New to Meducation?
Sign up
Already signed up? Log In

Category

Preview
1
27

Pre-eclampsia and Eclampsia

Pre-eclampsia and eclampsia are different stages of the same condition. Pre-eclampsia can result in eclampsia at any time. Eclampsia is immediately life-threatening and often symptomatic.   Pre-eclampsia is a condition characterised by increased blood pressure, proteinuria and often oedema during pregnancy. It is typically asymptomatic, and occurs after 20 weeks, although it rarely presents before 32 weeks – but when it does, it is associated with a worse prognosis.  
almostadoctor.com - free medical student revision notes
over 5 years ago
Www.bmj
1
31

A weak leg

A 50 year old right handed man presented with weakness of his right leg and arm of two months’ duration. The symptoms had come on over several days, during which he described a “dead leg” and he noticed his foot dragging while walking. On examination he had right lower limb pyramidal type distal weakness with a foot drop, power was graded at 4/5, and he had an upgoing plantar reflex. A computed tomogram of the brain showed a left parietal lesion with surrounding oedema but no midline shift, so contrast enhanced magnetic resonance imaging was undertaken (figs 1⇓ and 2⇓). Analysis of the cerebrospinal fluid showed raised protein with normal cell counts, normal angiotensin converting enzyme values, oligoclonal bands, IgG of 185 mg/L (normal value <40), and a negative viral polymerase chain reaction. Serum immunoglobulins and vitamin B12 values were normal; viral antibodies and antibodies for spirochetes were negative. He had no history of a neurological deficit.  
www.bmj.com
over 5 years ago
Preview
2
40

Review of Edema

Edema presentation, showing definitions, physiology, etiology and related factors.  
SlideShare
almost 5 years ago
Preview
1
38

Cirrhosis - Physical Findings

A review of the physical exam findings of cirrhosis, including ascites, edema, jaundice, caput medusae, asterixis, hypotension, palmar errythema, gynecomasti...  
YouTube
almost 5 years ago
Preview
2
78

Acute Cholecystitis

This page includes the following topics and synonyms: Acute Cholecystitis, Hydrops Gallbladder, Cholecystitis.  
fpnotebook.com
over 4 years ago
Preview
1
78

Cirrhosis - Physical Findings

A review of the physical exam findings of cirrhosis, including ascites, edema, jaundice, caput medusae, asterixis, hypotension, palmar errythema, gynecomasti...  
YouTube
over 4 years ago
Preview
1
201

Nephrotic Syndrome: Background, Pathophysiology, Etiology

Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic-range proteinuria is 3 grams per day or more.  
emedicine.medscape.com
over 4 years ago
Preview
1
28

A case of progressive bilateral pitting oedema

A 68 year old man presented with a two month history of progressive shortness of breath. He had previously been able to swim three times a week, but was now becoming short of breath on climbing stairs. His associated symptoms included orthopnoea, swollen ankles, weight gain, and anorexia. He was being treated with simvastatin for hypercholesterolaemia and diltiazem for hypertension and had never smoked.  
bmj.com
over 4 years ago
Foo20151013 2023 2njk5o?1444774020
4
1326

LWW: Case Of The Month - April 2013

This month’s case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e, with 15% off using the discount code: MEDUCATION. The case below is followed by a quiz question, allowing you a choice of diagnoses. Select the one letter section that best describes the patient’s condition. The Case A 28-year old woman has an unremarkable pregnancy through her first 28 weeks of gestation, with normal weight gain and no serious complications. She has no previous history of diabetes, hypertension of other systemic disease before or during her current pregnancy. During her 30-week checkup, her blood pressure measures 128/85, and she complains about feeling slightly more “bloated” than usual with swelling in her legs that seems to get more uncomfortable as the day goes on. Her obsterician recommends that she get more bed rest, stay off her feet as much as possible and return for evaluation in one week. At the one-week follow-up, the patient presents with noticable”puffiness” in her face, and a blood pressure of 145/95. She complains she has been developing headaches, sporadic blurred vision, right-sided discomfort and some shortness of breath. She has gained more than 10 lb (4.5kg) in the past week. A urinalysis on the patient revelas no glucose but a 3+ reading for protein. Her obstetrician decides to admit her immediately to a local tertiary care hospital for further evaluation. Over the next 24 hours, the patient’s urine output is recorded as 500mL and contains 6.8 grams of protein. Her plasma albumin level is 3.1 g/dl, hemacrit 48%, indirect bilirubin 1.5mg/dl and blood platelets=77000/uL, respectively. Her blood pressure is now 190/100. It is decided to try to deliver the foetus. The expelled placenta is small and shows signs of widespread ischmic damage. Within a week of delivery, the mother’s blood pressure returns to normal, and her oedema subsides. One month later, the mother shows no ill effects of thos later-term syndrome. Question What is the clinical diagnosis of this patient’s condition and its underlying pathophysiology? A. Gestational Hypertension B. Preeclampsia C. Gestational Diabetes D. Compression of the Inferior Vena Cava Answer The correct answer is "B. Preeclampsia". The patient’s symptoms and laboratory findings are consistent with a diagnosis of Preeclampsia, which is a condition occurring in some pregnancies that causes life-threatening organ and whole body regulatory malfunctions. The patient’s negative urine glucose is inconsistent with gestational diabetes. Gestational hypertension or vena caval compression cannot explain all of the patient findings. The patient has three major abnormal findings- generalised oedema, hypertension and proteinuria which are all common in preeclampsia. Although sequalae of a normal pregnancy can include water and salt retention, bloating, modest hypertension and leg swelling (secondary to capillary fluid loss from increased lower limb capillary hydrostatic pressure due to compression of the inferior vena cava by the growing foetus/uterus), oedema in the head and upper extremities, a rapid 10 pound weight gain and shortness of breath suggests a generalized and serious oedematous state. The patient did not have hypertension before or within 20 weeks gestation (primary hypertension) and did not develop hypertension after the 20th week of pregnancy with no other abnormal findings (gestational hypertension). Hypertension with proteinuria occurring beyond the 20th week of pregnancy however is a hallmark of preeclampsia. In addition, the patient has hemolysis (elevated bilirubin and LDH levels), elevated liver enzyme levels and thrombocytopenia. This is called the HELLP syndrome (HELLP = Hemolysis, Elevated Liver enzymes and Low Platelets.), and is considered evidence of serious patient deterioration in preeclampsia. A urine output of 500 ml in 24 hours is 1/2 to 1/4 of normal output in a hydrated female and indicates renal insufficiency. Protein should never be found in the urine and indicates loss of capillaries integrity in glomeruli which normally are not permeable to proteins. The patient has substantial 24 urine protein loss and hypoalbuminemia. However, generally plasma albumin levels must drop below 2.5 gm/dl to decrease plasma oncotic pressure enough to cause general oedema. The patient’s total urinary protein loss was insufficient in this regard. Capillary hyperpermeability occurs with preeclampsia and, along with hypertension, could facilitate capillary water efflux and generalized oedema. However myogenic constriction of pre-capillary arterioles could reduce the effect of high blood pressure on capillary water efflux. An early increase in hematocrit in this patient suggests hemoconcentration which could be caused by capillary fluid loss but the patient’s value of 48 is unremarkable and of little diagnostic value because increased hematocrit occurs in both preeclampsia and normal pregnancy. PGI2, PGE2 and NO, produced during normal pregnancy, cause vasorelaxation and luminal expansion of uterine arteries, which supports placental blood flow and development. Current theory suggests that over production of endothelin, thromboxane and oxygen radicals in preeclampsia antagonize vasorelaxation while stimulating platelet aggregation, microthrombi formation and endothelial destruction. These could cause oedema, hypertension, renal/hepatic deterioration and placental ischemia with release of vasotoxic factors. The patient’s right-sided pain is consistent with liver pathology (secondary to hepatic DIC or oedematous distention). Severe hypertension in preeclampsia can lead to maternal end organ damage, stroke, and death. Oedematous distension of the liver can cause hepatic rupture and internal hemorrhagic shock. Having this patient carry the baby to term markedly risks the life of the mother and is not considered current acceptable clinical practice. Delivery of the foetus and termination of the pregnancy is the only certain way to end preeclampsia. Read more This case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at (lww.co.uk)[http://lww.co.uk] when you use the code MEDUCATION when you check out! About LWW/ Wolters Kluwer Health Lippincott Williams and Wilkins (LWW) is a leading publisher of high-quality content for students and practitioners in medical and related fields. Their text and review products, eBooks, mobile apps and online solutions support students, educators, and instiutions throughout the professional’s career. LWW are proud to partner with Meducation.  
Lippincott Williams & Wilkins
over 6 years ago
Foo20151013 2023 1eqve0g?1444774030
1
89

LWW: Case Of The Month - May 2013

This month’s case is by Barbara J. Mroz, M.D. and Robin R. Preston, Ph.D., author of Lippincott’s Illustrated Reviews: .Physiology (ISBN: 9781451175677). For more information, or to purchase your copy, visit: http://tiny.cc/PrestonLIR, with 15% off using the discount code: MEDUCATION. The case below is followed by a choice of diagnostic tests. Select the one lettered selection that would be most helpful in diagnosing the patient’s condition. The Case A 54-year-old male 2 pack-per-day smoker presents to your office complaining of cough and shortness of breath (SOB). He reports chronic mild dyspnea on exertion with a daily cough productive of clear mucus. During the past week, his cough has increased in frequency and is now productive of frothy pink-tinged sputum; his dyspnea is worse and he is now short of breath sometimes even at rest. He has had difficulty breathing when lying flat in bed and has spent the past two nights sleeping upright in a recliner. On physical examination, he is a moderately obese male with a blood pressure of 180/80 mm Hg, pulse of 98, and respiratory rate of 22. His temperature is 98.6°F. He becomes winded from climbing onto the exam table. Auscultation of the lungs reveals bilateral wheezing and crackles in the lower posterior lung fields. There is pitting edema in the lower extremities extending up to the knees.  Question Which if the following tests would be most helpful in confirming the correct diagnosis? A. Spirometry B. Arterial blood gas C. Complete blood count D. B-type natriuretic peptide blood test E. Electrocardiogram Answer? The correct answer is B-type natriuretic peptide blood test. Uncomfortable breathing, or feeling short of breath, is a common medical complaint with multiple causes. When approaching a patient with dyspnea, it is helpful to remember that normal breathing requires both a respiratory system that facilitates gas exchange between blood and the atmosphere, and a cardiovascular system that transports O2 and CO¬2 between the lungs and tissues. Dysfunction in either system may cause dyspnea, and wheezing (or bronchospasm) may be present in both cardiac and pulmonary disease. In this patient, the presence of lower extremity edema and orthopnea (discomfort when lying flat) are both suggestive of congestive heart failure (CHF). Elevated blood pressure (systolic of 180) and a cough productive of frothy pink sputum may also be associated symptoms. While wheezing could also be caused by COPD (chronic obstructive pulmonary disease) in the setting of chronic tobacco use, the additional exam findings of lung crackles and edema plus systolic hypertension are all more consistent with CHF. What does the B-type natriuretic peptide blood test tell us? When the left ventricle (LV) fails to maintain cardiac output (CO) at levels required for adequate tissue perfusion, pathways are activated to increase renal fluid retention. A rising plasma volume increases LV preload and sustains CO via the Frank-Starling mechanism. Volume loading also stimulates cardiomyocytes to release atrial- (ANP) and B-type (BNP) natriuretic peptides. BNP has a longer half-life than ANP and provides a convenient marker for volume loading. Plasma BNP levels are measured using immunoassay; levels >100 pg/mL are suggestive of overload resulting in heart failure. How does heart failure cause dyspnea? Increasing venous pressure increases mean capillary hydrostatic pressure and promotes fluid filtration from the vasculature. Excess filtration from pulmonary capillaries causes fluid accumulation within the alveoli (pulmonary edema) and interferes with normal gas exchange, resulting in SOB. Physical signs and symptoms caused by high volume loading include: (1) Lung crackles, caused by fluid within alveoli (2) Orthopnea. Reclining increases pulmonary capillary hydrostatic pressure through gravitational effects, worsening dyspnea when lying flat. (3) Pitting dependent edema caused by filtration from systemic capillaries, an effect also influenced by position (causing edema in the lower legs as in our ambulatory patient or in dependent areas like the sacrum in a bedridden patient). What would an electrocardiogram show? Heart failure can result in LV hypertrophy and manifest as a left axis deviation on an electrocardiogram (ECG), but some patients in failure show a normal ECG. An ECG is not a useful diagnostic tool for dyspnea or CHF per se. Wouldn’t spirometry be more suitable for diagnosing the cause of dyspnea in a smoker? Simple spirometry will readily identify the presence of airflow limitation (obstruction) as a cause of dyspnea. It's a valuable test to perform in any smoker and can establish a diagnosis of chronic obstructive pulmonary disease (COPD) if abnormal. While this wheezing patient is an active smoker who could have airflow obstruction, the additional exam findings above point more to a diagnosis of CHF. What would an arterial blood gas show? An arterial blood gas measures arterial pH, PaCO¬2, and PaO2. While both CHF and COPD could cause derangements in the values measured, these abnormalities would not necessarily be diagnostic (e.g., a low PaO2 could be seen in both conditions, as could an elevated PaCO¬2). Would a complete blood count provide useful information? A complete blood count could prove useful if anemia is a suspected cause of dyspnea. Test result BNP was elevated (842 pg/mL), consistent with CHF. Diuretic treatment was initiated to help reduce volume overload and an afterload reducing agent was started to lower blood pressure and improve systolic function.  
Lippincott Williams & Wilkins
over 6 years ago
Preview
0
21

