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A 1-month-old infant is hospitalized and on a strict diet. Using the body weight method to calculate the daily maintenance fluid volume, the corresponding value for this patient will be: | 60 ml/kg/day. | 30 ml/kg/day. | 100 ml/kg/day. | Medicine | 80 ml/kg/day. | 82 | 4 | f5c98e9c-f89c-499a-83d3-3e80c6b1ec9d | 2021 |
Regarding prophylactic treatment with lithium in bipolar disorder, indicate the correct answer: | Its use is safe during pregnancy. | The margin between therapeutic and toxic doses is narrow. | Thiazide diuretics can decrease your blood rate and therefore their effectiveness. | Medicine | The new antipsychotics have made their use practically obsolete. | 83 | 1 | 0e6f3f41-0e26-432b-a41b-123e38db3787 | 2021 |
Which of the following antipsychotics requires routine blood counts during treatment due to an increased risk of agranulocytosis?: | Quetiapine. | Olanzapine. | Risperidone. | Medicine | Clozapine. | 84 | 3 | c4e7c338-73a2-41b0-92ef-90bdc365ab4b | 2021 |
In a patient who is 85 years old with cognitive impairment and a depressive episode, indicate the antidepressant treatment that should be avoided: | Sertraline. | Amitriptyline. | Venlafaxine. | Medicine | Vortioxetine. | 85 | 1 | 8b1de10c-a069-432c-8c52-0e41738bb5b0 | 2021 |
In relation to hypomania, indicate which of the following characteristics is incorrect: | The history of hypomania in a patient with a major depressive episode changes the diagnosis of depressive disorder and influences the therapeutic decision. | Hypomania is almost never a reason for consultation and should be sought in the anamnesis of depressive episodes. | These patients exhibit psychotic symptoms, such as delusions of grandeur. | Medicine | Patients with hypomania may feel more active and sociable, although their behavior is generally somewhat inappropriate. | 86 | 4 | 0a512fe2-8178-4877-b665-c1992b58aa0d | 2021 |
A patient with a psychotic relapse who has started treatment with an antipsychotic that showed good response in the previous episode, comes to the consultation because of a feeling of motor restlessness that forces him to constantly move and prevents him from sitting still. Which of the following is the most appropriate treatment?: | Add β-blockers. | Reduce the dose of the antipsychotic and add bromocriptine. | Add an anticholinergic. | Medicine | Add dantrolene. | 87 | 2 | 7e1c8c34-4b90-4f2b-b68d-4372e5e3d7b2 | 2021 |
According to the DSM 5, body dysmorphic disorder belongs to the group of: | Anxiety disorders. | Obsessive-compulsive disorder and related disorders. | Mood Disorders. | Medicine | Psychosomatic disorders. | 88 | 1 | c819fb83-4cfb-434d-b04a-5be600879198 | 2021 |
To treat peripheral neuropathic pain, one of the following antiepileptic drugs could be used: | Vigabatrin. | Ethosuximide. | Levetiracetam. | Medicine | Gabapentin. | 89 | 3 | ff5b3b3b-1138-47ca-b88b-e0473098880a | 2021 |
A 59-year-old man, married, with no psychiatric history, has progressively over the last two years shown notable irritability and apathy. He has been absent from his job several times and his performance has notably decreased. He has been reprimanded at work for insulting several clients or for unjustified absences. On weekends, he is a recreational leader with teenagers, where it is reported that he excessively jokes with the boys and a female leader has complained that he has made inappropriate insinuations. Up until now, there have never been behaviors of this type. His wife is very worried because he says strange things and is thinking about separating. His family doctor has performed a Mini-Mental cognitive test that is within the normal range and no significant memory deficits are apparent. What is the least likely diagnosis? | Late-onset manic episode. | Late-onset Schizophrenia. | Frontotemporal dementia. | Medicine | Alzheimer's Disease. | 90 | 3 | e288bc81-8300-4d6d-b9fe-9b3ecfe9e9ef | 2021 |
Indicate which of the following studies by CT can differentiate, in a wake-up stroke, the cerebral area at risk of potentially recoverable ischemia from the area of already established irreversible infarction: | Diffusion CT. | Angio CT. | Non-contrast CT scan. | Medicine | Perfusion CT scan. | 91 | 3 | 915edfe6-301d-40a4-adc2-0ca507fe543a | 2021 |
Indicate which of the following clinical manifestations would make you doubt a diagnosis of Parkinson's disease: | Falls within the first two years of symptomatology. | Onset age at 55 years old. | Absence of tremor. | Medicine | Presence of a behavioral disorder during REM sleep. | 92 | 2 | 7ee22cf1-835c-4cac-b8ca-4539ca70301b | 2021 |
A 65-year-old patient with a history of regular alcohol consumption is attended to in emergency due to a clinical picture evolving over 24 hours of fever, headache, neck stiffness, and progressive deterioration of consciousness level. A cranial CT is performed which is normal and subsequently a lumbar puncture is performed which shows a CSF with pleocytosis (1500 cells/µl), hyperproteinorrachia (325 mg/dl), and hypoglucorrhachia (< 10 mg/dl). The most correct initial empirical antibiotic treatment among the following is: | Cefotaxime and vancomycin. | Cefotaxime and ampicillin. | Cefotaxime and antitubercular drugs. | Medicine | Cefotaxime, vancomycin and ampicillin. | 93 | 3 | 67102b93-5ea6-48f9-8cdc-6a21a2572ece | 2021 |
A 55-year-old woman with a history of type 2 diabetes mellitus and anxiety goes to the emergency room because suddenly that afternoon she started having difficulty with language production ("I wanted to say table but couldn't") and uncontrollable "jolting" movements in her right arm and leg. After two minutes, the movements subsided and she could speak normally. She was aware of the situation at all times. What is the most likely diagnosis? | Transient ischemic attack in the right carotid territory. | Complex focal seizure. | Simple focal seizure. | Medicine | Anxiety crisis. | 94 | 4 | 07536b53-369e-46e2-b40a-b4faf473c3be | 2021 |
A 64-year-old man who has been experiencing a progressive language disorder for a year. This is characterized by difficulty in finding words. He uses many umbrella terms and circumlocutions. He understands perfectly and his speech is relatively fluid except for anomia pauses. The difficulty to repeat long sentences is noticeable in the examination. He has no memory disorders or evident behavior problems. What is the most probable diagnosis? | Logopenic variant of primary progressive aphasia, probably due to Alzheimer's disease. | Nonfluent variant of primary progressive aphasia, probably due to frontotemporal dementia. | Unspecific dysnomia in the elderly patient. | Medicine | Diffuse Lewy body dementia. | 95 | 2 | d68ee8c1-c6dd-4277-b98c-1eb18e3c335e | 2021 |
