Harvey Hoya iHuman Case Study and Best Guide 2025

Table of Contents

Harvey Hoya iHuman Case Study

Harvey Hoya is a 57-year-old Hispanic male construction worker presenting with elevated blood pressure discovered at a community health fair. The patient reports associated symptoms including morning headaches, fatigue, sleep difficulties, and mild shortness of breath on exertion. He describes his headaches as dull, non-pulsating, non-radiating, 3-4 out of 10, present upon awakening in mornings, lasting approximately 2 hours. Notably, his symptoms are pointing toward obstructive sleep apnea (OSA) with daytime somnolence and morning headaches that may be contributing to his hypertension diagnosis.

In this comprehensive guide, we’ll walk you through how to approach Harvey’s case, from initial cardiovascular assessment through systematic physical examination to the final diagnosis of Essential Hypertension with comorbid Obstructive Sleep Apnea. You’ll learn the key clinical reasoning steps for hypertension evaluation, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this essential primary care case simulation involving cardiovascular and sleep disorder management.

Harvey Hoya iHuman Case Overview (Doorway Information)

Patient Overview: Harvey Hoya is a 57-year-old Hispanic male construction worker who presents with elevated blood pressure, headaches, and symptoms of sleep apnea. He reports elevated BP at community health fair and a nurse instructed him to follow up with primary care provider. He reports a previous provider educated him on HTN and dietary restrictions “years ago”, but he has never sought treatment for his HTN.

Key Background Information:

Age/Gender: 57-year-old Hispanic male
Height/Weight: Overweight status with elevated BMI
Occupation: Construction worker
Chief Complaint: High blood pressure reading at community health fair
Presenting Situation: 57-year-old overweight Hispanic construction worker who presents for evaluation of an elevated blood-pressure reading at a recent local health fair. He reports intermittent mild headaches, and interrupted sleep with snoring
Associated Conditions: Morning headaches, fatigue, sleep difficulties, mild SOB on exertion, 10lb weight gain over last year
Significant History: Father died at 62 from stroke; grandfather died at 52 due to heart attack; family history of diabetes
Current Status: Essential hypertension and sleep apnea requiring intervention
Risk Factors: Male gender, Hispanic ethnicity, smoking, overweight status, family history, construction work stress
Physical Findings: BP 172/94 L and 178/98 R; laterally displaced PMI; and, funduscopic findings of A-V nicking

The patient presents with primary hypertension and obstructive sleep apnea. He is a heavy smoker which leads to acute increase in heart rate and blood pressure and causes malignant hypertension. His presentation with classic symptoms of both conditions requires comprehensive cardiovascular and sleep disorder evaluation and management.

Harvey Hoya (57 y/o Hispanic male) – Adult Cardiovascular Assessment

CC: High blood pressure discovered at community health fair
MSAP: Essential Hypertension with comorbid Obstructive Sleep Apnea – requiring antihypertensive therapy and sleep study evaluation
Associated symptoms: Morning headaches, fatigue, sleep difficulties, mild SOB on exertion, snoring
History: Previous provider warning about hypertension importance years ago, no follow-up care since
High-risk factors: Hispanic male, smoking, overweight, family history of CVD, NSAID use

History Questions

How can I help you today?
What brought you to the clinic today?
Tell me about the blood pressure reading at the health fair?
Have you been told you have high blood pressure before?
Do you currently take any medications for blood pressure?
Tell me about the headaches you’ve been experiencing?
When do these headaches typically occur?
How would you rate the severity of your headaches on a scale of 1-10?
What helps relieve your headaches?
Do you have any problems with fatigue or difficulty sleeping?
Does your wife notice any snoring or breathing interruptions during sleep?
Have you experienced any shortness of breath, especially during work?
Tell me about your work as a construction worker?
Do you use tobacco products? How much and for how long?
What medications do you currently take, including over-the-counter?
Tell me about your family’s health history, especially heart problems?
How is your appetite and have you noticed any weight changes?
Do you have any chest pain or heart palpitations?
Tell me about your typical diet and exercise habits?
Have you had any recent illness or hospitalizations?
Do you have any known allergies to medications?

