Simulation 17_2023

Question 1

define disinfection

Answer 1

the reduction and/or elimination of pathogens present in the air or on surfaces.

Question 2

Sister Mary Joseph’s nodule, Krukenberg’s tumor, Blumer’s step sign are all?

Answer 2

typical of gastric adenocarcinoma
The Sister Mary Joseph nodule indicates a nodule in the periumbilical region, the Blumer step sign indicates nodules at the peritoneal level, while the Krukenberg tumor indicates nodules at the ovarian level.

Question 3

Ficat classification

Answer 3

of aseptic necrosis of the femoral head

Question 4

vinyl chloride monomer facts

Answer 4

CMV has been used in the past as an anesthetic gas as it is easily absorbed by inhalation.
Causes fatal arrhythmias, including AF and VF
It is currently used in the production of PVC.
Chronic “CMV disease” (Raynaud’s phenomenon, osteolysis, scleroderma) can occur in exposed workers.
is an IARC1 carcinogen
hepatocellular carcinomas or angiosarcomas. The latter histotype has a latency of onset of approximately 17 years and is very typical of previous exposure to CMV, unlike HCC; whose etiology is more varied (liver cirrhosis, chronic hepatitis, aflatoxins etc).

Question 5

The most important marker of liver damage is

Answer 5

alanine amiotransferase (ALT)
(AST is an enzyme that can also be localized at the level of the myocardium, skeletal muscles and brain.)

Question 6

BMI classes

Answer 6

underweight (BMI <18.5 Kg/m^2)
Normal weight (BMI between 18.6 and 25.0 Kg/m^2)
overweight (BMI 25.1-30.0 Kg/m ^2)
Severe obesity grade I (30.1-34.9 Kg/m^2)
Severe obesity grade II (35-39.9 Kg/m^2)
Severe obesity grade III (>40 kg/m^2)

Question 7

ECG findings in mild/moderate mitral stenosis

Answer 7

mitral P wave, i.e. bifid in I, II and from V4 to V6 or diphasic in V1 and V2.

Question 8

What is the gold standard for studying lung metastases?

Answer 8

CT

Question 9

A singer has diffuse swelling of vocal folds. DX?

Answer 9

Reinke’s edema is a more or less widespread chordal edema, capable of causing dysphonia and, in the most severe cases, dyspnoea. Treatment consists of removing the triggering factors and, if necessary, a surgical approach

Question 10

What is the main method used to stage cervical cancer?

Answer 10

Recto-vaginal examination in narcosis. The staging of cervical cancer is carried out through manual recto-vaginal exploration because it allows the evaluation of parameters, vagina and rectovaginal septum, the possible involvement of which more heavily influences the subsequent therapeutic strategy and prognosis.

Question 11

T/F Staging on the “operating table” is typically carried out for ovarian cancer, for which only direct vision allows us to understand the real extent of the disease and therefore whether it is operable or not

Answer 11

T

Question 12

Acute otitis externa presentation, causes, otoscope presentation and TX

Answer 12

It is an inflammation of the external auditory canal mainly caused by Staphylococci and pseudomonas aeruginosa
SX: otalgia evoked by compression on the tragus, accompanied by hearing loss.
On otoscopic: edema of the external auditory canal with hyperemia. creamy secretions of variable colour.
TX: administration of topical preparations such as neomycin, washes with acetic acid, topical antifungals in the case of fungal infection.

Question 13

TX of otitis media

Answer 13

Amoxicillin 50 mg/kg/day in 3 doses.
Amoxicillin represents the antibiotic therapy of first choice in the absence of otorrhea, recurrence or risk factors for bacterial resistance. If one of these elements is present, the use of the amoxicillin+clavulanic acid association is preferred.

Question 14

What is meant by recurrent otitis media?

Answer 14

3 or more episodes in 6 months

Question 15

T/F The current indications provided by the AHA/ACC state, in fact, that patients with minor risk factors can undergo elective surgery without additional investigations, whatever the nature of the planned operation, if their functional reserve is at least moderate. and, in case of poor functional capacity, whether the surgery is low or intermediate risk

Answer 15

T

Question 16

How many types of joint involvement in IBD

Answer 16

In chronic inflammatory diseases (IBD), the most frequent extra-intestinal manifestations are joint ones.
Three types of joint involvement are recognized: type I (oligoarticular), type II (polyarticular) and type III (spondyloarthropathy).
Knee is most often affected

Question 17

Possible extraarticular manifestations of IBD

Answer 17

Uveitis
Osteomalacia
Osteoporosis
Amyloidosis

Question 18

T/F The focal seizure, on the other hand, occurs without loss of consciousness.

