Physical Exam Key Points

1. Vital signs. BP must be taken with a cuff that covers 80% of patient's upper arm. Obtain measurements in both arms and, preferably, in legs. Feel for femoral pulses.

2. Eyes. Diagnosis of hypertensive encephalopathy largely depends on presence of papilledema. Evaluate fundus for hemorrhage, exudate, arteriolar narrowing, and arteriovenous nicking.

3. Lungs. Rales occur with congestive heart failure in hypertensive emergency.

4. Heart. Listen for murmur of aortic regurgitation or gallop rhythm due to congestive heart failure.

5. Abdomen. Palpate for masses and enlarged kidneys (large hydronephrosis, polycystic or multicystic kidneys, Wilms tumor).

6. Neurologic exam. Evaluate mental status; look for focal deficit. Disorientation and somnolence are ominous signs of hypertensive encephalopathy.

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