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Old 02-09-2013
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Question Edema Pathophysiology

Physical examination reveals symmetrical pitting edema of ankles, which of the following most likely decrease in this patient??

1) plasma oncotic pressure
2) tissue lymphatic drainage
3) circulating aldosterone level
4) capillary hydrostatic pressure

i know its easy question not difficult but after your's response i will ask another question which is related to this question, first give me answer of this question
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Last edited by neha_subh; 02-09-2013 at 03:21 AM.
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2) tissue lymphatic drainage
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plasma oncotic pressure
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ya its plasma oncotic pressure.. i was wrong
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Q:2)
this patient most likely has hypoalbuminemia, then what will be the aldosterone level seen in this patient increased or decreased??
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Increase right?

Well, when it comes to transudate (pitting edema) i usually think of heart failure.
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Quote:
Originally Posted by abcxyz View Post
Increase right?

Well, when it comes to transudate (pitting edema) i usually think of heart failure.
what about nephrotic syndrome ?
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Old 02-09-2013
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ya..nephrotic syndrome or liver cirrhosis. Just to get the general idea that protein low --> transudate (pitting edema)

But I guess in either case, renin (and thus aldosterone) would increase because fluid would move out of the blood vessel.

In heart failure, renin would increase due to low renal perfusion.

Hope i have the concept right
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Aldosterone should be high.. In heart failure, ..macula densa .. JGA.. Renin.. Aldosterone..
In nephrotic/ cirrhotic, fluid loss to interstitium.. Again same reason.. Macula densa.. JGA.. Renin.. Aldosterone
??
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Quote:
Originally Posted by neha_subh View Post
Physical examination reveals symetrical piting edema of ankles,which of the folowing most likely decrease in this patient??

1) plasma oncotic presure
2)tisue lymphatic drainage
3)circulating aldosterone level
4)capilary hydrostatic presure



i know its easy question not dificuilt but after your's response i wil ask another question which is related to this question, first give me answer of this question


There will be decrease plasma oncotic pressure due to the fact that there's decrease albumin. Sounds like Nephrotic syndrome to me.

Next, what about aldostrone level?

Well, here's how I would think about it. Besides Nephrotic syndrome, what else causes edema? How about Right sided heart failure? What causes Right Sided heart failure? How about Left sided heart failure? Now put Left sided heart failure + Right sided heart failure together and you now have Congestive heart failure.

Next, what happens in CHF?

1. Decrease Blood Pressure
2. Decrease Renal perfusion pressure

Then what happens?

1. Increase sympathetic nerves
2. Increase Renin secretion - which increase aldosterone

So in Edema there is:

1. Decreased plasma oncotic pressure
2. Increased aldosterone

In other way of looking at it, Nephrotic syndrome belongs to Transudate. What else belongs in this group of Transudate? How about CHF?



A friend of mine told me the difference between Exudate and Transudate when I asked. Remember?

Last edited by Doctor Ali; 02-09-2013 at 12:12 PM.
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Default nephrotic syndrome:

Physical examination reveals symmetrical pitting edema of ankles, which of the following most likely decrease in this patient??

1) plasma oncotic pressure------decrease (hypoalbuminemia)
2) tissue lymphatic drainage-----increased (bc fluid is acumulated in intrstitium it must be drained particularly in this patient)
3) circulating aldosterone level--increased (bc decrease intravascular volume due to leakage into intrstitium-- compnsatory increase aldosterone--fluid retention)
4) capillary hydrostatic pressure--increased..

this patient has nephrotic syndrome..
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Old 02-10-2013
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Default we really need threads like this one..

hello everybody this is my first post..

I really think we need more of such posts discussing multi step questions and testing our understanding randomly..

Cud we make this thread the mother thread of such useful stuff??
To let anybody ask confusions, share amazing mechanisms/links/logics between topics etc..?
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Default pahtophysio quesiton pool:

Quote:
Originally Posted by singular View Post
hello everybody this is my first post..

I really think we need more of such posts discussing multi step questions and testing our understanding randomly..

Cud we make this thread the mother thread of such useful stuff??
To let anybody ask confusions, share amazing mechanisms/links/logics between topics etc..?
dont ask you can...
put questions in this pool (easy+ dificult)
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Question Acid Base disorder:

High altitude exposure lasting more than few days (5days),ABG's value would be most expected in this patient???

