Hypertension

Question 1

What is S3?

Answer 1

Rapid ventricular filling due to ventricular dilatation

Question 2

What is S4?

Answer 2

Sound of atrial contraction in ventricular hypertrophy

Question 3

Who can have S3 physiologically?

Answer 3

Really fit athletes

Question 4

Contrast ventricular hypertrophy and ventricular dilatation

Answer 4

VH = HTN causes muscle to push really hard and become thicker inwards 
VD = failing heart becomes baggy outwards

Question 5

Ventricular hypertrophy on ECG?

Answer 5

Tall R waves

Question 6

Ventricular dilatation on CXR?

Answer 6

Cardiomegaly

Question 7

Which state is S3?

Answer 7

Kentucky

Question 8

Which state is S4?

Answer 8

Tenesse

Question 9

What is gallop rhytm?

Answer 9

FOUR heart sounds

Have HTN & heart failure so have 4 1 2 3

Question 10

BMI <18. Dx?

Answer 10

Underweight

Question 11

What is healthy BMI?

Answer 11

18.5 - 24.9

Question 12

Overweight BMI?

Answer 12

25-29.9

Question 13

Obese BMI?

Answer 13

30-34.9

Question 14

Morbid obese BMI?

Answer 14

40-50

Question 15

Why is a BMI of 24 not necessarily healthy?

Answer 15

If Asian, >23 is a huge risk factor

Question 16

Unfit man with BP 200/120. He wants to go the gym. What should you say to him?

Answer 16

Low salt diet

BP treatment if persistently high

Question 17

List signs of chronic HTN

Answer 17

S4
Flame haemorrhages / AV nipping on fundoscopy
Heave
Bruits

Question 18

What BP reading would you be worried about enough to send to A&E?

Answer 18

If diastolic >140

Question 19

List the grades of HTN retinopathy

Answer 19

SAFE 
1= Silver wiring 
2= AV nipping 
3= Flame haemorrhages 
4= papilloEdema

Question 20

What is silver wiring?

Answer 20

Silver line in middle of arteries coming off blind spot

Question 21

What is AV nipping?

Answer 21

Artery crosses vein and causes vein to squish due to really high pressure in artery

Question 22

What can also be present with flame haemorrhages?

Answer 22

Cotton wool spot

Question 23

What does cotton wool spot mean?

Answer 23

Ischaemia in the retina

Question 24

What does papilloedema look like?

Answer 24

Edge of disc isn’t visible

Question 25

What does papilloedema mean?

Answer 25

Pressure in CSF is high - can be due to really high HTN or space occupying lesion causing raised ICP

Question 26

Are hard exudates part of HTN retinopathy?

Answer 26

NO - they are diabetic features

Question 27

What are the Sx of retinopathy?

Answer 27

NONE - patients will just suddenly go blind

Question 28

What are signs of LV hypertrophy on examination?

Answer 28

NONE - only detected on ECG

Question 29

What does HTN retinopathy show?

Answer 29

Pt has had HTN for a long time

Question 30

List secondary causes of HTN

Answer 30

``` Phaeochromocytoma Acromegaly Renal artery stenosis Cushings Drugs - eg cocaine Conns Coarctation of aorta ```

Question 31

What is essential HTN?

Answer 31

Ppl that just have HTN due to poor diet / randomly - they just need normal HTN medication

Question 32

What basic Ix need to be done after HTN found?

Answer 32

``` FBC U&E ECG Urinalysis Fasting glucose Lipid profile ```

Question 33

Why would you do a FBC?

Answer 33

Look for polycythaemia

Question 34

Why would you do U&Es?

Answer 34

K might be low in Conns etc | Renal function might be affected

Question 35

Why would you do an ECG?

Answer 35

LV hypertrophy

Question 36

Why would you do urinalysis?

Answer 36

Nephritis or renal disease

Question 37

HTN with high aldosterone but low renin. Dx?

Answer 37

Conn's

Question 38

HTN with high aldosterone and high renin. Dx?

Answer 38

Renal artery stenosis

Question 39

What causes renin secretion?

Answer 39

Pressure on juxtaglomerular artery

Question 40

Which drug should be used in patients with DM who have microalbuminaemia ?

Answer 40

ACE i

Question 41

What drug is available to statin intolerance?

Answer 41

Ezetemibe | Evolocumab

Question 42

Side effects of statins?

Answer 42

Muscle aches - but might be psychological

Question 43

What drugs are -mab ?

Answer 43

Monoclonal antibodies

Question 44

Which group of patients will benefit from evolocumab?

Answer 44

Familial hypercholesteralaemia