1.

Simulacro ENARM 2010

MUJER DE 78 AÑOS, LLEVADA A URGENCIAS POR CEFALEA INTENSA, NÁUSEA,

VÓMITOS, TRASTORNOS DE LA MEMORIA,APATÍA Y SOMNOLENCIA. ANTECEDENTES
DE DIABETES MELLITUS Y ENFERMEDAD ARTICULAR DE TIPO DEGENERATIVO AMBAS
BAJO TRATAMIENTO MÉDICO. E.F.: TEMP 38º C, TA 140/90 MMHG, RCR, CAMPOS
PULMONARES CLAROS, EXTREMIDADES CON DISMINUCIÓN DE FUERZA MUSCULAR
3/5 EN HEMICUERPO IZQUIERDO, REFLEJOS DE ESTIRAMIENTO MUSCULAR
CONSERVADO. DISMINUCIÓN DE CAMPOS VISUALES. B.H. Y Q.S. NORMALES.

1.- EL AGENTE CAUSAL MÁS PROBABLE EN ESTE PACIENTE ES:

a) BACTERIANO.
b) VIRAL.
c) NEOPLASICO
d) METABÓLICO.

2.- EL MÉTODO MÁS SENSIBLE PARA CORROBORAR EL DIAGNÓSTICO EN ESTE

PACIENTE ES:

a) PUNCIÓN LUMBAR.
b) RESONANCIA MAGNETICA
c) HEMOGLOBINA GLUCOSILADA.
d) ANGIOGRAFÍA

ANXIETY, DEPRESSION LINKED TO ANGINA FREQUENCY IN HEART PATIENTS NEW

RESEARCH SHOWS THAT ISCHEMIC HEART DISEASE PATIENTS WHO SUFFER
SIGNIFICANT ANXIETY HAVE CLOSE TO A 5-FOLD INCREASED RISK OF
EXPERIENCING FREQUENT ANGINA AND THOSE WITH DEPRESSION HAVE MORE THAN
A 3-FOLD INCREASED RISK FOR THESE EPISODES. THIS OBSERVED LINK BETWEEN
PSYCHIATRIC SYMPTOMS AND ANGINA UNDERLINES THE IMPORTANCE OF TREATING
ANXIETY AND DEPRESSION IN CARDIAC PATIENTS. PSYCHOSOCIAL FACTORS: THE
RESEARCHERS EXAMINED 5 PSYCHOSOCIAL FACTORS THAT MIGHT AFFECT ANGINA
FREQUENCY: ANXIETY; DEPRESSION; NEUROTICISM (TENDENCY TO EXPERIENCE
NEGATIVE EMOTIONS SUCH AS SADNESS, ANGER, OR GUILT); ALEXITHYMIA
(IMPAIRED ABILITY TO EXPRESS INNER FEELINGS); AND SOMATOSENSORY
AMPLIFICATION (TENDENCY TO EXPERIENCE A SOMATIC SENSATION AS INTENSE,
NOXIOUS, AND DISTURBING). THERE WAS MORE ANXIETY AND DEPRESSION AMONG
PATIENTS WITH FREQUENT ANGINA. FOR INSTANCE, 22% OF PATIENTS WITH NO
ANGINA HAD CLINICALLY SIGNIFICANT ANXIETY, DEFINED AS A SCORE OF 16 OR
GREATER ON THE BECK ANXIETY INVENTORY SCALE, COMPARED WITH 38% FOR
PATIENTS WITH MONTHLY ANGINA AND 64% FOR THOSE WITH WEEKLY OR DAILY
ANGINA. OTHER PSYCHOSOCIAL FACTORS WERE ALSO INCREASED AMONG PATIENTS
WITH MORE FREQUENT ANGINA. FOR EXAMPLE, 38% OF PATIENTS WITH WEEKLY OR
DAILY ANGINA HAD A HIGH LEVEL OF ALEXITHYMIA COMPARED WITH 17% OF
PATIENTS WITH MONTHLY ANGINA AND 14% OF THOSE WITHOUT ANGINA.
HOWEVER, AFTER ADJUSTMENT FOR DEGREE OF MYOCARDIAL ISCHEMIA, GREATER
ANXIETY SCORE (ODDS RATIO, 1.39 PER HALF–STANDARD DEVIATION INCREASE IN
ANXIETY SCORE) AND GREATER DEPRESSION SCORE (OR, 1.51 PER HALF–STANDARD
DEVIATION INCREASE IN DEPRESSION SCORE) WERE THE ONLY PSYCHOSOCIAL
FACTORS SIGNIFICANTLY ASSOCIATED WITH MORE FREQUENT ANGINA. AS
EXPECTED, PREVIOUS CORONARY REVASCULARIZATION WAS ALSO SIGNIFICANTLY
ASSOCIATED WITH FREQUENT ANGINA. PATIENTS WITH AT LEAST MODERATE
ANXIETY SYMPTOMS EXPERIENCED A 4.7-FOLD INCREASED RISK OF HAVING MORE
FREQUENT ANGINA. PATIENTS WITH CLINICALLY RELEVANT DEPRESSIVE SYMPTOMS
HAD A 3.2-FOLD INCREASED RISK OF EXPERIENCING MORE FREQUENT ANGINA.
BIOLOGICAL FACTORS: NOT EVERY PATIENT WITH CORONARY ARTERY DISEASE
DEVELOPS ANGINA. UP TO 45% OF THESE PATIENTS HAVE ASYMPTOMATIC
ISCHEMIA. SEVERAL BIOLOGICAL FACTORS MIGHT EXPLAIN THE DISCREPANCY
BETWEEN CORONARY ARTERY DISEASE AND ANGINA SEVERITY, ACCORDING TO THE
AUTHORS. FOR EXAMPLE, METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE
INJURY MAY INFLUENCE PAIN LEVELS.

3.- WHAT HAS NEW RESEARCH DEMONSTRATED ABOUT ISCHEMIC HEART DISEASE
PATIENTS WITH DEPRESSION?

a) THIS PATIENTS HAVE MORE INCREASED RISK OF EXPERIENCING FREQUENT

ANGINA.
b) THIS PATIENTS HAVE MORE INCREASED RISK OF THIS EPISODES.
c) A PATIENTS HEART DISEASE IS NOT RELATED WITH ANY PSYCHIATRIC DISEASE.
d) THERE IS NO OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA.

