Hypertension

Question 1

A 30-year-old woman presenting with hypertension is found to have
hypokalaemia and a mild metabolic alkalosis. Diagnosis?

Answer 1

Conn’s syndrome

Question 2

2 An anxious 26-year-old woman presents with episodes of chest pain and
palpitations precipitated by stress and smoking. Her 24-hour urine shows
elevated catecholamines.
Diagnosis?

Answer 2

Phaeochromocytoma

Question 3

A 45-year-old woman presents with weight gain, muscle weakness and
hirsutism. On examination she is hypertensive and has pedal oedema.

Answer 3

Cushing’s syndrome

Question 4

A 40-year-old man is brought to A&E with severe headache. On examination he
has papilloedema and fundal haemorrhages. His BP is 220/145 mmHg.
Diagnosis?

Answer 4

Malignant hypertension

Question 5

Hypertension in a 75 year old who is a heavy smoker with widespread peripheral
vascular disease.
Diagnosis?

Answer 5

Renal artery stenosis

Question 6

Buzzword - elevated catecholamines

Answer 6

Phaeochromocytoma

Question 7

If unequal sized kidneys, what should you suspect?

Answer 7

Renal artery stenosis

Question 8

How should home blood pressure monitoring be done?

Answer 8

BP recorder 2x day for at least 4 days, but preferably 7
Two consecutive seated measurements, 1 minute apart per time
Patient should be seated
Measurements on the first day are discarded

Question 9

What are the definitions of stage 1,2 and severe hypertension?

Answer 9

Stage 1 - clinic BP is 140/90 or higher AND ABPM or HBPM daytime average is 135/85 mm Hg or higher
Stage 2 - clinic BP is 160/100 mmHg or higher AND ABPM or HBPM daytime average is 150/95 or higher
Severe - clinic systolic BP is 180 mmHg or higher OR clinic diastolic BP is 110 or higher

Question 10

What will be seen on ECG?

Answer 10

Left ventricular hypertrophy

Question 11

What is the best treatment for resistant hypertension?

Answer 11

Spironolactone

Question 12

What does hypertension cause pathologically in the heart?

Answer 12

Left ventricular hypertrophy
Poor perfusion
Interstitial fibrosis around the individual cardiac myocytes - impairs their contractility
Micro-infarcts

Question 13

What drugs can lead to high blood pressure?

What is an alternative to this?

Answer 13

NSAIDS e.g. ibuprofen

Paracetamol

Question 14

What hypertension drug shouldn’t be given in gout?

Answer 14

Thiazide diuretic

Question 15

What condition should you think about in young people who have hypertension?

Answer 15

Fibromuscular dysplasia - causes abnormal growth within the wall of an artery

Question 16

What drug is contraindicated in pregnancy?

Answer 16

ACEI