Deck 1 Flashcards

Question

True or false: **Neurogenic TOS** is the most common type of Thoracic outlet syndrome.

Answer 1

TRUE ## Footnote It accounts for a significant majority of cases.

Answer 2

It is a dynamic compression of the brachial plexus and/or subclavian vessels by bony, muscular, or fibrous structures ## Footnote This produces posture-dependent neurological or vascular symptoms in the upper limb.

Answer 3

Pernicious Anemia ## Footnote It is characterized by autoimmune gastritis causing intrinsic factor deficiency.

Answer 4

* Autoimmune gastritis * Intrinsic factor deficiency ## Footnote This results in megaloblastic anemia and neurological dysfunction.

Answer 5

* Hematologic: Fatigue, pallor, dyspnea * Neurologic: Paresthesia, numbness, tingling * Gastrointestinal: Anorexia, weight loss * Autoimmune associations: Thyroid disease, type 1 diabetes, vitiligo ## Footnote Each feature reflects the systemic impact of vitamin B12 deficiency.

Answer 6

* Autoantibodies target parietal cells * Loss of intrinsic factor * Impaired B12 absorption in terminal ileum * B12 deficiency leads to impaired DNA synthesis ## Footnote This results in megaloblastic anemia and neurological issues.

Answer 7

* Fatigue * Pallor * Dyspnea * Glossitis (beefy tongue) * Mild jaundice ## Footnote These symptoms are due to ineffective erythropoiesis.

Answer 8

* Paresthesia * Numbness * Gait instability * Loss of vibration & proprioception * Spastic paresis ## Footnote These symptoms indicate involvement of the spinal cord and peripheral nerves.

Answer 9

* FBC: Macrocytic anemia * Peripheral smear: Hypersegmented neutrophils * Serum B12: Low * MMA: Elevated * Homocysteine: Elevated * Autoantibodies: Anti-intrinsic factor, Anti-parietal cell ## Footnote These tests help confirm B12 deficiency and autoimmune involvement.

Answer 10

* Vitamin B12 replacement (parenteral initially) * Monitor potassium in severe anemia * Check for coexisting folate deficiency ## Footnote Lifelong treatment is necessary to prevent neurological damage.

Answer 11

FALSE ## Footnote Delayed treatment can lead to irreversible neurologic damage.

Answer 12

* MMA: Sensitive and specific marker of B12 deficiency * Homocysteine: Elevated in both B12 and folate deficiency ## Footnote Monitoring these markers is crucial for assessing B12 status.

Answer 13

neurologic ## Footnote This highlights the importance of recognizing neurologic involvement in diagnosis.

Answer 14

**AB = Autoimmune B12** ## Footnote This mnemonic helps recall that Addison–Biermer Disease is an autoimmune condition leading to B12 deficiency.

Answer 15

* Autosomal dominant syndrome * Caused by germline mutations in DNA mismatch repair (MMR) genes: MLH1, MSH2, MSH6, PMS2, or EPCAM deletions * Leads to microsatellite instability (MSI) → high risk of colorectal and other cancers ## Footnote Lynch Syndrome is also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC).

Answer 16

50–80% ## Footnote Colorectal cancer is often right-sided and has an early onset (<50 years).

Answer 17

30–60% ## Footnote This risk is significant for individuals with Lynch Syndrome.

Answer 18

* Ovary * Stomach * Small intestine * Hepatobiliary * Urinary tract * Brain * Skin ## Footnote These cancers are part of the broader risk profile for individuals with Lynch Syndrome.

Answer 19

* Early-onset colorectal cancer (mean age ~44) * Synchronous or metachronous tumors * Family history across ≥2 generations * Tumors often poorly differentiated, right-sided, mucinous, tumor-infiltrating lymphocytes ## Footnote Synchronous tumors are diagnosed ≤6 months apart, while metachronous tumors are diagnosed >6 months later.

Answer 20

* Amsterdam I (“3-2-1” rule): 1. ≥3 relatives with colorectal cancer 2. Across ≥2 generations 3. ≥1 diagnosed <50 years 4. Exclude FAP * Amsterdam II: includes other Lynch-associated tumors (endometrium, small bowel, ureter, renal pelvis) ## Footnote These criteria help identify families at risk for Lynch Syndrome.

Answer 21

* CRC <50 years * Synchronous/metachronous CRC or other Lynch tumor * CRC with MSI-H histology <60 years * CRC with ≥1 first-degree relative with Lynch tumor <50 * CRC with ≥2 first-/second-degree relatives with Lynch tumors ## Footnote These criteria indicate which CRC patients should have MSI or MMR testing.

Answer 22

* MLH1/MSH2: every 1–2 years from age 20–25 * MSH6/PMS2: start age 30–35 ## Footnote This schedule is more frequent than the general population due to increased cancer risk.

Answer 23

* Annual TVUS + endometrial biopsy * Prophylactic hysterectomy after childbearing ## Footnote This is to monitor for endometrial and ovarian cancers.

Answer 24

* Standard CRC surgery * Consider extended colectomy for high metachronous risk * MSI-H tumors respond differently to chemotherapy and immunotherapy ## Footnote Treatment strategies may vary based on the specific characteristics of the tumors.

Answer 25

TRUE ## Footnote Lynch Syndrome is characterized by microsatellite instability (MSI) and a high risk of colorectal and other cancers.

Answer 26

* Amsterdam = strict, family history * Bethesda = broader, includes tumor and age features ## Footnote Both criteria are used to identify individuals at risk for Lynch Syndrome.

Answer 27

* Often right-sided * Poorly differentiated * Mucinous * Tumor-infiltrating lymphocytes ## Footnote These characteristics can help in identifying Lynch Syndrome-related tumors.

Answer 28

MSI-high ## Footnote This condition is often associated with early-onset cancers and requires intensive surveillance.

Answer 29

* Metabolised by CYP3A4 * Transported by P-glycoprotein ## Footnote Understanding the metabolism is crucial for managing drug interactions and toxicity.

Answer 30

* Potent CYP3A4 inhibitor * Decreases tacrolimus metabolism * Increases blood levels * Leads to toxicity ## Footnote This interaction is pharmacokinetic, not pharmacodynamic.

Answer 31

* Tremor * Confusion * Dysarthria * Seizures (severe cases) ## Footnote Neurological symptoms are the most tested in exams.

Answer 32

* Acute kidney injury (vasoconstriction of afferent arteriole) ## Footnote Renal effects are significant in the context of tacrolimus use.

Answer 33

* Hyperkalaemia * Hypertension ## Footnote These symptoms can complicate the clinical picture in patients on tacrolimus.

Answer 34

FALSE ## Footnote Azithromycin has minimal CYP3A4 inhibition and is considered safer.

Answer 35

Always think drug levels / interactions ## Footnote This is crucial for managing potential toxicity.

Answer 36

Narrow therapeutic index ## Footnote Small changes in metabolism can lead to significant clinical effects.

Answer 37

* Stop clarithromycin * Reduce or temporarily stop tacrolimus * Monitor levels closely * Supportive care ± ICU if severe ## Footnote These steps are critical for patient safety.

Answer 38

* Which species was eaten * How much * When it was eaten * Onset time of symptoms ## Footnote This information is essential for appropriate treatment.

Answer 39

Time to symptom onset ## Footnote Early symptoms are usually less dangerous, while late symptoms indicate more severe toxicity.

Answer 40

* Nausea * Vomiting * Diarrhoea * Abdominal pain ## Footnote These symptoms are almost always present.

Answer 41

* Neurological: drowsiness, agitation, confusion, tremor * Muscarinic syndrome: sweating, lacrimation, bronchospasm, hypotension ## Footnote Severe cases may require treatment with atropine.

Answer 42

Hypotension due to blockade of preganglionic sympathetic fibres ## Footnote This typically occurs within the first 15–20 minutes after injection.

Answer 43

* Peripheral vasodilation * ↓ systemic vascular resistance * ↓ venous return (↓ preload) ## Footnote Understanding this mechanism is crucial for managing patients.

Answer 44

* Bradycardia * Nausea and vomiting * Urinary retention * Post-dural puncture headache ## Footnote These effects are important to monitor post-procedure.

Answer 45

* Deep, labored, sighing breaths * Compensatory hyperventilation to blow off CO₂ ## Footnote It is typically triggered by metabolic acidosis.

Answer 46

* Diabetic ketoacidosis * Uremic renal failure * Severe hypoxia or hypercapnia * Lactic acidosis * Massive pulmonary embolism ## Footnote These conditions lead to compensatory hyperventilation.

Answer 47

ASA II ## Footnote This classification is important for assessing surgical risk.

Answer 48

* Detect hidden anemia or coagulopathy * Assess renal, liver, and metabolic function * Guide perioperative management ## Footnote These tests are crucial for preventing complications.

Answer 49

Killip II ## Footnote This classification helps assess the severity of heart failure after acute MI.

Answer 50

* Oxygen therapy * Furosemide (loop diuretic) * Nitrates (IV or sublingual) ## Footnote This combination stabilizes respiratory function and reduces preload and afterload.

Answer 51

* Reduce preload * Reduce afterload * Improve cardiac output and pulmonary pressures ## Footnote Nitrates help relieve pulmonary congestion.

Answer 52

* OAC (DOAC or warfarin) * Aspirin (low dose) * P2Y12 inhibitor (clopidogrel preferred) ## Footnote This therapy is used to prevent stent thrombosis and stroke.

Answer 53

1 month of triple therapy ## Footnote After this, dual therapy is continued for up to 12 months.

Answer 54

* Genetic disease * Replacement of RV myocardium with fibrofatty tissue * Mutation in desmosomal proteins ## Footnote ARVC can lead to serious arrhythmias and heart failure.

Answer 55

Triangle of dysplasia ## Footnote This area includes the right ventricular inflow tract, outflow tract, and apex.

Answer 56

Fibrofatty replacement of RV myocardium ## Footnote ARVC is often associated with the *triangle of dysplasia* and can lead to ventricular arrhythmias.

Answer 57

* Often autosomal dominant * Desmosomal gene mutation ## Footnote These genetic factors are crucial in the development of ARVC.

Answer 58

Triangle of dysplasia ## Footnote This area includes the RV inflow tract, outflow tract, and apex.

Answer 59

* Ventricular arrhythmias * Syncope * Sudden cardiac death * Heart failure late ## Footnote Early presentation often features arrhythmias rather than heart failure.

Answer 60

Triangle of dysplasia ## Footnote This term is essential for identifying ARVC in clinical scenarios.

Answer 61

LV (±RV) dilation with systolic dysfunction ## Footnote DCM is characterized by an enlarged heart and impaired pumping ability.

Answer 62

* Idiopathic * Genetic * Post-viral * Alcoholic * Toxins ## Footnote These factors can contribute to the development of DCM.

Answer 63

* Heart failure symptoms (dyspnea, fatigue) * Arrhythmias * Thromboembolism ## Footnote Patients may experience a range of symptoms related to heart failure.

Answer 64

Dilatation + reduced EF ## Footnote This phrase helps identify DCM in exam settings.

Answer 65

Asymmetric septal hypertrophy ## Footnote HCM may also present with apical hypertrophy.

Answer 66

* Myocyte disarray * Fibrosis ## Footnote These changes contribute to the clinical manifestations of HCM.

Answer 67

Autosomal dominant sarcomere mutations ## Footnote These mutations are critical in the development of HCM.

Answer 68

* Dyspnea * Syncope * Sudden death in young adults * Outflow obstruction ## Footnote HCM can lead to serious complications, especially in younger patients.

Answer 69

Asymmetric septal hypertrophy + systolic anterior motion of mitral valve ## Footnote This phrase is important for identifying HCM in exams.

Answer 70

Normal wall thickness, stiff ventricles ## Footnote This leads to impaired diastolic filling.

Answer 71

* Amyloidosis * Hemochromatosis * Post-radiation * Idiopathic ## Footnote These conditions can lead to RCM.

Answer 72

* Heart failure symptoms with preserved EF * Exercise intolerance * Atrial enlargement ## Footnote Patients may experience symptoms similar to heart failure despite normal ejection fraction.

Answer 73

Diastolic dysfunction with normal EF ## Footnote This phrase helps identify RCM in clinical scenarios.

Answer 74

X-linked lysosomal storage disease, α-galactosidase A deficiency ## Footnote This genetic condition leads to multi-system involvement.

Answer 75

Concentric LV hypertrophy ## Footnote This often mimics HCM.

Answer 76

Multi-system involvement (kidneys, skin, neuropathy) ## Footnote Patients may present with a variety of systemic symptoms.

Answer 77

LVH + systemic Fabry signs ## Footnote This phrase is important for identifying Fabry Cardiomyopathy in exams.

Answer 78

* Short PR interval: <0.12 s * Delta wave: Slurred upstroke at the start of the QRS * Wide QRS: >0.08 s ## Footnote These features are critical for diagnosing WPW.

Answer 79

AVRT (atrioventricular reentrant tachycardia), sudden cardiac death ## Footnote Although rare, these risks are significant in patients with WPW.

Answer 80

Irregularly irregular rhythm, no distinct P waves ## Footnote AF is the most common sustained arrhythmia and poses a high stroke risk.

Answer 81

Sawtooth flutter waves ## Footnote This pattern is typically visible in leads II, III, and aVF.

Answer 82

Wide QRS (>0.12 s), regular rhythm ## Footnote VT can be a life-threatening condition, especially post-MI.

Answer 83

Chaotic, irregular, no identifiable QRS or P waves ## Footnote VF is an emergency that requires immediate defibrillation.

Answer 84

* Type I: Ascending aorta, often to descending * Type II: Confined to ascending aorta * Type III: Descending aorta ## Footnote This classification helps guide treatment decisions.

Answer 85

* Type A: Involves ascending aorta * Type B: Involves descending aorta only ## Footnote Type A dissections are surgical emergencies.

Answer 86

Ascending aorta involvement → surgical emergency ## Footnote This is critical for determining the urgency of intervention.

Answer 87

160–179 / 100–109 ## Footnote This classification indicates the severity of hypertension and guides treatment decisions.

Answer 88

Immediately, regardless of CV risk, plus lifestyle measures ## Footnote This is a key rule in managing hypertension.

Answer 89

Repeated measurements on ≥2 visits, OR home BP monitoring (HBPM), OR 24-h ABPM ## Footnote These methods ensure accurate diagnosis of hypertension.

Answer 90

* Grade 1 hypertension * Low cardiovascular risk * No organ damage ## Footnote These criteria allow for a trial period of lifestyle changes before medication.

Answer 91

* High-normal: 130–139 / 85–89 * Grade 1: 140–159 / 90–99 * Grade 2: 160–179 / 100–109 * Grade 3: ≥180 / ≥110 ## Footnote These classifications help in assessing the severity of hypertension.

Answer 92

* Age and sex * Smoking * Diabetes * Dyslipidaemia * Family history * Target organ damage (LVH, CKD, retinopathy) * Established cardiovascular disease ## Footnote This assessment is crucial for determining treatment strategies.

Answer 93

* High CV risk / organ damage / diabetes / CKD: Start drug therapy immediately * Low–moderate risk: Lifestyle changes for 3–6 months, then drugs if uncontrolled ## Footnote This approach tailors treatment based on individual risk factors.

Answer 94

Two-drug combination at low dose: * ACE-inhibitor or ARB PLUS Calcium channel blocker OR Thiazide / thiazide-like diuretic ## Footnote Single-pill combinations are preferred whenever possible for ease of adherence.

Answer 95

Step 2: Triple therapy: * ACE-i or ARB * Calcium channel blocker * Thiazide / thiazide-like diuretic ## Footnote This escalates treatment for better blood pressure control.

Answer 96

<140/90 mmHg, then if tolerated: <130/80 mmHg ## Footnote Age-specific targets are also recommended to optimize treatment.

Answer 97

* Salt reduction * Weight loss * Physical activity * Mediterranean diet * Limit alcohol * Smoking cessation ## Footnote Lifestyle changes are essential but never replace drugs in grade 2–3 hypertension.

Answer 98

FALSE ## Footnote Lifestyle measures are always added but never excluded from treatment.

Answer 99

* Aspirin (ASA) * Anticoagulation (Unfractionated heparin IV) ## Footnote Aspirin loading dose is 150–300 mg PO (or IV if not possible) and should be given as soon as STEMI is diagnosed.

Answer 100

Routine pre-treatment with oral P2Y12 inhibitors is NOT recommended ## Footnote This is due to unknown coronary anatomy and risks such as need for urgent CABG, bleeding, and inability to absorb oral drugs.

Answer 101

* Aspirin loading dose * IV unfractionated heparin * Oxygen if SpO₂ <90% * Morphine if severe pain * No routine P2Y12 pre-loading ## Footnote These measures are critical for immediate management of STEMI patients.

Answer 102

* Ticagrelor or prasugrel * Cangrelor IV if oral not possible ## Footnote These P2Y12 inhibitors are administered after coronary anatomy is defined.

Answer 103

ASA plus anticoagulation as pre-treatment; routine pre-treatment with P2Y12 inhibitors is no longer recommended. ## Footnote This reflects current ESC guidelines.

Answer 104

* Prevent further thrombosis * Get to Cath-Lab ASAP * Avoid unnecessary bleeding before anatomy is known ## Footnote These goals guide the treatment approach in STEMI cases.

Answer 105

* Aspirin loading dose * P2Y12 inhibitor early (ticagrelor preferred) * Anticoagulation (fondaparinux preferred) * Nitrates if ischemic pain * Beta-blockers if appropriate ## Footnote The focus is on reducing ischemia and preventing thrombus growth.

Answer 106

* Ongoing chest pain * Pulmonary congestion * Hypertension * Hemodynamically stable ## Footnote Nitrates are used for symptomatic relief and coronary vasodilation.

Answer 107

* Hypotension * Right ventricular infarction * Recent PDE-5 inhibitor use * Severe aortic stenosis ## Footnote These conditions can lead to adverse effects when nitrates are administered.

Answer 108

NO ## Footnote Nitrites and heparin serve completely different purposes in treatment.

Answer 109

* Antithrombotic * Prevents clot propagation * Mandatory in STEMI and NSTEMI * Prognostic benefit ## Footnote Heparin is crucial for managing thrombotic events.

Answer 110

* Anti-ischemic / symptomatic * Venodilation → ↓ preload → ↓ myocardial oxygen demand * Coronary vasodilation * No effect on mortality ## Footnote Nitrates are optional and based on symptoms and blood pressure.

