USMLE® Step 1 style questions USMLE
A 55-year-old man is brought to the emergency department due to the acute onset of diffuse headache, blurry vision, and nausea that started 2 hours ago. His partner states that the patient has not visited a physician in several years. Medical history is significant for type 2 diabetes mellitus, hypertension and smoking 1 pack of cigarettes daily for 30 years. Temperature is 37.7°C (99.8°F), pulse is 90/min, respirations are 20/min, and blood pressure is 189/130 mmHg. On physical examination, the patient is confused and dyspneic. No neck pain or stiffness is noted. Lung auscultation reveals bilateral crackles without wheezing. Fundoscopic examination reveals bilateral blurring of the optic disc margins. The rest of the physical examination is within normal limits. Which of the following is the most likely diagnosis?
Hypertensive emergency refers to a spike in blood pressure to dangerously high levels, specifically above 180/120 mm Hg, associated with signs of acute end-organ damage. Signs of end-organ damage may include severe headache, blurred vision, nosebleeds, vomiting, cardiac symptoms, hematuria, etc. This is an emergency because it can damage the heart, brain, and other vital organs. Hypertensive emergencies should be treated quickly and carefully to prevent complications including sudden death.