🤔 MEDIUM
Hypertension is one of the most prevalent conditions to find walking down the street and in a GP clinic. Here are some questions to test your knowledge modelled on the NICE 2020 Guidelines for Hypertension.
Second Author: Katrina Bogus
Reviewed by: awaiting review
Approach to the Patient with Hypertension
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Question 1 |
Stem 1 of 5
At a routine GP appointment, a 65YOF’s blood pressure is measured to be 145/100. She is of Afro-Carribean descent and is sent home with an ambulatory blood pressure monitor. She phones the GP to report an average score, from home, of 140/90.
The patient is brought to the clinic. Select all of the following steps you would conduct in this consultation from the list below.
Anterior cervical palpation
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Electrocardiography trace | |
Fundoscopic examination | |
Repeat clinical blood pressure
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Urine dipstick reading
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Question 2 |
Stem 2 of 5
Which of the following is a modifiable risk factor for hypertension? Select all that apply.Age | |
High salt intake
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Obesity
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Sedentary lifestyle
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Type 1 diabetes
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Question 3 |
Stem 3 of 5
What is the most likely diagnosis in this patient?Hypertensive crisis
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Secondary hypertension
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Stage 1 hypertension
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Stage 2 hypertension
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Stage 3 hypertension
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Question 4 |
Stem 4 of 5
Amongst other tests, an albumin-creatinine ratio (ACR) is ordered. Select all the options that may cause an increased ACR.Type two diabetes
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Urinary tract infection
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Nephrotic syndrome
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Dehydration | |
High intensity exercise |
Question 5 |
Stem 5 of 5
The patient is placed on a tablet at the end of the consultation. Which is the most likely choice?Furosemide
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Nifedipine | |
Ramipril | |
Spironolactone
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Tamsulosin
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Question 6 |
Stem 1 of 5
A 45YOF with paraesthesia and fluctuating mood is referred to endocrinology for further assessment. Ambulatory blood pressure monitoring averages 165/115 and sodium is 165 mmol/L. A CT scan reveals a mass present above the kidney.
From which part of the suprarenal glands is cortisol released?
Adrenal medulla
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Chromaffin cells
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Zona fasciculata
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Zona glomerulosa
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Zona reticularis
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Question 7 |
Stem 2 of 5
A diagnosis of primary aldosteronism is made. Which of the following history findings would most likely support the conclusion?A shaking, cold-sensation despite a warm environment
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Polyuria or nocturia | |
Excessive growth of hair in the mental area
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Feeling of “fluttering, pounding” heart
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Pain in the ophthalmic and maxillary nerve region
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Question 8 |
Stem 3 of 5
During assessment, the physician examines the thyroid. Which of the following would be undertaken in this consultation? Select all that may apply.Fine tremor of the hands
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Measuring the size of any mass
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Observing the patient’s swallow
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Percussion of the manubrium
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Superoinferior proptosis examination
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Question 9 |
Stem 4 of 5
Given the patient's diagnosis, which of the following investigation results best fit this clinical picture?Low renin | |
Elevated pH | |
Hypokalaemia | |
Hypermagnesemia | |
Hypernatraemia |
Question 9 Explanation:
Primary hyperaldosteronism is associated with higher BP, aldosterone pH and low renin, potassium and magnesium with variably raised/normal sodium levels. It is important to differentiate this condition from renal artery stenosis which would see elevated renin additionally.
Question 10 |
Stem 5 of 5
Spironolactone is administered as a bridge to surgery. However the patient quickly states soreness of the breast tissue when wearing a bra. Which of the following is the most appropriate management change?Acetazolamide | |
Amiodarone
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Bendroflumethiazide
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Eplerenone
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Furosemide
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There are 10 questions to complete.
