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A 68-year-old woman who uses +4.00 diopter glasses for distance vision in both eyes. She consults because for a few weeks she has had eye pain with a headache and blurred vision at night when she is watching television in dim light. Which of the following conditions is she most likely to have? | Migraine. | Primary angle-closure glaucoma. | Dry eye syndrome. | Medicine | Actinic keratitis. | 64 | 1 | fbdb72cd-4b62-4e59-8ea8-47decc8ac079 | 2022 |
Which of the following entities is a patient who comes to a consultation for blurred vision and metamorphopsia most likely to present?: | Optic neuritis. | Maculopathy. | Intumescent cataract. | Medicine | Acute glaucoma. | 65 | 1 | 084496e2-fd84-4f73-8a59-ffd23c3ddd13 | 2022 |
A 60-year-old woman with episodes of dizziness lasting seconds, triggered by movements of her head to the right and when she turns in bed to the right. It is not associated with hearing loss, a sense of blockage, or tinnitus. The otological examination, as well as the standing and walking assessment are normal. No spontaneous nystagmus is evident, but with the Dix-Hallpike maneuver to the right, after a brief latency, a disconjugate nystagmus (more torsional right and more vertical left) is identified, lasting about 30 seconds with dizziness and nausea. Indicate the correct statement about her diagnosis and management: | Benign paroxysmal positional vertigo, should be treated with the right Epley maneuver. | Vertigo of central origin, it is necessary to perform a neuroimaging test. | First crisis of Ménière's disease in right ear, intratympanic corticosteroids will be administered. | Medicine | Right vestibular neuronitis, must be treated with sulpiride. | 66 | 2 | f618e986-5eaa-4001-928f-5e30c8f6ac4a | 2022 |
A 40-year-old man without relevant medical history presents with gradual onset left-sided hearing loss and an ipsilateral lump in his neck. He does not report upper respiratory tract infection, watery rhinorrhea, nasal itching, otalgia, otorrhea, vertigo, or tinnitus. In the otoscopy, the left eardrum appears intact with an image of amber liquid with bubbles in the middle ear, while the right ear examination is normal. Rinne test is positive in the right ear and negative in the left ear, Weber test lateralizes to the left ear. Which of the following diseases is he most likely to have in his left ear?: | Chronic cholesteatoma otitis media that needs to be treated through surgery. | Acute otitis media that should be treated with oral antibiotics. | Sensorineural hearing loss that requires the performance of a tonal audiometry and a speech audiometry. | Medicine | Serous otitis media that requires a nasopharyngeal examination in search of a neoplasm or obstruction of the Eustachian tube. | 67 | 3 | 10c1ae95-d6d4-45e3-9ee6-73afdb37774d | 2022 |
A 52-year-old woman, who was diagnosed with acute maxillary, ethmoidal, and right frontal sinusitis three weeks ago. She initially improved with antibiotic treatment, nasal decongestant, mucolytic, and topical corticosteroids. She comes in two weeks later with a fever, intense headache, nausea, and general malaise. For the study of possible intracranial purulent complications, the most appropriate complementary test is: | Nasal endoscopy with rigid or flexible optics. | Computed tomography scan of the facial mass with coronal and axial cuts. | Lumbar puncture. | Medicine | Nuclear magnetic resonance with gadolinium. | 68 | 3 | 8d76cddb-d4fa-441e-ab73-8a043b0e19da | 2022 |
What is the most important sonographic marker in the screening for preeclampsia in the first trimester of pregnancy? | Placental thickness. | Cranio-caudal length. | Pulsatility index of the mother's central retinal artery. | Medicine | Pulsatility index of the uterine arteries. | 69 | 3 | b9bf7380-4b06-4bde-a014-6d003cc00fa5 | 2022 |
A 43-year-old woman with a levonorgestrel intrauterine device is consulting due to lack of night rest, experiencing heat and palpitations. In the analysis, she has a free T4 of 10.5 pmol/L (9-19), thyrotropin 2.1 mIU/L (0.30-5.00), FSH 95.6 IU/L (1.38-16.7), LH 21 IU/L (2.4-9.3), estradiol < 0.07 nmol/L (0.07 - 1.14). What is the most appropriate treatment? | Vaginal Estrogens. | Benzodiazepines. | Continuous regimen of transdermal estrogens. | Medicine | Oral estrogens and progestogens in a continuous regimen. | 70 | 4 | 8566da92-da11-4fca-991a-08f4db01ecb3 | 2022 |
Regarding the prenatal study of aneuploidies through combined first trimester screening, what is the correct statement? | It is carried out through the combination of analytical and ultrasound data. | The value of the free fraction of chorionic gonadotropin is decreased in trisomy 21. | The nuchal translucency should be measured between 11 and 14 weeks, by performing a sagittal slice and with the embryo in a hyperflexion position. | Medicine | It is indicated in the first trimester for at-risk pregnant population. | 71 | 2 | 73e79f19-17ff-43fc-ab47-3fb2742a41cf | 2022 |
Which of the following does not constitute a selection criterion for choosing the delivery route in breech presentation during the onset of labor?: | Measurement of fetal biparietal diameter. | Type of breech presentation (pure, complete or incomplete buttocks). | Position of the fetal head. | Medicine | Fetal weight. | 72 | 2 | 9f245577-8863-4e5c-b7da-49d0a8a7966a | 2022 |
A 51-year-old woman, menopausal for a year and a half, who consults due to vaginal spotting lasting 2 weeks. She reports that the spotting is less than a period. An ultrasound shows an endometrium of 7 mm. Indicate the correct option: | The endometrium is not thickened, so tranexamic acid is prescribed along with outpatient monitoring. | The endometrium is thickened and given the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula. | The endometrium is not thickened, but since there are clinical symptoms of metrorrhagia, performing an endometrial biopsy is indicated. | Medicine | Indicated for diagnostic hysteroscopy without the need for endometrial biopsy. | 73 | 1 | ee947163-1944-456f-8f9c-edb7735948aa | 2022 |
A 34-week primigravida presenting with blood pressure figures of 165/95 and a headache that has been evolving for two days. Analytically: hemoglobin 10.5 g/dL, platelets 98,000/mm3, AST 356 IU/L (0-31), ALT 234 IU/L (0-31), LDH 878 IU/L (125-243). The lab calls about the presence of schistocytes in a peripheral blood smear. She has received the second dose of corticosteroids for fetal maturation 24 h ago. Obstetric ultrasound shows the estimated fetal weight is at the 1st percentile for gestational age and the umbilical artery Doppler shows absence of end-diastolic flow. Which of the following is the most appropriate clinical attitude? | Watchful waiting attitude with antihypertensive treatment at home and checks every 48 hours. | Expectant management with antihypertensives and magnesium sulfate until the improvement of maternal platelets. | Immediate termination of pregnancy. | Medicine | Termination of pregnancy when fetal lung maturation is complete. | 74 | 4 | c8b41835-e1b7-4610-9baa-acec792e38ec | 2022 |
