1. CURSO DE INGLÉS
ENGLISH COURSE
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
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2. BRIEF CLINICAL CASES
CASOS CLÍNICOS BREVES
(8)
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
2

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CASE # 71
You are the Student Health Director for a
community college. An administrator calls
regarding recommendations for students
exposed to another student with
meningococcal meningitis.
The most appropriate action would be to:

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a) Place all exposed students on
prophylactic antibiotics
b) Place all students that have not
received meningococcal vaccine on
antibiotic prophylaxis
c) Close the dormitories and send the
students home for at least 10 days

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d) Immunize all students who have not
yet received meningococcal vaccine

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CASE # 72
Which one of the following is true
regarding PPD testing for tuberculosis?
A) Patients who test positive only on the
second step of a two-step PPD test,
given 2 weeks after the first test, are
at high risk for development of active
disease

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b) PPD testing is contraindicated in
patients who are HIV positive
c) Patients who have converted within
the past year should be treated,
regardless of age
d) In patients who previously received a
BCG vaccination, the threshold for a
positive test is 25 mm of induration

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CASE # 73
A 75-year-old African-American female is
diagnosed with macular degeneration. She
is being treated for type 2 diabetes
mellitus, hypothyroidism, hypertension,
hypercholesterolemia, and gout.
Which one of her conditions is associated
with macular degeneration?

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a) Type 2 diabetes mellitus
b) Hypothyroidism
c) Hypertension
d) Gout

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CASE # 74
A positive spot urine test for homovanillic
acid (HMA) and vanillylmandelic acid
(VMA) is a marker for which one of the
following?

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a) Lymphoma
b) Wilms’ tumor
c) Hepatoblastoma
d) Malignant teratoma
e) Neuroblastoma

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CASE # 75
A 28-year-old white female at 28 weeks
gestation with an uncomplicated
pregnancy presents with pain in the right
wrist. She thinks it may be related to
hand-washing several articles of clothing
in a creek and hanging them on a line to
dry while on a camping trip.

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The pain in the wrist radiates down the
thumb and the radial side of the wrist.
There is no history of trauma or
penetrating injury. On examination there
is tenderness when the right radial styloid
is compressed. The pain is exacerbated by
ulnar rotation of the wrist while the
patient’s fingers are folded over the
thumb. The most likely diagnosis is:

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a) Radial sensory nerve entrapment
b) Occult navicular fracture
c) Osteoarthritis of the first
carpometacarpal joint
d) De Quervain’s tenosynovitis
e) Carpal tunnel syndrome

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CASE # 76
You are the attending physician at a long-
term care facility. A new resident, an 85-
year-old female, presents for an initial
visit. Upon reviewing her history, you find
that she is on 18 different medications.
While attempting to obtain additional
history and medical information, you
decide to stop or decrease some of her
medications and monitor her response.

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Which one of the following would be most
appropriate to stop or decrease initially?:
a) Acetaminophen/diphenhydramine
(Tylenol PM HS), 500 mg/25 mg daily
b) Digoxin, 0.125 mg every other day

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c) Omeprazole (Prilosec), 20 mg daily
d) Dipyridamole/aspirin (Aggrenox), 200
mg/25 mg
e) Sertraline (Zoloft), 25 mg daily

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CASE # 77
You have provided care for a 27-year-old
married, monogamous female for several
years. One year ago, she had abnormal
cervical cytology that was interpreted as
“atypical squamous cells of undetermined
significance” (ASC-US).

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She had repeat cervical cytologic
examinations 6 months ago and again last
week, both reported as negative.
Which one of the following would be the
most appropriate next step?:

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a) Cervical culture for herpesvirus
b) Screening for human papillomavirus
c) Colposcopic examination with a biopsy
and endocervical curettage
d) Resuming a routine screening protocol
e) Repeat cervical cytology again in 4–6
months

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CASE # 78
A 45-year-old white male presents with a
3-day history of new-onset acute upper
abdominal pain radiating to the back. His
pulse rate is 110 beats/min and other vital
signs are normal. Bowel sounds are
hypoactive and epigastric tenderness
without guarding is present.

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a) Serum amylase and lipase levels may
be falsely low in renal failure
b) Elevated serum triglyceride levels can
cause falsely elevated serum amylase
levels
c) There is a direct correlation between
serum amylase levels and the severity
of the pancreatitis

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d) A serum amylase level that is three
times normal is highly specific for
pancreatitis

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CASE # 79
You are evaluating a 28-year-old
primigravida for an abnormal
Papanicolaou (Pap) test.
Which one of the following procedures
would be contraindicated?:

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a) Endocervical curettage
b) Human papillomavirus (HPV) testing
c) Colposcopy
d) Cervical staining
e) A cervical biopsy

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CASE # 80
Which one of the following should be
withheld before the administration of
intravenous contrast?
a) Insulin
b) Metformin (Glucophage)

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a) Rosiglitazone (Avandia)
b) Glyburide (Micronase, DiaBeta)

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Continuará……

29. Gracias por su atención
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 – 40 - 26
DR.JCDT
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