niryuu/sni-each-converted huggingface dataset:
Question: Question linked to image nº3 A 64-year-old woman with no history of interest, with progressive dyspnea of ​​several weeks of evolution, whose frontal chest radiograph suggests a practically definitive radiological diagnosis. What would this be? 
 Options:  <1> Pulmonary thromboembolism with infarcts. <2> Pneumonia due to Pneumocystis jiroveci. <3> Alveolar proteinosis. <4> Pulmonary edema. <5> Chronic eosinophilic pneumonia.
Output: 5
Question: Question linked to image # 3 In relation to the suspected diagnosis you have established, what would be the most appropriate confirmation test? 
 Options:  <1> Determination of pulmonary capillary pressure, using a Swan-Ganz catheter. <2> Bronchoalveolar lavage. <3> Thoracic computed tomography (pulmonary arteries). <4> Determination of eosinophils in peripheral blood. <5> Determination of anti-HIV antibodies.
Output: 4
Question: Question linked to image nº4 70-year-old man, active smoker, who underwent a chest radiological study as a preoperative protocol for prostatic hypertrophy. What would be the fundamental semiological finding of this radiological image? 
 Options:  <1> Encapsulated left pleural effusion. <2> Tumor of the anterior soft tissues of the thorax. <3> Collapse of the left upper lobe. <4> Anterior mediastinal mass. <5> Elevation of the left diaphragmatic dome.
Output: 3
Question: Question linked to image # 4 What would be the most likely radiological diagnosis to justify this finding? 
 Options:  <1> Central bronchogenic carcinoma. <2> Left phrenic paralysis. <3> Anterior thoracic wall abscess. <4> Left pleural mesothelioma. <5> Anterior mediastinal lymphoma.
Output: 1
Question: Question linked to image no. 5 A 41-year-old man referred for presenting for more than 5 years bilateral alternating gluteal pain predominantly nocturnal, which interferes with sleep and relieves with mobilization. It is accompanied by stiffness for more than 1 hour after inactivity. Denies pain, swelling or deformity to another level. It provides elementary analytics without alterations except PCR 11.5 mg / dl (N <5) and the attached radiograph. The objective radiological alteration and the most probable diagnosis would be: 
 Options:  <1> Fracture of Looser- Osteomalacia. <2> Bilateral sacroiliitis - Ankylosing spondylitis. <3> Coexistence of lytic and blastic lesions Paget's disease. <4> Blastic lesions - Prostatic adenocarcinoma with bone metastases. <5> Osteosclerosis - Lymphoma.
Output: 2
Question: Question linked to image # 5 In relation to this patient, which of the following treatments would not be useful? 
 Options:  <1> Indomethacin <2> Etoricoxib. <3> Systemic corticosteroids <4> Physiotherapy. <5> Adalimumab.
Output: 3
Question: Question linked to the image nº6 A friend of his 37 years shows him the photograph of his own right hand that is shown in the image A. He had made a cold day in November and tells him that after a few minutes regained its normal color With a magnifying magnifying glass, look at the B image in the nail bed. What is the most likely diagnosis? 
 Options:  <1> Systemic sclerosis <2> Acrocyanosis <3> Livedo reticularis. <4> Raynaud's disease. <5> Cold agglutinin disease.
Output: 1
Question: Question linked to image nº6 Which of the following medications would you not recommend: 
 Options:  <1> Nifedipine <2> Sildenafil <3> Prazosin <4> Atenolol. <5> Losartan
Output: 4
Question: Question linked to image nº7 A 31-year-old patient, with no previous history of interest, consulted due to muscle weakness of a few months of evolution that has progressively made it difficult for her to go up and down stairs. Physical examination is notable for the desquamative papuloerithematous lesions seen in the figure. To achieve the diagnosis, a muscle biopsy is performed, among other tests, which can be seen in the figure. What do you think is the most likely diagnosis? 
 Options:  <1> Vasculitis type panarteritis nodosa. <2> Systemic lupus erythematosus. <3> Dermatomyositis <4> Myositis with inclusion bodies. <5> Sarcoidosis
Output: 3
Question: Question linked to image # 7 Among the complementary tests that could help us better define the clinical picture of the patient are all but one. Point it out 
 Options:  <1> Thoracoabdominal CT. <2> Gynecological exploration. <3> Autoantibodies that include ANA and antisintetase. <4> Electromyography <5> Arteriography of the renal arteries.
Output: 5
Question: Question linked to image nº8 A 75-year-old patient with a history of hypertension and hyperuricemia. In treatment with ACE inhibitors and allopurinol 100 mg daily. He went to the emergency room for a picture of several days of evolution of inflammatory rhythm pain in the small joints of the hands of progressive course together with daily fever of up to 37.8ºC. It has raised yellowish lesions on the skin around the interphalangeal and metatarsophalangeal joints that in recent days have left a yellowish liquid through the skin. On examination, it presents inflammatory signs at the proximal and distal interphalangeal levels of both hands. A simple x-ray of both hands is performed (see image). Which of the following statements is true in relation to the diagnosis of this patient? 
 Options:  <1> The drainage of yellowish whitish material through the skin is synonymous with infection and requires the initiation of antibiotic treatment immediately. <2> If the analysis of the synovial fluid showed a cell count between 2000 and 60,000 / μl, it would be a septic polyarthritis and specific treatment should be started immediately. <3> To establish the diagnosis of tophaceous gout, it is essential that uric acid levels are well above the reference range in all determinations. <4> To confirm the diagnosis, a complete study of the fluid is recommended. <5> The diagnostic technique of choice is arthroscopy.
Output: 4
Question: Question linked to image # 8 In relation to the previous case, how would you approach the initial treatment of this patient? 