A 30-year-old woman is requesting a contraceptive method. She has a history of an emergency cesarean section 7 months ago, giving birth to a girl weighing 3.550 g. She is exclusively breastfeeding. Indicate the correct statement: | She is told that the levonorgestrel IUD is contraindicated due to having had a cesarean less than a year ago. | She is told that, if she is experiencing amenorrhea, she does not need another contraceptive method since breastfeeding is sufficient as a contraceptive method. | She is offered combined hormonal contraception. | Medicine | She is told that she could use a hormonal method of only progestogens. | 75 | 3 | 8c3ff67a-019b-4cf4-a509-45dbbe260cdd | 2022 |
A 40-year-old woman consulted because she has noticed a lump in the upper outer quadrant of her right breast for a month. She provides a report from a mammogram describing a BIRADS 3 lesion. What is the course of action to take?: | That classification likely implies surgery since the probability of cancer is over 10%. This is explained to the patient and they are preferably referred to the Breast Unit. | Reassure him, since an imaging test has already been done and malignancy has been ruled out. | The findings are of low suspicion for cancer (between 2 and 10%) but a biopsy is necessary. | Medicine | This is probably a benign finding, given that there is less than a 2% probability of cancer. It is explained that a follow-up is required every 6-12 months up to 24 months or a biopsy. | 76 | 3 | 90bd08b0-26e2-4dde-a369-bd104394f268 | 2022 |
Following the indications for cervical cancer screening, which woman would you perform a cytology on among the following candidates?: | 40-year-old woman with negative cytology and human papillomavirus test 3 years ago. | 26-year-old woman with no previous cytologies. | 22-year-old woman vaccinated for the human papilloma virus and started having sexual relations 1 year ago. | Medicine | 67-year-old woman with stress urinary incontinence. | 77 | 1 | 73183ad0-29df-4f2d-9f9a-46cafe3eca33 | 2022 |
In a genetic disease with a dominant autosomal inheritance pattern, the risk of recurrence of the disease in future offspring is: | 50% in each pregnancy in case the child is a male. | 25% in each pregnancy. | 50% in each pregnancy regardless of the sex of the offspring. | Medicine | 50% in each pregnancy as long as the partner is also a carrier. | 78 | 4 | 0a6b3ada-1e98-4921-a0cb-bb48e529722e | 2022 |
In the event of clinical manifestations, what is the most common clinical form of primary infection by the herpes simplex virus type 1 in infants and young children? | Genital. | Meningitis. | Gingivostomatitis and pharyngitis. | Medicine | Pneumonia. | 79 | 4 | 2909d3ad-524f-4cb3-a9d3-b6919692f88b | 2022 |
A 2-month-old infant with a 3-day upper respiratory tract infection, beginning with moderate breathing difficulty and lung auscultation with expiratory wheezing. The oxygen saturation is 89%. Respiratory syncytial virus is isolated in the nasopharyngeal exudate. Which of the following treatments do you consider most appropriate for this condition?: | Nebulized Salbutamol. | Oral Ribavirin. | Intravenous corticosteroids. | Medicine | Supplementary oxygen. | 80 | 3 | 247472f9-c33d-4e9e-aadc-acfa51f7e7dc | 2022 |
Regarding interventricular communications (IVC) in childhood, point out the incorrect answer: | The VSDs located in the middle and apical portion of the interventricular septum are of the muscular type. | Except for the bicuspid aortic valve, VSD is the most common congenital heart disease. | Membranous VSDs are the most common and the ones with the highest likelihood of spontaneous closure. | Medicine | The clinical impact and the need for treatment depend on the size of the communication. | 81 | 4 | 1afda36e-8272-467a-afe5-3335d3e05209 | 2022 |
Concerning neonatal respiratory distress syndrome (hyaline membrane disease), indicate the false answer: | Its clinical manifestations appear after the first 24 hours of life. | Antenatal corticosteroids reduce the risk of its occurrence. | Its main cause is the deficiency of pulmonary surfactant. | Medicine | The risk of occurrence decreases in the event of premature rupture of membranes. | 82 | 2 | 629289d1-edca-4305-a782-96d49547b553 | 2022 |
Phenylketonuria is a congenital metabolic disease. In relation to this, indicate the false answer: | Intellectual disability is constant and progressive if the diet is not properly followed. | Phenylalanine must be completely eliminated from the diet. | It is recommended to study it 24-48 hours after the start of the newborn's intake. | Medicine | It may be due to a deficiency in tetrahydrobiopterin BH4. | 83 | 1 | 05ee9295-dac4-449b-8173-02f034580937 | 2022 |
In a neurological genetic disease, the phenomenon of anticipation involves the onset of manifestations earlier and generally more severely in the next generation. Since anticipation occurs due to the expansion of trinucleotides, indicate in which of these diseases you can expect this phenomenon: | Duchenne Muscular Dystrophy. | Spinal muscular atrophy. | Steinert's Myotonic Dystrophy. | Medicine | Parkinson's Disease. | 84 | 4 | cf0cd8ea-d57d-476d-a046-ae5645eab5e9 | 2022 |
Neuroblastoma is the most common extracranial solid tumor in children. In relation to its diagnosis, indicate the false answer: | There is almost always an increase in the urinary excretion of catecholamine metabolites. | We should suspect it when we see the appearance of an opsoclonus-myoclonus-ataxia syndrome. | The technetium scan is very specific and is indicated to better define its extent. | Medicine | Most are diagnosed in children under 6 years of age. | 85 | 4 | b885fa0e-7206-4d7b-adc5-7c5119424e45 | 2022 |
Which of the following is not an indication for performing immunoprophylaxis with palivizumab in an infant?: | Infant born before 32 weeks of gestation with chronic lung disease of prematurity in the first year of life. | Infant born before 29 weeks of gestation in the first year of life. | 12-month-old infant suffering from severe combined immunodeficiency. | Medicine | Infant diagnosed with cystic fibrosis of the pancreas in the neonatal screening during the first year of life. | 86 | 3 | 4fb313aa-8fe9-4a9e-aa6c-9926d91cee9b | 2022 |
Regarding the sudden infant death syndrome, indicate the correct statement: | In the event of a sudden infant death episode, the ordinary death certificate should be signed by the specialist from the emergency services. | The presence of a history of similar deaths in siblings/relatives is a diagnostic criterion for this syndrome. | The existence of a serious pathology diagnosed at autopsy is a diagnostic criterion for this syndrome. | Medicine | The child being older than 1 year rules out the diagnosis, regardless of whether or not they are infants. | 87 | 3 | d59fd784-e136-4225-b56b-b3ef28705b1c | 2022 |
A 23-month-old boy presents with fever, hypotension, repeated vomiting, meningeal signs, petechiae, and ecchymosis. The blood count shows 25,000 leukocytes (75% neutrophils, 10% bands) and 12,000 platelets/microL and the coagulation study shows a prothrombin activity of 35%. What option is not suitable for his management?: | Performing a lumbar puncture. | Administration of intravenous cefotaxime. | Intravenous fluids. | Medicine | Collection of blood culture. | 88 | 2 | 57da6951-49e5-4d6e-9eb1-d5d2bbfe1608 | 2022 |
