Question 1

This test is used to distinguish primary versus secondary etiologies of membranous nephropathy

Accepted Answer

Phospholipase A2 receptor staining on kidney biopsy (positive = primary, negative = secondary, such as malignancy, lupus, etc)

Question 2

What is the ACC/AHA definition of hypertension? Ambulatory blood pressure monitoring: normal daytime, normal nighttime, normal 24 hour average? How to make the diagnosis?

Accepted Answer

``` HTN: >/= 130/80 Ambulatory: -Daytime normal <120/80 -Nighttime normal < 100/65 -24 hour average <115/75 Make the diagnosis: average of two or more elevated systolic and/or diastolic BP's obtained on two or more occasions. ```

Question 3

How often to screen for HTN in the following populations, per USPSTF:
1) Age 18 or over
2) Age 18-39 with BP<130/85, no cardiovascular risk factors
3) Age 40 or over
4) BP 130-139/85-89
5) Overweight
6) Black
Per ACC/AHA:
7) BP 120-129/<80 or 130-139/80-89 not yet on BP therapy

Accepted Answer

1) Screen all 2) Every 3-5 years 3) Annual 4) Annual 5) Annual 6) Annual 7) Repeat within 3-6 months

Question 4

Habitual high _X_ and low _Y_ intake contribute to worldwide high prevalence of hypertension:

Accepted Answer

High sodium, low potassium

Question 5

Definition of stage I and stage 2 HTN

Accepted Answer

Stage 1: 130-139/80-89 (office) or >/= 125/75 ambulatory Stage 2: >/= 140/90 (office) or >/= 130/80 ambulatory

Question 6

Patients in which stage(s) of hypertension should initiate pharmacologic therapy?

Accepted Answer

``` Stage 1 (130-139/80-89 office readings) with clinical cardiovascular disease or 10 year cardiovascular risk >/= 10% Stage 2 (>140/90 office readings): all ```

Question 7

What is/are the initial recommended antihypertensive medication(s) for treatment of hypertension in: - non-black population, including those with diabetes? - black patients?

Accepted Answer

Non-black: thiazide diuretic, CCB, ACE-i, or ARB Black: thiazide diuretic or CCB

Question 8

Preferred initial anithypertensive agent with symptomatic heart failure or CKD with eFR<30:

Accepted Answer

Loop diuretic

Question 9

Which patients with hypertension should receive combination therapy with two first-line antihypertensives?

Accepted Answer

Stage 2 HTN (>140/90 office)with average blood pressure 20/10mmg Hg above BP target

Question 10

What is 'masked hypertension'? When should antihypertensive medication be initiated?

Accepted Answer

Definition: BP normal in office but elevated ambulatory. Treat if ambulatory BP is >/= 130/80 despite 3 months of lifestyle modification

Question 11

Blood pressure target with HTN and CKD? Preferred antihypertensive for stage G3 CKD or higher, or G1/G2 CKD with severe albuminuria?

Accepted Answer

BP target <130/80 Ace-i or ARB, low sodium diet, and PRN diuretic

Question 12

What are the two types of renovascular disease and which ages are they most common?

Accepted Answer

1) Atherosclerotic, age > 45 2) Fibromuscular dysplasia: young, especially female

Question 13

Therapies for renovascular hypertension

Accepted Answer

Treatment of underlying cardiac risk factors
ACE-i or ARB
Perc angioplasty and stenting or surgical intervention for select patients (EG short period of hypertension, recurrent severe hypertension or flash pulmonary edema)

Question 14

Triad of findings raising concern for primary hyperaldosteronism

Accepted Answer

1) Resistant hypertension 2) Metabolic alkalosis 3) Hypokalemia

Question 15

How to screen for primary hyperaldosteronism How to treat primary hyperaldosteronism

Accepted Answer

Plasma aldosterone concentration (PAC)/plasma renin activity (PRA) ratio.
-High ratio suggestive of the dx

Then, dedicated adrenal CT.

hyperplasia: aldosterone receptor antagonist (EG spironolactone)
adenoma: surgical rsxn

Nephrology Flashcards

(26 cards)