 Options:  <1> The treatment is the use of allopurinol at a minimum dose of 800 mg daily, so the dose used by the patient should be increased early. <2> During the acute phase, the treatment is NSAIDs, which can be associated with colchicine. <3> Given the severity of the lesions, intravenous colchicine should be used. <4> If synovial fluid has a cell count above 3000 cells / μl, treatment with parenteral antibiotics should be initiated with coverage against Staphylococcus Aureus and Streptococcus spp. And maintained at least 6 weeks. <5> In this disease, systemic or intraarticular steroids have not proven their efficacy.
Output: 2
Question: Question linked to image no. 9 A 64-year-old patient complains of easy fatigability after a few months of evolution and loss of appetite, although she has not observed any weight loss. We are struck by the facies that it presents when we observe it (see image). Before proceeding with the interrogation and the clinical examination, we come up with a diagnostic hypothesis. Which of the following analytical tests do you think would guide us best in our diagnostic suspicion? 
 Options:  <1> TSH <2> CK <3> Hemogram, iron, ferritin. <4> Proteinuria <5> ANA.
Output: 1
Question: Question linked to image no. 9 To rule out situations that may simulate the patient's manifestations and establish a differential diagnosis, we must continue with the interrogation. One of the following habits or antecedents would be difficult to relate to the facial alterations observed. Point out which one. 
 Options:  <1> Habit of stretching the hairs (trichotillomania). <2> A sexually transmitted disease <3> Contact with people or geographic areas with leprosy. <4> Drug intake. <5> History of hyperuricemia.
Output: 5
Question: Question linked to image nº10 A 74-year-old man, asymptomatic, who in a routine laboratory test has leucocytes 37,000 / mL, hemoglobin 15,7 g / dL, platelets 190,000 / mL. In the examination, adenopathies and organomegalies are not appreciated. An extension of peripheral blood is made (image). What is the most likely diagnosis? 
 Options:  <1> Viriasis <2> Chronic myeloid leukemia <3> Monoclonal gammopathy of uncertain significance. <4> Chronic lymphatic leukemia. <5> Myelodysplastic syndrome
Output: 4
Question: Question linked to image nº10 Given this clinical picture, what would be the most appropriate treatment? 
 Options:  <1> Do not treat; wait and see. <2> Interferon. <3> Chlorambucil and prednisone. <4> Inhibitors of bcr / abl (imatinib). <5> Cyclophosphamide, vincristine and prednisone.
Output: 1
Question: Question linked to the image nº11 The ultrasound image presented to him corresponds to a 37-year-old woman who consulted for non-traumatic right back pain associated with fever. Based on that background and the sonographic findings, point out the correct answer: 
 Options:  <1> An enlarged gallbladder with a double-walled sign is observed. <2> The findings suggest perinephric abscess with free perirenal fluid. <3> The image does not provide enough data to help the diagnosis. <4> The image suggests a large parapelic cyst; It is a minor find. <5> Ultrasound suggests obstruction of the urinary tract.
Output: 5
Question: Question linked to image nº11 In relation to the treatment of this patient, indicate the correct answer: 
 Options:  <1> It would be necessary to perform evacuation puncture guided by CT of the perinephritic collection and prescribe broad spectrum antibiotic therapy. <2> Urinary diversion is the key in the initial management of cases with hydronephrosis and deterioration of renal function or infection. The definitive treatment will depend on the etiology. <3> Before making therapeutic decisions we must continue the study by abdominal CT. <4> It is an acalculous cholecystitis and requires an urgent cholecystectomy. <5> At present, the level of evidence suggests that non-steroidal anti-inflammatory drugs (NSAIDs) no longer represent the first analgesic step in the treatment of patients with nephritic colic who go to an emergency department.
Output: 2
Question: Question linked to image nº12 An 88-year-old woman with a history of Alzheimer's dementia, mitral insufficiency and persistent atrial fibrillation, enters a hospital due to a deterioration in her general condition that is attributed to a urinary tract infection. The peripheral venous routes are not accessible and it is decided to channel a central vein through a peripheral vein (cephalic vein) guided by ultrasound. Once the technique is done, it is verified that the blood flows back normally through the catheter. The patient did not present any complications during the maneuver and a catheter control X-ray was later performed. Where do you think the distal end of the catheter has been located? 
 Options:  <1> Right subclavian vein <2> Right jugular vein <3> Vena cava superior. <4> Right basilic vein. <5> Brachiocephalic trunk.
Output: 4
Question: Question linked to image # 12 What is the most reasonable attitude at this time ?: 
 Options:  <1> Remove the entire catheter and reinsert it. <2> Extract about 10 cm the catheter and install the appropriate treatment. <3> Channel another central venous line through the jugular vein. <4> Leave it as it is because it can be used to monitor central venous pressure. <5> We can not use the catheter because it has perforated the vein and it is located in the lung.
Output: 2
Question: Question linked to the image nº13 A 12-year-old boy who goes to primary care Pediatrics for fever, vomiting, abdominal pain and diarrhea. On cardiopulmonary auscultation, he presents with an ejection systolic murmur II / VI in a pulmonary focus with a fixed second unfolded noise, the remainder being the normal physical examination. For the evaluation of the murmur the pediatrician performs an ECG that is shown below. In relation to the interpretation of it, please indicate below the correct answer: 
 Options:  <1> It is a normal ECG. <2> He presents a first-degree atrioventricular block as the only alteration. <3> It presents a left extreme QRS axis. <4> It presents a QRS axis deviated to the right with an rsR' pattern. <5> There are clear signs of left ventricular hypertrophy.
Output: 4
Question: Question linked to image # 13 What would be the suspicion of the pediatrician and what other complementary tests would be done to confirm it? 