A 4-year-old girl presenting with high fever for 6 days. In clinical examination, she has a maculopapular erythematous rash on the trunk and genital area, tending to confluence, though not reaching scarlatiniform; conjunctival injection without secretions and red lips with a strawberry tongue. She also has erythema with swelling in hands and feet and a unilateral cervical lymphadenopathy of 2 cm in diameter. The most probable suspected clinical diagnosis is: | Measles. | Kawasaki Disease. | Scarlet fever. | Medicine | Measles. | 89 | 1 | 3925f2a8-2f29-4e0f-b9f3-b46fe0940149 | 2022 |
Within the cyanotic heart diseases, Tetralogy of Fallot stands out. In relation to this condition, indicate the incorrect answer: | The presence of pulmonary hyper blood flow is typical. | In the hyperoxia test with 100% O2, the O2 saturation does not significantly increase. | The cardiac silhouette presents the typical image of a boot-shaped heart. | Medicine | In the face of any suspicion, a prostaglandin E1 infusion should be administered early. | 90 | 2 | 210b2969-f909-449f-b40e-4d2a6c460212 | 2022 |
Which of the following is not an indication for performing neuroimaging tests in psychiatry?: | Seizure crisis with psychiatric symptoms. | Mental disorder onset after the age of 50. | Presence of atypical psychiatric symptoms. | Medicine | Psychotic relapse after discontinuing treatment following a first psychotic episode. | 91 | 3 | 6a38543f-5ace-430f-9e7d-a455b5f85c47 | 2022 |
A 75-year-old woman was brought to the clinic by her family because they have noticed her being depressed and having memory lapses for several months. They are worried she may have Alzheimer's disease. The patient reports that she does not believe anything is wrong and that she feels the same as always. In what order do the following symptoms generally appear in the progression of Alzheimer's disease?: | Behavioral symptoms, motor symptoms, decline in functional independence. | Mood changes, behavioral symptoms, cognitive deficits. | Behavioral symptoms, mood changes, motor symptoms. | Medicine | Mood swings, cognitive deficit, decline in functional independence. | 92 | 3 | 9f90986c-b95d-4887-b807-39d4bf932107 | 2022 |
A 35-year-old married man, and father of three children, is admitted to the hospital for a complicated ankle fracture. On the second day, he seemed nervous and started to shake. He is questioned about possible toxic habits and denies them, explaining that he occasionally drinks a beer. The wife indicates that for three years he has been consuming significant amounts of beer daily and occasionally becomes violent. The following day, the nurses report that he has slept poorly, is very anxious, and speaks incoherently, being disoriented in time. From the following therapeutic guidelines, which is the most appropriate?: | Short half-life benzodiazepines and beta blockers. | Long half-life benzodiazepines and clomethiazole. | Short half-life benzodiazepines and clozapine. | Medicine | Long half-life benzodiazepines and carbamazepine. | 93 | 1 | 2d86d003-9bbe-4762-b645-a55c0211e62c | 2022 |
A male patient seeks advice because his mother died 1 month ago, after a long period of neurodegenerative disease. Despite the time elapsed, he continues to have occasional sleep difficulties and problems accepting her death, feeling great longing and high emotional response when he remembers or is spoken about her. On the other hand, if he is distracted, he is able to enjoy something and his job performance is practically normal. Which of the following statements is false?: | If sleep difficulties have consequences on the wakefulness of the following day, I could temporarily prescribe you a hypnotic drug. | The diagnosis is bereavement (Z63.4, according to the 10th edition of the International Classification of Diseases -ICD-10-). | It is advisable to give him a new appointment after 1-2 months to monitor his progress. | Medicine | Given the elapsed time, a low-dose antidepressant should be started. | 94 | 3 | 6f4ac05a-b378-41c9-b8b8-c7435c9e3568 | 2022 |
A 23-year-old woman who consults due to having sudden and recurrent anxiety attacks for the past 2 months with palpitations, sweating, trembling, feelings of suffocation, and chest pain. Indicate which of the following statements is not correct: | In the differential diagnosis, pheochromocytoma, thyrotoxicosis and hypoglycemia should be considered. | In the progression, it's common to find agoraphobia and avoidance behaviors. | The most likely diagnosis is generalized anxiety disorder. | Medicine | It is necessary to rule out a paroxysmal atrial tachycardia. | 95 | 4 | 0d060f03-86e0-420d-9a59-c2b7085c25ff | 2022 |
Regarding the risk factors of suicide, indicate from the following which factor has the LOWEST risk: | Long duration stress event. | Substance abuse. | Advanced age. | Medicine | Coexisting panic disorder. | 96 | 2 | b0282b46-7565-4ab6-9c25-59fed29b0d82 | 2022 |
Indicate the correct statement regarding the treatment of mania: | Clozapine is the drug of choice for acute treatment. | The usual treatment in the first 48 hours is based on benzodiazepines in monotherapy by parenteral route. | In severe or resistant cases, electroconvulsive therapy may be used. | Medicine | The combination of lithium and antipsychotics is contraindicated in the initial stages of treatment. | 97 | 4 | 241c2eb7-4e2d-4ea3-ab64-2d9d9cf877e8 | 2022 |
Regarding the use of repetitive transcranial magnetic stimulation in psychiatric disorders, indicate the correct answer: | It has a higher efficacy than electroconvulsive therapy. | It is especially useful in psychiatric disorders secondary to epilepsy. | For your safety, it is the treatment of choice for late-onset schizophrenia. | Medicine | It is indicated for depression resistant to pharmacological treatment. | 98 | 3 | ae2bab62-14af-474e-984a-908f3d088678 | 2022 |
In regards to a depressive syndrome in a 68-year-old male with no psychiatric history, indicate which of the following statements is incorrect: | The presence of resting tremor, unswinging gait, and facial amimia guide the diagnosis towards Parkinson's disease. | The presence of disorientation, apathy, and memory loss points towards the diagnosis of dementia. | The recent initiation of treatment with beta blockers and nonsteroidal anti-inflammatory drugs may justify the onset of a depressive syndrome. | Medicine | The presence of hypercholesterolemia, bradypsychia, bradycardia, and constipation points towards the diagnosis of hypothyroidism. | 99 | 1 | 3aee7c49-c990-4434-adb5-ca89df97e560 | 2022 |
80-year-old woman with a history of high blood pressure and diabetes mellitus who suddenly presents with a language disorder. Upon her arrival at the hospital, unknown atrial fibrillation is detected and the examination reveals fluent speech with a tendency towards jargon aphasia, poor language comprehension, inability to repeat and nominal aphasia. Semiotically, she presents a picture consistent with: | Conduction aphasia. | Broca's Aphasia. | Wernicke's Aphasia. | Medicine | Transcortical sensory aphasia. | 100 | 4 | 83a24e7d-c27d-48f1-9b95-0de28fcc9806 | 2022 |
All the following neurodegenerative diseases are related to an alteration in the Tau protein, except: | Frontotemporal dementia. | Alzheimer's Disease. | Progressive supranuclear palsy. | Medicine | Parkinson's Disease. | 101 | 3 | dcb02b18-da9d-47ea-8dd1-d869d0fe8e80 | 2022 |
