The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes)

Knowing this, and that we are dealing with cyanide poisoning, it is easier to answer the question

Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin

Administration of oxygen by means of a 50% Venturi type mask

Administration of intravenous hydroxycobalamin

Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning

What is stated in option 4 about fluid therapy is not indicated

Fluid therapy with infusion of physiological saline solution at 21 ml/h

in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses


In this case it is associated with persistent arterial hypotension

Option 2 would be correct if the patient were not hypotensive

Enoxaparin: 80 mg sc every 12 hours, starting upon diagnostic suspicion

diagnostic confirmation is not necessary to initiate anticoagulant therapy in case of PTE without hypotension

Enoxaparin; 80 mg sc every 12 hours, starting upon diagnostic confirmation

Option 4 is not indicated
Fondaparinux: 7.5 mg sc daily
Attack

Option 5 would be correct only if the patient had a contraindication to fibrinolysis

Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis

Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed


He already tells you that the dentist "didn't see anything", so he rules out 1

Dental cause / reevaluation by the dentist

He provides a dentist's report that rules out a dental cause

It is not an abscess of the base of the tongue either, because in three months it would have killed him: neither is 2

Abscess of the base of the tongue / debridement

The picture he explains is odynodysphagia of 3 months of evolution and left otalgia

When there is doubt that it could be cancer, we should not fool around and order a new CT scan and biopsy

Malignant process of oropharynx / repeat CT scan and biopsy

Tongue base cancers are very treacherous and it is one of the fears of any otolaryngologist when he suspects a neoplasm

palpation of the base of the left tongue showed an induration of stony consistency of approximately 3cm and with indirect laryngoscopy no ulceration of the mucosa was observed

He also refers to having been visited by different specialists and provides a head and neck CAT scan (without iodine contrast) which is reported as normal

It is not uncommon for them to arise without exophytic masses or ulcerations of the tongue mucosa and they are difficult to detect on CT when contrast is not used

The correct answer is 4 and I do not think it can be challenged


Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment

Dysmorphic red blood cells and/or hematic casts

although it is not usual in the form of isolated microalbuminuria

Proteinuria can also appear in variable range

Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours

hematuria with pyuria although it is not characteristic

Coexistence of hematuria with pyuria without bacteriuria

Clots usually appear in the context of alterations of the lower urinary tract

option 4 incorrect
Clots in the urine with the naked eye
Attack


In this case we are being told that the teste is always in the inguinal canal (cryptorchidism)

The most probable diagnosis is retractile testicle

The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location)

Orchidopexy is the treatment of choice when we are faced with cryptorchidism, being desirable to perform it between 6 months and one year of age, and should not be deferred beyond two years of age

The indication for orchidopexy should not be deferred

Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use

Human chorionic gonadotropin is the treatment of first choice


The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5º and then 20º, performing internal and external rotations of the leg

In case this reproduces the pain that the patient refers, the test will be considered as positive

During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive

It is a test used for the diagnosis of meniscal pathology

sensitivity greater than 90% and specificity greater than 95%

Answer 1 correct
Meniscal injury
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Thessaly test. Provocation test performed in suspected meniscal injury


the description of the picture is very exhaustive as well as typical

All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)

It is a disease that produces fever, arthralgias and a generalized exanthema with petechiae on the lower limbs

The CBC shows leukopenia accompanied by plateletopenia and elevated transaminases

Malaria has been ruled out as a possible cause


between the two options that include acenocoumarol we are inclined to choose option 4

it includes carvedilol, a drug that has been shown to increase survival in heart failure

Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure: they do not increase survival (they even increase morbidity and mortality) and specifically the non-dihydropyridines (verapamil and diltiazem) should not be associated with beta-blockers due to the increased risk of conduction system blockade


The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect), which has also been shown to reduce recurrences

In conjunction with glucocorticoid boluses of 1 g/day, infliximab should be used as a first-line drug for remission induction

Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects

In the presence of ischemic symptoms, and in order not to worsen the vascular risk of the patient, the use of glucocorticoids at doses higher than 30 mg/day should be avoided

