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Simulacro ENARM 2010

Simulacro ENARM 2010

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    Simulacro ENARM 2010

    MUJER DE 78 AÑOS, LLEVADA A URGENCIAS POR CEFALEA INTENSA, NÁUSEA, VÓMITOS, TRASTORNOS DE LA MEMORIA,APATÍA Y SOMNOLENCIA. ANTECEDENTES DE DIABETES MELLITUS Y ENFERMEDAD ARTICULAR DE TIPO DEGENERATIVO AMBAS BAJO TRATAMIENTO MÉDICO. E.F.: TEMP 38º C, TA 140/90 MMHG, RCR, CAMPOS PULMONARES CLAROS, EXTREMIDADES CON DISMINUCIÓN DE FUERZA MUSCULAR 3/5 EN HEMICUERPO IZQUIERDO, REFLEJOS DE ESTIRAMIENTO MUSCULAR CONSERVADO. DISMINUCIÓN DE CAMPOS VISUALES. B.H. Y Q.S. NORMALES.

    1.- EL AGENTE CAUSAL MÁS PROBABLE EN ESTE PACIENTE ES:

    a) BACTERIANO.
    b) VIRAL.
    c) NEOPLASICO
    d) METABÓLICO.


    2.- EL MÉTODO MÁS SENSIBLE PARA CORROBORAR EL DIAGNÓSTICO EN ESTE PACIENTE ES:

    a) PUNCIÓN LUMBAR.
    b) RESONANCIA MAGNETICA
    c) HEMOGLOBINA GLUCOSILADA.
    d) ANGIOGRAFÍA

    ANXIETY, DEPRESSION LINKED TO ANGINA FREQUENCY IN HEART PATIENTS NEW RESEARCH SHOWS THAT ISCHEMIC HEART DISEASE PATIENTS WHO SUFFER SIGNIFICANT ANXIETY HAVE CLOSE TO A 5-FOLD INCREASED RISK OF EXPERIENCING FREQUENT ANGINA AND THOSE WITH DEPRESSION HAVE MORE THAN A 3-FOLD INCREASED RISK FOR THESE EPISODES. THIS OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA UNDERLINES THE IMPORTANCE OF TREATING ANXIETY AND DEPRESSION IN CARDIAC PATIENTS. PSYCHOSOCIAL FACTORS: THE RESEARCHERS EXAMINED 5 PSYCHOSOCIAL FACTORS THAT MIGHT AFFECT ANGINA FREQUENCY: ANXIETY; DEPRESSION; NEUROTICISM (TENDENCY TO EXPERIENCE NEGATIVE EMOTIONS SUCH AS SADNESS, ANGER, OR GUILT); ALEXITHYMIA (IMPAIRED ABILITY TO EXPRESS INNER FEELINGS); AND SOMATOSENSORY AMPLIFICATION (TENDENCY TO EXPERIENCE A SOMATIC SENSATION AS INTENSE, NOXIOUS, AND DISTURBING). THERE WAS MORE ANXIETY AND DEPRESSION AMONG PATIENTS WITH FREQUENT ANGINA. FOR INSTANCE, 22% OF PATIENTS WITH NO ANGINA HAD CLINICALLY SIGNIFICANT ANXIETY, DEFINED AS A SCORE OF 16 OR GREATER ON THE BECK ANXIETY INVENTORY SCALE, COMPARED WITH 38% FOR PATIENTS WITH MONTHLY ANGINA AND 64% FOR THOSE WITH WEEKLY OR DAILY ANGINA. OTHER PSYCHOSOCIAL FACTORS WERE ALSO INCREASED AMONG PATIENTS WITH MORE FREQUENT ANGINA. FOR EXAMPLE, 38% OF PATIENTS WITH WEEKLY OR DAILY ANGINA HAD A HIGH LEVEL OF ALEXITHYMIA COMPARED WITH 17% OF PATIENTS WITH MONTHLY ANGINA AND 14% OF THOSE WITHOUT ANGINA. HOWEVER, AFTER ADJUSTMENT FOR DEGREE OF MYOCARDIAL ISCHEMIA, GREATER ANXIETY SCORE (ODDS RATIO, 1.39 PER HALF–STANDARD DEVIATION INCREASE IN ANXIETY SCORE) AND GREATER DEPRESSION SCORE (OR, 1.51 PER HALF–STANDARD DEVIATION INCREASE IN DEPRESSION SCORE) WERE THE ONLY PSYCHOSOCIAL FACTORS SIGNIFICANTLY ASSOCIATED WITH MORE FREQUENT ANGINA. AS EXPECTED, PREVIOUS CORONARY REVASCULARIZATION WAS ALSO SIGNIFICANTLY ASSOCIATED WITH FREQUENT ANGINA. PATIENTS WITH AT LEAST MODERATE ANXIETY SYMPTOMS EXPERIENCED A 4.7-FOLD INCREASED RISK OF HAVING MORE FREQUENT ANGINA. PATIENTS WITH CLINICALLY RELEVANT DEPRESSIVE SYMPTOMS HAD A 3.2-FOLD INCREASED RISK OF EXPERIENCING MORE FREQUENT ANGINA. BIOLOGICAL FACTORS: NOT EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA. UP TO 45% OF THESE PATIENTS HAVE ASYMPTOMATIC ISCHEMIA. SEVERAL BIOLOGICAL FACTORS MIGHT EXPLAIN THE DISCREPANCY BETWEEN CORONARY ARTERY DISEASE AND ANGINA SEVERITY, ACCORDING TO THE AUTHORS. FOR EXAMPLE, METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY MAY INFLUENCE PAIN LEVELS.

    3.- WHAT HAS NEW RESEARCH DEMONSTRATED ABOUT ISCHEMIC HEART DISEASE PATIENTS WITH DEPRESSION?

    a) THIS PATIENTS HAVE MORE INCREASED RISK OF EXPERIENCING FREQUENT ANGINA.
    b) THIS PATIENTS HAVE MORE INCREASED RISK OF THIS EPISODES.
    c) A PATIENTS HEART DISEASE IS NOT RELATED WITH ANY PSYCHIATRIC DISEASE.
    d) THERE IS NO OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA.


    4.- WHAT RELATIONSHIP WAS FOUND BETWEEN PSYCHIATRIC SYMPTOMS AND PATIENTS WITH FREQUENT ANGINA?

    a) THIS PATIENTS HAD CLINICALLY SIGNIFICANT ANXIETY.
    b) THIS PATIENTS HAD A 16 SCORE OR GREATER ON THE BECK ANXIETY INVENTORY SCALE.
    c) THIS PATIENTS SUFFERED FROM WEEKLY OR DAILY ANGINA.
    d) THIS PATIENTS HAD MORE ANXIETY AND DEPRESSION.


    5.- WHAT PSYCHOSOCIAL FACTORS INCREASED AMONG PATIENTS WHO SUFFERED OF FREQUENT ANGINA?

    a) ALEXITHYMIA.
    b) ANXIETY.
    c) SOMATOSENSORY AMPLIFICATION.
    d) NOXIOUS.


    6.- WHAT ADJUSTMENT FOR DEGREE WAS THERE AFTER MYOCHARDIAL ISCHEMIA?

    a) ANXIETY AND DEPRESSION DECREASED.
    b) DEPRESSION AND ANXIETY INCREASED.
    c) ANXIETY AND DEPRESSION REMAINED THE SAME.
    d) THERE WAS NO SIGNIFICANT CHANGES.


    7.- WHAT BIOLOGICAL FACTORS EFFECTS PATIENTS WITH ANGINA?

    a) EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA.
    b) PREVIOUS CORONARY REVASCULARIZATION WAS ALSO ASSOCIATED WITH FREQUENT ANGINA.
    c) SOME OF THIS PATIENTS HAVE ASYMPTOMATIC ISQUEMIA.
    d) METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY ARE NOT RELATED.

    MUJER DE 31 AÑOS. ES ATENDIDA EN CONSULTA POR PRESENTAR ACTIVIDAD UTERINA REGULAR Y DOLOROSA. ACTUALMENTE CURSA EMBARAZO GEMELAR DE 33 SEMANAS . NIEGA SANGRADO TRANSVAGINAL, SALIDA DE LÍQUIDO TRANSVAGINAL. REFIERE MOVIMIENTOS FETALES PRESENTES. ANTECEDENTES: G:3, P:2, DIABETES GESTACIONAL MANEJADA CON DIETA Y METFORMINA CON BUEN CONTROL GLICÉMICO. E.F.: PRODUCTO ÚNICO LONGITUDINAL PÉLVICO, DORSO DERECHA. CON FCF 130 LPM. TACTO VAGINAL 1 CM DE DILATACIÓN CON 80% BORRRAMIENTO.

    8.- EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:

    a) INHIBIDORES DE LA SINTESIS DE PROSTAGLANDINAS.
    b) BETAMIMÉTICOS.
    c) NIFEDIPINO.
    d) REPOSO.

    NIÑA DE 4 AÑOS, INGRESA AL SERVICIO DE URGENCIAS POR DOLOR ABDOMINAL CONSTANTE DE 48 HORAS DE EVOLUCIÓN. SU MADRE LE DIÓ PARACETAMOL AYER, SIN EMBARGO EL DOLOR PERSISTE Y SE AGREGARON VÓMITO VERDOSO Y FIEBRE DE 39°C. ANTECEDENTES: OPERADA DE HIPERTROFIA PILÓRICA A LOS 2 MESES. E.F.: TA/ 100/60, FC 120LPM, FR 30 RPM, TEMPERATURA 38.7°C. ABDOMEN CON DOLOR A LA PALPACIÓN MEDIA Y RESISTENCIA, TIMPÁNICO, PERISTALSIS NULA.

    9.- EL DIAGNÓSTICO DE MÁS PROBABILIDAD ES:

    a) OCLUSIÓN INTESTINAL BAJA.
    b) INVAGINACIÓN INTESTINAL.
    c) OCLUSION POR ADHERENCIAS.
    d) APENDICITIS COMPLICADA.


    10.- EL TRATAMIENTO INMEDIATO PARA ESTA PACIENTE ES:

    a) ADMINISTRAR SONDA A DERIVACIÓN.
    b) LAPAROTOMIA EXPLORADORA.
    c) SOLUCIONES PARENTERALES.
    d) OBSERVACIÓN.


    HOMBRE DE 45 AÑOS. ATENDIDO EN LA CONSULTA POR PRESENTAR EXPECTORACIÓN CON SANGRE. ANTECEDENTES: TABAQUISMO POSITIVO, 42 CAJETILLAS AL AÑO. TOS CRÓNICA CON EXPECTORACIÓN MUCOSA ABUNDANTE, DE 3 AÑOS DE EVOLUCIÓN. E.F.: TA 130/80 MM HG, FC 88 LPM, FR 14 RPM, TEMP 37ºC. DISMINUCIÓN DE AMPLEXIÓN Y AMPLEXACIÓN. RX DE TÓRAX MUESTRA OPACIDAD HILIAR DERECHA.

    11.- EL SIGUIENTE ESTUDIO QUE SE DEBE REALIZAR EN ESTE PACIENTE PARA CONFIRMAR EL DIAGNÓSTICO ES:

    a) CITOLOGÍA EN EXPECTORACIÓN.
    b) LAVADO, CEPILLADO BRONQUIAL POR BRONCOSCOPÍA.
    c) TOMA DE BIOPSIA TRANSBRONQUIAL POR BRONCOSCOPIA.
    d) TOMA DE BIOPSIA TRANSTORÁCICA CON AGUJA FINA.