A 29-year-old woman with a history of febrile seizures and significant smoking. She consults due to having frequent, stereotyped episodes for about 2 years, which start with a rising epigastric sensation and an unpleasant smell, followed by disconnection from the environment. The family members who are with her observe that she makes sucking movements and repeated opening and closing of the left hand. After two minutes, the movements subside but she struggles to respond adequately and only partially remembers what happened. Of the following, what is the most likely diagnosis?: | Transient ischemic attacks in the right carotid territory. | Complex focal seizures of the temporal lobe. | Episodes of transient global amnesia. | Medicine | Simple focal motor seizures. | 102 | 1 | 411adead-4b65-4960-a71a-1c01a0a9e56d | 2022 |
A 30-year-old male who presents with unilateral periorbital headaches that rapidly progress to become very intense. The pain crises last between 30-60 minutes, occur 2-3 times a day, and are accompanied by tearing in the eye that hurts and unilateral rhinorrhea. What is the most appropriate preventive treatment? | Oral Prednisone with withdrawal in one month, combined with oral Verapamil at a dosage of 80-180 mg every 8 hours. | Oral Prednisone with withdrawal in 2-3 months. | Indomethacin at a dose of 50 mg every 8 hours for one month. | Medicine | Carbamazepine at a dose of 600-1200 mg per day. | 103 | 2 | e2394f01-d372-4f19-a8f8-7e793d9c2d2e | 2022 |
In a patient with left peripheral facial paralysis (Bell's palsy), which of the following signs or symptoms would you not expect to find?: | Hypoesthesia of the left hemiface. | Left-sided hyperacusia. | Lack of tearing in the left eye. | Medicine | Hypogeusia. | 104 | 2 | 9a822e8b-f231-4de1-8fdd-4453e3d9a478 | 2022 |
A 45-year-old male was brought to the clinic by his family members due to a year-long progression of memory loss, which has worsened to the point of requiring help for some daily activities. He has a history of migraines and some episodes of self-limiting neurological focus that he has never consulted. The neuropsychological examination is consistent with early dementia, and the brain MRI shows severe leukoencephalopathy. What test should be requested?: | Genetic study for presenilin 1 (PSEN1). | Lumbar puncture to analyze amyloid and tau protein in cerebrospinal fluid. | Genetic study for progranulin. | Medicine | Genetic study for NOTCH3. | 105 | 3 | 1bd21e7f-cd0d-4b55-a583-64a9efb9962c | 2022 |
Regarding the treatment of intracranial hypertension, it is not an accepted measure: | The drainage of CSF (Cerebrospinal Fluid) through a lumbar drain. | Raise the patient's head and keep the head centered. | Glucocorticoids in certain circumstances. | Medicine | Moderate hyperventilation. | 106 | 2 | 37d6bd19-3898-4894-a525-d197dcd1e49d | 2022 |
A 55-year-old male suffering from a subarachnoid hemorrhage due to rupture of a middle cerebral artery aneurysm. He is treated surgically. After a good recovery where he regains the ability to walk, a month after suffering the hemorrhage he presents with progressive deterioration, becoming clouded and having difficulty obeying orders. Indicate the correct statement: | This progressive deterioration is probably secondary to the rebleeding of the aneurysm. | It is at the stage of evolution where vasospasm is most common. | The diagnostic technique of choice is cerebral angiography. | Medicine | The subacute deterioration that is most likely present is due to hydrocephalus. | 107 | 3 | 1c7cf9f9-436e-47cc-969d-f8c29616898a | 2022 |
A 49-year-old male is admitted to the ICU due to a traumatic brain injury following a workplace accident. In the physical examination, he doesn't open his eyes, doesn't emit sounds before being intubated, and shows limb extension to nociceptive stimulus. An intracranial pressure sensor is placed, and a decompressive craniotomy must be performed due to an intraparenchymal hemorrhage. Which of the following statements is correct? | The cerebral perfusion pressure is the mean arterial pressure plus the intracranial pressure. | Upon arrival, they are in a Glasgow scale coma of 7. | Cerebral vascular flow increases with hypercapnia and acidosis. | Medicine | Vasogenic cerebral edema occurs due to cellular edema, membrane rupture, and cell death. | 108 | 4 | e6e1ad86-d8e3-4e14-b52d-3e43054c8189 | 2022 |
Regarding the sedation of the critically ill patient on mechanical ventilation in the ICU, which of the following statements is true?: | Non-benzodiazepine sedatives are preferred because benzodiazepines are associated with worse clinical outcomes. | Neuromuscular blockers are indicated when the patient presents asynchronies, regardless of the degree of analgesia and sedation. | Paracetamol is the main pharmacological agent for achieving adequate analgesia in intubated and mechanically ventilated patients. | Medicine | The daily interruption of sedation does not shorten the time of mechanical ventilation nor the stay in the ICU. | 109 | 2 | f47b4d16-9397-4596-ba30-ccd99e8d9ac5 | 2022 |
The osteosarcoma is a malignant bone tumor that: | Your treatment with chemotherapy and radiotherapy usually avoids surgery. | It is more common in the first decade of life. | If you have a previous Paget's disease, you have a better prognosis. | Medicine | It more frequently affects bones in the vicinity of the knee joint. | 110 | 3 | 2b8e13f5-9827-457a-91e0-2513398cb987 | 2022 |
Carpal Tunnel Syndrome: | Presents with hypoesthesia in the fingertips from the second to the fifth. | It is more common in males. | It is accompanied by atrophy of the musculature of the hypothenar eminence. | Medicine | The symptoms worsen during the night. | 111 | 3 | 93efa2f3-ca20-406f-9a61-48db173cf7aa | 2022 |
A 61-year-old woman, an administrative worker, with a history of being overweight, hypertension, dyslipidemia, and metabolic syndrome, is seeking advice for pain in both buttocks, the left trochanteric region, the lateral face of the left thigh down to the knee, and the left leg down to the middle third. The pain appears when we lift the lower limb with the knee extended, but is relieved upon bending the knee. What is the first clinical suspicion? | Left coxofemoral osteoarthritis. | Gouty arthritis of the left hip. | Claudication due to spinal stenosis. | Medicine | Radiating lower back pain / sciatica. | 112 | 3 | 111c1fe6-e6e3-427f-9f04-f086e1848aa9 | 2022 |
A 35-year-old male, postman, with no notable medical history, who attends the emergency room due to acute cervical pain that has been evolving for 24 hours, without preceding trauma, which radiates to his left arm up to the hand and is accompanied by paresthesia in the radial edge of the forearm. He doesn't present any noticeable loss of strength, maintains neck mobility although it is painful, and contracture of the paravertebral muscles is observed. The initial approach will be: | Urgent call to the neurosurgeon for surgical evaluation. | Conservative treatment with non-steroidal anti-inflammatory drugs, local heat, and relative rest. | Preferred referral to outpatient traumatology consultations. | Medicine | Priority request for magnetic resonance imaging and electromyogram. | 113 | 1 | 3f99497c-8a86-4d09-8d04-f1e2888d70c9 | 2022 |
