Table III.
Clinical Vignettesa
| Internal Medicine | Family Medicine | Surgery | Overall | |
|---|---|---|---|---|
| You are called by a nurse at 10 pm with an elevated BP of 182/100 mm Hg in a 74‐y‐old female with known HTN on her home medications who is not in any pain and has no other symptoms other than the cough caused by her pneumonia. How would you respond? | ||||
| Give 20 mg IV labetalol and recheck BP in 1 h. | 10 (14.7) | 1 (5.0) | 0 (0) | 11 (12.2) |
| Give 0.2 mg of oral clonidine and recheck BP in 1 h. | 1 (1.5) | 0 (0) | 0 (0) | 1 (1.1) |
| Do nothing acutely. | 17 (25.0) | 2 (10.0) | 0 (0) | 19 (21.1) |
| Give codeine for her cough. | 40 (58.8) | 17 (85.0) | 2 (100.0) | 59 (65.6) |
| Your 32‐y‐old male patient who was involved in a motor vehicle collision is being discharged today. You notice that he has had persistently, but mildly elevated BPs (140–159/90–100 mm Hg) over the past 3 days prior to discharge that are not clearly related to pain or nausea. He has no primary care physician, and he takes no medications for HTN at home. His kidney function was normal on admission, but he does have trace proteinuria on urinalysis, and ECG showed left ventricular hypertrophy. What actions are you likely to take in response to this elevated BP? | ||||
| 1. No response is necessary. We are not sure these elevated BP measures represent true HTN. | 11 (16.4) | 7 (35.0) | 0 (0) | 18 (20.2) |
| 2. Tell the patient he has stage 1 HTN and note this in his discharge summary. | 17 (25.4) | 4 (20.0) | 0 (0) | 21 (23.6) |
| 3. # 2 above, and tell him to get primary care follow up. | 27 (40.3) | 5 (25.0) | 2 (100) | 34 (38.2) |
| 4. # 3 above, and prescribe a medication for HTN. | 12 (17.9) | 4 (20.0) | 0 (0) | 16 (18.0) |
| You have a 65‐y‐old patient with known HTN, hyperlipidemia, and revascularized coronary artery disease, compensated ischemic cardiomyopathy with an ejection fraction of 30% who is seen after an elective procedure. During the 3 days of hospitalization, systolic BP has ranged from 150 to 170 mm Hg based on nurses’ oscillometric BP measures. Current HTN medications include metoprolol tartrate 25 mg twice a day, lisinopril 40 mg/d, and furosemide 40 mg/d. She is followed for primary care by a family medicine physician in a neighboring town. Which of the following describes what you are most likely to have done if faced with a similar patient in the past year? | ||||
| Continue home medications as the patient is compensated and has good follow‐up care. | 6 (8.8) | 3 (15.0) | 1 (50.0) | 10 (11.1) |
| Switch to metoprolol succinate at a titrated dose that has better “data” for use in patients with heart failure. | 25 (36.8) | 7 (35.0) | 0 (0) | 32 (35.6) |
| Add spironolactone 25 mg daily to the patient’s regimen. | 32 (47.1) | 8 (40.0) | 1 (50.0) | 41 (45.5) |
| Call the primary care physician and ask what they suggest doing. | 5 (7.3) | 2 (10.0) | 0 (0) | 7 (7.8) |
Abbreviations: BP, blood pressure; ECG, electrocardiogram; HTN, hypertension; IV, intravenous. aClinical vignette items were completed at the Medical University of South Carolina and Spartanburg sites only.