Review questions/AIMS exercises

Question 1

T/F The left vagus nerve descends anterior to the aortic arch

Answer 1

T
The left vagus travels anterior to the aortic arch (behind the primary left bronchus and into the esophagus)
The right vagus nerve travels behind the esophagus and primary right bronchus.
Both nerves exit the jugular foramen, penetrate the carotid sheath between the internal and external carotid arteries and then pass posterolaterla to the common carotid artery.

Question 2

When you give a blood transfusion, you must expect a possible decrease in the amount of ionized calcium in the plasma

Answer 2

T
Due to the sodium citrate preservative (anti coag) put in blood bags, citrate binds to the patient’s endogenous calcium when blood products are administered, rendering calcium inactive.

Question 3

PaCO2 will not increase if the FiO2 decreases

Answer 3

T
Bc. PaCO2 is the O2 that has been e to exchanged CO2 in the alveolar capillaries. If the FiO2 decreases, then the PaCO2 will also decrease.

Question 4

Pulmonary edema presents when capillary pressure is above

Answer 4

25 mmHg

Question 5

the thoracic duct drains into the

Answer 5

left subcalvian vein
It drains the lypmh from the entire right side of the body

Question 6

Morgagni hernia

Answer 6

are rare congenital parasternal diaphragmatic defects that can lead to bowel obstruction and incarceration if not repaired.

Question 7

Which drug is used to perform the stress test on the fetus?

Answer 7

oxytocin
the stress test is done when you have an ambiguous cardiotocographic pattern

Question 8

A newborn is diagnosed with hypoplastic left heart syndrome using cardiac color Doppler ultrasound. What is the classic cause of this congenital heart disease?

Answer 8

mitro-aortic atresia (narrowing)
Associated with patent ductus arteriosus, atrial septal defect.
MUST CLOSE PDA WITH PROSTAGALNDIN INFUSION
A loud, single 2nd heart sound (S2) and a nonspecific systolic murmur are common.
The definitive treatment is surgical correction or heart transplant.

Question 9

85% of superior vena cava syndrome is due to lung cancer

Answer 9

T
Superior vena cava syndrome is a set of symptoms caused by impaired blood flow between the superior vena cava and the right atrium.
It is an oncological emergency that is treated with radiotherapy.

Question 10

Magnesium sulphate is indicated for which arrhythmias?

Answer 10

Mg is a membrane stabiliser.
ventricular arrythmias
torsade de pointes
pre-eclampsia to prevent convulsion episodes

Question 11

A 12-year-old boy goes to the periodic medical check-up to obtain competitive sports eligibility. On auscultation, a soft ejection systolic murmur is detected in the left 2nd intercostal space, associated with constant splitting of the 2nd tone. What is the first suspected diagnosis?

Answer 11

atrial septal defect

Question 12

An elderly man goes to his GP because he fainted the day before and now feels a little dizzy. He feels a strange sensation of fluttering wings in his chest. During the ECG, the patient loses consciousness and then regains it immediately. What could be the most probable pathology?

Answer 12

sinus node disease

Question 13

Anaphylactic shock is characterized by:
HR
BP
JVP

Answer 13

Hypotension, tachycardia, central venous pressure (CVP) reduced

Question 14

Congestion is the first stage of lobar pneumonia,The next stage is called red hepatization, referring to the liver-like appearance of the thickened lung, he next stage is represented by gray hepatization, The final stage is represented by resolution,

Answer 14

T

Question 15

mong the drugs listed above, the one that can most cause QT prolongation is sotalol. This alteration can trigger torsades de pointes which can be promptly treated with IV magnesium. under conditions of hemodynamic stability. If the patient is hemodynamically unstable, he must be electrically cardioverted. Flecainide and amiodarone also have QT prolonging effects but to a less significant extent than sotalol.

Answer 15

T

Question 16

Pleural effusions are commonly associated with pneumonia and should be treated with thoracentesis to determine whether the pleural fluid is infected. In order to prevent these complications, it is recommended that all pleural effusions larger than 10 mm undergo thoracentesis. If the pleural fluid pH is less than 7.20 or the pleural fluid glucose is less than 60 mg/dl, placing a drainage tube is indicated.

Answer 16

T

Question 17

Taking which drug during pregnancy could cause the onset of Ebstein’s anomaly?

Answer 17

lithium
Ebstein’s malformation is a congenital heart disease characterized by the dislocation towards the tip of the right ventricle of the septal and inferior leaflets of the tricuspid valve, normally located at the level of the atrioventricular junction.

Question 18

A patient’s chest x-ray shows “eggshell” mediastinal calcifications. What will be the most likely diagnosis?

Answer 18

Eggshell adenopathies are a very indicative and important manifestation given that there are very few pathologies that produce such an effect: silicosis, sarcoidosis and tuberculosis. The main population-level cause (population attributable risk) of “eggshell” adenopathies is silicosis.

Question 19

Mr. Andrea, 74 years old, visits you due to dyspnea. The dyspnea appears to be worsening in the last 10 days. On auscultation he presents a diastolic murmur which can be appreciated very well at the level of the focus of Erb. What do we suspect?

Answer 19

aortic valve insuff
The most characteristic auscultational finding of aortic insufficiency is a high-frequency early diastolic murmur that decreases until the end of diastole. It can be heard well at the level of the aortic focus and the focus of Erb (third intercostal space at the level of the left sternal margin). It is easier to hear the murmur during forced expiration and with the patient leaning forward.

Question 20

The presence of a QRS morphology with RR’ in the right precordial leads (V1-V2) lasting less than 120msec tends towards an intraventricular conduction delay of the incomplete right bundle branch block type

Answer 20

t

Question 21

Francesca, a girl suffering from PCOS comes to your clinic. She says she takes various drugs and in particular an antiandrogen to treat hirsutism, but she doesn’t remember the name of it. What will this drug likely be?