Regarding the rupture of the anterior cruciate ligament of the knee, indicate the correct answer: | It rarely presents with hemarthrosis. | It is common for it to occur due to a trauma on the front of the tibia with the knee in flexion. | Physical therapy treatment with quadriceps and hamstring strengthening can prevent surgery. | Medicine | The Lachman maneuver is negative. | 114 | 4 | be7a379f-be66-4567-827e-ca6a158fea0c | 2022 |
A 27-year-old male, regular athlete, reports pain in his right leg after continuous running. He has visited a physiotherapist several times, being diagnosed with an overload in the calves. Several months have passed, he has not improved and reports intense pain after physical activity that subsides with rest in the following hours after exercise. What test may assist in the diagnosis? | Determination of the pressure in the posterior compartment immediately after activity. | Positron emission tomography with 18 FDG. | Magnetic resonance spectrometry. | Medicine | Doppler Ultrasound to rule out a circulatory disorder of the lower extremity. | 115 | 2 | 89c554c7-36bc-42aa-9779-a6c64c8d6cb7 | 2022 |
A 95-year-old woman who lives in a residence, independent for her basic daily activities, goes out to the garden for a walk. She has a history of hypertension, dyslipidemia, osteoporosis, and mild cognitive impairment. She suffers a fall when getting up at night to the bathroom. The radiograph shows a displaced subcapital fracture of the right hip. What is the recommended treatment? | Fixation with trochanteric nail. | Hip hemiarthroplasty. | Conservative: bed-chair life. | Medicine | Fixation with cannulated screws. | 116 | 1 | 203a04c8-3885-443a-bae0-f758729485b8 | 2022 |
Regarding the fractures of the epicondyle in children, indicate the incorrect statement: | They are associated in up to 50% of cases with a postero-lateral dislocation of the elbow. | They are triggered by a mechanism of forced elbow valgus in the fall. | It is more common in children aged between 4 and 6 years. | Medicine | They may present with an associated neurapraxia of the ulnar nerve. | 117 | 4 | e26a2d50-957a-4b0c-9ef7-10637cb96d18 | 2022 |
A 41-year-old male presents with knee pain of several days duration. During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is conducted, which results as positive. Which of the following injuries is most likely? | Injury due to rupture of the anterior cruciate ligament. | Meniscal injury. | Injury due to degenerative arthropathy. | Medicine | Injury due to rupture of the posterior cruciate ligament. | 118 | 1 | 46ec8c30-8394-4937-aa2b-249c2b940f0c | 2022 |
A 13-year-old girl, with no relevant medical history, who had menarche 3 months ago, has been being monitored for idiopathic scoliosis since the age of 10, which has worsened. Upon physical examination, she presents a hump of 7 degrees on the Adams test and in the scoliogram a thoracolumbar curve T4-L1 of 35 degrees of Cobb and a Risser 0. The appropriate action to take will be: | Prescribe a corset-type orthosis. | Recommend swimming and review in three months. | Review in 6 months with a new x-ray. | Medicine | Refer to physiotherapy for elasticity improvement of the spine. | 119 | 2 | 7655359b-8503-438b-a1c1-af98529c799f | 2022 |
79-year-old woman admitted for an osteoporotic hip fracture. Regarding the secondary prevention of fragility fractures, indicate the incorrect answer: | Bone remodeling markers may be useful for early monitoring of the response to treatment. | Low adherence to treatment is associated with an increased risk of fracture. | An increase in dietary calcium or taking calcium supplements alone does not protect against the onset of fractures. | Medicine | Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly individuals. | 121 | 3 | 58a7b21b-bd03-4afd-ad83-c76a981a3ccd | 2022 |
A 78-year-old patient with no history consults due to fatigue and shortness of breath that have progressed over a period of 3 months, which has progressed to a resting state in the last few days. In the days leading up to the consultation, the patient also reports angina-like chest pain with minor exertion. On examination, noteworthy findings include a blood pressure of 110/80 mmHg, heart rate of 85 bpm, and auscultation revealing a harsh systolic murmur in the second right intercostal space and crackles in both lung bases. What is the most likely diagnosis? | Aortic stenosis. | Mitral insufficiency. | Dilated cardiomyopathy of ischemic origin. | Medicine | Aortic insufficiency. | 122 | 2 | 8538430a-bde0-49d8-92c3-9208f713807d | 2022 |
Which of the following statements is false in relation to Long QT Syndrome?: | Tricyclic antidepressants can lead to acquired long QT syndrome. | Beta blockers are contraindicated in congenital long QT syndrome. | Its pathophysiology is based on an alteration of the ion channels responsible for the transmembrane action potential of the myocardial cell. | Medicine | Predisposes to polymorphic ventricular tachycardia. | 123 | 1 | 00afdee4-3cb7-405f-9ef1-659595be3a63 | 2022 |
An 82-year-old woman with chronic atrial fibrillation of 10 years evolution and preserved biventricular systolic function who presents symptomatic episodes of complete atrioventricular block, for which it is decided to implant a permanent cardiac stimulation system. Which of the following is indicated?: | VVI Pacemaker (single-chamber ventricular). | DDD Pacemaker (biventricular). | Ventricular Resynchronization Therapy (VRT). | Medicine | AAI Pacemaker (single-chamber atrial). | 124 | 2 | 315c3cf2-a636-4854-9864-73dacd11e698 | 2022 |
A 23-year-old male diagnosed with Wolff-Parkinson-White syndrome presents to the emergency department with palpitations. The ECG shows a wide QRS irregular tachycardia, with a heart rate of 205 bpm, consistent with pre-excited atrial fibrillation. Which of the following drugs do you consider appropriate to administer to stop the tachycardia?: | Digoxin. | Verapamil. | Procainamide. | Medicine | Adenosine. | 125 | 4 | 8bc4fde0-2dd9-4027-a38e-40d6e5f86e78 | 2022 |
Among the interventions on the cardiovascular risk factors shown, which is the most cost-effective for reducing coronary events in secondary prevention? | Increase in the levels of high-density lipoproteins (HDL cholesterol). | Quitting tobacco. | Increase in physical activity. | Medicine | Proper control of blood sugar in diabetic patients. | 127 | 1 | 6bc78a51-a15e-4bec-933f-1cbdb12e8149 | 2022 |
A 75-year-old woman with a history of heart failure with an ejection fraction of 25% comes in for a review, finding herself stable in NYHA functional class III. She has an implanted cardioverter defibrillator. Her current medication consists of lisinopril, carvedilol, and spironolactone at the maximum tolerated doses. In the physical examination, her BP is 118/74 mmHg, HR is 78 bpm. A third heart sound is detected on cardiac auscultation, the pulmonary auscultation is normal, and she does not present with edema. What is the most appropriate next step in her management? | Add ivabradine. | Add sacubitril/valsartan. | Discontinue carvedilol and initiate ivabradine. | Medicine | Stop taking lisinopril and start sacubitril/valsartan. | 128 | 3 | d5e654bb-f3e7-49bd-8bc8-a7d9ccdafcfc | 2022 |
