Simulation 13_2023

Question 1

If pt has metastatic gastric cancer with HER2 mutation, treatment must be

Answer 1

anti HER2 drug (trastuzumab)
cisplatin, fluorouracil

Question 2

T/F Bevacizumab is not used in clinical practice

Answer 2

T

Question 3

Which serotonin receptor is characteristically blocked by second generation antipsychotics, ensuring a better tolerability profile than first generation antipsychotics?

Answer 3

5-HT 2A

Question 4

Define: nevus sebaceous, spitz nevous, nevus of Ota, nevus of Ito, pilomatrixoma

Answer 4

The sebaceous nevus is a benign skin growth with 15% malignant transformation into basal cell carcinoma in adulthood
Spitz nevus histologically resembles melanomas, but its malignant potential does not exceed that of common melanocytic nevi
the nevus of Ota is a dermal melanocytic nevus present at the level of the V1 and V2 branches of the trigeminal nerve
nevus of Ito is a dermal melanocytic nevus located at the level of the shoulders, chest and upper back
pilomatrixoma is a benign neoformation of the hair appendages

Question 5

The most frequent nephritis that affects children is

Answer 5

acute post-infectious glomerulonephritis
begins 10-15 days after infectious episode (stretococcal)
SX: arterial HTN, poor diuresis, sloping edema

Question 6

Testicular torsion signs on doppler, how to diagnose, and TX

Answer 6

lack of vascular signal and inhomogeneity of the testicular parenchyma
Note that the diagnosis of testicular torsion is clinical: the pain associated with torsion occurs in conjunction with the absence of cremasteric reflex and/or upward retraction of the testicle.
TX: Within 6-8 hours from onset perfrom acute manual detorsion. Exploratory surgical intervention via scrotum is recommended.

Question 7

Local anesthetics: Amino amides vs amino esters

Answer 7

amino amide: lidocaine, levobupivacaine, ropivacaine, bupivacaine
amino esters: tetracaine

Question 8

Which is the most specific autoantibody for Systemic Lupus Erythematosus?

Answer 8

Anti-SM (found in 30% of cases). Anti-DNA SS with ic present in 90% of cases but isn’t specific.

Question 9

Prior to a transplant, what is the gold standard for measuring kidney function

Answer 9

renal scanning (scintigraphy)

Question 10

What is bullous impetigo

Answer 10

a superficial bacterial infection that mainly affects pediatric patients due to the production of toxin A by Staphylococcus aureus, which acts against the desmosomal proteins of keratinocytes.
leading to the formation of bubbles with serous content, which break down and transform into brown crusts.

Question 11

Which patients are most likely to get dermatitis herpetiformis

Answer 11

those affected by celiac disease

Question 12

Chicken pox is characterised by

Answer 12

itching, lesions such as papules, pustae and crusts.

Question 13

What is Meckels diverticulum? SX? DX? TX?

Answer 13

the most common congenital malformation of the GI tract, is a true diverticulum
It arises from incomplete obliteration of the vitelline duct and is a sacculation that arises from the antimesenteric border of the ileum. located within 80 cm of the ileocecal valve and often contains heterotopic gastric and/or pancreatic tissue.
SX: often asx, BUT can have bleeding, intestinal obstruction and inflammation (diverticulitis).
DX: Tc-99m pertechnetate scan (shows ectopic gastric mucosa)
TX: surgical resection for symptomatic diverticula

Question 14

Hep B has five phases based on HBeAg, HBV DNA, GPT (ALT) values which are

Answer 14

Immune active phase
Inactive phase (inactive carrier)
Immune tolerant (maternal transmission)
Resolved infectoin
Status after vaccination

Question 15

What is a peri-mesencephalic subarachnoid hemorrhage

Answer 15

type of SAH in which an aneurysm underlying the bleeding is not identified. It is more frequent in men unlike aneurysm SAH and has a generally benign course. It is diagnosed via skull CT as in the case of classic SAH.