A 75-year-old woman is consulting for a condition of stabbing pain that runs across her right lip and nostril. She is unable to wash her face or brush her teeth due to the pain it causes, which she describes as an electric shock. She reports no pain when sleeping. Choose the correct answer: | The treatment of choice is phenytoin. | The diagnosis corresponds to a paroxysmal hemicrania. | It can be treated with radiosurgery, but with a risk of recurrence. | Medicine | The most likely cause is a compression of the VII pair in its cisternal path. | 96 | 4 | 954f8eda-e80c-48f4-9d23-7ffbfb181c2f | 2021 |
After a traffic accident, you attend to an injured person. The patient opens his eyes to call, but only utters words that are inappropriate. In the motor examination, he locates pain in the right limbs but extends when stimulating the left limbs. How would you describe their situation according to the Glasgow Coma Scale? | E3V3M5. | E3V2M4. | E2V4M5. | Medicine | E2V3M4. | 97 | 2 | 100920d7-abb3-4d6e-9dc0-4730020d1efa | 2021 |
Which of the following is not a main feature of frontotemporal dementia? | Disinhibition (sexual, talkativeness). | Stereotyped speech or echolalia. | Loss of personal hygiene. | Medicine | Rapid onset and progression of the disease. | 98 | 3 | 7177a2fa-3493-4eb2-8f17-767466ba5f99 | 2021 |
In relation to restless legs syndrome in older patients, indicate the incorrect answer: | Iron deficiency is considered a risk factor for its occurrence. | There is a familial form. | It is more common in males than in females. | Medicine | Its prevalence increases from the age of 70. | 99 | 4 | 7f1493c9-fad8-467a-9eb1-c11d5cfc5fe5 | 2021 |
A 73-year-old patient with a history of chronic kidney disease exhibiting a case of 5 days of fever, headache, and confusion, accompanied by a tonic-clonic epileptic seizure. The clinical condition at the time of the assessment is good and the physical examination is normal. Tests highlight leukocytosis of 18,000/µl with 92% neutrophilia, normal red series and platelets; creatinine 2.3 mg/dl, eGFR 32 ml/min and CRP 15 mg/L (VN<5). The cranial CT does not show alterations. The CSF shows a clear liquid with 200 leukocytes/µl (60% lymphocytes), glucose 80 mg/dl, proteins 85 mg/dl (VN<50), ADA 25 IU/l (VN<15); the Gram stain of the CSF shows no microorganisms. What treatment would you recommend at this time? | Aciclovir plus isoniazid, rifampicin, ethambutol, and pyrazinamide. | Aciclovir. | Vancomycin, ampicillin and IV ceftriaxone. | Medicine | Acyclovir plus methylprednisolone IV. | 100 | 1 | 056d4027-fda2-4e09-8660-10e6321734be | 2021 |
15-year-old male, admitted after being run over in the street, ending up ejected. He is admitted conscious and oriented, with intense pain in the left hemithorax and dyspnea. Physical examination reveals blood pressure 90/60 mmHg, heart rate 130 bpm, baseline oxygen saturation 90%, respiratory rate 35 rpm. There is entire loss of breath sounds in the left hemithorax and dullness to percussion. Chest X-ray reveals multiple left rib fractures and massive ipsilateral pleural effusion. Placement of a pleural drain is indicated, with an output of 1700 cc of hematic fluid. What is the decision that needs to be made?: | Analgesia, oxygen therapy, request blood transfusion and indicate an urgent surgical intervention. | Establish non-invasive mechanical ventilation and request a blood transfusion. | Orotracheal intubation and execution of an urgent CT scan for precise assessment of the injuries. | Medicine | Orotracheal intubation, request blood transfusion and observation for, in case of worsening, indicate surgical intervention. | 101 | 2 | c7a7c2bc-f0da-4f6a-b3db-d8e97d303be1 | 2021 |
In a patient in a septic shock situation with a manageable infectious focus, which of the following statements is true?: | The control of the infection will be carried out after administering at least two doses of antibiotics. | Focus control should only be attempted once the patient has achieved hemodynamic stability and is not dependent on vasopressors. | If the septic shock situation has been progressing for more than 12 hours, controlling the source will no longer be beneficial for the patient. | Medicine | The control of the focus will be carried out as soon as possible. | 102 | 3 | 96d7efcf-63d8-452a-be59-9586a4da405c | 2021 |
A 56-year-old patient is found in a coma at his home. He has a history of high blood pressure and diabetes mellitus. He has no toxic habits or any other chronic diseases. He is being treated with irbesartan and empagliflozin. He shows no signs of malnutrition. He has a blood pressure of 110/60 mmHg, a heart rate of 110 bpm, a SatO2 of 90%, a capillary glucose of 120 mg/dl, and a respiratory rate of 7 rpm. What initial therapeutic approach do you think is the most correct? | Administer naloxone, flumazenil and hypertonic glucose. | Administer naloxone, flumazenil and thiamine. | Administer thiamine and hypertonic glucose. | Medicine | Administer naloxone and flumazenil. | 103 | 3 | f5ca1504-c04c-400f-897d-7c395cb99c71 | 2021 |
A 34-year-old male is involved in a traffic accident and is attended to at the scene. The medical personnel note that he is pale, sweaty, has a threadlike pulse with a blood pressure of 90/50 mmHg, a heart rate of 127 bpm, a respiratory rate of 28 rpm, and an oxygen saturation of 92%. He is infused with 20 ml/kg of crystalloids. During his transfer to the hospital, his vital signs temporarily improve and then deteriorate upon his arrival at the hospital. Indicate the correct answer: | Requires emergency blood transfusion (O Rh negative). | Requires type-specific blood transfusion. | The infusion of another 20 ml/kg of crystalloids should be tested again. | Medicine | A possible blood transfusion should be prepared with cross-matching tests. | 104 | 1 | b89425c4-83b4-4197-9c3a-07d1201c1e00 | 2021 |
A 24-year-old woman with a history of migraines, undergoing treatment with propranolol and oral contraceptives, presents with severe dyspnea, hoarseness, skin rash, nausea, and vomiting 30 minutes after taking metamizol. She has a blood pressure of 90/40 mmHg and a SatO2 of 90%. The most correct initial treatment would be to administer: | Epinephrine and dexchlorpheniramine. | Epinephrine. | Epinephrine, dexchlorpheniramine and glucagon. | Medicine | Epinephrine, dexchlorpheniramine and methylprednisolone. | 105 | 4 | 55d1cf69-71f8-4409-97d1-9076e7771197 | 2021 |
A 65-year-old patient suffered a fall three weeks ago with an anterior fracture-dislocation of the shoulder that was reduced in the emergency room. A sling was applied and it was recommended to be removed after 3 weeks. Upon removing the immobilization, an area of dysesthesia is observed circumscribed to the lateral region of the shoulder. The patient can perform abduction, but only reaches 15º. There is a magnetic resonance imaging study available in which the rotator cuff is unharmed. What is the most probable suspected diagnosis? | Adhesive capsulitis. | Tendinopathy of the teres major. | Axillary nerve injury. | Medicine | Suprascapular nerve neuropathy. | 106 | 4 | 9fdd7716-be1b-4b43-9d68-74681445d015 | 2021 |
