Systemic Hypertension Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Systemic Hypertension. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Systemic Hypertension Indian Medical PG Question 1: Which of the following is not a measure of primary prevention of hypertension?
- A. Exercise promotion
- B. Reduction of salt intake
- C. Weight reduction
- D. Early diagnosis of hypertension (Correct Answer)
Systemic Hypertension Explanation: ***Early diagnosis of hypertension***
- **Early diagnosis** is a measure of **secondary prevention**, aiming to detect and manage a condition that has already developed but is not yet symptomatic or severe.
- **Primary prevention** aims to prevent the disease from occurring in the first place, whereas secondary prevention seeks to halt its progression.
*Weight reduction*
- **Weight reduction** is a key lifestyle modification that can prevent the development of **hypertension**, especially in individuals with overweight or obesity.
- Maintaining a **healthy weight** reduces the strain on the cardiovascular system and can normalize blood pressure.
*Exercise promotion*
- Promoting **regular physical activity** helps to improve cardiovascular health, maintain a healthy weight, and **lower blood pressure**, thereby preventing hypertension.
- **Aerobic exercise** strengthens the heart and makes blood vessels more elastic, reducing the risk of developing high blood pressure.
*Reduction of salt intake*
- **Reducing dietary salt intake** is a well-established strategy to prevent hypertension, as excessive sodium contributes to fluid retention and increased blood pressure.
- Limiting **sodium** in the diet can significantly lower the risk of developing hypertension, particularly in salt-sensitive individuals.
Systemic Hypertension Indian Medical PG Question 2: Which of the following is caused by congenital 17 hydroxylase deficiency:
- A. Hypertension (Correct Answer)
- B. Virilism
- C. Hyperkalemia
- D. Hermaphroditism
Systemic Hypertension Explanation: ***Hypertension***
- **Congenital 17-hydroxylase deficiency** leads to impaired synthesis of **cortisol** and **sex steroids**, resulting in an accumulation of **mineralocorticoid precursors (corticosterone and deoxycorticosterone)** [1].
- Increased levels of these mineralocorticoids cause **sodium and water retention**, leading to **hypertension** and **hypokalemia**.
*Virilism*
- **17-hydroxylase deficiency** impairs **androgen synthesis**, preventing the development of male secondary sexual characteristics [2].
- Individuals with this deficiency often present with **female external genitalia** regardless of their genetic sex, or **under-virilization** in genetic males, not virilism [2].
*Hyperkalemia*
- The excess mineralocorticoids (deoxycorticosterone) in **17-hydroxylase deficiency** promote **sodium reabsorption** and **potassium excretion** in the kidneys [1].
- This leads to **hypokalemia**, which is the opposite of hyperkalemia.
*Hermaphroditism*
- **17-hydroxylase deficiency** affects the development of gonads and internal reproductive organs depending on genetic sex.
- Genetic males (**XY**) with this deficiency typically develop **female external genitalia** (pseudohermaphroditism or 46, XY DSD), while genetic females (**XX**) typically present as normal females but with **primary amenorrhea** [2]. This genetic condition does not result in true hermaphroditism (presence of both ovarian and testicular tissue) [2].
Systemic Hypertension Indian Medical PG Question 3: A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?
- A. Intravenous salbutamol
- B. Nebulization with salbutamol
- C. Oxygen and antibiotics
- D. Intravenous nitroglycerin (Correct Answer)
Systemic Hypertension Explanation: ***Intravenous nitroglycerin***
- The chest X-ray shows diffuse bilateral infiltrates and **cardiomegaly**, consistent with **pulmonary edema** due to **acute decompensated heart failure** in a hypertensive patient.
- **Intravenous nitroglycerin** is crucial for patients with acute cardiogenic pulmonary edema, as it **reduces preload and afterload**, thereby decreasing pulmonary congestion and improving breathlessness.
*Intravenous salbutamol*
- **Salbutamol** is a **bronchodilator** used for bronchospasm in conditions like asthma or COPD.
