18.8.2013(Edema,cough)

Question 0

Why is lymphedema intractable?

Answer 0

As there is excess protein in interstitial fluid

Question 1

Drugs associated with Edema

Answer 1

NSAID
direct arterial/arteriolar vasodilators
 Hydralzine
 Clonidine
 MethylDOPA
 Guanethidine
 Minoxidil
Calcium channel antagonists
Alpha adrenergic antagonists
Thiazelidenidiones 
Steroid hormones
 Glucocorticoids
 Anabolic steroids
 Estrogens
 Progestins
Cyclosporine
GH
immunotherapies
 IL-2
 OKT3 mAb

Question 2

Edema of heart failure occurs in

Answer 2

Dependent portions of the body

Question 3

Edema in acute glomerulonephritis is associated with

Answer 3

Hematuria
Proteinuria
Hypertension

Question 4

Orthopnea in Edema due to renal failure

Answer 4

Never

Question 5

Nephrotic syndrome

Answer 5

Marked proteinuria> 3.5g/day
Hypoalbuminemia <35g/L
Hypercholesterolemia

Question 6

Cause of pedal Edema in cirrhosis

Answer 6

Increased intraabdominal pressure due to Ascitic fluid impedes venous return

Question 7

Edema of nutritional origin is associated with

Answer 7

Beri beri heart disease

Question 8

Cause of Edema in beri beri

Answer 8

Multiple peripheral AV fistulas

• reduced effective systemic perfusion
• decreased effective arterial blood volume

Question 9

Refeeding Edema

Answer 9

Aggravation of Edema when famished persons are provided with adequate diet
Increase in quantity of Nacl ingested
Increase release of insulin which increases tubular Na+ reabsorption

Question 10

Cause of Edema in hypothyroidism

Answer 10

Deposition of Hyaluronic acid

Question 11

Pretibial myxedema in graves?

Answer 11

Lymphocytic infiltration and inflammation

Question 12

Diff btw Edema due to hepatic disease and CRF

Answer 12

Hepatic disease
BP lower than in renal or cardiac disease
Hypokalemia
Respiratory alkalosis

Question 13

Symptoms of uremia

Answer 13

Decreased appetite 
Metallic/fishy taste
Altered sleep pattern
Difficulty concentrating
Restless leg syndrome 
Myoclonus

Question 14

Edema restricted to one leg or to one or both arms

Answer 14

Lymphatic or venous obstruction

Question 15

Causes of facial Edema

Answer 15

Hypoproteinemia
Trichinosis
Allergic reactions
Myxedema

Question 16

Edema in paralysis

Answer 16

Unilateral Edema

Question 17

Diff btw Edema due to Hypoproteinemia and CCF?

Answer 17

Distribution
 Periorbital
 Pedal(CCF)
Timing
 Morning
 Evening(CCF)

Question 18

Edema due to venous obstruction..Associated finding?

Answer 18

Cyanosis

Question 19

Skin of pts with repeated prolonged episodes of Edema

Answer 19

Thickened and indurated

Question 20

Proteinuria in heart failure

Answer 20

Slight to moderate

Question 21

Adverse effects of excessive cough

Answer 21

Emesis
Syncope
Muscular pain
Rib fractures
Aggravation of abdominal or inguinal hernias
Urinary incontinence

Question 22

Chemical stimuli for cough

Answer 22

Capsaicin

Question 23

Expression of which receptor is increased in pts with chronic cough

Answer 23

Type 1 vanniloid receptor(a cation ion channel)

Question 24

Afferent nerve endings of cough

Answer 24

``` Larynx Pharynx Airways till the level of terminal bronchioles Lung parenchyma External auditory meatus Esophagus ```

Question 25

Type of fibres mediating cough

Answer 25

Type C

Question 26

Sensory signal pathway for cough

Answer 26

Vagus----->cough centre in nucleus tractus solitarius

Question 27

Intra thoracic pressures during cough

Answer 27

300mm hg

Question 28

Velocity of exhalation in cough

Answer 28

50miles/hr

Question 29

Surrogate markers of cough strength

Answer 29

Peak expiratory flow or maximal expiratory pressure at mouth

Question 30

Causes of cough that fails to clear secretions despite normal expiratory velocities

Answer 30

Cystic fibrosis | Tracheomalacia with expiratory collapse during cough

Question 31

Causes of impaired cough

Answer 31

``` Impaired inspiratory muscle strength Impaired expiratory muscle strength Chest wall deformity Impaired glottic closure or tracheostomy Tracheomalacia Abnormal airway secretions Central respiratory depression ```

Question 32

Cough of chronic bronchitis

Answer 32

Doesn't cause much discomfort Mucoid appearing sputum Lasts only seconds to minutes

Question 33

Causes of Acute cough(<3weeks)

Answer 33

Respiratory tract infection Aspiration event Inhalation of noxious chemicals or smoke

Question 34

Causes of subacute cough(3-8weeks)

Answer 34

Tracheobronchitis(pertussis) | Post viral tussive syndrome

Question 35

Common causes of chronic cough(>8weeks) if chest radiograph and examination is normal

Answer 35

Cough variant asthma GERD Nasopharyngeal drainage ACE inhibitors

Question 36

Examination in cough

Answer 36

``` CVS RS EAC tympanic membrane Nasal passageways Nails(clubbing) ```

Question 37

Systemic diseases that can produce cough

Answer 37

Sarcoidosis | Vasculitis

Question 38

Timing of ACE inhibitor induced cough

Answer 38

Can occur at any time

Question 39

What strongly argues against the diagnosis of ACE inhibitor induced cough

Answer 39

Persistent cough even after stopping ACE inhibitor for more than 1month

Question 40

Polymorphisms in which gene are associated with ACE inhibitor associated cough

Answer 40

Neurokinin 2 receptor

Question 41

Clues to post nasal drainage

Answer 41

``` Post nasal drip Frequent throat clearing Sneezing and rhinorhea Edematous nasal mucosa Cobble stoned posterior pharyngeal wall mucosa ```

Question 42

Clues to GERD as cause of cough

Answer 42

Recurrent Eructation Retrosternal burning pain after meals or recumbency Hoarseness Throat pain

Question 43

Cough alone as a manifestation of asthma is common in

Answer 43

Children

Question 44

Cough variant asthma

Answer 44

Cough due to asthma in the absence of wheezing,shortness of breath,chest tightness

Question 45

Chronic Eosinophilic bronchitis

Answer 45

Cough with normal X ray | Sputum eosinophilia in excess of 3% without bronchial hyperresponsiveness or airway obstruction

Question 46

Rx of chronic Eosinophilic bronchitis

Answer 46

Inhaled steroids

Question 47

Diseases causing cough that may be missed on chest X ray

Answer 47

Carcinoid Early interstitial lung disease Bronchiectasis Atypical mycobacterial infection

Question 48

Chronic idiopathic cough

Answer 48

Common in women Tickling sensation in throat Dry

Question 49

Rx of chronic idiopathic cough

Answer 49

Codeine Hydrocodone Dextromethorphan Benzonatate

Question 50

Mechanism of action of benzonatate

Answer 50

Inhibits sensory nerves in cough pathway

Question 51

Causes of diffuse alveolar hemorrhage

Answer 51

``` Wegener Microscopic polyangitis pulmonary capillaritis in SLE Goodpasture After bone marrow transplant ```

Question 52

Cause of hemoptysis in bronchiectasis

Answer 52

Bronchial arteries are closer to mucosal surface

Question 53

Pneumonias commonly associated with hemoptysis

Answer 53

Necrotising lung infection Staphylococcus Klebsiella

Question 54

Infections associated with hemoptysis

Answer 54

``` Viral bronchitis Bacterial superinfection in chronic bronchitis Streptococcus pneumoniae H.influenzae Moraxella catarrahlis TB necrotising pneumonia Paragonimiasis ```

Question 55

Airway irritants causing hemoptysis

Answer 55

Inhalation of toxic chemicals Thermal injury Trauma due to suctioning of airways Foreign body inhalation

Question 56

Lung cancers that cause hemoptysis

Answer 56

Cancers that affect proximal airways

Question 57

Multiple pulmonary nodules and hemoptysis

Answer 57

``` Metastasis to lung from RCC Breast Colon Testicular Thyroid Melanoma ```

Question 58

Diseases of pulmonary vasculature causing hemoptysis

Answer 58

``` MS MR AV malformation Pulmonary embolism Pulmonary artery hypertension ```

Question 59

Massive hemoptysis

Answer 59

200-600ml blood in 24 hrs

Question 60

Hemoptysis with mucocutaneous Telangiectasias

Answer 60

AV malformation

Question 61

Complication of bronchial artery embolisation

Answer 61

Paraplegia