niryuu/sni-each-converted huggingface dataset:
Question: A 17-year-old boy, an athlete with no history of interest, goes to the doctor for occasional conjunctival jaundice. Denies drug intake and abdominal pain. In the analyzes performed, normal ALT, AST, GGT, and FA were observed, with total bilirubin of 3.2 mgr / dl and direct bilirubin of 0.4 mgr / dl. It does not have anemia and the liver is ecographically normal. What is your diagnosis? 
 Options:  <1> Rotor syndrome. <2> Coledocolithiasis <3> Dubin-Johnson syndrome. <4> Acute hepatitis <5> Gilbert's syndrome.
Output: 5
Question: In the presence of a patient with Crohn's disease who is going to start treatment with biological anti-TNF therapy (antibodies against tumor necrosis factor alpha), which of the following diagnostic tests is not necessary before initiating such therapy? 
 Options:  <1> Evaluation of the immune stage by lymphocyte count. <2> Serology of hepatitis B virus (HBV). <3> Tuberculin test. <4> Chest x-ray. <5> Serology of the human immunodeficiency virus (HIV).
Output: 1
Question: The initial procedure of choice to investigate a possible obstruction of the biliary tract is: 
 Options:  <1> Hepatobiliary ultrasound. <2> Endoscopic retrograde cholangiopancreatography (ERCP). <3> Colangio Magnetic Resonance. <4> Computed tomography. Abdominal CT <5> Percutaneous transhepatic cholangiography.
Output: 1
Question: 54-year-old man who comes to review in his company. A body mass index of 32.8 kg / m2 and fasting blood glucose of 138 mg / L are detected. One month later, glycemia 130 mg / dL. What therapeutic recommendation would you make in the first place? 
 Options:  <1> Administration of metformin. <2> Prescribe a sulfonylurea. <3> Behavioral changes: Diet and physical exercise. <4> Insulin before each meal. <5> Take acarbose at night, before going to bed.
Output: 3
Question: A 62-year-old man with type 2 diabetes mellitus of 10 years of evolution performs treatment with metformin and sitagliptin. Does little physical exercise and performs a proper diet. In the last 6 months he has lost weight and has more asthenia. Their glycemic controls have deteriorated, going from basal glycemia of 110-140 mg / dl to glycemias of 170-200 mg / dl, as well as their glycosylated hemoglobin, which has gone from 7.1 to 8.5%. The most appropriate therapeutic measure to perform is: 
 Options:  <1> Increase the intake of protein and long chain carbohydrates in the diet to improve asthenia and weight loss. <2> Associate a dose of basal insulin with the treatment. <3> Associate acarbose treatment. <4> Replace sitagliptin with pioglitazone. <5> Replace metformin with glimepiride.
Output: 2
Question: A 70-year-old woman, worried about her risk of having a stroke, comes to our office because her mother died of this cause a year ago. He has a history of high blood pressure and type 2 diabetes mellitus, so he is being treated with glipizide, aspirin, enalapril and atorvastatin. He smokes 20 cigarettes a day and does not exercise regularly. On examination, a blood pressure of 150/80 mmHg is detected. The analytical highlights a hemoglobin A1c of 8% and an LDL cholesterol of 110 mg / dl. Which of the following is associated with a greater reduction in stroke risk? 
 Options:  <1> Achieve optimal levels of hemoglobin A1C. <2> Achieve an optimal control of blood pressure. <3> Add an antioxidant to the treatment. <4> Abandon tobacco <5> Achieve optimal levels of LDL.
Output: 2
Question: A 63-year-old woman attended the emergency service referring to intense headache with signs of meningeal irritation, bilateral visual alterations and ophthalmoplegia. A CT scan was performed showing space-occupying lesion in a 2 cm sella turcica compatible with pituitary adenoma with signs of intratumoral hemorrhage, with deviation of the pituitary stalk and compression of the glandular tissue. Indicate which of the following answers is INCORRECT: 
 Options:  <1> The diagnostic suspicion is a pituitary apoplexy. <2> Treatment should be started with corticosteroids at high doses and observe the evolution, since this treatment could reduce the volume of the lesion and avoid intervention. <3> Treatment with glucocorticoids should be considered to avoid secondary adrenal insufficiency that compromises the patient's vital prognosis. <4> The presence of ophthalmoplegia and visual defects are indications to intervene without delay by urgent surgical decompression. <5> After the resolution of the acute condition, the development of panhypopituitarism is frequent.
Output: 2
Question: A 45-year-old woman came to the consultation sent from Surgery with the diagnosis of a neuroendocrine tumor diagnosed after partial pancreatectomy due to a 2-cm tumor in the tail of the pancreas. The tumor had been detected by chance on an abdominal CT scan requested to complete the study of a simple liver cyst. Interrogating the patient, the background is irregular rules, being in amenorrhea for 6 months, and repetitive colic of recurrence from the age of 20 for those who have required lithotripsy on several occasions. In addition, he has a family history of renoureteral colic. What is your diagnostic suspicion? 
 Options:  <1> A multiple endocrine neoplasia type 1 or Wermer syndrome. <2> A multiple endocrine neoplasia type 2 A or Sipple syndrome. <3> A multiple endocrine neoplasia type 2B. <4> Somatostatinoma. <5> A neuroendocrine tumor producing PTH.
Output: 1
Question: A 54-year-old patient with an alcoholic intake of 110 g / day, admitted due to chronic diarrhea and the appearance of muscle cramps in recent days. In the analytical one, glucose stands out 320 mg / dL, Urea 25 mg / dL, Creatinine 0.75 mg / dL, Potassium 2.5 mmol / L (3.5-5.1), Calcium 2.0 mmol / L (2 , 2-2.5), Phosphorus 0.52 mmol / L (0.87-1.55) Magnesium 0.25 mmol / L (0.66-0.99) and Albumin of 28 g / L (3552) With what would initiate the treatment? 
 Options:  <1> Insulin. <2> Potassium. <3> Calcium. <4> Match. <5> Magnesium.
