Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Pre eclampsia is

A

HTN plus proteinuria after 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

High BP and CLARIFY registry

A

J shaped relation with CAD but not with stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sulfa based diuretic

A

HCTZ And Furosemide are Sulfa based
But risk of reaction is low even in sulfa allergic pt
Spironolactone. Triamterene etc doesn’t contain Sulfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference b/w SAM and Pseudo SAM

A

Pseudo SAM— 1.Seen inIn HTN with LVH

  1. SAM Peaks between 2/3 rd and End systole while Pseudo SAM at end systole ( i.e. SAM much earlier than maximum movt of Posterior wall while PseudoSAM when postr wall has contracted fully.
  2. AML returns to initial level prior to opening of MV in SAM while it doesn’t in Pseudo SAM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DBP in elderly should be maintained above

A

60 mm Hg as per a German presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Angiographic appearance inFMD

A

String of beads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Type of cerebrovascular involvement in FMD

A

EXTRACRANIAL cerebrovascular i.e. Carotid and Vertebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In Lower limbs FMD commonly involves which arteries

A

External iliac arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

EXTRACRANIAL cerebrovascular involvement occurs in upto—— of FMD patients

A

2/3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Onset of HTN before —–/ in a female u should suspect FMD

A

35 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pressure gradient considered significant in Renal FMD

A

MEAN Pressure drop 10% or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Role of CTA and Doppler in diagnosing FMD

A

With experienced operators this is enough in most vascular beds EXCEPT Carotids

Direct Angio is necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How FMD Renal angioplasty is different from others

A

Stenting usually not done. ( Only if there’s dissection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DOC for HTN in FMD

A

ACE/ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Efferent arteriole means

A

Post Glomerular arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The rise in Creatinine which is acceptable with ACE/ARB in FMD

A

Upto 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to check Creatinine after starting ACE /ARB in FMD

A

After one week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Definition of Resistant HTN

A

Not controlled with THREE Med which includes a Diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What % of Primary hyperaldosteronism has hypokalemia

A

Less than 50 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First test to look for hyperaldosteronism

A

Plasma aldosterone concentration / Plasma Renin activity

Ratio more than 20 and also PAC should also be elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Inappropriate elevation of aldosterone in relation to renin may be seen in …. in addition to hyperaldosteronism

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which studies proved Telmisartan and Ramipril are equal

A

ON TARGET , TRANSCEND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fractionated catecholamines and metamephrines means

A

Fractionated catecholamines - Epinephrine, Nor epinephrine and Dopamine

Fractionated metanephrine- means Metanephrine and Normetanephrine

Ie the assay measures all components separately

24
Q

Common causes of secondary hypertension

A

Primary Aldosteronism
RAS
Obstructive Sleep Apnea
Renal parenchymal disease

Uncommon-Pheo, Cushing, Hyperparathyroidism, Coarctation , Hypothyroidism

25
Q

Least specific test for catecholamine metabolites

A

VMA

Metanephrines- an intermediate metabolite b/w Epinephrine and VMA is now considered as most sensitive and specific test

26
Q

Atherosclerosis of Renal artery primarily affects adults after

A

45 yrs

27
Q

FMD affects females below….and ……part of Renal artery

A

50 yrs

Distal main Renal A or intrarenal branches

28
Q

Potential concerns for medical therapy alone for RAS

A
  1. Progression of stenosis
  2. Long term ischemic damage to kidney
  3. Impaired kidney function with ACE/ARB
29
Q

Urinary metanephrines includes

A

Metanephrine, Normetanephrine & 3- ortho methyl dopamine

3OMD is normal in benign pheochromocytoma but Elevated in Malignant Pheo

30
Q

Hyperaldosteronism initial Evaln after K is

A

PAC/PRA….Pakkara

31
Q

How to take morning sample for PAC/PRA

A

Pt out of bed for at least 2 hours and seated for at least 5-15 mts before sample is drawn

32
Q

How long should you stop Aldactone before doing PAC/PRA for Hyperaldosteronism

A

6 weeks

Diuretic also 6 wks- Internet
Other medicines-2 wks- Internet

33
Q

PAC/PRA results in Primary hyperaldosteronism

A

Both PAC & PAC/PRA ratio will be high

Ratio of >20 is considered significant & PAC is usually > 15

34
Q

Effect of beta blockers on PAC/PRA ratio in primary hyperaldosteronism

A

Reduces PRA and increases ratio but not to significant levels. So continue .
Also PAC Will be less than 15 in Pts without hyperaldosteronism

