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Foundations 2 exam 2 > HTN 1 > Flashcards

HTN 1 Flashcards

1
Q
  • Elevated Systolic BP
  • Elevated Diastolic BP
  • Both systolic & diastolic BP elevated
  • Often asymptomatic
A

HTN

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2
Q

Contraction

A

Systolic

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3
Q

Relaxation

A

Diastolic

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4
Q
  • HTN is a precursor to which 4 main systemic diseases?
  • What is the physiology?
A
  • Cardiovascular disease***
  • Renal failure
  • Cerebrovascular disease
  • Hypertensive retinopathy

Physiology: The perfusion to these organs are affected, leading to damage.

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5
Q

Why do women have higher rates of HTN when they turn 55 compared to when they were 45-54 y/o?

A

Menopause

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6
Q

Which race has higher incidence of HTN?

A

African Americans

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7
Q

Beginning at a BP of 115/75 mmHg, the risk for CVD doubles for each increment of what?

A

20/10

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8
Q

Which type of HTN accounts for 90-95% of all cases?

A

Primary (essential) HTN

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9
Q

Which 3 things control BP?

A
  • Sympathetic Nervous System
  • RAAS
  • Plasma volume (mediated by kidneys)
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10
Q

What are the 5 modifiable risk factors of HTN?

A
  • Smoking
  • Diet (sodium)
  • Excess ETOH
  • Obesity/weight gain
  • Physical inactivity

“POSED”

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11
Q
  • Renal disease
  • Medication induced
  • Thyroid/Parathyroid disease
  • Obstructive sleep apnea (obese patients)
  • Pheochromocytoma
A

Causes of Secondary HTN

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12
Q
  • Coarctation of the Aorta
  • Primary Aldosteronism
  • Renovascular Disease
  • Cushing’s Syndrome
A

Causes of Secondary HTN

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13
Q
  • HTN onset at young age
  • onset of Diastolic HTN at age over 50 yrs
  • Target organ damage (end organ damage)
  • Poor response to generally effective therapy
A

You should suspect Secondary HTN

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14
Q
  • Hypokalemia
  • Abdominal bruit
  • Labile pressures w/ tachycardia, sweating, and tremor
  • Family hx of kidney disease
A

Signs of secondary HTN

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15
Q
  • Myocardial infarction
  • Angina
  • Coronary revascularization
  • Heart failure
A

Heart disease

(Target Organ Damage / End Organ Damage)

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16
Q
  • Ischemic stroke
  • Cerebral hemorrhage
  • TIA
A

Cerebrovascular Disease

(Target Organ Damage / End Organ Damage)

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17
Q
  • Retinopathy
  • Renal Disease
  • Peripheral arterial disease
A

Target Organ Damage / End Organ Damage

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18
Q
  • Medications
  • Illicit drug use
  • Muscle weakness
  • Tachycardia
  • Sweating
  • Tremor
  • Thinning skin
  • Flank pain
A

Secondary HTN

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19
Q
  • Early morning headaches
  • Daytime somnolence
  • Loud snoring
  • Erratic sleep
A

Signs of sleep apnea

(Secondary HTN)

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20
Q
  • Smoking
  • Diabetes
  • Dyslipidemia
  • Physical inactivity

(risk factors for what?)

A

Cardiovascular risk factors

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21
Q
  • HA
  • Transient weakness/blindness
  • Loss of visual acuity
  • CP
  • Dyspnea
  • Claudication
  • Sexual dysfunction
A

Signs of Target Organ Damage

22
Q

What are 2 additional “vital signs” of a HTN evaluation?

A
  • BMI
  • Waist circumference
23
Q

What are 4 general PE findings you should assess for when evaluating HTN?

A
  • Body fat distribution
  • Skin lesions
  • Muscle strength
  • Alertness
24
Q
  • Narrowing of the arterial diameter to less than 50% of venous diameter
A

Grades 1 - 2 Hypertensive Retinopathy

25
Q
  • Copper or silver wire appearance
  • Exudates 3+
  • Cotton wool spots
  • Hemorrhages
A

Grade 3 Hypertensive Retinopathy

26
Q
  • Flame hemorrhage
  • Hard exudate
  • Cotton wool spot
  • Papilledema **
A

Grade 4 Hypertensive Retinopathy

27
Q

What are 2 components of a neck exam needed to evaluate for HTN?

