Review questions/AIMS exercises Flashcards
T/F The left vagus nerve descends anterior to the aortic arch
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The left vagus travels anterior to the aortic arch (behind the primary left bronchus and into the esophagus)
The right vagus nerve travels behind the esophagus and primary right bronchus.
Both nerves exit the jugular foramen, penetrate the carotid sheath between the internal and external carotid arteries and then pass posterolaterla to the common carotid artery.
When you give a blood transfusion, you must expect a possible decrease in the amount of ionized calcium in the plasma
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Due to the sodium citrate preservative (anti coag) put in blood bags, citrate binds to the patient’s endogenous calcium when blood products are administered, rendering calcium inactive.
PaCO2 will not increase if the FiO2 decreases
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Bc. PaCO2 is the O2 that has been e to exchanged CO2 in the alveolar capillaries. If the FiO2 decreases, then the PaCO2 will also decrease.
Pulmonary edema presents when capillary pressure is above
25 mmHg
the thoracic duct drains into the
left subcalvian vein
It drains the lypmh from the entire right side of the body
Morgagni hernia
are rare congenital parasternal diaphragmatic defects that can lead to bowel obstruction and incarceration if not repaired.
Which drug is used to perform the stress test on the fetus?
oxytocin
the stress test is done when you have an ambiguous cardiotocographic pattern
A newborn is diagnosed with hypoplastic left heart syndrome using cardiac color Doppler ultrasound. What is the classic cause of this congenital heart disease?
mitro-aortic atresia (narrowing)
Associated with patent ductus arteriosus, atrial septal defect.
MUST CLOSE PDA WITH PROSTAGALNDIN INFUSION
A loud, single 2nd heart sound (S2) and a nonspecific systolic murmur are common.
The definitive treatment is surgical correction or heart transplant.
85% of superior vena cava syndrome is due to lung cancer
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Superior vena cava syndrome is a set of symptoms caused by impaired blood flow between the superior vena cava and the right atrium.
It is an oncological emergency that is treated with radiotherapy.
Magnesium sulphate is indicated for which arrhythmias?
Mg is a membrane stabiliser.
ventricular arrythmias
torsade de pointes
pre-eclampsia to prevent convulsion episodes
A 12-year-old boy goes to the periodic medical check-up to obtain competitive sports eligibility. On auscultation, a soft ejection systolic murmur is detected in the left 2nd intercostal space, associated with constant splitting of the 2nd tone. What is the first suspected diagnosis?
atrial septal defect
An elderly man goes to his GP because he fainted the day before and now feels a little dizzy. He feels a strange sensation of fluttering wings in his chest. During the ECG, the patient loses consciousness and then regains it immediately. What could be the most probable pathology?
sinus node disease
Anaphylactic shock is characterized by:
HR
BP
JVP
Hypotension, tachycardia, central venous pressure (CVP) reduced
Congestion is the first stage of lobar pneumonia,The next stage is called red hepatization, referring to the liver-like appearance of the thickened lung, he next stage is represented by gray hepatization, The final stage is represented by resolution,
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mong the drugs listed above, the one that can most cause QT prolongation is sotalol. This alteration can trigger torsades de pointes which can be promptly treated with IV magnesium. under conditions of hemodynamic stability. If the patient is hemodynamically unstable, he must be electrically cardioverted. Flecainide and amiodarone also have QT prolonging effects but to a less significant extent than sotalol.
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Pleural effusions are commonly associated with pneumonia and should be treated with thoracentesis to determine whether the pleural fluid is infected. In order to prevent these complications, it is recommended that all pleural effusions larger than 10 mm undergo thoracentesis. If the pleural fluid pH is less than 7.20 or the pleural fluid glucose is less than 60 mg/dl, placing a drainage tube is indicated.
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Taking which drug during pregnancy could cause the onset of Ebstein’s anomaly?
lithium
Ebstein’s malformation is a congenital heart disease characterized by the dislocation towards the tip of the right ventricle of the septal and inferior leaflets of the tricuspid valve, normally located at the level of the atrioventricular junction.
A patient’s chest x-ray shows “eggshell” mediastinal calcifications. What will be the most likely diagnosis?
Eggshell adenopathies are a very indicative and important manifestation given that there are very few pathologies that produce such an effect: silicosis, sarcoidosis and tuberculosis. The main population-level cause (population attributable risk) of “eggshell” adenopathies is silicosis.
Mr. Andrea, 74 years old, visits you due to dyspnea. The dyspnea appears to be worsening in the last 10 days. On auscultation he presents a diastolic murmur which can be appreciated very well at the level of the focus of Erb. What do we suspect?
aortic valve insuff
The most characteristic auscultational finding of aortic insufficiency is a high-frequency early diastolic murmur that decreases until the end of diastole. It can be heard well at the level of the aortic focus and the focus of Erb (third intercostal space at the level of the left sternal margin). It is easier to hear the murmur during forced expiration and with the patient leaning forward.
The presence of a QRS morphology with RR’ in the right precordial leads (V1-V2) lasting less than 120msec tends towards an intraventricular conduction delay of the incomplete right bundle branch block type
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Francesca, a girl suffering from PCOS comes to your clinic. She says she takes various drugs and in particular an antiandrogen to treat hirsutism, but she doesn’t remember the name of it. What will this drug likely be?
Cyproterone acetate
a steroid used in combination with ethinyl estradiol to treat women with severe acne and symptoms of androgenization.
A bronchopathic patient goes to the doctor for a routine check-up. Upon inspection of the chest, the so-called “Schweninger crown” is found. What type of injury is it?
Sometimes venular telangiectasias can be found at the base of the thorax, distributed circularly in a fringe, at the level of the insertion of the diaphragm. These lesions are called “Schweninger’s crown” or “Salhi’s vascular wreath”. These findings, although more frequent in bronchopneumopaths, do not have a certain pathological significance, because they can also be found in normal subjects.
How does edentulism affect the patient’s airway management?
It makes mask ventilation more difficult but facilitates intubation. In fact, the absence of teeth, by modifying the anatomy of the face, makes it more difficult for the mask to adhere, leading to leaks, on the contrary intubation is facilitated as the opening of the mouth increases, furthermore the risk of damaging the teeth with the laryngoscope.
Wells score: signs and symptoms of deep vein thrombosis (3 points); less likely alternative diagnosis of pulmonary thromboembolism (3 points); tachycardia (1.5 points);** immobilization or surgery in the previous 4 weeks **(1.5 points); previous DVT/TOE (1.5 points); hemoptysis (1.5 points); neoplasm undergoing therapy or undergoing therapy in the last 6 months (1 point).
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If the total score is greater than or equal to 4, the diagnosis of TEP is considered probable. If the total score is less than 4, the diagnosis of TEP is considered unlikely.
What is meant by PETCO2?
PETCO2 corresponds to the end-expiratory partial pressure of CO2.
At which level is the usual location of the carina in the cadaveric position?
T4–T5 intervertebral disc (level of the manubriosternal angle of Louis)
Polso bigemino is typical of
ventricolare extrasistolia
(Bigeminy is a type of abnormal heart rhythm in which every other heartbeat is a premature contraction or extra heartbeat)
What drug can be used for a pt with AV block temporarily before PM implantation
Isoprenaline - a B agonist
Il test alla flecainide viene effettuato nei tipi II e III della sindrome di Brugada, in quanto la sindrome è caratterizzata da una alterazione dei canali del sodio.
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A severe side effect of checkpoint inhibitors is myocarditis
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TAPSE (tricuspid annular plane systolic excursion).
Un indice ecocardiografico utilizzato per valutare la funzione del ventricolo destro
In un pz con scompenso cardiaco acute, Gli ACEi, i sartani, così come lo spironolattone sono controindicati per via della possibile iperkaliemia.