Output: 5
Question: A calcium figure of 11 mg / dL (normal less than 10.5 mg / dL) is found in a 30-year-old patient during a routine business examination. The PTH determination was 45 pg / ml (VN 10-55 pg / ml). The story is anodyne, except for the fact that the mother and the paternal grandfather were diagnosed with hyperparathyroidism and intervened, although they remained hypercalcemic. Which test is most useful to confirm the diagnosis? 
 Options:  <1> 25-OH D. <2> 1,25-OH 2D. <3> Calcium / creatinine ratio in urine. <4> Tubular reabsorption of phosphates. <5> PTHrP.
Output: 3
Question: What drugs are useful to stop endogenous hypercortisolism? 
 Options:  <1> Ketokonazol. <2> Methimazole <3> Octreotide. <4> Fludrocortisone <5> Propylthiouracil.
Output: 1
Question: A 71-year-old man presented with severe pancytopenia without any immature cells and with a medullar study suggestive of severe aplastic anemia. What would be the fundamental therapeutic approach? 
 Options:  <1> Treatment with methylprednisolone at a dose of 1 g / Kg / day for 5 days. <2> Study of siblings and if any is HLA compatible, allogeneic transplant of hemopoietic progenitors. <3> Immunosuppressive therapy with cyclosporine and antitimocitic immunoglobulin. <4> Hemotherapeutic support. <5> Chemotherapy and if autologous transplant response of hemopoietic progenitors.
Output: 3
Question: In a 29-year-old woman the following parameters are in the course of a routine analysis: Hb 11.5 g / dL, VCM 70 fl, HCM 28 pg, Ferritin 10 ng / mL, leukocytes 5,200 / mm3, platelets 335,000 / mm3. Physical examination is normal. The most indicated exploration in this situation is: 
 Options:  <1> Gynecological exploration. <2> Study of occult blood in stool. <3> Radiological study of the digestive system. <4> Electrophoresis of hemoglobins. <5> Test of Coombs.
Output: 1
Question: A 68-year-old patient who consulted for edema and asthenia. In the analytical carried out, creatinine of 5 mg / dl, hemoglobin of 10 gr / dl and marked serum hypogammaglobulinemia at the expense of IgG, IgA and IgM are observed. A urinalysis reveals the presence of kappa light chains. What is your diagnostic suspicion? 
 Options:  <1> Disease due to deposit of light chains kappa. <2> Nephrotic syndrome. <3> Amyloidosis <4> IgA myeloma with Bence Jones preoteinuria. <5> Myeloma of light chains.
Output: 5
Question: A 67-year-old patient on ticlopidine treatment went to the emergency department with headache, asthenia and petechiae in the lower extremities. In the analytical sample hemoglobin 8.2 g / dl, VCM 100 fl, platelets 25000 / ul and leukocytes 7500 / ul with normal formula. The number of reticulocytes is high and in the blood smear numerous schistocytes are observed. The coagulation studies (APTT, TP and Fibrinogen) are normal. In the biochemistry highlights LDH 2700 IU / l and bilirubin 2.6 mg / dl. What is the most likely diagnosis of the patient? 
 Options:  <1> Autoimmune thrombocytopenic purpura. <2> Thrombotic thrombocytopenic purpura. <3> Medullary aplasia. <4> Drug-induced thrombocytopenia. <5> Disseminated intravascular coagulation.
Output: 2
Question: A 72-year-old man with a pathological fracture in the left femur goes to the Emergency Department. After the surgical intervention, the diagnostic study was performed to find out the underlying pathology with the following findings: hemoglobin 9.5 g / dl, total protein 11 g / dl, (VN: 6-8 g / dl), serum albumin 2 g / dl, (VN 3.5-5.0 g / dl), beta 2 microglobulin 6 mg / l (VN 1.1-2.4 mg / l), serum creatinine 1.8 mg / dl (VN: 0 , 1-1.4 mg / dl). Indicate what would be the diagnostic tests necessary to confirm the most probable diagnosis: 
 Options:  <1> Radiological bone series and bone marrow aspiration. <2> Serum and urinary electrophoresis and renal function tests. <3> Bone marrow aspirate and serum calcium concentration. <4> Bone marrow aspiration and serum and urinary electrophoresis. <5> Biopsy of the pathological fracture and radiological bone series.
Output: 4
Question: A 19-year-old girl with no medical history of interest, except for a self-limiting flu-like illness 3 weeks before, who went to the Emergency Department for petechiae and spontaneously occurring bruising. On physical examination, the patient is in good general condition, afebrile, normotensive and oriented in time and space. Petechiae disseminated by EEII and small abdomen and ecchymoses are observed in decubitus areas. No enlarged adenopathy or splenomegaly. The analysis carried out offers the following findings: Hb 12.6 g / dL, Leukocytes 5,500 / mm3, platelets 7000 / mm3. The study of the peripheral blood smear offers a normal erythrocyte morphology, normal differential leukocyte count and the platelet count is concordant with the autoanalyzer figure without observing plaque aggregates. Biochemistry, proteinogram, beta 2 microglobulin and normal LDH. What do you think is the most appropriate initial treatment of the following? 
 Options:  <1> Platelet transfusion. <2> Rituximab in weekly schedule. <3> Cyclophosphamide in pulses of 4 days every 21 days. <4> Plasmapheresis daily. <5> Prednisone at 1 mg / day for 2-3 weeks.
Output: 5
Question: A 34-year-old man consulted for fever and malaise. In the clinical history, homosexual relationships were collected for 4 months with a new partner. 2 months before the current consultation, she had an ulcerous lesion on the glans, painless, with bilateral inguinal adenopathies, all self-limiting. Serological studies are requested with the following results: HIV negative, RPR 1/320, TPHA 1/128. What treatment would you indicate in this patient? 