    12.- EN ESTE PACIENTE EL REPORTE ANATOMOPATOLÓGICO MÁS PROBABLE ES:

    a) CARCINOMA EPIDERMOIDE.
    b) ADENOCARCINOMA.
    c) LINFOMA DE HODGKIN.
    d) CARCINOMA DE CELULAS PEQUEÑAS.


    13.- EN ESTE PACIENTE, UNA VEZ TRATADO, USTED ESPERA QUE PUEDA TENER:

    a) EDEMA DE MIEMBROS INFERIORES.
    b) ASCITIS.
    c) CRISIS CONVULSIVAS.
    d) ARRITMIAS CARDIACAS.

    HOMBRE DE 40 AÑOS. ATENDIDO EN LA CONSULTA EXTERNA POR DOLOR INTENSO EN PRIMER ORTEJO DEL PIE DERECHO Y FIEBRE. ANTECEDENTES: SE ENCUENTRA EN QUIMIOTERAPIA POR PADECER DE LEUCEMIA GRANULOCÍTICA CRÓNICA. E.F.: TA 130/70 MM HG, FC 120 LPM, FR 14 RPM, TEMP 38ºC. EL DEDO REFERIDO ESTA INFLAMADO MUY DOLOROSO AL MENOR ESTÍMULO. LABORATORIO: LEUCOCITOS 25,000/MM3, ÁCIDO ÚRICO 14 MG/DL. CREATININA SERICA 0.9 MG/DL.

    14.- LA EXPLICACIÓN MÁS PROBABLE DE ESTE CUADRO CLÍNICO ES:

    a) INGESTIÓN ABUNDANTE DE CARNES ROJAS.
    b) AUMENTO DE RECAMBIO TISULAR.
    c) DISMINUCIÓN EN LA ELIMINACIÓN RENAL DE ÁCIDO ÚRICO.
    d) CONSECUENCIA DEL TRATAMIENTO ANTINEOPLASICO.

    LACTANTE DE 2 MESES DE EDAD. ES ATENDIDO EN LA CONSULTA POR PRESENTAR ADENOMEGALIA EN REGIÓN AXILAR DERECHA CON DOLOR E INMOVILIZACIÓN DE LA ARTICULACIÓN. REFIERE LA MADRE QUE TIENE ESQUEMA COMPLETO DE VACUNACIÓN. E.F.: MASA DE 3 CM EN AXILA CON CAMBIOS DE COLOR Y AUMENTO DE TEMPERATURA EN LA REGIÓN. TEMPERATURA 37.3º, FC. 124LPM, FR 36 RPM.

    15.- LA PRINCIPAL SOSPECHA CLÍNICA EN ESTE CASO ES:

    a) ABSCESO AXILAR.
    b) TUBERCULOMA.
    c) LIPOMA.
    d) INFECCIÓN.


    16.- ESTUDIO MAS SENSIBLE PARA REALIZAR EL DIAGNÓSTICO:

    a) REVISAR EL ESQUEMA DE VACUNACIÓN.
    b) TOMA DE BIOPSIA.
    c) APLICACIÓN DE PPD.
    d) BAAR POR SONDA OROGÁSTRICA.
    SUDDEN CARDIAC DEATH (SCD) IS DEFINED AS THE UNEXPECTED NATURAL DEATH FROM CARDIAC CAUSES WITHIN A SHORT TIME PERIOD IN A PERSON WITHOUT A CARDIAC CONDITION THAT WOULD APPEAR FATAL. SCD IS RESPONSIBLE FOR APPROXIMATELY 300,000 FATALITIES IN THE UNITED STATES ALONE. IT IS ESTIMATED THAT 50% OF ALL CARDIAC DEATHS ARE SUDDEN, AND THIS PROPORTION HAS REMAINED CONSTANT DESPITE THE OVERALL DECLINE IN CARDIOVASCULAR MORTALITY DURING THE LAST DECADES. IN APPROXIMATELY THREE FOURTHS OF CASES, SCD IS CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF), ALTHOUGH IN PATIENTS WHO HAVE UNDERLYING CONGESTIVE HEART FAILURE (CHF), A SIGNIFICANT PROPORTION OF SCD IS THE CONSEQUENCE OF BRADYCARDIC EVENTS OR ELECTROMECHANICAL DISSOCIATION. THIS ARTICLE SUMMARIZES THE CURRENT KNOWLEDGE ON RISK STRATIFICATION IN PATIENTS WHO HAVE STRUCTURAL HEART DISEASE, NOTABLY CORONARY ARTERY DISEASE AND NONISCHEMIC CARDIOMYOPATHY. ALTHOUGH OTHER TYPES OF STRUCTURAL HEART DISEASE AND INHERITED ION CHANNEL ABNORMALITIES ARE ALSO ASSOCIATED WITH A RISK OF SCD, THE RISK STRATIFICATION STRATEGIES AND DATA IN THESE ENTITIES ARE DIVERSE AND BEYOND THE SCOPE OF THIS ARTICLE. THE MAGNITUDE OF THE PROBLEM IN SPECIFIC SUBGROUPS OF PATIENTS PRONE TO SCD WAS ADDRESSED BY MYERBURG IN A REVIEW OF THE POPULATION IMPACT OF EMERGING IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR (ICD) TRIALS. THE HIGHEST INCIDENCE OF SCD OCCURRED IN SURVIVORS OF OUT-OF-HOSPITAL CARDIAC DEATH AND HIGH-RISK POST INFARCTION SUBGROUPS, BUT THE GREATEST ABSOLUTE NUMBER OF SCD EVENTS (POPULATION ATTRIBUTABLE RISK) OCCURRED IN LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS. THE CHALLENGE IS TO IDENTIFY RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK, WHICH APPLIES, FOR EXAMPLE, DIRECTLY TO SURVIVORS OF MYOCARDIAL INFARCTION, IN AN ERA WHEN THE PROGNOSIS HAS IMPROVED SUBSTANTIALLY IN COMPARISON WITH PRIOR SERIES ANTEDATING THE WIDESPREAD USE OF REPERFUSION THERAPY. AMONG PATIENTS SUFFERING FROM CARDIAC ARREST, MOST HAVE SOME FORM OF STRUCTURAL HEART DISEASE, WITH MOST PATIENTS SUFFERING FROM CORONARY ARTERY DISEASE, BUT ACUTE MYOCARDIAL INFARCTION IS SEEN IN LESS THAN HALF. IN A SERIES OF 151 HEARTS FROM MEN WHO DIED FROM SUDDEN CARDIAC DEATH, THE PRESENCE OF ACUTE THROMBUS/PLAQUE RUPTURE OR EROSION WAS NOTED IN 67% OF PATIENTS AGED 30 TO 39, BUT THIS PROPORTION DECLINED WITH AGE AND WAS PRESENT IN ONLY 31% OF PATIENTS AGES 60 TO 69.

    17.- IN MOST CASES SCD WAS

    a) CAUSED BY VENTRICULAR TACHYCARDIA (VT)
    b) CAUSED BY FIBRILLATION (VF)
    c) CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF)
    d) CAUSED BY BRADYARDIC EVENTS AND ELECTROMECHANICAL DISSOCIATION


    18.- THE RISK STRATIFICATION STRATEGIES AND DATA OF SCD

    a) ARE INCLUDED WITH DETAIL AND EXAMPLES IN THIS ARTICLE
    b) COMPARATIVE DETAILS AND EXAMPLES ARE INCLUDED IN THIS ARTICLE
    c) ONLY SCD RISK STRATEGIES ARE INCLUDED IN THIS ARTICLE
    d) SCD RISK STRATIFICATION STRATEGIES AND INFORMATION IS NOT THE OBJECTIVE OF THIS ARTICLE


    19.- THE GREATEST NUMBER OF SCD OCURRED IN

    a) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT HIGHER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    b) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER AND HIGHER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    c) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH RIGHT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    d) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS


    20.- THE CHALLENGE IS TO IDENTIFY

    a) RISK FACTORS FOR SCD AMONG THE SMALL GROUP OF PATIENTS AT RELATIVELY LOW RISK
    b) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY HIGH RISK
    c) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK
    d) NON-RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK


    21.- THE HIGHEST RISK GROUP OF PATIENTS SUFFERING FROM CARDIAC ARREST WHO HAD SOME FORM OF STRUCTURAL HEART DISEASE AND CORONARY ARTERY DISEASE WERE

    a) YOUNGER MEN
    b) MIDDLE AGED MEN
    c) OLDER MEN
    d) OF ALL ADULT AGES

    MUJER 82 AÑOS. ATENDIDA EN URGENCIAS POR DOLOR EN EPIGASTRIO INTENSO QUE SE ACOMPAÑA DE NÁUSEA Y VÓMITO EN POZOS EN CAFÉ. HA TENIDO EVACUACIONES MELÉNICAS Y CON SANGRE FRESCA ASÍ COMO DISTENSIÓN ABDOMINAL . TIENE ANTECEDENTES DE ENFERMEDAD ARTICULAR DEGENERATIVA TRATADA CON AINES. E.F.: TA 80/40 MMHG, FC 120 LPM, RCR, CAMPOS PULMONARES CLAROS, ABDOMEN DOLOROSO A LA PALPACIÓN, CON REBOTE POSITIVO Y PERISTALSIS AUSENTE.

    22.- EL ESTUDIO INICIAL PARA CORROBORAR EL DIAGNÓSTICO ES:

    a) RX DE ABDOMEN DE PIE Y DECÚBITO.
    b) ENDOSCOPÍA.
    c) TAC DE ABDOMEN.
    d) COLONOSCOPÍA.


    23.- EL TRATAMIENTO DEFINITIVO EN ESTE PACIENTE ES:

    a) BLOQUEADORES DE BOMBA DE PROTONES.
    b) LAVADO GÁSTRICO.
    c) CIRUGÍA.
    d) SUSPENDER AINES.

    APPENDICITIS: SELECTIVE USE OF ABDOMINAL CT REDUCES NEGATIVE APPENDECTOMY RATE APPENDICITIS ACCOUNTS FOR OVER 3% OF THE DISEASES THAT INVOLVE THE DIGESTIVE SYSTEM, IS THE MOST COMMON ACUTE SURGICAL PROBLEM OF THE ABDOMEN, AND APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT. IT IS ALSO ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE ACCURATELY. RATES OF NEGATIVE APPENDECTOMY RANGE FROM 20% TO 44%. THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE, RANGING FROM 25% TO AS HIGH AS 52%. REPORTED PERFORATION RATES RANGE FROM 15% TO 37%. THESE RATES OF NEGATIVE APPENDECTOMY HAVE BEEN CONSIDERED ACCEPTABLE BECAUSE THE MORBIDITY ASSOCIATED WITH COMPLICATED APPENDICITIS IS SIGNIFICANTLY HIGHER THAN THAT OF NON-THERAPEUTIC APPENDECTOMY. NUMEROUS DIAGNOSTIC TOOLS HAVE BEEN IMPLEMENTED IN AN EFFORT TO REDUCE THE HIGH RATE OF NEGATIVE APPENDECTOMY WHILE AT THE SAME TIME NOT INCREASE THE PERFORATION RATE. SOME OF THESE TOOLS INCLUDE CLINICAL SCORING SYSTEMS, ULTRASOUND, COMPUTERIZED DECISION SUPPORT, VARIOUS LABORATORY TESTS, AND OTHER, NON-TRADITIONAL METHODS. THESE VARIOUS MODALITIES HAVE ALL YIELDED MIXED RESULTS AS TO THEIR USEFULNESS IN CLINICAL PRACTICE. STUDIES HAVE SHOWN THAT HELICAL COMPUTERIZED TOMOGRAPHY (CT) SCANNING OF THE ABDOMEN HAS BEEN SUCCESSFUL IN REDUCING NONTHERAPEUTIC APPENDECTOMY RATES TO AS LOW AS 3%. THESE RESULTS PROVIDE EVIDENCE THAT THERE MAY FINALLY BE A DIAGNOSTIC TOOL THAT CAN BE EFFECTIVE IN REDUCING RATES OF NONTHERAPEUTIC APPENDECTOMY WHILE NOT INCREASING THE MORBIDITY AND MORTALITY ASSOCIATED WITH APPENDICITIS.

