Hypertension CIS

Question 1

to diagnose hypertension

Answer 1

need TWO readings

Question 2

essential HTN

Answer 2

no known cause - idiopathic

Question 3

most likely cause of HTN

Answer 3

essential - no known cause

Question 4

risk factors for essential HTN

Answer 4

obesity
high salt diet
hereditary
alcohol
age

Question 5

headaches and HTN

Answer 5

don’t treat to solve headache

Question 6

HTN risk of what conditions

Answer 6

stroke
MI
heart failure
ESRD
aortic dissection
PVD

Question 7

HTN in young**

Answer 7

increased peripheral vascular disease (vasospasm)

• level of small arterioles
• both systolic and diastolic elevated

Question 8

HTN in old**

Answer 8

aorta stiff - collagen replaces elastin

-isolated systolic HTN**

Question 9

recommended life-style modifications for patient

Answer 9

minimum 30 minutes most days of week
-HR elevation 70% (220-age)

DASH diet - fruit, veggies, low fat

moderation of alcohol - less than 2/day or 10/week

Question 10

treat with drugs or wait for lifestyle mods?

Answer 10

drug.

Question 11

intitial HTN med for non-black

Answer 11

ACE (-)
ARB
CCB
thiazide diuretics

Question 12

initial HTN med for black

Answer 12

CCB

thiazide diuretics

Question 13

cushings

Answer 13

• adrenal overactivity
• striae - fast weight gain
• cause of HTN

Question 14

dexamethasone suppression test

Answer 14

cushing test

Question 15

secondary HTN

Answer 15

• hard to control HTN
• compelling ginding
• atypical age
• absence of predisposing factors

Question 16

renal artery stenosis

Answer 16

cause of secondary HTN

Question 17

Dx for renovascular HTN

Answer 17

captopril
DSA
MRI - angiography
arteriography
renal vein renin ration

Question 18

captopril

Answer 18

rise in renin and large fall in BP after administration

captopril - ACE (-)

• abnormal test - renovascular disease
• diagnosis - renal artery stenosis

Question 19

two main causes of renal artery stenosis

Answer 19

• atherosclerosis

- fibromuscular dysplasia

Question 20

careful with these meds with renal a. stenosis

Answer 20

ACE (-)

unilateral - BP falls
bilateral - unpredictable, may worsen HTN
one kidney - unpredicatble, may worsen HTN

Question 21

fibromuscular dysplasia

Answer 21

young females
bilateral renal a stenosis
responds to angioplasty

Question 22

atherosclerosis

Answer 22

older males

unilateral renal a stenosis

Question 23

test for hyperthyroid

Answer 23

TSH

Question 24

black with hyperthyroid meds for HTN

Answer 24

beta-blocker

• non-selective
• propanolol

Question 25

HTN with low K

Answer 25

hyperaldosteronism

hypokalemia is the clue**

Question 26

hypertensive urgency

Answer 26

systolic > 180
diastolic > 130
NO evidence of organ damage

Question 27

hypertensive emergency

Answer 27

any BP - includes end organ damage

Question 28

secondary hyperaldosteronism

Answer 28

diuretics
CHF
cirrhosis
ascites
nephrosis
etc

Question 29

weak with hyperaldosteronism?

Answer 29

hypokalemia - muscle weakness

Question 30

Tx for hyperaldosterone HTN

Answer 30

spironolactone

-aldosterone blocker**

Question 31

adrenal conditions with 2nd HTN

Answer 31

cushings
hyperaldosteronism
pheochromocytoma

Question 32

test for pheochromocytoma

Answer 32

VMA levels

Question 33

coarctation of aorta

Answer 33

difference in BP arms to legs
-20mmHg

also - systolic ejection murmur

can cause secondary HTN

narrowing medial layer of aorta

• commonly at ligamentum arteriosum
• interrupted, preductal, postductal