nadiabarati
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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
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| doc_clotaire
Forum Guru
Topics: 159
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A ) Exercise and weight reduction program
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| smal
Forum Guru
Topics: 140
Posts: 727
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2 possiblities-
1.obesity
2.GN induced ht-but its only happened once.
would go for A.
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| ram3
Forum Guru
Topics: 47
Posts: 510
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By definition she has hypertension I go for Hydrochlorothiazide therapy
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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It sounds that this Hypertension is due to obesity. And the TX is same as in adult.
I agree with A, that should be done and followed for 6 mo. and if HTN persist, it should start with treatment. But, also need to do renal angiography to rule out the most common cause of HTN in these ages.
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| dr in trouble
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Topics: 60
Posts: 592
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it seems A
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| shadi21681
Forum Newbie
Topics: 0
Posts: 1
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the fist line treatment of HTN (not malignant ofcourse) would be to try weight reduction and excersize. Medications are THEN used, thiazides are probably the most appropriate in this case, but not the answer. A is correct.
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| young_doc
Forum Guru
Topics: 55
Posts: 732
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i'm just thinking though, should we assume the HTN here is primary/essential?? Perhaps it's best to r/o other causes of HTN here... like cortisol.
I mean i agree that obesity is a RF for HTN, but at this young of an age? There is an epidemic of overweight kids these days in the US, but they don't all have HTN..
I'd measure cortisol levels first... and THEN put her on a diet & exercise program.
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| sandra
Forum Guru
Topics: 200
Posts: 468
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is she kinda on the obese side? cushing's ? ...urine cortisol?
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| khorshid
Forum Guru
Topics: 32
Posts: 591
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what about the fact that the rest of exam is completely NL? If it was cortisol, shouldn't she have other signs and symptoms after a year? I think in that case they would have given us a clue somewhere.
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| young_doc
Forum Guru
Topics: 55
Posts: 732
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I'm not sure how long it would take to see other signs/symptoms of Cortisol excess.. but i can tell you that i would NOT want to miss a secondary cause of overweight + HTN in a kid!!
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