Answer 111

A pre-infarction syndrome indicating a large anterior MI is imminent due to critical stenosis of the proximal LAD ## Footnote Patients may appear stable with normal troponins but can develop a massive anterior STEMI within hours to days.

Answer 112

Patients may look stable, have normal troponins, and no ST elevation, but can suddenly develop a massive anterior STEMI ## Footnote This can occur within hours to days.

Answer 113

* Prolonged retrosternal pain >40 minutes * Not relieved by nitrates * Sounds ischemic and unstable ## Footnote Chest pain history is a crucial indicator.

Answer 114

* Deep, symmetric T-wave inversions * In V2–V4 (sometimes V1–V6) * No ST elevation * QT often prolonged * Pattern appears when pain has improved ## Footnote This indicates ischemia of the anterior wall.

Answer 115

* Normal or minimally elevated * Indicates myocardium is ischemic but still viable ## Footnote This is important as it shows that an infarction has not yet occurred.

Answer 116

* Type A: Biphasic T waves in V2–V3 * Type B: Deep, symmetric, inverted T waves in V2–V3 (can extend to V1 and V4–V6) ## Footnote Type B is more common.

Answer 117

* Transient LAD occlusion → brief ischemia * Partial spontaneous reperfusion * ECG changes appear after reperfusion * Coronary artery remains critically stenosed ## Footnote Pain decreases, troponins normalize, but ECG indicates impending closure of LAD.

Answer 118

Stress testing ## Footnote It increases myocardial demand, can trigger acute LAD occlusion, and cause catastrophic anterior STEMI.

Answer 119

* Treat as high-risk unstable angina * Urgent coronary angiography * Revascularization (PCI or CABG) ## Footnote Do not observe, stress test, or send the patient home.

Answer 120

A pre-infarction state caused by critical proximal LAD stenosis, characterized by deep or biphasic T-wave inversions in anterior leads with normal or minimally elevated troponins, requiring urgent coronary angiography ## Footnote This is a key point for exams.

Answer 121

Chest pain caused by a transient coronary artery spasm, not by a fixed atherosclerotic stenosis ## Footnote The problem is vasospasm, not plaque rupture.

Answer 122

* At rest * Classically at night * Early morning * Not related to exertion * Often occurs in cycles ## Footnote These features help differentiate it from other types of angina.

Answer 123

* Transient ST-segment elevation * Mimics a STEMI * Reversible when pain resolves ## Footnote Between episodes, the ECG can be completely normal.

Answer 124

* Usually normal * May have mild elevation if spasm is prolonged * No persistent necrosis ## Footnote This is a key distinguishing feature from other acute coronary syndromes.

Answer 125

* Rapid resolution of pain * ST elevation disappears ## Footnote This distinguishes it from plaque-related acute coronary syndromes.

Answer 126

Hyperreactivity of coronary smooth muscle → intense vasoconstriction ## Footnote This causes temporary complete or near-complete occlusion of a coronary artery.

Answer 127

* Endothelial dysfunction * Increased sensitivity to vasoconstrictors * Reduced nitric oxide availability ## Footnote These factors can exacerbate the condition.

Answer 128

* Smoking * Cocaine or amphetamines * Cold exposure * Emotional stress * Hyperventilation * Certain drugs (e.g. triptans) ## Footnote Smoking has a very strong association with this condition.

Answer 129

* Younger than classic CAD patients * Often no major atherosclerotic risk factors * Frequently smokers * May have other vasospastic disorders (e.g. migraine, Raynaud phenomenon) ## Footnote This profile helps in identifying the condition in clinical practice.

Answer 130

* Often normal coronary arteries * Or mild non-obstructive disease * Spasm can sometimes be provoked (ergonovine / acetylcholine) ## Footnote This is why Prinzmetal falls under MINOCA (Myocardial Infarct with Non-Obstructive Coronary Arteries).

Answer 131

* Calcium channel blockers * Nitrates (acute and prophylactic) ## Footnote These treatments are crucial for managing symptoms.

Answer 132

* Beta-blockers * Routine dual antiplatelet therapy unless other indications ## Footnote Beta-blockers can worsen spasm due to unopposed alpha activity.

Answer 133

* Prinzmetal: ST elevation resolves with nitrates * STEMI: ST elevation persists, troponins rise ## Footnote This distinction is important for diagnosis and treatment.

Answer 134

* NSTEMI: troponin rise, ST depression or T-wave inversion * Prinzmetal: ST elevation, minimal enzyme rise ## Footnote Understanding these differences aids in accurate diagnosis.

Answer 135

* Wellens: T-wave inversion, critical LAD stenosis, pain often resolved * Prinzmetal: ST elevation during pain, normal coronaries ## Footnote This comparison highlights the unique characteristics of Prinzmetal angina.

Answer 136

Prinzmetal angina is a vasospastic angina causing transient ST-segment elevation at rest, typically in smokers, with rapid resolution after nitrates and without significant coronary stenosis ## Footnote This summary encapsulates the key features of the condition.

Answer 137

Increase in intensity of a right-sided holosystolic murmur during inspiration, diagnostic of tricuspid regurgitation ## Footnote This sign helps distinguish right-sided vs left-sided murmurs.

Answer 138

* Inspiration → negative intrathoracic pressure * Increased venous return to the right heart * Augments right ventricular stroke volume * Incompetent tricuspid valve → increased regurgitant flow → louder murmur ## Footnote This mechanism explains the physiological basis for the sign.

Answer 139

Lower left sternal border (4th–5th intercostal space) near the xiphoid ## Footnote This is the optimal area for auscultation of the murmur.

Answer 140

Holosystolic (throughout systole) ## Footnote This timing is critical for identifying the murmur correctly.

Answer 141

* Increases with inspiration * Decreases with expiration ## Footnote This variation is key to recognizing the sign during physical examination.

Answer 142

* Primary valve disease (rare) * Secondary (functional) due to pulmonary hypertension, right ventricular dilatation, or left-sided heart disease * Carcinoid heart disease (rare exam classic) ## Footnote Understanding these causes aids in clinical diagnosis.

Answer 143

TRUE ## Footnote Mitral regurgitation murmur is louder in expiration, while tricuspid regurgitation is louder in inspiration.

Answer 144

expiration ## Footnote This contrasts with the Rivero–Carvallo sign for tricuspid regurgitation.

Answer 145

inspiration ## Footnote This is a key feature of the Rivero–Carvallo sign.

Answer 146

* Sharp * Pleuritic (worse with inspiration or cough) * Retro- or precordial * Relieved by leaning forward or sitting upright * Worsened by lying flat (supine) ## Footnote This is a classic exam feature — often one of the first “giveaway” signs.

Answer 147

* Stage I: Widespread ST elevation, PR depression * Stage II: ST normalizes, T waves flatten * Stage III: T-wave inversion * Stage IV: ECG returns to normal ## Footnote Important: Voltage is not elevated; in large pericardial effusions, you may see low voltage or electrical alternans.

Answer 148

* Idiopathic * Viral (preceded by recent respiratory infection) ## Footnote Less common causes include bacterial, autoimmune, post-MI, post-surgery, and neoplastic.

Answer 149

* Friction rub: triphasic sound, best heard at LLSB with patient leaning forward * Mild fever * Pericardial effusion may develop if untreated or severe ## Footnote These findings are important for diagnosis.

Answer 150

idiopathic ## Footnote Low voltage may be present if effusion is present.

Answer 151

* Detect inducible myocardial ischemia * Assess functional capacity * Stratify risk for adverse events * Monitor response to therapy ## Footnote The exercise stress test is crucial for evaluating heart health and response to exercise.

Answer 152

* Progressive increase of workload on cycle ergometer or treadmill * Monitor ECG changes (ST depression, arrhythmias) * Monitor heart rate and BP response * Monitor symptoms (chest pain, dyspnea, fatigue) ## Footnote This method helps assess the heart's performance under stress.

Answer 153

* Severe angina * Significant ECG changes * Dangerous arrhythmias * Extreme BP changes ## Footnote Stopping criteria are critical for patient safety during the test.

Answer 154

Exercise ECG ## Footnote It is reserved for inconclusive or high-risk cases.

Answer 155

Non-invasive functional testing (exercise ECG) ## Footnote This approach is recommended before considering more complex or invasive tests.

Answer 156

* Functional imaging (stress echo, nuclear perfusion, or CCTA) ## Footnote These methods provide further evaluation when initial tests are not definitive.

Answer 157

Extent of ischemia and prognosis ## Footnote This correlation is important for risk stratification in patients.

Answer 158

It is the simplest, specific, and low-risk test for evaluating inducible ischemia in stable angina patients ## Footnote This guideline emphasizes the importance of starting with less invasive tests.

Answer 159

Reproducible chest pain on exertion, relieved by rest ## Footnote Understanding stable angina is crucial for diagnosis and management.

Answer 160

Exercise ECG (treadmill or bike) ## Footnote This test is preferred for initial assessment.

Answer 161

* Severe pain * Marked ST changes * Dangerous arrhythmias * Hypotension/hypertension ## Footnote These criteria ensure patient safety during the test.

Answer 162

* Stress imaging or coronary angiography ## Footnote This step is necessary for further evaluation of coronary artery disease.

Answer 163

Stable angina → Stress first, Scan second, Cath only if high risk ## Footnote This mnemonic helps remember the order of diagnostic approaches.

Answer 164

A set of gastrointestinal and systemic symptoms caused by rapid gastric emptying into the small intestine, usually after gastrectomy, gastric bypass, or pyloroplasty ## Footnote It can also occur after vagotomy.

Answer 165

* Rapid transit of hyperosmolar food into the duodenum * Mechanical distension → activation of mechanoreceptors * Hormonal response: excess serotonin, bradykinin, neurotensin, VIP * Rapid glucose absorption → hyperglycemia → excessive insulin → reactive hypoglycemia ## Footnote This explains the two-phase symptom pattern.

Answer 166

* Nausea * Abdominal cramping * Diarrhea * Fullness * Bloating * Early satiety * Flushing * Tachycardia * Palpitations * Hypotension ## Footnote Occurs 10–30 minutes after a meal.

Answer 167

* Hypoglycemia * Weakness * Sweating * Dizziness * Palpitations ## Footnote Occurs 1–3 hours after a meal.

Answer 168

* High-sugar meals * Hyperosmolar foods (sweet drinks, refined carbs) * Large meals ## Footnote These triggers can exacerbate symptoms.

Answer 169

* Common after partial gastrectomy * Common after Roux-en-Y gastric bypass * Can limit quality of life if untreated ## Footnote Understanding this helps in managing patient care.

Answer 170

* Eat small, frequent meals * Avoid liquid calories with solids * Prefer high-protein, high-fiber meals ## Footnote These strategies can help alleviate symptoms.

Answer 171

* Acarbose (for late dumping/hypoglycemia) * Octreotide in severe cases ## Footnote These medications can be used when non-pharmacological methods are insufficient.

Answer 172

* Look for postprandial GI + vasomotor symptoms * Early vs late: <30 min vs 1–3 h after eating * Key clue: history of gastric surgery ## Footnote These points are crucial for diagnosis.

Answer 173

hypo ## Footnote This one-line memory aids in recalling the symptoms of dumping syndrome.

Answer 174

* High intake of red meat * Processed meat * Fats ## Footnote Protective factors include high fiber, fruits, and vegetables.

Answer 175

* Faster transit * Dilution of carcinogens * Modulation of gut microbiome ## Footnote These mechanisms help reduce the risk of colon cancer.

Answer 176

* Obesity * Smoking * Alcohol * Inflammatory bowel disease (IBD) * Family history * Age ## Footnote These factors contribute to the overall risk of developing colon cancer.

Answer 177

Smoking ## Footnote Other major risk factors include chronic pancreatitis, diabetes, and obesity.

Answer 178

Evidence is less strong; obesity is more relevant than fat alone ## Footnote This indicates that while diet may play a role, other factors are more significant.

Answer 179

* Chronic hepatitis B/C * Alcohol * Cirrhosis * Aflatoxin exposure * Metabolic syndrome ## Footnote High-fat diets contribute indirectly via obesity and non-alcoholic fatty liver disease.

Answer 180

* Smoking * Radon * Occupational exposures ## Footnote Diet plays a minimal role; some antioxidants may offer slight protection.

Answer 181

* Female sex * Age * Obesity post-menopause * Hormonal therapy * Alcohol ## Footnote High fat may increase risk slightly, particularly post-menopausal.

Answer 182

* Age * Family history * African ancestry ## Footnote High fat may be a minor contributor; dairy and calcium are also implicated.

Answer 183

TRUE ## Footnote This is especially true when combined with low fiber and high red/processed meat intake.

Answer 184

* Pancreatic cancer * Lung cancer * Liver cancer * Breast cancer * Prostate cancer ## Footnote In these cases, diet is usually a secondary or indirect factor.

Answer 185

Left colon (sigmoid colon) ## Footnote It is not found in the ileum or cecum.

Answer 186

Usually over 50 years old ## Footnote It is not common in patients aged 20–50.

Answer 187

CT scan of the abdomen ## Footnote It can detect the site, extent of inflammation, abscesses, or perforation.

Answer 188

* Antibiotics * Sometimes percutaneous drainage if an abscess is present ## Footnote This approach is conservative.

Answer 189

* Hartmann’s procedure (resection with end colostomy) * Primary anastomosis in selected, stable patients ## Footnote Surgical options are reserved for severe cases or generalized peritonitis.

Answer 190

FALSE ## Footnote Diverticula do not become malignant.

Answer 191

CT scan, not surgery immediately ## Footnote This is an important exam tip.

Answer 192

* Location: left colon * Typical age: over 50 ## Footnote These are high-yield facts for exams.

Answer 193

AFP ↑ ## Footnote AFP is the main tumor marker associated with liver cancer.

Answer 194

* AFP ↑ * β-hCG may also ↑ ## Footnote These markers are used to diagnose and monitor testicular cancer.

Answer 195

β-hCG ↑ (AFP usually normal) ## Footnote This distinguishes seminoma from non-seminomatous germ cell tumors.

Answer 196

CA 19-9 ↑ ## Footnote CA 19-9 is often used in the diagnosis and monitoring of pancreatic cancer.

Answer 197

CEA ↑ ## Footnote CEA is a common marker for gastrointestinal cancers.

Answer 198

CA-125 ↑ ## Footnote CA-125 is primarily used for monitoring ovarian cancer.

Answer 199

* CA 15-3 ↑ * sometimes CEA ↑ ## Footnote These markers help in monitoring breast cancer treatment and recurrence.

Answer 200

CEA ↑ (sometimes CYFRA 21-1) ## Footnote CEA is commonly elevated in various lung cancers.

Answer 201

Calcitonin ↑ ## Footnote Elevated calcitonin levels are indicative of medullary thyroid carcinoma.

Answer 202

PSA ↑ ## Footnote PSA is the primary marker used for prostate cancer screening and monitoring.

Answer 203

TRUE ## Footnote AFP is a key marker for liver cancer and certain testicular cancers.

Answer 204

gestation ## Footnote AFP functions mainly as a transport protein for fatty acids.

Answer 205

* Liver regeneration * Chronic hepatitis * Cirrhosis with regenerative nodules * After liver injury ## Footnote These conditions can lead to increased AFP levels but are not indicative of cancer.

Answer 206

Monitoring treatment response or recurrence in HCC ## Footnote AFP is not very reliable for diagnosis alone.

Answer 207

Esophageal cancer ## Footnote Risk factors include age, male sex, smoking, alcohol, and chronic GERD.

Answer 208

* Progressive dysphagia (solids first, then liquids) * Weight loss * Pain or hoarseness ## Footnote Progressive dysphagia in an older adult with weight loss is a red flag for malignancy.

Answer 209

* Squamous cell carcinoma * Adenocarcinoma ## Footnote Squamous cell carcinoma is associated with smoking and alcohol, while adenocarcinoma is linked to Barrett’s esophagus and chronic reflux.

Answer 210

Loss of inhibitory neurons in the myenteric plexus → failure of lower esophageal sphincter (LES) to relax ## Footnote This leads to dysphagia for both solids and liquids from onset.

Answer 211

* Dysphagia for both solids and liquids * Regurgitation of undigested food * Chest discomfort ## Footnote The course is usually slow and chronic, with potential weight loss.

Answer 212

Liquids sometimes affected before solids ## Footnote This is an important exam tip for recognizing achalasia.

Answer 213

High-amplitude peristaltic contractions in the distal esophagus ## Footnote It is classified as a motility disorder.

Answer 214

* Chest pain (often retrosternal) * Occasional dysphagia, especially for solids ## Footnote Rarely causes progressive dysphagia or weight loss.

Answer 215

Smooth muscle atrophy and fibrosis due to systemic sclerosis ## Footnote It is often part of a multisystem disease.

Answer 216

* Dysphagia (solids and liquids) * Heartburn * Regurgitation ## Footnote Associated features include Raynaud’s phenomenon and skin thickening.

Answer 217

Incompetent lower esophageal sphincter → acid reflux ## Footnote GERD typically does not cause progressive dysphagia or rapid weight loss.

Answer 218

* Heartburn * Regurgitation * Sometimes mild dysphagia ## Footnote Symptoms can persist for years without causing progressive obstruction.

Answer 219

esophageal cancer ## Footnote This is a key takeaway for exam preparation.

Answer 220

TRUE ## Footnote This is an important distinction in understanding dysphagia causes.

Answer 221

Pancreatic tissue located outside the usual pancreas, with no direct vascular or duct connection ## Footnote Occurs in ~2% of people.

Answer 222

* Stomach * Duodenum * Jejunum * Ileum * Sometimes in Meckel’s diverticulum ## Footnote Usually asymptomatic and found incidentally.

Answer 223

* Acini (clusters of cells that secrete digestive enzymes) * Sometimes ducts or islets * Solid and firm, submucosal ## Footnote Classic for ectopic pancreas.

Answer 224

Mucosa gastrica ## Footnote Usually found in a Meckel’s diverticulum or stomach; rare in jejunum and typically smaller.

Answer 225

FALSE ## Footnote Usually in older kids or adults, produces larger masses, often ulcerated, and can cause systemic symptoms.

Answer 226

Extremely rare in children; usually presents in adults with obstruction or bleeding ## Footnote Adenocarcinoma is not commonly found in the small intestine of a child.

