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In which of the following diseases should we apply contact and airborne (aerosols) isolation precautions?: | Tuberculosis. | Measles. | Chickenpox. | Medicine | Norovirus. | 47 | 4 | 85d44abe-9d64-406b-8c20-2f0075684afc | 2023 |
In the forest plot diagram that shows the results of a systematic review of studies, the square that appears next to each study is: | The estimator of interest (such as the relative risk) from each study. | The size of each study. | The weight of each study when conducting a meta-analysis of said studies. | Medicine | The confidence interval of the estimator of interest in each study. | 48 | 2 | 12c9ea13-d158-4a1f-95b9-43b32352c3d9 | 2023 |
In the assessment of the risk of bias in an epidemiological study, one of the following criteria is considered: | The excessive width of the 95% confidence interval of the main result of the study. | Insufficient sample size. | Measurement errors in some of the main variables. | Medicine | The lack of statistical significance of the results. | 49 | 4 | fb43f08f-a4f3-42ff-904e-a370bede333c | 2023 |
The best preventive strategy to slow the progression of the disease in a smoker diagnosed with COPD is to achieve the goal of tobacco cessation. The following measure is not included in the current first-choice protocols for the treatment of tobacco abstinence reinforcement, because there are no demonstrative studies on its clinical efficacy and safety: | Bupropion. | Nicotine skin patch. | Electronic cigarette. | Medicine | Varenicline. | 50 | 4 | d7854bc2-6763-4317-92bf-2d5a3db32230 | 2023 |
The conjugated vaccines: | These are whole virus vaccines conjugated with a polysaccharide to be able to combine them and make the trivalent or tetravalent viral vaccine. | These are combined virus and bacteria vaccines made to be less immunogenic and cause fewer side effects. | They are polysaccharide vaccines conjugated with a protein to make it T-cell dependent and achieve long-term immunological memory. | Medicine | They are bacterial vaccines conjugated with a polysaccharide in order to combine them and create penta or hexavalent vaccines. | 51 | 4 | 5c1a2515-02d2-41bf-a44f-1d27c3f43740 | 2023 |
A clinical trial in which participants are randomly assigned to one of several clinical interventions is known as: | Non-randomized controlled trial. | Double-blind trial. | Superiority trial. | Medicine | Randomized controlled trial. | 52 | 3 | 732dba22-3464-4d5b-a9a9-7132dd7f23eb | 2023 |
In the management of a pregnant woman diagnosed with bipolar disorder, which of the following drugs is effective in this disease and has been established as safer during pregnancy? | Olanzapine. | Fluphenazine. | Carbamazepine. | Medicine | Lithium. | 53 | 2 | 1be17001-7d50-4402-b832-af88b4a6b957 | 2023 |
A 69-year-old patient diagnosed with lymphoma has been prescribed intravenous treatment with methotrexate. On the third day of treatment, the patient presents nephrotoxicity and delayed renal elimination of the drug with a urinary pH less than 7. Taking into account the chemical nature of methotrexate (pKa between 4 and 5.5), which of the following actions would be the most correct to handle the toxicity?: | Intravenous administration of sodium bicarbonate solution to accelerate methotrexate diuresis. | Intravenous administration of physiological saline with ammonium chloride to facilitate the renal elimination of methotrexate. | Intravenous administration of furosemide in serum with a neutral pH to induce forced diuresis. | Medicine | Enteral administration of sodium bicarbonate solution to reduce the digestive absorption of methotrexate. | 54 | 2 | 90e72870-bb39-43c9-ba3d-886eb389c0fa | 2023 |
What is the mechanism by which ivabradine, acting on the cells of the sinoatrial node, produces a decrease in heart rate? | Modulates the beta-1 adrenergic receptors. | It enhances repolarization by activating potassium outflow currents. | Activates the muscarinic M2 receptors. | Medicine | It blocks the If pacemaker current. | 55 | 3 | b4536808-3087-4078-9d97-0612f814f17d | 2023 |
In a patient with a duodenal ulcer and high cardiovascular risk due to ischemic heart disease, if they require treatment with a NSAID, which of the following would you recommend as the safest?: | Celecoxib. | Naproxen. | Ibuprofen. | Medicine | Ketorolac. | 56 | 1 | e2069a51-b402-469c-b3d2-c781d415bf86 | 2023 |
A 68-year-old male with a history of obesity and type 2 diabetes mellitus, being treated with metformin. He is admitted due to a first episode of heart failure. He has a glycated hemoglobin of 8.5%. To optimize the treatment of diabetes at discharge, which of the following drugs is contraindicated?: | Canagliflozin. | Linagliptin. | Pioglitazone. | Medicine | Dulaglutide. | 57 | 4 | ae924fe6-a01b-47dd-80bc-3997a887f932 | 2023 |
A 5-year-old boy who suffered a bicycle accident with facial trauma without loss of consciousness, was observed in the emergency room with only a wound on his chin, which was sutured. He was referred for a consultation 5 days after the trauma due to limited and deviated mouth opening. What is the most likely diagnosis? | Combined fracture of the jaw and upper maxilla. | LeFort type fracture. | Fracture of the symphysis and horizontal branch of the jaw. | Medicine | Mandibular condyle fracture. | 58 | 3 | 7e46fd76-e942-4efd-910d-457e63a099b1 | 2023 |
Of the following malignant tumors that can affect the tongue, which is the most frequent type and where does it usually metastasize?: | The squamous cell carcinoma metastasizes in the cervical lymph nodes. | The sarcoma metastasizes in the cervical lymph nodes. | The squamous cell carcinoma metastasizes in liver tissue. | Medicine | The sarcoma metastasizes to distant bone tissue. | 59 | 2 | 43d53942-1b9a-4791-b9e3-6e86f382d4b1 | 2023 |
Which of the following descriptions defines stage II of a pressure ulcer according to the staging system of the National Pressure Injury Advisory Panel? | Total thickness loss of skin with exposure of subcutaneous cellular tissue. | Non-blanching erythema. | Appearance of granulation tissue in the defect bed. | Medicine | Loss of epidermis with exposure of the dermis. | 60 | 3 | 87a874bd-e60f-4397-9f9b-d5a11a5d546f | 2023 |
Regarding skin grafts, indicate the incorrect answer: | We can classify them into partial skin grafts (if they only have the epidermis) or total skin grafts (if they have both the epidermis and underlying dermis). | One of the beds considered graftable due to its rich vascularization is the granulation tissue. | Among the medical comorbidities associated with graft loss, we can highlight diabetes, smoking and peripheral vasculopathy. | Medicine | They usually undergo a contraction process, which occurs both at the time of being extracted and after having been grafted. | 61 | 2 | 797d2fe4-8f8a-44b9-b983-3f546b2347b7 | 2023 |
A 38-year-old woman has been experiencing a sensation of grittiness and burning in both eyes for several weeks, which worsens throughout the day, during windy conditions, and with air conditioning. What is the most likely diagnosis? | Episcleritis. | Allergic Conjunctivitis. | Dry keratoconjunctivitis. | Medicine | Pterygium. | 62 | 4 | db1b193d-f002-489a-aa4f-c06699655bb3 | 2023 |
Regarding posterior vitreous detachment, indicate the incorrect statement: | The Weiss ring is a characteristic sign in the ophthalmoscopic examination. | The symptoms for which patients usually consult are phosphenes and floaters. | It occurs due to the liquefaction of the vitreous gel due to age. | Medicine | The Shaffer's sign or tobacco dust is a sign of good prognosis. | 63 | 3 | b22c3a0b-fe62-4767-b008-e6f0431a2103 | 2023 |
A 25-year-old male reports a significant decrease in night vision and poor adaptation to darkness in recent months. He is noticing difficulty driving, going down stairs, and has lately been tripping on curbs. However, he can read and watch television. Which of the following entities would you associate this patient's symptoms with?: | Best's vitelliform macular dystrophy. | Stargardt Disease. | Retinal detachment. | Medicine | Retinitis Pigmentosa. | 64 | 3 | a47bb563-0b33-4de2-ad61-454d2d7bebc7 | 2023 |
A 22-month-old child was treated for acute bilateral middle ear infection, which presented with pain, fever, discharge from the ear, and partial hearing loss. Oral antibiotics and topical drops were administered, improving the symptoms. Twelve days later, the child was brought to the emergency department again due to recurring fever, and the parents noticed that the earlobe has moved outwards and downwards and that the skin behind the ear is red and swollen. What is the most likely diagnosis? | Mastoiditis. | External otitis. | Cellulitis. | Medicine | Chondritis. | 65 | 2 | 38f1b87d-0827-47d0-b842-5da272f1f46a | 2023 |
A 40-year-old woman who presents with a spell of dizziness accompanied by nausea and vomiting, lasting about twenty minutes. She has not lost consciousness and has been able to hold onto a wall to maintain her balance. This has happened to her on previous occasions. She reports having felt a sense of fullness in her ears, tinnitus and hearing loss in her right ear. Physical examination reveals normal otoscopy, grade II leftward rotatory nystagmus, positive Romberg on the right, and Unterberger with rightward laterodeviation. What is the most likely diagnosis? | Vestibular Neuritis. | Benign paroxysmal positional vertigo. | Ramsay-Hunt Syndrome. | Medicine | Meniere's Disease. | 66 | 3 | 9145cea9-33a1-44d3-b38b-aff707461ffa | 2023 |
Oropharyngeal dysphagia is the difficulty in transferring food from the oral cavity to the proximal esophagus. Among the causes of motor oropharyngeal dysphagia are the following except: | Gastroesophageal reflux. | Myasthenia gravis. | Dermatomyositis. | Medicine | Tetanus. | 67 | 2 | d067c955-cb1a-475e-9423-4edd35f5a07d | 2023 |
In relation to vulvovaginal infections, indicate the incorrect statement: | Candidal vulvovaginitis is the most prevalent vulvovaginal infection in Europe. | Bacterial vaginosis is usually a monomicrobial infection. | Bacterial vaginosis should only be treated pharmacologically when it is symptomatic. | Medicine | It is defined as recurrent candidal vulvovaginitis when 4 or more episodes occur in a year. | 68 | 1 | dd31fde1-30d3-46de-9665-7ac42a5f07dc | 2023 |
Referring to polycystic ovary syndrome, point out the incorrect statement: | Clinically, it is characterized by the presence of hirsutism, acne, and amenorrhea or oligomenorrhea. | It presents in young women. | Increases the risk of ovarian cancer. | Medicine | It is associated with obesity and insulin resistance. | 69 | 4 | 611d6dfd-ee0a-43c1-96c1-2dfea7349d87 | 2023 |
A 35-year-old woman pregnant for the first time, who is in the second stage of labour. She is on epidural analgesia. When would it be appropriate to apply the vacuum to expedite the expulsion period? | When witnessing a start of heavy vaginal bleeding with fetal repercussion and the presentation is on the upper narrow of the maternal pelvis. | When, after 2 hours in complete, the presentation remains in a Hodge's second plane with maternal efforts. | When fetal bradycardia occurs that does not recover after the cessation of contraction and the lesser fontanel is past the III Hodge plane. | Medicine | When the presentation remains on a fourth plane and the guide point is the chin. | 70 | 4 | 2bf6aa93-199a-4ab2-a1cd-2d7c5f1b4504 | 2023 |
A 41-year-old pregnant woman at 13+2 weeks, after undergoing an ultrasound in the 12th week, presents a combined risk of chromosomal abnormalities for trisomy 21 of 1 in 30. What would be the most appropriate advice? | Perform an invasive test. | Advance the ultrasound of week 20. | Reassure him because it is an intermediate risk and it is justified by the maternal age. | Medicine | Reassure them because it is a combined risk that is low risk in any case. | 71 | 2 | 05512dda-42ff-4e05-9424-7119fda09199 | 2023 |
A primigravida at 26 weeks of gestation, with normal follow-up to date. She goes to her health center with an O´Sullivan test result of 175 mg/dL. Given this situation, how should we proceed? | An oral glucose overload of 100 g will only be indicated if there are risk factors for alterations in glucose metabolism. | She must be informed of the risk of gestational diabetes with fetal risk and referred to the hospital emergency service. | A diagnostic confirmation of gestational diabetes should be requested by conducting a 100 g oral glucose tolerance test. | Medicine | Being a value higher than 165 mg/dL confirms the diagnosis of gestational diabetes. | 72 | 4 | 3856b8c8-98c7-47a7-adac-c9e84081a12b | 2023 |
A 36-year-old woman with a history of 2 first trimester miscarriages and severe preeclampsia which required a cesarean section due to fetal distress at 33 weeks of gestation. The postpartum analytical study is normal except for the presence of antiphospholipid antibodies IgM and IgG, the rest of the thrombophilia study being normal. The presence of antiphospholipid antibodies was confirmed 4 months after the first analysis. What recommendation would we make to this patient in case of a new pregnancy? | High-dose antioxidant vitamins. | Aspirin and low molecular weight heparin at prophylactic doses. | Treatment according to first trimester preeclampsia screening with low-dose aspirin if high risk. | Medicine | Attempt conception through preimplantation genetic diagnosis. | 73 | 1 | c9fb9183-5bbe-4609-8220-5cef05378e73 | 2023 |
54-year-old nulliparous woman who consults due to urinary leakage after perceiving urinary urgency and the sensation of needing to urinate 3-4 times at night. In the gynecological examination, a first-degree cystocele and moderate vaginal atrophy are evident. What would be the initial measures to take? | Conducting a urinary diary and bladder retraining. | Surgical correction of cystocele. | Prescription of oral treatment with cholinergic drugs. | Medicine | Indication for uroflowmetry and evaluation of urethral function. | 74 | 2 | cbe53112-3f1b-4970-9a6e-b6807c8a9e23 | 2023 |
A 29-year-old primigravid with no noteworthy medical history has been referred at 36.5 weeks of gestation due to suspicion of growth restriction from ultrasound findings. In the consultation her blood pressure is 125/75 mmHg. The obstetric ultrasound shows an estimated fetal weight compatible with the 6th percentile for gestational age, and a Doppler pulsatility index of the umbilical artery above the 95th percentile. What recommendation would you make in this situation? | Weekly check-ups with fetal monitoring and obstetric ultrasound every two weeks until the spontaneous onset of labor. | Immediate termination of pregnancy through a cesarean section. | Induction of labor starting from the 37th week of gestation. | Medicine | Weekly check-ups with fetal monitoring and obstetric ultrasound every two weeks until 40 weeks of gestation. | 75 | 4 | eb720c8d-1b85-43d1-9976-0e701342e62f | 2023 |
A 35-year-old woman presents with amenorrhea lasting 6 months. In the patient history, she states that she has recently been having difficulty sleeping and wakes up at night feeling very hot. Menarche at the age of 12. She has 2 daughters (eutocic births) and completed her desire to have children. Her mother experienced menopause at the age of 41. Blood analysis reveals FSH 65.1 U/L (2-13.8), LH 12 U/L (2-13.8), estradiol < 0.05 pg/mL (follicular phase: 30-100; luteal phase: 50-150; ovulatory peak: 100-400). Two months later, she gets the blood tests redone with similar results. What is the suspected diagnosis and the next steps to take? | Premature ovarian insufficiency. Starts study with karyotype and indicates hormone replacement therapy. | She is probably menopausal, but until 12 months of amenorrhea have passed, she cannot start any treatment. | Hypothalamic amenorrhea. Requires study with a cranial MRI. | Medicine | Premature ovarian failure. It explains that healthy lifestyle habits are essential: no smoking, exercise and adequate intake of vitamin D. It leaves hormone therapy as a second-line treatment. | 76 | 2 | b1214c82-16b6-4359-b604-55a6bdd9dcf5 | 2023 |
Which of the following vaccines should not be administered to a 9-month-old infant with a combined primary immunodeficiency?: | Flu vaccine. | 13-valent pneumococcal conjugate vaccine. | Type B Antimeningococcal vaccine. | Medicine | Vaccine against rotavirus. | 77 | 3 | 86a1db45-44ff-4aee-b15a-cd6fc8010db5 | 2023 |
19-month-old male, correctly vaccinated for his age. Previously well, he suddenly begins a clinical picture with a high fever of up to 40 °C without other symptoms, except irritability. The examination the next day is normal, except for slight hyperemia of oral mucosa and tympanic membrane, and laterocervical microadenopathies. On the fourth day, the fever completely disappears and a morbilliform erythematous rash appears, maculopapular distribution on face, trunk and limbs. Of the following, what is the most likely diagnosis?: | Measles or first disease. | Infectious erythema or fifth disease. | Scarlet fever or second disease. | Medicine | Roseola, sudden rash or sixth disease. | 78 | 3 | cf463ec6-f265-41ce-bae7-27959c8abf4d | 2023 |
A 14-month-old infant was brought to the emergency department with a case of irritability over the last 12 hours and bloody, mucusy stools. Examination highlighted episodes of crying, with bending of the lower limbs. On abdominal palpation, a poorly defined cylindrical mass was identified, with the child's crying increasing when pressure was applied to the right side of the abdomen. What is your suspected diagnosis and what test would you perform to confirm it?: | Intestinal intussusception. Abdominal ultrasound. | Acute appendicitis. Abdominal ultrasound. | Intestinal intussusception. Abdominal CT scan. | Medicine | Acute appendicitis. Abdominal CT scan. | 79 | 2 | 0814496d-d1a9-4ece-ad60-c55a8fc174cb | 2023 |
Regarding acute gastroenteritis (AGE) in pediatrics, identify the incorrect statement: | The main bacterial pathogens that cause Gastroenteritis are non-typhoidal Salmonella, Shigella, Campylobacter, and Yersinia. | Rotaviruses are a rare cause of acute gastroenteritis in children worldwide. | Among the bacterial pathogens that cause foodborne diseases are Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus. | Medicine | Clostridioides difficile disease can be both nosocomial and community-acquired in children. | 80 | 1 | 3b4e69e2-21ee-454b-9502-99d70a98d4f4 | 2023 |
Among the following clinical characteristics related to anorexia nervosa, point out the correct statement: | It is distributed equally between both sexes. | A clinical form is associated with binge eating and purging behaviors. | There is a desire to lose weight, but with a normal perception of one's own constitution. | Medicine | Amenorrhea is a necessary diagnostic criterion for disease in women. | 81 | 1 | a022cd3c-d6ae-4ce6-9c16-14ea9a9048fa | 2023 |
In relation to hypertrophic pyloric stenosis, indicate the incorrect statement: | A higher incidence has been found in daughters of mothers treated with macrolides during pregnancy. | It predominantly affects first-born males. | The treatment of choice is the Ramstedt extramucosal pyloromyotomy. | Medicine | The typical hydroelectrolytic alteration is a hypochloremic metabolic acidosis. | 82 | 3 | a2c757a4-08a4-4e81-8c54-3de4c5099a5e | 2023 |
For the diagnosis of classic Kawasaki disease, the presence of fever for at least five days and 4 of the main signs of the disease are necessary. Of the following, indicate which IS NOT CONSIDERED a main sign: | Polymorphic exanthema. | Erythema of the pharyngeal and oral mucosa with strawberry tongue and/or cracked lips. | Bilateral exudative conjunctival injection. | Medicine | Cervical lymphadenopathy (> 1.5 cm in diameter), usually unilateral. | 83 | 4 | 4ae73989-5cf7-4405-9ac8-b19c83b324e3 | 2023 |
Regarding vaccines and vaccination schedules in the autonomous communities of Spain, indicate the incorrect statement: | Non-systematic vaccines are those that are not administered universally in all autonomous communities. | Systematic vaccines are those that are mandatorily administered to all children according to the current vaccination schedule in their autonomous community. | Vaccination schedules should be continuously updated according to the development of new vaccines or the change in incidence of diseases in a specific geographic area. | Medicine | The vaccination schedule is defined as the chronological sequence of vaccines that are systematically administered in a specific country or geographical area. | 84 | 1 | 0e46d43d-bb38-4517-a37c-05cda42d2668 | 2023 |
A 7-year-old patient has been admitted for several days with a diagnosis of pneumonia, treated with antibiotics. He continues to have fever spikes which prompts a thoracic ultrasound, in which pleural effusion with multiple partitions is observed. A diagnostic thoracocentesis is performed, extracting purulent material. What should be done next?: | Repeated thoracentesis to remove as much effusion as possible. | Closed drainage with a chest tube with instillation of fibrinolytics. | Expansion of antibiotic coverage. | Medicine | Surgical decortication. | 85 | 1 | 1aab9cfd-5186-4f38-ab21-a2686a22f2b7 | 2023 |
A 13-year-old female presents to the clinic with high fever of 5 days duration, sore throat, headache, abdominal pain, and severe fatigue that interferes with her daily life. Upon examination, red tonsils with exudative membrane that are foul-smelling are observed. Anterior, posterior, occipital, and epitrochlear lymph nodes are palpable. The liver is palpable at 1 cm and the spleen at 3 cm from the costal margin. Given these symptoms and findings, which serological test would you request? | Measles. | Measles. | Parvovirus B 19. | Medicine | Epstein-Barr. | 86 | 3 | b58ccd18-3eeb-4b53-98a3-7054fc72df08 | 2023 |
Indicate which drug is not recommended for the maintenance treatment of bipolar disorder: | Valproate. | Lithium. | Chlorazepate. | Medicine | Carbamazepine. | 87 | 4 | b20d7eaf-f49a-4838-9488-5fe15e7ef6b0 | 2023 |
A 26-year-old male has presented with a first depressive episode, with complete remission of symptoms with a first antidepressant in monotherapy. How long is it recommended to maintain the treatment? | It is recommended to maintain the treatment for a minimum of three months after remission. | In a first episode in young patients with a good response, treatment can be discontinued after a month. | It is recommended to maintain the treatment for a minimum of two years to prevent relapses. | Medicine | It is recommended to continue the treatment for a minimum of six months after remission. | 88 | 3 | c9cb8695-fccb-48ac-a0e3-5634b2451678 | 2023 |
A 71-year-old male with no psychiatric history presents with a three-week progression characterized by memory deficit, inattention, insomnia, weight loss, restlessness, morning prevalent distress, and delusional ideas of guilt and harm. Of the following, the most likely diagnosis is: | Late-onset schizophrenia. | Catalepsy. | Severe depressive episode with psychotic symptoms. | Medicine | Alzheimer's Disease. | 89 | 4 | 6517b603-5fe8-405a-9d87-3d931fa56f95 | 2023 |
Major depression, especially if it is endogenous/melancholic in nature, is characterized by one of the following alterations: | Decreased cortisol secretion. | Increase in appetite. | Morning worsening. | Medicine | Difficulty waking up in the morning. | 90 | 4 | 2e50de0b-23b0-4dfc-9890-bd06264f460b | 2023 |
Indicate which of the following disorders is not an anxiety disorder according to the DSM-5: | Selective Mutism. | Obsessive-compulsive disorder. | Panic disorder. | Medicine | Situational phobia. | 91 | 1 | c44098c1-b555-459e-93ca-8045a6fc928e | 2023 |
In psychogeriatrics, when the use of benzodiazepines is necessary, which one is the drug of choice? | Lorazepam. | Chlorazepate. | Benzodiazepines are contraindicated. | Medicine | Diazepam. | 92 | 2 | 14d3326d-a50f-4d27-b0c5-0413427ec15b | 2023 |
In relation to the side effects of antipsychotics, point out the incorrect statement: | Sedation is a common side effect with most antipsychotics, more pronounced at the beginning of treatment. | The occurrence of metabolic syndrome is more common with the use of typical antipsychotics. | Akathisia is an extrapyramidal side effect for which the addition of benzodiazepines or the use of beta blockers may be indicated for treatment. | Medicine | Tardive dyskinesia is an involuntary movement disorder that most frequently affects the orofacial region, appears after prolonged administration of antipsychotics and may be irreversible. | 93 | 1 | aa19bd24-cf07-427a-8521-7768924154c4 | 2023 |
Regarding combined therapy with psychotropic drugs and psychotherapy for mental disorders, it is true that: | The quick relief of anxiety symptoms due to medication reduces the motivation for psychotherapy. | It is only indicated when both forms of treatment have failed separately. | The results of combined therapy are superior to those of each one used separately. | Medicine | It requires that the same professional carry out both treatment modalities. | 94 | 4 | 1595f9c4-6d42-4445-ad04-5f0dc8fa9a2f | 2023 |
Within the primary parkinsonian syndromes, Parkinson's disease is caused by: | A degeneration of the nuclei of the pons, inferior olive, and the cerebellum. | A neuronal degeneration that particularly affects the globus pallidus, reticular substance, and inferior olive, resulting in a dopamine deficit. | A progressive neuronal degeneration at the cortical level and in the basal ganglia. | Medicine | A cellular degeneration in the substantia nigra reduces the dopamine rate at the striatum level, which causes excessive subthalamic and pallidal activity. | 95 | 3 | 29d28870-1a73-4fd6-af3a-639d04565a37 | 2023 |
Regarding the neurological examination of a lesion in the corticospinal tract, indicate the incorrect statement: | The Babinski reflex is present. | Global weakness is found in all muscle groups of the affected limbs. | There is hyperreflexia in the patellar tendon reflexes. | Medicine | Displays hypertonia of the rigidity type. | 96 | 3 | 57721860-824c-4c27-aee2-a20c552c1f6e | 2023 |
A 52-year-old male, diabetic, who is consulting for painless right foot drop. On examination, there is weakness in the anterior tibial muscle and right peroneals, with preserved patellar and achilles reflexes. What is the most likely diagnosis? | Right external popliteal sciatic mononeuropathy. | Right S1 radiculopathy. | Diabetic Amyotrophy. | Medicine | Right L5 radiculopathy. | 97 | 2 | 175809e0-fc18-422f-8329-057f0d8af598 | 2023 |
In a patient with a parkinsonian syndrome that has evolved over two years, indicate which of the following clinical manifestations would make you doubt a diagnosis of Parkinson's disease: | Absence of tremor. | Severe dysarthria. | Constipation. | Medicine | Presence of a REM sleep behavior disorder. | 98 | 1 | 7d870be4-fec6-473a-8e3f-0f7dc36c7f3b | 2023 |
A 19-year-old student suffers a first generalized tonic-clonic seizure while lying on the couch. The neurological examination is normal. In the directed anamnesis, he tells us that he had been sleeping fewer hours these days because he was studying for exams and that sometimes, in the mornings, he has arm spasms when grabbing the breakfast cup. His electroencephalogram shows generalized spike and polyspike-wave discharges. Indicate the incorrect answer: | I would not start treatment as this is a first crisis. | The cranial MRI is probably normal. | Would start treatment with valproate. | Medicine | The most likely diagnosis is juvenile myoclonic epilepsy. | 99 | 2 | 4e268f2a-88c0-45f6-8333-e93aac55d19d | 2023 |
A 21-year-old male presents with a psychiatric condition characterized by hallucinations, behavioral changes, and episodes of catatonia. Within a few days, memory deficit and oral dyskinesias are added to the condition and on the tenth day, he starts having seizures. Which of the following tests would provide more information for the diagnosis? | Long-duration EEG with video-EEG. | Cerebral MRI with spectroscopy. | Study of specific autoimmune autoantibodies in cerebrospinal fluid (CSF) and serum. | Medicine | Perform a treatment cycle with high-dose methylprednisolone to evaluate response. | 100 | 4 | 9d9492e2-804d-4c7f-b8c2-cd357b57fd28 | 2023 |
A 53-year-old woman with no significant history presents to the emergency department with sudden onset speech disturbance one hour ago. On evaluation, only motor aphasia is detected. The baseline cranial CT is normal. However, the perfusion CT shows a flow defect in the left frontal cortical region with no involvement in the volume maps. Furthermore, the angio-CT shows a thrombus in the distal segment (M3-M4) of the left middle cerebral artery. Identify which of the following is the most appropriate treatment: | Endovenous fibrinolysis with rTPA. | Mechanical thrombectomy. | Anticoagulation with sodium heparin. | Medicine | Endovenous fibrinolysis and, if recanalization is not achieved, mechanical thrombectomy. | 101 | 2 | d6a63aba-7442-4050-88d5-b975bbb181f7 | 2023 |
In patients with tuberous sclerosis (Bourneville's disease), indicate the incorrect response: | They usually present with facial angiofibromas. | They often have epileptic seizures. | They often present with neurinomas. | Medicine | The most common brain tumor is the subependymal giant cell astrocytoma. | 102 | 4 | 89c5999d-1ad4-4723-aa23-50d7872771df | 2023 |
A 64-year-old woman presents with facial pain in the territory of the third branch of the V pair. Regarding the diagnosis of trigeminal neuralgia, indicate the incorrect statement: | The pain has a trigger point, associated with tactile stimulation of the affected area. | Sharp, very short-lasting pain. | It is associated with facial hypoesthesia. | Medicine | The pain can disappear spontaneously after persisting for weeks or months. | 103 | 4 | e2a57906-cda2-46d7-86c3-51d8a77025a2 | 2023 |
Regarding post-traumatic epileptic seizures, it is true that: | Penetrating injuries and the severity of the injury are contributing factors. | They are common immediately after the impact. | After a couple of years of higher risk, patients with severe injuries have the same risk as the general population. | Medicine | Prophylactic anticonvulsant treatment is indicated. | 104 | 2 | e07f595e-83b9-4224-8edc-6002abe79485 | 2023 |
A 25-year-old male is admitted to the ICU after an undetermined pharmacological intoxication. Due to a progressive decrease in the level of consciousness, with no improvement with naloxone or flumazenil, it was decided to perform orotracheal intubation and invasive mechanical ventilation. Which of the following drugs would not be used to perform the orotracheal intubation?: | Rocuronium. | Quetiapine. | Fentanyl. | Medicine | Etomidate. | 105 | 1 | 098b7107-0378-4755-8789-6f3441152867 | 2023 |
A 50-year-old male with Legionella pneumonia requiring admission to the ICU due to acute respiratory failure. He needs to be intubated orotracheally and connected to invasive mechanical ventilation. He is diagnosed with acute respiratory distress syndrome and is placed in the prone position. With respect to this positional technique, indicate the incorrect statement: | It is performed by trained personnel to avoid complications. | It is performed to try to increase the relationship between the partial pressure of oxygen and the inspired fraction of oxygen. | The prone position during invasive mechanical ventilation requires deep sedation. | Medicine | The relationship between the partial pressure of oxygen and the inspired fraction of oxygen below which is recommended is 300 mmHg. | 106 | 3 | 63cc99f7-1342-42d4-af63-6697fb29725f | 2023 |
A 58-year-old patient suffering from pneumonia due to COVID-19 requiring intubation with mechanical ventilation in ICU. After a week, a tracheostomy is performed, and the patient continues to require mechanical ventilation. A motor deficit is detected in all four limbs with general hypo-reflexivity. The initial diagnostic orientation and the therapeutic approach to follow will be: | Post-COVID Syndrome. Respiratory rehabilitation. | Guillain-Barré Syndrome. Confirm the diagnosis with additional tests. | Critical illness myopathy. Intensive respiratory and motor rehabilitation. | Medicine | Critical Illness Myopathy. Steroids and supplementary tests. | 107 | 4 | ead4618e-3997-460b-b56c-b8a21b038c08 | 2023 |
A 55-year-old man with no significant medical history, who after exertion, experiences lumbar pain radiating to the lower right limb, anterior and lateral part of the thigh, and front of the knee. Examination: positive Lasègue sign at 40 º, decreased patellar reflex, and difficulty in heel to toe walking. What is the most likely diagnosis? | Right L3-L4 disc herniation. | Right L2-L3 disc herniation. | Right L5-S1 disc herniation. | Medicine | Right disc herniation L4-L5. | 108 | 3 | 1d907296-c789-42c2-8724-50b479ae28a2 | 2023 |
A 5-year-old patient comes to emergency with a fever that has lasted for 48 hours, responding poorly to antipyretics and refusing to support on the left lower limb. In the physical examination, limited mobility of the hip is observed. Analysis shows an increase in CRP and leukocytosis. What supplemental test should be the first to be requested?: | Hip ultrasound. | Hip X-ray. | Hip Arthrography. | Medicine | MRI of both hips. | 109 | 2 | 4d09b440-f22b-4cf0-93da-9345bc9ba88f | 2023 |
82-year-old woman with a history of congestive heart failure and breast cancer who is consulting for a left wrist fracture. The fracture is stable, not comminuted, and does not have intra-articular traces. Which of the following treatments is most appropriate?: | Total wrist arthroplasty. | Closed reduction and forearm cast. | Do not immobilize, immediate rehabilitation. | Medicine | Osteosynthesis with dorsal and volar plates. | 110 | 1 | 2167c477-49a6-40c5-9b90-3acac9f8ffad | 2023 |
A 35-year-old domestic worker, with no relevant medical history, right-handed, who reports pain in the 5th finger of her left hand and the inner side of her left forearm accompanied by numbness and partial loss of sensitivity. What would be the first diagnostic suspicion? | Cervical disc herniation C3-C4. | Carpal Tunnel Syndrome. | De Quervain's Tendinitis. | Medicine | Epitrochlear ulnar compression. | 111 | 3 | a7814c10-bc05-4efa-ad08-f7af5ec0f388 | 2023 |
Regarding the nonunion of the scaphoid, indicate the incorrect statement: | It can progress in an asymptomatic manner. | It usually progresses with necrosis of the distal fragment of the fracture. | In early stages, the treatment of choice is the fixation of the fracture and provision of a bone graft. | Medicine | In the long term, it usually causes radiocarpal osteoarthritis. | 112 | 1 | 6c32aaca-3378-4fb4-87bb-d0804761f0d0 | 2023 |
69-year-old male with a body mass index of 37 and significant central (abdominal) obesity, suffering from incapacitating lumbar pain that extends to both buttock regions, but does not radiate to the lower limbs. It prevents him from standing still and walking for more than 10 minutes, but disappears when sitting and in bed. The Lasègue maneuver is negative. What is the most probable diagnosis? | Lumbar canal stenosis. | Disc herniation at the L5-S1 level. | Bacterial spondylodiscitis. | Medicine | Disc herniation at level L4-L5. | 113 | 2 | a623bf67-6c99-4caf-a554-4a503c369634 | 2023 |
In the case of a diaphyseal lesion of the humerus of lytic character that affects the entire diameter of the bone in a 67-year-old male with a history of lung cancer (estimated survival greater than 2 years) and causing him poorly controlled continuous pain. Which of the following is the best therapeutic approach?: | Application of high-dose morphine to control pain that allows him to undergo physiotherapy to recover function. | Observant approach, as this is a non-weight bearing bone, which reduces the risk of fracture. | Placement of a locked intramedullary nail. | Medicine | Adjust a cast correctly to reduce the risk of fracture. | 114 | 4 | 323c77db-4107-4611-89ff-7ba550d54fdc | 2023 |
A 29-year-old male presents with lumbar pain and hand edema of several weeks duration, along with blurred vision and red eyes. He has had multiple unprotected sexual encounters and there are cases of psoriasis in his family. On physical examination, he presents with a temperature of 37.5 ºC, bilateral conjunctival injection, and swelling of the distal parts of the fingers and left wrist, with positive sacroiliac maneuvers. What is the most likely diagnosis? | Psoriatic arthritis. | Reactive arthritis. | Ankylosing spondylitis. | Medicine | Enteropathic Arthritis. | 115 | 1 | 788786da-399d-47ce-8634-a87c1084feb6 | 2023 |
A 55-year-old male with a history of hyperuricemia presents to the emergency department with a first episode of very intense and disabling acute pain in the right knee accompanied by redness, swelling and edema. Low-grade fever of 37.5ºC. What is the most advisable course of action to follow?: | Start treatment with colchicine because you are experiencing a gout episode. | Perform arthrocentesis and send the synovial fluid to the laboratory to evaluate the presence of crystals and germs. | Start treatment with an NSAID, allopurinol and an antibiotic to treat the gout episode, hyperuricemia, and probable infection. | Medicine | Start treatment with an NSAID and allopurinol to treat the gout episode and hyperuricemia. | 116 | 1 | 52cb51a6-b276-48b1-87ea-ff2aa6e8a97a | 2023 |
An 81-year-old asthmatic woman who frequently uses corticosteroids to control bronchospasm outbreaks is seeking help because she has intense acute pain in the dorsolumbar region after falling at home from a chair. What is the most advisable course of action to follow?: | Request a thoracic and lumbar MRI and schedule analgesic treatment and rest for the pain. | Urgently request dorsal and lumbar spine x-rays and prescribe analgesic treatment for the pain. | Request a densitometry, schedule analgesic treatment and start with antiresorptive treatment, calcium and vitamin D. | Medicine | Prescribe analgesic treatment and start antiresorptive therapy. | 117 | 1 | 6b12595a-6f02-4bfa-8056-76d0438df91c | 2023 |
Which of the following is not a criterion for the diagnosis of infectious endocarditis?: | A single positive blood culture for Coxiella burnetii. | Presence of major arterial embolic phenomena. | Presence of hemolytic anemia. | Medicine | At least two positive blood cultures drawn with an interval > 12 hours of microorganisms compatible with an infectious endocarditis. | 118 | 4 | 595011e9-e2a4-44ed-902a-fb908cc34129 | 2023 |
Which of the following criteria is considered high risk in the stratification of syncope? | Syncope during exertion or while lying supine. | Syncope produced when turning the head or pressing the carotid sinus. | Second degree Mobitz I atrioventricular block. | Medicine | Syncope after an unpleasant sight, sound, or smell. | 119 | 2 | 08f9d608-ab03-4675-8b28-01f9504672ae | 2023 |
Indicate which of the following tachycardias cannot be explained by a re-entry mechanism: | Polymorphic ventricular tachycardia type torsade de pointes. | Atrial flutter or fluttering. | Tachycardia associated with defects in the interatrial septum. | Medicine | Reciprocal atrioventricular tachycardia in Wolff-Parkinson-White syndrome. | 120 | 2 | 8453b1a1-5523-4aef-beed-aa46fa76f7dd | 2023 |
A 68-year-old male with a mechanical mitral valve, anticoagulated with acenocoumarol, presents with an INR of 9 in a routine check-up at his health center. He has no symptoms of bleeding at the current moment. Which of the following is the most correct approach?: | Discontinue the acenocoumarol and refer the patient to a hospital center to monitor the onset of bleeding. | Discontinue treatment with acenocoumarol and administer 10 mg of vitamin K in slow intravenous infusion, which should be repeated every 12 hours if necessary. | Begin the administration of prothrombin complex concentrate or fresh frozen plasma according to weight. | Medicine | Temporarily suspend the acenocoumarol and resume anticoagulation when the therapeutic range has been achieved, recalculating the dose. | 121 | 3 | c6a8ee5a-6778-4d38-88cb-41eb273087ef | 2023 |
Regarding cardiac tamponade, which of the following statements is true?: | Typical symptoms include low blood pressure, tachycardia, decreased jugular venous pressure, and diminished heart sounds. | The echocardiographic manifestations and hemodynamic changes occur prior to the appearance of clinical manifestations. | The paradoxical pulse is a characteristic finding of the physical examination, defined as a decrease of 5-10 mmHg in systolic blood pressure during inspiration. | Medicine | The volume of pericardial fluid required to produce tamponade is similar in acute pericarditis as in chronic pericarditis. | 122 | 1 | 15bd3666-3392-466c-a24b-36e6801c7926 | 2023 |
A 71-year-old patient, diabetic, with no other comorbidities, previously diagnosed with severe aortic stenosis. He was admitted for an acute coronary syndrome without ST elevation, Killip I with a slightly elevated peak in troponin. The catheterization shows coronary disease with significant proximal lesions of the three coronary vessels. His ventricular function is normal. Which of the following therapeutic strategies is the most correct?: | Surgical mechanical aortic valve prosthesis, followed by interventional percutaneous coronary treatment at a later stage. | Interventional treatment with the implantation of coronary stents in all 3 vessels and simultaneous implantation of a transcatheter aortic bioprosthesis (TAVI). | Simultaneous surgical treatment with valve replacement and coronary surgical revascularization with bypass. | Medicine | Transcatheter aortic biological prosthesis (TAVI) and then, on an outpatient basis, percutaneously treat the coronary arteries with stents. | 123 | 4 | d2cc7dce-97e2-49f2-a721-3f0148416a6a | 2023 |
A 75-year-old male who reports progressive dyspnea, with decreasing tolerance for effort. He reports fainting on two occasions in recent months, coinciding with moderate effort and reports occasional chest pain that increases with effort. On examination, the presence of a parvus et tardus arterial pulse and a mesosystolic murmur are notable. The analysis is normal except for a creatinine of 2.2 mg/dL. The surgical risk assessment establishes an intermediate risk. Please indicate which of the following therapeutic options is most recommended: | Percutaneous implantation of the aortic valve (TAVI). | Surgical replacement of the mitral valve. | Percutaneous mitral valvulotomy. | Medicine | Surgical replacement of the aortic valve. | 124 | 2 | 3f73364b-7657-4b5a-8f4b-dcffb4841f92 | 2023 |
A 43-year-old woman, professional swimmer, with no relevant medical history, reports swelling and heaviness in her right arm for 72 hours. Upon examination, edema of the right upper limb is noticeable with the presence of dilated veins in the pectoral region. Regarding the diagnostic approach, indicate the incorrect answer: | A simple chest x-ray should be performed to detect bone abnormalities. | The color Doppler ultrasound is of great value as the first diagnostic test. | A phlebography should be performed to confirm the presence of axillosubclavian venous thrombosis. | Medicine | The angiogram-CT allows for confirmatory diagnosis. | 125 | 4 | 7189f568-c27b-4a89-a206-b8d56a8e426d | 2023 |
A 72-year-old male presents to the emergency department with fever, cough, and purulent expectoration for the past three days. Upon examination, he is oriented and has a good level of consciousness. Blood pressure is 110/75 mmHg, respiratory rate is 32 breaths/min. Pulmonary auscultation reveals crackles in the middle field of the right hemithorax. The chest X-ray shows an alveolar infiltrate in the middle lobe. Point out the correct statement about the severity criteria gathered in the CRB-65 scale and the attitude to follow: | Score of 1 point and would be eligible for discharge and outpatient treatment depending on the doctor's judgement. | Score of 0 points and would be subject to discharge and outpatient treatment. | Score of 3 points and requires hospital admission. | Medicine | Score of 2 points and may require hospital admission depending on the doctor's discretion. | 126 | 3 | ddb6048e-862c-4f46-abeb-43c596dbfd89 | 2023 |
A 67-year-old male diagnosed with COPD with a GOLD 1 category, smoker, who reports dyspnea with intense efforts, without exacerbations. Which of the following would be the most correct therapeutic recommendation?: | Regular treatment with long-acting beta-adrenergic bronchodilators (LABA). | Regular treatment with long-acting muscarinic bronchodilators (LAMA). | Non-pharmacological treatment. | Medicine | Treatment with LABA plus inhaled glucocorticoids. | 127 | 4 | 0065e38a-2da4-40cc-be68-1e00d4968c56 | 2023 |
70-year-old woman admitted for severe traumatic brain injury with secondary subarachnoid hemorrhage. On the second day of admission, she presents with dyspnea and chest pain. A chest angio-CT scan is performed which confirms the diagnosis of pulmonary embolism. The treatment of choice is: | Rivaroxaban. | Low molecular weight heparin. | Inferior vena cava filter. | Medicine | Acenocoumarol. | 129 | 4 | 8184f4a6-1b3b-4a61-ac1c-3ea5c8b69b91 | 2023 |
A 71-year-old patient presents with jaundice with a total bilirubin of 6 mg/dL (direct bilirubin 4 mg/dL), normal transaminases and elevated GGT of 349 U/L and alkaline phosphatase of 260 U/L. An abdominal ultrasound shows dilation of the intra- and extrahepatic bile ducts. The patient does not have pain but reports a weight loss of about 5 kg in the last month. An endoscopic retrograde cholangiopancreatography was performed, revealing an abrupt stenosis of the distal bile duct. What is your first diagnostic suspicion?
| Choledocholithiasis. | Primary sclerosing cholangitis. | Acute hepatitis. | Medicine | Pancreatic cancer. | 130 | 3 | 9e4dd04f-069a-48d1-8df7-30c30519e51b | 2023 |
A 58-year-old male with compensated cirrhosis Child A-5 secondary to non-alcoholic fatty liver, with no other history. He reports asthenia without anorexia or weight loss. In a screening abdominal ultrasound and subsequently in a triphasic thoracoabdominal CT, four liver lesions (one of them 6 cm) are detected, hypervascular in the arterial phase and with washout in the venous phase, with portal vein invasion and without extrahepatic metastases. No ascites is observed. Which of the following is the best treatment?: | Sorafenib. | Transarterial chemoembolization. | Radiofrequency ablation. | Medicine | Liver transplant. | 131 | 2 | 67b1854f-588d-40f2-bf87-fe80ae3f099c | 2023 |
Which of the following types of acute appendicitis most frequently presents with a positive psoas sign?: | Mesoceliac Appendicitis. | Pelvic Appendicitis. | Mid-inguinal appendicitis. | Medicine | Retrocecal appendicitis. | 132 | 3 | e8a02108-c5af-41c6-8a3f-10b0cad89a97 | 2023 |
A 45-year-old patient had an episode of cholecystitis three months ago, in which gallstones were discovered by ultrasound. Now the patient presents with high alkaline phosphatase and in a new ultrasound, small size gallstones with a bile duct of 1 cm in diameter. Which of the following examinations would you perform before the surgical intervention? | Endoscopic Ultrasound. | Endoscopic Retrograde Cholangiopancreatography. | Cholangio MRI. | Medicine | Transhepatic cholangiography. | 133 | 4 | 0b8ac6e2-5436-4d2f-aa98-3ed534031a08 | 2023 |
Regarding the anal fissure, indicate the incorrect statement: | It has two typical forms: the primary or idiopathic appears in healthy individuals and is not associated with any type of disease; the secondary is detected in patients who are suffering from another process. | It consists of a longitudinal tear in the skin that covers the portion of the anal canal distal to the dentate line, causing intense pain during defecation. | Fissures secondary to other diseases often appear in more lateral positions. | Medicine | Most primary fissures are located in the anterior commissure, as this is an area of the anal canal more susceptible to trauma and mucosal ischemia. | 134 | 3 | 66449219-7daf-4c9a-96dd-2860da0290c1 | 2023 |
A 24-year-old woman underwent endometriosis surgery a year ago due to episodes of intense abdominal pain, particularly related to her menstrual cycle, occasionally accompanied by nausea and vomiting. Despite the surgery, she has not noticed any improvement, with progressive worsening and spreading of the pain throughout her body, along with limb weakness. Routine tests are normal, antinuclear antibodies and rheumatoid factor are negative, there are only some isolated results with a Na of 132 mEq/L and some slightly elevated ALT (GOT). Recent abdominal ultrasound and abdominopelvic CT scan are normal. Two months ago, she was diagnosed with depression and fibromyalgia. Antidepressant treatment and opiate-derived analgesics appear to have no effect. She has spent months hardly getting out of bed. We are asked for a second opinion. Indicate which of the following diagnostic tests we should check has been performed: | Porphobilinogen and aminolevulinic acid in urine. | Study of the MEFV gene. | Calprotectin in stool. | Medicine | Antimitochondrial antibodies in blood. | 135 | 2 | 64e3f911-cd11-4c66-8dd9-050a0db1f8c3 | 2023 |
A 34-year-old male, who goes to the emergency room due to dyspnea evolved over three weeks, along with the presence of intermittent red urine over the last ten days. The physical examination reveals: temperature 36.6 ºC, BP 132/72 mmHg, respiratory rate 16 rpm and heart rate 88 bpm, along with dispersed fine rales in pulmonary auscultation. Blood analysis: BUN 56 mg/dL, creatinine 5.8 mg/dL. Urine analysis: red cells 4+, proteins 2+. A kidney biopsy is performed, revealing a diffuse glomerulonephritis with crescent formations. Which of the following tests would confirm the diagnosis?: | Titers of anti-glomerular basement membrane antibodies. | C3 complement concentration. | Stool culture for Escherichia coli O157:H7. | Medicine | Anti-streptolysin O titers. | 136 | 2 | 9b6241a1-a191-479d-9a55-c5034b689d1e | 2023 |
A 36-year-old patient arrives at the emergency department due to general malaise. No previous analytical tests exist. Creatinine 10 mg/dL, Hb 6.5 g/L, absence of microalbuminuria, PTH 500 pg/ml, total diuresis preserved are detected. Ultrasound: kidneys are reduced in size. Which of the following diagnoses is most likely?: | Rapidly progressive glomerulonephritis. | Autosomal dominant polycystic kidney disease. | Diabetic nephropathy. | Medicine | Chronic tubulointerstitial nephropathy. | 137 | 3 | faf86b41-1e10-490b-946e-955bdc0f1bd4 | 2023 |
English translation: A 73-year-old man presents to the emergency department with pain in the lumbosacral area radiating to both flanks and hypogastrium, of two-week's duration, that does not alleviate with high doses of ibuprofen. He has a history of hypertension, infrarenal aortic aneurysm, and L5-S1 disc herniation. He reports a loss of 6 kg in weight over the past month. Examination: Generally poor condition, mucocutaneous pallor, and doubtful bilateral renal fist percussion, with no other findings. Lab results: Hb 8.2 g/dL, MCV 81 fL, leukocytes 6,330 (normal formula), glucose 89 mg/dL, urea 228 mg/dL, creatinine 5.4 mg/dL, Na 134 mEq/L, K 5.1mEq/L, Ca 11.3 mg/dL, total proteins 8.2 g/dL, albumin 3.0 g/dL, CRP 0.54 mg/dL. Urine: proteins 30 mg/dL with estimated proteinuria 1.5 g/24h. Urine sediment: leukocytes 20-30/field, erythrocytes >50/field. What diagnosis do you think is most likely as the cause of renal failure?: | Multiple Myeloma. | Acute interstitial nephropathy due to analgesics. | Progression of the aortic aneurysm with bilateral involvement of the renal arteries. | Medicine | Acute pyelonephritis. | 139 | 2 | c0b5e935-1e52-4156-88d3-45f058d8113a | 2023 |
A 45-year-old man was brought to the emergency room after experiencing tonic-clonic seizures in public. He appears confused and responds with vague and incoherent answers. After reviewing his history, it is found that he has been diagnosed with schizophrenia and depressive disorder, but he seems to have stopped taking his treatment for the past few weeks. Examination: Stuporous, no other findings. Lab tests show a normal hemoglobin count, glucose at 98 mg/dL, urea at 37 mg/dL, creatinine at 0.8 mg/dL, Na at 118 mEq/L, K at 3.4 mEq/L, Ca at 9.7 mg/dL, serum osmolality is 252 mOsm/kg, urinary osmolality is 78 mOsm/kg, urine density is 1002, and normal urine sediment. What is the most likely cause of his electrolyte abnormalities? | Primary Polydipsia. | Adrenal insufficiency. | Inappropriate ADH Secretion Syndrome. | Medicine | Diabetes insipidus. | 140 | 2 | a6ad76eb-f760-4c8b-9a2a-f55a70393ca3 | 2023 |
In relation to radical prostatectomy for the treatment of prostate cancer, indicate the incorrect answer: | The recovery of erectile function after radical prostatectomy is associated with younger individuals, quality of erections before the operation, and absence of damage to the neurovascular bundles. | The factors related to continence after a radical prostatectomy include advanced age, urethra length, and surgeon's experience. | A PSA >0.01 after a radical prostatectomy is indicative of biochemical recurrence. | Medicine | Alprostadil can help restore satisfactory sexual function. | 141 | 4 | db1a7766-1e80-4fc0-9aa1-53af1aa7af03 | 2023 |
In prostate cancer it is true that: | For its diagnosis, contemporary schemes recommend biopsies with 10 cylinders. | Patients with clinically localized disease are treated with radical prostatectomy, radiotherapy, or active surveillance. | In its treatment, first-generation non-steroidal antiandrogens such as bicalutamide and abiraterone are used. | Medicine | After radical prostatectomy, the PSA becomes undetectable in the blood within two weeks. | 142 | 1 | 66d8cc4b-1dd4-41ca-9984-4b0f4a41d7f1 | 2023 |
The performance of the selective biopsy of the sentinel lymph node and the lymphatic map in breast cancer: | It is indicated if there is clinical involvement of the axillary lymph nodes. | It is indicated in disseminated breast cancer. | It is not indicated for males with breast cancer. | Medicine | If it is negative, there is no need to expand the axillary surgery. | 143 | 3 | 44587933-fa9f-47a1-af55-acf2fd22b18b | 2023 |
Regarding radiotherapy treatment, indicate the incorrect answer: | It is also used for certain benign pathologies. | It can be an alternative for curative treatment in various situations in oncology. | It has proven usefulness in controlling pain from bone metastases. | Medicine | It is contraindicated for the treatment of pediatric tumors. | 144 | 3 | 2c7a2a0e-1b71-4433-8431-beb400c13d11 | 2023 |
Patient with a diagnosis of glioblastoma multiforme. The pathology report indicates the presence of methylation of the MGMT gene promoter (methyl guanine methyl transferase). Regarding the treatment of this patient: | The presence of methylation increases survival in patients treated with temozolomide. | This information is not relevant. | The presence of methylation would support the decision of treatment with cisplatin compared to the use of an alkylating agent. | Medicine | The presence of methylation would contraindicate treatment with temozolomide. | 145 | 2 | 9ebeef36-4907-4610-844f-d4f35efa13db | 2023 |
Radiation therapy in the treatment of locally advanced breast cancer and adverse molecular prognosis: | It is contraindicated after mastectomy. | Should include the locoregional lymph node regions. | Your best aesthetic alternative is partial breast irradiation. | Medicine | It is contraindicated after neoadjuvant chemotherapy. | 146 | 1 | 7ef2d9fc-48ab-4fe7-8d73-29485cf5a53d | 2023 |
19-year-old male, asymptomatic, who presents in a preoperative analysis with thrombocytopenia (platelets 43 x 10^9/L) with normal levels of hemoglobin and leukocytes. What should be the first course of action?: | Perform a bone marrow biopsy to determine if the thrombocytopenia is of central or peripheral origin. | Start treatment with oral prednisone. | Transfuse a platelet concentrate to prevent a hemorrhagic problem. | Medicine | Perform a morphological examination of the blood smear to rule out the presence of platelet aggregates induced by the anticoagulant. | 147 | 3 | 48615517-b1d8-4067-92de-8652a81d6643 | 2023 |
A 35-year-old male, diagnosed with Hemophilia A since childhood, received a liver transplant due to chronic liver disease caused by the Hepatitis C virus. Six months after the procedure, he presents a normal coagulation study with 100% factor VIII activity. Which of the following statements is true?: | The immunosuppressive treatment has solved the problem as we are dealing with an autoimmune condition. | Hemophilia has been cured since factor VIII is synthesized in the liver. | It can only be a mistake or a laboratory artifact, as Hemophilia A is a genetic disease that is incurable today. | Medicine | The long half-life of the antihemophilic factors used in the transplant ensures that their effect lasts several months. | 148 | 1 | c8d8c304-784e-4b3a-ae94-b3d5f9407254 | 2023 |
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