SIMULATION 01_2023 Flashcards
Il posizionamento in basso della valvola tricuspide prende il nome di
Anomalia di Ebstein
Associated with tricuspid insufficiency, WPW syndrome, prolapse of the mitral valve
Kussmaul sign is
Paradoxical increase in JVP during inspiration OR a drop in pressure during inspiration typically found in cardiac tamponade
Che cosa è il Fattore Reumatoide?
Un anticorpo diretto contro la regione Fc delle immunoglobuline IgG
Is microcytoma (type of lung cancer) radiosensible?
Yes
Qual è il cut-off alla spirometria per parlare di pattern ostruttivo?
FEV1/FVC < 0.7
The Tiffenau index allows a diagnosis of an obstuctive pattern
How to calculate CHA2DS2-VASc?
Congestive heart failure, Hypertension, Age ( > 65 = 1 point, > 75 = 2 points), Diabetes, previous Stroke/transient ischemic attack (2 points), vascular disease, female
Un tumore mammario con istotipo Luminal A is HER2 ( ) and ( ) for hormonal receptors and has a ( ) proliferative index
Il tumore luminal A della mammella è HER2 negativo, con positività dei recettori per gli ormoni (ER+, PR+) e indice proliferativo basso (Ki67<20%).
What are the 4 hypersensitivity reactions?
Type I: reaction mediated by IgE antibodies.
Type II: cytotoxic reaction mediated by IgG or IgM antibodies.
Type III: reaction mediated by immune complexes.
Type IV: delayed reaction mediated by cellular response. (T cells - e.g. contact dermatitis, drug hypersensitivity)
a corretta sequenza di benzodiazepine, ordinate in base a durata d’azione ed emivita crescente? MACD
clonazepam, alprazolam, midazolam, diazepam, flurazepam
midazolam (<6 hrs), alprazolam (6-18 hrs), clonazepam (18-36 hrs),
diazepam (>36ore)
flurazepam (40-114hrs)
un PAP test seguito da biopsia. Siamo in presenza di un atto di prevenzione livello ( )
secondaria
T/F Inosservanza si definisce come colpa specifica
T
un tumore della prostata che si estende per 1/3 di un lobo viene definito come
T2a
un tumore prostatico T2a interessa la metà o meno di un lobo. T1c rappresenta un tumore diagnosticato mediante biopsia prostatica ; T2b un tumore che interessa più della metà di un lobo; T2c un tumore che interessa entrambi i lobi ; T3 un tumore esteso al di fuori della prostata.
Cell mediated illnesses do not include
atopic dermatitis (do include nichel allergy, contact dermatitis)
Becks triad consists of
In case of cardiac tamponade:
Hypotension
Jugular venous distension (PVC)
Distant heart sounds
Burn victim fluid calculation
la formula di Parkland,
WEIGHT (KG) X 4ML X %OF BSA BURNED.
1/2 of this in the first 8 hours and the other half in 16 hours.
For septic shock hypotension tx is
Noradrenaline
Siewart classification for gastroesophageal tumors
3 gruppi di neoplasie:
Siewert I identifica un tumore dell’esofago che si trova tra 1-5cm a monte della linea Z
Siewert II identifica un tumore che si localizza tra 1cm a monte e 2cm a valle della linea Z
Siewert III identifica un tumore che si localizza tra 2-5cm a valle della linea Z
dehydration is associated with hyper or hyponatermia?
hypernatremia
ASA mechanism of action
is an irreversible inhibitor of COX1 and COX2 (more COX1).
An anti-aggregant
The leading cause of death in high income countries from: ischemic heart disease, stroke, congential anomalies, alcheimers, COPD
In low income countries the order is:
Ischemic heart disease, followed by stroke, then COPD
In low income countries: neonatal anomalies, respiratory tract infections, then ischemic heart disease
How does sarcoidosis appear on Xray?
bilateral hilar adenopathy
dry cough + dyspnea + Diabetes insipidus + erythema nodosum
What are the types of cardiac arrest rhythms
two macro-categories: shockable (ventricular fibrillation and pulseless ventricular tachycardia)
non-shockable (asystole and pulseless electrical activity).
