M2-C6-L25 --> Htn I

Front 1

ESSENTIAL HYPERTENSION

- causes what % of HTN?

- defined how?

Back 1

- 95% of all HTN cases

- can not pinpoint the exact cause of the HTN

Front 2

ESSENTIAL HYPERTENSION

- what are the Risk Factors? x8

Back 2

(FW POSADA)

- Family Hx (#1)
- Weight gain

- Personality types (A)
- Obesity
- Salt intake
- African americans
- Dyslipidemia
- Alcohol

Front 3

ESSENTIAL HYPERTENSION

- which risk factor has the strongest correlation?

- HTN more common in which race?

Back 3

- Family Hx

- Blacks

Front 4

ESSENTIAL HYPERTENSION

T/F : Salt intake is necessary for HTN

T/F : Salt intake is a significant cause for HTN

Back 4

- True

- False

(although necessary, salt intake is NOT a SIGNIFICANT CAUSE of HTN)

Front 5

ESSENTIAL HYPERTENSION

- which risk factor is the Main determinant of BP rise in the elderly?

Back 5

- Weight gain

Front 6

ESSENTIAL HYPERTENSION

- which risk factor is associated with HTN development, BUT is INDependent of Obesity?

Back 6

- Dyslipidemia

Front 7

ESSENTIAL HYPERTENSION

- if you have 1 or 2 Hypertensive parent, how common would HTN be?

Back 7

- Twice as common

Front 8

ESSENTIAL HYPERTENSION

- Inherited tendency for HTN resides primarily in what organ?

Back 8

- Kidney

Front 9

ESSENTIAL HYPERTENSION

- what are the environmental factors? x6

Back 9

(Environmentally, SOSA SO white)

- Salt intake
- Obesity
- Smoking
- Alcohol

- Socioeconomic status
- Occupation (baseball player)

Front 10

ESSENTIAL HYPERTENSION

- affluent society's association with HTN

- less affluent society's association with HTN

Back 10

- Increase in BP with age

- Decrease in BP with age

Front 11

ESSENTIAL HYPERTENSION

- HTN along with Obesity and what else is a component of Metabolic X syndrome?

Back 11

- Insulin resistance (DM)

Front 12

ESSENTIAL HYPERTENSION

- increased BMI (weight) also increases the risk for? x4

Back 12

- HTN

- Cholethiasis (kidney stones)
- DM type 2
- CHD

Front 13

ESSENTIAL HYPERTENSION

- Pathogenesis of HTN involves a complex interplay between what 4 pathologies? x4

Back 13

(PERV)

- Prostaglandins

- Endothelium derived factors

- Resistance to Insulin

- Vascular Hypertrophy

Front 14

ESSENTIAL HYPERTENSION

- US Preventative Services Task Force (USPSTF) guidelines for normal individuals?

- Criteria for "Normal" people? x2

Back 14

- Every 2 years

- Systolic below 120
AND
- Diastolic below 80

Front 15

ESSENTIAL HYPERTENSION

- USPSTF guidelines for PRE-hypertensives?

- Criteria for Prehypertensives? x2

Back 15

- Yearly

- Systolic 120 to 129

- Diastolic 80 to 89

Front 16

ESSENTIAL HYPERTENSION

- on an INITIAL MD visit, what are the 4 goals/objectives in a NEW hypertensive patient?

Back 16

(AREA)

(ALICE) - Assess Lifestyle & Identify CV (or Concomitant Disorders) that Effect the prognosis and treatment.

(2) Reveal Secondary causes of high bp

(EPT) Establish a PreTreatment baseline

(ACT) Assess presence of absence of Target organ damage & CVD

Front 17

ESSENTIAL HYPERTENSION

- Signs and Symptoms associated with what 3 things?

Back 17

- Elevated BP

- Vascular Dz (Target organ damage)

- Other Secondary Factors

Front 18

ESSENTIAL HYPERTENSION

- although mostly asymptomatic, what are some signs and symptoms of Elevated BP? x6

Back 18

(HMO-PIED)

- Headache (morning or Occipital)

- Palpitations
- Impotence
- Easily fatigued
- Dizzyness

Front 19

ESSENTIAL HYPERTENSION

- although mostly asymptomatic, what are some signs and symptoms of Vascular Dz (target organ damage)? x6

Back 19

(Vascular Target for HBP ETA)

- Hematuria, Epistaxis, Angina, TIA

- Blurry vision with Retinal changes

- PE

Front 20

ESSENTIAL HYPERTENSION

- although mostly asymptomatic, what are some secondary disorders x3 & some signs and symptoms.

Back 20

(HPC)

- Primary HyperAldo (muscle weakness)

- Pheochromocytoma
(Palpitations, HA episodic, Diaphoresis)

- Cushings (Weight gain, Emotional lability)

Front 21

ESSENTIAL HYPERTENSION

- Target organ damage seen in brain. x2

Back 21

- Stroke

- TIA

Front 22

ESSENTIAL HYPERTENSION

- Target organ damage seen in Kidney

- "Other" Target organ damages. x2

Back 22

(C-PR)

- CKD

- PAD
- Retinopathy

Front 23

ESSENTIAL HYPERTENSION

- Target organ damage seen in the heart. x5

- which is the first one you would see clinically?

Back 23

(HALF Hearted MC)

- HF
- Angina
- LVH (1st one clinically)
- Former or Prior MI
- Former or Prior CV ReVascularization

Front 24

BP MEASUREMENT

- what should be the cuff width?

- what should be the cuff length?

Back 24

- 2/3 of distance from Axilla to Antecubital fossa

- 80% of arm circumference

Front 25

BP MEASUREMENT

- technique that should be utilized especially in elderly?

