Pathophys - Htn

Front 1

Age of premature CV disease

Back 1

w < 65
m < 55

Front 2

Def orthostatic hypotension

Back 2

sys dec > 20 mm hg
diastol dec > 10 mm hg
within 3m of standing

Front 3

best indicator of kidney func

Back 3

gfr

Front 4

physical exam signs of RAS

Back 4

1. rapid rise in bp
2. bp often very high
3. abdominal/flank bruit
4. athero of abdom aorta
5. htn retinopathy

Front 5

ACE I side effect

Back 5

dry cough, ~10%, more often in women

Front 6

ACE I and cough

Back 6

bradykinin and sub p norm degraded by ACE
accum in U Res tract/lungs

Front 7

winter's formula

trick?

Back 7

eval resp compensation during metab acidosis
trick: metab acidosis last 2 digits of pH = pCO2

Front 8

anion gap formula?

Back 8

Na - (Cl - HCO3)

norm = 12 +/- 4

Front 9

secondary htn prev?

Back 9

5-10% of htn pts

identifiable cause

Front 10

secondary htn suspicion

Back 10

htn in young person below puberty
prev non htn, w/ no f hx and non AA
prev non htn over 50

Front 11

causes of secondary htn

Back 11

chronic renal disease
high renin states (tumor poss)
genetic - inc tubular salt reabsorp
coarctation aorta
endocrine - aldosterone prod tumor, pheochromocytoma, glucocoricoid excess (steroid use, cushings syn), hypothyroid, hyper-parathyroid
sleep apnea
drugs (o contra, cocaine, amphetamine)

Front 12

ABCDE of secondary

Back 12

A - obstructive sleep apnea
B - bruits, bad kidney
C - Catechol, coarction, cushings
D - drugs, diet
E - erythropoetin, endocrine

Front 13

detecting kidney damage

Back 13

1. elev serum creatinine
2. inc urine protein
3. abnormal urine sed
4. image
- abnormal size and echogenicity

Front 14

RAS prev

Back 14

10-45% of pts with severe htn (rare in mild)
ras due to athero in older pts, most common with diabetes

Front 15

pathophy mech of RAS

Back 15

atherosclerisis = prox to aorta
fibromuscular dysplasia or intimal fibrosis = more peripheral
---> dec renal blood flow --> RAAS --> refractory htn

Front 16

primary aldosteronism mech

Back 16

inc aldosterone --> na retention --> vol expansion --> renin suppression

NO edema (escape due to Na wasting secondary to vol expasion--kidney sees lot of Na so tries to correct)

Front 17

sx of primary aldosteronism

Back 17

htn
hypokalemia (pt will show Uk > 20mEq/L and serumK < 3.4)
mild hypernatremia
metabolic alkalosis
hypomagnesemia

pasma aldos: renin >20
elev urine aldos on high salt diet

Front 18

cushings syndrome prev and basis

Back 18

-1% of htn pts
-80% of cushings pts have htn
-excessive glucocorticoid production

Front 19

causes of cushings

Back 19

pit adenoma
adrenal adenoma or carcinoma
bronchogenic carcinoma
glucocor meds

Front 20

physical exam for cushings

Back 20

moon facies
truncal obesity
buffalo hump
striae
acne
hirsituism
eccymoses

Front 21

labs for cushings

Back 21

hypokalemia (abnormal Na and K exchange in DCT)
abnormal carbo metab
DEXA scan -- for osteoporosis
xray -- hip fractures are common
elev 24h free cortisol --> confirmed with a dexamethasone suppression test

Front 22

cushings trtmnt

Back 22

anti-htn drugs
K sparring diuretics
surgery to get tumor

Front 23

pheochromocytoma peak incidence

Back 23

30-50s

Front 24

pheochromocytoma mech

Back 24

inc catechol secretion (90% of lesions found in adrenal gland)
-NE sec acting on alpha recep --> HTN --> can mimic panic attack (anxiety, headache, palps)

htn can be episodic

Front 25

presentation of phechromocytoma

Back 25

induction of anesthesia
micturition when tumor near bladder
pressure on abdomen

all = severe htn triggers

use of cocaine can mimic
sudden stop in htn meds cam mimic

Front 26

pheo extra-adrenal incid ? sex?

Back 26

10% --> paraganglionomas
more common in men

Front 27

best screening test for pheo?

Back 27

plasma metanephrines
> 4x normal levels = definite pos
if normal pt does NOT have pheo

Front 28

JNC normal BP

Back 28

sys < 120
dia < 80

Front 29

JNC pre-htn

Back 29

s 120-139
d 80-89

Front 30

jnc stage 1

Back 30

s 140-159
d 90-99

Front 31

JNC stage 2

Back 31

s > 160
d > 100

Front 32

Pulse pressure =?

Back 32

SBP - DBP
wide = risk for CV problems

Front 33

target organs of htn? (4)

Back 33

brain
kidney
heart
retina

Front 34

pt w/ CKD or diabetes goal BP?

with what meds?

Back 34

< 130/80

diabetics often > 3 drugs
--> ACEi or ARBS not beta blockers (asthmatics should also not get beta blockers)

Front 35

resistant htn definition?

Back 35

BP uncontrolled > 4 drugs
pt non adherance
poor bp measurement techniques
use of other drugs (nsaids, herbals)