In hand pathology, which of the following statements about Dupuytren's disease is incorrect? | Conservative treatment with physiotherapy is minimally effective. | It most frequently affects the ring and little fingers. | It is more common in manual laborers. | Medicine | It is a thickening and retraction of the palmar aponeurosis. | 107 | 4 | 6ec539b2-71dc-4c08-b6a3-f293a84a41ac | 2021 |
In a posterior hip dislocation, indicate the incorrect answer: | An emergency reduction needs to be performed. | The lower limb is in flexion, external rotation, and abduction. | Once reduced, recurrences are rare. | Medicine | One of its possible complications is the necrosis of the femoral head. | 108 | 1 | 201c1e6b-18ba-45d1-ab22-438141fd1126 | 2021 |
A child suffers a distal tibial epiphysiolysis in a sports accident. When informing the parents about the prognosis, which of the following factors does not influence the risk of future deformity?: | Intra-articular fracture. | Age and gender of the child. | Sports activity. | Medicine | Salter and Harris Type. | 109 | 4 | 8c93b5e7-0044-428b-895b-1f46c2f30790 | 2021 |
A 45-year-old patient who presents a first episode of lower back pain that has lasted 3 weeks and prevents him from living his normal life. He reports no trauma or underlying pathology. In the physical examination, there is no neurological deficit. What imaging test would be indicated? | Magnetic resonance imaging, which provides more information about soft tissues and possible herniations. | As this is the first episode of lower back pain, only a simple X-ray of the lumbar spine is needed. | There is no indication for imaging test. | Medicine | CT scan, to better assess the bone structure and potential fractures. | 110 | 4 | a0771df2-4670-4128-b29a-8e1595f1d0cb | 2021 |
A 40-year-old patient begins to feel discomfort in the right buttock after a long car trip. From that moment, he cannot tolerate prolonged sitting due to the recurrence of pain. He occasionally feels numbness in the right lower limb that disappears when he stands up. He has a magnetic resonance imaging study and hip radiograph which do not report anomalies. The examination of sensitivity and osteotendinous reflexes shows no alterations. The maneuvers of external rotation and resisted abduction, with the hip at 90º of flexion, reproduce the pain. The most likely diagnosis is: | Iliotibial band syndrome. | Femoroacetabular impingement syndrome. | Pyramidal syndrome. | Medicine | S1 Radiculopathy. | 111 | 4 | 800b9681-eaf0-4f85-9a7d-55c9ef634c75 | 2021 |
Regarding the familial Mediterranean fever, it is false to say that: | The inflammatory episodes are brief and recurrent, with asymptomatic intervals. | The vast majority of patients present with a high fever suddenly. | They may experience chest pain due to pleuritis and/or sterile pericarditis. | Medicine | Digestive manifestations are infrequent. | 112 | 3 | 7f7c1682-d5e5-4161-80a5-6642b31d53e1 | 2021 |
Which of the following extra-articular manifestations is not characteristic of rheumatoid arthritis?: | Subcutaneous nodules. | Pleurisy. | Interstitial lung disease. | Medicine | Proliferative Glomerulonephritis. | 113 | 3 | 649115df-d5a0-427e-8e97-ac9cda3160fd | 2021 |
Regarding fibromyalgia, indicate the correct answer: | The most common age of onset is over 50 years old. | It has a prevalence in the general population between 5 and 10%. | Fatigue is a very common symptom, affecting over 70% of patients. | Medicine | There are multiple drugs approved for its treatment. | 114 | 4 | 47c76ad9-8e99-4285-a4b4-39a2c5d119d3 | 2021 |
Regarding gout, it is false that: | The drug of choice is allopurinol, starting with low doses. | The hypouricemic treatment should be initiated during the gout attack, as soon as possible. | Around 50% of cases present as acute inflammatory monoarthritis of the first metatarsophalangeal joint. | Medicine | As a general rule, asymptomatic hyperuricemia should not be treated. | 115 | 1 | d5998f73-11e6-4bef-ae13-c6d522bcdfa3 | 2021 |
Among the following drugs for the treatment of osteoporosis, which one does not cause mandibular osteonecrosis or atypical femur fracture as a side effect?: | Denosumab. | Zoledronate. | Teriparatide. | Medicine | Alendronate. | 116 | 4 | 09274bcc-1c32-4fa1-b234-744b0ca2d871 | 2021 |
Which of the following is a priority objective in the therapeutic strategy for rheumatoid arthritis?: | Avoid unnecessary treatments in patients who, despite having symptoms, can maintain an acceptable daily activity. | Avoid frequent changes in treatment and avoid combinations of drugs. | The same protocol should be applied to all patients. | Medicine | The treatment should be early and intensive. | 117 | 3 | 450c1643-08d1-47a0-b22e-63a1a97a3917 | 2021 |
In scleroderma, in order to diagnose lung disease in early stages, it is recommended to perform: | Doppler echocardiogram and functional respiratory tests, only if the patient shows signs of respiratory and/or cardiac failure. | Pulmonary function tests and high-resolution CT scans every year. | Respiratory function tests and 6-minute walking test. | Medicine | Respiratory function tests and Doppler echocardiogram, both with annual frequency. | 118 | 3 | 8c02823d-0dd3-4c0e-8d5d-f6fe098946c5 | 2021 |
A 45-year-old patient with a history of gastroesophageal reflux has been experiencing episodes of paleness in some fingers of the hands when exposed to cold for a year. She was recently prescribed prednisone at a dose of 20 mg/day due to joint pain and skin hardening in hands and arms. She has been experiencing malaise and severe headache for the last 48 hours, which is why she went to the emergency room. The examination only reveals rhythmic tachycardia at 100 bpm, no neurological focus is appreciated. The blood pressure is 200/110 mmHg. In the analysis, only a creatinine level of 2.5 mg/dl is notable. Indicate which of the following autoantibodies is best associated with the described process: | Anti-centromere antibodies. | Anti-RNA polymerase III antibodies. | Anti-PM-Scl antibodies. | Medicine | Anti-proteinase 3 antibodies. | 119 | 1 | d06584eb-68c3-44f2-8121-cac2312a2378 | 2021 |
A 2-week-old newborn, whose mother during pregnancy had unaffiliated polyarthralgias and who, after the first sun exposure, developed erythematous polycyclic skin lesions that resemble those of subacute cutaneous lupus erythematosus. Which of the following autoantibodies should be investigated?: | Neutrophil cytoplasmic antibodies (ANCA) in the mother. | Anti-DNA antibodies in the newborn. | Anti-Sm antibodies in the newborn. | Medicine | Anti-Ro/SS-A antibodies in the mother. | 120 | 3 | 74646267-acd4-4018-a797-4dcc835922b0 | 2021 |
