Rosiglitazone Study Cardiovascular Outcomes Type 2 Diabetes

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Subsecretara de Integracin y Desarrollo del Sector Salud Direccin General de Calidad y Educacin en Salud Direccin de Educacin en Salud CIFRHS - Comit de Posgrado y Educacin Continua XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 SIMULADOR DE EXAMEN 2011
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Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369
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CASO CLNICO ROSIGLIATAZONE EVALUATED FOR CARDIOVSCULAR OUTCOMES IN ORAL AGENT COMBINATION THERAPY FOR TYPE 2 DIABETES (RECORD): A MULTICENTRE, RANDOMISED, OPEN LABEL TRIAL. PHILIP D HOME DM, STUART J POCOCK
PHD. AND COLLEAGUES. ROSIGLITAZONE IS AN INSULIN SENSITISER USED IN COMBINATION WITH MEFORMIN, A SULFONYLUREA, OR BOTH, FOR LOWERING BLOOD GLUCOSE IN PEOPLE WITH TYPE 2 DIABETES. WE ASSESSED CARDIOVASCULAR OUTCOMES AFTER ADDITION OF ROSIGLITAZONE TO EITHER METFORMIN OR SULFONYLUREA COMPARED WITH THE COMBINATION OF THE OVER 5-7 YEARS OF FOLLOW UP. WE ALSO ASSESSED COMPARATIVE SAFETY METHODS. IN A MULTICENTRE, OPEN-LABEL TRIAL, 4447 PATIENTS WITH TYPE 2 DIABETES ON METFORMIN OR SULFONYLUREA MONOTHERAPY WITH MEAN HAEMOGLOBIN A1C (HB A1C) OF 7-9% WERE RANDOMLY ASSIGNED TO ADDITION OF ROSIGLITAZONE (N=2220) OR TO A COMBINATION OF METFORMIN AND SULFONYLUREA (ACTIVE CONTROL GROUP, N=2227). THE PRIMARY ENDPOINT WAS CARDIOVASCULAR HOSPITALISATION OR CARDIOVASCULAR DEATH, WITH A HAZARD RATIO (HR) NON INFERIORITY MARGIN OF 1.20. ANALYSIS WAS BY INTENTION TO TREAT. THIS STUDY IS REGISTERED WITH GOVERNMENT CLINICAL TRIALS NUMBER NCT00379769. FINDINGS. 321 PEOPLE IN THE ROSIGLITAZONE GROUP AND 323 IN THE ACTIVE CONTROL GROUP EXPERIENCED THE PRIMARY OUTCOME DURING A MEAN 5-5 YEAR FOLLOW UP, MEETING THE CRITERION ON NON-INFERIORITY (HR 0.99, 95% CL 0.85-1.16). HR WAS 0-84 (0-59) FOR CARDOVASCULAR DEATH, 1-14 (0.80 1.63) FOR MYOCARDIAL INFARCTION, AND 0.72 (0.49-1.06) FOR STROKE. HEART FAILURE CAUSING ADMISSION TO HOSPITAL OR DEATH OCCURRED IN 61 PEOPLE IN THE ROSIGLITAZONE GROUP AND 29 IN THE ACTIVE CONTROL GROUP (HR2.10, 1.35 3.27, RISK DIFFERENCE PER 1000 PERSON-YEARS 2.6, 1.1-4.1). UPPER AND DISTAL LOWER LIMB FRACTURE RATES WERE INCREASED MAINLY IN WOMEN RANDOMLY ASSIGNED TO RSIGLITAZONE. MEAN HBA1C WAS LOWER IN THE ROSIGLITAZONE GROUP THAN IN THE CONTROL GROUP AT 5 YEARS. INTERPRETATION. ADDITION ROSIGLITAZONE TO GLUCOSE LOWERING THERAPY IN PEOPLE WITH TYPE 2 DIABETES IS CONFIRMED TO INCREASE THE RISK OF HEART FAILURE AND OF SOME
FRACTURES, MAINLY IN WOMEN. ALTHOUGH THE DATA ARE INCONCLUSIVE ABOUT ANY POSSIBLE EFFECT ON MYOCARDIAL INFARCTION, ROSIGLITAZONE DOES NOT INCREASE THE RISK OF OVERALL CARDIVASCULAR MORBIDITY OR MORTALITY COMPARED WITH STANDARD GLUCOSE LOWERING DRUGS.
PREGUNTA 1 WHAT WAS THE MAIN PURPOSE OF THE STUDY? A TO TREAT PATIENTS WITH TYPE 2 DIABETES. B TO DETERMINE THE INCIDENCE OF HOSPITALIZATION IN PATIENTS TAKING ROSIGLITAZONE. C TO DISCOVER THE EFFECTS THAT ROSIGLITAZONE HAS ON HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES. D TO GET GOVERNMENT APPROVAL FOR ROSIGLITAZONE. PREGUNTA 2 ROSIGLITAZONE IS AN INSULIN SENSITISER USED TO: A LOWER INSULINE IN PEOPLE WITH TYPE 2 DIABETES B LOWER BLOOD GLUCOSE IN PEOPLE WITH TYPE 2 DIABETES. C INCREASE BLOOD GLUCOSE IN PEOPLE WITH TYPE 2 DIABETES. D DIMINISH INSULINE IN PEOPLE WITH TYPE 1 DIABETES. PREGUNTA 3 WHAT DID THE TWO GROUPS HAVE IN COMMON? A PARTICIPANTS WERE GIVEN SULFONYLUREA. B PARTICIPANTS WERE GIVEN ROSIGLITAZONE. C PARTICIPANTS HAD NEARLY SIMILAR LEVELS OF HBA1C. D PARTICIPANTS WERE ALL FROM THE SAME CENTRE. PREGUNTA 4 WHAT DOES THE AUTHOR CONCLUDE REGARDING THE SAFETY OF ROSIGLITAZONE IN GLUCOSE-LOWERING THERAPY FOR PATIENTS WITH TYPE-2 DIABETES?
A THE PERCENTAGE OF PATIENTS RESULTING IN HEART FAILURE WAS VERY HIGH FOR BOTH GROUPS. B ROSIGLITAZONE, IN GENERAL, CAUSES HEART FAILURE. C ROSIGLITAZONE IS GENERALLY SAFE, BUT NOT FOR WOMEN. D ROSIGLATAZONE SHOULD BE USED ONLY FOR MALE PATIENTS. PREGUNTA 5 ADDITION ROSIGLITAZONE TO GLUCOSE LOWERING THERAPY IN PEOPLE WITH TYPE 2 DIABETES IS CONFIRMED TO: A INCREASE THE RISK OF HEART FAILURE AND OF SOME FRACTURES, MAINLY IN MEN. B INCREASE THE RISK OF HEART FAILURE AND OF SOME FRACTURES, MAINLY IN WOMEN. C THE DATA ARE CONCLUSIVE ABOUT ANY POSSIBLE EFFECT ON MYOCARDIAL INFARCTION, D ROSIGLITAZONE INCREASES THE RISK OF OVERALL CARDIVASCULAR MORBIDITY.
XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 5:05 PM
Subsecretara de Integracin y Desarrollo del Sector Salud Direccin General de Calidad y Educacin en Salud Direccin de Educacin en Salud CIFRHS - Comit de Posgrado y Educacin Continua XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011
SIMULADOR DE EXAMEN 2011
CASO CLNICO PIGMENTARY DISORDERS IN LATIN AMERICA FALABELLA, RAFAEL DERMATOLOGIC CLINICS - VOLUME 25, ISSUE 3 W. B. SAUNDERS COMPANY JULY 2007 PITYRIASIS ALBA (PA) IS A COMMON DISORDER OBSERVED IN LATIN AMERICAN PATIENTS. LESIONS DISCLOSE HYPOPIGMENTATION, MAINLY OBSERVED ON FACIAL AREAS AND SUNLIGHT EXPOSED SURFACE OF ARMS AND FOREARMS; THOSE ON THE TRUNK AND LOWER EXTREMITIES ARE LESS COMMON. AN ATOPIC DIATHESIS IS PRESENT IN MOST PATIENTS, AND THE CONDITION FREQUENTLY DEVELOPS IN CHILDREN AND YOUNG ADULTS. THE AVERAGE LESION BEGINS WITH A SLIGHTLY HYPOPIGMENTED MACULE THAT ENLARGES GRADUALLY FROM 1 CM TO 3 CM AND MAY COALESCE WITH NEIGHBORING MACULES, RESULTING IN LARGER HYPOPIGMENTED DEFECTS. A FINE DESQUAMATION AND DRYNESS OF SKIN ARE CHARACTERISTIC AND THE CLINICAL PICTURE USUALLY WORSENS DURING SUMMER OR DURING
FREQUENT WATERSPORT ACTIVITIES. A FOLLICULAR VARIETY WITH MILD HYPERKERATOSIS AT THE HAIR FOLLICLE OSTIUM FREQUENTLY OCCURS. ON HISTOLOGIC EXAMINATION, EPIDERMAL AND FOLLICULAR SPONGIOSIS, FOCAL PARAKERATOSIS, SLIGHT ACANTHOSIS, AND MILD SUPERFICIAL PERIVASCULAR INFILTRATES ARE SEEN. IN A STUDY, ULTRASTRUCTURAL EXAMINATION DISCLOSED SMALL AND REDUCED NUMBERS OF MELANOCYTES AND MELANOSOMES. ALTHOUGH PA IMPROVES SPONTANEOUSLY AFTER PUBERTY, LOW POTENCY CORTICOSTEROIDS, SUCH AS 1% HYDROCORTISONE OR 0.5% DESONIDE, FREQUENT EMOLLIENT APPLICATION, AND SUNLIGHT AVOIDANCE/PROTECTION ARE USEFUL TO CONTROL THIS DISORDER. SKIN CONTACT WITH DIVERSE CHEMICALS MAY INDUCE ACQUIRED HYPOPIGMENTATION, WHICH MAY OCCUR EITHER DURING PROFESSIONAL ACTIVITIES OR AS AN INCIDENTAL EVENT. AREAS OF CONTACT, SUCH AS HANDS AND FEET, MAY BECOME AFFECTED WITH OR WITHOUT INITIAL DERMATITIS, AND THEREAFTER HYPOPIGMENTATION OCCURS. SOME OF THE INVOLVED CHEMICALS ARE CATECHOL AND BENZENE DERIVATIVES USED AS ANTISEPTICS AND CLEANSERS, PESTICIDES, AND EPOXY RESINS COMMONLY USED IN HOUSEHOLD WORK. MACULAR LESIONS SHOW DIFFERENT GRADES OF HYPOPIGMENTATION OR TRUE DEPIGMENTATION INDISTINGUISHABLE FROM VITILIGO; A PREVIOUS HISTORY OF SUBSTANCE CONTACT AND DERMATITIS ARE IN FAVOR OF THE CHEMICAL NATURE OF DEPIGMENTATION . ON HISTOLOGIC EXAMINATION, JUST A FEW MELANOCYTES ARE PRESENT AND REDUCED OR ABSENT MELANIN IS OBSERVED. TREATMENT OF DEPIGMENTATION IS DIFFICULT, BECAUSE MOST OF THE TIME ACRAL AREAS ARE INVOLVED AND MELANOCYTES IN AFFECTED AREAS ARE SCARCE. IF VITILIGO-LIKE DEPIGMENTATION BECOMES REFRACTORY TO MEDICAL THERAPY, MELANOCYTE GRAFTING MAY BE AN IMPORTANT THERAPEUTIC SOLUTION.
