050415 edema

Question 1

differential for bilateral leg edema

Answer 1

heart failure
cirrhosis
renal
anemia

meds:

• dihydropyridine Ca ch blockers
• direct vasodilators
• corticosteroids
• estrogens, progesterones, testosterone
• NSAIDs
• others

GI (malabsorption, nutritional deficiency)
venous obstruction (more likely unilat)
venous insufficiency
myxedema
lymphedema (lymphatic obstruction)

Question 2

causes of R sided heart failure

Answer 2

L sided heart failure
cor pulmonale (pulmonary causes-sleep apnea)
pulmonary HTN
constrictive pericarditis (TB)

Question 3

differential for unilateral leg edema

Answer 3

venous obstruction:

• acute-DVT
• subacute-external compression as in proximal LAD

venous insufficiency
lymphedema/lymphatic obstruction
baker cyst
localized edema

Question 4

causes of lymphedema/lymphatic obstruction

Answer 4

usually secondary: neoplasm, surgery, radiation, relatively uncommon infections (TB, cat scartch, filiarisis)

Question 5

causes of localized unilateral edema

Answer 5

cellulitis/erysipelas
burns
angioedema/urticaria (hives)
trauma

Question 6

what can fever point you towards in terms of edema

Answer 6

infection-cellulitis
DVT
PE

Question 7

what can elevated BP point you towards

Answer 7

heart failure

renal failure

Question 8

what can tachypnea and low pulse ox point you towards

Answer 8

PE, cor pulmonale, CHF

Question 9

what can tachycardia point you towards

Answer 9

meds (vasodilators)
CHF with or w/o shock
PE
cellulitis
sepsis

Question 10

what can tenderness, warmth, erythema point you towards

Answer 10

infection, DVT, etc

Question 11

non pitting edema

Answer 11

lymphedema, cellulitis

Question 12

risk factors for cellulitis

Answer 12

chronic edema
obesity
entry methods (tinea pedis, injection drug, IV site, scratch)
immunosuppression

Question 13

bugs for cellulitis

Answer 13

most common:

• beta hemolytic strep (usually no exudate)
• staph aureus (sometimes has exudate, can be MRSA)

others:

• hot tub-Pseudomonas aerug
• salt water-vibrio vulnificus
• fresh water-aeomonas hydrophilia
• diabetic foot ulcer-polymicrobial
• perianal-group A strep, gran neg rods

Question 14

are beta lactams reversible or irreversible at binding to PBPs?

Answer 14

irreversible

Question 15

MOA of clindamycin

Answer 15

binds to 50S and blocks translocation along ribosomes

Question 16

MOA of tetracyclines

Answer 16

transported into cells, prevent attachment of aminoacyl-tRNA to 30S ribosomal subunits

Question 17

MOA of linezolid

Answer 17

binds to 50S ribosomal subunit, interfering w formation of 70S initiation complex

Question 18

ex of anti-folates

Answer 18

sulfonamides (sulfamethoxazole, sulfadiazine)

trimethoprim

Question 19

nephrotic syndrome-manifestations

Answer 19

hypoalbuminemia, proteinuria
hyperlipidemia
hypercoagulability
relative immune deficiency

Question 20

tx of nephrotic syndrome

Answer 20

ACE inhibitors/ARBs
loop diuretics
consider heparins in high risk situations
consider HMG-CoA reductase inhibitor

for kidney diseases:
consider corticosteroids/immunosuppresants

Question 21

list loop diuretics

Answer 21

furosemide
bumetanide
ethacrynic acid

Question 22

in pt w liver failure, what can decreased breath sounds in lower third of right lung field indicate

Answer 22

ascites that comes up from diaphgram-pleural effusion

Question 23

dupuytren’s contractures

Answer 23

fingers can’t straighten completely (palmar fibromatosis)

Question 24

why can platelets RBCs and WBCs be low in cirrhosis

Answer 24

due to portal HTN and splenic sequestration

Question 25

types of gallstones

Answer 25

cholesterol stones (most common)

black-chronic hemolysis like sickle cell disease
brown stones-chronic bile duct infection

Question 26

pathophysiology of ascites

Answer 26

portal HTN, splanchnic arterial vasodilatation, decreased effective circulating volume, activation of vasoconstrictor and antinatriuretic factors, sodium and water retention, plasma volume expansion, ascites

water retention due to vasopressin and more than sodium retention due to RAAS, so you have hyponatremia leading to ascites

Question 27

what is consistent w sponatneous bacterial peritonitis

Answer 27

more than 250 PMNs in ascites

Question 28

common pathogens in spontaneous bacterial peritonitis

Answer 28

E coli
Strep
Klebsiella

mostly gram negative

Question 29

tx for Wilson’s dis

Answer 29

penicillamine or trientine and oral zinc

Question 30

UC is assoc with

Answer 30

PSC (onion skinning)