Clinical lectures

Question 1

What are the 4 CV risk factors?

Answer 1

High BP, Hypercholesterolemia, smoking, diabetes/obesity

Question 2

What is the exogenous metabolite pathway?

Answer 2

Dietary impact–> conversion into chylomicrons–> broken down in liver–> LDL

Question 3

What molecule is increased in expression through statin mechanism and what is the effect?

Answer 3

NO, vasodilation

Question 4

What pathway do statins block?

Answer 4

conversion of HMG-CoA to Mevalonic acid

Question 5

What are the 2 classifications of hypertension?

Answer 5

Essential (90% and idiopathic) and secondary

Question 6

Name some of the diseases attributable to secondary hypertension

Answer 6

blindness, heart failure, aortic aneurysm, MI, coronary heart disease, stroke, preeclampsia

Question 7

Name some drugs which lower BP and explain how they should be prescribed

Answer 7

Thiazides, Beta blockers, ACE, ARB

Many drugs with lose doses more beneficial than monotherapy

Question 8

What is metabolic syndrome?

Answer 8

All major risk factors, life habit factors and emerging risk factors

Question 9

What are the factors which influence metabolic syndrome?

Answer 9

abdominal obesity, triglycerides, HDL lowered, increased BP, increased fasting glucose

Question 10

What are the treatments for Ischaemia at the target?

Answer 10

Antianginal medications: Beta blockers, Nitrates, Ca blockers
Revascularisation: Angioplasty, CABG

Question 11

What are the treatments for Atherothrombosis at the target?

Answer 11

Aspirin, statin, beta blockers, ACE inhibitors, exercise, smoking cessation

Question 12

What is the pathogenesis of Atherosclerotic plaques?

Answer 12

Epithelial damage–> Cellular adhesion molecule production–> Monocytes and T lymphocytes attack to “sticky” endothelial cells–> macrophages take up oxididised LDL–> Lipid rich foam cells–> fatty streak and plaque

Question 13

When should ambulatory blood pressure monitoring be offered to confirm hypertension and what is the procedure?

Answer 13

If clinical BP is 140/90mmHg or higher. Measure twice an hour during waking hours

Question 14

What are the definitions of stage 1 hypertension?

Answer 14

Stage 1- clinical BP 140/90 or higher, daytime 135/85

Question 15

What are the definitions of stage 2 hypertension?

Answer 15

clinical BP- 106/100…..daytime ABPM is 150/95

Question 16

What are the definitions of stage 3 hypertension?

Answer 16

clinical: 180/110

Question 17

What is the “white coat effect”?

Answer 17

High clinical pressure and variable ABPM (daytime) BP

Question 18

What is masked hypertension?

Answer 18

Low clinical BP but increasing ambulatory BP

Question 19

How should CV an organ risk be assessed?

Answer 19

Test urine for protein
Measure glucose, electrolytes, creatinine, glomerular filtrate rate and cholesterol
examine fundi for hypertensive retinopathy (severe)
12 lead ECG

Question 20

What are the risk factors of end organ damage?

Answer 20

Left ventricular hypertrophy
Creatinine Raised
Albuminuria/microalbuminuria
Retinopathy

Question 21

Name some established Vascular Diseases

Answer 21

Ischaemic heart disease, cerebra-vascular disease, peripheral vascular disease, diabetes

Question 22

What is hypertensive retinopathy?

Answer 22

When there are haemorrhages and hard exudates in the retina

Question 23

For people with the “white coat effect” what is the target BP?

Answer 23

below 135/85 in aged 80yrs

Question 24

What is fibromuscular dysplasia?

Answer 24

non-atherosclerotic, non-inflammatory vascular disease that causes abnormal growth within the wall of an artery and occurs in middle aged women. May be indicated by hypertension. Treat using angioplasty

Question 25

What hypertensive drugs should be used in those <55 as first line?

Answer 25

ACE inhibitors or ARB

Question 26

What hypertensive drugs should be used in those >55 as first line?

Answer 26

Ca antagonists

Question 27

What is Spironolactone and what can it be used to treat?

Answer 27

It is a slight anti-diuretic used to treat heart failure and hypertension

Question 28

What should be advised when prescribing Spironolactone?

Answer 28

Start at low doses due to risk of renal failure and hypocalcaemia

Question 29

What drugs should be avoided if a patient has gout?

Answer 29

Thiazide diuretics

Question 30

What is a characteristic indicator of gout?

Answer 30

high plasma urate

Question 31

What are diclfenac sodium tablets used to treat?

Answer 31

Rheumatoid arthritis

Question 32

What class of drugs should you NEVER use in asthma?

Answer 32

Beta blockers

Question 33

Why should swollen ankles in men be a warning sign?

Answer 33

Men don't tend to get swollen ankles- mainly women

Question 34

What does having an MI increase the risk of heart failure?

Answer 34

MI leaves scar tissue which leads to loss of pumping action in the ventricle meaning that cardiac output is decreased

Question 35

What is the time frame from an MI to heart failure?

Answer 35

10mins-10years

Question 36

What drug treats hypertension but not heart failure?

Answer 36

Ca antagonist

Question 37

What drug should a post MI patient immediately be put on?

Answer 37

a statin

Question 38

When are nitrates used?

Answer 38

For angina but not hypertension

Question 39

When should aspirin be used post MI?

Answer 39

When BP is down

Question 40

What can microalbumunuria indicate and what damage has been caused?

Answer 40

hypertension or diabetes. Damage to the kidneys

Question 41

Name an extra risk factor in a hypertensive patient

Answer 41

Left ventricular hypertrophy

Question 42

What can be used to treat left ventricular hypertrophy both mono therapy and another drug?

Answer 42

ACE inhibitors and addition of Ca antagonist

Question 43

What is Cushing's Syndrome and its associated features?

Answer 43

"Moon face" due to excessive production of cortisol. A tumour (corticol adenoma) could secrete large amounts of cortisol or it could be from glucocorticoids.

Question 44

Why should a patient with hypertension be assessed?

Answer 44

To assess target organ damage, to establish the cause and assess secondary hypertension, co risk factors for atheroma

Question 45

What are the key tests in a patient with suspected hypertension?

Answer 45

Protein, blood, glucose

Question 46

What are the biochemical tests in a patient with hypertension and why?

Answer 46

Hypokalemia- low serum potassium and is very suggestive of aldersteronism Hyperuricaemia- usually high levels of uric acid, may reflect gout in those taking diuretics Microaluminuria- abnormal levels of albumin in urine cannot be taken in a conventional urine test

Question 47

What should you look out for in an ECG when a patient has hypertension?

Answer 47

Ventricular hypertrophy and coronary artery disease

Question 48

When should surgery be considered in the treatment of hypertension?

Answer 48

1. Renal artery stenosis by angioplasty 2. Endocrine causes such as adrenal tumours 3. Coarction of the aorta