Answer 21

Cyproterone acetate
a steroid used in combination with ethinyl estradiol to treat women with severe acne and symptoms of androgenization.

Question 22

A bronchopathic patient goes to the doctor for a routine check-up. Upon inspection of the chest, the so-called “Schweninger crown” is found. What type of injury is it?

Answer 22

Sometimes venular telangiectasias can be found at the base of the thorax, distributed circularly in a fringe, at the level of the insertion of the diaphragm. These lesions are called “Schweninger’s crown” or “Salhi’s vascular wreath”. These findings, although more frequent in bronchopneumopaths, do not have a certain pathological significance, because they can also be found in normal subjects.

Question 23

How does edentulism affect the patient’s airway management?

Answer 23

It makes mask ventilation more difficult but facilitates intubation. In fact, the absence of teeth, by modifying the anatomy of the face, makes it more difficult for the mask to adhere, leading to leaks, on the contrary intubation is facilitated as the opening of the mouth increases, furthermore the risk of damaging the teeth with the laryngoscope.

Question 24

Wells score: signs and symptoms of deep vein thrombosis (3 points); less likely alternative diagnosis of pulmonary thromboembolism (3 points); tachycardia (1.5 points);** immobilization or surgery in the previous 4 weeks **(1.5 points); previous DVT/TOE (1.5 points); hemoptysis (1.5 points); neoplasm undergoing therapy or undergoing therapy in the last 6 months (1 point).

Answer 24

T
If the total score is greater than or equal to 4, the diagnosis of TEP is considered probable. If the total score is less than 4, the diagnosis of TEP is considered unlikely.

Question 25

What is meant by PETCO2?

Answer 25

PETCO2 corresponds to the end-expiratory partial pressure of CO2.

Question 26

At which level is the usual location of the carina in the cadaveric position?

Answer 26

T4–T5 intervertebral disc (level of the manubriosternal angle of Louis)

Question 27

Polso bigemino is typical of

Answer 27

ventricolare extrasistolia
(Bigeminy is a type of abnormal heart rhythm in which every other heartbeat is a premature contraction or extra heartbeat)

Question 28

What drug can be used for a pt with AV block temporarily before PM implantation

Answer 28

Isoprenaline - a B agonist

Question 29

Il test alla flecainide viene effettuato nei tipi II e III della sindrome di Brugada, in quanto la sindrome è caratterizzata da una alterazione dei canali del sodio.

Answer 29

t

Question 30

A severe side effect of checkpoint inhibitors is myocarditis

Answer 30

T

Question 31

TAPSE (tricuspid annular plane systolic excursion).

Answer 31

Un indice ecocardiografico utilizzato per valutare la funzione del ventricolo destro

Question 32

In un pz con scompenso cardiaco acute, Gli ACEi, i sartani, così come lo spironolattone sono controindicati per via della possibile iperkaliemia.

Answer 32

T

Question 33

Il rabdomioma è il tumore cardiaco più frequente in età pediatrica. Lo andiamo ad individuare:

Answer 33

nei ventricoli, in forma di noduli multipli intramuscolari

Question 34

AUSTIN FLINT MURMER IS =

Answer 34

INSUFFICIENZA AORTICA

Question 35

l modello Erasmus per cosa è utilizzato?

Answer 35

Per migliorare l’accuratezza nella valutazione del rischio operatorio CV.

Question 36

Morgani nodules are found in which heart valve?

Answer 36

ciascuna semiluna della valvola polmonare

Question 37

Dopo un intervento è necessario Aumentare l’idratazione e somministrare potassio e magnesio perché durante un intervento cardiochirurgico è facile che la giunzione atrio-ventricolare e gli atri siano irritati da un insulto meccanico, per tale motivo è frequente l’insorgenza di FA post intervento.

Answer 37

t

Question 38

What are the anatomical regions making up the 2 arches seen on the right and 3 seen on the left in a standard CXR

Answer 38

RIGHT:
- FIRST: superior vena cava and ascending aorta
- SECOND: right atrium

LEFT:
- FIRST: aortic arch
- SECOND: pulmonary artery trunk + left auricle
- THIRD: left ventricle

Question 39

The most frequent manifestation of mitral stenosis is represented by paroxysmal or permanent atrial fibrillation (60% of cases)

Answer 39

t

Question 40

Mechanical prostheses require permanent oral anticoagulation treatment, regardless of the position in which they have been placed. Prosthesis placed on the right have a greater risk of thrombi.

Answer 40

in the case of implantation of a mechanical valve prosthesis, it is necessary to proceed with lifelong anticoagulation with vitamin K antagonists, maintaining INR values ​​defined on the basis of the thrombogenicity of the implanted prosthesis and the patient’s individual risk factors.

Question 41

Myocarditis with an AV block can cause cardiogenic shock

Answer 41

T

Question 42

What is the most commonly used modality currently used to repair the anterior leaflet of the mitral valve?

Answer 42

chordae tendineae loop implantation.

Question 43

Which of the following represents the mechanism by which the impella mechanically supports the circle?

Answer 43

It is a coaxial pump, positioned retrogradely in a transvalvular aortic position, which sucks blood from the left ventricle to introduce it into the ascending aorta

Question 44

The incidence of live births with congenital heart disease is approximately 4-10 cases per 1000 live births. Ventricular septal defect represents 25% of these pathologies. 0.008

Answer 44

T

Question 45

the diagonal arteries are branches arising from the anterior interventricular or anterior descending artery and supply the free wall of the left ventricle.

Answer 45

T

Question 46

When a pt comes in with dyspnea and Hamptons signs are seen on X RAY (hinting pulmonary embolism) what exam do you need before giving treatment?

Answer 46

The aPTT ratio
the patient will be administered UFH heparin. Normally its value ranges from 1.5 to 2.5.

Treatment with UFH involves first an initial bolus and then an administration by infusion.

If the ratio is < 1.2, an initial bolus of 80 IU/Kg is given (approximately 5000 IU), if the ratio is between 1.5 and 2.5, 40 IU/Kg is administered as an initial bolus. As regards the following infusion, 18 IU/kg is given if the ratio is between 1.5 and 2.5. If the ratio is between 1.2 and 1.5, 2 IU/Kg are added, if the ratio is < 1.2, 4 IU/Kg are added.

However, if the aPTT ratio is > 3, it is interrupted for 60 minutes and resumed by decreasing by 3 IU/Kg.

Question 47

If during right cardiac catheterization we detect an average pressure in the pulmonary artery > 25 mmHg and a wedge pressure > 15 mmHg, we will say that it is a Pulmonary arterial hypertension secondary to left heart disease

Answer 47

t

Question 48

What value is abdominal aortic aneurysm defined as?

Answer 48

> 3cm

Question 49

Electrical stimulation (pace maker) is indicated in all emergency conditions due to symptomatic bradyarrhythmias

Answer 49

T

Question 50

85% of superior vena cava syndrome cases are due to the existence of lung cancer

Answer 50

t
The symptoms that make it suspicious are dyspnea, cough, redness and swelling of the face, neck, upper trunk and extremities (mantle edema). This syndrome is usually indicative of locally advanced bronchogenic carcinoma, easily detectable on chest x-ray. It is an oncological emergency that is treated with radiotherapy.

Question 51

Magnesium sulphate is indicated for which arrhythmias

Answer 51

torsades de point

Question 52

lingual numbness, the only true pathognomonic sign of CNS toxicity

Answer 52

t

Question 53

Anaphylactic shock is characterized by:

Answer 53

Hypotension, tachycardia, central venous pressure (CVP) reduced

Question 54

. If the pleural fluid pH is less than 7.20 or the pleural fluid glucose is less than 60 mg/dl, placing a drainage tube is indicated.

Answer 54

t

Question 55

Ventricular systole facts

Answer 55

Ventricular extrasystoles are usually followed by a compensatory pause, i.e. the sum of the pre- and post-extrasystolic interval is equal to twice one sinus cycle
They can be detected in up to 60% of healthy adult subjects
They can be recognized on the ECG by the presence of a premature QRS lasting > 120 msec
They do not worsen the prognosis of subjects without heart disease
They worsen the prognosis in heart patients, especially if frequent

Question 56

What is the etiological agent of Kaposi sarcoma?

Answer 56

human herpes virus 8

Question 57

Ear ossicle order from most lateral to innermost

Answer 57

hammer (malleus)
anvil (incus)
stirrups (stapes) - which connects to the oval window

Question 58

what areas of the body are most frequently affected by psoriasis vulgaris?

Answer 58

symmetrically distributed plaques on the scalp, elbows, knees, and intergluteal fissure (extensor surface of limbs)

Question 59

Teriparatide is a drug for the treatment of osteoporosis, how does it work?

Answer 59

by stimulating the activity of osteoblasts

Question 60

Testicular tumors can originate from germ cell or non germ cell (sertoli cell tumor).

Answer 60

non germinal gonadal tumors are more rare than germ cell tumors.
germ cell can be seminomas and non seminomas (teratoma, embryonic carcinoma)

Question 61

first line therapy in juvenile myoclonic epilepsy in male patients is

Answer 61

valproic acid
CANT USE IN FEMALES BC IS HIGHLY TERATOGENIC

Question 62

What is thiopentone

Answer 62

A barbiturate
Water soluble salt
use din induction phase of general anesthesia (is a hypno inducer)
Causes unconsciousness in less than 1 minute
Is rapidly absorbed by the brain
causes a dose dependent decrease in BP and cardiac output with possible tachycardia

Question 63

Above what value is ocular HTN considered

Answer 63

21 mmHg
(normal intra-ocular pressure range = 10-21mmHg) - to be measured with a Goldmann tonometer

Question 64

Fibromyalgia diagnosis

Answer 64

11/18 points are tender

Question 65

Lesch nyhan is syndrome is inherited as an X-linked recessive genetic disorder that, with rare female exceptions, most often affects males. The symptoms of Lesch-Nyhan syndrome include impaired kidney function, acute gouty arthritis, and self-mutilating behaviors such as lip and finger biting and/or head banging.

Answer 65

Has a complete deficiency of hypoxanthine-guanine phosphoribosyl transferase

Question 66

In gout, which joints are mostly deposited with monosodium urate crystals?

Answer 66

metatarsal phalangeal joints (big toe)

Question 67

the max time limit for reviving the facial nerve after trauma is

Answer 67

72 hours

Question 68

Type 2 respiratory failure (hypercapnic) occurs with which conditions?

Answer 68

pathologies that result in failure of the ventricular pump
- central respiratory drive malfunction
- pathologies of chest wall
- obstuctive pathologies
- alteration of neuromuscular function of breathing muscles

Question 69

the silvio acqueduct connects the

Answer 69

3rd and 4th cerebral ventricles

Question 70

If a pt already on DOAC has a cardioembolic ischemic stroke, you can only perform systemic thrombolysis if the pt has not taken anti coagulation in the past 24 hours

Answer 70

T

Question 71

fetal alcohol syndrome causes

Answer 71

microcephaly
facial dysmorphism
cardiac alterations
motor and behavioral disorders
hydronephrosis
mental retardation

Question 72

Cyanide: is also called zyklon B, has a high affinity for ferroproteins, is a poison, causes coma, convulsions, and bradycardia

Answer 72

T

Question 73

What is erythromelelgia

Answer 73

parinful paroxysmal vasodilation in the small arteries caused by exposure to heat, hyperemia, and intense burning pain
Often associated with polycythemia VERA

Question 74

what are tx options for retinal detachment?

Answer 74

cryopxy
pneumoretinopexy
vitrectomy
scleral cerclage

Question 75

hepatocellular carcinoma and clear cell carcinoma of the kidney both have significant arterial enhancement

Answer 75

T

Question 76

Sick building syndrome

Answer 76

at least 20% of the pop presents with eye/upper airway irritation, nausea, headache, general tension, hypersensitivity to odors and perfumes

Question 77

acute pro myelocytic leukemia can be treated with all trans-retinoic acid

Answer 77

T

Question 78

apple core on X ray

Answer 78

colon cancer
which metastasixes the most to the liver

Question 79

Still’s disease

Answer 79

is recurrent fever, arthralgia’s, and maculo papular rash
Use Yamaguchi criteria for diagnosis (Major criteria: >39C for >1WK, arthalgia>2Wks, rash, WBC>10K. Minor criteria: sore throat, lymphadenopathy, hepatosplenomegaly, >LFT, - ANA and RF)
TX: NSAIDS, prednisone, IL1RA (anakinra)
equally common in males and females

Question 80

Herniations and associated lost reflexes

Answer 80

C5-C6: BICIPITAL
C7-C8: TRICEPS
L4: PATELLAR
S1: ACHILLES

Question 81

NEBIVOLOL ic contraindicated in sinus node disease and sinoatrial blocks, raynaud phenomenon

Answer 81

T

Question 82

RIPA or ristocetin induced platelet aggregation test is used to diagnose

Answer 82

von willebrand syndrome
ristocetin concentration increases in vWF deficiency

Question 83

Hemophilia A, B, C is deficiency of coagulation factors 8, 9, 10

Answer 83

t

Question 84

Patient to most common cause of intestinal obstruction

Answer 84

Neonates: meconial ileus
Infants: intussepction
Aduts 16-50: incarcerated hernia
adults >50: neoplasia of sigmoid
Gastrectomized subjects: adhesions

Question 85

failure to commit suicide differs from attempted suicide by

Answer 85

the adequacy of the medium

Question 86

Conn’s syndrome

Answer 86

is primary hyperaldosteronism
Has Conns adenoma (yellow)

Question 87

The most frequent form of suicide in youth is

Answer 87

ingestion of drugs

Question 88

Acceptable vitamin D range

Answer 88

> 20 ng/dl
10-20 = deficiency

Question 89

Minimal change disease is the most common nephrotic syndrome in children?
What is the therapy?

Answer 89

T
it presents with sloping edema (peri orbital swelling in the night, edemi declivi at night)
Therapy: systemic cortisone therapy

Question 90

which laryngeal muscle has a dilating action?

Answer 90

posterior cricoarytenoid

Question 91

What is priapism

Answer 91

a urological emergency
is a state of prolonged (>4hours) and painful erection not related to sexual stimulus or which persists beyond stimulus

Question 92

What is Whipples disease?

Answer 92

systemic disease of middle age men, eith joint involvement, weight loss, and GI disorders.
Is cause by Tropheryma whippleri - a gram +, PAS positive slow growing bacillus
DX: needs biopsy of mucosa of small intestine
TX: ceftriaxone

Question 93

interferon alpha terapy causes hypothyroidism

Answer 93

T

Question 94

confirmation of eosinophilic esophagitis needs > 15 eosinophils per field in 5 biospy specimens

Answer 94

T

Question 95

Spinocerebellar ataxia is a degenerative cerebellar pathology, AD and AR.
Most frequent form is SCA 3, but SCA7 is the only one to show retinal degeneration with blindness

Answer 95

T

Question 96

What is the target of HbA1c in diabetic and renal patients

Answer 96

<7%
6.5%=48mmol

Question 97

in REITERS or reactive arthritis, the synovial fluid is ASEPTIC

Answer 97

T

Question 98

What are osler nodules

Answer 98

painful and erythematous nodules on the finger tips

Question 99

FAB (french, american, british) classification for acute myeloid leukemia
RAI and BINET for chronci lymphocytic leukemia

Answer 99

T

Question 100

exposure keratopathy is the most frequent late complication in pts undergoing upper eyelid reconstructive surgery

Answer 100

T

Question 101

Flebocortid causes hyperglycemia and potassium depletion

Answer 101

T

Question 102

Name the 5 gastric gland cells and what they produce

Answer 102

• principal/zymogenic: pepsin and lipase
• parietal/oxyntic: HCl and oxyntic factor
• mucus cells of the collar that release secretory mucin
• stem cells and neuroendocrine cells that control intestinal motility and gastric secretion

Question 103

Domperidone induces hyperprolactinemia

Answer 103

T

Question 104

There are 9 laryngeal cartilages. 3 unique (cricoid, thyroid and epiglottis) and 6 symmetrical (arytenoid, cuneiform, corniculate)

Answer 104

T

Question 105

What is Hans Selye syndrome?

Answer 105

the general adaption syndrome which describes the organisms reactions to a non specific stressful stimulus prolonges over time and inclusdes three phases:
alarm state
resistance state
exhaustion state

Question 106

to diagnose corneal ablation you need to perform this test. To TX it

Answer 106

fluorescein staining
Tx: cycloplegic agents, erythromycin, fluoroquinolones, NSAIDS

Question 107

what is crystalloid cardioplegia

Answer 107

administering various substances including K+ in order to favor a diastolic arrest of the heart which allows protection against ischemic insult

Question 108

sulfonylureas (anti diabetes by inducing release of insulin from pancreas) cause highest risk of hypoglycemia

Answer 108

T

Question 109

what is diagnostic procedure for aganglionic congenital megacolon

Answer 109

rectal biopsy

Question 110

for varicocele bleeding, whats first line in hemodynamically stable pt

Answer 110

IV somatostatin (a vasoactive agent)

Question 111

audiometric curve of noise induced hearing loss is

Answer 111

a spoon

Question 112

what is the first order neuron in the visual pathway

Answer 112

bipolar cell

Question 113

the subglottis is vascularised by the posterio-inferior laryngeal artery

Answer 113

T

Question 114

the most common cause of posterior uveititis is toxoplasmosis

Answer 114

T

Question 115

Truelove and Witts severity index is a prognostic score used in the evaluation of ulcerative colitis

Answer 115

T

Question 116

Vagosis is aka pre eclampsia

Answer 116

T

Question 117

the cormack lamberty classification refers to fasciocutaneous flaps

Answer 117

T

Question 118

above 3.5mm nuchal translucency is considerd altered at a first trimester screening

Answer 118

T

Question 119

> 140/90 is considered high BP

Answer 119

T

Question 120

the largest termial branch of teh external carotid artery is the internal maxillary artery

Answer 120

T

Question 121

The Ajmalina test is an alternate to the flecainamide test for the diadnosis of brugada syndrome

Answer 121

T

Question 122

Sabin tetrad

Answer 122

intracranial calcifications
hydrocephalus
chorioretinitis
convulsions

Question 123

VHL syndrome has an increased risk of hemangioblastoma

Answer 123

T

Question 124

If a pt underwent surgery with the lichenstein technique, where is the scar?

Answer 124

inguinal region

Question 125

What pathogen causes ecthyma gangrenosum?

Answer 125

Pseudomonas aerouginosa
single or multiple macules that evolve into bullous lesions with hemorrhagic/necrotic phenomenon and eschar formation
Often in gluteal, perineal and axillary regions
gram - bacilli on skin biopsy

Question 126

To diagnose a STEMI:
you need ST elevation >1mm in two contiguous leads
EXCEPTION: >2 mm in V2-V3 in men older than 40, and > 2.5mm in younger men
> 1.5mm in women

Answer 126

T

Question 127

B lines of chest eco are pathonomonic for acute pulmonary edema

Answer 127

T

Question 128

Diagnostic criteria for SLE include these 4 things

Answer 128

non scarring alopecia
oral or nasal apthae
direct Coombs positive test
thrombocytopenia

Question 129

pediatrics, history of pharyngotonsillitis, present mitral insufficiency, joint pain, nodules, erythema marginatum, syndenhams chorea - JONES CRITERIA

Answer 129

After group A beta hemolytic streptococcus infection
J (JOINTS)
O (ENDOCARDITIS)
N (SUBCUTE. NODULES)
E (ERYTHEMA MARGINATUM)
S (SYNDENHAM CHOREA - an extrapyramidal neurological dx, non repetitive, disappear during sleep, ocular muscles are NOT afftected)

Question 130

sjogren syndrome comes with a greater incidence of non hodgkin lymphoma and waldenstroms macroglobulinemia

Answer 130

T

Question 131

Potassium citrate is useful to prevent the formation of kidney stones

Answer 131

T
Citrate (citric acid) is filtered by kidneys and liver and excreted via urine. It influences the crystallisatino fo calcium oxalate (main compoment of urinary stones) preventing aggregation and consequent stone formation

Question 132

what layers of the cornea are affected by Fuch’s dystrophy?

Answer 132

endothelium
Its a non inflammatory, sporadic or AD dystrophy.
Leads to vision loss
TX: hypertonic eye drops, corneal transplant

Question 133

Lancefield classification of streptococci

Answer 133

(according to antigenic characteristics of cell wall polysaccharides - C antigen)
S. agalactiae is group B
Strep pyogenes is group A
Strep sanguis is group H
strep pneumonia is part of the non lancefield group

Question 134

what infectious dx’s are screened for in pregnancy

Answer 134

rubella
toxoplasma
syphilis
HIV
HBV
asymptomatic bacteriura

Question 135

the intermediate host of genitourinary shistosomiasis is

Answer 135

snails
a parasite (trematode class)
transmitted though contamination fo fresh water with urine of infected pts (has eggs)

Question 136

what defect most frequently gives rise to adrenogenital syndrome

Answer 136

21 hydroxylare deficiency

Question 137

IL12 is synthesized by

Answer 137

Dendritic cells

Question 138

Brutons malattia causes agammaglobulinemia X linked

Answer 138

T

Question 139

Mepolizumab – anti-IL5
Ipilimumab – anti-CTL4
Etanercept – anti-TNFalfa
Adalimumab - anti-EGFR
Infliximab - anti TNF alfa

Answer 139

T

Question 140

‘Pomfi’ in english

Answer 140

Wheals (allergy)

Question 141

MBL (allergology) stands for

Answer 141

Lecitina legante il mannosio

Question 142

Un bambino di 20 mesi, inizia a presentare movimenti coreici, oftalmoplegia e infezioni respiratorie ricorrenti. Nei sette mesi anteriori sono comparse telangiectasie sul volto e nei cavi poplitei. Quale alterazione è alla base di tale quadro clinico?

Answer 142

Si tratta di un caso clinico di atassia-teleangiectasia. Tale sindrome è legata a un’alterazione nei meccanismi di riparazione del DNA.

Question 143

IL1 is the most potent pro inflammatory cytokine

Answer 143

T

Question 144

the internal saphenous nerve doesnt belong in the deep venous circulation ategory

Answer 144

T

Question 145

the spinal cord ends at the L1-L2 vertebral level

Answer 145

T

Question 146

The guidelines regarding ongoing medical treatments recommend not stopping cardioaspirin before any surgical operation

Answer 146

T

Question 147

No drug is injected intraarterially

Answer 147

T

Question 148

Fentanyl and morphine are both strong opioids (the first synthetic and with a rapid onset, the second natural and with a long duration of action), but while for fentanyl no histamine-release reactions are described, morphine, together with meperidine, although very rarely can trigger allergic reactions precisely through this mechanism.

Answer 148

T

Question 149

Propofol acts by stimulating the transmission pathway mediated by the neurotransmitter GABA with a final effect of depression of the activity of the central nervous system (CNS) and therefore, consequently, it induces hypnosis in the patient.

Answer 149

T

Question 150

What is meant by Macklin’s sign?

Answer 150

Tomographic sign of air collection outside the bronchi, predicting pneumomediastinum.

Question 151

The Wilkins score evaluates which of the following pathologies?

Answer 151

Mitral stenosis.

Question 152

A 75-year-old patient suffers from severe calcific aortic stenosis. On the echocardiogram the patient presents left ventricular hypertrophy (SIV=15mm) and on the coronary angiography a stenosis >90% of the proximal part of the DA and the CX. Is there a surgical indication?

Answer 152

Yes, aortic valve replacement plus myocardial revascularization is indicated
If severe aortic stenosis is associated with critical coronary artery disease (otherwise two-vessel), concomitant surgery for valve replacement and coronary artery bypass grafting is indicated. In this case it is not allowed to postpone the operation and carry out a simple follow up, due to the high hemodynamic risk. It doesn’t even make sense to perform two separate surgeries, due to the higher surgical-anesthesiological risk they would entail. Alcoholization of the septum is a procedure reserved for patients suffering from hypertrophic cardiomyopathy, however with a septum > 30 mm: in this case the ventricular hypertrophy is secondary to the valve defect.

Question 153

above In case of aortic dissection, after confirming the diagnosis, blood pressure must be reduced to minimum values ​​to ensure perfusion of the internal organs, as well as heart rate reduced, in order to minimize tangential stress on the aortic wall.
reduction in blood pressure to values ​​of 100 – 120 mmHg in systole
B) reduction in heart rate to approximately 55 – 60 bpm
C) Urgent hospitalization

Answer 153

t

Question 154

In fact, cor triatriatum is a congenital heart disease that consists of the presence, within the left atrium, of a fibro-muscular sepum with a central opening that divides the atrium into 2 chambers, an upper one connected to the pulmonary veins and a lower one. in continuity with the mitral valve.

Answer 154

t

Question 155

The most common type of fistula is

Answer 155

interspincteric

Question 156

what are the ligaments of the liver

Answer 156

triangular
falciform
round
coronary

Question 157

What is the treatment in case of advanced Gist?

Answer 157

Imatinib

Question 158

When should a liver transplant be considered?

Answer 158

MELD ≥15

Question 159

OIS, Organ Injury Scale is used for the evaluation of parenchymatous organs; the AIS, Abbreviated Injury Scale, is used for all organs; the ISS, Injury Severity Scale, is used to establish the prognosis and severity of the trauma in an overall manner,

Answer 159

t

Question 160

Shwachman syndrome is a congenital spinal cord aplasia characterized by exocrine pancreatic insufficiency, metaphyseal dysplasia and haematologically, neutropenia and possibly anemia and thrombocytopenia. Other congenital aplasias are represented by Fanconi anemia (the most frequent among congenital spinal cord aplasias), dyskeratosis congenita, Blackfan-Diamond syndrome, TAR (thrombocytopenia with radial aplasia or congenital amegakaryocytic thrombocytopenia).

Answer 160

t

Question 161

Modest deficiencies of f. Paucisymptomatic VIII are frequently the expression of von Willebrand’s disease,

Answer 161

Modest deficiencies of f. Paucisymptomatic VIII are frequently the expression of von Willebrand’s disease, which represents the most frequent coagulation defect. Hemophilia A tends to be much more severe and the aPTT much more prolonged, even in mild forms. Lupus anticoagulant is usually associated with a greater thrombotic, non-hemorrhagic tendency; it is not a hereditary disorder; does not prolong bleeding time; and is not associated with reduced levels of factor VIII. Vitamin K deficiency can occur in patients on total parenteral nutrition or prolonged antibiotic treatment or in cases of malnutrition, especially if therapy with warfarin is associated. This condition is characterized by progressively prolonged PT and aPTT (PT > aPTT) and normal thrombin time.

Question 162

The treatment of sickle cell anemia is based on: Exchange blood transfusion, transfusion of concentrated red blood cells, Hydration to avoid sickle formation, prevention and early treatment of infections with vaccination against capsulated germs. Splenectomy is not useful, as it is in other congenital hemolytic anemias.

Answer 162

t

Question 163

A 70-year-old patient undergoing hip replacement surgery showed the appearance of thrombocytopenia (40,000/micronL) after one week. The most likely cause of thrombocytopenia is:

Answer 163

Thrombocytopenia induced by heparin therapy

Question 164

Child suffering from Hemoglobinosis type H: What is the phenotype that characterizes the pathology?

Answer 164

Alpha +- / - -

Question 165

The diagnosis of acute leukemia can be made solely on the basis of:

Answer 165

Biopsy or bone marrow aspirate

Question 166

Rituximab acts through various biological mechanisms including ADCC, CDC and induction of apoptosis. The inhibition of EGFR signaling is the effect of other monoclonal antibodies such as Trastuzumab (used in solid tumors such as colorectal cancer, breast cancer etc…).

Answer 166

t

Question 167

Tutte le possibili sindromi sopra indicate possono essere causa di ipocalcemia: la sindrome di DiGeorge è dovuta alla agenesia del timo e delle paratiroidi; la sindrome PGA tipo 1 si manifesta spesso con ipoparatiroidismo, morbo di Addison e diabete mellito; lo pseudoipoparatiroidismo è dovuto alla resistenza periferica all’azione del PTH.

Answer 167

t

Question 168

Il segno di Hertoghe è tipico dell’ipotiroidismo. Consiste in:

Answer 168

Scomparsa del terzo esterno delle sopracciglia

Question 169

Il carcinoma follicolare è un tumore differenziato della tiroide, solitamente unicentrico, e nel quale il coinvolgimento dei linfonodi è poco frequente.
C) La FNA permette di diagnosticare il carcinoma papillare della tiroide, mentre non è utile per la diagnosi del carcinoma follicolare della tiroide.
D) Il carcinoma papillare della tiroide è più frequente nelle zone ricche di iodio, mentre il carcinoma follicolare della tiroide è più frequente nelle zone con deicit dello stesso.
E) La localizzazione metastatica del carcinoma follicolare è soprattutto ossea e polmonare

Answer 169

t

Question 170

La 5-alfa-reduttasi è un enzima che catalizza la trasformazione di:

Answer 170

testosterone a diidrotestosterone

Question 171

Quale tra queste è la causa più frequente di malattia di Addison?

Answer 171

Autoimmune

Question 172

Il paziente è affetto da acromegalia. La concentrazione basale del GH non è valida per la diagnosi dato che ha una secrezione pulsatile. Invece la presenza si IGF-1 elevato, la mancata soppressione del GH, 2 ore dopo la curva da carico di glucosio e la RM con gadolino possono a formulare la diagnosi di acromegalia/gigantismo.

Answer 172

r

Question 173

Obesità e conseguente pubertà precoce. Richiederei FSH, LH e 17 betaestradiolo e maturazione scheletrica per comprovarlo. Inizierei al momento con restrizione calorica e rivalutazione tra 6 mesi

Answer 173

L’enunciato di questa domanda non è del tutto corretto. Ci parlano di una bambina di 9 anni che è aumentata di peso negli ultimi tre anni. In anamnesi esistono dati per sospettare che si tratti di una obesità di causa esogena, come dire sicuramente la bimba non ha problemi endocrinologici ed il suo aumento di peso si deve al buon appetito con conseguente ingestione eccessiva di alimenti, oltre alla tendenza all’inattività. Ci dicono anche che si è avuto un importane crescita in altezza ed un anticipo della pubertà. Il BMI al quale si riferiscono non è corretto, poiché questo indice si calcola dividendo il peso (kg)/altezza² (cm) i cui valori oscillano tra il 18% (denutrizione) ed il 40% (obesità patologica), pertanto il 158% al quale si riferiscono nella domanda non può corrispondere a questo indice. In realtà si riferiscono alla percentuale del BMI che varia tra il 90% (normale) ed il 120% (obesità) che si calcola dividendo il BMI del paziente con il BMI medio per l’età. Detto ciò è evidente che la bimba è obesa e probabilmente l’aumento in altezza e l’anticipo della pubertà sono conseguenza di questa patologia. Andranno fatti pertanto degli esami ormonali per comprovare che non esista alcuna alterazione endocrinologica e, una volta comprovato ciò, sarà sufficiente una restrizione calorica ed una vita attiva per controllarne la sintomatologia.

Question 174

Cosa si intende per sindrome di Verner Morrison?

Answer 174

Diarrea secretiva con alterazioni elettrolitiche

Question 175

Gli stadi puberali, definiti da Tanner e Marshall nel 1962, esprimono il grado di maturazione genitale del soggetto e vanno dal grado 1, che indica una condizione ancora pre-pubere, al grado 5 che si raggiunge al termine della maturazione genitale. Per la definizione dello stadio si considerano nella femmina la morfologia e le dimensioni del seno, la distribuzione dei peli pubici, la morfologia e le dimensioni dei genitali esterni (piccole e grandi labbra e clitoride).

Answer 175

T

Question 176

Paziente donna, 31 anni, arriva in PS per emorragia uterina indolore, con aspetto di colore rosato, nausea, vomito. All’ecografia presenta un pattern caratteristico di vescicole multiple di piccole dimensioni “a fiocchi di neve”. In base alla patologia sospettata, come ci aspettiamo i valori di beta-HCG

Answer 176

In caso di mola idatiforme, i livelli di beta-HCG sono estremamente elevati, > 100.000 U/L.. In caso di aborto, saranno in diminuzione, mentre nella gestazione ectopica vi è un aumento, senza tuttavia duplicarsi ogni 48 ore.

Question 177

Cosa esprime il rapporto tra il maggior asse fetale e i diametri dell’utero materno?

Answer 177

Situazione

Question 178

Da quali cellule viene prodotto l’AMH?

Answer 178

Cellule della granulosa

Question 179

Si definisce coniugata ostetrica la linea tesa: Dal promontorio sacrale al punto più sporgente all’indietro della sinfisi pubica

Answer 179

Ci vengono descritti 4 dei 6 diametri dello stretto superiore. Ricordiamo che lo stretto superiore è delimitato in avanti dal margine superiore della sinfisi pubica, indietro dal promontorio sacrale e lateralmente dalla linea innominata. La coniugata ostetrica è la linea tesa dal promontorio sacrale al punto più sporgente all’indietro della sinfisi pubica e misura 10,5-10,8cm. Va distinta dalla coniugata anatomica che è invece una linea tesa dal promontorio sacrale al margine superiore della sinfisi pubica e misura 11cm . Le risposte B e C indicano, rispettivamente, il diametro obliquo destro che misura 12cm e quello sinistro che misura 12,5cm. Per completezza ricordiamo anche il diametro trasverso massimo (teso tra i punti più sporgenti delle ossa coxali), che misura 13,5cm e il diametro trasverso medio, che è definito come la linea perpendicolare alla coniugata anatomica tesa nel punto di incrocio dei due diametri obliqui e misura 12cm. Ricordate che, anche se sul piano teorico il diametro maggiore sarebbe quello trasverso massimo, la presenza dei muscoli ileopsoas fa si che esso non possa essere sfruttato. È dunque lungo il diametro obliquo sinistro che si posiziona la parte presentata del feto secondo il suo asse maggiore.

Question 180

Una donna di 42 anni con protesi mammarie vi consulta per un tumore palpabile nei quadranti interni della mammella destra. Che prova di imaging deve richiedere per escludere un cancro?

Answer 180

La mammografia è il metodo diagnostico d’immagine principale nei casi di patologia mammaria. Questo test viene utilizzato nelle pazienti asintomatiche come metodo di screening e nelle pazienti sintomatiche per riuscire ad effettuare una diagnosi. Solitamente vengono effettuate due proiezioni per ogni seno: una cranio-caudale e una obliqua esterna di 60°. La funzione principale della risonanza magnetica (RM) è l’individuazione della multifocalità. Questa, può essere persino utilizzata per il controllo delle cicatrici nel caso in cui siano stati effettuati dei trattamenti di conservazione su pazienti con protesi mammarie e nel caso di screening delle donne ad alto rischio, ad esempio nelle portatrici di una mutazione del gene BRCA.

Question 181

I criteri diagnostici sono: (H di “hemolysis”): Emolisi. (EL di “elevated liver enymes”): Enzimi epatici elevati. (LP di “low platelet count”): conteggio basso delle piastrine. L’iperbilirubinemia è una conseguenza dell’anemia emolitica.

Answer 181

t

Question 182

Secondo la sua opinione, qual è l’oncogene implicato nella patogenesi del cancro mammario che viene attualmente utilizzato come target terapeutico mediante un anticorpo monoclonale specifico a fronte dello stesso oncogene?

Answer 182

ERBB2 o HER2.

Question 183

The t(8;21) translocation is mainly observed in

Answer 183

M2 acute myeloid leukemia

Question 184

Pseudomonas keratitis. The patient wearing contact lenses with pain, red eye, opacification and corneal ulceration presents typical characteristics of keratitis associated with contact lenses. In most cases, the etiological agents are linked to Gram negative organisms such as Pseudomonas and Serratia; sometimes also by gram positives as well as some fungi and amoebae. The picture is a real medical emergency as it can lead to corneal perforation, scarring and permanent vision loss.

Answer 184

the cornea is generally spared in the case of uncomplicated conjunctivitis. Contact lens wearers are at risk of both conjunctivitis and keratitis.

Question 185

Which drug is used as first choice in the pharmacological therapy of acromegaly?

Answer 185

The first choice therapy is surgery, but among pharmacological therapies octreotide represents the first choice. Somatostatin analogues (such as Octreotide or Lanreotide)

Question 186

In case of compartment syndrome, what are the areas to keep most under control?

Answer 186

limbs

Question 187

The rotator cuff is a set of four muscles and their respective tendons. The rotator cuff has the fundamental task of stabilizing the glenohumeral joint of the shoulder.
The muscles that make up the rotator cuff are: Supraspinatus muscle; Infraspinatus muscle; Teres minor muscle; Subscapularis muscle.

Answer 187

lesions most frequently affect the supraspinatus. Jobe +

Question 188

Charcot’s triad describes the clinical nature of cholangitis. Reynolds’ pentad (Answer B wrong) represents an extension of the much better known Charcot triad, characteristic of acute cholangitis (Answer A wrong). While the latter includes jaundice, fever, and abdominal pain (Answer C incorrect), Reynolds’ pentad adds shock and altered mental status, which are usually simplified to hypotension and mental confusion.

Answer 188

t

Question 189

Which of the following is a sign of tuberculosis of the genitourinary system?

Answer 189

Sterile pyuria
Alternative Answers

A) Selective proteinuria
B) Non-selective proteinuria
D) Hematuria at the end of urination
E) Kidney stones

Question 190

What is the unit of measurement used by the International System of Units to measure the energy value of a food?

Answer 190

Joules (J)

Question 191

. The diagnostic criteria for dermatomyositis were proposed by Bohan and Peter and consist of: characteristic skin lesions, proximal muscle weakness, serum elevation of muscle enzymes, etc. The Rome IV criteria are used for irritable bowel syndrome (option B incorrect), while the Milan criteria are used for patients with hepatocellular carcinoma (option C incorrect). Light’s criteria for identifying exudative pleural effusions, while Jones’ criteria for rheumatic disease (answers D and E incorrect).

Answer 191

t

Question 192

Which cranial nerve is responsible for miosis?

Answer 192

III

Question 193

The most frequent cause of spontaneous subarachnoid hemorrhage in the adult population is:

Answer 193

Rupture of intracranial aneurysm

Question 194

What is the activation threshold of stapedial reflexes?

Answer 194

Approximately 70 dB above hearing threshold

Question 195

The On-Off effect is a double negative deflection appreciable in the evaluation of the stapedial reflexes typical of this condition. Its finding, combined with a picture of conductive hearing loss, allows us to make a diagnosis of otosclerosis

Answer 195

T

Question 196

ISS significa?

Answer 196

istituto superiore di salute

Question 197

vernakalant is the fastest drug to restore sinus rhythm

Answer 197

T

Question 198

The antidote for magnesium sulfate is calcium gluconate.

Answer 198

T

Question 199

What molecule does the ovarian struma secrete?

Answer 199

thyroid hormones. Struma ovarii is an ovarian teratoma composed almost exclusively of mature thyroid tissue. It can, therefore, cause hyperthyroidism.

Question 200

What is the incubation period for Mediterranean button fever?

Answer 200

7

Question 201

Which of the following antibiotics inhibits protein synthesis by binding to the 30s subunit of the bacterial ribosome?

Answer 201

gentamicin

Question 202

The quantity of hypostases is defined as “abundant” when they reach the anterior axillary line (wrong answer E), normal when they stop at the middle axillary line (wrong answer D) and scarce when they reach the posterior axillary line

Answer 202

T

Question 203

The probability of vertical transmission of HIV infection to the fetus can be reduced from 7% to less than 1% in case of taking antiretroviral therapy during pregnancy, which has never demonstrated teratogenic effects.

Answer 203

T

Question 204

What is the most common age to be diagnosed with autism spectrum disorder?

Answer 204

2-3 years