HTN

Question 1

When is angioplasty indicated for RAS?

Answer 1

Severe BILATERAL DZ

Unilateral dz w/ solitary kidney

Question 2

What trial showed that PTCA is not better than OMT for unilateral RAS?

Answer 2

CORAL

Question 3

Which gender has higher incidence of coarctation ?

Answer 3

Males

Question 4

What is Turner’s syndrome associated with?

Answer 4

Coarctation

Question 5

Name 5 things coarctation is associated with

Answer 5

Bicuspid AV
VSD, PDA, AS
Intracranial aneurysm

Question 6

CXR findings for coarctation of Ao

Answer 6

Rib notching

3 sign

Question 7

What is the definitive modality to evaluate for coarctation ? Why?

Answer 7

Echo b/c you can messier pressure gradient across it

Question 8

What peak to peak gradient is significant in coarctation ?

Answer 8

20mm Hg

Question 9

What is a complication of end to end anastomoses surgery for coarctation?

Answer 9

Re-coarctation and aneurysm at site of repair

Question 10

What is treatment of choice for coarctation?

Answer 10

Balloon angioplasty with stent

Question 11

What are top two things to remember that are associated with coarctation?

Answer 11

Bicuspid AV

Intracerebral aneurysm

Question 12

Best test for pheo (highest Sn)?

Answer 12

24h urine catecholamines and metanephrines

Question 13

Triad for pheo

Answer 13

Episodic HA, sweating, tachycardia

Question 14

10% rule for pheo

Answer 14

10% malignant
10% multiple
10% extra-adrenal

Question 15

What is considered a positive test for pheo with 24 h urine metanephrines ?

Answer 15

2x ULN

Question 16

What is wrong with doing plasma fractionated metanephrines for pheo?

Answer 16

High false positives

Question 17

What can falsely elevate levels of catecholamines and metanephrines?

Answer 17

Abrupt cessation of clonidine

Question 18

Name 4 psych drugs that can increase metanephrines and catecholamines

Answer 18

Levodopa
Amphetamines
Buspirone
TCAs

Question 19

What is Sn and Sp of CT/MR for pheo?

Answer 19

Sn- 100%

Sp 79% (Incidentalomas)

Question 20

What radiological test confirms extraadrenal pheo?

Answer 20

MIBG

Question 21

Can you send or to Sx for pheo based on MIBG images alone?

Answer 21

No

Question 22

Which receptor do you block first for pheo preop?

Answer 22

Alpha before beta

Question 23

What is the best alpha blocker to start preop for pheo and when do you start it?

Answer 23

Phenoxybenzamine

7-10d preop

Question 24

What are two pharmacological properties of phenoxybenzamine that make it a good alpha blocker for preop pheo?

Answer 24

Irreversible

Nonspecific

Question 25

Which of the following do you use for preop pheo: prazosin, doxazosin or phenoxybenzamine?

Answer 25

phenoxybenzamine

Question 26

When do you start BB for preop pheo?

Answer 26

After alpha blockers | 2-3 d preop

Question 27

Top 3 Meds to use intraop if a pheo squirts and causes hypertensive crisis

Answer 27

Nitroprusside Phentolamine Nicardipine

Question 28

Phenylalanine MOA

Answer 28

Non selective, short acting alpha blocker

Question 29

In primary hyperaldosteronism, what are the levels of renin ?

Answer 29

Low

Question 30

In secondary hyperaldosteronism , what will renin levels be?

Answer 30

High

Question 31

When to screen hypertensive pt's for primary hyperaldosteronism?

Answer 31

Severe or resistant HTN | Hypokalemia

Question 32

What is the screening test for primary hyperaldosteronism ?

Answer 32

PAC/PRA | Plasma Aldo conc)/ (plasma renin activity

Question 33

What plasma Aldo conc/plasma renin activity signifies essential HTN vs primary hyperaldosteronism?

Answer 33

Essential: 10 | Hyperaldosteronism : 30

Question 34

What is Dx if you have a hypertensive pt and you do an oral sodium load of 5g over 3 days and their Aldo level is >12mcg/24h?

Answer 34

Primary hyperaldosteronism

Question 35

What are two tests you can do to diagnose primary hyperaldosteronism ?

Answer 35

Oral sodium load Saline infusion test (Aldo will be > 10)

Question 36

Which patients get Sx for primary hyperaldosteronism?

Answer 36

Unilateral adenoma

Question 37

2 drugs you can give to treat primary hyperaldosteronism

Answer 37

Spirinolactone | Eplerenone

Question 38

What are the major components of DASH diet?

Answer 38

Fruits, vegetables, fiber, low fat dairy

Question 39

What did ALLHAT show for ACEI, CCB vs diuretics?

Answer 39

No difference in reducing CV events

Question 40

What did LIFE trial show for losartan vs atenolol in HTN?

Answer 40

Losartan better for LVH and reducing stroke

Question 41

What did ACCOMPLISH trial show for high risk hypertensives and amlodipine/benazepril vs HCTZ/benazepril ?

Answer 41

Lower BP and CV events with amlodipine/benazepril

Question 42

According to JNC 7, what is total recommended sodium intake for hypertensives?

Answer 42

2400 mg daily

Question 43

where is Beta 1 receptor found and what is its effect?

Answer 43

heart | inc inotropy and chronotropy

Question 44

where is Beta 2 found and what is Beta 2 receptor effect?

Answer 44

vessels | vasodilation

Question 45

does angiotensin II increase both BP and cardiac output?

Answer 45

yes

Question 46

After starting an ACEI, how much Cr rise should make you worry?

Answer 46

> 30%

Question 47

Verapamil and diltiazem are ?

Answer 47

Nondihydropyridines

Question 48

What adverse effect if alpha antagonists did ALLHAT show for hypertensives?

Answer 48

Inc'd CHF

Question 49

Clonidine mech

Answer 49

Alpha 2 blocker

Question 50

Main side effect of Hydralazine

Answer 50

Lupus like syndrome

Question 51

Main side effect of minoxidil

Answer 51

Hirsutism

Question 52

hydralazine mech

Answer 52

direct vasodilator (via inc. in NO and cGMP

Question 53

what is hypertensive urgency?

Answer 53

BP > 180/120, relatively asymptomatic

Question 54

er how long can you decrease BP in HTN urgency? what med is contraindicated?

Answer 54

hours to days | SL nifedipine

Question 55

why is SL nifedipine dangerous?

Answer 55

increases risk of MI

Question 56

4 drugs you can use to treat hypertensive emergency

Answer 56

Nitroprusside, labetalol, nicardipine, fenoldepam

Question 57

what side effect comes with long term use of nitroprusside?

Answer 57

cyanide tox

Question 58

can you give iv nitroprusside in pregnancy?

Answer 58

no

Question 59

definition of preeclampsia

Answer 59

previously normotensive woman now at least 20 weeks pregnant with new HTN and proteinuria

Question 60

definition of gestational HTN

Answer 60

HTN without proteinuria

Question 61

***criteria for preeclampsia

Answer 61

SBP>140 or DBP > 90 with 2 measurements at least 6 h apart (within 1 week) Proteinuria > .3g in 24hrs

Question 62

first line therapy in preeclampsia?

Answer 62

bedrest

Question 63

when do you consider giving meds in preeclampsia?

Answer 63

when BP 160/105 or sxs

Question 64

drug of choice for preeclampsia?

Answer 64

labetalol IV

Question 65

what is the main adverse event of HTN in pregnancy?

Answer 65

stroke

Question 66

What part of renal artery will atherosclerosis occur? What about FMD?

Answer 66

Proximal | Distal