    24.- WHAT IS RELATION OF APPENDICITIS WITH OTHER GASTROINTESTINAL TRACT DISEASES?

    a) IS ONE OF THE LESS COMMON SURGICAL PROCEDURES OF THE GASTROINTESTINAL TRACT.
    b) IT HAS NO RELATION WITH OTHER GASTROINTESTINAL TRACT DISEASES.
    c) IT HAS THE HIGHEST INDEX OF MORBILITY.
    d) IS THE FIFTH MOST COMMON SURGICAL PROCEDURE OF THE GASTROINTESTINAL TRACT.


    25.- WHY CAN APPENDICITIS END IN A COMPLICATED PERFORATION?

    a) BECAUSE IS THE MOST COMMON ACUTE SURGICAL PROBLEM OR THE ABDOMEN.
    b) BECAUSE IT IS ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE ACURATELY.
    c) BECAUSE APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT.
    d) BECAUSE OF THE LACK OF DIAGNOSTIC TOOLS.


    26.- WHAT ARE THE RATES OF NEGATIVE APPENDECTOMY?

    a) THESE RATES ARE EVEN LOWER IN WOMEN OF CHILDBEARING AGE.
    b) THESE RATES ARE NOT CONSIDERED ACCEPTABLE.
    c) THESE RATES ARE EVEN HIGHER IN WOMEN WHO ARE NOT IN CHILDBEARING AGE.
    d) THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE.


    27.- WHICH OF THE NEXT DIAGNOSTIC TOOLS HAS SUCCESFULLY REDUCED NONTHERAPEUTIC APPENDECTOMY?

    a) SCORING SYSTEMS.
    b) HELICAL COMPUTERIZED TOMOGRAPHY.
    c) ULTRASOUND.
    d) LABORATORY TESTS.


    28.- WHAT IS THE FINAL RESULT OF THIS STUDY?

    a) THE HELICAL COMPUTERIZED TOMOGRAPHY CAN PREVENT NONTHERAPEUTICAL APPENDECTOMY.
    b) THE RATES OF NONTHERAPEUTICAL APPENDECTOMY HAVE INCREASED.
    c) APPENDICITIS IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT.
    d) NUMEROUS DIAGNOSTIC TOOL HAVE BEEN IMPLEMENTED IN AN EFFORT TO REDUCE THE RISK OF NONTHERAPEUTICAL APPENDECTOMY.

    MUJER DE 23 AÑOS. ASISTE A URGENCIAS POR PRESENTAR SALIDA DE LÍQUIDO TRANSVAGINAL DE INICIO SÚBITO POSTERIOR A UNA RELACIÓN SEXUAL. ACTUALMENTE CURSA SU PRIMER EMBARAZO Y ESTÁ EN LA SEMANA 39 DE GESTACIÓN. E.F.: PRODUCTO LONGITUDINAL CEFÁLICO DORSO IZQUIERDA. FCF EN 140 LPM. GENITALES HÚMEDOS. SE VISUALIZA CÉRVIX CERRADO FORMADO Y POSTERIOR. NO HAY LÍQUIDO EN FONDO DE SACO.

    29.- EL MÉTODO MÁS SENSIBLE Y ESPECÍFICO PARA ESTABLER EL DIAGNÓSTICO EN ESTA PACIENTE ES:

    a) CRISTALOGRAFÍA .
    b) INYECCIÓN DE PIGMENTO POR AMNIOCENTESIS Y OBSERVACIÓN DE FUGA HACIA CANAL VAGINAL.
    c) PRUEBA DE NITRAZINA.
    d) PH VAGINAL.
    MUJER DE 25 AÑOS. ES ATENDIDA EN CONSULTA PARA CONTROL PRENATAL. 13 SEMANAS DE GESTACIÓN POR FUR. ULTRASONIDO TRANSABDOMINAL SE OBSERVA LA PRESENCIA DE DOS FETOS DENTRO DE UN SACO GESTACIONAL. SE APRECIA UNA MEMBRANA DIVISORIA DELGADA QUE AL UNIRSE A LA PLACENTA FORMA UNA IMAGEN EN “T”.

    30.- LA CAUSA MÁS PROBABLE DE ESTE HALLAZGO ES:

    a) SEPARACIÓN ANTES DE LA DIFERENCIACIÓN DEL TROFOBLASTO (ANTES DÍA 3).
    b) SEPARACIÓN DESPUÉS DE LA DIFERENCIACIÓN DEL TROFOBLASTO PERO ANTES DE LA FORMACIÓN DEL AMNIOS (DIA 3 – .
    c) SEPARACIÓN DE TROFOBLASTO Y DIVISIÓN POSTERIOR A LA FORMACIÓN DEL AMNIOS (DIA 8-13) .
    d) SEPARACION POSTERIOR A LA FORMACIÓN DEL AMNIOS (DÍAS 10 A 15).

    A 71-YEAR-OLD MAN PRESENTED WITH A 2-WEEK HISTORY OF PAIN AND SWELLING OF HIS LEFT ARM. EXAMINATION REVEALED A CRAGGY, MOBILE MASS WITH IRREGULAR BORDERS IN THE EXTENSOR COMPARTMENT OF THE LEFT ARM MEASURING 6 × 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM DEMONSTRATED THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE LEFT TRICEPS MUSCLE, MEASURING 5 × 3 CM. THIS LED TO FURTHER RADIOLOGIC EVALUATION IN THE FORM OF MRI OF THE LEFT ARM. MRI SHOWED INTERMEDIATE SIGNAL MASS IN THE TRICEPS MUSCULATURE ON T1-WEIGHTED IMAGES WITH FAT SATURATION. THIS LESION IS CONFINED TO THE EXTENSOR COMPARTMENT OF THE ARM. A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS MADE. AN INCISIONAL BIOPSY WAS PERFORMED. THIS WAS FOUND TO BE CONSISTENT WITH METASTATIC SQUAMOUS CELL CARCINOMA WITH A POSSIBLE LUNG PRIMARY, FURTHER SUPPORTED DUE TO A POSITIVE CK7 AND NEGATIVE CK20 STAIN ON IMMUNOHISTOCHEMISTRY. CT SCAN OF THE CHEST REVEALED A LESION MEASURING 4 × 2 CM IN THE LEFT UPPER LOBE. FIBER-OPTIC BRONCHOSCOPY AND BIOPSY CONFIRMED THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL CARCINOMA OF THE LUNG. HE UNDERWENT PALLIATIVE RADIOTHERAPY TO THE MASS IN THE ARM, 20 GY IN 4 FRACTIONS. THIS PROVIDED GOOD RELIEF FROM PAIN AND SWELLING WITHIN 2 WEEKS OF COMPLETING TREATMENT. SYSTEMIC THERAPY WAS NOT OFFERED ON THE BASIS OF POOR AND DETERIORATING PERFORMANCE STATUS. UNFORTUNATELY, THE PATIENT DIED WITHIN 10 WEEKS OF PRESENTATION. INTRAMUSCULAR METASTASES IN CANCER PATIENTS ARE RARE. THIS IN ITSELF IS QUITE PECULIAR BECAUSE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF TOTAL BODY WEIGHT. IT IS THOUGHT THAT MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES CONTRIBUTE TO THE RARE OCCURRENCE OF THIS PHENOMENON. THE TRUE INCIDENCE OF MUSCULAR METASTASIS REMAINS UNKNOWN, BUT AN AUTOPSY SERIES SUGGESTS THAT ITS INCIDENCE COULD BE AS LOW AS 0.8%. LUNG CARCINOMA SEEMS TO BE THE UNDERLYING PRIMARY CANCER IN MOST OF THESE CASES. MANY OTHER TUMORS, SUCH AS KIDNEY, STOMACH, PANCREAS, THYROID GLAND, BREAST, OVARY, PROSTATE, AND BLADDER CANCERS HAVE ALSO BEEN SPORADICALLY DESCRIBED IN ASSOCIATION WITH INTRAMUSCULAR SECONDARIES. HOWEVER, PRIMARY PRESENTATION OF AN INTRAMUSCULAR METASTASIS, SUCH AS DEMONSTRATED BY OUR PATIENT, REMAINS AN EXCEPTIONALLY UNUSUAL OCCURRENCE. THE MOST FREQUENT PRESENTATION OF MUSCULAR METASTASIS IS PAIN WITH OR WITHOUT SWELLING. DIAGNOSIS, EVEN WITH RADIOLOGIC IMAGING IS OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT TISSUE TUMORS.

    31.- WHY WAS THE RADIOLOGIC EVALUATION DONE?

    a) BECAUSE OF THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE RIGHT TRICEPS MUSCLE.
    b) BECAUSE OF THE RESULTS OF THE ULTRASONOGRAPHY
    c) BECAUSE DIAGNOSIS WITH RADIOLOGIC IMAGING IS OFTEN TRICKY.
    d) BECAUSE OF THE CLINICAL HISTORY OF THE PATIENT.


    32.- WHY ARE THE INTRAMUSCULAR METASTASES IN CANCER PATIENTS RARE?

    a) BECAUSE THE AMOUNT OF THE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF THE TOTAL BODY WEIGHT.
    b) DUE TO THE MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND ACCUMULATION OF LACTIC ACID AND OTHER METASTASIS.
    c) BECAUSE THE PATIENTS DIE WITHIN 10 WEEKS OF PRESENTATION
    d) BECAUSE PATIENTS LEAD AN ACTIVE LIFE


    33.- WHAT KIND OF CANCER DID THE 71-YEAR-OLD PATIENT HAVE?

    a) LUNG CARCINOMA.
    b) KIDNEY CANCER
    c) PROSTATE CANCER
    d) BREAST CANCER


    34.- HOW WAS THE PATIENT’S CANCER CONFIRMED?

    a) THROUGH THE MRI.
    b) WITH IMMUNOHISTOCHEMISTRY
    c) THROUGH FIBER-OPTIC BRONCHOSCOPY AND BIOPSY
    d) THROUGH OBSERVATION OF THE SWELLING AND THE PAIN PRESENTED BY THE PATIENT


    35.- WHY WASN’T SYSTEMATIC THERAPY OFFERED?

    a) BECAUSE THE PATIENT WAS TOO OLD TO RESIST THE THERAPY
    b) BECAUSE THE PALLIATIVE RADIOTHERAPY PROVIDED GOOD RELIEF FROM PAIN AND SWELLING.
    c) BECAUSE THE PATIENT SHOWED VERY LITTLE IMPROVEMENT.
    d) THE PATIENT DIED 10 WEEKS AFTER THE FIRST PRESENTATION.
    NIÑO DE 5 AÑOS. ES ATENDIDO EN LA CONSULTA POR PRESENTAR MORETONES EN PIERNAS SIN ANTECEDENTE DE TRAUMATISMO. ANTECEDENTES: HACE 2 MESES CON HIPOREXIA, BAJA DE PESO, SANO PREVIAMENTE. E.F.: TA 110/65 MM HG, FC 120 LPM, FR 28 RPM. PÁLIDO ++, HIPOACTIVO. SE PALPA HÍGADO A DOS CENTÍMETROS POR ABAJO DEL BORDE COSTAL. LABORATORIO: HB 9G/DL, LEUCOCITOS 25, 000 PREDOMINO DE LINFOCITOS 50%, PLAQUETAS 100,000.

