<prompt> True statement regarding Acute high altitude pulmonary edema ncludesAssociation with raised ESRMandates immediate descentUsually occurance above 6000 metres heightNone of the above  <response>: B Mandates immediate descent High altitude pulmonary edema HAPE is a life-threatening form of non-cardiogenic pulmonary edema fluid accumulation in the lungs that occurs in otherwise healthy mountaineers at altitudes typically above 2,500 meters 8,200 ft. Symptoms: at least two of: Difficulty in breathing dyspnea at rest Cough Weakness or decreased exercise performance Chest tightness or congestion Signs: at least two of: Crackles or wheezing while breathing in at least one lung field Central cyanosis blue skin color Tachypnea rapid shallow breathing Tachycardia rapid heartrate. Mechanisms by which this shortage of oxygen causes HAPE are poorly understood, but two processes are believed to be important: Increased pulmonary arterial and capillary pressures pulmonary hypertension secondary to hypoxic pulmonary vasoconstriction. An idiopathic non-inflammatory increase in the permeability of the vascular endothelium.The standard and most important treatment is to descend to lower altitude as quickly as possible, preferably by at least 1000 metres. Oxygen should also be given if possible. Symptoms tend to quickly improve with descent, but less severe symptoms may continue for several days. Standard drug treatments for which there is strong clinical evidence are dexamethasone and nifedipine Phosphodiesterase inhibi- tors such as tadalafil are also effective but may worsen the headache of mountain sickness. 