- It would not address the underlying pathology of **pulmonary edema** and could potentially worsen the condition by causing **tachycardia** and increasing myocardial oxygen demand.
*Nebulization with salbutamol*
- Similar to intravenous salbutamol, nebulized salbutamol is used for **bronchospasm** and is ineffective in treating **cardiogenic pulmonary edema**.
- There is no indication of airway constriction, and its systemic effects could paradoxically **exacerbate heart failure**.
*Oxygen and antibiotics*
- While **oxygen** is always indicated for hypoxemia, it alone is insufficient to manage severe **pulmonary edema**.
- **Antibiotics** are used to treat bacterial infections, but there are no signs of infection (e.g., fever, purulent sputum) to suggest **pneumonia** as the primary cause of breathlessness; the X-ray findings are more typical of edema.
Systemic Hypertension Indian Medical PG Question 4: Most common cause of persistent hypertension in a child with intrinsic renal disease is -
- A. CGN (Correct Answer)
- B. Obstructive uropathy
- C. Renal tumor
- D. Chronic Pyelonephritis
Systemic Hypertension Explanation: ***CGN***
- **Chronic glomerulonephritis (CGN)** is a leading cause of persistent hypertension in children with intrinsic renal disease due to widespread glomerular damage leading to **renin-angiotensin-aldosterone system** activation and fluid retention.
- The damaged kidneys are unable to filter waste and regulate blood pressure effectively, contributing to sustained hypertension.
*Chronic Pyelonephritis*
- While chronic pyelonephritis can cause hypertension, it is typically due to **scarring and inflammation** affecting renal function.
- However, it is not as common a cause of persistent hypertension as CGN in children with intrinsic renal disease.
*Obstructive uropathy*
- **Obstructive uropathy** is classified as a **post-renal (obstructive) disorder** rather than intrinsic renal disease, though it can lead to secondary renal parenchymal damage.
- It can cause hypertension through renal parenchymal damage and **renin release** due to increased pressure, but it is not a primary intrinsic renal disease.
*Renal tumor*
- **Renal tumors**, such as Wilms' tumor, can cause hypertension through **compression of renal arteries** or increased renin production.
- While a significant cause of hypertension, it is generally less common than CGN as a cause of persistent hypertension in children with *intrinsic renal disease* overall.
Systemic Hypertension Indian Medical PG Question 5: A dense persistent nephrogram may be seen in all of the following except:
- A. Severe hydronephrosis
- B. Acute ureteral obstruction
- C. Systemic hypertension (Correct Answer)
- D. Dehydration
Systemic Hypertension Explanation: ***Systemic hypertension***
- **Systemic hypertension** itself does not directly cause diffuse prolongation of the nephrogram phase unless there's an associated acute kidney injury from a different cause.
- While chronic hypertension can lead to **nephrosclerosis**, which may affect contrast excretion, a persistent, dense nephrogram isn't its typical acute imaging finding.
*Severe hydronephrosis*
- **Severe hydronephrosis**, reflecting chronic or acute obstruction, can lead to impaired glomerular filtration and tubular function, causing delayed and prolonged contrast excretion.
- The contrast remains in the dilated tubules and collecting system for an extended period, resulting in a **dense persistent nephrogram**.
*Acute ureteral obstruction*
- **Acute ureteral obstruction** causes increased collecting system pressure, leading to decreased glomerular filtration rate and impaired tubular flow.
- This results in the contrast medium pooling in the renal tubules and interstitium, leading to a **delayed and persistent nephrogram**.
*Dehydration*
- **Dehydration** can lead to altered renal hemodynamics and concentrated urine, which can prolong the nephrogram phase due to slower contrast clearance.
- Reduced renal blood flow and increased reabsorption of water lead to a more concentrated and thus **denser nephrogram** that persists longer than usual.
Systemic Hypertension Indian Medical PG Question 6: A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:
- A. Renal parenchymal disease
- B. Coarctation of aorta (Correct Answer)
- C. Takayasu arteritis
- D. Grand mal seizures
Systemic Hypertension Explanation: ***Coarctation of aorta***
- The combination of **severe hypertension in the upper extremities** (200/140 mm Hg), **impalpable femoral pulses**, and seizures in a 10-year-old boy is highly suggestive of **aortic coarctation**.
- Aortic coarctation causes a **pressure gradient** across the narrowed aorta, leading to high pressure proximal to the coarctation (upper body) and low pressure distal to it (lower body).
*Renal parenchymal disease*
- While renal parenchymal disease can cause **hypertension**, it typically does not present with **differential blood pressures** between upper and lower extremities or absent femoral pulses.
- The hypertension in renal disease is usually due to **fluid overload** and **renin-angiotensin-aldosterone system activation**.
*Takayasu arteritis*
- Takayasu arteritis is a form of **large vessel vasculitis** that can affect the aorta and its branches, leading to differential pulses and hypertension.
- However, it more commonly affects **young adult women** (typically 10-40 years old) and often presents with systemic symptoms like **fever, malaise**, and **arterial bruits**, which are not mentioned here.
*Grand mal seizures*
- Grand mal seizures are a neurological symptom, not a diagnosis of the underlying cause.
- While **severe hypertension** from any cause can lead to seizures (hypertensive encephalopathy), this option does not explain the specific cardiovascular findings of **differential blood pressure** and **impalpable femoral pulses**.
Systemic Hypertension Indian Medical PG Question 7: An infant presents with LVH and pulmonary complications. ECG shows left axis deviation. The most likely diagnosis is:
- A. Tricuspid atresia (Correct Answer)
- B. TAPVC
- C. VSD
- D. TGA
Systemic Hypertension Explanation: ***Tricuspid atresia***
- **Left ventricular hypertrophy (LVH)** is common because the left ventricle must pump blood to both the systemic and pulmonary circulations through a **ventricular septal defect (VSD)** and/or **patent ductus arteriosus (PDA)**.
- **Left axis deviation** on ECG is characteristic of tricuspid atresia due to the hypoplasia or absence of the right ventricle and the dominance of the left ventricle.
*TAPVC*
- **Total anomalous pulmonary venous connection (TAPVC)** typically presents with right ventricular hypertrophy and right axis deviation on ECG, as the right ventricle handles the entire systemic venous return.
- Pulmonary complications are common, but the cardiac structural changes and ECG findings differentiate it from tricuspid atresia.
*VSD*
- A **ventricular septal defect (VSD)** alone would typically cause **right ventricular hypertrophy** or biventricular hypertrophy depending on the size and shunt direction.
- While a large VSD can cause **pulmonary hypertension** and complications, it usually does not present with isolated LVH and left axis deviation without other associated anomalies.
*TGA*
- **Transposition of the great arteries (TGA)** typically presents with **right ventricular hypertrophy** and right axis deviation on ECG, as the RV functions as the systemic ventricle.
- While cyanosis and pulmonary complications occur, the ECG pattern shows RVH, not LVH with left axis deviation.
Systemic Hypertension Indian Medical PG Question 8: A child presented with headache, dizziness, intermittent claudication with occasional dyspnea. The most probable diagnosis is:
- A. PDA
- B. TOF
- C. Coarctation of aorta (Correct Answer)
- D. ASD
Systemic Hypertension Explanation: ***Coarctation of aorta***
- **Coarctation of the aorta** presents with upper extremity hypertension and lower extremity hypotension.
- This pressure difference typically causes symptoms such as **headache**, **dizziness**, and **intermittent claudication** in the legs.
*PDA*
- A **patent ductus arteriosus (PDA)** typically presents with a continuous murmur and, if large, signs of heart failure or pulmonary hypertension.
- While it can cause dyspnea, **headache, dizziness, and claudication** are not defining symptoms.
*TOF*
- **Tetralogy of Fallot (TOF)** is characterized by cyanosis, exertional dyspnea, and "tet spells."
- It does not typically cause **headaches, dizziness, or claudication** in the absence of severe complications.