27-year-old black woman who consults for the appearance of edema in the lower limbs, decreased urination, fever, and a malar rash in butterfly wings of 20 days of evolution. Analytically, creatinine 3 mg/dl stands out, leucopenia, hemoglobin 10.5 g/dl (normocytic normochromic), CRP 9 mg/dl and ESR 60 mm. Regarding the pathology that this patient presents, indicate the correct answer: | Anticentromere antibodies are detected in 90% of the cases. | Anti-Sm antibodies are not specific to this pathology. | Anti-double stranded or native DNA is correlated with the risk of nephritis. | Medicine | The ANA (antinuclear antibodies) are detected in 50% of the cases. | 121 | 4 | 0cbc52ff-8364-4ee7-9669-ea6eb26f3a76 | 2021 |
75-year-old male, hypertensive under treatment with enalapril (20 mg/day), who reports general deterioration, bitemporal headache and mandibular claudication for 3 weeks. In addition, in the last few hours, he reports two episodes of fleeting amaurosis in the left eye. Physical examination reveals thickening and absence of pulse in the left temporal artery. Analysis: CRP 6 mg/dl (VN <1); hemoglobin 10.5 g/dl; ESR 92 mm. Normal chest X-ray. Considering the most likely diagnosis, mark the correct option regarding the treatment: | Tocilizumab has been shown to be effective in reducing relapses and the accumulated dose of prednisone in more than 50% of patients. | Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects. | Along with boluses of glucocorticoids of 1 g/day, infliximab should be used as a first-line drug for induction into remission. | Medicine | In the presence of ischemic symptoms, and to not worsen the patient's vascular risk, the use of glucocorticoids at doses higher than 30 mg/day should be avoided. | 122 | 2 | 99e66668-683e-4975-a39d-21fa4d2f934b | 2021 |
A woman consults after having suffered a sexual assault 3 hours ago. Regarding post-exposure prophylaxis to HIV, indicate the incorrect answer: | A serology test for HIV must be carried out at the beginning and at the end of the prophylaxis. | The duration should be 28 days. | The treatment is tenofovir and emtricitabine. | Medicine | The evidence for the usefulness of this treatment is not based on clinical trials. | 123 | 4 | b2d4b709-df48-435c-a1d1-2d938f8df50e | 2021 |
A 45-year-old patient was diagnosed with HIV infection three months ago, presenting at that time with CD4 45 lymphocytes/µl and an HIV-1 viral load of 500,000 copies/ml. At that time, he had a negative Mantoux test. He began treatment with an integrase inhibitor and two reverse transcriptase inhibitors, and a month later he had 25,000 copies and the CD4 had risen to 80/µl. He consults due to presenting a case of cervical lymphadenopathy and fever that has evolved over two weeks. The puncture of one of the lymph nodes shows acid-alcohol resistant isolated bacilli and epithelioid granulomas. | The patient is not responding to treatment and is suffering from an opportunistic infection. | This refers to a ganglionic tuberculosis associated with an incomplete immune recovery. | The fact of having a negative Mantoux test rules out tuberculosis. | Medicine | This is an opportunistic infection unmasked in the context of immune reconstitution. | 124 | 3 | 683cdfbc-2e81-4371-b21d-3ba8695f87c6 | 2021 |
Regarding severe bacterial meningitis caused by Streptococcus pneumoniae, which of the following is false?: | The mortality rate of S. pneumoniae meningitis requiring ICU admission exceeds 30%. | In our environment, more than 50% of S. pneumoniae causing meningitis are resistant to penicillin. | The use of dexamethasone improves functional and vital prognosis. | Medicine | The early initiation of treatment is essential for a good prognosis. | 125 | 1 | 2571412a-af46-4edb-aea0-92bec7385c4b | 2021 |
The monitoring of plasma drug concentrations is often done in clinical practice to adjust the dosage regimen of: | Pioglitazone. | Digoxin. | Carbimazole. | Medicine | Acenocoumarol. | 126 | 1 | ca834221-1b3c-44dc-88ea-c3596e836dad | 2021 |
The occurrence of torsades de pointes, due to prolongation of the QT interval on the electrocardiogram, is more likely to occur during antiarrhythmic treatment with drugs from the following group: | Ib (for example, lidocaine). | Ia (for example, procainamide). | IV (for example, diltiazem). | Medicine | II (for example, bisoprolol). | 127 | 1 | 621580ec-8ddf-4b7a-a7c3-f2585e9fa8ab | 2021 |
Indicate which characteristic corresponds to heart failure with preserved systolic function: | Atrial arrhythmias are well tolerated. | It is more common in young males. | High blood pressure is the most associated pathology. | Medicine | The 1-year prognosis is good, with a mortality rate of less than 5%. | 128 | 4 | 317f95b6-8f1e-4f19-9afe-97e0eda94c01 | 2021 |
A 40-year-old man consults for slowly progressive exertional dyspnea for the past year. He has no toxic habits or significant medical history. He has not had chest pain. He presents with a harsh systolic murmur at the aortic focus, radiating to the cardiac apex and carotids. The ECG in sinus rhythm shows criteria for left ventricular hypertrophy and on the chest X-ray, a dilated aortic root is evident. Based on this information, what is the most probable diagnosis? | Perimembranous ventricular septal defect. | Stenotic bicuspid aortic valve. | Restrictive cardiomyopathy. | Medicine | Degenerative aortic insufficiency. | 129 | 1 | 2a80ddde-1103-44ed-bf09-6d85636e274a | 2021 |
A 66-year-old male, diabetic and smoker, suffers from an anterior myocardial infarction with ST-segment elevation. The urgent coronary angiography shows a single lesion with acute occlusion in the proximal anterior descending artery, with a coated stent being implanted. At discharge, his electrocardiogram is in sinus rhythm with left bundle branch block (QRS 150 ms). The ejection fraction is 32%. Two months later, he comes for a review. Despite following optimal treatment, his functional class is III of the NYHA and the ejection fraction is 30%. What treatment should be offered to him at this time?: | Repeat the coronary angiography due to suspicion of thrombosis in the implanted stent. | Implant an automatic defibrillator and cardiac resynchronizer. | Refer him to a transplant unit to be included on the waiting list. | Medicine | Add digoxin and loop diuretics and wait for the improvement of the ejection fraction in 6 months. | 130 | 1 | 4631a37d-5eb8-405a-bc38-db7fd4dbb8fd | 2021 |
A 28-year-old woman with no cardiac history is admitted for syncope. She does not take drugs or consume toxins. She does not present with electrolyte imbalances. Her electrocardiogram shows a complete atrioventricular block with a ventricular rate of 30 bpm that requires the implantation of a permanent pacemaker. Based on this information, which of the following pathologies should be suspected?: | A pulmonary embolism with lung infarction. | A rheumatic valve disease with mitral stenosis. | An inferior vena cava thrombosis. | Medicine | A systemic infiltrative or inflammatory disease. | 131 | 3 | 4835ec46-cedf-4704-9d76-3bcdda398d10 | 2021 |
In relation to popliteal artery aneurysms: | The risk of aneurysm rupture is high. | When a wide popliteal pulse is suspected by palpation, ultrasound is the diagnostic test of choice. | They are more common in women than in men at a ratio of 2:1. | Medicine | The compression edema of the popliteal vein is the most frequent manifestation. | 132 | 1 | 66aa0c08-b7c9-4bc7-abc6-7ba4fab97ef2 | 2021 |