Physical Exam

Vitals: Blood pressure 172/94 left arm and 178/98 right arm, pulse, respirations, temperature, weight, height, BMI calculation

General appearance: Overweight Hispanic male construction worker, appears stated age, alert and oriented

Cardiovascular Assessment:

Heart rate and rhythm evaluation: Regular heartbeats, normal pulse rate, normal heart sounds on auscultation
Blood pressure assessment: Elevated sitting/lying and orthostatic blood pressure measurements
Point of maximal impulse: Laterally displaced PMI suggesting left ventricular hypertrophy
Heart sounds and murmurs evaluation

Head, Eyes, Ears, Nose, Throat (HEENT):

Fundoscopic examination: Hypertensive retinopathy with AV nicking indicating chronic hypertensive damage
Detailed examination for signs of end-organ damage
Temporal artery palpation and assessment
Assessment for signs of sleep apnea (enlarged uvula, crowded oropharynx)

Respiratory Assessment:

Assessment for signs of pulmonary edema or heart failure
Evaluation of dyspnea and exercise tolerance

Neurological Assessment:

Mental status evaluation
Assessment for signs of stroke or TIA
Headache pattern evaluation

Additional Systems Review:

Renal assessment for secondary hypertension causes
Endocrine evaluation for metabolic causes
Musculoskeletal assessment related to occupation

Assessment Note

H.H. is a 57-year-old overweight Hispanic construction worker who presents for evaluation of an elevated blood-pressure reading at a recent local health fair. He reports intermittent mild headaches, and interrupted sleep with snoring. Physical examination is notable for BP 172/94 L and 178/98 R; laterally displaced PMI; and, funduscopic findings of A-V nicking. His presentation suggests Stage 2 hypertension under JNC-8 Guidelines with recommendation to start pharmacologic treatment and about one half of patients who have essential hypertension have obstructive sleep apnea.

Diagnostic Testing: ECG showing sinus rhythm with left ventricular hypertrophy, CXR showing left ventricular hypertrophy, TTE confirming left ventricular hypertrophy, Polysomnography/sleep study positive for OSA, Normal CBC, Normal CMP, Normal FT4, Normal UA

Diagnosis: Primary Diagnosis: Essential hypertension (I10); Secondary Diagnosis: Sleep Apnea unspecified (G47.30)

Plan:

Initiate combination antihypertensive therapy with ACE inhibitor and thiazide diuretic (lisinopril/hydrochlorothiazide)
Sleep apnea management with lifestyle modifications, CPAP therapy consideration, head-of-bed elevation
Smoking cessation counseling and nicotine replacement therapy education
DASH diet education and sodium restriction counseling
Specialist referrals: Somnologist for sleep apnea, Nutritionist for dietary modifications, Cardiologist for left ventricular hypertrophy

Harvey Hoya SOAP Note

Patient: Harvey Hoya

Subjective Data

CC: “High blood pressure” discovered at community health fair

HPI: 57-year-old Hispanic male who presents to the clinic with complaints of elevated blood pressure. The patient states that a local health professional at a local health clinic was concerned by the elevated blood pressure, and advised him to see a doctor. He admits that he has been informed about his elevated blood pressure before, but has remained uncontrolled. Associated symptoms include intermittent headaches rating 3-4/10, and described as dull. He also reports problems with sleeping due to snoring. He reports constant, mild to moderate fatigue for 6 months and associates it with poor sleep, 10lb weight gain over the last year, and mild SOB upon exertion at work.

Medications: Ibuprofen 800 mg 3 times per day for headaches, omeprazole every morning for gastritis

Allergies: No known drug, food, or environmental allergies reported

PMH: Patient has been diagnosed with gastritis in the past managed with medication. Patient denies any other previous pertinent health history

Family History: Father died at 62 from stroke; mother alive with diabetes; grandmother alive with diabetes; grandfather died at 52 due to heart attack

Social History: Patient smokes a pack of cigarettes a day, history of alcohol occasionally, mostly on weekends. Construction worker. Patient can afford to co-pay for clinic visits and medications

Review of Systems: Reports morning headaches lasting approximately 2 hours, sleep difficulties with snoring, mild dyspnea on exertion, fatigue, denies chest pain, palpitations, or syncope

Objective Data

General: Overweight Hispanic male construction worker in no acute distress, appears stated age

Vital Signs: Blood pressure 172/94 left arm and 178/98 right arm, elevated BMI indicating overweight status

Physical Examination:

Appearance: Alert, oriented, cooperative male in no acute distress
Cardiovascular: Regular heartbeats, normal heart sounds on auscultation, laterally displaced PMI suggesting left ventricular hypertrophy
HEENT: Fundoscopic examination reveals hypertensive retinopathy with AV nicking
Respiratory: Clear to auscultation bilaterally, no signs of pulmonary edema
Neurological: Alert and oriented, no focal neurological deficits
Other Systems: Overweight appearance, normal heart sounds, evidence of heartburn symptoms

