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6th year subjects > Internal common topics > Flashcards

Internal common topics Flashcards

1
Q

Define obstructive lung disease?

A

Increased resistance to airflow caused by narrowing of airways

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2
Q

Etiology of obstructive lung disease (OLD)

A

COPD
Bronchial asthma
Bronchiectasis
Cystic fibrosis
Laryngeal tumors
Vocal cord palsy

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3
Q

A-a gradient in obstructive lung disease

A

Difference between the pO2 in the alveoli (A) and the arteries (a).

Normal range is 5-10 mmHg, and varies with age, altitude, and the concentration of inhaled oxygen.

In diseased states, A-a gradient increases with a ventilation-perfusion mismatch and/or impaired gas diffusion across the alveoli.

In OLB it INCREASES

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4
Q

Imaging finding in OLD

A
  1. Hyperlucency of lung tissue
  2. Horizontal ribs and widened intercostal spaces
  3. Increased AP diameter
  4. Diaphragm pushed down and flattened
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5
Q

Physiological lung volumes

A

(TLC) Total lung capacity
(IRV) Inspiratory reserve volume
(FRC) Functional residual capacity
(IRC) Inspiratory reserve capacity
(ERV) Expiratory reserve volumes
(RV) Residual volume
(VC) Vital capacity

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6
Q

Lung volume flow loop in OLD

A

The top graph is a normal flow-volume loop and a time-volume curve used to determine the FEV1.

Obstructive lung diseases result in a concave flow-volume loop due to increased resistance. Absolute FEV1, as well as FEV1 relative to vital capacity (FEV1/FVC), is diminished.

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7
Q

FEV 1

A

The ratio of FEV₁ (maximum volume of air that can be forcefully expired within 1 second after maximal inspiration

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8
Q

FEV1/FCV

A

FEV₁/FVC ratio is decreased in obstructive lung disease.
In restrictive lung diseases, FEV₁/FVC ratio may be normal or increased

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9
Q

Pulmo testing results

A
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10
Q

How can you test the lung function?

A

Spirometry
Plethysmograph
DLco

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11
Q

Spirometri findings in OLD

A
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12
Q

Plethysmograph findings in OLD

A
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13
Q

what is measured in anemia?

A

Hematorcrit
Hemoglobin

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14
Q

Hct in Anemia

A

M: < 40%
F: < 35%

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15
Q

Hb in anemia

A

M: < 14
F: < 12

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16
Q

Anemia severity

A

Mind 10-11
Moderate 8-10
Severe 7-8

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17
Q

Classification of anemia

A

MCV < 80: Microcytic anemia- Small RBC
MCV 80-100: Normocytic anemia Normal-sized RBC
MCV > 100: Macrocytic anemia- Larger RBC

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18
Q

what to check in Microcytic anemia?

A

Ferritiin (high/low)
TIBC (high/low)

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19
Q

Etiology of microcytic anemia?

A

Iron deficiency anemia
Anemia of chronic disease
B-thallasemia
Bart disease
Sideroblastic anemia

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20
Q

Etiology of normocytic anemia? What do you look for?

A

Reticulocytes high/ low
EPO high/low
Signs of hemolysis?

  • CKD
  • Aplastic anemia
  • Blood loss
  • Hemolytic anemia
21
Q

Signs of hemolysis?

A

High LDH
High Indirect billi
Low Haptoglobin

22
Q

what to look for in Macrocytic anemia

A

Are there megaloblast or not?
Yes: megaloblastic anemia
No: Non-megaloblastic anemia

23
Q

Causes of Macrocytic anemia?

A

Megaloblasts:
Reticulocytosis
Liver disease
Drugs (methotrexate)
Hypothyroidism
Multiple myeloma
Myeloproliferative diaseases

Non-megaloblast
Vitamin b12 def
Folate def

24
Q

what is TIBC

A

TIBC (Total Iron Binding Capacity) differentiates between Iron deficiency anemia and Anemia of chronic disease

25
Q

Mentzer Index in anemia

A

is calculated to find out if it is Thalassemia MCV/RBC

Index <13 → suggests a thalassemia trait
Index >13 → suggests that the patient has an IDA or ACD

26
Q

what are reticulocytes?

A

immature RBC produced by BM, predicts how fast red blood cells are made by the and released into the blood.

Normal range 0.5-1.5%
Hypo-proliferative: <2%
Hyper-proliferative: >2%

27
Q

what are megaloblasts?

