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A patient admitted for an opportunistic systemic mycosis is prescribed an antifungal drug with a narrow therapeutic index. The active form of the drug is excreted unmetabolized in urine by 60%. The patient suffers from severe renal failure, with a creatinine clearance of 20 ml/min. If the usual dosing schedule for the antifungal is 40 mg/kg/10 h, which of the following schedules is more suitable?: | 30 mg/kg/10 h (the dose is only reduced to 30 mg/kg). | 40 mg/kg/10 h (no dosage adjustment is required). | 40 mg/kg/20 h (only the interval between doses is extended to 20 h). | Medicine | 30 mg/kg/20 h (the dose is reduced to 30 mg/kg and the interval between doses is extended to 20 h). | 184 | 4 | 18e4c841-76f3-465f-8484-287a851441a3 | 2021 |
In a patient known to have had a negative Mantoux test a few years ago, there is a turnaround of the same. The first reaction: | It is a false negative. | It is a true negative. | It is a false positive. | Medicine | It is a true positive. | 185 | 1 | 94c5994e-34df-46e5-91aa-f8ceeb95ddc2 | 2021 |
Regarding plasma proteins, indicate the incorrect statement: | Albumin is the major protein in plasma, thus participating in the maintenance of oncotic pressure. | Albumin is synthesized in the liver and metabolized in numerous tissues, allowing them to utilize the amino acids derived from its degradation. | Given the numerous genetic variants of albumin, it is possible to observe a double band of albumin in a proteinogram, which is known as bisalbuminemia, but which lacks clinical significance. | Medicine | Albumin is involved in the transport of direct or conjugated bilirubin, as well as fatty acids, calcium, and some vitamins, hormones, and drugs. | 28 | 3 | be0fb831-7960-4998-9e87-9a1e7ffdbd7d | 2020 |
In relation to the pentose phosphate pathway (also known as the hexose monophosphate shunt), indicate the correct answer: | When the cell only requires NADPH (reduced form of nicotinamide adenine dinucleotide phosphate), the pentose 5-phosphate from the pathway is recycled to glucose 6-phosphate through a biotin-dependent carboxylation. | The first reaction of the non-oxidative branch of this pathway is the transformation of glucose 6-phosphate by glucose 6-phosphate dehydrogenase. | The production of NADPH through this pathway particularly protects red blood cells from oxidative aggression. | Medicine | Abnormal forms of glucose 6-phosphate dehydrogenase with lower catalytic activity severely affect tissues because they lack alternative mechanisms to synthesize NADPH or to induce the synthesis of the enzyme. | 29 | 4 | ce95297d-4053-46e0-8c08-068490c1032d | 2020 |
To determine whether the regular use of acetylsalicylic acid is associated with a higher risk of hypertension, a group of subjects is selected, it is found out how many are taking acetylsalicylic acid and they are followed for 5 years to identify new cases of hypertension. Indicate the correct answer about the design of this study: | It is an ecological study because many subjects are followed. | It is a clinical trial because it is carried out with drugs. | It's a cohort study, because subjects are followed according to their exposure to identify the risk of a disease. | Medicine | It is a case-control study, in which the cases take aspirin and the controls do not. | 30 | 4 | 685544d7-7edc-4784-8aba-66806a441bbd | 2020 |
In a population, 2,000 fatal traffic accidents occurred from January 1st to December 31st, 2019. What measure of accident frequency has been used? | Period prevalence. | Point prevalence. | Incidence. | Medicine | Lethality. | 31 | 4 | 26eef034-c4e2-4085-bb6c-195995923241 | 2020 |
Of the following criteria for causality in a statistical association between an exposure and an outcome, which is the only necessary one?: | Consistency. | Biological plausibility or coherence. | Strength of the association. | Medicine | Appropriate temporal relationship. | 32 | 3 | dcaa44a5-32a6-4ac2-bcb8-32220eca52ad | 2020 |
Regarding the relative risk, indicate the incorrect answer: | Their values vary between 0 and 1. | It is the ratio between the cumulative incidence in the exposed population and the cumulative incidence in the non-exposed population. | For its proper interpretation, it is necessary to know its confidence interval. | Medicine | It has no units. | 34 | 2 | 3ba2a860-b9b3-4279-9d47-686750f36c76 | 2020 |
Of the five recommended moments in hand hygiene, indicate the incorrect answer: | After contact with the patient. | Before contact with the patient. | After contact with the patient's environment. | Medicine | Before contact with the patient's environment. | 35 | 3 | dbd055f7-f013-4ed4-951e-5f955744203b | 2020 |
Among the precautions to be taken in droplet isolation, the following are excluded: | Particle mask (N95). | Single room. | Place a surgical mask on the patient if it is necessary to move them out of the room. | Medicine | The door of the room can remain open. | 36 | 2 | bb61ef9c-3242-4308-9992-dacb61be525f | 2020 |
We inform the management of our hospital that the incidence density of infection in the Intensive Care Unit (ICU) is 15 per thousand and they ask us what that figure means. Our response should be: | For every 1,000 admissions to the hospital, 15 get infected in the ICU. | If there were 1,000 patients admitted to the ICU, there would be 15 new infections every day. | 15 out of every 1,000 patients admitted to the ICU get infected. | Medicine | The daily risk of admission to the ICU is 15 per 1,000 inhabitants in the reference population. | 37 | 1 | f513d34c-338a-4666-9b8e-bf3d838102dd | 2020 |
A pregnant woman comes to the consultation for hypercholesterolemia. Which drug will be contraindicated due to the high risk of fetal anomalies demonstrated in humans, exceeding its possible therapeutic benefit?: | Gemfibrozil. | Nicotinic acid. | Cholestyramine. | Medicine | Simvastatin. | 38 | 3 | 88ef26d4-6ba3-47f1-a349-879ceab1f777 | 2020 |
When dealing with a patient with Parkinson's disease who is experiencing nausea at the start of treatment with dopaminergic agonists, which drug would you use to improve this symptom? | Domperidone. | Clebopride. | Sulpiride. | Medicine | Metoclopramide. | 39 | 2 | 4514aca8-f23a-494d-b5fd-33fdbd74b8e4 | 2020 |
One of the following drugs is specific for preventing the onset of non-convulsive generalized epileptic seizures by blocking T-type calcium channels. Indicate which one: | Zonisamide. | Levetiracetam. | Ethosuximide. | Medicine | Lamotrigine. | 40 | 4 | bec5cd95-61d1-4d6e-9cba-d13111aecdc6 | 2020 |
If we use a repeated administration regimen with a drug that has a half-life of 8 hours, the steady-state plasma concentration will be reached: | 24 hours after the start of administration. | After 16 hours from the start of administration. | After 40 hours from the start of administration. | Medicine | After 32 hours from the start of administration. | 41 | 4 | 96c4cb18-745b-44ff-8ac8-ea2fb07f555a | 2020 |