Assessment

Primary Diagnosis: Essential Hypertension (I10) – Stage 2 hypertension without identifiable cause

Secondary Diagnosis: Obstructive Sleep Apnea (G47.30) – evidenced by daytime somnolence, morning headaches, and snoring

Secondary Concerns:

Tobacco use disorder contributing to cardiovascular risk
Left ventricular hypertrophy requiring cardiology evaluation
Excessive NSAID use with risk of renal complications
Occupational stress factors from construction work

Differential Diagnoses

Essential Hypertension: Most likely diagnosis given this is primary hypertension without an identifiable cause. Stage 2 hypertension requiring immediate pharmacological intervention. Risk factors include male gender, Hispanic ethnicity, elevated BMI, age, family history of HTN, and smoking, which exclude a preexisting etiology.

Secondary Hypertension: Elevation of blood pressure due to a primary cause such as obstructive sleep apnea, renal parenchymal disease, hyperaldosteronism, renal artery stenosis, Cushing’s syndrome, thyroid disease, pheochromocytoma, coarctation of aorta, and some medications. Although obstructive sleep apnea can be a causative condition for secondary hypertension, it is also a common comorbidity seen with essential HTN.

White Coat Hypertension: Defined as in-office elevated blood pressure in contrast to a normotensive blood pressure in the home setting. Evaluation typically involves 24-hour ambulatory blood pressure monitoring. Less likely given consistent elevated readings at health fair and clinic.

Obstructive Sleep Apnea: Definitive diagnosis supported by polysomnographic results. Episodic breathing pauses related to transient upper airway obstruction occurring during sleep, closely associated with elevated BMI, HTN, and cardiovascular disease. Symptoms include daytime lethargy, morning headaches, snoring, and unrestful sleep.

Medication-Induced Hypertension: Possible consideration given frequent NSAID use. NSAIDs can worsen kidney function and contribute to hypertension.

Most Likely Diagnosis: Essential Hypertension with comorbid Obstructive Sleep Apnea evidenced by Stage 2 hypertension readings, family history, risk factors, and sleep study confirmation of OSA.

Plan

Health Promotion:

✓ Lifestyle Modifications – DASH diet education and moderating foods high in sodium, saturated fats, and added sugar. Additionally, reducing the consumption of fast food

✓ Smoking Cessation – Education on smoking cessation and the further health risks associated with smoking. Additionally, can provide information about the nicotine patch and other nicotine replacement therapies to aid in cessation

✓ Weight Management – Nutritionist referral for hypertension and weight loss diet modifications

✓ Patient Education – Home blood pressure monitoring education and utilizing a blood pressure log to bring to future appointments

Screening:

✓ Cardiovascular Assessment – ECG, CXR, and TTE to evaluate for left ventricular hypertrophy and cardiac function

✓ Laboratory Studies – Complete CBC, CMP, thyroid function tests, and urinalysis to rule out secondary causes ✓ Sleep Study – Polysomnography confirmed positive for OSA requiring specialist evaluation

Interventions:

✓ Antihypertensive Therapy – Combination drug of ACE inhibitor and thiazide diuretic (lisinopril/hydrochlorothiazide 10mg/12.5mg) 1 tablet daily

✓ Sleep Apnea Management – Lifestyle modifications (smoking cessation, weight control), CPAP therapy consideration, head-of-bed elevation

✓ NSAID Counseling – Education on the risk of excessive NSAID use and the risk of ulcers and gastrointestinal bleeding

Long-term Management:

✓ Specialist Referrals – Somnologist for new sleep apnea and possible need for CPAP machine; Nutritionist/Dietitian for hypertension and weight loss diet modifications; Cardiologist due to laterally displaced PMI and left ventricular hypertrophy

✓ Follow-up Plan – Return visit in 2-4 weeks to assess treatment response and medication tolerance

✓ Monitoring – Regular blood pressure checks and sleep apnea compliance monitoring

Complete Step-by-Step Guide to Writing the Harvey Hoya iHuman Case Study

Completing the Harvey Hoya iHuman case requires a systematic approach focused on adult cardiovascular assessment and evidence-based hypertension management. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, review the doorway information and formulate your initial clinical approach.

