Cardiac - Hypertension and lipid disorders

Question 1

Hypertension

Definition
Cut-offs

Answer 1

Question 2

Hypertension

Define ambulatory and white coat hypertension

Answer 2

Question 3

Hypertension

Define malignant hypertension

Answer 3

ABCDEF:
* Azotemia
* BP ≥220/120
* Cardiac failure
* Distress
* Encephalopathy
* Fundus

Clinical presentation: ↑BP + rapidly progressive TOD
□ Retina: papilloedema, retinal haemorrhages and exudates
□ HTN encephalopathy: severe headache, vomiting, visual disturbances, transient paralyses, convulsions, stupor and coma
□ Heart: acute LV failure
□ Kidneys: acute RF with oliguria, proteinuria

Question 4

Define urgency hypertension

Answer 4

Question 5

Define emergency hypertension

Answer 5

Question 6

Primary/ Essential hypertension

Risk factors

Answer 6

Question 7

Secondary hypertension

Causes

Answer 7

Question 8

Hypertension

Physiological variation of BP

Answer 8

Question 9

Hypertension

Clinical presentation, target organ damage

Answer 9

Question 10

Hypertension

Diagnosis

Answer 10

Question 11

on

Hypertension

History taking questions

Answer 11

Question 12

Hypertension

P/E

Answer 12

`

Question 13

Hypertension

Biochemical Ix

Answer 13

Question 14

Hypertension

Radiological Ix

Answer 14

Question 15

Hypertension

Treatment target
General lifestyle modifications

Answer 15

Lifestyle modifications:

• Weight reduction
• Diet: Low sodium, Low fat, High fruit/ vegetables, High K, DASH diet
• Exercise: 30min/day
• Alcohol: moderation ≤2 (M) or ≤1 (F) drinks/day
• Medical therapy: Change dose/ combination therapy accordingly

First line: ACEI/ARB, CCB, thiazide diuretic (+/- BB)
Second line: Alpha blocker, Aldosterone antagonist or vasodilator
Adjunctive drugs: Aspirin (lower CVD risk), Statins (hyperlipidemia)
Substitute drugs: Methyldopa, hydralazine for pregnancy; Loop diuretics for CKD
Compelling indications: DM, CKD, CAD, LV dysfunction, Ischemic stroke

Question 16

ACEi

Examples
MoA
S/E
C/I

Answer 16

Question 17

ARB

Examples
MoA
S/E
C/I

Answer 17

Question 18

B-blockers

Examples
MoA
S/E
C/I

Answer 18

Question 19

CCB

Examples
MoA
S/E
C/I

Answer 19

Question 20

Loop diuretics

Examples
MoA
S/E
C/I

Answer 20

Question 21

Thiazide diuretics
Examples
MoA
S/E
C/I

Answer 21

Question 22

Potassium sparing diuretics

Examples
MoA
S/E
C/I

Answer 22

Question 23

Hypertension

Drug choice combinations

Answer 23

A= ACEi/ ARB
B = B-blocker
C = CCB
D = Diuretics

Question 24

Hypertension

Drug combination for asymptomatic organ damage

Answer 24

Question 25

Hypertension Drug combinations for stroke, MI, stable angina, HF, AA, Afib

Answer 25

Question 26

Hypertension Drug combination for isolated systolic HTN, metabolic syndrome, DM, pregnancy

Answer 26

Question 27

Hypertension Contraindication of ACEi/ARB

Answer 27

Question 28

Hypertension Contraindications of BB, CCB

Answer 28

Question 29

Hypertension Contraindications of diuretics

Answer 29

Question 30

Hypertensive urgency Treatment

Answer 30

Question 31

Hypertensive emergency Treatment

Answer 31

Question 32

Hypertension Macrovascular complications

Answer 32

Question 33

Hypertension Microvascular complications

Answer 33

Question 34

Hypertension Risk factors for poor prognosis

Answer 34

Question 35

histological findings of renal disease induced by hypertension?

Answer 35

Question 36

Lipoprotein Classes and functions

Answer 36

Question 37

Lipid profile Metrics Procedure

Answer 37

Question 38

Lipoprotein pattern Metrics Procedure

Answer 38

Question 39

Hyperlipidemia Investigations (apart from lipoprotein pattern and profile)

Answer 39

Question 40

Reference lipoprotein levels

Answer 40

Question 41

CHD risk equivalent Definition Risk factors of major coronary event

Answer 41

Question 42

Hyperlipidemia Major risk factors that modify LDL-C target

Answer 42

Question 43

Hyperlipidemia Risk categories and corresponding LDL targets

Answer 43

Question 44

Hyperlipidemia Phenotypes and associated defects

Answer 44

Question 45

Primary Hyperlipidemia Phenotypes associated with CHD, pancreatitis

Answer 45

Question 46

Familial hypercholesterolemia Types Genetic causes Pathophysiology

Answer 46

Question 47

Familial hypercholesterolemia Clinical manifestations Diagnosis Treatment

Answer 47

Question 48

Statins MoA Effect on lipid profile S/E Example

Answer 48

Question 49

Fibrates MoA Effect on lipid profile S/E Example

Answer 49

Question 50

Resins MoA Effect on lipid profile S/E Examples

Answer 50

Question 51

Niacin MoA Effect on lipid profile S/E Example

Answer 51

Question 52

Cholesterol absorption inhibitors MoA Effect on lipid profile S/E Example

Answer 52

Question 53

Summary of lipid lowering drug effect on lipid profile

Answer 53

Question 54

What can contribute to hypertriglyceridemia?

Answer 54

Question 55

P/E for secondary hypertension

Answer 55

Question 56

Indicators of secondary hypertension

Answer 56

Question 57

Resistant HTN Definition Diagnosis Treatment

Answer 57

Definition Poor HTN control under 3 antihypertensive with 1 diuretic HTN only controlled by ≥4 drugs Diagnosis: Exclude pseudoresistance: → Adherence → Timing of drugs → Home and ambulatory BP → Exclude secondary hypertension → Identify confounding factors: diet, obesity, drugs Treatment: * Increase dosage of existing therapy * Use second-line drugs: Aldosterone blockers, Loop diuretics * Alter combination of therapy

Question 58

Differentiate hypertensive emergency with hypertensive urgency

Answer 58

Hypertensive emergency (i.e. with TOD) * BP >180/120 + worsening/new TOD * Indication for acute BP control * e.g. aortic dissection, pheochromocytoma, eclampsia Hypertensive urgency (i.e. no TOD) * Malignant HTN without TOD * HT with grade III or IV retinal changes * e.g. Hypertension with pre-op/ perioperative bleeding, Hypertension complicated by pregnancy, AMI, unstable angina * e.g. Catecholamine excess or sympathomimetic overdose

Question 59

Indications for immediate treatment of hypertension

Answer 59

Question 60

Investigations for target organ damage due to hypertension

Answer 60

Question 61

Indications for emergency BP reduction with IV treatments

Answer 61