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DPD 2020 > Clinical Presentation of severe hypertension &Severe Hypertension: Understanding the Patholog > Flashcards

Clinical Presentation of severe hypertension &Severe Hypertension: Understanding the Patholog Flashcards

1
Q

What BMI is considered high (obese) in white and asian people

A

white - 25

asian- 23.9

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2
Q

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 adn repeat of his BP

C. advise him to see his GP beofre allowing him to exercise in the gym

D. refer him to casualty for blood pressure control

A

A. encourage regular exercise

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3
Q

if someone has hypertension what would you look for

A

Fundoscopy

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4
Q

What happens in the different grades of hypertension?

A

Grade 1: silver wiring

Grade 2: AV nipping

Grade 3: flame shaped haemorrhage

Grade 4: papilloedema

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5
Q

What could papilloedema indicate

A

high ICP- possibly brain tumour

hypertension

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6
Q

WHat are feature of long standing hypertension exist

A

left ventricular hypertrophy (ECG)

feel a heave

hear a bruit

hear an S4

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7
Q

WHat grade is this

A

grade 3

see flame haemorrhage

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8
Q

What are 6 causes of hypertension

A
  1. Conn’s
  2. Cushing’s
  3. Phaechromocytoma
  4. renal artery stenosis
  5. Acromegaly
  6. co arctation of the aorta
  7. essential
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9
Q

What are investigation would you like to do?

if someone presents with hypertension

A
  • FBC
  • U&E low K+ high Sodium
  • ECG look for LVH
  • Urinalysis (renal disease and nephritis)
  • Fasting glucose
  • Lipids
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10
Q

What percentage of people have secondary hypertension

A

10%

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11
Q

What are specific investigations to diagnose secondary causes of hypertension

A

renin aldosterone ration

24 hour urine for catecholamines

24 hour urine cortisol

glucose tolerance test

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12
Q

Someone presents with

renin 0.4 (1.1-4.5)

aldosterone 1600 (100-450)

24 hour urine catecholamine normal

What does he have

A

Conn

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13
Q

How do you treat conn’s

A

surgery remove it

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14
Q

patient presents with

renin: 7.4 (1.1-4.5)
aldosterone: 900 (100-450)

24 hour urine catecholamines is normal

What does this patient have

A

renal artery stenosis

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15
Q

What is the gold standard way of diagnosing renal artery stenosis

A

Digital subtraction angiogram

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16
Q

what does this patient have?

Renin: 2.4 (1.1 -4-5)

Aldosterone: 300(100-450)

24 hour urine for catecholamines RAISED

A

phaechromocytoma

17
Q

how does phaechromocytoma present?

A

anxiety

palpitation

headache

sweating

18
Q

What is the treatment for phaechromocytoma?

A

MEDICAL EMERGENCY

alpha blockade

19
Q

How do you manage a phaechromocytoma

A
  1. alpha blockade (rehydrate if needed)
  2. beta blockade
  3. localise the lesion
  4. surgery (many weeks after alpha blockade)- laprascopic adrenalectomy
20
Q

What does an MIBG scan show

A

is a radioactive scan and shows where the tumour is

the bladder always lights up

21
Q

How do you treat essential hypertension?

A

Over 55 or afrocaribean

  1. CCB or thiazide
  2. add an ACE to either
  3. CCB and ACE and Thiazide

under 55

  1. ACE
  2. add a thiazide or CCB
  3. CCB and ACE and Thiazide
22
Q

After a myocaridal infarction or angina, what anti hypertensive would give the most benefit?

A

beta blocker

very good for MI and angina strongly encaouraged

23
Q

When do you not give a beta blocker

A

severe heart failure

heart block

Asthma COPD

24
Q

When do you not give an ACE OR ARB?

A

renal impairement

Peripheral vascular disease

pregnancy

renovascular disease

25
Q

When do you not give a thiazide diuretic?

A

Gout

26
Q

What antihypertensive drugs activate and which decreases the activity of the RAAS system

A

decrease RAS

ACE/ARB

b blocker

increase RAS
Thiazide

CCB

27
Q

A 65 year old patient with previous MI has a BP of 140/80 on atenolol

What do you do ?

A

add a thiazide or CCB to reach 120/80

STUDY showed it reduced their death

Especially if he had a previous MI

28
Q

What is the optimal medical therapy for someone that has had an MI

A
  1. intensive lifestyle modification
  2. aspirin
  3. high atorvastatin
  4. optimal blood pressure
  5. assess for type 2
29
Q

If someone has a had an MI, at what level do you want their blood pressure to be?

A

120/80

really strict

because improves survival

30
Q

How does PCSK9 drugs work?

A

lowers cholesterol by binding to the LDL receptor and causes it to be destroyed by a lysossome instead of being recycled

EXAMPLE DRUG EVOLOCUMAB

31
Q

does PCSK9 work

A

Didn’t reduce death

no effect on mortality

only use in people with familial hypercholesterolaemia

32
Q

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?

A

Obese.

33
Q

What do you see on fundoscopy of grade 1

A

Silver wiring

34
Q

What do you see on fundoscopy of grade 2 hypertension?

A

Silver wiring.
AV nipping.

35
Q

What do you see on fundoscopy of grade 3 hypertension?

A

Silver wiring.
AV nipping.
Flame haemorrhage.

36
Q

What do you see on fundoscopy of grade 4 hypertension?

A

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

37
Q

What does hypertensive retinopathy suggest?

A

Hypertension is severe and prolonged.

DPD 2020 (48 decks)

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