 Options:  <1> None. <2> Intravenous penicillin G, 24 MU every day for 14 days. <3> Penicillin Benzatine 2.4 MU intramuscular, three doses in three consecutive weeks. <4> Ceftriaxone 2 grams intramuscular in a single dose. <5> Penicillin Benzatine 2.4 MU intramuscular in a single dose.
Output: 5
Question: A patient under chemotherapeutic treatment for leukemia is admitted for pneumonia for which treatment with cefepime has been prescribed. A thorax Rx / CT scan shows an infiltrate with the sign of the halo and meniscus lunate. The lesion is peripheral and a transthoracic puncture is indicated for sampling. Until you have definitive histological and microbiological results, what antimicrobial would you add to the treatment? 
 Options:  <1> Ganciclovir <2> Caspofungin <3> Fluconazole <4> Piperacillin-tazobactam <5> Voriconazole
Output: 5
Question: A 54-year-old man diagnosed with diabetes mellitus type 2 came to our clinic. He reported fever of 40ºC with chills and shivering, arthromyalgia and headache, which is why he started treatment with paracetamol. The painting began 24 hours before his return to Spain. After 3 days, he presented with a generalized maculo-papular rash that progressed to the formation of more intense petechiae in the lower limbs. It provides analytics where leukopenia stands out with 3,200 / mm3 and platelets 91,000 / mm3 and mild elevation of aminotransferases. Thickness, peripheral blood smear, polymerase chain reaction (PCR) and malaria antigen are negative. What is the most likely suspected diagnosis? 
 Options:  <1> Coronavirus infection. <2> Lymphocyte choriomeningitis. <3> Dengue. <4> Chikungunya virus infection. <5> Encephalitis of Saint Louis.
Output: 3
Question: A 53-year-old woman consulted for a fever of 15 days of evolution, without symptoms of infectious focality. On examination, a painful hepatomegaly was detected 5 cm from the costal margin and the spleen was palpated 14 cm from the left costal margin. The hemogram shows Hb 8.5 g / dL, Leucocytes 630 / mL (lymphocytes 63%, monocytes 20%, neutrophils 17%) and platelets 35,000 / mL. The biochemistry shows a moderate elevation of the liver biochemistry, LDH is normal and a polyclonal hypergammaglobulinemia (3.5 g / dL) is observed in the proteinogram. She has a history of HIV infection known for 10 years and irregular adherence to antiretroviral treatment, with recent determinations of CD4 lymphocytes 350 cells / mL and viral load of HIV 154 copies / mL. During the last 3 months she has been treated for seronegative symmetric polyarthritis with 10-20 mg / day of prednisone. Which of the following statements is correct? 
 Options:  <1> Perform a bone marrow biopsy, since the most likely diagnosis is visceral leishmaniasis. <2> Pancytopenia is justified by cirrhosis associated with virus C and would not perform further tests. <3> Probably it is a medullary toxicity by prednisone that would treat with withdrawal of the drug and filgastrim. <4> I would request a determination of ANAs to rule out disseminated systemic lupus. <5> It would intensify the antiretroviral treatment, since it is probable that all the manifestations that it presents are due to HIV.
Output: 1
Question: A 70-year-old patient diagnosed three years ago with multiple myeloma who is in a period of neutropenia after a cycle of chemotherapy. It enters due to fever, cough and yellowish expectoration. The chest radiograph shows a condensation image in the right hemithorax. The most likely diagnosis is: 
 Options:  <1> Post-chemotherapy toxic pneumonitis. <2> Pneumococcal pneumonia <3> Pneumonia due to aspergillus. <4> Viral pneumonia due to community respiratory virus. <5> Cytomegalovirus pneumonia.
Output: 2
Question: A 50-year-old man with a chronic bronchitis who was admitted for a pneumonic episode with a blood culture positive for Streptococcus pneumoniae, with a CMI at penicillin of 0.0125 mg / l. Treatment with 2 million penicillin is started every 4 hours. On the fifth day it continues with a fever of 38ºC. Which of the following decisions do you think is right? 
 Options:  <1> I would change the treatment to ceftriaxone because of its greater efficacy. <2> I would add a quinolone to the treatment. <3> I would switch to amoxicillin / clavulanic acid. <4> It would rule out the presence of a pleural empyema. <5> I would continue with the same treatment, assuming that it is simply a problem of time.
Output: 4
Question: A 17-year-old boy referred to a health center referring to a 39-degree fever of 48 hours of evolution with a sore throat. The family doctor consults the history of the patient where it does not cost any previous illness. The patient did not report cough and the examination performed by his family doctor reveals the presence of bilateral whitish tonsillar exudate and anterior cervical adenopathies enlarged and painful on palpation. What would be the treatment of choice for this patient? 
 Options:  <1> Penicillin V or amoxicillin. <2> Amoxicillin clavulanic. <3> Doxycycline <4> Ciprofloxacin <5> Metronidazole
Output: 1
Question: Which of the following diseases is NOT transmitted by tick bite? 
 Options:  <1> Lyme's desease. <2> Recurrent fever due to Borrelia hispanica. <3> Mediterranean botanical fever. <4> Rocky mountain spotted fever by R. rickettsii. <5> Exanthematic typhus
Output: 5
Question: A patient with a history of excessive alcohol consumption has been diagnosed with pulmonary tuberculosis due to cough, fever, expectoration, and isolation in the Mycobacterium tuberculosis sputum culture. The patient has begun treatment with isoniazid, rifampin, ethambutol and pyrazinamide, with adequate tolerance. A report of resistance to rifampicin of M. tuberculosis isolated in the sputum is received 20 days after the start of treatment. What regime would you select based on this report? 
 Options:  <1> Isoniazid, ethambutol, pyrazinamide for 12 months. <2> Isoniazid, ethambutol, pyrazinamide for 12 months and streptomycin for two months. <3> Isoniazid, ethambutol, pyrazinamide for 12 months and a quinolone for two months. <4> Isoniazid, ethambutol, pyrazinamide and a quinolone for 18 months. <5> Isoniazid, ethambutol, pyrazinamide for 18 months and streptomycin and a quinolone for two months.
