Rosh Emergency Medicine Practice Test

Which physical exam finding is most consistent with a diagnosis of hypertensive emergency?

1. Microaneurysms of the retina

2. Pallor

3. Papilledema

4. Portal hypertension

The correct answer is: Papilledema

In the context of hypertensive emergency, papilledema is a key finding during a physical exam that is particularly indicative of increased intracranial pressure secondary to severely elevated blood pressure. Hypertensive emergencies are characterized by a significant rise in blood pressure (often exceeding 180/120 mmHg) accompanied by acute target organ damage. Papilledema suggests that the elevated blood pressure has affected the central nervous system, which can lead to conditions such as hypertensive encephalopathy or intracranial hemorrhage. When papilledema is observed during an eye examination, it is indicative of swelling of the optic disc due to increased pressure in the optic nerve sheath; this is commonly associated with impending damage to the brain or other systemic effects that require immediate intervention. Other findings, although potentially relevant to the overall picture of hypertension or its complications, do not specifically point to acute end-organ damage in the way that papilledema does. For instance, microaneurysms of the retina can indicate chronic hypertension but are not exclusive to acute emergencies. Pallor may be a general sign of shock or inadequate perfusion but is not specifically linked to the hypertensive state. Portal hypertension, while related to systemic vascular issues, pertains to liver conditions and does not signify a