Answer 18

T

Question 19

Seborrhoic keratosis facts
TX?

Answer 19

represents the most frequent benign epithelial tumor, is typical of advanced age and the white race
No TX

Question 20

Keratoacanthoma

Answer 20

Keratoacanthoma manifests itself with a rounded and reddish papule with a crater filled with keratotic material in the center

Question 21

actinic keratosis presents itself as an asymptomatic desquamated lesion with an erythematous halo

Answer 21

T
while cryotherapy and 5-fluorouracil for actinic keratosis

Question 22

T/F basal cell carcinoma as a pearly plaque with telangiectasias on the surface (often ulcerated in the center), while finally squamous cell carcinoma as a friable papule or ulcer with superficial serocrusts that bleeds episodically

Answer 22

T

Elective surgery and/or radiotherapy are treatments used for example for squamous cell carcinoma

Question 23

TX for intestinal obstruction

Answer 23

Fasting, nasogastric tube placement, IV fluids, and viscerolysis.
There are then specific treatments depending on the etiology of the occlusion: in case of intussusception in the child, for example, we can use an enema, since the cause is usually the laxity of the mucous and submucosal tissues
the positioning of a stent is indicated in cases of colon cancer, in which one can also opt for a resection followed by anastomosis of the stumps
while colonoscopy can be decisive as a non-surgical treatment in cases of volvulus of the sigmoid colon, especially in elderly patients
In cases of occlusion due to adhesions caused by previous surgical interventions, as, probably, in our clinical case, the treatment consists of viscerolysis, i.e. the resolution of the adhesions through surgery. Antibiotic therapy, however, is generally reserved for cases in which intestinal infarction or ischemia is suspected.

Question 24

All of them are true for heart failure TX
Dapaglifozin is indicated in patients with heart failure, regardless of diabetes
Eplerenone is an antialdosterone with low risk of gynecomastia
The implantation of an ICD is indicated for primary prevention in patients with NYHA class II-III, FE reduced, after optimized medical therapy for 3 months and at least 40 days from the last infarction
The CRT can be used both if the QRS > 150 msec with LBBBx pattern and between 130 and 150 msec with non-LBBBx pattern

Answer 24

T

Question 25

A 27-year-old boy, who returned about 15 days ago from a trip to India, presents abdominal pain and diarrhea with traces of blood. Through parasitological examination of the feces, the diagnosis of intestinal amoebiasis is made. Which treatment of the case in question?

Answer 25

METRONIDAZOLE for tx of amoebiasis is Entamoeba histolytica,

Question 26

In the case of extraintestinal amoebiasis, what would be the most frequently involved organ?

Answer 26

liver

Question 27

What is Weil’s disease

Answer 27

Weil’s disease, or icteric leptospirosis, represents a form of severe leptospirosis, which occurs in 5-10% of symptomatic cases and is characterized by liver involvement with jaundice, renal failure and, in the most severe cases, pulmonary hemorrhage and ARDS. It has a mortality of approximately 10%. Leptospirosis is a zoonosis caused by spirochetes belonging to the genus Leptospira. Various species of mammals represent the reservoir of the disease, mainly rodents. The infection is generally transmitted through continuous solutions in body parts that have come into contact with water contaminated by the urine of tank animals, which is why it is often an occupational disease. Man represents an accidental host. Most cases are asymptomatic, but if symptoms are present, the infection can manifest itself in a mild form (anicteric leptospirosis) or in the form of Weil’s disease. The yellow hand sign and Filatow’s mask are characteristic of scarlet fever; with orient button we mean the typical lesion of cutaneous leishmaniasis; Köplik’s spots are a typical manifestation of measles.

Question 28

Mario, 75 years old, is hospitalized for right abscessed pyelonephritis on ipsilateral stones with normal renal function. Mario has been diabetic for about 13 years, hypertensive and dyslipidemic. He is currently undergoing treatment with Metformin, Empagliflozin, Atorvastatin, Amlodipidine. Which of these drugs could be suspended to avoid encouraging the ongoing infectious process?

Answer 28

Empagliflozin is a selective inhibitor of sodium-glucose co-transporter type 2 (SGLT-2) located in the kidney. SGLT-2 is primarily responsible for the reabsorption of filtered glucose from the tubular lumen. Inhibition of this transporter reduces renal reabsorption of glucose, thus favoring its excretion with consequent glycosuria. Gliflozines include among their side effects the increased risk of non-sexually transmitted urinary and genital infections precisely due to their glycosuric effect: during pyelonephritis, suspension is desirable to avoid a worsening of the infectious clinical picture.

