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Questions and Answers
Which of the following treatments can be used for resistant hypertension?
Which of the following treatments can be used for resistant hypertension?
Chlorthalidone is used as a first-line treatment for all patients with Chronic Kidney Disease (CKD).
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?
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 _______.
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 _______.
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Match the following treatments with their associated conditions:
Match the following treatments with their associated conditions:
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Which of the following is the most important risk factor for primary hypertension?
Which of the following is the most important risk factor for primary hypertension?
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Secondary hypertension accounts for 30-40% of all hypertension cases.
Secondary hypertension accounts for 30-40% of all hypertension cases.
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Name two vasodilators that serve as protective factors against hypertension.
Name two vasodilators that serve as protective factors against hypertension.
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The _______ nervous system is one of the main vasoconstrictors involved in hypertension.
The _______ nervous system is one of the main vasoconstrictors involved in hypertension.
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Match the following risk factors with their corresponding categories:
Match the following risk factors with their corresponding categories:
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Which of the following is NOT a genetic cause of hypertension?
Which of the following is NOT a genetic cause of hypertension?
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Resistant hypertension is defined as uncontrolled hypertension despite treatment with three medications, including diuretics.
Resistant hypertension is defined as uncontrolled hypertension despite treatment with three medications, including diuretics.
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What is the initial investigation to assess hypertension suspected to be caused by renal artery issues?
What is the initial investigation to assess hypertension suspected to be caused by renal artery issues?
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One of the conditions included in the triad for Primary Hyperaldosteronism is __________.
One of the conditions included in the triad for Primary Hyperaldosteronism is __________.
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Match the following blood pressure readings with their corresponding actions:
Match the following blood pressure readings with their corresponding actions:
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Which signals are crucial for the formation of the hepatocytes and cholangiocytes?
Which signals are crucial for the formation of the hepatocytes and cholangiocytes?
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Hepatoblasts are unipotent cells that only develop into hepatocytes.
Hepatoblasts are unipotent cells that only develop into hepatocytes.
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What do hepatoblasts secrete during liver development?
What do hepatoblasts secrete during liver development?
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The defect in the Jagged 1/NOTCH2 pathway is associated with __________ syndrome.
The defect in the Jagged 1/NOTCH2 pathway is associated with __________ syndrome.
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Match the following terms with their descriptions:
Match the following terms with their descriptions:
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Which of the following drugs is an example of a Calcium Channel Blocker?
Which of the following drugs is an example of a Calcium Channel Blocker?
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ACE Inhibitors and ARBs can both be used as front-line drugs for hypertension treatment.
ACE Inhibitors and ARBs can both be used as front-line drugs for hypertension treatment.
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What is the recommended initial therapy for hypertension according to ESH?
What is the recommended initial therapy for hypertension according to ESH?
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If there is no response to the initial therapy, the next step is to add _____ for better treatment effectiveness.
If there is no response to the initial therapy, the next step is to add _____ for better treatment effectiveness.
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Match the following hypertension treatments with their specifics:
Match the following hypertension treatments with their specifics:
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Which of the following is the main factor responsible for hypertension?
Which of the following is the main factor responsible for hypertension?
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Smoking is considered a risk factor for hypertension.
Smoking is considered a risk factor for hypertension.
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What is the major risk association of hypertension that relates to stroke?
What is the major risk association of hypertension that relates to stroke?
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A sustained rise in ________ alone will not produce sustained hypertension.
A sustained rise in ________ alone will not produce sustained hypertension.
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Match the risk factors with their associated conditions:
Match the risk factors with their associated conditions:
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What embryological layer gives rise to the liver?
What embryological layer gives rise to the liver?
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The hepatic artery supplies 70% of the blood to the liver lobules.
The hepatic artery supplies 70% of the blood to the liver lobules.
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What is the term for the structural and functional unit of the liver?
What is the term for the structural and functional unit of the liver?
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Liver cirrhosis involves the replacement of liver lobules with ________ connected by fibrous septae.
Liver cirrhosis involves the replacement of liver lobules with ________ connected by fibrous septae.
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Match the following liver structures with their respective features:
Match the following liver structures with their respective features:
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What ECG change is associated with serum potassium levels of 7-8 mmol/L?
What ECG change is associated with serum potassium levels of 7-8 mmol/L?
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Calcium gluconate can change the resting membrane potential of the myocardium.
Calcium gluconate can change the resting membrane potential of the myocardium.
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What is the mechanism of action of insulin in treating potassium imbalance?
What is the mechanism of action of insulin in treating potassium imbalance?
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At serum potassium levels greater than ______ mmol/L, a sine wave pattern is observed in the ECG.
At serum potassium levels greater than ______ mmol/L, a sine wave pattern is observed in the ECG.
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Match the treatment with its mechanism of action:
Match the treatment with its mechanism of action:
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What is considered the cutoff value for diagnosing hypertension in terms of systolic blood pressure (SBP)?
What is considered the cutoff value for diagnosing hypertension in terms of systolic blood pressure (SBP)?
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Ambulatory blood pressure monitoring can provide mean blood pressure readings for both daytime and nighttime.
Ambulatory blood pressure monitoring can provide mean blood pressure readings for both daytime and nighttime.
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What procedure should be followed for measuring office blood pressure?
What procedure should be followed for measuring office blood pressure?
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Secondary hypertension may result from conditions such as _______ and obstructive sleep apnea syndrome.
Secondary hypertension may result from conditions such as _______ and obstructive sleep apnea syndrome.
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Match the following causes of secondary hypertension with their descriptions:
Match the following causes of secondary hypertension with their descriptions:
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Which of the following statements about office blood pressure measurement is true?
Which of the following statements about office blood pressure measurement is true?
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Calculating the mean of three blood pressure readings is sufficient to confirm a diagnosis of hypertension.
Calculating the mean of three blood pressure readings is sufficient to confirm a diagnosis of hypertension.
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List two underlying conditions that can cause secondary hypertension.
List two underlying conditions that can cause secondary hypertension.
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What structure plays a crucial role in dividing the liver into left and right sections?
What structure plays a crucial role in dividing the liver into left and right sections?
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The Vitelline veins are only connected to the hepatic artery.
The Vitelline veins are only connected to the hepatic artery.
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Name the three zones of the liver.
Name the three zones of the liver.
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The __________ line is an imaginary line that divides the liver into left and right regions.
The __________ line is an imaginary line that divides the liver into left and right regions.
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Match the following veins with their connections:
Match the following veins with their connections:
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Which position in the liver is associated with the central part of the acinus?
Which position in the liver is associated with the central part of the acinus?
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Ischemic hepatitis is a condition related to the portal vein.
Ischemic hepatitis is a condition related to the portal vein.
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Which disease is associated with paracetamol poisoning?
Which disease is associated with paracetamol poisoning?
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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.
