Hypertension

HISTORY_LIST
***** HISTORY OR PRESENT ILLNESS
onset of hypertension
baseline BP
deg. of sustained BP elevation
baseline BUN
baseline creatnine
chest pain
back pain
headaches
dyspnea
orthopnea
dizziness
blurred vision
diplopia
nausea
vomiting
mental status changes
agitation
lethargy
confusion
tremors
palpitations
edema
claudication
nocturia
dysuria
polyuria
hematuria
UTI
hemiparesis
diaphoresis
diarrhea
***** HISTORY
PREVIOUS TESTS
UA
IV pyelogram
SOCIAL HISTORY
smoking
alcohol
caffeine
illicit drugs - cocaine
high salt intake
exercise history
diet pills
FAMILY HISTORY
HTN
renal disease
thyroid cancer
pheochromocytomia
hyperthyroidism
diabetes
obesity

MEDS_LAB_TESTS
***** MEDS
noncompliance with
   antihypertension meds
OTC cold remedies
beta agonist
sympathomimetics eye drops
bronchodilators
topical hemorrhoid treatments
amphetamines
NSAIDS
oral contraceptives
antidepressants
steroids
tricyclics
MAO inhibitors
***** LAB
Electrolytes
BUN
Creatnine
CBC
LFT's
CPK
cholesterol
triglycerides
uric acid
UA with microscopic analysis
***** TESTS
ECG
CXR

REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty in fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
hospitalization
   for psychiatric problems
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia

PHYSICAL_EVAL_1
VITALS
supine BP #1 =
supine Pulse #1 =
supine Heart rate #1 =
supine BP #2 =supine Pulse #2 =
supine Heart rate #2 =
up right BP #1 =
upright Pulse #1 =
upright Heart rate #1 =
up right BP #2 =
upright Pulse #2 =
upright Heart rate #2 =
Temp =
OSLER'S MANEUVER
Inflate cuff above systolic.
   If the radial artery pulse
   remains palpable, true BP
   (poss. pseudohypertension
   due to hardened arteries)
GENERAL
agitation
lethargy
confusion
tremors
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethroa
neurofibromatosis lesions
HEENT
hypertensive retinopathy
arteriolar narrowing & thickening
flame shaped retinal hemorrhages 
dot and blot hemorrhages
exudates
cotton wood spots
sausage linking
   (focal constrictions)
A-V nicking
A-V ratio < 2:1
papilledema
loss of venous pulsation
extraocular movements
Cushingoid face (moon face)
NECK
JVD
carotid wave form
carotid pulse
carotid bruits

PHYSICAL_EVAL_2
CHEST
crackles
wheezes
effusions
enlarged intercostal arteries
intercostal bruits
HEART
rhythm
laterally displaced, sustained
 or forceful apical impulse
impulse prolonged 
 (half of systole)
ventricle lift in
  L lateral position
narrow split of S2
  with 1 aortic component
aortic ejection click
systolic ejection murmur
ABDOMEN
renal bruits
aortic enlargement
aortic pulsation
hepatomegaly
renal mass
enlarged kidney
costrovertebral
   angle tenderness
truncal obesity
GU
ambiguous genitalia
occult blood
EXTREMITIES
pitting edema
non-pitting edema
extent of edema
varicose veins
erythema
skin warm to the touch
mottled brown discoloration
   of ankles
increased circumference
tenderness
Homan's sign
pulses
cyanosis
clubbing
needle marks
sclerotic veins
scars
decreased peripheral pulses
asymmetric, delayed femoral
   to radial pulse
simultaneous palpation of
   femoral and brachial pulses
femoral bruits
elevated pallor
dependent rubor
skin atrophy
tremor
NEURO
rapid return phase of DTR's
localized weakness
cranial nerve palsies
visual acuity
clonus

DIFF_DIAGNOSIS
Essential HTN
Renal stenosis
Renal disease
Medication induced HTN
Sodium over indulgence
Aortic coartation
Hyperaldosteronism
Oral contraceptives
Cushing's disease
Hyperthyroidism
Adrenogential syndrome
Pheochromocytoma
Preeclampsia of pregnancy

