Oedema

Question 1

Chronic, unilateral peripheral oedema differentials

Answer 1

Varicose veins
Chronic venouse insufficiency
Trauma
Malignancy, Pelvic surgery
Inflammatory arthritis
Stasis
Congential

Question 2

Causes of acute unilateral peripheral oedema

Answer 2

DVT
Ruptured bakers cyst
Cellulitis
Superficial thrombophlebitis

Question 3

Bilateral peripheral oedema systemic causes

Answer 3

Cardiac - HF
Pulmonary - Ccor pulmonale
Hepatic - liver cirrhosis
Lymphoedema
Lipoedema
Trauma
Post hip/knee surgery

Question 4

Symptoms of ruptured bakers cyst

Answer 4

Onset sudden - secs
Popliteal mass
BG: arthritic knee
Aching, clicking knee
Knee swelling and pain
Fouchers sign - tense on extension soft on flexion swell

Question 5

Symptoms of varicose veins

Answer 5

Itching, discomfort
Heaviness in leg
Dull aches
Swelling
Burning sensation/paraesthesia
Exercise intolerance
RFs - pregnancy, FHx, prolonged standing, obesity

Question 6

Signs varicose veins

Answer 6

Distended, tortous veins worse when standing
Vein empty when pressed then refull
Skin changes - ulcers, eczema, pigmentation, telangiectasia

Question 7

Congestive HF

Answer 7

SOB, fatigue, weight loss
Fluid retention, ascites, Orthopnoea, PND,
Nocturnal cough - pink frothy sputum, wheeze
Nocturia, cold peripheries

Question 8

Signs of HF on exam

Answer 8

Increased HR
Decreased cap refill
Cyanosis, decreased BP
Displaced apex
RV heace
Raised JVP
S3 heard
Basal crackles/wheeze
Pleural effusion
Hepatomegaly
Peripheral oedema

Question 9

Stepwise treatemnt for chronic HF

Answer 9

ACEi
Diuretucs
Beta blocker
Aldosterone antagonist - spironaloctone
Ivabradine (decreases HR) , digoxin, opiates

Question 10

What can cause cor pulmonale?

Answer 10

COPD
IOSA
CF, fibrosis
MND
Recurrent emboli
Vasculitis

Question 11

Cor pulmonale symptoms

Answer 11

Worsening SOB at rest
Fatigue
Peripheral oedema
Exertional dyspnoea
Haemoptysis
Angina tyoe chest pain - not relieved by GTN
Hepatic cpongestion

Question 12

Cor pulmonale signs

Answer 12

Cyanosis, plethora
Increase resp effort
Decreased air entry, crackles, wheeze
RV heave
Raised JVP
Loud P2
Hepatomegaly

Question 13

Treatment for cor pulmonale

Answer 13

Long term oxygen therapy
Diuretics
Vasodilators - nifedipine
Anitcoagulation if VTE is cause of RHF
SOB - bronhcodilators, theophylline

Question 14

What sort of welling does myxoedema present aas?

Answer 14

Bilateral, non pitting, cool
Caused by hypothyroidsim

Question 15

Causes of lymphoedema?

Answer 15

LN removal in cancer
Radiotherapy
Overweight

Question 16

Symptoms and signs of lymphoedema

Answer 16

Aching, heavy, swelling limb
Thickening of skin
Cellulitis
Firm, nnon tender non pitting oedema
Skin changes

Question 17

Physiological causes of oedema

Answer 17

Pregnancy
Immobility/post-hip or knee replacement
Increased fluid from venous stasis
Myxoedema - hypothyroidism

Question 18

How can GI problems cause oedema?

Answer 18

Decreased oncotic pressure, hypoalbuminaemia
Starvation, malnutrition, malabsorption
Proein-losing enteropathy,, IBD, coeliac, liver cirrhosis

Question 19

Renal causes of odema

Answer 19

Decreased oncotic pressure from protein loss, increased fluid pressure from Na: H2O retention
Acute nephritic syndrome, nephrotic syndrome