4.- WHAT RELATIONSHIP WAS FOUND BETWEEN PSYCHIATRIC SYMPTOMS AND

PATIENTS WITH FREQUENT ANGINA?

a) THIS PATIENTS HAD CLINICALLY SIGNIFICANT ANXIETY.

b) THIS PATIENTS HAD A 16 SCORE OR GREATER ON THE BECK ANXIETY INVENTORY
SCALE.
c) THIS PATIENTS SUFFERED FROM WEEKLY OR DAILY ANGINA.
d) THIS PATIENTS HAD MORE ANXIETY AND DEPRESSION.

5.- WHAT PSYCHOSOCIAL FACTORS INCREASED AMONG PATIENTS WHO SUFFERED

OF FREQUENT ANGINA?

a) ALEXITHYMIA.
b) ANXIETY.
c) SOMATOSENSORY AMPLIFICATION.
d) NOXIOUS.

6.- WHAT ADJUSTMENT FOR DEGREE WAS THERE AFTER MYOCHARDIAL ISCHEMIA?

a) ANXIETY AND DEPRESSION DECREASED.

b) DEPRESSION AND ANXIETY INCREASED.
c) ANXIETY AND DEPRESSION REMAINED THE SAME.
d) THERE WAS NO SIGNIFICANT CHANGES.

7.- WHAT BIOLOGICAL FACTORS EFFECTS PATIENTS WITH ANGINA?

a) EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA.

b) PREVIOUS CORONARY REVASCULARIZATION WAS ALSO ASSOCIATED WITH
FREQUENT ANGINA.
c) SOME OF THIS PATIENTS HAVE ASYMPTOMATIC ISQUEMIA.
d) METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY ARE NOT
RELATED.

MUJER DE 31 AÑOS. ES ATENDIDA EN CONSULTA POR PRESENTAR ACTIVIDAD

UTERINA REGULAR Y DOLOROSA. ACTUALMENTE CURSA EMBARAZO GEMELAR DE 33
SEMANAS . NIEGA SANGRADO TRANSVAGINAL, SALIDA DE LÍQUIDO TRANSVAGINAL.
REFIERE MOVIMIENTOS FETALES PRESENTES. ANTECEDENTES: G:3, P:2, DIABETES
GESTACIONAL MANEJADA CON DIETA Y METFORMINA CON BUEN CONTROL
GLICÉMICO. E.F.: PRODUCTO ÚNICO LONGITUDINAL PÉLVICO, DORSO DERECHA.
CON FCF 130 LPM. TACTO VAGINAL 1 CM DE DILATACIÓN CON 80% BORRRAMIENTO.

8.- EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:

a) INHIBIDORES DE LA SINTESIS DE PROSTAGLANDINAS.

b) BETAMIMÉTICOS.
c) NIFEDIPINO.
d) REPOSO.

NIÑA DE 4 AÑOS, INGRESA AL SERVICIO DE URGENCIAS POR DOLOR ABDOMINAL

CONSTANTE DE 48 HORAS DE EVOLUCIÓN. SU MADRE LE DIÓ PARACETAMOL AYER,
SIN EMBARGO EL DOLOR PERSISTE Y SE AGREGARON VÓMITO VERDOSO Y FIEBRE DE
39°C. ANTECEDENTES: OPERADA DE HIPERTROFIA PILÓRICA A LOS 2 MESES. E.F.:
TA/ 100/60, FC 120LPM, FR 30 RPM, TEMPERATURA 38.7°C. ABDOMEN CON DOLOR A
LA PALPACIÓN MEDIA Y RESISTENCIA, TIMPÁNICO, PERISTALSIS NULA.

9.- EL DIAGNÓSTICO DE MÁS PROBABILIDAD ES:

a) OCLUSIÓN INTESTINAL BAJA.

b) INVAGINACIÓN INTESTINAL.
c) OCLUSION POR ADHERENCIAS.
d) APENDICITIS COMPLICADA.

10.- EL TRATAMIENTO INMEDIATO PARA ESTA PACIENTE ES:

a) ADMINISTRAR SONDA A DERIVACIÓN.

b) LAPAROTOMIA EXPLORADORA.
c) SOLUCIONES PARENTERALES.
d) OBSERVACIÓN.

HOMBRE DE 45 AÑOS. ATENDIDO EN LA CONSULTA POR PRESENTAR EXPECTORACIÓN

CON SANGRE. ANTECEDENTES: TABAQUISMO POSITIVO, 42 CAJETILLAS AL AÑO. TOS
CRÓNICA CON EXPECTORACIÓN MUCOSA ABUNDANTE, DE 3 AÑOS DE EVOLUCIÓN.
E.F.: TA 130/80 MM HG, FC 88 LPM, FR 14 RPM, TEMP 37ºC. DISMINUCIÓN DE
AMPLEXIÓN Y AMPLEXACIÓN. RX DE TÓRAX MUESTRA OPACIDAD HILIAR DERECHA.

11.- EL SIGUIENTE ESTUDIO QUE SE DEBE REALIZAR EN ESTE PACIENTE PARA

CONFIRMAR EL DIAGNÓSTICO ES:

a) CITOLOGÍA EN EXPECTORACIÓN.
b) LAVADO, CEPILLADO BRONQUIAL POR BRONCOSCOPÍA.
c) TOMA DE BIOPSIA TRANSBRONQUIAL POR BRONCOSCOPIA.
d) TOMA DE BIOPSIA TRANSTORÁCICA CON AGUJA FINA.

12.- EN ESTE PACIENTE EL REPORTE ANATOMOPATOLÓGICO MÁS PROBABLE ES:

a) CARCINOMA EPIDERMOIDE.
b) ADENOCARCINOMA.
c) LINFOMA DE HODGKIN.
d) CARCINOMA DE CELULAS PEQUEÑAS.

