Flashcards
Cos’è una zoonosi
Con il termine zoonosi si intende una qualsiasi malattia infettiva che può essere trasmessa dagli animali (escluso l’uomo) all’uomo, direttamente o indirettamente
il vettore della Leishmania donovani
Flebotomo
tattamento della dissenteria amebica
metronidazolo
Quale test diagnostico conferma il tifo addominale
Reazione di widal
Corretta profilassi malarica con clorochina
2 settimane prima della partenza per la zona malarica e protraendolo per 4-6 settimane dopo l’arrivo
Quale esame fareste eseguire nel sospetto di teniasi
esame coproparassitologico
How long does the colera vaccination last
6 months
Antibiotici di prima scelta nella brucellosi
tetracicline
Terapia del Morbo di Hansen forma tubercoloide
dapsone + rifampicina
Corretta profilassi malarica con meflochina
1 settimana prima della partenza per la zona malarica e per 4 settimane dopo l’arrivo
Cosa sono i dermatofagoidi
Principali costituenti allergenici della polvere domestica
What class of drug is divided into ergot and not ergot derived?
dopamino-agonisti
Bioavailaibility
Fraction of administered drug reaching systemic circulation unchanged. For an i.v. dose, F = 100%.
Orally: F typically < 100% due to incomplete absorption and first-pass metabolism.
Volume di distribuzione
Theoretical volume occupied by the total amount of drug in the body relative to its plasma concentration.
Vd =amount of drug in the body/plasma drug concentration
Half-life t1/2
The time required to change the amount of drug in the body by 1⁄2 during elimination.
In first-order kinetics, a drug infused at a constant rate takes 4–5 half-lives to reach steady state. It takes 3.3 half-lives to reach 90% of the steady-state level.
t1/2 =(0.7 × Vd)/CL in first-order elimination
Zero order drug elimination
rate of elimination is constant regardless of Cp. Cp decreases LINEARLY with time. examples of drugs (Phenytoin, Ethanol, and Aspirin).
[PEA (a pea is round, shaped like the “0” in
zero-order)]
First order elimination
Rate of First-order elimination is directly proportional to the drug concentration. Cp decreases EXPONENTIALLY with time.
Metabolism first order reactions
Reduction, Oxidation, Hydrolysis with cytochrome p-450.
R-OH
Metabolism second order reactions
conjugation (Methylation, Glucuronidation, Acetylation, Sulfation).
usually yields very polar, inactive metabolites (renally excreted).
[More GAS]
Whipple desease most important symptoms
Cardiac symptoms, Arthralgias, and Neurologic symptoms are common. Diarrhea/steatorrhea occur later.
FOAMY Whipped cream in a CAN
REYE syndrome features
[REYE of sunSHINE]
Steatosis of liver/hepatocytes Hypoglycemia/Hepatomegaly Infection (VZV, influenza) Not awake (coma) Encephalopathy
Avoid aspirin in children except in those with kawasaki disease
Terapia clostridium (posologia)
Vancomicina 2 g (500 mg ogni 6 ore)
Most specific antibody in rheumatoid arthritis
anti cyclic cytrullinated peptide antibody
Differences between artrosi e artrite reumatoide clinicamente
Artrosi: Pain in weight-bearing joints after use (eg,
at the end of the day), improving with REST.
Asymmetric joint involvement.
Artrite Reumatoide: pain, swelling and morning stiffness > 1 hour, improving with USE. Symmetric joint involvement.
Joint findings and joint involvement in artrosi
Osteophytes (bone spurs),
joint space narrowing,
subchondral sclerosis and cysts.
DIP (distal interphalangeal joint)-(Heberden nodes B ) PIP (proximal interphalangeal joint)-(Bouchard nodes) 1st CMC (carpometacarapal joint) not MCP (metacarpophlangeal)
Joint involvement in rheumatoid arthritis
MCP (metacarpophlangeal) PIP (proximal interphalangeal joint) wrist not DIP (distal interphalangeal joint) not 1st CMC (carpometacarapal joint)
Terapia artrosi
FANS intra articular glucocorticoid injection for temorary relief weight loss physical therapy (joint substitution)
What are the seronegative spondyloarthritis?