A 63-year-old male with a history of hypertension, Sjögren's syndrome, and left iliofemoral revascularization (thromboendarterectomy). He has lost 10 kg and has severe abdominal pain after eating. The abdominal-pelvic angioCT shows severe stenosis of the celiac trunk and superior mesenteric artery. Indicate the false answer: | The treatment consists of thromboembolectomy with a Fogarty catheter. | The physical examination often reveals signs of malnutrition and an abdominal murmur. | Angioplasty with stent placement in the visceral trunks is a therapeutic option with a success rate of 80%. | Medicine | The Doppler ultrasound (duplex) is a non-invasive examination useful for diagnosis. | 133 | 2 | 01bc2df3-9f2a-4817-bbc9-eb366aeab8e4 | 2021 |
A 53-year-old woman with a personal history of obesity and migraines. Her blood pressure has been measured on several occasions in both medical and nursing consultations with readings below 140/90 mmHg. However, she has purchased a certified blood pressure monitor and has been taught to use it correctly. She comes in showing blood pressure readings taken at her home over several weeks with values above 140/90 mmHg. Please indicate the correct answer: | He/she presents with masked arterial hypertension. | The patient has secondary arterial hypertension. | He/She presents with refractory arterial hypertension. | Medicine | Presents with isolated clinical hypertension. | 134 | 2 | 568a0408-9797-43f3-87d4-201dacc128cf | 2021 |
A 64-year-old patient, who smokes 1 pack a day, with a personal history of type 2 diabetes mellitus and dyslipidemia, comes to the consultation reporting pain in the right calf when walking 200 meters and that improves with rest. What test would you perform first? | Doppler Ultrasound of lower limbs. | Ankle-brachial index. | Abdominal CT scan. | Medicine | Lumbar spine X-ray. | 135 | 1 | f7e58c5e-7a7c-4178-8eb9-d18217799d9e | 2021 |
Among the different exploratory maneuvers of the heart, which one has the lowest diagnostic yield (sensitivity and specificity)?: | Palpation of the precordial area. | Inspection of the precordium. | Cardiac auscultation. | Medicine | Cardiac percussion. | 136 | 3 | 0bc25334-0470-4c80-a285-502ec7337eba | 2021 |
All the following therapies have shown to increase survival in the treatment of heart failure with depressed left ventricle ejection fraction except one. Indicate which: | Digoxin. | ACEI or ARB 2. | Beta blockers. | Medicine | ICD (implantable cardioverter defibrillator) or resynchronizer. | 137 | 2 | de705808-0c08-4ec8-94f8-17f01e5ec5b3 | 2021 |
Which of the following statements regarding right ventricle infarction is false?: | The elevation of the ST segment in V4 is the most common presentation in the electrocardiogram. | The infarction of the right ventricle can produce Kussmaul's sign. | With echocardiography, we can observe hypokinesis and dilation of the right ventricle. | Medicine | The treatment includes volume expansion to preserve the preload of the right ventricle. | 138 | 2 | 96de5836-1986-48dd-b6c1-aafad2672a8e | 2021 |
Regarding thromboangiitis obliterans (Buerger's disease), indicate the correct answer: | The presence of acute phase reactants determines the prognosis. | It predominates in the female sex. | It is characterized as a segmental inflammatory thrombosis, atheromatous, which affects medium and small caliber arteries and veins. | Medicine | The evolution of the lesions largely depends on the cessation of smoking habit. | 139 | 3 | ec4c332a-e08c-4439-95ce-83984ec82d5f | 2021 |
A 54-year-old male with persistent high cholesterol levels despite receiving treatment with 40 mg of atorvastatin (he did not tolerate the 80 mg dose due to myalgia) and having associated ezetimibe. He reports no history of hypertension or diabetes. He provides recent analysis with the following results: total cholesterol 302 mg/dl, LDL-cholesterol 270 mg/dl, HDL-cholesterol 32 mg/dl and normal triglycerides. In the physical examination, a BMI of 29 and a thickening at the level of the Achilles tendons stands out. With respect to the diagnostic suspicion and treatment, indicate the incorrect statement: | If the condition is confirmed in the patient, we must conduct genetic testing on all first-degree relatives. | The diagnosis can be made through a genetic analysis. | It is crucial to control all cardiovascular risk factors due to the association of this pathology with early cardiovascular events. | Medicine | You could benefit from starting treatment with a PCSK9 inhibitor drug. | 140 | 2 | 131bb87a-c9d1-471e-b418-f61b4a0692ef | 2021 |
In the adult respiratory distress syndrome, it is true that: | Pulmonary edema is due to an injury to the alveolocapillary membrane. | Pulmonary edema is due to an increase in pulmonary capillary pressure. | The lung injury is primarily due to bronchoaspiration. | Medicine | The lung injury is due to a very negative pleural pressure. | 141 | 2 | 7cbc65d2-1cb4-47a0-a3e6-04d2cf3847eb | 2021 |
In a patient with small cell lung carcinoma, thoracic radiation therapy: | It is only used in superior vena cava syndrome. | It is contraindicated in chemo-resistance. | It is recommended simultaneously with the first two cycles of chemotherapy. | Medicine | It's more effective after chemotherapy. | 142 | 4 | 025a9a12-e950-4d4c-b181-73be1e4e0ea6 | 2021 |
After a month of standard treatment for pulmonary tuberculosis, a patient shows hyperuricemia in a control analysis, with a value of 12 mg/dl (upper limit of normality 7 mg/dl). The patient is asymptomatic. What would be your approach? | Continue with the same treatment. | Remove all the medication. | Discontinue the pyrazinamide. | Medicine | Discontinue the isoniazid. | 143 | 2 | a1399b8b-c367-4c34-8255-48e33644904d | 2021 |
An 84-year-old woman, diagnosed with chronic obstructive pulmonary disease and undergoing home oxygen therapy, comes to the emergency room due to a worsening of her general condition, a fever of 39ºC, cough and purulent expectoration that has lasted for 5 days. Physical examination reveals a blood pressure of 90/70 mmHg, a heart rate of 125 bpm, a basal oxygen saturation of 86%, and a respiratory rate of 35 rpm. Auscultation reveals left basal hypoventilation. Her lab tests show 30,000 leukocytes (85% neutrophils). In the chest radiograph, a large left apical lung infiltrate and a moderate ipsilateral pleural effusion are detected. A thoracentesis is performed, yielding purulent pleural fluid, from which a culture is requested. What is the suspected diagnosis and the initial therapeutic approach?: | Pleural effusion under study. Antibiotic coverage should be carried out and serial radiological controls should be conducted. | Community-acquired pneumonia. Pneumococcal antigenuria should be requested and broad-spectrum antibiotic coverage should be scheduled. | Community-acquired pneumonia and left parapneumonic pleural empyema. Antibiotic coverage should be carried out, pneumococcal antigenuria should be requested, and an urgent left pleural drainage should be performed. | Medicine | Community-acquired pneumonia and left parapneumonic effusion. Antibiotic coverage must be applied and await the results of the pleural fluid culture to consider the placement of a pleural drain. | 144 | 4 | 8c4302d9-00e4-4f09-bf51-d7aa5062716e | 2021 |