In relation to the control of coronary blood flow, it is false that: | In the presence of very low concentrations of oxygen in the myocytes, the availability of adenosine increases. | If the strength of the heart contraction increases, the speed of the coronary flow also increases. | The direct and indirect effects of the parasympathetic coronary activity (vagal) cause vasodilation of the coronary arteries. | Medicine | The direct effect of coronary sympathetic activation can cause both vasoconstriction and vasodilation. | 42 | 4 | 91781a41-f583-477d-bac4-50858f1ef688 | 2020 |
Indicate which of the following factors causes an increase in the amount of oxygen released by hemoglobin: | Decrease in CO2. | Decrease in hydrogen ions. | Decrease in 2,3-bisphosphoglycerate. | Medicine | Increase in temperature. | 43 | 3 | 6ff7a66e-db90-4088-90e5-315b9f38518d | 2020 |
The process of genetic anticipation, whereby the clinical manifestations of a disease become more severe as it passes from one generation to another, is usually a consequence of: | Accumulation of point mutations in several genes of the same pathway as generations pass. | Accumulation of point mutations in a gene as generations pass. | Transgenerational changes in chromatin acetylation. | Medicine | Triplet expansion mutations. | 44 | 3 | 219a3fbd-237a-4abe-b78a-f6242b20de48 | 2020 |
A 15-year-old girl who shows a delay in menarche and is short in stature. She does not have an intellectual disability. Which of the following genetic tests would typically be used for the diagnosis of this patient?: | FISH. | Massive sequencing (NGS). | Karyotype. | Medicine | DNA and/or RNA microarrays. | 45 | 4 | e1c567a5-6973-4fb1-9419-ae664f4dd520 | 2020 |
In the treatment of inflammatory bowel disease, humanized monoclonal antibodies can be used that are targeted against TNF-alpha (such as adalimumab) or against the integrin a4ß7 (such as vedolizumab). Regarding the integrin a4ß7 (also called LPAM-1), it is true that: | It is a receptor for TNF-a in CD4+ T lymphocytes of the mucosa-associated lymphoid system. | It binds to ICAM-1 and is responsible for the passage of lymphocytes from the peripheral blood to the lymph nodes. | It binds to the adhesin MadCAM-1 and promotes the passage of lymphocytes from the peripheral blood to the Peyer's patches and the intestinal lamina propria. | Medicine | It is expressed in the cells of the gastrointestinal epithelium in patients with inflammatory bowel disease. | 46 | 4 | 49357683-66cb-4b6d-bccf-6c1d3c478a4c | 2020 |
The Ministry of Health recommends that during the third trimester of pregnancy, women should be revaccinated against Bordetella pertussis, the causative agent of whooping cough. Why?: | So that the mother's immune system produces IgG isotype antibodies, specific against the pathogen, that allow the baby to be passively immunized after birth. | For the mother's immune system to produce IgM isotype antibodies, specific against the pathogen, which allow both her and the fetus to be immunized. | For the mother's immune system to produce memory T lymphocytes, which cross the placenta and allow the baby to be passively immunized after birth. | Medicine | In order for the fetus's immune system to produce IgM and IgG isotype antibodies, specific against the pathogen, which allow the baby to be actively immunized after birth. | 47 | 2 | 69491a9f-8ebe-4a42-9eef-d7523a84bebd | 2020 |
In a 40-year-old woman, not pregnant and with no relevant pathological history, diagnosed with intermittent mild-moderate allergic rhinitis due to sensitization to grass pollens, which of the following symptomatic treatments is the first choice?: | Oral Bilastine and Mometasone (nasal spray). | Oral hydroxyzine and ipratropium bromide (nasal spray). | Oral Ketotifen and topical nasal Oxymetazoline. | Medicine | Oral dexchlorpheniramine and topical nasal cromoglycate. | 48 | 2 | d477ae90-fd50-4592-8c1c-2265208965f7 | 2020 |
A 60-year-old man undergoing treatment with carbamazepine for epilepsy, presenting with fever (38.8°C), odynophagia (painful swallowing), conjunctivitis, brownish skin lesions spread over a large part of the body surface, similar to a target in appearance, and accompanied by epidermal detachment (over 30%) at the slightest touch. It is highly likely that he is showing clinical signs of: | Minor exudative erythema secondary to drugs. | Acute urticaria caused by pharmacological reasons. | Toxic Epidermal Necrolysis. | Medicine | Pharmacological Stevens-Johnson Syndrome. | 49 | 4 | de8b0f33-811a-420c-b3c1-02362c8aec2a | 2020 |
All of the following are causes of metastatic calcification except: | Paget's disease of the bone. | Cellular necrosis. | Elevation of parathyroid hormone. | Medicine | Diffuse bone metastasis. | 50 | 1 | 428f4b21-6158-4605-88fd-2474869a9e19 | 2020 |
The vasopressor of choice to maintain perfusion pressure in a patient with septic shock is: | Norepinephrine. | Dopamine. | Phenylephrine. | Medicine | Dobutamine. | 51 | 2 | 22b5c76b-3862-4a54-b289-8c586f1300e2 | 2020 |
During general anesthesia, the patient's temperature has been progressively increasing and you come to the conclusion that they are suffering from malignant hyperthermia. Regarding this complication, one of the following statements is true: | It is caused by the use of barbiturates and opioids. It should be treated with dantrolene. | It is caused by the use of halogenated anesthetics and non-depolarizing muscle relaxants. It should be treated with benzodiazepines. | It is caused by the use of ketamine and local anesthetics. There is no treatment. | Medicine | It is caused by the use of halogenated anesthetics and depolarizing muscle relaxants. It should be treated with dantrolene. | 52 | 3 | 29f748bc-b20f-445e-bb60-4b729fe2509f | 2020 |
Which of the following functions does not correspond to the Healthcare Ethics Committees?: | Advise on clinical cases with complex ethical dilemmas where careful deliberation is recommended. | Conduct the mandatory ethical counseling of a clinical trial with human beings. | Advise patients or family members who consult about an ethical issue in relation to healthcare. | Medicine | Explore the training needs in the field of bioethics of the professionals at the institution. | 53 | 1 | 8ff66469-6fce-4957-a103-02ba6d2ebfdf | 2020 |
Regarding the tumors of the salivary glands: | The adenoid cystic carcinoma is the most common tumor of the salivary glands and typically settles in the submaxillary gland. | The adenoid cystic carcinoma is the most common tumor of the salivary glands and typically settles in the parotid gland. | The pleomorphic adenoma is the most common tumor of the salivary glands and typically settles in the submandibular gland. | Medicine | The pleomorphic adenoma is the most common tumor of the salivary glands and typically settles in the parotid gland. | 54 | 3 | dc66621c-3e49-4747-9efd-beaec002634a | 2020 |
