06. HTN

Question 1

What are the initial drugs of choice for HTN?

Answer 1

ACE inhibitors
Angiotensin receptor blocker
Thiazide diuretics
Ca channel blockers

Question 2

What lifestyle changes should be made for a pt with HTN?

Answer 2

Stop smoking
Blood glucose and lipid control
Healthy diet - less alcohol and Na
Increase physical activity

Question 3

Which system of hypertensive retinopathy is graded in groups?

Answer 3

Keith-Wegner-Barker

Question 4

What is KWB group 1 defined as?

Answer 4

Slight narrowing, sclerosis, and tortuosity of the retinal arterioles; mild, asymptomatic HTN

Question 5

What is KWB group 2 defined as?

Answer 5

Definite narrowing, focal constriction, sclerosis, and AV nicking; BP is higher and sustained; few if any, symptoms referable to BP

Question 6

What is KWB group 3?

Answer 6

Retinopathy (CWS, arteriosclerosis, hemorrhages)
BP is higher and more sustained
Headaches, vertigo and nervousness
Mild impairment of cardiac, cerebral and renal function

Question 7

What is KWB group 4?

Answer 7

Neuroretinal edema, including papilledema;
Siegrist streaks, Elscnhig spots
BP persistently elevated
Headaches, asthenia, loss of weight, dyspnea, visual disturbances
Impairment of cardiac, cerebral, and renal function

Question 8

What is modified Scheie grade 0?

Answer 8

No changes

Question 9

What is modified Scheie grade 1?

Answer 9

Barely detectable arterial narrowing

Question 10

What is modified Scheie grade 2?

Answer 10

Obvious arterial narrowing, with focal irregularities

Question 11

What is modified Scheie grade 3?

Answer 11

Grade 2 plus retinal hemorrhages and/or exudates

Question 12

What is modified Scheie grade 4?

Answer 12

Grade 3 plus disc swelling

Question 13

What occurs in the vasoconstrictive sates of HTN?

Answer 13

Generalized narrowing of the retinal arterioles

Decrease in AVR

Question 14

What is the initial response to increased BP?

Answer 14

Vasoconstriction

Question 15

What occurs in the sclerotic stage of HTN?

Answer 15

Hyperplasia and thickening of the arteriole walls
Increased ALR
AV crossing changes

Question 16

What occurs in the exudative stage of HTN?

Answer 16

Autoregulation fails and high BP is transmitted to capillaries
Hemorrhages (flame>blots), CWS, exudates
Optic nerve swelling

Question 17

What are the symtpoms of hypertensive encephalopathy?

Answer 17

HTN, headaches, nausea, papilledema, accelerated BP

Question 18

There is a direct relationship between AV nicking / arteriolar narrowing and what?

Answer 18

Increased risk of stroke and heart disease

Question 19

CWS are really what?

Answer 19

Soft exudates

Question 20

What is the pathogenesis of hypertensive choroidopathy?

Answer 20

Elevation in systemic BP -> fibrin-platelet obstruction -> obstruction of choroid arteries and choriocapillaries -> necrosis of overlying RPE -> fibrinous exudation

Question 21

Hypertensive choroidopathy is associated with what?

Answer 21

Moderate and severe HTN retinopathy

Question 22

T or F the choroid doesn’t autoregulate.

Answer 22

True

Question 23

What are Elschnig spots?

Answer 23

Choroidal exudation
Changes in the RPE from the non-perfused areas of the choriocapillaris
“moth-eaten appearance”

Question 24

What is HTN crisis, according to JNC-8?

Answer 24

> 180/>110

Terminal organ damage

Question 25

What is hypertensive urgency?

Answer 25

>180/110 May have headaches No progressive TOD HTN ret w/o disc edema

Question 26

What is hypertensive emergency?

Answer 26

``` >180/110 Progressive/threatening TOD Headaches Shortness of breath Dizziness HTN ret WITH disc edema ```

Question 27

What signs/symptoms should be present to call 911 for HTN?

Answer 27

Bilateral disc swelling with headaches Confusion Dyspnea Extremity swelling

Question 28

What signs/symptoms should be present to send a pt to the ER for HTN?

Answer 28

Bilateral disc swelling Headaches Exudates, hemes, CWS (suggest TOD)

Question 29

What ocular diseases may present secondary to HTN?

Answer 29

``` Hypertensive retinopathy Retinal vein occlusions Retinal artery occlusions Ocular ischemic syndrome Macroaneurysm CN palsies (III, IV, VI) Sub-conj hemes Anterior ischemic optic neuropathy Hypertensive choroidopathy ```

Question 30

What part of the vessel does atherosclerosis affect?

Answer 30

Intimal layer

Question 31

What happens in atherosclerosis?

Answer 31

Nodular lesions that contain lipid, fibrous tissue, and Ca block it Plaques are present

Question 32

What does arteriosclerosis affect?

Answer 32

Smaller arteries

Question 33

What parts of the arteries are affected in arteriosclerosis?

Answer 33

Intimal and medial layers

Question 34

What occurs in arteriosclerosis?

Answer 34

Endothelial hyperplasia Intimal hyalinization Medial hypertrophy

Question 35

What are the risk factors for retinal venous occlusion?

Answer 35

``` Hypertension Increased age Increased LDL DM Blood hyperviscosity POAG Periphlebitis ```

Question 36

What causes a vein occlusion?

Answer 36

Thickening of the arterial walls inside the shared adventitia compresses the vein Turbulence of flow results in endothelial cell damage and thrombotic occlusion

Question 37

Which needs a large thrombus in a bottleneck location to occlude, CRVO or BRVO?

Answer 37

CRVO

Question 38

Where are branched retinal vein occlusions the most common?

Answer 38

Superior temporal arcade

Question 39

What are the 4 risk factors for BRVO?

Answer 39

History of systemic arterial HTN Cardiovascular disease Increased body mass index at 20 years of age History of glaucoma

Question 40

What signs are commonly seen in BRVO?

Answer 40

Flame hemes CWS (vein is missing)