- what's the purpose for doing above?

Back 25

- inflate up to 200 mmHg

- to avoid underestimating BP

Front 26

BP MEASUREMENT

- what condition is seen in 2.5% of elderly?

- why so in elderly?

Back 26

- PseudoHTN

- Stiff, Non-compliant Arteries

Front 27

BP MEASUREMENT

- Korotkoff sound quality is the basis for identifying what?

Back 27

- different phases of measurement in BP

Front 28

BP MEASUREMENT

- average Arterial BP

- average Pulmonary BP

Back 28

120/80

22/8

Front 29

BP MEASUREMENT

- non pathological factors that increase BP. x6

Back 29

(Increased BP if it TASTE Cold)

- TALKING
- Arm below heart
- Small Cuff
- Tobacco
- EtOH
- Cold Temperature

Front 30

BP MEASUREMENT

- non pathological factors that decreases the Diastolic?

- what other non-pathological factors decrease the overall BP? x3

Back 30

- Supine position

(ABCDecrease)

- Arm Above Heart
- Bias MD
- Cuff is too large

Front 31

BP MEASUREMENT

- what is the protocol clinically to DX HTN?

Back 31

- 2+ reading on each visit separated by as much time as possible

- if readings separated by more than 6 mmHg, take additional readings until you get close consecutive values.

Front 32

BP MEASUREMENT

- for DX'ing HTN, what 4 things do you NEED to have?

Back 32

- 3 readings at least 1 week apart

- Both arms measured

- Higher arm BP if pressure differs btw arms

- If arm pressure is elevated, take pressure in one leg, especially if under 30.

Front 33

DIAGNOSIS : HTN

- at least how many readings?

- how far apart?

- measured BP in which arm?

Back 33

- 3

- 1 week at least

- Both

Front 34

DIAGNOSIS : HTN

- after measuring in both arm, what if pressures differ?

- if arm pressure is elevated, then what?

- do the above especially in which patients?

Back 34

- take the BP of HIGHER arm

- measure one leg

- UNDER 30 y.o.

Front 35

PULSE PRESSURE

- define?

- equation for PP = ??

Back 35

- Artery Expansion in response to blood volume ejected by LV

= Systolic BP - Diastolic BP

Front 36

PULSE PRESSURE

- what is Mean Arterial Pressure representing?

- MAP value is closer to Systolic or Diastolic?

- why?

Back 36

- Average Arterial pressure during Cardiac cycle

- Diastolic

- period of Diastolic is longer than in Systole

Front 37

PULSE PRESSURE

- Equation for MAP = ??? ***

Back 37

= Diastolic Pressure + 1/3 PP

= Diastolic BP + 1/3 (Systolic - Diastolic)

Front 38

PULSE PRESSURE

- Increases in PP indicates what?

- especially in which anatomical part?

Back 38

- Greater Stiffness (PPenis) in Large Conduit arteries

- Thoracic aorta

Front 39

PULSE PRESSURE

- PP is what kind of measure and for what & when?

- PP may be a better marker for what rather than SBP or DBP alone?

- especially in which patients?

Back 39

- Surrogate measure
- of Dynamic Cycle STRESS
- during Systole

- Increased CV dz Risk

- Older patients

Front 40

PULSE PRESSURE

- PP increase correlates with an increase of what disease?

- PP is an INDependent risk factor for?

Back 40

- CHD

- CV mortality

Front 41

WHITE COAT HYPERTENSION

- what % of patient seen in the clinic will have it?

- MC in what patients?

- Most infrequent (<5%) in which patients?

Back 41

20 to 25%

- Elderly Female

- pts with Office DBP of 105 mmHg

Front 42

WHITE COAT HYPERTENSION

- what can you do to get around WC HTN?

Back 42

- Nurse or Tech take BP rather than MD

Front 43

WHITE COAT HYPERTENSION

- what technique for looking at white coat effect?

Back 43

- Ambulatory monitoring

(pts takes home a holter monitor and brings it back w/ several readings over time)

Front 44

WHITE COAT HYPERTENSION

- indications for Ambulatory BP. x5

Back 44

(DRESS)

- Develop HYPOTension symptoms (dizzy, weak) on various MEDS

- Resistance to Increasing MEDS

- EvAluation of Episodic HTN or Autonomic dysfunction

-Significant HTN with little/no evidence of End-Stage organ damage

- Self-measured BP values have Large variations

Front 45

PHYSICAL EXAM : HYPERTENSION

- during PE, compare what? x2 comparisons

- check what artery well & how?

Back 45

- UE BP
- Supine vs. Standing

- Carotid artery Palpation & Auscultation

Front 46

PHYSICAL EXAM : HYPERTENSION

- what other exams do you include? x4

Back 46

(OPAL)

- Optic Fundi exam ** (detailed)
- Peripheral artery exam
- Abd exam
- Lung & heart exam

Front 47

PHYSICAL EXAM : HYPERTENSION

- what classification system to assess Hypertensive Retinopathy?

Back 47

- Modified SCHEIE classification

Front 48

HYPERTENSIVE RETINOPATHY
MODIFIED SCHEIE

- Grade 0?

- Grade 1?

- Grade 2?

- Grade 3?

- Grade 4?

Back 48

- (Zero) No changes

- Minimum Arterial Narrowing

- Obvious Arterial narrowing WITH Focal Irregularities

- Grade 2 + Retinal Hemorrhage and/or Exudate

- Grade 3+ Swollen Optic Nerve

Front 49

HYPERTENSIVE RETINOPATHY
MODIFIED SCHEIE

- Grade 4 may be indicative of what type of HTN?

- Grade 4 criteria?

Back 49

- Malignant HTN

- Grade 3 + Swollen Optic Nerve