 Options:  <1> I would suspect an innocent murmur and I would not do any more tests. <2> Given that it presents a left anterior hemiblock, it could be a partial atrioventricular canal (CIA ostium primun and cleft mitral), so a chest radiograph and an echocardiogram were performed. <3> Given that it presents a right axis and a rsR' pattern, an ostium secundum atrial septal defect could be treated and a chest X-ray and an echocardiogram were performed to confirm it. <4> It would be necessary to consider the implantation of a pacemaker. <5> As there are data of left ventricular hypertrophy, he would perform a family study to rule out hypertrophic cardiomyopathy.
Output: 3
Question: Question linked to image nº14 A 75-year-old woman consulted for abdominal pain and increased abdominal perimeter. It does not refer previous history of liver disease. On physical examination, the abdomen is bulging with central tympany and changing dullness in the flanks. There are no masses or visceromegalies. In the analysis, only a hemoglobin figure of 10.9 g / dL, VCM 92 fl, with normal leukocytes and platelets stands out. Biochemistry and normal hepatic profile. By means of paracentesis, amber ascitic fluid with an albumin gradient of 0.7 and cytology suspected of malignancy is extracted. TAC (image) is provided. What is the most likely diagnosis? 
 Options:  <1> Peritoneal pseudomyxoma. <2> Krukenberg's tumor. <3> Peritoneal mesothelioma. <4> Ovarian adenocarcinoma. <5> Colon adenocarcinoma.
Output: 4
Question: Question linked to image nº14 Once the diagnosis of suspicion has been confirmed. What is the most correct therapeutic behavior? 
 Options:  <1> Cytoreductive surgery and chemotherapy with taxol-carboplatin. <2> Gastrectomy with double adnexectomy. <3> Laparoscopy with peritoneal washes and infusion of mitomycin and 5-fluorouracil. <4> Systemic chemotherapy with cisplatin and pemetrexed. <5> Laparoscopic surgery and chemotherapy with oxaliplatin and 5-fluorouracil (FOLFOX).
Output: 1
Question: Question linked to image nº15 A 67-year-old patient who reported a decrease in unilateral visual acuity and rapidly evolving metamorphopsia. The attached retinography presents the image of the affected eye. The most likely diagnosis would be: 
 Options:  <1> Macular degeneration associated with exudative age. <2> Retinal detachment. <3> Retinitis pigmentosa <4> Central vein thrombosis of the ischemic retina. <5> Equatorial choroidal melanoma.
Output: 1
Question: Question linked to image nº15 The following diagnostic test that is most appropriate to perform in this patient is: 
 Options:  <1> Angiofluoresceingraphy. <2> Visual evoked potentials. <3> Vitreous sampling using vitrectomy. <4> Nuclear magnetic resonance. <5> Computerized field.
Output: 1
Question: Question linked to the image nº16 Patient of 48 years smoker. Consultation due to symmetrical and bilateral reddening in both feet accompanied by burning pain (image). The general examination, the neurological examination and the peripheral pulses are normal. The analytical highlights: Hb 16.8 g / dl, leukocytes 12,400 / mm3, platelets 720,000 / mm3. Biochemistry: Glucose 87 mg / dl, Creatinine 0.7 mg / dl, Protein 7.5 g / dl, Calcium 9.4 mg / dl, GOT 40 U / L, GPT 35 U / L, GGT 64 U / L, FA 124 U / L, LDH 187 U / L, VSG 24 mm / h. Hemostasis and normal immunoglobulins. Serology against hepatitis B and C negative virus. What is the most likely diagnosis? 
 Options:  <1> Livedo reticularis. <2> Erythromelalgia. <3> Buerger's disease <4> Systemic mastocytosis. <5> Mixed cryoglobulinemia.
Output: 2
Question: Question linked to image # 16 Which of the following will support the diagnosis of the underlying disease? 
 Options:  <1> Cutaneous biopsy. <2> Microangiography <3> Determination of cryoglobulins. <4> Serum tryptase. <5> JAK 2 mutation study.
Output: 5
Question: Question linked to image nº17 The following figure describes the survival function of the variable progression free of disease (Progression-free Survival, PFS) by the Kaplan-Meier method of two groups of patients. Group A: patients treated with the best support treatment (Best Suportive Care, BSC). Group B: patients who in addition to BSC receive Panitumumab. Data complementary to the figure: patients with disease progression: Group A = 184/232 (79%), Group B = 161/231 (70%). Percentage of censures: Group A = 24/232 (10%), Group B = 38/231 (16%). Log-rank test p <0.0001. Hazard Ratio [95% CI]: 0.54 [0.44-0.66]. Which of the following statements is correct: 
 Options:  <1> The gain in terms of the median time to progression in Group B does not exceed two weeks in relation to Group A. <2> To interpret the results of these two survival curves, it is necessary and sufficient to evaluate and contrast the percentages of progression, that is, 79% in Group A versus 70% in Group B. <3> The ratio of medians in time to progression of the two treatment groups is 0.54. <4> The log-rank test evaluates the average difference in the follow-up time. <5> The results of the log-rank test and the Hazard Ratio estimate (95% confidence interval, 95% CI), are not compatible since the first one indicates that the differences are significant while the second indicates that they are not.
Output: 1
Question: Question linked to image nº17 Which of the following statements is correct: 
 Options:  <1> All the patients in the study except one had progression of the disease at 50 weeks of follow-up. <2> Since the survival curves overlap at the end of the follow-up time, the results should not be described as statistically significant. <3> The reduction of the risk of progression of the disease in group B (BSC + panitumumab) is 46% with respect to group A (BSC alone). <4> The average time to progression is the best estimator of the effect of the treatments and the difference between groups should be indicated to evaluate its relevance. <5> The Hazard Ratio analysis is not acceptable since the percentage of censorships is different between groups, p <0.0001.
Output: 4
Question: The placenta is a derivative of: 
 Options:  <1> The zona pellucida. <2> The trophoblast. <3> The ectoderm <4> The mesoderm <5> The primitive line.
