Hypertension CIS

Question 1

urgency vs emergency

Answer 1

urgency occurs at systolic BP over 180 or diastolic BP over 130 with no evidence of end organ damage

emergency may occur at any BP but involves DAMAGE to at least 1 organ system

Question 2

signs of target organ involvment

CV
CNS
Renal
Ophthalmologic

Answer 2

CV: MI, angina, aortic dissection, aneurysmal dilation of large vessels, LVH, CHF

Renal: hematuria, proteinuria, AKI

CNS: cerebral edema, altered mental status, bleed, stroke

Ophthalmologic: retinal hemorrhages or exudates, papilledema, A-V nicking

Question 3

what type of drug is methyldopa

Answer 3

alpha agonist

Question 4

reponse to angioplasty when you have renal artery stenosis from atherosclerosis

Answer 4

not very responsive because of a progressive disease

Question 5

2 causes of renal artery stenosis

Answer 5

fibromuscular dysplasia and atheroscleoris

Question 6

medial fibromuscular dysplasia uni or bilateral

Answer 6

70% are bilateral,

and this type of dysplasia is the most common (85%) of the fibromuscular dysplasias

Question 7

unilateral, bilateral, one kidney RAS and intravascular volume

Answer 7

unilateral - decreased intravas volume

bilateral and one kidney - increased intravascular volume

Question 8

which of the RAS are unpredictable and may worsen hypertension

Answer 8

bilateral and one kidney

Question 9

diagnosis of renovascular hypertension

Answer 9

renal ultrasound with arterial dopplers

captopril test (reactive rise in renin and large fall in BP after admin)

DSA - digital subtraction angiography

MRI - angiography

arteriography

renal vein renin ratio (ratio of 1.5 or greater)

Question 10

contraindications of ACE inhibitors

Answer 10

bilateral renal artery stenosis

unilateral RAS with solitary kidney

pregnancy

known angioneurotic edema with prior ACE admin

ACE induced cough

Question 11

secondary hypertension causes

Answer 11

sleep apnea
drug induced causes 
CKD
primary aldosteronism
renovascular disease
steroid therapy or cushing's syndrome
pheochromocytoma
coarctation of aorta
thyroid disesae 
parathyroid disease

Question 12

AV nicking found in

Answer 12

long standing HTN

Question 13

papilledema found in

Answer 13

hypertensive emergency

Question 14

cardiovascular causes of hypertension

Answer 14

MI
acute LV failure
vasculitis
coarctation of aorta
aortic dissection 
volume overload (including pulm edema)
essential hypertension

Question 15

coarctation of aorta

Answer 15

narrowing of medial layer of aorta
commonly at ligamentum arteriosum
3 types
 -interrupted 
 -preductal
 -postductal

Question 16

diagnosis of coarctation

Answer 16

differences in UE and LE
systolic hypertension in infant
20 mmhg btwn arms difference

systolic ejection murmur in aortic outlet

cardiomegaly
rib nothcin on PA chest
3-sign on lateral chest

Question 17

primary hyperaldosteronism cause

Answer 17

aldosterone producing adenoma

bilateral adrenal hyperplasia

Question 18

secondary hyperaldosteronism causes

Answer 18

elevated aldosterone and renin levels
from:
diuretics, CHF, cirrhosis, ascites, nephrosis

Question 19

after MI give

caution with

Answer 19

beta blocker, ACEI

caution: direct vasodilater

Question 20

with CHF give

caution with

Answer 20

diuretic, ACEI, beta blocker

caution: beta blocker, and CCB

Question 21

with hypertrophic cardiomyopathy give

caution with:

Answer 21

bb, ccb

caution: diuretic, ACEI, vasodilator

Question 22

with tachyarrhythmias give

Answer 22

BB, verapamil

Question 23

with angina give

caution with

Answer 23

beta blocker, ccb, nitroglycerine

caution: direct vasodilators

Question 24

with copd/road give

caution with

Answer 24

ccb, arb, thiazide diuretic

caution: beta blockers

Question 25

with aortic dissection give caution with

Answer 25

nitroprusside and beta blocker caution: drugs that increase cardiac output

Question 26

with bilateral RAS be cautious with

Answer 26

ACEI, angiotensin blockers

Question 27

with chronic renal insufficiency agent of choice caution with:

Answer 27

ACEI with serum creatinine below 2.5 loop diuretics, CCB caution: ACEI, angiotensin blockers

Question 28

renal transplants be careful with

Answer 28

ACEI

Question 29

migraine headacehes give

Answer 29

beta blockers, CCB

Question 30

stroke or TIA give caution with

Answer 30

ACEI caution: vasodilators (may increase intracranial pressure)

Question 31

diabetes give

Answer 31

ACEI

Question 32

prenancy (preeclampsia, eclampsia)

Answer 32

methyldopa, hydralazine caution: ACEI, angiotensin blockers, diuretics

Question 33

gout be cautious with

Answer 33

diuretics

Question 34

cocaine use, use __ | caution with

Answer 34

labetalol, clonidine caution: selective b-blockers

Question 35

GI bleed use caution

Answer 35

non selective beta blocker caution beta blockers

Question 36

pheochromocytoma use caution

Answer 36

alpha blocker then beta blockade caution with selective beta blocker

Question 37

BPH use and caution with

Answer 37

alpha 1 antag (terazocin) caution selective beta blocker

Question 38

weight reduction and BP

Answer 38

maintain normal body weight (BMI 18.5-24.9) reduce 5-20 mm hg/10 kg weight loss

Question 39

DASH eating plan and BP

Answer 39

diet rich in fruits, veggies, low fat dairy products with reduced saturated and total fat -8-14 mmhg bp reduction

Question 40

dietary sodium reduction and BP

Answer 40

reduce intake to no more than 100 mEq/day decrease bp by 2-8 mmhg

Question 41

physical activity and bp

Answer 41

aerobic activity for at least 30 mintues per day most days of week -drop bp 4-9 mmhg

Question 42

moderation of alcohol consumption and bp

Answer 42

no more than 2 drinks per day in men no more than 1 drink per day in women -drop bp by 2-4 mmhg

Question 43

in coronary ischemia what is the preferred drug treatment

Answer 43

nitroglycerin