CPRS Case 4: Hypertension

Question 1

Pathophysiology of raised blood pressure

Answer 1

See lecture notes Pathology of hypertension

Question 2

Differentiate between primary and secondary hypertension

Answer 2

See lecture

2 factors: CO and TPR

CO by 2 factors:

• cardiac: HR, contractility
• non-cardiac: blood volume, salt intake, mineralcorticoid level

Question 3

Different classes of antihypertensive

Answer 3

See lecture

Patient <55: ACE inhibitor —> + ARB —> + CCB —> + thiazide
Patient >55 / African-Caribbean: CCB —> CCB + thiazide —> + ACE/ARB

Question 4

Mechanism of action of thiazide diuretics in treatment of hypertension

Answer 4

See lecture

Question 5

Mechanism of action of CCB in treatment of hypertension

Answer 5

See lecture

Question 6

Mechanism of action of ACE inhibitors in treatment of hypertension

Answer 6

See lecture

Question 7

Complications of uncontrolled hypertension

Answer 7

Heart: Left ventricular hypertrophy
Large vessels: Atherosclerosis
Small vessels: Hypertrophy, fibrinoid necrosis, aneurysm
Brain: harmorrhage, infarction
Kidneys: nephrosclerosis

Question 8

Factors influencing patient’s compliance to long term medication

Answer 8

1. Poverty
2. Misunderstanding instructions
3. Complex regimens
4. Forgetfulness
5. Feeling stigmatised
6. Improvement in symptoms
7. Not effective from previous treatment

Question 9

Issues of patient’s confidentiality

Answer 9

Obtain consent before disclosure of medical information to third party

Exception:

1. disclosure in public interest
2. disclosure in individual’s interest (because failing to disclose would exposure the patient / someone else to risk of deaths / serious harm)
3. when required by law

Personal data ordinance: patient’s right of access / correction of information in medical record and circumstances in which right may be refused

Question 10

Information needed in a medical report

Answer 10

1. Personal information of deceased
2. Past medical history
   - physical findings
   - duration
   - diagnosis
   - treatment
3. Death
   - date amen time
   - place
   - cause
4. Risk factors that predispose to death
5. Copy of post-morgen examination report

Question 11

Attitudes of society towards death and autopsies

Answer 11

Traditional Chinese culture

Question 12

Attitudes of doctors towards death and death investigation

Answer 12

No LO