Output: 2
Question: Juan is 60 years old, smokes 2 packs / day for years and has been talking about persistent cough for 6 months. Check that your left eyelid is more droopy and that the pupil of that eye is smaller. Juan says that the medial part of his left hand is numb and less powerful. Your doctor checks for palpebral ptosis and left miosis; check that you can close both eyelids with symmetry and that both pupils respond correctly to the light. He also checks that he does not sweat through the left side of the face, that he feels less the puncture on the inside surface of that hand and that he has less strength in the grip of that hand. Regarding the ocular symptomatology, where is the lesion located? 
 Options:  <1> The sympathetic fibers, at some level that would span from the hypothalamus to the Clark-intermediate column of the dorsal medulla. <2> The left common ocular motor nerve in the mesencephalon. <3> The nucleus of Edinger-Westphal, above the nucleus of the left ocular motor nerve. <4> The parasympathetic fibers, at some level that would extend from the EdingerWestphal nucleus to the constrictor muscle of the left pupil. <5> The tarsal muscle exclusively.
Output: 1
Question: What root predominantly depends on the sensory innervation of the first toe? 
 Options:  <1> L3. <2> L4. <3> L5 <4> S1 <5> L2.
Output: 3
Question: The human papilloma virus (HPV) is involved in the pathogenesis of: 
 Options:  <1> Cervical cancer <2> Endometrial cancer. <3> Ovarian cancer. <4> Breast cancer <5> Burkitt lymphoma.
Output: 1
Question: Hepatocytes in ground glass are characteristic of: 
 Options:  <1> Chronic hepatitis by HBV. <2> Chronic HCV hepatitis. <3> Chronic hepatitis by VH delta. <4> Toxic hepatitis. <5> Hepatitis for alcohol.
Output: 1
Question: The most common pancreatic cancer is: 
 Options:  <1> The intraductal mucinous papillary tumor. <2> Pancreatic neuroendocrine carcinoma. <3> The pancreatic cystadenocarcinoma. <4> The malignant insulinoma. <5> Ductal adenocarcinoma of the pancreas.
Output: 5
Question: A 20-year-old man, with symptoms of ataxia, headache and solid-cystic mass in the right cerebellar hemisphere, underwent surgery, resecting a lesion that histologically shows cells with long and fine cytoplasmic processes, a fascicular and microcystic pattern, and numerous vessels and fibers. Rosenthal. The most likely antimopathological diagnosis is: 
 Options:  <1> Pilocytic astrocytoma. <2> Pleomorphic Xanthoastrocytoma. <3> Central neurocytoma. <4> Liponeurocytoma <5> Prion disease.
Output: 1
Question: A 70-year-old woman with a history of hypertension and moderate heart failure attended the clinic due to a persistent and dry cough that started as a sensation of itching in the throat. In the analytical hyperkalemia is observed. What is the drug suspected of causing the clinical and analytical alteration of the patient? 
 Options:  <1> Hydrochlorothiazide. <2> Bisoprolol. <3> Furosemide. <4> Enalapril <5> Hydralazine
Output: 4
Question: What factors depends on the apparent volume of distribution of a drug ?: 
 Options:  <1> Its degree of binding to plasma and tissue proteins and its elimination half-life. <2> Of its distribution coefficient and its elimination half-life. <3> Of its elimination half-life and its elimination constant. <4> Its degree of binding to plasma and tissue proteins and their distribution coefficient. <5> Of its constant elimination and its clearing.
Output: 4
Question: What is a prodrug? 
 Options:  <1> A drug of series of a therapeutic class. <2> A drug that has been withdrawn from the market. <3> An inactive product that is enzymatically converted to an active drug. <4> A compound of natural origin from which one or more drugs are obtained by hemisynthesis. <5> A drug that lacks activity but enhances the action of others.
Output: 3
Question: Which of the following pairings between anticoagulant drug and mechanism of action is INCORRECT? 
 Options:  <1> Heparin - cofactor of antithrombin III. <2> Acenocoumarol - inhibits vitamin K epoxide reductase. <3> Dabigatran - inhibits thrombin. <4> Rivaroxaban - inhibits factor Xa. <5> Warfarin - inhibits the absorption of vitamin K.
Output: 5
Question: Orally administered proton pump inhibitor drugs: 
 Options:  <1> Neutralize hydrochloric acid from gastric secretion. <2> They dye the stools black. <3> They block the histaminergic receptor. <4> They block the gastrin receptor. <5> They require enteric cover.
Output: 5
Question: Indicate which of the following statements about vascular smooth muscle is FALSE: 
 Options:  <1> Its main function is to maintain the tone of the vessels. <2> It is contracted by an increase in the intracellular calcium concentration. <3> Its contraction is controlled by the binding of calcium to troponin. <4> Its tone is controlled by the autonomic nervous system. <5> The endothelium modulates vascular smooth muscle tone.
Output: 3
Question: In a clinical trial of an antineoplastic drug, a significant increase in plasma levels of LDL (low density lipoproteins) is observed. Indicate among the following statements which is correct in the interpretation and consequences of this fact: 
 Options:  <1> LDL represents the transport mode of cholesterol from the intestine to the liver. Therefore, they reflect a greater incorporation of cholesterol from lipid intake. <2> LDL is involved in the reverse transport of cholesterol from peripheral tissues to the liver. Therefore, high levels are beneficial for lowering plasma cholesterol levels. <3> LDL are rich in triglycerides and low in cholesterol. An increase in plasma LDL reflects an increase in de novo synthesis and / or ingestion of triglycerides. <4> An increase in plasma LDL levels is beneficial because it protects the arteries from the formation of atherosclerotic plaques. <5> LDL transport cholesterol from the liver to peripheral tissues, where they enter the cells through endocytosis processes.