A case of progressive bilateral pitting oedema

A 68 year old man presented with a two month history of progressive shortness of breath. He had previously been able to swim three times a week, but was now becoming short of breath on climbing stairs. His associated symptoms included orthopnoea, swollen ankles, weight gain, and anorexia. He was being treated with simvastatin for hypercholesterolaemia and diltiazem for hypertension and had never smoked.  
feeds.bmj.com
over 4 years ago
Preview
0
11

Peripheral Edema: The Drug Behind the Edema

A number of drugs are associated with peripheral edema. What's going on in this case?  
medscape.com
over 4 years ago
Preview
0
7

UOTW #42 – Ultrasound of the Week

52 y/o male presents stating that he has had an area of redness on his right thigh that has “fever” in it. No systemic fever/SOB/CP. On physical exam, vitals are normal and there is a 5 cm patch of erythema and induration on the patient’s right anterior thigh. No lower extremity edema, no fluctuance of the area. You recall an article that showed 40% of patients with clinically suspected cellulitis were diagnosed with abscess via ultrasound and required incision and drainage, so you obtain the following scan.  What’s the diagnosis?  
ultrasoundoftheweek.com
over 4 years ago
9
0
14

Asthma in Adults

Say what? Chronic inflammation of your patient’s bronchi. Their bronchi are hypersensitive to environmental or intrinsic stimuli, leading to reversible episodes of bronchial constriction and mucosal edema. Your patient will report: Wheezing Cough Dyspnea Chest tightness Chest pain You will ask about: Comorbid diseases - you do not want to overlook another etiology to your…  
foamneedssoap.com
over 4 years ago
Www.bmj
0
10

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago
Preview
0
8

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago
Preview
0
8

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
10

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago
Preview
0
12

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago
Preview
0
10

A 77 year old man with asthma and renal impairment

A 77 year old man presented after a collapse at home with a three week history of dyspnoea, malaise, and myalgia. He reported a 10 year history of hypertension, and that he had undergone a nasal polypectomy seven years earlier and had recently been diagnosed as having asthma. Prescribed drugs included candesartan 4 mg daily, enalapril 20 mg daily, beclometasone dipropionate 200 µg twice daily, and salbutamol as needed. He had not recently changed his drugs or used non-steroidal anti-inflammatory agents or herbal remedies. On examination his blood pressure was 156/88 mm Hg; temperature was 36.8°C; and he had generalised polyphonic wheeze, raised jugular venous pressure (5 cm above the sternal angle), and mild bilateral ankle oedema.  
feeds.bmj.com
over 4 years ago