HTN

Question 1

بسم الله ربنا عليك توكلنا وإليك وأنبنا وإليك المصير
بارك لنا ربنا فيما أعطيت وأجعل لنا في أوقاتنا وعقولنا وأفهامنا وأسماعنا وأبصارنا البركة ما أحييتنا انت مولانا
Definition of HTN .

Answer 1

It is progressive elevation of sustained elevated blood pressure >140/90 with thikening of the arterioles

Question 2

Mention primary HTN theories ,

Answer 2

Essential HTN is idiopathic and represents 95% of cases may due to : 5s
1-stress increasing Sympahathic stimulation and vc in the long run Muscle proliferation occurs casuing vc of vessel
2-salt intolerance the kideny is powerful in reabposption of na and water increaing blood volume and cop and abp
3-Sensitivity to angiotenisn 2 due to increased receptors it is the most potent vasoconstrictor in the body
4-secretion of aldosternoe with abnormal metabolism
5-smoking

Question 3

Mention caused of 2ry HTN .

Answer 3

NERVE ! عصب

N:eurogenic increaed intracranial pressure
E:ndocranial conns cushing and pheochrmomcytoma
Renal reinin increases in nephritis and congential and vascular diseas and Tumors

Vascular : Aortic coarcatatrion and plycythemia AV SHUNT
Eclampsia and preeclampsia renal pregnancy HTN

Question 4

Grades of HTN

:

Answer 4

mild 140-159/90-99
moderate 160-179/100-109
svere 180-199 / 110-119
vere severe >210/120

Question 5

Benign HTN

Answer 5

is HTN usually primamry gradual onset long duaraiton in elderly >50years less than 200/100?

Question 6

Effect of Bening HTN of arterioles mention .

Answer 6

Leads to stimulation of fibroblast to increase deposition of elaastic fibers called Elastosis alot of elastic fibers collect together and are compressed casuing homogenous pink apperarncae called Hyalinosis and this reuslt in Narrowing of the lumen and thickness of the wall leading to increased The BP more entering into a Viscous cycle .
so Microscopic: Elastosis and Hyalinosis
So Gross : narrwowing lumen thickness of the wall

Question 7

Microscopic: of benign htn Arterioles

Answer 7

Elastosis and Hyalinosis

Question 8

Gross of Bening HTN ? arterioells

Answer 8

Gross : narrwowing lumen thickness of the wall

Question 9

What occurs to kideny in Benign HTN ?

Answer 9

The renal arteriole witnesses Elastosis and Hyalinosis and decreasfd kifeny supply casuing Atrophy of the glomeruli and its tubules and some of them has compensatory dilatation response .
the atrophied places may witness fibrosis

Microscopic : Atrophy + Fibrosis in kideny
arterioles : elastosis + Hyalinosis

so the kidney grossly may show: Contracted kideny
Decrease in size bilateral\
firm Granular appearance and pale color due to fibrosis reteaction
multiple cysts due to compensatroty tubular dilatation
No demarcation between cortex and medulla
caspule is adherent and dry
perinephric fat is increased!

Question 10

What are effect of benign HTN on the arteries ?

Answer 10

Atherosclerosis and it complications like aortic aneryusm

Question 11

Kideny in benign HTN MICROSCOPIC nephrosclerosis

Answer 11

Microscopic : Atrophy + Fibrosis in kideny

arterioles : elastosis + Hyalinosis

Question 12

the kidney grossly may show:? in benign HTN ?

nephrosclerosis

Answer 12

the kidney grossly may show: Contracted kideny
Decrease in size bilateral\
firm Granular appearance and pale color due to fibrosis reteaction
multiple cysts due to compensatroty tubular dilatation
No demarcation between cortex and medulla
caspule is adherent and dry
perinephric fat is increased!

Question 13

TIP STROKE MEAN
نوبات اغماء مفاجئ بسبب نزيف في المخ
Mention effect of the Bening HTN on the Heart

Answer 13

Increased Blood pressure leads to increased afterload againST Heart
and this leads to left ventricular Hypertrophy and Dystolic dysfucntion and ischemia and may precipitate Heart failure conestive !

Question 14

Mention effect of the Bening HTN on brain

Answer 14

May casue charcot or cereberal micro anyrusm in the small vessels in brain and its repture csauing hemorhage casuing stroke !

شلل أطراف
شلل كلام
تقل الخحركة
مشاكل الاحساس

Also in malignant HTN

Question 15

Mention effect of the Bening HTN on EYES ?