Corticosteroid therapy remains the first choice (answer 1 incorrect), to be administered as pulses (doses differ according to the literature, but at least 125 mg/d) in case of ocular involvement

answer 1 incorrect
answer 3 incorrect
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Tocilizumab has been shown to be effective in reducing recurrences and cumulative prednisone dose in more than 50% of patients


there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes

1 is false
Thrombotic thrombocytopenic purpura
Attack

in this case it is not mentioned
In 2 the coagulation must be altered
Attack

In 2 the coagulation must be altered
Disseminated intravascular coagulation
Attack


In this clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia

a picture compatible with pulmonary thromboembolism

Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)

The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem

antiphospholipid antibodies can be detected through the prolongation of phospholipid-dependent coagulation tests

correct answer 1
Antiphospholipid syndrome
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On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time

In the case of hemophilia there would be a problem in blood coagulation but it is not a frequent cause of thromboembolism

Finally, although acute pericarditis could manifest itself in 4 days and with tachycardia, the rest of the symptoms or analytical parameters are not characteristic


Dendritic corneal ulcer is typical of herpes simplex keratitis

Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite

A 35-year-old man comes to the emergency department with pain in his right eye of 3 days' evolution

It presents with pain, not too striking, and scarce or absent red eye

Although in practice we should pay attention to the shape of the dendrite (the true dendrite is deeper and has terminal bulbs at the end of each branch), and pay attention to the evolution of the pain (in the pseudodendrite after abrasion the pain should improve), when answering a MIR question it is simpler: if it is a dendrite, the first thing we have to think is herpes

Fungal and bacterial keratitis have corneal infiltrates

And glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration


This is a patient undergoing chemotherapy with respiratory symptoms and the "halo sign" on X-ray

very suggestive of invasive pulmonary aspergillosis

Treatment is with voriconazole
Voriconazole
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it would not be a valid option
Fluconazole
Attack


The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed

Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4

we are in the ENT block, the airway specialty.

The first diagnostic probability is carcinoma of the floor of the mouth with bilateral cervical metastases

The therapeutic priority is to ensure the patient's nutrition

We must perform as a first diagnostic measure a cytology by fine needle aspiration puncture

We must consider as a priority the risk of airway obstruction

We are almost certainly facing a mediastinitis


You are faithfully describing an Edwards' syndrome

Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome


Complementary tests include: hemoglobin 8.5 mg/dL, hematocrit 26%, MCV 86 fL, MCH 29 pg, leukocytes 2800/mL with 300 neutrophils /ml, platelets 54000/ml, GOT 85 U/l, GPT92 U/l and polyclonal hypergammaglobulinemia in serum proteinogram

Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar

The origin of the girl is also indicative of this diagnosis, although it is a disease that also occurs in the Mediterranean area


Attempting pregnancy without any previous treatment

An asymptomatic myoma of this size that does not deform the endometrial cavity is not a problem for pregnancy

During this check-up, a 4cm uterine myoma is detected, partly intramural and partly subserosal, located on the anterior aspect of the uterus and which does not deform the endometrial cavity


The treatment of choice is corticosteroids

Brain metastases produce pain due to cranial hypertension


the patient should be advised not to become pregnant again until at least 6 months with negative BHCG titers

She should not become pregnant until she has undergone periodic controls and has spent one year with negative BHCG levels

The risk of recurrence in another pregnancy is low (1/55)

The risk of a new molar gestation in a future pregnancy is 50%

regardless of whether the evacuation has been complete or not

Gestational trophoblastic disease should be followed up

90% of cases progress satisfactorily without developing neoplasia

It is necessary to carry out periodic controls since 40% of the cases will develop a gestational trophoblastic neoplasia

Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete


The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms

By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done

In this case, they are very nonspecific nodes, without signs of malignancy (mobile, soft, not painful)

that do not lead us to suspect neoplastic infiltration

the lack of other clinical signs also leads us to rule out the presence of STD

A lues serology since it is most likely a Treponema pallidum infection

A gynecological examination to rule out ovarian cancer

The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful


In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment

Low adherence to treatment is associated with an increased risk of fracture

Answer 2 is found in the SER guidelines, which confirm that some studies conclude that bone remodeling markers can be useful for early monitoring of adherence and response to treatment

Bone remodeling markers may be useful for early monitoring of response to treatment

again in the SER 2019 guidelines they quote: "The current scientific evidence allows us to affirm that neither increasing dietary calcium nor taking calcium supplements alone protects against the appearance of fractures"