A 65-year-old male presents to the emergency department with the appearance of mottled cyanotic lesions on the fingers of both feet. Personal history: smoking, high blood pressure, and dyslipidemia. Chest X-ray: mediastinal widening. Thoraco-abdomino-pelvic AngioCT: descending thoracic aortic aneurysm 7 cm in diameter, distal to the left subclavian artery and with mural thrombus. Of the following, indicate the correct option: | An urgent diagnostic aortography is necessary. | Statin treatment is recommended to stabilize the thrombus. | The implantation of a thoracic endoprosthesis is indicated. | Medicine | In the surgery, the aneurysmal segment is replaced with a tubular prosthesis with reimplantation of the supra-aortic trunks. | 129 | 4 | a1c31b3c-38a4-407b-8a99-e9aee9f9f8ef | 2022 |
An 85-year-old male in permanent atrial fibrillation presents with sudden pain and coldness in his right foot for the past 6 hours. Upon examination, plantar cyanosis is evident with partial deficit of sensitivity and mobility. The femoral pulse is palpable, with the popliteal and distal pulses of that extremity absent. From the following, what is the ideal therapeutic approach?: | Apply heat and notify the on-call vascular surgeon. | Dismiss the revascularization surgery, due to the prolonged period of ischemia. | Urgent medical treatment with intravenous prostaglandins. | Medicine | Urgent surgical treatment through thromboembolectomy. | 130 | 3 | 72dc9078-7c47-4e2e-b764-87a8f63e5f66 | 2022 |
A 30-year-old male with a thin build, who during a basketball game suffers an episode of acute right chest pain, accompanied by sudden onset of dyspnea and shallow breathing for which he goes to the emergency room. Which of the following exploratory signs would you most likely find in the lung auscultation? | Decrease in vesicular murmur at the right base, decrease in vocal vibrations and dullness to percussion. | Tubal murmur and crackling at the right base. | Scattered rhonchi and wheezing. | Medicine | Decrease/abolition of vocal vibrations and tympany on percussion in the right hemithorax. | 131 | 3 | 4c880a5b-ddd3-49d5-b661-53349e0f9e8c | 2022 |
A 75-year-old male with a history of COPD presented to the emergency department with progressive shortness of breath for several days and a decrease in level of consciousness. The following values were reported in the arterial blood gas breathing room air (FiO2 21%): pH 7.25; pO2 45 mmHg; pCO2 70 mmHg; H2CO3 26 mmol/L; BE -0.1 mmol/L. From a gasometric point of view, he presents: | Global respiratory failure with metabolic acidosis. | Global respiratory insufficiency with respiratory acidosis. | Partial respiratory failure with respiratory alkalosis. | Medicine | Partial respiratory failure with metabolic acidosis. | 132 | 1 | 82b3120a-0344-4891-9b2b-340695eb775f | 2022 |
A 78-year-old woman consults for dyspnea, and she is diagnosed with an exacerbation of her COPD. After being evaluated, it is decided to administer prednisone. Which of the following statements is correct?: | A good option would be to administer prednisone 40 mg/day orally for 5 days. | In this case, it is preferable to administer prednisone intravenously as it is more effective than oral administration. | Prednisone should be scheduled in such a way that the dose reduction is carried out gradually over 10 days. | Medicine | The dose of prednisone should be at least 1 mg/kg of body weight per day. | 133 | 2 | 3184f5f3-ab44-43c5-bc14-d7f7243abb84 | 2022 |
A 71-year-old patient with no cardiovascular history is seeking consultation for chronic snoring and witnessed sleep apneas. An examination reveals a body mass index of 31 kg/m2. Daytime sleepiness evaluated with the Epworth scale is at 5. A respiratory polygraphy is carried out, revealing an apnea/hypopnea index of 15 per recording hour, with an average oxygen saturation of 94%. The first indicated therapeutic intervention is: | Home nocturnal oxygen therapy. | Continuous positive airway pressure (CPAP). | General hygienic-dietary measures. | Medicine | Positive double-level pressure in the airway. | 134 | 4 | b58c4167-9b44-4fe9-a18b-61e29c8ebb92 | 2022 |
66-year-old woman, non-smoker, with cough and shortness of breath for one year. High-resolution chest CT is performed due to suspicion of idiopathic pulmonary fibrosis. Which of the following radiological findings are typical of this condition?: | Patchy or diffuse ground-glass opacities, bilateral and symmetrical. | Honeycomb cysts and reticular pattern with basal predominance. | Traction bronchiectasis and subpleural nodular pattern in lung bases. | Medicine | Multiple consolidations, with peripheral distribution in lower lung fields. | 135 | 1 | bd574d30-889f-4b8a-9a99-0adecb139775 | 2022 |
Patient is 65 years old, non-smoker, who reports having worked in his youth in an industry related to asbestos. He consults for a progressive dyspnea condition, with no fever. Chest x-ray shows left pleural calcifications and nodular characteristics of right pleural thickening, which is confirmed in the chest CT, without mediastinal lymphadenopathy, nodules, or pulmonary or mediastinal masses. With regard to the course of action to take with this patient, indicate the correct statement: | The most likely diagnosis is bronchogenic carcinoma, so a diagnostic fibrobronchoscopy should be performed first. | Positron emission tomography allows for a specific diagnosis if a high level of hypermetabolism is observed at the pleural level. | In the case of an atypical pleural effusion, an infectious cause must be ruled out, so a thoracentesis with biochemical analysis and culture should be performed to indicate a possible pleural drainage. | Medicine | The first diagnostic maneuver should be a thoracentesis. If an etiological diagnosis is not achieved, a diagnostic thoracoscopy should be considered for the collection of a pleural biopsy. | 136 | 3 | 14e05ee6-c264-4a70-b446-47d57fde1eae | 2022 |
A 55-year-old patient with alcoholic liver cirrhosis, abstinent, with no signs of portal hypertension. Analysis: AST 34 U/L (normal < 37 U/L); ALT 19 U/L (normal < 41 U/L); total bilirubin 0.78 mg/dl (normal < 1 mg/dl); alpha-fetoprotein 7 ng/ml (normal < 10 ng/ml). A liver ultrasound is performed which detects a hypoechoic space-occupying lesion of 1.5 cm in diameter. Magnetic resonance imaging shows a lesion with arterial phase uptake and venous phase wash-out. Which of the following approaches is most correct?: | Repeat the ultrasound in 3 months. | Perform a biopsy of the nodule, since the size is less than 2 cm. | Request extension study. | Medicine | Indicate a liver transplant. | 137 | 4 | b62277d6-8986-40db-9e44-a70045e325a5 | 2022 |
A 27-year-old woman presents with swallowing difficulty and painful swallowing. In recent months, she has noticed a sensation of difficulty swallowing, more so with liquids than with solids, central chest pain, occasional isolated vomiting without strain, similar to regurgitation. She does not report any weight loss or loss of appetite. Physical examination is normal. Complete blood workup is within normal limits. Oral endoscopy shows no structural changes or mucosal lesions. High-resolution esophageal manometry: vigorous activity and lack of peristalsis in the esophageal body with normal relaxation of the lower esophageal sphincter. The most likely diagnosis is: | Hypercontractile esophagus. | Distal esophageal spasm. | Fragmented peristalsis. | Medicine | Type I Achalasia. | 138 | 1 | 98697966-ab31-462d-becf-a61caf7decf6 | 2022 |
