Q1. Using a blood pressure cuff that is TOO SMALL for the patient's arm will: A. Read falsely LOW B. Read falsely HIGH C. Have no effect on the reading D. Only affect diastolic pressure ANSWER: B — falsely high. Why: an undersized cuff requires more pressure to occlude the artery. It is a common avoidable error that systematically over-diagnoses hypertension in larger patients. LEARNING POINT: never diagnose hypertension on a single or poorly taken reading.

Q2. The greatest harm prevented by treating hypertension is: A. STROKE B. Peptic ulceration C. Cataract D. Osteoporosis ANSWER: A — stroke. Why: hypertension is the leading modifiable risk factor for stroke, and blood pressure lowering reduces stroke risk very reliably. It also reduces heart failure, ischaemic heart disease and kidney disease. LEARNING POINT: the benefit is a reduced future risk, not a symptom relieved today.

Q3. A 28-year-old has severe hypertension resistant to three drugs, with persistently LOW potassium and no diuretic use. The best next step is: A. Add a fourth antihypertensive B. INVESTIGATE FOR A SECONDARY CAUSE C. Reassure and review in a year D. Advise salt restriction only ANSWER: B. Why: young age, severity, resistance to treatment and unexplained hypokalaemia each suggest a secondary cause; together they make one likely. Hypokalaemia in particular raises aldosterone excess. LEARNING POINT: also review NSAIDs, steroids, contraceptives and alcohol.

Q4. A patient has a very high blood pressure but feels well, with normal fundi, clear chest and normal renal function. Management should be: A. Rapid intravenous reduction to normal B. ORAL treatment with reduction over DAYS and close follow-up C. No treatment D. Immediate admission to intensive care ANSWER: B. Why: without acute end-organ damage this is a hypertensive URGENCY. Rapid reduction in a chronically hypertensive patient risks cerebral and renal ischaemia because autoregulation is set at a higher range. LEARNING POINT: the emergency/urgency distinction rests on organ damage, not on the height of the number.

Q5. A man stopped his antihypertensive because he "felt no different". The most useful response is: A. Warn him to be more careful in future B. EXPLAIN that treatment prevents future stroke rather than relieving symptoms, and address barriers C. Change to a stronger drug D. Discharge him from follow-up ANSWER: B. Why: his reasoning is logical given what he understood. Hypertension causes no symptoms, so no treatment can relieve any — the purpose must be stated explicitly, along with attention to side effects and cost. LEARNING POINT: adherence is built through explanation, not warnings.

Q6. Which finding converts a very high blood pressure from an URGENCY into an EMERGENCY? A. A systolic reading above a particular number B. ACUTE END-ORGAN DAMAGE such as encephalopathy or pulmonary oedema C. The patient feeling anxious D. A family history of stroke ANSWER: B. Why: the distinction rests on evidence of acute damage — encephalopathy, papilloedema, pulmonary oedema, aortic dissection or acute kidney injury — not on the height of the reading. LEARNING POINT: even then, reduction is controlled rather than rapid.

Q7. In a hypertensive smoker with diabetes, which single intervention is likely to reduce cardiovascular risk MOST? A. Adding a second antihypertensive B. STOPPING SMOKING C. Reducing dietary fat only D. Vitamin supplementation ANSWER: B — stopping smoking. Why: hypertension is treated as part of TOTAL cardiovascular risk, and smoking cessation frequently delivers a larger risk reduction than any single blood pressure drug. LEARNING POINT: the same blood pressure means different things in different patients.