LearnWithTest

1 A 55-year-old man with long-standing congestive heart failure presents with worsening bilateral pedal edema despite normal serum albumin levels. Which physiological mechanism is the primary driver of edema formation in this patient?

Reduced plasma oncotic pressure due to protein loss Increased capillary hydrostatic pressure secondary to venous congestion Primary lymphatic obstruction Increased capillary permeability from inflammation

2 A 28-year-old woman with nephrotic syndrome develops generalized edema and ascites. Which sequence best explains the pathophysiology of edema in this condition?

Proteinuria → sodium loss → hypovolemia → edema Proteinuria → hypoalbuminemia → reduced oncotic pressure → interstitial fluid accumulation Proteinuria → increased capillary permeability → lymphatic failure Proteinuria → hypertension → venous obstruction

3 A patient with severe sepsis develops rapidly progressive generalized edema with normal cardiac function. Which mechanism most directly explains this finding?

Renal sodium retention mediated by aldosterone Decreased lymphatic drainage Increased capillary permeability due to inflammatory mediators Reduced plasma oncotic pressure from malnutrition

4 A 45-year-old man develops unilateral leg edema after prolonged immobilization. Doppler confirms deep vein thrombosis. What is the primary physiological cause of edema in this condition?

Reduced plasma oncotic pressure Increased capillary permeability Increased venous and capillary hydrostatic pressure distal to obstruction Lymphatic failure due to inflammation

5 A patient with advanced liver cirrhosis develops peripheral edema and ascites. Which combination of mechanisms is most responsible?

Increased capillary permeability and lymphatic obstruction Portal hypertension and hypoalbuminemia Primary renal sodium loss Reduced venous pressure and vasodilation

6 A woman on long-term amlodipine therapy develops bilateral ankle edema without cardiac or renal disease. What is the key physiological mechanism?

Renal sodium retention Preferential arteriolar dilation increasing capillary hydrostatic pressure Direct endothelial injury Reduced lymphatic flow

7 A patient with severe hypothyroidism presents with non-pitting facial and limb edema. Why does this edema fail to pit on pressure?

High capillary hydrostatic pressure Protein-rich inflammatory exudate Deposition of glycosaminoglycans binding water in interstitium Venous obstruction

8 A malnourished patient presents with bilateral pedal edema but normal renal function. Which physiological abnormality is most likely?

Increased hydrostatic pressure Decreased plasma oncotic pressure Increased capillary permeability Primary lymphatic obstruction

9 A patient with chronic kidney disease has persistent edema despite normal serum albumin. What mechanism best explains this?

Reduced capillary permeability Excess renal sodium and water retention Lymphatic obstruction Primary venous insufficiency

10 A critically ill patient receiving large volumes of IV fluids develops generalized edema. Which Starling force alteration is most responsible?

Decreased interstitial oncotic pressure Increased capillary hydrostatic pressure Reduced plasma oncotic pressure Increased lymphatic drainage

11 A patient with chronic lymphedema develops progressive limb swelling without pitting. Which mechanism is central to this condition?

Increased venous pressure Decreased plasma albumin Failure of lymphatic drainage Capillary endothelial injury

12 A patient with nephrotic syndrome develops edema that worsens after diuretic therapy. Which physiological explanation best accounts for diuretic resistance?

Excessive lymphatic drainage Reduced intravascular volume due to hypoalbuminemia Primary venous obstruction Increased capillary permeability

13 A patient with acute allergic angioedema develops rapid facial swelling. Which mechanism is responsible?

Reduced plasma oncotic pressure Increased capillary permeability mediated by histamine Venous obstruction Renal sodium retention

14 A patient with chronic venous insufficiency presents with ankle edema and skin hyperpigmentation. What physiological factor predominates?

Decreased lymphatic flow Increased venous and capillary hydrostatic pressure Reduced oncotic pressure Inflammatory capillary leak

15 A patient develops generalized edema with normal heart, liver, and kidney function tests. Capillary leak syndrome is suspected. Which mechanism best defines this condition?

Isolated sodium retention Reduced plasma oncotic pressure alone Systemic increase in capillary permeability Primary lymphatic obstruction

16 A 64-year-old man presents with progressive bilateral leg swelling for 6 months, worse at the end of the day and associated with skin hyperpigmentation and varicosities. Cardiac, renal, and liver function tests are normal. What is the most likely cause of edema?

Nephrotic syndrome Congestive heart failure Chronic venous insufficiency Hypothyroidism

17 A 30-year-old woman presents with sudden unilateral painful swelling of the left leg after a long-haul flight. The limb is warm and tender. What is the most appropriate diagnostic test?

Serum albumin Echocardiography Venous Doppler ultrasound Lymphoscintigraphy

18 A 7-year-old child presents with periorbital edema, frothy urine, and normal blood pressure. Urinalysis shows heavy proteinuria. Which investigation confirms the underlying diagnosis?

Serum electrolytes 24-hour urinary protein estimation Renal artery Doppler Serum calcium level

19 A patient with known liver cirrhosis presents with pedal edema and tense ascites. Which laboratory abnormality most strongly contributes to edema formation?

Elevated serum bilirubin Low serum albumin High serum ammonia Elevated alkaline phosphatase

20 A 55-year-old man presents with generalized edema, raised jugular venous pressure, and basal lung crepitations. Urinalysis is normal. What is the most likely diagnosis?