Question 16

voluntary drunkenness.
Accidental drunkenness
Preordained drunkenness
Habitual drunkenness

Answer 16

Accidental drunkenness occurs outside of the subject’s will and/or due to reasons of force majeure (art. 91.) Voluntary drunkenness does not exclude or reduce imputability (art. 92) and occurs when a person wanted to get drunk to overcome a state of sadness or forget pain and sorrow; or when he behaves carelessly and imprudently regarding the consumption of alcohol. Preordained drunkenness occurs in order to commit a crime or prepare an excuse and is an aggravating circumstance of a crime (art. 92).
Habitual drunkenness includes periodic but frequent episodes of acute inebriation, interspersed with moments of lucidity. In these cases, the sentence is increased.

Question 17

Tyrosine kinase inhibitors (TKIs) are a group of anticancer drugs belonging to the class of:

Answer 17

molecular target drugs
imatinib (used in the treatment of CML and ALL), sorafenib (used in kidney and liver cancer), sunitinib (for kidney cancer ), dabrafenib and trametinib (used in BRAF mutated melanoma).

Question 18

When to transfuse blood before endoscopy

Answer 18

patient who is hemodynamically stable and WITHOUT underlying cardiac pathology, therefore transfusing if the Hb falls below 7 g/dl (or 70 g/L)

In the event that there is an underlying cardiac pathology (acute or chronic), one acts less sparingly, therefore it is advisable to transfuse even at hemoglobin levels <8 g/dl.

Question 19

How soon should digestive endoscopy be performed in acute bleeding?

Answer 19

within 24 hours
Gastroscopy can be defined as urgent if performed within 12 hours, early/early if performed within 24 hours and deferred/delayed if performed after 24 hours.
it is recommended to stabilize the patient and undergo endoscopy within 24 hours.

Question 20

What is posterior vitreous detachment? TX?

Answer 20

the separation between the posterior cortex of the vitreous and the retina.
The vitreous is tightly adhered to the retina in 3 specific points: ora serrata, optic disc and macula
Detachment of vitreous from the optic disc can produce the formation of Weiss’ ring
The traction of the vitreous on the retina causes a series of symptoms such as bright flashes and floaters, and can also cause symptomatic or non-symptomatic retinal tears.
TX: no TX for PVD alone. But urgent laser barrage within 24 hours for the retinal tears.

Question 21

Signs of central arterial occlusion? TX?

Answer 21

vision loss
pale retina and cherry red spots on macula
TX: occular massage and paracentesis

Question 22

signs of central venous occlusion? TX?

Answer 22

decreased vision
flame hemorrhages
TC: pan retinal photocoagulation

Question 23

when is a vitrectomy indicated?

Answer 23

retinal detachment
vitreous hemorrhage
macular hole

Question 24

MI, pneumonia, hemorrhagic proctitis, skin erythema are all consequences of radiotherapy

Answer 24

T

Question 25

Tuberous sclerosis is associated with which urinary/genital lesion?

Answer 25

renal angiomyolipoma (a benign renal tumor)
Their size may lead to simple follow-up (if less than 4 cm) or embolization in case of conspicuous bleeding (greater than 4 cm).

Question 26

when is neoadjuvant therapy given?

Answer 26

its chemotherapy done before surgery to shrink or slow the spread of cancer to make surgery less invasive

Question 27

when is adjuvent chemotherapy done

Answer 27

after surgery to kill any remaining cells to reduce risk of recurrence

Question 28

Heyde syndrome is

Answer 28

the association of aortic stenosis and duodenal angiodysplasias (acquired von willebrands disease)

Question 29

Fracture of which anatomical region most commonly presents with anatomical snuffbox pain?

Answer 29

scaphoid

Question 30

cacchi ricci disease is aka

Answer 30

kidney with sponge medulla
It is a rare autosomal dominant disease. The discovery is usually made via renal ultrasound and is associated with the presence of stones.

Question 31

Acute angle closure glaucoma presentation? TX?

