Hypertension

Question 1

What is athlerosclerosis?

Answer 1

The formation of a lipid rich plaque in the wall of a blood vessel

Question 2

What is peripheral vascular disease?

Answer 2

Flurrying up of arteries supplying arms and legs

Question 3

What are aneurysms?

Answer 3

Abnormal ballooning out of blood vessels

Question 4

What can high blood pressure cause?

Answer 4

Atherosclerosis
Heart failure
Chronic Kidney Disease

Question 5

What are the main symptoms of high Bp?

Answer 5

Typically no symptoms except in accelerated hypertension (very rare)

Question 6

What is systolic BP?

Answer 6

Maximum pressure in the vessels after cardiac contraction

Question 7

What is diastolic BP?

Answer 7

Minimum pressure in vessels during cardiac contraction

Question 8

Which artery is normally used to measure BP?

Answer 8

Brachial artery

Question 9

What constitutes as normal BP?

Answer 9

90/60 - 120/80 mmHg (no definite answer)

Question 10

What is the clinical BP stage 1 hypertension?

Answer 10

Systolic - 140-159

Diastolic - 90-99

Question 11

What is the clinical BP stage 2 hypertension?

Answer 11

Systolic - 160-179

Diastolic - 100-119

Question 12

What is the clinical BP of stage 3 hypertension?

Answer 12

Systolic - over 180

Diastolic - over 120

Question 13

What are the 3 steps in investigating a patient with hypertension?

Answer 13

1. Establish if hypertension is present
2. Look for evidence of target organ damage
3. Look for evidence of secondary cause

Question 14

What does an ambulatory monitoring do?

Answer 14

A cuff inflates throughout the day taking BP at different times throughout a 24 hour period

Question 15

What is primary hyperaldosteronism?

Answer 15

An excessive production of aldosterone (secondary cause of high blood pressure)

Question 16

What is Cushing’s syndrome?

Answer 16

An excess of corticosteroid production

Question 17

List secondary causes of hypertension

Answer 17

Primary hyperaldosteronism 
Cushing’s syndrome 
Phaeochromocytoma 
Renal artery stenosis 
Intrinsic renal disease 
Coarctation of the aorta 
Obstructive sleep apnoea

Question 18

What is renal artery stenosis?

Answer 18

Narrowing of the main artery supplying the kidney causing an increase in BP

Question 19

What does a high Bp in a pregnant woman indicate?

Answer 19

A high bp in the future

Question 20

What do non steroidal anti-inflammatory drugs do?

Answer 20

They are taken to relieve inflammation and pain and they cause salt and water retention which can increase bp

Question 21

If a patient complained of sweating and palpitations, what secondary condition would come to mind?

Answer 21

phaeochromocytoma - when the body decides to pump out more adrenaline and it may be because you have a tumour in your adrenal gland and the tumour makes too much adrenaline (RARE)

Question 22

If a patient complained of flank pain, what secondary condition would come to mind?

Answer 22

Kidney disease

Question 23

If a patient had daytime somnolence, snoring and erratic sleep, what secondary condition would come to mind?

Answer 23

Obstructive sleep apnea - body fires or adrenaline every now and then

Question 24

What is oedema?

Answer 24

Swelling

Question 25

What is postural hypertension?

Answer 25

When a patient’s bp falls when standing up

Question 26

What does a bad ophthalmology examination tell us? ( in relation to blood pressure )

Answer 26

High blood pressure for a long period of time

Question 27

List 4 target organs of high bp?

Answer 27

Heart Kidney Eye Artery walls

Question 28

What happens the heart in high bp?

Answer 28

The heart can thicken - (Left ventricular hypertrophy)

Question 29

What on an ECG indicates left ventricular hypertrophy ?

Answer 29

Pronounced P and S waves

Question 30

What can high bp do to the kidney ?

Answer 30

It can cause kidney disease

Question 31

How can kidney disease be detected?

Answer 31

1. Look at the urine - a healthy kidney won’t let protein out into the urine 2. Look at the blood - high creatinine levels can indicate kidney dysfunction and problem with the filtration of the kidney

Question 32

How do you investigate Cushing’s syndrome?

Answer 32

Measure the amount of steroids in the urine (cortisol)

Question 33

How to test for phaeochromocytoma ?

Answer 33

Measure the amount of adrenaline in the blood or urine

Question 34

How to detect renal artery stenosis?

Answer 34

1. Wishing noise when listening to patients abdomen | 2. Scan of kidney

Question 35

What website do we use to calculate a patients risk factor if having an MI or stroke ?

Answer 35

QRISK-3

Question 36

``` Which of the following is least important in terms of cardiovascular risk? Smoking Diabetes Osteoarthritis Migraine Depression ```

Answer 36

Osteoarthritis - inflammatory conditions that increase the risk not osteoarthritis Note - not asked in QRISK questioning

Question 37

List lifestyle interventions to reduce cardiovascular risk?

Answer 37

1. Stop smoking 2. Achieve a healthy body weight 3. Eat a healthy diet (DASH Diet) 4. Restrict diet intake 5. Moderate alcohol intake 6. Take adequate exercise 7. Discourage excessive caffeine intake

Question 38

Who should you give drug treatment to for hypertension ?

Answer 38

^ persistent stage 2 hypertension | ^ stage 1 hypertension of patients who are over 80

Question 39

Who do you give ACE inhibitors or Angiotension Receptor Blockers to as a first stage ?

Answer 39

~ patients with hypertension and type 2 diabetes | ~ patients with hypertension, who are under 55 and are not from black African or African-Caribbean family origin

Question 40

Who do you give calcium channel blockers to as a first stage?

Answer 40

~ patients age 55 or over | ~ patients of black African or African-Caribbean family origin (any age)