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13 Posts

sandra
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08/21/06 - 06:17 PM

40. A 54-year-old man has a 3-week history of
bilateral ankle swelling. Evaluation shows the
following pressures:

Capillary hydrostatic 32 mm Hg N=35-45
Interstitial hydrostatic 10 mm Hg N=2-5
Capillary oncotic 18 mm Hg N=23-27
Interstitial oncotic 0 mm Hg N=1-3

Which of the following is the most likely explanation
for the ankle swelling?

A. Chronic bronchitis
B. Congestive heart failure
C. Hepatic venous outflow obstruction
D. Lymphatic obstruction
E. Nephrotic syndrome

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mitty
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08/21/06 - 07:03 PM

E

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sridevibandaru24
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08/22/06 - 08:31 PM

D since interstitial hydrostatic pressure is elevated

DrS
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08/22/06 - 10:03 PM

E,

Increased interstitial hydrostatic pressure would not cause edema, it would actually work against it.

docarchana
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08/22/06 - 10:17 PM

nephrotic - loss of protein - dec plasma oncotic

MRMAVERICK
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08/23/06 - 01:06 AM

it looks like e-

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MRMAVERICK
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08/23/06 - 01:07 AM

but pls can u explain y capilarry hydrostatic pressure is decreased

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muzammil
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08/23/06 - 01:37 PM

i wud go for nephrotic

hari.v
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08/26/06 - 09:24 AM

would capply hydrostatic pr decrease as a compensatory mechm. decreased ocotic leading to oedema leading to increased interstitial hydrostatic pr and thus dec capp hydro pr.??? or am i just messed up!!

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Allison
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10/30/06 - 10:33 PM

#10

E. Nephrotic syndrome
Capillary oncotic pressure is decreased by renal disease.

drfax
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10/30/06 - 11:42 PM

#11

The answer is E. , but why ?

capillary oncotic pressure reflect presence of plasma protien, and recall that plasma protien "sucks" fluid from interstitial, therefore decrease in capillary oncotic pressue (or plasma protien) will lead to accumulation of fluid in interstitial space and Edema,

also the most common cause of decrease oncotic pressure is RENAL DISEASE specifically NEPHROTIC SYNDROME which causes loss of high amount of plasma protien (=oncotic pressure) more than 3 g/24 hrs.

the second most common cause is pregnancy because of relative decrease in albumin.

Best luck

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usmle4me
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10/31/06 - 07:36 AM

#12

shall go with E

ssrpk
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10/31/06 - 12:02 PM

#13

exactly E!

if it were lymphatic obstruction, interstitial oncotic pressure wub hv been elevated!

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