13.- EN ESTE PACIENTE, UNA VEZ TRATADO, USTED ESPERA QUE PUEDA TENER:

a) EDEMA DE MIEMBROS INFERIORES.

b) ASCITIS.
c) CRISIS CONVULSIVAS.
d) ARRITMIAS CARDIACAS.

HOMBRE DE 40 AÑOS. ATENDIDO EN LA CONSULTA EXTERNA POR DOLOR INTENSO

EN PRIMER ORTEJO DEL PIE DERECHO Y FIEBRE. ANTECEDENTES: SE ENCUENTRA EN
QUIMIOTERAPIA POR PADECER DE LEUCEMIA GRANULOCÍTICA CRÓNICA. E.F.: TA
130/70 MM HG, FC 120 LPM, FR 14 RPM, TEMP 38ºC. EL DEDO REFERIDO ESTA
INFLAMADO MUY DOLOROSO AL MENOR ESTÍMULO. LABORATORIO: LEUCOCITOS
25,000/MM3, ÁCIDO ÚRICO 14 MG/DL. CREATININA SERICA 0.9 MG/DL.

14.- LA EXPLICACIÓN MÁS PROBABLE DE ESTE CUADRO CLÍNICO ES:

a) INGESTIÓN ABUNDANTE DE CARNES ROJAS.

b) AUMENTO DE RECAMBIO TISULAR.
c) DISMINUCIÓN EN LA ELIMINACIÓN RENAL DE ÁCIDO ÚRICO.
d) CONSECUENCIA DEL TRATAMIENTO ANTINEOPLASICO.

LACTANTE DE 2 MESES DE EDAD. ES ATENDIDO EN LA CONSULTA POR PRESENTAR

ADENOMEGALIA EN REGIÓN AXILAR DERECHA CON DOLOR E INMOVILIZACIÓN DE LA
ARTICULACIÓN. REFIERE LA MADRE QUE TIENE ESQUEMA COMPLETO DE
VACUNACIÓN. E.F.: MASA DE 3 CM EN AXILA CON CAMBIOS DE COLOR Y AUMENTO
DE TEMPERATURA EN LA REGIÓN. TEMPERATURA 37.3º, FC. 124LPM, FR 36 RPM.

15.- LA PRINCIPAL SOSPECHA CLÍNICA EN ESTE CASO ES:

a) ABSCESO AXILAR.
b) TUBERCULOMA.
c) LIPOMA.
d) INFECCIÓN.

16.- ESTUDIO MAS SENSIBLE PARA REALIZAR EL DIAGNÓSTICO:

a) REVISAR EL ESQUEMA DE VACUNACIÓN.

b) TOMA DE BIOPSIA.
c) APLICACIÓN DE PPD.
d) BAAR POR SONDA OROGÁSTRICA.
SUDDEN CARDIAC DEATH (SCD) IS DEFINED AS THE UNEXPECTED NATURAL DEATH
FROM CARDIAC CAUSES WITHIN A SHORT TIME PERIOD IN A PERSON WITHOUT A
CARDIAC CONDITION THAT WOULD APPEAR FATAL. SCD IS RESPONSIBLE FOR
APPROXIMATELY 300,000 FATALITIES IN THE UNITED STATES ALONE. IT IS
ESTIMATED THAT 50% OF ALL CARDIAC DEATHS ARE SUDDEN, AND THIS
PROPORTION HAS REMAINED CONSTANT DESPITE THE OVERALL DECLINE IN
CARDIOVASCULAR MORTALITY DURING THE LAST DECADES. IN APPROXIMATELY
THREE FOURTHS OF CASES, SCD IS CAUSED BY VENTRICULAR TACHYCARDIA (VT)
AND FIBRILLATION (VF), ALTHOUGH IN PATIENTS WHO HAVE UNDERLYING
CONGESTIVE HEART FAILURE (CHF), A SIGNIFICANT PROPORTION OF SCD IS THE
CONSEQUENCE OF BRADYCARDIC EVENTS OR ELECTROMECHANICAL DISSOCIATION.
THIS ARTICLE SUMMARIZES THE CURRENT KNOWLEDGE ON RISK STRATIFICATION IN
PATIENTS WHO HAVE STRUCTURAL HEART DISEASE, NOTABLY CORONARY ARTERY
DISEASE AND NONISCHEMIC CARDIOMYOPATHY. ALTHOUGH OTHER TYPES OF
STRUCTURAL HEART DISEASE AND INHERITED ION CHANNEL ABNORMALITIES ARE
ALSO ASSOCIATED WITH A RISK OF SCD, THE RISK STRATIFICATION STRATEGIES
AND DATA IN THESE ENTITIES ARE DIVERSE AND BEYOND THE SCOPE OF THIS
ARTICLE. THE MAGNITUDE OF THE PROBLEM IN SPECIFIC SUBGROUPS OF PATIENTS
PRONE TO SCD WAS ADDRESSED BY MYERBURG IN A REVIEW OF THE POPULATION
IMPACT OF EMERGING IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR (ICD) TRIALS.
THE HIGHEST INCIDENCE OF SCD OCCURRED IN SURVIVORS OF OUT-OF-HOSPITAL
CARDIAC DEATH AND HIGH-RISK POST INFARCTION SUBGROUPS, BUT THE
GREATEST ABSOLUTE NUMBER OF SCD EVENTS (POPULATION ATTRIBUTABLE RISK)
OCCURRED IN LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK,
INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR
CORONARY EVENTS. THE CHALLENGE IS TO IDENTIFY RISK FACTORS FOR SCD
AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY LOW RISK, WHICH APPLIES,
FOR EXAMPLE, DIRECTLY TO SURVIVORS OF MYOCARDIAL INFARCTION, IN AN ERA
WHEN THE PROGNOSIS HAS IMPROVED SUBSTANTIALLY IN COMPARISON WITH
PRIOR SERIES ANTEDATING THE WIDESPREAD USE OF REPERFUSION THERAPY.
AMONG PATIENTS SUFFERING FROM CARDIAC ARREST, MOST HAVE SOME FORM OF
STRUCTURAL HEART DISEASE, WITH MOST PATIENTS SUFFERING FROM CORONARY
ARTERY DISEASE, BUT ACUTE MYOCARDIAL INFARCTION IS SEEN IN LESS THAN
HALF. IN A SERIES OF 151 HEARTS FROM MEN WHO DIED FROM SUDDEN CARDIAC
DEATH, THE PRESENCE OF ACUTE THROMBUS/PLAQUE RUPTURE OR EROSION WAS
NOTED IN 67% OF PATIENTS AGED 30 TO 39, BUT THIS PROPORTION DECLINED
WITH AGE AND WAS PRESENT IN ONLY 31% OF PATIENTS AGES 60 TO 69.

