Simulation 09_2023 Flashcards
What agent reverses the anesthetic effect of cortare (rocuronium bromide)?
4 vials of Neostigmine (total 2mg) and 2 vials of atropine (total 1mg)
both the drugs have anticholinesterase activity
What is and how does anti-phospholipid syndrome present?
its a systemic autoimmune dx with antibodies against cells, coagulation factors and complement system.
Causes venous/arterial thrombosis, abortions, fetal deaths, thrombocytopenia, autoimmune hemolytic anemia
Sjogrens syndrome presents with
Xerostomia or xerophthalmia
CREST sign is from which autoimmune dx
systemic sclerosis
- calcinosis, raynauds phenomenon, esophageal dysmotility, sclerodactyly, telangectasia
What is primary prophylaxis for anti phospholipid syndrome?
What is secondary prophylaxis?
acetylsalicylic acid for thrombophylaxis
!! If the pt also had lupus use hydroxychloroquine +/- ASA
Secondary: oral anticoagulation
Apple core image is a sign of cancer in which organ
colon
does lorazepam have a hypnotic activity?
no, its an anxiolytic
Which area corresponds to “Bunnell’s no-man’s land” at hand level
zone 2
At the hand level, there are five different areas of injury to the flexor tendons, characterized by different prognoses; Zone 2 presents the worst prognosis for anatomical reasons. Bunnell’s area begins at the level of the distal palmar fold and ends in the middle part of F2, where the insertion of the superficial flexor tendon bends ends.
daBRAFenib, a drug to treat melanoma, targets which molecule?
BRAF
Nivolumab targets?
PD-1
PD-L1 inhibitors are
atezolizumab, durvalumab and avelumab
Ipilimumab is an
CTLA-4 inhibitor
define subclinical hyperthyroidism
low TSH
normal free T4 and T3 levels, without or with minimal symptoms of hyperthyroidism.
What is the pathogenesis of ventricular pseudo-aneurysm
It forms following a transmural infarction that causes wall rupture, which in turn is delimited by thrombosis. This prevents the evolution into hemopericardium and the consequent probable tamponade.
what is the valsalva manuver for varicocele evaluation
during increased abdominal pressure by the patient
Subclinical, when they are neither visible nor palpable but seen on Doppler
grade 1 when it is palpable only during Valsalva
grade 2 when it is palpable even when at rest
grade 3 when visible.
what are side effects of RX
Breast cancer
secondary lymphoma
pulmonary fibrosis
coronary stenosis
NOT LEUKEMIA
How many stages of Angle’s occlusion of teeth
3
In a women with breast cancer treated with adjuvent hormone therapy for 5 years, what do you do to prevent osteoporosis
Prescribe antiresorptive therapy (bisphosphates or denosumab) to protect the bone and adequate supplementation with calcium and vitamin D
What is guilain barre syndrome?
an inflammatory polyradiculoneuritis with ascending tingling, starting from the extremities (hands and feet) and moving up the limbs and trunk in a few days.
leads to paralysis of the four limbs, with areflexia, and with dysautonomia (note respiratory and sphincter function)
TX is IV immunoglobulins
NOT GENETIC
How are levels of validity of scientific work expressed?
Level A includes evidence from multiple randomized experimental studies, Level B includes evidence from one randomized experimental study OR multiple quasi-experimental studies OR multiple large cohort studies, while Level C includes evidence from observational studies (excluding cohort ones) OR by expert consensus.
The appearance of dizziness following efforts, loud noises or increases in external pressure suggests
Minor’s syndrome
What is waste water
water that requires appropriate purification treatments before being eliminated into the environment
When does ascending pyelonephritis occur?
the main causes of infection for women consist in the deformation of the urethra during sexual intercourse, while for men it is often secondary to endoscopic maneuvers.
Factor VII or VIII deficiency is? age of onset? Signs? Signs on coagulation panel
x-linked hereditary haemorrhagic coagulopathy, haemophilia A or B, depending on whether there is a deficiency of factor VIII or IX respectively
Usually the first manifestations occur around the age of one year (include haemarthrosis, muscle haematomas, ecchymoses and mucosal haemorrhages)
The coagulation analysis shows a lengthening of the aPTT with normal platelet counts and prothrombin time.
MDR TB means?
TB due to a strain resistant to rifampicin and isoniazid
What does flucytosine treat?
is an anti-fungal
Placental alkaline phosphatase and alpha-fetoprotein are used in the diagnosis of
germinoma (often in the pineal region)
Symptoms in a case of foodborne botulism?
Autonomic system disorders
manifests 12-36 hours after incubation/ingestion
TX of multiple sclerosis?
high dose corticosteroids in acute situations then dimethyl fumarate/monoclonal antibodies (ocrelizumab, natalizumab) for long term
The Gelli-Bianco law provides that punishment can be excluded for a doctor in the event of
incompetence
BMI divisions
normale fra 18.5-25, sovrappeso fra 25 e 30, obesità sopra i 30, sottopeso sotto i 17.5.