Output: 4
Question: A 20-year-old girl comes to the clinic with an acute fever, cervical adenopathy and skin rash. According to the patient, 3 weeks ago, she had a sexual relationship that could be at risk for contracting the HIV virus. Does it indicate which of the following answers is true? 
 Options:  <1> A negative HIV-1 / HIV-2 serology performed using the ELISA technique rules out the possibility that the patient has been infected with the HIV virus. <2> The clinical process suffered by the patient does not match that of acute HIV infection. <3> If the patient's ELISA test was positive, it would not be necessary to do anything else for the diagnosis of HIV infection. <4> The ELISA technique has a high sensitivity for the diagnosis of HIV infection, but its specificity is even greater. <5> If the ELISA test to diagnose HIV in the patient was negative, we could determine by the PCR technique the viral load in blood.
Output: 5
Question: A 16-year-old boy who consulted due to pultulose tonsillitis, fever up to 38.5ºC, painful cervical adenopathies, non-pruritic macular exanthema in the thorax and mild hepatosplenomegaly, 4-5 days old. The Paul-Bunnell test and the IgM for the Epstein-Barr virus are positive. During his admission he develops a continuous fever of up to 40ºC, pancytopenia, icteric hepatitis and coagulopathy of progressive intensity. One week after admission, he was transferred to the ICU due to confusion and respiratory failure. The blood cultures and a urine culture are negative, the CSF is normal and the chest plate does not show infiltrates. Procalcitonin is normal, but PCR and ferritin are very high. From the statements below, what would be the most correct diagnostic and therapeutic approach? 
 Options:  <1> It has a bacterial sepsis of undetermined origin and should be administered ceftriaxone and supportive treatment. <2> It has a bacterial sepsis of undetermined origin and should be administered vancomycin, ceftacidime and supportive treatment. <3> It is an infectious mononucleosis of severe course and glucocorticoids must be administered. <4> It is an infectious mononucleosis of severe course and treatment with acyclovir should be started. <5> Perform a biopsy / aspirate of bone marrow and if hemophagocytosis is confirmed, start treatment with immunosuppressants.
Output: 5
Question: 30-year-old man without a history of interest. He came to the clinic because of the presence of small erythematous-violaceous lesions that appear elevated on palpation, in the pretibial region. The analytical study shows a blood count and coagulation study without alterations and in the biochemistry, creatinine and ions are also within the range of normality. The study of urinary sediment demonstrates hematuria, for which the patient had already been studied on other occasions, without obtaining a definitive diagnosis. Regarding the entity that you suspect in this case is FALSE that: 
 Options:  <1> In 20% to 50% of cases there is an elevation of the serum IgA concentration. <2> In the renal biopsy the mesangial deposits of IgA are characteristic. <3> The existence of proteinuria in the nephrotic range is frequent. <4> It is considered a benign entity since less than 1/3 of the patients progress to renal failure. <5> Skin biopsy allows the diagnosis to be established in up to half of the cases.
Output: 3
Question: A 72-year-old woman with type 2 diabetes and chronic renal failure in stage 5. If a pulmonary thromboembolism is suspected, indicate which diagnostic test would be contraindicated: 
 Options:  <1> Transthoracic echocardiogram. <2> Pulmonary scintigraphy <3> Pulmonary angioCT. <4> Electrocardiogram. <5> Chest x-ray.
Output: 3
Question: Except in patients whose chronic renal failure is due to diabetic nephropathy or tubulointerstitial nephropathy, the arterial blood gas pattern that you would expect to find in a patient with chronic renal failure would be: 
 Options:  <1> pH 7.30, HCO3 18 mEq / L, Cl 116 mg / dL, because metabolic acidosis with normal anion gap is characteristic. <2> pH 7.46, HCO3 18 mEq / L, Cl 116 mg / dL, because hyperchloremic metabolic alkalosis is characteristic. <3> pH 7.456, HCO3 18 mEq / L, Cl 100 mg / dL, because metabolic acidosis with increased anion gap is characteristic. <4> pH 7.46, HCO3 30 mEq / L, Cl 90 mg / dL, because metabolic alkalosis with normal anion gap is characteristic. <5> pH 7.45, HCO3 23 mEq / L, Cl 100 mg / dL, because metabolic alkalosis with normal anion gap is characteristic.
Output: 3
Question: Regarding the definition of chronic kidney disease, one is INCORRECT: 
 Options:  <1> It requires persistent presence of structural or functional alterations of the kidney for at least 2 months. <2> It includes alterations in urine as proteinuria, independently of the glomerular filtration rate (GFR). <3> It includes a lower GFR of 60 ml / min / 1.73m2 of body surface regardless of the presence or absence of other markers of kidney damage. <4> It is classified into 5 stages according to the TFG. <5> The preparation for renal replacement therapy should be done in stage 4.
Output: 1
Question: A 38-year-old man consulted for dyspnea and hemoptysis. Blood tests have creatinine 7 mg / dl, urea 250 mg / dl and anti-MBG (anti-glomerular basement membrane antibodies) positive high titer. A renal biopsy was performed, showing crescents in 75% of the glomeruli, and in the immunofluorescence a linear Ig deposition pattern appeared. Which of the following is the correct answer? 
 Options:  <1> It is an Ig A Nephropathy with acute renal failure. <2> The performance of plasmapheresis would be indicated. <3> It is a membranous glomerulonephritis. <4> Mycophenolate mofetil is the initial treatment of choice. <5> Glomerular involvement is caused by the presence of circulating immune complexes.
Output: 2
Question: In a renal transplant patient, which of the following characteristics is the characteristic of acute renal rejection? 
 Options:  <1> Interstitial infiltrate of B lymphocytes. <2> Preferably infiltrated with T lymphocytes in the renal interstitium and in the renal tubules. <3> Fibrosis and tubular atrophy. <4> Proliferative glomerulonephritis without affecting the interstitium. <5> Presence of circulating antidonant antibodies and renal infarcts.
