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WorksheetsChapter 46: Primary and Secondary HTN — Multiple Choice
Total questions: 10
Worksheet time: 5mins
Which of the following statements is TRUE?
AT2R is associated with endothelial cell dysfunction and produces extensive profibrotic and proinflammatory changes.
In the hypertensive environment, it is the presence of renal AT1R that mediates hypertension and organ injury.
Stimulation of the Ang II type 1 receptor (AT1R) is associated with vasodilation, natriuresis, and antiproliferative effects.
Angiotensin II produces increased sodium reabsorption in the proximal tubule by decreasing the activity of NHE3, the sodium-bicarbonate exchanger, and Na+-K+-ATPase
EB, a 33-year old hypertensive male, visited the clinic for a regular consult because his BP readings at home were high (140-160/90-100). However, at the clinic, BP recorded was 100-110/70-80. What kind of hypertension does the patient have?
White coat hypertension
Isolated Office Hypertension
Masked Hypertension
Blue coat hypertension
NSAIDs are known to cause elevations in BP by inhibiting the production of vasodilatory prostaglandins and may increase BP by as much as __ mmHg.
4
6
8
10
The most representative BP among patients undergoing dialysis is the one taken:
Afternoon after dialysis
Morning after dialysis
Morning before dialysis
During dialysis
KC, a 29-year old male, was brought to the emergency due to persistent occipital headache, associated with generalized body weakness and inability to ambulate. Patient was alert, with BP 180/100 mmHg, HR 101 bpm, RR 21 cpm, and temp of 37.2C. Pertinent physical examination revealed muscle strength of 3/5 on all extremities. Upon work-up, creatinine was 1.2 mg/dl, serum sodium was 145 mEq/L, serum potassium was 2.7 mEq/l, plasma aldosterone concentration was 17.3 ng/dL, and plasma renin activity was 0.5 ng/ml/h, with an Aldosterone Renin ratio of 34.4. What is the next best step in the diagnosis of the most likely secondary cause of this patient’s hypertension according to the Clinical Practice Guidelines from the Endocrine Society?
Patient’s aldosterone concentration is considered indeterminate and should be retested.
Get CT scan of the adrenals.
Proceed with a confirmatory test, such as the captopril challenge test.
Proceed with adrenal venous sampling.
NV, a 21-year old female, was admitted due to complaints of paroxysmal attacks of palpitation, dizziness, blurring of vision and headache for the last 6 months. Each attack persists for few minutes to half an hour occurring irregularly once within 2-3 days to 2-3 times a day. Patient has unremarkable physical examination findings except for the high blood pressure during paroxysmal attack, with range of 150-210/100-140. You are suspecting a catecholamine-secreting tumor. Which of the diagnostic tests is usually recommended as screening test?
Dexamethasone suppression test
Glucagon Stimulation testing
Clonidine suppression test
Plasma free or urinary fractionated metanephrines
What is the most common cut-off value for Aldosterone Renin Ratio that usually leads to further investigation, or is considered positive?
20
30
40
50
The drug of choice for hypertensive encephalopathy:
Nitroprusside
Nimodipine
Clonidine
Beta blocker
Obesity Related Hypertension is characterized primarily by:
Impaired sodium excretion and endothelial dysfunction
Decreased levels of leptin, resistin and increased level of Free fatty acids
Increased levels of adiponectin resulting to insulin resistance
All of the above
A 38-year old known hypertensive female was rushed to the emergency room because of severe chest pain with a BP 180/100. Aortic Dissection is highly considered. What is the emergency management in this patient?
BP should be lowered gradually to MAP within the next 4 hours
BP should be lowered within 20 minutes to systolic BP below 120mmHg
Drug of choice is Beta Blocker plus centrally acting agents
Ischemic Stroke should be ruled out first prior to aggressive BP control