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Il rabdomioma è il tumore cardiaco più frequente in età pediatrica. Lo andiamo ad individuare:
nei ventricoli, in forma di noduli multipli intramuscolari
AUSTIN FLINT MURMER IS =
INSUFFICIENZA AORTICA
l modello Erasmus per cosa è utilizzato?
Per migliorare l’accuratezza nella valutazione del rischio operatorio CV.
Morgani nodules are found in which heart valve?
ciascuna semiluna della valvola polmonare
Dopo un intervento è necessario Aumentare l’idratazione e somministrare potassio e magnesio perché durante un intervento cardiochirurgico è facile che la giunzione atrio-ventricolare e gli atri siano irritati da un insulto meccanico, per tale motivo è frequente l’insorgenza di FA post intervento.
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What are the anatomical regions making up the 2 arches seen on the right and 3 seen on the left in a standard CXR
RIGHT:
- FIRST: superior vena cava and ascending aorta
- SECOND: right atrium
LEFT:
- FIRST: aortic arch
- SECOND: pulmonary artery trunk + left auricle
- THIRD: left ventricle
The most frequent manifestation of mitral stenosis is represented by paroxysmal or permanent atrial fibrillation (60% of cases)
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Mechanical prostheses require permanent oral anticoagulation treatment, regardless of the position in which they have been placed. Prosthesis placed on the right have a greater risk of thrombi.
in the case of implantation of a mechanical valve prosthesis, it is necessary to proceed with lifelong anticoagulation with vitamin K antagonists, maintaining INR values defined on the basis of the thrombogenicity of the implanted prosthesis and the patient’s individual risk factors.
Myocarditis with an AV block can cause cardiogenic shock
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What is the most commonly used modality currently used to repair the anterior leaflet of the mitral valve?
chordae tendineae loop implantation.
Which of the following represents the mechanism by which the impella mechanically supports the circle?
It is a coaxial pump, positioned retrogradely in a transvalvular aortic position, which sucks blood from the left ventricle to introduce it into the ascending aorta
The incidence of live births with congenital heart disease is approximately 4-10 cases per 1000 live births. Ventricular septal defect represents 25% of these pathologies. 0.008
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the diagonal arteries are branches arising from the anterior interventricular or anterior descending artery and supply the free wall of the left ventricle.
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When a pt comes in with dyspnea and Hamptons signs are seen on X RAY (hinting pulmonary embolism) what exam do you need before giving treatment?
The aPTT ratio
the patient will be administered UFH heparin. Normally its value ranges from 1.5 to 2.5.
Treatment with UFH involves first an initial bolus and then an administration by infusion.
If the ratio is < 1.2, an initial bolus of 80 IU/Kg is given (approximately 5000 IU), if the ratio is between 1.5 and 2.5, 40 IU/Kg is administered as an initial bolus. As regards the following infusion, 18 IU/kg is given if the ratio is between 1.5 and 2.5. If the ratio is between 1.2 and 1.5, 2 IU/Kg are added, if the ratio is < 1.2, 4 IU/Kg are added.
However, if the aPTT ratio is > 3, it is interrupted for 60 minutes and resumed by decreasing by 3 IU/Kg.
If during right cardiac catheterization we detect an average pressure in the pulmonary artery > 25 mmHg and a wedge pressure > 15 mmHg, we will say that it is a Pulmonary arterial hypertension secondary to left heart disease
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What value is abdominal aortic aneurysm defined as?
> 3cm
Electrical stimulation (pace maker) is indicated in all emergency conditions due to symptomatic bradyarrhythmias
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85% of superior vena cava syndrome cases are due to the existence of lung cancer
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The symptoms that make it suspicious are dyspnea, cough, redness and swelling of the face, neck, upper trunk and extremities (mantle edema). This syndrome is usually indicative of locally advanced bronchogenic carcinoma, easily detectable on chest x-ray. It is an oncological emergency that is treated with radiotherapy.
Magnesium sulphate is indicated for which arrhythmias
torsades de point
lingual numbness, the only true pathognomonic sign of CNS toxicity
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Anaphylactic shock is characterized by:
Hypotension, tachycardia, central venous pressure (CVP) reduced
. If the pleural fluid pH is less than 7.20 or the pleural fluid glucose is less than 60 mg/dl, placing a drainage tube is indicated.
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Ventricular systole facts
Ventricular extrasystoles are usually followed by a compensatory pause, i.e. the sum of the pre- and post-extrasystolic interval is equal to twice one sinus cycle
They can be detected in up to 60% of healthy adult subjects
They can be recognized on the ECG by the presence of a premature QRS lasting > 120 msec
They do not worsen the prognosis of subjects without heart disease
They worsen the prognosis in heart patients, especially if frequent
What is the etiological agent of Kaposi sarcoma?
human herpes virus 8
Ear ossicle order from most lateral to innermost
hammer (malleus)
anvil (incus)
stirrups (stapes) - which connects to the oval window
what areas of the body are most frequently affected by psoriasis vulgaris?
symmetrically distributed plaques on the scalp, elbows, knees, and intergluteal fissure (extensor surface of limbs)
Teriparatide is a drug for the treatment of osteoporosis, how does it work?
by stimulating the activity of osteoblasts
Testicular tumors can originate from germ cell or non germ cell (sertoli cell tumor).
non germinal gonadal tumors are more rare than germ cell tumors.
germ cell can be seminomas and non seminomas (teratoma, embryonic carcinoma)
first line therapy in juvenile myoclonic epilepsy in male patients is
valproic acid
CANT USE IN FEMALES BC IS HIGHLY TERATOGENIC
What is thiopentone
A barbiturate
Water soluble salt
use din induction phase of general anesthesia (is a hypno inducer)
Causes unconsciousness in less than 1 minute
Is rapidly absorbed by the brain
causes a dose dependent decrease in BP and cardiac output with possible tachycardia
Above what value is ocular HTN considered
21 mmHg
(normal intra-ocular pressure range = 10-21mmHg) - to be measured with a Goldmann tonometer
Fibromyalgia diagnosis
11/18 points are tender
Lesch nyhan is syndrome is inherited as an X-linked recessive genetic disorder that, with rare female exceptions, most often affects males. The symptoms of Lesch-Nyhan syndrome include impaired kidney function, acute gouty arthritis, and self-mutilating behaviors such as lip and finger biting and/or head banging.
Has a complete deficiency of hypoxanthine-guanine phosphoribosyl transferase
In gout, which joints are mostly deposited with monosodium urate crystals?
metatarsal phalangeal joints (big toe)
the max time limit for reviving the facial nerve after trauma is
72 hours
Type 2 respiratory failure (hypercapnic) occurs with which conditions?
pathologies that result in failure of the ventricular pump
- central respiratory drive malfunction
- pathologies of chest wall
- obstuctive pathologies
- alteration of neuromuscular function of breathing muscles
the silvio acqueduct connects the
3rd and 4th cerebral ventricles
If a pt already on DOAC has a cardioembolic ischemic stroke, you can only perform systemic thrombolysis if the pt has not taken anti coagulation in the past 24 hours
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fetal alcohol syndrome causes
microcephaly
facial dysmorphism
cardiac alterations
motor and behavioral disorders
hydronephrosis
mental retardation
Cyanide: is also called zyklon B, has a high affinity for ferroproteins, is a poison, causes coma, convulsions, and bradycardia
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What is erythromelelgia
parinful paroxysmal vasodilation in the small arteries caused by exposure to heat, hyperemia, and intense burning pain
Often associated with polycythemia VERA
what are tx options for retinal detachment?
cryopxy
pneumoretinopexy
vitrectomy
scleral cerclage
hepatocellular carcinoma and clear cell carcinoma of the kidney both have significant arterial enhancement
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Sick building syndrome
at least 20% of the pop presents with eye/upper airway irritation, nausea, headache, general tension, hypersensitivity to odors and perfumes
acute pro myelocytic leukemia can be treated with all trans-retinoic acid
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apple core on X ray
colon cancer
which metastasixes the most to the liver