Increasing dietary calcium or taking calcium supplements alone does not protect against the occurrence of fractures

Therefore, the correct answer to this question is option 3

Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly

Patients on pharmacological treatment for OP should use calcium and vitamin D supplements because practically all clinical trials that have demonstrated efficacy of antiosteoporotic drugs routinely include calcium supplements and cholecalciferol (vitamin D3), but not in monotherapy


the clinical picture described is of diabetic neuropathy

Of the drugs proposed, the first choice would be a dual antidepressant such as duloxetine

She comes to the office with 3 months of clinical evolution of tingling in both feet, with distribution in sock, with paresthetic pain and sensation of hot feet predominantly at night, which significantly interferes with sleep

A woman diagnosed with type 1 diabetes mellitus for 24 years


the picture of high fever of several days that suddenly subsides with the appearance of a rash, we have a sudden exanthem

Parvovirus B19 is the cause of erythema infectiosum or "fifth disease", whose characteristic rash is on the cheeks, giving the appearance of a slapped face

a high fever of 39°C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition

Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles

EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils

Herpes virus type 6
Herpes virus type 6
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The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake

Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case)

Cerebral amyloid angiopathy (congophilic angiopathy)

the most frequent localizations are: putamen, thalamus, pons and cerebellum

The response that may cause the most doubts is 2, hypertension

In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs

although this data would not serve to rule out the response

An 80-year-old man is admitted for a sudden onset of aphasia and right hemiparesis

Answer 1, a malformation is typical of young patients, rare in older people

Arteriovenous malformation masked by acute hematoma

Answer 4, a brain tumor, does not seem likely

it is more difficult not to find such a lesion after contrast administration

Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people

Isolated vasculitis of the nervous system


We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers

The only option that includes all the data is 4

Diaphyseal fracture of humerus with radial nerve injury

Option 1 does not explain the involvement of the wrist and fingers

Dislocation fracture of proximal humerus

The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm

Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow

there is no data to suggest double forearm fracture

Diaphyseal fracture of the humerus associated with double forearm fracture


The indication of omalizumab in a patient such as the one referred to is a correct indication, although in severe asthma that is difficult to control, there are other prior measures that are not contemplated and that must always be taken into account before resorting to this treatment

Once all of the above has been checked, it would be time to start a trial treatment with omalizumab


I think answer 1 is more true than answer 2

It is indicated after studying the Consultant's genotype and only if it is heterozygous

She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms

Nevertheless, I would do the genetic test on the pregnant woman to be on the safe side

This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation

Her younger brother (index case) aged 26 years is affected by ataxia and genetically diagnosed as a heterozygous carrier of an expansive mutation of 70 CAG repeats in the SCA3 gene (chromosome 14)

In this clinical case, the one who has the disease and has the mutated gene in heterozygosis is the brother (26 years old) of the pregnant woman


Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life

Although the virus is excreted in breast milk, the risk of infection by this route is very low

it is not currently a contraindication for breastfeeding


Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity


Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type

only for this last data, we would have to discard it in a direct way

a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +

Option 2: the correct one
Chronic infection
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It complies with all the characteristics

the only thing that positivizes in a vaccinated patient is the AntiBs. IgG type

Option 3: The vaccinated patient cannot have DNA of the virus

In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA

Option 4: The option that could offer more doubts


The fear of all on-call hematologists... that you will get a TTP

Because, although infrequent, it is the greatest hematologic emergency

The clinical case is fairly typical
Thrombotic thrombocytopenic purpura
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it tells you that the coombs is negative

To distinguish it from the rest of things (although you should not hesitate...)

