What does fixed unilateral mydriasis in a comatose patient suggest?
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Third cranial nerve compression.
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What does fixed unilateral mydriasis in a comatose patient suggest?
Third cranial nerve compression.
What is the initial treatment of sigmoid volvulus in the absence of ischemia or perforation?
a) endoscopic distortion, effective for 60-95% of patients.
Which of the following is NOT an entity of small intestine occlusion?
Paralytic ileus.
What is a false statement regarding anal fissures?
Pain is almost always relieved by the presence of intestinal transit and is usually accompanied by melena.
Which statement about simple febrile seizures in children is true?
There are generalized tonic-clonic seizures.
What radiological sign is characteristic of small bowel occlusion?
Hydro-aerial levels.
What is a common clinical manifestation of anorectal abscesses?
Anorectal pain and the presence of a palpable mass or swelling at the perineal level.
What are some etiologies of conductive hearing loss?
External otitis, otitis media, tympanic membrane perforation.
What type of coma state has the best prognosis?
Coma states generated by metabolic causes that can be corrected.
Which condition is typically associated with neonatal nuclear jaundice?
Maternal-fetal incompatibility ABO.
What classes of drugs are included in the current medical treatment of ulcerative colitis?
Corticosteroids, immunomodulators, antibiotics, and biological therapy.
What investigations are required for a stroke patient in the first hour?
a) cerebral computed tomography, c) blood sugar level, d) blood count.
What is the mortality rate associated with acute mesenteric ischemia (IMA)?
Mortality is not low; treatment is often not effective.
What is a complication of cryptorchidism?
Infertility.
What does not include the clinical manifestations of complicated colonic diverticulitis?
e) the appearance of colon cancer.
What does the radiological aspect of papillary necrosis represent?
The sign of the ring (ring shadows around detached papilla) and clubbed calyces (necrotic papilla).
What are the common pathologies that can cause conductive hearing loss?
Pathology involving the external auditory canal, eardrum, middle ear, and ossicular chain.
What is a common characteristic of lupus arthritis?
It is the most common clinical manifestation.
What are the indications for tonsillectomy?
Recurrent acute tonsillitis (6 episodes/year), recurrent acute tonsillitis (3 episodes/year), chronic tonsillitis, recurrent peritonsillar abscess, and suspicion of malignancy.
Which symptom is NOT characteristic of Crohn's disease?
The progressive evolution of symptoms.
What typically causes vocal cord nodules?
They are secondary to vocal abuse.
Which statement is false regarding benign esophageal tumors?
c) The most common benign tumor is lipoma.
What type of dysfunction can occur in pleuro-pulmonary involvement in lupus?
Obstructive respiratory dysfunction.
What are the histopathological changes in chronic tubulointerstitial nephropathy?
Chronic cellular inflammatory infiltrate, tubular atrophy, interstitial fibrosis, and interstitial edema.
What characterizes Crohn's disease?
It is a chronic transmural inflammatory disease of the digestive tract.
What arteries ensure the arterial vascularization of the esophagus?
Upper thyroid arteries, bronchial arteries, internal mammary arteries, inferior thyroid arteries.
How are right colon cancers typically characterized?
As exophytic lesions associated with occult hemorrhages, which can cause iron deficiency anemia.
What are the three most common classes of drugs that can cause hypersensitivity reactions with acute tubulointerstitial nephropathy?
Penicillins, nonsteroidal anti-inflammatory drugs (NSAIDs), and Chinese herbs.
Can reflux nephropathy be unilateral?
Yes, it can be unilateral.
What are true statements about the use of the left colon for esophageal reconstruction?
It is used in an isoperistaltic manner and has the advantage of easy ascent to the level of the cervical esophagus.
What are the characteristics of meningeal syndrome?
Headache, neck stiffness, fever.
What is a false statement regarding analgesic nephropathy treatment?
NSAIDs can be administered.
What is the importance of nasogastric tube placement in SBO?
It is important for decompression.
What is true about CADASIL?
It is autosomal dominant inherited, characterized by cerebral infarcts and leukoencephalopathy.
What is a significant risk factor for laryngeal malignant tumors?
Smoking.
What is Ogilvie syndrome?
Acute pseudo-occlusion of the colon.
What are typical signs of acute pseudo-occlusion of the colon?
Abdominal pain, nausea, vomiting, and colon dilation on radiographs.
Why might a second laparotomy be required in acute mesenteric ischemia?
Due to complications or inadequate initial treatment.
What is a common laboratory finding in chronic tubulointerstitial nephropathy?
Mild proteinuria (<1g/day).
What characterizes the clinical picture of AMI?
Disproportionate pain on clinical examination and risk factors like atrial fibrillation.
What are the metabolic causes of chronic tubulointerstitial nephropathy?
Balkan endemic nephropathy, Hyperoxaluria, Nephrocalcinosis, Hyperuricemia.
What is the most modifiable risk factor for stroke?
Arterial hypertension.
What is a common cause of dysphonia?
Vocal cord nodules.
What symptoms may be present in the clinical picture of drug-induced tubulointerstitial nephropathy?
Patients may be asymptomatic, or present with fever, arthralgia, rash, oliguric renal failure, or hypertension.
What type of joint involvement is typical in lupus arthritis?
Involvement of small joints.
What is a rare complication in pleuro-pulmonary involvement in systemic lupus erythematosus?
Pulmonary fibrosis.
Which of the following is NOT a major etiology of acute mesenteric ischemia (AMI)?
Splenic vein thrombosis.
What are extraintestinal manifestations of Crohn's disease more common with?
When colonic involvement is present.
What is a potential complication of vasculitis in systemic lupus erythematosus?
Intrapulmonary hemorrhage.
In which decades of life is the peak incidence of laryngeal malignant tumors observed?
5th and 6th decades.
What are the major etiologies of acute mesenteric ischemia (AMI)?
Embolism of the superior mesenteric artery, upper mesenteric artery thrombosis, splenic vein thrombosis, thrombosis of the superior mesenteric vein, and non-occlusive mesenteric ischemia.
What are the components of Fallot's tetralogy?
Ventricular septal defect (DSV), right ventricular hypertrophy (HVD), overriding aorta, and obstruction of right ventricular (VD) ejection.
Where does epistaxis most commonly originate?
The Kisselbach Plexus.
What local conditions might prevent anastomosis during colorectal surgery?
Stercoral peritonitis, unstable patient, or advanced condition.
Where does Meckel's diverticulum exist as an outer pocket?
Ileum.
What causes extradural hemorrhage?
A tear in a branch of the middle meningeal artery.
Which bacterium is associated with reactive arthritis?
Chlamydia trachomatis.
What are the characteristics of fungal rhinosinusal infections?
Caused by Phycomycetes and Aspergillus, facial hyperaesthesia, seromucous nasal secretions, and necrosis of the nasal turbinates.
What is the most common cause for subarachnoid hemorrhage?
Sacular aneurysm.
What symptom is associated with papilar necrosis?
Pain in the flank.
What is a common symptom that patients with SBO usually present with?
Pain.
What are the common symptoms of acute otitis media?
Otalgia, with either intact or perforated erythematous eardrum.
What is a true statement about Wilms tumor?
It is a malignant tumor.
What is a key characteristic of large bowel occlusion related to the ileo-cecal valve?
If competent, a 'closed loop' forms, leading to colonic distension.
What statements are true regarding the ingestion of foreign bodies?
a) It is common in mentally ill children and adults; b) In adults, most cases involve impacting food; c) Most impacts occur in the cricopharyngeal muscle or in a peptic stricture in the distal esophagus; e) Symptoms include inability to swallow secretions, sialorrhea, and chest pain.
What statements are true in the case of imaging exploration after ingestion of foreign bodies?
a) Simple cervical and thoracic radiography to rule out cervical and mediastinal emphysema; c) Cervical and thoracic CT scan provides useful information; d) Endoscopic examination should be performed under anesthesia.
What imaging examination can demonstrate the presence of a hydroaerial level in the mediastinum in patients with hiatal hernias?
Simple chest radiography.
What are characteristic symptoms of Crohn's disease?
Diarrhea and weight loss.
What components do tumors of the small intestine originate from?
Epithelial and mesenchymal components of the intestine.
What are physiological causes of hyperbilirubinemia in newborns?
Low excretion and failure of natural feeding.
What is a reason for performing an ileostomy or colostomy related to intestinal segments?
Absence of an intestinal segment necessary for performing an anastomosis.
Which statement about colon anatomy is false?
b) the distal third of the transverse colon, the descending colon, the sigmoid and the rectum develop embryologically from metenterone.
What organs are used for esophageal reconstruction after resection for cancer?
The stomach, jejunum, ileum, large intestine, duodenum.
What is a true statement about palliative treatment in esophageal cancer?
It relieves severe dysphagia.
Which complication is NOT associated with Crohn's disease?
Urine retention.
Which viruses are known to cause tubulointerstitial nephropathy in immunocompromised patients?
Cytomegalovirus and Polyoma (BK).
How is intracerebral hemorrhage immediately detected?
Cerebral computed tomography.
What can cause cerebral veins and sinuses thrombosis?
Hypercoagulability states, arterial hypertension, thrombotic diseases, malignant diseases, diabetes mellitus.
What percentage of malignant tumors of the larynx are squamous cell carcinomas?
95%.
What statements are true about paraclinical examinations for diagnosing benign esophageal tumors?
a) Barium swallow highlights a mass with a smooth, well-defined contour that occupies the lumen of the esophagus; b) Diagnostic evaluation includes direct endoscopic visualization and echoendoscopy; d) Computed tomography is the method that brings valuable information in incipient tumors.
What occurs in type I hiatal hernia?
The phenomenon of stomach prolapse in the chest occurs.
What does type IV hiatal hernia involve?
Herniation of other organs such as the colon or spleen into the chest.
What layers of the intestine does Ulcerative colitis affect?
The mucosa and submucosa.
What complication is associated with ventricular septal defect (DSV)?
Increased risk of endocarditis.
What prevents the development of anti-Rh antibodies?
Administration of Rho (D) immunoglobulin (RhoGAM) within the first 72 hours of life.
What is a treatment option for mild cases of croup?
Steroids and antileukotriene (leukotriene receptor antagonist).
Are tumors of the small intestine easily diagnosed by simple abdominal radiography?
No, they are not easily diagnosed by simple abdominal radiography.
What indicates multiple episodes of seizures in 24 hours?
It classifies febrile seizures as complex.
What does M0 indicate in the TNM staging system?
Without the presence of distant metastases.
What is the most common vasculitis in children?
Kawasaki Disease.
Which vein does NOT provide venous drainage for the esophagus?
Upper thyroid vein.
What are the manifestations of allergic rhinitis?
Nasal obstruction, rhinorrhea, sneezing, pruritus, and increased prevalence in children under 5 years old.
What causes respiratory distress syndrome in newborns?
It is due to surfactant deficiency.
What is the appearance of vocal cord nodules?
They have a whitish appearance.
What are the clinical signs for lacunar stroke?
a) pure motor hemiparesis, c) pure hemisensory syndrome, d) unilateral ataxia with sudden onset.
What is a common cause of acute otitis media?
Eustachian tube dysfunction.
What is a common respiratory issue associated with systemic lupus erythematosus?
Recurrent pleurisy.
What happens if the ileo-cecal valve is incompetent in large bowel occlusion?
Signs and symptoms are similar to those of small bowel occlusion.
What are the characteristics of acute laryngitis?
Usually viral etiology, dysphonia, erythematous vocal cords, self-limiting, and healing is not influenced by vocal rest.
What complications are common in acute mesenteric ischemia?
Medical and surgical complications are common.
What is frequently found in cases of acute mesenteric ischemia?
An extensive segment of necrotic intestine.
When do anti-Rh antibodies cause severe hemolysis of fetal erythrocytes?
In subsequent pregnancies with Rh-positive fetuses.
Do anti-Rh antibodies cause severe hemolysis in pregnancies with Rh-negative fetuses?
No, they do not cause severe hemolysis in Rh-negative fetuses.
What does the ostiomeatal complex at endonasal level consist of?
The anterior ethmoidal sinus and the middle meatus.
What are the indications for performing an ileostomy or colostomy?
After right hemicolectomy, healing of a distal anastomosis, or when anastomosis cannot be performed.
What are common clinical presentations of bronchiolitis in infants?
Nasal congestion, respiratory distress, inspiratory stridor, wheezing, and prolonged expiration.
What allows the classification of febrile seizures as complex?
Focal seizures.
What is the treatment for symptomatic patients with Zenker diverticulum?
Cricopharyngeal myotomy and diverticulectomy or diverticulopexy.
What is the surgical approach for rectal cancer?
Total rectocolectomy with primary anastomosis.
What virus most commonly causes bronchiolitis in children?
Respiratory syncytial virus.
What does the initial clinical picture in ulcerative colitis depend on?
b) the extent of lesions in the colon and the severity of the disease.
What can extradural hemorrhage produce in terms of pupil response?
Ipsilateral pupil dilation.
What serious condition can result from extradural hemorrhage?
Rapid transtentorial herniation.
What is the immediate risk of injury to the cervical esophagus?
Sepsis.
How are vocal cord nodules observed on the vocal cords?
Symmetrically on both vocal cords.
What are the thrombolysis exclusion criteria?
a) thrombocytes < 100,000/mm³, b) creatinine > 3.5 mg/dL, c) blood sugar < 2.8 mmol/L or > 26.2 mmol/L, d) INR > 1.7 if treated with warfarin, e) systolic blood pressure > 160 mmHg.
Consciousness is based on which anatomic and physiologic system?
Ascending reticular activating system.
What are common signs and symptoms of small bowel obstruction?
Abdominal pain, abdominal distension, nausea and vomiting.
What are the characteristic clinical signs for subarachnoid hemorrhage?
a) severe headache, b) vomiting, d) positive Kernig sign.
What are the two most common forms of inflammatory bowel disease?
Ulcerative colitis (UC) and Crohn's disease (BC).
What factors contribute to the development of Ulcerative colitis and Crohn's disease?
A combination of genetic and environmental factors.
When should endoscopic decompression be considered in acute pseudo-occlusion?
When neostigmine treatment is contraindicated or ineffective.
Is barium swallow contraindicated in patients with hiatal hernias?
Yes, it is contraindicated.
What is the gold standard for diagnosing AMI?
Mesenteric arteriography.
What is the most common cause of epiglottitis?
Haemophilus influenzae.
What can cause overproduction of bilirubin without hemolysis?
Hemorrhage and maternal-fetal transfusion.
What characterizes grade I internal hemorrhoids?
Protrusion at the level of the anal lumen; does not prolapse outside the lumen.
What is the recommended follow-up for colorectal cancer in the first 2 years?
Anamnesis, physical examination, and CEA dosing every 3 months.
What is the role of technological advances in rectal cancer surgery?
They allow the resection of colon cancers to be done safely and effectively by minimally invasive laparoscopic surgery.
What symptom is associated with rectal prolapse?
Rectal pain or sensation of anal pressure.
What is a true statement about respiratory distress in newborns?
The debut takes place in the first 2 days after birth.
Amaurosis fugax is frequently the first clinical sign of stenosis in which artery?
Internal carotid artery.
What can complicate analgesic nephropathy?
Papilar necrosis.
What is a common radiological finding in reflux nephropathy?
Loss of cortical tissue in the area of the blunt calyces.
What is a false statement regarding thoracic esophageal perforations?
Patients with Boerhave syndrome have a good prognosis.
Which statement about enuresis is true?
Most cases resolve by the age of 4 years.
What substance is produced by Chinese herbs nephropathy?
Aristolohic acid.
What are the optimal characteristics of inspired air?
Temperature of 37°C and 80% humidity.
What types of manifestations are included in the extraintestinal manifestations of Crohn's disease?
Ocular, ear, skin, and joint manifestations.
When is surgical treatment applied in Crohn's disease?
Only to complicated cases or those refractory to medical treatment.
What are the first therapeutic options for malignant tumors of the larynx?
Surgery and radiotherapy.
Which parts of the digestive tract are affected by Ulcerative colitis?
Only the colon and rectum.
Is perianal involvement with fistulas common in Crohn's disease?
Yes, it is common.
What is the main goal in the treatment of AMI?
To quickly restore intestinal blood flow.
What sensory organ is found in the inner ear?
The organ of Corti.
What does N2 indicate in the TNM staging system?
Metastases in more than 4 pericolic lymph nodes, or perirectal lymph nodes.
What is one argument for the malignant potential of colorectal polyps in adenomas?
Simultaneous occurrence of cancers and polyps in the same patient.
How is Hirschsprung's disease defined?
Absence of autonomic intestinal innervation.
What is a characteristic feature of papillary necrosis in radiology?
Loss of cortical tissue.
What are the characteristics of a vegetative state?
Normal respiration, maintained wake-sleep rhythm, inability to open eyes, presence of some reflex movements, patients are fed by gastrostomy.
What is a potential consequence of extradural hemorrhage?
Respiratory arrest.
What are the indications for surgical treatment in diverticular colonic disease?
Free perforation, obstruction, hemorrhage, and fistula.
Which systemic diseases may be associated with chronic tubulointerstitial nephropathy?
Diabetes mellitus, systemic lupus erythematosus/vasculitis, Balkan endemic nephropathy, Alport syndrome, and sarcoidosis.
What are the paired cartilages of the larynx?
Arytenoid and corniculate.
What is the most common congenital heart defect?
Ventricular septal defect (DSV).
What is a potential outcome of Chinese herbs nephropathy?
Progression to chronic end-stage renal disease.
What are the complications for subarachnoid hemorrhage?
a) obstructive hydrocephalus, c) vasospasm.
What are common manifestations of Crohn's disease?
Lesions such as 'cobblestone', formation of fistulas or abscesses, and pain in the right lower quadrant.
What is a potential complication of surgical treatment for Crohn's disease?
Short bowel syndrome can sometimes occur.
What is a common etiology of sensorineural hearing loss?
Retrocochlear pathology.
When is surgical treatment reserved in cases of pseudo-acute occlusion of the colon?
For cases complicated by colonic ischemia, perforation, or refractory dilation.
Which viruses are etiological agents of croup in children?
Respiratory syncytial virus, influenza virus, and adenovirus.
How can tumors of the small intestine affect intestinal function?
They can act as starting points for invagination.
What treatments are available for bronchiolitis in infants?
Nasal aspiration, humidification of the air, and adequate hydration.
What is a characteristic of the Zenker diverticulum?
It is a pocket-like structure.
How is the diagnosis of Zenker diverticulum confirmed?
By Barium swallow.
What artery supplies the anal canal and anal sphincter?
a) inferior hemorrhoidal artery originating from the internal pudendal artery, branch of the internal iliac artery.
Which virus is a common etiology of reactive arthritis?
Hepatitis B virus.
What conditions can mimic a coma state?
Psychogenic coma, sleep, 'locked-in' syndrome, catatonia, severe palsy.
What is the most common organ used for esophageal replacement after cancer resection?
The stomach.
In which group are respiratory distress syndrome of the newborn most commonly present?
Premature newborns, especially before 30 weeks of gestation.
What are some extrinsic causes of small bowel occlusion (SBO)?
Postoperative adhesions, strangled inguinal and umbilical hernias, peritoneal carcinomatosis, biliary ileus, and volvulus.
What symptoms can neoplasms of the tonsillar fossa cause?
Hemoptysis, dysphagia, odynophagia, trismus, and dyspnea.
What should be the approach to non-operative treatment of thoracic esophageal perforations?
Non-operative treatment should be the exception and not the rule.
What neurological symptom can occur in meningeal syndrome?
Epileptic seizures.
What is the initial treatment approach for SBO?
Hydro-electrolytic rebalancing.
What are the manifestations of acute viral rhinitis?
Nasal obstruction, rhinorrhea, sneezing.
Is a small ventricular septal defect (DSV) usually asymptomatic?
Yes.
Is bleeding common in Crohn's disease?
Yes, bleeding is common.
What dB range is considered mild hearing loss?
25-40 dB.
Is MRI examination mandatory for diagnosing hiatal hernias?
No, it is not mandatory.
What is the primary abnormality in achalasia?
A degenerative disease of Aurbach plexus.
What type of seizure can classify febrile seizures as complex?
Generalized tonic-clonic seizures.
What happens to the resection piece of colon or rectal cancer?
It is sent to the pathologist for staging.
What is the most common cause of tubulointerstitial nephritis?
d) drugs.
Which conditions are associated with pulsatile tinnitus?
Glomus tympanicum, glomus jugulare, intracerebral aneurysms.
What characterizes a transient ischemic attack?
Cerebral or retinal temporary ischemia, duration less than 24 hours, complete recovery.
Which symptom is NOT typically associated with meningeal syndrome?
Motor deficit.
What are the true statements about acute tubulointerstitial nephropathy with uveitis?
It occurs frequently in childhood and more frequently in women.
What is the most common type of hiatal hernia?
Sliding hiatal hernia.
Which congenital heart defect is most common in Down syndrome?
Ventricular septal defect (DSV).
What is a clinical manifestation of chronic tubulointerstitial nephropathy?
Oliguria.
Which statements are true regarding the ingestion of caustic substances?
a) May be accidental in children; b) Represents a medical emergency; e) The long-term complication is the formation of stenoses.
Is prolonged hospitalization in the intensive care unit common for acute mesenteric ischemia?
There can be prolonged hospitalization in the intensive care unit.
What is considered the gold standard for imaging the upper digestive tract?
The upper digestive tract with contrast substance.
What symptoms can tumors of the small intestine cause?
Obstructive symptoms or bleeding.
What is a false statement regarding the treatment of hiatal hernias?
In tarred patients, a simple reduction of the stomach and gastropexy are preferred.
Is endoscopy important for the diagnosis of achalasia?
No, endoscopy is not important for diagnosis.
What is the prognosis for colorectal cancer regarding recurrences?
Most recurrences occur in the first 18-24 months, making patient supervision extremely important.
What is the safety margin for rectal cancer surgery?
The rectum is removed with a safety margin of 5 mm distal to the tumor.
What is a correct statement about acute tubulointerstitial nephropathy caused by Hanta virus?
It appears as a complication of systemic infection.
What is a subdural hematoma?
a) a blood collection in the subdural space, c) caused by a tear in a cerebral bridging vein, e) appears after traumatic head injury.
What syndrome can occur in the absence of treatment for ventricular septal defect?
Eisenmenger syndrome (irreversible).
Where is Crohn's disease typically located?
In the small and large intestine, usually near the ileocecal valve.
What additional information does a CT scan provide in cases of hiatal hernias?
Additional details about the anatomy of the hernia.
What can increased hemolysis in newborns be due to?
ABO maternal-fetal incompatibility.
What is the definition of grade II internal hemorrhoids?
Prolapses during defecation and decreases spontaneously.
How are grade III internal hemorrhoids defined?
Prolapses during defecation and is reduced manually.
What does T4 indicate in the TNM staging system?
Tumor that directly invades other nearby organs or structures or perforates the visceral peritoneum.
What is the main hypothesis regarding the etiopathogenesis of Balkan endemic nephropathy?
d) intoxication by ingestion of aristolochic acid.
What causes severe hemolysis of fetal erythrocytes in the first pregnancy?
Anti-Rh antibodies do not cause severe hemolysis at initial interaction.
Are tumors of the small intestine common?
They are not very common despite the length of the intestine.
What type of condition is Crohn's disease?
A transmural condition.
Why are antibiotics frequently given in AMI treatment?
Due to the risk of intestinal necrosis.
What liver abnormalities can lead to hyperbilirubinemia?
Gilbert syndrome and Crigler-Najjar syndrome.
When is a colonoscopy routinely performed after colorectal cancer surgery?
At 1 year and 4 years postoperatively, then every 5 years.
What percentage of cases of tubulointerstitial nephritis is due to drug hypersensitivity reactions?
a) 8%.
What does Rho (D) immunoglobulin (RhoGAM) do for future pregnancies?
It protects future pregnancies from hemolytic disease.
What severe treatment is used for croup?
Epinephrine plus corticosteroids.
What is the main symptom of achalasia?
Progressive dysphagia in solids and then in liquids.
What does T2 indicate in the TNM staging system for colorectal cancer?
The tumor invades through the muscular layer in the serosa or in the nonperitonealized dangerous or perirectal tissue.
Which statement about the treatment of acute hyperuricemic nephropathy is false?
c) limiting water intake.
Can congenital heart malformations cause hyperbilirubinemia?
Yes, conditions like patent ductus arteriosus and tetralogy of Fallot can contribute.
What type of treatment is balloon dilation of the lower esophageal sphincter?
Always contraindicated.
What duration classifies a seizure as complex?
Longer than 15 minutes.
What prolonged condition can classify febrile seizures as complex?
Prolonged postictal status or focal deficit.
What is indicated when a rectal tumor invades the anal sphincter?
Low rectal resection with colo-anal anastomosis.
What additional lesions can drug administration cause in tubulointerstitial nephritis?
a) minimal lesions glomerulopathy.