Most frequent extra-articular manifestation of ankylosing spondyloarthropathies?
extra-articular manifestations (mucocutaneous, ocular, intestinal or genitourinary).
Amyloidosis, bilateral apical fibrosis, and IgA nephropathy are all possible extra-articular manifestations of AS, but less frequent than acute anterior uveitis
What test on physical exam for ankylosing spondyloarthropathies
Schober test. It is the semiological examination that allows you to evaluate the rigidity of the spine and the limitation of lumbar motility in the anterior flexion of the spine starting from the upright position.
As an anesthesiologist, what TX do you 100% have to suspend before an intervention?
ACE i for HTN
The intake of statins, fibrates, diuretics (such as furosemide and canrenone), clonidine should not be stopped in preparation for surgery
Define asymptomatic bacteriuria, do you give them tx?
asymptomatic bacteriuria is at least 100,000 CFU per ml of urine - asymptomatic in 2 consecutive urine samples in women and in a single sample in men.
The indications for screening and treatment in adults are represented by pregnancy and subjects who must undergo instrumental urological maneuvers.
What shifts the dissociation of O2 Hb curve to the right? (meaning Hb has a decreased affinity of O2)
increase temp, pCO2, H+, 2,3-diphosphoglycerate
DX method of choice in gastric cancer
EGDS with biopsy
Why does acetazolamide cause metabolic alkalosis?
being a carbonic anhydrase inhibitor, causes a reduction in bicarbonate reabsorption at the proximal tubule level
How many cc of volume is the anatomical dead space?
150 cc (is the area that doesn’t participate in gas exchange)
How deep must chest compressions be?
at least 5 cm
in a number of 30 followed by 2 ventilations , at a speed of approximately 100 per minute, therefore just under 2 compressions per second
T/F Tension headache, cluster headache and migraine are types of headaches that are characterized by acute attacks that resolve after a few hours, at most after a few days.
T
T/F In case of benign intracranial hypertension, it is possible to have a “stretch” of the VI cranial nerve which causes double horizontal vision especially from a distance.
T
T/F multiple myeloma presents with hypercalcemia symptoms
T
(such as constipation, polydipsia, vomiting, nausea, mental confusion)
Diagnose with protein electrophoresis which will show a monoclonal peak, and immunofixation which will identify the type of CM.
T/F Cobalamin (vitamin B12) deficiency typically manifests with macrocytic anemia, pancytopenia, and symptoms related to malabsorption. Hypersegmented neutrophils may be seen on a peripheral blood smear and typically disappear after treatment. What is its most common cause?
Pernicious anemia represents the most frequent cause of vitamin B12 deficiency and is related to autoimmune atrophic gastritis which causes a deficiency of intrinsic factor, necessary for the absorption of cobalamin.
T/F First-line therapy for status epilepticus is based on the immediate administration of a benzodiazepine (BDZ).
T
IV or IM
- note midazolam is not first line
Pulmonary thromboembolism on ABG
hypocapnea and hypoxemia
In case of symptomatic bradycardia, what doses of atropine do you give?
0.5 mg boluses, repeatable up to 6 times.
If doesn’t work, use epinephrine 2-10 µg/min or isoprenaline at a dosage of 5 µg/min are administered in the second line
What is distributive shock
Distributive shock is caused by a relative inadequacy of the intravascular volume caused by vasodilation (arterial or venous) despite the presence of a preserved circulating blood volume.