Regarding the reconstruction of the smile in patients with facial paralysis, we can affirm that: | Dynamic reconstruction involves performing a neurotized muscle transfer. | It is not recommended to perform a dynamic reconstruction without previously performing a static reconstruction. | Direct nerve sutures from a motor nerve to the damaged facial nerve can be performed in the first few months after the facial nerve injury occurs. | Medicine | Static reconstruction is indicated in cases where facial paralysis has been established for less than a year. | 56 | 4 | d7f1df6b-aeeb-4bbd-916a-86770683d5ed | 2020 |
In relation to the powerful opioid analgesics commonly used to treat severe pain in patients with advanced irreversible chronic disease, indicate the incorrect answer: | Morphine has a half-life of 4 hours. | Fentanyl should be adjusted in case of renal insufficiency. | Buprenorphine can be administered transdermally. | Medicine | Oxycodone has a lower incidence of nausea than morphine. | 57 | 2 | c7f3b722-61c2-40df-bdac-6777963d1ccd | 2020 |
In the case of a patient who is in a terminal state, with a life expectancy of less than a month, and who presents with intense anorexia, indicate which of the following treatments you think is most appropriate to treat this symptom: | Paroxetine (10 - 20 mg/day). | Megestrol acetate (320 - 480 mg/day). | Dexamethasone (4 - 8 mg/day). | Medicine | Oxybutynin (2.5 - 10 mg/day). | 58 | 4 | ca250855-e6ea-453f-8001-07d138c533e7 | 2020 |
Of the following methods, which is the most reliable for estimating the post-mortem interval in the early period after death? | Observation of the evolution of post-mortem lividity. | Quantification of potassium in vitreous humor. | Assessment of ocular reactivity to acetylcholine eye drops. | Medicine | Determination of rectal temperature. | 59 | 3 | 41824e21-83a1-4750-bb74-c9dafc2a2aa7 | 2020 |
In a minor patient, all the following infections should be suspected as being caused by sexual contact, once perinatal transmission has been ruled out. Only one of them probably has a non-sexual origin in little girls. Please specify which one: | Genital Chlamydia trachomatis. | Pharyngeal Neisseria gonorrhoeae. | Trichomonas vaginalis. | Medicine | Molluscum contagiosum of the genital area. | 60 | 3 | 95572745-6554-4201-ac78-a5eb8c2e7424 | 2020 |
What would be the treatment for a 31-year-old patient, nulliparous and asymptomatic, who was diagnosed with a lesion consistent with a 4 cm right ovarian endometrioma on a routine ultrasound? | Diagnostic-therapeutic laparoscopy for confirmation and extent of disease diagnosis. | Gynecological examination and regulated ultrasound study for deep endometriosis screening. | Initiation of treatment with gonadotropin-releasing hormone (GnRH) analogues to prevent disease progression. | Medicine | Right laparoscopic cystectomy. | 61 | 1 | 6b35f1fa-637e-463b-a54e-d41b422bc1e2 | 2020 |
What is the most important sonographic marker in the screening of aneuploidies in the first trimester of pregnancy? | The alteration of the venous duct wave. | The absence of nasal bone. | The measurement of nuchal translucency. | Medicine | The presence of choroid plexus cysts. | 62 | 4 | 8c100f06-337e-4b49-a837-cce8603636f8 | 2020 |
The following parameters, except one, are routine data for periodic control in premature rupture of membranes in a preterm pregnancy. Indicate which one: | Cervical length. | Body temperature. | External cardiotocographic record. | Medicine | Complete blood count and determination of C-reactive protein. | 63 | 2 | 413f89f1-4470-44ff-b5c8-3e8f4d44a949 | 2020 |
65-year-old woman without comorbidities, who undergone conservative surgery of the left breast with selective biopsy of the sentinel node. The pathological anatomy of the specimen shows a grade III infiltrating ductal carcinoma of 11 mm, two negative sentinel nodes, estrogen receptors: 0%, progesterone receptors: 0%, Ki 67: 70%, HER2: negative. The extension study is negative. The adjuvant treatment would be: | Chemotherapy based on anthracyclines and taxanes, radiation therapy and tamoxifen. | Anthracycline and taxane-based chemotherapy, radiotherapy and trastuzumab. | Anthracycline and taxane-based chemotherapy, radiotherapy, and aromatase inhibitors, since she is postmenopausal. | Medicine | Chemotherapy based on anthracyclines and taxanes, and radiotherapy. | 64 | 3 | fd7fc47d-70d9-4783-8a69-3e5400de9036 | 2020 |
A 30-year-old woman comes to your clinic because she has noticed a lump in her right breast that has recently appeared. Her grandmother had breast cancer. Upon examination, a 2.5 cm nodule with regular edges is palpated in the upper-outer quadrant. She has no previous imaging tests. Indicate the correct answer: | Requests a mammogram because it is the "gold standard" diagnostic test. | Requests a mammary ultrasound given the patient's age. | He explains to her that, being 30 years old, it is probably a cyst and will opt for a clinical check-up in 6-12 months. If it persists, then he will request an imaging test. | Medicine | Requests a magnetic resonance imaging given the patient's age and family history. | 65 | 1 | a98b63bc-87d1-4aac-a3eb-2b5333be19ed | 2020 |
A first-time mother at 40+2 weeks presents to the emergency room with obvious amniotic fluid leakage and regular contractions. Prenatal follow-up has been normal, and she has tested positive for Group B streptococcus in a vaginal-rectal swab. On obstetric examination, her cervix is 5 cm dilated, 80% effaced, and centered, with a single fetus in a head-down presentation. What would be the recommended course of action for this patient? | Return home and antibiotic prophylaxis with penicillin during expulsion period. | Hospital admission in obstetrics ward and observation. | Hospital admission in dilation room and antibiotic prophylaxis with penicillin. | Medicine | Assessment in outpatient obstetrics consultations for the performance of obstetric ultrasound and fetal Doppler. | 66 | 4 | 382e2bd1-9258-42dc-a951-c9123efadcec | 2020 |
A 34-year-old woman diagnosed with polycystic ovary syndrome has been dealing with primary infertility for 2 years and has been unsuccessfully treated for 6 months with clomiphene citrate (100 mg/day for 5 days). She has not associated other causes of infertility. What would be the most appropriate treatment at this point? | Increase the dosage of clomiphene citrate to 200 mg/day for 5 days, for an additional 6 months. | Artificial insemination and FSH (follicle-stimulating hormone). | Metformin. | Medicine | In vitro fertilization (IVF). | 67 | 1 | 98a46010-4503-474b-9cfb-90e76c3699e3 | 2020 |
