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45 Cards in this Set
- Front
- Back
identify grade 1/2 hypertensive retinopathy
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1-2: moderate- severe retinal arteriole NARROWING
2: arteriovenous NICKING |
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features of grade 3 hypertensive retinopathy
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bilateral soft EXUDATES or flame-shaped HAEMORRHAGES
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features of grade 4 hypertensive retinopathy
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bilateral optic nerve PAPILLOEDEMA
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5 types of end-organ damage
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CHF
coronary artery disease - MI cerebrovascular disease- STROKE renal failure hypertensive retinopathy |
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6 secondary causes for HTN
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fibromuscular dysplasia
renal/ renovascular disease coarctation of aorta hyperaldersteronism Cushing's Phaeochromocytoma (adrenal medullar --> ⇧NA & adrenaline) |
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epidemiology of coronary heart disease:
gender age culture status race |
men ♂
<60 western deprived BLACK men ♂ |
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BMI ranges for overweight/ obese
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25-30 = overweight
>30 = obese |
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5 major food groups
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fruit & veg
carbs dairy meat & fish (eggs & beans) fat/ sugar |
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what defines high fat food
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>20g per 100g
sat fat worse |
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what defines high sugar foods
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>15g per 100g
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what's the daily salt recommendation and what defines high salt foods
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6g/day
>1.5g per 100g |
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the big 4's & little 4s - modifiable risk factors for CVD
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big: - HTN, ⇧cholesterol, smoing, obesity
little: physical inactivity, alcohol, stress, deprivation |
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events in atherosclerosis developing
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what 5 cinical effectsmanifest from an atherosclerotic plaque
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impaired vision
TIAs/ strokes IHD: angina renal failure POAD (intermittent claudication) |
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what 4 factors ↑ oxidative stress in arteries
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↑LDL
↑BP DM smoking |
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What are the role and course of macrophages in atherosclerosis
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migrate through endothelial wall
take up oxidised LDL foam cells fatty streak |
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normal ranges (mmol/L) for:
- cholesterol - triglycerides - LDL -HDL |
cholesterol: <6
triglycerides: <2 LDL: <4.4 HDL: >1 |
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what's the mainstay of treatment for high cholesterol
action effects |
STATINS- comp inhib HMG-CoA reductase (cholesterol synthesis)
- ↓total & LDL - pleotrophic |
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some clinical markers for dyslipidaemia / hyperlipidaemia
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xanthelasma (eyes)
xanthomas (skin) corneal arcus (can be normal >50) |
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normal BP range
target for high risk groups (who are these?) |
<140/90
<130/80: DM, renal disease |
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pharamacological management HTN
- <55 - ≥55 |
ACE- lisinopril, ARB- losartan, CCB- nicorandil, thiazide- bendrfluazide
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what 4 factors contribute to metabolic syndrome
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obese
↑ waist circumference (M>102, F>88) ↑triglycerides ↑fasting glucose |
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what link does ↑CRP have in CVD
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linked with MI & ↑TC:HDL
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how can you calculate an individuals risk for CVD
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ASSIGN score
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3 medications and 2 targets for established atherosclerosis
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aspirin (anti-platelet)
statin BBs (atenolol, metropolol) ACEI (lisinopril) exercise smoking cessation |
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6 secondary causes of HTN
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fibromuscular dysplasia
renal/ renovascular disease coarctation of aorta hyperaldersteronism Cushing's Phaeochromocytoma (adrenal medullar --> ⇧NA & adrenaline) |
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what BP rage defines MALIGNANT/ accelerated HTN - needs URGENT treatment
pathological hallmark |
papilloedema of the optic nerve (grade 4 HTN retinopathy)
>180/110 FIBRINOID NECROSIS |
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3 pathological changes of blood vessels in HTN
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microvascular injury- scarring from fibrosis
medial thickening hyaline athersclerosis (plasma proteins in walls) |
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4 arterial pathological consequences of atherosclerosis
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artery stenosis
arterial thrombosis/ embolism aneurysm dissection |
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how does arterial thrombosis occur
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thin fibrous plaque ruptures
collagen release stimulates COAGULATION cascade |
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what's an aneurysm
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abnormal DILATATION & reduced elasticity of artery wall
media weakened by atherosclerosis ---> RUPTURE! |
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what's a dissection
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media SPLIT --> sudden TEARING pain
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what's LVH, why and how is it dysfunctional (3)
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fibrous, collagenous = stiff & less complaint
- DIASTOLIC dysfunction - DISARRAY of electric impulse - arrhythmias - thicker= reduced PERFUSION |
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if repeated clinic BP is >140/90 what do you do?
how is this done? |
offer ABPM to confirm HTN diagnosis
- 2 per hr during WAKING hrs (average of 14) |
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alternative to ABPM
how is this taken |
HBPM
- 2 consecutive measurements >1min apart - seated - BD (morn/ eve) - 7days - discard 1st measurement |
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What 4 ways do you assess target end organ damage in pt's with HTN?
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- proteinuria (albumin:creatinine), haematuria
- Bloods: glucose, U&Es, eGFR, cholesterol - hypertensive retinopathy - ECG |
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ABPM/ HBPM target
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135/85
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what's classified as stage 2 and severe/ accelerated HTN
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stage 2- 160/100
severe- S>180 or D>110 |
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is adding drugs or increasing dose of monotherapy more effective in treating HTN
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adding = synergistic
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who's offered CCBs as first line treatment of HTN
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≥55
BLACK person of African/ Caribbean origin - any age |
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What 2 reasons would you give a1-blocker to treat HTN
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?after step 4 (A+C+D)
or benign prostatic hyperplasia |
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at what BP do you treat ALL pt's
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≥160/100
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when would you treat a pt with BP ≥130/80
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DM or CKD
Target end organ damage: - HTN retinopathy - stroke/ TIAs - HF/ CHD/ LVH - POAD |
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HTN below what age is likely to be secondary HTN
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<40yrs
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which HTN range do you treat IMMEDIATELY
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malignant/ accelerated (w/ papilloedema) > 180/110
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