Answer 227

* Pelvis * Retroperitoneum * Along gonadal descent ## Footnote Not typically inside the intestine.

Answer 228

HHV-7, possibly HHV-6 ## Footnote Classic features include a “herald patch” followed by a generalized rash.

Answer 229

Starts with a “herald patch” followed by a generalized rash ## Footnote The rash follows skin tension lines, creating a “Christmas tree” pattern on the back.

Answer 230

4–8 weeks ## Footnote It is usually self-limited and not contagious.

Answer 231

Allergic reactions, sweating, or stress ## Footnote It is not viral and features small, itchy vesicles on palms and soles.

Answer 232

* Flaccid blisters * Oral mucosa involvement ## Footnote It is autoimmune, with antibodies against desmogleins and can be life-threatening if untreated.

Answer 233

Malassezia yeast (fungal) ## Footnote It features hypo- or hyperpigmented scaly patches, often on the trunk.

Answer 234

KOH prep (“spaghetti and meatballs” appearance) ## Footnote This diagnosis is high-yield in dermatology.

Answer 235

Measles virus (paramyxovirus) ## Footnote It features fever, cough, conjunctivitis, and a generalized maculopapular rash.

Answer 236

* Fever * Cough * Coryza * Conjunctivitis * Koplik spots * Generalized maculopapular rash ## Footnote Measles is highly contagious and vaccine-preventable.

Answer 237

* Skin involvement: <10% of body surface area (BSA) * Features: Painful red or purplish rash, blisters, mucosal involvement (eyes, mouth, genitals) * Common triggers: Medications (e.g., sulfonamides, anticonvulsants, NSAIDs), infections (especially viral) ## Footnote SJS is a severe skin reaction often triggered by medications or infections.

Answer 238

* Skin involvement: >30% of BSA * Features: Widespread skin necrosis, massive epidermal detachment, high risk of infection and fluid loss * Overlap zone: 10–30% BSA (SJS/TEN overlap) ## Footnote TEN is a more severe condition than SJS, with greater skin involvement.

Answer 239

It’s all about the percentage of skin affected ## Footnote Both conditions share similar causes and pathophysiology; severity differentiates them.

Answer 240

* A severe drug-induced hypersensitivity reaction * Often confused with other drug rashes, SJS, or TEN ## Footnote DRESS has distinctive systemic features that set it apart from SJS and TEN.

Answer 241

* Timing: Appears 2–6 weeks after starting a drug * Skin: Morbilliform rash, facial edema, sometimes exfoliation * Systemic involvement: Fever, lymphadenopathy, internal organ involvement (liver most common) * Blood abnormalities: Eosinophilia, atypical lymphocytes ## Footnote DRESS has a longer latency than SJS/TEN and involves systemic symptoms.

Answer 242

* Anticonvulsants: phenytoin, carbamazepine, lamotrigine * Allopurinol * Sulfonamides * Sometimes antibiotics ## Footnote Drugs are the most important exam point for DRESS Syndrome.

Answer 243

* DRESS: 10% * SJS/TEN: Up to 30% in TEN ## Footnote Mortality rates highlight the severity of these conditions.

Answer 244

Drug Reaction with Eosinophilia and Systemic Symptoms ## Footnote This acronym captures the essence of the syndrome.

Answer 245

Think of SJS as 'small fire' (<10%) and TEN as 'total skin fire' (>30%) ## Footnote This analogy helps remember the severity and skin involvement.

Answer 246

* DRESS: 2–6 weeks * SJS/TEN: 1–3 weeks ## Footnote The latency period is a key distinguishing feature.

Answer 247

Reciprocal translocation t(15;17)(q24;q21) ## Footnote This translocation is crucial for the development of Acute Promyelocytic Leukaemia.

Answer 248

Fusion of PML gene on chromosome 15 with RARα gene on chromosome 17 → blocks differentiation of promyelocytes → accumulation of abnormal promyelocytes ## Footnote This mechanism is key to understanding the pathology of APL.

Answer 249

* Bleeding * Coagulopathy (DIC) ## Footnote These symptoms are critical for diagnosis and management of APL.

Answer 250

ATRA (all-trans retinoic acid) therapy ## Footnote ATRA induces differentiation of promyelocytes, leading to improved outcomes.

Answer 251

PML-RARα ## Footnote This is an important exam tip for identifying APL.

Answer 252

t(9;22) → 'Philadelphia chromosome' ## Footnote This genetic alteration is a hallmark of Chronic Myeloid Leukemia.

Answer 253

Constitutively active tyrosine kinase → uncontrolled myeloid proliferation ## Footnote This mechanism drives the pathophysiology of CML.

Answer 254

* Leukocytosis * Splenomegaly * Chronic phase → blast crisis ## Footnote These symptoms are critical for the diagnosis and progression of CML.

Answer 255

* Polycythemia vera * Essential thrombocythemia * Primary myelofibrosis ## Footnote These myeloproliferative disorders are linked to activation of the JAK-STAT pathway.

Answer 256

Deletion of the long arm of chromosome 5 ## Footnote This deletion is a significant marker for Myelodysplastic syndrome.

Answer 257

* Macrocytic anemia * Dysplastic neutrophils * Thrombocytosis ## Footnote These symptoms are typically observed in older adults with MDS.

Answer 258

Think of APL as a '15 to 17-year-old prom' → promyelocytes at the 'prom' → PML-RARα ## Footnote This mnemonic aids in recalling the association of PML-RARα with APL.

Answer 259

Fava beans ## Footnote Favism refers to hemolysis triggered by the consumption of fava beans in individuals with G6PD deficiency.

Answer 260

* Bacterial pneumonia * Fever ## Footnote Infections can exacerbate hemolysis in patients with G6PD deficiency.

Answer 261

* Sulfonamides * Chloramphenicol * Antimalarials (e.g., chloroquine, primaquine, quinine) ## Footnote These medications are known triggers for hemolysis in individuals with G6PD deficiency.

Answer 262

* Cephalosporins * Particularly cephalothin ## Footnote Cephalosporins, especially cephalothin, do not typically trigger hemolysis.

Answer 263

Favism ## Footnote Remember: FAVA, FEVER, FUN drugs (antimalarials, sulfonamides) trigger hemolysis.

Answer 264

FALSE ## Footnote Cefalosporins, especially cephalothin, are generally safe for patients with G6PD deficiency.

Answer 265

Favism & Drugs ## Footnote The mnemonic highlights fava beans, fever, and certain medications that can trigger hemolysis.

Answer 266

Toxoplasma gondii ## Footnote Usually occurs in immunocompetent patients.

Answer 267

* Diffuse follicular hyperplasia * Numerous dispersed macrophages * 'Starry sky' appearance ## Footnote The 'starry sky' appearance is due to macrophages scattered among lymphocytes.

Answer 268

Aggressive B-cell lymphoma ## Footnote It is characterized by rapid growth and often presents in extranodal sites.

Answer 269

Classic 'starry sky' pattern ## Footnote This pattern is due to tangible-body macrophages amid rapidly dividing lymphocytes.

Answer 270

* Often extranodal (jaw, abdomen) * Very fast-growing ## Footnote It is more common in pediatric patients or immunocompromised adults.

Answer 271

Think Burkitt lymphoma or toxoplasmosis ## Footnote This pattern is a significant histological clue.

Answer 272

* Mild systemic symptoms * Exposure history * Serology positive ## Footnote These clues help differentiate it from other conditions.

Answer 273

* Aggressive mass * Extranodal involvement * Pediatric or immunocompromised adult ## Footnote These features are critical for clinical diagnosis.

Answer 274

* Itching / pruritus * Redness / erythema * Swelling / edema / urtication ## Footnote Triggered by rubbing a skin lesion due to histamine release from mast cells in the lesion.

Answer 275

Cutaneous mastocytosis (especially urticaria pigmentosa) ## Footnote Often presents in children as brownish macules or papules.

Answer 276

Histamine release from mast cells ## Footnote This release causes the symptoms of itching, redness, and swelling.

Answer 277

Rub → Red + Itchy + Swollen ## Footnote Think mastocytosis.

Answer 278

* Gentle lateral pressure on skin → epidermis peels off easily ## Footnote Associated with pemphigus vulgaris and sometimes toxic epidermal necrolysis (TEN).

Answer 279

Loss of adhesion between keratinocytes (acantholysis) ## Footnote This leads to easy peeling of the epidermis.

Answer 280

Push and peel → think pemphigus! ## Footnote Helps to remember the association with pemphigus vulgaris.

Answer 281

* Scrape or remove scales → pinpoint bleeding ## Footnote Associated with psoriasis.

Answer 282

Thinned epidermis over dilated dermal capillaries ## Footnote This causes pinpoint bleeding when scales are removed.

Answer 283

Pinpoint blood under silver scales → psoriasis! ## Footnote Helps to remember the association with psoriasis.

Answer 284

* Small, greasy, warty papules, often on chest and back ## Footnote Different from Darier’s sign; it is a genetic disorder affecting keratinization.

Answer 285

Darier’s sign = mast cells, Darier disease = greasy papules ## Footnote Helps to differentiate the two conditions.

Answer 286

New lesions appear at sites of trauma ## Footnote Associated with psoriasis, lichen planus, and vitiligo.

Answer 287

Scratch → lesions pop up ## Footnote This helps to remember the association with new lesions appearing.

Answer 288

Pigmentation extending onto the nail fold ## Footnote Associated with subungual melanoma.

Answer 289

Pigment climbs the cuticle → worry about melanoma ## Footnote Helps to remember the association with subungual melanoma.

Answer 290

Transient piloerection or elevation of a lesion when rubbed ## Footnote Associated with smooth muscle hamartomas.

Answer 291

Goosebumps when rubbed → smooth muscle nodule ## Footnote Helps to remember the association with smooth muscle hamartomas.

Answer 292

Violaceous papules over knuckles and joints ## Footnote Associated with dermatomyositis.

Answer 293

Knuckle bumps → think dermatomyositis ## Footnote Helps to remember the association with dermatomyositis.

Answer 294

Single, oval, salmon-colored lesion before generalized rash ## Footnote Associated with pityriasis rosea.

Answer 295

One patch calls the others → pityriasis rosea ## Footnote Helps to remember the association with pityriasis rosea.

Answer 296

* Physiological: pregnancy, stress, nipple stimulation * Pathological: prolactinoma, hypothyroidism, pituitary stalk lesions * Iatrogenic (drug-induced) ## Footnote Iatrogenic causes are the most exam-relevant.

Answer 297

* Dopamine antagonists / antipsychotics * Gastrointestinal prokinetics / antiemetics ## Footnote These drug classes increase prolactin levels by antagonizing dopamine.

Answer 298

* Phenothiazines: chlorpromazine * Butyrophenones: haloperidol * Atypical antipsychotics: risperidone, levosulpiride ## Footnote These medications are commonly used in psychiatric treatment.

Answer 299

* Metoclopramide * Domperidone ## Footnote These drugs are used to enhance gastrointestinal motility.

Answer 300

Dopamine normally inhibits prolactin release at the anterior pituitary → antagonists increase prolactin ## Footnote This mechanism highlights the role of dopamine in regulating prolactin secretion.

Answer 301

* ACE inhibitors (e.g., enalapril) * Beta-blockers * Digoxin * Most antihypertensives (except rarely verapamil) ## Footnote These drugs do not affect the dopamine/prolactin axis.

Answer 302

dopamine/prolactin axis ## Footnote This is a key exam strategy.

Answer 303

* Dopamine antagonists * Risperidone/antipsychotics * Upper GI prokinetics (metoclopramide, domperidone) * GI antiemetics * Stress/stimulation (physiologic) ## Footnote This mnemonic helps remember the causes of elevated prolactin levels.

Answer 304

Diffuse goiter: Symmetric, firm, non-tender ## Footnote Often occurs in middle-aged women.

Answer 305

Hashimoto’s thyroiditis ## Footnote Characterized by diffuse goiter and lymphocytic infiltrate.

Answer 306

* Dense lymphocytic infiltrate with germinal centers * Follicular atrophy * Hürthle (oncocytic) cell metaplasia * Scant colloid * Possible fibrosis in chronic stages ## Footnote Hürthle cells are enlarged follicular cells with eosinophilic granular cytoplasm.

Answer 307

* Hashimoto’s: Diffuse, firm, lymphoid infiltrate, Hürthle cells * Graves’: Hyperplasia of follicles, scalloped colloid, minimal lymphocytes, hyperthyroid ## Footnote Remember to think hyperthyroidism for Graves’, not Hürthle cells.

Answer 308

* Dense fibrous replacement * Stony hard gland * Chronic inflammation ## Footnote It is a rare, fibrosis-dominant condition.

Answer 309

* Multinucleated giant cells * Granulomas * Painful thyroid ## Footnote This condition is subacute and tender.

Answer 310

* Solitary nodule * Hürthle cells * No diffuse infiltration ## Footnote It is a benign nodule and not autoimmune.

Answer 311

HASH: Hürthle cells, Autoimmune lymphocytes, Shrunken/atrophic follicles, Hyperplastic germinal centers ## Footnote This helps recall the key histological features.

Answer 312

Diffuse enlargement, lymphoid infiltrate with germinal centers, and Hürthle cell transformation ## Footnote These features are essential for diagnosis.

Answer 313

Plummer’s disease = toxic thyroid adenoma ## Footnote Sometimes refers to toxic multinodular goiter if multiple adenomas are present.

Answer 314

Thyroid follicular cells ## Footnote Most thyroid adenomas are nonfunctional, but in Plummer’s disease, the adenoma is functionally autonomous.

Answer 315

Hyperthyroidism ## Footnote Hormones overproduced: T4 (thyroxine) and T3 (triiodothyronine).

Answer 316

* Weight loss * Palpitations * Heat intolerance * Tremor ## Footnote Usually a solitary “hot nodule” on scintigraphy.

Answer 317

Usually a solitary toxic thyroid adenoma ## Footnote Multiple autonomously functioning nodules define toxic multinodular goiter.

Answer 318

Functional autonomy vs regular adenoma (non-toxic) ## Footnote Exam tip: “Plummer = autonomous, toxic thyroid nodule.”

Answer 319

TSH ## Footnote This causes hyperthyroidism.

Answer 320

Toxic multinodular goiter ## Footnote Sometimes also called Plummer’s disease in a broader sense.

Answer 321

APECED (Autoimmune Polyendocrinopathy, Candidiasis, Ectodermal Dystrophy) ## Footnote APS-1 is characterized by a classic triad of symptoms.

Answer 322

* Chronic mucocutaneous candidiasis * Primary hypoparathyroidism * Addison’s disease ## Footnote Chronic mucocutaneous candidiasis is often the first manifestation.

Answer 323

AIRE gene mutation ## Footnote APS-1 is inherited in an autosomal recessive manner.

Answer 324

* Enamel hypoplasia * Keratopathy * Autoimmune hepatitis * Type 1 diabetes (sometimes) ## Footnote These features can accompany the classic triad.

Answer 325

Usually childhood ## Footnote Candidiasis is often the first symptom, followed by Addison’s and hypoparathyroidism later.

Answer 326

APS-2 ## Footnote APS-2 includes Addison’s disease and autoimmune thyroid disease.

Answer 327

* Addison’s disease * Autoimmune thyroid disease (Hashimoto’s or Graves’) * Type 1 diabetes ## Footnote APS-2 typically has an onset in adulthood.

Answer 328

HLA-DR3/DR4 associations ## Footnote These genetic markers are significant in the development of APS-2.

Answer 329

Autoimmune thyroid disease + other autoimmune disease excluding Addison’s ## Footnote Examples include thyroiditis with type 1 diabetes or pernicious anemia.

Answer 330

Other combinations of autoimmune endocrine disorders not fitting APS 1–3 ## Footnote APS-4 is considered a catch-all category and is rare.

Answer 331

Think childhood triad: Candidiasis + Hypoparathyroidism + Addison’s ## Footnote This mnemonic helps recall the key features of APS-1.

Answer 332

Adult triad: Addison’s + Thyroid + Diabetes ## Footnote This helps in identifying APS-2 during examinations.

Answer 333

Thyroid disease + other autoimmune, no Addison ## Footnote This distinguishes APS-3 from other types.

Answer 334

Rare, miscellaneous autoimmune combinations ## Footnote This highlights the less common nature of APS-4.

Answer 335

Candidiasis ## Footnote This symptom is a key indicator of APS-1.

Answer 336

Autosomal dominant, mutation in MEN1 gene (encodes menin) ## Footnote MEN1 is characterized by the presence of multiple endocrine tumors.

Answer 337

* Parathyroid adenomas * Pancreatic endocrine tumors * Pituitary adenomas ## Footnote Parathyroid adenomas lead to primary hyperparathyroidism, the most common and first manifestation.

Answer 338

20–40 years ## Footnote This age range is typical for the manifestation of symptoms.

Answer 339

Hypercalcemia (from parathyroid adenoma) ## Footnote This is a high-yield exam tip for MEN Type 1.

Answer 340

Autosomal dominant, mutation in RET proto-oncogene ## Footnote MEN Type 2 is divided into subtypes based on tumor characteristics.

Answer 341

* Medullary thyroid carcinoma (MTC) * Pheochromocytoma * Primary hyperparathyroidism ## Footnote MTC is often the first manifestation in MEN2A.

Answer 342

More aggressive MTC, mucosal neuromas, Marfanoid habitus ## Footnote MEN2B does not involve parathyroid tumors.

Answer 343

CDKN1B mutation ## Footnote MEN Type 4 is very rare in humans.

Answer 344

* Pituitary adenomas * Parathyroid tumors * Adrenal tumors ## Footnote MEN Type 4 is sometimes referred to as MENX in mice studies.

Answer 345

3 Ps = Parathyroid, Pancreas, Pituitary ## Footnote Primary hyperparathyroidism is the first manifestation.

Answer 346

Medullary thyroid carcinoma + Pheochromocytoma + Parathyroid hyperplasia ## Footnote This combination is key for identifying MEN2A.

Answer 347

Medullary thyroid carcinoma + Pheochromocytoma + Mucosal neuromas/Marfanoid ## Footnote This highlights the aggressive nature of MEN2B.

Answer 348

MEN1 gene ## Footnote This test helps confirm the diagnosis of MEN Type 1.

Answer 349

RET proto-oncogene ## Footnote This test is crucial for diagnosing MEN Type 2.

Answer 350

A rare systemic inflammatory disorder in children and adults with differing features ## Footnote Exists as Systemic Juvenile Idiopathic Arthritis (sJIA) in children and Adult-Onset Still’s Disease (AOSD) in adults.

Answer 351

* Systemic Juvenile Idiopathic Arthritis (sJIA) * Adult-Onset Still’s Disease (AOSD) ## Footnote sJIA usually has an onset <16 years, while AOSD is rare and typically occurs in ages 16–35.

Answer 352

* Quotidian fever * Evanescent salmon-pink rash * Arthritis or arthralgia ## Footnote The clinical triad includes fever spiking >39°C, rash appearing with fever, and arthritis affecting joints.

Answer 353

* Sore throat * Lymphadenopathy * Hepatosplenomegaly * Serositis * Myalgias * Fatigue, weight loss ## Footnote These features can accompany the clinical triad.

Answer 354

* Elevated ferritin (>1000 ng/mL) * Leukocytosis with neutrophilia * High ESR and CRP * Mild anemia * Negative RF and ANA ## Footnote These findings help distinguish Still’s disease from other autoimmune diseases.

Answer 355

* Autoinflammatory disease * Driven by cytokines: IL-1, IL-6, IL-18, TNF-alpha ## Footnote It is not primarily autoimmune, hence RF and ANA are usually negative.

Answer 356

Mostly clinical, supported by labs and exclusion of infections, malignancies, and other autoimmune diseases ## Footnote Yamaguchi criteria are commonly used for AOSD diagnosis.

Answer 357

* ≥5 criteria including ≥2 major * Major: Fever ≥39°C ≥1 week, arthritis ≥2 weeks, typical rash, leukocytosis ≥10,000/mm³ with ≥80% neutrophils * Minor: Sore throat, lymphadenopathy, hepatosplenomegaly, abnormal liver enzymes, negative RF/ANA ## Footnote These criteria help confirm the diagnosis of AOSD.

Answer 358

* Macrophage activation syndrome (MAS) * Chronic arthritis * Hepatic involvement * Pericarditis/pleuritis ## Footnote MAS is potentially life-threatening and should be monitored.

Answer 359

NSAIDs ## Footnote For moderate to severe cases, corticosteroids are used.

Answer 360

* IL-1 inhibitors: Anakinra, Canakinumab * IL-6 inhibitors: Tocilizumab ## Footnote These are used for cytokine-driven cases.

Answer 361

Still’s disease = spiking fever + salmon-pink rash + arthritis + high ferritin + RF/ANA negative ## Footnote Always consider MAS as a dangerous complication.

Answer 362

* Definition: The population is divided into groups (clusters) * Method: A random sample of clusters is selected, and all or some units within the chosen clusters are studied ## Footnote High-yield exam tip: Think “groups first, then sample clusters.” Useful when a complete list of individuals is hard to obtain.

Answer 363

* Definition: Every unit in the population has an equal chance of being selected * Method: Use random numbers or computer-generated randomization to select units ## Footnote High-yield exam tip: Key phrase: “each unit has the same probability.”

Answer 364

* Definition: Population is divided into strata (subgroups) based on certain characteristics * Method: A random sample is taken from each stratum, often proportional to the stratum size ## Footnote High-yield tip: Ensures representation of key subgroups and reduces variability compared to simple random sampling.

Answer 365

* Definition: Select every k-th unit from a population list after a random start ## Footnote High-yield tip: Easy to implement. Watch for periodic patterns in the list (can bias results).

Answer 366

* Definition: Units are chosen based on ease of access or availability ## Footnote High-yield tip: Non-random → high risk of bias. Common in pilot studies or preliminary research.

Answer 367

* Definition: Units are selected based on researcher’s judgment, usually to target a specific characteristic ## Footnote High-yield tip: Often used in qualitative research. Non-probabilistic → results are not generalizable.

Answer 368

10 vaccines are mandatory ## Footnote This includes the Hexavalent (6) + MMRV (4). Without these, children 0–6 cannot enter nursery schools.

Answer 369

* Meningococcal B/ACWY * Pneumococcal * HPV ## Footnote These vaccines are free and strongly urged.

Answer 370

High-dose antigen for young children ## Footnote It is distinguished from dTap, which is a low-dose antigen booster for adults/teens.

Answer 371

2-dose start with a 1-dose booster ## Footnote Most primary series follow this schedule at 3rd, 5th, and 11th months.

Answer 372

FALSE ## Footnote They cannot attend nursery/kindergarten (ages 0–6). Older students (6–16) can attend but parents may face fines.

Answer 373

Conjugate vaccine (PCV13) ## Footnote Conjugate vaccines are better for babies as they help their immature immune systems.

Answer 374

* Start with Conjugate vaccine (PCV13 or PCV20) * Follow up with Polysaccharide vaccine (PPSV23) ## Footnote The polysaccharide version covers more strains but doesn't last as long.

Answer 375

Palivizumab (Synagis) ## Footnote It required monthly injections during winter for very high-risk/preterm babies.

Answer 376

Nirsevimab (Beyfortus) ## Footnote It is a single shot that protects babies for the entire RSV season.

Answer 377

* Polio * Diphtheria * Tetanus * Pertussis * Hepatitis B * Haemophilus Influenzae B * Measles * Mumps * Rubella * Varicella ## Footnote These vaccines are grouped into Hexavalent and MMRV.

Answer 378

At birth (risk only) ## Footnote It is recommended for newborns.

Answer 379

* Hexavalent * Pneumo (PCV13) * Rota * MenB ## Footnote These vaccinations are mandatory.

Answer 380

* Hexavalent * Pneumo (PCV13) ## Footnote These vaccinations are mandatory.

Answer 381

* Tetravalent (DTaP + IPV) * MMRV ## Footnote These vaccinations are mandatory.

Answer 382

* dTap + IPV * HPV * MenACWY ## Footnote These vaccinations are mandatory.

Answer 383

* Tetanus * Diphtheria * Pertussis ## Footnote Together, these are referred to as dTap.

Answer 384

Pertussis (dTap) ## Footnote It is recommended at 28 weeks.

Answer 385

* Flu * Pneumo (PCV13 + PPSV23) * Shingles ## Footnote These vaccinations are recommended.

Answer 386

Ineffective under 2 years of age ## Footnote This vaccine does not provide adequate protection for infants.

Answer 387

* No immunological memory * No herd immunity * Short-term protection only ## Footnote It does not prevent the carriage of bacteria in the throat.

Answer 388

* Effective under 2 years of age * Provides immunological memory * Allows herd immunity * Creates long-term immunity ## Footnote These features make conjugated vaccines more effective in preventing disease.

Answer 389

Pure polysaccharides are invisible to the immune system of a child under 2 ## Footnote This is why polysaccharides are conjugated to proteins to enhance immune response.

Answer 390

Reduces 'nasopharyngeal carriage' ## Footnote Vaccinated individuals do not carry the bacteria in their throat, preventing transmission.

Answer 391

Can make the immune system less responsive over time (immunological tolerance) ## Footnote This risk does not occur with conjugate vaccines.

Answer 392

* Overexpression of TGF-α * Excessive signalling to EGFR receptors * Gastric surface mucosa hyperplasia * Atrophy of parietal cells * Hypochlorhydria ## Footnote This leads to an increase in mucous cells and a decrease in stomach acid production.

Answer 393

Protein-Losing Gastropathy ## Footnote This condition is characterized by hypoalbuminemia, peripheral oedema, and weight loss/diarrhoea.

Answer 394

* Hypoalbuminemia * Peripheral oedema * Weight loss * Diarrhoea ## Footnote These symptoms result from massive protein loss through the gastric mucosa.

Answer 395

* Giant rugal folds in the fundus and body * Normal appearance of the antrum ## Footnote This finding is significant for diagnosis.

Answer 396

* Large, corkscrew-shaped gastric glands * Foveolar hyperplasia * Reduced parietal/chief cells ## Footnote These features help confirm the diagnosis.

Answer 397

* High-protein diet * Antisecretory agents (e.g., PPIs like Omeprazole) * Cetuximab ## Footnote Cetuximab is a monoclonal antibody that targets TGF-α.

Answer 398

Total Gastrectomy ## Footnote This is reserved for cases that do not respond to medical treatment or have a high suspicion of cancer.

Answer 399

FALSE ## Footnote It is precancerous with a risk of Adenocarcinoma but is not a malignancy itself.

Answer 400

* Ménétrier's: Low acid (hypochlorhydria) * Zollinger-Ellison: High acid (hyperchlorhydria) and high Gastrin ## Footnote This distinction is crucial for diagnosis.

Answer 401

CMV (Cytomegalovirus) ## Footnote In adults, the disease is chronic and progressive.

Answer 402

How much of the oesophagus is occupied by the veins and their appearance ## Footnote The grading system categorizes the form and size of the varices.

Answer 403

Straight (Occupy < 1/3 of the esophageal radius) * Thin, small * Disappear with air insufflation ## Footnote F1 varices indicate minimal involvement of the esophagus.

Answer 404

Tortuous/Beaded (Occupy 1/3 to 2/3 of the radius) * Larger, 'pearl-like' veins * Do not disappear with air ## Footnote F2 varices show moderate involvement and complexity.

Answer 405

Tumid/Convoluted (Occupy > 2/3 of the radius) * Large, mass-like veins * Look like a 'bunch of grapes' ## Footnote F3 varices indicate severe involvement of the esophagus.

Answer 406

A high risk of imminent bleeding ## Footnote RC signs are important indicators in clinical assessments.

Answer 407

* RC0: No red signs * RC1: Red-Wheals (looks like a red welt) * RC2: Cherry-red spots (small red dots) * RC3: Hematocystic spots (large red 'blisters') ## Footnote These signs are crucial for assessing bleeding risk.

Answer 408

FALSE ## Footnote Even an F1 varix is considered high risk if RC signs are present.

Answer 409

Primary prophylaxis usually not mandatory unless severe liver cirrhosis (Child-Pugh C) ## Footnote Monitoring via endoscopy is key.

Answer 410

Non-selective Beta-blockers (Propranolol or Nadolol) ## Footnote These medications reduce portal pressure.

Answer 411

Variceal Band Ligation (EVL or Legatura elastica) ## Footnote This procedure is used to manage variceal bleeding.

Answer 412

F1 (Straight) ## Footnote Low-risk features include size and color indicators.

Answer 413

Child-Pugh C ## Footnote Liver status is a critical factor in assessing risk.

Answer 414

Beta-blockers or Banding ## Footnote High-risk patients require more aggressive management strategies.

Answer 415

Describing the liver's reserve in patients with cirrhosis ## Footnote It combines laboratory values and clinical findings.

Answer 416

* Albumin * Bilirubin * Coagulation (INR) * Distension (Ascites) * Encephalopathy ## Footnote A helpful mnemonic to remember these components is ABCDE.

Answer 417

5 – 6 ## Footnote Class A indicates compensated liver function with low risk.

Answer 418

~45% ## Footnote Class C indicates decompensated liver function with high risk.

Answer 419

FALSE ## Footnote These are subjective measures based on clinical judgment.

Answer 420

Usually safe for elective surgery ## Footnote Class B patients can undergo surgery with caution, while Class C is generally contraindicated.

Answer 421

1 point is < 4 instead of < 2 ## Footnote This adjustment is necessary due to naturally higher bilirubin levels in these patients.

Answer 422

diuretics ## Footnote This can lead to a change in classification from B to A, despite liver scarring.

Answer 423

Model for End-Stage Liver Disease ## Footnote MELD is the gold standard for organ allocation in liver transplants.

Answer 424

* Bilirubin * INR * Creatinine ## Footnote These variables represent Bile, Clotting, and Kidneys.

Answer 425

Liver's ability to clear waste ## Footnote High bilirubin levels indicate impaired liver function.

Answer 426

Liver's ability to make clotting factors ## Footnote A higher INR indicates a greater risk of bleeding due to liver dysfunction.

Answer 427

Kidney function ## Footnote Kidney function is often affected when the liver fails.

Answer 428

MELD-Na ## Footnote Sodium is added to the formula due to its predictive value for mortality in liver patients.

Answer 429

Major predictor of death ## Footnote Low sodium levels can indicate worsening liver disease.

Answer 430

6 to 40 ## Footnote The score predicts the 90-day mortality risk.

Answer 431

~2% mortality risk; low risk; re-check in 1 year ## Footnote Patients with low scores are less likely to need urgent transplants.

Answer 432

15 ## Footnote At this score, the benefits of transplant usually outweigh the risks.

Answer 433

> 50% mortality risk; high priority; re-check every 7 days ## Footnote Patients in this range are at significant risk and require close monitoring.

Answer 434

> 70% mortality risk; grave condition; urgent transplant needed ## Footnote This score reflects a critical state requiring immediate medical intervention.

Answer 435

A false diverticulum occurring at the back of the throat ## Footnote It involves only the mucosa and submucosa, not the muscle layer.

Answer 436

At Killian’s Triangle ## Footnote This area is a site of muscular weakness between the thyropharyngeal and cricopharyngeal parts of the inferior constrictor muscle.

Answer 437

It is a pulsion diverticulum ## Footnote Increased pressure during swallowing pushes the mucosa through the weak spot.

Answer 438

* Dysphagia * Regurgitation * Halitosis * Gurgling sounds * Aspiration pneumonia (rare) ## Footnote Patients may feel like they 'eat now but taste it again later'.

Answer 439

Barium Swallow (Esofagogramma baritato) ## Footnote It clearly shows the pouch filling with contrast.

Answer 440

Endoscopy (Gastroscopy) ## Footnote The scope can accidentally enter the diverticulum instead of the oesophagus and cause a perforation.

Answer 441

Only if the patient is symptomatic ## Footnote Treatment options include surgical and endoscopic procedures.

Answer 442

* Diverticulectomy * Cricopharyngeal myotomy ## Footnote These procedures involve removing the pouch and cutting the tight muscle.

Answer 443

Dohlman Procedure ## Footnote A stapler or laser is used to join the diverticulum and the oesophagus into one channel.

Answer 444

FALSE ## Footnote It is a false diverticulum, involving only the mucosa and submucosa.

Answer 445

* Acute Hepatitis: Often stable, may not require hospitalization * Acute Liver Failure: Life-threatening emergency, requires inpatient treatment ## Footnote The AISF guidelines help distinguish between the two conditions.

Answer 446

* INR > 1.5 (or PT < 50%) * Encephalopathy * Severe Bilirubinemia (> 10–15 mg/dL) * Intractable Vomiting * Fragile Patient ## Footnote These criteria help assess the severity of acute liver conditions.

Answer 447

FALSE ## Footnote Patients without the 'Alarm Bells' can be managed in the community.

Answer 448

* Viral Serology (Sierologia Virale) * Abdominal Ultrasound (Ecografia Addominale) ## Footnote Viral serology tests for HAV, HBV, HCV, and others; ultrasound rules out post-hepatic causes.

Answer 449

Sign of massive necrosis; liver has no more cells left to leak enzymes ## Footnote This is a medical emergency indicating end-stage liver failure.

Answer 450

A diagnostic tool for functional gastrointestinal disorders based on symptom criteria.

Answer 451

TRUE ## Footnote IBS stands for Irritable Bowel Syndrome, a common functional gastrointestinal disorder.

Answer 452

Irritable Bowel Syndrome (IBS) and Functional Dyspepsia.

Answer 453

To standardize the diagnosis of functional gastrointestinal disorders based on symptoms.

Answer 454

At least once a week for the last three months.

Answer 455

Deciding how to manage breast cancer ## Footnote The AIOM (Associazione Italiana di Oncologia Medica) guidelines are considered the gold standard.

Answer 456

Conservative surgery MUST be followed by Radiotherapy (RT) ## Footnote If RT cannot be safely performed after surgery, the surgery should not be performed.

Answer 457

Maximum lifetime dose of radiation ## Footnote Prior RT to the breast risks severe tissue necrosis, fibrosis, and failure to heal.

Answer 458

* Prior Radiation to the breast or chest wall * Diffuse Malignant Microcalcifications * Multicentric Tumour * Persistent Positive Margins * Pregnancy (1st/2nd Trimester) ## Footnote These conditions necessitate a mastectomy to ensure local control of the disease.

Answer 459

Tumour Size vs. Breast Size ## Footnote A large tumour in a very large breast may allow for conservative removal, while a small breast may require a mastectomy.

Answer 460

* Scleroderma * Lupus ## Footnote These conditions can cause poor skin reactions to radiation.

Answer 461

* Multifocal: Multiple foci within the same quadrant (BCS possible) * Multicentric: Multiple foci in different quadrants (BCS contraindicated; Mastectomy required) ## Footnote This distinction is important in treatment decisions.

Answer 462

The first node to receive lymphatic drainage from the tumour ## Footnote If the sentinel node is 'clean' (negative for cancer), it is statistically highly unlikely that the other nodes are involved.

Answer 463

* Clinically Negative Axilla (cN0) * Tumour Size (usually T1 and T2) * The Procedure (injection of radioactive tracer or blue dye) ## Footnote The patient must have no palpable nodes and a 'clean' ultrasound of the axilla before surgery.

Answer 464

A trial to determine whether the whole axilla should be cleared if the Sentinel Node is positive ## Footnote Full Axillary Dissection can be avoided if: * Tumour is T1 or T2 (< 5 cm) * Only 1 or 2 positive Sentinel Lymph Nodes * Patient undergoing Breast Conserving Surgery * Patient planned for Whole-Breast Radiotherapy.

Answer 465

* Clinically Positive Nodes (cN+) * Inflammatory Breast Cancer * 3 or more Positive Sentinel Nodes * Positive SLN + Mastectomy ## Footnote A full dissection is required in these cases to manage the risk of cancer spread.

Answer 466

Stage (I–IV) ## Footnote The TNM system categorizes cancer based on Tumor size, Node involvement, and Metastasis.

Answer 467

Tumor ## Footnote Describes the size or depth of invasion of the primary tumor.

Answer 468

"In situ" (hasn't broken the basement membrane) ## Footnote Represents an early stage of tumor development.

Answer 469

The tumor gets larger or invades deeper into nearby structures ## Footnote Higher T numbers indicate more advanced tumor characteristics.

Answer 470

Nodes ## Footnote Describes the regional lymph nodes involved in cancer.

Answer 471

No nodes involved ## Footnote Indicates no regional lymph node involvement.

Answer 472

Metastasis ## Footnote Describes distant spread of cancer.

Answer 473

No distant spread ## Footnote Indicates that cancer has not spread to distant sites.

Answer 474

* T1: ≤ 2 cm * T2: > 2 cm to 5 cm * T3: > 5 cm * T4: Any size with extension ## Footnote This rule helps remember the size-based classification of breast tumors.

Answer 475

* N1: Mobile axillary nodes * N3: Supraclavicular nodes ## Footnote These classifications help determine the extent of lymph node involvement.

Answer 476

Submucosa ## Footnote Refers to the layer of invasion in colorectal cancer staging.

Answer 477

Perforates the visceral peritoneum or invades other organs ## Footnote Indicates advanced disease with significant invasion.

Answer 478

The Liver ## Footnote Due to portal venous drainage, the liver is a common site for metastasis.

Answer 479

≤ 3 cm ## Footnote Refers to the size of the tumor in lung cancer staging.

Answer 480

> 7 cm or invades vital structures ## Footnote Indicates a very advanced stage of lung cancer.

Answer 481

Clinically inapparent ## Footnote Detected by PSA or biopsy, not felt on DRE.

Answer 482

Primarily Osteoblastic bone metastases ## Footnote Indicates the presence of bone metastases in advanced prostate cancer.

Answer 483

≤ 1.0 mm ## Footnote Refers to the Breslow thickness measurement in melanoma staging.

Answer 484

Automatically upgraded ## Footnote Ulceration indicates a more advanced stage of melanoma.

Answer 485

Stage 0 (Tis) ## Footnote Represents a very early stage where the tumor has not invaded beyond the basement membrane.

Answer 486

Stage IV (M1) ## Footnote Indicates that cancer has spread to distant sites.

Answer 487

At least Stage III (N1) ## Footnote Indicates involvement of regional lymph nodes, suggesting more advanced disease.

Answer 488

SIGO-AOGOI-AGUI ## Footnote These guidelines are from the *Società Italiana di Ginecologia e Ostetricia*.

Answer 489

placental endothelial ## Footnote This indicates that they are interconnected conditions rather than separate diseases.

Answer 490

New-onset hypertension after 20 weeks of gestation due to abnormal remodelling of spiral arteries ## Footnote It leads to placental ischemia and the release of anti-angiogenic factors (sFlt-1) into maternal blood.

Answer 491

* Hypertension (> 140/90 mmHg) * Proteinuria (> 300 mg/24h or '1+' on dipstick) * Oedema ## Footnote Oedema is no longer a strict diagnostic criterion but is highly common.

Answer 492

end-organ ## Footnote Examples include Thrombocytopenia, Renal insufficiency, Liver dysfunction, Pulmonary oedema, or Cerebral/Visual symptoms.

Answer 493

Progression of pre-eclampsia to unexplained generalized tonic-clonic seizures ## Footnote It represents a severe complication of pre-eclampsia.

Answer 494

Magnesium Sulphate (MgSO4) ## Footnote It is used for treating seizures and as prophylaxis in severe pre-eclampsia.

Answer 495

* Reflexes * Respirations * Renal ## Footnote These parameters help ensure safe levels of Magnesium Sulphate.

Answer 496

Loss of patellar reflexes ## Footnote If absent, the infusion of Magnesium should be stopped.

Answer 497

Calcium Gluconate (1g IV over 10 minutes) ## Footnote It is used as an antidote for magnesium toxicity.

Answer 498

* H: Haemolysis * EL: Elevated Liver enzymes * LP: Low Platelets ## Footnote HELLP Syndrome is a severe variant of pre-eclampsia that is a medical emergency.

Answer 499

* Microangiopathic haemolytic anaemia * Look for Schistocytes * High LDH ## Footnote These lab findings are critical for diagnosis.

Answer 500

AST/ALT > 2x normal ## Footnote Elevated liver enzymes are a key diagnostic criterion.

Answer 501

< 100,000/mm3 ## Footnote This low platelet count is significant for diagnosis.

Answer 502

* Epigastric pain * Right Upper Quadrant (RUQ) pain ## Footnote This pain is due to Glisson’s capsule distension.

Answer 503

Rupture of the capsule ## Footnote This is considered a surgical emergency.

Answer 504

* Labetalol * Nifedipine (oral) * Methyldopa (Aldomet) ## Footnote Labetalol is the most common choice.

Answer 505

Low-dose Aspirin (Cardioaspirina 100-150 mg) ## Footnote This should start from the 12th week of gestation.

Answer 506

Delivery of the Placenta ## Footnote This is the only way to stop the process.

Answer 507

Deliver immediately ## Footnote This is due to the increased risk of complications.

Answer 508

Attempt to delay for 48 hours for Betamethasone ## Footnote This is to promote fetal lung maturity unless maternal status is unstable.

Answer 509

Induction of Labor is recommended at 37 weeks ## Footnote This is due to the risk of stroke or eclampsia.

Answer 510

At 34 weeks ## Footnote This is if there are severe features like very high BP or low platelets.

Answer 511

Vaginal delivery ## Footnote This is preferred over C-section as it is less stressful on the cardiovascular system.

Answer 512

A group of infections causing significant congenital abnormalities if acquired in utero or during birth ## Footnote The mother often has mild or no symptoms, but the effect on the fetus can be devastating, especially during the first trimester.

Answer 513

Toxoplasmosis ## Footnote Toxoplasmosis can be contracted from undercooked meat, cat feces, and unwashed vegetables.

Answer 514

* Syphilis * Varicella * Parvovirus B19 * HIV * Listeria ## Footnote These are categorized as 'Others' in the TORCH complex.

Answer 515

Rubella (Rosolia) ## Footnote Rubella can cause serious congenital defects if contracted during pregnancy.

Answer 516

Cytomegalovirus (CMV) ## Footnote CMV is the most common congenital infection and the leading cause of non-hereditary deafness.

Answer 517

Herpes Simplex (HSV-2) ## Footnote Transmission usually occurs during passage through the birth canal.

Answer 518

* Chorioretinitis * Hydrocephalus * Intracranial Calcifications ## Footnote This triad is known as Sabin’s Triad.

Answer 519

* Cataracts * Sensory Neural Deafness * Congenital Heart Disease (PDA) ## Footnote This triad is known as Gregg’s Triad.

Answer 520

> 80% risk if infected in the first 12 weeks ## Footnote Early infection poses the greatest risk for congenital defects.

Answer 521

MMR Vaccine (MPR in Italy) ## Footnote It is a live-attenuated vaccine and cannot be given during pregnancy.

Answer 522

* Periventricular Calcifications * Microcephaly * Petechial Rash (Blueberry muffin spots) ## Footnote These signs help in diagnosing CMV in newborns.

Answer 523

Detection of CMV in newborn urine or saliva within the first 3 weeks of life ## Footnote Early diagnosis is crucial for management.

Answer 524

* Skin-eye-mouth (SEM) vesicles * Encephalitis * Disseminated multi-organ failure ## Footnote These can occur if the infection is transmitted during birth.

Answer 525

* Snuffles * Palm/sole desquamation * Hepatosplenomegaly ## Footnote These signs indicate possible congenital syphilis.

Answer 526

* Hutchinson Teeth * Interstitial Keratitis * 8th Nerve Deafness ## Footnote These are characteristic findings in congenital syphilis.

Answer 527

Saber shins (bowing of the tibia) ## Footnote This is a notable physical finding in congenital syphilis.

Answer 528

A type of herpes simplex virus primarily causing oral herpes.

Answer 529

Cold sores

Answer 530

HSV1 typically causes oral lesions, while HSV2 causes genital lesions.

Answer 531

TRUE ## Footnote HSV1 can be transmitted to the genital area through oral sex.

Answer 532

McCune-Albright Syndrome ## Footnote Both involve skin spots and bone issues.

Answer 533

* Polyostotic Fibrous Dysplasia * Café-au-lait Spots * Autonomous Endocrine Hyperfunction ## Footnote Patients typically exhibit at least two of these symptoms.

Answer 534

Normal bone replaced by fibrous tissue ## Footnote Leads to fractures, deformities, and a 'ground-glass' appearance on X-rays.

Answer 535

Light brown skin patches ## Footnote Usually stay on one side of the body (mosaicism) with irregular borders in McCune-Albright.

Answer 536

Irregular borders ('Coast of Maine') ## Footnote Neurofibromatosis has smooth borders ('Coast of California').

Answer 537

Precocious Puberty ## Footnote Especially in girls, who may experience vaginal bleeding/spotting as young as age 2.

Answer 538

GNAS gene mutation ## Footnote This mutation keeps the G-protein constantly 'switched on.'

Answer 539

It is constantly 'switched on' ## Footnote This leads to multiple glands becoming overactive simultaneously.

Answer 540

* Ovaries * Thyroid * Pituitary * Adrenals ## Footnote Each can lead to various hormonal excesses.

Answer 541

Precocious Puberty ## Footnote May include vaginal bleeding/spotting as young as age 2.

Answer 542

Happens after fertilization ## Footnote Only some cells are affected, leading to a mosaic of healthy and mutated tissue.

Answer 543

It would be a germline mutation ## Footnote The patient survives with a mosaic of healthy and mutated tissue.

Answer 544

'Ground-glass' appearance ## Footnote This condition often affects craniofacial bones, leading to asymmetry.

Answer 545

A group of genetic disorders causing tumours on nerve tissue ## Footnote These tumours can develop anywhere in the nervous system, including the brain, spinal cord, and peripheral nerves.

Answer 546

* NF1 * NF2 ## Footnote These genes are tumour suppressors that normally act like 'brakes' on cell growth.

Answer 547

Autosomal Dominant ## Footnote A child has a 50% chance of inheriting it if one parent has it, but about 50% of cases are spontaneous mutations.

Answer 548

NF1 (Von Recklinghausen Disease) ## Footnote This is primarily a peripheral and cutaneous (skin) disease.

Answer 549

Chromosome 17 ## Footnote This chromosome contains the gene responsible for Neurofibromatosis Type 1.

Answer 550

* Neurofibromas * Café-au-lait Spots * Lisch Nodules * Crowe Sign * Optic Glioma ## Footnote These features are critical for diagnosis and management of NF1.

Answer 551

* C – Café-au-lait spots * A – Axillary or inguinal freckling * F – Fibromas * E – Eye hamartomas * S – Skeletal lesions * P – Positive family history * OT – Optic Tumour ## Footnote This mnemonic helps remember the key features of Neurofibromatosis Type 1.

Answer 552

Small, dome-shaped, pigmented tumours on the iris ## Footnote They are considered a pathognomonic finding for Neurofibromatosis Type 1 (NF1).

Answer 553

Tiny, clear-to-yellowish-brown bumps on the iris ## Footnote They are usually bilateral and made of melanocytes.

Answer 554

FALSE ## Footnote They are asymptomatic and do not cause any pain or discomfort.

Answer 555

Slit-lamp examination ## Footnote While large nodules can be seen with a penlight, a slit-lamp is needed for confirmation.

Answer 556

By age 5 ## Footnote Their prevalence increases with age, reaching >90-100% by age 20.

Answer 557

Chromosome 22 ## Footnote This gene is linked to the development of bilateral vestibular schwannomas.

Answer 558

* Bilateral Vestibular Schwannomas * MISME (Meningiomas, Intracranial Schwannomas, Multiple Ependymomas) * Cataracts ## Footnote Bilateral vestibular schwannomas are the hallmark feature leading to hearing loss, tinnitus, and balance issues.

Answer 559

* Meningiomas * Intracranial Schwannomas * Multiple Ependymomas ## Footnote These are the other tumors commonly associated with NF2.

Answer 560

Cataracts ## Footnote Often seen at a young age as juvenile posterior subcapsular lenticular opacities.

Answer 561

Intense, chronic pain ## Footnote This pain is often much worse than the size of the tumors would suggest.

Answer 562

FALSE ## Footnote Patients develop multiple schwannomas on spinal and peripheral nerves, but never on the vestibular (hearing) nerves.

Answer 563

Growth of numerous benign tumours (hamartomas) in various organs ## Footnote Particularly affects the brain, skin, heart, kidneys, and lungs.

Answer 564

Autosomal Dominant ## Footnote 60-70% of cases are due to spontaneous mutations.

Answer 565

* TSC1 (Hamartin) on Chromosome 9 * TSC2 (Tuberin) on Chromosome 16 ## Footnote These genes inhibit the mTOR pathway, and mutations lead to hyperactivity of mTOR.

Answer 566

Mutated genes lead to hyperactive mTOR, causing uncontrolled cell growth (hamartomas) ## Footnote mTOR pathway is normally inhibited by TSC1 and TSC2.

Answer 567

* Epilepsy (Infantile spasms/seizures) * Intellectual Disability (Mental retardation) * Adenoma Sebaceum (Facial angiofibromas) ## Footnote Only about 30% of patients show the full triad.

Answer 568

* A – Ash-leaf spots * S – Shagreen patches * H – Heart Rhabdomyoma * L – Lung LAM (Lymphangioleiomyomatosis) * E – Epilepsy * A – Angiofibromas * F – Fibromas ## Footnote This mnemonic helps remember the clinical features of TSC.

Answer 569

Hypopigmented (white) macules ## Footnote Often the very first sign of TSC in an infant, best seen with a Wood’s Lamp.

Answer 570

Leathery, 'orange-peel' skin usually found on the lower back ## Footnote A clinical feature of Tuberous Sclerosis.

Answer 571

Heart Rhabdomyoma ## Footnote High-yield because they often regress on their own.

Answer 572

Cystic lung destruction seen almost exclusively in females ## Footnote LAM stands for Lymphangioleiomyomatosis.

Answer 573

Infantile Spasms (West Syndrome) in babies ## Footnote A significant clinical feature of TSC.

Answer 574

Small red facial bumps usually in a butterfly distribution across the nose and cheeks ## Footnote Formerly called adenoma sebaceum.

Answer 575

Fibromas growing from the nail beds ## Footnote Also known as Koenen tumours.

Answer 576

AIFA and SIGO ## Footnote These guidelines provide recommendations for safe medication use during pregnancy.

Answer 577

Paracetamol ## Footnote It is considered the safest option for managing pain and fever in pregnant patients.

Answer 578

* alpha-Methyldopa * Labetalol * Nifedipine ## Footnote These medications are recommended for managing high blood pressure in pregnant women.

Answer 579

* Penicillins (Amoxicillin) * Cephalosporins * Erythromycin (except the estolate form) ## Footnote These antibiotics are commonly prescribed for infections in pregnant patients.

Answer 580

LMWH (Heparin) ## Footnote It is a large molecule that does not cross the placenta, making it safer for use in pregnant patients.

Answer 581

Insulin ## Footnote Insulin is the preferred medication for managing diabetes in pregnant women.

Answer 582

* Inhaled Corticosteroids (Budesonide) * Salbutamol (Ventolin) ## Footnote These medications help manage asthma symptoms safely during pregnancy.

Answer 583

Levothyroxine ## Footnote The dosage usually needs to be increased during pregnancy to meet the needs of both mother and fetus.

Answer 584

* H - Hydralazine * L - Labetalol * M - Methyldopa * N - Nifedipine ## Footnote This mnemonic helps remember the safe medications for treating hypertension in pregnant patients.

Answer 585

* ACE Inhibitors / ARBs * Warfarin * Isotretinoin (Roaccutan) * Tetracyclines * Aminoglycosides * Valproate * Thalidomide * Lithium * Statins ## Footnote These drugs are almost always the 'wrong' answer for a pregnant patient due to their fetal risks.

Answer 586

* Renal dysgenesis * Oligohydramnios * Skull defects ## Footnote These effects can lead to significant complications during pregnancy.

Answer 587

* Nasal hypoplasia * CNS defects * Skeletal stippling ## Footnote Warfarin is known for its severe fetal risks.

Answer 588

* Ear malformations * Heart malformations * CNS malformations ## Footnote It is considered extremely teratogenic.

Answer 589

Permanent yellow/brown discoloration of teeth ## Footnote This effect can have lasting impacts on the child.

Answer 590

Ototoxicity (CN VIII damage/deafness) ## Footnote This can lead to hearing loss in the child.

Answer 591

Neural Tube Defects (Spina Bifida) ## Footnote Valproate poses a significant risk during pregnancy.

Answer 592

Phocomelia (limb deformities) ## Footnote Thalidomide is notorious for causing severe limb malformations.

Answer 593

Ebstein Anomaly (tricuspid valve displacement in the heart) ## Footnote Lithium use can lead to serious cardiac defects.

Answer 594

Potential disruption of fetal cholesterol synthesis ## Footnote This can affect fetal development.

Answer 595

Generally avoided, especially in the 3rd trimester ## Footnote They can cause premature closure of the Ductus Arteriosus.

Answer 596

Low-dose Aspirin (100mg) is used to prevent pre-eclampsia ## Footnote This is a specific case where Aspirin is beneficial.

Answer 597

Concerns about fetal cartilage damage ## Footnote This class of antibiotics poses risks to fetal development.

Answer 598

Risk of 'Floppy Infant Syndrome' ## Footnote This condition can affect the newborn's muscle tone.

Answer 599

400 micrograms (0.4 mg) daily starting at least one month before conception ## Footnote This is to prevent Neural Tube Defects.

Answer 600

5 mg ## Footnote This is recommended for women taking anti-epileptics like Carbamazepine.

Answer 601

* IgA * IgD * IgE * IgG * IgM ## Footnote These classes play various roles in the immune response.

Answer 602

Big (Pentamer), first on the scene, stays in the blood ## Footnote IgM is the first antibody produced in response to an infection.

Answer 603

Small (Monomer), crosses placenta, long-term memory ## Footnote IgG is the most abundant antibody in the blood and provides long-term immunity.

Answer 604

Secreted in milk (protects baby's gut) ## Footnote IgA is crucial for mucosal immunity and is found in secretions like saliva and breast milk.

Answer 605

Sneezing (Allergy) and Worms (Parasites) ## Footnote IgE is involved in allergic reactions and defense against parasitic infections.

Answer 606

Fragment Antigen Binding ## Footnote Fab is responsible for binding to specific antigens on pathogens.

Answer 607

Fragment Crystallizable ## Footnote Fc binds to receptors on phagocytes (macrophages/neutrophils) or the placenta.

Answer 608

IgG ## Footnote IgG is also the only class of antibody that can cross the placenta.

Answer 609

IgM ## Footnote IgM is associated with the primary response and is a marker for acute infections.

Answer 610

Found in secretions (breast milk, tears, saliva) ## Footnote IgA is important for mucosal immunity and exists as a dimer.

Answer 611

IgE ## Footnote IgE is primarily involved in allergic reactions and defense against parasites.

Answer 612

Found on the surface of B cells ## Footnote IgD is involved in B-cell activation.

Answer 613

Actively transported via FcRn (Neonatal Fc Receptor) ## Footnote This receptor is located in the syncytiotrophoblast of the placenta.

Answer 614

Passive immunity ## Footnote This immunity lasts for the first 3–6 months of life while the newborn's immune system matures.

Answer 615

IgM ## Footnote IgM is a large pentamer that cannot cross the placenta, preventing a crisis during pregnancy for a mother with Type O blood and a baby with Type A blood.

Answer 616

The pathogen (bacteria, virus, etc.) ## Footnote Antigenes are recognized by antibodies.

Answer 617

The specific part of the antigene that the antibody recognizes ## Footnote A pathogen can have many different epitopes.

Answer 618

The part of the anticorpo that binds to the epitope ## Footnote It’s referred to as the 'key' in the antibody-antigen interaction.

Answer 619

The two 'arms' of the Y-shaped antibody ## Footnote This is where the paratopo is located.

Answer 620

Determines the class (IgG, IgM, etc.) and binds to receptors on our own cells ## Footnote It is the 'tail' or 'stem' of the antibody.

Answer 621

The process where opsonine coats a pathogen to make it more recognizable ## Footnote Opsonins like IgG or the complement fragment C3b enhance the immune response.

Answer 622

bacteria ## Footnote This is the initial step in the opsonisation process.

Answer 623

Sticks out like a handle ## Footnote This facilitates binding to macrophages or neutrophils.

Answer 624

They have 'Fc-receptors' that bind to the antibody ## Footnote This interaction makes phagocytosis significantly faster and more efficient.

Answer 625

* Episomal (Low Risk) * Integrated (High Risk) ## Footnote The state of the viral DNA determines the risk of developing cervical cancer.

Answer 626

The viral DNA remains a separate, circular loop ## Footnote This is typical of low-risk strains (HPV 6 and 11) which cause Condylomas but rarely cancer.

Answer 627

The viral DNA breaks and inserts itself into the human host's DNA ## Footnote This is characteristic of high-risk strains (HPV 16 and 18) and leads to malignancy.

Answer 628

* HPV 16 * HPV 18 ## Footnote These strains are known for integrating their DNA into the host's genome.

Answer 629

* E6 * E7 ## Footnote These proteins disable the regulatory mechanisms of the human cell cycle.

Answer 630

Inhibits p53 ## Footnote p53 is known as the 'Guardian of the Genome' and its degradation prevents apoptosis in damaged cells.

Answer 631

Stops the cell from dividing ## Footnote E7 'kidnaps' pRb, forcing the cell to replicate its DNA indefinitely.

Answer 632

FALSE ## Footnote E6 degrades p53, preventing apoptosis even when DNA is damaged.

Answer 633

S-phase ## Footnote This leads to indefinite replication of both the cell's and the virus's DNA.

Answer 634

Cervical Intraepithelial Neoplasia ## Footnote Pathologists use the CIN scale to grade dysplasia in cervical cells.

Answer 635

Squamous cells with a 'raisin-like' shrunken nucleus and a clear halo ## Footnote They indicate active HPV infection but not necessarily cancer.

Answer 636

Dysplasia in the lower 1/3 of the epithelium ## Footnote CIN I is considered low grade and usually regresses spontaneously.

Answer 637

Dysplasia in the lower 2/3 of the epithelium ## Footnote CIN II is classified as high grade.

Answer 638

Dysplasia involving the full thickness of the epithelium ## Footnote The basement membrane remains intact; if it breaks, it becomes Invasive Carcinoma.

Answer 639

GISCi (Gruppo Italiano Screening del Cervicocarcinoma) ## Footnote These guidelines are aligned with international standards, emphasizing the HPV-DNA Test.

Answer 640

Ages 25–29 ## Footnote HPV infections are common in this age group but usually transient.

Answer 641

Ages 30–64 ## Footnote If the HPV test is negative, the woman returns in 5 years; if positive, a Reflex Pap Test is performed.

Answer 642

A 'Reflex' Pap Test is performed ## Footnote This test checks if the virus has caused cell changes.

Answer 643

Exactly like a Pap test ## Footnote A clinician uses a speculum and a small brush to collect cells from the transformation zone.

Answer 644

Sample is analyzed for **DNA** of high-risk HPV strains instead of looking at cells under a microscope ## Footnote The sample is put into a liquid vial (Liquid-Based Cytology) for analysis.

Answer 645

A Cytology (Pap test) is performed on the same sample if the HPV-DNA test is positive ## Footnote This occurs because many people have HPV but no cellular damage yet.

Answer 646

Because it happens automatically as a reaction to the positive HPV result ## Footnote The lab does not call the patient back in yet.

Answer 647

Bethesda System ## Footnote The Bethesda System is preferred over the CIN (Cervical Intraepithelial Neoplasia) classification.

Answer 648

L-SIL (Low-grade Squamous Intraepithelial Lesion) ## Footnote Management often involves follow-up or repeat testing in 6–12 months.

Answer 649

Colposcopy + Biopsy ## Footnote CIN II is classified as H-SIL (High-grade Squamous Intraepithelial Lesion) in the Bethesda system.

Answer 650

H-SIL (High-grade Squamous Intraepithelial Lesion) ## Footnote Management typically involves surgical intervention (Conizzazione).

Answer 651

Colposcopy and a Biopsy ## Footnote The biopsy determines the type of CIN and further management required.

Answer 652

Watch and wait ## Footnote CIN 2 may regress, so active intervention is often deferred.

Answer 653

Surgical (Conizzazione) ## Footnote The risk of cancer is too high to consider non-surgical management.

Answer 654

Conizzazione (Conization) ## Footnote This procedure involves removing a cone-shaped piece of the cervix.

Answer 655

* Diagnostic (checking for micro-invasion) * Therapeutic (removing the entire pre-cancerous lesion) ## Footnote Conizzazione serves both to diagnose and treat cervical lesions.

Answer 656

Loop Electrosurgical Excision Procedure ## Footnote This is one of the methods used in Conizzazione.

Answer 657

Large Loop Excision of the Transformation Zone ## Footnote This term is used interchangeably with LEEP in different countries.

Answer 658

They are essentially the same procedure, just with different names used in different countries ## Footnote Italy uses both terms.

Answer 659

Conizzazione a lama (Cold Knife) ## Footnote This method uses a scalpel instead of electricity and is reserved for suspected invasive cancer.

Answer 660

To avoid 'heat damage' that could blur the margins for the pathologist ## Footnote This is particularly important when invasive cancer is suspected.

Answer 661

The size of the lesion and how deep into the cervical canal it goes ## Footnote The surgeon makes this choice based on the specific case.

Answer 662

The Italian Ministry of Health ## Footnote The vaccine is provided to all 11-year-olds (both boys and girls) and women treated for CIN II+ lesions.

Answer 663

HPV-DNA Test (not Pap) ## Footnote This test looks for the virus and has high sensitivity.

Answer 664

The virus ## Footnote It is known for its high sensitivity.

Answer 665

The damage ## Footnote It is known for its high specificity.

Answer 666

11 years old ## Footnote The vaccination is for both genders.

Answer 667

Go to Colposcopy ## Footnote H-SIL stands for High-Grade Squamous Intraepithelial Lesion.

Answer 668

Do a Conizzazione (LEEP/LLETZ) ## Footnote CIN 3 indicates a high-grade lesion that requires treatment.

Answer 669

The virus is active and causing high-grade dysplasia ## Footnote p16 is a biological marker for HPV activity.

Answer 670

p16 positive on immunohistochemistry ## Footnote If p16 is positive, it confirms the presence of a high-grade lesion.

Answer 671

A protein inside the human cell ## Footnote Normally, p16 levels are low but increase in response to high-risk HPV.

Answer 672

It forces the cell to try to 'brake' the cell cycle ## Footnote The cell produces massive amounts of p16 as a defense mechanism.

Answer 673

Strong and diffuse positivity ## Footnote This indicates that a high-risk HPV has successfully hijacked the cell cycle.

Answer 674

* Clinical Healing: Occurs within 3–7 days of starting correct antibiotic therapy * Radiological Healing: Takes time for X-ray findings to be reabsorbed ## Footnote Symptoms disappear faster than X-ray findings, leading to potential misinterpretation if X-rays are performed too early.

Answer 675

4–6 weeks (roughly 30 days) ## Footnote This timing allows for confirmation of resolution and exclusion of underlying malignancy.

Answer 676

* Confirmation of Resolution * Exclusion of Underlying Malignancy ## Footnote A persistent opacity may indicate a hidden lung tumor, necessitating further investigation.

Answer 677

FALSE ## Footnote Not everyone needs a follow-up; it is mandatory for specific groups such as older patients and those with persistent symptoms.

Answer 678

* Patients over age 50-60 * Smokers or former smokers * Patients with persistent symptoms (cough, weight loss) * Patients with a history of recurrent pneumonia in the same lobe ## Footnote These groups are at higher risk for complications or underlying issues.

Answer 679

Treponema pallidum ## Footnote Syphilis is a gram-negative, spirochaete bacterium.

Answer 680

* Direct, unprotected skin-to-skin contact with an active syphilis sore * From a pregnant person to their foetus (congenital syphilis) * Rarely through blood transfusions ## Footnote Syphilis is a sexually transmitted infection.

Answer 681

A single, painless ulcer with a clean, red base and a 'cartilaginous' consistency ## Footnote This is a descriptor used to identify syphilis.

Answer 682

Enlarged, 'rubbery,' and painless lymph nodes in the groin ## Footnote This is another clinical presentation of syphilis.

Answer 683

The classic 'great imitator' rash of the secondary stage ## Footnote This rash is characteristic of secondary syphilis.

Answer 684

A maculopapular rash that involves the palms of the hands and soles of the feet ## Footnote This occurs in the secondary stage of syphilis.

Answer 685

Flat, velvet-like, greyish-white lesions in moist areas (axilla, groin) ## Footnote These lesions are highly infectious.

Answer 686

The 'Gummy' lesions of the tertiary stage ## Footnote These lesions are associated with late-stage syphilis.

Answer 687

A late-stage sign where the pupil constricts during accommodation but does not react to light ## Footnote This is a specific clinical finding in advanced syphilis.

Answer 688

No, it appears where Treponema entered the body ## Footnote It can be genital or extragenital depending on the type of sexual contact.

Answer 689

* Glande (glans) * Prepuzio (prepuce) * Solco balano-preputiale ## Footnote These are common sites for the primary chancre in males.

Answer 690

* Grandi labbra * Piccole labbra * Inside the vagina or on the cervice uterina (cervix) ## Footnote It is often missed in females due to its painless nature.

Answer 691

* Lips * Tongue * Oropharynx * Anal/rectal area ## Footnote This depends on the type of sexual contact.

Answer 692

3–6 weeks after infection ## Footnote Characterized by a painless ulcer at the site of entry, known as a chancre (Sifiloma).

Answer 693

* Systemic spread * Skin rash (palms/soles) * Fever * Lymphadenopathy * Condiloma lata ## Footnote This stage represents the bacteremic phase with the highest transmission risk.

Answer 694

Months to Years ## Footnote Asymptomatic with no clinical signs, but positive serology. Divided into early latent (<1yr) and late (>1yr).

Answer 695

* Gummy Syphilis: Destructive granulomas (Gomme) * Aortitis: Dilation of ascending aorta * Neurosyphilis: Tabes dorsalis ## Footnote This stage can lead to severe tissue destruction over years to decades.

Answer 696

* Chronic, destructive granulomas * Start as firm nodules * Necrose in the center, becoming soft and rubbery ## Footnote Can occur in skin, bones, or liver, causing deep ulcers and destruction.

Answer 697

Can occur at any stage, classic forms are tertiary ## Footnote Includes conditions like Tabes Dorsalis and Paralisi Progressiva.

Answer 698

* Degeneration of the posterior columns of the spinal cord * Signs: 'Lightning pains', loss of proprioception (ataxia), Argyll Robertson pupil ## Footnote This condition is a classic form of neurosyphilis.

Answer 699

* General paresis of the insane * Causes psychiatric symptoms (dementia, delusions of grandeur) * Motor deficits ## Footnote This condition is associated with tertiary neurosyphilis.

Answer 700

1-3 months ## Footnote This phase is characterized by various systemic manifestations.

Answer 701

Years to decades ## Footnote This phase can lead to severe complications affecting multiple organ systems.

Answer 702

Antibodies against cardiolipin ## Footnote These tests do not detect the bacteria itself but rather antibodies released by damaged host cells.

Answer 703

* Screening * Monitoring treatment ## Footnote The titre drops (e.g., 1:32) when treatment works; if it doesn't drop, treatment failed or the patient was re-infected.

Answer 704

* Pregnancy * Viral infections (EBV, Hepatitis) * Autoimmune diseases (Lupus) ## Footnote These factors can lead to incorrect positive results in Non-Treponemal Tests.

Answer 705

Antibodies specific to Treponema pallidum ## Footnote These tests confirm a positive screening test.

Answer 706

Usually remain positive for life ## Footnote This is referred to as the 'cicatrice sierologica' and cannot be used to determine if a patient is newly re-infected.

Answer 707

To see spirochetes moving like 'corkscrews' ## Footnote This is done using Dark-field microscopy specifically for primary sifiloma fluid.

Answer 708

Lumbar Puncture (Liquor analysis) ## Footnote This is done to check for VDRL in the CSF.

Answer 709

* Drug: Benzathine Penicillin G * Dose: 2.4 million units * Route: Intramuscular injection * Frequency: Single Dose ## Footnote This treatment is standardized for early stages of syphilis.

Answer 710

Doxycycline (100 mg twice daily for 14 days) ## Footnote This alternative is used when the patient cannot receive Penicillin.

Answer 711

* A systemic reaction * Symptoms: fever, chills, headache, myalgia * Caused by rapid release of toxins from dying spirochetes ## Footnote Patients should be warned about this reaction after receiving Penicillin.

Answer 712

Usually within 24 hours ## Footnote This timing is important for patient monitoring.

Answer 713

Supportive care (Antipyretics/NSAIDs) ## Footnote It is important to note that this reaction is not an allergic reaction to Penicillin.

Answer 714

* Clean base * Indurated (hard) * No pain (Painless) ## Footnote Syphilis is caused by the pathogen *T. pallidum*.

Answer 715

* Exudative base * Ragged edges * Yes (Painful) ## Footnote Chancroid is caused by *H. ducreyi*.

Answer 716

* Multiple vesicles on erythematous base * Yes (Burning/Pain) ## Footnote Genital Herpes is caused by *HSV-2*.

Answer 717

* Pathogen: Haemophilus ducreyi * Painful ulcer with ragged edges * Causes large, painful unilateral bubo ## Footnote Mnemonic: *You do cry with H. ducreyi* because it is painful.

Answer 718

* Single dose of Azithromycin * Ceftriaxone ## Footnote Treatment options may vary by location.

Answer 719

* Screening * Monitoring treatment * Can give False Positives ## Footnote False positives can occur due to lupus, pregnancy, or viral infections.

Answer 720

* Confirmation of syphilis * Usually stays positive for life ## Footnote These tests confirm syphilis and remain positive even after treatment.

Answer 721

Salmonella Typhi (or Paratyphi) ## Footnote Typhoid Fever is an enteric fever spread via the fecal-oral route (contaminated food/water).

Answer 722

Febbre continua-remittente (high and stable, 39-40°C) ## Footnote This refers to a sustained high fever.

Answer 723

Relative Bradycardia ## Footnote The heart rate stays slow despite the high fever.

Answer 724

Macule roseoliformi (Rose spots) ## Footnote Small, faint pink spots on the chest/abdomen.

Answer 725

Diarrea a purè di piselli (pea-soup diarrhea—yellow/green) ## Footnote This is often accompanied by splenomegaly.

Answer 726

Rantoli bronchiali (bronchial rales) ## Footnote These are common early on in the disease.

Answer 727

Rickettsia prowazekii ## Footnote This is the key distinction from Typhoid Fever.

Answer 728

Human body louse (Pediculus humanus corporis) ## Footnote Transmission occurs via louse feces rubbed into skin abrasions.

Answer 729

Overcrowded, unsanitary conditions (refugee camps, trenches) ## Footnote It is often referred to as a 'War and Famine disease.'

Answer 730

Petechiae (small purple/red spots) ## Footnote This differs from the pink 'rose spots' seen in Typhoid Fever.

Answer 731

Tifo esantematico (Epidemic Typhus) ## Footnote Vector: Lice (Pidocchi)

Answer 732

Febbre bottonosa del Mediterraneo ## Footnote Vector: Ticks (Zecche del cane)

Answer 733

Febbre maculosa delle Montagne Rocciose ## Footnote Vector: Ticks

Answer 734

Febbre Q ## Footnote Vector: Aerosol (Cattle/Sheep)

Answer 735

Rickettsia conorii ## Footnote Look for the 'tache noire' and a high fever.

Answer 736

TRUE ## Footnote This symptom is significant in diagnosing these infections.

Answer 737

* Fecal-oral * Pea-soup diarrhea * Relative bradycardia * Rose spots ## Footnote These symptoms are critical for diagnosis.

Answer 738

Lice (Pidocchi) ## Footnote This pathogen is commonly found in epidemic settings.

Answer 739

Salmonella Typhi ## Footnote High-yield clue: Rose spots, 'Pea-soup' diarrhea, abdominal pain.

Answer 740

* Atypical pneumonia * Hyponatremia * Diarrhea ## Footnote Pathogen: Legionella pneumophila.

Answer 741

Coxiella burnetii ## Footnote High-yield clue: Farmers/Veterinarians, Hepatitis, Endocarditis.

Answer 742

* 'Break-bone' fever (severe myalgia) * Retro-orbital pain * Rash ## Footnote Pathogen: Dengue Virus.

Answer 743

* Jaundice * Black vomit * Traveler history ## Footnote Pathogen: Flavivirus.

Answer 744

Brucella spp. ## Footnote High-yield clue: Undulant fever, unpasteurized cheese, bone pain.

Answer 745

Legionella pneumophila ## Footnote It is a Gram-negative bacterium that stains poorly and requires Buffered Charcoal Yeast Extract (BCYE) agar for culture.

Answer 746

Inhalation of aerosolized water ## Footnote It is not transmitted from person to person.

Answer 747

* Atypical Pneumonia: High fever and non-productive cough * GI Symptoms: Watery diarrhoea * Neurological/Renal: Confusion/Headache and Hyponatremia ## Footnote This triad is important for exams and diagnosis.

Answer 748

Urinary Antigen Test ## Footnote This test is crucial for rapid diagnosis.

Answer 749

* Macrolides (Azithromycin) * Fluoroquinolones (Levofloxacin) ## Footnote Penicillins are ineffective because the bacteria live inside human macrophages.

Answer 750

Free water retention (dilutional hyponatremia) ## Footnote This condition leads to low sodium levels in the blood.

Answer 751

Direct toxic effect on tubules leading to salt wasting ## Footnote This renal damage contributes to sodium loss.

Answer 752

Sodium lost via diarrhea ## Footnote Watery diarrhoea is a common symptom of the disease.

Answer 753

* IL-6 * TNF-alpha ## Footnote These cytokines play a role in the pathophysiology of hyponatremia.

Answer 754

A viral haemorrhagic fever transmitted by the Aedes aegypti mosquito ## Footnote The disease has distinct clinical phases and can lead to severe liver failure.

Answer 755

* Infection Phase: Fever, headache, back pain * Remission: Symptoms disappear for 24 hours * Toxic Phase: Severe jaundice, coagulopathy ## Footnote The Toxic Phase is characterized by Faget's Sign and severe complications.

Answer 756

Councilman Bodies ## Footnote These are apoptotic hepatocytes seen on liver biopsy.

Answer 757

A highly effective live-attenuated vaccine (Stamaril) ## Footnote This vaccine is mandatory for travel to certain African and South American countries.

Answer 758

The 'Break-bone' Fever ## Footnote It is caused by the Aedes albopictus (Tiger mosquito).

Answer 759

* High fever * Retro-orbital pain * Extreme muscle/joint pain ## Footnote The term 'febbre rompi-ossa' refers to the severe muscle pain experienced.

Answer 760

Occurs when a person is infected a second time with a different serotype ## Footnote The immune response causes a 'cytokine storm,' leading to capillary leak and shock.

Answer 761

* Leukopenia * Thrombocytopenia ## Footnote These findings indicate low white blood cells and platelets.

Answer 762

* Air conditioning * Diarrhoea * Low Sodium ## Footnote These are key indicators associated with Legionella infections.

Answer 763

* Mosquitoes * Jaundice * Councilman Bodies ## Footnote These elements are critical for identifying Yellow Fever.

Answer 764

* Muscle pain * Retro-orbital pain * Rash ## Footnote These symptoms are characteristic of Dengue Fever.

Answer 765

Peptidoglycan ## Footnote Peptidoglycan is a crucial component of bacterial cell walls.

Answer 766

They bind to **Penicillin-Binding Proteins (PBP)** to stop cross-linking ## Footnote This action disrupts the structural integrity of the bacterial cell wall.

Answer 767

* Penicillina G * Penicillina V * Amoxicillina * Ampicillina * Tazocin * Cefazolina * Ceftriaxone * Meropenem ## Footnote These antibiotics are used for various bacterial infections.

Answer 768

They bind directly to the substrate (the bricks of the wall) ## Footnote Examples include Vancomycin and Teicoplanin.

Answer 769

It binds to **D-Ala-D-Ala**, blocking the building blocks of the cell wall ## Footnote Vancomycin is effective primarily against Gram-positive bacteria.

Answer 770

FALSE ## Footnote Vancomycin is a Gram-positive specialist due to its size.

Answer 771

Infusing **Vancomycin** too quickly ## Footnote It is a histamine release, not an allergy.

Answer 772

It is a **Beta-lactamase inhibitor** ## Footnote It protects the antibiotic from being rendered ineffective by bacterial enzymes.

Answer 773

For **Gram-positive bone infections** ## Footnote Teicoplanina is frequently used in clinical settings for specific infections.

Answer 774

1st Generation **Cephalosporin** ## Footnote It is often used for surgical prophylaxis.

Answer 775

3rd Generation **Cephalosporin** ## Footnote It is used for a wide range of infections, including pneumonia and meningitis.

Answer 776

30S and 50S ribosomal subunits ## Footnote It helps remember the antibiotics that target these ribosomal subunits.

Answer 777

* Aminoglycosides (e.g. Gentamicin) * Tetracyclines (e.g. Doxycycline) ## Footnote Aminoglycosides are used for severe Gram-negative aerobes like Pseudomonas.

Answer 778

A mean Gent has Negative guns ## Footnote This helps recall the characteristics of Aminoglycosides.

Answer 779

* Lyme Disease * Rickettsia infections * Severe Acne ## Footnote Doxycycline is a type of Tetracycline antibiotic.

Answer 780

* Chloramphenicol * Erythromycin (Macrolides) * Linezolid * Lincosamides (Clindamycin) ## Footnote These antibiotics target the 50S ribosomal subunit.

Answer 781

They are 'Atypical' specialists used when there is no cell wall to attack ## Footnote Effective against pathogens like Legionella and Mycoplasma.

Answer 782

LINcosamide and cLINdamycin both have LIN within the words ## Footnote This helps remember the name and class of the antibiotic.

Answer 783

Macrolides (Azithromycin, Clarythromycin) ## Footnote It helps remember the antibiotics that target the 50S subunit.

Answer 784

H Pylori eradication ## Footnote It is a type of Macrolide antibiotic.

Answer 785

GI motility ## Footnote Erythromycin is a Macrolide antibiotic.

Answer 786

* Skin infections * Dental abscesses ## Footnote Clindamycin is a Lincosamide antibiotic.

Answer 787

DNA Gyrase ## Footnote They are effective for respiratory issues but can cause Achilles tendon rupture.

Answer 788

FLuoro = Floxacin and fLOXacins LOCK the DNA ## Footnote This helps recall their mechanism of action.

Answer 789

Anaerobes and protozoa ## Footnote It causes a Disulfiram-like reaction when mixed with alcohol.

Answer 790

* Macrolides * Quinolones ## Footnote Caution is advised for patients with a history of arrhythmias.

Answer 791

* Fluoroquinolones: Risk of cartilage damage * Aminoglycosides: Risk of ototoxicity * Sulfonamides: Risk of kernicterus * Tetracyclines: Risk of teeth discoloration and bone growth inhibition ## Footnote These classes should be avoided in pregnancy.

Answer 792

It uses PABA to synthesize folic acid ## Footnote Bacteria must synthesize folic acid to produce DNA.

Answer 793

By competitively inhibiting Dihydropteroate Synthase ## Footnote It mimics PABA and prevents its entry into the enzyme.

Answer 794

Dihydrofolate Reductase ## Footnote It is a Dihydrofolate Reductase inhibitor.

Answer 795

Methotrexate ## Footnote Both Methotrexate and Co-Trimoxazole act on the folic acid synthesis pathway, leading to bone marrow failure.

Answer 796

Haemolysis ## Footnote Bactrim (Co-Trimoxazole) should never be given to patients with G6PD deficiency.

Answer 797

First trimester ## Footnote It is also contraindicated in the third trimester due to the risk of kernicterus.

Answer 798

Steven-Johnson Syndrome (SJS) ## Footnote SJS is a life-threatening skin reaction.

Answer 799

Bactrim (Co-Trimoxazole) ## Footnote It is used for both treatment and prophylaxis.

Answer 800

Bactrim (Co-Trimoxazole) ## Footnote It is used as an alternative in such cases.

Answer 801

Bactrim (SMX-TMP) ## Footnote Nocardia is often referred to as the 'great mimicker' of tuberculosis or malignancy.

Answer 802

* Pulmonary: Pneumonia with cavitation * Cutaneous: Skin abscesses or 'mycetomas' * CNS: Multi-loculated brain abscesses ## Footnote Nocardia typically affects immunocompromised patients.

Answer 803

Gram-positive aerobe ## Footnote It usually affects immunocompromised patients and is found in soil.

Answer 804

* Nocardia: Aerobe (Needs air) * Actinomyces: Anaerobe (Hates air) ## Footnote This distinction is important for diagnosis.

Answer 805

* Nocardia: Weakly Positive * Actinomyces: Negative ## Footnote This helps in distinguishing between the two bacteria.

Answer 806

* Nocardia: Lungs / Brain / Skin * Actinomyces: Jaw ('Lumpy Jaw') / Pelvis (IUDs) ## Footnote This difference is crucial for clinical identification.

Answer 807

Penicillin G ## Footnote This distinguishes it from Nocardia, which is treated with Bactrim.

Answer 808

Single IM dose of Penicillin G (2.4 MU) ## Footnote This is a standard treatment for syphilis.

Answer 809

Macrolides ## Footnote Macrolides are effective against Legionella infections.

Answer 810

Symptoms: Pea-soup Diarrhoea + Slow Pulse (Faget's Sign); Treatment: Ceftriaxone ## Footnote Ceftriaxone is the antibiotic of choice for typhoid fever.

Answer 811

Clindamycin ## Footnote Clindamycin is effective against anaerobic bacteria in mouth abscesses.

Answer 812

Metronidazole ## Footnote Metronidazole targets anaerobic bacteria in abdominal abscesses.

Answer 813

Cefazolina ## Footnote Cefazolina is commonly used to prevent infections during surgery.

Answer 814

Ceftriaxone ## Footnote Ceftriaxone is a first-line treatment for bacterial meningitis.

Answer 815

Azithromycin ## Footnote Azithromycin is effective against atypical pneumonia pathogens.

Answer 816

Vancomycin ## Footnote Vancomycin is the drug of choice for Methicillin-resistant Staphylococcus aureus.

Answer 817

Tazocin ## Footnote Tazocin is a combination antibiotic effective against Pseudomonas aeruginosa.

Answer 818

Doxycycline ## Footnote Doxycycline is commonly prescribed for Lyme disease.

Answer 819

Levofloxacin ## Footnote Levofloxacin is another option for treating Legionella.

Answer 820

Fosfomycin ## Footnote Fosfomycin is effective for urinary tract infections.

Answer 821

Amoxicillin/Clavulanic Acid ## Footnote These antibiotics are effective against bacteria from animal bites.

Answer 822

Pasteurella Multocida ## Footnote This bacterium is often found in cat and dog bites.

Answer 823

* Amoxicillina OR * Macrolide (Azitromicina) ## Footnote This treatment is recommended for community-acquired pneumonia in outpatient settings.

Answer 824

* Amoxicillina/Clavulanato (Augmentin) AND * Azitromicina ## Footnote The combination covers S. pneumoniae and atypical pathogens.

Answer 825

To cover the **Atypicals** (Legionella, Mycoplasma) ## Footnote Amoxicillin primarily targets S. pneumoniae.

Answer 826

* Macrolides (Claritromicina/Azitromicina) * Levofloxacina ## Footnote These antibiotics are effective against atypical pathogens.

Answer 827

* Amoxicillina/Clavulanato * Levofloxacina ## Footnote These options are chosen based on their effectiveness in exacerbations.

Answer 828

* Fosfomicina (Monuril - single 3g dose) * Nitrofurantoina (alternative) ## Footnote Italian guidelines emphasize resistance patterns for E. coli.

Answer 829

* Ciprofloxacina * Levofloxacina ## Footnote These fluoroquinolones are effective for kidney infections.

Answer 830

* Fluoroquinolones ## Footnote Treatment duration is long (4–6 weeks) due to tissue penetration.

Answer 831

* Ceftriaxone (Rocefin) * Vancomicina ## Footnote This treatment is critical and should not wait for cultures.

Answer 832

* Ampicillina ## Footnote It covers **Listeria monocytogenes**, which Ceftriaxone does not.

Answer 833

To cover **Listeria monocytogenes** ## Footnote Listeria is an intracellular pathogen affecting immunocompromised individuals.

Answer 834

Penicillina G Benzatina (2.4 MU IM, single dose) ## Footnote This antibiotic is effective for treating primary and secondary syphilis.

Answer 835

* Ceftriaxone (1g IM single dose) * Azitromicina (1g oral) ## Footnote This combination is recommended for treating gonorrhea.

Answer 836

* Doxiciclina (100mg x2/day for 7 days) * Azitromicina (1g single dose) ## Footnote Both options are effective for treating chlamydia infections.

Answer 837

* PPI * Claritromicina * Amoxicillina (or Metronidazolo) ## Footnote This combination is used to eradicate H. pylori infections.

Answer 838

* Vancomicina (oral) * Fidaxomicina ## Footnote These antibiotics are effective against Clostridium difficile infections.

Answer 839

Cefazolina (1st gen Cephalosporin) administered 30–60 mins before the incision ## Footnote This antibiotic helps prevent infections during surgery.

Answer 840

* Amoxicillina/Clavulanato * Ciprofloxacina + Metronidazolo ## Footnote These combinations are used for treating diverticulitis.

Answer 841

* Piperacillina/Tazobactam (Tazocin) * Ceftazidime * Amikacina ## Footnote These antibiotics are effective against Pseudomonas aeruginosa.

Answer 842

* Vancomicina * Linezolid ## Footnote These antibiotics are used to treat Methicillin-resistant Staphylococcus aureus infections.

Answer 843

Ceftazidime/Avibactam (Zavicefta) ## Footnote This combination is effective against KPC-producing Klebsiella infections.

Answer 844

Alcohol Dehydrogenase ## Footnote Acetaldehyde is the substance that causes hangover symptoms.

Answer 845

Converts toxic acetaldehyde into harmless Acetic Acid ## Footnote This process normally prevents the accumulation of acetaldehyde.

Answer 846

Acetaldehyde levels skyrocket to 5–10 times higher than normal ## Footnote This leads to severe reactions when alcohol is consumed.

Answer 847

* Severe Flushing * Tachycardia * Nausea and Violent Vomiting * Headache and Hypotension ## Footnote In severe cases, it can lead to respiratory depression or cardiovascular collapse.

Answer 848

Metronidazole ## Footnote It is used for treating 'below the belt' anaerobes or Trichomonas.

Answer 849

* Cefotetan * Cefoperazone ## Footnote These contain a side chain that mimics Disulfiram.

Answer 850

Chemotherapy drug for Hodgkin Lymphoma ## Footnote It can also cause a Disulfiram-like reaction.

Answer 851

Sulfonylurea (1st generation) ## Footnote It is used for Diabetes and can cause a Disulfiram-like reaction.

Answer 852

Avoid alcohol during treatment and for at least 48–72 hours after the last dose ## Footnote This is crucial to prevent severe reactions.

Answer 853

Because it mimics the effects of Disulfiram (Antabuse) ## Footnote Disulfiram is prescribed to deter drinking by making it physically miserable.

Answer 854

A form of permanent brain damage caused by excessively high levels of unconjugated bilirubin ## Footnote It is the most feared complication of severe neonatal jaundice.

Answer 855

* Bilirubin is normally bound to albumin * High bilirubin levels displace it from albumin * Free unconjugated bilirubin builds up ## Footnote Unconjugated bilirubin is lipophilic and can cross the Blood-Brain Barrier in newborns.

Answer 856

* Basal Ganglia * Globus pallidus * Brainstem nuclei ## Footnote This causes yellow staining and neuronal death.

Answer 857

* Acute Bilirubin Encephalopathy * Chronic Kernicterus ## Footnote Acute stage includes lethargy, poor feeding, and a high-pitched cry.

Answer 858

* Choreoathetoid Cerebral Palsy * Gaze abnormalities * Sensorineural hearing loss * Dental enamel hypoplasia ## Footnote These symptoms develop if the child survives the acute phase.

Answer 859

* Sulphonamides (Bactrim) * Ceftriaxone ## Footnote These antibiotics compete with bilirubin for binding sites on albumin.

Answer 860

* Phototherapy * Exchange Transfusion ## Footnote Phototherapy uses blue-green light to convert unconjugated bilirubin into lumirubin.

Answer 861

Converts unconjugated bilirubin into lumirubin, which is water-soluble ## Footnote Lumirubin can be excreted without being processed by the liver.

Answer 862

TRUE ## Footnote These drugs increase the amount of free bilirubin in the blood.

Answer 863

* 2 NRTIs * 1 INSTI ## Footnote This combination is preferred for its potency and high barrier to resistance, often available as a Single Tablet Regimen (STR).

Answer 864

Nucleoside Reverse Transcriptase Inhibitors ## Footnote NRTIs are fake DNA building blocks that cause DNA chain termination.

Answer 865

* Tenofovir * Emtricitabine * Abacavir ## Footnote NRTIs mimic DNA bases but lack the necessary group to add the next base.

Answer 866

Hypersensitivity reaction (fever/rash) ## Footnote Patients must be tested for the HLA-B*5701 allele before prescribing Abacavir.

Answer 867

* Nephrotoxicity * Bone density loss ## Footnote The newer version, TAF, is safer for kidneys and bones.

Answer 868

Non-Nucleoside Reverse Transcriptase Inhibitors ## Footnote NNRTIs bind to the Reverse Transcriptase enzyme and block its function.

Answer 869

* Efavirenz * Rilpivirine ## Footnote NNRTIs have ‘vir’ in the center of the word.

Answer 870

* Vivid dreams * Insomnia * Neuropsychiatric symptoms ## Footnote Efavirenz crosses the blood-brain barrier easily.

Answer 871

Integrase Strand Transfer Inhibitors ## Footnote INSTIs prevent viral DNA from integrating into the human genome.

Answer 872

* Dolutegravir * Bictegravir * Raltegravir ## ## Footnote INSTIs are generally well tolerated and are first-line treatments in Italy. The INSTIs have the suffixs ‘tegravir’.

Answer 873

* Weight gain * Muscle pains (elevated CK) ## Footnote These side effects are important to monitor in patients.

Answer 874

Protease Inhibitors ## Footnote PIs prevent the virus from maturing by inhibiting the cutting of protein chains.

Answer 875

* Darunavir * Atazanavir ## Footnote PIs have the suffix ‘-navir’.

Answer 876

To inhibit CYP3A4 in the liver ## Footnote This keeps the PI levels high in the blood.

Answer 877

* Hyperlipidemia * Hyperglycemia/diabetes * Lipodystrophy (buffalo hump) ## Footnote These side effects are significant considerations in treatment.