Output: 5
Question: The glomerular filtration rate increases when: 
 Options:  <1> Increases the resistance in the glomerular afferent arteriole. <2> Decreases the resistance in the glomerular efferent arteriole. <3> Increases the activity of the renal sympathetic nerves. <4> Obstruction of the urinary tract occurs. <5> Decreases the concentration of plasma proteins.
Output: 5
Question: A thirty-five-year-old man (index case) affected by ataxia and with clinical manifestations for three years, presents an expansive trinucleotide CAG mutation in heterozygosis in the ATXN1 gene. The molecular diagnosis is of spinocerebellar ataxia type 1 (SCA1; 6p22.3) and in the genetic report it is said that the disease is of complete penetrance throughout life. In genetic counseling, the risks of transmitting the disease to their offspring will be explained to the index case. What follows from the above? 
 Options:  <1> Being the male index case, all female descendants will inherit ataxia; but no male child. <2> The mutation will be transmitted to 50% of the descendants of the index case, who will develop ataxia from some point in their life. <3> The mutation will be transmitted to 25% of the descendants of the index case, who will develop ataxia from some point in their life. <4> The ataxia will be transmitted throughout the life of the index case affecting all of its offspring. <5> If the partner of the index case carries another SCA mutation (for example, in SCA36, great genetic heterogeneity), ataxia will be suffered by 25% of the descendants from some point in their life. If the couple is not a carrier, the ataxia will not be transmitted.
Output: 2
Question: A 30-year-old man (index case) affected by Leber's optic atrophy presents the mutation of the mitochondrial genome LHON11778A. In genetic counseling you will be informed of the risks of transmitting the disease to your offspring. What information is correct? 
 Options:  <1> The index case will transmit the disease to all its male descendants (holándrica inheritance). <2> The disease will be transmitted to 50% of the descendants of the index case, regardless of their sex. <3> The disease will be transmitted to all descendants of the index case, as it is of paternal inheritance. <4> The disease will be transmitted to female descendants; but to no man. <5> The disease will not be transmitted to the descendants of the index case, because it is of maternal inheritance.
Output: 5
Question: What are the possibilities, in each pregnancy, of parents bearing a mutation in the CFTR gene, having a child with cystic fibrosis? 
 Options:  <1> 0.01. <2> 0.1 <3> 0,25. <4> 0.5. <5> one.
Output: 3
Question: Which of the following answers is true about the HLA molecules? 
 Options:  <1> They are very polymorphic nuclear proteins. <2> They are divided into molecules of class IgG, IgA and IgM. <3> They join peptides and present them on the cell surface. <4> They interact with cytokines to modulate the immune response. <5> They are monomorphic.
Output: 3
Question: In which of the following clinical contexts is NOT the use of intravenous gammaglobulins recommended? 
 Options:  <1> Substitute treatment in humoral immunodeficiencies (defect in the formation of antibodies). <2> Prevention of monoclonal gammopathy of uncertain significance (MGUS). <3> Treatment of Kawasaki syndrome. <4> Management of inflammatory / autoimmune neurological pathologies (Sd. Guillain-Barré, multiple sclerosis). <5> Therapeutic management of immune thrombocyanic purpura (ITP).
Output: 2
Question: Among the biological advantages of fever is NOT found. 
 Options:  <1> Inhibits bacterial growth. <2> Increases bactericidal activity of phagocytes. <3> Stimulates the alternative route of the complement. <4> It stimulates the synthesis of acute phase proteins and immunoglobulins. <5> It produces serum iron sequestration.
Output: 3
Question: Which of the following cytokines exert an anti-inflammatory and immunosuppressive effect? 
 Options:  <1> Interleukin-1 alpha, interleukin-1 beta. <2> Tumor necrosis factor-alpha, Tumor necrosis factor-beta. <3> Interleukin-17, Interleukin-22. <4> Interleukin-10, Transforming growth factor beta. <5> Interleukin 2, Interferon-gamma.
Output: 4
Question: The reactivation of a latent cytomegalovirus in an immunosuppressed patient can lead to a severe systemic picture. How would the ethological diagnosis? 
 Options:  <1> Detecting the specific IgG in the serum. <2> By urine culture in an advanced cell line. <3> By chain reaction of quantitative polymerase in the blood. <4> By detection of antigen in the urine. <5> By detection of specific IgM in the serum.
Output: 3
Question: In routine clinical practice, in patients infected with the human immunodeficiency virus (HIV) who are undergoing antiretroviral treatment, the laboratory tool that is used to, in the short term, know if the treatment is being effective is: 
 Options:  <1> The levels of CD4 T lymphocytes, which increase rapidly if the treatment is being effective. <2> Anti-HIV antibody levels, which decrease when a combination of antivirals is effective. <3> P24 antigenemia, which increases in effective treatments. <4> Plasma viral load (HIV RNA per ml of plasma), which decreases to undetectable levels in effective treatments. <5> The intensity of the bands observed in the Western blot, which disappear if the treatment is effective.
Output: 4
Question: Which of the following hepatitis viruses is a subsidiary of treatment with viral protease inhibitors? 
 Options:  <1> The hepatitis C virus <2> The hepatitis B virus <3> The hepatitis A virus <4> The hepatitis E virus <5> The TTV virus.
Output: 1
Question: Which of the following pathogens is the cause of cat scratch disease? 
 Options:  <1> Bartonella henselae. <2> Mycobacterium tuberculosis. <3> Mycobacterium avium complex. <4> Toxoplasma gondii. <5> Epstein Barr virus.
Output: 1
Question: Mycobacterium tuberculosis complex includes the bacillus that causes human tuberculosis (Mycobacterium tuberculosis hominis, Koch's bacillus), as well as other mycobacteria, among which are the following, except one: 
 Options:  <1> Mycobacterium bovis. <2> Mycobacterium africanum. <3> Bacillus Calmette-Guerin (BCG). <4> Mycobacterium microti. <5> Mycobacterium avium-intracellulare.
Output: 5
Question: An 82-year-old patient comes to the clinic due to sudden and frequent dizziness, without prodromes, of short duration and that subside spontaneously, without ever presenting syncope. The physical examination and the baseline electrocardiogram are normal. In an ambulatory record of the electrocardiogram during 24 hours, short duration phases of absence of P waves before the QRS are detected with an escape rhythm of the atrio-ventricular junction with narrow QRS at 40 bpm and a wave at the beginning of the ST segment corresponding to a retrograde P. No periods of asystole greater than 3 seconds are detected. Before this you would say: 
 Options:  <1> The patient has an atrioventricular block of 3rd degree and requires the implantation of a pacemaker. <2> The absence of periods of asystole> 3 seconds excludes a cardiac cause of dizziness. <3> A pharmacological treatment that would increase conduction in the atrio-ventricular node would be indicated. <4> The patient presents a sinus dysfunction with sinoatrial block and requires implantation of a pacemaker due to the presence of symptoms. <5> The alterations detected in the ambulatory electrocardiogram are typical of patients of this age and there is no indication of therapeutic intervention.
Output: 4
Question: A 82-year-old hypertensive woman on treatment with atenolol, hydrochlorothiazide and digoxin. He goes to the emergency room for atrial fibrillation and is administered verapamil i.v. Complete atrioventricular block is evidenced in ECG. What is the most likely cause of this clinical situation? 
 Options:  <1> Digitalis intoxication by pharmacokinetic interaction by verapamil. <2> Hypokalemia due to the administration of thiazide and digoxin. <3> Pharmacodynamic interaction of beta-blocker, digoxin and verapamil. <4> Hypotensive effect of the thiazide diuretic. <5> Cardiac arrhythmia due to verapamil.
Output: 3
Question: A 45-year-old woman with a history of a heart murmur detected in the pediatric age. Enter the Emergency Department for symptoms of palpitations, easy fatigue and malignant edema. Physical examination reveals absence of cyanosis. Oxygen Saturation by pulse oximeter 97%. TA: 120/80 mm Hg. Irregular heart rate at 100 bpm. Systolic ejection murmur (2/6) in pulmonary focus. 2nd R unfolded, wide and fixed. No death rattles. Slight hepatomegaly (2-3 cm). Slight malleolar edema. ECG: complete arrhythmia due to atrial fibrillation at 100 bpm. AQRS: + 120º. Conduction disorder of the right branch of the bundle of His. What is your diagnostic orientation? 
 Options:  <1> Ventricular communication. <2> Aortic stenosis. <3> Mitral stenosis. <4> Interauricular communication. <5> Persistent ductus arteriosus.
Output: 4
Question: In which patient would an urgent coronary angiography be performed? 
 Options:  <1> 66-year-old diabetic woman with a single episode of pain at rest and elevation of troponins. <2> A 77-year-old man admitted for two 30-minute episodes of pain with a decrease in the ST segment on the ECG during the episode of pain. <3> A 55-year-old man who, after a week of treatment with double antiaggregation, underwent an isotopic ergometry showing extensive ischemia in the anterior face. <4> A 65-year-old woman with pain at rest and positive clinical ergometry in the third stage of Bruce. <5> A 55-year-old patient admitted for chest pain and dyspnea saturating 80% despite the administration of oxygen and with an ECG with ST-segment depression in the anterolateral aspect that does not revert with the administration of intravenous nitroglycerin.
Output: 5
Question: What electrocardiographic alteration is interpreted as a subendocardial lesion? 
 Options:  <1> The reversal of the T wave. <2> The supra-leveling of the ST segment. <3> The tipped T wave. <4> The presence of Q wave <5> The rectilinear depression of the ST segment.
Output: 5
Question: A 52-year-old patient who reported dyspnea of ​​medium effort for 6 months. He has not presented angina or syncopes. The physical examination and diagnostic tests show the existence of an average aortic transvalvular gradient of 55 mmHg and a calculated area of ​​0.7 cm2. Ejection fraction of 65%. The treatment that should be indicated to this patient is: 
 Options:  <1> Diuretics and more frequent controls by a specialist. <2> In case of increasing dyspnea on exertion, a percutaneous dilatation of the aortic valve with a balloon catheter should be performed. <3> Replacement of the aortic valve with a prosthesis / bioprosthesis. <4> Replacement of the aortic valve by a homograft. <5> Implantation of a percutaneous valve.
Output: 3
Question: When it comes to pericardial tamponade, which of the following statements is NOT correct? 
 Options:  <1> Chest radiography is very useful for diagnosis. <2> The jugular venous registry allows to objectify a very deep collapse. <3> The presence of a paradoxical arterial pulse is common. <4> Right atrial collapse is very sensitive for diagnosis. <5> Right ventricular collapse is very specific for diagnosis.
Output: 1
Question: The following patients are sent to the hypertension clinic. Indicate which one you would NOT suspect secondary hypertension. 
 Options:  <1> 25 year old woman with an abdominal puff. <2> Hypertension with hypokalemia in a 50-year-old man who does not take drugs. <3> A 55-year-old woman with a body mass index of 28 and dyslipidemia. <4> A 78-year-old woman who has not been controlled with 3 drugs for 3 months. <5> Man of 60 years with daytime sleepiness, morning headache and snoring.