Question 29

Erythrochotopheresis is a procedure used to separate cellular components such as red blood cells from the blood. It is used for therapeutic purposes for:

Answer 29

apheresis is used to isolate erythrocyte components from the blood, very often of a pathogenic nature. In both classic painful sickle cell crises and those associated with priapism we find erythrocytes with a pathological shape, the famous “sickle”, responsible for vascular stenosis. Equally with a pathological form, schitozites are found, more cellular fragments than actual erythrocytes, after the rupture of the Plasmodium from the host erythrocyte cell. In the latter case the sudden release of red blood cells leads to actual ruptures of the intracranial capillaries with consequent fever, headache up to delirium, drowsiness and coma and a quick solution to the problem is to eliminate these pathological cellular components from the blood.

Question 30

During the anamnesis, the neurologist asks a key question to try to understand whether it could be a pathology of the neuromuscular plate. Which?

Answer 30

:do complaints worsen in the evening or after trying to exert force?:
In the case of diplopia and physical tiredness, it is appropriate to think of a pathology of the neuromuscular plaque such as myasthenia gravis

Question 31

A patient comes to you complaining of fever, intense oropharyngeal pain and trismus. Observing the oropharynx, you notice that the right palatine tonsil is inflamed, significantly medialized and anteriorized. The left tonsil, however, is only inflamed. What is it about?

Answer 31

pertonsillar abscess

Question 32

What is the treatment of atrial myxoma?

Answer 32

surgery

Question 33

acne fulminans SX, PX, TX

Answer 33

Acne Fulminans. Acne fulminans is a rare and severe form of ulcerative, feverish acne. It is characterized by the sudden appearance of confluent abscesses, responsible for hemorrhagic necrosis. Leukocytosis, lymphomegaly, edema and joint pain may also occur.
TX: The treatment of this severe form of acne is generally based on the administration of isotretinoin at low doses (as a high dosage can even be harmful) and systemic corticosteroids (for the anti-inflammatory effect). Furthermore, in case of superinfection/impetiginization of the lesions, oral antibiotic therapy is advisable and in case of fever, the intake of paracetamol may be recommended.

Question 34

in 2021, the average age of first birth in Italy was:

Answer 34

33

Question 35

Which anticoagulant should be stopped on the day of the low-risk endoscopic procedure?

Answer 35

All anticoagulants should be discontinued before an endoscopic procedure. In the case of warfarin, if the INR is within range, a procedure can also be carried out under warfarin

Question 36

Macular degeneration PX, DX

Answer 36

macular degeneration
leading causes of blindness in the industrialized world.
One of the earliest signs of the pathology is distorted vision of straight lines. The Amsler test is a simple test that can be used to screen. Patients with early signs of macular degeneration will describe the grid lines as broken, wavy, or distorted. The peripheral retina is not involved in visual acuity.
You see drusen on ocular fundus exam (as yellowish deposits under the retina, they are made up of lipids and proteins.)

Question 37

A 72-year-old patient suffers from psoriasis vulgaris. What is the treatment of the mild form (BSA, PASI, DLQI < 10)?

Answer 37

corticosteroids + vitamin D analogue. The treatment of psoriasis uses topical and systemic therapies: in mild and localized psoriasis it is preferable to use therapies with topical corticosteroids and vitamin D derivatives; in the most severe forms, systemic therapy with phototherapy, systemic retinoids, methotrexate or cyclosporine A may be used

Question 38

What drugs are included in the ALS protocol?

Answer 38

adrenaline, amiodarone and lidocaine. The ALS protocols provide for the use, in shockable rhythms (pulseless VT and VF), of adrenaline 1g and amiodarone 300mg at the first administration and 150mg at the second (this at the 3rd and 5th resuscitation cycle respectively), if not Amiodarone is available, the alternative is lidocaine.

Question 39

What are Janeway lesions?

Answer 39

Erythematous palmar-plantar macules, not painful. Janeway lesions are a characteristic clinical manifestation of cases of infective endocarditis due to septic embolization phenomena mainly affecting the skin of the palms of the hands and soles of the feet.

Question 40

The KNEE XRAY in the first instance is negative, what is the next step?

Answer 40

Discharge the patient from the emergency room with indication for an orthopedic examination with knee MRI if the symptoms persist after 1-2 weeks.

Question 41

Heart failure facts

Answer 41

From a pathophysiological point of view, HF involves the presence of at least one of “reduction in cardiac output” and “increase in ventricular filling pressures”.
C) Generally the right HF responds better to diuretic therapy and tolerates beta-blocking drugs less.
D) A certain degree of diastolic dysfunction is almost always present in HF with reduced EF, on the other hand alterations in contractility and systolic function can also be present in subjects with HF with preserved EF.
E) The BNP dosage is mainly indicated in excluding the diagnosis of HF given the high negative predictive value. However, it may be increased in primary pulmonary hypertension and reduced in obesity.
The chronic liver damage of IC is manifested by typical increases in cholestasis enzymes, bilirubin and gammaGT specifically

Question 42

During fasting tests, what values ​​are determined through blood sampling?

Answer 42

blood sugar, insulin, c peptide
Note the fasting test is indicated in case of documented hypoglycaemia in suspicion of insulinoma

Question 43

TX of neurogenic bladder

Answer 43

The treatment of emergency incontinence of neurogenic origin includes both educational measures such as scheduled urination, exercises to strengthen the pelvic floor muscles and the improvement of lifestyle (reduction of weight, abstention from cigarette smoking, etc.)
level I treatments Anticholinergic, antimuscarinic drugs, vaginal estrogens, B3 adrenergic receptor agonists, electrostimulatio of the pelvic floor.
level II treatments stimulation of the sacral roots using neurostimulators, intravescial injections of botulinum toxin, enlargement enterocystoplasty and continent urinary diversions.

Question 44

A patient presents with this pattern. Which of the following drugs has been shown to be useful in preventing the development of VF in these patients?

Answer 44

quinidineQuinidine, a class IA drug, is able to block the ITO and IKR potassium currents preventing the development of ventricular fibrillations therefore it can be used in the arrhythmic storms of patients with Brugada
rsr’ pattern with ST segment elevation of > 2 mm with a descending course, with isoelectric crossing and negative T in V1-V2. In the past, to diagnose Brugada syndrome, a pattern of symptoms was needed. Since the 2013 consensus, having noted that the majority of patients with Brugada are asymptomatic, Brugada is also defined as the mere presence of a pattern, in the absence of malignant arrhythmias and whether it is spontaneous or induced by tests.

Question 45

what is cruralgia

Answer 45

Cruralgia is described as pain and symptoms arising from the crural, sural and femoral nerve. Those nerves start from the lower back and travel to the side and front of the thigh.

Question 46

what is linear schleroderma? PX? SX? DX? TX?

Answer 46

Morphea or localized scleroderma is a chronic-relapsing inflammatory dermatosis characterized by a disorder of cellular immunity, microcirculation and abnormal collagen synthesis. This triad of components leads to an initial inflammation of the skin followed by a sclerotic phase
The disease can extend into subcutaneous fat, fascia, muscle, and (rarely) bone.
Important complications are represented by functional anomalies such as joint contractures, limb dysmetria, skin fragility and pigmentary outcomes. It can be associated with systemic autoimmune diseases (e.g. thyroiditis, arthritis).
DX: ANA, Anti Scl70, Anti centromere NEGATIVE

Question 47

anti psychotic medication effects

Answer 47

EXTRA-PYRAMIDAL effects: tremors, parkinsonism, rigidity, dyskinesias late, akathisia (inability to stay still)
increase in apetite

Question 48

what is the toxic dose

Answer 48

it is the dose capable of causing toxicity
the lethal dose is the one capable of causing death
the LD50 (lethal dose 50), as this is the dose capable of causing the death of 50% of exposed subjects

Question 49

Shoe makers can be victims of solvent-related polyneuropathy, caused by:

Answer 49

N-hexane and Methyl-N-butylketone

Question 50

The capacity to understand and will is defined by which article of the penal code?

Answer 50

85

Question 51

What is the most common cause of liver failure in Western countries?

Answer 51

Acute drug-induced hepatitis.

Question 52

What would you suspect in a child who has had several febrile episodes, accompanied by pharyngitis and adenopathy, lasting up to 5 days, occurring at regular intervals?

Answer 52

PFAPA
most widespread periodic fever syndrome among children
febrile episodes lasting 3 to 6 days that repeat every 28 days, pharyngitis, aphthous ulcers and adenopathy.
ages of 2 and 5
etiology unknown.
DX: clinical- concomitance of: at least 3 feverish episodes, lasting up to 5 days and occurring at regular intervals; pharyngitis plus adenopathy or aphthous ulcers; good health between episodes and normal growth.
Inflammatory indices such as CRP and ESR are elevated during febrile episodes, but not in the interictal period.
TX: PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) is optional and depends on the frequency and severity of exacerbations; may include glucocorticoids, which, if given at the beginning of an episode, can dramatically stop fever attacks within hours, cimetidine, and, rarely, tonsillectomy.
Patients tend to recover without sequelae.

Question 53

PAPA syndrome

Answer 53

is characterized by pyogenic arthritis, pyoderma gangrenosum, and acne

Question 54

What is the diagnostic method used for the first local staging of rectal cancer?

Answer 54

Magnetic resonance imaging (MRI) without contrast medium.
Magnetic resonance imaging (MRI) without contrast medium.

Question 55

Which symptoms should make you suspect pyloric stenosis?

Answer 55

alimentary vomiting, constipation alternating with dark stools and weight loss.
a congenital malformation that affects 3/1000 children between the third and eighth week of life.
Therapy consists of Ramstedt extramucosal pylorotomy.

Question 56

In the case of insulinoma, awaiting surgery, which drug is used to correct the frequent episodes of hypoglycemia and normalize the profiles?

Answer 56

Diazoxide is a molecule that is used both in cases of hypoglycemia and hypertensive emergencies: the latter in particular when it is administered intravenously, producing a reduction in blood pressure, secondary to a vasodilatory effect on the arterioles, which leads to a decrease in resistance peripherals. In case of hypoglycemia, administered orally, increasing the concentration of glucose in the plasma by inhibiting the secretion of insulin from the pancreatic β cells.

Question 57

Nephrotic proteinuria is defined when the value is:

Answer 57

> 3.5 g/24h. To speak of nephrotic syndrome the following points must be present in the patient: edema, proteinuria > 3.5g/24h, hypoalbuminemia (3g/dl) and dyspylidemia.
Edema, lipiduria, thrombophilia
Diagnosis with electrophoresis - reduced albumin, increase alpha2 and b globulins

Question 58

What is the main mechanism of action of ondansetron?

Answer 58

erotonergic antagonist (5-HT3). Ondansetron is the most suitable drug for nausea and vomiting caused by chemotherapy and post-surgery.
It acts as an antagonist of the 5HT3 receptor
5HT receptors are actually located in critical areas involved in the vomiting process, including the vagal afferents, the nucleus of the solitary tract, and the area postrema or trigger zone. 5HT3 receptor antagonists act on all these sites

Question 59

The finding of granulation tissue in the CUE of a diabetic subject who complains of intense ear pain suggests:

Answer 59

malignant otitis externa.
Malignant otitis externa is a serious pathology typical of subjects with decompensated diabetes. Its treatment requires a timely approach as if allowed to progress, it leads to exitus

Question 60

Which pathologies can be associated with an increased risk of schizophrenia?

Answer 60

DiGeorge syndrome or 22q11.2 deletion syndrome or velo-cardio-facial syndrome

Question 61

What do I expect to find at the urinary level in a patient taking high doses of thiazide?

Answer 61

hypocalciuria and hyperkalauria.
thiazide acts on the distal convoluted tubule and in particular on the sodium/chlorine cotransporter, blocking the entry of sodium itself. At the same time, calcium, which under normal conditions is eliminated in this tract with each entry of sodium, will remain in the blood compartment, thus favoring hypocalciuria (less presence of urinary calcium). The non-reabsorbed sodium will continue its journey inside the tubule and will arrive at the ENaC channel which, in an attempt to absorb it, will cause a loss of potassium at the urinary level and therefore hyperkapoxyuria. All this also happens in the presence of Gitelman syndrome.

Question 62

Which European country has the lowest fertility rate?

Answer 62

malta

Question 63

In a patient diagnosed with stage III osteonecrosis of the femoral head, the therapy of choice will be:

Answer 63

Surgical given the future degeneration of the pathology.

Question 64

What is a common complication of carpal dislocation?

Answer 64

median nerve injury
Carpal dislocation often involves the lunate where the median nerve passes,

Question 65

By spina bifida we mean:

Answer 65

neural tube malformation

Question 66

You are called to evaluate a child who presents with intense widespread itching. The anamnesis shows that the itching was initially localized especially near the buttocks and in the interdigital spaces, while now it is more widespread and worsens during the night. Upon examination you notice scratching lesions, especially on the hands and armpits, which mask raised and sinuous lesions. What would you tell parents?

Answer 66

The child will not be able to go to school for at least 24 hours from the start of the treatment, the linen will have to be changed and washed at high temperature and the cohabitants will also have to carry out the treatment. The clinical case described identifies a manifestation of scabies, a very contagious ectoparasitosis, due to the female human mite. The clinical manifestations include intense itching, mainly nocturnal, especially in the interdigital spaces but then widespread, linear or sinuous raised lesions (tunnels dug for egg laying) usually surmounted by scratching lesions. Bacterial superinfections are frequent. The diagnosis is usually clinical, but a direct microscopic examination can possibly help highlight the mite. (Answer A incorrect) The therapy is based on the application of topical antiparasitics all over the body (permethrin cream 5%) with oral antihistamines to limit itching. Scabies requires mandatory notification (class IV), with removal from school for at least one day following the start of therapy. Furthermore, obviously, correct disinfection of the linen and carrying out the treatment by all cohabitants is recommended
TX: PERMETHRIN CREAM

Question 67

Carlo, 57 years old, comes to the visit with the finding of an adrenal adenoma < 2 cm found during an MRI for other reasons. Which of the following is the most appropriate management?

Answer 67

Re-evaluate electrolytes through periodic dosing, after excluding the diagnosis of pheochromocytoma.
an adrenal adenoma > 4 cm and solid must be excised.

Question 68

a likely new marker in follow-up for membranous glomerulonephritis?

Answer 68

THS7DA. The thrombospondin anti-domain containing 7A (THSD7A) has been found to be present in the serum of patients affected by primary MGN. Despite these extraordinary results, making a diagnosis using serum alone is still difficult due to the lack of a universally agreed cutoff value for diagnosis and follow-up.

Question 69

valsalva manuver

Answer 69

The Valsalva maneuver (MV) significantly increases intrathoracic pressure and intra-abdominal pressure, promoting, among other things, the emptying of the viscera (correct option E). This maneuver includes four phases (option A correct): tension initiation phase, tension phase, relaxation phase, recovery phase, and consists of a relatively deep inhalation followed by a forced exhalation with the glottis closed lasting approximately 10 seconds. The first to use MV were Arab doctors in the 11th century AD and only much later was it introduced into clinical practice by Italian doctors and has in fact been widely used in classical semiotics (correct option C) for the evaluation of patients with congestive heart failure ( SCC) and also for a more in-depth evaluation of heart murmurs. The advent of more modern imaging methods such as echocardiography has reduced the use of this maneuver in clinical practice, which however still constitutes a valid aid in the echocardiography laboratory in the evaluation of the diastolic function of the left ventricle ( option B).

Question 70

What is meant by Sever’s disease?

Answer 70

osteochondritis of the posterior tuberosity of the calcaneus

Question 71

Which of these drugs is approved in case of persistent aggression in conduct disorders/intellectual disability?

Answer 71

Risperidone is a second generation antipsychotic drug, with excellent blockade of the dopamine D2 receptor. At low doses compared to those used for schizophrenia, it can be used for the treatment of persistent aggression both for conduct disorders/intellectual disability, and in the other extreme of the age groups, i.e. in elderly people with aggression and major neurocognitive disorder ( dementia). The risk is always of hyperprolactinemia and extrapyramidal symptoms. The others are not approved for these issues.

Question 72

Eosinophilia is found in hyperproliferation of the granulocytic line (chronic myelogenous leukemia, helminthic parasitic infections, simple ascaris infections, Löffler syndrome).
Idiopathic hypereosinophilic syndrome occurs in the absence of secondary causes, parasitic or immunoallergological infections.

Answer 72

t

Question 73

Which of the following antibiotics requires dosage adjustment in renal failure?

Answer 73

vancomycin
During intravenous infusion of vancomycin, intense diffuse skin redness, called “red man syndrome”, may occur.

Question 74

Morris syndrome is characterized by an insensitivity to androgenic action which can be complete if the mutations are at the expense of the androgen receptor (AR) receptor, while incomplete forms are known whose mutations are at the expense of the transcriptional factors linked to the previously mentioned receptor. Phenotypically the subject is female, 46 XY karyotype, the testes are often undescended and the androgen levels do not correspond to normal values ​​for the age.

Answer 74

T

Question 75

lab tests found in acute tumor lysis syndrome

Answer 75

The characteristic laboratory alterations are: hyperkalemia/hyperkalemia, hyperuricosuria, hyperuricema, hyperphosphatemia and hypocalcemia.

Question 76

Drugs used against benign prostatic hypertrophy (BPH) can cause complications during cataract removal surgery. The α1-adrenergic receptor antagonists (in particular tamsulosin and silodosin), today the first line against BPH, are those at greatest risk of Intraoperative Floppy Iris Syndrome (IFIS). The syndrome is characterized by a flaccid iris that tends to prolapse towards the cataract extraction area.

Answer 76

t

Question 77

How do you define the disorder characterized by symptoms of schizophrenia lasting more than a day but less than a month?

Answer 77

Brief psychotic disorder. Psychotic symptoms typical of schizophrenia (delusions, hallucinations, disorganization) present for more than a day but less than a month lead the diagnosis towards a BRIEF PSYCHOTIC DISORDER or DELIRITANT BOUFFE. The evolution is not necessarily towards schizophrenia, as it can only represent a transitory episode. Schizophreniform disorder is instead a schizophrenia, but which has not yet reached the 6 months necessary for diagnosis: here the evolution is more oriented towards schizophrenia. Chronic delusional disorder is characterized by the presence of delirium for more than a month, but without the loss of the individual’s normal functioning.

Question 78

During pregnancy there is an increase in plasma volume which causes physiological hemodilution anemia.
For the same reason there is also an increase in renal plasma flow and glomerular filtration with a reduction in the levels of creatinine, urea and uric acid and a reduction in the concentration of total proteins and albumin .
The high levels of circulating estrogen cause an increase in coagulation factors and fibrinogen creating a hypercoagulable state.
The** increase in transaminases, however, is never physiological**, being found in the case of multiple obstetric pathologies (preeclampsia, HELLP, cholestasis).

Answer 78

T

Question 79

A 17-year-old boy presents himself with his parents to a dermatologist due to the presence of red spots on the lower limbs and buttocks. The dermatologist immediately recommends blood tests and describes the lesions on the limbs as rashes. The young man also reports sporadic abdominal pain associated with diffuse arthralgias. What will be the exclusively renal form of this pathology?

Answer 79

Nephropathy with IgA mesangial deposits, also called Berger syndrome.

The case description is that of an IgA vasculitis or also known as Henoch-Schönlein: skin, intestinal and joint manifestations.

Question 80

A 12-year-old girl diagnosed with rhabdomyosarcoma of the left orbit and face underwent exenteratio and en bloc resection also of the bone. Which reconstructive technique would you use to correct the residual defect?

Answer 80

“ALT (anterolateral thigh) flap of skin, subcutaneous fat, fascia and vastus lateralis muscle.”.

Question 81

Reduced osmotic resistance of the erythrocyte is found in the following pathology:

Answer 81

Spherocytosis is an autosomal dominant hereditary disease characterized by an abnormal shape of the red blood cells which makes them more fragile, especially under osmotic forces. This gives rise to hemolytic reactions which can lead to jaundice, anemia and even splenomegaly. Crohn’s disease can be immediately discarded as it is an inflammatory intestinal disease and not a hematological one. In other hematological pathologies the membrane is not at all subject to osmolytic fragility. For example, in paroxysmal nocturnal hemoglobinuria the main etiological player is the complement cascade and not the intrinsic properties of the erythrocyte membrane itself. In iron deficiency anemia this type of fragility is not found, in fact it does not even fall into the class of hemolytic anemia. Lastly, the deficiency of glucose-6-phosphate dehydrogenase leads to a greater susceptibility not to the forces of osmotic but oxidative stress.

Question 82

Carney complex is an autosomal dominant syndrome characterized by the appearance of recurrent and relapsing cardiac myxomas, most often in the ventricles. The syndromic picture is associated with cutaneous myxomas, breast fibroadenomas, pigmented skin lesions and endocrine neoplasms.

Answer 82

T

Question 83

Brucellosis is the most frequent zoonosis in the world. Brucellae are Gram-negative cocco-bacilli with intracellular localization (B. melitensis is the species mainly widespread in the Mediterranean basin). This pathology presents a protean clinical spectrum, being able to involve any organ or system (it is considered one of the “great mimics” of medicine). When the osteoarticular system is involved, brucellosis can manifest itself in the form of monoarthritis, sacroiliitis or spondylodiscitis. Brucella spondylodiscitis must be placed in a differential diagnosis with Pott’s disease (tuberculosis): in the case of brucellosis, the Pons sign, i.e. a “step” erosion of the antero-superior margin of the vertebra, can be recognized on imaging.

Answer 83

t

Question 84

How long does it take for chronic GVHD (graft-vs-host disease) to appear in the allograft?

