Ophthalmology 1.10 – Harry has severe hypertension

by | Jan 21, 2018

Harry is a 61-year-old man who comes in for a mild URTI and is incidentally noted to have a blood pressure of 178/120 mm Hg on examination for this. You have no further history on this gent as he is new to the practice. You perform fundoscopy in context of cardiovascular examination after measuring this BP with image as below:

Describe the Features seen on this fundoscopic picture (5)

  1. Generalized arteriolar narrowing
  2. Focal arteriolar narrowing
  3. Arteriolar wall opacification,
  4. Arteriovenous nipping
  5. Flame-shaped hemorrhages
  6. Blot-shaped hemorrhages
  7. Cotton-wool spots
  8. Hard exudates
  9. Microaneurysms
  10. Optic disc swelling (papilledema)

 

What are your differentials for this presentation? (2)

  1. Hypertensive retinopathy
  2. Diabetic retinopathy
  3. HIV retinopathy
  4. Optic neuritis

You check his medical record and find he has no other past medical history of note.

What is the most likely diagnosis? (1)

  1.  Hypertensive retinopathy

What are the possible key features of history in this condition? (3)

  1. Usually asymptomatic
  2. History of hypertension
  3. History of poor diabetic control
  4. History of HIV

What are the key features of management of this presentation?

  1. Treat hypertension
  2. Attend to lifestyle changes
  3. Referral to ophthalmologist

What are the key features of fundoscopic examination in the mild form of this condition?

  1. Generalized arteriolar narrowing
  2. Focal arteriolar narrowing
  3. Arteriolar wall opacification
  4. Arteriovenous nipping 

 What are the key features of fundoscopic examination in the moderate form of this condition?

  1. Generalized arteriolar narrowing
  2. Focal arteriolar narrowing
  3. Arteriolar wall opacification,
  4. Arteriovenous nipping
  5. Flame-shaped hemorrhages
  6. Blot-shaped hemorrhages
  7. Cotton-wool spots
  8. Hard exudates
  9. Microaneurysms

What are the key features of fundoscopic examination in the severe form of this condition?

  1. Generalized arteriolar narrowing
  2. Focal arteriolar narrowing
  3. Arteriolar wall opacification,
  4. Arteriovenous nipping
  5. Flame-shaped hemorrhages
  6. Blot-shaped hemorrhages
  7. Cotton-wool spots
  8. Hard exudates
  9. Microaneurysms
  10. Optic disc swelling (papilledema)
  11. Retinal detachment

References

  1. patient.info
  2. Murtaghs
  3. Colour Atlas of Family Medicine
  4. Dynamed