his medications. Smokes one pack of cigarettes a day and drinks a six-pack of beer on weekends. On assessment, he is moderately obese, apical pulse palpable in the fourth intercostal space lateral to midclavicular line, ECG results of left ventricular hypertrophy, Serum creatine level of 141mmol/L, urinalysis: protein 0.3g/L. Questions What risk factors for hypertension do Mr. L. have? What evidence of target-organ damage is present? Explain the significance of the results of the laboratory/diagnostic tests. Based on your assessment identify any collaborative problems.

          Mr. L, a 48-year-old Aboriginal man with previous history of hypertension. At the screening clinic, his BP was found to be 180/120 mmHg. His familial history is as follows: Father died of stroke at age 60 and mother is alive but has Diabetes type 2. He was also diagnosed with Diabetes Type 2 five years ago and non-compliant with his medications. Smokes one pack of cigarettes a day and drinks a six-pack of beer on weekends. On assessment, he is moderately obese, apical pulse palpable in the fourth intercostal space lateral to midclavicular line, ECG results of left ventricular hypertrophy, Serum creatine level of 141mmol/L, urinalysis: protein 0.3g/L. 
Questions
What risk factors for hypertension do Mr. L. have? 
What evidence of target-organ damage is present? 
Explain the significance of the results of the laboratory/diagnostic tests. 
Based on your assessment identify any collaborative problems.

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Added by Alexis M.

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Solved by Expert Bryan Valdivia

05/18/2023

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L. - Age: Being 48 years old places him in an age group where hypertension becomes more prevalent. - Ethnicity: Being Aboriginal can be a risk factor as certain ethnic groups have higher rates of hypertension. - Family History: His father died of a stroke at age Show more…

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Mr. L, a 48-year-old Aboriginal man with previous history of hypertension. At the screening clinic, his BP was found to be 180/120 mmHg. His familial history is as follows: Father died of stroke at age 60 and mother is alive but has Diabetes type 2. He was also diagnosed with Diabetes Type 2 five years ago and non-compliant with his medications. Smokes one pack of cigarettes a day and drinks a six-pack of beer on weekends. On assessment, he is moderately obese, apical pulse palpable in the fourth intercostal space lateral to midclavicular line, ECG results of left ventricular hypertrophy, Serum creatine level of 141mmol/L, urinalysis: protein 0.3g/L. Questions What risk factors for hypertension do Mr. L. have? What evidence of target-organ damage is present? Explain the significance of the results of the laboratory/diagnostic tests. Based on your assessment identify any collaborative problems.

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00:01 Okay, this question says an obese 47 year old male came in for an annual checkup.

00:05 A 47 year old male.

00:08 So we have 47 year old man.

00:13 Okay.

00:16 And it says he's 5 foot 10 inches tall, weighs 250 pounds, smokes two packs of cigarettes a day, and slams down 12 ounces of whiskey a day.

00:26 He's a truck driver and he's on the go a lot.

00:29 He frequently eats at fast food joints.

00:32 On physical examination you'll find high blood pressure or the blood pressure to be 180 over 105.

00:39 His point of maximum impulse is detected in the sixth intercostal space in the anterior axillary line and his phantoscopic examination is normal.

00:48 He has no carotid bruises.

00:49 Please answer the following questions based on the clinical presentation.

00:53 It says what is the most likely diagnosis of this patient? and based on clinical presentation provided, the likely diagnosis for this patient is hypertension.

01:06 Okay.

01:06 The elevated blood pressure here in this case for this patient indicates uncontrolled hypertension.

01:13 Other factors such as obesity, smoking, excessive alcohol consumption, and unhealthy dietary habits contribute to the development of hypertension.

01:21 Okay.

01:22 The presence of an abnormal point of maximum impulse and the absence of other findings suggest that hypertension is likely primary or essential hypertension rather than secondary to another secondary cause or underlying cause.

01:37 Okay.

01:37 So this is the answer for his diagnosis.

01:40 The case is provided an initial diagnostic workup of this patient based on your answer to question number one...

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