A
  • Thyroid (secondary HTN)
  • Carotids
28
Q

2 concerning respiratory PE findings for HTN

A
  • Rhonchi
  • Rales
29
Q

3 concerning abdominal PE findings for HTN

A
  • Renal masses
  • Renal bruits
  • Femoral pulses
30
Q

3 concerning Neuro PE findings for HTN

A
  • Visual disturbance
  • Focal weakness
  • Confusion
31
Q

Which 2 pulses should you palpate simultaneously when evaluating a patient who may have HTN?

A
  • Brachial
  • Femoral
32
Q
  • Displaced PMI
  • ECG evidence

FIndings for what?

A

Left Ventricular Hypertrophy (HTN)

33
Q

What murmur will you hear in patient w/ HTN?

A

S4 (presystolic gallop) due to decreased compliance of left ventricle

34
Q

What 3 arteries do you need to auscultate for bruits when evaluating pt w/ HTN?

A
  • Carotid
  • Abdominal (aorta)
  • Femoral
35
Q

What are the screening recommendations for HTN by the USPSTF?

A

All adults 18+

  • 18 - 39 y/o (every 3 - 5 years), w/ normal BP and no risk factors
  • 40+ y/o (annually)
  • At increased risk for HTN (annually)
36
Q

What is required for diagnosis of HTN?

  • How many readings?
  • How many office visits?
A

Based on the average of:

  • 2 (or more) properly measured, seated, BP readings
  • on each of 2 (or more) office visits
37
Q

SBP: <120

and

DBP: <80

A

Normal BP

(2017 ACC/AHA guidelines)

38
Q

SBP: 120 - 129

and

DBP: <80

A

Elevated BP

(2017 ACC/AHA guidelines)

39
Q

SBP: 130 - 139

or

DBP: 80 - 89

A

Stage 1 HTN

(2017 ACC/AHA guidelines)

40
Q

SBP: >140 (140 or higher)

or

DBP: >90 (90 or higher)

A

Stage 2 HTN

(2017 ACC / AHA guidelines)

41
Q
  • If a patient has BPs within more than 1 category, do we diagnose the higher or lower category?
  • Ex: SBP: 130 DBP: 92
A
  • Higher (always round up)
  • Stage 2 HTN
42
Q

Ex: SBP: 125 DBP: 83

A

Stage 1 HTN

43
Q

Ex: SBP: 122 DBP: 78

A

Elevated BP

44
Q
  • 20 - 25% of Stage 1 HTN
  • Pt is hypertensive only in the office
A

White coat HTN

45
Q
  • 10% of patients
  • Increased cardiovascular risk
  • In office, pt w/ normal BP, but most of the time has high BP at home
A

Masked HTN

46
Q

What 6 tests should you order to evaluate for HTN?

A
  • CBC
  • TSH
  • EKG
  • UA
  • Blood chemistries (glucose, Ca, creatnine, electrolytes, GFR)
  • Lipid profile
47
Q

What are 3 tests you might consider ordering to evaluate for HTN?

A
  • Urine albumin excretion
  • Echocardiogram
  • Sleep study
48
Q

Treatment for pt w/ normal BP

less than 120/80

(according to ACC/AHA 2017)

A
  • Promote healthy lifestyle habits
  • Reassess in 1 year
49
Q

Tx for pt w/ elevated BP

120-129 / less than 80

(according to ACC / AHA 2017)

A
  • Nonpharm therapy (lifestyle changes)
  • Reasses in 3 - 6 months
50
Q

Tx for Pt w/ Stage 1 HTN w/ risk under 10%

130 - 139 / 80 - 90

(according to ACC / AHA 2017)

A
  • Nonpharm therapy (lifestyle changes)
51
Q

Tx for Pt w/ Stage 1 HTN w/ risk 10% or higher

130-139 / 80-90

(according to ACC / AHA 2017)

A
  • Nonpharm therapy (lifestyle changes)
  • BP lowering medication
52
Q

Tx for Pt w/ Stage 2 HTN

Over 140/90

(according to ACC / AHA 2017)

A
  • Nonpharm therapy (lifestyle changes)
  • BP lowering medication

Foundations 2 exam 2 (13 decks)

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