17.- IN MOST CASES SCD WAS

a) CAUSED BY VENTRICULAR TACHYCARDIA (VT)

b) CAUSED BY FIBRILLATION (VF)
c) CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF)
d) CAUSED BY BRADYARDIC EVENTS AND ELECTROMECHANICAL DISSOCIATION

18.- THE RISK STRATIFICATION STRATEGIES AND DATA OF SCD

a) ARE INCLUDED WITH DETAIL AND EXAMPLES IN THIS ARTICLE

b) COMPARATIVE DETAILS AND EXAMPLES ARE INCLUDED IN THIS ARTICLE
c) ONLY SCD RISK STRATEGIES ARE INCLUDED IN THIS ARTICLE
d) SCD RISK STRATIFICATION STRATEGIES AND INFORMATION IS NOT THE
OBJECTIVE OF THIS ARTICLE
19.- THE GREATEST NUMBER OF SCD OCURRED IN

a) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT HIGHER RISK, INCLUDING

PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY
EVENTS.
b) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER AND HIGHER RISK,
INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR
CORONARY EVENTS.
c) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING
PATIENTS WITH RIGHT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY
EVENTS.
d) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK, INCLUDING
PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY PRIOR CORONARY
EVENTS

20.- THE CHALLENGE IS TO IDENTIFY

a) RISK FACTORS FOR SCD AMONG THE SMALL GROUP OF PATIENTS AT RELATIVELY
LOW RISK
b) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY
HIGH RISK
c) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT RELATIVELY
LOW RISK
d) NON-RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT
RELATIVELY LOW RISK

21.- THE HIGHEST RISK GROUP OF PATIENTS SUFFERING FROM CARDIAC ARREST
WHO HAD SOME FORM OF STRUCTURAL HEART DISEASE AND CORONARY ARTERY
DISEASE WERE

a) YOUNGER MEN
b) MIDDLE AGED MEN
c) OLDER MEN
d) OF ALL ADULT AGES

MUJER 82 AÑOS. ATENDIDA EN URGENCIAS POR DOLOR EN EPIGASTRIO INTENSO

QUE SE ACOMPAÑA DE NÁUSEA Y VÓMITO EN POZOS EN CAFÉ. HA TENIDO
EVACUACIONES MELÉNICAS Y CON SANGRE FRESCA ASÍ COMO DISTENSIÓN
ABDOMINAL . TIENE ANTECEDENTES DE ENFERMEDAD ARTICULAR DEGENERATIVA
TRATADA CON AINES. E.F.: TA 80/40 MMHG, FC 120 LPM, RCR, CAMPOS
PULMONARES CLAROS, ABDOMEN DOLOROSO A LA PALPACIÓN, CON REBOTE
POSITIVO Y PERISTALSIS AUSENTE.

22.- EL ESTUDIO INICIAL PARA CORROBORAR EL DIAGNÓSTICO ES:

a) RX DE ABDOMEN DE PIE Y DECÚBITO.

b) ENDOSCOPÍA.
c) TAC DE ABDOMEN.
d) COLONOSCOPÍA.
23.- EL TRATAMIENTO DEFINITIVO EN ESTE PACIENTE ES:

a) BLOQUEADORES DE BOMBA DE PROTONES.

b) LAVADO GÁSTRICO.
c) CIRUGÍA.
d) SUSPENDER AINES.

APPENDICITIS: SELECTIVE USE OF ABDOMINAL CT REDUCES NEGATIVE

APPENDECTOMY RATE APPENDICITIS ACCOUNTS FOR OVER 3% OF THE DISEASES
THAT INVOLVE THE DIGESTIVE SYSTEM, IS THE MOST COMMON ACUTE SURGICAL
PROBLEM OF THE ABDOMEN, AND APPENDECTOMY IS THE FIFTH MOST COMMON
SURGICAL PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT. IT IS ALSO
ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE ACCURATELY.
RATES OF NEGATIVE APPENDECTOMY RANGE FROM 20% TO 44%. THESE RATES ARE
EVEN HIGHER IN WOMEN OF CHILDBEARING AGE, RANGING FROM 25% TO AS HIGH
AS 52%. REPORTED PERFORATION RATES RANGE FROM 15% TO 37%. THESE RATES
OF NEGATIVE APPENDECTOMY HAVE BEEN CONSIDERED ACCEPTABLE BECAUSE THE
MORBIDITY ASSOCIATED WITH COMPLICATED APPENDICITIS IS SIGNIFICANTLY
HIGHER THAN THAT OF NON-THERAPEUTIC APPENDECTOMY. NUMEROUS DIAGNOSTIC
TOOLS HAVE BEEN IMPLEMENTED IN AN EFFORT TO REDUCE THE HIGH RATE OF
NEGATIVE APPENDECTOMY WHILE AT THE SAME TIME NOT INCREASE THE
PERFORATION RATE. SOME OF THESE TOOLS INCLUDE CLINICAL SCORING SYSTEMS,
ULTRASOUND, COMPUTERIZED DECISION SUPPORT, VARIOUS LABORATORY TESTS,
AND OTHER, NON-TRADITIONAL METHODS. THESE VARIOUS MODALITIES HAVE ALL
YIELDED MIXED RESULTS AS TO THEIR USEFULNESS IN CLINICAL PRACTICE.
STUDIES HAVE SHOWN THAT HELICAL COMPUTERIZED TOMOGRAPHY (CT) SCANNING
OF THE ABDOMEN HAS BEEN SUCCESSFUL IN REDUCING NONTHERAPEUTIC
APPENDECTOMY RATES TO AS LOW AS 3%. THESE RESULTS PROVIDE EVIDENCE
THAT THERE MAY FINALLY BE A DIAGNOSTIC TOOL THAT CAN BE EFFECTIVE IN
REDUCING RATES OF NONTHERAPEUTIC APPENDECTOMY WHILE NOT INCREASING
THE MORBIDITY AND MORTALITY ASSOCIATED WITH APPENDICITIS.