Answer 31

eye pain, decreased vision, nausea and vomiting.
On the ophthalmological exam, conjunctival injection, corneal edema and a reactive pupil in medium mydriasis.
The reduced amplitude of the angle can be confirmed by gonioscopic examination while the increase in pressure by tonometer.
TX: intravenous acetazolamide to reduce acqueous humor production

Question 32

Endopthalmitis causes and presentation

Answer 32

is an intraocular infection in most cases exogenous post-operative.
It presents with red eye, pain, visual impairment, hypopyon (the accumulation of neutrophils and fibrin that typically settles ventrally within the anterior chamber).

Question 33

Anterior ischemic optic neuropathy presents with

Answer 33

anterior ischemic optic neuropathy is divided into an arteritic form (NOIA-A) and a non-arteritic form (NOIA-NA). The pathology leads to painless monocular vision loss (more severe in the arteritic form). It manifests as a relative afferent pupillary defect (RAPD) and pallor with optic disc edema.
TX: IV methylprednisone

Question 34

How does opthalmic zoster present? TX?

Answer 34

ocular pain and a dermatomal rash following the ophthalmic division of the trigeminal nerve.
TX: oral valacyclovir

Question 35

Bone metastasis - elderly
Eosinophilic granuloma - young
Adamantimoma - adult
Myeloma - elderly
Ewing sarcoma - young ppl (onion bulb periosteal reaction, t1122

Answer 35

T

Question 36

The Magnus-De Klein sign is positive in subjects affected by:

Answer 36

meningitis
Rotating the head to one side causes tonic contraction of the extensor muscles of the limbs on the same side and the flexors of the contralateral limbs. Furthermore, it is also positive in decerebrate subjects

Question 37

Explain:
Oroya fever
Lassa fever
Rift Valley fever
Katayama fever

Answer 37

Oroya fever: (Peru, Colombia), begins after 3 weeks (incubation period varies from 2 to 14 weeks) following skin inoculation with Bartonella bacilliformis, an intracellular gram- bacillus , through the bite of the sand fly vector Lutzomyia verrucarum. The reservoir is man.
severity is variable, from modest feverish episodes to cases characterized by massive hemolytic anemia, hepatomegaly, generalized lymphadenopathy and shock. If not subjected to treatment (generally with ciprofloxacin) the lethality is high, although it remains considerable (around 10%) even in cases subjected to therapy. In cases with a favorable evolution, a persistent chronic infection can develop with the appearance of spontaneously healing red-purple mucocutaneous lesions (Peruvian wart).
Lassa fever and Rift Valley fever are diseases of viral origin; Katayama fever is an acute manifestation of schistosomiasis (trematode)

Question 38

Fanconi syndrome is a pathology that affects which section of the tubule?

Answer 38

Fanconi syndrome consists of multiple defects in proximal tubular reabsorption that cause the loss of all those elements absorbed in this tract.
glycosuria, phosphaturia, generalized aminoaciduria and loss of bicarbonate

Question 39

make a diagnosis of Squamous cell carcinoma without a biopsy

Answer 39

squamous cell carcinoma. To make a diagnosis it is necessary to focus on some key terms which are: “smoker”, “short time”, “underlying keratotic skin” and finally “lip”.
cSCC is a neoplasm that develops in photoexposed areas
Actinic keratosis, leukoplakia, Marjolin’s ulcer, and cutaneous horns are associated with squamous cell carcinoma.

Question 40

In gram-positive bacteria there is NOT:

Answer 40

periplasm
Gram-positive bacteria do not have an outer membrane and, consequently, a periplasm.
The term periplasm, also known as periplasmic space, refers to the space delimited by the plasma membrane and the external membrane,

Question 41

Metabolic syndrome definition

Answer 41

characterized by the simultaneous presence of multiple conditions that predispose to a high cardiovascular risk and type 2 diabetes.
at least three of the following criteria be present to make the diagnosis of MS: increased waist circumference (≥102 cm in men and ≥88 cm in women), high levels of triglycerides ( ≥150 mg/dl or ongoing hypotriglyceride-lowering therapy), low HDL cholesterol levels (<40 mg/dl in men and <50 mg/dl in women), high blood pressure levels (≥130/85 mmHg or antihypertensive treatment in act) and fasting blood sugar ≥100 mg/dl (or hypoglycaemic treatment in progress).

Question 42

the most common cause of CKD in individuals over the age of 65?

Answer 42

Nephroangiosclerosis

Question 43

damage to
- ulnar nerve
- radial nerve
- median nerve

Answer 43

ulnar: paresthesia of 4th and 5th fingers
radial: deficit in hand extension, paresthesia of dorsum of the hand, deficit in elbow extension
median: paresthesia of i, ii, iii finger

Question 44

single
double
triple blind study

Answer 44

In the single blind only patients are kept in the dark
In double blinding, doctors and patients are unaware of the randomization.
In the triple blind the data analysts are also unaware, who are already normally independent from the experimenters for greater neutrality.

Question 45

chronic kidney disease
Methothrexate
chronic myeloproliferative syndromes
liver disease
can all cause

Answer 45

acquired thrombocytopenia

Question 46

COHb levels and symptoms

Answer 46

Natural levels of CoHb are around 2%, in smokers they can reach between 5 and 13%.
Acute levels of 5-15% can give non-specific symptoms, often confused with the flu. Between 15 and 25% intense headache, dizziness, visual disturbances, sinus tachycardia, hypotension occur
25-30, convulsions, coma, respiratory failure, rhythm disturbances, myocardial ischemia and death. Percentages between 40 and 70% are practically always lethal.
Therapy consists of hyperbaric O2.

Question 47

Chronic noise damage can occur for noise greater than:

Answer 47

80 db

Question 48

Which interleukin is primarily responsible for the proliferation and differentiation of eosinophilic leukocytes?

Answer 48

IL5

Question 49

Harm from acute noise:
It is generally unilateral
It can be conductive
It can be mixed
It can resolve without sequelae

Answer 49

T

Question 50

drugs effective against mycoplasma pneumoniae

Answer 50

doxycycline
levofloxacin
moxifloxacin
azithromycin

Question 51

what is brachytherapy

Answer 51

brachytherapy is carried out by placing a source of radiation in close contact with the lesion and this allows a selective action on the disease with a good chance of therapeutic success. It is mainly used in endocavitary lesions such as cervical and vaginal gynecological neoplasms, anal and prostate cancer.

Question 52

In what type of patient do you expect to encounter a torus fracture?

Answer 52

10 year old child. The Torus fracture is caused by axial compression of the bone, resulting in bowing of the child’s immature bone and a compression fracture on the side of the concavity.

Question 53

Pseudomonas aeruginosa facts

Answer 53

gram-negative
aerobic
non fermenting
oxidase positive
bacillus
Ertapenem is the only carbapenem without activity against Pseudomonas.

Question 54

What does a newborn’s eye normally look like at birth?

Answer 54

hyperopic (shorter axial lenght)

Question 55

First line for OCD TX
Second line?

Answer 55

sertraline
second: clomipramine (tricyclic drug), risperidone, aripiprazole

Question 56

The Barbecue maneuver is useful in cases of:

Answer 56

canalolithiasis of the CSLaterale (right horizontal canal). In fact, this maneuver, which consists in rotating the patient placed in a supine position through 360°, is useful in the treatment of this pathology

Question 57

patient’s medical history reported a previous allergic reaction to contrast medium. You need urgent CT chest with mdc. what do you do?

Answer 57

The radiologist must perform the CT scan after intravenous bolus infusion of Benetelan (betamethasone)

Question 58

first line treatment in case of catatonia?

Answer 58

benzodiazepines

Question 59

Which tumor is most frequently associated with bladder exstrophy?