PREGUNTA 6 PITYRIASIS ALBA IS A COMMON DISORDER FREQUENTLY OBSERVED IN: A ARMS AND LEGS B FACE, ARMS AND FOREARMS C TRUNK AND LOWER EXTREMITIES. D FACE, ARMS AND LEGS PREGUNTA 7 THE AVERAGE LESION BEGINS WITH A SLIGHTLY HYPOPIGMENTED SPOT THAT: A GROWS FROM 1 TO 3 CM. B REDUCES FROM 1 TO 3 CM C ENLARGES TO 5 CM. INDEPENDENTLY D CHANGES COLOR PREGUNTA 8 TO CONTROL THIS DISORDER IT IS USEFUL TO: A USE ANON FREQUENT EMOLLIENT APPLICATION B USE HIGH POTENCY CORTICOSTEROIDS C KEEP AWAY FROM THE SUN. D LACK THE PROTECTION OF THE SUN PREGUNTA 9 HYPOPIGMENTATION OCCURS WHEN: A SKIN HAS CONTACT WITH DIVERSE CHEMICALS B WE HAVE INCIDENTAL ACTIVITIES C WE TAKE CORTISONE. D WE USE SUN PROTECTION. PREGUNTA 10 PITYRIASIS ALBA IS DANGEROUS BECAUSE: A PATIENTS BECOME INTOLERANT TO LIGHT. B SOME OF THE TREATMENTS ARE TOXIC. C PRE-CANCEROUS LESIONS CAN FORM. D DELICATE SURGERY IS SOMETIMES REQUIRED.
CASO CLNICO
UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN ZORC, JOSEPH J. CLINICAL PEDIATRIC EMERGENCY MEDICINE EL SERVIER DOI.10.1016.CPEM.209.03.008 MARCH 2009. UPPER RESPIRATORY TRACT INFECTIONS (INCLUDING OTITIS MEDIA) ARE THE MOST COMMON ILLNESSES AFFECTING CHILDREN. ON AVERAGE, CHILDREN EXPERIENCE AROUND SIX TO EIGHT UPPER RESPIRATORY TRACT INFECTIONS (URTIS) EACH YEAR. ALTHOUGH THESE INFECTIONS USUALLY ARE MILD AND SELF LIMITING, THEY OCCASIONALLY LEAD TO COMPLICATIONS THAT CAN BE LIFE THREATENING. MOST URTIS CAN BE PLACED WITHIN THREE MAIN CATEGORIES OF INFECTION: RHINOSINUSITIS, PHARYNGITIS, AND OTITIS MEDIA. WITHIN EACH CATEGORY OF ILLNESS THERE IS A RANGE OF RELATED CONDITIONS THAT MAY HAVE SIMILAR OR OVERLAPPING CLINICAL PRESENTATIONS. SOME JUDGMENT IS REQUIRED IN DETERMINING WHICH PART OF THE RESPIRATORY MUCOSA IS MOST AFFECTED. IN THIS ARTICLE, THE TERM RHINOSINUSITIS IS USED TO DESCRIBE ILLNESSES WITH PREDOMINANTLY NASAL SYMPTOMS (INCLUDING THE COMMON COLD, NASOPHARYNGITIS, AND SINUSITIS). THE TERM PHARYNGITIS IS USED TO DESCRIBE ILLNESSES WHEN SORE THROAT IS MOST PROMINENT (INCLUDING TONSILLITIS). THE TERM OTITIS MEDIA IS USED TO DESCRIBE ILLNESSES WITH PREDOMINANTLY MIDDLE EAR SYMPTOMS (INCLUDING ACUTE OTITIS MEDIA [AOM], OTITIS MEDIA WITH EFFUSION [OME], AND CHRONIC SUPPURATIVE OTITIS MEDIA [CSOM]). CHILDREN WHO HAVE COUGH AS THE PREDOMINANT SYMPTOM ARE CONSIDERED TO HAVE BRONCHITIS (A LOWER RESPIRATORY TRACT INFECTION). TO MAKE MATTERS MORE COMPLICATED, ALL AREAS OF THE RESPIRATORY MUCOSA MAY BE AFFECTED, SIMULTANEOUSLY OR AT DIFFERENT TIMES, DURING ONE ILLNESS. THE CAUSE OF THESE RESPIRATORY MUCOSAL INFECTIONS MOST COMMONLY IS VIRAL BUT CAN BE BACTERIAL AND MANY INFECTIONS INVOLVE BOTH VIRUSES AND BACTERIA. IN DEVELOPED COUNTRIES, BOTH VIRAL AND BACTERIAL INFECTIONS ARE
LIKELY TO BE SELF LIMITED. PERSISTENT DISEASE IS MOST LIKELY TO INDICATE A BACTERIAL INFECTION.
PREGUNTA 11 WHY ARE UPPER RESPIRATORY TRACT INFECTIONS SO DIFFICULT TO DIAGNOSE IN CHILDREN? A THEY GET MANY OF THEM. B THE SYMPTOMS OF DIFFERENT URTIS OVERLAP. C THERE ARE DIFFERENT KINDS OF URTIS. D VIRAL AND BACTERIAL INFECTIONS EXIST. PREGUNTA 12 AN EXAMPLE OF A LOWER RESPIRATORY INFECTION IS: A NASOPHARYNGITIS. B BRONCHITIS. C SINUSITIS. D TONSILLITIS. PREGUNTA 13 THE CAUSE OF THE ILLNESS IN RESPIRATORY INFECTIONS IS BEST DETERMINED BY THE: A SYMPTOMS. B PRESENCE OF A VIRAL INFECTION. C PRESENCE OF A BACTERIAL INFECTION. D AFFECTED PART OF THE RESPIRATORY MUCOSA. PREGUNTA 14 THE MAIN AREA AFFECTED IN INFECTIONS TERMED "OTITIS MEDIA" IS THE: A EYE B EAR C NOSE D THROAT PREGUNTA 15
OME, AOM, AND SCOM ALL BELONG TO THE FAMILY OF THE INFECTION CALLED: A BRONCHITIS B PHARYNGITIS C RHINOSINUSITUS D OTITIS MEDIA
CASO CLNICO FREQUENCY OF GERD SYMPTOMS IN ELDERLY PATIENTS WHO COME TO A FAMILY MEDICINE CLINIC. OBJECTIVES: TO ASCERTAIN THE PREVALENCE OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ELDERLY PEOPLE ATTENDING TO FAMILY MEDICINE CLINICS. MATERIAL AND METHODS: THE STUDY WAS CONDUCTED BY USING A PROSPECTIVE DESIGN IN WHICH PARTICIPANTS WERE RANDOMLY SELECTED FROM A FAMILY MEDICINE CLINIC LOCATED IN MEXICO CITY. THE STUDY WAS RUN FROM AUGUST TO SEPTEMBER 2003, AND INCLUDED PATIENTS AGED SIXTY YEARS OR OLDER, REGARDLESS OF GENDER. THEY SHOULD NOT HAVE COGNITIVE DAMAGE, WHICH WAS ASCERTAINED BY THE FOLSTEIN MINI MENTAL STATE EXAMINATION. THOSE PATIENTS THAT DID NOT ACCEPT TO PARTICIPATE AND THOSE HAVING INCOMPLETE OR ILLEGIBLE MEDICAL RECORDS WERE EXCLUDED. THE SOCIO-DEMOGRAPHIC CHARACTERISTICS TEST AND CARLSSON-DENT TEST WERE APPLIED. THE INFORMATION ABOUT DIAGNOSIS, DRUGS PRESCRIPTIONS, AND PHARMACOLOGICAL AND NO PHARMACOLOGICAL GASTROESOPHAGEAL PROTECTION WAS OBTAINED FROM THE MEDICAL CHARTS AND PRESCRIPTIONS. RESULTS: 400 ELDERLY PATIENTS WERE EVALUATED BY USING THE CARLSSON-DENT TEST. GERD PREVALENCE WAS 25% (IC 95 % 21-29) THE AVERAGE AGE OF PATIENTS WITH AND WITHOUT GERD WAS 68 7 YEARS AND 70 7 YEARS RESPECTIVELY (P = . 002). WOMEN SUFFERED GERD MORE FREQUENTLY THAN MEN (P = 0.001). GERD DIAGNOSIS WAS NOT FOUND IN ANY OF THE REVIEWED MEDICAL CHARTS. ANTACIDS, HISTAMINE- 2 RECEPTOR ANTAGONISTS (H2 AS) AND WERE PRESCRIBED IN 39% (IC 95 % 34-44) OF PATIENTS WITH GERD AND IN 18% (IC 95
% 15-21) WITHOUT GERD. CONCLUSIONS: ELDERLY PATIENTS ATTENDING TO PRIMARY CARE FACILITIES OFTEN HAVE GERD SYMPTOMS, BUT THEY ARE NOT PROPERLY DIAGNOSED OR FOLLOWED UP. THE CARLSSON-DENT QUESTIONNAIRE IS AN ALTERNATIVE TO IDENTIFY GERD PATIENTS.
PREGUNTA 16 ABOUT THE DESIGN OF THE STUDY: A RESEARCHERS USE A PROSPECTIVE DESIGN, PARTICIPANTS WERE FAMILY MEDICINE SPECIALIST FROM MEXICO CITY SELECTED AT RANDOM. B PARTICIPANTS ARE SELECTED AT RANDOM FROM A FAMILY MEDICINE CLINIC FROM AN ELDERLY FEMALE POPULATION. C ELDERLY PATIENTS WERE INCLUDED WITHOUT CONSIDERING GENDER. D IT WAS ORIGINALLY PLANNED TO BE DONE IN THREE MONTHS. PREGUNTA 17 THE INCLUSION OF PATIENT CRITERIA WAS: A CERTAINLY NOT TO HAVE ANY BRAIN DAMAGE. B TO HAVE COGNITIVE COMPETENCE PROVEN BY THE FOLSTEIN MINI MENTAL STATE EXAMINATION. C NOT TO ACCEPT TO PARTICIPATE IN THE STUDY. D THERE WERE INCOMPLETE OR ILLEGIBLE MEDICAL RECORDS. PREGUNTA 18 RESEARCHERS OBTAIN THE INFORMATION ABOUT DIAGNOSIS, DRUGS PRESCRIPTIONS, AND PHARMACOLOGICAL AND NO PHARMACOLOGICAL GASTROESOPHAGEAL PROTECTION FROM: A A SOCIO-DEMOGRAPHIC CHARACTERISTICS TEST. B A CARLSSON-DENT TEST. C CLINIC DATABASES.
PATIENT RECORDS.
PREGUNTA 19 THE AIM OF THE STUDY GAVE AS A RESULT: A GERD PREVALENCE WAS 25%. B AVERAGE AGE OF PATIENTS WITH AND WITHOUT GERD WAS 68 7 YEARS AND 70 7 YEARS RESPECTIVELY. C WOMEN SUFFERED GERD MORE FREQUENTLY THAN MEN. D ANTACIDS, H2 AS AND WERE PRESCRIBED IN 39% OF PATIENTS WITH GERD. PREGUNTA 20 THE MAIN CONCLUSION OF THE STUDY WAS: A PATIENTS WITHOUT GERD STILL RECEIVED TREATMENT. B PARTICIPANTS OFTEN HAD GERD SYMPTOMS. C PATIENTS IDENTIFIED WITH GERD SYMPTOMS WERE DIAGNOSED AND FOLLOWED UP CORRECTLY. D THE CARLSSON-DENT QUESTIONNAIRE WAS THE BEST ALTERNATIVE TO IDENTIFY GERD PATIENTS.
