A case of severe hypertension

Question 1

List the causes of hypertension.

Answer 1

Essential.
Phaeochromocytoma.
Cushings.
Conn's.
Acromegaly.
Renal artery stenosis..
Co-arctation of the aorta.

Question 2

What is the management plan for phaechromocytoma?

Answer 2

Rehydrate if dehydrated.
Alpha blockade.
Beta blockade.
Localise the lesion.
Surgery (laparoscopic adrenalectomy).

Question 3

Case: 45y/o bank executive, BMI 31.5, unfit and wants to join a gym, smokes 30/day, BP 200/120, alcohol 1 glass wine daily, nil drugs.
Is this man 
a) normal BMI
b) overweight
c) obese
d) severe obesity 
e) morbid obesity?

Answer 3

Obese.

Question 4

Case: 45y/o bank executive, BMI 31.5, unfit and wants to join a gym, smokes 30/day, BP 200/120, alcohol 1 glass wine daily, nil drugs.
What would you advise his PT at the gym?
a) encourage regular exercise
b) ban him from doing any exercise at all and recommend rest and repeat of his BP
c) advise him to see his GP before allowing him to exercise at the gym
d) refer him to casualty for BP control.

Answer 4

Encourage regular exercise.

Should subsequently see GP for BP control.

Question 5

What do you see on fundoscopy of grade 1 hypertension?

Answer 5

Silver wiring.

Question 6

What do you see on fundoscopy of grade 2 hypertension?

Answer 6

Silver wiring.

AV nipping.

Question 7

What do you see on fundoscopy of grade 3 hypertension?

Answer 7

Silver wiring.
AV nipping.
Flame haemorrhage.

Question 8

What do you see on fundoscopy of grade 4 hypertension?

Answer 8

Silver wiring.
AV nipping. 
Flame haemorrhage.
Papilloedema.
Cotton wool spots and hard exudates.

Question 9

What does hypertensive retinopathy suggest?

Answer 9

Hypertension is severe and prolonged.

Question 10

Case: 
renin 0.4units (1.1-4.5).
aldosterone 1600nmol/L (100-450).
24hr urine for catecholamines normal.
Patient did not look Cushingoid or Acromegaloid.
What is the cause of this patient's hypertension?
a) essential hypertension
b) renal artery stenosis
c) Cushing's syndrome
d) phaeochromocytoma
e) Conn's syndrome.

Answer 10

Conn’s syndrome.

Question 11

Case: 
renin 7.4units (1.1-4.5).
aldosterone 900nmol/L (100-450).
24hr urine for catecholamines normal.
Patient did not look Cushingoid or Acromegaloid.
What is the cause of this patient's hypertension?
a) essential hypertension
b) renal artery stenosis
c) Cushing's syndrome
d) phaeochromocytoma
e) Conn's syndrome.

Answer 11

Renal artery stenosis.

Question 12

Case: 
renin 2.4units (1.1-4.5).
aldosterone 300nmol/L (100-450).
24hr urine for catecholamines raised.
Patient did not look Cushingoid or Acromegaloid.
What is the diagnosis?
a) essential hypertension
b) renal artery stenosis
c) Cushing's syndrome
d) phaeochromocytoma
e) Conn's syndrome.

Answer 12

Phaeochromocytoma.

Question 13

What is the first therapeutic step in a patient with phaeochromocytoma?

a) alpha blockade
b) beta blcokade
c) calcium antagonist
d) ACE inhibitor
e) bendofluazide.

Answer 13

Alpha blockade.

Question 14

Case: 65y/o man with a previous MI has BP 140/80 on atenolol.
What would you do?
a) leave on atenolol to 140/80
b) add a thiazide diuretic to 120/80.

Answer 14

Add a thiazide diuretic to reduce BP to 120/80.