Laboratory tests show anemia with evidence of hemolysis (increased LDH and retis, presence of schistocytes in peripheral blood) and severe thrombopenia

A young person with fever and neurological symptoms that make him go to the emergency department


The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)

Coombs negative migroangiopathic hemolytic anemia (presence of schistocytes)


If he has a pediatric murmur, I'm thinking congenital

So we rule out aortic and mitral stenosis

Hepatomegaly, malleolar edema and BRD, something that overloads the right heart

A patent ductus would give cyanosis: ruled out

a VSD does not produce atrial dilatation

If I am told that he has AF, it is because the atria are of size XL


Therefore, the first thing we will have to do will be to study the valve disease: we do not want to put the patient to run or overload him with dobuta and have a syncope, nor do we want to do a catheterization without having first performed another noninvasive test

And cardioTC, in someone 80 years old, is going to tell us what we already know: that he has calcium up to his eyebrows


the levels of complement fractions C3 and C4 are low

Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia

Immunological study: antiDNA negative; ANCA negative; antiMBG negative, rheumatoid factor negative; C3 20 mg/dL (normal 60-120); C4 10 mg/dL (normal 20-40)


It is evident from the patient's clinical picture that an urgent reperfusion strategy is indicated, which invalidates options 4 and 5

Hemodynamic stabilization and deferred revascularization procedure

Immediate treatment with fondaparinux and abciximab

Immediate transfer to a tertiary center for treatment with fibrinolysis

since in the event that fibrinolysis is indicated, it would only be a waste of time to make the transfer

Immediate transfer to a tertiary center for percutaneous coronary revascularization procedure

A history of stroke (presumably ischemic) 4 months ago is a relative contraindication for fibrinolysis (if the time is less than 3 months it is an absolute contraindication)

Immediate systemic fibrinolysis at the regional hospital

the definitive factor that tips the balance towards PCI is the extent of AMI and the presence of shock, which are indications for urgent PCI

To begin with, this is a patient with an extensive anterior and lateral AMI, with cardiogenic shock

On the other hand, in the history, we are told that the patient had a stroke 4 months ago


Altered state of consciousness
Fluctuation of the alert level
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Warfarin-induced skin necrosis is a rare and serious adverse effect of oral anticoagulant therapy, occurring in only 0.01 to 0.1% of patients and is especially related to coagulation protein C and S deficiency

However, after starting treatment with acenocoumarol, she develops a picture of skin necrosis affecting the abdominal region and extremities


Exhaustive debridement-wound lavage in the operating room with at least 10 liters of saline

Gustilo II fractures are mainly covered with Gram (+) by means of a 1st generation Cepha

it is not a question of prevention but of treatment (it is considered to be contaminated)


The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness

1 would be if he was making a profit, if he was knowingly simulating and to make a profit he was faking his illness

Conversive would be if the symptom wanted to transmit something to us, that is to say, it was a metaphor of its internal world

The most exact in this case: 5
Conversive disorder
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The option of adding a quinolone during the first two months of treatment (moxifloxacin or levofloxacin) is considered in cases of extensive pulmonary involvement

All the factors mentioned above make us lean more towards answer number 3

In this case, they do not tell us anything about extensive pulmonary involvement but they give us a data "excessive alcohol consumption"

Alcohol exerts a direct immunosuppressive effect

moreover, alcoholism is related to the affectation of immunity in the respiratory tract

The social context that usually accompanies the alcoholic patient does not help either

Isoniazid, ethambutol, pyrazinamide for 12 months and a quinolone for two months

although it is undeniable that number 1 could also be correct

Twenty days after starting treatment, a report of rifampicin resistance of M. tuberculosis isolated in sputum is received

In case of resistance to rifampicin, rifampicin is withdrawn and treatment is completed with the 3 remaining drugs for 12 months


The treatment is intradermal botulinum toxin injection

during mastication, erythema and preauricular sweating occur

This clinical picture is called Frey's syndrome and consists of an anomalous reinnervation of regional structures after parotidectomy due to lesion of the auriculotemporal nerve


The correct answer is: 2
Focal and segmental glomerulonephritis
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Focal segmental glomerulonephritis
The correct answer is: 2
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In urinalysis: sediment without alterations and in 24 h urine proteinuria of 6.3 g/24 h

We are in front of a patient with renal insufficiency whose manifestation is a proteinuria

That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)

If we also consider that the patient was obese, slightly hypertensive, the most probable is that it is a focal segmental glomerulonephritis

A 58-year-old woman, weight 130 kg, height 155 cm, body mass index > 30 with mild hypertension, blood glucose 108 mg/dL and absence of edema in the lower limbs


A 75-year-old patient with significant gonarthrosis with "Genu Varo" that causes marked functional impotence, limited mobility and continuous pain that requires continuous antirheumatic, anti-inflammatory and analgesic medication

We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu varum and an important gonarthrosis

This means that we can do nothing with an arthroscopy, let alone a synovectomy (1 and 5 false)

Perhaps years ago before the osteoarthritis took place it would have been resolutive but not now (4 false).