What genetic and reproductive advice would you give to a 30-year-old woman who consults because she is a carrier of a premutation in the FMR1 gene, responsible for fragile X chromosome syndrome, and wants to have offspring? Indicate the correct answer: | There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms. | All their male children will be carriers and, therefore, will manifest the disease. | 50% of his daughters will be carriers, but they will not show clinical manifestations of the disease. | Medicine | Preimplantation genetic diagnosis for sex selection of embryos through fluorescent in situ hybridization (FISH) is the best option for having healthy offspring. | 68 | 2 | 5417046e-0d48-4122-958f-d7cdefcdfa49 | 2020 |
A myopic 83-year-old man is being treated for diabetes and hypertension. His family brings him to a consultation because in the past few days, he has been spilling his glass of water on the table and hitting his head on the kitchen furniture multiple times, although he does not report any visual deficit. The intraocular pressure is 18 mmHg in both eyes and visual acuity is 0.9 in both eyes. What would be the correct response? | This could be a case of cortical blindness and a visual field test should be conducted to assess a possible homonymous hemianopsia with macular sparing. | Treatment with prostaglandin analogs in eye drops must be initiated, because there is normal tension glaucoma with visual field impairment. | The patient has a peripheral retinal detachment secondary to their myopia, which has not yet affected the posterior pole. | Medicine | As he does not report any visual problems, has normal intraocular pressure and normal visual acuity, these are normal oversights for his age. | 69 | 2 | da020f28-8dfa-4787-9103-f11e5223b5e5 | 2020 |
A 67-year-old woman has been experiencing luminescent flashes in her left eye when she moves her head for the past three days, mainly at night. As of this morning, she has noticed a dark area that moves with her gaze. Visual acuity is 1.0 in both eyes. What would be the correct approach? | The presence of phosphenes is a pathognomonic sign of posterior vitreous detachment, which should be treated with pneumatic retinopexy. | A visual field test must be carried out to confirm the presence of a posterior vitreous detachment, as this is the only way to distinguish a posterior vitreous detachment from a retinal detachment. | An ocular hypotensive treatment must be established, as the patient has suffered acute glaucoma which was caused by the flashes and visual field alterations due to nerve damage are appearing today. | Medicine | The appearance of phosphenes followed by a dark spot that moves with the gaze suggests a posterior vitreous detachment, although a fundus examination should be carried out to rule out a retinal tear or vitreous hemorrhage. | 70 | 3 | f89b2621-bd05-4e89-b20b-38b0a64bcdb4 | 2020 |
A 40-year-old patient, with a normal physical examination, in whom a mediastinal mass and a hepatic nodule have been revealed in the computed tomography, and in the analysis an elevation of serum lactic dehydrogenase (LDH), human chorionic betagonadotropin (beta-HCG) and alpha-fetoprotein in the blood. What is your diagnostic suspicion? | Metastatic extragonadal seminoma. | Metastatic hepatocarcinoma. | Metastatic extragonadal nonseminomatous germ cell cancer. | Medicine | Mediastinal lymphoma. | 71 | 4 | 8384cb10-a682-4e77-ac25-beae75d41767 | 2020 |
In a patient with lung cancer without comorbidity, the combination of chemotherapy and radiotherapy is the first-choice treatment in: | Solitary pulmonary nodule. | Stage I non-small cell cancer. | Small cell cancer. | Medicine | Stage II non-small cell cancer. | 72 | 4 | 5ebaf0c6-82c4-4af6-9661-be4e9de3fd41 | 2020 |
Radiation therapy in breast cancer is not indicated in: | Stage I post-mastectomy. | Carcinoma in situ post-tumor removal. | Symptomatic metastatic disease. | Medicine | Locally advanced stages. | 73 | 2 | 52b4c268-cd6e-4471-9589-c2d323dcfe2e | 2020 |
A 27-year-old healthy man, presented with intense pain in his right ear that worsens with pressure on the tragus, purulent discharge, feeling of blockage, itchiness, and a certain degree of hearing loss for several hours duration. Otoscopic examination verifies the presence of ear discharge and significant inflammatory signs in the external auditory canal. What is the most likely diagnosis? | Diffuse external otitis. | Serous otitis media. | Perforated acute middle ear infection. | Medicine | Malignant otitis externa. | 74 | 2 | c4be9b5d-c5f6-4cfb-a5fd-ed68b83c30ba | 2020 |
Indicate the most sensitive examination method to establish the diagnosis of sinusitis, study the anatomy of the osteomeatal complex, and identify possible complications due to local spread of the infection: | Rhinoscopy. | Magnetic resonance with gadolinium. | Simple X-ray of paranasal sinuses. | Medicine | Coronal Computed Tomography. | 75 | 3 | 9df40aab-59bf-4200-aa41-627075d31aaf | 2020 |
A 5-year-old boy diagnosed with chronic renal failure. He goes to the emergency room due to vomiting, general discomfort, and palpitations. An electrocardiogram is performed where elevated T waves stand out and blood analysis with potassium levels of 5.9 mEq/L. Immediate administration of calcium gluconate is decided. What is the objective of this treatment?: | Decrease the circulating potassium to promote its hepatic elimination. | Promote the displacement of potassium from the plasma space to the intracellular space. | Antagonize the action of potassium on the myocardial cell membrane. | Medicine | Chelate the circulating potassium to promote its renal elimination. | 76 | 4 | f0842aeb-8f06-487e-961f-dc591969d725 | 2020 |
Infant of 6 months presented to the emergency room due to respiratory difficulty. Examination: axillary temperature 37.2°C, respiratory rate 40 rpm, heart rate 160 bpm, blood pressure 90/45 mmHg, SatO2 95% with room air. Shows moderate respiratory difficulty with intercostal and subcostal retraction. Lung auscultation: scattered expiratory wheezing, prolonged expiration and slight decrease in air entry in both lung fields. Heart auscultation: no murmurs. It is decided to keep the patient under observation in the hospital for a few hours. What is the most appropriate course of action to take at this point in terms of additional tests?: | Request chest x-ray. | Request venous blood gas, leukocyte count, and acute phase reactants. | Do not request additional tests. | Medicine | Request arterial blood gas and acute phase reactants. | 77 | 4 | 9ae211f4-db5e-44b1-8431-cb5007f303f5 | 2020 |
The most common cause of permanent congenital hypothyroidism is: | Dyshormonogenesis (congenital errors in the synthesis/secretion of thyroid hormones). | The alteration in the embryonic development of the thyroid gland (thyroid dysgenesis). | The syndromes of resistance to thyroid hormones. | Medicine | Hypothalamic-pituitary hypothyroidism. | 78 | 1 | e0eb781f-e271-4d84-b850-7cd732e88ae1 | 2020 |