In a patient with asthma, central bronchiectasis, and suspicion of allergic bronchopulmonary aspergillosis, what supplementary test would support the diagnosis of this condition? | Specific IgE against Aspergillus fumigatus. | Sweat test. | Bronchoscopy. | Medicine | Specific IgE against Aspergillus niger. | 145 | 2 | 76c397bc-ace2-423a-87db-b09004560588 | 2021 |
A 59-year-old patient from sub-Saharan Africa, with frequent episodes of diminished consciousness due to chronic alcoholism. Consultation for night sweats, cough, and fever lasting several weeks. In the X-ray and thoracic CT, a cavitary lesion of 3.5 cm in diameter with a hydroaerial level in the right lower lobe is observed. What would be the incorrect answer?: | An empirical treatment with metronidazole should be initiated. | It is necessary to analyze samples of induced sputum to rule out tuberculosis. | If there is suspicion of immune compromise, a bronchoscopy with biopsy or CT-guided needle aspiration should be performed immediately. | Medicine | If a specific pathogen is not isolated in the sputum, the presence of anaerobic germs is assumed. | 146 | 2 | b8c1e917-e7ca-4cc5-9442-b8ffd69eb4f9 | 2021 |
A 72-year-old woman with no notable medical history. Following a complicated kidney colic, a cystic lesion in the tail of the pancreas, measuring 2 cm, is accidentally found in an abdominal CT scan, along with multiple bilateral renal cystic lesions. Endoscopic ultrasonography shows a polycystic lesion made up of multiple vesicles with central calcification in the tail of the pancreas with no connection to the Wirsung duct. The fluid analysis is consistent with a serous cystadenoma. Among the following, which is the most appropriate approach regarding the management of this patient?: | Puncture guided by endoscopic ultrasonography and ethanolization of the same. | Surgical resection (corporocaudal pancreatectomy). | Kidney-pancreas transplant. | Medicine | Follow-up of the injury through MRI. | 148 | 3 | 78f9443c-53f4-4376-a02a-08151ad5effd | 2021 |
The diagnosis of irritable bowel syndrome is primarily clinical and is based on compatible symptoms and the absence of warning signs or symptoms. Which of the following is not considered a warning sign or symptom?: | Weight loss. | Onset of symptoms over the age of 50. | Urgent need to defecate. | Medicine | Positive for hidden blood in stool. | 149 | 4 | ad10d650-3dfe-4f86-ac3e-f6a2a305678f | 2021 |
An 83-year-old male who consults for a recurring episode of abdominal pain in the left iliac fossa, accompanied by diarrhea of up to 6 stools a day without pathological products, lasting 10-15 days. He does not report fever or general health impairment. A recent analysis shows no leukocytosis and he tested negative for occult blood in stool. Examination reveals mild pain on palpating the left iliac fossa without peritoneal irritation. He underwent a colonoscopy three years ago, which reported diverticula throughout the colon, more numerous in the left colon, without other associated lesions. Of the following, what would be the best course of action? | Request a priority colonoscopy. | Perform an empirical treatment with antibiotics. | Refer to surgery to consider sigmoidectomy. | Medicine | Request an urgent abdominal ultrasound. | 150 | 1 | ac1af9c9-0c61-4803-90ce-c7ff1896cb50 | 2021 |
A 43-year-old man with no notable medical history presents with a ten-day history of jaundice of the skin and mucous membranes, dark urine, and pale stools. He reports no abdominal pain, weight loss, or other symptoms, except for generalized itching. He denies alcohol consumption. He's not taking any medications aside from occasional ibuprofen for muscle pain after physical exercise. His blood tests show an increase in bilirubin, primarily direct bilirubin. An urgent ultrasound shows a normal liver, gallbladder cholesterolosis, and no dilation of the bile duct, with no other notable abnormalities. What is the most likely diagnosis? | Ibuprofen-induced toxic hepatitis. | Acute cholangitis due to biliary sludge. | Gilbert's Syndrome. | Medicine | Cholangiocarcinoma. | 151 | 2 | 2ffe7065-69b4-4bb0-a2be-45faee4b2983 | 2021 |
A 79-year-old woman with hypertension being treated with olmesartan attended a consultation due to watery diarrhea of 4 to 6 bowel movements a day for the past two months. Three months ago, she underwent treatment with non-steroidal anti-inflammatory drugs for three weeks due to sciatica. She underwent gastroscopy and colonoscopy, both without macroscopic abnormalities. Duodenal biopsies were normal, while in colon biopsies a chronic inflammatory infiltration of the lamina propria with an irregular band of collagen immediately below the surface epithelium of the mucosa with a thickness greater than 10 mm and a number of intraepithelial lymphocytes > 20 per 100 epithelial cells were observed. What is the most probable diagnosis? | NSAID-Induced Enteropathy. | Microscopic colitis. | Irritable Bowel Syndrome. | Medicine | Olmesartan-associated enteropathy. | 152 | 1 | d1c6e874-fa19-4100-bd2c-12578bc9e756 | 2021 |
Patient diagnosed with acute diverticulitis, treated with amoxicillin/clavulanic acid. After 5 days, the patient starts to experience fever and diarrhea. The patient is diagnosed with Clostridium difficile colitis, the amoxicillin/clavulanic acid is discontinued, and metronidazole is prescribed. After 4 days, the patient has not responded to the metronidazole, but is clinically stable. The next step in the treatment is: | Change the metronidazole to piperacillin/tazobactam (4 g of piperacillin/0.5 g of tazobactam every 8 hours). | Change metronidazole to oral vancomycin (125 mg, four times a day for 10 days). | Perform a loop ileostomy with anterograde polyethylene glycol lavage. | Medicine | Indicate a subtotal colectomy. | 153 | 1 | 81c6b7ca-9838-416a-8174-15b5ee643a93 | 2021 |
An 82-year-old man comes to the emergency room due to constipation together with significant abdominal distension. In simple abdominal radiology, the coffee bean sign is observed, and in the barium enema, the bird's beak sign is seen. If there are no signs of gangrene or peritonitis, the treatment will begin with: | Segmental colectomy and Hartmann's procedure. | Endoscopic detorsion. | Surgical detorsion and pexy of sigmoid. | Medicine | Segmental colectomy and laparoscopic colorectal anastomosis. | 154 | 1 | 3e462531-963f-4f98-a80b-69b44e291f45 | 2021 |
The most common benign tumors of the esophagus are: | The leiomyomas. | Fibrovascular polyps. | The hemangiomas. | Medicine | Squamous papillomas. | 155 | 2 | 428b6b7b-6f8f-4421-afda-311b3875f135 | 2021 |
