🤔 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.
A
Anterior cervical palpation
B
Electrocardiography trace
C
Fundoscopic examination
D
Repeat clinical blood pressure
E
Urine dipstick reading
Question 2

Stem 2 of 5

Which of the following is a modifiable risk factor for hypertension? Select all that apply.
A
Age
B
High salt intake
C
Obesity
D
Sedentary lifestyle
E
Type 1 diabetes
Question 3

Stem 3 of 5

What is the most likely diagnosis in this patient?
A
Hypertensive crisis
B
Secondary hypertension
C
Stage 1 hypertension
D
Stage 2 hypertension
E
Stage 3 hypertension
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.
A
Type two diabetes
B
Urinary tract infection
C
Nephrotic syndrome
D
Dehydration
E
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?
A
Furosemide
B
Nifedipine
C
Ramipril
D
Spironolactone
E
Tamsulosin
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?
A
Adrenal medulla
B
Chromaffin cells
C
Zona fasciculata
D
Zona glomerulosa
E
Zona reticularis
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
A shaking, cold-sensation despite a warm environment
B
Dry mouth and increased drinking intake
C
Excessive growth of hair in the mental area
D
Feeling of “fluttering, pounding” heart
E
Pain in the ophthalmic and maxillary nerve region
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.
A
Fine tremor of the hands
B
Measuring the size of any mass
C
Observing the patient’s swallow
D
Percussion of the manubrium
E
Superoinferior proptosis examination
Question 9

Stem 4 of 5

Given the patient's diagnosis, which of the following investigation results best fit this clinical picture?
A
Low renin
B
Elevated pH
C
Hypokalaemia
D
Hypermagnesemia
E
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?
A
Acetazolamide
B
Amiodarone
C
Bendroflumethiazide
D
Eplerenone
E
Furosemide
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