Key Information to Note:

57-year-old Hispanic male construction worker with elevated blood pressure and sleep symptoms
Stage 2 hypertension requiring pharmacological intervention
Multiple cardiovascular risk factors including smoking, family history, and occupational stress

Initial Clinical Mindset: Approach this case with essential hypertension as your leading consideration while evaluating for secondary causes. Hypertension is the most common condition seen in primary care, affecting approximately 45% of adults, and requires systematic evaluation for end-organ damage and comorbidities.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your hypertension diagnosis. Use the OLDCARTS mnemonic systematically:

Onset: Ask about when hypertension was first noted and recent changes

Key points to elicit: Previous provider warning years ago, no follow-up care since
Target response: Long-standing uncontrolled hypertension with recent health fair discovery

Location: Determine specific symptoms and their locations

Important detail: Morning headaches, shortness of breath location
Critical descriptors: Dull, non-pulsating, non-radiating headaches upon awakening

Duration: How long symptoms have persisted

Essential findings: Headaches lasting approximately 2 hours, years-long history

Character: Detailed description of symptoms and associated findings

Critical descriptors: Morning headaches, fatigue, sleep difficulties, snoring, mild SOB on exertion

Aggravating factors: What makes symptoms worse

Essential findings: Occupational stress from construction work, smoking, poor dietary habits

Relieving factors: What provides symptom relief

Key response: Headache improvement with OTC ibuprofen 800mg

Timing: Pattern of symptom occurrence

Important pattern: Morning headaches upon awakening, increased frequency recently

Severity: Impact on daily function and cardiovascular risk

Typical response: Stage 2 hypertension readings (172/94, 178/98) with end-organ damage

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to cardiovascular and related systems:

Cardiovascular:

Chest pain, palpitations, dyspnea on exertion
Mild SOB upon exertion at work
Orthopnea, paroxysmal nocturnal dyspnea

Neurological:

Headache patterns, severity, timing
Visual changes, weakness, numbness
History of stroke or TIA

Respiratory:

Sleep difficulties, snoring patterns
Witnessed apnea episodes
Daytime somnolence

Constitutional:

Fatigue patterns, weight changes
Sleep quality and patterns
Energy levels throughout day

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

Previous gastritis diagnosis, prior hypertension counseling
Previous cardiovascular evaluations or treatments
Hospitalizations or surgical procedures

Social History:

Construction worker – assess occupational stress and physical demands
Pack-a-day smoker, occasional weekend alcohol use
Dietary habits, exercise patterns
Excessive NSAID use for headaches

Family History:

Father died at 62 from stroke; grandfather died at 52 due to heart attack
Maternal family history of diabetes
Family history significantly contributed to the client’s hypertension risk

Step 5: Physical Examination Strategy

Perform a comprehensive cardiovascular physical examination:

General Assessment:

Expected findings: Overweight Hispanic male construction worker, appears stated age
Critical component: Overall cardiovascular and neurological status assessment

Vital Signs:

Look for: Significantly elevated blood pressure readings, BMI calculation

Cardiovascular Examination:

Regular heartbeats, normal heart sounds, laterally displaced PMI suggesting left ventricular hypertrophy
Assessment for murmurs, gallops, extra heart sounds
Peripheral pulse evaluation

Fundoscopic Examination:

Critical finding: AV nicking indicating hypertensive retinopathy
Assessment for papilledema, hemorrhages, exudates

Step 6: Developing Differential Diagnoses

Propose at least 4-5 appropriate differentials with rationales:

Primary Consideration: Essential Hypertension

Supporting evidence: Stage 2 readings, family history, risk factors, normal diagnostic tests

Secondary Considerations:

Secondary hypertension: Consider sleep apnea as causative factor
White coat hypertension: Less likely given consistent readings
Obstructive sleep apnea: Confirmed by polysomnography
Medication-induced hypertension: Consider NSAID contribution

Step 7: Diagnostic Test Interpretation

Interpret clinical findings to support your diagnosis:

Expected Key Findings:

ECG: sinus rhythm with left ventricular hypertrophy; CXR: left ventricular hypertrophy; TTE: left ventricular hypertrophy
Polysomnography: positive for OSA
Normal CBC, CMP, FT4, UA excluding secondary causes

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Essential Hypertension (I10)

Justification:

Stage 2 hypertension readings (172/94, 178/98)
Strong family history of cardiovascular disease
Multiple risk factors including smoking, obesity, occupational stress
End-organ damage evidenced by LVH and hypertensive retinopathy

MSAP Selection: Choose “Essential Hypertension” as your Most Significant Active Problem, as this represents the primary cardiovascular condition requiring immediate intervention and long-term management.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