*ASD*
- An **atrial septal defect (ASD)** is often asymptomatic until adulthood or presents with mild symptoms like fatigue or dyspnea with exertion.
- It is not associated with **headache, dizziness, or intermittent claudication**.
Systemic Hypertension Indian Medical PG Question 9: A 50-year-old drug abuser presents with fever and weight loss. Exam shows hypeension, nodular skin rash, and peripheral neuropathy. ESR is 100 mm/L, and RBC casts are seen on urinalysis. The most likely condition is:
- A. Drug-induced lupus erythematosus
- B. Reiter syndrome
- C. Polyarteritis nodosa (Correct Answer)
- D. Behcet syndrome
Systemic Hypertension Explanation: ***Polyarteritis nodosa***
- The constellation of **fever**, **weight loss**, **hypertension**, **nodular skin rash**, and **peripheral neuropathy** in a drug abuser, coupled with **elevated ESR** and **RBC casts in urinalysis**, strongly points to Polyarteritis nodosa (PAN) [1].
- PAN is a **systemic necrotizing vasculitis** of small and medium-sized arteries, often associated with **Hepatitis B virus**, which can be seen in drug abusers, and affects multiple organs, including the skin, kidneys (leading to hypertension and RBC casts), and nerves [1].
*Drug-induced lupus erythematosus*
- While drug-induced lupus can cause **fever** and **skin rash**, it typically presents with **arthralgias** and sometimes **serositis**, and often spares the kidneys from severe vasculitic damage like RBC casts.
- The **nodular rash**, **severe hypertension**, and clear evidence of **renal vasculitis (RBC casts)** are less characteristic of drug-induced lupus erythematosus.
*Reiter syndrome*
- Reiter syndrome (now known as **Reactive Arthritis**) is characterized by a triad of **arthritis**, **urethritis**, and **conjunctivitis**, typically following an infection, not generally associated with nodular skin rashes, hypertension, or a severe, systemic vasculitic picture in a drug abuser.
- While some skin lesions (e.g., circinate balanitis, keratoderma blennorrhagica) can occur, they are distinct from **nodular rashes** and the disease profile does not include severe renal involvement or widespread vasculitis.
*Behcet syndrome*
- Behcet syndrome primarily presents with **recurrent oral and genital ulcers**, **uveitis**, and various skin lesions (e.g., erythema nodosum, papulopustular lesions), but typically not a **nodular rash** as described, nor the severe **hypertension** and **vasculitic renal involvement** (RBC casts) seen in this case.
- While it can involve blood vessels, the pattern of systemic manifestations, particularly renal and peripheral nervous system involvement with hypertension, does not fit well with Behcet syndrome.
Systemic Hypertension Indian Medical PG Question 10: Child with PDA will NOT have:
- A. Necrotizing enterocolitis
- B. CO₂ washout
- C. Bounding pulses
- D. Pulmonary hemorrhage
Systemic Hypertension Explanation: This question asks which finding is NOT associated with Patent Ductus Arteriosus (PDA).
*Bounding pulses*
- **Bounding pulses ARE characteristically present in PDA**, not absent
- Result from wide pulse pressure due to diastolic run-off from aorta to pulmonary artery
- This is a classic clinical sign of hemodynamically significant PDA
***Necrotizing enterocolitis - needs verification***
- PDA CAN be associated with NEC in premature infants
- "Steal phenomenon" diverts blood from splanchnic circulation
- However, NEC is multifactorial and not a direct consequence of PDA
***CO₂ washout - needs verification***
- Increased pulmonary blood flow from PDA can affect ventilation
- May contribute to respiratory complications
- The relationship is complex and context-dependent
***Pulmonary hemorrhage - needs verification***
- Large PDA with significant left-to-right shunt increases pulmonary blood flow
- Can lead to pulmonary hemorrhage, especially in preterm infants
- Increased pulmonary vascular pressure and volume cause capillary damage
**Note:** This question has a structural issue - all listed options except bounding pulses (which IS present in PDA) CAN occur with PDA. The question requires review for medical accuracy and clarity.
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