    36.- EL DIAGNÓSTICO MAS PROBABLE CON ESTE PACIENTE ES:

    a) ANEMIA APLÁSICA.
    b) HISTIOCITOSIS X.
    c) LEUCEMIA LINFOBLÁSTICA.
    d) PÚRPURA TROMBÓTICA.


    37.- EL SIGUIENTE PASO EN LA ATENCIÓN DE ESTE PACIENTE QUE DEBE REALIZAR USTED ES:

    a) INICIAR ESQUEMA DE QUIMIOTERAPIA.
    b) TRANSFUNDIRLE PAQUETE GLOBULAR.
    c) DERIVAR AL HEMATÓLOGO.
    d) ANÁLISIS MÉDULA ÓSEA.
    ENDOMETRIAL CANCER IN THE UNITED STATES ENDOMETRIAL CANCER REFERS TO SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS. ENDOMETRIAL CANCERS ARE THE MOST COMMON GYNECOLOGIC CANCERS IN THE UNITED STATES, WITH OVER 35,000 WOMEN DIAGNOSED EACH YEAR IN THE U.S. THE MOST COMMON SUBTYPE, ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN A FEW DECADES OF MENOPAUSE, IS ASSOCIATED WITH EXCESSIVE ESTROGEN EXPOSURE, OFTEN DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA, AND PRESENTS MOST OFTEN WITH VAGINAL BLEEDING. ENDOMETRIAL CARCINOMA IS THE THIRD MOST COMMON CAUSE OF GYNECOLOGIC CANCER DEATH (BEHIND OVARIAN AND CERVICAL CANCER CLINICAL EVALUATION: ROUTINE SCREENING OF ASYMPTOMATIC WOMEN IS NOT INDICATED, SINCE THE DISEASE IS HIGHLY CURABLE IN ITS EARLY STAGES. RESULTS FROM A PELVIC EXAMINATION ARE FREQUENTLY NORMAL, ESPECIALLY IN THE EARLY STAGES OF DISEASE. CHANGES IN THE SIZE, SHAPE OR CONSISTENCY OF THE UTERUS AND/OR ITS SURROUNDING, SUPPORTING STRUCTURES MAY EXIST WHEN THE DISEASE IS MORE ADVANCED. •A PAP SMEAR MAY BE EITHER NORMAL OR SHOW ABNORMAL CELLULAR CHANGES. •ENDOMETRIAL CURETTAGE IS THE TRADITIONAL DIAGNOSTIC METHOD. BOTH ENDOMETRIAL AND ENDOCERVICAL MATERIAL SHOULD BE SAMPLED. •IF ENDOMETRIAL CURETTAGE DOES NOT YIELD SUFFICIENT DIAGNOSTIC MATERIAL, A DILATION AND CURETTAGE (D&C) IS NECESSARY FOR DIAGNOSING THE CANCER. •HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE CAVITY AND CAN BE USED TO DETECT THE PRESENCE OF LESIONS OR TUMOURS. IT ALSO PERMITS THE DOCTOR TO OBTAIN CELL SAMPLES WITH MINIMAL DAMAGE TO THE ENDOMETRIAL LINING (UNLIKE BLIND D&C). •ENDOMETRIAL BIOPSY OR ASPIRATION MAY ASSIST THE DIAGNOSIS. •TRANSVAGINAL ULTRASOUND TO EVALUATE THE ENDOMETRIAL THICKNESS IN WOMEN WITH POSTMENOPAUSAL BLEEDING IS INCREASINGLY BEING USED TO EVALUATE FOR ENDOMETRIAL CANCER. •RECENTLY, A NEW METHOD OF TESTING HAS BEEN INTRODUCED CALLED THE TRUTEST, OFFERED THROUGH GYNECOR. IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS. THIS METHOD IS LESS PAINFUL THAN A PIPELLE BIOPSY AND HAS A LARGER LIKELIHOOD OF PROCURING ENOUGH TISSUE FOR TESTING. SINCE IT IS SIMPLER AND LESS INVASIVE, THE TRUTEST CAN BE PERFORMED AS OFTEN, AND AT THE SAME TIME AS, A ROUTINE PAP SMEAR, THUS ALLOWING FOR EARLY DETECTION AND TREATMENT. •ONGOING RESEARCH SUGGESTS THAT SERUM P53 ANTIBODY MAY HOLD VALUE IN IDENTIFYING HIGH-RISK ENDOMETRIAL CANCER.[4]

    38.- ENDOMETRIAL CANCER REFERS TO:

    a) SPECIFIC TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.
    b) SEVERAL TYPES OF MALIGNANCY WHICH NEVER ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.
    c) ALL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM.
    d) SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.


    39.- ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN:

    a) EXCESSIVE ESTROGEN.
    b) A LOT OF DECADES OF MENOPAUSE.
    c) ALWAYS PRESENTS VAGINAL BLEEDING.
    d) ALWAYS DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA.


    40.- RESULTS FROM A PELVIC EXAMINATION ARE:

    a) ALWAYS CHANGES IN THE SIZE AND NEVER IN SHAPE
    b) SOMETIMES NORMAL, ESPECIALLY IN THE EARLY STAGES OF THE DISEASE.
    c) CHANGES IN THE SIZE, SOMETIMES THE SHAPE BUT NEVER THE CONSISTENCY OF THE UTERUS
    d) CHANGES IN THE SIZE, SHAPE BUT NEVER IN THE CONSISTENCY OF THE UTERUS


    41.- CLINICAL METHOD FOR EVALUATION:

    a) A PAP IS THE BEST OPTION YOU CAN USE.
    b) ENDOMETRIAL CURETTAGE IS NOT THE TRADITIONAL DIAGNOSTIC METHOD.
    c) HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE CAVITY.
    d) ENDOMETRIAL BIOPSY OR ASPIRATION ALWAYS ASSIST IN THE DIAGNOSIS.


    42.- HOW IS THE DEVELOPEMENT OF THIS NEW METHOD?

    a) IT USES THE HUGE FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.
    b) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE UTERUS.
    c) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.
    d) IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.

    MUJER DE 25 AÑOS. TRABAJA EN UN ASILO DE ANCIANOS. ES ATENDIDA EN URGENCIAS POR PRESENTAR DESDE HACE 24 HORAS, MALESTAR GENERAL, CEFALEA INTENSA, VÓMITO, DIARREA, MIALGIAS Y FIEBRE. G:2 , C:1. CURSA CON EMBARZO DE 22 SEMANAS. E.F.: PESO 63 KGS. TEMP. 38.3° C . FCF: 128 LPM.

    43.- LO MÁS PROBABLE ES QUE EL AGENTE CAUSAL SEA:

    a) ROTAVIRUS.
    b) ADENOVIRUS INTESTINAL.
    c) ASTROVIRUS.
    d) NOROVIRUS.
    MUJER DE 33 AÑOS. EMBARAZADA, INGRESA A URGENCIAS CON ACTIVIDAD UTERINA. REFIERE HABER INICIADO CON CEFALEA HACE 4 HORAS Y ACTIVIDAD UTERINA REGULAR. G: 4, P:3. CURSA CON EMBARZO DE 35.4 SEMANAS, TOMA HIDRALAZINA Y ALFAMETILDOPA E.F.: PESO 74 KGS. TA 140/90 MM/HG. FU: 32 CMS. PRODUCTO CEFÁLICO CON FCF: 128 LPM. TACTO VAGINAL: CERVIX, SEMIBORRADO SIN DILATACIÓN.

    44.- PARA CORROBORAR EL DIAGNÓSTICO SE DEBE DE REALIZAR :

    a) PRUEBAS DE FUNCION HEPÁTICA.
    b) DEPURACIÓN DE CREATININA.
    c) DETERMINACIÓN DE ÁCIDO ÚRICO.
    d) PROTEÍNAS EN ORINA.
    HOMBRE DE 89 AÑOS. LLEVADO A URGENCIAS POR UN VECINO YA QUE PRESENTA DESDE HACE UNA SEMANA TOS CON EXPECTORACIÓN VERDE-AMARILLENTA. HA PRESENTADO ALTERACIONES EN EL ESTADO DE CONCIENCIA, FIEBRE, ASTENIA, ADINAMIA E HIPOREXIA Y OLIGURIA DE 5 DIAS DE EVOLUCIÓN. E.F.: PESO 45KG, TEMP 39 º C, FC 110 LPM, MUCOSAS ORALES DESHIDRATADAS, RCR DE BAJA INTENSIDAD, CAMPOS PULMONARES CON ESTERTORES CREPITANTES DISEMINADOS. GIORDANO DUDOSO BILATERAL, EXTREMIDADES INFERIORES Y SUPERIORES HIPOTRÓFICAS Y ESCARA EN REGIÓN SACRA.

    45.- EL PRINCIPAL PROBLEMA DE ESTE PACIENTE ES:

    a) ISQUEMIA CEREBRAL TRANSITORIA.
    b) DEMENCIA SENIL.
    c) INFECCIÓN DE VIAS URINARIAS.
    d) SÍNDROME DE ABANDONO.


    46.- EL MANEJO MÉDICO INICIAL EN ESTE PACIENTE ES:

    a) HOSPITALIZACIÓN, HIDRATACIÓN Y PENICILINA BENZATÍNICA Y DESINFLAMATORIOS.
    b) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS RESPIRATORIAS.
    c) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS URINARIAS.
    d) HOSPITALIZACIÓN Y OBSERVACIÓN.

    RECIÉN NACIDO DE TÉRMINO. ES ATENDIDO EN LA CONSULTA A LOS 3 DÍAS POR NOTAR LA MADRE ENROJECIMIENTO INTENSO DE SU OMBLIGO Y LLANTO CONSTANTE. ANTECEDENTES: NACIDO CON PARTERA. E.F.: TA 94/52 MM HG, FC 160 LPM, FR 50 POR MINUTO, TEMPERATURA DE 39°C. DECAÍDO, RECHAZA EL PECHO, LLENADO CAPILAR DE 4 SEGUNDOS.

    47.- EL DIAGNÓSTICO MAS PROBABLE EN ESTE CASO ES:

    a) ONFALITIS.
    b) PERITONITIS.
    c) SEPSIS.
    d) ERITEMA DEL NEONATO.


    48.- LOS MICROORGANISMOS MAS COMUNES EN ESTOS CASOS SON:

    a) ANAEROBIOS.
    b) GRAM POSITIVOS.
    c) GRAM NEGATIVOS.
    d) VIRUS.
    RECIÉN NACIDO DE 40 SEMANAS DE GESTACIÓN. APGAR DE 3 AL MINUTO. ANTECEDENTES: MADRE SIN CONTROL PRENATAL, OBRERA, GESTA 8, LLEGÓ A URGENCIAS POR NO SENTIR MOVIMIENTOS DEL BEBÉ. E.F.: TA 50/20 MM HG, FC < 100 LPM, FR 10 RPM, TEMPERATURA 37.5°C. LLENADO CAPILAR > 4 SEG.

    49.- EL MANEJO INMEDIATO PARA ESTE PACIENTE ES:

    a) HABLARLE AL PEDIATRA E INICIAR MANIOBRAS.
    b) ADMINISTRAR ADRENALINA E INICIAR MANIOBRAS.
    c) ADMINISTRAR ATROPINA E INICIAR MANIOBRAS.
    d) VENTILACIÓN Y COMPRESIÓN CARDIACA
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    MUJER DE 78 AÑOS, LLEVADA A URGENCIAS POR CEFALEA INTENSA, NÁUSEA, VÓMITOS, TRASTORNOS DE LA MEMORIA,APATÍA Y SOMNOLENCIA. ANTECEDENTES DE DIABETES MELLITUS Y ENFERMEDAD ARTICULAR DE TIPO DEGENERATIVO AMBAS BAJO TRATAMIENTO MÉDICO. E.F.: TEMP 38º C, TA 140/90 MMHG, RCR, CAMPOS PULMONARES CLAROS, EXTREMIDADES CON DISMINUCIÓN DE FUERZA MUSCULAR 3/5 EN HEMICUERPO IZQUIERDO, REFLEJOS DE ESTIRAMIENTO MUSCULAR CONSERVADO. DISMINUCIÓN DE CAMPOS VISUALES. B.H. Y Q.S. NORMALES.

    1.- EL AGENTE CAUSAL MÁS PROBABLE EN ESTE PACIENTE ES:

    a) BACTERIANO.
    b) VIRAL.
    c) NEOPLASICO
    d) METABÓLICO.


    2.- EL MÉTODO MÁS SENSIBLE PARA CORROBORAR EL DIAGNÓSTICO EN ESTE PACIENTE ES:

    a) PUNCIÓN LUMBAR.
    b) RESONANCIA MAGNETICA
    c) HEMOGLOBINA GLUCOSILADA.
    d) ANGIOGRAFÍA

    ANXIETY, DEPRESSION LINKED TO ANGINA FREQUENCY IN HEART PATIENTS NEW RESEARCH SHOWS THAT ISCHEMIC HEART DISEASE PATIENTS WHO SUFFER SIGNIFICANT ANXIETY HAVE CLOSE TO A 5-FOLD INCREASED RISK OF EXPERIENCING FREQUENT ANGINA AND THOSE WITH DEPRESSION HAVE MORE THAN A 3-FOLD INCREASED RISK FOR THESE EPISODES. THIS OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA UNDERLINES THE IMPORTANCE OF TREATING ANXIETY AND DEPRESSION IN CARDIAC PATIENTS. PSYCHOSOCIAL FACTORS: THE RESEARCHERS EXAMINED 5 PSYCHOSOCIAL FACTORS THAT MIGHT AFFECT ANGINA FREQUENCY: ANXIETY; DEPRESSION; NEUROTICISM (TENDENCY TO EXPERIENCE NEGATIVE EMOTIONS SUCH AS SADNESS, ANGER, OR GUILT); ALEXITHYMIA (IMPAIRED ABILITY TO EXPRESS INNER FEELINGS); AND SOMATOSENSORY AMPLIFICATION (TENDENCY TO EXPERIENCE A SOMATIC SENSATION AS INTENSE, NOXIOUS, AND DISTURBING). THERE WAS MORE ANXIETY AND DEPRESSION AMONG PATIENTS WITH FREQUENT ANGINA. FOR INSTANCE, 22% OF PATIENTS WITH NO ANGINA HAD CLINICALLY SIGNIFICANT ANXIETY, DEFINED AS A SCORE OF 16 OR GREATER ON THE BECK ANXIETY INVENTORY SCALE, COMPARED WITH 38% FOR PATIENTS WITH MONTHLY ANGINA AND 64% FOR THOSE WITH WEEKLY OR DAILY ANGINA. OTHER PSYCHOSOCIAL FACTORS WERE ALSO INCREASED AMONG PATIENTS WITH MORE FREQUENT ANGINA. FOR EXAMPLE, 38% OF PATIENTS WITH WEEKLY OR DAILY ANGINA HAD A HIGH LEVEL OF ALEXITHYMIA COMPARED WITH 17% OF PATIENTS WITH MONTHLY ANGINA AND 14% OF THOSE WITHOUT ANGINA. HOWEVER, AFTER ADJUSTMENT FOR DEGREE OF MYOCARDIAL ISCHEMIA, GREATER ANXIETY SCORE (ODDS RATIO, 1.39 PER HALF–STANDARD DEVIATION INCREASE IN ANXIETY SCORE) AND GREATER DEPRESSION SCORE (OR, 1.51 PER HALF–STANDARD DEVIATION INCREASE IN DEPRESSION SCORE) WERE THE ONLY PSYCHOSOCIAL FACTORS SIGNIFICANTLY ASSOCIATED WITH MORE FREQUENT ANGINA. AS EXPECTED, PREVIOUS CORONARY REVASCULARIZATION WAS ALSO SIGNIFICANTLY ASSOCIATED WITH FREQUENT ANGINA. PATIENTS WITH AT LEAST MODERATE ANXIETY SYMPTOMS EXPERIENCED A 4.7-FOLD INCREASED RISK OF HAVING MORE FREQUENT ANGINA. PATIENTS WITH CLINICALLY RELEVANT DEPRESSIVE SYMPTOMS HAD A 3.2-FOLD INCREASED RISK OF EXPERIENCING MORE FREQUENT ANGINA. BIOLOGICAL FACTORS: NOT EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA. UP TO 45% OF THESE PATIENTS HAVE ASYMPTOMATIC ISCHEMIA. SEVERAL BIOLOGICAL FACTORS MIGHT EXPLAIN THE DISCREPANCY BETWEEN CORONARY ARTERY DISEASE AND ANGINA SEVERITY, ACCORDING TO THE AUTHORS. FOR EXAMPLE, METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY MAY INFLUENCE PAIN LEVELS.

    3.- WHAT HAS NEW RESEARCH DEMONSTRATED ABOUT ISCHEMIC HEART DISEASE PATIENTS WITH DEPRESSION?

    a) THIS PATIENTS HAVE MORE INCREASED RISK OF EXPERIENCING FREQUENT ANGINA.
    b) THIS PATIENTS HAVE MORE INCREASED RISK OF THIS EPISODES.
    c) A PATIENTS HEART DISEASE IS NOT RELATED WITH ANY PSYCHIATRIC DISEASE.
    d) THERE IS NO OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA.


    4.- WHAT RELATIONSHIP WAS FOUND BETWEEN PSYCHIATRIC SYMPTOMS AND PATIENTS WITH FREQUENT ANGINA?

    a) THIS PATIENTS HAD CLINICALLY SIGNIFICANT ANXIETY.
    b) THIS PATIENTS HAD A 16 SCORE OR GREATER ON THE BECK ANXIETY INVENTORY SCALE.
    c) THIS PATIENTS SUFFERED FROM WEEKLY OR DAILY ANGINA.
    d) THIS PATIENTS HAD MORE ANXIETY AND DEPRESSION.


    5.- WHAT PSYCHOSOCIAL FACTORS INCREASED AMONG PATIENTS WHO SUFFERED OF FREQUENT ANGINA?

    a) ALEXITHYMIA.
    b) ANXIETY.
    c) SOMATOSENSORY AMPLIFICATION.
    d) NOXIOUS.


    6.- WHAT ADJUSTMENT FOR DEGREE WAS THERE AFTER MYOCHARDIAL ISCHEMIA?

    a) ANXIETY AND DEPRESSION DECREASED.
    b) DEPRESSION AND ANXIETY INCREASED.
    c) ANXIETY AND DEPRESSION REMAINED THE SAME.
    d) THERE WAS NO SIGNIFICANT CHANGES.


    7.- WHAT BIOLOGICAL FACTORS EFFECTS PATIENTS WITH ANGINA?

    a) EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA.
    b) PREVIOUS CORONARY REVASCULARIZATION WAS ALSO ASSOCIATED WITH FREQUENT ANGINA.
    c) SOME OF THIS PATIENTS HAVE ASYMPTOMATIC ISQUEMIA.
    d) METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY ARE NOT RELATED.

    MUJER DE 31 AÑOS. ES ATENDIDA EN CONSULTA POR PRESENTAR ACTIVIDAD UTERINA REGULAR Y DOLOROSA. ACTUALMENTE CURSA EMBARAZO GEMELAR DE 33 SEMANAS . NIEGA SANGRADO TRANSVAGINAL, SALIDA DE LÍQUIDO TRANSVAGINAL. REFIERE MOVIMIENTOS FETALES PRESENTES. ANTECEDENTES: G:3, P:2, DIABETES GESTACIONAL MANEJADA CON DIETA Y METFORMINA CON BUEN CONTROL GLICÉMICO. E.F.: PRODUCTO ÚNICO LONGITUDINAL PÉLVICO, DORSO DERECHA. CON FCF 130 LPM. TACTO VAGINAL 1 CM DE DILATACIÓN CON 80% BORRRAMIENTO.

    8.- EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:

    a) INHIBIDORES DE LA SINTESIS DE PROSTAGLANDINAS.
    b) BETAMIMÉTICOS.
    c) NIFEDIPINO.
    d) REPOSO.

    NIÑA DE 4 AÑOS, INGRESA AL SERVICIO DE URGENCIAS POR DOLOR ABDOMINAL CONSTANTE DE 48 HORAS DE EVOLUCIÓN. SU MADRE LE DIÓ PARACETAMOL AYER, SIN EMBARGO EL DOLOR PERSISTE Y SE AGREGARON VÓMITO VERDOSO Y FIEBRE DE 39°C. ANTECEDENTES: OPERADA DE HIPERTROFIA PILÓRICA A LOS 2 MESES. E.F.: TA/ 100/60, FC 120LPM, FR 30 RPM, TEMPERATURA 38.7°C. ABDOMEN CON DOLOR A LA PALPACIÓN MEDIA Y RESISTENCIA, TIMPÁNICO, PERISTALSIS NULA.

    9.- EL DIAGNÓSTICO DE MÁS PROBABILIDAD ES:

    a) OCLUSIÓN INTESTINAL BAJA.
    b) INVAGINACIÓN INTESTINAL.
    c) OCLUSION POR ADHERENCIAS.
    d) APENDICITIS COMPLICADA.


    10.- EL TRATAMIENTO INMEDIATO PARA ESTA PACIENTE ES:

    a) ADMINISTRAR SONDA A DERIVACIÓN.
    b) LAPAROTOMIA EXPLORADORA.
    c) SOLUCIONES PARENTERALES.
    d) OBSERVACIÓN.


    HOMBRE DE 45 AÑOS. ATENDIDO EN LA CONSULTA POR PRESENTAR EXPECTORACIÓN CON SANGRE. ANTECEDENTES: TABAQUISMO POSITIVO, 42 CAJETILLAS AL AÑO. TOS CRÓNICA CON EXPECTORACIÓN MUCOSA ABUNDANTE, DE 3 AÑOS DE EVOLUCIÓN. E.F.: TA 130/80 MM HG, FC 88 LPM, FR 14 RPM, TEMP 37ºC. DISMINUCIÓN DE AMPLEXIÓN Y AMPLEXACIÓN. RX DE TÓRAX MUESTRA OPACIDAD HILIAR DERECHA.

    11.- EL SIGUIENTE ESTUDIO QUE SE DEBE REALIZAR EN ESTE PACIENTE PARA CONFIRMAR EL DIAGNÓSTICO ES:

    a) CITOLOGÍA EN EXPECTORACIÓN.
    b) LAVADO, CEPILLADO BRONQUIAL POR BRONCOSCOPÍA.
    c) TOMA DE BIOPSIA TRANSBRONQUIAL POR BRONCOSCOPIA.
    d) TOMA DE BIOPSIA TRANSTORÁCICA CON AGUJA FINA.


    12.- EN ESTE PACIENTE EL REPORTE ANATOMOPATOLÓGICO MÁS PROBABLE ES:

    a) CARCINOMA EPIDERMOIDE.
    b) ADENOCARCINOMA.
    c) LINFOMA DE HODGKIN.
    d) CARCINOMA DE CELULAS PEQUEÑAS.


    13.- EN ESTE PACIENTE, UNA VEZ TRATADO, USTED ESPERA QUE PUEDA TENER:

    a) EDEMA DE MIEMBROS INFERIORES.
    b) ASCITIS.
    c) CRISIS CONVULSIVAS.
    d) ARRITMIAS CARDIACAS.

    HOMBRE DE 40 AÑOS. ATENDIDO EN LA CONSULTA EXTERNA POR DOLOR INTENSO EN PRIMER ORTEJO DEL PIE DERECHO Y FIEBRE. ANTECEDENTES: SE ENCUENTRA EN QUIMIOTERAPIA POR PADECER DE LEUCEMIA GRANULOCÍTICA CRÓNICA. E.F.: TA 130/70 MM HG, FC 120 LPM, FR 14 RPM, TEMP 38ºC. EL DEDO REFERIDO ESTA INFLAMADO MUY DOLOROSO AL MENOR ESTÍMULO. LABORATORIO: LEUCOCITOS 25,000/MM3, ÁCIDO ÚRICO 14 MG/DL. CREATININA SERICA 0.9 MG/DL.

    14.- LA EXPLICACIÓN MÁS PROBABLE DE ESTE CUADRO CLÍNICO ES:

    a) INGESTIÓN ABUNDANTE DE CARNES ROJAS.
    b) AUMENTO DE RECAMBIO TISULAR.
    c) DISMINUCIÓN EN LA ELIMINACIÓN RENAL DE ÁCIDO ÚRICO.
    d) CONSECUENCIA DEL TRATAMIENTO ANTINEOPLASICO.

    LACTANTE DE 2 MESES DE EDAD. ES ATENDIDO EN LA CONSULTA POR PRESENTAR ADENOMEGALIA EN REGIÓN AXILAR DERECHA CON DOLOR E INMOVILIZACIÓN DE LA ARTICULACIÓN. REFIERE LA MADRE QUE TIENE ESQUEMA COMPLETO DE VACUNACIÓN. E.F.: MASA DE 3 CM EN AXILA CON CAMBIOS DE COLOR Y AUMENTO DE TEMPERATURA EN LA REGIÓN. TEMPERATURA 37.3º, FC. 124LPM, FR 36 RPM.

    15.- LA PRINCIPAL SOSPECHA CLÍNICA EN ESTE CASO ES:

    a) ABSCESO AXILAR.
    b) TUBERCULOMA.
    c) LIPOMA.
    d) INFECCIÓN.


    16.- ESTUDIO MAS SENSIBLE PARA REALIZAR EL DIAGNÓSTICO:

    a) REVISAR EL ESQUEMA DE VACUNACIÓN.
    b) TOMA DE BIOPSIA.
    c) APLICACIÓN DE PPD.
    d) BAAR POR SONDA OROGÁSTRICA.
    SUDDEN CARDIAC DEATH (SCD) IS DEFINED AS THE UNEXPECTED NATURAL DEATH FROM CARDIAC CAUSES WITHIN A SHORT TIME PERIOD IN A PERSON WITHOUT A CARDIAC CONDITION THAT WOULD APPEAR FATAL. SCD IS RESPONSIBLE FOR APPROXIMATELY 300,000 FATALITIES IN THE UNITED STATES ALONE. IT IS ESTIMATED THAT 50% OF ALL CARDIAC DEATHS ARE SUDDEN, AND THIS PROPORTION HAS REMAINED CONSTANT DESPITE THE OVERALL DECLINE IN CARDIOVASCULAR MORTALITY DURING THE LAST DECADES. IN APPROXIMATELY THREE FOURTHS OF CASES, SCD IS CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF), ALTHOUGH IN PATIENTS WHO HAVE UNDERLYING CONGESTIVE HEART FAILURE (CHF), A SIGNIFICANT PROPORTION OF SCD IS THE CONSEQUENCE OF BRADYCARDIC EVENTS OR ELECTROMECHANICAL DISSOCIATION. THIS ARTICLE SUMMARIZES THE CURRENT KNOWLEDGE ON RISK STRATIFICATION IN PATIENTS WHO HAVE STRUCTURAL HEART DISEASE, NOTABLY CORONARY ARTERY DISEASE AND NONISCHEMIC CARDIOMYOPATHY. ALTHOUGH OTHER TYPES OF STRUCTURAL HEART DISEASE AND INHERITED ION CHANNEL ABNORMALITIES ARE ALSO ASSOCIATED WITH A RISK OF SCD, THE RISK STRATIFICATION STRATEGIES AND DATA IN THESE ENTITIES ARE DIVERSE AND BEYOND THE SCOPE OF THIS ARTICLE. THE MAGNITUDE OF THE PROBLEM IN SPECIFIC SUBGROUPS OF PATIENTS PRONE TO SCD WAS ADDRESSED BY MYERBURG IN A REVIEW OF THE POPULATION IMPACT OF EMERGING IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR (ICD) TRIALS. THE HIGHEST INCIDENCE OF SCD OCCURRED IN SURVIVORS OF OUT-OF-HOSPITAL CARDIAC DEATH AND HIGH-RISK POST INFARCTION SUBGROUPS, BUT THE GREATEST ABSOLUTE NUMBER OF SCD EVENTS (POPULATION ATTRIBUTABLE RISK) OCCURRED IN LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS. THE CHALLENGE IS TO IDENTIFY RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK, WHICH APPLIES, FOR EXAMPLE, DIRECTLY TO SURVIVORS OF MYOCARDIAL INFARCTION, IN AN ERA WHEN THE PROGNOSIS HAS IMPROVED SUBSTANTIALLY IN COMPARISON WITH PRIOR SERIES ANTEDATING THE WIDESPREAD USE OF REPERFUSION THERAPY. AMONG PATIENTS SUFFERING FROM CARDIAC ARREST, MOST HAVE SOME FORM OF STRUCTURAL HEART DISEASE, WITH MOST PATIENTS SUFFERING FROM CORONARY ARTERY DISEASE, BUT ACUTE MYOCARDIAL INFARCTION IS SEEN IN LESS THAN HALF. IN A SERIES OF 151 HEARTS FROM MEN WHO DIED FROM SUDDEN CARDIAC DEATH, THE PRESENCE OF ACUTE THROMBUS/PLAQUE RUPTURE OR EROSION WAS NOTED IN 67% OF PATIENTS AGED 30 TO 39, BUT THIS PROPORTION DECLINED WITH AGE AND WAS PRESENT IN ONLY 31% OF PATIENTS AGES 60 TO 69.

    17.- IN MOST CASES SCD WAS

    a) CAUSED BY VENTRICULAR TACHYCARDIA (VT)
    b) CAUSED BY FIBRILLATION (VF)
    c) CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF)
    d) CAUSED BY BRADYARDIC EVENTS AND ELECTROMECHANICAL DISSOCIATION


    18.- THE RISK STRATIFICATION STRATEGIES AND DATA OF SCD

    a) ARE INCLUDED WITH DETAIL AND EXAMPLES IN THIS ARTICLE
    b) COMPARATIVE DETAILS AND EXAMPLES ARE INCLUDED IN THIS ARTICLE
    c) ONLY SCD RISK STRATEGIES ARE INCLUDED IN THIS ARTICLE
    d) SCD RISK STRATIFICATION STRATEGIES AND INFORMATION IS NOT THE OBJECTIVE OF THIS ARTICLE


    19.- THE GREATEST NUMBER OF SCD OCURRED IN

    a) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT HIGHER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    b) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER AND HIGHER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    c) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH RIGHT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS.
    d) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS


    20.- THE CHALLENGE IS TO IDENTIFY

    a) RISK FACTORS FOR SCD AMONG THE SMALL GROUP OF PATIENTS AT RELATIVELY LOW RISK
    b) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY HIGH RISK
    c) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK
    d) NON-RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK


    21.- THE HIGHEST RISK GROUP OF PATIENTS SUFFERING FROM CARDIAC ARREST WHO HAD SOME FORM OF STRUCTURAL HEART DISEASE AND CORONARY ARTERY DISEASE WERE

    a) YOUNGER MEN
    b) MIDDLE AGED MEN
    c) OLDER MEN
    d) OF ALL ADULT AGES

    MUJER 82 AÑOS. ATENDIDA EN URGENCIAS POR DOLOR EN EPIGASTRIO INTENSO QUE SE ACOMPAÑA DE NÁUSEA Y VÓMITO EN POZOS EN CAFÉ. HA TENIDO EVACUACIONES MELÉNICAS Y CON SANGRE FRESCA ASÍ COMO DISTENSIÓN ABDOMINAL . TIENE ANTECEDENTES DE ENFERMEDAD ARTICULAR DEGENERATIVA TRATADA CON AINES. E.F.: TA 80/40 MMHG, FC 120 LPM, RCR, CAMPOS PULMONARES CLAROS, ABDOMEN DOLOROSO A LA PALPACIÓN, CON REBOTE POSITIVO Y PERISTALSIS AUSENTE.

    22.- EL ESTUDIO INICIAL PARA CORROBORAR EL DIAGNÓSTICO ES:

    a) RX DE ABDOMEN DE PIE Y DECÚBITO.
    b) ENDOSCOPÍA.
    c) TAC DE ABDOMEN.
    d) COLONOSCOPÍA.


    23.- EL TRATAMIENTO DEFINITIVO EN ESTE PACIENTE ES:

    a) BLOQUEADORES DE BOMBA DE PROTONES.
    b) LAVADO GÁSTRICO.
    c) CIRUGÍA.
    d) SUSPENDER AINES.

    APPENDICITIS: SELECTIVE USE OF ABDOMINAL CT REDUCES NEGATIVE APPENDECTOMY RATE APPENDICITIS ACCOUNTS FOR OVER 3% OF THE DISEASES THAT INVOLVE THE DIGESTIVE SYSTEM, IS THE MOST COMMON ACUTE SURGICAL PROBLEM OF THE ABDOMEN, AND APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT. IT IS ALSO ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE ACCURATELY. RATES OF NEGATIVE APPENDECTOMY RANGE FROM 20% TO 44%. THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE, RANGING FROM 25% TO AS HIGH AS 52%. REPORTED PERFORATION RATES RANGE FROM 15% TO 37%. THESE RATES OF NEGATIVE APPENDECTOMY HAVE BEEN CONSIDERED ACCEPTABLE BECAUSE THE MORBIDITY ASSOCIATED WITH COMPLICATED APPENDICITIS IS SIGNIFICANTLY HIGHER THAN THAT OF NON-THERAPEUTIC APPENDECTOMY. NUMEROUS DIAGNOSTIC TOOLS HAVE BEEN IMPLEMENTED IN AN EFFORT TO REDUCE THE HIGH RATE OF NEGATIVE APPENDECTOMY WHILE AT THE SAME TIME NOT INCREASE THE PERFORATION RATE. SOME OF THESE TOOLS INCLUDE CLINICAL SCORING SYSTEMS, ULTRASOUND, COMPUTERIZED DECISION SUPPORT, VARIOUS LABORATORY TESTS, AND OTHER, NON-TRADITIONAL METHODS. THESE VARIOUS MODALITIES HAVE ALL YIELDED MIXED RESULTS AS TO THEIR USEFULNESS IN CLINICAL PRACTICE. STUDIES HAVE SHOWN THAT HELICAL COMPUTERIZED TOMOGRAPHY (CT) SCANNING OF THE ABDOMEN HAS BEEN SUCCESSFUL IN REDUCING NONTHERAPEUTIC APPENDECTOMY RATES TO AS LOW AS 3%. THESE RESULTS PROVIDE EVIDENCE THAT THERE MAY FINALLY BE A DIAGNOSTIC TOOL THAT CAN BE EFFECTIVE IN REDUCING RATES OF NONTHERAPEUTIC APPENDECTOMY WHILE NOT INCREASING THE MORBIDITY AND MORTALITY ASSOCIATED WITH APPENDICITIS.

    24.- WHAT IS RELATION OF APPENDICITIS WITH OTHER GASTROINTESTINAL TRACT DISEASES?

    a) IS ONE OF THE LESS COMMON SURGICAL PROCEDURES OF THE GASTROINTESTINAL TRACT.
    b) IT HAS NO RELATION WITH OTHER GASTROINTESTINAL TRACT DISEASES.
    c) IT HAS THE HIGHEST INDEX OF MORBILITY.
    d) IS THE FIFTH MOST COMMON SURGICAL PROCEDURE OF THE GASTROINTESTINAL TRACT.


    25.- WHY CAN APPENDICITIS END IN A COMPLICATED PERFORATION?

    a) BECAUSE IS THE MOST COMMON ACUTE SURGICAL PROBLEM OR THE ABDOMEN.
    b) BECAUSE IT IS ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE ACURATELY.
    c) BECAUSE APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT.
    d) BECAUSE OF THE LACK OF DIAGNOSTIC TOOLS.


    26.- WHAT ARE THE RATES OF NEGATIVE APPENDECTOMY?

    a) THESE RATES ARE EVEN LOWER IN WOMEN OF CHILDBEARING AGE.
    b) THESE RATES ARE NOT CONSIDERED ACCEPTABLE.
    c) THESE RATES ARE EVEN HIGHER IN WOMEN WHO ARE NOT IN CHILDBEARING AGE.
    d) THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE.


    27.- WHICH OF THE NEXT DIAGNOSTIC TOOLS HAS SUCCESFULLY REDUCED NONTHERAPEUTIC APPENDECTOMY?

    a) SCORING SYSTEMS.
    b) HELICAL COMPUTERIZED TOMOGRAPHY.
    c) ULTRASOUND.
    d) LABORATORY TESTS.


    28.- WHAT IS THE FINAL RESULT OF THIS STUDY?

    a) THE HELICAL COMPUTERIZED TOMOGRAPHY CAN PREVENT NONTHERAPEUTICAL APPENDECTOMY.
    b) THE RATES OF NONTHERAPEUTICAL APPENDECTOMY HAVE INCREASED.
    c) APPENDICITIS IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT.
    d) NUMEROUS DIAGNOSTIC TOOL HAVE BEEN IMPLEMENTED IN AN EFFORT TO REDUCE THE RISK OF NONTHERAPEUTICAL APPENDECTOMY.

    MUJER DE 23 AÑOS. ASISTE A URGENCIAS POR PRESENTAR SALIDA DE LÍQUIDO TRANSVAGINAL DE INICIO SÚBITO POSTERIOR A UNA RELACIÓN SEXUAL. ACTUALMENTE CURSA SU PRIMER EMBARAZO Y ESTÁ EN LA SEMANA 39 DE GESTACIÓN. E.F.: PRODUCTO LONGITUDINAL CEFÁLICO DORSO IZQUIERDA. FCF EN 140 LPM. GENITALES HÚMEDOS. SE VISUALIZA CÉRVIX CERRADO FORMADO Y POSTERIOR. NO HAY LÍQUIDO EN FONDO DE SACO.

    29.- EL MÉTODO MÁS SENSIBLE Y ESPECÍFICO PARA ESTABLER EL DIAGNÓSTICO EN ESTA PACIENTE ES:

    a) CRISTALOGRAFÍA .
    b) INYECCIÓN DE PIGMENTO POR AMNIOCENTESIS Y OBSERVACIÓN DE FUGA HACIA CANAL VAGINAL.
    c) PRUEBA DE NITRAZINA.
    d) PH VAGINAL.
    MUJER DE 25 AÑOS. ES ATENDIDA EN CONSULTA PARA CONTROL PRENATAL. 13 SEMANAS DE GESTACIÓN POR FUR. ULTRASONIDO TRANSABDOMINAL SE OBSERVA LA PRESENCIA DE DOS FETOS DENTRO DE UN SACO GESTACIONAL. SE APRECIA UNA MEMBRANA DIVISORIA DELGADA QUE AL UNIRSE A LA PLACENTA FORMA UNA IMAGEN EN “T”.

    30.- LA CAUSA MÁS PROBABLE DE ESTE HALLAZGO ES:

    a) SEPARACIÓN ANTES DE LA DIFERENCIACIÓN DEL TROFOBLASTO (ANTES DÍA 3).
    b) SEPARACIÓN DESPUÉS DE LA DIFERENCIACIÓN DEL TROFOBLASTO PERO ANTES DE LA FORMACIÓN DEL AMNIOS (DIA 3 – .
    c) SEPARACIÓN DE TROFOBLASTO Y DIVISIÓN POSTERIOR A LA FORMACIÓN DEL AMNIOS (DIA 8-13) .
    d) SEPARACION POSTERIOR A LA FORMACIÓN DEL AMNIOS (DÍAS 10 A 15).

    A 71-YEAR-OLD MAN PRESENTED WITH A 2-WEEK HISTORY OF PAIN AND SWELLING OF HIS LEFT ARM. EXAMINATION REVEALED A CRAGGY, MOBILE MASS WITH IRREGULAR BORDERS IN THE EXTENSOR COMPARTMENT OF THE LEFT ARM MEASURING 6 × 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM DEMONSTRATED THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE LEFT TRICEPS MUSCLE, MEASURING 5 × 3 CM. THIS LED TO FURTHER RADIOLOGIC EVALUATION IN THE FORM OF MRI OF THE LEFT ARM. MRI SHOWED INTERMEDIATE SIGNAL MASS IN THE TRICEPS MUSCULATURE ON T1-WEIGHTED IMAGES WITH FAT SATURATION. THIS LESION IS CONFINED TO THE EXTENSOR COMPARTMENT OF THE ARM. A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS MADE. AN INCISIONAL BIOPSY WAS PERFORMED. THIS WAS FOUND TO BE CONSISTENT WITH METASTATIC SQUAMOUS CELL CARCINOMA WITH A POSSIBLE LUNG PRIMARY, FURTHER SUPPORTED DUE TO A POSITIVE CK7 AND NEGATIVE CK20 STAIN ON IMMUNOHISTOCHEMISTRY. CT SCAN OF THE CHEST REVEALED A LESION MEASURING 4 × 2 CM IN THE LEFT UPPER LOBE. FIBER-OPTIC BRONCHOSCOPY AND BIOPSY CONFIRMED THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL CARCINOMA OF THE LUNG. HE UNDERWENT PALLIATIVE RADIOTHERAPY TO THE MASS IN THE ARM, 20 GY IN 4 FRACTIONS. THIS PROVIDED GOOD RELIEF FROM PAIN AND SWELLING WITHIN 2 WEEKS OF COMPLETING TREATMENT. SYSTEMIC THERAPY WAS NOT OFFERED ON THE BASIS OF POOR AND DETERIORATING PERFORMANCE STATUS. UNFORTUNATELY, THE PATIENT DIED WITHIN 10 WEEKS OF PRESENTATION. INTRAMUSCULAR METASTASES IN CANCER PATIENTS ARE RARE. THIS IN ITSELF IS QUITE PECULIAR BECAUSE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF TOTAL BODY WEIGHT. IT IS THOUGHT THAT MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES CONTRIBUTE TO THE RARE OCCURRENCE OF THIS PHENOMENON. THE TRUE INCIDENCE OF MUSCULAR METASTASIS REMAINS UNKNOWN, BUT AN AUTOPSY SERIES SUGGESTS THAT ITS INCIDENCE COULD BE AS LOW AS 0.8%. LUNG CARCINOMA SEEMS TO BE THE UNDERLYING PRIMARY CANCER IN MOST OF THESE CASES. MANY OTHER TUMORS, SUCH AS KIDNEY, STOMACH, PANCREAS, THYROID GLAND, BREAST, OVARY, PROSTATE, AND BLADDER CANCERS HAVE ALSO BEEN SPORADICALLY DESCRIBED IN ASSOCIATION WITH INTRAMUSCULAR SECONDARIES. HOWEVER, PRIMARY PRESENTATION OF AN INTRAMUSCULAR METASTASIS, SUCH AS DEMONSTRATED BY OUR PATIENT, REMAINS AN EXCEPTIONALLY UNUSUAL OCCURRENCE. THE MOST FREQUENT PRESENTATION OF MUSCULAR METASTASIS IS PAIN WITH OR WITHOUT SWELLING. DIAGNOSIS, EVEN WITH RADIOLOGIC IMAGING IS OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT TISSUE TUMORS.

    31.- WHY WAS THE RADIOLOGIC EVALUATION DONE?

    a) BECAUSE OF THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE RIGHT TRICEPS MUSCLE.
    b) BECAUSE OF THE RESULTS OF THE ULTRASONOGRAPHY
    c) BECAUSE DIAGNOSIS WITH RADIOLOGIC IMAGING IS OFTEN TRICKY.
    d) BECAUSE OF THE CLINICAL HISTORY OF THE PATIENT.


    32.- WHY ARE THE INTRAMUSCULAR METASTASES IN CANCER PATIENTS RARE?

    a) BECAUSE THE AMOUNT OF THE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF THE TOTAL BODY WEIGHT.
    b) DUE TO THE MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND ACCUMULATION OF LACTIC ACID AND OTHER METASTASIS.
    c) BECAUSE THE PATIENTS DIE WITHIN 10 WEEKS OF PRESENTATION
    d) BECAUSE PATIENTS LEAD AN ACTIVE LIFE


    33.- WHAT KIND OF CANCER DID THE 71-YEAR-OLD PATIENT HAVE?

    a) LUNG CARCINOMA.
    b) KIDNEY CANCER
    c) PROSTATE CANCER
    d) BREAST CANCER


    34.- HOW WAS THE PATIENT’S CANCER CONFIRMED?

    a) THROUGH THE MRI.
    b) WITH IMMUNOHISTOCHEMISTRY
    c) THROUGH FIBER-OPTIC BRONCHOSCOPY AND BIOPSY
    d) THROUGH OBSERVATION OF THE SWELLING AND THE PAIN PRESENTED BY THE PATIENT


    35.- WHY WASN’T SYSTEMATIC THERAPY OFFERED?

    a) BECAUSE THE PATIENT WAS TOO OLD TO RESIST THE THERAPY
    b) BECAUSE THE PALLIATIVE RADIOTHERAPY PROVIDED GOOD RELIEF FROM PAIN AND SWELLING.
    c) BECAUSE THE PATIENT SHOWED VERY LITTLE IMPROVEMENT.
    d) THE PATIENT DIED 10 WEEKS AFTER THE FIRST PRESENTATION.
    NIÑO DE 5 AÑOS. ES ATENDIDO EN LA CONSULTA POR PRESENTAR MORETONES EN PIERNAS SIN ANTECEDENTE DE TRAUMATISMO. ANTECEDENTES: HACE 2 MESES CON HIPOREXIA, BAJA DE PESO, SANO PREVIAMENTE. E.F.: TA 110/65 MM HG, FC 120 LPM, FR 28 RPM. PÁLIDO ++, HIPOACTIVO. SE PALPA HÍGADO A DOS CENTÍMETROS POR ABAJO DEL BORDE COSTAL. LABORATORIO: HB 9G/DL, LEUCOCITOS 25, 000 PREDOMINO DE LINFOCITOS 50%, PLAQUETAS 100,000.

    36.- EL DIAGNÓSTICO MAS PROBABLE CON ESTE PACIENTE ES:

    a) ANEMIA APLÁSICA.
    b) HISTIOCITOSIS X.
    c) LEUCEMIA LINFOBLÁSTICA.
    d) PÚRPURA TROMBÓTICA.


    37.- EL SIGUIENTE PASO EN LA ATENCIÓN DE ESTE PACIENTE QUE DEBE REALIZAR USTED ES:

    a) INICIAR ESQUEMA DE QUIMIOTERAPIA.
    b) TRANSFUNDIRLE PAQUETE GLOBULAR.
    c) DERIVAR AL HEMATÓLOGO.
    d) ANÁLISIS MÉDULA ÓSEA.
    ENDOMETRIAL CANCER IN THE UNITED STATES ENDOMETRIAL CANCER REFERS TO SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS. ENDOMETRIAL CANCERS ARE THE MOST COMMON GYNECOLOGIC CANCERS IN THE UNITED STATES, WITH OVER 35,000 WOMEN DIAGNOSED EACH YEAR IN THE U.S. THE MOST COMMON SUBTYPE, ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN A FEW DECADES OF MENOPAUSE, IS ASSOCIATED WITH EXCESSIVE ESTROGEN EXPOSURE, OFTEN DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA, AND PRESENTS MOST OFTEN WITH VAGINAL BLEEDING. ENDOMETRIAL CARCINOMA IS THE THIRD MOST COMMON CAUSE OF GYNECOLOGIC CANCER DEATH (BEHIND OVARIAN AND CERVICAL CANCER CLINICAL EVALUATION: ROUTINE SCREENING OF ASYMPTOMATIC WOMEN IS NOT INDICATED, SINCE THE DISEASE IS HIGHLY CURABLE IN ITS EARLY STAGES. RESULTS FROM A PELVIC EXAMINATION ARE FREQUENTLY NORMAL, ESPECIALLY IN THE EARLY STAGES OF DISEASE. CHANGES IN THE SIZE, SHAPE OR CONSISTENCY OF THE UTERUS AND/OR ITS SURROUNDING, SUPPORTING STRUCTURES MAY EXIST WHEN THE DISEASE IS MORE ADVANCED. •A PAP SMEAR MAY BE EITHER NORMAL OR SHOW ABNORMAL CELLULAR CHANGES. •ENDOMETRIAL CURETTAGE IS THE TRADITIONAL DIAGNOSTIC METHOD. BOTH ENDOMETRIAL AND ENDOCERVICAL MATERIAL SHOULD BE SAMPLED. •IF ENDOMETRIAL CURETTAGE DOES NOT YIELD SUFFICIENT DIAGNOSTIC MATERIAL, A DILATION AND CURETTAGE (D&C) IS NECESSARY FOR DIAGNOSING THE CANCER. •HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE CAVITY AND CAN BE USED TO DETECT THE PRESENCE OF LESIONS OR TUMOURS. IT ALSO PERMITS THE DOCTOR TO OBTAIN CELL SAMPLES WITH MINIMAL DAMAGE TO THE ENDOMETRIAL LINING (UNLIKE BLIND D&C). •ENDOMETRIAL BIOPSY OR ASPIRATION MAY ASSIST THE DIAGNOSIS. •TRANSVAGINAL ULTRASOUND TO EVALUATE THE ENDOMETRIAL THICKNESS IN WOMEN WITH POSTMENOPAUSAL BLEEDING IS INCREASINGLY BEING USED TO EVALUATE FOR ENDOMETRIAL CANCER. •RECENTLY, A NEW METHOD OF TESTING HAS BEEN INTRODUCED CALLED THE TRUTEST, OFFERED THROUGH GYNECOR. IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS. THIS METHOD IS LESS PAINFUL THAN A PIPELLE BIOPSY AND HAS A LARGER LIKELIHOOD OF PROCURING ENOUGH TISSUE FOR TESTING. SINCE IT IS SIMPLER AND LESS INVASIVE, THE TRUTEST CAN BE PERFORMED AS OFTEN, AND AT THE SAME TIME AS, A ROUTINE PAP SMEAR, THUS ALLOWING FOR EARLY DETECTION AND TREATMENT. •ONGOING RESEARCH SUGGESTS THAT SERUM P53 ANTIBODY MAY HOLD VALUE IN IDENTIFYING HIGH-RISK ENDOMETRIAL CANCER.[4]

    38.- ENDOMETRIAL CANCER REFERS TO:

    a) SPECIFIC TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.
    b) SEVERAL TYPES OF MALIGNANCY WHICH NEVER ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.
    c) ALL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM.
    d) SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR LINING OF THE UTERUS.


    39.- ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN:

    a) EXCESSIVE ESTROGEN.
    b) A LOT OF DECADES OF MENOPAUSE.
    c) ALWAYS PRESENTS VAGINAL BLEEDING.
    d) ALWAYS DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA.


    40.- RESULTS FROM A PELVIC EXAMINATION ARE:

    a) ALWAYS CHANGES IN THE SIZE AND NEVER IN SHAPE
    b) SOMETIMES NORMAL, ESPECIALLY IN THE EARLY STAGES OF THE DISEASE.
    c) CHANGES IN THE SIZE, SOMETIMES THE SHAPE BUT NEVER THE CONSISTENCY OF THE UTERUS
    d) CHANGES IN THE SIZE, SHAPE BUT NEVER IN THE CONSISTENCY OF THE UTERUS


    41.- CLINICAL METHOD FOR EVALUATION:

    a) A PAP IS THE BEST OPTION YOU CAN USE.
    b) ENDOMETRIAL CURETTAGE IS NOT THE TRADITIONAL DIAGNOSTIC METHOD.
    c) HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE CAVITY.
    d) ENDOMETRIAL BIOPSY OR ASPIRATION ALWAYS ASSIST IN THE DIAGNOSIS.


    42.- HOW IS THE DEVELOPEMENT OF THIS NEW METHOD?

    a) IT USES THE HUGE FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.
    b) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE UTERUS.
    c) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.
    d) IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE UTERUS.

    MUJER DE 25 AÑOS. TRABAJA EN UN ASILO DE ANCIANOS. ES ATENDIDA EN URGENCIAS POR PRESENTAR DESDE HACE 24 HORAS, MALESTAR GENERAL, CEFALEA INTENSA, VÓMITO, DIARREA, MIALGIAS Y FIEBRE. G:2 , C:1. CURSA CON EMBARZO DE 22 SEMANAS. E.F.: PESO 63 KGS. TEMP. 38.3° C . FCF: 128 LPM.

    43.- LO MÁS PROBABLE ES QUE EL AGENTE CAUSAL SEA:

    a) ROTAVIRUS.
    b) ADENOVIRUS INTESTINAL.
    c) ASTROVIRUS.
    d) NOROVIRUS.
    MUJER DE 33 AÑOS. EMBARAZADA, INGRESA A URGENCIAS CON ACTIVIDAD UTERINA. REFIERE HABER INICIADO CON CEFALEA HACE 4 HORAS Y ACTIVIDAD UTERINA REGULAR. G: 4, P:3. CURSA CON EMBARZO DE 35.4 SEMANAS, TOMA HIDRALAZINA Y ALFAMETILDOPA E.F.: PESO 74 KGS. TA 140/90 MM/HG. FU: 32 CMS. PRODUCTO CEFÁLICO CON FCF: 128 LPM. TACTO VAGINAL: CERVIX, SEMIBORRADO SIN DILATACIÓN.

    44.- PARA CORROBORAR EL DIAGNÓSTICO SE DEBE DE REALIZAR :

    a) PRUEBAS DE FUNCION HEPÁTICA.
    b) DEPURACIÓN DE CREATININA.
    c) DETERMINACIÓN DE ÁCIDO ÚRICO.
    d) PROTEÍNAS EN ORINA.
    HOMBRE DE 89 AÑOS. LLEVADO A URGENCIAS POR UN VECINO YA QUE PRESENTA DESDE HACE UNA SEMANA TOS CON EXPECTORACIÓN VERDE-AMARILLENTA. HA PRESENTADO ALTERACIONES EN EL ESTADO DE CONCIENCIA, FIEBRE, ASTENIA, ADINAMIA E HIPOREXIA Y OLIGURIA DE 5 DIAS DE EVOLUCIÓN. E.F.: PESO 45KG, TEMP 39 º C, FC 110 LPM, MUCOSAS ORALES DESHIDRATADAS, RCR DE BAJA INTENSIDAD, CAMPOS PULMONARES CON ESTERTORES CREPITANTES DISEMINADOS. GIORDANO DUDOSO BILATERAL, EXTREMIDADES INFERIORES Y SUPERIORES HIPOTRÓFICAS Y ESCARA EN REGIÓN SACRA.

    45.- EL PRINCIPAL PROBLEMA DE ESTE PACIENTE ES:

    a) ISQUEMIA CEREBRAL TRANSITORIA.
    b) DEMENCIA SENIL.
    c) INFECCIÓN DE VIAS URINARIAS.
    d) SÍNDROME DE ABANDONO.


    46.- EL MANEJO MÉDICO INICIAL EN ESTE PACIENTE ES:

    a) HOSPITALIZACIÓN, HIDRATACIÓN Y PENICILINA BENZATÍNICA Y DESINFLAMATORIOS.
    b) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS RESPIRATORIAS.
    c) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS URINARIAS.
    d) HOSPITALIZACIÓN Y OBSERVACIÓN.

    RECIÉN NACIDO DE TÉRMINO. ES ATENDIDO EN LA CONSULTA A LOS 3 DÍAS POR NOTAR LA MADRE ENROJECIMIENTO INTENSO DE SU OMBLIGO Y LLANTO CONSTANTE. ANTECEDENTES: NACIDO CON PARTERA. E.F.: TA 94/52 MM HG, FC 160 LPM, FR 50 POR MINUTO, TEMPERATURA DE 39°C. DECAÍDO, RECHAZA EL PECHO, LLENADO CAPILAR DE 4 SEGUNDOS.

    47.- EL DIAGNÓSTICO MAS PROBABLE EN ESTE CASO ES:

    a) ONFALITIS.
    b) PERITONITIS.
    c) SEPSIS.
    d) ERITEMA DEL NEONATO.


    48.- LOS MICROORGANISMOS MAS COMUNES EN ESTOS CASOS SON:

    a) ANAEROBIOS.
    b) GRAM POSITIVOS.
    c) GRAM NEGATIVOS.
    d) VIRUS.
    RECIÉN NACIDO DE 40 SEMANAS DE GESTACIÓN. APGAR DE 3 AL MINUTO. ANTECEDENTES: MADRE SIN CONTROL PRENATAL, OBRERA, GESTA 8, LLEGÓ A URGENCIAS POR NO SENTIR MOVIMIENTOS DEL BEBÉ. E.F.: TA 50/20 MM HG, FC < 100 LPM, FR 10 RPM, TEMPERATURA 37.5°C. LLENADO CAPILAR > 4 SEG.

    49.- EL MANEJO INMEDIATO PARA ESTE PACIENTE ES:

    a) HABLARLE AL PEDIATRA E INICIAR MANIOBRAS.
    b) ADMINISTRAR ADRENALINA E INICIAR MANIOBRAS.
    c) ADMINISTRAR ATROPINA E INICIAR MANIOBRAS.
    d) VENTILACIÓN Y COMPRESIÓN CARDIACA
    h
  3. 1
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    #3

    ??

    donde encuentro las respuestas???
  4. 2
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    #4
    Gracias.
  5. 1
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    recibidos
    #5
    donde encuentro las respuestas???
  6. 3
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    #6
    Holaa. oye mil gracias. ojalà pudieras proporcionarme mas material como este porque viene si no es que igualisisimo que el enarm y serviria de ayuda de manera impresionante. mi mail es canterville81@yahoo.com.mx. saludos.
  7. 4
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    #7
    Esta exelente. pero alguien save la respuesta del la pregunta de RPM?
    cual es la prueba mas especifica
  8. 1
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    #8
    donde encuentro las respuestas???

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