Medicine Marrow Pg No 975-984 (Endocrinology)
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Medicine Marrow Pg No 975-984 (Endocrinology)

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Questions and Answers

Which of the following treatments can be used for resistant hypertension?

  • Beta-blockers (correct)
  • ACE inhibitors
  • Prazosin (correct)
  • Calcium channel blockers

    • Chlorthalidone is used as a first-line treatment for all patients with Chronic Kidney Disease (CKD).

    False

    What is the recommended starting combination for patients with Coronary Artery Disease (CAD) presenting with angina?

    A + B

    In cases where the estimated Glomerular Filtration Rate (eGFR) is less than or equal to 30 ml/min, the first line of treatment includes medication A and _______.

    <p>Chlorthalidone</p> Signup and view all the answers

    Match the following treatments with their associated conditions:

    <p>Beta-blockers = Coronary Artery Disease Prazosin = Resistant Hypertension Clonidine = Special Scenarios Spironolactone = CKD</p> Signup and view all the answers

    Which of the following is the most important risk factor for primary hypertension?

    <p>Obesity and weight gain</p> Signup and view all the answers

    Secondary hypertension accounts for 30-40% of all hypertension cases.

    <p>False</p> Signup and view all the answers

    Name two vasodilators that serve as protective factors against hypertension.

    <p>NO, ANP</p> Signup and view all the answers

    The _______ nervous system is one of the main vasoconstrictors involved in hypertension.

    <p>sympathetic</p> Signup and view all the answers

    Match the following risk factors with their corresponding categories:

    <p>Obesity = Risk Factor Vasoconstrictor = High sodium diet Stress = Risk Factor Adiponectin = Vasodilator</p> Signup and view all the answers

    Which of the following is NOT a genetic cause of hypertension?

    <p>Primary Hyperaldosteronism</p> Signup and view all the answers

    Resistant hypertension is defined as uncontrolled hypertension despite treatment with three medications, including diuretics.

    <p>True</p> Signup and view all the answers

    What is the initial investigation to assess hypertension suspected to be caused by renal artery issues?

    <p>USG with Renal artery doppler</p> Signup and view all the answers

    One of the conditions included in the triad for Primary Hyperaldosteronism is __________.

    <p>Hypokalemia</p> Signup and view all the answers

    Match the following blood pressure readings with their corresponding actions:

    <p>≥ 130/80 mm Hg = Start medication for coronary artery disease ≥ 140/90 mm Hg = Start monotherapy ≥ 150/95 mm Hg = Consider treatment after lifestyle changes Uncontrolled HTN with 3 drugs = Diagnose resistant HTN</p> Signup and view all the answers

    Which signals are crucial for the formation of the hepatocytes and cholangiocytes?

    <p>BMP 7 and FGF</p> Signup and view all the answers

    Hepatoblasts are unipotent cells that only develop into hepatocytes.

    <p>False</p> Signup and view all the answers

    What do hepatoblasts secrete during liver development?

    <p>AFP (α-fetoprotein)</p> Signup and view all the answers

    The defect in the Jagged 1/NOTCH2 pathway is associated with __________ syndrome.

    <p>Alagille</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Hepatocyte = Secretes AFP Cholangiocyte = Bile duct epithelial cell BMP 7 = Signals for liver formation Alagille syndrome = Defect in Jagged 1/NOTCH2 pathway</p> Signup and view all the answers

    Which of the following drugs is an example of a Calcium Channel Blocker?

    <p>Benidipine</p> Signup and view all the answers

    ACE Inhibitors and ARBs can both be used as front-line drugs for hypertension treatment.

    <p>True</p> Signup and view all the answers

    What is the recommended initial therapy for hypertension according to ESH?

    <p>ACE inhibitors and Calcium channel blockers</p> Signup and view all the answers

    If there is no response to the initial therapy, the next step is to add _____ for better treatment effectiveness.