[PAIR]
Psoriasic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
Symptoms in reactive arthritis (Reiter syndrome)
[can’t see, can’t pee, can’t bend my knee]
Conjunctivitis
Urethritis
Arthritis
Eziologia reactive artritis
[ShY ChiCS]
Shygella Yersinia Chlamydia Campylobacter Salmonella
LES features
[RASH OR PAIN]
Rash (malar or discoid)
Arthritis (non erosive)
Serositis (eg, pleuritis, pericarditis)
Hematologic disorders (eg, pancytopenias)
Oral/nasopharyngeal ulcers (usually painless)
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
Neurologic disorders (eg, seizures, psychosis)
Most common death causes in LES
[patients die with Redness In their Cheeks]
Renal failure (mosto common)
Infections
Cardiovasculare disease
Libman Sacks Endocarditis (LSE)
LES
Gout involvements
first MTP joint (podagra) and the midfoot,
knees
ankles
wrists
the hips and shoulders are generally spared.
Difference between Cushing Syndrome and Cushing Disease
Cushing’s syndrome = too much cortisol.
Cushing’s disease = too much cortisol from an ACTH-producing pituitary adenoma.
Most frequent cause of Cushing syndrome
Iatrogenic
Differences between ENDOGENOUS insulin and EXOGENOUS insulin
EXOGENOUS insulin lacks of C-peptides
Farmaco anti diabetico spesso associato a ipoglicemie
Sulfaniluree
Oral drugs in diabetes
[Be Sure My Grey Dog Swallows ALFA]
Biguanidi Sulfoniluree Metglinidi Glitiazioni/tiazolidinedioni DPP-4 inibitori Sodio-Glucosio cotrasporto (SGLT2) inibitori Alfa glucosidasi inibitori
Patogenesi dell’anemia di Kwasharkior
anemia da carenza proteica
Cos’è lo hiatus leucaemicus
assenza di forme di maturazione intermedia nel sangue periferico
Differences between Direct Coombs test and Indirect Coombs test
Direct Coombs test—anti-Ig antibody (Coombs
reagent) added to patient’s RBCs. RBCs
agglutinate if RBCs are coated with Ig.
Indirect Coombs test—normal RBCs added to
patient’s serum. If serum has anti-RBC surface
Ig, RBCs agglutinate when Coombs reagent
added.
The indirect Coombs’ test detects
antibodies to RBCs in the patient’s
serum. The direct Coombs’ test detects
sensitized erythrocytes.
Pulse pressure
sistolic pressure-diastolic pressure
Pulse pressure is proportional to SV (gittata sistolica), inversely proportional to arterial compliance
PP increases:
- hyperthyroidism,
- aortic regurgitation,
- aortic stiffening (systolic hypertension in elderly),
- obstructive sleep apnea
- anemia,
- exercise (transient).
PP decreases
- aortic stenosis,
- cardiogenic shock,
- advanced heart failure (HF).
- cardiac tamponade,
Cardiac Contractility when does increase and decrease? What is the best contractility index?
Contractility INCREASES
- Catecholamine stimulation via β1 receptor:
- intracellular Ca2+
- LESS extracellular Na+
- Digitalis
Contractility DECREASES
- β1-blockade
- HF with systolic dysfunction
- Acidosis
- Hypoxia/hypercapnia ( Po2/ Pco2)
- Non-dihydropyridine Ca2+ channel blockers
FE is the best index contractility
Frazione di eiezione
EF = gittata sistolica/EDV(end diastolic volume)
= (EDV-ESV)/EDV
Cardiac sounds features
S1—mitral and tricuspid valve closure.
S2—aortic and pulmonary valve closure.
S3—in early diastole during rapid ventricular
filling phase. Associated with increased filling
pressures (eg, mitral regurgitation, HF) and
more common in dilated ventricles (but can
be normal in children, young adults, and
pregnant women).
S4—in late diastole (“atrial kick”). (Best heard
at apex with patient in left lateral decubitus
position). High atrial pressure. Associated with
ventricular noncompliance (eg, hypertrophy).
Left atrium must push against stiff LV wall.
Consider abnormal, regardless of patient age.
Jugular venous pulse
A WAVE—Atrial contraction (absent in atrial
fibrillation).
C WAVE—right ventricol Contraction (closed tricuspid valve bulging into atrium).
X DESCEND—downward displacement of closed
tricuspid valve during rapid ventricular ejection phase (reduced or absent in tricuspid regurgitation and right heart failure)
V WAVE—increasing right atrial pressure due to filling
(“Villing”) against closed tricuspid valve.
Y DESCEND—right atrial emptYing into right ventricole. (prominent in constrictive pericarditis, absent in cardiac
tamponade)
Filtro di Kim Ray Greenfield
Filtro per la prevenzione dell’embolia polmomonare
Manovre cliniche per la trombosi venosa profonda
-Segno di Homan: flessione dorsale forzata del piede evoca dolore al polpaccio.
-Segno di Bauer: dolore evocato comprimendo la muscolatura surale contro la membrana interossea
Segno di Laurel: dolore al polpaccio durante il colpo di tosse
Terapia TVP
-Use unfractionated heparin or low-molecularweight heparins (eg, enoxaparin) for prophylaxis and acute management. -Use oral anticoagulants (eg, warfarin, rivaroxaban) for treatment (long-term prevention).
Doppia aggregazione profilattica post intervento di angioplastica coronarica con BMS (bare metal stent) e con stent medicato
BMS: 1 mese
Stent medicato: 1 anno
Definizione spondilolistesi
Scivolamento di una vertebra su quella sottostante
Valgismo e Varismo
Alterato rapporto tra gli ossi di due segmenti ossei contigui che vengono a formare un angolo ottuso aperto all’esterno
vaRismo=Rombo
valgismo=imbuto
Malattia di Pott (sintomi)
Paraplegia, dolore, gibbo (marcata sporgenza dorsale di una o più vertebre)
Malattia di De Quervain (def)
Tenosinovite cronica stenosante della guaina comune dei muscoli: breve estensore e lungo abduttore del pollice
Onde e intervalli ecg
-Onda P (depolarizzazione atri) 0,05-0,12 sec
-QRS (depolarizzazione ventricoli) <0,12 sec
-Onda T: (ripolarizzazione ventricoli) 0,18-0,20 sec
-Onda U: prominent in hypokalemia (think
hyp“U”kalemia), bradycardia.
- Inter. PR: 0,16-0,20 sec
- Inter. ST: 0,27 – 0,33 sec
- Inter. QT: <0,44 sec (QTc>0,44 QT lungo)
-Inter RR: 0,8-0,9 sec
Drug-induced long QT
[ABCDE]
AntiArrhythmics (class IA, III) AntiBiotics (eg, macrolides) Anti“C”ychotics (eg, haloperidol) AntiDepressants (eg, TCAs) AntiEmetics (eg, ondansetron)
Congenital long QT syndrome
- Romano-Ward syndrome—autosomal dominant, pure cardiac phenotype .
- Jervell and Lange-Nielsen syndrome— autosomal recessive, sensorineural deafness.
Brugada syndrome
- Autosomal dominant
- ECG: pseudo blocco di branca destra e sopraST in V1-V3
- Prevent SCD with implantable cardioverter-defibrillator (ICD)
Wolff-Parkinson-White syndrome
- DELTA wave with widened QRS complex and shortened PR interval on ECG.
- Reentry circuit
- Supraventricular tachycardia
Q waves in trasmural infarct
Onda Q>0,40 sec o di ampiezza >1/3 del complesso QRS
Blocco di branca SINISTRA e DESTRA
SINISTRA
- QRS>0,12 sec
- no R, ma S ampie in V1,
- R alte e ampie in D1, V5, V6
DESTRA
- QRS>0,12 sec, RSR’ (rabbit ears)
- qR o ampie R in V1
- ampie S in D1, V5, V6
Segno di Trendelemburg
Displasia congenita dell’anca
Artrodesi
Azione chirurgica che trasforma una qualsiasi articolazione da mobile a statica .Può essere definita come una “anchilosi chirurgica”.
Constant-Murley score
Determines the functionality after the treatment of a shoulder injury
