Investigations

Question 1

When performing fundoscopy, what signs would you be looking for in a person with newly diagnosed HTN?

Answer 1

Retinopathy; including cotton wool spots, papilloedema and flame haemorrhages

Question 2

What signs would be important to look for in the urine?

Answer 2

Haematuria

Urine albumin:creatinine ratio

Question 3

What bloods would you look at?

Answer 3

HbA1c to check for diabetes
U&E to look for end organ kidney damage
eGFR
Total cholesterol, HDL and LDL

Question 4

What would you be looking for on a 12-lead ECG?

Answer 4

• Adequate cardiac function

- Signs of LVH (ST depression and T wave inversion in the lateral leads)

Question 5

What risk assessment tool would you use to assess cardiovascular risk?

Answer 5

QRISK

Question 6

What is a significant QRISK score?

Answer 6

CVD risk of 10% in the next 10 years or above

Question 7

What steps in management would you take in someone with a significant QRISK score?

Answer 7

Prescribe a statin and anti-platelet therapy

Question 8

List the renal causes of secondary HTN

Answer 8

1. Chronic pyelonephritis
2. Diabetic nephropathy
3. Glomerulonephritis
4. PKD
5. Obstructive uropathy
6. Renal cell carcinoma

Question 9

List the vascular disorders causing secondary HTN

Answer 9

1. Coarctation of the aorta

2. Renal artery stenosis

Question 10

List the endocrine causes of secondary HTN

Answer 10

1. Primary hyperaldosteronism
2. Phaeochromocytoma
3. Cushing’s syndrome
4. Acromegaly
5. Hypothyroidism
6. Hyperthyroidism

Question 11

List some drugs and substances that can cause secondary HTN

Answer 11

1. Alcohol
2. Ciclosporin
3. Cocaine
4. OCP (combined)
5. Corticosteroids
6. Erythropoietin
7. Leflunomide
8. Liquorice
9. NSAIDS
10. Sympathomimetics
11. Venlafaxine