35
Q

Safest drugs to take while checking PAC/PRA in primary hyperaldosteronism

A

Verapamil, Hydralazine, Alpha blockers. -Internet

But uptodate says most Med except Aldosterone inhibitors are ok

36
Q

Protocol for doing PAC/PRA in Primary hyperaldosteronism

A

Out of bed at least 2 hours prior
Seated for at least 5-15 mts
Preferably 8 am

37
Q

According to 2017 update on JNC 7 Guidelines of 2013…
Stage I HTN is

ie 2017 ACC/AHA Guidelines
N.B .- Surpringly not described as update on JNC 8 , 2014 guidelines

A

130/80 mm Hg
DBP of 80 is Hypertension!!!!

Stage 2 is 140/90

KEY- These are based on ABPM. Office recordings has not changed 😜😜
Stage 1 is same 140/90

38
Q

Study which supported higher BP targets in elderly and the study which was against it

A

2008 HYVET- Hypertension in Very Elderly Trial. Target BP was < 150. Age_80 or more

2016 SPRINT produced opposite results

39
Q

Target BP in SPRINT 2016

A

120 vs 140 in persons aged more than 50 yrs.

Mean age was 68

40
Q

Which trial showed Renal denervation is not effective

A

2014 SYMPLICITY HTN-3 trial

41
Q

2017 SPYRAL HTN-OFF MEDICINE trial showed that

A

Renal denervation can reduce BP around 10/5 with modified procedure compared to SYMPLICITY HTN 3

42
Q

Ideal pulse pressure according to the 2017 CLARIFY registry is

A

45-65

43
Q

Rise in serum creatinine of more than ——- with ACE/ARB in CKD should be evaluated for RAS

A

30%

CKD definition-e GFR <60ml/ 1.72m2/ min with or without proteinuria

ESC 2018 guidelines

44
Q

Physical activity and BP response- ESC 2018

A

Acute raise in BP esp SBP

Followed by a short lived decline inBP below baseline

45
Q

Type of exercise which reduce BP in hypertensives

A

Aerobic endurance training

ESC 2018

46
Q

Exercise duration advised for hypertensive Pt ESC2018 guidelines

A

At least 30mt x 5 days aerobic

Resistance exercise can be done 2-3days/week

Gradually increase aerobics to 300 mts/ week

More the better

47
Q

Impact of isometric exercise on BP and CV risk

A

Less well established

ESC 2018

48
Q

Is RAS a contraindication to ACE/ARB treatment

A

In BILATERAL RAS its to be avoided

ESC 2018 guidelines

49
Q

ESC HTN guidelines started from

A

2003

Then 2007,13, 18

50
Q

Change in ESC 2018 HTN guidelines regarding treating BP 130-139/85-89

A

Previous was red. Now yellow
May be considered when CV risk very high DUE to established CVD esp CAD

3to 2b

51
Q

Difference in guidelines in treating stage 1 HTN between 2013 and 2018 ESC

A

In low- moderate risk (<5% SCORE) -after a period of LSM start med-class1
Previously it was 2a

Also in >65<80 subset - treatment of grade 1 HTN was 2b before now it is class1

52
Q

Difference inBP treatment targets between 2013 and 18 guidelines

A

Before it was just below 140/90.

Now it is for all below 140/90
If tolerated target 130/80 or below in most patients

SBP in <65 , SBP should be
lowered to 120-129 in most

> 65 ::SBP130-139

DBP::<80 for all patients (2a)

53
Q

Exceptions for SPC (single pill combination)in ESC 2018 HTN subset

A
  1. Frail older patients

2. Low risk Gd 1 HTN (((esp if SBP < 150)))

54
Q

For resistant HTN - after mineralocorticoid antagonist, the drugs mentioned are

A

Bisoprolol and Doxazosin(alpha blocker)

55
Q

ESC definition of BP is for people more than

A

18 years

Guide

56
Q

HTN grading in ESC 2018 guidelines

A

ONH- ON Hypertension

O-optimal
N- Normal
H-High Normal
Then Grade 1-3

Cardio (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions