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Renal II Final > HTN- Karila CIS > Flashcards

HTN- Karila CIS Flashcards

1
Q

65y/o F, increasingly confused. Complained of terrible headache, blurred vision. Hx of HTN, tachyarrythmia. Pt is on metoprolol, she ran out of meds 2 weeks ago. BP 200/120. Loud S4 (asso w/ HTN) . ECHO shows LV hypertrophy. what’s the most appropriate next step in this pt?

A

give IV nitroprusside. Goal by that is to control her BP fast and right away.

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2
Q

with HTN, what’s the difference between urgency and emergency?

A

With emergency you’d start to seeing end organ damage with any BP not just greater than 180 which would be an urgency.

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3
Q 
With HTN emergency, indicate how these organs are involved:
A. CV
B. CNS
C. Renal
D. eyes
A

A. MI, Angina, Aortic dissection, aneurysmal dilation or large vessels, LVH, CHF
B. edema, altered mental status, bleed, stroke or TIA
C. Hematuria, proteinuria, AKI
D. retinal hemorrhage or exudates, papilledema, AV nicking

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4
Q

If a young’n with no History of elevated BP or HTN presents with, elevated BP, headaches, palpitations, abd bruit and other CV issues, think Renal issues. If on MRI of abd you see strings of beads bilaterally of kidney, A. what does that indicate? B. what drug would be used with utmost vigilance?

A

A. Renal artery stenosis due to fibromuscular dysplasia

B. ACEI

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5
Q

Compare atherosclerosis and fibromuscular dysplasia based on age, sex, laterality, and responsiveness to angioplasty

A

Athero: >50yr, male, 33% bilateral, poor response to angioplasty

Fibromuscular dysplasia:

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6
Q

what is the most common form of fibromuscular dysplasia?

A

Medial fibromuscular dysplasia (85%) and can also be seen in carotids and iliac not just renal.

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7
Q

How does ACEI affect Unilateral, bilateral or one kidney, fibromuscular dysplasia?

A

Unilateral: BP falls with ACEI

Bilateral and one kidley: ACE response unpredictable, may worsen HTN

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8
Q

How is fibromuscular dysplasia diagnosed?

A

Start off with an US and doppler. then you can do these:

  1. Captopril test (reacive rise in renin and large fall in BP after admin)
  2. DSA
  3. MRI
  4. Arteriography
  5. Renal vein renin ratio
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9
Q

How is fibromuscular dysplasia treated?

A
  1. Aimed at BP control and preservation of renal function
  2. medical RX- anti-HTN meds
  3. Unilateral stenosis - ACEI
  4. Bilateral or one kidney: can see renal dysfunction with ACEI
  5. Poor response to 3 or more agents points way to nonpharmacologic intervention
  6. surgical tx.
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10
Q

Which of these is/are contraindications for ACEI?
A. Bilateral renal artery stenosis
B. Unilateral renal artery stenosis with solitary kidney
C. Pregnancy
D. Known angioneurotic edema with prior ACE admin
E. Relative contraindication - ACE induced cough
F. All of the above

A

F. All of the above

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11
Q

What are some causes of secondary hypertension?

A
  1. sleep apnea
  2. drug induced causes
  3. Chronic kidney disease
  4. Primary aldo
  5. Renovascular disease
  6. Steroid therapy or Cushings syndrome
  7. Pheochromocytoma
  8. Coarctation of aorta
  9. Thyroid disease
  10. Parathyroid disease
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12
Q 
For Pts who run out of their antiHTN meds, which of the following would have the greatest concern of rebound hypertention? 
A. Atenolol
B. Clonidine
C. Felodipine
D. HCTZ
E. Lisinopril
A

B. Clonidine, its a centrally acting a2 inhibitor.

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13
Q

48 yr old male, with hx of DM and HTN, on meds. Glucose and lipids are under control but BP is still elevated. Has been watching diet and exercise but BP is still high. What medication is the appropriate to start off with for hypertension?

A

ACEI (lisinopril)

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14
Q

A 21 year old, otherwise, active, healthy no prior med history, presents with elevated BP, acute ST segment elevation, pupils are widely dilated and is hostile and mumbling incoherently. What is the likely differential?

A

recreational drug use. Sounds like he had wide range sympathetic activation

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15
Q

what are some CV causes of hypertension?

A
  1. essential HTN
  2. MI
  3. ALVF
  4. Vasculitis
  5. C of A
  6. Aortic dissection
  7. Vol overload, pulmonary edema
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16
Q

Coarctation of aorta is commonly found in what location?

A

ligamentum arteriosum.

17
Q

A 2yr old was evaluated and found to have systolic hypertension. Upon further evaluation to find specifc cause, ti was found that his BP measured from his arm was significantly different from BP measured in his legs. An ejection murmur was also heart. On radiology, the heart appeared to be larger than normal for this age. What is the likely diagnosis?

A

Coactation of aorta.

18
Q

what is the first line of therapy to treat HTN for a patient who is not diabetic, according to JNC?

A

Thiazide diuretic

19
Q

After switching from HCTz to an enalapril, pt developed facial swelling that progressed to a stridorous SOB. what is the mostly med you’d prescribe next?

A

Sounds like pt developed angioedema, a side effect of ACEI. Clinically you’d avoid ACEI and ARB and give you other class of drugs like a beta blocker or diuretics.

20
Q

According to JNC, pharmacologic treatment should be initiated when blood pressure is _ 1_or higher in adults 60 or older; or 2 or higher in adults younger than 60.

A
  1. 150/90

2. 140/90

21
Q

Pts who are diabetic and hypertensive, what BP requires pharmacologic treatment regardless of age?

A

140/90

22
Q

Initial antihypertensive treatment should include which of the following for black patient population?

A

Thiazide diuretic or Calcium channel blocker

23
Q

If a patient appears hypertensive with hypokalemia, which endocrine disorder is likely?

A

hyperaldosteronism. Can be tested with renin and alodsterone levels testing

24
Q

In a patient with hyperaldosteronism, what serum levels are elevated and which one is reduced?

A

Aldosterone is elevated. renin and potassium is reduced.

25
Q

What secondary causes can produce hyperaldosteronism?

A
  1. Diuretics
  2. CHF
  3. Cirrhosis
  4. Ascites
  5. Nephrosis
26
Q 
52 y/o female on predisone for sarcoidosis. She usually has normal BP and takes no meds and her electrolytes are normal. which of the following is most likely cause of her hypertension? 
A. Coartation of aorta
B. Pheo
C. primary aldo
D. Fibromuscular dysplasia
E. Cushing's syndrome
A

E. Cushing syndrome secondary to use of corticosteroid

Renal II Final (4 decks)

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