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Questions and Answers
The first step when evaluating a patient with suspected endocrine-related hypertension is to exclude other causes of secondary hypertension, such as:
The first step when evaluating a patient with suspected endocrine-related hypertension is to exclude other causes of secondary hypertension, such as:
The most common cause of secondary hypertension is:
The most common cause of secondary hypertension is:
Which of the following are reasonable next steps if you suspect your patient has obstructive sleep apnea?
Which of the following are reasonable next steps if you suspect your patient has obstructive sleep apnea?
A systolic blood pressure of over 180 mmHg with evidence of organ damage is known as:
A systolic blood pressure of over 180 mmHg with evidence of organ damage is known as:
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Which of the following are the primary regulatory mechanisms for blood pressure?
Which of the following are the primary regulatory mechanisms for blood pressure?
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About home BP monitoring, which of the following statement is correct?
About home BP monitoring, which of the following statement is correct?
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The most common thyroid disorder is:
The most common thyroid disorder is:
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Which of the following confirmed values meet the diagnostic threshold for diabetes?
Which of the following confirmed values meet the diagnostic threshold for diabetes?
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One of the symptoms of hypothyroidism is:
One of the symptoms of hypothyroidism is:
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Hypothyroidism can affect pregnancy by:
Hypothyroidism can affect pregnancy by:
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A person with untreated hypothyroidism may also have:
A person with untreated hypothyroidism may also have:
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How is hypothyroidism treated?
How is hypothyroidism treated?
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The main hormone secreted by the Thyroid gland is:
The main hormone secreted by the Thyroid gland is:
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Iodine deficiency can cause:
Iodine deficiency can cause:
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Medications for hypothyroidism include treatment that:
Medications for hypothyroidism include treatment that:
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Which of these diseases is not related to thyroid glands?
Which of these diseases is not related to thyroid glands?
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Drugs used in treatment of thyrotoxicosis:
Drugs used in treatment of thyrotoxicosis:
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Thyroid storm:
Thyroid storm:
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Immediate postoperative complication of thyroid surgery is:
Immediate postoperative complication of thyroid surgery is:
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This measure does not help to prevent diabetes complications:
This measure does not help to prevent diabetes complications:
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This diabetes drug acts by decreasing the amount of glucose produced by the liver:
This diabetes drug acts by decreasing the amount of glucose produced by the liver:
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SGLT2 inhibitors are characterized by the following, except:
SGLT2 inhibitors are characterized by the following, except:
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What is the most common symptom of renal artery stenosis?
What is the most common symptom of renal artery stenosis?
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Renal artery stenosis may occur in all of the following except:
Renal artery stenosis may occur in all of the following except:
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The main reason for the arterial hypertension in chronic glomerulonephritis is:
The main reason for the arterial hypertension in chronic glomerulonephritis is:
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Benign nephrosclerosis is characterized morphologically by:
Benign nephrosclerosis is characterized morphologically by:
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A 79 year old lady presents to hospital with high blood pressure (T/ A 170/100), vomiting and a serum creatinine of 270 umol/L (normal range: 70-90 umol/L), with an estimated glomerular filtration rate of 15 mL/min/1.73 m2. Which investigation result best indicates that she has an underlying chronic rather than acute kidney disease?
A 79 year old lady presents to hospital with high blood pressure (T/ A 170/100), vomiting and a serum creatinine of 270 umol/L (normal range: 70-90 umol/L), with an estimated glomerular filtration rate of 15 mL/min/1.73 m2. Which investigation result best indicates that she has an underlying chronic rather than acute kidney disease?
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Which of these can increase your risk of high blood pressure?
Which of these can increase your risk of high blood pressure?
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What can you do to control high blood pressure?
What can you do to control high blood pressure?
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Why does reducing how much salt (sodium) you eat help prevent high blood pressure?
Why does reducing how much salt (sodium) you eat help prevent high blood pressure?
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Study Notes
Hypertension Evaluation
- Initial evaluation of suspected endocrine-related hypertension involves excluding secondary causes, such as hypoactivity of the islets of Langerhans, adrenal cortex, renal disorders, and spleen disorders.
Common Cause of Secondary Hypertension
- Renal disease is the most frequent cause of secondary hypertension.
- Primary aldosteronism is another common cause.
- Diabetes and sleep apnea are also possible factors.
Suspected Hypertension Cause
- Elevated blood pressure, polyuria, nocturia, muscle weakness, and palpitations may suggest primary hyperaldosteronism as a possible cause of the elevated blood pressure.
- Muscular dystrophy, diabetes mellitus, and paroxysmal supraventricular tachycardia are other potential causes.
Obstructive Sleep Apnea Evaluation
- If obstructive sleep apnea is suspected, a CPAP trial, assessment of sleep posture (side vs. back), and Friedman Palate scale evaluation could be helpful.
Hypertensive Crisis
- A systolic blood pressure exceeding 180 mmHg with organ damage constitutes a hypertensive crisis.
Blood Pressure Regulation
- The primary regulatory mechanisms for blood pressure involve antidiuretic hormone, adrenaline, aldosterone, renin, and angiotensin.
Home Blood Pressure Monitoring (HBPM)
- HBPM can aid in better predicting end-organ damage and cardiovascular risk compared to clinic blood pressure readings.
- HBPM often requires less patient participation.
- HBPM can accurately identify diurnal blood pressure variation.
- While valuable, HBPM doesn't fully eliminate white coat hypertension.
Common Thyroid Disorder
- Hypothyroidism is the most common thyroid disorder.