Which of the following statements about autoimmune thyroiditis or Hashimoto's disease is incorrect?: | Patients with Down syndrome (trisomy 21) have a higher incidence of autoimmune thyroiditis than the general population. | It is a pathology that can occur in childhood-adolescence. | Patients with Turner syndrome (karyotype 45, X0) and Klinefelter syndrome (karyotype 47, XXY) have a lower incidence of autoimmune thyroiditis than the general population. | Medicine | Autoimmune thyroiditis usually progresses towards hypothyroidism, but at the onset of the disease, patients may experience a transient phase of hyperthyroidism. | 79 | 4 | 2c335949-08dc-4822-864f-1abd2e990bfe | 2020 |
8-year-old boy who consults due to the appearance of pubic hair at the base of the penis for the past 12 months. The testicle has not increased in volume and the penis has not increased in size. No increase in growth rate is observed in the last year. The bone age is one year older than the chronological age. What would be the most likely diagnosis? | Peripheral early puberty. | Central precocious puberty. | Adrenal tumor. | Medicine | Early adrenarche. | 80 | 3 | f2371f3c-0d52-4df2-b4c1-240ec6d5b094 | 2020 |
In relation to celiac disease, indicate the correct answer: | The genetics (DQ2/DQ8) have a high negative predictive value. | Confirmation with an intestinal biopsy is necessary for a definitive diagnosis. | It is common to develop gluten tolerance with age. | Medicine | People with Prader-Willi syndrome are at a higher risk of developing celiac disease than the general population. | 81 | 2 | 718a03dc-65d0-41c4-a1b8-4c7060dffd20 | 2020 |
In the treatment of acute diarrhea in a child, only one of the proposed measures is correct, please indicate it: | It is recommended to initially reduce the intake of lactose during the first few days of diarrhea. | An astringent diet low in fiber should be recommended until it is resolved. | The presence of Salmonella in the stool should be treated with antibiotics to prevent its spread. | Medicine | Oral rehydration should be proposed for 4-6 hours and subsequent refeeding with a normal diet. | 82 | 3 | 4af8cc5f-84ff-46c7-b09f-debfd6b9c302 | 2020 |
In the refeeding syndrome at the start of treatment for chronic malnutrition, all of the following analytical alterations may appear, except one. Indicate which one: | Hyperphosphatemia. | Hyperglycemia. | Hypomagnesemia. | Medicine | Hypokalemia. | 83 | 2 | 4b779241-4558-45ed-84c5-bf01ea07c326 | 2020 |
A patient with moderate Alzheimer's disease who presents episodes of severe agitation and aggression along with psychotic symptoms can be treated with one of the following drugs, which is approved for this indication. Indicate which: | Lorazepam. | Escitalopram. | Trazodone. | Medicine | Risperidone. | 84 | 3 | 4397af86-137b-41e1-bc7c-e67fa3ccd52d | 2020 |
A 79-year-old patient is brought to the Emergency Department at 7 pm from a residence, but we do not have the referral report and therefore do not know his medical history. He is disoriented in time and space. He has trouble remembering simple information. Sometimes he becomes very nervous and agitated, because he sees threatening people, even when he is alone. At other times he appears drowsy and inattentive. The main evidence supporting the diagnosis of delirium rather than dementia is: | The cognitive symptoms. | The presence of visual hallucinations. | The fluctuation of the alert level. | Medicine | Psychomotor agitation. | 85 | 4 | 2d6b9f9a-a9c0-421b-ba10-00ec246789c2 | 2020 |
Indicate which is not an indication for electroconvulsive therapy: | Depression during pregnancy. | Severe major depressive disorder in the elderly. | Acute forms of schizophrenia in young people. | Medicine | Severe and disabling agoraphobia in young people. | 86 | 3 | 21194dfa-af31-4ce5-b9f3-3e71b46b66da | 2020 |
In the case of a sudden onset of obsessive-compulsive disorder (OCD) in a 9-year-old child who also presents with tics and chorea as neurological manifestations, an infection by: should be ruled out. | Alpha-hemolytic streptococcus. | Viridans Streptococcus. | Enterococcus. | Medicine | Beta-hemolytic Streptococcus, group A. | 87 | 3 | b7d68c0c-5805-4b8f-8afd-cadfa7655b11 | 2020 |
What is the mechanism of action of the antidepressant bupropion? | Inhibits the reuptake of noradrenaline and dopamine. | Inhibits the reuptake of norepinephrine and serotonin. | It is a glutamate antagonist and inhibits the reuptake of dopamine. | Medicine | It is a dopamine antagonist and inhibits the reuptake of serotonin. | 88 | 2 | e7d8c653-54cb-4a9c-884c-66400688100b | 2020 |
A 46-year-old man with bipolar disorder is rushed to the emergency room after an overdose of lithium carbonate. On examination, there is intense tremor, ataxia, dysarthria, myoclonus, and fasciculations. His lithium level is 4.1 mEq/L (toxicity > 1.6 mEq/L). Which of the following therapeutic options would be most appropriate?: | Activated charcoal. | Aminophylline associated with a cathartic. | Forced diuresis. | Medicine | Hemodialysis. | 89 | 3 | c5c8f539-f4db-4035-a1fa-f540d52a5bb4 | 2020 |
Among the interactions of antipsychotics with other pharmacological groups, indicate which of the following is false: | Lithium can worsen extrapyramidal symptoms and increase neurotoxicity. | Smokers usually have higher levels of antipsychotics in their plasma than non-smokers. | Antidepressants increase plasma levels of antipsychotics. | Medicine | Carbamazepine decreases the plasma levels of antipsychotics. | 90 | 1 | b36c8f36-a642-45e2-b14d-ca58abbe6489 | 2020 |
An 11-year-old and 6-month-old premenarchal girl, with known idiopathic scoliosis. The spine radiograph taken 6 months ago showed a left thoraco-lumbar curve of 18° (Cobb angle). In the current one, a Cobb angle of 28° is observed, with an iliac crest maturation (Risser sign) of 2. At this developmental stage, what is the most appropriate treatment to try to stop the curve's progression? | Postural reeducation exercises. | Swimming exercises. | The surgical intervention through spinal fusion. | Medicine | Orthopedic corrective corset. | 91 | 3 | 1f22e4fe-ff70-46be-a893-36b9c5bb2065 | 2020 |
A woman is having difficulty walking after gynecological surgery. She experiences mild pain in the thigh and her leg gives out when she puts weight on it. Upon examination, she shows weakness when flexing the hip and extending the knee, and has dysesthesia in the front of the thigh. What is the most probable suspected diagnosis? | Meralgia paresthetica of the femoral cutaneous nerve. | Femoral nerve neuropathy. | Sciatic nerve neuropathy. | Medicine | Obturator nerve neuropathy. | 92 | 1 | 5c1ef9b6-b4f4-4e83-b329-9da31b197b98 | 2020 |
A 58-year-old hypertensive man goes to the emergency room for a 30-second fainting episode while running, with spontaneous recovery and no sequelae. Blood pressure is 135/65 mmHg. Cardiac auscultation presents a rough, intense systolic murmur, which is reduced with Valsalva maneuvers and a muted second sound. The ECG shows a sinus rhythm at 72 bpm, with criteria for left ventricular hypertrophy and inverted T waves on the anterior face. Indicate the correct statement: | The provided data indicates hypertrophic cardiomyopathy with severe obstruction of the left ventricle outflow tract. | The clinical picture suggests a pulmonary embolism. | An aortic dissection should be ruled out using a contrast-enhanced computed tomography scan. | Medicine | These data correspond to severe aortic stenosis. | 93 | 3 | d1ab625f-c525-4234-b8a1-028d96aed43d | 2020 |
Among the following combinations of drugs, which one has shown a reduction in mortality in heart failure with reduced ejection fraction?: | Digoxin and beta blockers. | Beta blockers and angiotensin-converting enzyme inhibitors. | Angiotensin converting enzyme inhibitors and calcium channel antagonists. | Medicine | Loop diuretics and calcium channel antagonists. | 94 | 1 | 257595e3-0b97-4f71-9e5b-a927b848e484 | 2020 |
An 83-year-old woman with a beta-lactam allergy was admitted due to acute pyelonephritis and vomiting. She has been taking amiodarone for 3 years for paroxysmal atrial fibrillation. Upon admission, levofloxacin and metoclopramide are prescribed. Haloperidol is added due to nocturnal agitation. On the 6th day, she suffers a syncope from which she recovers within a few seconds. The ECG shows a sinus rhythm at 50 bpm, narrow QRS and QTc 510 ms. In this clinical context, what etiology would explain the syncope? | An acute myocardial infarction. | A polymorphic ventricular tachycardia. | A complete atrioventricular block. | Medicine | A cardioembolic stroke. | 95 | 1 | 4bf2b7ce-8031-431f-a175-b709f6eab488 | 2020 |
Regarding a patient with acute pericarditis and severe pericardial effusion, which of the following measures is incorrect?: | Administration of diuretics that facilitate the disappearance of the effusion. | Admission for close monitoring of the onset of signs of tamponade. | Administration of non-steroidal anti-inflammatory drugs. | Medicine | Admission and consideration of pericardiocentesis. | 96 | 2 | c81b4490-835c-4272-9446-f1ed6dd6d3e8 | 2020 |
42-year-old man with a history of compensated liver cirrhosis, brought to the emergency room for jaundice, fever, increased abdominal girth, and significant general status deterioration. Which of the following analytical parameters would not provide information about the prognosis?: | International Normalized Ratio (INR). | Serum albumin. | Transaminases (value of ALT and AST). | Medicine | Serum total bilirubin. | 97 | 4 | 9e9c2e8b-e0c1-4e31-b245-46552eca9ac2 | 2020 |
A 55-year-old man was referred for consultation following the detection of hypertransaminasemia and hepatic steatosis during a health examination. He has hypothyroidism and is undergoing replacement therapy, along with well-controlled diabetes managed with metformin. He consumes alcohol very occasionally. Physical examination revealed Type I obesity (body mass index, BMI 33 kg/m2). The lab analysis indicated: aspartate aminotransferase (AST) 87 UI/L, alanine aminotransferase (ALT) 65 UI/L, gamma-glutamyltransferase (GGT) 100 UI/L, total cholesterol 230 mg/dL, and fasting blood glucose level 132 mg/dl. Bilirubin, alkaline phosphatase, thyroid hormones, and ferritin were all normal. Coagulation was also normal. Virological hepatitis serology (HAV, HBV, and HCV) and autoimmunity (ANA, AMA, AML, antiLKM) were both negative. Indicate the most appropriate statement: | It is indicated to perform a liver biopsy due to the suspicion of autoimmune hepatitis. | You have hepatic steatosis without the risk of developing cirrhosis or hepatocellular carcinoma, hence periodic metabolic control is sufficient. | It is recommended to replace metformin with pioglitazone, which has proven to be more effective in improving hepatic steatosis. | Medicine | It is useful to perform a transition elastography (FibroScan ®) to determine the existence or absence of fibrosis. | 98 | 3 | 90809989-8b00-4d8d-8c91-043db1d47db2 | 2020 |
Patient with stage B Child hepatic cirrhosis with ascites and history of spontaneous bacterial peritonitis (SBP). Which of the following antibiotic treatment guidelines is considered appropriate as prophylaxis for SBP?: | Norfloxacin 400 mg / day. | Vancomycin 500 mg / day. | Amoxicillin 1000 mg / day. | Medicine | Metronidazole 250 mg / day. | 99 | 2 | 31b86c9f-dabf-4d1a-b00e-1f1721b7705a | 2020 |
Young patient with inflammatory bowel disease diagnosed with ankylosing spondylitis. Which of the following statements is false?: | The activity of ankylosing spondylitis is related to the inflammatory activity of inflammatory bowel disease. | Ankylosing spondylitis is more common in patients with Crohn's disease. | The progression of ankylosing spondylitis is slow and progressive. | Medicine | The activity of ankylosing spondylitis does not subside with glucocorticoids. | 100 | 2 | 3136e729-9543-4b29-90dc-be7aff5660c0 | 2020 |
The medical treatment of macroprolactinomas should reduce the tumor mass, normalize serum prolactin levels, and restore gonadal function. This can be achieved with: | Selective agonists of D2 dopaminergic receptors. | Selective serotonin reuptake inhibitors. | Antagonists of the V2 receptors of desmopressin. | Medicine | Somatostatin analogues. | 101 | 2 | 370e2fb2-8d02-4c59-9859-b719f0b2c403 | 2020 |
Postabsorptive hypoglycemia caused by non-insulinoma tumors is characterized by: | Because plasma levels of proinsulin, insulin and C-peptide are suppressed during hypoglycemia. | As it is common in small-sized abdominal tumors with rapid growth. | Because tumoral hypoglycemia is one of the most frequent complications in hematological neoplasms in the absence of cachexia. | Medicine | Because the levels of IGFI are characteristically elevated and the IGFII/IGFI ratio is abnormally low. | 102 | 2 | d2d73a47-f6d4-4a69-8eb4-683796d5045b | 2020 |
Oral administration of urea results in increased diuresis and decreased natriuresis, thus constituting a safe and effective treatment for: | Hypotonic hyponatremia in a hypovolemic situation. | Hypotonic hyponatremia in a situation of euvolemia. | Hypertonic hyponatremia. | Medicine | Isotonic hyponatremia associated with hyperproteinemia. | 103 | 1 | 67c89319-579c-4a6d-a631-4a47343660f1 | 2020 |
Lithium-induced nephrogenic diabetes insipidus: | 2. It is due to a marked reduction in the levels of aquaporin-2. | It is caused by mutations of aquaporin- | Thiazide diuretics and amiloride are contraindicated in their treatment. | Medicine | Responds to low doses of desmopressin. | 104 | 2 | fa768d18-3ce8-4024-9f16-a19cee527614 | 2020 |
A 67-year-old patient who, in the last 6 months, in two routine laboratories, presents progressive lymphocytosis. In the last one, hemoglobin 15.4 g/dl; leukocytes 18.5 x10³/µL with 82% of mature lymphocytes that express the CD5/CD19/CD23 antigens by flow cytometry and platelets 240 x10³/µL. What seems to be the appropriate approach? | Bone aspiration/biopsy to confirm the diagnosis. | Study of TP53 mutations to establish prognosis. | New clinical and analytical control in 6 months. | Medicine | PET/CT to establish the therapeutic approach. | 105 | 4 | d3f359aa-65e4-4bfb-9f03-60e3fc13e94b | 2020 |
A 65-year-old woman was sent to emergencies due to fever and alterations in her blood test: Hemoglobin 11.4 g/dL, leukocytes 0.86 x10³/µL, (neutrophils 41.9%, lymphocytes 55.8%), platelets 48.0 x10³/µL, fibrinogen 118 mg/dL, D-dimer 20.2 µg/mL. Bone marrow examination was carried out, from which she was diagnosed with acute leukemia with t(15;17) in 60% of the cells. Which of the following responses is correct? | Treatment will be initiated with arsenic trioxide, ATRA and supportive therapy. | If she is asymptomatic, trans retinoic acid (ATRA) will be initiated and day hospital checks will be recommended. | Antibiotic treatment should be started. Once the fever has subsided, leukemia treatment will be initiated. | Medicine | It is a type M3 myeloblastic leukemia, so chemotherapy treatment and heparin will be initiated to control disseminated intravascular coagulation. | 106 | 2 | fa52c967-f1a6-4285-8607-919914cb0a2c | 2020 |
An 18-year-old patient goes to the emergency room with a several days old nosebleed, with no relevant personal or family history. On examination, the patient is afebrile, multiple bruising is observed, no splenomegaly is palpated. Blood tests show: Leukocytes 7.2 x10³/µL, Hb 12.3 g/dL, Platelets 6.0 x10³/µL. Thrombocytopenia is confirmed in the smear, where enlarged platelets are observed. Coagulation study and biochemistry are normal. What is the most probable diagnosis? | Disseminated intravascular coagulation. | Thrombotic Thrombocytopenic Purpura. | Primary immune thrombocytopenia. | Medicine | Thrombocytopenia induced by infection. | 107 | 4 | 850e9eeb-f310-48c1-a67b-9fc4ce8edb4f | 2020 |
In relation to follicular lymphoma, point out the incorrect one: | The neoplastic cells are derived from a lymphocyte of the bone marrow. | It is the second most common lymphoma in the West. | It can remain for years without needing treatment. | Medicine | It can transform into a diffuse large B-cell lymphoma. | 108 | 2 | d4f59847-2af0-43ba-a034-ab0361076bd0 | 2020 |
Regarding Listeria monocytogenes, indicate the incorrect statement: | It is widely distributed in soil, wastewater, and decomposing vegetation. | It is a gram-positive bacillus, catalase positive. | The treatment of choice for meningitis caused by L. monocytogenes is a cephalosporin. | Medicine | Humans and animals can be asymptomatic carriers. | 109 | 4 | b568f94d-d5ac-45f0-a148-b595da244564 | 2020 |
A 54-year-old man who is seeking consultation for urination symptoms consistent with prostatic pathology. I-PSS=22+4, residual urine volume 120 cc, maximum flow 7.2 ml/s, PSA=0.91 ng/ml, and prostatic volume in ultrasound 31 cc. His first therapeutic recommendation will be: | 5-alpha reductase inhibitor. | Alpha-blocker. | Transurethral resection of the prostate. | Medicine | Anti-muscarinic. | 110 | 1 | 2e2685aa-eea1-4cf4-ba44-a72206d6bfaf | 2020 |
A 37-year-old woman with no other significant history than an appendectomy. She shows up at the emergency department with right kidney-area pain that has been ongoing for 3 days and a fever of 39°C. Her blood work shows leucocytosis (14 x10³/µL with neutrophilia) and a C-reactive protein level of 15 mg/dL. Her urinalysis shows microscopic hematuria, significant leucocyturia and pyuria. She is admitted with a diagnosis of acute pyelonephritis and intravenous ceftriaxone antibiotic treatment is started. Three days later, she still has a fever of 38.5°C, increased leucocytosis, and deteriorating renal function. Considering the diagnostic suspicion, what test would you request next? | Intravenous urography. | Computed axial tomography with intravenous contrast. | Urological ultrasound. | Medicine | Abdominal nuclear magnetic resonance. | 111 | 4 | 6b38d2b5-c763-42cf-a467-7d3cb2b8ac99 | 2020 |
59-year-old man with diabetic nephropathy, with an estimated glomerular filtration rate of 36 ml/min/1.73 m2 and an albuminuria/creatininuria index of 350 mg/g. According to the KDIGO 2012 chronic kidney disease classification, this corresponds to the category: | Stage G4 A3. | Stage G3b A2. | Stage G4 A2. | Medicine | Stage G3b A3. | 112 | 3 | ac5122bf-2800-4ad7-a9ea-1cc4d050556c | 2020 |
In relation to membranous nephropathy, indicate the false answer: | What best predicts the prognosis is the presence of interstitial involvement and not glomerular damage (stages I to IV). | The majority of membranous nephropathies are of idiopathic cause. | 90% of patients achieve remission with corticosteroids only. | Medicine | Antibodies against the phospholipase A2 receptor (Anti-PLA2R) are usually positive in idiopathic forms. | 113 | 4 | 35678ccf-0c2c-4fe7-8be6-262c5fc6815c | 2020 |
In which of the following situations can a metabolic acidosis without an elevated anion gap occur?: | Diabetic ketoacidosis. | Kidney failure. | Prolonged fasting. | Medicine | Diarrhea. | 114 | 3 | c0977823-df76-4538-8cf9-fb1247570c8b | 2020 |
A 27-year-old woman with a non-productive cough, fever and pleuritic pain that has developed over a month. The chest X-ray reveals a left pleural effusion. The pleural fluid analysis shows a lymphocytic exudate with a pH of 7.32, glucose 66 mg/dL and adenosine-deaminase 59 U/L. What is the most likely etiology? | Meigs' Syndrome. | Heart failure. | Pleural Tuberculosis. | Medicine | Chylothorax. | 115 | 4 | de833ae5-f5eb-4056-ba7c-1f4744c02fc9 | 2020 |
In a subject over 65 years old, a tuberculin test has shown an induration of 3 mm. The induration in a second test, performed 10 days later, is 13 mm. Indicate the correct answer: | The second reaction is a true positive. | The first reaction is a false positive. | The second reaction is a false positive. | Medicine | The first reaction is a true negative. | 116 | 2 | a088c0a9-c82c-449a-a718-8fd23ffdf235 | 2020 |
Which of the following alternatives to total lung lavage is not appropriate in the treatment of autoimmune alveolar proteinosis?: | Corticosteroids. | Granulocyte-macrophage colony-stimulating factor (GM-CSF). | Rituximab. | Medicine | Plasmapheresis. | 117 | 2 | 520f8d93-bd52-4ad6-b505-3b306d990dcc | 2020 |
72-year-old man with a history of COPD with severe airway obstruction, with two severe exacerbations in the last year, comes to the emergency room with tachypnea and use of accessory muscles. He is alert. The basal arterial blood gas shows: pH 7.29, PaCO2 68 mmHg, PaO2 51 mmHg. Bronchodilator treatment, steroids, empirical antibiotic therapy are started and oxygen therapy is adjusted to achieve a SatO2 between 88 and 92%. After an hour, the arterial blood gas is repeated with nasal cannula at 2 lpm and presents pH 7.28, PaCO2 70 mmHg, PaO2 62 mmHg. Indicate the correct course of action: | Proceed with orotracheal intubation and initiate mechanical ventilation. | Start non-invasive mechanical ventilation. | Combine benzodiazepines with high flows of oxygen to ensure a decrease in tachypnea and improve the ventilation pattern. | Medicine | Increase oxygen therapy until achieving an oxygen saturation (SatO2) of at least 99%. | 118 | 1 | 8172021f-9ea7-44ce-87a4-efe3b289d272 | 2020 |
16-year-old woman who begins follow-up in the adult Neurology consultation, referred from Neuropediatrics with the diagnosis of juvenile myoclonic epilepsy (JME). She is on treatment with valproic acid and well controlled. Would you consider making any changes to her treatment? | No, because the patient is free of episodes and changing it at this moment would be assuming unnecessary risks. | No, because valproic acid is the treatment of choice in patients with this epileptic syndrome. | Yes, due to the relationship of this drug with polycystic ovary syndrome. | Medicine | Yes, because its use should be avoided in women of childbearing age, as it is the antiepileptic drug with the highest teratogenicity and causes problems in the neurodevelopment of children. | 119 | 3 | d4722a45-84c0-463d-bd6c-b35baec514d6 | 2020 |
A 79-year-old man with a history of mild cognitive impairment presents with a sudden onset of right homonymous hemianopsia, aphasia, and right inferior facial paresis. Upon his arrival to the emergency department, his blood pressure is recorded: 190/85 mmHg. A head CT is performed, revealing a left frontal lobar intraparenchymal hematoma and another left occipital hematoma. What is the most likely etiology of these hematomas?: | Amyloid angiopathy. | Hypertensive. | Arteriovenous malformation. | Medicine | Underlying tumor lesion. | 120 | 2 | b09add68-5bed-4d48-822e-e1a27199438f | 2020 |
A 60-year-old woman is being studied for various episodes of loss of consciousness. The differential diagnosis is considered between epileptic seizures and syncope. Indicate which of the following data would not support the diagnosis of syncope: | Facial cyanosis during the episode. | Incontinence of sphincters during the episode. | Jerking of all four limbs lasting 1-2 seconds, during the episode. | Medicine | Head trauma during the episode. | 121 | 2 | 3f86890e-be94-40ed-97ca-f6a99cc7da13 | 2020 |
A 70-year-old man consults due to non-radiating lumbar pain lasting 1 week, of progressive intensity, accompanied by a marked limitation of the spine's mobility and low-grade fever. The lumbar spine x-ray shows no alterations. What diagnosis should we rule out first and with what technique? | Bone metastases with bone scintigraphy using technetium. | Vertebral crushing with computed tomography (CT). | Pyogenic spondylodiscitis with magnetic resonance imaging (MRI). | Medicine | Ankylosing vertebral hyperostosis with radiography of the dorsolumbar spine. | 122 | 4 | 557e4ca9-9736-4b3a-9bd1-2d36d7d31c1f | 2020 |
A 60-year-old woman consults due to numbness of the right hand that has been evolving for months, which awakens her at night and forces her to mobilize the hand until it passes. It seems that she has lost strength and sometimes things have fallen from that hand. Indicate the correct answer: | If the neurological examination shows numbness in the first to third fingers, we will consider the possibility of median nerve involvement at the level of the carpal tunnel. | If the neurological examination shows numbness in the first to third fingers, we will consider impairment of the ulnar nerve at the epitrochlear level. | The treatment for ulnar nerve involvement at the epitrochlear level or median nerve at the carpal level is surgical intervention, since conservative treatment does not improve the symptoms. | Medicine | To make a diagnosis, it is not necessary to perform an electromyography, since the physical examination presents very good probability coefficients. | 123 | 2 | 3f8fef5c-cc16-4440-9cbe-5eeb11fa338d | 2020 |
Regarding temporal arteritis, indicate the incorrect answer: | Approximately a quarter of patients develop an aneurysm or dilation of the thoracic aorta. | It mainly occurs in white individuals and those over 50 years old. | The highest incidence occurs between the sixth and seventh decade of life. | Medicine | Unilateral or bilateral vision loss is one of the most serious complications. | 124 | 4 | 97d99629-888b-492d-b91c-0aefeb941fc8 | 2020 |
Which of the following statements is true in relation to Leriche syndrome? | It is the result of a bilateral femoropopliteal occlusion. | It is a clinical picture that includes the triad of plantar claudication, impotence coeundi, and absence of distal pulses. | The arteriography is the first diagnostic test to be performed. | Medicine | The femoral pulses are absent. | 125 | 3 | cbb00460-b28f-4e6f-bf2c-b39eb8fb19c2 | 2020 |
73-year-old man with a history of acute myocardial infarction treated with percutaneous transluminal coronary angioplasty 6 weeks ago. He comes to the emergency department due to sudden pain, coldness, and loss of mobility in the right lower limb. On examination, the right femoral pulse is present, with absence of the rest of the pulses in that limb. He maintains pulses at all levels in the contralateral limb. Regarding the suspected diagnosis, point out the false statement: | Paralysis is a late onset sign indicating that revascularization treatment should be performed as soon as possible. | The most likely cause is of embolic origin. | In case of rigid paralysis with deep anesthesia and absence of Doppler signal, an urgent arteriography is indicated. | Medicine | The treatment consists of femoral arterial embolectomy with a Fogarty catheter. | 126 | 4 | a81e293e-7d33-4f4a-877a-c6e3670c4c96 | 2020 |
A 60-year-old man, a smoker of 40 packs/year, who consults for pain in the ulnar edge of the left arm and left palpebral ptosis for a month. The chest x-ray shows a mass in the left upper lobe and the CT scan confirms the lesion with invasion of the second rib. In relation to the suspected diagnosis, the most appropriate treatment is: | Neoadjuvant chemotherapy without surgery, followed by radiotherapy. | Neoadjuvant chemotherapy with combined chemoradiotherapy, followed by surgery. | Radiotherapy without chemotherapy, followed by surgery. | Medicine | Surgery followed by combined chemoradiotherapy. | 127 | 1 | 3302814a-8b0e-41d6-b987-31cc0060fbd3 | 2020 |
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