CASO CLNICO NEW THINKING ON HOW TO PROTECT THE HEART BY JANE E. BRODY SURGERY MAY NOT BE THE BEST WAY TO AVOID A HEART ATTACK OR SUDDEN CARDIAC DEATH, THE NEXT STEP IS FINDING OUT WHAT CAN WORK AS WELL OR BETTER TO PROTECT YOUR HEART. MANY MEASURES ARE PROBABLY FAMILIAR: NOT SMOKING, CONTROLLING CHOLESTEROL AND BLOOD PRESSURE, EXERCISING REGULARLY AND STAYING AT A HEALTHY WEIGHT. BUT SOME NEWER SUGGESTIONS MAY SURPRISE YOU. IT IS NOT THAT THE OLD ADVICE, LIKE EATING A LOW-FAT DIET OR EXERCISING VIGOROUSLY, WAS BAD ADVICE; IT WAS BASED ON THE BEST AVAILABLE EVIDENCE OF THE TIME AND CAN STILL BE VERY HELPFUL. THE WELLESTABLISHED RISK FACTORS FOR HEART DISEASE REMAIN INTACT: HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, SMOKING, DIABETES, ABDOMINAL OBESITY AND SEDENTARY LIVING. BUT BEHIND THEM A RELATIVELY NEW FACTOR HAS EMERGED THAT MAY BE EVEN MORE IMPORTANT AS A CAUSE
OF HEART ATTACKS THAN, SAY, HIGH BLOOD LEVELS OF ARTERY-DAMAGING CHOLESTEROL. THAT FACTOR IS CREACTIVE PROTEIN, OR CRP, A BLOOD-BORNE MARKER OF INFLAMMATION THAT, ALONG WITH COAGULATION FACTORS, IS NOW INCREASINGLY RECOGNIZED AS THE DRIVING FORCE BEHIND CLOTS THAT BLOCK BLOOD FLOW TO THE HEART. EVEN IN PEOPLE WITH NORMAL CHOLESTEROL, IF CRP IS ELEVATED, THE RISK OF HEART ATTACK IS TOO. DIET REVISITED THE NEW DIETARY ADVICE IS ACTUALLY BASED ON A RATHER OLD FINDING THAT PREDATES THE MANTRA TO EAT A LOW-FAT DIET. IN THE SEVEN COUNTRIES STUDY STARTED IN 1958 FOUND THAT HEART DISEASE WAS RARE IN THE MEDITERRANEAN AND ASIAN REGIONS WHERE VEGETABLES, GRAINS, FRUITS, BEANS AND FISH WERE THE DIETARY MAINSTAYS. BUT IN COUNTRIES LIKE FINLAND AND THE UNITED STATES WHERE PLATES WERE TYPICALLY FILLED WITH RED MEAT, CHEESE AND OTHER FOODS RICH IN SATURATED FATS, HEART DISEASE AND CARDIAC DEATHS WERE EPIDEMIC. THE FINDING RESULTED IN THE WELLKNOWN ADVICE TO REDUCE DIETARY FAT AND ESPECIALLY SATURATED FATS (THOSE THAT ARE FIRM AT ROOM TEMPERATURE), AND TO REPLACE THESE HARMFUL FATS WITH UNSATURATED ONES LIKE VEGETABLE OILS. WHAT WAS MISSED AT THE TIME AND HAS NOW BECOME INCREASINGLY APPARENT IS THAT THE HEART-HEALTHY MEDITERRANEAN DIET IS NOT REALLY LOW IN FAT, BUT ITS MAIN SOURCES OF FAT OLIVE OIL AND OILY FISH AS WELL AS NUTS, SEEDS AND CERTAIN VEGETABLES HELP TO PREVENT HEART DISEASE BY IMPROVING CHOLESTEROL RATIOS AND REDUCING INFLAMMATION.
PREGUNTA 21 ACCORDING TO THE ARTICLE, THE BEST WAY TO AVOID A HEART ATTACK IS: A EATING A LOW FAT DIET AND EXERCISING VIGOROUSLY. B HAVING A SURGERY.
C D
CONTROLLING YOUR CRP CONTROLLING YOUR CHOLESTEROL
PREGUNTA 22 ACCORDING TO THE ARTICLE, THE BEST DIET TO FOLLOW IS: A A LOW-FAT DIET B SATURATED FATS C RED MEAT AND CHEESE D A MEDITERRANEAN DIET. PREGUNTA 23 THE MEDITERRANEAN DIET CONSISTS MAINLY OF: A LOW CARBOHYDRATES B RED MEAT AND CHEESE C UNSATURATED FATS D VEGETABLES PREGUNTA 24 DRINKING RED WINE IS GOOD FOR YOU BECAUSE: A IT MAKES YOU RELAX B HAS ANTIOXIDANT PROPERTIES C IT PREVENTS THE FORMATION OF CHOLESTEROL D ITS EASY TO DIGEST PREGUNTA 25 FROM THE ARTICLE WE CAN CONCLUDE THAT: A IF WE FOLLOW A LOW-FAT DIET AND EXERCISE VIGOROUSLY WE WILL AVOID HAVING A HEART ATTACK B GOING TO THE PERIODONTIST, EXERCISING 15 MINUTES A DAY, RELAXING, AND FOLLOWING A MEDITERRANEAN DIET WE WILL AVOID HAVING A HEART ATTACK C TAKING A VACATION, EXERCISING VIGOROUSLY AND FOLLOWING A MEDITERRANEAN DIET WE WILL AVOID HAVING A HEART ATTACK D PRACTICING THE RELAXATION RESPONSE ONCE OR TWICE A DAY BY BREATHING DEEPLY AND RHYTHMICALLY IN A QUIET PLACE WILL AVOID HAVING A HEART ATTACK.
CASO CLNICO MATERNAL MORBIDITY, MORTALITY, AND RISK ASSESSMENT MATERNAL MORTALITY IS THE TIP OF THE MATERNAL MORBIDITY ICEBERG; SEVERAL OBSTETRIC, ANESTHETIC, AND SOCIAL CHALLENGES IMPACT MORBIDITY AND MORTALITY IN WOMEN. MATERNAL MORTALITY IS THE YARDSTICK TO MEASURE WHEN HEALTH CARE PERSONNEL FAIL TO RECOGNIZE RISKS, LACK INTERDISCIPLINARY COMMUNICATION, OR PROVIDE SUBSTANDARD CARE, THUS RESULTING IN COMPLICATIONS DURING PREGNANCY, LABOR, OR DELIVERY. PREGNANCY-RELATED DEATH IS DEFINED BY THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION (ICD-10) AS THE DEATH OF A WOMAN WHILE PREGNANT OR WITHIN 42 DAYS OF TERMINATION OF PREGNANCY, DESPITE THE CAUSE OF DEATH. ALTHOUGH THE RISK FOR DEATH FROM COMPLICATIONS OF PREGNANCY DECREASED DRAMATICALLY DURING THE 20TH CENTURY IN THE UNITED STATES, THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) REPORTS A FAIRLY STATIC MATERNAL MORTALITY RATIO (MMR), OF APPROXIMATELY 7.5 MATERNAL DEATHS PER 100,000 LIVE BIRTHS. IN THE YEAR 2000, A COLLABORATIVE EFFORT INVOLVING WORLD HEALTH ORGANIZATION (WHO), UNITED NATIONS CHILDREN'S FUND (UNICEF), AND UNITED NATIONS POPULATION FUND (UNFPA) ESTIMATED 660 MATERNAL DEATHS, THUS AVERAGING 11 MATERNAL DEATHS PER 100,000 LIVE BIRTHS, PLACING THE MMR ABOVE THE STATISTICS REPORTED BY THE CDC. THESE SURVEYS ON MATERNAL MORTALITY SURVEILLANCES ARE LIMITED IN SCOPE BECAUSE THE INFORMATION IS OBTAINED FROM DEATH CERTIFICATES, AND VARIOUS STATES OR ACADEMIC INSTITUTIONS COULD BE UNDERREPORTING. ACCURATE STATISTICS ARE LACKING, THUS RESULTING IN ONLY A SNAPSHOT OF THE ACTUAL MATERNAL MORBIDITY AND MORTALITY. THE RECENT WHO ESTIMATE IN THE UNITED STATES SHOW THAT MATERNAL MORTALITY IS APPROXIMATELY 17 IN 100,000 PREGNANCIES. THIS ESTIMATE IS SIGNIFICANTLY HIGHER THAN THE GOAL SET BY THE U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES IN HEALTHY PEOPLE 2010, WHICH SETS THE TARGET FOR MATERNAL MORTALITY AT LESS THAN 3.3 IN 100,000 LIVE BIRTHS. SOME REGIONAL REPORTS DOCUMENT RATIOS AS HIGH AS 22.8 PER 100,000 LIVE BIRTHS, WHICH IS AN UNACCEPTABLY HIGH RATE. IN UNITED STATES, THE MOST COMMON CAUSES OF MATERNAL DEATHS, ALTHOUGH THEY VARY AMONG STATES, INCLUDE THROMBOEMBOLISM; AMNIOTIC FLUID EMBOLISM; HEMORRHAGE; COMPLICATIONS OF HYPERTENSION, INCLUDING PREECLAMPSIA AND ECLAMPSIA; AND INFECTION. PULMONARY DISEASE, ANESTHESIA-RELATED DEATHS, AND CARDIOMYOPATHY ARE ALSO SIGNIFICANT CONTRIBUTORS TO MATERNAL MORBIDITY AND MORTALITY.
PREGUNTA 26 FOR MATERNAL MORTALITY A RISK FACTOR COULD BE: A EXCESIVE INTERDISCIPLINARY COMMUNICATION BY HEALTH CARE PERSONNEL. B FAILURE TO RECOGNIZE RISKS BY HEALTH CARE PERSONNEL . C HEALTH CARE PERSONNEL PROVIDE STANDARD CARE. D ALL ABOVE ARE RISK FACTORS. PREGUNTA 27 THE MAIN REASON WHY THE MATERNAL MORTALITY SURVEILLANCES ARE LIMITED IN SCOPE WOULD BE: A BECAUSE THE INFORMATION IS OBTAINED OF DEATH CERTIFICATES. B A SITUATION OF UNDERREPORTING. C BECAUSE VARIOUS STATES OR ACADEMIC INSTITUTIONS COULD BE OVERREPORTING. D THE MATERNAL MORTALITY SURVEILLANCES ARE ACCURATE. PREGUNTA 28
ACCORDING TO THE FINDINGS FROM THE STUDY CONDUCTED BY WHO, UNICEF AND THE UNFPA WHAT IS THE CONCLUSION: A PREGNANCY RELATED DEATH IS THE DEATH OF A PREGNANT WOMAN . B PREGNANCY REALTED DEATH IS THE DEATH OF A WOMAN WITHIN 42 DAYS OF TERMINATION OF PREGNANCY, DESPITE THE CAUSE OF DEATH. C THE RISK OF DEATH FROM COMPLICATIONS OF PREGNANCY DECREASED DRAMATICALLY DURING THE 20TH CENTURY IN THE UNITED STATES. D THE MMR STATISTICS ARE ABOVE THE CDC STATISTICS. PREGUNTA 29 ALTHOUGH THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS PROJECTED GOALS FOR 2010, WHAT IS THE ACTUAL RATIO: A MATERNAL MORTALITY IS APPROXIMATELY 17 IN 100,000 PREGNANCIES. B MATERNAL MORTALITY IS AT LESS 3.3 IN 100,000 LIVE BIRTHS. C THE RESULTS HAVE NOT BEEN WHAT THEY EXPECTED. D MATERNAL MORTALITY IS 22.8 PER 100,000 LIVE BIRTHS. PREGUNTA 30 ABOUT THE CAUSES OF MATERNAL DEATHS WHICH WOULD BE CONSIDERED A CONTRIBUTOR FROM THE FOLLOWING: A THROMBOEMBOLISM. B AMNIOTIC FLUID EMBOLISM. C PREECLAMPSIA AND ECLAMPSIA. D CARDIOMYOPATHY.
XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011
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CASO CLNICO VACCINE TAKES AIM AT HYPERTENSION ORLANDO, FLA: SOME PATIENTS WITH HYPERTENSION HAVE INADEQUATE CONTROL OF BLOOD PRESSURE BECAUSE THEY ARE NOT CONSISTENTLY ADHERENT IN TAKING THEIR MEDICATIONS. BUT HELP MAY BE ON THE WAY IN THE FORM OF A VACCINE THAT LOWERS BLOOD PRESSURE BY CONTROLLING ANGIOSTENSIN II,
SUGGEST FINDINGS FROM A SMALL SAFETY STUDY PRESENTED AT THE SCIENTIFIC SESSIONS OF THE AMERICAN HEART ASSOCIATION IN NOVEMBER. THE STUDY OF 72 PATIENTS WITH MILD-TO-MODERATE HYPERTENSION, PRESENTED BY JURG NUSSBERGER, MD, PROFESSOR OF MEDICINE AT THE UNIVERSITY HOSPITAL OF THE CANTON OF VAUD, LAUSANNE, SWITZERLAND, FOUND THAT AT 14 WEEKS, THOSE INJECTED WITH CYTOO6-ANGQB (AT 0,4, AND 12 WEEKS) HAD A DAYTIME SYSTOLIC BLOOD PRESSURE THAT WAS 5.6 MM HG LOWER AND A DIASTOLIC BLOOD PRESSURE 2.8 MM HG LOWER THAN THOSE OF PATIENTS WHO RECEIVED PLACEBO. CYT006-ANGQB, WHICH IS UNDER DEVELOPMENT BY CYTOS BIOTECHNOLOGY AG (ZURICH, SWITZERLAND), IS A VIRUS-SHAPED NONINFECTIOUS PARTICLE THAT IS CHEMICALLY COUPLED WITH ANGIOTENSIN II, AND OCTAPEPTIDE VASOCONSTRICTOR. SUCH COUPLING INDUCES THE BODY TO PRODUCE ANTIBODIES AGAINST THIS SMALL MOLECULE TOP MINIMIZE ITS EFFECTS ON CONSTRICTING BLOOD VESSELS. NUSSBERGER SAID HE IS NOT CONCERNED THAT THE VACCINE MIGHT CAUSE HYPOTENSION BECAUSE ANTIBODY TITERS STARTED TO DECREASE SHORTLY AFTER THE BOOSTER OF TWELVE WEEKS INDUCED PEAK ANTIBODY LEVELS. HE ALSO SAID THE LIKELIHOOD OF VACCINEINDUCED ANTIBODIES CROSS-REACTING WITH OTHER PROTEINS WAS MINIMAL BECAUSE THE SMALL SIZE OF THE TARGET MOLECULE LIMITS THE NUMBER OF EPITOPES THAT COULD BE AFFECTED. NUSSBERGER SPECULATED THAT IF THE CYT006-ANGQB VACCINE IS ULTIMATELY APPROVED, PATIENTS WOULD BE ABLE TO AVOID THE NEED FOR MEDICATION BUT WOULD REQUIRE A BOOSTER SHOT 2 OR 3 TIMES A YEAR. HE SAID THE NEXT STEP IN STUDYING THE VACCINE WILL BE TO CONDUCT ANOTHER SMALL TRIAL TO DETERMINE THE APPROPRIATE DOSING TO CREATE THE LARGEST ANTIBODY RESPONSE AND GREATEST REDUCTIONS IN BLOOD PRESSURE. MORRIS J. BROWN, MD, PROFESSOR OF CLINICAL PHARMACOLOGY AT THE UNIVERSITY OF CAMBRIDGE IN ENGLAND AND PAST PRESIDENT OF THE BRITISH
HYPERTENSION SOCIETY, SAID THE FINDINGS OF THE STUDY (WHICH WAS FUNDED BY CYTOS) ARE INTRIGUING BUT OFFERED A CAVEAT. I AM A LITTLE WARY OF TOP-LINE RESULTS FROM BOITECHS, ESPECIALLY SECONDARY EFFICACY VARIABLES IN A PRIMARY SAFETY STUDY, HE SAID. BROWN HAS ALSO HAD A HAND IN ATTEMPTS TO CREATE A HYPERTENSION VACCINE, PMD3117, UNDER DEVELOPMENT BY PROTHERICS PLC IN RUNCORN, ENGLAND (BROWN MJ ET AL. CLIN SCI.
PREGUNTA 31 ABOUT PATIENTS THAT DON`T TAKE THEIR TREATMENT REGULARY: A THIS PATIENTS HAVE AN ADEQUATE CONTROL OF BLOOD PRESSURE. B THEY ARE CONSISTENTLY ADHERENT IN TAKING THEIR MEDICATIONS. C THEY MUST HAVE A REGULAR DIET CONTROL. D THEY HAVE AN INADEQUATE CONTROL OF BLOOD PRESSURE. PREGUNTA 32 ABOUT THE WORKING MECHANISM OF THE VACCINE: A IT`S WORKING MECHANISM IS BY CONTROLLING THE ANGIOTENSIN I. B IT`S WORKING MECHANISM IS BY CONTROLLING THE ANGIOTENSIN II. C IT`S WORKING MECHANISM IS BY CONSTRICTING BLOOD VESSELS. D IT INDUCES ANTIBODIES CROSS-REACTION WITH OTHER PROTEINS. PREGUNTA 33 WITH RESPECT TO THE CYT006-ANGQB VACCINE, CONSIDERATION HAVE BEEN MADE THAT: A THE VACCINE MAY PRODUCE HYPERTENSION.
B THE VACCINE DOES NOT INDUCE ANTIBODIES CROSSREACTION WITH PROTEINS. C THE VACCINE MAY CAUSE HYPOTENSION. D THE VACCINE MIGHT CAUSE IMPOTENCY. PREGUNTA 34 WHAT IS THE REASON OF THE REDUCED NUMBER OF AFFECTED EPITOPES ? A BECAUSE OF THE SMALL SIZE OF THE EPITOPES. B BECAUSE OF THE SMALL SIZE OF THE TARGET MOLECULE. C BECAUSE ANTIBODY TITERS STARTED TO DECREASE. D THE NUMBER OF EPITOPES WAS NEVER AFFECTED. PREGUNTA 35 WHAT SHALL BE DONE TO DETERMINE THE LARGEST ANTIBODY RESPONSE AND GREATEST REDUCTIONS IN BLOOD PRESSURE: A A SMALL TRIAL TO DETERMINE THE RIGHT DOSING HAD TO BE CONDUCTED. B BOOSTER SHOT 2 OR 3 TIMES A YEAR. C ANGIOTENSIN II AND OCTAPEPTIDE VASOCONSTRICTOR INDUCE THE BODY TO PRODUCE ANTIBODIES. D ANGIOTENSIN II WOULD ALONE REGULATE THE BLOOD PRESSURE.
CASO CLNICO WILLIAM THOMAS GREEN MORTON ON OCTOBER 16, 1846, DEMONSTRATED THAT ETHER COULD INDUCE INSENSIBILITY TO THE SURGEON'S KNIFE. A JAW TUMOR WAS REMOVED FROM GILBERT ABBOT BY JOHN COLLINS WARREN AT THE MASSACHUSETTS GENERAL HOSPITAL IN FRONT OF AN AUDIENCE OF MEDICAL PROFESSIONALS. THE NEWS OF THIS PUBLIC DEMONSTRATION TRAVELED QUICKLY, GIVEN THE NATURE OF COMMUNICATION IN THE 1840S. ON DECEMBER 16, 1846, THE INFORMATION IN THE FORM OF A LETTER ARRIVED IN LONDON. ON DECEMBER 19, THE FIRST ETHER ANESTHETIC WAS GIVEN IN THE UNITED KINGDOM FOR THE REMOVAL OF A
TOOTH. ON DECEMBER 21, THE FAMOUS SURGEON ROBERT LISTON AMPUTATED THE LEG OF A BUTLER, AND UTTERED THE FAMOUS WORDS, THIS YANKEE DODGE BEATS MESMERISM HOLLOW .JAMES YOUNG SIMPSON, THE PROFESSOR OF MIDWIFERY IN EDINBURGH, SCOTLAND, WAS AMONG THE FIRST TO USE ETHER FOR THE RELIEF OF LABOR PAIN. ON JANUARY 19, 1847, HE USED ETHER TO AMELIORATE THE PAIN OF LABOR. THIS FIRST CASE, THAT OF A YOUNG WOMAN WITH RICKETS AND A SEVERELY DEFORMED PELVIS, WAS AT GRAVE RISK OF DYING AND THERE WAS NO HOPE FOR A LIVE BIRTH. BY USING ETHER, THE MOTHER SURVIVED THE COMPLICATED DELIVERY PAIN-FREE. THAT SAME JANUARY DAY, SIMPSON WAS APPOINTED THE QUEEN'S PHYSICIAN IN SCOTLAND. SIMPSON CONTINUED TO PROVIDE ANESTHESIA IN CHILDBIRTH FOR BOTH COMPLICATED AND NORMAL DELIVERIES; HOWEVER, HE RAPIDLY BECAME DISSATISFIED WITH ETHER AND SOUGHT A MORE PLEASANT, RAPID-ACTING ANESTHETIC. AT THE SUGGESTION OF DAVID WALDIE, HE EXPERIMENTED WITH CHLOROFORM, WHICH HAD FIRST BEEN PREPARED IN 1831. ON THE EVENING OF NOVEMBER 4, 1847, SIMPSON AND HIS FRIENDS INHALED IT AFTER DINNER AT A PARTY IN SIMPSON'S HOME. THEY PROMPTLY FELL UNCONSCIOUS AND, WHEN THEY AWOKE UNDER THE TABLE AND CLEARLY OFF THEIR DINING ROOM CHAIRS, WERE DELIGHTED WITH THEIR SUCCESS. WITHIN 2 WEEKS, SIMPSON SUBMITTED HIS FIRST ACCOUNT OF CHLOROFORM'S USE TO THE LANCET.IN THE NINETEENTH CENTURY, THE RELIEF OF OBSTETRIC PAIN HAD SIGNIFICANT SOCIAL AND RELIGIOUS CONSEQUENCES, WHICH MADE ANESTHESIA DURING CHILDBIRTH A CONTENTIOUS SUBJECT. THE BATTLE CENTERED ON WHETHER RELIEVING LABOR PAIN WAS CONTRARY TO GOD'S WILL. THE PAIN ASSOCIATED WITH CHILDBIRTH WAS BELIEVED TO BE A DEVINE PUNISHMENT FOR ORIGINAL SIN. SHORTLY AFTER GIVING HIS FIRST OBSTETRIC ANESTHETICS, SIMPSON PUBLISHED A PAMPHLET ENTITLED ANSWERS TO THE RELIGIOUS OBJECTIONS ADVANCED AGAINST THE EMPLOYMENT OF ANESTHETIC
AGENTS IN MIDWIFERY AND SURGERY AND OBSTETRICS, WHICH ARGUED AGAINST THESE RELIGIOUS PROHIBITIONS.
PREGUNTA 36 WILLIAM THOMAS GREEN MORTON USED A ETHER ON A PATIENT SO THERE WOULD BE NO SENSIBILITY IN THE OPERATION. B ETHER ON A PATIENT TO REDUCE THE SENSIBILITY DURING THE OPERATION C ETHER TO DISINFECT THE KNIFE IN THE OPERATION AND OTHER OPERATING EQUIPMENT D ETHER INSTEAD OF AN ANESTHETIC. PREGUNTA 37 JAMES YOUNG SIMPSON WAS THE FIRST TO USE ETHER FOR A CURING A PATIENT WHO HAD RICKETS B REDUCING THE LABOR PAIN OF A WOMEN WHEN GIVING BIRTH WITH A DEFORMED PELVIS C REDUCING THE PAIN OF SURGERY D SAVING THE NEWBORN FROM DYEING IN CHILDBIRTH PREGUNTA 38 SIMPSON PREFERRED TO CONTINUE A USING ETHER FOR CHILDBIRTH B TO CONTINUE USING ETHER AND CHLOROFORM FOR CHILDBIRTH C TO ONLY USE CHLOROFORM FOR CHILDBIRTH D PROVIDE ANESTHESIA IN CHILDBIRTH FOR BOTH COMPLICATED AND NORMAL DELIVERIES PREGUNTA 39 IT IS EVIDENT THAT THIS NEW PRACTICE OF USING ANESTHESIA IN CHILDBIRTH HAD SOCIAL AND RELIGIOUS CONSEQUENCES A SIMPSON WAS IN FAVOR OF RELIGIOUS BELIEFS IN CHILDBIRTH PRACTICE
B SIMPSON WAS IN FAVOR OF SOCIAL BELIEFS ABOUT CHILDBIRTH PRACTICE C SIMPSON WAS AGAINST RELIGIOUS BELIEFS IN CHILDBIRTH PRACTICE D SIMPSON WAS AGAINST THESE RELIGIOUS PROHIBITIONS PREGUNTA 40 THE PAIN ASSOCIATED WITH CHILDBIRTH WAS BELIEVED TO BE CAUSED AS. A CONSEQUENCE OF DEFORMED PELVIS. B A DEVINE PUNISHMENT FOR ORIGINAL SIN. C BECAUSE OF LACK OF ANESTHETICS. D AN OVERSIZED PRODUCT.