24.- WHAT IS RELATION OF APPENDICITIS WITH OTHER GASTROINTESTINAL TRACT

DISEASES?

a) IS ONE OF THE LESS COMMON SURGICAL PROCEDURES OF THE

GASTROINTESTINAL TRACT.
b) IT HAS NO RELATION WITH OTHER GASTROINTESTINAL TRACT DISEASES.
c) IT HAS THE HIGHEST INDEX OF MORBILITY.
d) IS THE FIFTH MOST COMMON SURGICAL PROCEDURE OF THE GASTROINTESTINAL
TRACT.

25.- WHY CAN APPENDICITIS END IN A COMPLICATED PERFORATION?

a) BECAUSE IS THE MOST COMMON ACUTE SURGICAL PROBLEM OR THE ABDOMEN.

b) BECAUSE IT IS ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO DIAGNOSE
ACURATELY.
c) BECAUSE APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL PROCEDURE
PERFORMED ON THE GASTROINTESTINAL TRACT.
d) BECAUSE OF THE LACK OF DIAGNOSTIC TOOLS.
26.- WHAT ARE THE RATES OF NEGATIVE APPENDECTOMY?

a) THESE RATES ARE EVEN LOWER IN WOMEN OF CHILDBEARING AGE.

b) THESE RATES ARE NOT CONSIDERED ACCEPTABLE.
c) THESE RATES ARE EVEN HIGHER IN WOMEN WHO ARE NOT IN CHILDBEARING
AGE.
d) THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE.

27.- WHICH OF THE NEXT DIAGNOSTIC TOOLS HAS SUCCESFULLY REDUCED

NONTHERAPEUTIC APPENDECTOMY?

a) SCORING SYSTEMS.
b) HELICAL COMPUTERIZED TOMOGRAPHY.
c) ULTRASOUND.
d) LABORATORY TESTS.

28.- WHAT IS THE FINAL RESULT OF THIS STUDY?

a) THE HELICAL COMPUTERIZED TOMOGRAPHY CAN PREVENT NONTHERAPEUTICAL

APPENDECTOMY.
b) THE RATES OF NONTHERAPEUTICAL APPENDECTOMY HAVE INCREASED.
c) APPENDICITIS IS THE FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED
ON THE GASTROINTESTINAL TRACT.
d) NUMEROUS DIAGNOSTIC TOOL HAVE BEEN IMPLEMENTED IN AN EFFORT TO
REDUCE THE RISK OF NONTHERAPEUTICAL APPENDECTOMY.

MUJER DE 23 AÑOS. ASISTE A URGENCIAS POR PRESENTAR SALIDA DE LÍQUIDO

TRANSVAGINAL DE INICIO SÚBITO POSTERIOR A UNA RELACIÓN SEXUAL.
ACTUALMENTE CURSA SU PRIMER EMBARAZO Y ESTÁ EN LA SEMANA 39 DE
GESTACIÓN. E.F.: PRODUCTO LONGITUDINAL CEFÁLICO DORSO IZQUIERDA. FCF EN
140 LPM. GENITALES HÚMEDOS. SE VISUALIZA CÉRVIX CERRADO FORMADO Y
POSTERIOR. NO HAY LÍQUIDO EN FONDO DE SACO.

29.- EL MÉTODO MÁS SENSIBLE Y ESPECÍFICO PARA ESTABLER EL DIAGNÓSTICO EN

ESTA PACIENTE ES:

a) CRISTALOGRAFÍA .
b) INYECCIÓN DE PIGMENTO POR AMNIOCENTESIS Y OBSERVACIÓN DE FUGA HACIA
CANAL VAGINAL.
c) PRUEBA DE NITRAZINA.
d) PH VAGINAL.
MUJER DE 25 AÑOS. ES ATENDIDA EN CONSULTA PARA CONTROL PRENATAL. 13
SEMANAS DE GESTACIÓN POR FUR. ULTRASONIDO TRANSABDOMINAL SE OBSERVA
LA PRESENCIA DE DOS FETOS DENTRO DE UN SACO GESTACIONAL. SE APRECIA UNA
MEMBRANA DIVISORIA DELGADA QUE AL UNIRSE A LA PLACENTA FORMA UNA
IMAGEN EN “T”.

30.- LA CAUSA MÁS PROBABLE DE ESTE HALLAZGO ES:

a) SEPARACIÓN ANTES DE LA DIFERENCIACIÓN DEL TROFOBLASTO (ANTES DÍA 3).
b) SEPARACIÓN DESPUÉS DE LA DIFERENCIACIÓN DEL TROFOBLASTO PERO ANTES
DE LA FORMACIÓN DEL AMNIOS (DIA 3 – .
c) SEPARACIÓN DE TROFOBLASTO Y DIVISIÓN POSTERIOR A LA FORMACIÓN DEL
AMNIOS (DIA 8-13) .
d) SEPARACION POSTERIOR A LA FORMACIÓN DEL AMNIOS (DÍAS 10 A 15).

A 71-YEAR-OLD MAN PRESENTED WITH A 2-WEEK HISTORY OF PAIN AND SWELLING

OF HIS LEFT ARM. EXAMINATION REVEALED A CRAGGY, MOBILE MASS WITH
IRREGULAR BORDERS IN THE EXTENSOR COMPARTMENT OF THE LEFT ARM
MEASURING 6 × 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM DEMONSTRATED THE
PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE
LEFT TRICEPS MUSCLE, MEASURING 5 × 3 CM. THIS LED TO FURTHER RADIOLOGIC
EVALUATION IN THE FORM OF MRI OF THE LEFT ARM. MRI SHOWED INTERMEDIATE
SIGNAL MASS IN THE TRICEPS MUSCULATURE ON T1-WEIGHTED IMAGES WITH FAT
SATURATION. THIS LESION IS CONFINED TO THE EXTENSOR COMPARTMENT OF THE
ARM. A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS MADE. AN
INCISIONAL BIOPSY WAS PERFORMED. THIS WAS FOUND TO BE CONSISTENT WITH
METASTATIC SQUAMOUS CELL CARCINOMA WITH A POSSIBLE LUNG PRIMARY,
FURTHER SUPPORTED DUE TO A POSITIVE CK7 AND NEGATIVE CK20 STAIN ON
IMMUNOHISTOCHEMISTRY. CT SCAN OF THE CHEST REVEALED A LESION MEASURING
4 × 2 CM IN THE LEFT UPPER LOBE. FIBER-OPTIC BRONCHOSCOPY AND BIOPSY
CONFIRMED THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL CARCINOMA OF THE
LUNG. HE UNDERWENT PALLIATIVE RADIOTHERAPY TO THE MASS IN THE ARM, 20 GY
IN 4 FRACTIONS. THIS PROVIDED GOOD RELIEF FROM PAIN AND SWELLING WITHIN
2 WEEKS OF COMPLETING TREATMENT. SYSTEMIC THERAPY WAS NOT OFFERED ON
THE BASIS OF POOR AND DETERIORATING PERFORMANCE STATUS. UNFORTUNATELY,
THE PATIENT DIED WITHIN 10 WEEKS OF PRESENTATION. INTRAMUSCULAR
METASTASES IN CANCER PATIENTS ARE RARE. THIS IN ITSELF IS QUITE PECULIAR
BECAUSE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF TOTAL BODY
WEIGHT. IT IS THOUGHT THAT MUSCULAR CONTRACTILE ACTIONS, LOCAL PH
ENVIRONMENT, AND ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES
CONTRIBUTE TO THE RARE OCCURRENCE OF THIS PHENOMENON. THE TRUE
INCIDENCE OF MUSCULAR METASTASIS REMAINS UNKNOWN, BUT AN AUTOPSY
SERIES SUGGESTS THAT ITS INCIDENCE COULD BE AS LOW AS 0.8%. LUNG
CARCINOMA SEEMS TO BE THE UNDERLYING PRIMARY CANCER IN MOST OF THESE
CASES. MANY OTHER TUMORS, SUCH AS KIDNEY, STOMACH, PANCREAS, THYROID
GLAND, BREAST, OVARY, PROSTATE, AND BLADDER CANCERS HAVE ALSO BEEN
SPORADICALLY DESCRIBED IN ASSOCIATION WITH INTRAMUSCULAR SECONDARIES.
HOWEVER, PRIMARY PRESENTATION OF AN INTRAMUSCULAR METASTASIS, SUCH AS
DEMONSTRATED BY OUR PATIENT, REMAINS AN EXCEPTIONALLY UNUSUAL
OCCURRENCE. THE MOST FREQUENT PRESENTATION OF MUSCULAR METASTASIS IS
PAIN WITH OR WITHOUT SWELLING. DIAGNOSIS, EVEN WITH RADIOLOGIC IMAGING
IS OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT
TISSUE TUMORS.

31.- WHY WAS THE RADIOLOGIC EVALUATION DONE?

a) BECAUSE OF THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS LOCATED IN

THE LONG AXIS OF THE RIGHT TRICEPS MUSCLE.
b) BECAUSE OF THE RESULTS OF THE ULTRASONOGRAPHY
c) BECAUSE DIAGNOSIS WITH RADIOLOGIC IMAGING IS OFTEN TRICKY.
d) BECAUSE OF THE CLINICAL HISTORY OF THE PATIENT.
32.- WHY ARE THE INTRAMUSCULAR METASTASES IN CANCER PATIENTS RARE?

a) BECAUSE THE AMOUNT OF THE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY

50% OF THE TOTAL BODY WEIGHT.
b) DUE TO THE MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND
ACCUMULATION OF LACTIC ACID AND OTHER METASTASIS.
c) BECAUSE THE PATIENTS DIE WITHIN 10 WEEKS OF PRESENTATION
d) BECAUSE PATIENTS LEAD AN ACTIVE LIFE

33.- WHAT KIND OF CANCER DID THE 71-YEAR-OLD PATIENT HAVE?

a) LUNG CARCINOMA.
b) KIDNEY CANCER
c) PROSTATE CANCER
d) BREAST CANCER

34.- HOW WAS THE PATIENT’S CANCER CONFIRMED?

a) THROUGH THE MRI.

b) WITH IMMUNOHISTOCHEMISTRY
c) THROUGH FIBER-OPTIC BRONCHOSCOPY AND BIOPSY
d) THROUGH OBSERVATION OF THE SWELLING AND THE PAIN PRESENTED BY THE
PATIENT

35.- WHY WASN’T SYSTEMATIC THERAPY OFFERED?

a) BECAUSE THE PATIENT WAS TOO OLD TO RESIST THE THERAPY

b) BECAUSE THE PALLIATIVE RADIOTHERAPY PROVIDED GOOD RELIEF FROM PAIN
AND SWELLING.
c) BECAUSE THE PATIENT SHOWED VERY LITTLE IMPROVEMENT.
d) THE PATIENT DIED 10 WEEKS AFTER THE FIRST PRESENTATION.
NIÑO DE 5 AÑOS. ES ATENDIDO EN LA CONSULTA POR PRESENTAR MORETONES EN
PIERNAS SIN ANTECEDENTE DE TRAUMATISMO. ANTECEDENTES: HACE 2 MESES CON
HIPOREXIA, BAJA DE PESO, SANO PREVIAMENTE. E.F.: TA 110/65 MM HG, FC 120
LPM, FR 28 RPM. PÁLIDO ++, HIPOACTIVO. SE PALPA HÍGADO A DOS CENTÍMETROS
POR ABAJO DEL BORDE COSTAL. LABORATORIO: HB 9G/DL, LEUCOCITOS 25, 000
PREDOMINO DE LINFOCITOS 50%, PLAQUETAS 100,000.

36.- EL DIAGNÓSTICO MAS PROBABLE CON ESTE PACIENTE ES:

a) ANEMIA APLÁSICA.
b) HISTIOCITOSIS X.
c) LEUCEMIA LINFOBLÁSTICA.
d) PÚRPURA TROMBÓTICA.

37.- EL SIGUIENTE PASO EN LA ATENCIÓN DE ESTE PACIENTE QUE DEBE REALIZAR

USTED ES:
a) INICIAR ESQUEMA DE QUIMIOTERAPIA.
b) TRANSFUNDIRLE PAQUETE GLOBULAR.
c) DERIVAR AL HEMATÓLOGO.
d) ANÁLISIS MÉDULA ÓSEA.
ENDOMETRIAL CANCER IN THE UNITED STATES ENDOMETRIAL CANCER REFERS TO
SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR
LINING OF THE UTERUS. ENDOMETRIAL CANCERS ARE THE MOST COMMON
GYNECOLOGIC CANCERS IN THE UNITED STATES, WITH OVER 35,000 WOMEN
DIAGNOSED EACH YEAR IN THE U.S. THE MOST COMMON SUBTYPE, ENDOMETRIOID
ADENOCARCINOMA, TYPICALLY OCCURS WITHIN A FEW DECADES OF MENOPAUSE, IS
ASSOCIATED WITH EXCESSIVE ESTROGEN EXPOSURE, OFTEN DEVELOPS IN THE
SETTING OF ENDOMETRIAL HYPERPLASIA, AND PRESENTS MOST OFTEN WITH
VAGINAL BLEEDING. ENDOMETRIAL CARCINOMA IS THE THIRD MOST COMMON
CAUSE OF GYNECOLOGIC CANCER DEATH (BEHIND OVARIAN AND CERVICAL CANCER
CLINICAL EVALUATION: ROUTINE SCREENING OF ASYMPTOMATIC WOMEN IS NOT
INDICATED, SINCE THE DISEASE IS HIGHLY CURABLE IN ITS EARLY STAGES.
RESULTS FROM A PELVIC EXAMINATION ARE FREQUENTLY NORMAL, ESPECIALLY IN
THE EARLY STAGES OF DISEASE. CHANGES IN THE SIZE, SHAPE OR CONSISTENCY OF
THE UTERUS AND/OR ITS SURROUNDING, SUPPORTING STRUCTURES MAY EXIST
WHEN THE DISEASE IS MORE ADVANCED. •A PAP SMEAR MAY BE EITHER NORMAL OR
SHOW ABNORMAL CELLULAR CHANGES. •ENDOMETRIAL CURETTAGE IS THE
TRADITIONAL DIAGNOSTIC METHOD. BOTH ENDOMETRIAL AND ENDOCERVICAL
MATERIAL SHOULD BE SAMPLED. •IF ENDOMETRIAL CURETTAGE DOES NOT YIELD
SUFFICIENT DIAGNOSTIC MATERIAL, A DILATION AND CURETTAGE (D&C) IS
NECESSARY FOR DIAGNOSING THE CANCER. •HYSTEROSCOPY ALLOWS THE DIRECT
VISUALIZATION OF THE UTERINE CAVITY AND CAN BE USED TO DETECT THE
PRESENCE OF LESIONS OR TUMOURS. IT ALSO PERMITS THE DOCTOR TO OBTAIN
CELL SAMPLES WITH MINIMAL DAMAGE TO THE ENDOMETRIAL LINING (UNLIKE
BLIND D&C). •ENDOMETRIAL BIOPSY OR ASPIRATION MAY ASSIST THE DIAGNOSIS.
•TRANSVAGINAL ULTRASOUND TO EVALUATE THE ENDOMETRIAL THICKNESS IN
WOMEN WITH POSTMENOPAUSAL BLEEDING IS INCREASINGLY BEING USED TO
EVALUATE FOR ENDOMETRIAL CANCER. •RECENTLY, A NEW METHOD OF TESTING
HAS BEEN INTRODUCED CALLED THE TRUTEST, OFFERED THROUGH GYNECOR. IT
USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE
UTERUS. THIS METHOD IS LESS PAINFUL THAN A PIPELLE BIOPSY AND HAS A
LARGER LIKELIHOOD OF PROCURING ENOUGH TISSUE FOR TESTING. SINCE IT IS
SIMPLER AND LESS INVASIVE, THE TRUTEST CAN BE PERFORMED AS OFTEN, AND AT
THE SAME TIME AS, A ROUTINE PAP SMEAR, THUS ALLOWING FOR EARLY DETECTION
AND TREATMENT. •ONGOING RESEARCH SUGGESTS THAT SERUM P53 ANTIBODY MAY
HOLD VALUE IN IDENTIFYING HIGH-RISK ENDOMETRIAL CANCER.[4]

38.- ENDOMETRIAL CANCER REFERS TO:

a) SPECIFIC TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR

LINING OF THE UTERUS.
b) SEVERAL TYPES OF MALIGNANCY WHICH NEVER ARISE FROM THE ENDOMETRIUM,
OR LINING OF THE UTERUS.
c) ALL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM.
d) SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM, OR
LINING OF THE UTERUS.
39.- ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN:

a) EXCESSIVE ESTROGEN.
b) A LOT OF DECADES OF MENOPAUSE.
c) ALWAYS PRESENTS VAGINAL BLEEDING.
d) ALWAYS DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA.

40.- RESULTS FROM A PELVIC EXAMINATION ARE:

a) ALWAYS CHANGES IN THE SIZE AND NEVER IN SHAPE

b) SOMETIMES NORMAL, ESPECIALLY IN THE EARLY STAGES OF THE DISEASE.
c) CHANGES IN THE SIZE, SOMETIMES THE SHAPE BUT NEVER THE CONSISTENCY OF
THE UTERUS
d) CHANGES IN THE SIZE, SHAPE BUT NEVER IN THE CONSISTENCY OF THE UTERUS

41.- CLINICAL METHOD FOR EVALUATION:

a) A PAP IS THE BEST OPTION YOU CAN USE.

b) ENDOMETRIAL CURETTAGE IS NOT THE TRADITIONAL DIAGNOSTIC METHOD.
c) HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE CAVITY.
d) ENDOMETRIAL BIOPSY OR ASPIRATION ALWAYS ASSIST IN THE DIAGNOSIS.