Output: 2
Question: Regarding benign prostatic hypertrophy, it is NOT true that: 
 Options:  <1> Abdominal ultrasound is a non-invasive method to assess prostate size and post-voiding residual. <2> It can cause increases in PSA levels. <3> Rectal examination is a method to estimate prostate size. <4> Treatment with 5-alpha reductase inhibitors decreases symptoms. <5> It is a precancerous lesion.
Output: 5
Question: Before a 49-year-old man, asymptomatic, with a family history of a father who died of prostate cancer, a PSA (Specific Prostate Antigen) of 5.9 ng / ml was identified in a routine company control, with a PSA ratio free / Total PSA of 11% and that in a digital rectal examination there is an increase in consistency in the right prostatic lobe, what is the following clinical indication? 
 Options:  <1> Ask the patient to perform a transrectal ultrasound and prostate biopsy. <2> Perform a abdominopelvic CT scan. <3> Start treatment with 5 alpha reductase inhibitors to halve PSA levels. <4> Start combined treatment of LHRH analogues and antiandrogens. <5> Perform a bone scan.
Output: 1
Question: A 54-year-old man is diagnosed with a left kidney tumor suggestive of renal cell carcinoma. In his preoperative analytical study, elevated levels of GPT, alkaline phosphatase and alpha-2-globulin and elongated prothrombin time are detected. The liver is enlarged diffusely, but without defects of hepatic infiltration. The most probable justification for these findings is due to: 
 Options:  <1> Liver metastases. <2> Intrahepatic tumor thrombosis. <3> Acute hepatitis <4> Presence of hepatotoxic substances produced by the tumor. <5> Hemochromatosis
Output: 4
Question: A 55-year-old asthmatic patient goes to the ER with an exacerbation. One hour after the administration of supplemental oxygen and two nebulizations of salbutamol the patient does not improve. On examination, he breathed at 42 rpm with supraclavicular drainage and presented disseminated inspiratory and expiratory wheezing. The peak flow has dropped from 310 to 220 L / min. A gasometry extracted with oxygen at 28% shows a pO2 of 54 mmHg and a pCO2 of 35 mmHg. Which of the following attitudes seems LESS indicated? 
 Options:  <1> Increase oxygen flow. <2> Administer 80 mg of methylprednisolone iv. <3> Nebulize ipratropium bromide together with salbutamol every 20 minutes. <4> Administer intravenous magnesium <5> Start non-invasive mechanical ventilation.
Output: 5
Question: Faced with a 23-year-old patient who went to the emergency room on a Friday morning after a street fight, with clear signs of enolism and knife injury (stabbing) at the level of III right intercostal space 3 mm from the sternal margin, actively bleeding and hemodynamically unstable associated with marked hypophonia of all right hemithorax. Which structure of the following should you think may be injured? 
 Options:  <1> Right primitive carotid artery. <2> Right internal thoracic artery. <3> Right subscapular artery. <4> Upper right thyroid artery. <5> Thigh superior thymic artery.
Output: 2
Question: Regarding COPD, which one is FALSE? 
 Options:  <1> Smoking is the most important factor in the development of COPD. <2> Contrary to asthma, there is no inflammatory component. <3> The genetic factor to develop better documented COPD is the deficit of alpha1 antitrypsin. <4> Acropachies are not characteristic of COPD and their presence should suggest associated bronchiectasis or bronchopulmonary carcinoma. <5> Spirometrically, obstruction is detected by a FEV1 / FVC ratio of less than 0.70.
Output: 2
Question: In a patient with mild chronic obstructive pulmonary disease (COPD) in stable phase, polyglobulia and respiratory insufficiency are evident. The chest radiograph shows no noticeable alterations. Which of the following procedures would you consider to carry out in the first place to rule out the coexistence of other diseases that may justify the described findings ?: 
 Options:  <1> Respiratory polygraphy <2> Echocardiogram. <3> Thoracic computed tomography. <4> Pulmonary scintigraphy <5> Puncture of bone marrow.
Output: 1
Question: A 24-year-old woman is found lying on the street by some passers-by. When the emergency team arrived, they found it with an oxygen saturation of 88% breathing ambient air and a punctiform pupil examination. It is transferred to the nearest hospital emergency, where arterial blood gas analysis shows: pH 7.25, PaCO2 60 mmHg, PaO2 58 mmHg, bicarbonate of 26 mEq / L and excess of bases of -1. In blood sodium is 137 mEq / L and chloride 100 mEq / L. From a gasometric point of view, the patient has: 
 Options:  <1> Partial respiratory failure. <2> Metabolic acidosis. <3> Pure respiratory acidosis <4> Respiratory alkalosis due to lack of chlorine. <5> The gasometry can only be of venous blood.
Output: 3
Question: A 50-year-old patient with a pleural effusion with the following characteristics: straw appearance, pH 7.3, ratio of pleura / serum proteins 0.8, ratio of LDH pleura / serum 0.9, Gram and Ziehl negative, total lipids, cholesterol and normal triglycerides, cells mesothelial <5%, intense lymphocytosis without atypia, ADA 64 U / l. What diagnosis do you suggest? 
 Options:  <1> Pleural empyema <2> Pleural effusion due to heart failure (transudate). <3> Pleural mesothelioma. <4> Tuberculous pleural effusion <5> Secondary effusion to pulmonary infarction.
Output: 4
Question: In a patient with hepatic cirrhosis and ascites, which develops a pleural effusion with the following data in the pleural fluid: LDH 45 U / L (serum 220 U / L), protein ratio pleura / serum 0.3 and ratio LDH pleura / serum 0.2. What would be the right attitude? 
 Options:  <1> The study of the fluid with cell count, glucose, pH, ADA, cholesterol and culture should be expanded. <2> Blind pleural biopsy. <3> Diagnostic video-assisted thoracoscopy. <4> Empirical antibiotic therapy for suspected parapneumonic effusion. <5> Continue the treatment of your liver disease.
Output: 5
Question: In the functional examination of a patient with chronic obstructive pulmonary disease, all findings are expected to be LESS one: 
 Options:  <1> FEV1 less than 80%. <2> DLCO decreased. <3> FEV1 / FVC ratio lower than 0.7. <4> Lung volumes decreased. <5> Negative bronchodilator test.
Output: 4
Question: The most common cause of mildmoderate hemoptysis is: 
 Options:  <1> Bronchiectasis <2> Bronchogenic carcinoma <3> Hemorrhagic diathesis. <4> Pulmonary infarction. <5> Pneumonia.
Output: 1
Question: A 65-year-old man with a history of pancreatic cancer undergoing chemotherapy. Emergency consultation for pain and edema of the entire lower limb from the groin. Which diagnostic test is more cost-effective to confirm the diagnostic suspicion? 
 Options:  <1> Dimer D. <2> Magnetic resonance. <3> Phlebography <4> Venous Doppler ultrasound. <5> Helical CT
Output: 4
Question: A 40-year-old woman who consulted for approximately 20 episodes a day of intense pain, left periocular of 15 minutes duration, accompanied by intense lacrimation and rhinorrhea. Your scan and magnetic resonance are normal. Your treatment of choice would be: 
 Options:  <1> Indomethacin <2> Lamotrigine <3> Verapamil <4> Prednisone. <5> Lithium carbonate.
Output: 1
Question: Indicate in what clinical situation would NOT indicate beginning interferon beta in a patient diagnosed with multiple sclerosis: 
 Options:  <1> Multiple recurring outbreaks. <2> Bad response to corticosteroids in outbreaks. <3> Having suffered a single outbreak of the disease with sequelae. <4> Be over 50 years old <5> A progressive primary clinical form.
Output: 5
Question: What drug should be recommended for the treatment of juvenile myoclonic epilepsy? 
 Options:  <1> Phenobarbital. <2> Valproic acid. <3> Oxcarbazepine <4> Diphenylhydantoin. <5> Topiramate.
Output: 2
Question: After a traffic accident, a 38-year-old patient enters the ICU in a coma. After several days the patient does not improve neurologically and CT shows hemorrhagic punctate lesions in the corpus callosum and cortico-subcortical union. What is your diagnosis? 
 Options:  <1> Acute subdural hematoma. <2> Thrombocytopenic purpura. <3> Cerebral hemorrhagic contusion. <4> Severe diffuse axonal injury. <5> Hypoxic-ischemic encephalopathy.
Output: 4
Question: In the treatment of patients with Alzheimer's disease, which of the following treatment options do you consider most appropriate? 
 Options:  <1> The initial treatment of any type of urinary incontinence with drugs such as oxybutynin is of choice due to its anticholinergic effects. <2> Treatment with acetylcholinesterase inhibitors. <3> For the treatment of associated depression prioritize the use of tricyclic antidepressants. <4> The typical neuroleptics at high doses. <5> Estrogen replacement therapy.
Output: 2
Question: A 76-year-old man consulted for cognitive deterioration, slowness and awkwardness of movements, of eight months of evolution. The family reported that the patient had visual hallucinations, so his Primary Care physician prescribed low doses of risperidone, with a significant worsening of motor status. In view of these data, what is the most likely diagnosis? 
 Options:  <1> Alzheimer disease. <2> Dementia due to Lewy bodies. <3> Frontotemporal dementia. <4> Vascular dementia <5> Occasional Creutzfeldt-Jakob disease.
Output: 2
Question: What sign or symptom is NOT typical of Guillain-Barré syndrome? 
 Options:  <1> Facial paralysis. <2> Sphincter alteration. <3> Hiccup or tendinous tendon reflex. <4> Muscular weakness. <5> Dysautonomia
Output: 2
Question: Which of the following clinical signs is NOT seen in the lesions of the lower motor neuron? 
 Options:  <1> Paralysis. <2> Amyotrophy <3> Fasciculations. <4> Arreflexia <5> Hypoesthesia
Output: 5
Question: An 80-year-old man is admitted with a sudden picture of aphasia and right hemiparesis. As background highlights, hypertension, well controlled diet and cognitive impairment in the last year under study by his neurologist. Emergency cranial CT demonstrates a left frontal lobar hematoma without contrast enhancement. What is the most likely cause of the hematoma? 
 Options:  <1> Arteriovenous malformation masked by the acute hematoma. <2> Chronic arterial hypertension. <3> Vasculitis isolated from the nervous system. <4> Brain tumor. <5> Amyloid cerebral angiopathy (congophilic angiopathy).
Output: 5
Question: NOT true about Rheumatoid Arthritis: 
 Options:  <1> Early diagnosis, intensive treatment and close control of the disease are essential. <2> Methotrexate is the drug of first choice to control the activity of the disease. <3> The rheumatoid factor is typical of the disease and is a mandatory criterion for diagnosis. <4> The specificity of citrullinated peptide antibodies is very high and has a prognostic value. <5> Biological drugs, such as anti TNF, have revolutionized the treatment.
Output: 3
Question: A 75-year-old woman, with menopause at 52 years of age, with no family or personal history of a fracture, diagnosed with temporal arteritis, who is going to start treatment with prednisone at high doses and with an expectation of treatment for at least one year. The delay of densitometry (DXA) in its center is 4-5 months. Preventive treatment of osteoporosis is proposed. Among the following, which is the most appropriate attitude ?: 
 Options:  <1> Request DXA and wait for the result. <2> Assess absolute risk of fracture using the FRAX questionnaire without BMD and treat only if it is high. <3> Start treatment with bisphosphonates and vitamin D (800 IU / day). <4> Administer calcium supplement (1g) and vitamin D (800 IU / day). <5> Assess if you have osteopenia on the radiographs and treat if it is present.