Abduction supratuberosity tibial supratuberosity tibial osteotomy

The genu varum could falsely make us think about an osteotomy, however even if we did it and corrected the varus now the damage is already done and the osteoarthrosis is severe

In addition, in order to consider an osteotomy, we should be given more data to know which bone to apply the osteotomy on, the tibia or the femur

Finally, we may think that it is best to first try rehabilitation before considering surgery, but I discard this option because the question emphasizes that we have exhausted pharmacological measures (although it could be considered because they have not specified whether it has been tried or not)

In any case with the knee prosthesis we correct the problem of osteoarthritis pain and we can also correct the knee varus


He is brought to the emergency department for clinical aphasia and right hemiparesis of sudden onset, 45 minutes earlier

The patient suffers an abrupt neurological deficit probably related to a vascular event

first we will have to perform a cranial CT scan to rule out a hemorrhagic stroke

the patient is in a good baseline condition

Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case

If the CT scan does not show bleeding, the patient has an acute ischemic stroke, probably cardioembolic due to his cardiac pathology, not anticoagulated

Perform a cranial CT scan and if there are no hemorrhagic lesions or other contraindications in the analysis, start immediate intravenous thrombolysis

Although the patient is 88 years old, age is no longer presented as an absolute exclusion criterion

the general situation of the patient must be taken into account

in this case it is specified that he presents a good baseline situation


Hepatocarcinoma can elevate (alone) alpha-fetus, seminoma LDH, lymphoma also LDH


FNA does not allow a histological study but a cytological one

Identify the typical cytologic features of papillary carcinoma

Distinguish between follicular adenoma or minimally invasive follicular carcinoma

Identify the areas of capsular or vascular invasion of the follicular carcinoma

Question 3 seems to have been put as a filler

Recognize G-cell hyperplasia associated with familial spinal cancer

papillary carcinoma is the most frequent.

Question 4 could raise doubts if you are not a pathologist

Distinguish between a Hurthle cell tumor and an oxyphilic follicular adenoma


Kallman's syndrome or Morsier's syndrome is a congenital insufficiency associated with hypogonadotropic hypogonadism due to a deficit in GnRH hormone production

Repeated injections of GnRH are performed to restore fertility


Sodium bicarbonate 1M 100 cc iv in 30 minutes

The blood test showed blood glucose 450 mg/dl, Na 142 mEq/l, K 4 mEq/l, pH 7.15, bicarbonate 12 mmol/l


The most influential cardiovascular factor for stroke in women over 70 is blood pressure


In the face of a PPD conversion within 2 years, and ruling out current TB disease, INH chemoprophylaxis is indicated, although I thought it was for 6 months and not 9


Actually, it can be all of them
PET SCAN
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Actually, it can be all of them
EAP
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Actually, it can be all of them
Lobar pneumonia
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Actually, it can be all of them
Alveolar hypoventilation
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Actually, it can be all of them
Bronchopneumonia
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the most frequent cause of acute uncompensated respiratory acidosis in a young person is bronchopneumonia


Left capsular lacunar lacunar infarction

If we are strict we would be talking about a pure motor lacunar infarction (with mild dysarthria)

Since the other 3 options do not give us a clinical picture like the one in the statement

A cortico-subcortical left frontotemporal sylvian infarction

Both options 2 and 3 give us a much more florid and extensive clinical picture


endoscopic therapy is recommended, preferably with 2 techniques

an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding

Answer 1 is not in accordance with what has been said

clots were found in the stomach and a 2 cm ulcer in the gastric antrum with fibrin background and a small grayish-white protrusion of 3 mm in the center of the ulcer (visible platelet thrombus vessel)

Consultation to the surgical service to consider urgent surgical treatment

4 will only be considered if bleeding is not controlled endoscopically

Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication

Endoscopic treatment by injection of adrenaline into the ulcer and placement of clips (metal staples) followed by i.v. administration of PPI

Answer 2 speaks of somatostatin, which is used for bleeding due to portal hypertension

Remove the endoscope, place nasogastric tube for continuous aspiration and initiate treatment with a PPI and somatostatin

Take biopsy for H. Pylori, remove the endoscope taking care not to dislodge the platelet thrombus and continue pharmacological treatment with i.v. PPI


in principle, unless the patient worsens and the pH is less than 7.10

We must take into account that, in this case, potassium is decreased

the most frequent cause (supported by the stains on the dress) would be diarrhea

it is most likely that their renal failure (although they do not give us urine ion data to confirm it) is of prerenal type

She has an acute renal failure of prerenal cause

These patients frequently present intense tachypnea (Kussmaul's breathing) in an attempt to compensate for MCA by hyperventilation


It is typical that after an episode of high fever an erythema appears on both cheeks in the form of a "slap" that usually has a cranial-caudal extension in the following days

We are being told about erythema súdenita or fifth disease (also called megaloerythema), caused by parvovirus B19


Although the majority of ACTH-producing adenomas recur, surgery is always the first therapeutic option

Selective surgical resection of the adenoma

Initially try medical treatment and, if not effective, resort to surgery

The available medications (ketoconazole, somatostatin analogues) are aimed at decreasing the effects of excess cortisol or decreasing ACTH release


The cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion

Colposcopy is indicated for all patients with altered cytology (intraepithelial lesion or suspicion of invasive cancer or HPV infection), as a second level of screening

If lesions are observed in this test, a biopsy of the lesion will be performed

this is a screening test, not a diagnostic test

There is no point in repeating the cytology

performing a hysterectomy for an intraepithelial lesion that has not been confirmed by biopsy is not indicated either

Hysterectomy with bilateral salpinguectomy and ovarian conservation

performing curettage of the endometrial cavity does not provide information


they are not sick and have already had a homozygous child

the probability of receiving it from both is 50%x50%=25%

The probability that the next offspring will be affected is 25%

the next offspring has a 50% chance of receiving the mutation from each parent


We are presented with a 68-year-old female patient

At that age the crystalline lens, although it does not normally have a cataract that needs surgery, it usually has increased in thickness

This implies that it projects the iris forward and reduces the depth of the anterior chamber

In an eye with a normal anterior chamber depth this is usually not a problem

But farsighted people already have a narrow anterior chamber

This is the usual combination we find in primary angular closure: farsightedness and age over 50-60 years

Younger hyperopes usually do not have this problem yet

And neither do older people who are emmetropic, myopic or have had cataract surgery

With this narrow angle, what triggers angular closure is mydriasis

That is, when you are in the penumbra, the pupil dilates and the iris thickens in the peripheral part, where it is already very close to the corneal endothelium in the case of a narrow chamber

She consults because she has been having eye pain with headache and blurred vision at night when she is watching television in dim light for a few weeks

Mydriasis then triggers angular closure, which is accompanied by ocular pain that may radiate backwards (headache)

And increased intraocular pressure produces corneal edema that causes blurred vision

Therefore, option 1 is correct
Primary angular closure glaucoma
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Migraine does not have to be related to penumbra

ocular pain and blurred vision is not particularly typical

In addition, the history of exposure is usually clear

Actinic keratitis is caused by exposure to ultraviolet radiation (such as solar radiation), and is not related to hyperopia or to being in penumbra

And finally, dry eye does not produce these symptoms either: it is more a question of burning, foreign body sensation, heaviness, etc

And it is also unrelated to the other elements: penumbra, hyperopia, etc


a "portrait" of the typical findings that can be found in hypertrophic cardiomyopathy

A young male patient with an aortic systolic murmur that increases with the Valsalva maneuver and signs of left ventricular enlargement


We rule out continuing with the same treatment since the patient is symptomatic

Maintain the same pharmacological regimen

Switch to ocmbined therapy with low-dose inhaled corticosteroids and long-acting beta2-adrenergics


In the physical examination she presents a hump of 7 degrees in the Adams test and in the scoliogram a T4-L1 thoracolumbar curve of 35 degrees of Cobb and a Risser 0

Treatment with a brace in Risser from 0 to 2 can be considered

Its use is considered for curves between 30-40º

since there is still growth to occur and correction can take place