    <p>Thiazide-like Diuretics</p> Signup and view all the answers

    Match the following hypertension treatments with their specifics:

    <p>C = Example: Benidipine 4 mg D = Example: Hydrochlorthiazide A = Example: Ramipril 2.5 mg β = Used in specific cases such as heart failure</p> Signup and view all the answers

    Which of the following is the main factor responsible for hypertension?

    <p>Vascular Remodeling</p> Signup and view all the answers

    Smoking is considered a risk factor for hypertension.

    <p>True</p> Signup and view all the answers

    What is the major risk association of hypertension that relates to stroke?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    A sustained rise in ________ alone will not produce sustained hypertension.

    <p>cardiac output</p> Signup and view all the answers

    Match the risk factors with their associated conditions:

    <p>Stroke = Major risk with hypertension Cardiovascular disease = Heart-related conditions influenced by hypertension Hyperlipidemia = High cholesterol levels increasing heart disease risk Diabetes = Metabolic disorder contributing to hypertension</p> Signup and view all the answers

    What embryological layer gives rise to the liver?

    <p>Endoderm</p> Signup and view all the answers

    The hepatic artery supplies 70% of the blood to the liver lobules.

    <p>False</p> Signup and view all the answers

    What is the term for the structural and functional unit of the liver?

    <p>Lobule</p> Signup and view all the answers

    Liver cirrhosis involves the replacement of liver lobules with ________ connected by fibrous septae.

    <p>nodules</p> Signup and view all the answers

    Match the following liver structures with their respective features:

    <p>Kupffer cells = Resident macrophages in the liver Hepatocytes = Main functional cells of the liver Glisson's capsule = Fibrous layer surrounding the liver Stellate (Ito) cells = Vitamin A storage and fibrosis regulation</p> Signup and view all the answers

    What ECG change is associated with serum potassium levels of 7-8 mmol/L?

    <p>Flattened P-wave and prolonged PR interval</p> Signup and view all the answers

    Calcium gluconate can change the resting membrane potential of the myocardium.

    <p>False</p> Signup and view all the answers

    What is the mechanism of action of insulin in treating potassium imbalance?

    <p>Cellular shift of potassium</p> Signup and view all the answers

    At serum potassium levels greater than ______ mmol/L, a sine wave pattern is observed in the ECG.

    <p>9</p> Signup and view all the answers

    Match the treatment with its mechanism of action:

    <p>Calcium Gluconate = Raises action potential threshold Insulin Dextrose = Cellular shift of potassium Albuterol = Bronchodilation Dialysis = Removes excess potassium from the body</p> Signup and view all the answers

    What is considered the cutoff value for diagnosing hypertension in terms of systolic blood pressure (SBP)?

    <p>140 mmHg</p> Signup and view all the answers

    Ambulatory blood pressure monitoring can provide mean blood pressure readings for both daytime and nighttime.

    <p>True</p> Signup and view all the answers

    What procedure should be followed for measuring office blood pressure?

    <p>The patient should sit comfortably for 3-5 minutes, and three consecutive readings should be taken with 1-minute intervals.</p> Signup and view all the answers

    Secondary hypertension may result from conditions such as _______ and obstructive sleep apnea syndrome.

    <p>kidney disease</p> Signup and view all the answers

    Match the following causes of secondary hypertension with their descriptions:

    <p>Renal disease = Kidney issues leading to high blood pressure Coarctation of the aorta = Narrowing of the aorta Obstructive Sleep Apnea Syndrome = Sleep disorder causing elevated blood pressure Takayasu arteritis = A type of vascular inflammation</p> Signup and view all the answers

    Which of the following statements about office blood pressure measurement is true?

    <p>Three consecutive readings should be documented at one-minute intervals.</p> Signup and view all the answers

    Calculating the mean of three blood pressure readings is sufficient to confirm a diagnosis of hypertension.

    <p>False</p> Signup and view all the answers

    List two underlying conditions that can cause secondary hypertension.

