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12 Cards in this Set

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Cause of new onset HTN in:
1. someone less than 30?
2. someone over 55?
3. HTN with hypokalemia
4. Episodic HTN with sweating, tachycardia and headaches
5. someone with abdominal bruit
6. Cold clammy hands, cafe au lait spots, strong apical pulse
7. Muscle weakness
8. Central obesity, striae, bruising
1. Fibromuscular dysplasia
2. Atherosclerotic
3. Primary hyperaldosteronism
4. Pheochromocytoma
5. RVH
6. Pheo
7. Primary hypoaldo (hypoK)
8. Cushing
Primary and secondary HTN? Which can we cure?
Primary- unknown cause, essential HTN
Secondary- known etiology, can CURE
Most common cause of secondary HTN? Describe how it happens?
Renal vascular HTN. Obstructed blood flow in a main renal artery. Decreased blood flow is sensed by the macula densa cells RAAS --> Angiotensin II --> vasoconstriction --> increased BP
Most common cause of renal vascular HTN? Other common cause?
Atherosclerotic plaque (elderly men)
Fibromuscular dysplasia (AD, non-atherosclerotic, thickening of artery, narrowing of lumen)
If the artery shows a pattern of sclerosis and dilitation --o--o--o--o-o-o-oo

Most often found where?
Classic finding in fibromuscular dysplasia

70% of time in renal artery
30% of time in carotid artery
Common auscultory finding in RVH?
Upper flank abdominal bruit
Lab findings in RVH:
Electrolytes?
Urinalysis?
Renal function tests?
If unilateral, electrolytes, urinalysis and renal function tests are NORMAL

If bilateral, increases in BUN and Cr
Gold standard test for RVH?

If problem is due to atherosclerosis, where along the artery will the lesions be seen?

If problem is due to fibromuscular dysplasia, where along the artery will the lesions be seen?

Which one gets surgery? Which one gets angioplasty?
Angiography

Athero- proximal segment
FMD- distal segment

FMD- angioplasty
Athero- surgery (if stenosis is >70%)
Drug resistant HTN with muscle weakness & metabolic alkalosis?
Primary aldosteronism
Screening for primary aldosteronism
Plasma aldosterone concentration (PAC)
Plasma Renin Activity (PRA)
Salt suppression study
PAC- increased
PRA- decreased
PAC/PRA- increased
No suppression with salt study
Triad of symptoms for pheochromocytoma
Headache, sweating, palpitations (if all 3, 80% chance of pheo)

May be normotensive!
Tests for pheo
Plasma metanephrines- sensitive and pretty specific (high false positive)
Urinary metanephrines- less sensitive, more specific (low false postive)