18.8.2013(Edema,cough) Flashcards
Why is lymphedema intractable?
As there is excess protein in interstitial fluid
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
Edema of heart failure occurs in
Dependent portions of the body
Edema in acute glomerulonephritis is associated with
Hematuria
Proteinuria
Hypertension
Orthopnea in Edema due to renal failure
Never
Nephrotic syndrome
Marked proteinuria> 3.5g/day
Hypoalbuminemia <35g/L
Hypercholesterolemia
Cause of pedal Edema in cirrhosis
Increased intraabdominal pressure due to Ascitic fluid impedes venous return
Edema of nutritional origin is associated with
Beri beri heart disease
Cause of Edema in beri beri
Multiple peripheral AV fistulas
- reduced effective systemic perfusion
- decreased effective arterial blood volume
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
Cause of Edema in hypothyroidism
Deposition of Hyaluronic acid
Pretibial myxedema in graves?
Lymphocytic infiltration and inflammation
Diff btw Edema due to hepatic disease and CRF
Hepatic disease
BP lower than in renal or cardiac disease
Hypokalemia
Respiratory alkalosis
Symptoms of uremia
Decreased appetite Metallic/fishy taste Altered sleep pattern Difficulty concentrating Restless leg syndrome Myoclonus
Edema restricted to one leg or to one or both arms
Lymphatic or venous obstruction
Causes of facial Edema
Hypoproteinemia
Trichinosis
Allergic reactions
Myxedema
Edema in paralysis
Unilateral Edema
Diff btw Edema due to Hypoproteinemia and CCF?
Distribution Periorbital Pedal(CCF) Timing Morning Evening(CCF)
Edema due to venous obstruction..Associated finding?
Cyanosis
Skin of pts with repeated prolonged episodes of Edema
Thickened and indurated
Proteinuria in heart failure
Slight to moderate
Adverse effects of excessive cough
Emesis Syncope Muscular pain Rib fractures Aggravation of abdominal or inguinal hernias Urinary incontinence
Chemical stimuli for cough
Capsaicin
Expression of which receptor is increased in pts with chronic cough
Type 1 vanniloid receptor(a cation ion channel)
Afferent nerve endings of cough
Larynx Pharynx Airways till the level of terminal bronchioles Lung parenchyma External auditory meatus Esophagus
Type of fibres mediating cough
Type C
Sensory signal pathway for cough
Vagus—–>cough centre in nucleus tractus solitarius
Intra thoracic pressures during cough
300mm hg
Velocity of exhalation in cough
50miles/hr
Surrogate markers of cough strength
Peak expiratory flow or maximal expiratory pressure at mouth
Causes of cough that fails to clear secretions despite normal expiratory velocities
Cystic fibrosis
Tracheomalacia with expiratory collapse during cough
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
Cough of chronic bronchitis
Doesn’t cause much discomfort
Mucoid appearing sputum
Lasts only seconds to minutes
Causes of Acute cough(<3weeks)
Respiratory tract infection
Aspiration event
Inhalation of noxious chemicals or smoke
Causes of subacute cough(3-8weeks)
Tracheobronchitis(pertussis)
Post viral tussive syndrome
Common causes of chronic cough(>8weeks) if chest radiograph and examination is normal
Cough variant asthma
GERD
Nasopharyngeal drainage
ACE inhibitors
Examination in cough
CVS RS EAC tympanic membrane Nasal passageways Nails(clubbing)
Systemic diseases that can produce cough
Sarcoidosis
Vasculitis
Timing of ACE inhibitor induced cough
Can occur at any time
What strongly argues against the diagnosis of ACE inhibitor induced cough
Persistent cough even after stopping ACE inhibitor for more than 1month
Polymorphisms in which gene are associated with ACE inhibitor associated cough
Neurokinin 2 receptor
Clues to post nasal drainage
Post nasal drip Frequent throat clearing Sneezing and rhinorhea Edematous nasal mucosa Cobble stoned posterior pharyngeal wall mucosa
Clues to GERD as cause of cough
Recurrent Eructation
Retrosternal burning pain after meals or recumbency
Hoarseness
Throat pain
Cough alone as a manifestation of asthma is common in
Children
Cough variant asthma
Cough due to asthma in the absence of wheezing,shortness of breath,chest tightness
Chronic Eosinophilic bronchitis
Cough with normal X ray
Sputum eosinophilia in excess of 3% without bronchial hyperresponsiveness or airway obstruction
Rx of chronic Eosinophilic bronchitis
Inhaled steroids
Diseases causing cough that may be missed on chest X ray
Carcinoid
Early interstitial lung disease
Bronchiectasis
Atypical mycobacterial infection
Chronic idiopathic cough
Common in women
Tickling sensation in throat
Dry
Rx of chronic idiopathic cough
Codeine
Hydrocodone
Dextromethorphan
Benzonatate
Mechanism of action of benzonatate
Inhibits sensory nerves in cough pathway
Causes of diffuse alveolar hemorrhage
Wegener Microscopic polyangitis pulmonary capillaritis in SLE Goodpasture After bone marrow transplant
Cause of hemoptysis in bronchiectasis
Bronchial arteries are closer to mucosal surface
Pneumonias commonly associated with hemoptysis
Necrotising lung infection
Staphylococcus
Klebsiella
Infections associated with hemoptysis
Viral bronchitis Bacterial superinfection in chronic bronchitis Streptococcus pneumoniae H.influenzae Moraxella catarrahlis TB necrotising pneumonia Paragonimiasis
Airway irritants causing hemoptysis
Inhalation of toxic chemicals
Thermal injury
Trauma due to suctioning of airways
Foreign body inhalation
Lung cancers that cause hemoptysis
Cancers that affect proximal airways
Multiple pulmonary nodules and hemoptysis
Metastasis to lung from RCC Breast Colon Testicular Thyroid Melanoma
Diseases of pulmonary vasculature causing hemoptysis
MS MR AV malformation Pulmonary embolism Pulmonary artery hypertension
Massive hemoptysis
200-600ml blood in 24 hrs
Hemoptysis with mucocutaneous Telangiectasias
AV malformation
Complication of bronchial artery embolisation
Paraplegia