CASO CLNICO A 71-YEAR-OLD MALE PRESENTED WITH A 2-WEEK HISTORY OF A HARD, PAINFUL, NONPULSATILE MASS IN HIS LEFT UPPER ARM. EXAMINATION REVEALED A CRAGGY, MOBILE MASS OF IRREGULAR BORDERS IN THE LEFT ARM MEASURING 6 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM DEMONSTRATED A DEEP OVOID HYPERECHOIC MASS LOCATED IN THE LONG AXIS OF THE LEFT TRICEPS MUSCLE. MRI SHOWED INTERMEDIATE SIGNAL MASS IN THE TRICEPS MUSCULATURE ON T1WEIGHTED IMAGES WITH FAT SATURATION. THIS LESION WAS CONFINED TO THE EXTENSOR COMPARTMENT OF THE ARM. A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS CONSIDERED. AN INCISIONAL BIOPSY REPORTED 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 LEFT UPPER LOBE LESION MEASURING 4 2 CM. FIBER-OPTIC BRONCHOSCOPY AND BIOPSY CONFIRMED THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL LUNG CARCINOMA. HE UNDERWENT PALLIATIVE RADIOTHERAPY TO THE MASS IN THE ARM. 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 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 OF THIS CONDITION, EVEN WITH RADIOLOGIC IMAGING IS OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT TISSUE TUMORS, HIGHLIGHTING THE VALUE OF HISTOLOGIC DIAGNOSIS. TREATMENT IN THE FORM OF RADIOTHERAPY, CHEMOTHERAPY, OR EVEN METASTASECTOMY OFTEN PROVIDES PALLIATION ONLY. MOST PATIENTS DIE IN LESS THAN A YEAR FROM DIAGNOSIS.
PREGUNTA 41 BASED ON THE CLINICAL AND THE DIVERSE IMAGING STUDYS FINDINGS WHICH OF THE FOLLOWING WAS THE PRESUMPTIVE DIAGNOSIS OF THE ATTENDING MEDICAL TEAM:
A A DEEP OVOID MASS LOCATED IN THE LEFT TRICEPS MUSCLE CONSIDERED A PROBABLE STAPHYLOCOCCUS AUREUS ABSCESS. B A MASS OF FAT SATURATION OBSERVED ON MRI ON T1WEIGHTED IMAGES. C A PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA LOCATED IN THE LEFT TRICEPS MUSCLE. D A DIAGNOSIS OF METASTATIC SQUAMOUS CELL CARCINOMA, WITH A POSSIBLE PRIMARY OF THE LUNG. PREGUNTA 42 THE PATIENT WAS SUBMITTED TO PALLIATIVE CARE AND NOT SYSTEMIC THERAPY BASED ON WHAT REASON? A A POSITIVE CK7 AND NEGATIVE CK20 STAIN ON IMMUNOHISTOCHEMISTRY IS OF POOR PROGNOSIS. B THE DIAGNOSIS OF STAGE IV SQUAMOUS CELL LUNG CARCINOMA WAS NOT CONFIRMED ON FIBER-OPTIC BRONCHOSCOPY. C HE ONLY UNDERWENT PALLIATIVE RADIOTHERAPY BECAUSE OF COST-BENEFIT REASONS. D BASED ON A POOR AND DETERIORATING PERFORMANCE STATUS SYSTEMIC THERAPY WAS DEFERRED FOR QUALITY OF LIFE PALLIATIVE THERAPY. PREGUNTA 43 WHICH OF THE FOLLOWING IS NOT DESCRIBED IN THE PRESENT ARTICLE AS A FACTOR THAT CONTRIBUTES TO THE RARE OCCURRENCE OF INTRAMUSCULAR METASTASES? A THE MUSCULAR MASS ACCOUNTS FOR APPROXIMATELY 50% OF TOTAL BODY WEIGHT. B MUSCULAR CONTRACTILE ACTIONS. C LOCAL PH ENVIRONMENT. D ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES. PREGUNTA 44
WHICH IS THE PRIMARY UNDERLYING CANCER IN MOST CASES OF INTRAMUSCULAR METASTASES? A LUNG CARCINOMA. B KIDNEY AND BLADDER CANCER. C STOMACH AND PANCREATIC CARCINOMA. D BREAST AND OVARIAN CANCER. PREGUNTA 45 THE MOST FREQUENT PRESENTATION OF INTRAMUSCULAR METASTASES SEEN IS? A PRESENTATION OF THE AFFECTED SITE WITH PAIN, WITH OR WITHOUT SWELLING. B THROMBOSIS OF THE AFFECTED EXTREMITY. C FEVER AND SEPSIS. D USUALLY INDOLENT AND ONLY FOUND AT AUTOPSY.
CASO CLNICO MIGRAINE IS CONSIDERED TO BE AN EPISODIC CONDITION WITH NO LONG-TERM CONSEQUENCES. HOWEVER, RECENT STUDIES SUGGEST THAT MIGRAINE ATTACKS MAY BE ASSOCIATED WITH PATHOLOGIC CHANGES IN THE BRAIN, PARTICULARLY IN THE CEREBELLUM. THE OBJECTIVE OF THE PRESENT STUDY WAS TO DETERMINE WHETHER INDIVIDUALS NOT REPORTING HEADACHE COMPARED WITH INDIVIDUALS REPORTING MIGRAINE SYMPTOMS, PARTICULARLY AURA, IN MIDLIFE ARE AT INCREASED RISK OF LATE-LIFE INFARCT-LIKE LESIONS FOUND ON MAGNETIC RESONANCE IMAGING (MRI) WITHOUT CONSIDERATION OF CLINICAL SYMPTOMS. A POPULATION-BASED STUDY OF MEN AND WOMEN IN REYKJAVIK, ICELAND (COHORT BORN 1907-1935; N= 4689; 57% WOMEN) WERE FOLLOWED UP SINCE 1967, EXAMINED, AND INTERVIEWED ABOUT MIGRAINE SYMPTOMS IN MIDLIFE (MEAN AGE, 51 YEARS; RANGE, 33-65 YEARS). BETWEEN 2002 AND 2006, MORE THAN 26 YEARS LATER, BRAIN MRIS WERE PERFORMED. PARTICIPANTS REPORTING HEADACHES ONCE OR MORE PER MONTH WERE ASKED ABOUT MIGRAINE SYMPTOMS INCLUDING NAUSEA, UNILATERAL LOCATION, PHOTOPHOBIA, VISUAL DISTURBANCE, AND NUMBNESS.
THESE INDIVIDUALS WITH HEADACHE WERE CLASSIFIED AS HAVING MIGRAINE WITHOUT AURA, MIGRAINE WITH AURA, OR NONMIGRAINE HEADACHE. A COMPREHENSIVE CARDIOVASCULAR RISK ASSESSMENT WAS PERFORMED AT BOTH EXAMINATIONS. THE PRESENCE OF INFARCT-LIKE LESIONS (TOTAL) AND SPECIFICALLY LOCATED IN THE CORTICAL, SUBCORTICAL, AND CEREBELLAR REGIONS WERE THE MAIN OUTCOME MEASURE. INFARCT-LIKE LESIONS WERE PRESENT IN 39.3% OF MEN AND 24.6% OF WOMEN. AFTER ADJUSTING FOR AGE, SEX, AND FOLLOW-UP TIME, COMPARED WITH THOSE NOT REPORTING HEADACHES ONCE OR MORE PER MONTH (N= 3243), THOSE WITH MIDLIFE MIGRAINE WITH AURA (N= 361) HAD AN INCREASED RISK OF LATE-LIFE INFARCT-LIKE LESIONS (ADJUSTED ODDS RATIO [OR], 1.4; 95% CONFIDENCE INTERVAL [CI], 1.1-1.8) THAT SPECIFICALLY REFLECTED AN ASSOCIATION WITH CEREBELLAR LESIONS IN WOMEN (PREVALENCE OF INFARCTS 23.0% FOR WOMEN WITH MIGRAINE WITH AURA VS 14.5% FOR WOMEN NOT REPORTING HEADACHES; ADJUSTED OR, 1.9; 95% CI, 1.4-2.6 VS A 19.3% PREVALENCE OF INFARCTS FOR MEN WITH MIGRAINE WITH AURA VS 21.3% FOR MEN NOT REPORTING HEADACHES; ADJUSTED OR, 1.0; 95% CI, 0.6-1.8; P<.04 FOR INTERACTION BY SEX). MIGRAINE WITHOUT AURA AND NONMIGRAINE HEADACHE WERE NOT ASSOCIATED WITH AN INCREASED RISK. MIGRAINE WITH AURA IN MIDLIFE WAS ASSOCIATED WITH LATE-LIFE PREVALENCE OF CEREBELLAR INFARCT-LIKE LESIONS ON MRI. THIS ASSOCIATION WAS STATISTICALLY SIGNIFICANT ONLY FOR WOMEN.
PREGUNTA 46 RECENT STUDIES SUGGEST THAT MIGRAINE ATTACKS MAY BE ASSOCIATED WITH PATHOLOGIC CHANGES IN THE BRAIN, WHICH LOCALIZATION IN PARTICULAR IS CONSIDERED? A THE CEREBELLUM. B THE WHITE MATTER. C THE HYPOCAMPUS.
THE FRONTAL LOBE.
PREGUNTA 47 IN THE POPULATION-BASED STUDY OF MEN AND WOMEN IN REYKJAVIK, ICELAND, WITH A MEAN AGE OF 51 YEARS AND RANGING FROM 33-65 YEARS, WHAT STUDY WAS CONDUCTED APPROXIMATELY 26 YEARS LATER? A BRAIN COMPUTERIZED AXIAL TOMOGRAPHY. B BRAIN BIOPSY. C BRAIN MAGNETIC RESONANCE IMAGING. D ELECTROENCEPHALOGRAM PREGUNTA 48 THOSE WITH MIDLIFE MIGRAINE WITH AURA HAD AN ODDS RATIOS OF 1-4 OF LATE-LIFE INFARCT-LIKE LESIONS, THIS WAS MORE SPECIFICALLY OBSERVED IN WHICH GROUP? A CEREBELLAR LESIONS IN WOMEN. B CEREBELLAR LESIONS IN MEN. C CORTICAL LESIONS IN WOMEN. D SUBCORTICAL LESIONS IN MEN. PREGUNTA 49 THE MAIN OUTCOME MEASURES OF THE STUDY WERE THE PRESENCE OF INFARCT-LIKE LESIONS SPECIFICALLY LOCATED IN WHICH REGIONS? A CORTICAL, CEREBELLAR AND MEDULLA OBLONGATA REGIONS. B CORTICAL, SUBCORTICAL, AND CEREBELLAR REGIONS. C CEREBELLAR, SUBCORTICAL AND WHITE MATTER REGIONS. D PERIVENTRICULAR, HYPOCAMPUS AND OCCIPITAL REGIONS. PREGUNTA 50 WHICH OF THE FOLLOWING TYPES OF HEADACHES WERE NOT ASSOCIATED WITH AN INCREASED RISK OF INFARCT-LIKE LESIONS AT FOLLOW-UP?
A POST-TRAUMATIC HEADACHE B HEADACHE AND MIGRAINE WITH AURA. C MIGRAINE WITHOUT AURA AND NON-MIGRAINE HEADACHE. D SINUSITIS AND MIGRAINE
CASO CLNICO HOMBRE DE 20 AOS, ES ATENDIDO EN EL SERVICIO DE CONSULTA EXTERNA, POR PRESENTAR DIFICULTAD RESPIRATORIA POSTERIOR A ESFUERZO FSICO. ANTECEDENTES: RINITIS ALRGICA DURANTE LA INFANCIA. EXPLORACIN FSICA: SE AUSCULTAN SIBILANCIAS RESPIRATORIAS.