42.- HOW IS THE DEVELOPEMENT OF THIS NEW METHOD?

a) IT USES THE HUGE FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE
UTERUS.
b) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE UTERUS.
c) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF
THE UTERUS.
d) IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF THE
UTERUS.

MUJER DE 25 AÑOS. TRABAJA EN UN ASILO DE ANCIANOS. ES ATENDIDA EN

URGENCIAS POR PRESENTAR DESDE HACE 24 HORAS, MALESTAR GENERAL, CEFALEA
INTENSA, VÓMITO, DIARREA, MIALGIAS Y FIEBRE. G:2 , C:1. CURSA CON EMBARZO
DE 22 SEMANAS. E.F.: PESO 63 KGS. TEMP. 38.3° C . FCF: 128 LPM.

43.- LO MÁS PROBABLE ES QUE EL AGENTE CAUSAL SEA:

a) ROTAVIRUS.
b) ADENOVIRUS INTESTINAL.
c) ASTROVIRUS.
d) NOROVIRUS.
MUJER DE 33 AÑOS. EMBARAZADA, INGRESA A URGENCIAS CON ACTIVIDAD
UTERINA. REFIERE HABER INICIADO CON CEFALEA HACE 4 HORAS Y ACTIVIDAD
UTERINA REGULAR. G: 4, P:3. CURSA CON EMBARZO DE 35.4 SEMANAS, TOMA
HIDRALAZINA Y ALFAMETILDOPA E.F.: PESO 74 KGS. TA 140/90 MM/HG. FU: 32 CMS.
PRODUCTO CEFÁLICO CON FCF: 128 LPM. TACTO VAGINAL: CERVIX, SEMIBORRADO
SIN DILATACIÓN.
44.- PARA CORROBORAR EL DIAGNÓSTICO SE DEBE DE REALIZAR :

a) PRUEBAS DE FUNCION HEPÁTICA.

b) DEPURACIÓN DE CREATININA.
c) DETERMINACIÓN DE ÁCIDO ÚRICO.
d) PROTEÍNAS EN ORINA.
HOMBRE DE 89 AÑOS. LLEVADO A URGENCIAS POR UN VECINO YA QUE PRESENTA
DESDE HACE UNA SEMANA TOS CON EXPECTORACIÓN VERDE-AMARILLENTA. HA
PRESENTADO ALTERACIONES EN EL ESTADO DE CONCIENCIA, FIEBRE, ASTENIA,
ADINAMIA E HIPOREXIA Y OLIGURIA DE 5 DIAS DE EVOLUCIÓN. E.F.: PESO 45KG,
TEMP 39 º C, FC 110 LPM, MUCOSAS ORALES DESHIDRATADAS, RCR DE BAJA
INTENSIDAD, CAMPOS PULMONARES CON ESTERTORES CREPITANTES DISEMINADOS.
GIORDANO DUDOSO BILATERAL, EXTREMIDADES INFERIORES Y SUPERIORES
HIPOTRÓFICAS Y ESCARA EN REGIÓN SACRA.

45.- EL PRINCIPAL PROBLEMA DE ESTE PACIENTE ES:

a) ISQUEMIA CEREBRAL TRANSITORIA.

b) DEMENCIA SENIL.
c) INFECCIÓN DE VIAS URINARIAS.
d) SÍNDROME DE ABANDONO.

46.- EL MANEJO MÉDICO INICIAL EN ESTE PACIENTE ES:

a) HOSPITALIZACIÓN, HIDRATACIÓN Y PENICILINA BENZATÍNICA Y

DESINFLAMATORIOS.
b) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS RESPIRATORIAS.
c) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS URINARIAS.
d) HOSPITALIZACIÓN Y OBSERVACIÓN.

RECIÉN NACIDO DE TÉRMINO. ES ATENDIDO EN LA CONSULTA A LOS 3 DÍAS POR

NOTAR LA MADRE ENROJECIMIENTO INTENSO DE SU OMBLIGO Y LLANTO
CONSTANTE. ANTECEDENTES: NACIDO CON PARTERA. E.F.: TA 94/52 MM HG, FC 160
LPM, FR 50 POR MINUTO, TEMPERATURA DE 39°C. DECAÍDO, RECHAZA EL PECHO,
LLENADO CAPILAR DE 4 SEGUNDOS.

47.- EL DIAGNÓSTICO MAS PROBABLE EN ESTE CASO ES:

a) ONFALITIS.
b) PERITONITIS.
c) SEPSIS.
d) ERITEMA DEL NEONATO.

48.- LOS MICROORGANISMOS MAS COMUNES EN ESTOS CASOS SON:

a) ANAEROBIOS.
b) GRAM POSITIVOS.
c) GRAM NEGATIVOS.
d) VIRUS.
RECIÉN NACIDO DE 40 SEMANAS DE GESTACIÓN. APGAR DE 3 AL MINUTO.
ANTECEDENTES: MADRE SIN CONTROL PRENATAL, OBRERA, GESTA 8, LLEGÓ A
URGENCIAS POR NO SENTIR MOVIMIENTOS DEL BEBÉ. E.F.: TA 50/20 MM HG, FC <
100 LPM, FR 10 RPM, TEMPERATURA 37.5°C. LLENADO CAPILAR > 4 SEG.

49.- EL MANEJO INMEDIATO PARA ESTE PACIENTE ES:

a) HABLARLE AL PEDIATRA E INICIAR MANIOBRAS.

b) ADMINISTRAR ADRENALINA E INICIAR MANIOBRAS.
c) ADMINISTRAR ATROPINA E INICIAR MANIOBRAS.
d) VENTILACIÓN Y COMPRESIÓN CARDIACA