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Year 3 > CSW2 severe hypertension (karim meeran) > Flashcards

CSW2 severe hypertension (karim meeran) Flashcards

1
Q

What are signs of chronic hypertension on examination?

A

Papilloedema

Raised JVP

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2
Q

What will happen to the heart in chronic hypertension?

A

It will shrink

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3
Q

What are the 4 grades of retinopathy?

A

1= silver wiring
2= ateriovenous nipping
3= flame haemorrhage
4=papilloedema

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4
Q

What is stage 1 retinopathy in chronic hypertension? What will you see

A

Silver wiring

Arteries are white and veins are dark (oxygenated vs deoxygenated blood)

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5
Q

What is stage 2 retinopathy in chronic hypertension? What will you see

A

AV nipping

As an artery passes a vein it nips it

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6
Q

What is stage 3 retinopathy in chronic hypertension? What will you see

A

Flame haemorrhage

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7
Q

What is stage 4 retinopathy in chronic hypertension? What will you see

A

Papilloedema

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8
Q

What do cotton wool spots on a retina suggest is happening?

A

Ischaemia

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9
Q

In chronic hypertension what happens to the heart?

A

Left ventricular hypertrophy

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10
Q

How is LVH detected on examination?

A

You cannot detect it on exam
You might feel a heave
You might hear a fourth heart sound (gallop rhythm)

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11
Q

What is seen on ECG if theres LVH?

A

Tall r waves

Deep s waves

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12
Q

What are causes of hypertension?

A 
Conn's 
Acromegaly
Cushing's
Renal artery stenosis
Fluid overload in renal failure 
Phaeochromocytoma
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13
Q

What base ix should be done for someone with hypertension and why?

A

FBC- check for polycythaemia
UE- potassium may be low (conns, cushings, phaeo all cause low K+) and you need to check renal function
ECG- check for LVH
Urinalysis- check for nephritis and renal disease
Fasting glucose- they are at risk of diabetes
Lipids

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14
Q

What arteriole does angiotensin II constrict in the kidney?

A

Efferent

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15
Q

What does angiotensin II stimulate adrenal glands to make?

A

Aldosterone

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16
Q

What hormone do the adrenals produce to increase BP?

A

Aldosterone

17
Q

What tests are done for cushings?

A

low dose dexamethasone

urine free cortisol

18
Q

How will phaeo’s present?

A 
Nervousness
Excess sweat
Racing heartbeat
Episodic severe hypertension
May have necrotic bowel due to severe vasconstriction
19
Q

How is hypertension characterised in phaeo?

A

severe and episodic

20
Q

Why is hypertension episodic in phaeo?

A

Because adrenaline is stored and then released all in one go

21
Q

How is phaeo treated?

A 
Rehydrate is dehydrated 
Alpha blockade first 
Beta blockade
Localise the lesion
Surgery to remove it
22
Q

What is the first step in medical management of a phaeo?

A

Alpha blockade

23
Q

In essential hypertension what is the next step in management when htn isnt controlled with acei/arb + CCB + thiazide like diuretic

A

Consider further diuretic or alpha or beta blocker and consider seeking expert advice

Year 3 (104 decks)

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