Answer 84

100 days

Question 85

According to the ERAS protocol, abstaining from high-fat foods:

Answer 85

it starts 8 hours before surgery. The ERAS (Enhanced Recovery After Surgery) protocol, which provides an innovative and multidisciplinary approach to the patient undergoing surgery with the aim of guaranteeing the patient, after surgery, optimal recovery and an early and safe return to daily activities, recommends abstaining from the intake of foods rich in lipids starting from 8 hours before surgery (options A, B, C, and D are incorrect) and does not require any particular continuation in the immediate post-operative period

Question 86

The acronym ‘MET’ stands for Metabolic Equivalent of Task, which literally translated indicates the Metabolic Equivalent of Work, understood as any activity that has an energy expenditure. In other words, it is a unit of measurement that estimates the amount of energy used by our body during an activity compared to when we are at rest (option B incorrect). It is expressed in terms of oxygen consumption, or sometimes kilocalories and, in detail, 1 MET is equal to 3.5 ml of O2/kg/min (option A) or 1 Kcal/kg/h (option C). Usually, from 1 to 3 METs we talk about light intensity activity, while MET values ​​between 3 and 6 we talk about moderate intensity aerobic physical activity

Answer 86

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Question 87

Mr. Fausto is a diabetic, hypertensive and smoker. He reports pain in his right leg when walking which does not improve immediately when sitting down but only with prolonged rest. The pain had appeared months earlier but has now worsened and comes on rapidly as soon as he walks the few meters to move from one room to another (about 10 metres). More precisely, he reports burning pain in the calf and lately it has also risen to the back of the knee and thigh. The leg in question shows a pale foot, not painful on palpation and without noticeable slope edema. What could the patient in question be suffering from?

Answer 87

obliterating arterial disease of the lower limbs, stage IIb. The timing, duration and clinical characteristics lean towards arteriopathy of the lower limbs, Leriche Fontaine grade IIb, with indication for surgery.

Question 88

What is the normal value of leukocytes in synovial fluid?

Answer 88

< 200 leukocytes/mmᶟ. Synovial fluid is a plasma filtrate with added hyaluronic acid. The study of synovial fluid is the most advantageous diagnostic test in the evaluation of rheumatological diseases and the first test to be carried out in the presence of acute monoarthritis. The normal values ​​of the elements within it are: leukocytes < 200 leukocytes/mmᶟ, glucose 50-100 mg/dl and total proteins 1-2 g/dl.

Question 89

Patients with schizophrenia are affected by a higher mortality risk than the general population, due to an increased risk of developing metabolic syndrome and cardiovascular disease, as well as an increased risk of suicide. Keep in mind that the increased risk is independent of the use of psychotropic drugs (which, net of an increase in side effects such as metabolic syndrome, reduce the rate of hospitalization and acute cardiovascular events compared to patients suffering from schizophrenia who do not take the therapy ). All the other answers are correct: the age of onset is between 18 and 25 years, with a later peak in women until after the age of 30 (protection due to the hormonal component). In the multifactorial nature of schizophrenia, there are genetic and family components, on which environmental components insist (perinatal infections, etc.). Characteristic is the increased risk in those born in the winter months: it seems to be due to greater exposure to viral infections in utero, which would impact normal neurodevelopment.

Answer 89

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Question 90

Alibercept is a drug:

Answer 90

anti-VEGF. Purely notional question, alibercept is a drug that targets the VEGF molecule, which is used for neovascularization and tumor neoangiogenesis.

Question 91

BiPAP, an acronym that stands for ‘Bilevel Positive Airway Pressure’, is a type of ventilatory support that is used in sleep apnea (option A) and other respiratory pathologies, both in hospitals and at home (option C). It allows to supply pressurized air at two levels (option D) and is used as an alternative to CPAP. The main difference between a BiPAP and CPAP machine is the way the air pressure is delivered, which occurs on two levels: the positive inspiratory pressure (IPAP), provided by the machine during inhalation, and the positive expiratory pressure ( EPAP), provided during exhalation (option B incorrect). Furthermore, through adaptive servo ventilation (ASV), it is possible to modify the time, length and volume of breaths (option E)

Answer 91

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Question 92

What is the most common form of kidney stone?

Answer 92

calcium oxalate

Question 93

Craniopharyngiomas are located in which cranial structure?

Answer 93

sella turcica

Question 94

The Sarin classification identifies esophagogastric varices based on their location. Where the GoV1s are located:

Answer 94

Gastroesophageal varices that extend towards the lesser curvature. The Sarin classification describes gastroesophageal varices, while the JRSPH (Japanese Research Society for Portal Hypertension) classification describes esophageal varices in F1, F2 and F3 based on size and color (Answer E wrong). The Sarin classification describes GoV2 as esophageal varices that extend towards the greater curvature (Wrong answer C). IGV1 are isolated varicose veins in the gastric fundus (Wrong answer D); IGV2 only gastric varices isolated in different locations (Answer A wrong)