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Semester 2 (3rd year) > case 24: the NHS health check (hypertension) > Flashcards

case 24: the NHS health check (hypertension) Flashcards

(54 cards)

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1
Q

what is the overall aim of the NHS well women/man health check

A

to identify evidence of CVD
to identify areas that need to be targeted with lifestyle/medical intervention
reduced risk of cardiovascular events

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2
Q

what is the leading cause of death of adults in the UK

A

CVD

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3
Q

what tool is used in general practice to determine someones cardiovascular risk

A

QRISK3

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4
Q

modifiable risk factors for CVD

A

hypertension
diet
alcohol
BMI
hypertension
physical activity
hypercholesterolaemia
smoking

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5
Q

non-modifiable risk factors for CVD

A

sex
age
family history

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6
Q

which blood vessels are responsible for generating the most resistance to blood flow

A

arterioles

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7
Q

which organs can be affected by systemic hypertension

A

eyes- hypertensive retinopathy can lead to blindness

brain- small vessel disease can progress to stroke or vascular dementia

heart- ischaemic heart disease, HF, Arrythmia (AF as a result of hypertension related atrial englargement)

kidneys- hypertensive nephropathy can lead to renal failure

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8
Q

what is the guidance for exercise per week

A

150 minutes of moderate intensity exercise per week

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9
Q

how to manage a high BP reading in GP

A

if 140/90 or higher:

take second reading
if this second reading is substantially different to the first take a third measurement (record the lowest 2 as their reading)

offer 24hr ambulatory BP to confirm diagnosis
if unable to tolerate ambulatory then can offer at home BP monitoring to confirm diagnosis

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10
Q

what investigations to order when investigating hypertension

A

Us and Es

HbA1C

Lipif profile

urine albumin:creatinine ratio (tells us whether excess protein is getting into the urine through the kidney- this indicates that the kidney is damaged and leaky

urine dip for microscopic haematuria

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11
Q

how to calculate rate on an ECG

A

300/number of large squares between 2 QRS complexes

1500/number of small squares between 2 QRS complexes

number of QRS complexes multiple by 6

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12
Q

sings and symptoms of organ damage from hypertension

A

headache
dyspnoea
visual changes
chest pain
sensory/motor problems

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13
Q

the 2 classifications of hypertension

A

primary (essential) hypertension

secondary hypertension (there is an underlying often reversible cause)

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14
Q

adrenal causes of secondary hypertension

A

pheochromocytoma (adrenaline secreting tumour)
hyperaldosteronism
cushings

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15
Q

renal causes of secondary hypertension

A

renal artery stenosis
CKD
PCKD
nephritic and nephrotic syndrome

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16
Q

thyroid causes of secondary hypertension

A

hyperthyroidism
hyperparathyroidism

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17
Q

other causes of secondary hypertension

A

contraction of aorta

obstructive uropathy

obstructive sleep apnoea

oral contraceptives

chronic alcohol use

NSAIDs

illicit drugs (cocaine) can cause pseudohypertension)

preeclampsia

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18
Q

what type of hypertrophy in the heat can you see with hypertension

A

LVH

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19
Q

systolic BP vs diastolic BP

A

systolic= pressure when heart is contracting
diastolic= pressure when heart relaxing

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20
Q

what diet is particularly bad for hypertension

A

high salt

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21
Q

signs of pheochromocytoma

A

sweating
headaches
palpitations

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22
Q

first line treatment for hypertension

Study These Flashcards
A

for under 55/diabetic= ACE inhibitor

for over 55/black= calcium channel blocker

23
Q

what is the first line agent used in a hypertensive emergency

Study These Flashcards
A

labetalol (beta blocker)

24
Q

what electrolyte abnormality may be seen with ACEi

Study These Flashcards
A

hyperkalaemia

25
definition of refractory hypertension
the inability to achieve BP control despite maximum tolerated doses of at least 5 antihypertensive medications (including diuretics)
26
symptoms suggesting a hypertensive emergency
focal neurological symptoms- agitation, delirium, stupor (near-unconsciousness), visual disturbances and headache (SIGNS OF INTRACRANIAL BLEED) vomiting, headache, agitation, delirium (SIGNS OF RAISED ICP) visual disturbance (SIGN OF RAISED ICP/HYPERTENSIVE RETINOPATHY) chest pain (SIGN OF MI/AORTIC DISSECTION back pain (SIGN OF AORTIC DISSECTION) SOB (SIGN OF PULMONARY OEDEMA)
27
how can IgA nephropathy cause hypertension
IgA antibodies circulate kidneys causing inflammation this affects the kidneys ability to filter blood inflammation allows blood and protein to lead through the glomeruli into the urine, and a damaged kidney cannot remove the fluid and produce urine so therefore the BP rises
28
criteria for diagnosing an MI
must have at least 2 of the 3: chest pain ischaemic changes on ECG biochemical evidence of ischaemia (raised troponin)
29
which drugs may precipitate a hypertensive emergency
amphetamines cocaine monoamine oxidase inhibitors (MAOI) recent discontinuation of hypertensive agents
30
hypertensive urgency vs hypertensive emergency
urgency= BP over 180/110 but there is no evidence of ACUTE end organ damage emergency = there needs to be evidence of ACUTE end organ damage
31
how quickly does hypertensive urgency need to be managed
in hours-days
32
management of asymptomatic hypertensive urgency
can start oral antihypertensives and discharge for outpatient management (needs early follow-up in ambulatory care/see GP in 1-2 days)
33
management of hypertensive emergencies
admission and close monitoring IV antihypertensives (nitroglycerine- GTN or labetolol) after around 8-24hrs IV medication can be tapered down and oral medication given instead
34
recurrent type of what infection can lead to hypertension
recurrent UTIs the kidneys can become chronically scarred and damaged meaning they are not able to remove fluid from the blood into the urine, therefore the autoregulatory mechanisms to increase GFR become deranged and lead to hypertension as a result
35
(potential cause of secondary hypertension) examination finding of contraction of the aorta
unequal BP measurements in both arms and radio-femoral delay
36
(potential cause of secondary hypertension) examination finding of renal artery stenosis
renal bruits
37
(potential cause of secondary hypertension) examination finding of PDKD
ballotable kidneys
38
(potential cause of secondary hypertension) examination finding of vasculitis
vasculitic rash
39
(potential cause of secondary hypertension) examination finding of pheochromocytoma
tachycardia flushing and sweating
40
(potential cause of secondary hypertension) examination finding of acromegaly
enlarged facial features
41
what is the most common cause of secondary hypertension in young adults
primary hyperaldosteronism
42
in the RAAS system what detects a reduction in blood pressure
it is detected by the juxtaglomerular apparatus (near the afferent arteriole)- this secretes renin
43
the RAAS system
renin coverts angiotensinogen to angiotensin I angiotensin I is converted to angiotensin II via ACE enzyme
44
effects of angiotensin II
it is a vasoconstrictor so increases systemic vascular resistance and therefore BP is also causes aldosterone production from the adrenal cortex- this leads to salt retention and therefore water retention which also increases the BP
45
in primary hyperaldosteronism what happens to renin levels
aldosterone is high therefore renin is low (due to negative feedback)
46
what causes primary hyperaldosteronism
there is an adrenal cause 1/3= benign adenoma of the adrenal gland (Conns syndrome) 2/3= bilateral hyperplasia of the adrenal glands
47
what causes secondary hyperaldosteronism
the cause is outside of the adrenal glands there is excessive stimulation of RAAS pathway, with high renin levels triggering high aldosterone production causes: reduced blood flow to kidneys- renal artery stenosis, fibromuscular dysplasia reduced cardiac output- CCF reduced circuiting volume- cirrhosis, ascites
48
hyperaldosteronism and Na+ and K+
aldosterone acts on epithelial sodium channels (ENaC) in the collecting tubules leading to sodium reabsorption therefore K+ is lost in urine to try and maintain the electrical neutrality (will have low K+, and Na+ can be on higher side)
49
what investigation would you do to distinguish between benign adrenal adenoma or bilateral adrenal hyperplasia
MRI of adrenals
50
management of bilateral adrenal hyperplasia
spironolactone- mineralocorticoid receptor antagonist, reduced salt and therefore water retention so decreases the circulating volume
51
what diet is recommended to all patients with hyperaldosteronism
salt restriction
52
follow up after prescribing spironolactone for hyperaldosteronsim
review in 2 weeks to repeat renal profile and K+
53
pneumonia vs pulmonary oedema on CXR
look similar but pneumonia will not be as symmetrical as a pleural effusion
54
what simple test can you do for pre-clampsia first
urine dip (will see proteinuria)

Semester 2 (3rd year) (12 decks)

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