The 1% Semester of 2021 - 2022 Academic Year in Nantong University, Final Exam of Internal Medicine Name: Nancy Jennifer Lawrence Nathan Student Number: w1717010003 |_. Definition (40 points in total, 5 points each) Score | Reviewer 1.Tuberculous perito! o Itis a serious condition with rising prevalence in recent years. o Itis especially common in those patients with risk factors such as an immuno compromised state, chronic kidney disease, or cirrhosis/ liver disease. o Spread is typically hematogenous from pulmonary foci. 2.Cullen sign : © 1to 2 weeks after the onset representing blood dissecting to those areas from the retroperitoneum near the pancreas along fascial planes, large ecchymoses may appear a bluish color in the flanks (Grey Turner's sign) or o In the umbilical area (Cullen's sign) 3. Barrett’s esophagus: o Itis a premalignant condition o The squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet and columnar cells (specialized intestinal metaplasia, which is believed to increase the risk of neoplasia). Most patients have a long history of reflux symptoms. 1/3 of patients report minimal or no symptoms, suggesting decreased acid sensitivity of Barrett's epithelium. oo4. Thyrotoxicos! © Clinical condition encompassing several specific diseases characterized by hypermetabolism and elevated serum level of free thyroid hormones. o Includes hyperthyroidism as one cause. 5. Nephrotic syndrome: o Itis akidney disorder characterized by a number of signs and symptoms like: proteinuria, hypoalbuminemia and edema. o Itis characterized by an increase in permeability of the capillary walls of the glomerulus leading to the presence of high levels of protein passing from the blood into the urine (proteinuria at least 3.5 grams per day per 1.73m2 body surface area); low levels of protein in the blood can cause ascites , edema, and a predisposition for coagulation. 6. Urinary tract infection o Acondition in which bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra). o Most urinary tract infections occur in the bladder or urethra. © Urethritis — infection of the urethra. o Cy: infection of the bladder. o pyelonephi — infection of the kidneys. o Vaginitis — infection of the vagina. is— 7. Anemii o Ithas been defined as a reduction in one or more of the major red blood cell (RBC) measurements obtained as a part of the complete blood count (CBC): hemoglobin concentration, hematocrit (HCT), or RBC count. o Insufficient red blood mass to adequately deliver oxygen to peripheral tissues.8. Myelodysplastic Syndrom Myelodysplastic syndrome (MDS) are hematological conditions with ineffective production of the myeloid class of blood cells, Patients with MDS can develop severe anemia and require blood transfusions. co In some cases, the disease worsens and the patient develops cytopenias (low blood counts) caused by progressive bone marrow failure. Il._ Essay questions (60 points in total, 10points each) Score Reviewer 1. Please illustrate the different clinical, endoscopic and radiographic features of ulcerative colitis and Crohn's disease briefly by a table. Features Ulcerative coli Crohn’s disease Pathology Rectal involvement Always Rare Skip lesions Never Common Transmural Rare Common Granulomas Occasional Common Perianal disease Never Common Cobblestone mucosa | Rare Common Radiology Collar button ulcers | Common Occasional Small intestinal Never Common involvement Discontinuous Never Common involvementFistula Never Common Structure Occasional Common Endoscopy Apthous ulcers Never Common Discontinuous Never Common involvement Rectal sparing Never Common Linear or serpiginous | Never Common ulcer Ulcers in terminal Never Common ileum 2. Diagnosis of intestinal tuberculosis @ Diagnosis of intestinal tuberculosis. @ Causative Organism: Mycobacterium Tuberculosis @ Route of Infection: Swallowing infected Sputum(Pt has pulmonary TB) The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound- guided aspiration followed by laparoscopy if needed. In advanced ileocecal disease gross wall thickening, adherent small bowel loops, large regional lymphnodes and exophytic mesenteric thickening together from a complex mass of varied density, which is characteristic of CT appearance of TB and is reproted to be seen in 45% of the cases. 