WBR0676
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 62 year old man, with a past medical history of myocardial infarction and heart failure, is brought to the emergency department in severe shortness of breath. He is unable to continue his sentences is breathing rapidly at rest. Physical examination is remarkable for tachycardia, tachypnea, diffuse fine crackles on anteroposterior pulmonary auscultation and lower extremity edema. Following appropriate work-up and imaging, the diagnosis of cardiogenic pulmonary edema is made. If the patient's pulmonary fluid and serum are to be analyzed, which of the following will most likely be present in the patient's condition?]] |
| Answer A | AnswerA::High fluid to serum protein ratio |
| Answer A Explanation | AnswerAExp::Transudative fluid usually has a low fluid to serum protein ratio. |
| Answer B | [[AnswerB::Fluid Specific gravity > 1.020]] |
| Answer B Explanation | [[AnswerBExp::The fluid specific gravity is usually low < 1.012.]] |
| Answer C | AnswerC::High fluid to serum lactate dehydrogenase (LDH) ratio |
| Answer C Explanation | AnswerCExp::Transudates generally have a low fluid to serum lactate dehydrogenase (LDH) ratio. |
| Answer D | AnswerD::Fluid poor in cellular components |
| Answer D Explanation | AnswerDExp::Transudates have fluid poor in cellular components. |
| Answer E | AnswerE::Serum with elevated oncotic pressure |
| Answer E Explanation | AnswerEExp::Cardiogenic edema has low serum oncotic pressure. |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::The patient is diagnosed with cardiogenic pulmonary edema, that is one of the main etiologies of transudative fluids. Transudates can be distinguished from exudates by their hypo cellular and protein-poor fluid. Accordingly, they have low specific gravities, usually < 1.012. Cardiogenic edema is due to elevated hydrostatic pressures and low oncotic pressures. In contrast, exudates are cellular, protein-rich fluids that have high specific gravities, usually > 1.020. They are commonly caused by lymphatic obstruction and inflammation.
Educational Objective:
Cardiogenic edema is associated with transudative fluid and low oncotic pressure and high hydrostatic pressure. |
| Approved | Approved::No |
| Keyword | WBRKeyword::oncotic, WBRKeyword::hydrostatic, WBRKeyword::pressure, WBRKeyword::pressures, WBRKeyword::cardiogenic, WBRKeyword::edema, WBRKeyword::lower, WBRKeyword::extremity, WBRKeyword::pulmonary, WBRKeyword::transudate, WBRKeyword::transudative, WBRKeyword::exudate, WBRKeyword::exudative, WBRKeyword::fluid, WBRKeyword::serum, WBRKeyword::ratio, WBRKeyword::cellular, WBRKeyword::protein, WBRKeyword::specific, WBRKeyword::gravity, WBRKeyword::lactate, WBRKeyword::dehydrogenase, WBRKeyword::LDH |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |