ROSIGLIATAZONE EVALUATED FOR CARDIOVSCULAR OUTCOMES IN ORAL AGENT COMBINATION THERAPY FOR TYPE 2 DIABETES (RECORD): A
MULTICENTRE, RANDOMISED, OPEN –LABEL TRIAL. PHILIP D HOME DM, STUART J POCOCK PHD. AND COLLEAGUES. ROSIGLITAZONE IS AN INSULIN SENSITISER USED IN COMBINATION WITH MEFORMIN, A SULFONYLUREA, OR BOTH, FOR LOWERING BLOOD GLUCOSE IN PEOPLE WITH TYPE 2
DIABETES. WE ASSESSED CARDIOVASCULAR OUTCOMES AFTER ADDITION OF ROSIGLITAZONE TO EITHER METFORMIN OR SULFONYLUREA
COMPARED WITH THE COMBINATION OF THE OVER 5-7 YEARS OF FOLLOW UP. WE ALSO ASSESSED COMPARATIVE SAFETY METHODS. IN A
MULTICENTRE, OPEN-LABEL TRIAL, 4447 PATIENTS WITH TYPE 2 DIABETES ON METFORMIN OR SULFONYLUREA MONOTHERAPY WITH MEAN
HAEMOGLOBIN A1C (HB A1C) OF 7-9% WERE RANDOMLY ASSIGNED TO ADDITION OF ROSIGLITAZONE (N=2220) OR TO A COMBINATION OF
METFORMIN AND SULFONYLUREA (ACTIVE CONTROL GROUP, N=2227). THE PRIMARY ENDPOINT WAS CARDIOVASCULAR HOSPITALISATION OR
CARDIOVASCULAR DEATH, WITH A HAZARD RATIO (HR) NON INFERIORITY MARGIN OF 1.20. ANALYSIS WAS BY INTENTION TO TREAT. THIS STUDY IS REGISTERED WITH GOVERNMENT CLINICAL TRIALS NUMBER NCT00379769. FINDINGS. 321 PEOPLE IN THE ROSIGLITAZONE GROUP AND 323 IN THE ACTIVE CONTROL GROUP EXPERIENCED THE PRIMARY OUTCOME DURING A MEAN 5-5 YEAR FOLLOW UP, MEETING THE CRITERION ON
NON-INFERIORITY (HR 0.99, 95% CL 0.85-1.16). HR WAS 0-84 (0-59) FOR
CARDOVASCULAR DEATH, 1-14 (0.80 – 1.63) FOR MYOCARDIAL INFARCTION, AND 0.72 (0.49-1.06) FOR STROKE. HEART FAILURE CAUSING ADMISSION TO HOSPITAL OR DEATH OCCURRED IN 61 PEOPLE IN THE ROSIGLITAZONE GROUP AND 29 IN THE ACTIVE CONTROL GROUP (HR2.10, 1.35 – 3.27, RISK DIFFERENCE PER 1000 PERSON-YEARS 2.6, 1.1-4.1). UPPER AND DISTAL LOWER LIMB FRACTURE RATES WERE INCREASED MAINLY IN WOMEN RANDOMLY ASSIGNED TO RSIGLITAZONE. MEAN HBA1C WAS LOWER IN THE ROSIGLITAZONE GROUP THAN IN THE CONTROL GROUP AT 5 YEARS. INTERPRETATION. ADDITION ROSIGLITAZONE TO GLUCOSE LOWERING THERAPY IN PEOPLE WITH TYPE 2 DIABETES IS CONFIRMED TO INCREASE THE RISK OF HEART FAILURE AND OF SOME FRACTURES, MAINLY IN
WOMEN. ALTHOUGH THE DATA ARE INCONCLUSIVE ABOUT ANY POSSIBLE EFFECT ON MYOCARDIAL INFARCTION, ROSIGLITAZONE DOES NOT
INCREASE THE RISK OF OVERALL CARDIVASCULAR MORBIDITY OR
MORTALITY COMPARED WITH STANDARD GLUCOSE –LOWERING DRUGS.
PREGUNTA 1
WHAT WAS THE MAIN PURPOSE OF THE STUDY?
B TO DETERMINE THE INCIDENCE OF HOSPITALIZATION IN PATIENTS TAKING ROSIGLITAZONE. C TO DISCOVER THE EFFECTS THAT ROSIGLITAZONE HAS ON HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES. D TO GET GOVERNMENT APPROVAL FOR ROSIGLITAZONE.
PREGUNTA 2
ROSIGLITAZONE IS AN INSULIN SENSITISER USED TO:
A LOWER INSULINE IN PEOPLE WITH TYPE 2 DIABETES
B LOWER BLOOD GLUCOSE IN PEOPLE WITH TYPE 2 DIABETES. C INCREASE BLOOD GLUCOSE IN PEOPLE WITH TYPE 2 DIABETES. D DIMINISH INSULINE IN PEOPLE WITH TYPE 1 DIABETES.
PREGUNTA 3
WHAT DID THE TWO GROUPS HAVE IN COMMON?
A PARTICIPANTS WERE GIVEN SULFONYLUREA. B PARTICIPANTS WERE GIVEN ROSIGLITAZONE.
C PARTICIPANTS HAD NEARLY SIMILAR LEVELS OF HBA1C. D PARTICIPANTS WERE ALL FROM THE SAME CENTRE.
PREGUNTA 4
WHAT DOES THE AUTHOR CONCLUDE REGARDING THE SAFETY OF ROSIGLITAZONE IN GLUCOSE-LOWERING THERAPY FOR PATIENTS WITH TYPE-2 DIABETES?
A THE PERCENTAGE OF PATIENTS RESULTING IN HEART FAILURE WAS VERY HIGH FOR BOTH GROUPS. B ROSIGLITAZONE, IN GENERAL, CAUSES HEART FAILURE.
D ROSIGLATAZONE SHOULD BE USED ONLY FOR MALE PATIENTS.
PREGUNTA 5
ADDITION ROSIGLITAZONE TO GLUCOSE LOWERING THERAPY IN PEOPLE WITH TYPE 2 DIABETES IS CONFIRMED TO:
A INCREASE THE RISK OF HEART FAILURE AND OF SOME FRACTURES, MAINLY IN MEN. B INCREASE THE RISK OF HEART FAILURE AND OF SOME FRACTURES, MAINLY IN WOMEN. C THE DATA ARE CONCLUSIVE ABOUT ANY POSSIBLE EFFECT ON MYOCARDIAL INFARCTION, D ROSIGLITAZONE INCREASES THE RISK OF OVERALL CARDIVASCULAR MORBIDITY.
PIGMENTARY DISORDERS IN LATIN AMERICA FALABELLA, RAFAEL
DERMATOLOGIC CLINICS - VOLUME 25, ISSUE 3 W. B. SAUNDERS COMPANY JULY 2007 PITYRIASIS ALBA (PA) IS A COMMON DISORDER OBSERVED IN LATIN AMERICAN PATIENTS. LESIONS DISCLOSE HYPOPIGMENTATION, MAINLY OBSERVED ON FACIAL AREAS AND SUNLIGHT EXPOSED SURFACE OF ARMS AND FOREARMS; THOSE ON THE TRUNK AND LOWER
EXTREMITIES ARE LESS COMMON. AN ATOPIC DIATHESIS IS PRESENT IN MOST PATIENTS, AND THE CONDITION FREQUENTLY DEVELOPS IN CHILDREN AND YOUNG ADULTS. THE AVERAGE LESION BEGINS WITH A SLIGHTLY HYPOPIGMENTED MACULE THAT ENLARGES GRADUALLY FROM 1 CM TO 3 CM AND MAY COALESCE WITH NEIGHBORING MACULES,
RESULTING IN LARGER HYPOPIGMENTED DEFECTS. A FINE DESQUAMATION AND DRYNESS OF SKIN ARE CHARACTERISTIC AND THE CLINICAL PICTURE USUALLY WORSENS DURING SUMMER OR DURING FREQUENT
WATERSPORT ACTIVITIES. A FOLLICULAR VARIETY WITH MILD
HYPERKERATOSIS AT THE HAIR FOLLICLE OSTIUM FREQUENTLY OCCURS. ON HISTOLOGIC EXAMINATION, EPIDERMAL AND FOLLICULAR SPONGIOSIS, FOCAL PARAKERATOSIS, SLIGHT ACANTHOSIS, AND MILD SUPERFICIAL PERIVASCULAR INFILTRATES ARE SEEN. IN A STUDY, ULTRASTRUCTURAL EXAMINATION DISCLOSED SMALL AND REDUCED NUMBERS OF
MELANOCYTES AND MELANOSOMES. ALTHOUGH PA IMPROVES
SPONTANEOUSLY AFTER PUBERTY, LOW POTENCY CORTICOSTEROIDS, SUCH AS 1% HYDROCORTISONE OR 0.5% DESONIDE, FREQUENT EMOLLIENT APPLICATION, AND SUNLIGHT AVOIDANCE/PROTECTION ARE USEFUL TO CONTROL THIS DISORDER. SKIN CONTACT WITH DIVERSE CHEMICALS MAY INDUCE ACQUIRED HYPOPIGMENTATION, WHICH MAY OCCUR EITHER DURING PROFESSIONAL ACTIVITIES OR AS AN INCIDENTAL EVENT. AREAS OF CONTACT, SUCH AS HANDS AND FEET, MAY BECOME AFFECTED WITH
OR WITHOUT INITIAL DERMATITIS, AND THEREAFTER HYPOPIGMENTATION OCCURS. SOME OF THE INVOLVED CHEMICALS ARE CATECHOL AND
BENZENE DERIVATIVES USED AS ANTISEPTICS AND CLEANSERS,
PESTICIDES, AND EPOXY RESINS COMMONLY USED IN HOUSEHOLD WORK. MACULAR LESIONS SHOW DIFFERENT GRADES OF HYPOPIGMENTATION OR TRUE DEPIGMENTATION INDISTINGUISHABLE FROM VITILIGO; A PREVIOUS HISTORY OF SUBSTANCE CONTACT AND DERMATITIS ARE IN FAVOR OF THE CHEMICAL NATURE OF DEPIGMENTATION . ON HISTOLOGIC
EXAMINATION, JUST A FEW MELANOCYTES ARE PRESENT AND REDUCED OR ABSENT MELANIN IS OBSERVED. TREATMENT OF DEPIGMENTATION IS DIFFICULT, BECAUSE MOST OF THE TIME ACRAL AREAS ARE INVOLVED AND MELANOCYTES IN AFFECTED AREAS ARE SCARCE. IF VITILIGO-LIKE DEPIGMENTATION BECOMES REFRACTORY TO MEDICAL THERAPY,
MELANOCYTE GRAFTING MAY BE AN IMPORTANT THERAPEUTIC SOLUTION.
PREGUNTA 6
PITYRIASIS ALBA IS A COMMON DISORDER FREQUENTLY OBSERVED IN:
A ARMS AND LEGS
B FACE, ARMS AND FOREARMS C TRUNK AND LOWER EXTREMITIES. D FACE, ARMS AND LEGS
PREGUNTA 7
THE AVERAGE LESION BEGINS WITH A SLIGHTLY HYPOPIGMENTED SPOT THAT: A GROWS FROM 1 TO 3 CM. B REDUCES FROM 1 TO 3 CM C ENLARGES TO 5 CM. INDEPENDENTLY D CHANGES COLOR PREGUNTA 8
A USE ANON FREQUENT EMOLLIENT APPLICATION B USE HIGH POTENCY CORTICOSTEROIDS
C KEEP AWAY FROM THE SUN.
D LACK THE PROTECTION OF THE SUN
PREGUNTA 9
HYPOPIGMENTATION OCCURS WHEN:
A SKIN HAS CONTACT WITH DIVERSE CHEMICALS B WE HAVE INCIDENTAL ACTIVITIES
C WE TAKE CORTISONE. D WE USE SUN PROTECTION.
PREGUNTA 10
PITYRIASIS ALBA IS DANGEROUS BECAUSE:
A PATIENTS BECOME INTOLERANT TO LIGHT. B SOME OF THE TREATMENTS ARE TOXIC. C PRE-CANCEROUS LESIONS CAN FORM.
D DELICATE SURGERY IS SOMETIMES REQUIRED.
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN ZORC, JOSEPH J. CLINICAL PEDIATRIC EMERGENCY MEDICINE EL SERVIER
DOI.10.1016.CPEM.209.03.008 MARCH 2009. UPPER RESPIRATORY TRACT INFECTIONS (INCLUDING OTITIS MEDIA) ARE THE MOST COMMON
ILLNESSES AFFECTING CHILDREN. ON AVERAGE, CHILDREN EXPERIENCE AROUND SIX TO EIGHT UPPER RESPIRATORY TRACT INFECTIONS (URTIS) EACH YEAR. ALTHOUGH THESE INFECTIONS USUALLY ARE MILD AND SELF LIMITING, THEY OCCASIONALLY LEAD TO COMPLICATIONS THAT CAN BE LIFE THREATENING. MOST URTIS CAN BE PLACED WITHIN THREE MAIN CATEGORIES OF INFECTION: RHINOSINUSITIS, PHARYNGITIS, AND OTITIS MEDIA. WITHIN EACH CATEGORY OF ILLNESS THERE IS A RANGE OF RELATED CONDITIONS THAT MAY HAVE SIMILAR OR OVERLAPPING CLINICAL PRESENTATIONS. SOME JUDGMENT IS REQUIRED IN
DETERMINING WHICH PART OF THE RESPIRATORY MUCOSA IS MOST AFFECTED. IN THIS ARTICLE, THE TERM ―RHINOSINUSITIS‖ IS USED TO DESCRIBE ILLNESSES WITH PREDOMINANTLY NASAL SYMPTOMS
(INCLUDING THE COMMON COLD, NASOPHARYNGITIS, AND SINUSITIS). THE TERM ―PHARYNGITIS‖ IS USED TO DESCRIBE ILLNESSES WHEN SORE
THROAT IS MOST PROMINENT (INCLUDING TONSILLITIS). THE TERM ―OTITIS MEDIA‖ IS USED TO DESCRIBE ILLNESSES WITH PREDOMINANTLY MIDDLE EAR SYMPTOMS (INCLUDING ACUTE OTITIS MEDIA [AOM], OTITIS MEDIA WITH EFFUSION [OME], AND CHRONIC SUPPURATIVE OTITIS MEDIA
[CSOM]). CHILDREN WHO HAVE COUGH AS THE PREDOMINANT SYMPTOM ARE CONSIDERED TO HAVE BRONCHITIS (A LOWER RESPIRATORY TRACT INFECTION). TO MAKE MATTERS MORE COMPLICATED, ALL AREAS OF THE RESPIRATORY MUCOSA MAY BE AFFECTED, SIMULTANEOUSLY OR AT DIFFERENT TIMES, DURING ONE ILLNESS. THE CAUSE OF THESE
RESPIRATORY MUCOSAL INFECTIONS MOST COMMONLY IS VIRAL BUT CAN BE BACTERIAL AND MANY INFECTIONS INVOLVE BOTH VIRUSES AND
BACTERIA. IN DEVELOPED COUNTRIES, BOTH VIRAL AND BACTERIAL INFECTIONS ARE LIKELY TO BE SELF LIMITED. PERSISTENT DISEASE IS MOST LIKELY TO INDICATE A BACTERIAL INFECTION.
PREGUNTA 11
WHY ARE UPPER RESPIRATORY TRACT INFECTIONS SO DIFFICULT TO DIAGNOSE IN CHILDREN?
A THEY GET MANY OF THEM.
B THE SYMPTOMS OF DIFFERENT URTIS OVERLAP. C THERE ARE DIFFERENT KINDS OF URTIS.
D VIRAL AND BACTERIAL INFECTIONS EXIST.
PREGUNTA 12
AN EXAMPLE OF A LOWER RESPIRATORY INFECTION IS:
A NASOPHARYNGITIS. B BRONCHITIS.
C SINUSITIS. D TONSILLITIS.
PREGUNTA 13
THE CAUSE OF THE ILLNESS IN RESPIRATORY INFECTIONS IS BEST DETERMINED BY THE:
A SYMPTOMS.
B PRESENCE OF A VIRAL INFECTION. C PRESENCE OF A BACTERIAL INFECTION.
D AFFECTED PART OF THE RESPIRATORY MUCOSA.
PREGUNTA 14
THE MAIN AREA AFFECTED IN INFECTIONS TERMED "OTITIS MEDIA" IS THE: A EYE B EAR C NOSE D THROAT PREGUNTA 15
OME, AOM, AND SCOM ALL BELONG TO THE FAMILY OF THE INFECTION CALLED:
A BRONCHITIS B PHARYNGITIS C RHINOSINUSITUS D OTITIS MEDIA
FREQUENCY OF GERD SYMPTOMS IN ELDERLY PATIENTS WHO COME TO A FAMILY MEDICINE CLINIC. OBJECTIVES: TO ASCERTAIN THE PREVALENCE OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ELDERLY PEOPLE ATTENDING TO FAMILY MEDICINE CLINICS. MATERIAL AND METHODS: THE STUDY WAS CONDUCTED BY USING A PROSPECTIVE DESIGN IN WHICH PARTICIPANTS WERE RANDOMLY SELECTED FROM A FAMILY MEDICINE
CLINIC LOCATED IN MEXICO CITY. THE STUDY WAS RUN FROM AUGUST TO SEPTEMBER 2003, AND INCLUDED PATIENTS AGED SIXTY YEARS OR OLDER, REGARDLESS OF GENDER. THEY SHOULD NOT HAVE COGNITIVE DAMAGE, WHICH WAS ASCERTAINED BY THE FOLSTEIN MINI MENTAL STATE
EXAMINATION. THOSE PATIENTS THAT DID NOT ACCEPT TO PARTICIPATE AND THOSE HAVING INCOMPLETE OR ILLEGIBLE MEDICAL RECORDS WERE EXCLUDED. THE SOCIO-DEMOGRAPHIC CHARACTERISTICS TEST AND
CARLSSON-DENT TEST WERE APPLIED. THE INFORMATION ABOUT DIAGNOSIS, DRUGS PRESCRIPTIONS, AND PHARMACOLOGICAL AND NO PHARMACOLOGICAL GASTROESOPHAGEAL PROTECTION WAS OBTAINED FROM THE MEDICAL CHARTS AND PRESCRIPTIONS. RESULTS: 400 ELDERLY PATIENTS WERE EVALUATED BY USING THE CARLSSON-DENT TEST. GERD PREVALENCE WAS 25% (IC 95 % 21-29) THE AVERAGE AGE OF PATIENTS WITH AND WITHOUT GERD WAS 68 ± 7 YEARS AND 70 ± 7 YEARS
RESPECTIVELY (P = .002). WOMEN SUFFERED GERD MORE FREQUENTLY THAN MEN (P = 0.001). GERD DIAGNOSIS WAS NOT FOUND IN ANY OF THE REVIEWED MEDICAL CHARTS. ANTACIDS, HISTAMINE- 2 RECEPTOR ANTAGONISTS (H2 AS) AND WERE PRESCRIBED IN 39% (IC 95 % 34-44) OF PATIENTS WITH GERD AND IN 18% (IC 95 % 15-21) WITHOUT GERD.
CONCLUSIONS: ELDERLY PATIENTS ATTENDING TO PRIMARY CARE
FACILITIES OFTEN HAVE GERD SYMPTOMS, BUT THEY ARE NOT PROPERLY DIAGNOSED OR FOLLOWED UP. THE CARLSSON-DENT QUESTIONNAIRE IS AN ALTERNATIVE TO IDENTIFY GERD PATIENTS.
PREGUNTA 16
ABOUT THE DESIGN OF THE STUDY:
A
RESEARCHERS USE A PROSPECTIVE DESIGN, PARTICIPANTS WERE FAMILY MEDICINE SPECIALIST FROM MEXICO CITY SELECTED AT RANDOM.
B PARTICIPANTS ARE SELECTED AT RANDOM FROM A FAMILY MEDICINE CLINIC FROM AN ELDERLY FEMALE POPULATION. C ELDERLY PATIENTS WERE INCLUDED WITHOUT CONSIDERING GENDER. D IT WAS ORIGINALLY PLANNED TO BE DONE IN THREE MONTHS.
PREGUNTA 17
THE INCLUSION OF PATIENT CRITERIA WAS:
B TO HAVE COGNITIVE COMPETENCE PROVEN BY THE FOLSTEIN MINI MENTAL STATE EXAMINATION. C NOT TO ACCEPT TO PARTICIPATE IN THE STUDY.
D THERE WERE INCOMPLETE OR ILLEGIBLE MEDICAL RECORDS.
PREGUNTA 18
RESEARCHERS OBTAIN THE INFORMATION ABOUT DIAGNOSIS, DRUGS PRESCRIPTIONS, AND PHARMACOLOGICAL AND NO PHARMACOLOGICAL GASTROESOPHAGEAL PROTECTION FROM:
A A SOCIO-DEMOGRAPHIC CHARACTERISTICS TEST. B A CARLSSON-DENT TEST.
C CLINIC DATABASES. D PATIENT RECORDS.
PREGUNTA 19
THE AIM OF THE STUDY GAVE AS A RESULT:
A GERD PREVALENCE WAS 25%.
B AVERAGE AGE OF PATIENTS WITH AND WITHOUT GERD WAS 68 ± 7 YEARS AND 70 ± 7 YEARS RESPECTIVELY. C WOMEN SUFFERED GERD MORE FREQUENTLY THAN MEN.
D ANTACIDS, H2 AS AND WERE PRESCRIBED IN 39% OF PATIENTS WITH GERD.
PREGUNTA 20
THE MAIN CONCLUSION OF THE STUDY WAS:
A PATIENTS WITHOUT GERD STILL RECEIVED TREATMENT. B PARTICIPANTS OFTEN HAD GERD SYMPTOMS.
D THE CARLSSON-DENT QUESTIONNAIRE WAS THE BEST ALTERNATIVE TO IDENTIFY GERD PATIENTS.
NEW THINKING ON HOW TO PROTECT THE HEART BY JANE E. BRODY SURGERY MAY NOT BE THE BEST WAY TO AVOID A HEART ATTACK OR SUDDEN CARDIAC DEATH, THE NEXT STEP IS FINDING OUT WHAT CAN WORK AS WELL OR BETTER TO PROTECT YOUR HEART. MANY MEASURES ARE PROBABLY FAMILIAR: NOT SMOKING, CONTROLLING CHOLESTEROL AND BLOOD PRESSURE, EXERCISING REGULARLY AND STAYING AT A HEALTHY WEIGHT. BUT SOME NEWER SUGGESTIONS MAY SURPRISE YOU. IT IS NOT THAT THE OLD ADVICE, LIKE EATING A LOW-FAT DIET OR
EXERCISING VIGOROUSLY, WAS BAD ADVICE; IT WAS BASED ON THE BEST AVAILABLE EVIDENCE OF THE TIME AND CAN STILL BE VERY HELPFUL. THE WELL-ESTABLISHED RISK FACTORS FOR HEART DISEASE REMAIN INTACT: HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, SMOKING,
DIABETES, ABDOMINAL OBESITY AND SEDENTARY LIVING. BUT BEHIND THEM A RELATIVELY NEW FACTOR HAS EMERGED THAT MAY BE EVEN MORE IMPORTANT AS A CAUSE OF HEART ATTACKS THAN, SAY, HIGH BLOOD LEVELS OF ARTERY-DAMAGING CHOLESTEROL. THAT FACTOR IS C-REACTIVE PROTEIN, OR CRP, A BLOOD-BORNE MARKER OF INFLAMMATION THAT, ALONG WITH COAGULATION FACTORS, IS NOW INCREASINGLY RECOGNIZED AS THE DRIVING FORCE BEHIND CLOTS THAT BLOCK BLOOD FLOW TO THE HEART. EVEN IN PEOPLE WITH NORMAL CHOLESTEROL, IF CRP IS ELEVATED, THE RISK OF HEART ATTACK IS TOO. DIET REVISITED THE NEW DIETARY ADVICE IS ACTUALLY BASED ON A RATHER OLD FINDING THAT PREDATES THE MANTRA TO EAT A LOW-FAT DIET. IN THE SEVEN COUNTRIES STUDY STARTED IN 1958 FOUND THAT HEART DISEASE WAS RARE IN THE MEDITERRANEAN AND ASIAN REGIONS WHERE
VEGETABLES, GRAINS, FRUITS, BEANS AND FISH WERE THE DIETARY MAINSTAYS. BUT IN COUNTRIES LIKE FINLAND AND THE UNITED STATES WHERE PLATES WERE TYPICALLY FILLED WITH RED MEAT, CHEESE AND OTHER FOODS RICH IN SATURATED FATS, HEART DISEASE AND CARDIAC DEATHS WERE EPIDEMIC. THE FINDING RESULTED IN THE WELL-KNOWN ADVICE TO REDUCE DIETARY FAT AND ESPECIALLY SATURATED FATS (THOSE THAT ARE FIRM AT ROOM TEMPERATURE), AND TO REPLACE THESE HARMFUL FATS WITH UNSATURATED ONES LIKE VEGETABLE OILS. WHAT WAS MISSED AT THE TIME AND HAS NOW BECOME INCREASINGLY
APPARENT IS THAT THE HEART-HEALTHY MEDITERRANEAN DIET IS NOT REALLY LOW IN FAT, BUT ITS MAIN SOURCES OF FAT — OLIVE OIL AND OILY FISH AS WELL AS NUTS, SEEDS AND CERTAIN VEGETABLES — HELP TO PREVENT HEART DISEASE BY IMPROVING CHOLESTEROL RATIOS AND REDUCING INFLAMMATION.
PREGUNTA 21
ATTACK IS:
A EATING A LOW FAT DIET AND EXERCISING VIGOROUSLY. B HAVING A SURGERY.
C CONTROLLING YOUR CRP
D CONTROLLING YOUR CHOLESTEROL
PREGUNTA 22
ACCORDING TO THE ARTICLE, THE BEST DIET TO FOLLOW IS:
A A LOW-FAT DIET B SATURATED FATS
C RED MEAT AND CHEESE D A MEDITERRANEAN DIET.
PREGUNTA 23
THE MEDITERRANEAN DIET CONSISTS MAINLY OF:
A LOW CARBOHYDRATES B RED MEAT AND CHEESE C UNSATURATED FATS D VEGETABLES
PREGUNTA 24
DRINKING RED WINE IS GOOD FOR YOU BECAUSE:
A IT MAKES YOU RELAX
B HAS ANTIOXIDANT PROPERTIES
D IT’S EASY TO DIGEST
PREGUNTA 25
FROM THE ARTICLE WE CAN CONCLUDE THAT:
A IF WE FOLLOW A LOW-FAT DIET AND EXERCISE VIGOROUSLY WE WILL AVOID HAVING A HEART ATTACK
B
GOING TO THE PERIODONTIST, EXERCISING 15 MINUTES A DAY, RELAXING, AND FOLLOWING A MEDITERRANEAN DIET WE WILL AVOID HAVING A HEART ATTACK
C
TAKING A VACATION, EXERCISING VIGOROUSLY AND FOLLOWING A MEDITERRANEAN DIET WE WILL AVOID HAVING A HEART
ATTACK
D
PRACTICING THE RELAXATION RESPONSE ONCE OR TWICE A DAY BY BREATHING DEEPLY AND RHYTHMICALLY IN A QUIET PLACE WILL AVOID HAVING A HEART ATTACK
MATERNAL MORBIDITY, MORTALITY, AND RISK ASSESSMENT MATERNAL MORTALITY IS THE TIP OF THE MATERNAL MORBIDITY ICEBERG; SEVERAL OBSTETRIC, ANESTHETIC, AND SOCIAL CHALLENGES IMPACT MORBIDITY AND MORTALITY IN WOMEN. MATERNAL MORTALITY IS THE YARDSTICK TO MEASURE WHEN HEALTH CARE PERSONNEL FAIL TO RECOGNIZE RISKS, LACK INTERDISCIPLINARY COMMUNICATION, OR PROVIDE SUBSTANDARD CARE, THUS RESULTING IN COMPLICATIONS DURING PREGNANCY, LABOR, OR DELIVERY. PREGNANCY-RELATED DEATH IS DEFINED BY THE
INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION (ICD-10) AS THE DEATH OF A WOMAN WHILE PREGNANT OR WITHIN 42 DAYS OF
TERMINATION OF PREGNANCY, DESPITE THE CAUSE OF DEATH. ALTHOUGH THE RISK FOR DEATH FROM COMPLICATIONS OF PREGNANCY DECREASED DRAMATICALLY DURING THE 20TH CENTURY IN THE UNITED STATES, THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) REPORTS A
FAIRLY STATIC MATERNAL MORTALITY RATIO (MMR), OF APPROXIMATELY 7.5 MATERNAL DEATHS PER 100,000 LIVE BIRTHS. IN THE YEAR 2000, A
COLLABORATIVE EFFORT INVOLVING WORLD HEALTH ORGANIZATION (WHO), UNITED NATIONS CHILDREN'S FUND (UNICEF), AND UNITED
NATIONS POPULATION FUND (UNFPA) ESTIMATED 660 MATERNAL DEATHS, THUS AVERAGING 11 MATERNAL DEATHS PER 100,000 LIVE BIRTHS,
PLACING THE MMR ABOVE THE STATISTICS REPORTED BY THE CDC. THESE SURVEYS ON MATERNAL MORTALITY SURVEILLANCES ARE LIMITED IN SCOPE BECAUSE THE INFORMATION IS OBTAINED FROM DEATH
CERTIFICATES, AND VARIOUS STATES OR ACADEMIC INSTITUTIONS COULD BE UNDERREPORTING. ACCURATE STATISTICS ARE LACKING, THUS
AND MORTALITY. THE RECENT WHO ESTIMATE IN THE UNITED STATES SHOW THAT MATERNAL MORTALITY IS APPROXIMATELY 17 IN 100,000 PREGNANCIES. THIS ESTIMATE IS SIGNIFICANTLY HIGHER THAN THE GOAL SET BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN
HEALTHY PEOPLE 2010, WHICH SETS THE TARGET FOR MATERNAL MORTALITY AT LESS THAN 3.3 IN 100,000 LIVE BIRTHS. SOME REGIONAL REPORTS DOCUMENT RATIOS AS HIGH AS 22.8 PER 100,000 LIVE BIRTHS, WHICH IS AN UNACCEPTABLY HIGH RATE. IN UNITED STATES, THE MOST COMMON CAUSES OF MATERNAL DEATHS, ALTHOUGH THEY VARY AMONG STATES, INCLUDE THROMBOEMBOLISM; AMNIOTIC FLUID EMBOLISM; HEMORRHAGE; COMPLICATIONS OF HYPERTENSION, INCLUDING
PREECLAMPSIA AND ECLAMPSIA; AND INFECTION. PULMONARY DISEASE, ANESTHESIA-RELATED DEATHS, AND CARDIOMYOPATHY ARE ALSO
SIGNIFICANT CONTRIBUTORS TO MATERNAL MORBIDITY AND MORTALITY.
PREGUNTA 26
FOR MATERNAL MORTALITY A RISK FACTOR COULD BE:
A EXCESIVE INTERDISCIPLINARY COMMUNICATION BY HEALTH CARE PERSONNEL. B FAILURE TO RECOGNIZE RISKS BY HEALTH CARE PERSONNEL . C HEALTH CARE PERSONNEL PROVIDE STANDARD CARE.
D ALL ABOVE ARE RISK FACTORS.
PREGUNTA 27
THE MAIN REASON WHY THE MATERNAL MORTALITY SURVEILLANCES ARE LIMITED IN SCOPE WOULD BE:
A BECAUSE THE INFORMATION IS OBTAINED OF DEATH CERTIFICATES. B A SITUATION OF UNDERREPORTING.
C BECAUSE VARIOUS STATES OR ACADEMIC INSTITUTIONS COULD BE OVERREPORTING. D THE MATERNAL MORTALITY SURVEILLANCES ARE ACCURATE.
ACCORDING TO THE FINDINGS FROM THE STUDY CONDUCTED BY WHO, UNICEF AND THE UNFPA WHAT IS THE CONCLUSION:
A PREGNANCY RELATED DEATH IS THE DEATH OF A PREGNANT WOMAN .
B
PREGNANCY REALTED DEATH IS THE DEATH OF A WOMAN WITHIN 42 DAYS OF TERMINATION OF PREGNANCY, DESPITE THE CAUSE OF DEATH.
C
THE RISK OF DEATH FROM COMPLICATIONS OF PREGNANCY DECREASED DRAMATICALLY DURING THE 20TH CENTURY IN THE UNITED STATES.
D THE MMR STATISTICS ARE ABOVE THE CDC STATISTICS.
PREGUNTA 29
ALTHOUGH THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS PROJECTED GOALS FOR 2010, WHAT IS THE ACTUAL RATIO:
A MATERNAL MORTALITY IS APPROXIMATELY 17 IN 100,000 PREGNANCIES. B MATERNAL MORTALITY IS AT LESS 3.3 IN 100,000 LIVE BIRTHS. C THE RESULTS HAVE NOT BEEN WHAT THEY EXPECTED.
D MATERNAL MORTALITY IS 22.8 PER 100,000 LIVE BIRTHS.
PREGUNTA 30
ABOUT THE CAUSES OF MATERNAL DEATHS WHICH WOULD BE CONSIDERED A CONTRIBUTOR FROM THE FOLLOWING:
A THROMBOEMBOLISM.
B AMNIOTIC FLUID EMBOLISM. C PREECLAMPSIA AND ECLAMPSIA. D CARDIOMYOPATHY.
VACCINE TAKES AIM AT HYPERTENSION ORLANDO, FLA: SOME PATIENTS WITH HYPERTENSION HAVE INADEQUATE CONTROL OF BLOOD PRESSURE BECAUSE THEY ARE NOT CONSISTENTLY ADHERENT IN TAKING THEIR MEDICATIONS. BUT HELP MAY BE ON THE WAY IN THE FORM OF A VACCINE THAT LOWERS BLOOD PRESSURE BY CONTROLLING
ANGIOSTENSIN II, SUGGEST FINDINGS FROM A SMALL SAFETY STUDY PRESENTED AT THE SCIENTIFIC SESSIONS OF THE AMERICAN HEART ASSOCIATION IN NOVEMBER. THE STUDY OF 72 PATIENTS WITH MILD-TO-MODERATE HYPERTENSION, PRESENTED BY JURG NUSSBERGER, MD, PROFESSOR OF MEDICINE AT THE UNIVERSITY HOSPITAL OF THE CANTON OF VAUD, LAUSANNE, SWITZERLAND, FOUND THAT AT 14 WEEKS, THOSE INJECTED WITH CYTOO6-ANGQB (AT 0,4, AND 12 WEEKS) HAD A DAYTIME SYSTOLIC BLOOD PRESSURE THAT WAS 5.6 MM HG LOWER AND A
DIASTOLIC BLOOD PRESSURE 2.8 MM HG LOWER THAN THOSE OF PATIENTS WHO RECEIVED PLACEBO. CYT006-ANGQB, WHICH IS UNDER
DEVELOPMENT BY CYTOS BIOTECHNOLOGY AG (ZURICH, SWITZERLAND), IS A VIRUS-SHAPED NONINFECTIOUS PARTICLE THAT IS CHEMICALLY COUPLED WITH ANGIOTENSIN II, AND OCTAPEPTIDE VASOCONSTRICTOR. SUCH COUPLING INDUCES THE BODY TO PRODUCE ANTIBODIES AGAINST THIS SMALL MOLECULE TOP MINIMIZE ITS EFFECTS ON CONSTRICTING BLOOD VESSELS. NUSSBERGER SAID HE IS NOT CONCERNED THAT THE VACCINE MIGHT CAUSE HYPOTENSION BECAUSE ANTIBODY TITERS
STARTED TO DECREASE SHORTLY AFTER THE BOOSTER OF TWELVE WEEKS INDUCED PEAK ANTIBODY LEVELS. HE ALSO SAID THE LIKELIHOOD OF VACCINE-INDUCED ANTIBODIES CROSS-REACTING WITH OTHER PROTEINS WAS MINIMAL BECAUSE THE SMALL SIZE OF THE TARGET MOLECULE LIMITS THE NUMBER OF EPITOPES THAT COULD BE AFFECTED.
NUSSBERGER SPECULATED THAT IF THE CYT006-ANGQB VACCINE IS
ULTIMATELY APPROVED, PATIENTS WOULD BE ABLE TO AVOID THE NEED FOR MEDICATION BUT WOULD REQUIRE A BOOSTER SHOT 2 OR 3 TIMES A YEAR. HE SAID THE NEXT STEP IN STUDYING THE VACCINE WILL BE TO CONDUCT ANOTHER SMALL TRIAL TO DETERMINE THE APPROPRIATE DOSING TO CREATE THE LARGEST ANTIBODY RESPONSE AND GREATEST REDUCTIONS IN BLOOD PRESSURE. MORRIS J. BROWN, MD, PROFESSOR OF CLINICAL PHARMACOLOGY AT THE UNIVERSITY OF CAMBRIDGE IN
ENGLAND AND PAST PRESIDENT OF THE BRITISH HYPERTENSION SOCIETY, SAID THE FINDINGS OF THE STUDY (WHICH WAS FUNDED BY CYTOS) ARE ―INTRIGUING‖ BUT OFFERED A CAVEAT. ―I AM A LITTLE WARY OF TOP-LINE RESULTS FROM BOITECHS, ESPECIALLY SECONDARY EFFICACY VARIABLES IN A PRIMARY SAFETY STUDY,‖ HE SAID. BROWN HAS ALSO HAD A HAND IN ATTEMPTS TO CREATE A HYPERTENSION VACCINE, PMD3117, UNDER DEVELOPMENT BY PROTHERICS PLC IN RUNCORN, ENGLAND (BROWN MJ ET AL. CLIN SCI.
PREGUNTA 31
ABOUT PATIENTS THAT DON`T TAKE THEIR TREATMENT REGULARY:
B THEY ARE CONSISTENTLY ADHERENT IN TAKING THEIR MEDICATIONS. C THEY MUST HAVE A REGULAR DIET CONTROL.
D THEY HAVE AN INADEQUATE CONTROL OF BLOOD PRESSURE.
PREGUNTA 32
ABOUT THE WORKING MECHANISM OF THE VACCINE:
A IT`S WORKING MECHANISM IS BY CONTROLLING THE ANGIOTENSIN I. B IT`S WORKING MECHANISM IS BY CONTROLLING THE ANGIOTENSIN II. C IT`S WORKING MECHANISM IS BY CONSTRICTING BLOOD VESSELS. D IT INDUCES ANTIBODIES CROSS-REACTION WITH OTHER PROTEINS.
PREGUNTA 33
WITH RESPECT TO THE CYT006-ANGQB VACCINE, CONSIDERATION HAVE BEEN MADE THAT:
A THE VACCINE MAY PRODUCE HYPERTENSION.
B THE VACCINE DOES NOT INDUCE ANTIBODIES CROSS-REACTION WITH PROTEINS. C THE VACCINE MAY CAUSE HYPOTENSION.
D THE VACCINE MIGHT CAUSE IMPOTENCY.
PREGUNTA 34
WHAT IS THE REASON OF THE REDUCED NUMBER OF AFFECTED EPITOPES ?
A BECAUSE OF THE SMALL SIZE OF THE EPITOPES.
B BECAUSE OF THE SMALL SIZE OF THE TARGET MOLECULE. C BECAUSE ANTIBODY TITERS STARTED TO DECREASE.
D THE NUMBER OF EPITOPES WAS NEVER AFFECTED.
PREGUNTA 35
WHAT SHALL BE DONE TO DETERMINE THE LARGEST ANTIBODY RESPONSE AND GREATEST REDUCTIONS IN BLOOD PRESSURE:
A A SMALL TRIAL TO DETERMINE THE RIGHT DOSING HAD TO BE CONDUCTED. B BOOSTER SHOT 2 OR 3 TIMES A YEAR.
C ANGIOTENSIN II AND OCTAPEPTIDE VASOCONSTRICTOR INDUCE THE BODY TO PRODUCE ANTIBODIES. D ANGIOTENSIN II WOULD ALONE REGULATE THE BLOOD PRESSURE. WILLIAM THOMAS GREEN MORTON ON OCTOBER 16, 1846, DEMONSTRATED THAT ETHER COULD INDUCE INSENSIBILITY TO THE SURGEON'S KNIFE. A JAW TUMOR WAS REMOVED FROM GILBERT ABBOT BY JOHN COLLINS WARREN AT THE MASSACHUSETTS GENERAL HOSPITAL IN FRONT OF AN AUDIENCE OF MEDICAL PROFESSIONALS. THE NEWS OF THIS PUBLIC DEMONSTRATION TRAVELED QUICKLY, GIVEN THE NATURE OF
COMMUNICATION IN THE 1840S. ON DECEMBER 16, 1846, THE INFORMATION IN THE FORM OF A LETTER ARRIVED IN LONDON. ON DECEMBER 19, THE FIRST ETHER ANESTHETIC WAS GIVEN IN THE UNITED KINGDOM FOR THE REMOVAL OF A TOOTH. ON DECEMBER 21, THE FAMOUS SURGEON ROBERT LISTON AMPUTATED THE LEG OF A BUTLER, AND UTTERED THE FAMOUS WORDS, ―THIS YANKEE DODGE BEATS MESMERISM HOLLOW‖ .JAMES YOUNG SIMPSON, THE PROFESSOR OF MIDWIFERY IN EDINBURGH, SCOTLAND, WAS AMONG THE FIRST TO USE ETHER FOR THE RELIEF OF LABOR PAIN. ON JANUARY 19, 1847, HE USED ETHER TO AMELIORATE THE PAIN OF LABOR. THIS FIRST CASE, THAT OF A YOUNG WOMAN WITH RICKETS AND A SEVERELY DEFORMED PELVIS, WAS AT GRAVE RISK OF DYING AND THERE WAS NO HOPE FOR A LIVE BIRTH. BY USING ETHER, THE MOTHER SURVIVED THE COMPLICATED DELIVERY PAIN-FREE. THAT SAME JANUARY DAY, SIMPSON WAS APPOINTED THE QUEEN'S PHYSICIAN IN SCOTLAND. SIMPSON CONTINUED TO PROVIDE ANESTHESIA IN CHILDBIRTH FOR BOTH COMPLICATED AND NORMAL DELIVERIES; HOWEVER, HE
RAPIDLY BECAME DISSATISFIED WITH ETHER AND SOUGHT A MORE PLEASANT, RAPID-ACTING ANESTHETIC. AT THE SUGGESTION OF DAVID WALDIE, HE EXPERIMENTED WITH CHLOROFORM, WHICH HAD FIRST BEEN PREPARED IN 1831. ON THE EVENING OF NOVEMBER 4, 1847, SIMPSON AND HIS FRIENDS INHALED IT AFTER DINNER AT A PARTY IN SIMPSON'S HOME. THEY PROMPTLY FELL UNCONSCIOUS AND, WHEN THEY AWOKE UNDER THE TABLE AND CLEARLY OFF THEIR DINING ROOM CHAIRS, WERE
DELIGHTED WITH THEIR SUCCESS. WITHIN 2 WEEKS, SIMPSON SUBMITTED HIS FIRST ACCOUNT OF CHLOROFORM'S USE TO THE LANCET.IN THE
NINETEENTH CENTURY, THE RELIEF OF OBSTETRIC PAIN HAD SIGNIFICANT SOCIAL AND RELIGIOUS CONSEQUENCES, WHICH MADE ANESTHESIA
DURING CHILDBIRTH A CONTENTIOUS SUBJECT. THE BATTLE CENTERED ON WHETHER RELIEVING LABOR PAIN WAS CONTRARY TO GOD'S WILL. THE PAIN ASSOCIATED WITH CHILDBIRTH WAS BELIEVED TO BE A DEVINE PUNISHMENT FOR ORIGINAL SIN. SHORTLY AFTER GIVING HIS FIRST
OBSTETRIC ANESTHETICS, SIMPSON PUBLISHED A PAMPHLET ENTITLED ANSWERS TO THE RELIGIOUS OBJECTIONS ADVANCED AGAINST THE
EMPLOYMENT OF ANESTHETIC AGENTS IN MIDWIFERY AND SURGERY AND OBSTETRICS, WHICH ARGUED AGAINST THESE RELIGIOUS PROHIBITIONS.
PREGUNTA 36
WILLIAM THOMAS GREEN MORTON USED
A ETHER ON A PATIENT SO THERE WOULD BE NO SENSIBILITY IN THE OPERATION. B ETHER ON A PATIENT TO REDUCE THE SENSIBILITY DURING THE OPERATION C ETHER TO DISINFECT THE KNIFE IN THE OPERATION AND OTHER OPERATING EQUIPMENT D ETHER INSTEAD OF AN ANESTHETIC.
PREGUNTA 37
JAMES YOUNG SIMPSON WAS THE FIRST TO USE ETHER FOR
A CURING A PATIENT WHO HAD RICKETS
B REDUCING THE LABOR PAIN OF A WOMEN WHEN GIVING BIRTH WITH A DEFORMED PELVIS C REDUCING THE PAIN OF SURGERY
D SAVING THE NEWBORN FROM DYEING IN CHILDBIRTH
PREGUNTA 38
A USING ETHER FOR CHILDBIRTH
B TO CONTINUE USING ETHER AND CHLOROFORM FOR CHILDBIRTH C TO ONLY USE CHLOROFORM FOR CHILDBIRTH
D PROVIDE ANESTHESIA IN CHILDBIRTH FOR BOTH COMPLICATED AND NORMAL DELIVERIES
PREGUNTA 39
IT IS EVIDENT THAT THIS NEW PRACTICE OF USING ANESTHESIA IN CHILDBIRTH HAD SOCIAL AND RELIGIOUS CONSEQUENCES
A SIMPSON WAS IN FAVOR OF RELIGIOUS BELIEFS IN CHILDBIRTH PRACTICE B SIMPSON WAS IN FAVOR OF SOCIAL BELIEFS ABOUT CHILDBIRTH PRACTICE C SIMPSON WAS AGAINST RELIGIOUS BELIEFS IN CHILDBIRTH PRACTICE D SIMPSON WAS AGAINST THESE RELIGIOUS PROHIBITIONS
PREGUNTA 40
THE PAIN ASSOCIATED WITH CHILDBIRTH WAS BELIEVED TO BE CAUSED AS.
A CONSEQUENCE OF DEFORMED PELVIS. B A DEVINE PUNISHMENT FOR ORIGINAL SIN. C BECAUSE OF LACK OF ANESTHETICS.
D AN OVERSIZED PRODUCT.
A 71-YEAR-OLD MALE PRESENTED WITH A 2-WEEK HISTORY OF A HARD, PAINFUL, NONPULSATILE MASS IN HIS LEFT UPPER ARM. EXAMINATION REVEALED A CRAGGY, MOBILE MASS OF IRREGULAR BORDERS IN THE LEFT ARM MEASURING 6 × 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM DEMONSTRATED A DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE LEFT TRICEPS MUSCLE. MRI SHOWED INTERMEDIATE SIGNAL MASS IN THE TRICEPS MUSCULATURE ON T1-WEIGHTED IMAGES WITH FAT SATURATION. THIS LESION WAS CONFINED TO THE EXTENSOR COMPARTMENT OF THE ARM. A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS CONSIDERED. AN INCISIONAL BIOPSY REPORTED
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 LEFT UPPER LOBE LESION MEASURING 4 × 2 CM. FIBER-OPTIC BRONCHOSCOPY AND BIOPSY CONFIRMED THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL LUNG CARCINOMA. HE UNDERWENT PALLIATIVE
RADIOTHERAPY TO THE MASS IN THE ARM. 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 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 OF THIS CONDITION, EVEN WITH
RADIOLOGIC IMAGING IS OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT TISSUE TUMORS, HIGHLIGHTING THE VALUE OF HISTOLOGIC DIAGNOSIS. TREATMENT IN THE FORM OF RADIOTHERAPY, CHEMOTHERAPY, OR EVEN METASTASECTOMY OFTEN PROVIDES
PALLIATION ONLY. MOST PATIENTS DIE IN LESS THAN A YEAR FROM DIAGNOSIS.
PREGUNTA 41
BASED ON THE CLINICAL AND THE DIVERSE IMAGING STUDY’S FINDINGS WHICH OF THE FOLLOWING WAS THE PRESUMPTIVE DIAGNOSIS OF THE ATTENDING MEDICAL TEAM:
A A DEEP OVOID MASS LOCATED IN THE LEFT TRICEPS MUSCLE CONSIDERED A PROBABLE STAPHYLOCOCCUS AUREUS ABSCESS. B A MASS OF FAT SATURATION OBSERVED ON MRI ON T1-WEIGHTED IMAGES.
C A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA LOCATED IN THE LEFT TRICEPS MUSCLE. D A DIAGNOSIS OF METASTATIC SQUAMOUS CELL CARCINOMA, WITH A POSSIBLE PRIMARY OF THE LUNG.
PREGUNTA 42
THE PATIENT WAS SUBMITTED TO PALLIATIVE CARE AND NOT SYSTEMIC THERAPY BASED ON WHAT REASON?
A A POSITIVE CK7 AND NEGATIVE CK20 STAIN ON IMMUNOHISTOCHEMISTRY IS OF POOR PROGNOSIS.
B THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL LUNG CARCINOMA WAS NOT CONFIRMED ON FIBER-OPTIC BRONCHOSCOPY. C HE ONLY UNDERWENT PALLIATIVE RADIOTHERAPY BECAUSE OF COST-BENEFIT REASONS.
D
BASED ON A POOR AND DETERIORATING PERFORMANCE STATUS SYSTEMIC THERAPY WAS DEFERRED FOR QUALITY OF LIFE PALLIATIVE THERAPY.
PREGUNTA 43
WHICH OF THE FOLLOWING IS NOT DESCRIBED IN THE PRESENT ARTICLE AS A FACTOR THAT CONTRIBUTES TO THE RARE OCCURRENCE OF
INTRAMUSCULAR METASTASES?
A THE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF TOTAL BODY WEIGHT. B MUSCULAR CONTRACTILE ACTIONS.
C LOCAL PH ENVIRONMENT.
D ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES.
PREGUNTA 44
WHICH IS THE PRIMARY UNDERLYING CANCER IN MOST CASES OF INTRAMUSCULAR METASTASES?
B KIDNEY AND BLADDER CANCER.
C STOMACH AND PANCREATIC CARCINOMA. D BREAST AND OVARIAN CANCER.
PREGUNTA 45
THE MOST FREQUENT PRESENTATION OF INTRAMUSCULAR METASTASES SEEN IS?
A PRESENTATION OF THE AFFECTED SITE WITH PAIN, WITH OR WITHOUT SWELLING. B THROMBOSIS OF THE AFFECTED EXTREMITY.
C FEVER AND SEPSIS.
D USUALLY INDOLENT AND ONLY FOUND AT AUTOPSY.
MIGRAINE IS CONSIDERED TO BE AN EPISODIC CONDITION WITH NO LONG-TERM CONSEQUENCES. HOWEVER, RECENT STUDIES SUGGEST THAT
MIGRAINE ATTACKS MAY BE ASSOCIATED WITH PATHOLOGIC CHANGES IN THE BRAIN, PARTICULARLY IN THE CEREBELLUM. THE OBJECTIVE OF THE PRESENT STUDY WAS TO DETERMINE WHETHER INDIVIDUALS NOT
REPORTING HEADACHE COMPARED WITH INDIVIDUALS REPORTING MIGRAINE SYMPTOMS, PARTICULARLY AURA, IN MIDLIFE ARE AT INCREASED RISK OF LATE-LIFE INFARCT-LIKE LESIONS FOUND ON MAGNETIC RESONANCE IMAGING (MRI) WITHOUT CONSIDERATION OF CLINICAL SYMPTOMS. A POPULATION-BASED STUDY OF MEN AND WOMEN IN REYKJAVIK, ICELAND (COHORT BORN 1907-1935; N= 4689; 57% WOMEN) WERE FOLLOWED UP SINCE 1967, EXAMINED, AND INTERVIEWED ABOUT MIGRAINE SYMPTOMS IN MIDLIFE (MEAN AGE, 51 YEARS; RANGE, 33-65 YEARS). BETWEEN 2002 AND 2006, MORE THAN 26 YEARS LATER, BRAIN MRIS WERE PERFORMED. PARTICIPANTS REPORTING HEADACHES ONCE OR MORE PER MONTH WERE ASKED ABOUT MIGRAINE SYMPTOMS INCLUDING NAUSEA, UNILATERAL LOCATION, PHOTOPHOBIA, VISUAL DISTURBANCE, AND NUMBNESS. THESE INDIVIDUALS WITH HEADACHE WERE CLASSIFIED AS HAVING MIGRAINE WITHOUT AURA, MIGRAINE WITH AURA, OR
NONMIGRAINE HEADACHE. A COMPREHENSIVE CARDIOVASCULAR RISK ASSESSMENT WAS PERFORMED AT BOTH EXAMINATIONS. THE PRESENCE OF INFARCT-LIKE LESIONS (TOTAL) AND SPECIFICALLY LOCATED IN THE CORTICAL, SUBCORTICAL, AND CEREBELLAR REGIONS WERE THE MAIN OUTCOME MEASURE. INFARCT-LIKE LESIONS WERE PRESENT IN 39.3% OF MEN AND 24.6% OF WOMEN. AFTER ADJUSTING FOR AGE, SEX, AND
ONCE OR MORE PER MONTH (N= 3243), THOSE WITH MIDLIFE MIGRAINE WITH AURA (N= 361) HAD AN INCREASED RISK OF LATE-LIFE INFARCT-LIKE LESIONS (ADJUSTED ODDS RATIO [OR], 1.4; 95% CONFIDENCE INTERVAL [CI], 1.1-1.8) THAT SPECIFICALLY REFLECTED AN ASSOCIATION WITH
CEREBELLAR LESIONS IN WOMEN (PREVALENCE OF INFARCTS 23.0% FOR WOMEN WITH MIGRAINE WITH AURA VS 14.5% FOR WOMEN NOT
REPORTING HEADACHES; ADJUSTED OR, 1.9; 95% CI, 1.4-2.6 VS A 19.3%
PREVALENCE OF INFARCTS FOR MEN WITH MIGRAINE WITH AURA VS 21.3% FOR MEN NOT REPORTING HEADACHES; ADJUSTED OR, 1.0; 95% CI, 0.6-1.8; P<.04 FOR INTERACTION BY SEX). MIGRAINE WITHOUT AURA AND
NONMIGRAINE HEADACHE WERE NOT ASSOCIATED WITH AN INCREASED RISK. MIGRAINE WITH AURA IN MIDLIFE WAS ASSOCIATED WITH LATE-LIFE PREVALENCE OF CEREBELLAR INFARCT-LIKE LESIONS ON MRI. THIS
ASSOCIATION WAS STATISTICALLY SIGNIFICANT ONLY FOR WOMEN.
PREGUNTA 46
RECENT STUDIES SUGGEST THAT MIGRAINE ATTACKS MAY BE ASSOCIATED WITH PATHOLOGIC CHANGES IN THE BRAIN, WHICH LOCALIZATION IN PARTICULAR IS CONSIDERED?
A THE CEREBELLUM. B THE WHITE MATTER. C THE HYPOCAMPUS. D THE FRONTAL LOBE.
PREGUNTA 47
IN THE POPULATION-BASED STUDY OF MEN AND WOMEN IN REYKJAVIK, ICELAND, WITH A MEAN AGE OF 51 YEARS AND RANGING FROM 33-65 YEARS, WHAT STUDY WAS CONDUCTED APPROXIMATELY 26 YEARS LATER?
A BRAIN COMPUTERIZED AXIAL TOMOGRAPHY. B BRAIN BIOPSY.
C BRAIN MAGNETIC RESONANCE IMAGING. D ELECTROENCEPHALOGRAM
PREGUNTA 48
THOSE WITH MIDLIFE MIGRAINE WITH AURA HAD AN ODDS RATIOS OF 1-4 OF LATE-LIFE INFARCT-LIKE LESIONS, THIS WAS MORE SPECIFICALLY OBSERVED IN WHICH GROUP?
A CEREBELLAR LESIONS IN WOMEN. B CEREBELLAR LESIONS IN MEN. C CORTICAL LESIONS IN WOMEN. D SUBCORTICAL LESIONS IN MEN.
PREGUNTA 49
THE MAIN OUTCOME MEASURES OF THE STUDY WERE THE PRESENCE OF INFARCT-LIKE LESIONS SPECIFICALLY LOCATED IN WHICH REGIONS?
A CORTICAL, CEREBELLAR AND MEDULLA OBLONGATA REGIONS. B CORTICAL, SUBCORTICAL, AND CEREBELLAR REGIONS.
C CEREBELLAR, SUBCORTICAL AND WHITE MATTER REGIONS. D PERIVENTRICULAR, HYPOCAMPUS AND OCCIPITAL REGIONS.
PREGUNTA 50
WHICH OF THE FOLLOWING TYPES OF HEADACHES WERE NOT
ASSOCIATED WITH AN INCREASED RISK OF INFARCT-LIKE LESIONS AT FOLLOW-UP?
A POST-TRAUMATIC HEADACHE
B HEADACHE AND MIGRAINE WITH AURA.
C MIGRAINE WITHOUT AURA AND NON-MIGRAINE HEADACHE. D SINUSITIS AND MIGRAINE
HOMBRE DE 20 AÑOS, ES ATENDIDO EN EL SERVICIO DE CONSULTA EXTERNA, POR PRESENTAR DIFICULTAD RESPIRATORIA POSTERIOR A ESFUERZO FÍSICO. ANTECEDENTES: RINITIS ALÉRGICA DURANTE LA INFANCIA. EXPLORACIÓN FÍSICA: SE AUSCULTAN SIBILANCIAS
RESPIRATORIAS.
PREGUNTA 51
LA REACCIÓN DE HIPERSENSIBILIDAD PRESENTE EN ESTE PACIENTE ES LA TIPO: A I B II C III D VI PREGUNTA 52
LA INMUNOGLOBULINA QUE PARTICIPA EN ESTE PADECIMIENTO ES:
A A B E C G D M
HOMBRE DE 9 AÑOS, ES ATENDIDO EN CONSULTA POR TOS, DISNEA AL HACER EJERCICIO, CONSTIPACIÓN Y PRURITO NASAL SIN PREDOMINIO DE HORARIO DE TRES AÑOS DE EVOLUCIÓN. ANTECEDENTES: HA SIDO
HOSPITALIZADO EN DOS OCASIONES REQUIRIENDO USO DE NEBULIZADOR, NO TIENE ANTECEDENTES FAMILIARES SIMILARES. EXPLORACIÓN FÍSICA: MUCOSA NASAL HIPERÉMICA CON HIPERTROFIA DE CORNETES,
AMIGDALITIS HIPERTRÓFICA CON IMPORTANTE DIFICULTAD PARA HABLAR. NO SE ESCUCHAN SIBILANCIAS EN TÓRAX.
PREGUNTA 53
PARA CORROBORAR EL DIAGNÓSTICO SE DEBE SOLICITAR:
A CULTIVO DE EXUDADO FARÍNGEO.
B DETERMINACIÓN DE EOSINÓFILOS EN MOCO NASAL. C BIOMETRÍA HEMÁTICA COMPLETA.
D PRUEBAS CUTÁNEAS CON ALÉRGENOS.
PREGUNTA 54
LO MÁS PROBABLE ES QUE LA CAUSA DE ESTE PADECIMIENTO ES:
A ÁCAROS Y CASPA DE LOS ANIMALES. B ESTREPTOCOCO B HEMOLÍTICO. C INFECCIONES VIRALES.
D HONGOS.
MUJER DE 22 AÑOS. ES ATENDIDA EN EL SERVICIO DE URGENCIAS POR DISNEA INTENSA, DE APARICIÓN SÚBITA. E.F.: TA 100/70, FC 120 LPM, FR 33 RPM, TEMP 37ºC. TIROS SUPRAESTERNAL, SUPRACLAVICULARES E
INTERCOSTALES, ESTERTORES RONCANTES Y SIBILANCIAS ESPIRATORIAS, ESPIRACIÓN PROLONGADA, FACIES DE ANGUSTIA, POLIPNÉICA,
DIAFORÉTICA. ANTECEDENTES: HA PRESENTADO CUADROS SIMILARES QUE HAN CEDIDO A TRATAMIENTO MÉDICO
PREGUNTA 55
EL ESTUDIO MÁS SENSIBLE QUE CONFIRMA EL DIAGNÓSTICO DE ESTE PACIENTE ES:
A DETERMINACIÓN DE ANTICUERPOS ESPECÍFICOS B BIOMETRÍA HEMÁTICA
C DETERMINACIÓN DE IGE
D DETERMINACIÓN DE NIVELES DE HISTAMINA
PREGUNTA 56
EL MEDICAMENTO DE PRIMERA ELECCIÓN EN EL TRATAMIENTO DE ESTA PACIENTE ES:
A INHIBIDORES DE LEUCOTRIENOS B HIDROCORTISONA
C TEOFILINA D ADRENALINA
HOMBRE DE 54 AÑOS, SE PRESENTA A CONSULTA POR: DOLOR PRECORDIAL OPRESIVO QUE SE DESENCADENA CON EL ESFUERZO Y SE ATENÚA CON EL REPOSO, CON UNA DURACIÓN DE MENOS DE 15 MINUTOS. ACTUALMENTE SE ENCUENTRA ASINTOMÁTICO. ANTECEDENTES: TABAQUISMO DE 20
PAQUETES/AÑO. EXPLORACIÓN FÍSICA: TA DE 150/90 MM HG, FC DE 84 LPM, CAMPOS PULMONARES LIMPIOS Y BIEN VENTILADOS. EL RESTO DE LA EXPLORACIÓN ES NORMAL.
PREGUNTA 57
LA ESTRUCTURA ANATÓMICA AFECTADA QUE ORIGINA LOS SÍNTOMAS, ES:
A LA AORTA TORÁCICA. B EL PERICARDIO. C LA VASCULATURA PULMONAR. D LA VASCULATURA CORONARIA. PREGUNTA 58
EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNÓSTICO DEL PACIENTE ES:
A PRUEBA DE ESFUERZO. B ECOCARDIOGRAMA SIMPLE. C PRUEBA DE INCLINACIÓN. D ELECTROCARDIOGRAMA EN REPOSO. PREGUNTA 59
EN ESTE PACIENTE, EL MEDICAMENTO DE ELECCIÓN PARA CONTROLAR LA HIPERTENSIÓN ARTERIAL ES:
A INHIBIDORES DE LA ECA. B ARA II.
C BETABLOQUEADORES. D DIURÉTICOS.
HOMBRE DE 68 AÑOS. ATENDIDO EN CONSULTA POR PRESENTAR UN CUADRO DE DISNEA DE MODERADOS ESFUERZOS, SÍNCOPE DE ESFUERZO EN TRES OCASIONES DURANTE LOS ÚLTIMOS 2 MESES, DOLOR PRECORDIAL LEVE OCASIONAL ACOMPAÑADO DE MAREOS. ANTECEDENTES DE
ESTREÑIMIENTO QUE SE MANEJA CON SENOSIDOS. EXPLORACIÓN FÍSICA: PULSOS DÉBILES, RECULARES CON UNA FC DE 64 LPM, TA 110/70 MMHG. LA AUSCULTACIÓN MUESTRA UN SOPLO SISTÓLICO CON FOCO MÁS
ACENTUADO EN EL SEGUNDO ESPACIO INTERCOSTAL DEL LADO DERECHO, IRRADIADO AL CUELLO. LA TELE DE TÓRAX MUESTRA UNA
CARDIOMEGALIA II/IV.
PREGUNTA 60
CONSIDERANDO EL DIAGNÓSTICO MÁS PROBABLE EN ESTE PACIENTE EL ELECTROCARDIOGRAMA DEBE MOSTRAR:
A CRECIMIENTO DE CAVIDADES DERECHAS.
B ALTERACIONES COMPATIBLES CON HIPERTROFIA VENTRICULAR IZQUIERDA. C FIBRILACIÓN AURICULAR.
D BLOQUEO AV AVANZADO.
PREGUNTA 61
EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNÓSTICO ES:
A PRUEBA DE ESFUERZO. B PRUEBA DE INCLINACIÓN. C ECOCARDIOGRAMA. D CATETERISMO CARDÍACO. PREGUNTA 62
A FARMACOLÓGICO. B METABÓLICO. C AUTOINMUNE. D DEGENERATIVO.
MUJER DE 90 AÑOS ES ATENDIDA EN CONSULTA PORQUE TUVO UN
DESMAYO HACE 8 DÍAS. ANTECEDENTE: 15 GESTAS. EXPLORACIÓN FÍSICA: TA 150/60 MM HG, FC 40 LPM, PULSOS AMPLIOS E IRREGULARES. ÁPEX EN EL QUINTO ESPACIO INTERCOSTAL EN LA LÍNEA MEDIOCLAVICULAR. RUIDOS CARDÍACOS ARRÍTMICOS, SOPLO SISTÓLICO EXPULSIVO AÓRTICO II/VI. CAMPOS PULMONARES LIMPIOS. VÁRICES EN MIEMBROS INFERIORES. ELECTROCARDIOGRAMA: AUSENCIA DE ONDA P CON COMPLEJOS QRS IRREGULARES, FRECUENCIA VENTRICULAR MEDIA DE 40 LPM.
PREGUNTA 63
EN ESTA PACIENTE EL DIAGNÓSTICO ETIOLÓGICO MÁS PROBABLE ES:
A ESCLEROSIS AÓRTICA.
B FIBRILACIÓN AURICULAR LENTA. C INSUFICIENCIA VENOSA.
D SÍNCOPE.
PREGUNTA 64
AL PACIENTE SE LE SOLICITA UN MONITOREO ELECTROCARDIOGRÁFICO DE 24 HORAS (HOLTER), EL CUAL REPORTA PREDOMINANCIA DE RITMOS LENTOS < 40 POR MINUTO Y EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:
A ADMINISTRAR ANTITROMBÓTICOS. B ADMINISTRAR BLOQUEADORES ALFA-1. C ADMINISTRAR CALCIOANTAGONISTAS. D COLOCAR MARCAPASO DEFINITIVO.