A 46-year-old patient underwent a Bilroth II gastrectomy for peptic ulcer a year ago. He presents with epigastric pain and upper gastrointestinal bleeding. Ulcers are detected in both the stomach and small intestine during the endoscopy. After stimulation with IV secretin, no significant increase in serum gastrin is observed. The situation most likely corresponds to: | Retained Antrum Syndrome. | Gastrinoma. | Gastric stump carcinoma. | Medicine | Afferent Loop Syndrome. | 156 | 2 | 602883e2-3974-48d7-afea-1fa627cf2761 | 2021 |
The total mesorectal excision combined with anterior rectal resection in the treatment of mid to low rectal cancer aims to: | Perform a lower anastomosis. | Perform an anastomosis with greater ease. | Decrease the disease-free interval. | Medicine | Decrease the number of local recurrences. | 157 | 3 | af033753-acfa-4da4-923d-b0e9ad10d34a | 2021 |
A 52-year-old woman who had a hysterectomy years ago due to a uterine fibroid, seeks consultation for distal constipation and a bulge in the posterior vaginal wall that increases during defecation maneuvers, having to insert a finger in the vagina to achieve defecation. The examination shows a 3rd degree rectocele. In magnetic resonance imaging, a descent of the vaginal vault together with the rectocele is observed. The most appropriate surgical treatment is: | Intervention to reinforce the rectovaginal septum via the transanal route (Khubchandani technique). | Colporrhaphy with mesh. | Anterior sphincteroplasty. | Medicine | Transperineal intervention with placement of mesh in the recto-vaginal septum. | 158 | 1 | cf1acd86-ee29-4370-9097-b2ecb273710f | 2021 |
The surgical treatment of choice for vascular compression of the duodenum, also known as superior mesenteric artery syndrome or Wilkie's syndrome, is: | The duodenojejunostomy. | The division of the Treitz ligament. | The bypass of the superior mesenteric artery. | Medicine | The change in the position of the duodenum. | 159 | 2 | 9f8c10c9-5ce5-45df-9358-faa1fffb1ee3 | 2021 |
Central diabetes insipidus is characterized by: | Plasma and urinary hypotonicity, polydipsia and polyuria with nocturia. | Adipsia and hypotonic urines. | Sodium levels in the high range of normal with urinary hypotonicity. | Medicine | Inappropriate response to the administration of vasopressin. | 160 | 4 | 2905a3e4-c67a-4ac9-884e-55873ebb73a0 | 2021 |
Central adrenal insufficiency due to the suppression of the hypothalamus-pituitary-adrenal axis by the administration of corticosteroids: | The dosage and duration of corticotherapy are not directly associated with the risk of adrenal insufficiency after its discontinuation. | It is the most common cause of adrenal insufficiency. | The resolution of adrenal insufficiency after chronic corticosterapy occurs 24-48 hours after the withdrawal of the drug. | Medicine | The administration of corticoids suppresses the secretion of ACTH but does not affect the secretion of CRH. | 161 | 1 | 16e91619-2161-42e6-aff0-ab8b5bef0bd2 | 2021 |
Once a Cushing's syndrome has been confirmed by clinical and biochemical criteria, what is the essential test to determine its cause?: | High-dose dexamethasone cortisol suppression test. | Determination of morning plasma ACTH. | Magnetic resonance imaging of the hypothalamic-pituitary region. | Medicine | Inferior petrosal sinus sampling and selective venous catheterization. | 162 | 1 | a15773f3-ead4-4722-baf3-24aab840504e | 2021 |
Pituitary apoplexy is usually an endocrine emergency. Indicate the correct answer: | Ophthalmoplegia due to cranial nerve involvement spontaneously subsides. | The patient presents with compressive symptoms, hypopituitarism and hyperprolactinemia due to sectioning of the pituitary stalk. | The most common hormonal deficiency is that of the antidiuretic hormone. | Medicine | In patients without alteration of the visual field, it is necessary to urgently perform transsphenoidal decompressive surgery. | 163 | 2 | a3a2835e-8a54-42c4-be47-1d9400b79279 | 2021 |
In a patient with poorly controlled diabetes mellitus and chronic kidney disease (eGFR 52 ml/min), it is recommended to add, for its cardiovascular benefit, after metformin: | Basal insulin. | Sulfonylurea. | SGLT2 inhibitor. | Medicine | Glitazone. | 164 | 4 | 736c352a-fdf0-4602-bb02-0e73c53c0e7b | 2021 |
A 66-year-old woman has been diagnosed with type 2 diabetes mellitus for three months. She has a BMI of 31 Kg/m2 and exhibits poor glycemic control despite implementing a program of non-pharmacological measures (healthy eating, exercise). Which of the following hypoglycemic drugs is associated with weight gain and should we avoid in this patient?: | Pioglitazone (thiazolidinedione). | Metformin (biguanide). | Liraglutide (agonist of the receptor for GLP-1). | Medicine | Canagliflozin (inhibitor of the sodium-glucose co-transporter 2 - SGLT2). | 165 | 2 | 07897fef-3b6f-4bc3-b099-c280885857ea | 2021 |
An 18-year-old patient consulted for edema. A complete analysis was performed showing proteinuria of 8 g/day without microhematuria, hypoalbuminemia, and hypercholesterolemia with normal renal function. Empirical corticosteroids were administered. After a month, the clinical picture has completely disappeared. What is your diagnostic hypothesis? | IgA Nephropathy or Berger's disease. | Amyloidosis. | Nephropathy with minimal changes. | Medicine | Alport Syndrome. | 166 | 4 | 599d21de-327d-4b8d-b732-dfa36270e52f | 2021 |
In the case of a patient with advanced chronic kidney disease (CKD G4, eGFR 20 ml/min) who goes to the emergency department due to general weakness and is found to have severe hyperkalemia (K 7 mEq/l) with electrocardiographic alterations. What would be the first measure to take?: | Placement of a catheter to start dialysis. | Administration of cation exchange resins. | Administration of oral furosemide. | Medicine | Administration of intravenous calcium gluconate. | 167 | 3 | 83af0a23-a734-40b3-a73e-b08d1d7ae0a3 | 2021 |
Which of the following statements is not characteristic of acute interstitial nephritis?: | Proteinuria is usually within the nephrotic range. | It is often caused by drugs. | The definitive diagnosis is established by kidney biopsy. | Medicine | Sterile leukocyturia is common. | 168 | 2 | b0c931b8-f6a6-4b1f-b0e4-82f92ac35307 | 2021 |
Which of the following urinary ions promotes the formation of urinary lithiasis?: | Magnesium. | Citrate. | Sulfate. | Medicine | Sodium. | 169 | 3 | 2b1b7e29-5785-44be-a051-dd4bc2c462d0 | 2021 |
In one of the following conditions, asymptomatic bacteriuria would not require treatment: | Institutionalized dependent elderly patients. | Children under 5 years old with vesicoureteral reflux. | Patients who need to undergo an endoscopic or surgical examination of the urinary tract. | Medicine | Neutropenic patients. | 170 | 2 | 5cdb8818-15c4-4e26-b47d-4c72d3cfd0b3 | 2021 |
