Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE related > Symptom To Diagnosis - Edema > Flashcards

Symptom To Diagnosis - Edema Flashcards

1
Q

GENERALIZED edema due to a systemic cause - General etiologies:

A
  1. Cardiovascular.
  2. Hepatic (cirrhosis).
  3. Renal.
  4. Anemia.
  5. Nutritional deficiency.
  6. Medications.
  7. Refeeding edema.
  8. Myxedema.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cardiovascular causes of edema:

A
  1. Systolic or diastolic dysfunction, or both.
  2. Constrictive pericarditis.
  3. Pulmonary HTN.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medications that cause generalized edema:

A
  1. Antidepressants: MAOIs.
  2. Antihypertensives: CCBs, hydralazine, minoxidil, beta-blockers.
  3. Hormones: Estrogens/progesterones, testosterone, steroids.
  4. NSAIDs and COX-2 inhibitors.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Limb edema - General etiologies:

A
  1. Venous diseases (obstruction + insufficiency).
  2. Lymphatic obstruction.
  3. Localized edema.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Venous disease as a cause of limb edema:

A
  1. OBSTRUCTION –> DVT, lymphadenopathy, pelvic mass.

2. INSUFFICIENCY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lymphatic obstruction as a cause of limb edema:

A
  1. PRIMARY –> (idiopathic, often bilateral), congenital, lymphedema praecox (onset in puberty) or tarda.
  2. SECONDARY –> (more common generally unilateral), neoplasm, surgery (esp. mastectomy), radiation, miscellaneous (TB, recurrent lymphangitis, filariasis).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Localized edema:

A
  1. Burns.
  2. Angioedema/hives.
  3. Trauma.
  4. Cellulitis, erysipelas.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MCC of cirrhosis:

A
  1. Alcohol.
  2. Chronic hep B, C.
  3. NAFLD.
  4. Hemochromatosis.
  5. Primary/secondary biliary cirrhosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Less common causes of cirrhosis:

A
  1. Drugs and toxins (isoniazid, methotrexate, amiodarone).
  2. Autoimmune hep.
  3. Genetic metabolic diseases (Wilson, alpha-1 antitrypsin def., glycogen storage diseases, porphyria).
  4. Infections (schistosomiasis, echinococcosis, brucellosis).
  5. Cardiac.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 MCC of cirrhosis in the USA:

A
  1. Alcoholic liver disease.

2. Chronic hep C.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk factors for developing cirrhosis in patients with hep C:

A
  1. > 50.
  2. Regular alcohol.
  3. Male sex.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for developing cirrhosis for those with NAFLD:

A
  1. Older age.
  2. Obesity.
  3. Insulin resistance.
  4. HTN.
  5. Hyperlipidemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Typical patient with ascites - Problem with daily living?

A

Patient complains of an inability to fasten her pants due to increasing abdominal girth, sometimes accompanied by dyspnea and edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diagnostic criteria of hepatorenal syndrome:

A
  1. Cirrhosis with ascites.
  2. Serum Cr >1.5.
  3. Serum Cr stays above 1.5 after at least 2 days of diuretic withdrawal and volume expansion with albumin.
  4. Absence of shock.
  5. No current or recent treatment with nephrotoxic drugs.
  6. Absence of parenchymal kidney disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type I hepatorenal syndrome:

A

Acute renal failure: Serum creatinine doubles or increases to >2.5 in less than 2 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Type II hepatorenal syndrome:

A

Refractory ascites: Serum creatinine 1.25-2.5 with a steady or slowly progressive course.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hepatorenal syndrome - Incidence in patients with cirrhosis at 1yr and in 5yrs:

A

18% at 1 yr.

39% at 5 yrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Precipitants of type I hepatorenal syndrome:

A
  1. Bacterial infections (esp. SBP).
  2. GI bleeding.
  3. Alcoholic hep.
  4. Overdiuresis.
  5. Large volume paracentesis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hepatorenal syndrome - Mechanism:

A

Peripheral vasodilation –> Decreased systemic vascular resistance –> Renal arteriolar vasoconstriction –> Decreased renal blood flow and a reduced GFR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SPB - Prevalence:

A

10-30% of hospitalized cirrhotic patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SBP - Recurrence rate in 1yr:

A

70%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SBP - Mortality rate of:

A

20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

3 common isolates in SBP:

A
  1. E.coli.
  2. Klebsiella.
  3. Pneumococci.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SBP - Symptoms:

A 
50-75% --> Fever.
27-72% --> Abdominal pain.
16-29% --> Chills.
8-21% --> Nausea/vomiting.
Up to 50% --> Mental status changes.
33% --> Decreased renal function.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SBP - Percentage of patients who are asymptomatic:

A

13%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for SBP:

A
  1. Ascitic fluid total protein level <1g/dL.
  2. Upper GI bleeding.
  3. Prior episode of SBP.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Criteria for performing a diagnostic paracentesis in patients with cirrhosis and ascites:

A
  1. Admission to the hospital.
  2. Change in clinical status.
  3. Development of leukocytosis, acidosis, or renal failure.
  4. Active GI bleeding.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Interpretation of ascitic fluid results - PMN >250 with single organism:

A

SPB.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Interpretation of ascitic fluid results - PMNs >250 with negative cultures:

A

Culture-negative neutrophilic ascites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Interpretation of ascitic fluid results - PMN<250 with single organism:

A

Monomicrobial non neutrocytic bacterascites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Interpretation of ascitic fluid - PMN >250 and polymicrobial:

A

Secondary bacterial peritonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Interpretation of ascitic fluid - PMN<250 and polymicrobial:

A

Polymicrobial bacterascites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

LR + of SAAG >1.1 for the diagnosis of ascites due to portal HTN:

A

4.6.

34
Q

LR- of SAAG<1.1 for the diagnosis of ascites due to portal HTN:

A

0.06.

35
Q

Hepatic encephalopathy - Presents in …-…% of patients with chronic liver disease.

A

50-70%.

36
Q

Hypersplenism in cirrhosis - Textbook presentation:

A

Cytopenias are found on routine blood testing in a patient with cirrhosis.

37
Q

Splenomegaly is found in …-…% of patients with cirrhosis.
…-…% have the clinical syndrome of hypersplenism.

A

36-92%.

11-55%.

38
Q

Is there a rough correlation between spleen size and decrease in RBCs?

A

Yes.

39
Q

Mechanisms of thrombocytopenia in liver disease:

A
  1. Platelet sequestration in the spleen.
  2. Impaired bone marrow production.
  3. Decreased platelet survival.
40
Q

Mechanism of leukopenia in liver disease:

A

Sequestration in spleen - RARE compared to thrombocytopenia.

41
Q

Mechanism of anemia in liver disease:

A
  1. Increased destruction in spleen.
  2. Iron or folate deficiency.
  3. Decreased EPO production.
42
Q

Nephrotic syndrome - Textbook presentation:

A
  1. Edema.
  2. HTN.
  3. Hypoalbuminemia.
  4. Hyperlipidemia.
    at least 3.5g/24h of proteinuria.
43
Q

Infections that lead to nephrotic syndrome:

A
  1. Hep B,C, HIV.
  2. Syphilis.
  3. Malaria.
44
Q

Malignancies associated with nephrotic syndrome:

A
  1. Lung.
  2. Breast.
  3. Colon.
  4. HL.
45
Q

3 drugs that may cause nephrotic syndrome:

A
  1. NSAIDs.
  2. Captopril.
  3. Heroin.
46
Q

Risk factors for thromboembolism in nephrotic syndrome:

A
  1. Serum albumin 8g/24h.
47
Q

Lab evaluation of nephrotic syndrome:

A
  1. CBC.
  2. Comprehensive metabolic panel (renal and liver function, including serum albumin).
  3. Fasting glucose and HbA1c.
  4. ANA.
  5. HIV, hep B, C.
  6. Serum and urine electrophoresis.
48
Q

Normal pulmonary arterial pressure is:

A

12mmHg.

49
Q

Pulmonary HTN is defined?

A

As a mean PAP>25mmHg, with a mean pulmonary arterial occlusion pressure Mean PAP of at least 50mmHg.

50
Q

3 components of the pathophysiology of pulmonary HTN:

A
  1. Vascular remodeling with vascular inflammation and endothelial cell proliferation.
  2. Platelet dysfunction and thrombosis.
  3. Vasoconstriction due to 2 factors.
51
Q

Why vasoconstriction in pulmonary HTN?

A

Endothelial dysfunction resulting in:
1. OVERproduction of endothelin-1.
2. UNDERproduction of vasodilators such as NO, PGI2, VIP.
+ ABNORMAL voltage-gated K channels.

52
Q

Clinical classification of pulm. arterial HTN (PAH):

A
  1. Idiopathic.
  2. Familial.
  3. PAH associated with:
    a. Collagen vascular disease (esp. scleroderma, SLE, mixed connective tissue disease).
    b. Congenital pulmonary-systemic shunts.
    c. Portal HTN (1-6%).
    d. HIV (0.5%).
    e. Drugs and toxins.
53
Q

INITIAL Symptoms of PAH:

A 
60% --> Dyspnea.
19% --> Fatigue.
7% --> Chest pain.
8% --> Syncope.
3% --> Edema.
54
Q

At the time the patients were given the diagnosis of PAH and were enrolled in the study:

A 
98% --> Dyspnea.
73% --> Fatigue.
47% --> Chest pain.
37% --> Edema.
36% --> Syncope.
33% --> Palpitations.
55
Q

PAH - Physical exam:

A
  1. Accentuated pulm. component of S2.
  2. Sustained left lower parasternal movement.
  3. An early systolic click.
  4. Increased jugular a and v waves.
  5. TV regurgitation.
  6. Hepatojugular reflex.
  7. Pulsatile liver.
  8. Elevated jugular venous pressure.
  9. Edema.
56
Q

Sustained left parasternal movement for detecting a mean PAP>50mmHg:

A

Sens - 71%.
Spec - 80%.
LR+ 3.6.
LR- 0.4.