Note that DVT gives obstructive shock as there is a ‘mechanical’ factor
what are the cardioselective BB’s
atenolol, betaxolol, bisoprolol, esmolol, acebutolol, metoprolol, and nebivolol. (Cardioselective means they target more B1 receptors)
T/F Due to its marked capacity for distant metastasis and its neurotrophism, the treatment of lung microcytoma (small cell lung cancer) involves prophylactic pan-encephalic radiotherapy
T
Cases where you can do emergency dialysis (AEIOU)
AEIOU
‘A’ stands for ‘severe metabolic acidosis’ with pH<7.1
‘E’ stands for for ‘electrolytes’, i.e. hyperkalemia >6.5 mEq/L
‘I’ stands for ‘ingestion’ of toxic substances or overdose of digitalis
‘O’ for ‘fluid Overload’
‘U’ for ‘uremia with pericarditis and mental decline
Kartagener syndrome
Young’s syndrome
Yellow nail syndrome
William-Campbell syndrome
All cause:
Bronchiectasis
The Bachmann, Wenckebach and Thorel bundles are the three internodal bundles through which the sinoatrial node propagates the cardiac impulse to the myocardial cells of the atria and to the atrioventricular node.
T
The bundle of His is between the
the His bundle determines the propagation of the impulse from the atrioventricular node towards the two ventricles.
Closed angle glaucoma presentation? And TX in acute phase
Female sex, age >50 years, and low anterior chamber are all risk factors for an acute glaucoma attack.
generally occurs after pupillary dilation
It manifests itself with severe pain, blurred vision, pupil in medium reactive mydriasis, nausea and vomiting.
(open angle glaucoma has slower onset)
TX: Therapy in the acute phase consists of the instillation of miotics (pilocarpine) and ocular hypotensives such as osmotic diuretics (mannitol) and carbonic anhydrase inhibitors (acetazolamide). Beta blockers can be used to reduce aqueous humor production.
T/F Cranial CT does not show ischemia occurring until many hours after onset, which is why it is only useful for excluding cerebral hemorrhage in the acute phase and NOT for seeing an early ischemic lesion!
T
what to do in a pt with infarct going into cardiogenic shock
(start of inotropic and diuretic treatment, urgent percutaneous revascularization, placement of a Swan-Ganz catheter), including the aortic counterpulsator, if it were not for the presence of aortic insufficiency. Remember: the latter and aortic dissection are contraindications to the use of this device.
What drugs can be used to prevent acute side effects of cisplatin-containing chemotherapy regimens
NK1-antagonist + Ondansetron + Dexamethasone
To reduce emesis
define risk
Risk is the product of Hazard x Exposure.
R = P x E
Presentation of Central venous occlusion (occular)
acute, painless and unilateral visual loss together with the finding of “flame hemorrhages” on the ocular fundus
Treatment of macular edema
Intravitreal Dexamethasone
health surveillance is carried out
Every year unless otherwise decided by the competent doctor or specific directives
premedical phase in general anesthesia consists of
it involves the administration of drugs with anxiolytic action, such as benzodiazepines. By ‘premedication’ we mean the administration of drugs before the patient arrives in the operating room
MS treatment first and second line
First-line drugs are for example dimethyl fumarate, teriflunomide, glatiramer acetate or interferon. In the second line it recalls, for example, Natalizumab, Cladribine, Fingolimod.
T/F temporal arteritis is associated with polymyalgia rheumatica
T
a corpse is shorter than a live person
T
Due to rigor and tissue retraction/decay, the corpse tends to shorten as time passes.
When to do mammographic screening
Mammographic screening, in standard situations, consists of performing a bilateral mammogram every 2 years in patients aged 50 to 69 years inclusive.
An ABI (ankle-brachial index)
An ABI value > or equal to 1 is normal
< 1 indicates ischemia
< 0.4 indicates severe ischemia.
Owl cells on blood smear means
Hodgkin’s lymphoma is a neoplasm of mature B lymphocytes that has two peaks of incidence (20-30 years and 60 years).
can be asymptomatic or present with B symptoms
On lymph node biopsy, Reed-Stenberg cells, binucleated or multinucleated cells, which present large, intensely eosinophilic (“owl’s eye”) nucleoli
Which arterial vessel is most used to perform CABG?
internal mammary artery
Above what voltage does cardiac arrest occur
2 amps”. In the event of electrocution with an amperage greater than 2 amperes, cardiac arrest occurs, while above 20-50 milliamps the patient goes into respiratory arrest.