PREGUNTA 51 LA REACCIN DE HIPERSENSIBILIDAD PRESENTE EN ESTE PACIENTE ES LA TIPO: A I B II C III D VI PREGUNTA 52 LA INMUNOGLOBULINA QUE PARTICIPA EN ESTE PADECIMIENTO ES: A A B E C G D M
CASO CLNICO HOMBRE DE 9 AOS, ES ATENDIDO EN CONSULTA POR TOS, DISNEA AL HACER EJERCICIO, CONSTIPACIN Y PRURITO NASAL SIN PREDOMINIO DE HORARIO DE TRES AOS DE EVOLUCIN. ANTECEDENTES: HA SIDO HOSPITALIZADO EN DOS OCASIONES REQUIRIENDO USO DE NEBULIZADOR, NO TIENE ANTECEDENTES FAMILIARES SIMILARES. EXPLORACIN FSICA: MUCOSA NASAL HIPERMICA CON
HIPERTROFIA DE CORNETES, AMIGDALITIS HIPERTRFICA CON IMPORTANTE DIFICULTAD PARA HABLAR. NO SE ESCUCHAN SIBILANCIAS EN TRAX.
PREGUNTA 53 PARA CORROBORAR EL DIAGNSTICO SE DEBE SOLICITAR: A CULTIVO DE EXUDADO FARNGEO. B DETERMINACIN DE EOSINFILOS EN MOCO NASAL. C BIOMETRA HEMTICA COMPLETA. D PRUEBAS CUTNEAS CON ALRGENOS. PREGUNTA 54 LO MS PROBABLE ES QUE LA CAUSA DE ESTE PADECIMIENTO ES: A CAROS Y CASPA DE LOS ANIMALES. B ESTREPTOCOCO B HEMOLTICO. C INFECCIONES VIRALES. D HONGOS.
CASO CLNICO MUJER DE 22 AOS. ES ATENDIDA EN EL SERVICIO DE URGENCIAS POR DISNEA INTENSA, DE APARICIN SBITA. E.F.: TA 100/70, FC 120 LPM, FR 33 RPM, TEMP 37C. TIROS SUPRAESTERNAL, SUPRACLAVICULARES E INTERCOSTALES, ESTERTORES RONCANTES Y SIBILANCIAS ESPIRATORIAS, ESPIRACIN PROLONGADA, FACIES DE ANGUSTIA, POLIPNICA, DIAFORTICA. ANTECEDENTES: HA PRESENTADO CUADROS SIMILARES QUE HAN CEDIDO A TRATAMIENTO MDICO
PREGUNTA 55 EL ESTUDIO MS SENSIBLE QUE CONFIRMA EL DIAGNSTICO DE ESTE PACIENTE ES: A DETERMINACIN DE ANTICUERPOS ESPECFICOS B BIOMETRA HEMTICA C DETERMINACIN DE IGE
DETERMINACIN DE NIVELES DE HISTAMINA
PREGUNTA 56 EL MEDICAMENTO DE PRIMERA ELECCIN EN EL TRATAMIENTO DE ESTA PACIENTE ES: A INHIBIDORES DE LEUCOTRIENOS B HIDROCORTISONA C TEOFILINA D ADRENALINA
CASO CLNICO HOMBRE DE 54 AOS, SE PRESENTA A CONSULTA POR: DOLOR PRECORDIAL OPRESIVO QUE SE DESENCADENA CON EL ESFUERZO Y SE ATENA CON EL REPOSO, CON UNA DURACIN DE MENOS DE 15 MINUTOS. ACTUALMENTE SE ENCUENTRA ASINTOMTICO. ANTECEDENTES: TABAQUISMO DE 20 PAQUETES/AO. EXPLORACIN FSICA: TA DE 150/90 MM HG, FC DE 84 LPM, CAMPOS PULMONARES LIMPIOS Y BIEN VENTILADOS. EL RESTO DE LA EXPLORACIN ES NORMAL.
PREGUNTA 57 LA ESTRUCTURA ANATMICA AFECTADA QUE ORIGINA LOS SNTOMAS, ES: A LA AORTA TORCICA. B EL PERICARDIO. C LA VASCULATURA PULMONAR. D LA VASCULATURA CORONARIA. PREGUNTA 58 EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNSTICO DEL PACIENTE ES: A PRUEBA DE ESFUERZO. B ECOCARDIOGRAMA SIMPLE. C PRUEBA DE INCLINACIN. D ELECTROCARDIOGRAMA EN REPOSO.
PREGUNTA 59 EN ESTE PACIENTE, EL MEDICAMENTO DE ELECCIN PARA CONTROLAR LA HIPERTENSIN ARTERIAL ES: A INHIBIDORES DE LA ECA. B ARA II. C BETABLOQUEADORES. D DIURTICOS.
CASO CLNICO HOMBRE DE 68 AOS. ATENDIDO EN CONSULTA POR PRESENTAR UN CUADRO DE DISNEA DE MODERADOS ESFUERZOS, SNCOPE DE ESFUERZO EN TRES OCASIONES DURANTE LOS LTIMOS 2 MESES, DOLOR PRECORDIAL LEVE OCASIONAL ACOMPAADO DE MAREOS. ANTECEDENTES DE ESTREIMIENTO QUE SE MANEJA CON SENOSIDOS. EXPLORACIN FSICA: PULSOS DBILES, RECULARES CON UNA FC DE 64 LPM, TA 110/70 MMHG. LA AUSCULTACIN MUESTRA UN SOPLO SISTLICO CON FOCO MS ACENTUADO EN EL SEGUNDO ESPACIO INTERCOSTAL DEL LADO DERECHO, IRRADIADO AL CUELLO. LA TELE DE TRAX MUESTRA UNA CARDIOMEGALIA II/IV.
PREGUNTA 60 CONSIDERANDO EL DIAGNSTICO MS PROBABLE EN ESTE PACIENTE EL ELECTROCARDIOGRAMA DEBE MOSTRAR: A CRECIMIENTO DE CAVIDADES DERECHAS. B ALTERACIONES COMPATIBLES CON HIPERTROFIA VENTRICULAR IZQUIERDA. C FIBRILACIN AURICULAR. D BLOQUEO AV AVANZADO. PREGUNTA 61 EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNSTICO ES: A PRUEBA DE ESFUERZO. B PRUEBA DE INCLINACIN. C ECOCARDIOGRAMA. D CATETERISMO CARDACO.
PREGUNTA 62 LA ETIOLOGA MS PROBABLE EN ESTE PACIENTE ES DE ORIGEN: A FARMACOLGICO. B METABLICO. C AUTOINMUNE. D DEGENERATIVO.
CASO CLNICO MUJER DE 90 AOS ES ATENDIDA EN CONSULTA PORQUE TUVO UN DESMAYO HACE 8 DAS. ANTECEDENTE: 15 GESTAS. EXPLORACIN FSICA: TA 150/60 MM HG, FC 40 LPM, PULSOS AMPLIOS E IRREGULARES. PEX EN EL QUINTO ESPACIO INTERCOSTAL EN LA LNEA MEDIOCLAVICULAR. RUIDOS CARDACOS ARRTMICOS, SOPLO SISTLICO EXPULSIVO ARTICO II/VI. CAMPOS PULMONARES LIMPIOS. VRICES EN MIEMBROS INFERIORES. ELECTROCARDIOGRAMA: AUSENCIA DE ONDA P CON COMPLEJOS QRS IRREGULARES, FRECUENCIA VENTRICULAR MEDIA DE 40 LPM.
PREGUNTA 63 EN ESTA PACIENTE EL DIAGNSTICO ETIOLGICO MS PROBABLE ES: A ESCLEROSIS ARTICA. B FIBRILACIN AURICULAR LENTA. C INSUFICIENCIA VENOSA. D SNCOPE. PREGUNTA 64 AL PACIENTE SE LE SOLICITA UN MONITOREO ELECTROCARDIOGRFICO DE 24 HORAS (HOLTER), EL CUAL REPORTA PREDOMINANCIA DE RITMOS LENTOS < 40 POR MINUTO Y EL TRATAMIENTO DE PRIMERA ELECCIN PARA ESTA PACIENTE ES: A ADMINISTRAR ANTITROMBTICOS. B ADMINISTRAR BLOQUEADORES ALFA-1.
C D
ADMINISTRAR CALCIOANTAGONISTAS. COLOCAR MARCAPASO DEFINITIVO.
CASO CLNICO MUJER DE 18 AOS, ATENDIDA EN CONSULTA POR CANSANCIO AL JUGAR VOLEY BALL EN SU COLEGIO. ANTECEDENTES: BRONQUITIS DE REPETICIN EN EDAD ESCOLAR. PRODUCTO DE SEGUNDA GESTA, PARTO EUTCICO A TERMINO, APGAR 9. E.F.: EUPNICA, AFEBRIL, TA 138/74, FC 80 LPM, FR 18RPM. R.C.R. CON SOPLO CONTINUO PARAESTERNAL SUBCLAVICULAR IZQUIERDO. CAMPOS PULMONARES VENTILADOS, PULSOS ARTERIALES CON AMPLITUD AUMENTADA.
PREGUNTA 65 EN EL ELECTROCARDIOGRAMA Y LA RX DE TRAX DE ESTA PACIENTE ES MUY PROBABLE QUE SE ENCUENTREN DATOS DE: A SOBRECARGA DE CAVIDADES IZQUIERDAS. B SOBRECARGA DE AURICULA DERECHA. C SOBRECARGA DE VENTRCULO DERECHO. D SOBRECARGA DE LAS CUATRO CAVIDADES. PREGUNTA 66 EL TRATAMIENTO DE ELECCIN EN ESTA PACIENTE ES: A INTERVENCIONISMO CARDIOLGICO. B CIRUGA CARDACA URGENTE. C MANEJO MDICO INICIAL. D CIRUGA CARDACA ELECTIVA.
CASO CLNICO HOMBRE DE 53 AOS PREVIAMENTE SANO. PRESENTA FIEBRE NO CUANTIFICADA DE TRES SEMANAS DE EVOLUCIN ACOMPANDOSE DE ESCALOFROS Y DIAFORESIS PROFUSA; REFIERE ADEMS PRDIDA DE PESO DE 5 KG. MIALGIAS Y ARTRALGIAS. E.F.: MICROHEMORRAGIAS EN DEDOS Y PLANTAS DE AMBOS PIES. LA AUSCULTACIN DEL TRAX MUESTRA UN SOPLO CORRESPONDIENTE A INSUFICIENCIA MITRAL III/VI. EL LABORATORIO REPORTA UNA HB DE 8.3
G/DL, LEUCOCITOS 12 500, VSG 60 MM/H (NORMAL HASTA 20) CREATININA 0.8 G/DL.
PREGUNTA 67 EL AGENTE CAUSAL MS PROBABLE EN ESTE CASO ES: A STREPTOCOCCUS VIRIDANS. B STREPTOCOCCUS PNEUMONIAE. C CARDIOBACTERIUM HOMINIS. D STAPHYLOCOCCUS COAGULASA NEGATIVO. PREGUNTA 68 EL TRATAMIENTO INICIAL PARA ESTE PACIENTE DEBE INCLUIR: A VANCOMICINA Y GENTAMICINA. B PENICILINA Y GENTAMICINA. C AMPICILINA Y SULBACTAM. D CLARITROMICINA. PREGUNTA 69 EN EL CULTIVO DE SANGRE, CRECI STREPTOCOCCUS BOVIS, EL ORIGEN MS PROBABLE DE LA BACTERIA ES: A GASTROINTESTINAL. B ODONTOLGICO. C PIEL Y TEJIDOS BLANDOS. D URINARIO.
CASO CLNICO HOMBRE DE 33 AOS, ADICTO A DROGAS INTRAVENOSAS, ES ATENDIDO EN CONSULTA POR CONVULSIONES GENERALIZADAS Y ESTADO CONFUSIONAL ACOMPAADO DE FIEBRE DE 4 SEMANAS DE EVOLUCIN Y PRDIDA DE PESO NO CUANTIFICADA. A LA EXPLORACIN FSICA: TA DE 90/60 MM HG, FC 110 LPM, TEMPERATURA 38 C, FR 22 RESPIRACIONES POR MINUTO. EXMENES DE LABORATORIO: HB DE 9.8 G/DL, LEUCOCITOS DE 16 300/MM3, PLAQUETAS 94,000/MM3. LA TELE DE TRAX MUESTRA INFILTRADOS EN PARCHE. SE ENVIAN HEMOCULTIVOS SERIADOS (3) QUE A LAS 24 HORAS SE
REPORTAN POSITIVOS PARA CRECIMIENTO BACTERIANO POR LO QUE SE REALIZA UNA TINCIN DE GRAM.