Output: 3
Question: The diagnosis of sarcoidosis is based on: 
 Options:  <1> Clinical-radiological compatible picture and presence of non-caseating granulomas in one or more organs, with negative cultures of mycobacteria and fungi. <2> Elevation of the serum level of the angiotensin conversion enzyme in a patient with a compatible clinical-radiological picture. <3> Characteristic radiological findings in high-resolution computed tomography of the chest in a patient with clinical suspicion. <4> Presence of lymphocytic alveolitis with predominance of CD4 + lymphocytes in bronchoalveolar lavage in a patient with a compatible clinical-radiological picture. <5> Finding of granulomatous cellularity in a fine needle aspiration puncture (FNAP) of an affected organ in a patient with a compatible clinical-radiological picture.
Output: 1
Question: The treatment of choice of Giant Cell Arteritis (Tertiary Arteritis or Horton's Arteritis) corticodependiente is: 
 Options:  <1> Etanercept. <2> Endovenous cyclophosphamide. <3> NSAID <4> Methotrexate <5> Rituximab
Output: 4
Question: A 14-year-old boy, 158 cm tall and weighing 76 kg, who came to our clinic for presenting for 4 months, without a previous traumatic event, mechanical pain in the right inguinal region, presented in the current clinical exploration, lameness with March with slight attitude in external rotation of said lower limb and limitation of hip flexion in neutral rotation. The diagnosis of suspicion will be: 
 Options:  <1> Fracture of the femoral neck. <2> Proximal femoral epiphysiolysis. <3> Perthes disease. <4> Still's disease <5> Transient synovitis of the hip.
Output: 2
Question: A 56-year-old woman presents, after a casual fall to the floor, pain, deformity and increased volume in the left arm, with impossibility for the dorsal flexion of the hand. What is the most likely diagnosis? 
 Options:  <1> Trocheter fracture in the left humerus. <2> Diaphyseal fracture of the left humerus with radial nerve injury. <3> Supraconcondylar fracture of the humeral palate with median nerve injury. <4> Fracture of the anatomical neck of the humerus with radial nerve injury. <5> Fracture of displaced epitrochlea with ulnar nerve injury.
Output: 2
Question: A 70-year-old man presents, for a few months, without previous trauma, lumbar pain, difficulty walking, loss of strength and paresthesias in lower limbs, having to stop a few meters after starting it. The patient is increasingly inclining the trunk forward. What is the most likely diagnosis? 
 Options:  <1> Osteoporotic lumbar vertebral fracture. <2> Central herniated disc L5-S1. <3> Spondylodiscitis. <4> Stenosis of the lumbar canal. <5> Degenerative lumbar scoliosis.
Output: 4
Question: A 36-year-old patient who came to the emergency room for pain and swelling in the epiphyseal region of the right tibia. The radiographic image is lytic, eccentric and insufflates the cortex. In which tumor lesion will one have to think as more probable? 
 Options:  <1> Osteosarcoma. <2> Tumor of giant cells. <3> Encondroma. <4> Osteoid osteoid <5> Chondrosarcoma.
Output: 2
Question: A 78-year-old woman is undergoing surgery to implant a definitive pacemaker for atrio-ventricular block. His personal history includes high blood pressure, hypercholesterolemia, diabetes mellitus and morbid obesity. The procedure is long and laborious due to the obesity of the patient and is carried out through infiltrations with local anesthetic. At forty-five minutes after the beginning of the intervention, she begins to show agitation and progressive disorientation. She says she is dizzy and does not see or hear well. Physical examination shows a discrete bilateral mydriasis, shivering and distal tremors in the upper extremities. What would be the most logical attitude to follow in this clinical picture? 
 Options:  <1> Neurological symptomatology leads to toxicity due to local anesthetics. The administration of local anesthetic should be interrupted, intravenous diazepam or midazolam administered, the procedure completed as soon as possible and the patient placed under clinical observation. <2> The symptomatology is clearly compatible with an acute ischemic stroke. The neurological examination must be completed once the implantation of the pacemaker has been completed and treatment with low molecular weight heparin has begun at a dose of 0.5 mg per kg per day, after an urgent CT scan. <3> The clinical picture is compatible with an anxiety crisis caused by pain during implantation of the pacemaker. The correct treatment includes a greater infiltration with the local anesthetic to relieve pain and the administration of intravenous diazepam for its anxiolytic effects. <4> Given the clinical history of the patient, it is most likely that she is suffering from an acute coronary syndrome. An electrocardiogram should be performed, obtain a CPK-MB determination and notify Cardiology to initiate the appropriate treatment. <5> An urgent determination of blood glucose should be made, since the clinical picture could correspond to a diabetic ketoacidosis.
Output: 1
Question: 84-year-old man with severe respiratory failure secondary to carcinomatous lymphangitis associated with gastric cancer. A companion of his service has begun, that same day, treatment with oral morphine 10 mg / 4 hours. The patient is restless, at 34 breaths per minute, O2 saturation is 80% with an FiO2 of 28%. What should his attitude be? 
 Options:  <1> Withdraw treatment because it may worsen respiratory failure. <2> Increase the doses up to 20 mg / 4 hours according to evolution. <3> Increase oxygen flow to 35%. <4> Change the treatment of morphine by scopolamine. <5> To add to a treatment of a risperidon.
Output: 2
Question: Which of the following circumstances does NOT define a patient with chronic pathology? 
 Options:  <1> A 66-year-old woman diagnosed with hypertension, Crohn's disease, type 2 diabetes mellitus with diabetic retinopathy. <2> 75-year-old ex-smoker, FEV1 75%, IMC 25, creatinine 1.2, anxiety-depressive syndrome. Pfeiffer 30 and Barthel 100. <3> An 82-year-old man diagnosed with osteoarthritis, with Barthel 40, hypertension and pharmacologically controlled dyslipidemia and Alzheimer's disease. <4> A 55-year-old ex-smoker, diagnosed with symptomatic peripheral arteriopathy and ulcerative colitis. <5> A 70-year-old man with enolism, portal hypertension and immobilized at home for 5 years by ACV.