    <p>Kidney disease and coarctation of the aorta.</p> Signup and view all the answers

    What structure plays a crucial role in dividing the liver into left and right sections?

    <p>Falciform ligament</p> Signup and view all the answers

    The Vitelline veins are only connected to the hepatic artery.

    <p>False</p> Signup and view all the answers

    Name the three zones of the liver.

    <p>Zone 1, Zone 2, Zone 3</p> Signup and view all the answers

    The __________ line is an imaginary line that divides the liver into left and right regions.

    <p>Cantlie's</p> Signup and view all the answers

    Match the following veins with their connections:

    <p>Superior Vitelline vein = Common hepatic vein Inferior Vitelline vein = Inferior portal vein</p> Signup and view all the answers

    Which position in the liver is associated with the central part of the acinus?

    <p>Centrilobular</p> Signup and view all the answers

    Ischemic hepatitis is a condition related to the portal vein.

    <p>False</p> Signup and view all the answers

    Which disease is associated with paracetamol poisoning?

    <p>Liver damage or hepatotoxicity</p> Signup and view all the answers

    Study Notes

    Management of Hypertension - 2023 Guidelines

    • Hypertension is a major public health concern, and its management is focused on treating the underlying cause and controlling blood pressure.
    • Endocrine causes of hypertension include genetic and acquired conditions.
    • Genetic causes include monogenic forms of endocrine hypertension or low renin hypertension, such as Liddle Syndrome, Apparent Mineralocorticosteroid Excess, and Glucocorticoid Remediable Hyperaldosteronism.
    • Acquired causes include Primary Hyperaldosteronism, a triad of high blood pressure, metabolic alkalosis, and hypokalemia.
    • Secondary hypertension should be ruled out before diagnosing primary hypertension, especially when the patient is diagnosed with hypertension before 40 years old or has resistant hypertension, which is uncontrolled hypertension with 3 drugs including diuretics, or when the patient has hypertension with target organ damage.

    Investigation & Treatment

    • Investigate hypertension through a series of tests, including ultrasound with renal artery doppler, urine albumin and creatinine analysis, renal function tests, serum electrolytes (Na, K, Ca, P), 24-hour urine fractionated metanephrines, thyroid function tests, parathyroid hormone levels, and left ventricular hypertrophy assessment.
    • Treatment depends on blood pressure levels and the presence of complications. Generally, start with single drug therapy and lifestyle changes.
    • Target blood pressure varies based on conditions.
    • Medications including ACE inhibitors, ARBs, calcium channel blockers, thiazide/thiazide-like diuretics, and beta-blockers are used to control blood pressure.
    • Beta-blockers are preferred for specific cases like coronary artery disease, atrial fibrillation, and heart failure with reduced ejection fraction.
    • European Society of Hypertension (ESH) recommends starting therapy with ACE inhibitors and calcium channel blockers, followed by incorporating thiazide-like diuretics if the blood pressure is not controlled.
    • Resistant hypertension requires further investigation to rule out secondary causes and then specific medications based on kidney function, such as spironolactone (eGFR > 30) or chlorthalidone (eGFR ≤ 30).

    Types of Hypertension

    • Primary hypertension is the most common type, accounting for 90-95% of cases.
    • Secondary hypertension accounts for 5-10% of cases and is caused by underlying medical conditions.
    • Risk factors:
      • Heritability: The most important factor for primary hypertension.
      • Obesity and weight gain: The most important risk factor for primary hypertension.
      • Diet: High intake of sodium, low calcium, low phosphate, and low magnesium.
      • Lifestyle factors: Smoking, alcohol, physical inactivity, stress, and genes like Alpha adducin gene.
      • Family history: Both parents with hypertension increases the risk to 30-40%, while a single parent with hypertension increases the risk to 25%.

