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ICC3 > hypertension > Flashcards

hypertension Flashcards

1
Q

what are the three main goals for new HTN patients

A

identify any co morbidities
asses target organ damage
exclude any secondary causes

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2
Q

what are some drugs that elevate blood pressure ?

A 
estrogen 
NSAIDS 
antidepressants
corticosteroids
diet pills
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3
Q

on examination what would indicate coartication of the aorta ?

A

arm-leg discrepancy or a decrease in femoral pulse

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4
Q

what would renal bruit on examination suggest ?

A

renal artery stenosis

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5
Q

what would a buffalo hump or moon face suggest ?

A

cushing syndrome

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6
Q

what would unprovoked hypokalemia suggest ?

A

hyperaldosternism (Conn’s syndrome)

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7
Q

what would elevated hematocrit suggest ?

A

polycythemia

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8
Q

what would azotemia or proteinurea suggest ?

A

renal disease

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9
Q

what is the ABCDE approach with hypertension

A 
A - Accuracy , apnea aldosteronism
B - bad kidneys 
C - cortications catecholamines cortisol 
D - Diet Drugs 
E - Endocrine erythropoeitn
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10
Q

what is the most common etiology causing 2ry hypertension in children

A

renal parenchymal disease
coartication of the aorta
left ventricular hypertrophy

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11
Q

what is the most common etiology causing secondary hypertension in older patients

A

hypothyroidism
atherosclerotic renal artery stenosis
renal failure

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12
Q

most children with hypertension secondary or primary ?

A

secondary hypertension (70-85%)

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13
Q

what routine testings could you add for children with hypertension

A

urine culture and renal ultrasonography

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14
Q

how would we confirm hypertension ?

A

Ambulatory blood pressure monitoring

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15
Q

what is the second most common cause of HTN in children

A

coartication of the aorta

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16
Q

what can confirm aortic coartication ?

A

arm-leg discrepancy and decrease in femoral pulse along with the classic 3 sign oor rib notching on the chest x ray

17
Q

what is resistant hypertension ?

A

when the patient isn’t improving and not responding to medications

18
Q

what is the best initial test when suspecting hyperaldosteronism ?

A

aldosterone :renin ratio

19
Q

when should a sample be takin for the aldosterone/renin ratio?

A

preferabbly in the morning at least 2 hrs after waking up and in the upright position

20
Q

what are the causes of hyperaldosteronism ?

A 
adrenal hyperplasia ( rarley a carcinoma)
aldosterone secreting adenoma
21
Q

what drugs should the patient stop before taking a sample for aldosteron renin ratio

A 
Any of :
spironolactone (aldosterone receptor agonist)
NSAIDS 
potassium wasting diuretics 
licorice (causes potassium wasting)
ACE/ARBs inhibitors
22
Q

what drugs are okay to use when preparing to test for aldosteron renin ratio

A

calcium channel blockers : verapamil
hydralazine
alpha blockers

23
Q

what to do when aldosterone;renin ratio is high ?

A

diagnostic for hyperaldosternism
if the cause is an adenoma then surgical resection
If hyperplasia, mineralocorticoid antagonist: Spironolactone - non selective

24
Q

what to consider with an old patient that has a new onset of hypertension ?

A

renal artery stenosis

atherosclerotic disease

25
Q

what are the diagnostic investigations for renal artery stenosis ?

A
  • Colour doppler ultrasound of renal arteries
  • MRA renal arteries
  • CT renal angiography
26
Q

when to use MRA and when to use CTA ?

A

if the patient has renal insufficiency then use MRA no contrast

27
Q

what is the problem with using renal doppler ?

A

operator dependent and can be changed by body habitus

28
Q

when to suspect obstructive sleep apnea ?

A

patients with resistant hypertension , obese and have a wide neck circumfrence

29
Q

what can be used to treat OSA

A

CPAP

30
Q

what is the diagnostic criteria for coartication of the heart?

A

echocardiograph

31
Q

what is the diagnostic criteria for cushing?

A

24hr urinary cortisol

dexamethasone suppression test

32
Q

what is the diagnostic criteria for phaeochromocytoma?

A

urinary and plasma metanephrines

33
Q

what is the diagnostic criteria for renal parenchymal disease ?

A

renal ultrasound
serum creatinine , urea eGFR
Urinary albumin
Kidney biopsy

34
Q

if i am still suspecting 2ry hypertension in a child what test should you do first ?

A

renal ultrasound

35
Q

if i am still suspecting 2ry hypertension in a young adult ?

A

renal artery MRI or CTA

36
Q

if i am still suspecting 2ry hypertension in a middle aged patient what test should i do first?

A

measure renin/aldosterone levels

ICC3 (66 decks)

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