57
Q

A palpable P2 for detecting a mean PAP>50mmHg:

A 
(studied in patients with MV stenosis).
Sens - 96%.
Spec - 73%.
LR+ 3.6.
LR- 0.05.
58
Q

ECG - Expected findings in PAH:

A
  1. Right axis deviation.
  2. RV hypertrophy.
  3. P-pulmonale pattern.
    NOT sensitive or specific enough to diagnose PAH.
59
Q

Venous insufficiency - Superficial or deep veins of the leg?

A

45% –> Superficial system.
40% –> Deep system + Superficial system.
Remainder –> Only deep system.

60
Q

Prevalence of varicose veins:

A

25-33% –> Women.

10-20% –> Men.

61
Q

Prevalence of skin changes in venous insufficiency:

A

3-11% –> Skin changes.

0.3-1% –> Skin ulcers.

62
Q

Risk factors for venous insufficiency:

A
  1. Age.
  2. Obesity.
  3. History of phlebitis or venous thrombosis.
  4. Serious leg trauma.
  5. Pregnancy.
  6. Prolonged standing.
  7. Greater height.
63
Q

Classification of venous insufficiency:

A

Class 1: Telangiectasias or reticular veins (non palpable subdermal veins up to 4mm in diameter).
Class 2: Varicose veins. (palpable >4mm in diameter).
Class 3: Edema without skin changes.
Class 4: Skin changes.
Class 5 and 6: Healed or non healed ulcers.

64
Q

Gold standard for venous insufficiency:

A

Venography.

65
Q

Best non invasive test for venous insufficiency:

A

Duplex US.

66
Q

Cellulitis definition:

A

An infection of the dermis and subcutaneous tissue.

67
Q

Erysipelas definition:

A

Superficial cellulitis with prominent lymphatic involvement.

68
Q

Risk factors for the development of cellulitis:

A
  1. Lymphedema.
  2. Peripheral edema.
  3. Venous insufficiency.
  4. Obesity.
  5. Diabetes.
  6. History of cellulitis.
  7. Breast cancer treatment.
69
Q

Cellulitis - Presence of systemic symptoms (fever, chills, myalgias)?

A

UNUSUAL –> Suggests concomitant bacteremia or a more serious infection such as necrotizing fasciitis.

70
Q

Risk factors for erysipelas:

A
  1. Similar to those for cellulitis.

2. Lymphedema and an identified portal of entry (primarily tinea pedis) are the 2 strongest risk factors in 1 study.

71
Q

Most common site for erysipelas?

A

Leg –> 90%.
5% –> Arm.
2.5% –> Face.

72
Q

BOTH cellulitis and erysipelas are … diagnoses.

A

Clinical.

73
Q

Erysipelas/cellulitis - Blood cultures are positive in …-…% of patients.

A

2-5%.

74
Q

Erysipelas/cellulitis - Skin biopsy cultures are positive in …-…% of patients.

A

5-40% - RARELY necessary.

75
Q

UPPER extremity DVT (UEDVT) - Textbook presentation:

A

Patients can be asymptomatic, but generally arm, shoulder, or neck discomfort or fullness as well as arm swelling are the presenting symptoms.

76
Q

Classification of UEDVT:

A

Primary (20%).

Secondary (80%).

77
Q

Effort thrombosis?

A

Paget-Schroetter syndrome:

  1. Young men after strenuous exercise, which causes microtrauma to the veins.
  2. May or may not find compression by hypertrophied muscles or a cervical rib.
78
Q

Secondary UEDVT - Etiology:

A
  1. Indwelling central venous catheter-associated UEDVT (up to 70% of cases).
  2. Malignancy (>40% of cases).
  3. Hypercoagulable states.
  4. Other miscellaneous causes (surgery, infection, immobility, concurrent lower DVT).
79
Q

UEDVT - Sites:

A

18-69% –> Subclavian.
5-42% –> Axillary.
8-29% –> Internal jugular vein.
4-13% –> Brachial.

80
Q

UEDVT - Clinical features:

A

80% –> Edema.
40% –> Pain.
Patients may note numbness, heaviness, paresthesias, pruritus, coldness.
Dilated cutaneous veins sometimes visible.

81
Q

UEDVT - Complications:

A
  1. PE –> 36%.
  2. Recurrent thrombosis –> 10%.
  3. Post thrombotic syndrome is seen in up to 4-34% of patients in different sites.
82
Q

How much must the interstitial volume be increased for edema to be clinically present?

A

2.5-3L.

OSCE related (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions