18.8.2013(Edema,cough) Flashcards Preview

Harrison- Approach to Symptoms > 18.8.2013(Edema,cough) > Flashcards

Flashcards in 18.8.2013(Edema,cough) Deck (62):
0

Drugs associated with Edema

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

1

Why is lymphedema intractable?

As there is excess protein in interstitial fluid

2

Edema of heart failure occurs in

Dependent portions of the body

3

Edema in acute glomerulonephritis is associated with

Hematuria
Proteinuria
Hypertension

4

Orthopnea in Edema due to renal failure

Never

5

Nephrotic syndrome

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

6

Cause of pedal Edema in cirrhosis

Increased intraabdominal pressure due to Ascitic fluid impedes venous return

7

Edema of nutritional origin is associated with

Beri beri heart disease

8

Cause of Edema in beri beri

Multiple peripheral AV fistulas
- reduced effective systemic perfusion
-decreased effective arterial blood volume

9

Refeeding Edema

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

10

Cause of Edema in hypothyroidism

Deposition of Hyaluronic acid

11

Pretibial myxedema in graves?

Lymphocytic infiltration and inflammation

12

Diff btw Edema due to hepatic disease and CRF

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

13

Symptoms of uremia

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

14

Edema restricted to one leg or to one or both arms

Lymphatic or venous obstruction

15

Causes of facial Edema

Hypoproteinemia
Trichinosis
Allergic reactions
Myxedema

16

Edema in paralysis

Unilateral Edema

17

Diff btw Edema due to Hypoproteinemia and CCF?

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

18

Edema due to venous obstruction..Associated finding?

Cyanosis

19

Skin of pts with repeated prolonged episodes of Edema

Thickened and indurated

20

Proteinuria in heart failure

Slight to moderate

21

Adverse effects of excessive cough

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

22

Chemical stimuli for cough

Capsaicin

23

Expression of which receptor is increased in pts with chronic cough

Type 1 vanniloid receptor(a cation ion channel)

24

Afferent nerve endings of cough

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

25

Type of fibres mediating cough

Type C

26

Sensory signal pathway for cough

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

27

Intra thoracic pressures during cough

300mm hg

28

Velocity of exhalation in cough

50miles/hr

29

Surrogate markers of cough strength

Peak expiratory flow or maximal expiratory pressure at mouth

30

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

Cystic fibrosis
Tracheomalacia with expiratory collapse during cough

31

Causes of impaired cough

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

32

Cough of chronic bronchitis

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

33

Causes of Acute cough(<3weeks)

Respiratory tract infection
Aspiration event
Inhalation of noxious chemicals or smoke

34

Causes of subacute cough(3-8weeks)

Tracheobronchitis(pertussis)
Post viral tussive syndrome

35

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

Cough variant asthma
GERD
Nasopharyngeal drainage
ACE inhibitors

36

Examination in cough

CVS
RS
EAC
tympanic membrane
Nasal passageways
Nails(clubbing)

37

Systemic diseases that can produce cough

Sarcoidosis
Vasculitis

38

Timing of ACE inhibitor induced cough

Can occur at any time

39

What strongly argues against the diagnosis of ACE inhibitor induced cough

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

40

Polymorphisms in which gene are associated with ACE inhibitor associated cough

Neurokinin 2 receptor

41

Clues to post nasal drainage

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

42

Clues to GERD as cause of cough

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

43

Cough alone as a manifestation of asthma is common in

Children

44

Cough variant asthma

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

45

Chronic Eosinophilic bronchitis

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

46

Rx of chronic Eosinophilic bronchitis

Inhaled steroids

47

Diseases causing cough that may be missed on chest X ray

Carcinoid
Early interstitial lung disease
Bronchiectasis
Atypical mycobacterial infection

48

Chronic idiopathic cough

Common in women
Tickling sensation in throat
Dry

49

Rx of chronic idiopathic cough

Codeine
Hydrocodone
Dextromethorphan
Benzonatate

50

Mechanism of action of benzonatate

Inhibits sensory nerves in cough pathway

51

Causes of diffuse alveolar hemorrhage

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

52

Cause of hemoptysis in bronchiectasis

Bronchial arteries are closer to mucosal surface

53

Pneumonias commonly associated with hemoptysis

Necrotising lung infection
Staphylococcus
Klebsiella

54

Infections associated with hemoptysis

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

55

Airway irritants causing hemoptysis

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

56

Lung cancers that cause hemoptysis

Cancers that affect proximal airways

57

Multiple pulmonary nodules and hemoptysis

Metastasis to lung from
RCC
Breast
Colon
Testicular
Thyroid
Melanoma

58

Diseases of pulmonary vasculature causing hemoptysis

MS
MR
AV malformation
Pulmonary embolism
Pulmonary artery hypertension

59

Massive hemoptysis

200-600ml blood in 24 hrs

60

Hemoptysis with mucocutaneous Telangiectasias

AV malformation

61

Complication of bronchial artery embolisation

Paraplegia