The most common cause of severe neutropenia (<500 neutrophils/microliter) is: | Primary due to acute leukemia. | Secondary to autoimmune diseases. | Due to hypersplenism developed in infections. | Medicine | Iatrogenic due to administration of medications. | 171 | 3 | 1d75fe47-a5f7-482b-9e51-e44bd6323109 | 2021 |
A 19-year-old woman, with a family history of anemia, shows signs of chronic hemolytic anemia, with a negative direct Coombs test. What would be the most likely diagnosis? | Erythrocytic pyruvate kinase deficiency. | Hereditary spherocytosis. | Paroxysmal nocturnal hemoglobinuria. | Medicine | Beta thalassemia major. | 172 | 1 | 38e0947f-fe51-41b2-96e4-402559641506 | 2021 |
A 70-year-old woman goes to the emergency room for asthenia. The physical examination reveals cutaneous-mucosal paleness with sub-jaundice conjunctiva, and a pansystolic murmur audible in all foci. Laboratory findings show hemoglobin 8 g/dl, MCV 100 fl, LDH 900 U/l, undetectable haptoglobin, and total bilirubin 3.5 mg/dl. An immunohematological test was requested. Indicate the correct response: | This is a case of hemolytic anemia; to determine its nature, we must request a hemoglobin electrophoresis. | The most likely diagnosis is lead poisoning; we must request a 24-hour urine lead test. | This is a case of hemolytic anemia; we must request a direct Coombs test, which determines the presence of free IgG in plasma. | Medicine | This refers to a hemolytic anemia; we need to request a direct Coombs test, which determines the presence of IgG and/or the C3 fraction of the complement on the red blood cell membrane. | 173 | 3 | c23140bf-f3bc-4643-9da4-e672331f1e05 | 2021 |
One of the following consequences cannot be directly attributed to immobility syndrome in the elderly patient: | Orthostatic hypotension. | Heart failure. | Aspiration pneumonia. | Medicine | Fecal impaction. | 174 | 1 | 35c7dbca-032f-42f1-b856-84cdfef733c4 | 2021 |
A 75-year-old man, in good health and who could be considered robust, seeks information about using some type of treatment to maintain his good health and physical condition. What would be the best recommendation for this patient? | Testosterone. | Growth hormone. | Regular physical exercise. | Medicine | Vitamin D. | 175 | 4 | 9e94a106-61e8-4c1d-b692-247f4bd00d51 | 2021 |
In the CT scan of the abdomen with intravenous contrast performed for the study of chronic pancreatitis, which of the following findings is typical of this disease?: | Focal areas of pancreatic necrosis. | Enlargement of the duodenal framework. | Dilation of the pancreatic duct. | Medicine | Increase in glandular enhancement in the arterial phase. | 177 | 4 | 05828be6-0512-4bde-8eb9-3ec3bac0f5a5 | 2021 |
In relation to encephalitis caused by N-methyl-D-Aspartate (NMDAR) receptor antibodies, indicate the incorrect answer: | In some cases, it can occur after an infection by the herpes simplex virus 1. | In adolescents, psychiatric manifestations predominate. | The diagnosis is established by demonstrating the presence of anti-NMDAR antibodies in the CSF and serum. | Medicine | It does not affect children under 1 year of age. | 178 | 3 | a05d4496-707f-4daf-abbe-aea83baaf5eb | 2021 |
A 32-year-old woman with type 2A multiple endocrine neoplasia syndrome (MEN-2A) and carrier of a RET mutation. A hypoechogenic nodule of 6 mm with calcifications inside is identified in a neck ultrasound. A total thyroidectomy and cervical lymph node dissection is decided. In the macroscopic study, a total of three nodules are identified, two in the right lobe of 5 and 6 mm, and one in the left lobe of 4 mm. In the microscopic study, the three lesions consist of a uniform proliferation of rounded cells that are arranged in a solid pattern and are accompanied by calcifications and amyloid deposits. The nuclei are not clear, nor do they show clefts or pseudo-inclusions. The immunohistochemical staining for synaptophysin is positive. Metastases are identified in the cervical lymph node dissection. What is the pathological diagnosis of the lesions identified in the total thyroidectomy? | Multifocal papillary carcinoma. | Multifocal medullary carcinoma. | Hyperplasia of parafollicular cells. | Medicine | Follicular Carcinoma. | 179 | 1 | 372f5598-6dcf-416a-bdbe-e16ad8933d48 | 2021 |
A 25-year-old patient who had a motorcycle accident on a Friday night. They are transferred to the emergency room and diagnosed with abdominal trauma (negative eco-fast), mild head injury (Glasgow = 14), and a displaced intracapsular fracture of the right hip. Hemodynamically, they are stable. What would be the treatment of choice? | Scheduled total arthroplasty for hip resurfacing on Monday. | Reduction, open if necessary, and osteosynthesis of the fracture in the first 24-36 hours. | In response to the risk of non-consolidation of these types of fractures, I would urgently implant a bipolar hemiarthroplasty of the hip. | Medicine | Wait for improvement from the head trauma and schedule a regulated surgery for the following week, which consists of the reduction and osteosynthesis of the fracture. | 180 | 1 | 051b8882-e74e-4b20-a1f5-3ce10e6cd3fd | 2021 |
A 33-year-old patient, non-smoker, with a history of pneumothorax on two occasions, comes to the clinic with progressive dyspnea. The chest X-ray shows a left pleural effusion that occupies 1/3 of the hemithorax and multiple cystic images evenly distributed throughout both lungs. In the spirometry, she presents an FEV1/FVC of 64% and a diffusion test with a TLCO of 50%. Indicate the most likely diagnosis: | X Histiocytosis. | COPD. | Lymphangioleiomyomatosis. | Medicine | Adenoid cystic malformation. | 181 | 4 | 90a9b1a2-0f83-4139-913b-bc1cf785ce3d | 2021 |
A class I recommendation in a clinical practice guideline means that: | There is evidence or agreement that following the recommendation has more benefits than harms for patients. | It is based on scientific evidence from clinical trials. | That the recommended intervention has a high cost. | Medicine | All patients who follow the recommendation will improve their health level. | 182 | 2 | b7453db2-09eb-45ff-830d-8c9f25a60300 | 2021 |
A 37-year-old male presents with asthenia, low-grade fever (37.6ºC), and weight loss of about 5 kg over a 2-month period. In the last 2 weeks, there is an addition of burning paresthesias and hypoesthesia in all four limbs, as well as non-painful palpable purpuric lesions on both legs and feet. Blood pressure, kidney function, and urine sediment are normal. What would be the complementary test to confirm the most likely diagnosis? | A "punch" (cookie cutter) type skin biopsy for the diagnosis of a polyarteritis nodosa. | A Doppler ultrasound of the renal arteries for the diagnosis of Takayasu's arteritis. | A kidney biopsy for the diagnosis of an IgA vasculitis. | Medicine | The detection of circulating cryoglobulins for the diagnosis of cryoglobulinemic vasculitis. | 183 | 3 | d34d560f-b92a-4b20-9bfc-293c00bc5e2b | 2021 |
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