Hypertension HISTORY_LIST 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 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) PHYSICAL_EVAL_2 NECK JVD carotid wave form carotid pulse carotid bruits 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