Output: 2
Question: A woman of 90 years of dementia, incontinent and immobilized by hemiparesis presents a sacral ulcer of grade III. In the examination we see that he is in bed on a wet pad and with a feeding tube that is well placed. He is afebrile and has a normal pulse and blood pressure. It has a 4 x 4 cm sacral ulcer that extends into the fascia with green exudate and normal skin surrounding the ulcer. What is the first priority in the care of this patient? 
 Options:  <1> Start treatment with antibiotics. <2> Cultivate the decubitus exudate. <3> Apply semi-moist bandages of saline three times a day. <4> Make postural changes to the patient every two hours. <5> Place a permanent urinary catheter.
Output: 4
Question: Which of the following is a more reliable marker of malnutrition in the elderly patient? 
 Options:  <1> Weight loss of 1 kg in the last month. <2> Body mass index greater than 24. <3> Difficulty swallowing, chewing and / or lack of appetite. <4> Albumin 4.5 gr / dl. <5> Mini Nutritional Assessment less than 17.
Output: 5
Question: One patient is diagnosed with a 4 cm lung cancer without pleural contact in the right upper lobe. The extension study reveals the presence of metastasis in right parahilar nodes, without evidence of distant metastasis. The staging of the tumor will be: 
 Options:  <1> Stage I. <2> Stage IIA. <3> Stage IIB. <4> Stage IIIA. <5> Stage IIIB.
Output: 2
Question: In relation to the treatment of a non-smoking woman with non-small cell lung carcinoma, stage IV adenocarcinoma, which of the following statements is correct? 
 Options:  <1> The determination of the epidermal growth factor receptor (EGFR) mutation is required. <2> Entry Gefitinib is the standard treatment without EGFR determination. <3> It has a standard treatment based on camptothecins. <4> Any type of standard chemotherapy is valid. <5> There is no predictive factor for this disease.
Output: 1
Question: 80-year-old woman who consults for presenting, for 1 month, progressive increase of the abdominal perimeter. During the previous 4-5 months note asthenia, anorexia and weight loss not specified. On physical examination, tension ascites and malleolar edema are seen, with no other relevant signs. Ultrasonography and CT scan of the abdomen demonstrate the presence of ascites, of homogeneous density, without appreciating peritoneal implants or abdominal or pelvic masses. Liver, pancreas, adrenal glands, spleen and kidneys without significant findings. Paracentesis is performed through a thick needle, obtaining a somewhat yellowish, dense and gelatinous fluid with difficulty. What is the most likely etiology? 
 Options:  <1> Hydropic decompensation secondary to liver cirrhosis. <2> Chylose ascites due to non-Hodgkin's lymphoma. <3> Peritoneal tuberculosis. <4> Peritoneal metastasis of adenocarcinoma. <5> Ascites secondary to constrictive pericarditis.
Output: 4
Question: As for the agonizing rattles (pre-mortem rales), it is true that: 
 Options:  <1> It is a situation well tolerated by the family. <2> They originate a silent breathing. <3> They are treated with morphine. <4> They are treated with prokinetics. <5> They are treated with scopolamine.
Output: 5
Question: In relation to intoxication by anticholinergic agents, point out the correct answer. 
 Options:  <1> In its treatment, atropine is used. <2> The presence of grade III or IV encephalopathy, acute renal failure and severe coagulopathy indicate liver transplantation. <3> Dantrolene is indicated in case of seizures. <4> The basic treatment consists of the repeated administration of activated charcoal and support measures. <5> The decrease in plasma cholinesterase confirms the diagnosis.
Output: 4
Question: A 67-year-old man, a schizophrenic in medical treatment, is treated in a city in southern Spain on August 15 for presenting fever and deteriorating levels of consciousness. On examination, she presented a Glasgow coma score of 5 points, tachypnea at 45 breaths per minute, oxygen saturation by pulse oximetry of 75%, rectal temperature of 41 ºC, and in the laboratory the CPK is 30,000 U / L. A lumbar puncture is performed that is normal. Point out the correct answer: 
 Options:  <1> Cooling by immersing the patient in a bathtub with ice is the safest method to reduce the temperature. <2> It is not necessary to sedate the patient, intubate them and connect them to mechanical ventilation. <3> Liver involvement is rare in this pathology. <4> In case of hypotension, dopamine should be used at doses higher than 10 micrograms / kg / minute. <5> The cerebellum is especially sensitive to elevated temperature above 40 degrees.
Output: 5
Question: Given the suspicion of hypertrophic pyloric stenosis, how would you start the complementary exams? 
 Options:  <1> Digestive transit. <2> Gastric pHmetry <3> Simple radiology <4> Ultrasound <5> Isotopic study
Output: 4
Question: 0 months previously healthy with acute gastroenteritis of one day of evolution and signs of mild dehydration, without blood or mucus in the stool and without oral intolerance. What is the initial choice treatment in our environment? 
 Options:  <1> Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet. <2> Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq / L) and continue with your usual diet. <3> Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq / L), maintain regular feeding and oral amoxicillin for 10 days. <4> Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq / L) and start feeding with lactose-free formula. <5> Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq / L), maintain regular feeding and loperamide 7 days.
Output: 2
Question: In relation to classical congenital adrenal hyperplasia indicate the correct answer: 
 Options:  <1> The lack of treatment causes a progressive postnatal virilization. <2> For the diagnosis, a stimulation test with ACTH is necessary. <3> In the male sex, the external genitalia are ambiguous at birth. <4> In the female sex, the external genitalia are normal at birth. <5> Prenatal treatment with glucocorticoids prevents the disease.
Output: 1
Question: Which of the following associations (disease - symptom or clinical sign) is incorrect? 
 Options:  <1> Measles - Koplik spots. <2> Sudden exanthema - Fever. <3> Infectious erythema - Anemia due to spinal aplasia. <4> Varicella - occipital adenopathies. <5> Scarlet fever - Fever and dysphagia.
Output: 4