Categories of mitral stenosis
mitral stenosis can be divided into 3 categories: mild with valve area between 1.5 and 2 cm2; moderate mitral stenosis with valve area between 1 and 1.5 cm2 and severe mitral stenosis with area <1cm2.
Klebsiella rhinoscleromatis causes
Rhinoscleroma is in fact a chronic granulomatous infectious disease that affects the mucosa of the upper airways
first line TX of dermatomyositis?
glucocorticoids
Forensic toxicology studies:
poisons
In drug therapy of cerebral edema
Cortisone is used in vasogenic edema, while mannitol in cytotoxic edema (extensive cerebral ischemia).
Candedemia TX
Echinocandins or fluconazole
duration of therapy in the non-neutropenic patient will be 14 days from the first negative blood culture for candida. The duration in the neutropenic patient, however, must also take into account the resolution of the neutropenia.
Maria, 21 years old, goes to your breast clinic because she reports feeling a “ball” in her left breast. Which test do you propose to the patient?
Ultrasound with 8 MHz probes
What opens at the level of the utricle?
semicircular canals
Cefazolin is a semi-synthetic antibiotic acting on the beta-lactam ring which is used in the pre-operative prophylaxis of infections. It must be administered:
within 60 minutes before the skin incision.
Vancomycin and fluoroquinolones, however, should be administered within 120 minutes before the skin incision
What is the recommended therapy for syphilis?
Benzyl-penicillin G 2.4 mU IM single dose
In the suspicion of an initial Alzheimer’s disease, which investigation could be most useful in defining the diagnosis? What are first line drugs?
BRAIN MRI
In the treatment of the disease in the initial stages (mild-moderate symptoms), drugs inhibitors of cerebral acetylcholinesterase, such as donepezil or rivastigmine, are indicated.
In patients with moderate-severe disease, memantine is indicated.
Which diagnostic test do you carry out as an alternative to confirm Pulmonary TE diagnosis as soon as possible without a CT angiography?
echocardiogram of right heart. If PTE is present, you have hypokinesia of the RV.
Doppler of lower limbs is done in dtable pt with positive d-dimer.
Which of the following drugs used in the treatment of HIV infection is also indicated in the treatment of patients with naïve HBV-related hepatitis?
Tenofovir disoproxil fumarate.
Which level II investigation would you request for rectal tumor?
MRI of the lower abdomen and pelvis. MRI should be taken into consideration as a first option and as a standard examination to locally stage rectal tumors in a locally advanced stage as it evaluates the invasion of the mesorectum, the infiltration of the perirectal fascia and contiguous organ-structures.
risk of myopia
Retinal detachment and macular degeneration
what is Dacryocystitis
Dacryocystitis is an inflammation of the lacrimal sac, manifested by redness and inflammation of the medial canthus with possible leakage of purulent material from the lacrimal punctum.
Therapy consists of systemic antibiotics.
What does frozen elephant trunk surgery consist of
Replacement of the aortic arch and descending aorta in a single operation.
T/F Respiratory arrhythmia is a completely benign condition, which therefore does not require any therapy
T
Lamotrigine
Lamotrigine is an excellent antiepileptic drug that acts on Na+ channels and is useful in young women as it is not teratogenic. Dose titration must be slow because it can cause even serious skin rashes.
Which of these antibiotics has activity against methicillin-resistant Staphylococcus aureus (MRSA)?
ceftaroline
What is first line TX for hypotensive shock? Norepi or epi?
norepinephrine
Overingestion of paracetamol. Diagnose acute exotoxic hepatitis. What therapy ASAP?
administration of N-Acetylcysteine
Specific fault is defined as:
non compliance
