HTN & funny turns

Question 1

Difference between primacy and secondary HTN?

Answer 1

Primary: hypertension with no identifiable underlying cause

o Secondary: reversible cause can be found

Question 2

5 red flag symptoms associated with HTN?

Answer 2

1. Headache
2. Blurred vision
3. Dyspnoea
4. Dizziness
5. Nose bleeds
6. Haematuria

Question 3

4 Key PMH finding in HTN

Answer 3

Previous stroke or TIA
▪ Ischaemic heart disease, angina, MI
▪ Elevation of cholesterol or triglycerides
▪ Diabetes

Question 4

Age and ethnic considerations for HTN?

Answer 4

ACE inhibitor initially UNLESS >55 or African/Caribbean (any age)
▪ Calcium channel blocker if >55 of African/Caribbean (any age)

Question 5

Cut off for treatment of HTN?

Answer 5

140 systolic

Question 6

Pt tired all the time with night sweats and fatigue what possible diagnosis?

Answer 6

TB

Malignancy

Question 7

Pt tired all the time with changed mood what possible diagnosis?

Answer 7

Depression

Question 8

Pt tired all the time with Breathless, heavy periods, melaena what possible diagnosis?

Answer 8

Anemia

Question 9

Pt tired all the time with Cold, gaining weight, losing hair what possible diagnosis?

Answer 9

Hypothyroid

Question 10

Sleep hygiene tips

Answer 10

Exercise earlier in day
▪ Fixed going to bed and getting up time
▪ Restful activity 30 minutes before bed
▪ Dark, quiet room: not too hot, cold, noisy, or bright
▪ Avoid caffeine, nicotine and alcohol from late afternoon
▪ Avoid watching or checking the clock throughout the night.
▪ Note worrying problems for morning (notebook and pen next to bed)
▪ Only use the bedroom for sleep and sexual activity
▪ Don’t nap next day

Question 11

Medication for sleep hygiene

Answer 11

▪ Over the counter – e.g. Nytol
▪ Prescription
• Benzodiazepine / Z drug – “only if daytime impairment”
o E.g. temazepam 10mg or zopiclone (3.75mg)
o Document: patient informed addictive, tolerance, driving
& <14/7

Question 12

6 red flag conditions for sudden headache

Answer 12

Meningitis 
Epidural haematoma
Subdural haematoma
Subarachnoid haemorrhage 
Giant Cell Arteritis

Question 13

Red flag symptoms in chronic headache?

Answer 13

Unexplained weight loss, focal neurological
deficits, Hx of cancer, headache on waking,
aggravated by exertion or Valsalva
(coughing/sneezing)

Question 14

Generalised throughout the head, often bilateral
pressure-like and non-throbbing pain, Often
described as feeling like a tight band around the
head describes what sort of headache?

Answer 14

Tension

Question 15

Previous, FH, unilateral, throbbing, visual aura,
nausea and vomiting, photophobia, significant
disability, sensitivity to noise describes what sort of headache

Answer 15

Migraine

Question 16

When would you suspect medication overuse headache?

Answer 16

Many headaches in preceding month,
medication used to control headache >10 days
in a month for 3 months

Question 17

Lifestyle changes for headache

Answer 17

headache diary / 
avoidance of triggers /
 better hydration 
/ reduce coffee / 
sleep hygiene

Question 18

Prophylaxis for migraine

Answer 18

propranolol

Question 19

Key structure of funny turn history

Answer 19

Before
during
After

Question 20

What investigations for funny turn?

Answer 20

o Bloods: FBC
o BM
o ECG

Question 21

If vasovagal syncope then what advice?

Answer 21

`▪ Stay hydrated
▪ Stay out of sun / hot places
▪ Avoid triggers
▪ Maximise anti-hypertensives
▪ Get up slowly from sitting position

Question 22

Safety net funny turn symptoms

Answer 22

o Biting self
o Incontinence
o Uncontrolled shaking

Question 23

senso of dread, wobbly legs, shaky, tachycardia, choking sensation, Pain anywhere
• Tingling in fingers/around mouth
• Over-breathing

Answer 23

Panic attack

Question 24

Investigations in panic attack

Answer 24

GAD7 if anxiety, 
Bloods: 
FBC,
TFTs,
ECG

Question 25

What examinations would you perfom for someone with suspected panic attack?

Answer 25

– therapeutic exam: HR & auscultation, RR, thyroid

Question 26

Management advice for panic attack

Answer 26

o Explain physiology of anxiety (e.g. common, flight – fight response)
o Deep breathing / put on radio
o Suggest speaking to university tutor / welfare / family
o Self-help steps: mindfulness, yoga, relaxation exercises, apps, leaflets
o Over the counter “calms”, “rescue” medicine