Nephrotic syndrome Congestive heart failure Cirrhosis of liver Lymphedema

21 A woman develops chronic non-pitting swelling of the right arm following breast cancer surgery and radiotherapy. Which diagnostic feature supports this cause?

Improvement with diuretics Positive pitting sign Thickened skin with reduced mobility Raised serum creatinine

22 A patient presents with facial swelling, hoarseness of voice, and difficulty breathing shortly after taking an ACE inhibitor. What is the most likely diagnosis?

Nephrotic edema Cardiac edema Angioedema Myxedema

23 A malnourished elderly patient presents with bilateral pedal edema. Which investigation is most useful to confirm the cause?

Serum albumin level Echocardiography Venous Doppler ultrasound TSH level

24 A patient with chronic kidney disease develops worsening edema despite normal serum albumin levels. Which test best explains the cause?

Urine sodium concentration Serum creatinine and urea Liver function tests Serum lipid profile

25 A patient presents with generalized edema, hypotension, and hemoconcentration after severe sepsis. Which diagnosis should be suspected?

Heart failure Nephrotic syndrome Capillary leak syndrome Cirrhosis of liver

26 A patient has bilateral ankle edema after starting amlodipine therapy. Cardiac and renal evaluations are normal. What is the most likely diagnosis?

Drug-induced edema Venous thrombosis Nephrotic syndrome Lymphedema

27 A patient presents with early morning periorbital edema and hypertension. Which investigation is most relevant?

Chest X-ray Urine routine examination Venous Doppler study Liver ultrasound

28 A patient with unilateral leg edema, skin thickening, and recurrent cellulitis is evaluated. Which diagnosis best fits this presentation?

Deep vein thrombosis Chronic venous insufficiency Lymphedema Nephrotic syndrome

29 A patient presents with massive generalized edema including ascites and pleural effusion. What term best describes this condition?

Localized edema Myxedema Anasarca Angioedema

30 A patient with edema has normal heart function, normal renal tests, normal liver enzymes, and non-pitting swelling. Which investigation is most useful next?

Serum albumin Lymphoscintigraphy Echocardiography 24-hour urine protein

31 A 58-year-old man with congestive heart failure presents with worsening bilateral pedal edema, raised JVP, and basal crepitations despite being on low-dose furosemide. What is the most appropriate next step in management?

Stop diuretics to prevent renal injury Increase loop diuretic dose and add salt restriction Start albumin infusion alone Initiate compression stockings immediately

32 A patient with nephrotic syndrome has massive edema and poor response to high-dose loop diuretics. What is the best adjunctive therapy to improve diuretic effectiveness?

Beta blockers Intravenous albumin followed by loop diuretics Calcium channel blockers Thiazide diuretics alone

33 A 62-year-old woman with liver cirrhosis presents with ascites and bilateral pedal edema. Which diuretic regimen is most appropriate?

Loop diuretic alone Thiazide diuretic alone Spironolactone with or without loop diuretic Osmotic diuretics

34 A patient with chronic kidney disease presents with generalized edema and hypertension. What is the most important non-pharmacological intervention?

High protein diet Strict sodium restriction Aggressive fluid loading Early compression therapy

35 A patient with chronic venous insufficiency presents with ankle edema and skin pigmentation. What is the cornerstone of long-term management?

High-dose diuretics Lifelong anticoagulation Compression stockings and leg elevation Albumin infusion

36 A patient develops acute facial swelling and airway compromise due to angioedema. What is the immediate management priority?

Loop diuretics Airway protection and epinephrine if indicated Fluid restriction Compression bandaging

37 A patient with hypothyroidism presents with non-pitting edema. Which treatment will most effectively resolve the edema?

High-dose diuretics Albumin infusion Levothyroxine replacement Salt restriction alone

38 A patient with lymphedema develops recurrent episodes of cellulitis. What is the best preventive management strategy?

Chronic loop diuretics Prophylactic antibiotics alone Compression therapy and meticulous skin care High-dose corticosteroids

39 A hospitalized patient with severe sepsis develops generalized edema due to capillary leak. Which management principle is most appropriate?

Aggressive diuresis immediately Judicious fluid management with vasopressors if needed Albumin infusion in all cases Strict fluid restriction from onset

40 A patient with unilateral leg edema due to deep vein thrombosis is diagnosed. What is the definitive management?

High-dose diuretics Compression stockings alone Anticoagulation therapy Albumin infusion

41 A patient with heart failure develops hypokalemia after high-dose loop diuretic therapy. What is the best corrective strategy?

Stop diuretics completely Add a potassium-sparing diuretic Increase loop diuretic dose Administer sodium bicarbonate

42 A patient with severe edema and skin breakdown is at high risk of infection. What supportive measure is most important?

Topical steroids Meticulous skin hygiene and moisturization Routine antibiotics High-protein diet alone

43 A patient with nephrotic syndrome develops edema and hypertension. Which class of drugs provides both antiproteinuric and anti-edema benefits?

Beta blockers ACE inhibitors Calcium channel blockers Loop diuretics alone

44 A patient with refractory generalized edema fails maximal medical therapy. What is the next management option?

Increase salt intake Ultrafiltration or dialysis Stop all medications Compression therapy alone

45 A patient with drug-induced edema from amlodipine requires blood pressure control. What is the best management approach?

Add high-dose diuretics Switch to another antihypertensive class Continue amlodipine without change Add albumin infusion