Answer 878

Pneumocystis jirovecii ## Footnote PCP is an opportunistic infection caused by a fungus that becomes pathogenic when the immune system is severely compromised.

Answer 879

< 200/mm³ ## Footnote This threshold indicates severe immunocompromise, making individuals susceptible to PCP.

Answer 880

* Dry cough (non-productive) * Exertional dyspnoea * Significant hypoxemia ## Footnote Unlike bacterial pneumonia, PCP presents with a gradual onset of symptoms. With the hypoxaemia, the patient looks okay, but their oxygen saturation is surprisingly low.

Answer 881

* Diffuse, bilateral interstitial infiltrates * 'Ground Glass' or 'Butterfly' pattern ## Footnote PCP rarely causes pleural effusion, lobar consolidation, or cavitation.

Answer 882

FALSE ## Footnote PCP rarely causes pleural effusion

Answer 883

High-dose Bactrim (Co-Trimoxazole) for 21 days ## Footnote This is the standard treatment protocol for managing PCP.

Answer 884

Prednisone ## Footnote Prednisone is added to prevent the inflammatory burst that can worsen respiratory failure.

Answer 885

Bactrim (Co-Trimoxazole) 1 tablet/day ## Footnote This prophylaxis helps prevent the occurrence of PCP.

Answer 886

Continue Bactrim until CD4 recovers above 200 for at least 3–6 months ## Footnote This ensures ongoing protection against PCP after recovery.

Answer 887

Within 2 weeks of starting antibiotic treatment ## Footnote ART should not be started within the first few days to avoid IRIS.

Answer 888

* P - Plasma CD4 < 200 * C - Chest RX: Interstitial (Ground Glass) * P - Primary Treatment: Potent Bactrim + Prednisone (if PaO2 < 70mmHg) ## Footnote This mnemonic helps recall key aspects of PCP diagnosis and treatment.

Answer 889

interstitial ## Footnote The presence of TB in HIV patients can complicate their clinical picture.

Answer 890

Nocardia ## Footnote Nocardia is acid-fast like TB but is weaker and characterized by branching filaments.

Answer 891

FALSE ## Footnote Nocardia is acid-fast like TB but is considered weaker.

Answer 892

HIV-RNA (PCR) ## Footnote This marker appears approximately 10 days post-exposure and measures the actual virus.

Answer 893

A protein from the virus's shell, appears around 15–20 days ## Footnote It is one of the key markers for diagnosing HIV.

Answer 894

Approx. 25–30 days ## Footnote These antibodies take the longest to develop as the immune system builds them.

Answer 895

4th Generation ELISA Combi Test ## Footnote This test detects both p24 Antigen and HIV Antibodies simultaneously.

Answer 896

TRUE ## Footnote If clinical suspicion is high, an HIV-RNA (PCR) Test should be ordered.

Answer 897

* Fever * Sore throat * Lymphadenopathy * Maculopapular rash ## Footnote Standard antibody tests might be negative during this stage.

Answer 898

Virus replicates in lymph nodes, patient often asymptomatic ## Footnote CD4 count slowly declines during this stage. This phase can last years.

Answer 899

CD4 count < 200 cells/mm³ OR presence of an AIDS-defining illness ## Footnote This is considered the final stage of HIV infection.

Answer 900

CD4 < 500 ## Footnote This stage includes infections such as Oral Candidiasis, Oral Hairy Leukoplakia, and Kaposi Sarcoma.

Answer 901

* Oral Candidiasis (Thrush) * Oral Hairy Leukoplakia (EBV) * Kaposi Sarcoma (HHV-8) ## Footnote Oral Candidiasis presents as white plaques that can be scraped off.

Answer 902

Lateral white borders on the tongue that cannot be scraped off ## Footnote It is associated with Epstein-Barr Virus (EBV).

Answer 903

Purple/red skin nodules (highly vascular) ## Footnote It is associated with HHV-8.

Answer 904

CD4 < 200 ## Footnote This zone is characterized by infections like Pneumocystis jirovecii (PCP).

Answer 905

Co-Trimoxazole ## Footnote PCP presents as 'Ground Glass' interstitial pneumonia.

Answer 906

Progressive Multifocal Leukoencephalopathy (PML) ## Footnote PML causes demyelination of the brain with white matter lesions on MRI.

Answer 907

CD4 < 100 ## Footnote This zone includes infections like Cerebral Toxoplasmosis and Cryptococcus neoformans.

Answer 908

Multiple ring-enhancing lesions on brain CT/MRI ## Footnote Prophylaxis is with Co-Trimoxazole.

Answer 909

India Ink or CrAg (Antigen) test ## Footnote It causes fungal meningitis.

Answer 910

Retinitis ('Pizza-pie' fundus) or Esophagitis (linear ulcers) ## Footnote CMV is significant in immunocompromised patients.

Answer 911

CD4 < 50 ## Footnote This stage includes infections like Mycobacterium Avium Complex and Primary CNS Lymphoma.

Answer 912

* Fever * Weight loss * Night sweats * Diarrhoea ## Footnote Prophylaxis was historically Azithromycin.

Answer 913

Usually a single ring-enhancing lesion ## Footnote It is EBV-related and hard to distinguish from Toxoplasmosis without a biopsy.

Answer 914

Bactrim + Steroids ## Footnote This finding is commonly associated with PCP.

Answer 915

Pyrimethamine + Sulfadiazine ## Footnote This is typically associated with Toxoplasmosis.

Answer 916

Start ART (chemo if severe) ## Footnote These nodules are indicative of Kaposi Sarcoma.

Answer 917

Fluconazole ## Footnote This condition is associated with Candida infection.

Answer 918

Amphotericin B + Flucytosine ## Footnote This finding is associated with Cryptococcus.

Answer 919

Within 72 hours (ideally <24h) ## Footnote Starting PEP as soon as possible is critical for effectiveness.

Answer 920

28 days ## Footnote PEP involves a standard ART regimen.

Answer 921

* Tenofovir * Emtricitabine * Dolutegravir ## Footnote This combination is part of the standard ART discussed.

Answer 922

* Men who have sex with men (MSM) * Serodiscordant couples * People who inject drugs ## Footnote These groups are considered at high risk for contracting HIV.

Answer 923

* Daily: One pill every day * On-Demand: The '2-1-1' protocol ## Footnote The On-Demand "2-1-1" protocol involves taking 2 pills before sex, 1 pill 24h later and another pill 48h later.

Answer 924

Patient is HIV-negative and kidney function is checked ## Footnote This is important due to the use of Tenofovir.

Answer 925

Must be started within 72 hours ## Footnote Every hour counts; the sooner, the better.

Answer 926

An HIV+ patient on ART with an undetectable viral load cannot transmit the virus ## Footnote This applies if the viral load has been undetectable for at least 6 months.

Answer 927

Post-Exposure Prophylaxis (PEP) ## Footnote It is often referred to as 'The Morning-After Pill for HIV.'

Answer 928

* Baseline * 6 weeks * 3 months ## Footnote This is to confirm no seroconversion occurred.

Answer 929

Mycobacterium tuberculosis ## Footnote It is an acid-fast bacillus (AFB) due to its cell wall containing mycolic acids.

Answer 930

Ghon Focus ## Footnote This is a small area of granulomatous inflammation, and if nearby lymph nodes are involved, it’s called a Ghon Complex.

Answer 931

Bacteria are walled off in a granuloma ## Footnote The patient is not contagious and has no symptoms.

Answer 932

Drop in immunity ## Footnote This can occur due to aging, HIV, or TNF-alpha inhibitors, typically affecting the Apex (upper lobes) of the lungs.

Answer 933

* Caseating: Soft, white, 'cheesy' necrosis (TB) * Non-Caseating: Solid collection of cells (Sarcoidosis) ## Footnote TB granulomas undergo caseous necrosis, while sarcoidosis granulomas do not.

Answer 934

Type IV Hypersensitivity ## Footnote Macrophages attempt to kill the bacteria but fail, leading to the formation of a granuloma.

Answer 935

Upper Lobes (Apex) ## Footnote This is due to the bacteria being obligate aerobes that thrive in high oxygen levels.

Answer 936

Erythema Nodosum ## Footnote This rash can also be seen in Sarcoidosis and Lupus Perni.

Answer 937

Hilar Lymph Nodes ## Footnote This contrasts with Tuberculosis, where granulomas are found in the upper lobes.

Answer 938

* Night sweats * Weight loss * Low-grade evening fever ## Footnote These symptoms indicate the consumptive nature of tuberculosis.

Answer 939

* Persistent cough (usually multiple weeks) * Haemoptysis * Pleuritic chest pain ## Footnote These symptoms are indicative of pulmonary tuberculosis.

Answer 940

TB in the spine ## Footnote This is one of the extrapulmonary manifestations of tuberculosis.

Answer 941

Lymphadenopathy in the neck ## Footnote This is another extrapulmonary manifestation of tuberculosis.

Answer 942

Base of the brain involvement ## Footnote This condition represents a serious extrapulmonary complication of tuberculosis.

Answer 943

* Painful, tender, red/purple nodules * Typically located on the shins * Caused by an immunological reaction to TB antigens ## Footnote This condition is a type of septal panniculitis associated with TB.

Answer 944

Screening (Latent TB) ## Footnote This involves tests like Mantoux (TST) and IGRA (QuantiFERON).

Answer 945

Skin injection ## Footnote It can yield false positives in patients who have had the BCG vaccine.

Answer 946

Blood test ## Footnote The results are not affected by the BCG vaccine.

Answer 947

Look for cavities in the upper lobes or 'millet seed' spots ## Footnote This is indicative of Miliary TB.

Answer 948

Sputum Culture ## Footnote This process takes weeks and uses Lowenstein-Jensen medium.

Answer 949

* Fast DNA test * Checks for Rifampicin resistance ## Footnote This test provides rapid results for active TB.

Answer 950

6 months (2 months of all four drugs, followed by 4 months of the first two) ## Footnote This treatment regimen includes Rifampin, Isoniazid, Pyrazinamide, and Ethambutol.

Answer 951

Red/Orange body fluids (tears, urine) ## Footnote Rifampin is also a potent CYP450 inducer.

Answer 952

* Nerves (Peripheral Neuropathy) * Liver ## Footnote Vitamin B6 (Pyridoxine) is given to prevent peripheral neuropathy.

Answer 953

Painful Joints (Hyperuricemia/Gout) ## Footnote This side effect is important to monitor during treatment.

Answer 954

Optic Neuritis ## Footnote Patients may lose red-green color vision.

Answer 955

“The RIPE Orange” or “Red-I’m-Pissin” ## Footnote This highlights that Rifampin turns body fluids orange.

Answer 956

“Eye”thambutol ## Footnote This indicates that Ethambutol affects the eyes.

Answer 957

“I’m-So-Numb-Azid” ## Footnote This refers to the peripheral neuropathy caused by Isoniazid.

Answer 958

Latent TB ## Footnote Not screening can lead to massive reactivation of TB.

Answer 959

In a negative pressure room with airborne precautions (FFP3 masks) ## Footnote This is crucial to prevent the spread of TB.

Answer 960

* Symptoms: None * RX Torace: Normal/Old Scar * Sputum/Culture: Negative * Treatment: Isoniazid (9 mo) ## Footnote Latent TB does not present symptoms but requires treatment to prevent progression.

Answer 961

* Symptoms: B-Symptoms * RX Torace: Cavities/Infiltrates * Sputum/Culture: Positive * Treatment: RIPE (6 mo) ## Footnote Active TB presents with symptoms and requires a more intensive treatment regimen.

Answer 962

the 'great mimic' ## Footnote Sarcoidosis and TB have similar appearances on X-ray but differ in their underlying biology.

Answer 963

Non-caseating granulomas ## Footnote These granulomas consist of solid clumps of epithelioid histiocytes and multinucleated giant cells.

Answer 964

* Young adults * Higher prevalence in females * Higher prevalence in people of African descent ## Footnote Sarcoidosis classically affects these groups.

Answer 965

* Bilateral hilar lymphadenopathy * Interstitial lung disease (restrictive pattern) ## Footnote Lungs are affected in 90% of cases.

Answer 966

Anterior uveitis ## Footnote Symptoms include blurry vision and pain.

Answer 967

* Erythema Nodosum (shins) * Lupus Pernio (purple/blue skin lesions on the face) ## Footnote These skin manifestations are characteristic of the disease.

Answer 968

* Heart block * Arrhythmias ## Footnote These issues occur due to granulomas in the conduction system.

Answer 969

Bell's Palsy (CN VII) ## Footnote This condition can occur due to nerve involvement.

Answer 970

* Elevated ACE (Angiotensin-Converting Enzyme) * Hypercalcemia ## Footnote Elevated ACE is produced by granulomas, while hypercalcemia results from increased calcium absorption due to active Vitamin D.

Answer 971

Biopsy showing non-caseating granulomas ## Footnote X-ray findings typically show bilateral hilar lymphadenopathy.

Answer 972

Corticosteroids (Prednisone) ## Footnote These medications suppress the overactive immune system.

Answer 973

To classify the different types of hypersensitivity ## Footnote The classification can be remembered with the ACID mnemonic.

Answer 974

Allergy ## Footnote Mechanism involves IgE-mediated responses.

Answer 975

IgE-mediated; antigens cross-link IgE on Mast cells and Basophils, causing a massive release of Histamine ## Footnote This leads to rapid allergic reactions.

Answer 976

* Anaphylaxis * Asthma ## Footnote Other examples include bee stings and hay fever.

Answer 977

Cytotoxic (Antibody-mediated) ## Footnote Mechanism involves antibodies binding to antigens on specific cell surfaces.

Answer 978

Antibodies (IgG or IgM) bind to antigens on a specific cell surface, leading to cell destruction ## Footnote This can occur via the complement system or phagocytosis.

Answer 979

* Rheumatic Fever * Myasthenia Gravis ## Footnote Other examples include hemolytic disease of the newborn and Goodpasture syndrome.

Answer 980

Immune Complex ## Footnote Mechanism involves antigen-antibody complexes forming in the blood.

Answer 981

Antigen-antibody complexes (IgG) form in the blood and deposit in tissues, triggering inflammation ## Footnote This can affect joints or kidneys.

Answer 982

* SLE (Lupus) * Serum Sickness ## Footnote Other examples include post-streptococcal glomerulonephritis and Arthus reaction.

Answer 983

Delayed (Cell-mediated) ## Footnote Mechanism involves T-cells as the primary drivers.

Answer 984

T-cells activate macrophages to cause damage ## Footnote This type does not involve antibodies.

Answer 985

* Tuberculosis (Mantoux test) * Contact dermatitis ## Footnote Other examples include multiple sclerosis and graft-vs-host disease.

Answer 986

Fast (minutes) ## Footnote This rapid response is characteristic of allergic reactions.

Answer 987

Slow (2–3 days) ## Footnote This delayed response is typical for cell-mediated reactions.

Answer 988

Molecular Mimicry: Antibodies against Strep pyogenes M-protein cross-react with cardiac myosin ## Footnote Affects the Mitral valve most commonly. Remember the Jones Criteria.

Answer 989

Give RhoGAM (Anti-D) at 28 weeks and after delivery ## Footnote Maternal IgG antibodies (from a previous pregnancy) cross the placenta and attack fetal RBCs.

Answer 990

Hemoptysis + Hematuria ## Footnote Mechanism: Antibodies attack the Type IV Collagen in basement membranes.

Answer 991

"Linear" immunofluorescence ## Footnote Mechanism: Antibodies attack the Type IV Collagen in basement membranes.

Answer 992

Antibodies block/destroy Post-synaptic ACh receptors ## Footnote Symptoms: Ptosis and diplopia that worsen with use (muscle fatigue).

Answer 993

* Ptosis * Diplopia that worsen with use ## Footnote Mechanism: Antibodies block/destroy Post-synaptic ACh receptors.

Answer 994

Anti-nuclear antibodies (ANA) form complexes that deposit in kidneys, joints, and skin ## Footnote Low C3/C4 complement levels because the complexes "consume" them.

Answer 995

"Lumpy-bumpy" (granular) immunofluorescence ## Footnote Mechanism: Complexes deposit in the kidney 1-3 weeks after a Strep infection.

Answer 996

TRUE ## Footnote Unlike Rheumatic Fever, this can follow skin (impetigo) OR throat infections.

Answer 997

Systemic reaction to foreign proteins (like horse serum or certain drugs) ## Footnote Symptoms: Fever, rash, and joint pain occurring 5-10 days after exposure.

Answer 998

Localized version of Type III, usually occurs at an injection site ## Footnote Sign: Localized oedema, necrosis, and pain within hours.

Answer 999

Type IV reaction where T-cells attack the Myelin sheath in the Central Nervous System ## Footnote Diagnostic: Oligoclonal bands in the CSF and "Dawson Fingers" (white matter lesions) on MRI.

Answer 1000

Diagnostic checklist for **Acute Rheumatic Fever (ARF)** ## Footnote ARF is a Type II Hypersensitivity reaction that follows a Group A Strep throat infection.

Answer 1001

* Evidence of a preceding Strep infection * PLUS: Either 2 Major criteria OR 1 Major + 2 Minor criteria ## Footnote Evidence can include Positive ASO titer, positive throat culture, or Rapid Strep Test.

Answer 1002

Joints (Migratory Polyarthritis) ## Footnote Large joints become red and swollen, and pain migrates from one joint to another.

Answer 1003

Carditis ## Footnote This can cause Pancarditis and may present with new murmurs or a friction rub.

Answer 1004

Nodules (Subcutaneous) ## Footnote Small, painless, firm lumps typically found over bony prominences.

Answer 1005

Erythema Marginatum ## Footnote A specific rash with red rings and clear centres that 'marches' across the trunk and limbs.

Answer 1006

Sydenham Chorea ## Footnote Involuntary, 'jerky' movements of the face and hands, often occurring months after the infection.

Answer 1007

* PR Interval Prolongation * Elevated ESR/CRP * Arthralgia * Cold (Fever) * Elevated WBC (Leukocytosis) ## Footnote These criteria support the diagnosis if major criteria are insufficient.

Answer 1008

2–4 weeks ## Footnote This is the usual gap between the infection and the onset of ARF.

Answer 1009

Chronic Rheumatic Heart Disease ## Footnote This condition is a long-term consequence of ARF.

Answer 1010

Penicillin G as secondary prophylaxis ## Footnote Used for years to prevent recurrence and further heart valve damage.

Deck 1 Flashcards

(1035 cards)