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In relation to iron metabolism and its control mediated by hepcidin, it is true that: | The increase in serum iron or inflammation stimulates the synthesis of hepcidin in the liver, which negatively regulates the function of ferroportin. | The drop in partial oxygen pressure promotes the activation of the hypoxia-inducible factor (HIF), which increases the expression of hepcidin. | In hereditary hemochromatosis type 1, mutations in the human hemochromatosis protein (HFE) cause an increase in the production of hepcidin. | Medicine | Hepcidin reduces intestinal iron absorption through the inactivation of the divalent metal transporter 1 (DMT1). | 26 | 2 | 0e2d7263-0f92-429d-8345-612348f07960 | 2024 |
Which of the following biochemical alterations is observed in the metabolic rearrangement of diabetes mellitus?: | The increase in urea production due to greater nucleotide degradation. | The decrease in the translocation of glucose transporters GLUT2 and GLUT4 from intracellular storage vesicles to the plasma membrane. | The increase in hepatic synthesis of glycerol as a gluconeogenic substrate. | Medicine | The increase in hepatic synthesis of triglycerides. | 27 | 3 | b7ff8c7d-3516-4544-9b2b-602939ff2144 | 2024 |
A healthy individual suffers dehydration after performing intense physical exercise at high temperatures without ingesting liquids. Regarding the activation of the renin-angiotensin-aldosterone system under these conditions, indicate the incorrect answer: | Vasoconstriction of the efferent arterioles occurs. | Changes in blood pressure are accompanied by proportional changes in glomerular filtration. | Increases the renal secretion of potassium. | Medicine | Increases the activity of the supraoptic and paraventricular hypothalamic nuclei. | 28 | 1 | 7e819aa6-5eef-4bd5-b999-5fec2db950e2 | 2024 |
From the following statements related to the anatomical structures that form the rotator cuff, indicate the correct one: | The tendons of the rotator cuff muscles reinforce the fibrous capsule of the scapulo-humeral joint. | The muscles that form the rotator cuff are the subscapular, the supraspinatus, the infraspinatus, and the teres major. | The supraspinatus muscle aids in the adduction (bringing closer) of the arm. | Medicine | The infraspinatus muscle rotates the arm inward. | 29 | 2 | 412479da-a41f-4746-90c5-4863d77e15c6 | 2024 |
Which of the following characteristics of the esophagus anatomy facilitates the performance of transesophageal echocardiography?: | The thoracic segment of the esophagus runs along the posterior face of the right atrium and ventricle. | The aortic arch contacts the esophagus at the level of the 4th dorsal vertebra and projects it forward. | The existence of a more dilated segment of the esophagus between the aortic narrowing and the diaphragmatic narrowing. | Medicine | The esophagus runs along the posterior side of the left atrium. | 30 | 3 | f09d66fc-d1d3-4381-8a74-401a998b7dae | 2024 |
A young and healthy person is in an upright anatomical position. Regarding the blood flow through the lungs and its distribution, indicate the incorrect answer: | Exercise increases blood flow in all pulmonary regions. | In a resting state, the flow in the pulmonary vertices is usually intermittent. | A significant decrease in the concentration of O2 in the alveoli causes vasodilation of the adjacent vessels. | Medicine | The increase in cardiac output during intense exercise is assumed by the pulmonary circulation without significant increases in pulmonary arterial pressure. | 31 | 4 | fe13d94c-1e03-48d5-9b64-9931be887c15 | 2024 |
Regarding the cardiac action potential, indicate the correct statement: | The resting potential of automatic cells is more negative than that of ventricular myocardial cells. | Automatic cells have a slow and calcium-dependent action potential. | The If channels are predominantly located in the cells of the ventricular myocardium. | Medicine | Automatic cells have fast sodium channels. | 32 | 1 | 62c6ecc6-defd-4b4c-8792-6b4ae2bd7bc2 | 2024 |
One of the following diseases is caused by hypermethylation of a CGG triplet expansion in the promoter region: | Friedreich's Ataxia. | Huntington's Disease. | Myotonic Dystrophy Type 1. | Medicine | Fragile X chromosome syndrome. | 33 | 3 | 1b9d242a-1a9d-4c45-a53b-9f96b0ac6a88 | 2024 |
A trait that appears in all generations, in both males and females, but males do not transmit it to their male children, corresponds with one of the following inheritance patterns: | Linked to dominant sex. | Autosomal dominant. | Mitochondrial. | Medicine | Sex-linked recessive. | 34 | 2 | 63ee9d62-87fb-4927-9042-78a9057ae4ba | 2024 |
Tumor cells develop different mechanisms aimed at avoiding the activation of the anti-tumor immune response. Among the anti-tumor immunotherapies aimed at counteracting these evasion mechanisms include: | The inoculation of innate immunity cells with antitumor capacity, such as myeloid-derived suppressor cells (MDSC). | The intratumoral inoculation of T regulatory cells specific to tumor antigens. | The use of immunomodulatory monoclonal antibodies against PD-1 or PD-1 ligands. | Medicine | The use of cytokines such as TGF-beta or IL-10 that inhibit tumor growth. | 35 | 4 | 63c9461e-f515-43b1-be14-47d00b543544 | 2024 |
In relation to the immune mechanism involved in the rejection of transplanted solid organs, indicate the incorrect answer: | The presence of specific antibodies against the donor (DSA) in the recipient prior to transplantation is a contraindication for it. | Acute T-cell mediated rejection can be controlled through the use of drugs such as cyclosporine A or corticosteroids. | Hyperacute rejection is mediated by cytotoxic T lymphocytes against donor antigens present in the recipient. | Medicine | Chronic rejection or chronic graft injury is associated with endothelial damage mediated by anti-HLA antibodies. | 36 | 4 | 5636d1af-e0b1-43b0-8a04-6f127dcf6785 | 2024 |
The vaccination using messenger RNA of the S protein (Spike) of SARS-CoV-2 is aimed at protecting the population from COVID-19. In relation to the response to this vaccine, indicate the incorrect statement: | A high percentage of immunosuppressed patients, such as those with organ transplants or with immunodeficiency, have a defect in the response to this vaccine. | The response does not require the collaboration of T lymphocytes, as it is a thymus-independent antigen. | It induces immunological memory based on the activation of B lymphocytes. | Medicine | It is a form of active immunization whose result is associated with the isotype change of antibodies. | 37 | 1 | a88e99a3-1ec6-4b3c-bd95-ed44b7878e91 | 2024 |
In relation to diseases associated with type II hypersensitivity mechanism, indicate the incorrect answer: | The presence of anti-desmoglein autoantibodies is associated with pemphigus vulgaris. | The presence of antibodies against the receptor of thyroid hormones T3 and T4 is associated with Graves' disease. | Goodpasture syndrome is associated with the presence of antibodies against the renal and pulmonary glomerular basement membrane. | Medicine | Myasthenia gravis is associated with the presence of antibodies against the acetylcholine receptor. | 38 | 1 | 443fe80f-97e0-4f98-b096-f2766a4f60a6 | 2024 |
In bronchial asthma, numerous cells are involved in the inflammation of the airway. In relation to the different lymphocyte populations and the cytokines they release, which of the following statements is correct?: | In bronchial asthma, there is a predominance of the TH1 lymphocyte phenotype. | B lymphocytes are responsible for coordinating the inflammatory response. | The population of regulatory T lymphocytes (CD4+ and CD25+) is increased. | Medicine | The cytokines IL4 and IL13 are the promoters of IgE synthesis. | 39 | 3 | 1b497b3a-4c9f-4f4d-b514-06b9dd4ec5cd | 2024 |
In a 16-year-old patient who has been experiencing significant skin dryness and eczematous lesions in flexion zones, primarily in the cubital and popliteal fossae, that are intensely itchy leading to scratching, and which present with exacerbations and remissions over several months, the most probable clinical diagnosis is: | Atopic Dermatitis. | Allergic contact dermatitis. | Dyshidrotic dermatitis. | Medicine | Seborrheic Dermatitis. | 40 | 2 | 71aea3cd-9eba-4602-a99d-2fa1864bb5f4 | 2024 |
A 63-year-old woman undergoing treatment with sulfonamides (trimethoprim-sulfamethoxazole) orally for a lower urinary tract infection. She goes to the emergency room presenting skin and mucosa (oral, conjunctival, and genital) lesions. The skin lesions are dark, irregular macules, with skin detachment and affect more than 30% of the body surface. It is interpreted as a possible serious pharmacological reaction. Which of the following diagnoses is most likely?: | Stevens-Johnson Syndrome. | Erythema multiforme. | Drug-induced hypersensitivity syndrome. | Medicine | Toxic epidermal necrolysis. | 41 | 3 | e83d04d1-0e98-4d3b-8f76-7d67b9575af2 | 2024 |
A patient comes to the consultation recently diagnosed with eosinophilic esophagitis and after presenting him with the treatment options, he prefers to do dietary treatment with a diet excluding two foods. What are the foods that he would have to remove from the diet?: | Cow's milk and fish. | Egg and wheat. | Cow's milk and wheat. | Medicine | Legumes and cow's milk. | 42 | 4 | f0e5b0a9-48ec-4d08-bade-0ae142c59a82 | 2024 |
In relation to the necessary conditions for the implementation of a population screening program for cancer, indicate the incorrect answer: | The disease detected through screening should be relevant from the public health perspective. | There must be an adequate test for detection, regardless of the test's acceptability in the population. | There must be sufficient resources available for the implementation of the medium / long-term strategy. | Medicine | The disease that is detected through screening should be treatable in the presymptomatic stage and the potential harm from the intervention should be less than that of the treatment in the symptomatic stage. | 43 | 1 | 0b2d92e5-2a43-4e85-92ca-4242df98ee1b | 2024 |
Which type of epidemiological study does NOT ALLOW the calculation of a relative risk?: | A retrospective cohort study. | A randomized clinical trial. | A case-control study. | Medicine | A prospective cohort study. | 44 | 4 | 9f4eb879-2b71-4186-b509-1ca144710203 | 2024 |
By increasing the sample size of a cross-sectional (or prevalence) study, the following increases: | The validity of the study. | The representativeness of the sample. | The accuracy of the study. | Medicine | The reproducibility of the study. | 45 | 4 | 57f0a163-389c-4088-b2bc-9216e5e5b6a2 | 2024 |
In a study on the validity of a diagnostic test, to summarize the relationship between the sensitivity and specificity of the test, one can use: | The ROC curve (receiver operating characteristics). | The Kappa Index. | The Altman and Bland graph. | Medicine | The intraclass correlation coefficient. | 46 | 2 | e2a9c34c-28c9-4b53-959c-3ae2ebae18fb | 2024 |
To determine whether exposure to ionizing radiation among workers in a mine influences the occurrence of deaths from lung cancer, a decision is made in 2010 to conduct a study. The researchers collect information from the radiation exposure registry at the mining company, with data on the radiation accumulated by each worker from 1980 to 2000, the year the mine was closed. They also collect information on deaths from lung cancer among these workers from 1980 to 2008, based on existing mortality records. They finally compare lung cancer mortality among workers with the highest and lowest exposure to ionizing radiation. What type of epidemiological design is this? | Prospective case-control study. | Retrospective case-control study. | Prospective cohort study. | Medicine | Retrospective cohort study. | 47 | 3 | d7ab1b16-f3cd-4876-996e-6636628bca66 | 2024 |
A 52-year-old man is recovering from alcohol dependence and requests pharmacological support to prevent relapse and maintain abstinence. Which of the following drugs is indicated as a complementary treatment to maintain abstinence in the framework of a treatment program for detoxified patients who have been dependent on alcohol?: | Nalmefene. | Varenicline. | Thiamine. | Medicine | Acamprosate. | 48 | 3 | a7007f76-639f-46ce-971a-8041cb691b40 | 2024 |
An article describes a phase IV randomized clinical trial in a sample of adults obtained from 42 health centers in 16 different countries who received a study drug and a placebo for 12 weeks. Which of the following statements best describes the context of this research considering these characteristics?: | The drug being investigated in this trial is already approved for prescription in other indications or clinical situations. | As this is a randomized study, the number of men in each of the experimental groups (drug or placebo) must be the same as that of women. | This type of study is called a meta-analysis as it includes patients from different health centers and countries. | Medicine | This clinical trial aims to analyze in healthy and sick individuals the therapeutic doses of an experimental drug compared to a placebo. | 49 | 2 | dc4f55d1-ce87-42d2-b9ed-23e68a5898e3 | 2024 |
A clinical trial whose main objective is to obtain preliminary data on therapeutic efficacy and establish the relationship between the doses and efficacy to determine an appropriate dose range, is a: | Phase I clinical trial. | Preclinical study. | Phase III clinical trial. | Medicine | Phase II clinical trial. | 50 | 3 | f034938e-5d30-48a6-9f7b-89df89d9ac00 | 2024 |
For the detection of infrequent adverse drug reactions (<1/10,000) the most appropriate pharmacovigilance method is: | Intensive hospital monitoring. | Spontaneous notifications. | Meta-analysis. | Medicine | Cohort studies. | 51 | 1 | 98e268ea-09d2-4436-b151-ae5a68a64989 | 2024 |
One of the following drugs, in addition to its analgesic effect, has a smooth muscle relaxant effect: | Paracetamol. | Diclofenac. | Metamizol. | Medicine | Ketorolac. | 52 | 4 | 59398659-98ec-4a9a-aebf-f7a9bb68b48c | 2024 |
Malignant hyperthermia is not related to: | Desflurane. | Succinylcholine. | Sevoflurane. | Medicine | Propofol. | 53 | 3 | 3ebfced0-2054-4d0c-8927-71b459fa8b5d | 2024 |
According to the preoperative physical status classification established by the ASA (American Society of Anesthesiology), a patient with poorly controlled arterial hypertension would correspond to a degree: | III. | IV. | I. | Medicine | II. | 54 | 2 | 7792e463-de79-47df-a9c1-09d02435554d | 2024 |
The adenoid cystic carcinoma: | It never affects the minor salivary glands at the level of the palate. | It is the most common malignant tumor of the salivary glands. | Radiation therapy should be used as the first therapeutic option. | Medicine | It can be associated with facial paralysis due to its neurotropism. | 55 | 3 | 25917f97-7063-491c-a5e4-ab68a05d8550 | 2024 |
Regarding tongue cancer: | It is related to etiopathogenic factors such as sun exposure and the human papillomavirus. | The most common histological type is basal cell carcinoma and its primary treatment is usually radiotherapy. | The most common histological type is squamous cell carcinoma and its surgical treatment usually involves cervical lymph node dissection. | Medicine | It rarely causes metastasis through the lymphatic pathway. | 56 | 4 | 664e18b4-9b91-4bf8-881b-0aa020cc35d6 | 2024 |
Which of the following flaps could NOT be used to perform the reconstruction of a defect in the posterior cervical region? | Free flap of latissimus dorsi muscle with skin island. | Anterolateral fasciocutaneous thigh flap, pedicled. | Free SCIP flap (derived from the superficial circumflex iliac system). | Medicine | Pedicled flap of trapezius (musculocutaneous). | 57 | 1 | fe8790da-08bc-4bcb-abf3-97053c35bb04 | 2024 |
45-year-old man with a history of recurrent herpetic keratitis in the left eye (LE). He consults for pain, hyperemia, and blurred vision in the LE developing over one day. Upon examination, he has a visual acuity with his correction of 1.0 in the right eye (RE) and 0.6 in the LE. Intraocular pressure is 18 mmHg in the RE and 35 mmHg in the LE. Slit lamp examination in the RE is normal and in the LE presents ciliary hyperemia, turbidity in the anterior chamber, slight corneal leukoma and a negative fluorescein test. With which of the following pathologies would you relate this clinical picture?: | Malignant glaucoma. | Hypertensive uveitis. | Herpetic epithelial keratitis. | Medicine | Neovascular glaucoma. | 58 | 1 | 9524b877-0270-4de4-8865-e0e4b1255ff5 | 2024 |
A 57-year-old woman consulted for a routine check-up. In the ophthalmological examination, she presents an uncorrected visual acuity (VA) of 1.0 in the right eye (OD) and 0.5 in the left eye (OI), the pinhole VA is 1.0 in both eyes, and the intraocular pressure is 16 mmHg in both eyes. What would be the most appropriate course of action to take?: | Perform a visual field test to rule out a peripheral visual deficit in the left eye. | Perform a refractive study to assess a refractive defect. | Follow up in a year to assess the evolution of the VA. | Medicine | Conduct a fundus eye study to evaluate a macular pathology in the left eye (OI). | 59 | 1 | 2d545e9b-9081-4ee7-8b86-22bf814618ee | 2024 |
The field defect associated with a lesion in the right optic tract is: | Bitemporal heteronymous hemianopsia. | Left homonymous hemianopsia. | Right homonymous quadrantanopsia. | Medicine | Left homonymous quadrantanopia. | 60 | 1 | 093b2dc3-b570-4e8c-a1ca-c97e09bcff90 | 2024 |
A 40-year-old man presents with a dizzying condition that has been developing over several hours. He does not have hearing loss, tinnitus, or a sensation of ear blockage. During the examination, spontaneous nystagmus is observed. What characteristics of the nystagmus will point to peripheral vertigo? | Vertical nystagmus, unidirectional, which is not suppressed with gaze fixation. | Horizontal nystagmus, unidirectional, that increases in intensity when directed towards the side of the fast phase. | Horizontal nystagmus, with a rotational component that is not suppressed by fixing the gaze. | Medicine | Horizontal nystagmus, with a rotary component, that changes direction when it moves to the side of the slow phase. | 61 | 1 | a69bba63-8a98-4590-8948-b25dd8974d28 | 2024 |
The following systemic diseases may present with otolaryngological symptoms. Indicate the one that most frequently can affect (approximately 70-80% of cases) the nasal cavity, oral cavity, and oropharynx, and that in half of the cases may also involve the larynx: | Relapsing Polychondritis. | Pemphigoid. | Pemphigus. | Medicine | Sarcoidosis. | 62 | 4 | 0691d9a0-5f11-4ef8-8cb5-0d564827b80f | 2024 |
A 48-year-old man, university professor, reports having problems with his voice for several years, which have progressively worsened and consist of a harsh and strained voice, with possible changes in tone, tiredness, and fatigue when speaking. In the fiberoptic endoscopic examination of the pharyngolarynx, no organic lesions are observed in the vocal cords, but a reduction in the anteroposterior diameter of the laryngeal vestibule during phonation is observed. The most likely diagnosis for the vocal disorder this patient is suffering from is: | Spasmodic dysphonia. | Laryngeal abductor paralysis. | Dysphonia due to muscle tension. | Medicine | Dystonia of the extrinsic laryngeal musculature. | 63 | 4 | 89048094-81aa-460a-8d00-9a96328edef4 | 2024 |
A 17-year-old woman presenting with amenorrhea for the past 7 months. She mentions no significant past medical history or any other symptoms. She hadn't sought medical attention earlier as she was training at a high-performance sports center. She had her menarche at 13, with very irregular cycles, no dysmenorrhea, and had a legal abortion at 16. The lab results show a normal complete blood count, FSH <0.1 U/L, LH <0.1 U/L, estradiol <5.0 pg/mL, TSH 1.56 mU/L. What is the most likely diagnosis and the appropriate course of action? | Asherman's Syndrome, therefore a hysteroscopy is indicated. | Premature ovarian failure, for which she is prescribed hormone replacement therapy and control in 3 months. | Functional hypothalamic central amenorrhea, for which a magnetic resonance imaging is requested to rule out other pathologies. | Medicine | Central hypophyseal amenorrhea (Sheehan's syndrome), for which a brain magnetic resonance imaging is requested to confirm the diagnosis and establish a substitution treatment. | 65 | 4 | 55baa318-fe6c-4ab0-b45e-b1113993ef7e | 2024 |
One of her patients, a first-time mother, has undergone a routine ultrasound at 20 weeks of gestation that has detected a myoma in her uterus that appears to have grown significantly compared to previous ones. She is very concerned about the possible sequelae that this tumor may have on the outcome of her pregnancy. You inform her that all of the following complications can occur in pregnancy as a result of uterine myomas, except: | Fetal malposition. | Necrosis and degeneration of the fibroids. | Preterm birth. | Medicine | Progression to leiomyosarcoma. | 66 | 3 | 10af320a-ff27-4abe-9ed3-892ae15bfab1 | 2024 |
A 35-year-old woman with no relevant medical history, who has never been pregnant, presents to the emergency department due to irregular bleeding of moderate quantity that is affecting her quality of life. She also mentions that she has recently been having much heavier periods. Her blood count and coagulation are normal. Gynecologic ultrasonography reveals an anteverted, regular uterus measuring 58x35 mm, with the endometrium in the proliferative phase, a hypoechoic nodule on the anterior surface of the uterus with high resistance peripheral Doppler (no central Doppler) measuring 28x29 mm, compatible with a type 1 leiomyoma (according to the FIGO 2011 classification). Adnexa are normal, with no free fluid in the Douglas space. Indicate the most correct action: | He explains that the leiomyoma is probably the cause of the bleeding and refers her to the hysteroscopy consultation. | The findings are explained to him and it is ruled out that the leiomyoma, given its location, is the cause of his bleeding. | Given the ultrasound findings, a priority magnetic resonance imaging is requested, a GnRH analog is scheduled, and a follow-up appointment is required. | Medicine | He explains that the leiomyoma is probably the cause of the bleeding and refers her to the gynecology clinic to schedule a laparoscopic myomectomy. | 67 | 2 | 52848470-00c8-4613-a737-30b29ecb2a46 | 2024 |
A 29-year-old woman with no significant medical history comes in due to a gestational desire of more than two years. She reports regular menstruation lasting 4 days with dysmenorrhea that prevents her from regular daily activities, pain during defecation, and dyspareunia. Which of the following is the suspected diagnosis?: | Premature ovarian failure. | Endometriosis. | Sterility of tubal origin. | Medicine | Polycystic ovary syndrome. | 69 | 1 | aca345e7-384f-4afa-81be-473650686422 | 2024 |
A 32-year-old postpartum woman (who had a normal delivery 2 months ago and has properly established breastfeeding) comes to the emergency department presenting pain, redness, and heat in the right breast, along with general malaise and a single fever spike of 38 ºC. What would be the most appropriate approach?: | Oral antibiotic therapy, along with proper emptying of the breast. | Discontinuation of breastfeeding with cabergoline and administration of oral probiotics, such as Lactobacillus fermentum, for 1 month. | Local antibiotics, along with breast washes with antiseptics. | Medicine | Withdrawal from breastfeeding with cabergoline and oral antibiotic therapy. | 70 | 2 | 428ed285-5de7-419e-b415-17db09a6aad3 | 2024 |
A 37 weeks pregnant woman, smoker, who comes to the emergency department due to vaginal bleeding similar to menstruation, with no other symptoms. She has no significant medical history except for a cesarean section. The pregnancy has not been monitored. Upon examination, continuous, active, and bright bleeding is observed. The cardiotocographic record shows an active reactive pattern, baseline of 140 beats per minute, normal short-term variability, without dynamics. Indicate the correct statement: | In the suspicion of total occlusive placenta previa, it indicates the termination of pregnancy through cesarean section. | In case of suspicion of premature detachment of normally inserted placenta, an emergency cesarean section is indicated. | In suspicion of a uterine rupture, an emergency cesarean section is indicated. | Medicine | In the suspicion of premature detachment of a normally inserted placenta, vaginal delivery is recommended as the monitoring is reassuring. | 71 | 2 | 28b774e5-3374-4f93-8293-ffab91e6ba8f | 2024 |
Pregnant woman at 29 weeks referred due to suspicion of intrauterine growth restriction (IUGR). An ultrasound reveals an estimated fetal weight in the 1st percentile with Doppler of the umbilical artery showing reversed flow wave during diastole. When is the termination of the pregnancy recommended? | This is about a IUGR type 1 fetus: termination at 37 weeks. | This is a fetus small for gestational age: termination at 40 weeks. | This refers to a IUGR (Intrauterine Growth Restriction) type 3 fetus: termination at 30 weeks. | Medicine | This is about a type 2 IUGR fetus: termination at 34 weeks. | 72 | 4 | 6552014e-c628-4cf8-b108-9ee63457ada8 | 2024 |
In relation to whooping cough caused by Bordetella pertussis, state the correct assertion: | Azithromycin is the antibiotic of choice for treatment in all age groups. | In the clinical examination of whooping cough, the presence of wheezing in lung auscultation is common. | Vomiting following the paroxysmal coughing episode is extremely rare. | Medicine | The "crow" (massive inspiratory effort) primarily occurs in children under 2 months of age. | 73 | 2 | 510b62c1-039f-4d75-b29f-b8b401db8f47 | 2024 |
A 3-year-old patient arrives at a hospital emergency room. In the pediatric evaluation triangle, there is an alteration on 2 sides: appearance and circulation. Notably, on examination, there is a blood pressure of 60/30 mmHg and a widespread macular erythematous rash. Additional tests show an increase in urea and creatinine, a lengthening of the prothrombin time, low fibrinogen, platelets at 50,000/mm3, and an increase in transaminases. A culture of the blood isolates Group A streptococcus. Which of the following is the most likely diagnosis?: | Poststreptococcal glomerulonephritis. | Streptococcal fasciitis. | Scarlet Fever. | Medicine | Streptococcal toxic shock. | 74 | 3 | 84e0fe91-2a7e-4c84-ad2e-4108494ebd41 | 2024 |
Regarding acute bronchiolitis in childhood, indicate the correct answer: | The administration of palivizumab is recommended to protect children at high risk against severe complications from RSV disease. | The respiratory syncytial virus (RSV) is the second leading cause of acute bronchiolitis and viral pneumonia in children under 1 year old. | The treatment is based on aerosols of hypertonic saline, adrenaline and/or beta-2 agonists depending on the severity. | Medicine | Bronchiolitis occurs due to obstruction and collapse of medium and large caliber respiratory tracts during exhalation. | 75 | 2 | 0f520c7c-40c4-493a-93fb-f9aace098191 | 2024 |
A 10-year-old girl who, on analysis, shows a significant elevation of transaminases, which persists in subsequent controls. Among the complementary studies, the presence of liver-kidney type 1 anti-microsomal antibodies (anti-LKM-1) in the blood stands out. The condition she presents has all the following characteristics, except for one of the following: | In the liver biopsy, it will present a typical interface hepatitis. | Hypogammaglobulinemia. | This is a type 2 autoimmune hepatitis. | Medicine | It is more common in females. | 76 | 1 | dd3ec0d2-5de7-4d59-aa71-dc2a669842c5 | 2024 |
A 2-year-old patient with fever, conjunctivitis, runny nose, and repetitive cough. Their vaccination status is unknown. Upon examination, on the oral mucosa, at the level of the premolars, there are bluish-white spots surrounded by an erythematous halo. Which of the following is the most likely diagnosis?: | Scarlet Fever. | Kawasaki Disease. | Measles. | Medicine | Measles. | 77 | 4 | fb644ed4-09d2-4909-9b8f-8110cbf610dc | 2024 |
An 18-month-old girl, recently adopted from an African country, is seen in consultation for a health examination. Upon analysis, very low levels of Vitamin D are observed. Given this finding, what is the least likely observation? | Widening of wrists and knees. | Persistence of anterior fontanelle. | Knock knees. | Medicine | Hepatomegaly. | 78 | 3 | a4376982-3ff2-4b9e-90a1-cd849c386b17 | 2024 |
The Apgar score is a practical method in the assessment of the newborn. It includes all the following signs except one. Which one?: | Respiratory rate. | Heart rate. | Color. | Medicine | Muscle tone. | 79 | 2 | f65b824a-55ed-4780-9c82-50269aa5a813 | 2024 |
8 year old boy, attended to for abdominal pain of 2 days duration. The previous night, he had a bloody stool. This morning he woke up with pain in both ankles, doesn't want to walk and has been seen with spots on his legs. Upon examination, he is in good general condition, normal auscultation, abdomen painful on palpation without signs of peritoneal irritation. In the ENT sphere, only a red pharynx is noticeable. He presents petechial lesions and bruises on both legs with inflammation of both ankles. The most probable clinical diagnosis with the data provided is: | Measles. | Schönlein-Henoch purpura. | Scarlet fever. | Medicine | Kawasaki Disease. | 80 | 1 | 83a1fb77-1878-4f07-b5f0-7f029a62ba26 | 2024 |
The hemolytic-uremic syndrome is one of the most frequent causes of acute renal failure in young children. It is typically characterized by all of the following, except: | Thrombocytopenia. | Microangiopathic hemolytic anemia. | It can be triggered by a previous infection with Streptococcus pneumoniae. | Medicine | Prolongation of coagulation times (APTT and prothrombin). | 81 | 3 | 181e3a1e-9395-4dea-81bb-21ecfd9d25c1 | 2024 |
Regarding the pharmacological treatment of acute mania in bipolar disorder, indicate the incorrect answer: | Antipsychotics are effective both in monotherapy and in combination with mood stabilizers. | Lithium is equally or slightly more effective than valproate. | There isn't a preferred antipsychotic in the treatment. | Medicine | Lithium shows similar efficacy to antipsychotics, although with a faster onset of action. | 82 | 3 | cb530421-7c14-4003-bcc9-2fcaa7e80e2d | 2024 |
Regarding the epidemiology of schizophrenia, indicate the correct statement: | Early onset is more common in males. | Its maximum age of onset is at 40 years old. | People who suffer from it have a 2 to 3 times lower likelihood of dying prematurely than the general population. | Medicine | As this is a neurodevelopmental disorder, the importance of psychosocial factors in its onset is negligible. | 83 | 2 | 1379d7b0-4933-463e-90aa-52263e78674b | 2024 |
A 50-year-old doctor frequently accumulates a delay of 2 hours in the consultation, creating some conflict, even though he has the smallest patient load. He starts his work day before hours to plan and get ahead of his work, but he is always the last one to leave. He explains: "I can't stand leaving something halfway, I’m very perfectionist, I have many things to do besides visits (bureaucracy, paperwork) and I have no time for anything else. I don't know how my colleagues who have family, hobbies... manage it. I don't even have time to go to the gym. On weekends I stay at home, resting. I have no social life." Upon examination, a concern for details, order and rules is evident, alongside an inability to discern what is urgent and important from what is not, an inflexible behaviour and an inability to delegate. Which of the following would be the diagnostic orientation? | Narcissistic personality disorder. | Schizoid personality disorder. | Unspecified personality disorder. | Medicine | Obsessive-compulsive personality disorder. | 84 | 3 | 1ea5870c-4899-4c90-ad16-d230a757ebe3 | 2024 |
The fundamental neurobiological basis of bulimia nervosa, which also supports its usual pharmacological treatment, consists of a dysfunction in neurotransmission: | Dopaminergic. | Serotonergic. | Cholinergic. | Medicine | Histaminergic. | 85 | 1 | 1ed52d65-a6fd-446d-8375-cdad8b70de60 | 2024 |
An 87-year-old woman suffers from moderate Alzheimer's disease and high blood pressure. She also suffers from urinary incontinence, which has been worsening in recent weeks, and a anticholinergic drug (oxybutynin) has recently been prescribed to her. What problem can the intake of this drug most frequently trigger? | The appearance of atrioventricular block. | The occurrence of delirium. | The appearance of a Sjögren's syndrome. | Medicine | The occurrence of hypertensive crises. | 86 | 1 | 18038d4c-5aa7-44b7-acfd-496586e8ab94 | 2024 |
We evaluated in the emergency room an adult person who is irritable, yawning, complaining of muscle pain and cramps. They are nauseous and have notable tearing. The pupils are dilated. Which of the following is the most probable diagnosis? | Opioid abstinence. | Benzodiazepine poisoning. | Alcohol abstinence. | Medicine | Cannabis poisoning. | 87 | 2 | 341dca14-207e-4700-a8c7-13a7e642387c | 2024 |
The DSM-5 criteria for the diagnosis of major depressive disorder require the presence of at least one of two main symptoms of the disease. Which of the following is one of these main symptoms?: | Insomnia. | Agitation. | Anhedonia. | Medicine | Anergia. | 88 | 4 | bdbaebc7-737c-4cfd-8600-85d84f867dfa | 2024 |
A 33-year-old man, single, has been living with his partner for 10 years. He is a worker by profession. He has a very good relationship with his birth family, with certain emotional dependency on his mother. For the past year, he has been increasingly worried about every aspect of his life and is very restless and occasionally irritable. He feels exhausted, tense and ill, which is why he has visited the emergency room a couple of times over the past year. Furthermore, he feels like he's out of control, experiences ruminations, anticipatory anxiety, sadness, and apathy. The clinical picture started when the company he works for began a process of employment regulation. What is the most probable diagnosis from the following? | Generalized anxiety disorder. | Dysthymic disorder. | Somatization Disorder. | Medicine | Major depressive episode. | 89 | 2 | f1c9a453-2c77-456b-8b20-dc43c79d6e3f | 2024 |
Within the neurological examination, the term astereognosis refers to: | The inability to locate a superficial tactile stimulus in the body. | The inability to recognize the shape, size, weight, and texture of an object by blind palpation, while basic sensitivities are normal. | The situation that occurs when two symmetrical points are stimulated simultaneously and only one of the stimuli is perceived. | Medicine | The loss of the sensory capacity to discriminate between two simultaneous stimuli that are typically recognized as independent. | 90 | 1 | c52dcfd2-bcae-43fc-80d1-97f671b1d8e9 | 2024 |
A 15-year-old teenager who begins to have myoclonic seizures, especially in the arms, more frequent upon awakening, which usually occur after sleep deprivation or alcohol consumption. After the myoclonic seizures, he sometimes has a generalized seizure. In the EEG, spike-wave complexes and poly-spike-wave complexes with high photosensitivity are identified. Of the following, which would be the most recommended antiepileptic drug to start the treatment?: | Carbamazepine. | Clonazepam. | Valproic Acid. | Medicine | Ethosuximide. | 91 | 4 | 363ba2f7-c4f8-4c6d-af5c-baae3c6fed84 | 2024 |
A 50-year-old woman reports difficulty falling asleep due to restlessness and paresthesia in her legs. Her physical and neurological examination is normal. Her treatment should not include: | Iron supplements, in case of iron deficiency. | Methylphenidate. | Pregabalin. | Medicine | Dopaminergic agonists. | 92 | 1 | 69d411d6-8ce0-494b-9fc7-621187701cc1 | 2024 |
A 7-year-old boy presents to the emergency department with a 12-hour history of fever, headache, neck stiffness, and petechiae on his trunk and legs, with a significant impairment of his general condition. Which of the following statements is correct?: | The most likely etiology is pneumococcus. | It is expected to find gram-positive diplococci in the cerebrospinal fluid. | The most appropriate initial empirical treatment is acyclovir. | Medicine | It will be necessary to perform chemoprophylaxis on individuals who have been in close contact with the patient. | 93 | 3 | ef643297-47ad-4f68-8df0-31f62b172332 | 2024 |
A 67-year-old man with a sudden deterioration in his level of consciousness, appears obnubilated. He presents visual alteration, with ptosis and mydriasis of the right eye associated with loss of vision in the right eye, he can only count fingers with the left eye. The cranial CT shows a hemorrhagic lesion that enlarges and deforms the pituitary fossa, with some suprasellar extension. In relation to this clinical picture, indicate the incorrect response: | It usually presents with hormonal hyperfunction. | Urgent transnasal endoscopic surgical treatment could improve the prognosis for visual impairment and nerve damage. | It usually occurs when there is a pre-existing tumor. | Medicine | This clinical picture can also occur in women after childbirth. | 94 | 2 | 5bc44948-3bbb-4f88-bb80-44492bbe99ac | 2024 |
A 45-year-old woman is experiencing stabbing pain in her right hemiface. The pain is triggered by touch, washing, or brushing her teeth. She does not experience pain at night. Indicate the incorrect answer: | Carbamazepine remains the treatment of choice. | The most effective treatment is surgical decompression if neurovascular contact exists. | The loss of sensitivity associated with pain is common. | Medicine | Both radiosurgery and ablative procedures (e.g., radiofrequency) carry a risk of recurrence. | 95 | 4 | 3ebaad29-9603-4250-af5d-02cdb5d0dea1 | 2024 |
Which of the following drugs is associated with a reduction in delirium in intensive care units?: | Dexmedetomidine. | Cisatracurium. | Venlafaxine. | Medicine | Midazolam. | 96 | 2 | 7d4fedce-e2fa-4d8b-97e0-e19064239195 | 2024 |
A 59-year-old man is admitted to the ICU due to acute hypoxemic respiratory failure secondary to severe community-acquired pneumonia. Due to respiratory failure, he requires sedation and connection to invasive mechanical ventilation. His occupational history includes working at a pig farm, so it is empirically decided to cover for methicillin-resistant Staphylococcus aureus until cultures from respiratory secretions are obtained. Which of the following antibiotics would you empirically start as monotherapy antimicrobial? | Ceftaroline. | Piperacillin-tazobactam. | Cefotaxime. | Medicine | Cefazolin. | 97 | 2 | b0f52abd-6e05-4551-90d9-e70e46cb1023 | 2024 |
A 27-year-old patient suffers a high-impact accident with an electric scooter on the street. Upon arrival at the emergency room, he is conscious and oriented, Glasgow 15, with a tendency towards hypotension. In the initial examination, he presents with functional impotence with a muscle balance according to Daniels of 5 in all upper extremity groups. In the lower extremities, psoas 5, quadriceps 3, anterior tibial, sural triceps, and big toe extensors 0 bilateral. Of the following, the initial diagnostic suspicion is: | Burst fracture of L2 with neurological involvement. | C7-T1 fracture-dislocation. | Burst fracture of T12 with complete spinal cord involvement. | Medicine | Lumbar spinal cord ischemia secondary to trauma. | 98 | 2 | fc7f83ba-6be3-4903-b57f-eb5940b27213 | 2024 |
A 12-year-old girl with no relevant medical history, who started menstruating 4 months ago, visits the rehabilitation clinic referred by her pediatrician after noticing a shoulder asymmetry during the annual checkup. In the physical examination, she presents an asymmetry in the height of the shoulders and hips with a positive Adams test. From the following, the correct approach to follow is: | Propose a review in 6 months with a supine scoliosis x-ray. | Request a standing scoliosis X-ray and depending on the Cobb angle, decide on treatment with a brace. | Recommend swimming for correction and review in 6 months. | Medicine | Refer to physiotherapy for stretching and massages of the spine. | 99 | 1 | 18786d01-350d-425c-815a-65ee44ca6198 | 2024 |
52-year-old woman, professional butcher, with no relevant medical history or falls, who has been experiencing shoulder pain for 4 months when raising her arm. The pain has inflammatory characteristics, and impingement tests are positive. Identify the incorrect attitude: | Refer to a specialist surgeon to perform a shoulder arthroscopy. | Start treatment with NSAIDs, request an ultrasound and refer to rehabilitation. | A rotator cuff injury (supraspinatus with subacromial bursitis) is suspected, so it is necessary to strengthen the shoulder's de-coaptant musculature. | Medicine | If there is passive limitation of joint range, with suspicion of adhesive capsulitis, refer urgently for passive mobilizations to rehabilitation. | 100 | 2 | da39839b-5979-44f1-895e-38810ec46550 | 2024 |
A 56-year-old woman consults because she twisted her ankle on the beach 4 months ago and it has been bothering her ever since. She gets tired when climbing stairs and finds it hard to wear flat shoes. Upon examination, she presents pain in the sinus tarsi, the heel, and the medial side of the ankle. On podoscopic examination, her heel is in valgus, although corrects when on tiptoes. The structure most likely affected is: | The anterior talofibular ligament. | The tendon of the posterior tibial muscle. | The intertalocalcaneal ligament. | Medicine | The tendon of the long flexor muscle of the big toe. | 101 | 1 | 68d42ee4-ef9a-463e-b22e-f4e80294e0c4 | 2024 |
Caregiver for individuals over 55 years old, with no notable medical history, right-handed, who reports pain and numbness on the palmar face of both hands, worse on the right, predominantly at night, as well as a feeling of significant swelling upon waking in the morning, being slightly more intense in the 2nd and 3rd fingers. She does not report any other symptoms in upper limbs or neck. Of the following, what is the first diagnostic suspicion?: | Epitrochlear ulnar compression. | Cervical spondyloarthrosis C5-C6. | Carpal Tunnel Syndrome. | Medicine | Cervical disc herniation C6-C7. | 102 | 4 | b9c5f6d0-8463-403a-9319-8581ea00fdd4 | 2024 |
A 67-year-old woman returns to the emergency room who was treated yesterday for a fracture of the distal end of the left radius through closed reduction under local anesthesia and forearm cast. She complains of unbearable pain, which increases when her fingers are moved; indeed, she is unable to actively move her fingers and they are very swollen. What complication should we immediately treat? | Local compartment syndrome. | Complex Regional Pain Syndrome. | Secondary displacement of the fracture. | Medicine | Tendon rupture of extensors. | 103 | 2 | a297279f-9e14-4659-a049-40fe6b815859 | 2024 |
An active 73 year old patient, who suffers from severe pain of EVA 8-9 intensity in the right shoulder (dominant limb) with loss of mobility. An X-ray and an MRI were performed, which show a complete tear of the rotator cuff with ascension of the humeral head and erosion (acetabularization) of the lower edge of the acromion. What is the most appropriate therapeutic approach?: | Infiltration of the rest of the cuff with mesenchymal cells. | Anatomical shoulder prosthesis. | Reverse shoulder prosthesis. | Medicine | Arthroscopic repair of the rotator cuff using double row anchors. | 104 | 4 | 18630edd-a9c1-4308-9931-6029bb8c3b87 | 2024 |
A 6-year-old girl who was celebrating a birthday in a bouncy castle, fell on her outstretched arm. She came to the emergency department with pain and deformity at the level of the distal right humerus and functional impotence of the elbow. On examination, no radial pulse is palpated, the capillary refill of the fingers is 2 seconds, and the color of the hand is pinkish. The most advisable approach is: | Reduce and fix the fracture in the operating room and observe the vascular response. | Perform an arteriography of the humeral artery. | Perform a Doppler ultrasound of the radial artery at the level of the wrist. | Medicine | Proceed to the surgical exploration of the humeral artery. | 105 | 2 | ef187dea-b4ea-4084-94ff-6a17079360a8 | 2024 |
A 3-week-old neonate presenting an asymmetrical Moro reflex. The baby was delivered vaginally by a primiparous mother, birth weight was 4.600 g. A lump can be felt on the right clavicle and the right shoulder is kept in adduction, with the elbow extended and laxity of the wrist and fingers of the right hand. The chest X-ray taken at birth shows a raised right hemidiaphragm. The presence of the following is an indicator of a poor prognosis: | An ipsilateral clavicle fracture. | Absence of bicep contraction at this age. | A congenital dislocation of the ipsilateral hip. | Medicine | An ipsilateral Horner's syndrome. | 106 | 3 | af5b2a9a-2814-45f5-94f8-aa9b2d2890da | 2024 |
A 62-year-old man with no relevant medical history and a sedentary occupation, who is consulting for very intense, debilitating pain in the lumbar region, which has been evolving for 1 week, radiating to the buttocks, the back of the left thigh, and the anterolateral aspect of the left leg. The Lasègue sign is negative and he does not present with muscle strength deficit in the lower limbs. The most appropriate therapeutic attitude among the following is: | Perform urgent radiography and magnetic resonance imaging of the lumbar spine. | Urgently refer to neurosurgery for imaging tests and surgical evaluation. | Request a priority electromyogram of the lower extremities. | Medicine | Prescribe a non-steroidal anti-inflammatory at high doses, avoid bed rest, mild local heat, and review in 2 weeks. | 107 | 3 | 4e7f71be-9fc1-4636-a7b8-502f48f7867f | 2024 |
60-year-old woman diagnosed with an autoimmune disease. During the physical examination, she presents bilateral enlargement of the parotids, cutaneous vasculitis, and a Schirmer test on the right eye of 2 mm, left eye 1 mm (below normal). The lab test highlights a positive rheumatoid factor, ESR 30 mm (1-20), CRP 1.3 (0-0.5), positive antinuclear antibodies with a fine speckled pattern, positive anti-Ro and anti-La antibodies, and hypocomplementemia. Which of these diseases is she more at risk of developing during the progression of the disease?: | B-cell lymphoma. | Acute Lymphoblastic Leukemia. | T-cell non-Hodgkin lymphoma. | Medicine | NK cell leukemia. | 108 | 2 | 699b90ec-0b8c-427c-ba8e-1202d46dfb00 | 2024 |
A 50-year-old man who consults for lumbar pain of 6 months duration that does not improve with rest, even wakes him up at night, with morning lumbar stiffness lasting more than an hour. Which of the following images is most likely to be found on a lumbar spine x-ray? | Typical osteophytes of spondyloarthritis. | Typical osteophytes of spondyloarthrosis. | Typical syndesmophytes of spondyloarthritis. | Medicine | Typical syndesmophytes of spondyloarthrosis. | 109 | 4 | d6f4cd77-2a1f-4cb9-863f-ecf47a12419d | 2024 |
Regarding the extra-articular manifestations of rheumatoid arthritis, indicate the incorrect answer: | The most common cardiac manifestation is pericarditis. | It is the most common cause of secondary Sjögren's syndrome and it presents with dry keratoconjunctivitis. | The most common hematological manifestation is leukopenia. | Medicine | Pleuritis is characterized by a pleural effusion with exudative characteristics and typically very low glucose. | 110 | 4 | 152ceb7d-4eaa-4574-a012-3c34f8e7376e | 2024 |
A 48-year-old man with a history of hypercholesterolemia and active smoking. He presents with central thoracic pain radiating to the neck accompanied by nausea and profuse sweating that has been evolving for an hour. The pain had started during a climb up a mountain, which is why he was transferred to a health center, where an EKG showed an acute anteroseptal myocardial infarction. The nearest tertiary hospital (with 24-hour hemodynamics on call) is three hours away. In which of the following circumstances would you RULE OUT extrahospital coronary reperfusion through intravenous fibrinolysis and propose a primary angioplasty?: | Previous cranial hemorrhage without sequelae 10 years ago. | Presence of signs of heart failure. | Blood pressure figures ≥ 140/90 mmHg. | Medicine | History of ischemic stroke 18 months ago. | 111 | 2 | 82b30af4-37e9-42a8-9c4f-0a1be70ba274 | 2024 |
All the situations listed below refer to patients at high risk of developing infectious endocarditis and therefore with an indication for antibiotic prophylaxis before invasive procedures, except ONE. Indicate which: | Patients with untreated cyanotic congenital heart disease. | Patients with transcatheter prosthetic aortic valve. | Patients who have previously suffered from infectious endocarditis. | Medicine | Patients with bicuspid aortic valve. | 112 | 3 | 9c653594-a43d-4362-8859-cd5d23bb20d1 | 2024 |
A 23-year-old man, following a bout of the flu, presents in a state of refractory cardiogenic shock to amines at a level 3 hospital. On the transthoracic echocardiogram, a left ventricular ejection fraction of 15% is observed. Given the suspicion of viral myocarditis, which of the following is the preferred therapeutic option to improve his hemodynamic situation?: | Placement of an intra-aortic balloon pump. | Increase the dose of amines and include in the urgent list for heart transplant. | Placement of a short-term ventricular assist device. | Medicine | Implantation of a biventricular electronic stimulation device. | 114 | 4 | 83516d1b-09c2-459a-a72f-0dfd3f9a1a31 | 2024 |
Regarding infectious endocarditis (IE), indicate which of the following situations has an indication for cardiac surgery within 24-48 hours: | A 70-year-old patient with mitral IE due to E. faecalis, in whom moderate valvular insufficiency is evidenced. | 82-year-old patient with IE by S. mitis on biological aortic prosthesis, with good clinical evolution, without valvular dehiscence, with a pseudoaneurysm of the aortic root at the 4th week of antibiotic treatment. | A 68-year-old patient with aortic IE due to S. aureus with moderate-severe aortic valve insufficiency and an episode of left ventricular failure with grade III heart failure according to the NYHA during the first week of antibiotic treatment. | Medicine | A 75-year-old patient with aortic IE with moderate valvular regurgitation and no hemodynamic compromise, with repeated isolations in blood cultures of Candida albicans sensitive to azoles. | 115 | 4 | 77b83d36-b042-4063-ae7e-1be335459931 | 2024 |
In relation to mitral valve prolapse, indicate the correct answer: | It is more common in men. | Myxomatous valve degeneration can also affect the tricuspid and aortic valves. | The heart murmur that can characteristically occur decreases in intensity with the Valsalva maneuver. | Medicine | It has a benign course and rarely causes mitral valve insufficiency. | 116 | 1 | 8fd385bf-4f70-4213-a0bf-5cf4ba56ccb0 | 2024 |
A 58-year-old woman, after an upper respiratory infection, is admitted to the hospital for dyspnea with minimal effort, intense asthenia, and paroxysmal nocturnal dyspnea in the previous days. The electrocardiogram shows a sinus rhythm at 70 bpm with left bundle branch block. The transthoracic echocardiogram shows a left ventricular ejection fraction (LVEF) of 25%. Coronary angiography rules out coronary artery disease. Of the following treatment proposals, which would be the recommended combination of drugs to improve her prognosis and reduce hospital readmissions due to cardiac decompensation?: | Beta-blocker, aldosterone antagonists, ivabradine and iSGLT2 (inhibitors of the sodium-glucose co-transporter type 2). | Beta-blocker, digoxin, ARNI (angiotensin receptor-neprilysin inhibitor) and iSGLT2 (sodium-glucose co-transporter-2 inhibitors). | Beta blocker, aldosterone antagonists, ARNI (neprilysin-angiotensin receptor inhibitor) and SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitors). | Medicine | Beta blocker, aldosterone antagonists, ARNI (neprilysin-angiotensin receptor inhibitor) and milrinone. | 117 | 4 | 0e883e30-0276-4246-8e2e-69d856273b12 | 2024 |
A 65-year-old patient with a history of an anterior myocardial infarction presents with tachycardia with wide QRS, accompanied by hypotension (BP 70/40 mmHg) and clouding of consciousness. Which of the following is the treatment of choice? | IV Amiodarone. | IV Lidocaine. | Urgent electrical cardioversion. | Medicine | IV Procainamide. | 118 | 4 | 9e26bdf8-385e-40c6-aaf4-3c5bdb9e7546 | 2024 |
In the face of a term newborn with cyanosis with a pO2 of 30 mmHg, right ventricular hypertrophy on the electrocardiogram and "egg" image on the chest radiograph, which of the following is the most likely diagnosis?: | Persistence of the arterial duct. | Dextro-transposition of great arteries. | Ebstein's Disease. | Medicine | Tetralogy of Fallot. | 119 | 1 | 540441c4-477a-467b-b6d7-ee74241e3c15 | 2024 |
A 70-year-old man, who underwent coronary revascularization surgery 5 days ago, comes to the emergency room due to a syncope followed by a persistent feeling of dizziness. Upon examination, blood pressure stands out at 70/40 mmHg, decreased heart sounds, and jugular venous distention with electrical alternans on the EKG. Which of the following diagnoses is most likely?: | Pericarditis. | Acute coronary syndrome. | Endocarditis. | Medicine | Cardiac tamponade. | 120 | 3 | 167472c3-1a67-41e4-83e1-2528bc051f62 | 2024 |
Asthmatic woman who, after a stormy day, presents with breathlessness and self-perceived wheezing. After initial treatment with a beta2 agonist and inhaled corticosteroids, there was no improvement in symptoms, requiring bronchodilators every hour for several consecutive hours, with a significant increase in respiratory work. Of the following, which is the most appropriate attitude?: | Before starting the treatment, a chest X-ray, arterial blood gas test, and general lab tests should be performed to establish the diagnosis. | Beta2 agonists should be urgently administered in nebulized form and, in case of absence of early response, intravenous corticosteroids should be added. | As a first choice, nebulized anticholinergics should be administered, due to the lack of response to beta2 agonists. | Medicine | Inhaled corticosteroids could be contraindicated due to the increased risk of pneumonia. | 121 | 1 | b1fdf38e-c273-425d-aa4b-33dbcd385c81 | 2024 |
A 75-year-old man with a history of heart failure with a left ventricular ejection fraction of 30%. He consults for sleep apneas witnessed by his partner. The degree of drowsiness on the Epworth scale is 5. The sleep study shows episodes of periodic breathing with an apnea-hypopnea index of 22 per hour of sleep, all respiratory events being central. Of the following, the recommended therapeutic approach is: | Optimize the treatment of heart failure. | Start treatment with continuous positive pressure through the nasal route. | Start treatment with servo-ventilation. | Medicine | Therapeutic trial with mandibular advancement prosthesis. | 122 | 2 | e251f796-a804-488b-baa5-433632a80557 | 2024 |
A 75-year-old patient, smoker (PAI 35), who reports progressive exertional dyspnea for the past 3 years. Chest X-ray does not show relevant alterations. In the baseline spirometry, the patient has FVC 1720 mL (62%), FEV1 610 mL (30%) and FEV1/FVC 35%. What is the suspected diagnosis and the next action to take? | The diagnosis of chronic obstructive pulmonary disease can be established. A thoracic CT scan should be requested to confirm the existence of emphysema. | This refers to a mixed ventilatory disorder with a predominant restrictive pattern. A complete functional study must be conducted to investigate the causes. | The patient presents a mixed ventilatory alteration with a severe obstructive component suggesting COPD. Once the absence of reversibility is confirmed, bronchodilator treatment can be initiated. | Medicine | This is a mixed ventilatory disorder with a severe obstructive component. It's likely COPD (Chronic Obstructive Pulmonary Disease), in which, once the absence of reversibility is confirmed, treatment with inhaled corticosteroids can be initiated. | 123 | 4 | 98384953-8d3a-4fe8-a304-80cf754a5a5b | 2024 |
In relation to idiopathic pulmonary fibrosis, indicate which of the following statements is true: | To establish the diagnosis, a biopsy of the lung parenchyma is required. | The characteristic image of the findings in the thoracic CT scan is the appearance of ground-glass opacities. | Antifibrotic therapy (pirfenidone and nintedanib) can slow down the deterioration of lung function. | Medicine | Sometimes it is associated with connective tissue diseases. | 124 | 4 | 9e02c92f-6a74-4077-89ce-c7e42cfae49b | 2024 |
A 65-year-old man diagnosed with COPD with two exacerbations in the past year, undergoing inhaled treatment with tiotropium. He has a maximum expiratory volume in the first second (FEV1) of 48%. After being in a stable clinical situation for more than two months, he presents a PaO2 of 58 mmHg and a PaCO2 of 49 mmHg in the arterial blood gas. In the blood test, he has 450 eosinophils/microL. He does not have pulmonary hypertension, cor pulmonale, or polycythemia. With this data, which of the following actions is most appropriate?: | Optimize bronchodilator treatment. | Initiate chronic home oxygen therapy. | Initiate chronic home oxygen therapy and non-invasive home mechanical ventilation. | Medicine | Optimize bronchodilator treatment and initiate chronic home oxygen therapy. | 125 | 2 | bca084a2-3e22-4728-930a-37629ee1d10a | 2024 |
The most common cause of hypoxemia is: | Disorders of alveolocapillary oxygen diffusion. | Alveolar hypoventilation. | Imbalance in the ventilation-perfusion ratio. | Medicine | Right-to-left shunt within the lungs. | 126 | 4 | cbe8ea3b-3bbd-4e45-aba6-1ebaa3a1621f | 2024 |
A 71-year-old woman diagnosed with amyotrophic lateral sclerosis. She is evaluated in the consultation for orthopnea and morning headache. She presents a forced vital capacity of 40%, PaCO2 of 53 mmHg. Nocturnal oximetry shows an average oxygen saturation of 91% and 16% of the time with oxygen saturation below 90% and some desaturation below 70%. Which of the following attitudes is most appropriate?: | Conduct clinical checks without starting a specific treatment at the present time. | Initiate non-invasive mechanical ventilation. | Initiate continuous positive airway pressure (CPAP). | Medicine | Initiate oxygen therapy due to nocturnal respiratory insufficiency. | 127 | 1 | be4c6ec7-8b5a-4e73-92b8-fd27e73ed475 | 2024 |
Regarding the usefulness of bronchoscopy in the diagnosis of respiratory diseases, indicate which of the following statements is true: | Cryobiopsy has a higher diagnostic yield than conventional transbronchial biopsy for diffuse parenchymal diseases, but it carries a higher risk of bleeding and pneumothorax. | Of all the bronchoscopic techniques, rigid bronchoscopy is the most used due to its greater safety when protecting the airway. | Bronchial aspiration avoids the risk of salivary contamination that may be found in a sputum sample and is very useful when samples from a specific lung lobe or segment are desired. | Medicine | The lymph nodes most easily accessible by endobronchial ultrasound for the staging of lung cancer are the paraesophageal nodes and those of the pulmonary ligament. | 128 | 2 | 61ee52b9-8018-4efd-b0f5-e8e660964d7f | 2024 |
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