Clinical presentation of severe hypertension

Question 1

How is BMI calculated.

Answer 1

Weight (kg)/ height (m2)

Question 2

What is a healthy BMI.

Answer 2

18.5-24.9

Question 3

What is an underweight BMI.

Answer 3

Under 18.5

Question 4

What is an overweight BMI.

Answer 4

25-29.9

Question 5

What is an obese BMI. (class 1 obesity).

Answer 5

30-34.9

Question 6

What is a severely obese BMI (class 2 obesity).

Answer 6

35-39.9

Question 7

What is a morbidly obese BMI. (class 3 obesity).

Answer 7

40-50

Question 8

What is a super obese BMI.

Answer 8

50-60

Question 9

What is a super-morbid obese BMI.

Answer 9

> 60

Question 10

What are clinical signs of hypertension. (4)

Answer 10

Retinopathy.
Left ventricular hypertrophy (may feel a heave).
S4.
Possibly some bruits.

Question 11

What is S4 caused by.

Answer 11

It is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.

Question 12

What does hypertensive retinopathy suggest.

Answer 12

That the hypertension is severe and prolonged.

Question 13

What are the causes of hypertension. (7)

Answer 13

Phaeochromocytoma. 
Cushings.
Conns. 
Acromegaly. 
Renal artery stenosis. 
Co-arctation of the aorta. 
Essential.

Question 14

What basic investigations should be performed in someone with hypertension. (6)

Answer 14

FBC (polycythaemia).
UandE (potassium might be low, renal function might be affected.)
ECG (LVH).
Urinalysis (nephritis or renal disease).
Fasting glucose (risk of diabetes).
Lipids.

Question 15

Where is renin produced.

Answer 15

Juxtaglomelular apparatus.

Question 16

What does renin do.

Answer 16

Conversion of angiotensinogen to angiotensin I.

Question 17

What converts angiotensin I to angiotensin II.

Answer 17

ACE.

Question 18

What does angiotensin II do.

Answer 18

Causes release of aldosterone from adrenals.

Question 19

What suppresses renin.

Answer 19

Aldosterone.

Question 20

What are some features that may present with hypertension. (5)

Answer 20

Nervousness. 
Sweat pouring down face. 
Racing heart (palpitations). 
Episodic severe hypertension. 
Severe vasoconstriction causes necrotic bowel.

Question 21

What are the management steps in a phaeochromocytoma. (5)

Answer 21

Rehydrate if necessary. 
Alpha block. 
Beta block. 
Localise the lesion. 
Surgery.

Question 22

How is hypertension defined.

Answer 22

It is graded from 1 to 3.

Question 23

What drugs can be used to treat hypertension. (6)

Answer 23

Diuretic. 
ACE inhibitor. 
Angiotensin receptor blocker. 
Calcium channel blocker. 
Beta blocker. 
Alpha blocker.

Question 24

What is the usual combination of drugs for a hypertensive patient younger than 55. (4)

Answer 24

1. ACE inhibitor.
2. ACE inhibitor and calcium channel blocker or thiazide diuretic.
3. ACE inhibitor, tiazide diuretic and calcium channel blocker.
4. Add further diuretic therapy or alpha blocker, or beta blocker.

Question 25

What is the optimal medical therapy for a patient with hypertension. (5)

Answer 25

Intensive lifestyle modification. 
Aspirin. 
High dose statin (atorvastatin 40-80mg OD). 
Optimal BP control. 
Assessment for probable T2DM.