niryuu/sni-each-converted huggingface dataset:
Question: Regarding the loss of bone mass in patients treated with glucocorticoids, what statement do you consider correct? 
 Options:  <1> If the dose of prednisone received by the patient is less than 15 mg per day, for a time less than 6 months, it is not a real problem and no preventive measure should be taken. <2> Thiazides have been shown to reduce the risk of fractures, both in the hip and in the spine, in patients treated with glucocorticoids. Therefore, its use should be recommended in these patients as a preventive measure. <3> It is recommended to perform a bone densitometry after the first year of treatment with glucocorticoids, since before there is no loss of bone mass. <4> All patients treated with glucocorticoids should receive an adequate supply of calcium and vitamin D, which can come from the diet or from pharmacological supplements. <5> The loss of bone mass is observed, especially in the hip, so the densitometry of the spine has no use in its assessment.
Output: 4
Question: A 33-year-old woman with a loss of 6 kg in the last 4 months, asthenia and anorexia. Amenorrhea for 2 months. The hormonal results indicate a basal cortisol serum concentration of 108 nmol / l (baseline normal value 115-550) and 123 nmol / l after stimulation with ACTH. The baseline plasma concentration of ACTH is 48 pmol / l (normal value: 2-12). What is the most likely diagnosis? 
 Options:  <1> Primary adrenal insufficiency. <2> Secondary adrenal insufficiency. <3> Tertiary adrenal insufficiency due to hypothalamic lesion. <4> ACTH-producing pituitary tumor (corticotropinoma). <5> More tests should be done since the diagnosis is inconclusive.
Output: 1
Question: Which of the following clinical pictures is compatible with the diagnosis of subacute thyroiditis? 
 Options:  <1> A 38-year-old woman with a 2-week history of thyroid pain, elevated T4 and T3, low TSH, and increased technetium uptake on the scan. <2> A 42-year-old man with a history of pain in the thyroid gland 4 months ago, fatigue, general malaise, low concentrations of free T4 and high TSH levels. <3> A 31-year-old woman with enlarged thyroid gland, painless on palpation, low TSH, high free T4 and T3, and increased technetium uptake on scintigraphy. <4> A 30-year-old woman under treatment with oral contraceptives, with discomfort in the neck and palpable thyroid nodule that behaves as a solid on ultrasound. Increase in total T4 with normal TSH. <5> A 46-year-old man who consulted due to fatigue during the last 3 months. In the analytical, low concentrations of free T4 and T3 and TSH were observed.
Output: 2
Question: Which statement regarding the substitution treatment with L-thyroxine in a patient with hypothyroidism is correct? 
 Options:  <1> Thyroid function will be determined 48 hours after its initiation to assess efficacy. <2> In elderly patients and in order to improve symptomatology quickly, treatment with L-T4 is started at a dose of 150-200 micrograms per day. <3> In pregnancy, thyroid hormone requirements usually increase by about 50 micrograms per day, over the previous dose. <4> The medication should be taken in the middle of meals. <5> It is advisable to administer a gastric protector simultaneously to avoid gastritis.
Output: 3
Question: Which of the following statements is INCORRECT in relation to the alterations of the acid-base balance? 
 Options:  <1> The arterial pH is regulated by the Henderson-Hasselbach equation and is 7.35-7.45. <2> Hypercapnia (increase in PaCO2) is a consequence of the increase in CO2 production. <3> Metabolic acidosis occurs due to increased endogenous acid production, acid accumulation and / or loss of bicarbonates. <4> In patients with lactic acidosis it is common to find an anion gap or difference greater than 12 mmol / L. <5> The use of alkalizing solutions should be reserved for cases of severe acidemia with ph <7.20.
Output: 2
Question: A 47-year-old man consulted for edema in lower limbs of 3 weeks of evolution. In blood analysis, creatinine 1.3 mg / dL, total cholesterol 270 mg / dL and albumin 2.4 g / dL. In the urine sediment, it presents 15-20 red cells per field and in urine of 24 hours proteinuria is detected 3.7 g / day. What is the most likely diagnosis? 
 Options:  <1> Minimal change disease. <2> Focal and segmental glomerulosclerosis. <3> Membranous nephropathy <4> Membranoproliferative glomerulonephritis type I. <5> Mesangial proliferative glomerulonephritis.
Output: 3
Question: A 68-year-old woman diagnosed with pulmonary tuberculosis. Treatment with Isoniacid, Rifampicin and Ethambutol was started. At 12 days after the start of treatment, he consulted for fever of 38ºC, skin rash, lymphadenopathy, arthralgia, lumbar pain, oliguria and eosinophilia with acute deterioration of renal function. The urine test revealed hematuria, leukocyturia with eosinophiluria in Wright's stain and non-nephrotic proteinuria (1.2 grams daily). With these clinical data the most likely diagnosis is: 
 Options:  <1> Acute tubular necrosis due to drug nephrotoxicity. <2> Acute tubular necrosis of ischemic etiology. <3> Ateroembolic disease. <4> Thrombotic occlusion of the main renal artery. <5> Acute tubulointerstitial nephritis.
Output: 5
Question: In which of the following types of glomerulonephritis is there a greater indication of IECAS or ARA-II as antiproteinuric therapy? 
 Options:  <1> Segmental and focal glomerulosclerosis secondary to hyperfiltration. <2> Acute postinfectious glomerulonephritis. <3> Extracapillary glomerulonephritis. <4> Glomerulonephritis due to minimal changes. <5> Membranoproliferative glomerulonephritis.
Output: 1
Question: Which of the following clinical situations carries a greater risk of progression of chronic kidney disease and would require more strict control by the nephrologist? 
 Options:  <1> Diabetic patient with a glomerular filtration rate of 46 mL / min and a urine albumin / creatinine ratio of 25 mg / g. <2> Diabetic patient with a glomerular filtration rate of 89 mL / min and urine albumin / creatinine ratio of 475 mg / g. <3> Hypertensive patient with glomerular filtration rate of 65 mL / min and urine albumin / creatinine ratio of 150 mg / g. <4> A 70-year-old hypertensive patient with 1 simple cyst in each kidney, a glomerular filtration rate of 35 mL / min and an albumin / creatinine ratio in urine of 10 mg / g. <5> An 87-year-old hypertensive patient with a glomerular filtration rate of 30 mL / min and a urine albumin / creatinine ratio of 5 mg / g.
Output: 2
Question: Chronic interstitial nephropathies affect the tubular structures and the renal interstitium. If we analyze the functional defects that these pathologies can produce, we will NOT wait to find: 
 Options:  <1> Isostenuria. <2> Hypochloremic metabolic alkalosis. <3> Tubular atrophy and interstitial fibrosis in the renal histological study. <4> Normal or little expressive urinary sediment. <5> Proteinuria of less than 2 grams per day.
Output: 2
Question: 18-year-old girl who came to the Hospital for edema in lower limbs of 1 week of evolution, highlighting in the laboratory a proteinuria in the nephrotic range with hypoproteinemia and hypoalbuminemia. In the anamnesis he refers to recurrent oral aphthae, arthritis of small joints of the hands, malar rash and photosensitivity. In the etiological study, the presence of ANA and antiDNA with hypocomplementemia stands out. The determination of ANCA is negative. A renal biopsy is performed in which we could find any of these types of glomerulonephritis, EXCEPT: 
 Options:  <1> Mesangial GNF. <2> Necrotizing GNF paucinmune. <3> Focal proliferative GNF. <4> Diffuse proliferative GNF. <5> Membranous GNF.
Output: 2
Question: Which of the following combinations of drugs is commonly used in the maintenance treatment of patients with a kidney transplant? 
 Options:  <1> Tacrolimus, cyclosporine and mycophenolate mofetil. <2> Tacrolimus, mycophenolate mofetil and glucocorticoids. <3> Tacrolimus, sirolimus and mycophenolate mofetil. <4> Tacrolimus, azathioprine and mycophenolate mofetil. <5> Cyclosporine, azathioprine and mycophenolate mofetil.
Output: 2
Question: A 78-year-old man who underwent cardiac catheterization with revascularization of the right coronary artery 3 weeks ago and consulted for nausea and vomiting of 3 days of evolution. It presents arterial pressure of 185/85 mm Hg and purple lesions on the toes of both feet. In the analytical, urea 230 mg / dL and creatinine 5.8 mg / dL were observed. What is the most likely diagnosis? 
 Options:  <1> Malignant arterial hypertension. <2> Acute tubular necrosis by contrast. <3> Rapidly progressive renal failure. <4> Renal atheroembolic disease. <5> Bilateral renal artery stenosis.
Output: 4
Question: A 65-year-old man with no medical history of interest who consulted for fine micturition, incomplete emptying, diurnal urinary frequency every 3 hours and nocturia 1-2 times. Rectal examination reveals a medium-large prostate without nodules. Prostate-specific antigen (PSA) 0.5 ng / mL. It provides reno-vesico-prostatic ultrasound that indicates a prostatic volume of 35 g, with absence of postvoid residual and without other evaluable alterations. What will be our attitude towards this patient? 
 Options:  <1> Offer radical prostatectomy as a treatment for your prostate cancer. <2> Request scintigraphic study to rule out the presence of bone and visceral metastases secondary to prostate cancer. <3> Start treatment with androgen blockade with LHRH analogs given the demonstrated efficacy of this drug in the treatment of patients with BPH. <4> Indicate surgical desobstructive treatment (transurethral resection of the prostate) as the treatment of choice for prostate hyperplasia. <5> Consider treatment with alpha-blockers as an initial treatment for benign prostatic hyperplasia (BPH).
Output: 5
Question: A 31-year-old woman with a history of nephritic colic 4 years ago consulted in the emergency department for left lumbar pain of colic characteristics for 3 days with the appearance of fever during the last 12 hours. The presence of 15,000 leukocytes / uL, 85% neutrophils, creatinine 0.8 mg / dL and PCR 20 mg / dL stand out in the blood analysis. The urine sediment reports countless leukocytes / field. Which of the following statements is true? 
 Options:  <1> Since it is an uncomplicated urinary tract infection, we must treat it with oral antibiotherapy and evolutionary control. <2> It is advisable to perform an urgent imaging study to rule out obstruction of the upper urinary tract that requires drainage. <3> This patient has a complicated urinary tract infection and it is most likely that the causative agent is S. aureus. <4> It is best to start treatment with fluconazole and control it in the outpatient clinic in 1 week. <5> The patient has acute pyelonephritis and the optimal treatment is the combination of bladder catheterization with intravenous antibiotic therapy.
Output: 2
Question: Which of the following drugs would indicate as first-line treatment in a 53-year-old patient diagnosed with metastatic clear cell renal cancer? 
 Options:  <1> Sunitinib. <2> Cetuximab. <3> Fluoropyrimidine <4> Panitumumab. <5> Bleomycin.
Output: 1
Question: 78-year-old man with poorly controlled rheumatoid arthritis (RA). A history of 2 admissions for heart failure and atrial fibrillation in the last 6 months. In current treatment with infliximab, prednisone, furosemide, enalapril, carvedilol and acenocoumarol. Enter again for biventricular heart failure clinic. The ECG showed atrial fibrillation at 102 bpm and advanced left bundle branch block. An echocardiogram shows biatrial dilation, thickening of the left ventricular wall with ejection fraction of 45% and restrictive pattern. The analytical highlights: Hb 10 gr / dL, creatinine 2.1 mg / dL (FG 20 mL / min), CRP 124 mg / L, rheumatoid factor 240 U / L, BNP 980 ng / L, proteinuria 4.8 g / 24h. What is the most likely diagnosis? 
 Options:  <1> Cardio-renal syndrome type 2. <2> Amyloidosis AA. <3> Myocarditis of giant cells. <4> Toxicity due to infliximab. <5> Membranous glomerulonephritis associated with RA.
Output: 2
Question: A 40-year-old man goes to the emergency department for inflammation of the right knee of about 24 hours of evolution. The patient does not report previous trauma and is the first episode of arthritis that presents. A the anamnesis directed that 4 weeks ago he returned from a trip to Morocco and that being there he presented chills and diarrhea that subsided after a week. The examination also revealed inflammation of the right Achilles tendon. What is the attitude to follow? 
 Options:  <1> It is a spondyloarthropathy, start treatment with methotrexate. <2> Immobilize the knee with a bandage for 15 days and give non-steroidal anti-inflammatories. <3> Practice an arthrocentesis to perform culture, analysis of microcrystals and cellular counting of the synovial fluid. <4> Perform an arthroscopy. <5> It is a gouty arthritis, I would start treatment with allopurinol.
Output: 3
Question: A 36-year-old woman diagnosed with systemic scleroderma diffuse form 2 years ago, is treated with 30 mg of prednisone in her health center for an eye problem. The patient consulted for headache and the clinical examination revealed high blood pressure and a deterioration in kidney function that was not known. The patient is referred to the emergency department with the suspicion of a sclerodermal renal crisis. Indicate which of the following statements is correct: 
 Options:  <1> The sclerodermal renal crisis is more frequent in the limited form of scleroderma. <2> The use of steroids at moderate doses can precipitate its appearance. <3> The diagnosis requires a renal biopsy. <4> Angiotensin-converting enzyme inhibitors are routinely used to prevent its occurrence. <5> The treatment of choice would be a dihydropyridine calcium antagonist.
Output: 2
Question: Which of the following is NOT considered a classification criterion for systemic lupus erythematosus? 
 Options:  <1> Cutaneous vasculitis <2> Photosensitivity <3> Hemolytic anemia. <4> Pericarditis <5> High concentration of antinuclear antibodies.
Output: 1
Question: In relation to osteoarthritis, what statement is correct? 
 Options:  <1> There is a close correlation between the radiological findings and the symptomatology of the patients. <2> The symptomatic involvement of the hip is much more frequent than the involvement of the knee. <3> Obesity has not been shown to be a risk factor for its development. <4> The presence of a high sedimentation rate strongly supports the diagnosis. <5> Morning stiffness usually lasts less than 30 minutes.
Output: 5
Question: A 35-year-old woman consulted for the appearance of maculo-papular lesions in the upper limbs without other symptoms. The biopsy of one of them demonstrates the presence of noncaseating granulomas. Blood tests are normal except for an elevation of angiotensin-converting enzyme (ACE) levels. On chest radiography, bilateral hilar adenopathies are detected. Which of the following considers the most appropriate attitude? 
 Options:  <1> Start treatment with corticosteroids orally. <2> Start treatment with oral hydroxychloroquine. <3> Start treatment with azathioprine orally. <4> Start treatment with leflunomide orally. <5> Continue study without starting treatment.
Output: 5
Question: Which of the following traumatic injuries requires, in order to avoid local complications, an earlier treatment? 
 Options:  <1> Posterior traumatic luxation of the hip. <2> Displaced fracture of the femoral neck of the elderly. <3> Trochanteric fracture of the elderly. <4> Cup fracture. <5> Subtrochanteric fracture.
Output: 1
Question: The most frequent complication of astragalus neck fractures is: 
 Options:  <1> Reflex algodystrophy. <2> Vicious consolidation <3> Pseudoarthrosis <4> Osteonecrosis. <5> Neurological injury of the posterior tibial.
Output: 4
Question: In a 14-year-old patient with Down syndrome who presents with nucalgia (normal neurological examination) and is going to be subjected to general anesthesia (orotracheal intubation) for elective abdominal surgery, the following should be ruled out: 
 Options:  <1> Atloaxoid instability. <2> Tracheoesophageal fistulas. <3> Brain tumor. <4> Vocal cord hyperplasia. <5> Hydrocephalus
Output: 1
Question: A 23-year-old boy, who makes a jump while playing basketball, falls on his right lower limb with his knee in hyperextension, applying a sharp turn to his knee while keeping his foot fixed on the ground. The patient, perceives a snap and sharp pain in his knee, unable to continue playing. Note feeling of instability when performing the support of said extremity. On clinical examination, intense articular effusion is seen, so arthrocentesis is performed, which shows an important acute hemarthrosis without the presence of droplets of fat supernatanting in the extracted fluid. The mobility of the knee is free and the Lachman maneuver is positive. What is the diagnostic suspicion? 
 Options:  <1> Break in cube handle of the inner meniscus. <2> Isolated rupture of the lateral collateral ligament. <3> Fracture by tearing of the anterior tibial spine. <4> Unicondylar fracture of the medial condyle. <5> Rupture of the anterior cruciate ligament
Output: 5
Question: A 20-year-old boy goes to the emergency room for fever of 39ºC, chills, papules and hemorrhagic pustules on the distal extensor surfaces of the extremities and arthritis of the knee. What is your diagnosis of initial suspicion? 
 Options:  <1> Rheumatoid arthritis. <2> Reiter syndrome. <3> Urica Drop <4> Gonococcal arthritis. <5> Vasculitis of Cogan.
Output: 4
Question: Which of the following species of Candida spp, is usually resistant or at least have a decreased sensitivity to fluconazole? 
 Options:  <1> C. albicans. <2> C. tropicalis. <3> C. parapsilosis. <4> C. Krusei. <5> C. giliermondii.
Output: 4
Question: A patient from Bolivia diagnosed with Chagas disease underwent a blood count that showed 1,100 eosinophils / μL (12% of leukocytes). Which of the following diagnoses is LESS likely? 
 Options:  <1> Infestation by Schistosoma haematobium. <2> Infestation by Ancylostoma duodenale. <3> Infestation by Strongyloides stercoralis. <4> Infestation by Ascaris lumbricoides. <5> Infestation by Necator americanus.
Output: 1
Question: A 60-year-old patient who came to the hospital's emergency department due to a left chest pain, cough and yellowish sputum, a temperature of 38.7ºC, a sensation of shortness of breath. Artificial saturation of 02 80%. Hemogram leukocytes 12000 / uL with 86% polymorphonuclear cells. Chest x-ray: alveolar infiltrate on the left base with air bronchogram. On suspicion of pneumonia, pneumococcal Ag is made in urine, which is positive and sputum culture is sent to the Microbiology service. Which empirical antibiotic treatment of the indicated ones is more correct in expectation of microbiological results? 
 Options:  <1> Ceftazidime <2> Clarithromycin <3> Azithromycin <4> Ceftriaxone <5> Doxycycline
Output: 4
Question: A 73-year-old woman is brought to the emergency room accompanied by the family due to a picture of chills and a productive cough of purulent mucus that lasted about 2 days; they also report a tendency to drowsiness with a decrease in oral intake to both liquids and solids. As background we report that the patient is diagnosed with hypertension, DM type 2 and incipient dementia. The physical examination highlights a thin patient, with discrete mucous dryness, sleepy but reactive to verbal commands. Meningism or motor or sensory focality is not objective. Temperature 35.9ºC. Heart rate 118 bpm, BP 84/50 mmHg, respiratory rate 22 rpm. O2 Saturation 93%. Cardiac tachyarrhythmic auscultation without murmurs. Respiratory auscultation with crackles in the right base. Point out the TRUE answer: 
 Options:  <1> Among the measures to be taken when sepsis is suspected, antibiotic therapy is administered in the 1st hour of arrival, although this attitude has not been correlated with a decrease in mortality. <2> The early administration of IV fluids is essential to maintain adequate tissue perfusion, the goal being to maintain an average blood pressure> 65 mmHg. <3> Among the complementary tests that are received we observed a lactate> 5.6 mmol / L; it must be taken into account but as long as hemodynamic stability is maintained we should not worry. <4> In fact, the diagnosis of sepsis is not correct since the absence of fever rules out it. <5> The patient presents hypotension despite intensive administration of intravenous fluid therapy; It is time to administer vasoactive drugs, with isoproterenol being the choice.
Output: 2
Question: The main indication for using 4 drugs in the initial treatment of tuberculosis is: 
 Options:  <1> Affectation of the central nervous system. <2> High prevalence of primary resistance to isoniazid. <3> Cavitated and extensive pulmonary tuberculosis with large bacillary load. <4> Disseminated tuberculosis associated with HIV infection. <5> Extrapulmonary tuberculosis in immunodepressed patients of any origin.
Output: 2
Question: Which of the following analytical determinations is less useful for decision making in the follow-up and control of an HIV-infected person? 
 Options:  <1> CD4 lymphocyte count in peripheral blood. <2> Quantification of immunoglobulin. <3> Measurement of viral load. <4> Studies of HIV resistance to antiretroviral drugs. <5> Analysis of the co-receptor tropism.
Output: 2
Question: The analysis of the data obtained from cases of Ebola virus disease in Guinea and Sierra Leone, allows us to affirm that: 
 Options:  <1> The mortality of the infection exceeds 85%. <2> The treatment is based on support measures (hydroelectrolitic replenishment i.v. and antibiotics). <3> More than half of the cases correspond to health personnel. <4> Gastrointestinal hemorrhage is a common cause of mortality. <5> Mortality is higher in adolescents.
Output: 2
Question: A 40-year-old patient, classified as ASA I according to the scale of the American Society of Anesthesiologists, is undergoing laparoscopic cholecystectomy for cholelithiasis. The intervention takes place initially without complications, but fifty minutes into the procedure there is a significant increase in the levels of teleespiratory carbon dioxide (CO2), without altering the oxygen saturation by pulse oximetry or raising the ventilation pressures . What would be your diagnosis of presumption and your attitude to this finding? 
 Options:  <1> With these findings we must suspect the existence of subcutaneous emphysema, so we must explore the patient and request that the insufflation pressure of the pneumoperitoneum be reduced or even interrupted. <2> The most likely diagnosis is a pneumothorax secondary to carbon dioxide or capnothorax, so an urgent chest radiograph must be ordered and the insertion of a thoracic drain must be prepared. <3> The elevation of carbon dioxide levels is normal in the context of a laparoscopic intervention. The only attitude to take is to increase the minute volume in the anesthetic machine. <4> The placement of the orotracheal tube should be checked for the possibility that it has progressed and that we are facing an endobronchial intubation, which is relatively frequent in this surgery due to the elevation of the diaphragm secondary to the pneumoperitoneum. <5> Elevation of the teleespiratory carbon dioxide, without affecting ventilation pressures, is typical of massive pulmonary embolism. The intervention must be interrupted, ventilated with pure oxygen and prepare vasoactive drugs for the possible hemodynamic instability.
Output: 1
Question: A patient comes to the clinic for general malaise and yellowing of the skin and his doctor suspects that it is a hepatitis A picture. Which of the following answers constitutes the most accurate and safest factor to determine the pre-test probability ( before carrying out any study) of what is said table? 
 Options:  <1> Intensity of jaundice. <2> Frequency of hepatitis A in the environment. <3> Days of duration of the painting. <4> Professional experience on jaundice pictures. <5> Previous illnesses of the patient.
Output: 2
Question: JMC, a 14-year-old patient admitted to the Emergency Department. The attending physician considers a blood transfusion necessary. The parents of the patient express their refusal to be given blood, signing the corresponding document of refusal to transfusion. The doctor warns that if the transfusion is not carried out, his life is in danger. They insist on their refusal, the alleged reason for the rejection is basically religious. Which of the following options would be the most correct? 
 Options:  <1> Transfuse the patient. <2> Transfuse the patient, but only when he has lost consciousness. <3> Transfer the case to the healthcare ethics committee so that it adopts the decision. <4> Respect expressed preference and attend without transfusion <5> I would inform the judge and not administer any treatment until the latter indicated it.
Output: 5
Question: In the clinical interview: 
 Options:  <1> The doctor has to show friend before professional. <2> The doctor should avoid warning the patient of the time available to assist him. <3> The professional must verify that the patient has understood the information. <4> It is advisable to take long breaks to avoid fatiguing the patient. <5> The doctor, during the interview, must remain standing or placed behind the head of the bed.
Output: 3
Question: A 24-year-old girl suffers a bicycle fall with trauma to the abdominal area with the handlebar. A few hours after the trauma begins with intense pain in the left hypochondrium, so he goes to consult an emergency service. Upon arrival the patient is pale and sweaty, the blood pressure figures are 82/54 mmHg and the heart rate is 120 beats per minute. What kind of shock is the most likely to suffer from this patient? 
 Options:  <1> Hypovolemic <2> Septic. <3> Cardiogenic <4> Anaphylactic. <5> Neurogenic
Output: 1
Question: Young person who goes to the emergency room for second degree flame burn of 10% of the body surface, affecting the right arm in an extensive and circular way. There is no arterial pulse in the hand measured by Doppler. What is the treatment of choice? 
 Options:  <1> Cures with occlusive silver sulfadiacin and evaluation of depth per week. <2> Lymphatic drainage and assess a vascular by-pass. <3> Escarotomy or emergency decompression incisions. <4> Expectant behavior <5> Amputation of the extremity.
Output: 3
Question: Enter in our plant from the Emergency Room to study an 80-year-old patient reporting weight loss and nonspecific central-abdominal discomfort, together with loss of appetite. The diagnostic process that we must develop during your admission will be guided by the following principles EXCEPT: 
 Options:  <1> All those tests that can bring light to the process suspected by the doctor covering the widest differential diagnosis from the beginning will be carried out. <2> The healthcare process will be adapted to the individual clinical context of the patient and it will be sought that the latter be a participant in the decisions regarding diagnosis and treatment. <3> It is important to think first of all in the most ordinary way, only later, once the most frequent entities are discarded with certainty, to consider the odd. <4> Some complementary tests may be redundant and may not add value to the diagnostic process, but at the cost of health. Thus, before two complementary tests of similar performance, it will always be decided by the most economical and least risky. <5> It is essential that the doctor does not add new discomforts with the practice of complementary explorations that are not strictly necessary.
Output: 1
Question: A patient consulted for recent and progressive development of acropachies and general deterioration. The search for possible underlying neoplasia begins. Which of the following tumors is more likely to be diagnosed? 
 Options:  <1> Gastric adenocarcinoma. <2> Esophageal epidermoid. <3> Mediastinal thymoma. <4> Follicular thyroid. <5> Pleural mesothelioma.
Output: 5
Question: The most frequent malignant tumor of the submaxillary gland is: 
 Options:  <1> Mucoepidermoid carcinoma. <2> Carcinoma ex-pleomorphic adenoma. <3> Lymphoma <4> Cylindroma or cystic adenoid carcinoma. <5> Papillomatous cystadedenolymphoma.
Output: 4
Question: Faced with a patient with diffuse otitis externa, what is the initial treatment? 
 Options:  <1> Surgery. <2> Antibiotics plus analgesics, both intravenously. <3> Antibiotics and analgesics, both orally. <4> Cleaning of the external auditory canal, topical antibiotic therapy plus oral analgesics. <5> Topical antibiotics
Output: 4
Question: Within head and neck carcinomas, what type of tumor is most obviously related to the human papillomavirus? 
 Options:  <1> Squamous cell carcinoma of the larynx. <2> Squamous cell carcinoma of the oropharynx. <3> Squamous cell carcinoma of the hypopharynx. <4> Adenocarcinoma sinonasal. <5> Undifferentiated carcinoma of cavum.
Output: 2
Question: A 1-year-old boy, who did not pass the tests of auditory screening at birth and who has auditory brainstem evoked potentials that determine bilateral mild-moderate hearing loss in the right ear and moderate-severe hearing loss in the left ear. What is the most correct attitude to follow at the present time? 
 Options:  <1> Perform an audiometry within 6 months to confirm the diagnosis. <2> Surgery to adapt a cochlear implant in the right ear. <3> Wait until 3 years to check if you develop the language. <4> Adaptation of bilateral hearing prosthesis and logopedic rehabilitation. <5> Surgery to adapt a cochlear implant in the left ear.
Output: 4
Question: A baby with 39º C of axillary temperature, edema of the left eyelid and rhinorrhea on the same side goes to the emergency room. What is the most likely diagnosis? 
 Options:  <1> Pansinusitis <2> Left maxillary sinusitis. <3> Left ethmoid sinusitis. <4> Sphenoid sinusitis left. <5> Left frontal sinusitis.
Output: 3
Question: Which of the following skin diseases is associated with celiac disease? 
 Options:  <1> Atopic dermatitis. <2> Dermatitis herpetiformis <3> Molluscum contagiosum. <4> Annular granuloma. <5> Rosacea
Output: 2
Question: The following entities may be accompanied by ocular inflammation (uveitis) except one. Indicate which: 
 Options:  <1> Sarcoidosis <2> Juvenile idiopathic arthritis. <3> Behçet's disease. <4> Marfan's disease <5> Multiple sclerosis.
Output: 4
Question: A 30-year-old woman who came to the emergency room due to loss of vision, pain, red eye and photophobia of OI of 5 days of evolution. In the differential diagnosis you must include all these pathologies EXCEPT one: 
 Options:  <1> Anterior uveitis. <2> Corneal ulcer. <3> Traumatic iritis <4> Sclerouveitis. <5> Serous central chorioretinopathy.
Output: 5
Question: A 75-year-old man who reported decreased visual acuity in his right eye of two weeks of evolution. In the fundus examination, soft drusen and serous detachment at the level of the macula are seen. What treatment is currently the most indicated for this disease? 
 Options:  <1> Focal photocoagulation with laser. <2> Photodynamic therapy. <3> Intravitreal injections of anti-angiogenic drugs. <4> Posterior vitrectomy. <5> Observation.
Output: 3
Question: What analysis should be controlled in maintenance treatments with lithium salts? 
 Options:  <1> Hepatic enzymes. <2> Antinuclear antibodies. <3> Ferritin and sideremia. <4> Thyroid and renal function. <5> Tirocalcitonina.
Output: 4
Question: Which of the following characteristics is NOT typical of the contents of obsessive ideas? 
 Options:  <1> Sexual thoughts <2> Phonemes <3> Need for symmetry. <4> Pathological doubt. <5> Pollution.
Output: 2
Question: Man of 42 years, married, with three children under age. No psychiatric history. After an ERE in the bank where he worked, he is finally fired and has been unemployed for 5 months. He does not find another work activity. He comes to consultation with the following clinical picture: general discouragement, lack of appetite, nervousness, insomnia, recurrent worries about his future and avoidance of socio-family activities. Which diagnostic option of the following is the most appropriate? 
 Options:  <1> Obsessive disorder <2> Adaptive disorder with anxious-depressive symptoms. <3> Social phobia. <4> Dysthymia <5> Anxiety with agoraphobia.
Output: 2
Question: Stereotyping is called: 
 Options:  <1> Strange buccolingual gestures. <2> Repeated and unnecessary repetition of an act. <3> Very bulky movements that increase the expressiveness of the gestures. <4> Very intense psychotic agitations. <5> Apparent gestures accompanied by profanity.
Output: 2
Question: A 28-year-old man brought to the emergency room, on a Saturday morning, in a state of psychomotor agitation and delirious ideas. His companion reports previous abuse, by the patient, of cocaine. What sign / symptom would you NOT expect to find? 
 Options:  <1> Hypothermia. <2> Tachycardia. <3> Mydriasis. <4> Diaphoresis <5> Thoracic pain.
Output: 1
Question: In the course of a patient's interview, you realize that you are not understanding what the patient is saying. He decides to focus his attention on the discourse and realizes that he does not have a guiding idea even though specific fragments of it are understandable. This alteration of the thinking language, typical of schizophrenia on the other hand, is what in psychopathology is known as: 
 Options:  <1> Dissociation of thought. <2> Fugue of ideas. <3> Persistent language. <4> Disorganization of thought. <5> Blocking of thought.
Output: 4
Question: A 28-year-old violinist who is consulting for having presented panic attacks during his public performances in the last 3 months. The crises are accompanied by intense fear of being blocked and not being able to continue with the performance, something that would be humiliating for him. This fear has made him cancel his next performances. In the rest of his daily activities he does not experience this fear, nor does he experience it when he rehearses with his orchestra colleagues. What diagnosis would you consider most likely for this case? 
 Options:  <1> Simple phobia <2> Panic disorder <3> Social phobia of execution. <4> Generalized anxiety disorder. <5> Agoraphobia.
Output: 3
Question: A 28-year-old Caucasian woman, Nulípara, attends an annual gynecological examination and requests the possibility of reducing the risk of ovarian cancer given that her mother died of this neoplasm at 64 years of age. In the detailed questioning, no other family history of ovarian or breast cancer is identified. Which of the following strategies is the most appropriate to reduce the risk of ovarian cancer in this patient? 
 Options:  <1> Bilateral tubal occlusion. <2> Bilateral laparoscopic salpingo-oophorectomy. <3> Continuous daily administration of aspirin at low dose. <4> Advise her to use artificial lactation if she is pregnant. <5> Treatment with combined oral contraceptives.
Output: 5
Question: Human papilloma virus has been linked to cervical intraepithelial neoplasia and cervical cancer. Which genotype is the most oncogenic? 
 Options:  <1> Genotype 16. <2> Genotype 11 <3> Genotype 6. <4> Genotype 23. <5> Genotype 55.
Output: 1
Question: Which of the following data does NOT correspond to a fungal vulvovaginitis ?: 
 Options:  <1> Pregnancy increases the risk of this infection. <2> It can occur in women who never had sex. <3> Vaginal discharge with white patches or lumps adhered to the walls of the vagina is typical. <4> It can be diagnosed in a fresh smear of vaginal discharge without the need for staining. <5> Adding a drop of potash to the vaginal discharge gives off a strong fishy odor.
Output: 5
Question: A pregnant woman of 31 weeks goes to the emergency department referring loss of fluid through the vagina. Objective speculum exploration of clear fluid through the external cervical os. It is apyletic. The cardiotocographic record does not reveal contractions and the fetal heart rate is normal. The ultrasound scan reveals no malformations and the cervix is ​​not shortened. What therapeutic combination would it indicate? 
 Options:  <1> Tocolytics, corticosteroids and antibiotics. <2> Tocolytics and antibiotics. <3> Tocolytics and corticosteroids. <4> Oxytocin, corticosteroids and antibiotics. <5> Corticosteroids and antibiotics
Output: 5
Question: A 26-year-old woman comes to the emergency room due to abdominal pain and scarce vaginal blood loss. It refers to an amenorrhea of ​​7 weeks. You perform a pregnancy test, with a positive result. What is the next step? 
 Options:  <1> Perform a vaginal ultrasound examination. <2> Recommend home rest and repeat the pregnancy test in a week. <3> Evacuate the uterus by curettage by aspiration. <4> Standard progesterone micronized vaginally until week 14 of gestation. <5> Evacuate the uterus by intravaginal administration of prostaglandins.
Output: 1
Question: With respect to the behavior of obstetric patients exposed to Varicella, it is FALSE: 
 Options:  <1> Infected women should be separated from other obstetric patients. <2> All obstetric patients exposed, without certainty of prior immunity, must make a serological determination of their immunization status. <3> Specific immunoglobulin should be administered to exposed non-immune obstetric patients. <4> The maximum period for administering the specific immunoglobulin after contact is 96 hours. <5> Pregnant women without immunity to Varicella-Zoster virus can be vaccinated during pregnancy to prevent primary infection.
Output: 5
Question: With vaginal ultrasound, from how long after conception is it possible to see an embryo with a heartbeat? 
 Options:  <1> Between 14 and 21 days. <2> Between 21 and 28 days. <3> Between 28 and 35 days. <4> Between 35 and 42 days. <5> Between 42 to 49 days.
Output: 2
Question: One of the following answers is FALSE regarding breast cancer. 
 Options:  <1> The majority of tumors (70%) have receptors for hormones. <2> The stage measured according to the TNM system is one of the prognostic factors of the disease. <3> The presence of axillary adenopathies contraindicates breast surgery. <4> Anthracyclines and taxanes are the chemotherapeutic agents most used in the complementary treatment. <5> The breast-conserving surgery associated with radiotherapy has comparable results to mastectomy.
Output: 3
Question: Which gene is most frequently associated with acquired mutations in breast cancer? 
 Options:  <1> p53. <2> PTEN. <3> BRCA-2. <4> BRCA-1. <5> Her2 / neu.
Output: 1
Question: Regarding substance abuse by the adolescent, point out the correct answer: 
 Options:  <1> It is usually an individual consumption which indicates a better prognosis. <2> The onset of abuse in adolescence has not shown an increased risk of becoming addicted. <3> It is independent of the risk of HIV infection. <4> The most popular drug among teenagers is cannabis. <5> It should be considered in adolescents who come to the emergency with a crisis.
Output: 5
Question: Which of the following congenital heart diseases is NOT considered as heart disease that produces volume overload ?: 
 Options:  <1> Interauricular communication. <2> Ventricular communication. <3> Defects of the atrio-ventricular septum. <4> Coarctation of the aorta. <5> Persistent ductus arteriosus.
Output: 4
Question: In the most frequent type of esophageal atresia: 
 Options:  <1> Prenatal ultrasound performed in the third trimester allows diagnosis in 6080% of cases. <2> It is associated in 50% of cases with microgastria and neural tube defects. <3> The distance between the proximal and distal atresic pockets is greater than in the other types of atresia. <4> Gastrostomy should be performed in the first 48 hours of life to allow enteral feeding. <5> The presence of air in the stomach and small intestine on abdominal radiography confirms the existence of a distal fistula.
Output: 5
Question: To decide to postpone discharge to a child in maternity 48 hours after childbirth, the following criteria will be taken into account EXCEPT one, indicate it. 
 Options:  <1> Jaundice evident on the first day of life. <2> VDRL positive. <3> Weight loss of 7%. <4> Breastfeeding not established. <5> Lack of evacuation of meconium.
Output: 3
Question: Which of the following data is NOT specific to hypertrophic pyloric stenosis? 
 Options:  <1> Metabolic alkalosis <2> Projective vomiting of bilious content. <3> Family incidence <4> Predominance of the masculine sex. <5> Palpable mesoepigastric mass.
Output: 2
Question: Diabetes mellitus type MODY (maturityonset diabetes of the young) is characterized by all the following EXCEPT: 
 Options:  <1> It is an autosomal dominant disorder. <2> It is characterized by a genetic defect in the function of beta cells of the pancreas. <3> Share the same HLA risk as Diabetes Mellitus type 1. <4> The patients have a slight fasting hyperglycemia. <5> They may need treatment with insulin for their control.
Output: 3
Question: What is the most common developmental complication in bacterial meningitis in the pediatric age? 
 Options:  <1> Hearing loss <2> Residual epilepsy <3> Mental retardation. <4> Hydrocephalus <5> Visual defects.
Output: 1
Question: A premature newborn presents at 2 days of life a picture of poor general condition, subcutaneous petechiae and ecchymoses and persistent bleeding from the puncture sites. The chest radiograph is compatible with pulmonary hemorrhage. In the coagulation study, prothrombin and partial thromboplastin times are elongated. The platelet count is 105,000 / uL. What is the most likely diagnosis? 
 Options:  <1> Disseminated intravascular coagulation secondary to neonatal sepsis. <2> Neonatal autoimmune thrombocytopenia. <3> Neonatal alloimmune thrombocytopenia. <4> Hemorrhagic disease of the newborn due to vitamin K deficiency. <5> Neonatal hemorrhage due to platelet dysfunction.
Output: 1
Question: Which of the following correlates with retinopathy of the premature newborn? 
 Options:  <1> The bilirubin. <2> Gentamicin <3> The corticoids <4> The Oxigen. <5> Fentanyl
Output: 4
Question: The parents of a 2-year-old girl consult because they are concerned about their daughter's development. They have observed that approximately from 18 months, their behavior is different from that of other children of their age. Until then, they had attributed their limited interaction to the fact that they were becoming more independent, and the lack of language development, to which they were not yet enrolled. In the consultation you observe that the girl does not respond when she calls her by her name, shows little eye contact, performs vocalizations without communicative intention, and does not look at where the parents point her. Given these findings, all of the following statements are true, EXCEPT one: 
 Options:  <1> Parents should be reassured, recommended schooling as soon as possible, and arrange a follow-up in 3 months. <2> The most likely diagnosis is autistic spectrum disorder. <3> A diagnostic evaluation must be carried out by a team with experience in autism. <4> Appropriate early intervention is recommended. <5> The origin of the disorder is multifactorial.
Output: 1
Question: If you want to study the efficacy and safety of a new cytostatic for a specific oncological process and, at the same time, contrast the efficacy that adds a new monoclonal antibody to this treatment, what would be the most appropriate study design? 
 Options:  <1> Parallel test. <2> Cross test <3> Factorial test. <4> Sequential test. <5> Test of n = 1.
Output: 3
Question: Which of these statements is NOT a characteristic of phase I clinical trials? 
 Options:  <1> They usually have non-therapeutic goals. <2> They can be done in healthy volunteers. <3> They can be done in patients. <4> They are usually randomized. <5> They are usually open.
Output: 4
Question: When comparing the characteristics of pragmatic or confirmatory clinical studies with explanatory or exploratory clinical studies, which of the following is an advantage of the former? 
 Options:  <1> Information about subgroups of patients representative of the usual clinical practice. <2> Very homogeneous sample, with little variability. <3> Greater capacity to detect differences in the effectiveness of interventions. <4> Greater internal validity <5> Smaller sample size
Output: 1
Question: He is presented with a cohort study involving 1000 female smokers and 2000 non-smoking women of the same age. If, after 5 years, 30 smokers and 20 nonsmoking women have experienced a stroke, what would be the relative risk and the attributable risk? 
 Options:  <1> Relative risk = 3, attributable risk = 10 out of every 1000. <2> Relative risk = 3, attributable risk = 20 out of every 1000. <3> Relative risk = 1.5, attributable risk = 10 out of every 1000. <4> Relative risk = 1.5, attributable risk = 30 out of 1000. <5> Relative risk = 10 out of 1000, attributable risk = 3.
Output: 2
Question: A study is being conducted in a health center to determine the effect of exposure to tobacco smoke in children of smoking parents. For this purpose, a group of healthy children between 3 and 7 years old whose parents are smokers is selected and at the same time an equal number of children whose parents are non-smokers are selected in the same center. A year later, the appearance of respiratory diseases during that year will be investigated in both groups. Indicate the correct answer: 
 Options:  <1> The study design is a prospective cohort. <2> The study design is cases and controls. <3> The study design follows a qualitative methodology. <4> The study is experimental. <5> The type of design used is efficient to study rare diseases.
Output: 1
Question: A study has been carried out to determine the risk of upper gastrointestinal bleeding (UGIB) associated with the use of different non-steroidal anti-inflammatory drugs (NSAIDs). For this purpose, 2,777 patients with UGIB and 5,532 patients matched with the previous ones were included by age and month of admission or consultation, in the same hospitals, but for reasons that had nothing to do with the use of NSAIDs. The comparative risk of suffering a UGIB associated with previous exposure to different NSAIDs was calculated. What kind of study is it? 
 Options:  <1> Cohort study. <2> Cases and controls study. <3> Transversal study. <4> Experimental study <5> Ecological study
Output: 2
Question: The presence (x = 1) or absence (x = 0) of bacteriuria has been determined in a group of subjects. What kind of variable is it? 
 Options:  <1> Ordinal. <2> Numeric <3> Categorical <4> Continuous quantitative <5> Discrete quantitative.
Output: 3
Question: A population estimate of blood creatinine levels is made in a group of pregnant women, obtaining the following results: mean (×) 0.8 mg / dL; typical deviation (s) 0.62 mg / dL; sample size (n) 85 women. According to the previous data, the confidence interval for the population mean (μ) with a confidence level of 95% (Z = 1.96) is: 
 Options:  <1> 0.8 ± 0.04. <2> 0.8 ± 0.13. <3> 0.8 ± 0.62. <4> 0.8 ± 1.96. <5> 0.8 ± 0.07.
Output: 2
Question: In economic evaluations, which of the following costs correspond to indirect non-health costs? 
 Options:  <1> Hospitalization of the patient. <2> Care at the patient's home. <3> Loss of patient productivity. <4> Travel expenses of the patient. <5> Rehabilitation of the patient.
Output: 3
Question: In a pharmacoeconomic study, drug A produces a life expectancy of 5 years with a total cost of 5,000 euros, while drug B produces a life expectancy of 6 years with a total cost of 15,000 euros (average values ​​per patient) . The decision criterion is based on choosing the most effective intervention with a cost-effectiveness threshold of 30,000 euros per year of additional life earned per patient, what drug is cost-effective compared to the other and why? 
 Options:  <1> Drug B, because the incremental cost-effectiveness with respect to A is below the cost-effectiveness threshold. <2> Drug A, because it costs much less than B and there is only one year of difference in life expectancy. <3> Drug A, because the incremental cost-effectiveness of B with respect to A is above the cost-effectiveness threshold. <4> Drug B, because each year of life has a cost of 29,500 euros below the cost-effectiveness threshold. <5> Drug A, because the incremental cost-effectiveness with respect to B is above the cost-effectiveness threshold.
Output: 1