Russells sign in anorexia/ED
The callus on the back of the hand
TX for bulemia nervosa?
Fluoxetine specifically, and serotonergic drugs in general, are the only drugs that have been shown to be able to reduce the symptoms of binge eating/vomiting in patients with bulimia nervosa,
Which drugs have a hyporexia effect (reduce appetite)
topiramate
Are calcified nodules on pulmonary CT malignant?
the nodules of calcific consistency are benign. On the contrary, solid, non-calcific nodules should be well monitored based on size. For nodules larger than 3 mm it is important to check them again over time, nodules larger than 1 cm are usually studied with contrast medium and examined in depth with functional tests such as PET CT
which joints affected in psoriatic arthritis? What do you see on RX?
distal interphalangeal joints
on rx: pencil in a cup.
In which pathologies is Nikolsky’s sign positive
pemphigous vulgaris.
Nikolsky’s sign is tested by rubbing the skin, in certain pathologies this causes the detachment of the superficial layer of the epidermis with the consequent formation of blisters.
Hutchinson fracture
Geràrd-Marchant fracture
Barton fracture
Colles fracture
Are all fractures of?
The distal radius
Penile cancer
rare
HPV 16 18 play a role
RF: balanitis, uncircumcision, STI
most frequent location is glans or under foreskin.
Biopsy is gold standard
most are SCC
At what pressure levels is compartment syndrome suspected?
> 35 mmHg and DBP-PAS <30.
philiadelphia chromosone
Although the t(9,22) translocation, known as the Philadelphia chromosome, is most associated with chronic myelogenous leukemia (CML), it has also been observed in acute lymphoblastic leukemia (ALL).
The Steno duct belongs to which salivary gland
parotid
Sjogrens syndrome comes with risk of ofthalmic
The key symptoms are keratoconjunctivitis sicca and xerostomia.
reduced visual acuity, superficial infections, corneal ulcers and in the most severe forms, corneal perforation.
how does RAAS work in the kidney
on the efferent arteriole by increasing resistance.
entropion
caused by hyperlaxity of the eyelid and peripalpebral tissues due to age, or by various traumatic causes, consists in the introflection of the ciliary rim towards the cornea: this, intuitively, can cause various problems due to the irritation of the eyelashes towards of the corneal surface and must therefore be corrected through a definitive surgical intervention. In ectropion, however, there is an extrusion of the ciliary rim towards the outside
MINOCA includes thrombosis on atherosclerotic plaque?
NO
MINOCA has enzymatic increase, chest pain, ECG changes but CORONARY ARTEREIS ARE FREE FROM ANGIOGRAPHICALLY SIGNIFICANT LESIONS
How does the impulse reach the ventricles in orthodromic atrioventricular reentry tachycardia
With the atrioventricular node.
can a pacemaker have a CT
yes
What is the structure that tends to prevent the spread of an abscess or neoplasm of the prostate and seminal vesicles to the rectum?
Denonvilliers fascia
reversible chronic venous insufficiency conditions and irreversible
edema, ocher dermatitis, eczema of the legs and infections
irreversible ones there are white atrophy, lipodermatosclerosis, ulcers and calcification.
How can contrast-induced nephropathy (CIN) in patients with impaired renal function be prevented?
intravenous hydration with saline.
OCTA opthalmologia stands for
optical coherence tomography angiography
Risser test is?
used to evaluate skeletal maturity.
- evaluates the percentage of fusion of the growth nucleus of the iliac crest. The scale goes from 0 to 5. Grades 4-5 consider skeletal maturation complete - therefore decide what tx for scoliosis
Neer test for
supraspinatus
Cobb test evalutates
degree of scoliosis
Schober test evaluates
ankylosing spondylitis and spinal stiffness
How is a cholecystectomy procedure classified?
clean-contaminated
meaning there is an uncontaminated opening of the GI, genitourinary or biliary tract, in the absence of urinary or biliary infection. In a clean operation, however, there is no septic focus, no opening of the digestive, respiratory or genitourinary tract.
senile cataracts are the most frequent form of cataract and is generally bilateral
T
WPW definition and on ECG
defined as a pathological condition characterized by ECG signs of ventricular pre-excitation and episodes of paroxysmal supraventricular tachycardia. It is due to the presence of a Na+ dependent accessory pathway, called Bundle of Kent.
most frequent ECG finding with dilated cardiomyopathy
left bundle branch block
what markers to type classical hodgkin lymphoma
B) CD3 -
C) CD15 +
D) CD45 -
E) CD30 +
Electromechanical dissociation (PEA) is characterized by
electrical visible on the electrocardiogram, in the absence of effective cardiac output.
can you use corticosteroids for perioral dermatitis?
no
Which antibiotics can cause a disulfiram-like reaction when given in combination with alcoholic beverages?
metronidazle
What is the most frequent cause of irreversible vision loss in developed countries in older adults?
age related macular degeneration
What is the role of radiotherapy in pancreatic cancer?
palliative
Schonlein-Henoch purpura
a systemic vasculitis of the small vessels, diagnosed by the presence of palpable purpura especially in the lower limbs (the violaceous lesions of the clinical case), associated with at least one of: arthalgias of the lower limbs (which are transitory and without outcome), GI involvement (abdominal pain mainly), renal involvement or skin/renal biopsy with evidence of IgA deposits.
