B4-041 Hypertension

Question 1

laterally displaced PMI may indicate

Answer 1

left ventricular hypertrophy

Question 2

high QRS voltage
ST depressions in lateral leads

Answer 2

left ventricular hypertrophy

Question 3

LVH is compensatory to overcome

Answer 3

increased afterload

Question 4

LVH leads to

Answer 4

1. distolic heart failure
2. perfusion mismatch

Question 5

what does an abdominal bruit 5 cm left of umbilicus signify?

Answer 5

renal artery stenosis

Question 6

how does renal artery stenosis cause hypertension?

Answer 6

1. fibromuscular dysplasia and atherosclerotic plaque build up cause decreased renal perfusion
2. kidney increases arterial pressure through RAAS

Question 7

if patient has dyslipidemia, assess […] risk

Answer 7

ASCVD

Question 8

hypertensive emergency

Answer 8

greater than 200/120

or end organ damage

Question 9

hypertensive urgency

Answer 9

SBP > 180 or DBP > 120

without end organ damage

Question 10

symptoms of end organ damage

Answer 10

• headache
• papilledema
• renal failure
• dyspnea
• chest pain
• encephalopathy

Question 11

stage 1 hypertension

Answer 11

130-139/80-89

Question 12

stage 2 hypertension

Answer 12

greater than 140/90

Question 13

hypertension is diagnosed by

Answer 13

2 readings on at least 2 occasions

Question 14

every 20 mmHg of SBP or 10mmHg of DBP

Answer 14

doubles risk of death from stroke or CVD

Question 15

systolic BP correlates with

Answer 15

SV and arterial compliance

Question 16

diastolic BP correlates with

Answer 16

TPR and HR

Question 17

95% of cases are […] hypertension

Answer 17

primary

Question 18

[…] hypertension has no defineable cause

Answer 18

primary

Question 19

if a patient is <40,

Answer 19

likely CO issue

Question 20

if patient is older,

Answer 20

TPR issue

Question 21

causes of secondary hypertension

Answer 21

• renal parenchyma damage
• renovascular disease
• pheochromocytoma
• endothelial cell dysfunction
• hyperaldosteronism

Question 22

damage impairs ability to excrete Na+ and H20

Answer 22

renal parenchyma damage

Question 23

renal parenchyma damage results in

Answer 23

increased blood volume

increased preload, SV, CO, and MAP

Question 24

elderly patient, historically well controlled BP worsening, escalating medications

Answer 24

renovascular htn

Question 25

triggers RAAS system

Answer 25

renovascular htn

Question 26

* headaches * sustained vs. paroxysmal meteoric BP * diaphoretic

Answer 26

pheochromocytoma

Question 27

release of NE and EPI causes HTN from increased CO and TPR

Answer 27

pheochromocytoma

Question 28

HTN + spontaenous or easily provoked hypokalemia with diuretic

Answer 28

hyperaldosteronism

Question 29

if you have a patient with: HTN with OSA HTN with a fib think...

Answer 29

hyperaldosteronism

Question 30

how does baroreceptor dysfunction impact HTN treatment?

Answer 30

baroreceptors will perceive hypotension, when in reality patient is normotensive due to chronic baseline elevation of MAP

Question 31

very first treatment strategy for HTN

Answer 31

lifestyle changes

Question 32

* decrease TPR via relaxation of arteriolar vascular smooth muscle * decrease CO by reducing venous return through relaxation of veins

Answer 32

alpha 1 antagonists

Question 33

reduce CO by decreasing HR and inotropic state

Answer 33

beta blockers

Question 34

end in -pril

Answer 34

ACE inhibitors

Question 35

end in -sartan

Answer 35

ARBs

Question 36

preferred treatment of primary aldosteronism

Answer 36

* spironolactone * eplerenone

Question 37

preferred in HFrEF

Answer 37

carvedilol

Question 38

not first line therapy, except in CAD and HFrEF

Answer 38

beta blockers

Question 39

associated with orthostatic hypotension

Answer 39

alpha-1 blockers

Question 40

increase risk of hyperkalemia in CKD

Answer 40

ACE inhibitors and ARBs

Question 41

cause edema

Answer 41

dihydropyridine CCBs | amlodopine

Question 42

treatment: stage 1 HTN

Answer 42

monotherapy

Question 43

treatment: stage 2 HTN

Answer 43

2 first line agents

Question 44

DOC without contraindication

Answer 44

* thiazides * ACE inhibitors * ARB * CCB * beta blocker

Question 45

DOC if patient has DM or CHF

Answer 45

* ACE inhibitor * ARB

Question 46

DOC patient with BPH

Answer 46

alpha blocker

Question 47

DOC patient with osteoporosis

Answer 47

thiazide | hypercalcemia

Question 48

DOC if pregnant

Answer 48

* labetalol * CCB * hydralazine (co-admin beta blocker for reflex tachy)

Question 49

if ASCVD is greater than 7.5%...

Answer 49

statin

Question 50

initial first line therapy for stage 1 hypertension

Answer 50

* thiazide * CCBs * ACE/ARBs

Question 51

function of endothelin-1

Answer 51

increase TPR | can cause hypertension

Question 52

hypertension drug classes contraindicated in pregnancy

Answer 52

* aliskiren * ACE * ARBs

Question 53

can cause injury and death to developing fetus in 2nd and 3rd trimesters

Answer 53

ACE inhibitors

Question 54

hypertension due to adrenal tumor which is releasing high levels of aldosterone

Answer 54

conn's syndrome

Question 55

plasma renin markedly elevated

Answer 55

renovascular hypertension

Question 56

low amplitude, long duration T wave

Answer 56

hypokalemia

Question 57

high levels of aldosterone promote

Answer 57

sodium reabsorption and potassium excretion | causing hypokalemia

Question 58

elevated plasma aldosterone will increase

Answer 58

blood volume --> increased venous return --> increased CO -->hypertension

Question 59

left ventricular hypertrophy suggests MAP

Answer 59

has been chronically elevated

Question 60

abdominal bruit

Answer 60

renovascular hypertension

Question 61

caused by plaque in renal artery

Answer 61

renovascular hypertension

Question 62

decreased renal blood flow causes

Answer 62

renin release --> angiotensin 2--> increased TPR

Question 63

causes increased renin, angiotensin, and aldosteron

Answer 63

decreased renal blood flow

Question 64

how does left ventricular hypertrophy affect the pressure volume curve?

Answer 64

shift up and to the left