    Pathophysiology

    • Vasoconstrictors:
      • Angiotensin II
      • Endothelin
      • Sympathetic nervous system
      • Arginine vasopressin
      • Reactive oxygen species
    • Vasodilators (Protective factors):
      • Nitric oxide
      • Atrial natriuretic peptide
      • Brain natriuretic peptide
      • Adrenomedullin
      • Prostacyclin
      • Adiponectin

    Important Note:

    • Beta-blockers mainly reduce cardiac output, making them less preferred as first-line drugs.

    Ambulatory Blood Pressure Monitoring (ABPM)

    • ABPM measures blood pressure over a 24-hour period, capturing diurnal variation and providing a more comprehensive picture of blood pressure fluctuations.
    • Measurements are taken during daytime (awake), nighttime (asleep), and calculated to determine the 24-hour mean blood pressure.
    • Home blood pressure monitoring can also be used to assess blood pressure readings in a familiar environment.
    • Cutoff values for diagnosing hypertension using ABPM are provided in the document.

    Secondary Hypertension

    • Carefully evaluate for underlying conditions that might be causing secondary hypertension, including renal and cardiac causes.
    • Potential conditions include:
      • Kidney disease
      • Coarctation of the aorta
      • Obstructive Sleep Apnea Syndrome (OSAS)
      • Thrombotic Microangiopathy
      • Chronic Glomerulonephritis (IgA/MPGN)
      • Reno-vascular causes like Takayasu arteritis, Fibromuscular dysplasia, and Atherosclerosis.

    ECG Changes and Treatment for Potassium Imbalance

    • Potassium imbalance can cause significant ECG changes, affecting the QRS complex, P wave, and T wave.
    • Approximate serum potassium levels correlate with specific ECG changes.
    • Acute Treatment (for emergency situations):
      • 10% Calcium Gluconate: Provides immediate stabilization of the myocardium by raising the action potential threshold.
      • Insulin Dextrose: Shifts Potassium into cells.
      • Albuterol: A beta-agonist that can shift potassium into cells.

    Definitive Treatment

    • For chronic potassium imbalance, definitive treatment may include dialysis for patients with Chronic Kidney Disease (CKD).

    Hepatology

    • The liver is a complex organ with distinct zones and blood vessel networks.

    Vitelline Veins

    • The vitelline veins, derived from the yolk sac, are crucial for embryonic liver development.
    • They divide into superior and inferior sections, contributing to the formation of the common hepatic vein and inferior portal vein.
    • Falciform ligament: Separates the liver lobes anteriorly, dividing the liver into left and right anatomical regions.
    • Cantlie's line: An imaginary line dividing the liver into left and right regions.

    Liver Histology

    • Microscopic images depict the histological structure of the liver, including hepatic acini.
    • The document also mentions specific diseases related to the liver's structure, including ischemic hepatitis and paracetamol poisoning.

    Basics of Development & Anatomy of Liver

    • The liver develops from endodermal and mesodermal origins.
    • The liver is a vital organ with diverse functions.
    • Lobule: The basic functional and structural unit of the liver.
    • The lobule's periphery contains the portal tract with a mixture of blood supply from the hepatic artery and the bile duct.
    • The lobule's centre is where the hepatic vein is located, which is not covered by Glisson's capsule.
    • The liver lobule is surrounded by Glisson's capsule, which is made up of connective tissue, stellate (Ito) cells, Kupffer cells, and sinusoids.
    • Pathology: Cirrhosis is characterized by the replacement of liver lobules with nodules connected by fibrous septae.
    • Fetal cardiac defects are associated with liver development issues.
    • Hepatocytes and cholangiocytes contribute to liver function.
    • The septum transversum, a mesodermal structure, forms connective tissue in the liver.

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    Description

    This quiz covers the latest guidelines for the management of hypertension, focusing on both endocrine and genetic causes. It includes details on investigation techniques, treatment options, and important considerations for diagnosing primary versus secondary hypertension. Test your knowledge on this critical public health issue and its management strategies.

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