Pbd Test 5 Hypertension/renal

Front 1

What are the 4 degrees of hypertension?

Back 1

1. Labile
2. Borderline
3. Chronic (benign)
4. Malignant hypertension

Front 2

Labile BP is chaeracterized by its ___(daily and random) and ___

Back 2

variability
reactivity

Front 3

Increase in BP by presence of medical personnel

Back 3

White coat Hypertension

Front 4

White coat Hypertension can give a ____ % increase in borderline hypertensive patients

Back 4

10-60

Front 5

Borderline BP

Back 5

140/90

Front 6

Degree of hypertension that results in premature death and disability if BP remains untreated

Back 6

chronic (benign)

Front 7

Degree of hypertension that is the silent killer

Back 7

chronic (benign)

Front 8

in chronic (benign) hypertension, death is usually due to ___

Back 8

atherosclerotic complications

Front 9

Most common form of hypertension

Back 9

chronic (benign)

Front 10

With Malignant hypertension, ___% die within 1 year if not treated

Back 10

80-90

Front 11

Swelling of the optic disc

Back 11

papilledema

Front 12

Form of hypertension that is associated with elevated R-A system

Back 12

Malignant hypertension

Front 13

Why is malignant hypertension associated with hypokalemia?

Back 13

aldosterone is released and has Na retention so K is thrown away

Front 14

most deaths from malignant hypertension are associated with ____

Back 14

target organ damage

Front 15

2 mechanisms that regulate BP

Back 15

1. SNS
2. Endocrine

Front 16

BP is regulated through the SNS by a negative feedback system sensed by ____

Back 16

baroreceptors

Front 17

7 components of the endocrine system that affect BP

Back 17

1. catecholamines
2. renin--angiotensin-aldosterone system
3. ADH
4. Insulin-hyperinsulinemia-insulin resistance
5. Local hormone factors
6. ANH
7. Digitalis-like factor/Natriuretic factor/ouabain-like factor

Front 18

What are the 4 local hormone factors that affect BP?

Back 18

1. Kinins
2. PG
3. EDRF, NO
4. Endothelin (EDCF)

Front 19

What 3 hormones affect CO and TPR?

Back 19

1. catecholamines
2. renin-angiotensin-aldosterone system.
3. ADH (vasopressin)

Front 20

ADH has ____ properties

Back 20

fluid retention

Front 21

ADH is released from the ___

Back 21

posterior pituitary

Front 22

Insulin/hyperinsulinemia/insulin resistance do 6 things:
1. Na retention called ____
2. Stimulates ____
3. Increases Vascular ____
4. Effects many transport systems on ____
5. With insulin resistance have elevated ___ and reduced ____
6. Insulin is a _____ promoter

Back 22

1. antiatriuretic
2. SNS
3. responsiveness
4. VSM
5. LDL, HDL
6. growth

Front 23

1. Kinins cause the release of ____ ,____, and ____,
2. all of which are ____
3. that have ____ and ____ affects

Back 23

1. EDRF, NO, PG
2. vasodilators
3. diuretic, natriuretic

Front 24

release sodium

Back 24

natriuretic

Front 25

retain sodium

Back 25

antinatriuretic

Front 26

____ are vasodilators that inhibit catecholamine release, and also have ___ and ____ properties

Back 26

PG (prostaglandins)
natriuretic, diuretic

Front 27

EDRF and NO relax VSM via ___

Back 27

cGMP

Front 28

EDRF

Back 28

endothelium derived relaxation factor

Front 29

Endothelin is a potent ____, and a mitogen (thing that can enlarge) for ____, and also has ___ properties

Back 29

vasoconstrictor
VSM
Antinatriuretic

Front 30

Where is the source of many local hormone factors?

Back 30

endothelial cells of vessels

Front 31

The major stimulus of ___ is an increase in Atrial P

Back 31

ANH

Front 32

___ functions as a volume regulator by increasing ___ and ___ loss, and also acts as a vaso____

Back 32

ANH
Na
water
dilator

Front 33

ANH has multiple antihypertensive actions by decreasing ____ and ____

Back 33

aldosterone, ADH

Front 34

ANH is natriuretic and diuretic by dilating afferent and constricting efferent arterioles to increase ____

Back 34

GFR

Front 35

ANH does what to VSM?

Back 35

reduces contractile effects

Front 36

ANH ___ renin release

Back 36

decreases

Front 37

ANH ____ responses to Ang II

Back 37

antagonizes

Front 38

ANH works through an increase in ____

Back 38

cGMP

Front 39

Stimulus for Digitalis-like factor/Natriuretic factor/ouabain-like factor is in increase in ____

Back 39

volume

Front 40

Digitalis inhibits the ____

Back 40

Na/K ATPase

Front 41

What is the effect on Na excretion for Digitalis-like factor/natriuretic factor/ouabain-like factor? The effect on BP?

Back 41

natriuresis
increase

Front 42

Digitalis-like factor/natriuretic factor/ouabain-like factor ____ intracellular Na and Ca, ____ NE uptake, and enhanced _____

Back 42

increase
reduce
vasoconstriction

Front 43

The kidney does volume regulation by long term control, ____ diuresis, and infinite negative feedback systems

Back 43

pressure

Front 44

A few mmHg pressure change can get a ____ % change in urinary output if system operating normally

Back 44

50-100

Front 45

____ develops when volume regulation system in kidney fails

Back 45

hypertension

Front 46

Once disturbances in volume regulation of kidney system fails, these 3 other systems are involved

Back 46

1. structural changes
2. renal changes
3. baroreceptor function

Front 47

primary or idopathic hypertension is ___% of all cases

Back 47

90-95

Front 48

Is there a cure for hypertension?

Back 48

no, control only

Front 49

___% of essentail hypertensives are salt sensitive

Back 49

60

Front 50

In the US we consume about ___ gms/day of NaCl (or ___ gm of Na/day)

Back 50

9-12, 4-5

Front 51

hypertension in people over 65: ____, in people under 34_____

Back 51

>50%
3%

Front 52

____ are gradually "reset" reduced sensitivity with age

Back 52

baroreceptors

Front 53

____% of people with hypertension are insulin resistant

Back 53

50

Front 54

The kidney can lose its source of antihyptertensive fuction with loss of ___ and ____

Back 54

kinins
PG

Front 55

In the 2 kidney, 1 clip model, initially ___ is elevated to bring BP up, hypertension occurs ___

Back 55

renin
always

Front 56

in the 1 kidney, 1 clip model, renin is ____ then excess volume and sodium and pressure shuts down renin release, hypertension occurs ____

Back 56

initially elevated
always

Front 57

medullary region of adrenal gland: ___

Back 57

pheochromocytoma

Front 58

A tumor of ____ cells can be removed to bring BP down in 1% of cases

Back 58

chromaffin

Front 59

What 3 things make up the symtomatic triad for diagnosis of chromaffin cells tumor causing high BP?

Back 59

1. tachycardia
2. headaches
3. attacks of sweating

Front 60

Overproduction of ____ causes ~10% of secondary hypertension and is called _____

Back 60

aldosterone
primary aldosteronism

Front 61

___ syndrome for high BP should be considered if patient has hypokalemis (<3.0 meq/L)

Back 61

Conns

Front 62

hypokalemia can lead to ____

Back 62

nephropathy

Front 63

In primary aldosteronism, plasma renin is ____, and is not stimulated by low sodium diet. ____ also is not reduced by high sodium diet

Back 63

low
aldosterone

Front 64

____ test shows that ratio of aldo/renin does not fall in Conn's syndrome patients

Back 64

oral captopril (ace inhibitor)

Front 65

In primary aldoteronism, CO is ___ and TPR is ___

Back 65

elevated
elevated

Front 66

this can result with a functional block of adrenal enzymes to disrupt ACTH feedback or some central ACTH overproduction, and could also occur with conditions that elevate renin and/or Angio II

Back 66

secondary aldosteronism

Front 67

____ is less than 0.1% of high BP, and has an increase in ____, with a 20% increase in adrenal clucocorticoids. TPR is ____

Back 67

cushing syndrome
increased

Front 68

Glucocorticoids can:
___ vascular reactivity to catecholamines, ___ catecholamine uptake, and ___ the synth of angiotensinogen and increase the # of AT1 receptors

Back 68

enhance
inhibit
increase

Front 69

Glucocorticoids ___ CO

Back 69

increase

Front 70

Excess glucocorticoids can have mineralocorticoid effects that have na and water ____ and increase ____

Back 70

retention
volume

Front 71

____ is high BP during late pregancy, with proteinuria or edema. It is a ___ disorder, when diastolic P increases to 95 mmHg, preinatal mortality increases ___ times

Back 71

preeclampsia
multisystemic
3

Front 72

In normal pregancy volume is increased by ____%

Back 72

40-60

Front 73

TPR in a normal pregancy should ___ and are ____ to angio II although RAS is elevated and BP may even fall

Back 73

decrease
hyporesponsive

Front 74

in preeclamptics, volume may ____, CO is ___ to normotensive controls, TPR does ____, responsiveness to Ang II, catecholamines, ADH is ____, and there is a ___ fold risk for diabetes

Back 74

not increase
similar
increase
elevated
2

Front 75

in preclampsia there is an increase in 4 things, a decrease in 3, and a greater ____ resistance

Back 75

increase: ET1 (endothelin), deoxycorticosterone, natriuretic factor, AT1 receptors
decrease: EDRF (NO), Prostacyclin/thromboxane ratio, Vitamin E, lipid peroxides ratio
greater insulin resistance

Front 76

When systolic BP is > 150 mmHg, risk of atherosclerosis is ____

Back 76

doubled

Front 77

When systolic pressure > 160 mmHg, risk of stroke is increased ___ times

Back 77

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