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GLNLkAL DA1A
1hls ls a case of paLlenL LM 32 y/o female slngle fllplno caLhollc resldlng aL MakaLl clLy admlLLlng aL
Lhe uPSu on augusL 192011 439 pm wlLh Lhe ch|ef comp|a|n of LLLVA1LD 8
nIS1Ck CI kLSLN1 ILLNLSS
3 uays prlor of admlsslon paLlenL had elevaLed 8 wlLh nape paln no headache no oLher
assoclaLed slgn sympLom no medlcaLlon Laken no consulLaLlon done
2 uays prlor Lo admlsslon paLlenL had perslsLence of 8 consulL Lo a prlvaLe Mu and she was
dlagnosed wlLh Pn glven AMLCDIINL 3mg once a day(+) nape paln
ew hours prlor Lo consulLaLlon perslsLence of above slgn and sympLom Lhen consulL Lo L8
hence admlsslon
AS1 MLDICAL nIS1Ck
un8LMA8kA8LL
IAMIL nIS1Ck
(+) uM 8oLh parenLs
(+) Pn 8oLh parenLs
(+) 8A Slbllngs
LkSCNAL AND SCCIAL nIS1Ck
aLlenL ls (+) Smoker ( 1 pack /day) and non alcohollc behaverage drlnker
kLVILW CI SS1LM
Constitutional: (-) Iever,chills,wt.loss and Iatigue
Skin: (-) rashes or lesions
Eyes: (-) acuity changes, glasses
ENT: (-) hearing loss,sore throat,discharge
Cardiovascular: (-) palpitations,chestpain
Respiratory: (-) shortness oI breath,cough, sputum () Nape pain
GI: (- ) nauses,vomiting ,(-) Diarrhea,(-) hypogastric pain
Genitourinary: (-) dysuria,Irequency,urgency,nocturia
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Musculoskeletal: (-) muscle pain or joint pain Patient was conscious ,coherent , ambulatory and
oriented to time and not in respiratory distress.
PHYSICAL EXAMINATION
Vital signs

P P:140/90
P R:70
P RR:18
P Temp : 36.5 c
P GCS: 15 ( E 4, V 5, M 6)

Skin:Good skin turgor,warmth to touch
EENT: Atraumatic,symmetrical,normal hair distribution,no mass and no lessions, pink palpable
conjunctiva, anicteric sclera.(-) CLAD
CEST AND LUNGS:symmetrical chest expansion,clear braeth sounds,no wheezes or crackles,(-)
retractions
EART:Adynamic precordium,NRRR , no murmur
ADOMEN: Ilabby, soIt and nontender , (-) lesions
EXTRIMITIES:Iull and equal pulses ,(-) cyanosis,(-) edema
ADMITTING IMPRESSION
nN II UNCCN1kCLLLD
CCUkSL IN 1nL WAkD
upon adm|ss|on requested for Chest xray12 |ead LCG C8CUr|na|ys|s 8UN CkLA k NA
SG1I8S LIID kCIILL AND UkIC ACID
1nLkALU1ICS Am|od|p|ne Smg ]tab CD
DIL1 |ow sa|t |ow fat
P 8eaveled resulL 8un 36 C8LA1lnlnL 67 C1ASluM 41 SCuluM 137 MMCL/Ll18L 88C
444PC1 C40 Pgb133 W8C 73SLC C60 LCSlnC CC3 L?MP C29 C 372 ChesL xray
revealed normal resulL LCC revealed lM ulffuse 1 wave abnormallLy may be suggesLlng
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lschemla ulLrasound lM normal slzed faLLy llver normal sonographlc sLudy of
gallbladder pancreas and spleen
Cn 1
sL
hosplLal day
P caLapress 73 mg /Lab (SL) lf 8 160/100
P norgeslc forLe for paln every 8 hours
P MonlLor vl1AL SlCn lnpuL / ouLpuL sLrlcLly
P WC Pn uC8
Cn 2
nd
hosplLal day
P Schedule for Lreadmllk LesL Loday
P 1 W/ Anu W/C bronchodlalaLor Lomorrow
P ConL amlodlplne
P or 2u echo wlLh uoppler Loday
Cn 3 rd hosplLal day
aLlenL was unremarkable and opLed Lo go home dlscharge lnsLrucLlon and medlcaLlon were
glven
IINAL DIAGNCSIS Pn 1?L 2 CCn18CLLLu
DIIILkLN1IAL DIAGNCSIS

nypertens|on (n1N) or h|gh b|ood pressure ls a cardlac chronlc medlcal condlLlon ln whlch Lhe
sysLemlc arLerlal blood pressure ls elevaLed WhaL LhaL means ls LhaL your hearL ls havlng Lo
work harder Lhan lL should Lo pump Lhe blood around your body 8lood pressure lnvolves Lwo
measuremenLs sysLollc and dlasLollc normal blood pressure ls 120/80 mm/Pg
PyperLenslon may be classlfled as essenLlal or secondary LssenLlal hyperLenslon ls Lhe Lerm for
hlgh blood pressure wlLh unknown cause lL accounLs for abouL 93 of cases Secondary
hyperLenslon ls Lhe Lerm for hlgh blood pressure wlLh a known dlrecL cause such as kldney
dlsease Lumors or blrLh conLrol pllls erslsLenL hyperLenslon ls one of Lhe rlsk facLors for
sLroke myocardlal lnfarcLlon hearL fallure and arLerlal aneurysm and ls a leadlng cause of
chronlc kldney fallure ModeraLe elevaLlon of arLerlal blood pressure leads Lo shorLened llfe
expecLancy uleLary and llfesLyle changes can lmprove blood pressure conLrol and decrease Lhe
rlsk of assoclaLed healLh compllcaLlons alLhough drug LreaLmenL may prove necessary ln
paLlenLs for whom llfesLyle changes prove lneffecLlve or lnsufflclenL
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CLASSllCA1lCn
8lood pressure ls usually classlfled based on Lhe sysLollc and dlasLollc blood pressures SysLollc
blood pressure ls Lhe blood pressure ln vessels durlng a hearL beaL ulasLollc blood pressure ls
Lhe pressure beLween hearLbeaLs A sysLollc or Lhe dlasLollc blood pressure measuremenL hlgher
Lhan Lhe accepLed normal values for Lhe age of Lhe lndlvldual ls classlfled as prehyperLenslon or
hyperLenslon
ypertension has several sub-classiIications, including hypertension stage I, hypertension stage
II, and isolated systolic hypertension. Isolated systolic hypertension reIers to elevated systolic
pressure with normal diastolic pressure and is common in the elderly. These classiIications are
made aIter averaging a patient's resting blood pressure readings taken on two or more oIIice
visits. Individuals older than 50 years are classiIied as having hypertension iI their blood
pressure is consistently at least 140 mmg systolic or 90 mmg diastolic. Patients with blood
pressures higher than 130/80 mmg with concomitant presence oI diabetes mellitus or kidney
disease require Iurther treatment.
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ypertension is also classiIied as resistant iI medications do not reduce blood pressure to normal
levels.
Causes oI hypertension
Essential hypertension
Essential hypertension is the most prevalent hypertension type, aIIecting 9095 oI
hypertensive patient
.
Although no direct cause has been identiIied, there are many Iactors such as
sedentary liIestyle smoking, stress, visceral obesity, potassium deIiciency (hypokalemia)
,
obesity

(more than 85 oI cases occur in those with a body mass index greater than 25),

salt (sodium)
sensitivity, alcohol intake, and vitamin D deIiciency that increase the risk oI developing
hypertension.
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Risk also increases with aging,

some inherited genetic mutations

and having
a Iamily history oI hypertension. An elevated level oI renin, a hormone secreted by the kidney, is
another risk Iactor, as is sympathetic nervous system overactivity ,
|
Insulin resistance, which is a
component oI syndrome X (or the metabolic syndrome), is also thought to contribute to
hypertension

,Recent studies have implicated low birth weight as a risk Iactor Ior adult essential
hypertension.
Secondary hypertension
Secondary hypertension by deIinition results Irom an identiIiable cause. This type is important to
recognize since it's treated diIIerently to essential hypertension, by treating the underlying cause
oI the elevated blood pressure. ypertension results in the compromise or imbalance oI the
pathophysiological mechanisms, such as the hormone-regulating endocrine system, that regulate
blood plasma volume and heart Iunction. Many conditions cause hypertension. Some are
common, well-recognized secondary causes such as renovascular hypertension and Cushing's
syndrome, which is a condition where the adrenal glands overproduce the hormone
cortisol.ypertension is also caused by other conditions that cause hormone changes, such as
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hyperthyroidism, hypothyroidism (citation needed), and certain tumors oI the adrenal medulla
(e.g., pheochromocytoma). Other common causes oI secondary hypertension include kidney
disease, obesity/metabolic disorder, pre-eclampsia during pregnancy, the congenital deIect
known as coarctation oI the aorta, and certain prescription and illegal drugs.