Gen med

Question 1

Essential (primary) HTN vs Secondary HTN

Answer 1

Primary:
No specific cause identified. Polygenic (sympathetic hyperactivity, renin activation, susceptibility to salt) and multi-environmental (obesity, alcohol, salt).
* Fam HX is important*

Secondary:
Specific cause identifiable therefore treatable but also MORE SEVERE.
Eg: Renal disease
Renal artery stenosis
Adrenal tumours secreting aldosterone, cortisol, catecholamines
Sleep apnoea

Question 2

When do you investigate HTN for secondary causes?

Answer 2

In young patients

Question 3

Stage 1 vs stage 2 HTN BP and treatment

Answer 3

Stage 1: 140-159/90-99 (pharm treatment with CV risk factors or end-organ damage only)

Stage 2: 160+/100+ (pharm treatment)

Question 4

Medications for HTN

Answer 4

1. ACE inhibitors (contraindicated w pregnancy and renal impairment)
2. Beta blockers (useful w IHD and heart failure)
3. Ca antagonists (first line in old or black patients)
4. Diuretics (Spironolactone, K sparing; useful w fluid retention)
5. Centrally acting agents (methyl dopa in pregnancy, vasodilators such as alpha1 adrenergic antagonists)

Question 5

What conditions does HTN predispose you to?

Answer 5

Coronary heart disease
Cardiac hypertrophy
Cardiac failure
Stroke
Kidney failure

Question 6

Causes of bacterial meningitis (3 most common)

Answer 6

Neisseria meningitis (rash)
Strep pneumonia (GP diplococci)
Haemophilius penicillin