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* . A 15-year-old girl is brought to the physician 3
 #605000  
  catchther - 08/08/11 09:23
 
  . 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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* Re:. A 15-year-old girl is brought to the physicia
#2445454
  joeblack - 08/08/11 10:02
 
  it's C) Measure the urine corticosteroid levels  
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* Re:. A 15-year-old girl is brought to the physicia
#2445459
  catchther - 08/08/11 10:10
 
  @joeblack- thank you.. even i thought soo.. cause she is obese,has high bp n h/o infection..  
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* Re:. A 15-year-old girl is brought to the physicia
#2445567
  mikajee - 08/08/11 13:34
 
  sorry i idnt get that, can you plz tell me the diagnosis?
thanks in advance
 
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* Re:. A 15-year-old girl is brought to the physicia
#2445581
  drguirand - 08/08/11 13:54
 
  In any the patient with hypertension particularly young patients, it is necessary to know if it is essential or secundary hypertension; because the treatment varies with the type of hypertension. To differenciate them, doctors have to rule out any secundary cause of hypertension ( renal pathology, cardiac pathology,adrenal pathology,etc). Thus, the most appropriate next step in management is measurement of urine corticosteroid levels to rule out adrenal pathologies.
 
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* Re:. A 15-year-old girl is brought to the physicia
#2445638
  yay - 08/08/11 15:18
 
  c.  
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* Re:. A 15-year-old girl is brought to the physicia
#2445648
  yay - 08/08/11 15:28
 
  I agree with drguirand, except the "essential H/T" bit.. almost ALL cases of H/T in the young are secondary. Essential H/T is common in the elderly group of patients.. when the vessel tones are increased due to aging.  
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* Re:. A 15-year-old girl is brought to the physicia
#2446039
  mikajee - 08/09/11 03:54
 
  thank you drguirand. I get it  
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* Re:. A 15-year-old girl is brought to the physicia
#2446113
  levosimendan - 08/09/11 08:09
 
  I m not so sure about C as the right answer, is true in youngs you have to search for 2 causes, first in list renal and congenital cardiovascular disease.
It just sound wierd, that the lab is perfect no alteration of Glicose Na or K and they don t discribe and partitular finding in the fisical examination, just a fat girl.
Let's not forget that overweight is one of the main causes of HT in older childs.

 
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* Re:. A 15-year-old girl is brought to the physicia
#3388927
  pzh200707 - 06/10/20 08:13
 
  The official answer is A exercise and weight reduction program acc to free 120 Qs sample of 2019  
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* Re:. A 15-year-old girl is brought to the physicia
#3389040
  longway2go - 06/20/20 20:30
 
  Can the answer be B? It can be Pheochromocytoma.  
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