Internal common topics Flashcards
Define obstructive lung disease?
Increased resistance to airflow caused by narrowing of airways
Etiology of obstructive lung disease (OLD)
COPD
Bronchial asthma
Bronchiectasis
Cystic fibrosis
Laryngeal tumors
Vocal cord palsy
A-a gradient in obstructive lung disease
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
Imaging finding in OLD
- Hyperlucency of lung tissue
- Horizontal ribs and widened intercostal spaces
- Increased AP diameter
- Diaphragm pushed down and flattened
Physiological lung volumes
(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
Lung volume flow loop in OLD
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.
FEV 1
The ratio of FEV₁ (maximum volume of air that can be forcefully expired within 1 second after maximal inspiration
FEV1/FCV
FEV₁/FVC ratio is decreased in obstructive lung disease.
In restrictive lung diseases, FEV₁/FVC ratio may be normal or increased
Pulmo testing results
How can you test the lung function?
Spirometry
Plethysmograph
DLco
Spirometri findings in OLD
Plethysmograph findings in OLD
what is measured in anemia?
Hematorcrit
Hemoglobin
Hct in Anemia
M: < 40%
F: < 35%
Hb in anemia
M: < 14
F: < 12
Anemia severity
Mind 10-11
Moderate 8-10
Severe 7-8
Classification of anemia
MCV < 80: Microcytic anemia- Small RBC
MCV 80-100: Normocytic anemia Normal-sized RBC
MCV > 100: Macrocytic anemia- Larger RBC
what to check in Microcytic anemia?
Ferritiin (high/low)
TIBC (high/low)
Etiology of microcytic anemia?
Iron deficiency anemia
Anemia of chronic disease
B-thallasemia
Bart disease
Sideroblastic anemia
Etiology of normocytic anemia? What do you look for?
Reticulocytes high/ low
EPO high/low
Signs of hemolysis?
- CKD
- Aplastic anemia
- Blood loss
- Hemolytic anemia
Signs of hemolysis?
High LDH
High Indirect billi
Low Haptoglobin
what to look for in Macrocytic anemia
Are there megaloblast or not?
Yes: megaloblastic anemia
No: Non-megaloblastic anemia
Causes of Macrocytic anemia?
Megaloblasts:
Reticulocytosis
Liver disease
Drugs (methotrexate)
Hypothyroidism
Multiple myeloma
Myeloproliferative diaseases
Non-megaloblast
Vitamin b12 def
Folate def
what is TIBC
TIBC (Total Iron Binding Capacity) differentiates between Iron deficiency anemia and Anemia of chronic disease
Mentzer Index in anemia
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
what are reticulocytes?
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%
what are megaloblasts?
Megaloblast cells are large non-nucleated red cells.
Majour cause if IDA
Decreased intake (diet)
Increased utilization (During pregnancy, the growth years)
Excessive loss of iron (blood loss, menstruation)
Incomplete absorption (diarrhea, gastric sleve)
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?
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
medication causin macrocytic anemia
Phenytoin
Sulfa drugs
Trimethoprim
Hydroxyurea
MTX
6-mercaptopurin
Characterization of hemolytic anemia
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
Etiology of intravascular hemolytic anemia?
- Toxins
- G6PD deficiency
- Anti-body mediated
- Macroangiopathic anemia
- Microangiopathic anemia
Etiology of extravascular anemia
- RBC defects (sickle cell disease, spherocytosis, PKD deficiency)
- Anti-b mediated hemolysis (warm and cold agglutinin disease)
signs of anemia
- Pallor
- Fatigue
- Exertional dyspnea
- In severe cases: tachycardia, angina pectoris, leg ulcers
Test that can be done in hemolytic anemia?
Coombs tets with Ab for immune proteins that mediate hemolysis, agglutination is a positive test
clinical symptoms of hodgkin lymphoma
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)
classification in Hodgkin lymphoma
Lugado classification
chemo in Hodgkin lymphoma
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
two classifications of Hodgkin lymphoma
Classical HL (4 types) (95%)
Non-lymphocyte predominant HL (5%)
difference between classical Hl and non-lymphocyte predominant HL?
Classical has CD 15 + 30
Non LPHL has CD 45 + 20
which HL has the worst prognosis?
Lymphocyte depleted classical HL
which HL has the best prognosis?
Lymphocyte rich classical HL
Etiology of non-Hodgkin lymphoma
Chromosomal translocations: most commonly t(14;18)
EBV, HIV
Helicobacter pylori: MALT lymphoma, DLBCL
Autoimmune diseases: Hashimoto thyroiditis, RA
Grades of Non HL
Low grade
- Follicular lymphoma
- Hairy cell leukemia
- Marginal zone B-cell lymphomas
- Mantle cell lymphoma
- Diffuse large B-cell lymphoma
Aggressive
- Burkitts
Symptoms of non-HL
Painless lymphadenopathy associated with fatigue
B symptoms
Hepatosplenomegaly
Non-HL diagnosis
Histopathological studies are required to diagnose lymphoma.
- B-cell lymphomas: CD20 positive
- T-cell lymphomas: CD3 positiv
Chemo in non-HL
Systemic chemotherapy: (R-CHOP)
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin/vincristine
Prednisolone
Define Non-Hodgkin lymphoma
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