3. How about the risk factors of gestational diabetes mellitus? o Gestational diabetes (GDM) + The type of diabetes that occurs in non-diabetic women during pregnancy. +It is any degree of glucose intolerance during the pregnancy. + This form of diabetes usually disappears after the birth of the baby.o Risk factors of gestational diabetes © Over the age of 30 yr © Obesity « Family history of diabetes e Having previously given birth to a very large child (over 4 kg) © Having previously given birth to a stillborn child or a child with a birth defect « Having gestational diabetes in the previous pregnancy ¢ Having high blood pressure o Symptoms & Signs ¢ Generally, gestational diabetes may not have any symptoms; however, the woman may experience Excessive weight gain Excessive hunger or thirst Excessive urination ¢ Recurrent vaginal infections 4. What are the four complications of nephrotic syndrome? @ Nephrotic Syndrome : Itis a kidney disorder characterized by a number of signs and symptoms like: proteinuria, hypoalbuminemia and edema It is characterized by an increase in permeabi of the capillary walls of the glomerulus leading to the presence of high levels of protein passing from the blood into the urine (proteinuria at least 3.5 grams. per day per 1.73m2 body surface area); low levels of protein in the blood can cause ascites , edema, and a predisposition for coagulation. @ Risk Factors Of Nephrotic Syndrome: Hypoalbuminaemia can lead to oedema and increased susceptibility to infections. May also produce pleural effusion and ascites. Subungual oedema may manifest as parallel white lines in the fingernail beds.+ Urinary losses of plasma proteins like thyroxine binding globulin can cause abnormalities in thyroid function tests. + Deficiency of antithrombin III (due to urine loss) may produce a hypercoagulable state and renal vein thrombosis. Other reasons for hypercoagulable state include altered activity and levels of proteins C and §, increased hepatic synthesis of fibrinogen, and increased platelet aggregation. + In adults, most thromboses are venous, while in children arterial thromboses are more common. + Patient with acute renal vein thrombosis can present with sudden onset of flank or abdominal pain, gross haematuria and an acute decline in renal function, but most patients are asymptomatic. + Other consequences of hypercoagulable state include pulmonary embolism, myocardial infarction and stroke. - Loss of globulins in urine may result in severe IgG deficiency leading to spontaneous bacterial peritonitis. + Loss of cholecalciferol-binding protein may lead to vitamin D deficiency state. + Loss of transferrin may result in microcytic hypochromic anaemia. + Loss of metal binding proteins may result in trace metal deficiency e.g. zinc, copper. + Loss of drug binding proteins results in altered drug pharmacokinetics. 5. Please explain the definition and the diagnosis of aplastic anemia. ] Aplastic anemia: fails to form blood cells of three lineage; decreased or absent BM precursor cells and peripheral blood cytopenia. Diagnosis 1. Pancytopenia in blood 2. Hypocellular in BM 3. Hepatosplenomegaly and lymphadenopathy should not be present 4. Must be differentiated from other causes of pancytopenia including: myelodysplasia, acute leukemia, myelofibrosis, PNH,megaloblastic. 6. Please introduce Ann Arbor staging classification of lymphoma. @ Clinical Staging (Ann Arbor) + Stage! Involvement of a single lymph node region or of a single extranodal organ or site(IE) + Stage Il: two or more lymph node regions on the same side or the diaphragm localized extranodal organ and one or more lymph node regions on the same side of the diaphragm(IIE) + Stage Ill lymph node regions on both sides of the diaphragm or with localized extranodal organ (Ill E) or spleen (Ills)or both (III ES). + Stage IV: Diffused or disseminated involvement of one or more extranodal organs, With Or without associated lymph node enlargement @ Clinical Staging - Subtype Group A Without general Symptoms Group B With general Symptoms Unexplained fever, >38°C Instina over 3 days weight loss, >10% of body weight within 6 months Night sweats defined by drenching night and sweats @ Staging Procedures @ Symptoms and signs @ X-ray film (chest, ect), Ultrasound,CT or PET @ Laboratory study including BM smear and biopsy