Combination antihypertensive therapy with lisinopril/hydrochlorothiazide
Patient education about proper medication use and home blood pressure monitoring

Short-term Management:

Smoking cessation counseling with nicotine replacement therapy
DASH diet education and sodium restriction
Sleep apnea evaluation and CPAP therapy consideration

Long-term Management:

Specialist referrals: Somnologist, Nutritionist, Cardiologist
Regular follow-up every 2-4 weeks initially
Home blood pressure monitoring with log maintenance

Patient Education:

Understanding hypertension as chronic condition requiring lifelong management
Proper medication adherence and potential side effects
Sleep apnea management and CPAP compliance if prescribed
Risk reduction strategies including smoking cessation and dietary modifications

Step 10: Documentation and Submission Tips

Writing Your Summary:

Create a concise 350-word summary explaining your clinical reasoning for hypertension diagnosis
Include how you arrived at the problem list with cardiovascular risk stratification
Cite specific examination findings and diagnostic test results
Use professional cardiovascular terminology

Key Documentation Elements:

Assessment Statement: Brief patient summary with key cardiovascular findings
Clinical Reasoning: Explain diagnostic thought process for essential hypertension with OSA
Evidence-Based Management: Link treatment choices to current hypertension guidelines
Risk Stratification: Address cardiovascular risk factors and prevention strategies

Final Submission Checklist:

✓ Complete cardiovascular history with systematic hypertension assessment
✓ Comprehensive physical examination including detailed cardiovascular evaluation
✓ Appropriate differential diagnoses with hypertension considerations
✓ Correct final diagnosis and MSAP
✓ Evidence-based hypertension management plan
✓ Professional documentation with proper cardiovascular terminology

Harvey Hoya iHuman Case Summary Grading Criteria

The Harvey Hoya iHuman case will evaluate you across several critical domains to ensure comprehensive cardiovascular assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points): You must ask targeted questions about hypertension symptoms, cardiovascular risk factors, and family history to get full credit. Essential questions include: blood pressure awareness and previous treatment, headache patterns and characteristics, sleep disturbances and snoring, family cardiovascular history, smoking and alcohol use. Don’t miss asking about: medication use and effectiveness, dietary habits and sodium intake, occupational stress factors, exercise tolerance and dyspnea. The rubric specifically rewards students who ask about hypertension-specific symptoms and comprehensive cardiovascular risk assessment.

(2) Physical Examination (High Weight): Focus your exam on systematic cardiovascular assessment and hypertension-related findings. Must-do components: comprehensive cardiovascular examination, blood pressure measurement in both arms, fundoscopic examination for retinopathy, assessment for signs of heart failure. Pro tip: The rubric awards points for thorough cardiovascular characterization and systematic assessment – key components that relate directly to hypertension diagnosis and end-organ damage evaluation.

(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 4 appropriate differentials with brief rationales. Expected differentials include: Essential Hypertension, Secondary Hypertension, White Coat Hypertension, and Obstructive Sleep Apnea. Scoring secret: The rubric rewards students who can distinguish between primary and secondary hypertension based on clinical presentation, risk factors, and diagnostic findings.

(4) Final Diagnosis & MSAP: You must correctly identify Essential Hypertension as your Most Significant Active Problem (MSAP). Justification is key – cite the Stage 2 hypertension readings, family history, risk factors, and end-organ damage as supporting evidence.

(5) Management Plan (Heavily Weighted): The rubric expects comprehensive hypertension management including: appropriate antihypertensive therapy selection, lifestyle modification counseling, specialist referrals, and long-term monitoring plans. High-scoring responses mention: combination therapy with ACE inhibitor and thiazide diuretic, home blood pressure monitoring, sleep apnea evaluation, and smoking cessation and dietary counseling.

(6) Patient Communication: Demonstrate appropriate communication for middle-aged adults with cardiovascular conditions. Bonus points for: explaining hypertension in patient-friendly terms, discussing cardiovascular risk reduction strategies, addressing lifestyle modifications, and providing clear medication instructions with monitoring requirements.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Harvey Hoya

Situation: 57-year-old overweight Hispanic construction worker presenting with Stage 2 hypertension discovered at community health fair requiring immediate antihypertensive therapy and comprehensive cardiovascular risk management.

Background: Significant findings include strong family history of cardiovascular disease (father died of stroke at 62, grandfather died of heart attack at 52), heavy smoking history, and occupational stress from construction work. Physical examination notable for severely elevated blood pressure readings (172/94, 178/98), laterally displaced PMI, and fundoscopic findings of AV nicking indicating end-organ damage.