PREGUNTA 70 EL HALLAZGO MS PROBABLE EN LA TINCIN DE LA MUESTRA ES: A COCOS GRAM NEGATIVOS. B COCOS GRAM POSITIVOS. C BACILOS GRAM NEGATIVOS. D BACILOS GRAM POSITIVOS. PREGUNTA 71 EN ESTA PACIENTE, LA VLVULA MS PROBABLEMENTE DAADA ES: A MITRAL. B ARTICA. C TRICSPIDE. D PULMONAR. PREGUNTA 72 LA DURACIN DEL TRATAMIENTO EN SEMANAS PARA ESTE PACIENTE ES: A 4. B 6. C 8. D 10.
CASO CLNICO MUJER DE 72 AOS ES ATENDIDA EN CONSULTA POR CUADRO DE DISNEA DE MODERADOS ESFUERZOS, SNCOPE DE ESFUERZO EN TRES OCASIONES DURANTE LOS LTIMOS 2 MESES. REFIERE DOLOR PRECORDIAL LEVE OCASIONAL, ACOMPAADO DE MAREOS. E.F.: PULSOS DBILES, REGULARES CON FC DE 64 LPM, TA 100/70 MM HG. AUSCULTACIN CON SOPLO SISTLICO CON FOCO MS ACENTUADO EN EL SEGUNDO ESPACIO INTERCOSTAL DEL
LADO DERECHO IRRADIADO AL CUELLO. LA TELE DE TRAX MUESTRA UNA CARDIOMEGALIA II/IV.
PREGUNTA 73 EL HALLAZGO MS PROBABLE EN EL ECOCARDIOGRAMA DE ESTE PACIENTE ES: A DILATACIN DE LAS CAVIDADES IZQUIERDAS. B INSUFICIENCIA PULMONAR SEVERA. C GRADIENTE TRANSVALVULAR PULMONAR INCREMENTADO. D HIPERTROFIA CONCNTRICA DEL VENTRCULO IZQUIERDO. PREGUNTA 74 LA VLVULA CARDACA MS PROBABLEMENTE AFECTADA ES: A MITRAL. B ARTICA. C PULMONAR. D TRICUSPIDEA. PREGUNTA 75 EL TRATAMIENTO DEFINITIVO DE ESTE PACIENTE ES: A NITRATOS. B DIURTICOS. C VALVULOPLASTA. D REEMPLAZO QUIRRGICO CON PRTESIS.
CASO CLNICO HOMBRE DE 56 AOS, ES ATENDIDO EN LA CONSULTA POR PRESENTAR EN ANTEBRAZOS Y MANOS PRURITO, ERITEMA Y ESFACELACIN CON EXACERBACIN DESDE HACE TRES MESES. AGREGNDOSE EDEMA FACIAL, MCULAS EN CUELLO Y PARTE ALTA DE TRAX. ANTECEDENTE DE TRABAJAR EN FBRICA DE CEMENTOS DESDE HACE 20 AOS. EXPLORACIN FSICA: PLACA ERITEMATOSA CON HIPERQUERATOSIS EN MIEMBRO PLVICO DERECHO CON EDEMA Y HUELLAS DE RASCADO.
PREGUNTA 76 EL DIAGNSTICO MAS PROBABLE ES: A DERMATITIS ATPICA. B DERMATITIS POR CONTACTO. C PSORIASIS. D URTICARIA. PREGUNTA 77 PARA INTEGRAR EL DIAGNSTICO LO MAS RECOMENDABLE ES REALIZAR: A ESTUDIO EPIDEMIOLGICO. B ESTUDIO DE CONTACTOS. C ESTUDIO DE AGENTES CONTAMINANTES. D ESTUDIO DE FACTORES DE RIESGO EN LA EMPRESA Y AMBIENTALES.
CASO CLNICO NIO DE 8 AOS ES ATENDIDO EN CONSULTA EXTERNA POR PRESENTAR ERUPCIN EN CUELLO Y PLIEGUES ANTECUBITAL Y POPLTEO, ACOMPAADA DE PRURITO. ANTECEDENTE: FAMILIARES CON ASMA.
PREGUNTA 78 EL HALLAZGO DE LABORATORIO QUE APOYA EL DIAGNSTICO ES: A BASOFILIA. B LINFOCITOSIS. C EOSINOFILIA. D NEUTROPENIA. PREGUNTA 79 EL TRATAMIENTO LOCAL DE PRIMERA ELECCIN PARA ESTE PACIENTE ES: A TAZAROTENO. B HIDROCORTISONA.
C D
PREDNISONA. CLOTRIMAZOL.
CASO CLNICO ADOLESCENTE DE 17 AOS CON LESIONES DERMATOLGICAS EN CARA Y TRONCO. LAS LESIONES COINCIDEN CON EL CAMBIO DE CIUDAD Y DE DIETA POR MOTIVOS DE ESTUDIO. ADEMS DEJAN CICATRIZ QUE PREOCUPA MUCHO AL PACIENTE. E.F.: COMEDONES EN DIFERENTES ESTADIOS DE EVOLUCIN.
PREGUNTA 80 EN ESTE PACIENTE EL DIAGNSTICO MS PROBABLE ES: A FOLICULITIS. B ROSCEA. C ACN VULGAR. D MILIARIA. PREGUNTA 81 ENTRE LAS MEDIDAS PREVENTIVAS PARA ESTE PACIENTE SE RECOMIENDA: A ANTIBITICO V.O. DE MANERA PERMANENTE. B UTILIZAR JABN NEUTRO Y EMOLIENTES. C EJERCICIO, DIETA BAJA EN GRASAS, JABN NEUTRO. D EVITAR EXPONERSE AL SOL.
CASO CLNICO MUJER DE 48 AOS, ATENDIDA EN CONSULTA POR CEFALEA FRONTAL DE PREDOMINIO MATUTINO. ANTECEDENTES GINECOOBSTTRICOS: CICLOS MENSTRUALES IRREGULARES. E.F: ESTATURA 1.54 M, PESO 82 KG, TA 140/100, GLUCEMIA EN AYUNAS DE 125 MG/DL, TRIGLICRIDOS 240 MG/DL, HDL 37, COLESTEROL TOTAL 320 MG/DL.
PREGUNTA 82 EL DIAGNSTICO DE ESTA PACIENTE ES: A OBESIDAD MRBIDA.
B C D
SNDROME METABLICO. HIPERTENSIN ARTERIAL ESENCIAL. SNDROME PREMENOPUSICO.
PREGUNTA 83 LAS ALTERACIONES FISIOPATOLGICAS EN ESTA PACIENTE SON: A HIPERCOAGULABILIDAD E HIPERLIPIDEMIA. B HIPERTENSIN ARTERIAL Y DIABETES MELLITUS. C RESISTENCIA A LA INSULINA E HIPERINSULINEMIA. D DISLIPIDEMIA E HIPERTENSIN ARTERIAL.
CASO CLNICO FEMENINO DE 56 AOS, ACUDE A CONSULTA POR PRESENTAR DESDE 2 SEMANAS PREVIAS HIPOSTENIA, HIPODINAMIA, PRDIDA DE PESO, POILIFAGIA, POLIURIA. ANTECEDENTES: PADRE DIABTICO. EXPLORACIN FSICA: OBESIDAD ABDOMINAL, PESO: 100 KG., TALLA 1.68 M. EXMENES DE LABORATORIO: GLUCOSA DE 120 MG/DL, COLESTEROL 200 MG/DL, TRIGLICRIDOS DE 360 MG/DL, COLESTEROL-HDL 30.
PREGUNTA 84 EL MECANISMO FISIOPATOLGICO DESENCADENANTE ES: A AUMENTO DE INTERLEUCINA-6. B DISMINUCIN DE SELECTINA. C AUMENTO DE LA ADIPONECTINA. D DISMINUCIN DE LEPTINA. PREGUNTA 85 EL PASO INICIAL EN EL TRATAMIENTO DE ESTE PACIENTE ES: A APLICACIN DE INSULINA. B ADMINISTRAR SECRETAGOGOS. C DIETA Y EJERCICIO. D HIPOLIPEMIANTES.
CASO CLNICO MUJER DE 25 AOS CON ANTECEDENTE DE DIABETES TIPO 1, CURSA EL PRIMER TRIMESTRE DEL EMBARAZO. HA LLEVADO
DE MANERA IRREGULAR SU CONTROL GLUCMICO. SE PRESENTA ASINTOMTICA A LA CONSULTA DE CONTROL PRENATAL CON UROCULTIVO POSITIVO CON 100,000 UFC/ML PARA E. COLI, SIN PIURIA SIGNIFICATIVA. LA PACIENTE MUESTRA PREOCUPACIN Y PREGUNTA CUAL ES EL RIESGO QUE LA DIABETES Y EL TRATAMIENTO GENEREN A SU PRODUCTO.
PREGUNTA 86 PARA ESTA PACIENTE, LA ASEVERACIN MS ADECUADA, ES: A ELLA Y SU PRODUCTO TIENEN MENOR RIESGO QUE LAS DIABTICAS GESTACIONALES. B NO EXISTE MAYOR RIESGO EN TANTO SE MANTENGA LA GLICEMIA EN AYUNO POR DEBAJO DE 120 MG/DL. C LA INSULINA NO ATRAVIESA LA BARRERA PLACENTARIA, POR LO QUE EL EMBARAZO SER DE CURSO NORMAL. D DE NO MANTENERSE CONTROL GLUCMICO EL RIESGO DE MALFORMACIONES INCREMENTA HASTA DIEZ VECES. PREGUNTA 87 PARA ESTA PACIENTE LA INTERPRETACIN MAS ADECUADA DEL RESULTADO DEL UROCULTIVO ES: A DEBE ATENDERSE AL RESULTADO Y PROPORCIONAR TRATAMIENTO ANTIBITICO. B SLO RECIBIR TRATAMIENTO ANTIBITICO SI PRESENTARA SINTOMATOLOGA. C EL RESULTADO DE LABORATORIO ES PRODUCTO DE CONTAMINACIN DE LA MUESTRA. D REQUIERE UN SEGUNDO CULTIVO CON TOMA DE MUESTRA.
CASO CLNICO HOMBRE DE 56 AOS, ATENDIDO EN CONSULTA POR AUMENTO DE VOLUMEN, DOLOR, CALOR LOCAL E HIPEREMIA DE RODILLA DERECHA DE 2 DAS DE EVOLUCIN. NIEGA TRAUMATISMO, REFIERE HISTORIA DE EPISODIOS DOLOROSOS SEMEJANTES, HACE UN AO EN PRIMERA
METATARSOFALNGICA DERECHA Y OTRO HACE 6 MESES EN TOBILLO IZQUIERDO. EXPLORACIN FSICA: NDULOS SUBCUTNEOS IRREGULARES EN CODOS Y SE CONFIRMA FLOGOSIS DE RODILLA DERECHA.
PREGUNTA 88 EL DIAGNSTICO DEFINITIVO ES MEDIANTE: A RECOLECCIN DE ORINA DE 24 HORAS. B PERFIL BIOQUMICO. C ARTROCENTESIS Y BUSQUEDA DE CRISTALES. D BIOPSIA DE NDULO. PREGUNTA 89 EL MECANISMO DE PRODUCCIN MS PROBABLE QUE LE OCURRE ES: A HIPERSECRECIN. B HIPOEXCRECIN. C MEDICAMENTOS. D INGESTA EXCESIVA DE CALCIO.
Subsecretara de Integracin y Desarrollo del Sector Salud Direccin General de Calidad y Educacin en Salud Direccin de Educacin en Salud CIFRHS - Comit de Posgrado y Educacin Continua
XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 SIMULADOR DE EXAMEN 2011
CASO CLNICO MUJER DE 26 AOS, ES ATENDIDA EN CONSULTA EXTERNA POR PRESENTAR DESDE HACE VARIAS SEMANAS TEMBLOR FINO DISTAL, SENSACIN DE ANGUSTIA, SUDORACIN PALMAR, HA PERDIDO PESO EN LOS LTIMOS MESES. SIN ANTECEDENTES DE IMPORTANCIA. EXPLORACIN FSICA: TA 130/86 MM HG, PESO 54 KG., TALLA 160 CM., EXOFTALMOS, SUDORACIN PALMAR, PIEL HMEDA Y CALIENTE, FC 110 LPM, ABDOMEN CON RUIDOS PERISTLTICOS INCREMENTADOS.
