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Acute decompensated heart failure — MCCQE Part 1 MCQ

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HardOedemaAcute decompensated heart failureMCCQE Part 1

A breast-cancer survivor has chronic unilateral nonpitting arm swelling after axillary dissection. Ultrasound excludes thrombosis and there is no heart, kidney or liver failure. What is the best management?

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Correct answer: B — Refer for compression-based decongestive therapy

Chronic unilateral swelling after axillary lymph-node treatment, with venous thrombosis and systemic fluid-overload causes excluded, is secondary lymphedema. Refer to a trained lymphedema therapist for complete decongestive therapy using appropriately fitted compression, exercise, skin care, education and manual techniques when indicated. Encourage gradual activity rather than immobilization. Diuretics remove intravascular sodium and water but do not repair lymphatic obstruction and can cause depletion when used solely for lymphedema. Meticulous skin care and prompt treatment of cellulitis are important. New rapid swelling, pain or erythema warrants reassessment for thrombosis, infection or cancer recurrence.

Reference: NCI Lymphedema PDQ: https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq