Review questions/AIMS exercises Flashcards
1
Q
T/F The left vagus nerve descends anterior to the aortic arch
A
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.
2
Q
When you give a blood transfusion, you must expect a possible decrease in the amount of ionized calcium in the plasma
A
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.
3
Q
PaCO2 will not increase if the FiO2 decreases
A
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.
4
Q
Pulmonary edema presents when capillary pressure is above
A
25 mmHg
5
Q
the thoracic duct drains into the
A
left subcalvian vein
It drains the lypmh from the entire right side of the body
6
Q
Morgagni hernia
A
are rare congenital parasternal diaphragmatic defects that can lead to bowel obstruction and incarceration if not repaired.
7
Q
Which drug is used to perform the stress test on the fetus?
A
oxytocin
the stress test is done when you have an ambiguous cardiotocographic pattern
8
Q
A newborn is diagnosed with hypoplastic left heart syndrome using cardiac color Doppler ultrasound. What is the classic cause of this congenital heart disease?
A
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.
9
Q
85% of superior vena cava syndrome is due to lung cancer
A
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.
10
Q
Magnesium sulphate is indicated for which arrhythmias?
A
Mg is a membrane stabiliser.
ventricular arrythmias
torsade de pointes
pre-eclampsia to prevent convulsion episodes
11
Q
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?
A
atrial septal defect
12
Q
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?
A
sinus node disease
13
Q
Anaphylactic shock is characterized by:
HR
BP
JVP
A
Hypotension, tachycardia, central venous pressure (CVP) reduced
14
Q
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,
A
T
15
Q
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.
A
T
16
Q
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.
A
T
17
Q
Taking which drug during pregnancy could cause the onset of Ebstein’s anomaly?
A
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.
18
Q
A patient’s chest x-ray shows “eggshell” mediastinal calcifications. What will be the most likely diagnosis?
A
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.
19
Q
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?
A
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.
20
Q
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
A
t
21
Q
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?
A
Cyproterone acetate
a steroid used in combination with ethinyl estradiol to treat women with severe acne and symptoms of androgenization.
22
Q
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?
A
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.
23
Q
How does edentulism affect the patient’s airway management?
A
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.
24
Q
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).
A
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.
25
What is meant by PETCO2?
PETCO2 corresponds to the end-expiratory **partial** pressure of CO2.
26
At which level is the usual location of the carina in the cadaveric position?
T4–T5 intervertebral disc (level of the manubriosternal angle of Louis)
27
Polso bigemino is typical of
ventricolare extrasistolia
(Bigeminy is a type of abnormal heart rhythm in which every other heartbeat is a premature contraction or extra heartbeat)
28
What drug can be used for a pt with AV block temporarily before PM implantation
Isoprenaline - a B agonist
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.
t
30
A severe side effect of checkpoint inhibitors is myocarditis
T
31
TAPSE (tricuspid annular plane systolic excursion).
Un indice ecocardiografico utilizzato per valutare la funzione del ventricolo destro
32
In un pz con scompenso cardiaco acute, Gli ACEi, i sartani, così come lo spironolattone sono controindicati per via della possibile iperkaliemia.
T
33
Il rabdomioma è il tumore cardiaco più frequente in età pediatrica. Lo andiamo ad individuare:
nei ventricoli, in forma di noduli multipli intramuscolari
34
AUSTIN FLINT MURMER IS =
INSUFFICIENZA AORTICA
35
l modello Erasmus per cosa è utilizzato?
Per migliorare l'accuratezza nella valutazione del rischio operatorio CV.
36
Morgani nodules are found in which heart valve?
ciascuna semiluna della valvola polmonare
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.
t
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
RIGHT:
- FIRST: superior vena cava and ascending aorta
- SECOND: right atrium
LEFT:
- FIRST: aortic arch
- SECOND: pulmonary artery trunk + left auricle
- THIRD: left ventricle
39
The most frequent manifestation of mitral stenosis is represented by paroxysmal or permanent atrial fibrillation (60% of cases)
t
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.
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.**
41
Myocarditis with an AV block can cause cardiogenic shock
T
42
What is the most commonly used modality currently used to repair the anterior leaflet of the mitral valve?
chordae tendineae loop implantation.
43
Which of the following represents the mechanism by which the impella mechanically supports the circle?
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
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*
T
45
the diagonal arteries are branches arising from the anterior interventricular or anterior descending artery and supply the free wall of the left ventricle.
T
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?
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.
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
t
48
What value is abdominal aortic aneurysm defined as?
>3cm
49
Electrical stimulation (pace maker) is indicated in all emergency conditions due to symptomatic bradyarrhythmias
T
50
85% of superior vena cava syndrome cases are due to the existence of lung cancer
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.
51
Magnesium sulphate is indicated for which arrhythmias
torsades de point
52
lingual numbness, the only true pathognomonic sign of CNS toxicity
t
53
Anaphylactic shock is characterized by:
Hypotension, tachycardia, central venous pressure (CVP) **reduced**
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.
t
55
Ventricular systole facts
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
56
What is the etiological agent of Kaposi sarcoma?
human herpes virus 8
57
Ear ossicle order from most lateral to innermost
hammer (malleus)
anvil (incus)
stirrups (stapes) - which connects to the oval window
58
what areas of the body are most frequently affected by psoriasis vulgaris?
symmetrically distributed plaques on the scalp, elbows, knees, and intergluteal fissure (extensor surface of limbs)
59
Teriparatide is a drug for the treatment of osteoporosis, how does it work?
by stimulating the activity of osteoblasts
60
Testicular tumors can originate from germ cell or non germ cell (sertoli cell tumor).
non germinal gonadal tumors are more rare than germ cell tumors.
germ cell can be seminomas and non seminomas (teratoma, embryonic carcinoma)
61
first line therapy in juvenile myoclonic epilepsy in male patients is
valproic acid
CANT USE IN FEMALES BC IS HIGHLY TERATOGENIC
62
What is thiopentone
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
63
Above what value is ocular HTN considered
21 mmHg
(normal intra-ocular pressure range = 10-21mmHg) - to be measured with a Goldmann tonometer
64
Fibromyalgia diagnosis
11/18 points are tender
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.
Has a complete deficiency of hypoxanthine-guanine phosphoribosyl transferase
66
In gout, which joints are mostly deposited with monosodium urate crystals?
metatarsal phalangeal joints (big toe)
67
the max time limit for reviving the facial nerve after trauma is
72 hours
68
Type 2 respiratory failure (hypercapnic) occurs with which conditions?
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
69
the silvio acqueduct connects the
3rd and 4th cerebral ventricles
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
T
71
fetal alcohol syndrome causes
microcephaly
facial dysmorphism
cardiac alterations
motor and behavioral disorders
hydronephrosis
mental retardation
72
Cyanide: is also called zyklon B, has a high affinity for ferroproteins, is a poison, causes coma, convulsions, and bradycardia
T
73
What is erythromelelgia
parinful paroxysmal vasodilation in the small arteries caused by exposure to heat, hyperemia, and intense burning pain
Often associated with polycythemia VERA
74
what are tx options for retinal detachment?
cryopxy
pneumoretinopexy
vitrectomy
scleral cerclage
75
hepatocellular carcinoma and clear cell carcinoma of the kidney both have significant arterial enhancement
T
76
Sick building syndrome
at least 20% of the pop presents with eye/upper airway irritation, nausea, headache, general tension, hypersensitivity to odors and perfumes
77
acute pro myelocytic leukemia can be treated with all trans-retinoic acid
T
78
apple core on X ray
colon cancer
which metastasixes the most to the liver
79
Still's disease
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
80
Herniations and associated lost reflexes
C5-C6: BICIPITAL
C7-C8: TRICEPS
L4: PATELLAR
S1: ACHILLES
81
NEBIVOLOL ic contraindicated in sinus node disease and sinoatrial blocks, raynaud phenomenon
T
82
RIPA or ristocetin induced platelet aggregation test is used to diagnose
von willebrand syndrome
ristocetin concentration increases in vWF deficiency
83
Hemophilia A, B, C is deficiency of coagulation factors 8, 9, 10
t
84
Patient to most common cause of intestinal obstruction
Neonates: meconial ileus
Infants: intussepction
Aduts 16-50: incarcerated hernia
adults >50: neoplasia of sigmoid
Gastrectomized subjects: adhesions
85
failure to commit suicide differs from attempted suicide by
the adequacy of the medium
86
Conn's syndrome
is primary hyperaldosteronism
Has Conns adenoma (yellow)
87
The most frequent form of suicide in youth is
ingestion of drugs
88
Acceptable vitamin D range
>20 ng/dl
10-20 = deficiency
89
Minimal change disease is the most common nephrotic syndrome in children?
What is the therapy?
T
it presents with sloping edema (peri orbital swelling in the night, edemi declivi at night)
Therapy: systemic cortisone therapy
90
which laryngeal muscle has a dilating action?
posterior cricoarytenoid
91
What is priapism
a urological emergency
is a state of prolonged (>4hours) and painful erection not related to sexual stimulus or which persists beyond stimulus
92
What is Whipples disease?
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
93
interferon alpha terapy causes hypothyroidism
T
94
confirmation of eosinophilic esophagitis needs > 15 eosinophils per field in 5 biospy specimens
T
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
T
96
What is the target of HbA1c in diabetic and renal patients
<7%
6.5%=48mmol
97
in REITERS or reactive arthritis, the synovial fluid is ASEPTIC
T
98
What are osler nodules
painful and erythematous nodules on the finger tips
99
FAB (french, american, british) classification for acute myeloid leukemia
RAI and BINET for chronci lymphocytic leukemia
T
100
exposure keratopathy is the most frequent late complication in pts undergoing upper eyelid reconstructive surgery
T
101
Flebocortid causes hyperglycemia and potassium depletion
T
102
Name the 5 gastric gland cells and what they produce
- 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
103
Domperidone induces hyperprolactinemia
T
104
There are 9 laryngeal cartilages. 3 unique (cricoid, thyroid and epiglottis) and 6 symmetrical (arytenoid, cuneiform, corniculate)
T
105
What is Hans Selye syndrome?
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
106
to diagnose corneal ablation you need to perform this test. To TX it
fluorescein staining
Tx: cycloplegic agents, erythromycin, fluoroquinolones, NSAIDS
107
what is crystalloid cardioplegia
administering various substances including K+ in order to favor a diastolic arrest of the heart which allows protection against ischemic insult
108
sulfonylureas (anti diabetes by inducing release of insulin from pancreas) cause highest risk of hypoglycemia
T
109
what is diagnostic procedure for aganglionic congenital megacolon
rectal biopsy
110
for varicocele bleeding, whats first line in hemodynamically stable pt
IV somatostatin (a vasoactive agent)
111
audiometric curve of noise induced hearing loss is
a spoon
112
what is the first order neuron in the visual pathway
bipolar cell
113
the subglottis is vascularised by the posterio-inferior laryngeal artery
T
114
the most common cause of posterior uveititis is toxoplasmosis
T
115
Truelove and Witts severity index is a prognostic score used in the evaluation of ulcerative colitis
T
116
Vagosis is aka pre eclampsia
T
117
the cormack lamberty classification refers to fasciocutaneous flaps
T
118
above 3.5mm nuchal translucency is considerd altered at a first trimester screening
T
119
>140/90 is considered high BP
T
120
the largest termial branch of teh external carotid artery is the internal maxillary artery
T
121
The Ajmalina test is an alternate to the flecainamide test for the diadnosis of brugada syndrome
T
122
Sabin tetrad
intracranial calcifications
hydrocephalus
chorioretinitis
convulsions
123
VHL syndrome has an increased risk of hemangioblastoma
T
124
If a pt underwent surgery with the lichenstein technique, where is the scar?
inguinal region
125
What pathogen causes ecthyma gangrenosum?
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
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
T
127
B lines of chest eco are pathonomonic for acute pulmonary edema
T
128
Diagnostic criteria for SLE include these 4 things
non scarring alopecia
oral or nasal apthae
direct Coombs positive test
thrombocytopenia
129
pediatrics, history of pharyngotonsillitis, present mitral insufficiency, joint pain, nodules, erythema marginatum, syndenhams chorea - JONES CRITERIA
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)
130
sjogren syndrome comes with a greater incidence of non hodgkin lymphoma and waldenstroms macroglobulinemia
T
131
Potassium citrate is useful to prevent the formation of kidney stones
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
132
what layers of the cornea are affected by Fuch's dystrophy?
endothelium
Its a non inflammatory, sporadic or AD dystrophy.
Leads to vision loss
TX: hypertonic eye drops, corneal transplant
133
Lancefield classification of streptococci
(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
134
what infectious dx's are screened for in pregnancy
rubella
toxoplasma
syphilis
HIV
HBV
asymptomatic bacteriura
135
the intermediate host of genitourinary shistosomiasis is
snails
a parasite (trematode class)
transmitted though contamination fo fresh water with urine of infected pts (has eggs)
136
what defect most frequently gives rise to adrenogenital syndrome
21 hydroxylare deficiency
137
IL12 is synthesized by
Dendritic cells
138
Brutons malattia causes agammaglobulinemia X linked
T
139
Mepolizumab – anti-IL5
Ipilimumab – anti-CTL4
Etanercept – anti-TNFalfa
Adalimumab - anti-EGFR
Infliximab - anti TNF alfa
T
140
'Pomfi' in english
Wheals (allergy)
141
MBL (allergology) stands for
Lecitina legante il mannosio
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?
Si tratta di un caso clinico di atassia-teleangiectasia. Tale sindrome è legata a un'alterazione nei meccanismi di riparazione del DNA.
143
IL1 is the most potent pro inflammatory cytokine
T
144
the internal saphenous nerve doesnt belong in the deep venous circulation ategory
T
145
the spinal cord ends at the L1-L2 vertebral level
T
146
The guidelines regarding ongoing medical treatments recommend not stopping cardioaspirin before any surgical operation
T
147
No drug is injected intraarterially
T
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.
T
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.
T
150
What is meant by Macklin's sign?
Tomographic sign of air collection outside the bronchi, predicting pneumomediastinum.
151
The Wilkins score evaluates which of the following pathologies?
Mitral stenosis.
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?
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.
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
t
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.
t
155
The most common type of fistula is
interspincteric
156
what are the ligaments of the liver
triangular
falciform
round
coronary
157
What is the treatment in case of advanced Gist?
Imatinib
158
When should a liver transplant be considered?
MELD ≥15
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,
t
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).
t
161
Modest deficiencies of f. Paucisymptomatic VIII are frequently the expression of von Willebrand's disease,
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.
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.
t
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:
Thrombocytopenia induced by heparin therapy
164
Child suffering from Hemoglobinosis type H: What is the phenotype that characterizes the pathology?
Alpha +- / - -
165
The diagnosis of acute leukemia can be made solely on the basis of:
Biopsy or bone marrow aspirate
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...).
t
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.
t
168
Il segno di Hertoghe è tipico dell'ipotiroidismo. Consiste in:
Scomparsa del terzo esterno delle sopracciglia
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
t
170
La 5-alfa-reduttasi è un enzima che catalizza la trasformazione di:
testosterone a diidrotestosterone
171
Quale tra queste è la causa più frequente di malattia di Addison?
Autoimmune
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.
r
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
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.
174
Cosa si intende per sindrome di Verner Morrison?
Diarrea secretiva con alterazioni elettrolitiche
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).
T
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
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.
177
Cosa esprime il rapporto tra il maggior asse fetale e i diametri dell'utero materno?
Situazione
178
Da quali cellule viene prodotto l'AMH?
Cellule della granulosa
179
Si definisce coniugata ostetrica la linea tesa: Dal promontorio sacrale al punto più sporgente all'indietro della sinfisi pubica
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.
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?
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.
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.
t
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?
ERBB2 o HER2.
183
The t(8;21) translocation is mainly observed in
M2 acute myeloid leukemia
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.
the cornea is generally spared in the case of uncomplicated conjunctivitis. Contact lens wearers are at risk of both conjunctivitis and keratitis.
185
Which drug is used as first choice in the pharmacological therapy of acromegaly?
The first choice therapy is surgery, but among pharmacological therapies octreotide represents the first choice. Somatostatin analogues (such as Octreotide or Lanreotide)
186
In case of compartment syndrome, what are the areas to keep most under control?
limbs
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.
lesions most frequently affect the supraspinatus. Jobe +
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.
t
189
Which of the following is a sign of tuberculosis of the genitourinary system?
Sterile pyuria
Alternative Answers
A) Selective proteinuria
B) Non-selective proteinuria
D) Hematuria at the end of urination
E) Kidney stones
190
What is the unit of measurement used by the International System of Units to measure the energy value of a food?
Joules (J)
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).
t
192
Which cranial nerve is responsible for miosis?
III
193
The most frequent cause of spontaneous subarachnoid hemorrhage in the adult population is:
Rupture of intracranial aneurysm
194
What is the activation threshold of stapedial reflexes?
Approximately 70 dB above hearing threshold
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
T
196
ISS significa?
istituto superiore di salute
197
vernakalant is the fastest drug to restore sinus rhythm
T
198
The antidote for magnesium sulfate is calcium gluconate.
T
199
What molecule does the ovarian struma secrete?
thyroid hormones. Struma ovarii is an ovarian teratoma composed almost exclusively of mature thyroid tissue. It can, therefore, cause hyperthyroidism.
200
What is the incubation period for Mediterranean button fever?
7
201
Which of the following antibiotics inhibits protein synthesis by binding to the 30s subunit of the bacterial ribosome?
gentamicin
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
T
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.
T
204
What is the most common age to be diagnosed with autism spectrum disorder?
2-3 years
205
