7-8

Question 1

What is the most important modifiable risk factor for heart disease?

Answer 1

HTN

Question 2

HTN classification:

1. Normal
2. Pre-HTN
3. Stage 1
4. Stage 2.

Answer 2

1. <120/80
2. 120-139/80-89
3. 150-159/90-99
4. > 160/100

Question 3

Complications of HTN:
Left ventricular hypertrophy:
Without coronary artery disease, treat with __

Answer 3

ACEI or ARB

Question 4

JNC8

Recommendation 5:

Answer 4

At least 18 years with diabetes, initiate pharmacologic treatment SBP>140 or DBP>90 and treat to a goal of less than those numbers (grade E)

Question 5

JNC8

Recommendation 7:

Answer 5

In the General black population, include a thiazide diuretics or a CCB (grade B). For those with diabetes this is a weak recommendation (grade C)

Question 6

Side effects of ACEI

Answer 6

Dry cough (due to bradykinin-evoked sensitization of airway sensory nerves)
Angioedema
Hyperkalemia

Question 7

Clinical clues suggestive of secondary HTN

Answer 7

• 3 antihypertensives and BP still not controlled
• Acute rise in BP in pt previously stable
• age <30 and non obese
• malignant or accelerate HTN
• onset before puberty

Question 8

Renal and adrenal causes of secondary HTN:

*What is the most common cause of secondary HTN?

Answer 8

*Renal
-renal artery stenosis
-primary kidney disease
Adrenal
-primary hyperaldosteronism
-pheochromocytoma
-Cushing’s syndrome

Question 9

Classic triad of pheochromocytoma:

Answer 9

Headache
Sweating
Tachycardia (palpitations)

Question 10

Diagnosis of pheochromocytoma

Answer 10

24 hour fractionated catecholamines and metanephrines

Plasma fractionated metanephrines

Question 11

Signs of Cushing’s syndrome

Answer 11

Red facial features

Abdominal striae

Question 12

Diagnosing Cushing’s syndrome:

First line tests:

Answer 12

• first make sure they are not taking too many exogenous glucocorticoids
  1. Late night salivary cortisol (2 measurements)
  2. 24hr urinary free cortisol (UFC-2 measurements)
  3. Low dose dexamethasone suppression test (DST)