Community Health

Question 1

Hypertension Stages

Answer 1

Stage 1 hypertension-
Clinic blood pressure is 140/90 mmHg or higher AND
subsequently Ambulatory blood pressure monitoring (ABPM) daytime average OR Home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher.

Stage 2 hypertension-
Clinic blood pressure is 160/100 mmHg or higher AND
subsequently ABPM daytime average or HBPM average blood pressure is 150/95 mmHg higher.

Severe hypertension-
Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher

Question 2

Who should be started on antihypertensive medication?

Answer 2

Stage 1-
Only if under 80 and with 1+ of:
Target organ damage
Established CV disease
Renal disease 
Diabetes 
10 year CV risk equivalent 20% or greater

Anyone with Stage 2 hypertension

For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage, cardiovascular disease, renal disease or diabetes, consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage.

Question 3

What drugs to be used to treat hypertension?

Answer 3

See link: https://bjcardio.co.uk/2011/10/changes-to-hypertension-guidelines/

Question 4

Asthma Step-wise Management

Answer 4

1 - Newly-diagnosed asthma:
Short-acting beta agonist (SABA)

2 - Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking:
SABA + low-dose inhaled corticosteroid (ICS)

3 -SABA + low-dose ICS + leukotriene receptor antagonist (LTRA)

4 - SABA + low-dose ICS + long-acting beta agonist (LABA)
Continue LTRA depending on patient’s response to LTRA

5 -SABA +/- LTRA
Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

6 - SABA +/- LTRA + medium-dose ICS MART
OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA

7 - SABA +/- LTRA + one of the following options:
increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline)
seeking advice from a healthcare professional with expertise in asthma

Question 5

Cervical Screening Guidelines

Answer 5

Offer cervical screening to all women between the ages of 25 years and 64 years.
Age 25 years: first invitation.
Age 25-49 years: screening every 3 years.
Age 50-64 years: screening every 5 years.
Women 65 years of age or older if they have not had a cervical screening test since 50 years of age or a recent cervical cytology sample is abnormal.