MUJER DE 18 AÑOS, ATENDIDA EN CONSULTA POR CANSANCIO AL JUGAR VOLEY BALL EN SU COLEGIO. ANTECEDENTES: BRONQUITIS DE REPETICIÓN EN EDAD ESCOLAR. PRODUCTO DE SEGUNDA GESTA, PARTO EUTÓCICO A
TERMINO, APGAR 9. E.F.: EUPNÉICA, AFEBRIL, TA 138/74, FC 80 LPM, FR 18RPM. R.C.R. CON SOPLO CONTINUO PARAESTERNAL SUBCLAVICULAR IZQUIERDO. CAMPOS PULMONARES VENTILADOS, PULSOS ARTERIALES CON AMPLITUD AUMENTADA.
PREGUNTA 65
EN EL ELECTROCARDIOGRAMA Y LA RX DE TÓRAX DE ESTA PACIENTE ES MUY PROBABLE QUE SE ENCUENTREN DATOS DE:
A SOBRECARGA DE CAVIDADES IZQUIERDAS. B SOBRECARGA DE AURICULA DERECHA. C SOBRECARGA DE VENTRÍCULO DERECHO. D SOBRECARGA DE LAS CUATRO CAVIDADES.
PREGUNTA 66
EL TRATAMIENTO DE ELECCIÓN EN ESTA PACIENTE ES:
A INTERVENCIONISMO CARDIOLÓGICO. B CIRUGÍA CARDÍACA URGENTE.
C MANEJO MÉDICO INICIAL. D CIRUGÍA CARDÍACA ELECTIVA.
HOMBRE DE 53 AÑOS PREVIAMENTE SANO. PRESENTA FIEBRE NO
CUANTIFICADA DE TRES SEMANAS DE EVOLUCIÓN ACOMPAÑÁNDOSE DE ESCALOFRÍOS Y DIAFORESIS PROFUSA; REFIERE ADEMÁS PÉRDIDA DE PESO DE 5 KG. MIALGIAS Y ARTRALGIAS. E.F.: MICROHEMORRAGIAS EN DEDOS Y PLANTAS DE AMBOS PIES. LA AUSCULTACIÓN DEL TÓRAX MUESTRA UN SOPLO CORRESPONDIENTE A INSUFICIENCIA MITRAL III/VI. EL
LABORATORIO REPORTA UNA HB DE 8.3 G/DL, LEUCOCITOS 12 500, VSG 60 MM/H (NORMAL HASTA 20) CREATININA 0.8 G/DL.
PREGUNTA 67
EL AGENTE CAUSAL MÁS PROBABLE EN ESTE CASO ES:
B STREPTOCOCCUS PNEUMONIAE. C CARDIOBACTERIUM HOMINIS.
D STAPHYLOCOCCUS COAGULASA NEGATIVO.
PREGUNTA 68
EL TRATAMIENTO INICIAL PARA ESTE PACIENTE DEBE INCLUIR:
A VANCOMICINA Y GENTAMICINA. B PENICILINA Y GENTAMICINA. C AMPICILINA Y SULBACTAM. D CLARITROMICINA. PREGUNTA 69
EN EL CULTIVO DE SANGRE, CRECIÓ STREPTOCOCCUS BOVIS, EL ORIGEN MÁS PROBABLE DE LA BACTERIA ES:
A GASTROINTESTINAL. B ODONTOLÓGICO.
C PIEL Y TEJIDOS BLANDOS. D URINARIO.
CASO CLÍNICO
HOMBRE DE 33 AÑOS, ADICTO A DROGAS INTRAVENOSAS, ES ATENDIDO EN CONSULTA POR CONVULSIONES GENERALIZADAS Y ESTADO CONFUSIONAL ACOMPAÑADO DE FIEBRE DE 4 SEMANAS DE EVOLUCIÓN Y PÉRDIDA DE PESO NO CUANTIFICADA. A LA EXPLORACIÓN FÍSICA: TA DE 90/60 MM HG, FC 110 LPM, TEMPERATURA 38 ºC, FR 22 RESPIRACIONES POR MINUTO.
EXÁMENES DE LABORATORIO: HB DE 9.8 G/DL, LEUCOCITOS DE 16 300/MM3, PLAQUETAS 94,000/MM3. LA TELE DE TÓRAX MUESTRA INFILTRADOS EN PARCHE. SE ENVIAN HEMOCULTIVOS SERIADOS (3) QUE A LAS 24 HORAS SE REPORTAN POSITIVOS PARA CRECIMIENTO BACTERIANO POR LO QUE SE REALIZA UNA TINCIÓN DE GRAM.
EL HALLAZGO MÁS PROBABLE EN LA TINCIÓN DE LA MUESTRA ES:
A COCOS GRAM NEGATIVOS. B COCOS GRAM POSITIVOS. C BACILOS GRAM NEGATIVOS. D BACILOS GRAM POSITIVOS.
PREGUNTA 71
EN ESTA PACIENTE, LA VÁLVULA MÁS PROBABLEMENTE DAÑADA ES:
A MITRAL. B AÓRTICA. C TRICÚSPIDE. D PULMONAR. PREGUNTA 72
LA DURACIÓN DEL TRATAMIENTO EN SEMANAS PARA ESTE PACIENTE ES:
A 4. B 6. C 8. D 10.
MUJER DE 72 AÑOS ES ATENDIDA EN CONSULTA POR CUADRO DE DISNEA DE MODERADOS ESFUERZOS, SÍNCOPE DE ESFUERZO EN TRES OCASIONES DURANTE LOS ÚLTIMOS 2 MESES. REFIERE DOLOR PRECORDIAL LEVE
OCASIONAL, ACOMPAÑADO DE MAREOS. E.F.: PULSOS DÉBILES, REGULARES CON FC DE 64 LPM, TA 100/70 MM HG. AUSCULTACIÓN CON SOPLO SISTÓLICO CON FOCO MÁS ACENTUADO EN EL SEGUNDO ESPACIO INTERCOSTAL DEL LADO DERECHO IRRADIADO AL CUELLO. LA TELE DE TÓRAX MUESTRA UNA CARDIOMEGALIA II/IV.
EL HALLAZGO MÁS PROBABLE EN EL ECOCARDIOGRAMA DE ESTE PACIENTE ES:
A DILATACIÓN DE LAS CAVIDADES IZQUIERDAS. B INSUFICIENCIA PULMONAR SEVERA.
C GRADIENTE TRANSVALVULAR PULMONAR INCREMENTADO. D HIPERTROFIA CONCÉNTRICA DEL VENTRÍCULO IZQUIERDO.
PREGUNTA 74
LA VÁLVULA CARDÍACA MÁS PROBABLEMENTE AFECTADA ES:
A MITRAL. B AÓRTICA. C PULMONAR. D TRICUSPIDEA. PREGUNTA 75
EL TRATAMIENTO DEFINITIVO DE ESTE PACIENTE ES:
A NITRATOS. B DIURÉTICOS.
C VALVULOPLASTÍA.
D REEMPLAZO QUIRÚRGICO CON PRÓTESIS CASO CLÍNICO
HOMBRE DE 56 AÑOS, ES ATENDIDO EN LA CONSULTA POR PRESENTAR EN ANTEBRAZOS Y MANOS PRURITO, ERITEMA Y ESFACELACIÓN CON
EXACERBACIÓN DESDE HACE TRES MESES. AGREGÁNDOSE EDEMA FACIAL, MÁCULAS EN CUELLO Y PARTE ALTA DE TÓRAX. ANTECEDENTE DE
TRABAJAR EN FÁBRICA DE CEMENTOS DESDE HACE 20 AÑOS. EXPLORACIÓN FÍSICA: PLACA ERITEMATOSA CON HIPERQUERATOSIS EN MIEMBRO
PÉLVICO DERECHO CON EDEMA Y HUELLAS DE RASCADO.
PREGUNTA 76
EL DIAGNÓSTICO MAS PROBABLE ES:
A DERMATITIS ATÓPICA.
B DERMATITIS POR CONTACTO. C PSORIASIS.
D URTICARIA.
PREGUNTA 77
PARA INTEGRAR EL DIAGNÓSTICO LO MAS RECOMENDABLE ES REALIZAR:
A ESTUDIO EPIDEMIOLÓGICO. B ESTUDIO DE CONTACTOS.
C ESTUDIO DE AGENTES CONTAMINANTES.
D ESTUDIO DE FACTORES DE RIESGO EN LA EMPRESA Y AMBIENTALES. NIÑO DE 8 AÑOS ES ATENDIDO EN CONSULTA EXTERNA POR PRESENTAR ERUPCIÓN EN CUELLO Y PLIEGUES ANTECUBITAL Y POPLÍTEO,
ACOMPAÑADA DE PRURITO. ANTECEDENTE: FAMILIARES CON ASMA.
PREGUNTA 78
EL HALLAZGO DE LABORATORIO QUE APOYA EL DIAGNÓSTICO ES:
A BASOFILIA. B LINFOCITOSIS. C EOSINOFILIA. D NEUTROPENIA. PREGUNTA 79
A TAZAROTENO. B HIDROCORTISONA. C PREDNISONA. D CLOTRIMAZOL.
CASO CLÍNICO
ADOLESCENTE DE 17 AÑOS CON LESIONES DERMATOLÓGICAS EN CARA Y TRONCO. LAS LESIONES COINCIDEN CON EL CAMBIO DE CIUDAD Y DE DIETA POR MOTIVOS DE ESTUDIO. ADEMÁS DEJAN CICATRIZ QUE PREOCUPA MUCHO AL PACIENTE. E.F.: COMEDONES EN DIFERENTES ESTADIOS DE EVOLUCIÓN.
PREGUNTA 80
EN ESTE PACIENTE EL DIAGNÓSTICO MÁS PROBABLE ES:
A FOLICULITIS. B ROSÁCEA. C ACNÉ VULGAR. D MILIARIA. PREGUNTA 81
ENTRE LAS MEDIDAS PREVENTIVAS PARA ESTE PACIENTE SE RECOMIENDA:
A ANTIBIÓTICO V.O. DE MANERA PERMANENTE. B UTILIZAR JABÓN NEUTRO Y EMOLIENTES.
C EJERCICIO, DIETA BAJA EN GRASAS, JABÓN NEUTRO. D EVITAR EXPONERSE AL SOL.
MUJER DE 48 AÑOS, ATENDIDA EN CONSULTA POR CEFALEA FRONTAL DE PREDOMINIO MATUTINO. ANTECEDENTES GINECOOBSTÉTRICOS: CICLOS MENSTRUALES IRREGULARES. E.F: ESTATURA 1.54 M, PESO 82 KG, TA 140/100, GLUCEMIA EN AYUNAS DE 125 MG/DL, TRIGLICÉRIDOS 240 MG/DL, HDL 37, COLESTEROL TOTAL 320 MG/DL.
PREGUNTA 82
EL DIAGNÓSTICO DE ESTA PACIENTE ES:
A OBESIDAD MÓRBIDA. B SÍNDROME METABÓLICO.
C HIPERTENSIÓN ARTERIAL ESENCIAL. D SÍNDROME PREMENOPÁUSICO.
PREGUNTA 83
LAS ALTERACIONES FISIOPATOLÓGICAS EN ESTA PACIENTE SON:
A HIPERCOAGULABILIDAD E HIPERLIPIDEMIA. B HIPERTENSIÓN ARTERIAL Y DIABETES MELLITUS. C RESISTENCIA A LA INSULINA E HIPERINSULINEMIA. D DISLIPIDEMIA E HIPERTENSIÓN ARTERIAL.
CASO CLÍNICO
FEMENINO DE 56 AÑOS, ACUDE A CONSULTA POR PRESENTAR DESDE 2 SEMANAS PREVIAS HIPOSTENIA, HIPODINAMIA, PÉRDIDA DE PESO,
POILIFAGIA, POLIURIA. ANTECEDENTES: PADRE DIABÉTICO. EXPLORACIÓN FÍSICA: OBESIDAD ABDOMINAL, PESO: 100 KG., TALLA 1.68 M. EXÁMENES DE LABORATORIO: GLUCOSA DE 120 MG/DL, COLESTEROL 200 MG/DL,
TRIGLICÉRIDOS DE 360 MG/DL, COLESTEROL-HDL 30.
PREGUNTA 84
EL MECANISMO FISIOPATOLÓGICO DESENCADENANTE ES:
A AUMENTO DE INTERLEUCINA-6. B DISMINUCIÓN DE SELECTINA. C AUMENTO DE LA ADIPONECTINA. D DISMINUCIÓN DE LEPTINA.
PREGUNTA 85
EL PASO INICIAL EN EL TRATAMIENTO DE ESTE PACIENTE ES:
A APLICACIÓN DE INSULINA. B ADMINISTRAR SECRETAGOGOS. C DIETA Y EJERCICIO.
D HIPOLIPEMIANTES.
MUJER DE 25 AÑOS CON ANTECEDENTE DE DIABETES TIPO 1, CURSA EL PRIMER TRIMESTRE DEL EMBARAZO. HA LLEVADO DE MANERA IRREGULAR SU CONTROL GLUCÉMICO. SE PRESENTA ASINTOMÁTICA A LA CONSULTA DE CONTROL PRENATAL CON UROCULTIVO POSITIVO CON 100,000 UFC/ML PARA E. COLI, SIN PIURIA SIGNIFICATIVA. LA PACIENTE MUESTRA
PREOCUPACIÓN Y PREGUNTA CUAL ES EL RIESGO QUE LA DIABETES Y EL TRATAMIENTO GENEREN A SU PRODUCTO.
PREGUNTA 86
PARA ESTA PACIENTE, LA ASEVERACIÓN MÁS ADECUADA, ES:
A ELLA Y SU PRODUCTO TIENEN MENOR RIESGO QUE LAS DIABÉTICAS GESTACIONALES. B NO EXISTE MAYOR RIESGO EN TANTO SE MANTENGA LA GLICEMIA EN AYUNO POR DEBAJO DE 120 MG/DL. C LA INSULINA NO ATRAVIESA LA BARRERA PLACENTARIA, POR LO QUE EL EMBARAZO SERÁ DE CURSO NORMAL. D DE NO MANTENERSE CONTROL GLUCÉMICO EL RIESGO DE MALFORMACIONES INCREMENTA HASTA DIEZ VECES.
PREGUNTA 87
PARA ESTA PACIENTE LA INTERPRETACIÓN MAS ADECUADA DEL RESULTADO DEL UROCULTIVO ES:
A DEBE ATENDERSE AL RESULTADO Y PROPORCIONAR TRATAMIENTO ANTIBIÓTICO. B SÓLO RECIBIRÁ TRATAMIENTO ANTIBIÓTICO SI PRESENTARA SINTOMATOLOGÍA.
D REQUIERE UN SEGUNDO CULTIVO CON TOMA DE MUESTRA. HOMBRE DE 56 AÑOS, ATENDIDO EN CONSULTA POR AUMENTO DE
VOLUMEN, DOLOR, CALOR LOCAL E HIPEREMIA DE RODILLA DERECHA DE 2 DÍAS DE EVOLUCIÓN. NIEGA TRAUMATISMO, REFIERE HISTORIA DE
EPISODIOS DOLOROSOS SEMEJANTES, HACE UN AÑO EN PRIMERA METATARSOFALÁNGICA DERECHA Y OTRO HACE 6 MESES EN TOBILLO IZQUIERDO. EXPLORACIÓN FÍSICA: NÓDULOS SUBCUTÁNEOS IRREGULARES EN CODOS Y SE CONFIRMA FLOGOSIS DE RODILLA DERECHA.
PREGUNTA 88
EL DIAGNÓSTICO DEFINITIVO ES MEDIANTE:
A RECOLECCIÓN DE ORINA DE 24 HORAS. B PERFIL BIOQUÍMICO.
C ARTROCENTESIS Y BUSQUEDA DE CRISTALES. D BIOPSIA DE NÓDULO.
PREGUNTA 89
EL MECANISMO DE PRODUCCIÓN MÁS PROBABLE QUE LE OCURRE ES:
A HIPERSECRECIÓN. B HIPOEXCRECIÓN. C MEDICAMENTOS.
D INGESTA EXCESIVA DE CALCIO.
CASO CLÍNICO
MUJER DE 26 AÑOS, ES ATENDIDA EN CONSULTA EXTERNA POR PRESENTAR DESDE HACE VARIAS SEMANAS TEMBLOR FINO DISTAL, SENSACIÓN DE ANGUSTIA, SUDORACIÓN PALMAR, HA PERDIDO PESO EN LOS ÚLTIMOS MESES. SIN ANTECEDENTES DE IMPORTANCIA. EXPLORACIÓN FÍSICA: TA 130/86 MM HG, PESO 54 KG., TALLA 160 CM., EXOFTALMOS, SUDORACIÓN PALMAR, PIEL HÚMEDA Y CALIENTE, FC 110 LPM, ABDOMEN CON RUIDOS PERISTÁLTICOS INCREMENTADOS.
EN ESTE PACIENTE VA A ENCONTRAR UNA DISMINUCIÓN DE: A TSH. B T4 LIBRE. C T4 TOTAL. D T3 R. PREGUNTA 91
EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:.
A YODO 131. B YODURO. C METIMAZOLE. D TIROIDECTOMÍA.
CASO CLÍNICO
MUJER DE 45 AÑOS, ACUDE A CONSULTA EXTERNA, POR PRESENTAR DESDE HACE 4-5 SEMANAS FATIGA FÁCIL, CONSTIPACIÓN INTESTINAL E
INTOLERANCIA AL FRÍO, HA TENIDO INCREMENTO DE PESO DE
APROXIMADAMENTE 6 KG. EN 3 MESES. EXPLORACIÓN FÍSICA: TA DE 116/86 MM HG, PESO 74 KG., TALLA 162 CM., FC 56 LPM, PIEL SECA, RUIDOS
CARDÍACOS RÍTMICOS, ABDOMEN BLANDO, NO DOLOROSO, EDEMA MODERADO DE PIERNAS.
PREGUNTA 92
EN ESTE PACIENTE SE VA ENCONTRAR UN AUMENTO DE:
A TSH. B T4L. C T4 TOTAL. D T3R. PREGUNTA 93
EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTE PACIENTE ES:
A TRIYODOTIRONINA. B LEVOTIROXINA. C YODURO.
D METIMAZOLE.
MUJER DE 77 AÑOS, INGRESA A URGENCIAS POR DESHIDRATACIÓN SEVERA, ASTENIA ADINAMIA, CON POLIURIA Y POLIDIPSIA, DOLOR DE MIEMBROS INFERIORES E HIPERTERMIA NO CUANTIFICADA. ANTECEDENTES: DIABETES MELLITUS, MAL CONTROLADA Y ABANDONO FAMILIAR. E.F.: PRESIÓN
ARTERIAL 150/105 , TEMP DE 38°C, MUCOSAS ORALES DESHIDRATADAS, TONO OCULAR DISMINUIDO, GIORDANO POSITIVO. LABORATORIO:
GLUCOSA DE 540 MG/DL, UREA 80 MG/DL, CREATININA 3.2 MG/DL, SODIO 125 MEQ, POTASIO 6.7 MEQ. LEUCOCITOS 15 MIL MM3.
PREGUNTA 94
EL TRATAMIENTO INMEDIATO PARA ESTE PACIENTE ES:
A INSULINA. B HIDRATACIÓN. C ANTIBIÓTICOTERAPIA. D DIÁLISIS. PREGUNTA 95
LA CAUSA MÁS PROBABLE DE LA SINTOMATOLOGÍA DEL PACIENTE ES:
A COMPLICACIONES TARDÍAS DE LA DIABETES. B PROCESO INFECCIOSO URINARIO.
C SUSPENSIÓN DE TRATAMIENTO MÉDICO. D TRANSGRESIÓN DIETÉTI
CASO CLÍNICO
HOMBRE DE 16 AÑOS, LLEVADO POR SUS FAMILIARES Y ATENDIDO EN EL SERVICIO DE URGENCIAS, POR DETERIORO PROGRESIVO DEL ESTADO DEL
ALERTA, DIFICULTAD PARA RESPIRAR, NÁUSEA Y VÓMITO; E.FÍ.: SOPOROSO, MUCOSAS ORALES SECAS, TAQUICÁRDICO CON TAQUIPNEA. LABORATORIO: LEUCOCITOS 13,800/MM3, GLUCOSA 420 MG/DL, SODIO 118 MEQ/L, POTASIO 3.0 MEQ/L, UREA 80 MG/DL, CL 110 MEQ/L, PH 7.10, PCO2 18 MM HG, HCO3 10 MG/DL, DEFICIT DE BASE -18.
PREGUNTA 96
EN ESTE PACIENTE SE VA ENCONTRAR UN AUMENTO DE:
A GLUCONEOGÉNESIS. B GLUCOGENOLISIS.
C CAPTACIÓN DE GLUCOSA POR MÚSCULO. D CAPTACIÓN DE GLUCOSA POR LA CELULA.
PREGUNTA 97
LA ALTERACIÓN METABÓLICA EN ESTE PACIENTE ES:
A ACIDOSIS LÁCTICA. B ACIDOSIS METABÓLICA. C ACIDOSIS HIPERCLORÉMICA. D ALCALOSIS RESPIRATORIA.
HOMBRE DE 40 AÑOS ATENDIDO EN CONSULTA POR PRESENTAR CANSANCIO Y PARESTESIAS EN MIEMBROS INFERIORES, A LO QUE SE AGREGA PÉRDIDA DE PESO NO CUANTIFICADA DESDE HACE APROX. 2 MESES. ANTECEDENTES: PADRE DIABÉTICO FALLECIÓ DE INFARTO DE
MIOCARDIO; ES SEDENTARIO Y ACOSTUMBRA COMER ALIMENTOS RICOS EN GRASAS Y CARBOHIDRATOS. E.F-: TA 160/100 , FC 100 LPM, FR 26 POR MIN, TEMP 36.8 ºC, PESO 107 KG., TALLA 1.71 M., REGULAR ESTADO GENERAL, CARDIOPULMONAR Y ABDOMEN SIN DATOS. EXÁMENES DE LABORATORIO: GLICEMIA 400 MG/DL, COLESTEROL TOTAL 260 MG/DL, TRIGLICÉRIDOS 358 MG/DL; GENERAL DE ORINA CETONURIA +, GLUCOSURIA +++.
PREGUNTA 98
EL TRATAMIENTO INMEDIATO PARA ESTE PACIENTE ES LA ADMINISTRACIÓN DE:
A INSULINA. B SULFONILUREAS. C BIGUANIDAS. D TIAZOLINDINEDIONAS. PREGUNTA 99
EL ESTUDIO DE LABORATORIO IDEAL PARA MONITOREAR A LARGO PLAZO EL TRATAMIENTO DE ESTE PACIENTE ES:
A PRUEBA DE TOLERANCIA A LA GLUCOSA. B GLICEMIA EN AYUNAS.
C GLICEMIA CAPILAR.
D HEMOGLOBINA GLICOSILADA
MUJER DE 18 AÑOS, ES ATENDIDA EN CONSULTA POR PRESENTAR
PALPITACIONES Y EVACUACIONES DIARREICAS EN PERIODOS FRECUENTES. ANTECEDENTES: BOCIO EN RAMA MATERNA. E.F.: TA 160/90 , FC 120 LPM. PACIENTE IRRITABLE, ANSIOSA, CON SUDORACIÓN EXCESIVA. ÁPEX ENÉRGICO. RUIDOS CARDÍACOS INTENSOS. PERISTALSIS AUMENTADA, PULSOS ARTERIALES PERIFÉRICOS INTENSOS.
PREGUNTA 100
EN ESTA PACIENTE SE VA A ENCONTRAR AUMENTO DE:
A HORMONA LIBERADORA DE TIROTROPINA. B HORMONA ESTIMULANTE DE LA TIROIDES. C TRIYODOTIRONINA Y TIROXINA.
D ANTICUERPOS ANTITIROIDEOS.
PREGUNTA 101
ESTA PACIENTE DEBE SER TRATADA CON UN MEDICAMENTO QUE ACTÚE A NIVEL DE:
A INHIBICIÓN DE PEROXIDASA TIROIDEA. B LIBERACIÓN DE TSH.
C LIBERACIÓN DE TIROTROPINA. D ANTICUERPOS ANTITIROIDEOS.
CASO CLÍNICO
HOMBRE DE 83 AÑOS, ATENDIDO EN CONSULTA EXTERNA, PRESENTA DESDE HACE UNA SEMANA ANOREXIA, NÁUSEA, DISTENSIÓN ABDOMINAL LEVE, DOLOR EPIGÁSTRICO DE MODERADA INTENSIDAD QUE DISMINUYE CON INGESTA DE ALIMENTOS, POSTERIORMENTE EVACUACIONES
OBSCURAS Y VÓMITO EN POZOS DE CAFÉ. HA PERDIDO
APROXIMADAMENTE 6 KG. EN 2 MESES. ANTECEDENTES: TABAQUISMO IMPORTANTE, ABUSO FRECUENTE DE ALCOHOL. EXPLORACIÓN FÍSICA: PÁLIDO, TA 130/86 MM HG, PESO 68 KG., TALLA 174 CM., ABDOMEN BLANDO, POCO DOLOROSO EN EPIGASTRIO, SIN DATOS DE IRRITACIÓN PERITONEAL. EXÁMENES DE LABORATORIO: HEMOGLOBINA DE 10.9 GR/DL, LEUCOCITOS 7200/MM3, PLAQUETAS 145,000/MM3, CREATININA 1.6 NG/ML, UREA 56 MG/DL.
PREGUNTA 102
EL MECANISMO HOMEOSTÁTICO AFECTADO EN ESTE PACIENTE ES:
A COMPETENCIA DEL ESFÍNTER ESOFÁGICO INFERIOR. B INTEGRIDAD DE LA MUCOSA GÁSTRICA O DUODENAL. C PRESIÓN DEL SISTEMA PORTA.
D MOTILIDAD GÁSTRICA.
PREGUNTA 103
EL DIAGNÓSTICO DEFINITIVO SE ESTABLECE MEDIANTE:
A MANOMETRÍA ESOFÁGICA. B TOMOGRAFÍA COMPUTADA.
C SERIE ESOFAGOGASTRODUODENAL. D PANENDOSCOPÍA.
COMPATIBLE CON HEPATITIS C. ANTECEDENTES: MÉDICO VETERINARIO, HETEROSEXUAL PROMISCUO, RECIBIÓ VARIOS PAQUETES GLOBULARES A LOS 10 AÑOS DE EDAD POR UN ACCIDENTE AUTOMOVILÍSTICO.
EXPLORACIÓN FÍSICA NORMAL. EXÁMENES DE LABORATORIO: AST, ALT, DHL, FA, BILIRRUBINAS, TP, TPT, COLESTEROL, LÍPIDOS Y TRIGLICÉRIDOS NORMALES. EL RESTO DE LA SEROLOGÍA VIRAL HEPÁTICA LO REPORTA COMO POSITIVO ANTI-HBS.
PREGUNTA 104
EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNÓSTICO EN ESTE PACIENTE ES:
A COMPLETAR SEROLOGÍA PARA HEPATITIS A Y E.
B SOLICITAR CARGA VIRAL E IDENTIFICACIÓN DE RNA DEL VIRUS C. C REALIZAR SEROLOGÍA COMPLETA PARA VHB.
D SOLICITAR PRUEBA VIH.
PREGUNTA 105
LA FUENTE DE CONTAGIO DE ESTE PACIENTE, LO MÁS PROBABLE ES:
A LA EXPOSICIÓN PREVIA AL VIRUS DE LA HEPATITIS B.
B EL CONTACTO FRECUENTE CON MATERIA FECAL DE ANIMALES. C LA CONDUCTA SEXUAL CONSIDERADA DE RIESGO.
D LA RECEPCIÓN DE LOS PAQUETES GLOBULARES.
HOMBRE DE 50 AÑOS EN ATENDIDO EN CONSULTA POR PRESENTAR
EVACUACIONES NEGRAS Y FÉTIDAS. ANTECEDENTES: DEPRESIÓN ANSIOSA DESDE HACE CINCO AÑOS Y SÍNDROME DEL INTESTINO IRRITABLE CON CONSTIPACIÓN. EN TRES OCASIONES SE HOSPITALIZÓ POR PARÁLISIS COLÓNICA RESUELTA CON ENEMAS, TOMA BROMURO DE PINAVERIO DE MANERA REGULAR. EXPLORACIÓN FÍSICA: SE PALPA MARCO CÓLICO DOLOROSO Y DOLOR EPIGÁSTRICO.
PREGUNTA 106
A DIVERTICULITIS. B COLITIS INFECCIOSA.
C HEMORRAGIA DE TUBO DIGESTIVO ALTO. D CUCI.
PREGUNTA 107
LA ETIOLOGÍA EXTRADIGESTIVA MAS PROBABLE DE ESTE CUADRO ES:
A PERSONALIDAD OBSESIVA COMPULSIVA. B DISTIMIA CON ANSIEDAD.
C DISAUTONOMÍA SECUNDARIA. D BROTE MANÍACO COMPULSIVO.
PREGUNTA 108
POSTERIOR A LA RESOLUCIÓN DEL CUADRO AGUDO EL TRATAMIENTO FARMACOLÓGICO PARA ESTE PACIENTE ES:
A LANSOPRAZOL, TEGASEROD Y ESCITALOPRAM. B RANITIDINA, CISAPRIDA Y LITIO.
C SUCRALFATO, METOCLOPRAMIDA Y DIAZEPAM. D FAMOTIDINA, AMOXICILINA Y CLONAZEPAM.
CASO CLÍNICO
MUJER DE 69 AÑOS. ATENDIDA EN URGENCIAS POR DOLOR EN
HIPOCONDRIO DERECHO, ICTERICIA SIN FIEBRE Y DIARREA AMARILLENTA DE DOS DÍAS DE EVOLUCIÓN. ANTECEDENTES: COLECISTECTOMÍA ABIERTA HACE DOS MESES SIN COMPLICACIONES INMEDIATAS. EXPLORACIÓN
FÍSICA: ICTERICIA EN CONJUNTIVAS, PALADAR Y PIEL, NO HAY HUELLAS DE SANGRADO NI IRRITACIÓN PERITONEAL. EXÁMENES DE LABORATORIO: HIPERBILIRRUBINEMIA MÁS DE TRES VECES SU VALOR, Y AUMENTO DE LA FOSFATASA ALCALINA. RELACIÓN AST/ALT AUMENTADA DOS A UNO. TIEMPOS DE COAGULACIÓN NORMALES.
PREGUNTA 109
LA CAUSA MÁS PROBABLE DE LA SINTOMATOLOGÍA DE ESTA PACIENTE ES:
A HEPATITIS VIRAL AGUDA POSTOPERATORIA. B RUPTURA DE LA LIGADURA DEL COLÉDOCO. C LESIÓN DE LA VENA HEPÁTICA.
D LITO RESIDUAL EN LA VÍA BILIAR.
PREGUNTA 110
EL SIGUIENTE PASO PARA CONFIMAR EL DIAGNÓSTICO EN ESTA PACIENTE ES:
A COLANGIOGRAFÍA RETROGRADA TRANSENDOSCÓPICA. B ULTRASONIDO DE LA VÍA BILIAR.
C COLANGIOGRAFÍA PERCUTÁNEA. D TOMOGRAFÍA DE LA VÍA BILIAR.
PREGUNTA 111
UNA PROBABLE COMPLICACIÓN DE LA CAUSA QUE MOTIVÓ EL CUADRO DE LA PACIENTE ES:
A PERFORACIÓN DEL CONDUCTO HEPÁTICO COMÚN. B HEMORRAGIA DEL LECHO CÍSTICO.
C COÁGULOS INTRAHEPÁTICOS. D PANCREATITIS BILIA
EL PASO INICIAL EN EL TRATAMIENTO DE ESTA PACIENTE ES:
A COLOCACIÓN DE SONDA RECTAL. B COLOCACIÓN DE ENEMA RECTAL.
D PROVOCACIÓN DEL VÓMITO.
PREGUNTA 113
EL HALLAZGO MÁS PROBABLE EN LA PANENDOSCOPÍA ES:
A PANGASTRITIS. B DUODENITIS BILIAR.
C GASTRITIS DE CUERPO Y ANTRO. D ESPASMO PILÓRICO.
PREGUNTA 114
LA CAUSA MÁS PROBABLE DE LOS SÍNTOMAS EN ESTA PACIENTE ES:
A AMIBIASIS. B ANSIEDAD.
C POLIPOSIS MÚLTIPLE. D ERGE.
CASO CLÍNICO
VARÓN DE 13 AÑOS. ES LLEVADO POR SU MADRE Y ATENDIDO EN
CONSULTA POR ICTERICIA DE 48 HORAS DE EVOLUCIÓN. ANTECEDENTES: ESTUDIANTE, REALIZA EJERCICIO 4 VECES A LA SEMANA, NIEGA
TABAQUISMO Y OTRAS TOXICOMANÍAS. EXPLORACIÓN FÍSICA: TA 120/70 MM HG, FC 90 LPM, FR 16 RPM, TEMP. 37.8 ºC. ICTERICIA DE PIEL Y
TEGUMENTOS. RESTO DE LA EXPLORACIÓN NORMAL. LABORATORIO: TGO 350, TGP 365, ANTI VHA POSITIVO, VHBSAG POSITIVO, VHBSAC NEGATIVO, VHBCAC NEGATIVO, ANTI VHC NEGATIVO.
PREGUNTA 115
EL PRONÓSTICO DE ESTE PACIENTE A LARGO PLAZO SIN TRATAMIENTO ES:
A REMISIÓN DE LA ENFERMEDAD. B EVOLOUCIÓN A LA CRONICIDAD.
C DESARROLLO DE COLANGIOCARCINOMA. D DESARROLLO DE HEPATITIS FULMINANTE.
PREGUNTA 116
EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTE PACIENTE ES:
A INTERFERON Y LAMIVUDINA.
B INTERFERON ALFA PEGILADO Y RIVABIRINA. C REPOSO.
D COLESTIRAMINA.
MUJER DE 72 AÑOS, ES ATENDIDA EN CONSULTA EXTERNA POR REFERIR 3 EPISODIOS DE FRACTURA VERTEBRAL EN UN LAPSO DE 4 AÑOS, SIN
COMPROMISO NEUROLÓGICO. ESTÁ PREOCUPADA POR DICHA SITUACIÓN. ANTECEDENTE: DIABETES MELLITUS DE 10 AÑOS DE EVOLUCIÓN NO
TRATADA ACTUALMENTE. EXPLORACIÓN FÍSICA: LIMITACIÓN MODERADA PARA MOVIMIENTOS DEL TRONCO. EXÁMENES DE LABORATORIO: CALCIO, FÓSFORO Y FOSFATASA ALCALINA NORMALES.
PREGUNTA 117
EL DIAGNÓSTICO PROBABLE EN ESTE CASO ES:
A OSTEOMALACIA.
B ENFERMEDAD DE PAGET. C OSTEOPOROSIS.
D RAQUITISMO.
HOMBRE DE 90 AÑOS, ES ATENDIDO EN CONSULTA POR CALAMBRES Y DEBILIDAD EN MIEMBROS INFERIORES, PARESTESIAS. TIENE
ANTECEDENTES DE HIPERTENSIÓN SISTÓLICA AISLADA YA EN TRATAMIENTO. EXPLORACIÓN FÍSICA: TA 160/70, FC 90 LPM, RUIDOS
CARDÍACOS ARRÍTMICOS. CAMPOS PULMONARES CON HIPOVENTILACIÓN BASAL BILATERAL Y LIGEROS CREPITOS, EXTREMIDADES INFERIORES CON EDEMA +.
EL SIGUIENTE PASO EN LA ATENCIÓN DE ESTE PACIENTE ES SOLICITAR: A ELECTROLITOS SÉRICOS. B ELECTROMIOGRAFÍA. C ECOCARDIOGRAMA. D RX DE TÓRAX PREGUNTA 119
LA COMPLICACIÓN MÁS FRECUENTEMENTE ASOCIADA AL CUADRO CLÍNICO DE ESTE PACIENTE ES:
A ARRITMIAS VENTRICULARES. B INFARTO DEL MIOCARDIO.
C INFECCIÓN DE VÍAS RESPIRATORIAS. D PARÁLISIS MUSCULAR.
MUJER DE 79 AÑOS. TRAÍDA POR SU FAMILIAR AL SERVICIO DE URGENCIAS POR PRESENTAR DESDE HACE 10 DÍAS AGITACIÓN PSICOLÓGICA,
POSTRACIÓN E INCONTINENCIA URINARIA. EXPLORACIÓN FÍSICA: TEMPERATURA: 38 °C. DESHIDRATADA, CON PIEL HÚMEDA Y FRÍA. LABORATORIO: EXAMEN GENERAL DE ORINA CON 15 LEUCOCITOS POR CAMPO, PRESENCIA NITRITOS Y ABUNDANTES BACTERIAS. LEUCOCITOS SÉRICOS: 9,000 MM3 CON 74 % DE POLIMORFONUCLEARES.
PREGUNTA 120
EL AGENTE ETIOLÓGICO MÁS PROBABLE EN ESTA PACIENTE ES:
A CHLAMYDIA TRACHOMATIS. B ESCHERICHIA COLI. C KLEBSIELLA PNEUMONIAE. D ESTAFILOCOCO AUREUS. PREGUNTA 121
EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNÓSTICO ETIOLÓGICO EN ESTE CASO ES:
A UROCULTIVO.
B EXAMEN GENERAL DE ORINA. C CISTOSCOPÍA.
D CISTOGRAMA
CASO CLÍNICO
HOMBRE DE 80 AÑOS, ATENDIDO CONSULTA POR ASTENIA, ADINAMIA, NAÚSEA Y VÓMITO OCASIONAL, VISIÓN BORROSA. TIENE ANTECEDENTES DE INSUFICIENCIA CARDIACA CON DISFUNCIÓN SISTÓLICA POR LO QUE ES MANEJADO CON DIGOXINA. E.F.: TA 110/70, FVM 55 LPM. RUIDOS CARDIACOS CON SOPLO SISTÓLICO EYECTIVO EN FOCO ACCESORIO, CAMPOS
PULMONARES CON LIGEROS ESTERTORES BASALES BILATERALES.
PREGUNTA 122
EL TRATAMIENTO INMEDIATO PARA ESTE PACIENTE ES:
A MARCAPASO B FUROSEMIDE
C DIFENILHIDANTOÍNA D DOPAMINA
MUJER DE 35 AÑOS, ATENDIDA EN CONSULTA POR PRESENTAR DESDE HACE UN MES CEFALEA INTENSA INTERMITENTE, DEBILIDAD, ARTRALGIAS,
DISNEA DE ESFUERZO Y ORINA DE COLOR OBSCURO. ANTECEDENTES: GESTA 3, PARA 3, ÚLTIMO PARTO HACE DOS MESES. NIEGA INGESTA DE MEDICAMENTOS O TRANSFUSIONES. EXPLORACIÓN FÍSICA: TA 150/72 MM HG, FC 92 LPM, PALIDEZ ACENTUADA, ESCLERÓTICAS ICTÉRICAS, ABDOMEN SIN MEGALIAS. RESTO DE EXPLORACIÓN SIN DATOS RELEVANTES. AL
INGRESO HB 9.8 G/DL, HTO 32%; UNA SEMANA DESPUÉS HB 3 G/DL Y HTO 9.7%. BILIRRUBINA TOTAL 9.2 MG/DL, INDIRECTA 8.2 MG/DL, AST 458 UI, ALT 560 UI, EXAMEN DE ORINA: UROBILINOGENO +++, SEROLOGÍA PARA
HEPATITIS B Y C NEGATIVA.
PREGUNTA 123
