Risk Factors

Front 1

identify grade 1/2 hypertensive retinopathy

Back 1

1-2: moderate- severe retinal arteriole NARROWING

2: arteriovenous NICKING

Front 2

features of grade 3 hypertensive retinopathy

Back 2

bilateral soft EXUDATES or flame-shaped HAEMORRHAGES

Front 3

features of grade 4 hypertensive retinopathy

Back 3

bilateral optic nerve PAPILLOEDEMA

Front 4

5 types of end-organ damage

Back 4

CHF
coronary artery disease - MI
cerebrovascular disease- STROKE
renal failure
hypertensive retinopathy

Front 5

6 secondary causes for HTN

Back 5

fibromuscular dysplasia
renal/ renovascular disease
coarctation of aorta
hyperaldersteronism
Cushing's
Phaeochromocytoma (adrenal medullar --> ⇧NA & adrenaline)

Front 6

epidemiology of coronary heart disease:
gender
age
culture
status
race

Back 6

men ♂
<60
western
deprived
BLACK men ♂

Front 7

BMI ranges for overweight/ obese

Back 7

25-30 = overweight
>30 = obese

Front 8

5 major food groups

Back 8

fruit & veg
carbs
dairy
meat & fish (eggs & beans)
fat/ sugar

Front 9

what defines high fat food

Back 9

>20g per 100g
sat fat worse

Front 10

what defines high sugar foods

Back 10

>15g per 100g

Front 11

what's the daily salt recommendation and what defines high salt foods

Back 11

6g/day
>1.5g per 100g

Front 12

the big 4's & little 4s - modifiable risk factors for CVD

Back 12

big: - HTN, ⇧cholesterol, smoing, obesity
little: physical inactivity, alcohol, stress, deprivation

Front 13

events in atherosclerosis developing

Back 13

Front 14

what 5 cinical effectsmanifest from an atherosclerotic plaque

Back 14

impaired vision
TIAs/ strokes
IHD: angina
renal failure
POAD (intermittent claudication)

Front 15

what 4 factors ↑ oxidative stress in arteries

Back 15

↑LDL
↑BP
DM
smoking

Front 16

What are the role and course of macrophages in atherosclerosis

Back 16

migrate through endothelial wall
take up oxidised LDL
foam cells
fatty streak

Front 17

normal ranges (mmol/L) for:
- cholesterol
- triglycerides
- LDL
-HDL

Back 17

cholesterol: <6
triglycerides: <2
LDL: <4.4
HDL: >1

Front 18

what's the mainstay of treatment for high cholesterol
action
effects

Back 18

STATINS- comp inhib HMG-CoA reductase (cholesterol synthesis)
- ↓total & LDL
- pleotrophic

Front 19

some clinical markers for dyslipidaemia / hyperlipidaemia

Back 19

xanthelasma (eyes)
xanthomas (skin)
corneal arcus (can be normal >50)

Front 20

normal BP range
target for high risk groups (who are these?)

Back 20

<140/90
<130/80: DM, renal disease

Front 21

pharamacological management HTN
- <55
- ≥55

Back 21

ACE- lisinopril, ARB- losartan, CCB- nicorandil, thiazide- bendrfluazide

Front 22

what 4 factors contribute to metabolic syndrome

Back 22

obese
↑ waist circumference (M>102, F>88)
↑triglycerides
↑fasting glucose

Front 23

what link does ↑CRP have in CVD

Back 23

linked with MI & ↑TC:HDL

Front 24

how can you calculate an individuals risk for CVD

Back 24

ASSIGN score

Front 25

3 medications and 2 targets for established atherosclerosis

Back 25

aspirin (anti-platelet)
statin
BBs (atenolol, metropolol)
ACEI (lisinopril)
exercise
smoking cessation

Front 26

6 secondary causes of HTN

Back 26

fibromuscular dysplasia
renal/ renovascular disease
coarctation of aorta
hyperaldersteronism
Cushing's
Phaeochromocytoma (adrenal medullar --> ⇧NA & adrenaline)

Front 27

what BP rage defines MALIGNANT/ accelerated HTN - needs URGENT treatment

pathological hallmark

Back 27

papilloedema of the optic nerve (grade 4 HTN retinopathy)
>180/110

FIBRINOID NECROSIS

Front 28

3 pathological changes of blood vessels in HTN

Back 28

microvascular injury- scarring from fibrosis
medial thickening
hyaline athersclerosis (plasma proteins in walls)

Front 29

4 arterial pathological consequences of atherosclerosis

Back 29

artery stenosis
arterial thrombosis/ embolism
aneurysm
dissection

Front 30

how does arterial thrombosis occur

Back 30

thin fibrous plaque ruptures
collagen release stimulates COAGULATION cascade

Front 31

what's an aneurysm

Back 31

abnormal DILATATION & reduced elasticity of artery wall
media weakened by atherosclerosis ---> RUPTURE!

Front 32

what's a dissection

Back 32

media SPLIT --> sudden TEARING pain

Front 33

what's LVH, why and how is it dysfunctional (3)

Back 33

fibrous, collagenous = stiff & less complaint
- DIASTOLIC dysfunction
- DISARRAY of electric impulse - arrhythmias
- thicker= reduced PERFUSION

Front 34

if repeated clinic BP is >140/90 what do you do?

how is this done?

Back 34

offer ABPM to confirm HTN diagnosis
- 2 per hr during WAKING hrs (average of 14)

Front 35

alternative to ABPM

how is this taken

Back 35

HBPM
- 2 consecutive measurements >1min apart
- seated
- BD (morn/ eve)
- 7days
- discard 1st measurement

Front 36

What 4 ways do you assess target end organ damage in pt's with HTN?

Back 36

- proteinuria (albumin:creatinine), haematuria
- Bloods: glucose, U&Es, eGFR, cholesterol
- hypertensive retinopathy
- ECG

Front 37

ABPM/ HBPM target

Back 37

135/85

Front 38

what's classified as stage 2 and severe/ accelerated HTN

Back 38

stage 2- 160/100
severe- S>180 or D>110

Front 39

is adding drugs or increasing dose of monotherapy more effective in treating HTN

Back 39

adding = synergistic

Front 40

who's offered CCBs as first line treatment of HTN

Back 40

≥55
BLACK person of African/ Caribbean origin - any age

Front 41

What 2 reasons would you give a1-blocker to treat HTN

Back 41

?after step 4 (A+C+D)
or
benign prostatic hyperplasia

Front 42

at what BP do you treat ALL pt's

Back 42

≥160/100

Front 43

when would you treat a pt with BP ≥130/80

Back 43

DM or CKD
Target end organ damage:
- HTN retinopathy
- stroke/ TIAs
- HF/ CHD/ LVH
- POAD

Front 44

HTN below what age is likely to be secondary HTN

Back 44

<40yrs

Front 45

which HTN range do you treat IMMEDIATELY

Back 45

malignant/ accelerated (w/ papilloedema) > 180/110