Output: 3
Question: In the treatment of heart failure: 
 Options:  <1> Angiotensin receptor blockers (ARA II) have shown superiority over angiotensin-converting enzyme (ACE) inhibitors and should be the first therapeutic option. <2> Aldosterone antagonists have not shown prognostic improvement, being contraindicated in patients with advanced systolic dysfunction and functional grade IV. <3> Beta-blockers have been shown to decrease mortality in patients with decreased ejection fraction. <4> Cardiac resynchronization pacemaker therapy is indicated in patients with systolic dysfunction whenever the QRS is narrow (less than 120 msg). <5> The implantation of automatic defibrillators is contraindicated in patients with ventricular dysfunction, especially if it is caused by ischemia.
Output: 3
Question: In a patient with symptoms of heart failure who have a disproportionately high ascites in relation to peripheral edema, the most likely etiology would be: 
 Options:  <1> A severe aortic stenosis. <2> A dilated cardiomyopathy with significant left ventricular dysfunction. <3> A primary pulmonary hypertension. <4> An obstructive hypertrophic cardiomyopathy. <5> A constrictive pericarditis.
Output: 5
Question: In choosing the type of cardiac valvular prosthesis (biological or mechanical) to be implanted in a patient, various aspects and characteristics of the patient and the prosthesis must be considered. In view of the aforementioned, point out the INCORRECT statement: 
 Options:  <1> Permanent anticoagulation is necessary in mechanical prostheses. <2> In general, biological prostheses are indicated in young patients, with long life expectancy. <3> Biological prostheses would be indicated in cases that present a formal contraindication for anticoagulation. <4> The rate of structural deterioration of a biological prosthesis is inversely proportional to the age of the subject. <5> Biological prostheses do not require permanent anticoagulation.
Output: 2
Question: Acute ischemia of a limb consists of a sharp decrease in arterial perfusion. It is important to differentiate between thrombosis and arterial embolism to be able to indicate the most appropriate treatment. Which of the following is correct? 
 Options:  <1> The presence of embolic focus and distal pulses in the contralateral limb leads to the suspicion of arterial thrombosis. <2> If the patient has a history of claudication and the clinic is of sudden onset, we will suspect arterial embolism in the first place. <3> If the contralateral limb has all the pulses present and the clinic starts slowly, we will suspect an arterial thrombosis. <4> If the clinic starts abruptly in a patient with embolism focus, we will suspect arterial embolism. <5> If the patient is a carrier of a previous arterial derivation, we will suspect arterial embolism.
Output: 4
Question: The characteristic Rovsing sign in acute appendicitis consists of: 
 Options:  <1> Pain in the epigastric pressure when applying a firm and persistent pressure on McBurney's point. <2> Acute pain that appears when the appendix is ​​compressed between the abdominal wall and the iliac crest. <3> Passive rebound sensitivity in the abdominal wall. <4> Loss of abdominal sensation when contracting the muscles of the abdominal wall. <5> Pain at McBurney's point when compressing the lower left quadrant of the abdomen.
Output: 5
Question: Regarding the Gastrointestinal Stromal Tumors (GIST), it is true that: 
 Options:  <1> These are tumors of epithelial origin, located mainly at the level of the mucosa of the digestive tract. <2> The mutation of the c-kit gene, which codes for a tyrosine kinase receptor, is characteristic of these tumors. <3> The treatment of localized tumors smaller than 2 cm is fundamentally medical, with the use of Imatinib. <4> They are tumors that only exceptionally bleed. <5> The most frequent localization of these tumors is the small intestine.
Output: 2
Question: A 45-year-old man underwent a truncal vagotomy and antrectomy with Billroth II reconstruction, for suffering from a chronic peptic ulcer disease with pylorus-duodenal stenosis. Six weeks after the surgery, he reported that shortly after (less than half an hour) of the ingestions he presented with a nauseating state, asthenia and sweating, dizziness and abdominal cramps, usually accompanied by diarrheal descent. Which of the following is the most appropriate attitude for its initial management? 
 Options:  <1> Apply treatment with a somatostatin analog (octeotide). <2> Follow specific dietary measures. <3> Perform a test treatment with a benzodiazepine. <4> Perform the search for a probable neuroendocrine tumor (eg, carcinoid). <5> Indicate surgical treatment to perform an anti-peristaltic gastro-jejunostomy in Roux-en-Y.
Output: 2
Question: Within the congenital anomalies of the abdominal wall are the omphalocele and gastroschisis. Both entities are defects of the wall. What is the difference between them? 
 Options:  <1> Omphalocele occurs at the umbilical level and gastroschisis at the epigastric level. <2> The defect, in the case of gastroschisis, is larger than the omphalocele. <3> In the omphalocele, a peritoneal sac covers the abdominal contents and not gastroschisis. <4> Omphalocele, unlike gastroschisis, is frequently associated with intestinal atresia. <5> Unlike the omphalocele, in gastroschisis the surgical treatment can be deferred.
Output: 3
Question: A 78-year-old woman went to the Emergency Department for pain in the left iliac fossa of 24 hours of evolution associated with fever and occasional vomiting. On examination, pain is palpated selectively in the left iliac fossa with a feeling of occupation, defense and positive decompression. Upon suspicion of acute diverticulitis. Which of the following statements is correct? 
 Options:  <1> The safest and best performing complementary scan is the enema with barium contrast. <2> In the case of a pelvic abscess, the placement of a percutaneous drainage guided with CT or ultrasound is indicated. <3> If surgical intervention is necessary after the acute episode is resolved, the laparoscopic approach is contraindicated. <4> In the case of acute uncomplicated diverticulitis, elective sigmoidectomy is indicated after the first acute episode has been cured. <5> If generalized peritonitis occurs, the most appropriate surgical technique is the practice of a derivative colostomy without resection of the affected sigmoid segment.
Output: 2
Question: Regarding intestinal polyposis, which of the following syndromes is NOT hereditary? 
 Options:  <1> Gardner syndrome. <2> Cronkhite-Canada syndrome. <3> Turcot syndrome. <4> Juvenile polyposis <5> Peutz-Jeghers syndrome.
Output: 2
Question: A 55-year-old man, the father of a celiac son, with iron deficiency anemia and a recent increase in the rhythm of deposition, has been determined to have a negative HLA-DQ2 and HLADQ8 allele. Which diagnostic study is the most appropriate in this case? 
 Options:  <1> Determination of IgA anti-transglutaminase antibodies. <2> Upper digestive endoscopy with taking of duodenal biopsies. <3> D-xylose test. <4> Evaluate the response to a gluten-free diet. <5> Colonoscopy
Output: 5
Question: A 37-year-old woman with an extensive ulcerative colitis has a severe outbreak where treatment with prednisone is started at a dose of 1 mg / kg. After a week of treatment, the patient does not show improvement. What is the next therapeutic measure to perform? 
 Options:  <1> Subtotal colectomy of urgency and in a second time proctectomy and ileoanal reservoir. <2> Associate an immunosuppressant such as azathioprine. <3> Associate mesalazine in doses of 4 grams per day oral and rectal triamcinolone 1 application every 12 hours <4> Endovenous cyclosporine 2 mg / Kg. <5> Treatment with etanercept (an anti-TNFa antibody) should be assessed.
Output: 4
Question: In a liver transplant patient who is receiving immunosuppression with tacrolimus, which of the following antibiotics markedly increases the levels of the immunosuppressant and should therefore be avoided? 
 Options:  <1> Amoxicillin clavulanic. <2> Ciprofloxacin <3> Erythromycin. <4> Cefuroxime <5> Norfloxacin.
Output: 3
Question: What disease would we suspect in a young patient who reported a frequent history of dysphagia to solids and liquids with impaired food repeated, without clinical symptoms of pyrosis and in which multiple oral esophageal rings with normal mucosa (trachealized appearance) are observed in oral endoscopy? 
 Options:  <1> Herpetic esophagitis. <2> Eosinophilic esophagitis. <3> Candidiasic esophagitis. <4> Cytomegalovirus esophagitis. <5> Adenocarcinoma of the esophagus.
Output: 2
Question: In the pathophysiology of peptic ulcer. What is the FALSE? 
 Options:  <1> Much of the gastro-duodenal ulcers can be attributed to H. pylori infection or mucosal injury by NSAIDs. <2> H. pylori is not related to the development of gastric lymphoma. <3> The transmission of H. pylori occurs from person to person via oral-oral or fecal-oral. <4> A lower educational level and a low socioeconomic status predispose to higher rates of colonization. <5> The incidence of gastric adenocarcinoma is higher in patients with H. pylori.
Output: 2
Question: A 65-year-old woman with a history of joint pains treated with anti-inflammatories, who is referred for a study due to anemia. In the complementary studies it presents 3.164.000 red blood cells, Hto. 32%, Hb 11 g / dl, VCM 69 fl, Leukocytes 7800, Platelets 370,000, PCR 0.29 mg / dl, Fe 20 ng / ml, Ferritin 18 ng / ml, Glucose 105 mg / dl, GOT, GPT, GGT , F. Alkaline, total Bilirubin, Cholesterol, Creatinine, Calcium and Phosphorus normal. Ac. Anti-transglutaminase and negative antigliadin Ac. Gastroscopy: hiatus hernia of 3 cm, rest without alterations. Colonoscopy: up to blind, isolated diverticula in sigma. Intestinal transit without alterations. Ultrasound of the abdomen without alterations. Which of the explorations listed below do you find most appropriate to complete the study? 
 Options:  <1> Jejunal biopsy <2> Arteriography <3> Endoscopic capsule <4> Radioisotopes. <5> Pelvic MRI.
Output: 3
Question: A patient goes to a hospital emergency department presenting frank hematemesis. In the initial assessment the patient is pale and sweaty, has a heart rate of 110 beats per minute and a systolic blood pressure of 98 mmHg. Which of the following actions would NOT be performed in the initial care of this patient? 
 Options:  <1> Ensure adequate oxygenation of the patient. <2> Channel two heavy gauge peripheral routes. <3> Use the hematocrit as an index of blood loss. <4> Replace the blood volume with crystalloid solutions. <5> Place a nasogastric tube.
Output: 3
Question: Which of the following statements about focal nodular hyperplasia of the liver is true? 
 Options:  <1> It is considered that its appearance is related to the consumption of contraceptives. <2> The risk of breakage hemoperitoneum is similar to that of the adenoma. <3> There is a risk of tumor degeneration. <4> It behaves as a focal hypovascular lesion in computed tomography with contrast administration. <5> In the histological study of the lesion, in addition to hepatocytes, bile ducts and other liver cells can be observed.
Output: 5
Question: A 50-year-old woman attended the emergency department for asthenia, anorexia, weight loss, jaundice, fever and abdominal pain. It does not refer to recent history of blood transfusion, risky sexual contacts or addiction to parenteral drugs. Usual consumption of 60 grams of alcohol per day during the last five years, consumption that has increased during the previous month due to family problems. Temperature 38.5ºC, blood pressure 100/60 mmHg. Physical examination shows temporo-spatial disorientation, malnutrition, asterixis, jaundice and painful hepatomegaly. No ascites or peritoneal irritation data. Laboratory tests include leukocytes 15,000 / microliter with 90% polymorphonuclear cells, red blood cells 3 million / mm3, hemoglobin 10 g / dl, mean corpuscular volume 115 fl, bilirubin 15 mg / dl direct predominance, AST (GOT) 300 IU / L, ALT (GPT) 120 IU / L, GGT 635 IU / L, prolongation of prothrombin time greater than 50%. What is the most likely diagnosis of the condition presented by the patient? 
 Options:  <1> Liver abscess. <2> Acute cholecystitis. <3> Acute cholangitis <4> Alcoholic hepatitis <5> Acute pancreatitis
Output: 4