06. HTN Flashcards Preview

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Flashcards in 06. HTN Deck (40)
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1
Q

What are the initial drugs of choice for HTN?

A

ACE inhibitors
Angiotensin receptor blocker
Thiazide diuretics
Ca channel blockers

2
Q

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

A

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

3
Q

Which system of hypertensive retinopathy is graded in groups?

A

Keith-Wegner-Barker

4
Q

What is KWB group 1 defined as?

A

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

5
Q

What is KWB group 2 defined as?

A

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

6
Q

What is KWB group 3?

A

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

7
Q

What is KWB group 4?

A

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

8
Q

What is modified Scheie grade 0?

A

No changes

9
Q

What is modified Scheie grade 1?

A

Barely detectable arterial narrowing

10
Q

What is modified Scheie grade 2?

A

Obvious arterial narrowing, with focal irregularities

11
Q

What is modified Scheie grade 3?

A

Grade 2 plus retinal hemorrhages and/or exudates

12
Q

What is modified Scheie grade 4?

A

Grade 3 plus disc swelling

13
Q

What occurs in the vasoconstrictive sates of HTN?

A

Generalized narrowing of the retinal arterioles

Decrease in AVR

14
Q

What is the initial response to increased BP?

A

Vasoconstriction

15
Q

What occurs in the sclerotic stage of HTN?

A

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

16
Q

What occurs in the exudative stage of HTN?

A

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

17
Q

What are the symtpoms of hypertensive encephalopathy?

A

HTN, headaches, nausea, papilledema, accelerated BP

18
Q

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

A

Increased risk of stroke and heart disease

19
Q

CWS are really what?

A

Soft exudates

20
Q

What is the pathogenesis of hypertensive choroidopathy?

A

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

21
Q

Hypertensive choroidopathy is associated with what?

A

Moderate and severe HTN retinopathy

22
Q

T or F the choroid doesn’t autoregulate.

A

True

23
Q

What are Elschnig spots?

A

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

24
Q

What is HTN crisis, according to JNC-8?

A

> 180/>110

Terminal organ damage

25
Q

What is hypertensive urgency?

A

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

26
Q

What is hypertensive emergency?

A
>180/110
Progressive/threatening TOD
Headaches
Shortness of breath
Dizziness
HTN ret WITH disc edema
27
Q

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

A

Bilateral disc swelling with headaches
Confusion
Dyspnea
Extremity swelling

28
Q

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

A

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

29
Q

What ocular diseases may present secondary to HTN?

A
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
30
Q

What part of the vessel does atherosclerosis affect?

A

Intimal layer

31
Q

What happens in atherosclerosis?

A

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

32
Q

What does arteriosclerosis affect?

A

Smaller arteries

33
Q

What parts of the arteries are affected in arteriosclerosis?

A

Intimal and medial layers

34
Q

What occurs in arteriosclerosis?

A

Endothelial hyperplasia
Intimal hyalinization
Medial hypertrophy

35
Q

What are the risk factors for retinal venous occlusion?

A
Hypertension
Increased age
Increased LDL
DM
Blood hyperviscosity
POAG
Periphlebitis
36
Q

What causes a vein occlusion?

A

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

37
Q

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

A

CRVO

38
Q

Where are branched retinal vein occlusions the most common?

A

Superior temporal arcade

39
Q

What are the 4 risk factors for BRVO?

A

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

40
Q

What signs are commonly seen in BRVO?

A

Flame hemes
CWS
(vein is missing)