A

Megaloblast cells are large non-nucleated red cells.

28
Q

Majour cause if IDA

A

Decreased intake (diet)
Increased utilization (During pregnancy, the growth years)
Excessive loss of iron (blood loss, menstruation)
Incomplete absorption (diarrhea, gastric sleve)

29
Q

If a gastroenterological evaluation fails to disclose a likely cause of IDA in a patent refractory to oral iron treatment what do you screen for?

A

Celiac disease, autoimmune gastritis, and Helicobacter pylori is recommended.
20% of patients with unexplained IDA
have autoimmune gastritis,
50% have evidence of active H. pylori infection
4% have celiac disease

30
Q

medication causin macrocytic anemia

A

Phenytoin
Sulfa drugs
Trimethoprim
Hydroxyurea
MTX
6-mercaptopurin

31
Q

Characterization of hemolytic anemia

A

By the cause and by the location::

Intrinsic hemolytic anemia: abnormalities in RBCs (hemoglobin, RBC membrane, or intracellular enzymes),

Extrinsic hemolytic anemia
external causes (immune-mediated or mechanical damage), which is called extrinsic hemolytic anemia.

Intravascular
Extravascular

32
Q

Etiology of intravascular hemolytic anemia?

A
  1. Toxins
  2. G6PD deficiency
  3. Anti-body mediated
  4. Macroangiopathic anemia
  5. Microangiopathic anemia
33
Q

Etiology of extravascular anemia

A
  1. RBC defects (sickle cell disease, spherocytosis, PKD deficiency)
  2. Anti-b mediated hemolysis (warm and cold agglutinin disease)
34
Q

signs of anemia

A
  • Pallor
  • Fatigue
  • Exertional dyspnea
  • In severe cases: tachycardia, angina pectoris, leg ulcers
35
Q

Test that can be done in hemolytic anemia?

A

Coombs tets with Ab for immune proteins that mediate hemolysis, agglutination is a positive test

36
Q

clinical symptoms of hodgkin lymphoma

A

Painless lymphadenopathy
B symptoms in the classical
Pel-Ebstein fever, rare but specific (2w fever 2w no fever)
Alcohol-induced pain in lymph nodes. Rar but specific
Pruritus (focal or generalized)

37
Q

classification in Hodgkin lymphoma

A

Lugado classification

38
Q

chemo in Hodgkin lymphoma

A

ABVD: adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine

Stanford V: doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone

BEACOPP: bleomycin, etoposide, adriamycin (doxorubicin), cyclophosphamide, oncovin (vincristine), procarbazine, prednisone

39
Q

two classifications of Hodgkin lymphoma

A

Classical HL (4 types) (95%)
Non-lymphocyte predominant HL (5%)

40
Q

difference between classical Hl and non-lymphocyte predominant HL?

A

Classical has CD 15 + 30
Non LPHL has CD 45 + 20

41
Q

which HL has the worst prognosis?

A

Lymphocyte depleted classical HL

42
Q

which HL has the best prognosis?

A

Lymphocyte rich classical HL

43
Q

Etiology of non-Hodgkin lymphoma

A

Chromosomal translocations: most commonly t(14;18)
EBV, HIV
Helicobacter pylori: MALT lymphoma, DLBCL
Autoimmune diseases: Hashimoto thyroiditis, RA

44
Q

Grades of Non HL

A

Low grade
- Follicular lymphoma
- Hairy cell leukemia
- Marginal zone B-cell lymphomas
- Mantle cell lymphoma
- Diffuse large B-cell lymphoma

Aggressive
- Burkitts

45
Q

Symptoms of non-HL

A

Painless lymphadenopathy associated with fatigue
B symptoms
Hepatosplenomegaly

46
Q

Non-HL diagnosis

A

Histopathological studies are required to diagnose lymphoma.
- B-cell lymphomas: CD20 positive
- T-cell lymphomas: CD3 positiv

47
Q

Chemo in non-HL

A

Systemic chemotherapy: (R-CHOP)
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin/vincristine
Prednisolone

48
Q

Define Non-Hodgkin lymphoma

A

Lymphomas are malignancies that arise from lymphocytes and are classified as either Hodgkin lymphomas (characterized by Reed-Sternberg cells) or non-Hodgkin lymphomas (NHLs), which comprise all other types of lymphoma. NHLs are further classified according to cell type

49
Q
A

6th year subjects (10 decks)

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