51 - low blood pressure, 55 Hypertension

Question 1

define shock

Answer 1

Inability of the circulatory system to maintain end-organ perfusion

Question 2

which system monitors signs of shock?

Answer 2

SHEWS

Question 3

few general signs of shock

Answer 3

Hypotension with responsive tachycardia (masked by beta blockers), anuria, disturbed consciousness, thirst, signs of dehydrations, cold skin.

Question 4

4 types of shock

Answer 4

Cardiogenic
Distributional (incl. septic)
Hypovolemic (blood loss)
Obstructive (tamponade, tension pneumothorax)

Question 5

What is addisons?

Answer 5

Primary adrenal insufficiency; adrenal glands do not produce sufficient hormones.
Often autoimmune

Question 6

Sx of addisons?

Answer 6

Abdominal pain, weakness, increased skin pigmentation and weight loss.

Question 7

Dx addisons

Answer 7

ACTH stimulation test

Question 8

Secondary cause of addisons

Answer 8

lack of ACTH

Question 9

Mx addisons

Answer 9

Replace hormones with fludrocortisone and hydrocortisone (with sick day rules)

Question 10

What happens in addisonian crisis? triggers?

Answer 10

Addisonian crises may occur: hypotension, vomiting, lower back pain and LoC.

Triggered by infection, injury, surgery or stress.

Question 11

Mx addisonian crisis?

Answer 11

Give hydrocortisone IM or IV with saline.

Fludrocortisone not needed.

Question 12

Define orthostatic hypotension

Answer 12

Fall systolic 20mmHg and 10 for diastolic

Question 13

Lifestyle factors affecting HTN

Answer 13

Obesity
High salt intake
Smoking
Alcohol
Stress
Birth control

Question 14

Secondary causes of HTN …Name 4

Answer 14

Diabetes, PKD, RAS, renal failure, phaeo, Conn’s syndrome, hyperparathyroidism, hyperthyroidism, Cushing’s, CAH, OSA, scleroderma, neurofibromatosis, cancer, drugs, pregnancy

Question 15

2 things that maintain blood pressure

Answer 15

cardiac output

systemic vascular resistance

Question 16

HTN mx

Answer 16

A: 55+ or Black Carribbean: Amlopidine
A2: ACE inhibitor or ARB if under 55.

B: Combine the two

C: Add thiazide diuretic.

D: Specialist care.

Question 17

How do CCBs work

Answer 17

block entry of calcium into arterial muscle walls, reducing contraction and systemic vascular resistance.

Question 18

Whats seen on CXR / Echo of pulm HTN

Answer 18

CXR shows effusions and oedema.

Echo shows RIGHT heart failure

Question 19

phaeochromocytoma

Sx? Dx? Mx?

Answer 19

Flank pain, tachycardia, hypertension with orthostatic hypotension, anxiety, palpitations, headaches, weight loss, sweating

Diagnose by 24 catecholamine and metanephrine in urine collection. Scan to localise tumour.

Treat with surgical resection

Question 20

What happens in renal artery stenosis ?

Answer 20

Narrowing of renal arteries. Often atherosclerotic. Impedes blood flow to kidney which produces systemic hypertension.

Question 21

How does renal artery stenoiss increase blood pressure further

Answer 21

Reduced blood supply and renal hypoxia promotes renin release which further raises blood pressure.

Question 22

Mx renal artery stenosis

Answer 22

Treat with antihypertensives and diuretics.

Surgery is a last resort.