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

18.8.2013(Edema,cough) Flashcards

0
Q

Why is lymphedema intractable?

A

As there is excess protein in interstitial fluid

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1
Q

Drugs associated with Edema

A 
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
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2
Q

Edema of heart failure occurs in

A

Dependent portions of the body

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3
Q

Edema in acute glomerulonephritis is associated with

A

Hematuria
Proteinuria
Hypertension

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4
Q

Orthopnea in Edema due to renal failure

A

Never

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5
Q

Nephrotic syndrome

A

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

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6
Q

Cause of pedal Edema in cirrhosis

A

Increased intraabdominal pressure due to Ascitic fluid impedes venous return

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7
Q

Edema of nutritional origin is associated with

A

Beri beri heart disease

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8
Q

Cause of Edema in beri beri

A

Multiple peripheral AV fistulas

  • reduced effective systemic perfusion
  • decreased effective arterial blood volume
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9
Q

Refeeding Edema

A

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

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10
Q

Cause of Edema in hypothyroidism

A

Deposition of Hyaluronic acid

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11
Q

Pretibial myxedema in graves?

A

Lymphocytic infiltration and inflammation

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12
Q

Diff btw Edema due to hepatic disease and CRF

A

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

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13
Q

Symptoms of uremia

A 
Decreased appetite 
Metallic/fishy taste
Altered sleep pattern
Difficulty concentrating
Restless leg syndrome 
Myoclonus
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14
Q

Edema restricted to one leg or to one or both arms

A

Lymphatic or venous obstruction

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15
Q

Causes of facial Edema

A

Hypoproteinemia
Trichinosis
Allergic reactions
Myxedema

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16
Q

Edema in paralysis

A

Unilateral Edema

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17
Q

Diff btw Edema due to Hypoproteinemia and CCF?

A 
Distribution
 Periorbital
 Pedal(CCF)
Timing
 Morning
 Evening(CCF)
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18
Q

Edema due to venous obstruction..Associated finding?

A

Cyanosis

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19
Q

Skin of pts with repeated prolonged episodes of Edema

A

Thickened and indurated

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20
Q

Proteinuria in heart failure

A

Slight to moderate

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21
Q

Adverse effects of excessive cough

A 
Emesis
Syncope
Muscular pain
Rib fractures
Aggravation of abdominal or inguinal hernias
Urinary incontinence
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22
Q

Chemical stimuli for cough

A

Capsaicin

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23
Q

Expression of which receptor is increased in pts with chronic cough

A

Type 1 vanniloid receptor(a cation ion channel)

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24
Q

Afferent nerve endings of cough

A 
Larynx
Pharynx
Airways till the level of terminal bronchioles
Lung parenchyma
External auditory meatus
Esophagus
25
Q

Type of fibres mediating cough

A

Type C

26
Q

Sensory signal pathway for cough

A

Vagus—–>cough centre in nucleus tractus solitarius

27
Q

Intra thoracic pressures during cough

A

300mm hg

28
Q

Velocity of exhalation in cough

A

50miles/hr

29
Q

Surrogate markers of cough strength

A

Peak expiratory flow or maximal expiratory pressure at mouth

30
Q

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

A

Cystic fibrosis

Tracheomalacia with expiratory collapse during cough

31
Q

Causes of impaired cough

A 
Impaired inspiratory muscle strength
Impaired expiratory muscle strength
Chest wall deformity
Impaired glottic closure or tracheostomy
Tracheomalacia
Abnormal airway secretions
Central respiratory depression
32
Q

Cough of chronic bronchitis

A

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

33
Q

Causes of Acute cough(<3weeks)

A

Respiratory tract infection
Aspiration event
Inhalation of noxious chemicals or smoke

34
Q

Causes of subacute cough(3-8weeks)

A

Tracheobronchitis(pertussis)

Post viral tussive syndrome

35
Q

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

A

Cough variant asthma
GERD
Nasopharyngeal drainage
ACE inhibitors

36
Q

Examination in cough

A 
CVS
RS 
EAC
tympanic membrane
Nasal passageways
Nails(clubbing)
37
Q

Systemic diseases that can produce cough

A

Sarcoidosis

Vasculitis

38
Q

Timing of ACE inhibitor induced cough

A

Can occur at any time

39
Q

What strongly argues against the diagnosis of ACE inhibitor induced cough

A

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

40
Q

Polymorphisms in which gene are associated with ACE inhibitor associated cough

A

Neurokinin 2 receptor

41
Q

Clues to post nasal drainage

A 
Post nasal drip
Frequent throat clearing
Sneezing and rhinorhea
Edematous nasal mucosa
Cobble stoned posterior pharyngeal wall mucosa
42
Q

Clues to GERD as cause of cough

A

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

43
Q

Cough alone as a manifestation of asthma is common in

A

Children

44
Q

Cough variant asthma

A

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

45
Q

Chronic Eosinophilic bronchitis

A

Cough with normal X ray

Sputum eosinophilia in excess of 3% without bronchial hyperresponsiveness or airway obstruction

46
Q

Rx of chronic Eosinophilic bronchitis

A

Inhaled steroids

47
Q

Diseases causing cough that may be missed on chest X ray

A

Carcinoid
Early interstitial lung disease
Bronchiectasis
Atypical mycobacterial infection

48
Q

Chronic idiopathic cough

A

Common in women
Tickling sensation in throat
Dry

49
Q

Rx of chronic idiopathic cough

A

Codeine
Hydrocodone
Dextromethorphan
Benzonatate

50
Q

Mechanism of action of benzonatate

A

Inhibits sensory nerves in cough pathway

51
Q

Causes of diffuse alveolar hemorrhage

A 
Wegener
Microscopic polyangitis
pulmonary capillaritis in SLE
Goodpasture 
After bone marrow transplant
52
Q

Cause of hemoptysis in bronchiectasis

A

Bronchial arteries are closer to mucosal surface

53
Q

Pneumonias commonly associated with hemoptysis

A

Necrotising lung infection
Staphylococcus
Klebsiella

54
Q

Infections associated with hemoptysis

A 
Viral bronchitis
Bacterial superinfection in chronic bronchitis
 Streptococcus pneumoniae
 H.influenzae
 Moraxella catarrahlis
TB
necrotising pneumonia
Paragonimiasis
55
Q

Airway irritants causing hemoptysis

A

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

56
Q

Lung cancers that cause hemoptysis

A

Cancers that affect proximal airways

57
Q

Multiple pulmonary nodules and hemoptysis

A 
Metastasis to lung from
RCC
Breast 
Colon
Testicular
Thyroid 
Melanoma
58
Q

Diseases of pulmonary vasculature causing hemoptysis

A 
MS
MR
AV malformation
Pulmonary embolism
Pulmonary artery hypertension
59
Q

Massive hemoptysis

A

200-600ml blood in 24 hrs

60
Q

Hemoptysis with mucocutaneous Telangiectasias

A

AV malformation

61
Q

Complication of bronchial artery embolisation

A

Paraplegia

Harrison- Approach to Symptoms (11 decks)

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