Questions and Answers



2013 The Swollen Limb: Questions and Answers

1. Oedema can be described as the accumulation of excess fluid in the

intracellular space.

2. Oedema may occur when the net fluid filtration from blood to tissue exceeds lymphatic drainage

3. Extracellular fluid is made up of interstitial fluid and circulating plasma.

4. The body water content of infants is around 45% of their body weight.

5. The interstitial space can be described as a framework of collagen and other fibrous molecules called glycosaminoglycans (long chain amino sugar polymers)

6. Relating to the principal of fluid exchange: interstitial fluid originates from plasma in the micro circulation

7. Relating to the principal of fluid exchange: fluid crosses the micro vessels at a rate determined by pressures on either sides of the wall

8. Relating to the principal of fluid exchange: interstitial fluid is continuously produced and removed and returned to the vascular system by the lymphatic circulation via the connection at the base of the each kidney known as thoracic duct and right thoracic duct

9. Increased capillary venous pressure without obstruction can be caused by cardiac failure

10. Increased capillary venous pressure without obstruction can be caused by primary superficial venous reflux

11. Diminished reabsorption of interstitial fluid due to reduced capillary osmotic pressure can be due to renal disease

12. Diminished reabsorption of interstitial fluid due to reduced capillary osmotic pressure can be due to primary lymphoedema

13. The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure.

14. Renin is a proteolytic enzyme that is released into the circulation primarily by the kidneys. Its release is stimulated by renal artery hypotension caused by systemic hypotension or renal artery stenosis

15. The macula densa senses the amount of sodium and chloride ion in the distal tubules

16. Angiotensin II has several important functions including stimulation of thirst centres within the brain

17. A cardiovascular examination should be done on patients with bilateral oedema

18. The findings of bilateral pitting oedema, a raised JVP, a third heart sound and basal crepitations of the lung suggest the findings of calf DVT

19. The findings of bilateral pitting oedema, a raised JVP, a third heart sound and basal crepitations of the lung suggest the findings of deep venous insufficiency of the femoral veins bilaterally

20. Important findings in the differential diagnosis of patients with swollen lower limbs includes whether the condition is unilateral or bilateral

21. Important findings in the differential diagnosis of patients with swollen lower limbs includes the medication taken

22. If chronic swelling is unilateral the cause is generally local and the most frequent diagnostic problem is whether the oedema is venous, arterial or both.

23. Primary lymphoedema is much more common than secondary lymphoedema

24. Lymphoedema is never associated with pitting oedema

25. Stemmer’s sign is a useful test for lymphoedema.

26. Calcium channel blockers are commonly used for the treatment of hypertension and if used with a diuretic, they do not cause oedema.

27. Oedema is never normal in pregnancy and requires full examination and

often drug treatment.

28. “Idiopathic oedema” describes a poorly understood syndrome of abnormal fluid retention that primarily affects middle aged men.

29. Pulmonary Hypertension can cause peripheral oedema

30. Some patients with oedema have multiple causes

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