A 69-year-old woman presents to the emergency department with a case of vomiting, constipation, abdominal cramps, and distension. Upon examination, a distended abdomen is observed, with no pain upon palpation, accompanied by metallic-sounding bowel noises. The standing plain abdominal radiograph shows multiple hydro-air levels and aerobilia. Of the following options, the most likely diagnosis is: | Phytobezoar. | Emphysematous cholecystitis. | Ischemic colitis. | Medicine | Gallstone ileus. | 139 | 3 | c2d8c666-cf65-4e58-b810-0b20a15e5d8e | 2022 |
In relation to the classification of surgical wounds based on the magnitude of the estimated bacterial load, an enterotomy during an intestinal obstruction is classified as: | Contaminated wound (class III). | Dirty wound (class IV). | Clean wound (class I). | Medicine | Clean/Contaminated Wound (Class II). | 140 | 2 | 828a57f9-ade6-485b-aaa9-0fe5ecab01c2 | 2022 |
An 18-year-old male who underwent surgery for gangrenous appendicitis by laparoscopy with localized pelvic peritonitis 10 days ago. He comes to the emergency room with a feverish syndrome, abdominal distention, and diarrheal stools for 48 hours. Which of the following diagnoses is most likely?: | Surgical wound infection. | Abscess in the Douglas pouch. | Hepatic abscess. | Medicine | Complicated urinary tract infection. | 141 | 1 | e4d3fd36-1bad-4fc6-8f4a-24458b899d1d | 2022 |
A patient with diffuse toxic goiter (Graves' disease) who refuses treatment with radioactive iodine and who has severe ophthalmopathy should undergo: | Total thyroidectomy. | Thyroid lobectomy. | Enucleation of the main nodule. | Medicine | Subtotal Thyroidectomy. | 142 | 2 | c1413141-55b8-4195-8347-8a3e998a5367 | 2022 |
A 51-year-old woman consults, after several episodes of mild sigmoid diverticulitis treated conservatively, because she now has persistent constipation that improves with the use of laxatives. Occasionally, she experiences colicky abdominal pain that improves with the expulsion of stools and gases. A colonoscopy is performed where a sigmoid stenosis is found that prevents the passage of the colonoscope. A sample is taken for a histopathological study that is inconclusive. In the barium enema, a sigmoid stenosis of about 5 cm in length is found. The most suitable therapeutic approach would be: | Conservative treatment with dietary fiber and rifaximin. | Laparoscopic sigmoidectomy. | Stent in area of stenosis. | Medicine | Endoscopic dilation. | 143 | 1 | f5b1002c-bcd8-4293-97b2-b4b44fcb883d | 2022 |
What is the main objective of adjuvant treatment for breast cancer? | Transform non-resectable tumors into resectable ones for surgery. | Increase in overall survival. | Improve symptom control. | Medicine | Increase progression-free survival. | 144 | 1 | 4c650971-11f6-442f-bb6a-c94b3bc7879e | 2022 |
Which of the following vaccines is not recommended prior to an elective splenectomy in an adult?: | Anti-haemophilus influenza B vaccine. | Pneumococcal vaccine PPV 23. | Tetanus vaccine. | Medicine | Meningococcal C Vaccine. | 145 | 4 | 289bdc49-0bc4-4f04-a162-2ece6fc0e042 | 2022 |
A 40-year-old woman, with no personal or family medical history of interest, presents with several days of watery and copious diarrhea, accompanied by a weight loss of 10 kg, facial flushing and redness, along with faintness and colicky abdominal pain. Lab data shows hypokalemia. An abdominal ultrasound reveals a mass 1.5 cm in diameter in the tail of the pancreas. Among the following, her primary diagnostic suspicion is: | PPoma. | Insulinoma. | Glucagonoma. | Medicine | VIPoma. | 146 | 3 | 80a4e3db-8322-4719-84bd-9dbaf08f7e7b | 2022 |
Regarding calprotectin, indicate the correct answer: | Their levels have a very good correlation with the activity evidenced by endoscopy, especially in ulcerative colitis. | It is a protein secreted by neutrophils that is determined in the blood to assess the activity of inflammatory bowel disease. | It is not useful in the monitoring of patients with inflammatory bowel disease. | Medicine | In patients with irritable bowel syndrome, it is detected at abnormally high levels. | 147 | 2 | ce73df15-ed55-4f63-926c-13ff2c5cf5ef | 2022 |
A 48-year-old patient referred to a nephrology consultation due to an estimated glomerular filtration (eGFR) of 32 ml/min/1.72 m2. Which of the following data would not suggest chronic kidney disease?: | Family history of nephropathy. | Small-sized kidneys. | Good ultrasonographic differentiation of renal cortex and medulla. | Medicine | Elevated levels of phosphorus in blood. | 148 | 4 | 657ea336-f4c9-4c76-aa86-183daa968a4c | 2022 |
A 67-year-old woman with chronic kidney disease secondary to diabetic nephropathy. Currently, she has a creatinine level of 3.2 mg/dl with an estimated glomerular filtration rate (CKD-EPI) of 14 ml/min. Which of the following statements is true?: | The patient has stage 5 chronic kidney disease and renal replacement therapy should be considered. | The patient has chronic kidney disease stage 3 and needs to start phosphorus binders. | It's unlikely that they will present a proteinuria higher than 500 mg/24h. | Medicine | Good glycemic control can reverse kidney failure. | 149 | 2 | fc7e311a-c099-4656-930f-9d0b91a04317 | 2022 |
A 47-year-old woman consults for urinary syndrome. She is diagnosed with uncomplicated urinary infection and treated with ciprofloxacin for 5 days. A week later, she comes back complaining of poor general condition, joint pain, and the appearance of a skin rash. The laboratory tests show a glomerular filtration rate of 45 ml/min (CKDEPI), which was 100 ml/min 6 months ago. In the sediment, leukocytes are identified but it's negative for nitrites. Among the following, what is the most likely cause of her kidney failure?: | Nephrotoxicity due to ciprofloxacin. | Postinfectious Glomerulonephritis. | Acute interstitial nephritis. | Medicine | Acute pyelonephritis. | 150 | 4 | af1af383-b89a-471d-a30a-046bc9991a52 | 2022 |
A 22-year-old male presents to the emergency department with "almost black" urine for the past 12 hours. He has no significant past medical history and is not taking any medications. He reports having had an upper respiratory tract infection for the past 4-5 days for which he has taken paracetamol. Examination: temperature 37.3 °C, blood pressure 150/95, heart rate 85 bpm, slight pharyngeal erythema, rest normal. In the lab report: Hb 12.8 g/dl, Hct 39%, leukocytes 10,500 /mm3 with normal formula, platelets 250,000 /mm3, normal coagulation, urea 25 mg/dl, creatinine 0.8 mg/dl, ions, hepatic profile, lipid, albumin and total proteins normal. Autoimmunity study normal and viral serology negative. 24-hour urine with proteinuria of 0.75 g/24h, sediment with 10 erythrocytes per field (90% dysmorphic), no leukocyturia. Normal renal ultrasound. What diagnosis do you think is most likely?: | Post-infectious glomerulonephritis. | Minimal Change Nephropathy. | Acute interstitial nephritis. | Medicine | IgA Nephropathy. | 151 | 3 | 583df7cd-cb65-43f1-902c-1373d10833cc | 2022 |
A 24-year-old male presenting with dysmorphic microhematuria, proteinuria of 3 g/24 h, eGFR (CKDEPI) 85 ml/min, and sensorineural hearing loss. He mentions that his maternal grandmother required dialysis at 70 years old and both his mother and younger sister have isolated microhematuria. Which of the following diseases is most likely? | IgA Nephropathy. | Alport Syndrome. | Autosomal dominant polycystic kidney disease. | Medicine | Fabry Disease. | 152 | 1 | 558aa4d6-13f5-4f37-90a2-d1f5f848d525 | 2022 |