Answer 15

The artrioles elastosis and hyalinosis
so they are rigid and wall is thickened compressing veins casuing congestion leading to papilledema and problems in sight and may cause detachment or retina or hemohhrage blindness
also in Malignant HTN

Question 16

Describe Malignant HTN >

Answer 16

It is more severe and usually 2ry Of sudden onset and short dureation fatal and appear in young age <30 years > 280/180

Question 17

(أَقِيمُوا الصُّفُوفَ ، وَحَاذُوا بَيْنَ الْمَنَاكِبِ ، وَسُدُّوا الْخَلَلَ ، وَلِينُوا بِأَيْدِي إِخْوَانِكُمْ ، وَلَا تَذَرُوا فُرُجَاتٍ لِلشَّيْطَانِ ، وَمَنْ وَصَلَ صَفًّا وَصَلَهُ اللَّهُ ، وَمَنْ قَطَعَ صَفًّا قَطَعَهُ اللَّهُ
ارفع صوتك بالنداء عاليا!
فلتكن فيك قوة !
describe morphological change in arteioles in malignant HTN

Answer 17

It beigns with stimlation of fibroblast and Elastosis and Hyalinosis Then there is proliferaiton of smooth muscle fibers and basement membrane(onion skin)
hyperplastic arteriolsclerosis,

casugin severe narrowing of the lumen causing broken collagen (fibrinoid necrosis ) and cracks in the wall of blood vessel and extension of cracks in the wall and permeability of plasma protein(FIBRIN) into the wall of blood vessel AND there is transmural crack into the wall casuing hemorrhage

Question 18

type on necrosis in malignant HTN in artrioles ?

Answer 18

Fibrnioid necrosis

Question 19

Arterioles:
Gross:
maglinant HTN

Answer 19

(onion skin)
very thick wall
multiple layers

Question 20

Microscopic of arterioles in Malignant HTN Describe.

Answer 20

Microscopic:
Elastosis + Hyalinosis 
-Hyperplasia of S.M. & basement membrane
-Fibrinoid necrosis + permeation of plasma proteins in the wall
-Ruptured vessels

Question 21

Controller Medications of asthma mention .

Answer 21

✓ Inhaled glucocorticosteroids
✓ Leukotriene modifiers
✓ LABA+ICS combination
✓ Systemic glucocorticosteroids
✓ Anti-IgE & Anti-IL4,5 (biological thearpy)

Question 22

Malignant HTN and Arteries

Answer 22

Arteries: Atherosclerosis & its
complications
with aortic dissection

Question 23

Malignant nephrosclerosis

Gross describe

Answer 23

Red spots (flea –bitten) focal necrosis

Question 24

Malignant HTN and Kideny in microscopic appearance

Answer 24

artrioles : elastosis and hylainosis + Smooth muscle proliferation and BM and fibrinoid necrosis +permeation of plasma proteins and ruptured blood vessel .
Tubules and glomeruli : hemorrhage .

Question 25

Malignant HTN and effects on the kidny ?

Answer 25

The arterioles are damaged as we said before and there is hemorrhage in the glomeruli and tubules and kidney is stopped and there is focal necrosis and flea bitten with its normal size due to sudden onset and smooth surface and easily detached capsule due to no fibrosis
easily demarcation between the cortex and medulla

Question 26

Left ventricular hypertrophy is

minimal in malignant HTN ?

Answer 26

due to suddent onset of action

Question 27

Benign &Malignant HTN their common complications are?

Answer 27

• Arteries atherosclerosis
• Cerebral Hemorrhage
• Retinal damage papilledema

Question 28

Causes of death in Bennign HTN?

Answer 28

1-Congestive Heart failure
2-IHD
3-Cerebral hemorrhage
4-Renal Failure

Question 29

Causes of death in Malignant HTN?

Answer 29

1-Renal failure MAIN
2-IHD and Heart failure
3-Cerebral hemorrhgae

Question 30

Discuss : Effect of hypertension on the Heart?

Answer 30

1. afterload (pressure overload), leading to
   ventricular hypertrophy→ relative ischemia → diastolic
   dysfunction
2. atheroscleros→ myocardial infarction
3. Heart failure.

Question 31

“كتاب أنزل إليك فلا يكن في صدرك حرج منه لتنذر به وذكري للمؤمنين”

الحمدلله رب العالمين