-- PH -- PaO2 -- PaCO2 -- HCO3

a) 7.48 -- 60 -- 20 -- 15

b) 7.50 --96-- 30-- 17

c) 7.57 -- 75 -- 50 -- 32
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ans; A
renal compensation within 2 days and max effect within 5 days
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Quote:
Originally Posted by neha_subh View Post
High altitude exposure lasting more than few days (5days),ABG's value would be most expected in this patient???

-- PH -- PaO2 -- PaCO2 -- HCO3

a) 7.48 -- 60 -- 20 -- 15

b) 7.50 --96-- 30-- 17

c) 7.57 -- 75 -- 50 -- 32

mine next question is: in emphysema alveolar spaces dilated then whats the reason behind air flow obstruction??
if any one have lil bit concept about it so pls share with us
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Quote:
Originally Posted by neha_subh View Post
mine next question is: in emphysema alveolar spaces dilated then whats the reason behind air flow obstruction??
if any one have lil bit concept about it so pls share with us

in emphysema, there's destruction of elastic tissue which leads to increase in compliance(yielding to pressure) and decrease in elasticity(not returning to original configuration).

they used to say in physiology that when we expire, it's out diaphragm which relaxes (passive process) and since it's contraction downwards produces -ve intrathoracic pressure, relaxation upwards produces relative +ve intrathoracic pressure. now if the conduit through which air passes is compliant and non-elastic, development of positive intrathoracic pressure over the conduit during expiration squeezes and collapses it which can't return to it's original open configuration coz of no elasticity.. so the air doesn't flow out of lungs and is retained. to make matters worse, inspired air with +ve pressure opens the conduit and fills alveoli more and more without air exiting, increasing the flexible A-P diameter to produce characteristic barrel chest.
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Quote:
Originally Posted by neha_subh View Post
mine next question is: in emphysema alveolar spaces dilated then whats the reason behind air flow obstruction??
if any one have lil bit concept about it so pls share with us
Emphysema causes hypoxia by dilating alveolar spaces so that there is insuficient contact between the air spaces and deoxygenated blood in the alveolar capilaries
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High altitude exposure lasting more than few days (5days),ABG's value would be most expected in this patient???

-- PH -- PaO2 -- PaCO2 -- HCO3

a) 7.48 -- 60 -- 20 -- 15 (answer)

b) 7.50 --96-- 30-- 17

c) 7.57 -- 75 -- 50 -- 32
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Quote:
Originally Posted by neha_subh View Post
High altitude exposure lasting more than few days (5days),ABG's value would be most expected in this patient???

-- PH -- PaO2 -- PaCO2 -- HCO3

a) 7.48 -- 60 -- 20 -- 15 (answer)

b) 7.50 --96-- 30-- 17

c) 7.57 -- 75 -- 50 -- 32
hmm ya its A..
resp alkalosis wid compensation of met acidosis..(renal)

and what can be said abt option C? is it uncompensated rep alkalosis?
if yes --> Is exposure of 5 days only key feature to choose the answer A then C??
plz explain?
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Quote:
Originally Posted by nandish_m View Post
hmm ya its A..
resp alkalosis wid compensation of met acidosis..(renal)

and what can be said abt option C? is it uncompensated rep alkalosis?
if yes --> Is exposure of 5 days only key feature to choose the answer A then C??
plz explain?
thats a picture of met. alkalosis
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Quote:
Originally Posted by nandish_m View Post
hmm ya its A..
resp alkalosis wid compensation of met acidosis..(renal)

and what can be said abt option C? is it uncompensated rep alkalosis?
if yes --> Is exposure of 5 days only key feature to choose the answer A then C??
plz explain?
C) metabolic alkalosis (Increased HCO3) compensated with hypoventilation (increased PaCO2)

B) respiratory alkalosis (increased PaO2) compenasated with metabolic acidosis (dec.HCO3)
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Default Allocation bias:

please tell me lil bit about alocation bias it results from the way that treatment and controled groups are assembled i cant understand its theory,when i see bias i get worse headache what should i do with them because these bias dont cros mine brain bariers easily i tried alot to improve biostatics but these bias wil take mine life one day esp on exam day
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Default alocation bias:

Quote:
Originally Posted by neha_subh View Post
alocation bias it results from the way that treatment and controled groups are assembled
got this explanation(from wikipedia):
it may ocur if subjects are assigned to study group of clinical trial in a non random fashion.
here is example: in a study group oral NSAIDs and intra articular corticosteroids injections for the treatment of the osteoarthritis,obese patient may be preferentialy assigned to the corticosteroids group.
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