Car 15 - Hypertension

Question 1

What is hypertension?

Answer 1

BP greater or equal to 140/90.

Question 2

What is Prehypertension?

Answer 2

BP greater or equal to 120/80.

Question 3

What is a normal BP range?

Answer 3

BP less than 120/80.

Question 4

What are the five major risk factors for HTN?

Answer 4

Age. Obesity. Smoking. Genetics. Race.

Question 5

What is the cause of 90-95% of HTN?

Answer 5

Essential hypertension.

Question 6

What is Hypertensive urgency?

Answer 6

BP greater or equal to 180/120. W/o evidence of end-organ damage (EKG changes, headache, vision abnormalities, chest pain, renal insuff, flash pulmonary edema).

Question 7

What is Hypertensive emergency?

Answer 7

BP greater or equal to 180/120 WITH evidence of end-organ damage (EKG changes, headache, vision abnormalities, chest pain, renal insuff, flash pulmonary edema).

Question 8

What is the difference b/w HTN urgency vs HTN emergency?

Answer 8

HTN urgency does NOT have end-organ damage while HTN emergency does.

Question 9

What disease are caused by long term HTN?

Answer 9

Atherosclerosis. Renal insuff. Stroke (Thromboembolic or hemorrhagic stroke). Retinopathy. LVH and CHF. Aortic dissection.

Question 10

Why is Left Ventricular hypertrophy bad?

Answer 10

Thickening of the LV wall (Not necessarily stronger like skeletal muscle). ^ myocardial oxygen demand. Stiffening of the LV (can cause S4). Encroachment upon the LV lumen.

Question 11

What is Aortic Dissection?

Answer 11

Tear in the intima of the aorta, causing blood to dissect into the wall of the aorta, b/w layers of the media, forming a false lumen. Most common in ascending aorta. Causes a tearing chest pain that radiates to the back. Widening of mediastinum in CXR. 75% mortality.

Question 12

What are the two classifications of Aortic dissection?

Answer 12

Standford A and B. A: any tear that involves the ascending aorta. B: descending aorta, distal to left subclavian artery. Type B is managed medically for the most part, type A can be mortal. [Type A involves the Ascending Aorta, type B occurs Beyond the Branches].

Question 13

What is the drug of choice for aortic dissection?

Answer 13

Beta-blockers.

Question 14

What would you most suspect the cause of HTN to be in a patient with: Paroxysms of increased sympathetic tone: anxiety, palpitations, diaphoresis.

Answer 14

Pheochromocytoma.

Question 15

What would you most suspect the cause of HTN to be in a patient with: age of onset b/w 20 and 50.

Answer 15

Primary HTN.

Question 16

What would you most suspect the cause of HTN to be in a patient with: Elevated serum creatinine and abnormal urinalysis.

Answer 16

Renal disease.

Question 17

What would you most suspect the cause of HTN to be in a patient with: Abdominal bruit.

Answer 17

Renal artery stenosis.

Question 18

What would you most suspect the cause of HTN to be in a patient with: Family history of HTN.

Answer 18

Primary HTN.

Question 19

What would you most suspect the cause of HTN to be in a patient with: tachycardia, heat intolerance, diarrhea.

Answer 19

Hyperthyroidism.

Question 20

What would you most suspect the cause of HTN to be in a patient with: Hyperkalemia.

Answer 20

Renal failure.

Question 21

What would you most suspect the cause of HTN to be in a patient with: Episodic sweating and tachycardia.

Answer 21

Pheochromocytoma.

Question 22

What would you most suspect the cause of HTN to be in a patient with: Abrupt onset in a patient younger than 20 or older than 50, and depressed serum K+ levels.

Answer 22

Hyperaldosteronemia.

Question 23

What would you most suspect the cause of HTN to be in a patient with: central obesity, moon-shaped face, hirsutism.

Answer 23

Cushing syndrome.

Question 24

What would you most suspect the cause of HTN to be in a patient with: Normal urinalysis and normal serum K+ levels.

Answer 24

Primary HTN.

Question 25

What would you most suspect the cause of HTN to be in a patient with: young individual w/ acute onset tachycardia.

Answer 25

Cocaine or amphetamines.

Question 26

What would you most suspect the cause of HTN to be in a patient with: Hypokalemia.

Answer 26

Renal artery stenosis.

Question 27

What would you most suspect the cause of HTN to be in a patient with: Proteinuria.

Answer 27

Renal disease.

Question 28

What CXR finding is possible sign for aortic dissection?

Answer 28

Widened mediastinum.