Diabetes Diagnosis
- The diagnostic threshold for diabetes encompasses fasting blood glucose levels of 126 mg/dL or higher.
- Random glucose over 160 mg/dL suggests diabetic conditions.
- Two-hour postprandial glucose measurements at or above 126 mg/dL also suggest diabetes.
Hypothyroidism Symptoms
- Hypothyroidism symptoms include fatigue, intolerance to cold, and weight gain.
Hypothyroidism and Pregnancy
- Hypothyroidism can decrease the chances of becoming pregnant, may increase the risk of gestational diabetes, and may make labor and delivery more challenging.
Hypothyroidism Treatment
- Synthetic hormones commonly treat hypothyroidism.
Thyroid Gland Hormone
- The thyroid gland primarily secretes T4 and T3 hormones.
Iodine Deficiency
- Iodine deficiency can lead to goiter, thyroid cancer, and thyroid nodules.
Hypothyroidism Medications
- Hypothyroidism treatment often involves medications that replace thyroid hormones.
Thyroid Gland Diseases Exclusion
- Cretinism, myxedema, and goiter are thyroid-related diseases.
- Acromegaly is unrelated to thyroid glands.
Thyrotoxicosis Treatment
- Metformin, levothyroxine, and sulfonylureas—amongst other treatments—can be used for thyrotoxicosis.
Thyroid Storm
- Thyroid storm can occur during thyroid surgery or procedures unrelated to thyroid glands.
- It leads to hyperthermia.
Post-Thyroid Surgery Complications
- Post-operative complications from thyroid surgery include hemorrhage and possibly keloid formation.
- Some post-surgery conditions can also include hyperthyroidism as a rare event.
Diabetes Complications Prevention
- Controlling blood lipids, blood pressure, and identifying diabetic eye and kidney conditions prevent diabetes complications.
- Limiting carbohydrate intake doesn't prevent all diabetes complications.
Diabetes Medication - Liver Glucose
- Medications like biguanides help decrease the production of glucose in the liver.
- Alpha-glucosidase inhibitors and sulfonylureas also have roles in controlling blood glucose but act through different mechanisms.
SGLT2 Inhibitors
- Some side effects of SGLT2 inhibitors include potential weight gain, and increased risk of urogenital tract infections.
- These medications, however, can also reduce the chance of hospitalization for heart failure.
Renal Artery Stenosis Symptoms
- The common symptom of renal artery stenosis is high blood pressure.
- Pain during urination sometimes signals the condition.
Renal Artery Stenosis Causes
- Atherosclerosis, fibromuscular dysplasia, polycystic renal disease, and Takayasu's arteritis are potential causes of renal artery stenosis.
Chronic Glomerulonephritis Hypertension Cause
- Hypertension in chronic glomerulonephritis is often related to the renin-angiotensin-aldosterone system activation and other factors.
Benign Nephrosclerosis Morphology
- Benign nephrosclerosis typically features fibrinoid necrosis of afferent arterioles, ischemic atrophy, and sometimes hyalinization of afferent arterioles, with consequent nephron atrophy.
- Deposition of basement membrane-like material in glomeruli is another defining feature.
Chronic Kidney Disease Risk Factors
- Obesity, family history, and smoking are associated with increased risk of high blood pressure.
High Blood Pressure Control
- Maintaining a healthy weight, regular exercise, and taking prescribed medication are crucial in managing high blood pressure.
High Blood Pressure and Salt
- Reducing sodium consumption can aid in managing high blood pressure. This lowers fluid buildup in the body.
Kidney Disease in Male Patient
- A 59-year-old male experiencing lower back pain, oliguria, and high blood pressure, combined with laboratory test abnormalities (high creatinine, urine composition issues) may point towards acute or chronic kidney conditions.
Post-Awake Facial Swelling
- A 22-year-old experiencing facial swelling after waking, with hypertension, edema in other areas, and abnormal urine composition might indicate kidney problems that need investigation.
Renal Diagnostic Testing
- Urine protein analysis, kidney biopsy, and renal scans with Tc-99 are diagnostic tests commonly used for renal function assessment.
Antihypertensive Medication Type
- Thiazide-type diuretics may serve as an initial treatment option for high blood pressure.
Renovascular Hypertension Causes
- Among young patients, fibromuscular dysplasia may be a contributing factor in renovascular hypertension.
Renovascular Hypertension Testing
- Radionuclide imaging, magnetic resonance angiography, and renal angiography are some diagnostic techniques for evaluating renovascular hypertension, and may also offer a therapeutic effect.
Chronic Kidney Disease Cause of Death
- Cardiovascular disease often leads to death in people with chronic kidney disease.
Nephrotic Syndrome Characteristics
- Nephrotic syndrome commonly involves proteinuria, edema, and hyperlipidemia.
Normal 24-Hour Urine Protein Ranges
- Normal 24-hour urine protein levels typically fall under 150 mg, although other figures may be found in certain literature.
Chronic Kidney Disease Stages
- Chronic kidney disease stage 3-4, renal insufficiency, involves significant nephron loss and often necessitates intervention, such as dialysis or renal transplant.
75-Year-Old Male's Primary Diagnosis
- A 75-year-old male with hypertension and kidney shrinkage on ultrasound is often evaluated for chronic kidney failure, although narrowed arteries are another possibility
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Description
This quiz covers the evaluation and common causes of hypertension, including endocrine-related factors and secondary causes such as renal diseases and primary aldosteronism. It also touches upon the implications of conditions like diabetes and obstructive sleep apnea on blood pressure. Test your knowledge on the assessment and management of hypertension.