Answer 59

adenocarcinoma
Bladder exstrophy is a rare malformation of the urogenital system already present at birth. More in males. it is a closure defect of the lower abdominal wall, which also involves the pelvic bones, which remain open

Question 60

What does a Serum-Ascites Albumin Gradient value greater than or equal to 1.1 g/dl indicate?

Answer 60

With an accuracy of 97% portal hypertension is involved in the formation of ascites.

Question 61

The Hasselback triangle, what is it?

Answer 61

The Hasselback inguinal triangle is a portion of the anterior abdominal wall delimited by the Cooper ligament, the epigastric vessels (inferior epigastric artery) and the lateral border of the rectus abdominis muscle and represents an area of ​​least resistance as it is covered only by the transversalis fascia . This anatomical portion is the area where direct inguinal hernias can form.

Question 62

In relapsing-remitting multiple sclerosis, to be defined as such a clinical relapse must have a duration of at least:

Answer 62

24 hours

Question 63

The Epley maneuver is useful in cases of:

Answer 63

CSPosteriore canalolithiasis. The Epley maneuver is in fact one of the cornerstones of the treatment of this form of canalolithiasis

Question 64

For the reconstruction of the base of the tongue, after demolition for oncological purposes, the ALT flap is often used: where is it taken from?

Answer 64

“Anterolateral part of the thigh.”

Question 65

In Guillain-Barré syndrome, which medications would you consider as your last option for neuropathic pain?

Answer 65

Drugs such as opioids for the dysautonomia of GBS patients and the high risk of constipation

Question 66

noise-induced hearing loss has the following characteristics:

Answer 66

Bilaterality
Audiometric spoon shape
Peak hearing impairment at 3000/4000 Hz
Neurosensory pattern

Question 67

Burkitt disease is associated with the following translocation:

Answer 67

the translocation between chromosomes 8 and 14.

Question 68

Familial Mediterranean fever,

Answer 68

aka paroxysmal polyserositis
is a hereditary disease of unknown etiology, characterized by recurrent episodes of fever, peritonitis and/or pleurisy.
It appears between the ages of 5-15, as recurrent episodes of high fever (24-48 hours), accompanied by abdominal pain, chest pain, joint pain or skin manifestations such as erysipeloid erythema on the lower limbs.
TX: lifelong colchicine (inhibitor of neutrophil chemotaxis). If doesn’t work then IL1 inhibitor

Question 69

Which drugs are indicated in the treatment of Clostridioides difficile diarrhea?

Answer 69

Fidaxomicin
(vancomycin too but has risk of relaspe)

Question 70

rotator cuff of the shoulder?

Answer 70

teres minor
supraspinatus
infraspinatus
subscapularis

Question 71

During therapy with ethambutol for TB it is recommended:

Answer 71

Subject the patient to repeated eye examinations. Among the side effects of ethambutol, optic neuritis with reduced visual acuity and decreased discrimination of red and green colors is characteristic,

Question 72

What does arthrodesis surgery consist of?

Answer 72

Joint lock

Question 73

Acute noise damage can occur for noises equal to:

Answer 73

125dB

Question 74

dermatoscopic findings is typical of basal cell carcinoma

Answer 74

maple leaf shaped structures
tree trunk telangiectasias
microerosions
macroerosions

Question 75

Primary progressive aphasia exists in how many variants?

Answer 75

3
Primary progressive aphasia is a neurodegenerative pathology that involves a deterioration of language as a cognitive function while leaving other functions more or less intact (executive, memory, attention). Primary progressive aphasia can be diagnosed in three variants: semantic, logopenic and nonfluent.

Question 76

Cyclin D1 overexpression in immunohistochemistry is typical of:

Answer 76

mantle cell lymphoma.

Question 77

minor criteria for the diagnosis of rheumatic disease?

Answer 77

For the diagnosis of rheumatic disease, major and minor criteria are taken into consideration: the former include arthritis, carditis, nodules, erythema marginatum and Sydenham’s chorea, while the latter include fever, increased of the indices of inflammation, arthralgia and PR elongation on the ECG.