PREGUNTA 90 EN ESTE PACIENTE VA A ENCONTRAR UNA DISMINUCIN DE: A TSH. B T4 LIBRE. C T4 TOTAL. D T3 R.
PREGUNTA 91 EL TRATAMIENTO DE PRIMERA ELECCIN PARA ESTA PACIENTE ES:. A YODO 131. B YODURO. C METIMAZOLE. D TIROIDECTOMA.
CASO CLNICO MUJER DE 45 AOS, ACUDE A CONSULTA EXTERNA, POR PRESENTAR DESDE HACE 4-5 SEMANAS FATIGA FCIL, CONSTIPACIN INTESTINAL E INTOLERANCIA AL FRO, HA TENIDO INCREMENTO DE PESO DE APROXIMADAMENTE 6 KG. EN 3 MESES. EXPLORACIN FSICA: TA DE 116/86 MM HG, PESO 74 KG., TALLA 162 CM., FC 56 LPM, PIEL SECA, RUIDOS CARDACOS RTMICOS, ABDOMEN BLANDO, NO DOLOROSO, EDEMA MODERADO DE PIERNAS.
PREGUNTA 92 EN ESTE PACIENTE SE VA ENCONTRAR UN AUMENTO DE: A TSH. B T4L. C T4 TOTAL. D T3R. PREGUNTA 93 EL TRATAMIENTO DE PRIMERA ELECCIN PARA ESTE PACIENTE ES: A TRIYODOTIRONINA. B LEVOTIROXINA. C YODURO. D METIMAZOLE.
CASO CLNICO MUJER DE 77 AOS, INGRESA A URGENCIAS POR DESHIDRATACIN SEVERA, ASTENIA ADINAMIA, CON POLIURIA Y POLIDIPSIA, DOLOR DE MIEMBROS INFERIORES E
HIPERTERMIA NO CUANTIFICADA. ANTECEDENTES: DIABETES MELLITUS, MAL CONTROLADA Y ABANDONO FAMILIAR. E.F.: PRESIN ARTERIAL 150/105 , TEMP DE 38C, MUCOSAS ORALES DESHIDRATADAS, TONO OCULAR DISMINUIDO, GIORDANO POSITIVO. LABORATORIO: GLUCOSA DE 540 MG/DL, UREA 80 MG/DL, CREATININA 3.2 MG/DL, SODIO 125 MEQ, POTASIO 6.7 MEQ. LEUCOCITOS 15 MIL MM3.
PREGUNTA 94 EL TRATAMIENTO INMEDIATO PARA ESTE PACIENTE ES: A INSULINA. B HIDRATACIN. C ANTIBITICOTERAPIA. D DILISIS. PREGUNTA 95 LA CAUSA MS PROBABLE DE LA SINTOMATOLOGA DEL PACIENTE ES: A COMPLICACIONES TARDAS DE LA DIABETES. B PROCESO INFECCIOSO URINARIO. C SUSPENSIN DE TRATAMIENTO MDICO. D TRANSGRESIN DIETTICA.
Subsecretara de Integracin y Desarrollo del Sector Salud
Direccin General de Calidad y Educacin en Salud Direccin de Educacin en Salud CIFRHS - Comit de Posgrado y Educacin Continua XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 SIMULADOR DE EXAMEN 2011
CASO CLNICO HOMBRE DE 16 AOS, LLEVADO POR SUS FAMILIARES Y ATENDIDO EN EL SERVICIO DE URGENCIAS, POR DETERIORO PROGRESIVO DEL ESTADO DEL ALERTA, DIFICULTAD PARA RESPIRAR, NUSEA Y VMITO; E.F.: SOPOROSO, MUCOSAS ORALES SECAS, TAQUICRDICO CON TAQUIPNEA. LABORATORIO: LEUCOCITOS 13,800/MM3, GLUCOSA 420 MG/DL, SODIO 118 MEQ/L, POTASIO 3.0 MEQ/L, UREA 80 MG/DL, CL 110 MEQ/L, PH 7.10, PCO2 18 MM HG, HCO3 10 MG/DL, DEFICIT DE BASE -18.
PREGUNTA 96 EN ESTE PACIENTE SE VA ENCONTRAR UN AUMENTO DE:
A B C D
GLUCONEOGNESIS. GLUCOGENOLISIS. CAPTACIN DE GLUCOSA POR MSCULO. CAPTACIN DE GLUCOSA POR LA CELULA.
PREGUNTA 97 LA ALTERACIN METABLICA EN ESTE PACIENTE ES: A ACIDOSIS LCTICA. B ACIDOSIS METABLICA. C ACIDOSIS HIPERCLORMICA. D ALCALOSIS RESPIRATORIA.
CASO CLNICO HOMBRE DE 40 AOS ATENDIDO EN CONSULTA POR PRESENTAR CANSANCIO Y PARESTESIAS EN MIEMBROS INFERIORES, A LO QUE SE AGREGA PRDIDA DE PESO NO CUANTIFICADA DESDE HACE APROX. 2 MESES. ANTECEDENTES: PADRE DIABTICO FALLECI DE INFARTO DE MIOCARDIO; ES SEDENTARIO Y ACOSTUMBRA COMER ALIMENTOS RICOS EN GRASAS Y CARBOHIDRATOS. E.F-: TA 160/100 , FC 100 LPM, FR 26 POR MIN, TEMP 36.8 C, PESO 107 KG., TALLA 1.71 M., REGULAR ESTADO GENERAL, CARDIOPULMONAR Y ABDOMEN SIN DATOS. EXMENES DE LABORATORIO: GLICEMIA 400 MG/DL, COLESTEROL TOTAL 260 MG/DL, TRIGLICRIDOS 358 MG/DL; GENERAL DE ORINA CETONURIA +, GLUCOSURIA +++.
PREGUNTA 98 EL TRATAMIENTO INMEDIATO PARA ESTE PACIENTE ES LA ADMINISTRACIN DE: A INSULINA. B SULFONILUREAS. C BIGUANIDAS. D TIAZOLINDINEDIONAS. PREGUNTA 99
EL ESTUDIO DE LABORATORIO IDEAL PARA MONITOREAR A LARGO PLAZO EL TRATAMIENTO DE ESTE PACIENTE ES: A PRUEBA DE TOLERANCIA A LA GLUCOSA. B GLICEMIA EN AYUNAS. C GLICEMIA CAPILAR. D HEMOGLOBINA GLICOSILADA.
CASO CLNICO MUJER DE 18 AOS, ES ATENDIDA EN CONSULTA POR PRESENTAR PALPITACIONES Y EVACUACIONES DIARREICAS EN PERIODOS FRECUENTES. ANTECEDENTES: BOCIO EN RAMA MATERNA. E.F.: TA 160/90 , FC 120 LPM. PACIENTE IRRITABLE, ANSIOSA, CON SUDORACIN EXCESIVA. PEX ENRGICO. RUIDOS CARDACOS INTENSOS. PERISTALSIS AUMENTADA, PULSOS ARTERIALES PERIFRICOS INTENSOS.
PREGUNTA 100 EN ESTA PACIENTE SE VA A ENCONTRAR AUMENTO DE: A HORMONA LIBERADORA DE TIROTROPINA. B HORMONA ESTIMULANTE DE LA TIROIDES. C TRIYODOTIRONINA Y TIROXINA. D ANTICUERPOS ANTITIROIDEOS. PREGUNTA 101 ESTA PACIENTE DEBE SER TRATADA CON UN MEDICAMENTO QUE ACTE A NIVEL DE: A INHIBICIN DE PEROXIDASA TIROIDEA. B LIBERACIN DE TSH. C LIBERACIN DE TIROTROPINA. D ANTICUERPOS ANTITIROIDEOS.
7:28 PM
CASO CLNICO HOMBRE DE 83 AOS, ATENDIDO EN CONSULTA EXTERNA, PRESENTA DESDE HACE UNA SEMANA ANOREXIA, NUSEA, DISTENSIN ABDOMINAL LEVE, DOLOR EPIGSTRICO DE MODERADA INTENSIDAD QUE DISMINUYE CON INGESTA DE ALIMENTOS, POSTERIORMENTE EVACUACIONES OBSCURAS Y VMITO EN POZOS DE CAF. HA PERDIDO
APROXIMADAMENTE 6 KG. EN 2 MESES. ANTECEDENTES: TABAQUISMO IMPORTANTE, ABUSO FRECUENTE DE ALCOHOL. EXPLORACIN FSICA: PLIDO, TA 130/86 MM HG, PESO 68 KG., TALLA 174 CM., ABDOMEN BLANDO, POCO DOLOROSO EN EPIGASTRIO, SIN DATOS DE IRRITACIN PERITONEAL. EXMENES DE LABORATORIO: HEMOGLOBINA DE 10.9 GR/DL, LEUCOCITOS 7200/MM3, PLAQUETAS 145,000/MM3, CREATININA 1.6 NG/ML, UREA 56 MG/DL.
PREGUNTA 102 EL MECANISMO HOMEOSTTICO AFECTADO EN ESTE PACIENTE ES: A COMPETENCIA DEL ESFNTER ESOFGICO INFERIOR. B INTEGRIDAD DE LA MUCOSA GSTRICA O DUODENAL. C PRESIN DEL SISTEMA PORTA. D MOTILIDAD GSTRICA. PREGUNTA 103 EL DIAGNSTICO DEFINITIVO SE ESTABLECE MEDIANTE: A MANOMETRA ESOFGICA. B TOMOGRAFA COMPUTADA. C SERIE ESOFAGOGASTRODUODENAL. D PANENDOSCOPA.
CASO CLNICO HOMBRE DE 46 AOS, ACUDE A DONAR SANGRE Y SU SEROLOGA ES COMPATIBLE CON HEPATITIS C. ANTECEDENTES: MDICO VETERINARIO, HETEROSEXUAL PROMISCUO, RECIBI VARIOS PAQUETES GLOBULARES A LOS 10 AOS DE EDAD POR UN ACCIDENTE AUTOMOVILSTICO. EXPLORACIN FSICA NORMAL. EXMENES DE LABORATORIO: AST, ALT, DHL, FA, BILIRRUBINAS, TP, TPT, COLESTEROL, LPIDOS Y TRIGLICRIDOS NORMALES. EL RESTO DE LA SEROLOGA VIRAL HEPTICA LO REPORTA COMO POSITIVO ANTI-HBS.
PREGUNTA 104 EL SIGUIENTE PASO PARA CONFIRMAR EL DIAGNSTICO EN ESTE PACIENTE ES: A COMPLETAR SEROLOGA PARA HEPATITIS A Y E. B SOLICITAR CARGA VIRAL E IDENTIFICACIN DE RNA DEL VIRUS C. C REALIZAR SEROLOGA COMPLETA PARA VHB. D SOLICITAR PRUEBA VIH. PREGUNTA 105 LA FUENTE DE CONTAGIO DE ESTE PACIENTE, LO MS PROBABLE ES: A LA EXPOSICIN PREVIA AL VIRUS DE LA HEPATITIS B. B EL CONTACTO FRECUENTE CON MATERIA FECAL DE ANIMALES. C LA CONDUCTA SEXUAL CONSIDERADA DE RIESGO. D LA RECEPCIN DE LOS PAQUETES GLOBULARES.

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View Earlier Messages 1 Week2 Weeks1 Month3 Months Ricardo Lpez Snchez 4:57 PM

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CONTROLLING YOUR CRP CONTROLLING YOUR CHOLESTEROL

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:04 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:04 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:15 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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THE FRONTAL LOBE.

XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:27 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:27 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:29 PM

SIMULADOR DE EXAMEN 2011

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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DETERMINACIN DE NIVELES DE HISTAMINA

XXXV Examen Nacional de Aspirantes a Residencias Mdicas 2011 6:31 PM

<< Salir y ver nm. de aciertos en el simulador >>

Nombre del mdico : RICARDO LOPEZ SANCHEZ Nm. de folio : 4369

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