Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine III > Block I: HTN > Flashcards

Block I: HTN Flashcards

1
Q

what is the definition of HTN?

A

130/80 (AHA)

OR

140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HTN is a silent disease until []

A

target organ damage is manifested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

[] HTN is a more powerful predictor of complications

A

systolic (in comparison to diastolic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some major complications of HTN

A
  1. CAD
  2. stroke
  3. cerebral infarction
  4. ESRD
  5. CHF
  6. aortic dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

[] HTN is more pathological and more likely to lead to CAD or stroke

A

SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

[] are major causes of morbidity and mortality in essential HTN

A

cardiac complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

preventing [] is the main goal in HTN therapy

A

cardiac complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is normal BP (ACC)

A

120/80 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is elevated BP (ACC)

A

120-129/ < 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is HTN stage I (ACC)

A

130-139/80-19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what HTN stage II (ACC)

A

140/90 +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the BP goal

A

130/80

*waiting to hear back from prof. young about what we need to know

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is primary/essential HTN

A

95% of cases where no cause can be identified , idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are important factors in primary/essential HTN

A
  1. age 22-55 ys
  2. genetics
  3. increased salt
  4. obesity
  5. alcohol
  6. cigarette smoking
  7. NSAIDS
  8. psuedoephedrine
  9. metabolic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pt. with high BP should consume no more than [] Na per day

A

2.4 g (some guidelines, 1.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does obesity contribute to HTN

A
  1. increases cardiovascular volume
  2. elevates CO
  3. weight reduction lowers BP modestly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does alcohol contribute to HTN?

A

by possibly increasing catecholamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how does smoking increase bp?

A

increases plasma NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

is it benifical to increase exercise in an already active HTN patient?

A

not very, no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NSAIDS can increase BP by [] mmHg

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what 2 drugs should be avoided in borderline hypertensive patients

A

psuedoephedrine, nsaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the most common cause secondary HTN

A

renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is another common cause of secondary HTN (other than renal diseasE)

A
  1. diabetic nephropathy
  2. renal vascular HTN
  3. excessive renin release due to reduction in renal blood flow and perfusion pressure
  4. estrogen use
  5. hyperaldosteronism
  6. pheocrhomocytoma
  7. coarctation of aorta
  8. thyroid disease
  9. prgnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

[] will occur if there is a reduction in renal perfusion

A

renin release from kindey -> raas -> htn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what effect does estrogen have of HTN

A

can cause small increase in BP

will cause volume expansion and increased activity of RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

does estrogne effect postmenopausal women and their BP?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how does primary aldosteronism affect BP

A

can increase by retaining Na and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how does pheochromocytoma affect BP

A

increase NE from tumor on adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how does coarctation of aorta affect BP

A

increase BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how does hypothyroidism affect BP

A

elevates diastolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how does hyperthyroidism affect BP

A

elevates systolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

[] is most common cause of maternal and fetal morbidity and mortality

A

HTN

33
Q

what are common target organs affected by HTN

A
  1. heart
  2. brain
  3. kidneys
  4. eyes
  5. peripheral arteries
34
Q

what is the most frequent symptom of HTN?

A

HA (nos)

35
Q

what HA is most assox. with HTN

A

sub, occipital pulsating HA,

normally during early morning and subsiding during the say

36
Q

physical findings of HTN depend on []

A

cause HTN, duration & severity, degree of effect on target organs

37
Q

how should BP be taken

A

in both arms and in legs (if lower extremity pulses are diminished or delayed) to exclude coarctation of aorta

38
Q

what are some findings on fundoscopic exam that may indicate HTN

A
  1. narrowing arterial diameter to less than 50%
  2. copper/silver wiring
  3. exudates
  4. cotton-wool spots
  5. hemorrhages
  6. papilledema
39
Q

what cardiovascular findings may be seen in a hypertensive patient

A
  1. left ventricular enlargement with left ventricular heave -> severe longstanding HTN
    - presystolic S4 gallop due to decreased compliance of L ventricle
40
Q

what heart sound may be present in a hypertensive patient

A
  1. presystolic s4 gallop due to decreased copmliance of L ventricle
  2. carotid, abdominal, femoral bruits
41
Q

what EKG abnormlaities may be present in HTN patient

A

increased QRS interval from hypertrophied ventricle

42
Q

what myocardial changes may occur in HTN

A

hypertrophied left ventricle, will increase QRS interval

43
Q

what might you feel on abdominal palpation in a HTN patient

A

enlarged kidneys and abdominal anneurysm (pulsatile mass)

44
Q

what are some diagnostic studies that can be done for HTN

A
  1. EKG (increased QRS interval)
  2. UA
  3. glucose
  4. hematocrit (increased)
  5. serum K (low)
  6. creatinine
  7. sodium
  8. calcium
  9. fasting lipids (HDL, LDL, tryglycerides)
45
Q

what foods cause an increase soluble fiber and what is the goal?

A

25 g

  1. oats
  2. pears
  3. beans
  4. cantaloupes
46
Q

describe the DASH diet

A

dietary approach to stop HTN

rich in fruit, veggies, calcium, low in saturated and total fat

47
Q

what is proven to have a modest reduxtion in BP

A
  1. weight redux
  2. reduced alcohol
  3. reduced salt
  4. smoking cessation will reduce overall CV risk
48
Q

what are 4 benefits of lifestyle modifications

A
  1. lower BP
  2. reduce dosage number antihypertensives
  3. minimize assoc. risk factors
  4. prevent progression to HTN from pre HTN
49
Q

what are initial, single drug therapy option for HTN

A
  1. ACEI
  2. ARB
  3. CCB
  4. BB
50
Q

how often should you f/u a patient on new HTN drugs

A

4-6 weeks to allow for full medication effects to be established before further titration or adjustment

51
Q

patient has been titrated to usual dose, has shown incomplete response, what is the next step?

A

2nd medication

52
Q

if first agent showed no efffect, what is the next step?

A

d/c and add new med

53
Q

what happens to efficacy when 2 low dose drugs are used incstead of one large

A

better efficacy, more likely to offer better end-target organ protection and better clinical outcome than single agent

54
Q

a patient has had excellent BP control over the years and is dedicated to continuing lifestyle modifications

A

can be considered for step down therapy, lower or d/c dose

55
Q

what drugs are essential for a HTN patient with diabetic nephropathy and proteinuria

A
  1. ACEI/ARB

if DM ACEI first then ARB

56
Q

what durgs are essential for HTN and stable engina

A
  1. BB

2. CCB

57
Q

what drugs are essential for HTN and unstable angina or MI

A
  1. BB

2. ACEI

58
Q

what drugs are essential for symptomatic ventricular dysfunction

A
  1. ACEI
  2. ARB
  3. BB
59
Q

what are special considerations for black patients

A
  1. begin with diuretic
  2. bb less effective
  3. CCB more effective
  4. high risk angioedema ACEI/ARB
    - can still be used in if CKD
60
Q

describe a HTN urgency

A
  1. HTN in otherwise healthy individual
  2. > 220/115
  3. RARELY needs emergency therapy unless end organ damage is present
61
Q

how to treat a HTN urgency (220/115)

A

lower over course 24 hours

62
Q

what is a HTN emergency (diastolic)

A

DBP > 115-130

assoc. with evidence of end organ damage

63
Q

what are examples of end-organ damage

A
  1. encephalopathy
  2. nephropathy
  3. myocardial ischemia or infarction
64
Q
  1. HA
  2. irritability
  3. confusion
  4. altered mental status
  5. cerebrovascularspasm

these are signs of

A

encephalopathy

65
Q

HTN emergencies require BP reduction in [] to avoid risk of serious morbidity and death

A

1 hours (remember 24 in ugency with no organ damage)

66
Q

BP is [] in terms of end-organ damge

A

irrelevant, organ damage dictates seriousness of approach

67
Q
  1. hematuria
  2. proteinuria
  3. pregressive renal dysfunction

indicative of []

A

hypertensive nephropathy

68
Q

what are some other HTN emergencies

A
  1. intracranial hemorrhage
  2. aortic dissection
  3. pre-eclampsia
  4. eclampsia
  5. pulmonary edema
  6. unstable angina
  7. MI
  8. malignant HTN
69
Q
  1. severe HTN with papilledema

2. rapid course, can cause necrosis of arterial walls in kidney, retina, and brain

A

malignant HTN

70
Q

death my malignant hypertension occurs most frequently by []

A

uremia or rupture of cerebral vessel

71
Q

initial goal in parenteral treatment of HTN emergency is to []

A

reduce by no more than 25% within minutes 1-2 hrs

-move forward 160/100mmHg within 2-6 hours

72
Q

excessive reduction in pressure during hypertensive emergency may lead to

A

coronary, cerebral, or retinal ischemia

73
Q

what are common IV meds for HTN emergencies

A
  1. nitroprusside
  2. nicardipine
  3. hydralazine
  4. labetalol
  5. metoprolol
74
Q

what is the def. orthostatic hypotension

A
  1. decrese in systolic BP of 20mmHG or decrease in diastolic BP of 1o mmHG within 3 minutes of standing when compared with BP from sitting/supine position
75
Q

what are some causes orthostatic hypotension

A
  1. hypovolemia
  2. drugs
  3. autonomic conditions
76
Q

what can cause hypovolemia

A
  1. hemorrhage
  2. burn
  3. spesis
  4. dialysis
  5. sweating
  6. hyperglycemia
  7. DI
  8. addison’s
  9. anorexia
  10. Na wastin
77
Q

what are drugs that can cause orthostatic hypotension

A
  1. diuretics
  2. alpha blockers
  3. antidespressants
  4. sildafenil
  5. nitrates
  6. alcohol
  7. narcotics
  8. sympatholytics
78
Q

what would a good workup of orthostatic hypotension include

A
  1. CBC
  2. CMP
  3. INR/PTT
  4. fecal occult blood
  5. EKG
  6. orthostatic vital signs
  7. +/- head CT

Clinical Medicine III (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions