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Medicine year 3- EOCP > Hypertension and scoring systems > Flashcards

Hypertension and scoring systems Flashcards

1
Q

Cut offs for hypertension

A

Hypertension stage 1- 140/90 mmHg
Over 80- 150/90
Type 1 diabetes 135/85
Type 2 diabetes 140/80

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2
Q

Risks of high blood pressure

A
  • Heart disease
    -Heart attacks
  • Strokes
  • Heart failure
  • Peripheral arterial disease
  • Aortic aneurysm
  • Kidney disease
  • Vascular dementia
  • Major cause of premature death worldwide
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3
Q

Risk factors for hypertension

A
  • Overweight
  • Too much salt
  • Not enough fruit/veg
  • Sedentary lifestyle
  • Excess alcohol or caffeine
  • Over 65
  • Family history
  • Black African or caribbean descent
  • Low socioeconomic status
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4
Q

Annual health checks

A

Offered to people over the age of 80
Do screening for diabetes (HBA1C)
Check BP for hypertension
Might do FBC and LFT- fatty liver disease
U&E- CKD
Lipid profile
Address lifestyle risk factors

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5
Q

HBA1c levels in annual health check

A
  • <42 normal
  • 42-48 - pre-diabetes, non-diabetic hyperglycaemia (NDH)
  • > 48 diabetes
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6
Q

Stage 1 hypertension

A

140-159/90-99
Manage lifestyle factors first and try to reduce blood pressure
Only treat if QRISK >10%

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7
Q

Stage 2 hypertension

A

> 160/>100
Pharmacological treatment

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8
Q

QRISK

A

The chance of having a cardiovascular event in the next 10 years, anything over 10% is significant
If high QRISK, important to start treatment
Statins are a good drug to reduce QRISK

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9
Q

Statins- when to use/not use

A

Before starting statins, do LFT to assess liver function and do it after 3 months
If hepatic impairment, statins are not suitable as they are metabolised in the liver by CYP450 enzymes
Offer a statin to anyone with a QRISK >10% even if their cholesterol isn’t particularly raised
Continue using statin unless ALT is more than 3x normal

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10
Q

Disadvantages of statins and what to use if contraindicated

A

Disadvantages- liver inflammation, muscle side effects, myalgia, rhadomyolysis
What to use if contraindicated- Zetamide

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11
Q

Types of prevention

A

Primary prevention- aims to prevent a disease before it even occurs. Done in GP and community
Secondary prevention- treating the disease ASAP to minimise complications, secondary care and hospital

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12
Q

Secondary causes of hypertension

A
  • Secondary problems include adrenal gland problems, renal problems, renal artery stenosis, endocrine disorders (primary hyperaldosteronism, hyperthyroidism, hypothyroidism), pheochromocytoma (neuroendocrine tumour)
  • If secondary to another disease, tend to be showing systemic symptoms as well as hypertension
  • Also, more likely to be young (<40) with no family history of HTN
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13
Q

Key NICE guideline message for Hypertension

A
  • Stepwise approach to treatment
  • Treatment threshold
  • Looking at overall CHD risk
  • Differences with different ethnic groups
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14
Q

Issues with concordance with anti-hypertensive medication

A

• Most people with hypertension feel well
• Anti-hypertensives can make people feel unwell or give unwanted side-effects [e.g., erectile dysfunction]
• Treating because of long term risks of events - this can be a hard concept to explain to patients

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15
Q

Treatment for adults with hypertension without type 2 diabetes

A

Under 55
1. ACE inhibitor or ARB
2. calcium channel blocker of thiazide diuretic

If black African or African-Caribbean
1. calcium channel blocker
2. ACE inhibitor, ARB or thiazide diuretic

Anyone over 55
1. calcium channel blocker
2. ACE inhibitor, ARB or thiazide diuretic

  1. ACEI/ARB AND calcium channel blocker AND thiazide like diuretic
    Monitor and review annually
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16
Q

Treatment for adults with T2 diabetes with hypertension

A
  • step 1 is ACE inhibitor or ARB
  • step 2 is calcium channel blocker or thiazide like diuretic
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17
Q

ACE inhibitors

A

Lisinopril, ramipril, imidapril

Angiotensin converting enzyme inhibitors
Relax veins and arteries and causes more water excretion
Prevent angiotensin converting enzyme in body from producing angiotensin II-substance which narrows blood vessels
Most common side effect is a dry cough

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18
Q

Contraindications for ace inhibitors

A
  • Dont use on patients with angioedema, pregnant/breastfeeding women
  • Use with caution in people of black african or caribbean origin, those with renal impairement, taking diuretics and some cardiomyopathies
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19
Q

ARBS

A

Candesartan, irbesartan, valsartan, losartan

Angiotensin receptor blockers
Reduce action of angiotensin II

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20
Q

Contraindications of ARBS

A
  • Contraindicated in people with diabetes, pregnant women and those planning pregnancy, breastfeeding women
  • Used with caution in people of black African or Caribbean origin, with renal impairment or renal artery stenosis or aortic/mitral valve stenosis, history of angioedema

Side effects- renal impairement, hyperkalaemia, angiodema, dizziness

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21
Q

Calcium channel blockers

A

amlodipine, felodipine, nifedipine

Lower BP by preventing calcium entering cells, calcium contracts muscular linings of blood vessels
Without calcium, blood vessels relax and heart muscles receive more blood

22
Q

Contraindications and side effects of calcium channel blockers

A

Contraindications= Heart failure, cardiac outflow obstruction, Hepatic/renal impairement

Side effects= Abdominal pain, AV block, constipation, dizziness

23
Q

Thiazide diuretics

A

Indapamide, Bendroflumethiazide

Relieve oedema due to chronic heart failure and lower BP
Inhibit sodium reabsorption. Affects distal renal tubule, blocks Na+/Cl- transporter

24
Q

Contraindications and side effects of thiazide diuretics

A

Contraindications- - Avoided in people with refractory hypokalaemia, hyponatraemia, hypercalcaemia, Addison’s disease, asymptomatic hyperuricaemia, severe liver disease, reduced eGFR and pregnant women.

Side effects- postural hypotension, electrolyte imbalance, arrhythmias, dizziness and headache

25
What are the parameters for the early warning scores
- Respiration rate - Oxygen saturation - Systolic blood pressure - Pulse rate - Level of consciousness or new confusion - Temperature
26
Threshold for the early warning score
Score 0-4 - low risk - ward-based response Score of 3 in any parameter - low/medium risk - urgent ward-based response Score of 5-6 - medium risk - key threshold for urgent response Score of 7 or more - high risk - urgent or emergency response
27
Mini mental state exam
30 point questionnaire to check for cognitive impairment 27 or higher is considered normal, 24-27 is mild cognitive impairment, 18-23 is mild dementia, 10-18 is moderate dementia, 10 or less is severe dementia
28
MoCA test
30 question test to assess for dementia Scores range from 0-30, 26 or higher is considered normal, 18-25 mild cognitive impairment, 10-17 moderate cognitive impairment, less than 10 severe cognitive impairment
29
GCS- E
1= No opening of the eye 2= Eyes opening in response to pain 3= Eyes opening in response to speech 4= Eyes opening spontaneously
30
GCS- V
1= no verbal response 2= Incomprehensible sounds 3= single words 4= Confused 5= Orientated
31
GCS- M
1= No response 2= Abnormal extension 'decerebrate' 3= Abnormal flexion 'decorticate' 4= Normal flexion 5= Localises to pain 6= Obeys command
32
Total anterior circulation stroke (TACS)
All 3 of the following - Unilateral weakness (and/or sensory) defecit of the face, arm and leg - Homonymous hemianopia - Higher cerebral dysfunction (dysphasia)
33
Partial anterior circulation stroke (PACS)
Two of the following: - Unilateral weakness (and/or sensory deficit) of the face, arm and leg - Homonymous hemianopia - Higher cerebral dysfunction (dysphasia, visuospatial)
34
Lacunar syndrome
One of the following - Pure sensory stroke - Pure motor stroke - Sensory and motor stroke - Ataxic hemiparesis
35
Posterior circulation stroke (POCs)
One of the following - Cranial nerve palsy and a contralateral motor/sensory defecit - Bilateral motor/sensory defecit - Conjugate eye movement disorder - Cerebellar dysfunction (DANISH) - Isolated homonymous hemianopia
36
Carotid dissection symptoms
-Ipsilateral headache, neck and facial pain - Transient blindness - Ptosis with miosis (partial Horner's syndrome) - Neck swelling - Pulsatile tinnitus - Decreased taste sensation - Focal weakness
37
CVST symptoms
- Sharp pain behind the eye - Symptoms begin a few days after an infection like a boil or sinusitis - Swelling and bulging of the eye - Red eye and eye pain - Difficulty moving the eye, drooping of the eye - High temperature, vomiting, changes in mental states and seizures
38
Re-entrant tachycardia
- Not a sinus rhythm because there is no P wave, narrow complex, tachycardic - Treatment: vagal manoeuvres, beta-blockers, calcium channel antagonist
39
ECG: 3rd degree heart block
- Narrow complex, bradycardic sinus rhythm. Not conducting to the ventricles - The ventricles and atrium are unrelated - Definitive treatment: pacemaker
40
ECG: Left ventricular hypertrophy and cardiomegaly
- High QRS complex - Left axis deviation causes a negative lead II (QRS complex upside down), right axis deviation causes a negative lead I. Axis deviation is often due to cardiomegaly
41
ECG: Atrial fibrilation
Wobbly base line Irregularly irregular
42
ECG: Unstable angina
Sinus bradycardia with T wave inversion
43
Breathlessness score
MRC score 1- Not troubled by breathlessness except on strenuous exercise 2- Short of breath when hurrying on the level or walking up a slight hill 3- Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace 4- Stops for breath after walking about 100 yards or after a few minutes on level ground 5- Too breathless to leave the house, or breathless when undressing
44
DECAF score
Measures mortality for acute exacerbations of COPD -MRC score -Eosinophilia score -Consolidation on chest x-ray -Acidaemia -Atrial fibrilation
45
Decubits x-ray
Done with the patient lying side on, done for the acutely unwell patient
46
Difference between cholangitis, choleystitis and pancreatitis
Cholecystitis: in the gallbladder Cholangitis: in the common bile duct Pancreatitis: gallstone in the ampullar vater, blocks the enzymes from leaving the pancreas, causes autolyses of the pancreas
47
Painless jaundice, portal hypertension and splenomegaly
Painless jaundice: pamcreatic cause Splenomegaly: caused by cirrhosis Portal hypertension: cuases ascites, varices and splenomegaly
48
Pneumoperitoneum
Air beneath the diaphragm, visible bilaterally. Suggests intestinal perforation or recent intra-abdominal surgery
49
Addisons disease
- Adrenal insufficiency causing a lack of cortisol and aldosterone - Symptoms: fatigue, low mood, postural dizziness, muscle cramps and dark pigmentation in the gums
50
Different scoring systems
Glasgow blatchford score- risk stratifies upper GI bleeds Forrest- stratifies severity of UGI bleeding according to endoscopic findings Oakland- predicts risk of readmission for lower GI bleeds Manning- used for the diagnosis of IBS

Medicine year 3- EOCP (27 decks)

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