A 19-year-old male with no relevant medical history presents to the emergency department after a respiratory infection with symptoms of asthenia, general malaise, oliguria, and headache. Physical examination: Blood pressure 210/120 mmHg, fundoscopic exam reveals grade III hypertensive retinopathy. Lab values: Hemoglobin 7.4 g/dl, platelets 85,000/mm3, 2-3 schistocytes in peripheral blood smear, LDH 950 IU/ml, serum creatinine 8.75 mg/dl. Urinalysis: proteinuria 300 mg/dl, sediment showing 15 red blood cells per field. ADAMTS-13 levels normal. Given these findings, what would be your primary diagnostic suspicion? | Atypical hemolytic uremic syndrome. | Thrombotic thrombocytopenic purpura. | Typical Hemolytic Uremic Syndrome. | Medicine | Disseminated intravascular coagulation. | 153 | 2 | 48e51e7c-11be-4057-8ff7-7a282a54ffdf | 2022 |
Regarding the obstruction of urinary flow, indicate the false response: | The frequent sites of obstruction are the pelviureteric and ureterovesical junctions, the bladder neck, and the urethral meatus. | The intensity of pain is independent of the speed at which distension occurs. | The obstruction of urinary flow increases the hydrostatic pressure proximal to the site of occlusion, causing pain, distension of the renal collecting system, and an increase in intratubular pressure. | Medicine | Diagnostic resources for identifying anatomical obstruction include flowmetry. | 154 | 1 | d5d7343b-da0e-44d5-a6cc-b3177f1aa5e5 | 2022 |
Which of the following is the most common metabolic complication in cancer?: | Hyperuricemia. | Hyponatremia. | Hypercalcemia. | Medicine | Hyperphosphatemia. | 155 | 4 | 225f2670-fee7-4759-bdb1-a1472f2a0c63 | 2022 |
In relation to spinal cord compression secondary to neoplastic infiltration of the spinal cord in cancer patients, indicate the incorrect answer: | Early treatment with corticosteroids reduces vasogenic edema and limits the progression of spinal cord injury. | Surgical laminectomy and radiotherapy, alone or as a complement to surgery, achieve a neurological recovery rate of less than 20%. | Magnetic resonance imaging is the diagnostic test of choice for diagnostic confirmation and the identification of the level of compression. | Medicine | The most common symptoms are paraparesis and reduced distal sensitivity to the compressed spinal segment. | 156 | 1 | e56422e9-a06f-4542-a0d8-03c09e4c48b3 | 2022 |
What is the best combination of oncological treatments for a patient diagnosed with adenoid cystic carcinoma of the hard palate T4N0M0? | Surgery of the lesion followed by adjuvant radiotherapy on the surgical bed. | Concurrent radiochemotherapy as the first therapeutic option. | It is a benign tumor and therefore does not require additional oncological treatments. | Medicine | Radiotherapy and subsequent surgery in the absence of a complete response. | 157 | 2 | 4d8acec3-1bae-4216-9b00-76baf8c7e0fe | 2022 |
Indicate the tumor in which brachytherapy is not an effective treatment alternative: | Invasive ductal carcinoma of the breast after surgical intervention of the tumor bed with close margin. | Endometrial adenocarcinoma stage I-B grade 2. | Prostate Adenocarcinoma T1N0M0 Gleason 6. | Medicine | Partially resected glioblastoma multiforme. | 158 | 3 | 4e1734b2-0abe-449f-8179-9b51d552e5cd | 2022 |
Besides possible hemorrhagic complications, what other adverse effect of parenteral treatment with heparin can be serious and endanger the patient's life?: | Gastrointestinal disorders with abundant diarrhea and dehydration. | Extreme hypokalemia. | Severe thrombocytopenia accompanied by venous or arterial thrombotic events. | Medicine | Metabolic alkalosis due to renal tubular toxicity. | 159 | 4 | 04779068-53d4-40dc-8f6f-7ba666d094cd | 2022 |
A 35-year-old woman, who is on contraceptives, comes to the emergency room with a feverish syndrome and paresthesias on the left side of her body. Blood tests show Hb 7.5 g/dl, platelets 7,000/microl, normal white blood cells with a normal differential count, LDH 1,200 IU/l, reticulocytes 10% (normal 0.5-2%), undetectable serum haptoglobin, negative direct Coombs test, and peripheral blood smear with schistocytes. Coagulation (prothrombin time and APTT) normal. What is the most likely diagnosis?: | Thrombotic thrombocytopenic purpura. | Autoimmune hemolytic anemia. | Idiopathic immune thrombocytopenia. | Medicine | Evans Syndrome (immune hemolytic anemia and thrombocytopenia). | 160 | 2 | 315453cc-0d3f-4d2f-a1bd-f440cca03814 | 2022 |
In the diagnosis of a lymphoproliferative process, molecular study and immunophenotyping are crucial. The detection of the 11:14 translocation affecting cyclin D1 is characteristic of a: | Marginal zone lymphoma. | Follicular lymphoma. | Mantle cell lymphoma. | Medicine | Lymphoblastic lymphoma. | 161 | 4 | 81f3559c-9fa1-4c9a-b372-1faee1df78fb | 2022 |
Which of the following scales or tools used to assess frailty condition in an older patient is based on the clinical judgment of the observer and is therefore the most subjective?: | The Clinical Frailty Scale. | The Fried phenotype. | Timed Up & Go. | Medicine | SPPB (Short Physical Performance Battery). | 162 | 2 | 870d758b-90db-449c-9918-99a3ebcdeaf2 | 2022 |
Regarding sarcopenia, it is true that: | It is characterized by loss of mass and strength of skeletal muscle. | It is a geriatric syndrome that appears exclusively in elderly patients. | It is treated with medications that increase muscle mass. | Medicine | It is synonymous with fragility. | 163 | 2 | 05ee2ea4-25d5-4361-89d0-3d89f0d1a9b9 | 2022 |
78-year-old male with benign prostatic hyperplasia being treated with finasteride and tamsulosin, independent for basic and instrumental daily life activities and without cognitive impairment. He is experiencing an increasing number of episodes of involuntary urine leakage with a sensation of urinary urgency (currently having 4-5 leaks during the day). His urine sediment is normal. He has a post-urination residual volume of 60 cc. Which of the following measures is most appropriate?: | Insert a urinary catheter. | Initiate treatment with oxybutynin. | Initiate urinary hygiene measures with bladder behavioral therapy. | Medicine | Discontinue the treatment with finasteride. | 164 | 4 | ae4a4732-fbb5-408a-9eac-635ebb1535d4 | 2022 |
An 88-year-old woman presents with an episode of disorientation in space and time, restlessness, and fluctuating level of consciousness after returning home from the hospital, following a hip fracture admission. Her medical history includes hypertension, mild hearing loss, mild cognitive impairment, and osteoporosis. Before the fracture, she was independent in all basic daily activities, and after surgery, she has begun to ambulate with a walker, and requires the assistance of another person for transfers. What is the most appropriate initial management for her condition? | Start haloperidol. | Pain assessment and ruling out a fecal impaction. | Recommend bed rest and mechanical restraint to prevent self-injury. | Medicine | Start diazepam. | 165 | 1 | 4854969c-12e2-49b4-9aa1-3c6d5c4851dd | 2022 |
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