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medical complexities and research methods > Hypertensive Disorders > Flashcards

Hypertensive Disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

Risks of chronic hypertension x3

A

Increased risk of developing pet
Increased risk of iugr
Increased risk of placental abrupt ion

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2
Q

Degrees of chronic hypertension

A

Mild, moderate and severe

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3
Q

Definition of mild chronic hypertension

A

140-149/90-99

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4
Q

Definition of moderate chronic hypertension

A

150-159/100-109

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5
Q

Definition of severe chronic hypertension

A

> 160/>110

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6
Q

Pregnancy induced hypertension

A

Development of blood pressure above 140/90 after 20/40 without proteinuria

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7
Q

Risks of PIH x1

A

Increased risk of PET

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8
Q

Antenatal care for a patient with PIH x3

A

Regular A/N checks - bp and urinalysis
Education on symptoms of PET
Anti hypertensives if BP persistently >150/90

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9
Q

Maternal Risk factors for PET x6

A 
Maternal family hx 
Personal hx of condition 
Ethnic background 
Greater interval between pregnancies 
Age 40
Multiple pregnancy
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10
Q

Medical disorder risk factors for PET x6

A 
Chronic hypertension
Renal disease 
Obesity 
Diabetes mellitus 
Adverse lipid profile 
Thromboembolic disorders
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11
Q

Systems affected by PET x5

A 
Cardiovascular 
Renal 
Liver 
Neurological 
Fetoplacental
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12
Q

When will signs of PET show

A

2nd half of pregnancy

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13
Q

Interplay of factors resulting in PET x3

A

Genetic predisposition
Immunological
Placental development/implantation

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14
Q

Placenta ischiaemia - pregnancies complicated by PET point 1

A

2nd wave of trophoblast cell invasion of spiral arterioles in 2nd trimester is abnormal = impaired perfusion of placental tissue

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15
Q

Placenta ischiaemia - pregnancies complicated by PET point 2

A

Spiral arteries remain intact endothelial and smooth muscle linings. They undergo less dilitation than expected.

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16
Q

Placenta ischiaemia - pregnancies affected by PET point 3

A

Development differences are thought to result in factors being released into maternal circulation.
These could be responsible for placental dysfunction, vasoconstriction and hypertension.

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17
Q

Placenta ischiaemia - damage to endothelial cells will: x4

A

Reduce production of prostacyclin and nitric oxide
Increase vascular sensitivity to angiotension 2
Activates coagulation cascade and production of thromboxane
Increases production of lipid per oxides and decreases antitoxidants

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18
Q

Placenta ischiaemia - a result of endothelial dysfunction

A

Circulating factors are released from placenta in response to hypoxia resulting from under perfusion

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19
Q

Placenta ischiaemia - what do endothelial cells form?

A

Endothelium

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20
Q

Placenta ischiaemia - what do endothelium do? X4

A

Line cv system
Play role in regulating capillary transport
Role in modulating vascular smooth muscle reactivity in response to various stimuli
Form inner lining of blood vessels

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21
Q

What study suggests length of sexual relationship is related to incidence of PET?

A

Robillard et al 1994

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22
Q

What is a sexual relationship of

A

A 7 fold increase in HDP

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23
Q

Partial explanation for increase incidence of HDP with x5

A 
Nulliparity
Primiparity 
Teenage pregnancy 
Aids 
Previous hx of pet with male partner
24
Q

Effects of placenta ischaemia and endothelial disruption x9

A 
Generalised vasoconstriction 
Increase systemic vascular resistance 
Increase vascular hydrostatic pressure 
Decrease in tissue perfusion
Multiple organ dysfunction/damage 
Increase in vascular permeability 
Oedema 
Decrease in circulating plasma volume 
Haemoconcentration
25
Q

Maternal symptoms - brain vasospams x3

A

Frontal headaches
Visual disturbances
Seizures

26
Q

Maternal symptoms - liver micro emboli/hypoxic damage x4

A

Liver swelling
Nausea and vomiting
Epigastric pain
Right upper quadrant pain

27
Q

Screening for hypertensive disorders properties x4

A

For those that have risks/signs at booking or f/u
Continuity care results in less mistakes
Regular bp and urinalysis
Observe for oedema

28
Q

What is the best way to measure bp?

A

Manually as it is the optimum method for diagnosis

29
Q

What must we consider when measuring bp? X5

A

Effects of physical condition, exertion, environment, smoking, white coat syndrome

30
Q

Proteinuria x3

A

Dipstick measurement
If proteinuria present obtain for msu
Confirm using qualitative measurement and timed urine

31
Q

What is RBC x2

A

Main blood component

Helps asses O2 carrying capacity

32
Q

Variation in normal RBC count x2

A

Increase may indicate polcythaemia

Decrease may indicate anaemia, fluid overload and haemorrhage

33
Q

What does haematocrit value tell us

A

Reflects % of blood occupied by RBC

34
Q

Normal haematocrit value

A

35-47%

35
Q

Variation in haematocrit levels x2

A

Decrease in level may mean anaemia, MOH

Increase in levels = polycythaemia

36
Q

Haemoglobin

A

Main component of RBC

37
Q

Normal hb level

A

11 - 14 g/dl

38
Q

Variation in levels of hb x2

A

Increased levels may = haemoconcentration

Decreased levels may = anaemia, recent haemorrhage, fluid retention

39
Q

PLT normal value

A

150-400 x 109/l

40
Q

PLT role x2

A

Role in forming blood clots

Role in haemostat in process

41
Q

Increased PLT x5

A 
Haemorrhage 
Pet 
Hellp
Dic
Idiopathic thrombocytopenia
42
Q

When do C-reactive protein concentration increase x2

A

During inflammation and infection

43
Q

What happens to GFR and u + e if excretion ability of kidney is compromised

A

Decreased GFR
U and e accumulate in blood
Serum concentration of both rise

44
Q

Normal urea level

A

2.5 - 6.4

45
Q

Normal creatinine level in pregnancy

A

44-73 mmol/l

46
Q

How can liver dysfunction be measured x2

A

By increased blood levels of various enzymes and metabolises usually cleared by liver

47
Q

What might increased levels of ALP enzyme indicate? X2

A

Hepatic and placental damage

48
Q

What is the role of albumin x2

A

Main plasma protein

Influences movement of fluid within capillaries

49
Q

Normal albumin value

A

Around 38g/l

50
Q

What does damage to capillaries in pet cause? X 2

A

Extra satin of plasma

Loss of plasma protein eg albumin

51
Q

What will low albumin levels result in

A

Indication for urgent delivery

52
Q

Neurological assessment x3

A

Cerebral vasospams
Cerebral oedema
Deep tendon reflexes

53
Q

Aims of antenatal treatment x 6

A 
Prevent maternal death 
Prolong pregnancy (why)
Monitor mother closely 
Control bp
Prevent seizures 
Aim for optimum delivery before compromise
54
Q

When would antihypertensive therapy be considered?

A

With women systolic bp >150

55
Q

Where would we like to maintain diastolic bp

A

90-110

56
Q

Fetal assessment x3

A

Ultrasound growth scan/rate
Doppler ultrasound assessment
Biophysical profile

57
Q

Chronic hypertension

A

Blood pressure of 140/90 or > before 20/40

medical complexities and research methods (5 decks)

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