Assessment: Clinical presentation and examination findings strongly support essential hypertension diagnosis with comorbid obstructive sleep apnea. Associated symptoms of morning headaches, daytime fatigue, and snoring patterns confirmed by positive polysomnography.

Primary Diagnosis: Essential Hypertension (I10) with Obstructive Sleep Apnea (G47.30)

Recommendation:

Initiate combination antihypertensive therapy with lisinopril/hydrochlorothiazide for optimal blood pressure control
Sleep apnea management with CPAP therapy evaluation and lifestyle modifications
Comprehensive lifestyle counseling including smoking cessation, DASH diet education, and home blood pressure monitoring
Specialist referrals to somnologist for sleep apnea management, cardiologist for left ventricular hypertrophy evaluation, and nutritionist for dietary modifications
Follow-up in 2-4 weeks for treatment response assessment and medication adjustment

Patient and Family Education Provided: Explained hypertension as chronic condition requiring lifelong management with both pharmacological and non-pharmacological interventions, discussed proper medication adherence and home blood pressure monitoring techniques, emphasized cardiovascular risk reduction through smoking cessation and dietary modifications, provided sleep apnea awareness education, and established clear follow-up plan with return precautions for hypertensive emergency symptoms.

Conclusion

By following this comprehensive approach to the Harvey Hoya case, you’ll demonstrate the cardiovascular assessment skills that iHuman evaluates. Remember, success in hypertension cases requires understanding primary versus secondary hypertension differentiation: gather detailed history about cardiovascular symptoms and risk factors, perform systematic cardiovascular examination with attention to end-organ damage, consider age-appropriate hypertension diagnoses in differential diagnosis, and develop evidence-based management plans with both pharmacological and lifestyle interventions. The key is treating each iHuman simulation as you would a real cardiovascular encounter – be thorough, consider the complexity of hypertension management and comorbidities, and always prioritize evidence-based therapy with comprehensive patient education. With this guide, you’re well-prepared to excel in this essential primary care cardiovascular case simulation.

Frequently Asked Questions

Q1: What is the correct diagnosis for Harvey Hoya’s presentation?

Harvey Hoya’s primary diagnosis is Essential Hypertension (I10) with secondary diagnosis of Obstructive Sleep Apnea (G47.30). The key distinguishing features include Stage 2 hypertension readings (172/94, 178/98), family history of cardiovascular disease, multiple risk factors, and evidence of end-organ damage with left ventricular hypertrophy and hypertensive retinopathy. Students often struggle between essential and secondary hypertension, but remember that although obstructive sleep apnea can be a causative condition for secondary hypertension, it is also a common comorbidity seen with essential HTN.

Q2: What are the critical physical examination components I need to perform to score well?

Essential physical exam elements include comprehensive cardiovascular examination with blood pressure measurement in both arms, cardiac auscultation for murmurs and extra sounds, assessment for displaced PMI, and fundoscopic examination for retinopathy. Key findings include laterally displaced PMI suggesting left ventricular hypertrophy and AV nicking on fundoscopy indicating hypertensive end-organ damage. Many students miss points by inadequately assessing for signs of heart failure or failing to perform thorough fundoscopic examination, which are crucial for staging hypertension severity and determining treatment urgency.

Q3: How do I pass the Harvey Hoya case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough cardiovascular history-taking using systematic questioning about hypertension symptoms, family history, risk factors, and lifestyle factors, complete all recommended cardiovascular exam components, propose appropriate differential diagnoses (including Essential Hypertension, Secondary Hypertension, and Sleep Apnea), and develop a comprehensive evidence-based management plan that includes combination antihypertensive therapy, lifestyle modifications, specialist referrals, and proper follow-up strategies. The key is being systematic and remembering that hypertension cases require evidence-based cardiovascular management principles.

Q4: What management interventions should I include in my treatment plan?

The comprehensive management plan should focus on evidence-based hypertension therapy with combination antihypertensive medication (lisinopril/hydrochlorothiazide) as first-line treatment for Stage 2 hypertension and sleep apnea management with lifestyle modifications and CPAP therapy consideration. Include comprehensive lifestyle modifications with smoking cessation counseling, DASH diet education, home blood pressure monitoring, and weight management strategies. Students often forget to address proper specialist referrals (somnologist, cardiologist, nutritionist) and medication safety education regarding NSAID use and cardiovascular risks, which are crucial components for managing hypertension with comorbidities and can significantly impact your overall score.