Males between 3-15 years old and is the most common cause of non-thrombocytopenic purpura in children.
Suspected IgA-mediated vasculitis, with deposits of IgA and C3 at the site of the lesion
Associated with infections of the upper respiratory tract and allergic reactions.
Vasculitis is usually self-limiting in about 4-6 weeks, so most cases are treatable at home. NSAIDs are usually used for arthralgia, systemic corticosteroids (Answer B) for intestinal complications, as well as intravenous immunoglobulinsin serious and relapsing cases. Surgical therapy is used in case of intestinal obstructions or perforations.
In a renal biopsy, the pathologist describes on immunofluorescence a picture of “full house” antibody and complement deposits; which secondary glomerular pathology are you thinking of?
lupus nephropathy
he presence of “full house” immune complexes indicates a deposition of the three antibody classes IgG, IgM, IgA (possible in 70% of cases) associated in more than 90% of cases with positivity to complement C3 and C1q.
Which of these maneuvers can be useful in diagnosing BPPV?
Pagnini-Mclure maneuver.
Acute hepatitis measures
Acute viral hepatitis is characterized by the presence of HBV-DNA, which is the first indicator of infection. The other unequivocal markers are: - HBsAg appears 1-2 months after the onset of symptoms and after another 2 months HBsAb appears.
However, the persistence of HBsAg for more than 6 months constitutes chronic hepatitis.
In severe mitral stenosis the valve area has a value less than
1 cm^2
Normal mitral valve is 4-6cm^2
what is a chancroid
is an STD whose etiological agent is Haemophilus ducreyi a gram-negative bacillus which requires media containing hemin (blood) to grow in culture.
What adjuvant therapy regimen would you use on a patient with HER2+ breast cancer?
Trastuzumab (monoclonal antibody directed against the extracellular domain of HER2)
The Harris-Benedict formula:
allows you to calculate a patient’s basal energy expenditure. A patient’s basal energy expenditure (measured in kcal/day) can be calculated from the patient’s height (h), weight (w), age (y) and gender
Sjogrens syndrome can also give rise to important haemato-oncological diseases
T cell lymphoma.
what is the Jarisch-Herxheimer reaction.
is a phenomenon that can generally occur within 24 hours following the administration of antibiotic therapy (generally the reaction begins after 6/8 hours), due to the release of bacterial cellular debris that forms following the bacterial lysis due to the action of the antibiotic.
characterized by fever and flu-like symptoms (general malaise, headache, arthromyalgia). In more severe cases it is possible to take NSAIDs or other antipyretics.
what is the rivalta reactions used for
The Rivalta reaction is a method used in the past to distinguish between exudates and transudates
pediatric dose of amoxicillin
50 mg/kg/day in 2 administrations.
what does bacterial transduction mean
Transfer of genetic material from one cell to another via bacteriophages
The Dix-Hallpike maneuver is used to diagnose:
canalolithiasis of the posterior semicircular canal. usually the first to be performed in cases of suspected BPPV
What complication can occur in a patient suffering from severe mitral stenosis?
paroxysmal or permanent atrial fibrillation (60% of cases)
Systemic embolisms are worrying consequences of the formation of thrombi in the dilated left atrium and in the left auricle, most likely the result of blood stasis and chronic atrial fibrillation, resulting in cerebral embolism or embolism in the upper limbs or lower limbs .
mechanism of action of acetylsalicylic acid?
It is an inhibitor of platelet aggregation
acts on COX1 + COX2
Laron’s syndrome
is a congenital disease with autosomal recessive transmission, characterized by very short stature associated with various alterations.
HBV is a DNA or RNA virus?
a DNA virus
when to consider corrective surgery in scoliosis
If age < 3 years, surgery is applied only in cases refractory to conservative therapy; if age 3-9 years, conservative treatment with orthoses in case of curve > 25°, surgical approach if the curve is greater than 40°; from 10 years, observation in case of curve < 30°, orthosis in case of curve 30° - 45°, surgery in case of curve > 45° and with growth potential.
In the treatment of hydrocephalus, where is the shunt made?
in the peritoneum.
What is the most frequent cause of endogenous hyperthyroidism?
graves dx
Osgood-Schlatter disease.
caused by traction apophysitis of the insertion of the patellar tendon on the tibial tuberosity following frequent stress on this structure during intense physical activity of the lower limbs in adolescents.
What is the first-line treatment in a patient with cardiac myxoma?
surgical removal
cardioverson = defibrillation?
no
cardioversion means the delivery of the shock in synchrony with a QRS.
Defibrillation, on the other hand, is used in all those cases in which the ventricular electrical activity is so disorganised, chaotic and at high frequency that it does not allow the synchronization of the discharge with one of the patient’s QRS:
