ESTUDIO ENARM

1. CASO CLÍNICO
DIA-MEDICINA ESPECIALIDADES 2019: INGLÉS 2019
58 PREGUNTAS JUNTA DEFINITIVA.
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
1._A 59-YEAR-OLD WOMAN WITH FOUR ADULT CHILDREN HAS HAD THREE DAYS OF VAGINAL
BLEEDING FOR A MONTH. IT IS THE FIRST EPISODE OF VAGINAL BLEEDING SINCE HER
MENOPAUSE AT 43 YEARS OF AGE. HE HAS A HISTORY OF ALCOHOLIC CIRRHOSIS. YOURBODY
MASS INDEX IS 32 KG / M2. HE HAS USED A COMBINATION OF ESTROGEN-PROGESTIN AS A
HORMONE REPLACEMENT THERAPY SINCE HE WAS 44 YEARS OLD. HE CURRENTLY HAS THREE
SEXUAL PARTNERS. YOUR PELVIC EXAM IS NORMAL AND THE PAP SMEAR IS SUBSEQUENTLY
READ AS NORMAL. THE NEXT MOST APPROPRIATE STEP IS:
ENDOMETRIAL BIOPSY IN THE OFFICE
COLPOSCOPY
TRANSVAGINAL ULTRASONOGRAPHY
MEASUREMENT OF CA-125 IN SERUM
CASO CLÍNICO
2._A 50 YEAR OLD WOMAN IS DIAGNOSED WITH CERVICAL CANCER. WHICH LYMPH NODE
GROUP WOULD BE THE FIRST INVOLVED IN METASTATIC SPREAD OF THIS DISEASE BEYOND
THE CERVIX AND UTERUS?
COMMON ILIAC NODES
SACRAL NODES
PARACERVICAL NODES
PARA AORTIC NODES
CASO CLÍNICO
3._A 21 YEAR OLD WOMAN PRESENTS WITH LEFT LOWER QUADRANT PAIN. AN ANTERIOR 7CM
FIRM ADNEXAL MASS IS PALPATED. ULTRASOUND CONFIRMS A COMPLEX LEFT ADNEXAL MASS
WITH SOLID COMPONENTS THAT APPEARS TO CONTAIN A TOOTH. WHAT PERCENTAGE OF
THESE TUMORS AREBILATERAL?

2. TO 3%
10%

3. DIA-MEDICINA 4 ESPECIALIDADES 2019: INGLÉS 2019
50%
GREATER THAN 75%
CASO CLÍNICO
4._TWO WEEKS AFTER AN UPPER AIRWAY VIRAL INFECTION, AN 11 YEAR OLD BOY DUETO
SEVERAL DAYS OF “MOUTH WEAKNESS”. HE HAS DEVELOPED DROOPING OF THE LEFT SIDE OF
HIS MOUTH AND IS UNABLE TO COMPLETELY CLOSE HIS LEFT EYE. HE SMILES ASSYMETRICALLY
AND EXAMINATION IS OTHERWISE NORMAL. WHICH OF THE FOLLOWING IS THE MOST LIKELY
DIAGNOSIS?
GUILLAIN-BARRÉ SYNDROME
BOTULISM
BRAINSTEM TUMOR
BELL PALSY
CASO CLÍNICO
5._AN INFANT CAN REGARD HIS PARENT'S FACE, FOLLOW TO MIDLINE, LIFT HIS HEAD FROMTHE
EXAMINING TABLE, SMILE SPONTANEOUSLY, AND RESPOND TO A BELL. HE DOES NOT YET
REGARD HIS OWN HAND, FOLLOW PAST MIDLINE, NOR LIFT HIS HEAD TO A 45° ANGLE OFF THE
EXAMINING TABLE. WHICH OF THE FOLLOWING IS THE MOST LIKELY AGE OF THEINFANT?
1 MONTH
3 MONTHS
6 MONTHS
9 MONTHS
CASO CLÍNICO
6._AN 8 YEAR OLD SICKLE CELL PATIENT ARRIVES AT THE EMERGENCY ROOM IN RESPIRATORY
DISTRESS. OVER THE PREVIOUS SEVERAL DAYS, THE CHILD HAS BECOME PROGRESSIVELY
TIRED AND PALE. THE CHILD’S HEMOGLOBIN CONCENTRATION IS 3.1 MG/DL. WHICH OF THE
FOLLOWING VIRUSES IS LIKELY THE CAUSE OF THIS CLINICAL PICTURE?
ROSEOLA

4. DIA-MEDICINA 4 ESPECIALIDADES 2019: INGLÉS 2019
PARVOVIRUS B19
COXSACKIE A16
CYTOMEGALOVIRUS
CASO CLÍNICO
7. _A 21 YEAR OLD WOMAN PRESENTS WITH LEFT LOWER QUADRANT PAIN. AN ANTERIOR 7CM
FIRM ADNEXAL MASS IS PALPATED. ULTRASOUND CONFIRMS A COMPLEX LEFT ADNEXAL MASS
WITH SOLID COMPONENTS THAT APPEARS TO CONTAIN A TOOTH. WHAT PERCENTAGE OF
THESE TUMORS AREBILATERAL?
2% TO 3%
10%
50%
GREATER THAN 75%
CASO CLÍNICO
8._AN INFANT CAN REGARD HIS PARENT'S FACE, FOLLOW TO MIDLINE, LIFT HIS HEAD FROMTHE
EXAMINING TABLE, SMILE SPONTANEOUSLY, AND RESPOND TO A BELL. HE DOES NOT YET
REGARD HIS OWN HAND, FOLLOW PAST MIDLINE, NOR LIFT HIS HEAD TO A 45° ANGLE OFF THE
EXAMINING TABLE. WHICH OF THE FOLLOWING IS THE MOST LIKELY AGE OF THEINFANT?
1-MONTH
2-MONTHS
6-MONTHS
9-MONTHS
CASO CLÍNICO
9._A MOTHER BRINGS TO YOUR OFFICE AN ARTICLE FROM THE INTERNET SUGGESTINGTHAT
INFANTS IN DAYCARE HAVE A STATISTICALLY HIGHER INCIDENCE OF UPPER RESPIRATORY
INFECTIONS (P<0.05) AS COMPARED TO CHILDREN NOT IN DAY CARE. YOU EXPLAIN TO HER
THAT THIS MEANS WHICH OF THEFOLLOWING?

5. DIA-MEDICINA 4 ESPECIALIDADES 2019: INGLÉS 2019
INFANTS IN DAY CARE ARE 5% MORE LIKELY TO HAVE AN UPPER RESPIRATORY TRACT INFECTION
THAN INFANTS NOT IN DAY CARE
A CRITICAL THRESHOLD FOR MEDICAL SIGNIFICANCE HAS BEEN REACHED
THE ODDS ARE LESS THAN 1 IN 20 THAT THE DIFFERENCES IN UPPER RESPIRATORY INFECTION
RATES OBSERVED WERE ONLY A CHANCE VARIATION
THE STUDY SUGGESTS THAT DAY CARES ARE NOT SAFE FOR CHILDREN
CASO CLÍNICO
10. _A PATIENT COMES TO YOUR OFFICE FOR A HOSPITAL FOLLOW UP. YOU HAD SENT HIM TO
THE HOSPITAL 3 WEEKS EARLIER FOR PERSISTENT FEVERS BUT NO OTHER SYMPTOMS; HE WAS
DIAGNOSED WITH ENDOCARDITIS AND IS CURRENTLY BEING TREATED APPROPRIATELY.
ADVICE TO THIS FAMILY SHOULD NOW INCLUDE WHICH OF THEFOLLOWING?
RESTRICT THE CHILD FROM ALL STRENUOUS ACTIVITIES
GIVE THE CHILD A NO SALT ADDED DIET
PROVIDE THE CHILD WITH ANTIBIOTIC PROPHYLAXIS FOR DENTAL PROCEDURES
TEST ALL FAMILY MEMBERS IN THE HOME WITH REPEATED BLOOD CULTURES
CASO CLÍNICO
11. _A MOTHER CALLS YOU ON THE TELEPHONE AND SAYS THAT HER 4 YEAR OLD SON BIT THE
HAND OF HER 2 YEAR OLD SON 2 DAYS AGO. THE AREA AROUND THE INJURY HAS BECOME RED,
INDURATED, AND TENDER, AND HE HAS A TEMPERATURE OF 39.4°C. WHICH OF THE FOLLOWING
IS THE MOST APPROPRIATE RESPONSE?
ARRANGE FOR A PLASTIC SURGERY CONSULTATION AT THE NEXT AVAILABLE APPOINTMENT
ADMIT THE CHILD TO THE HOSPITAL IMMEDIATELY FOR SURGICAL DEBRIDEMENT
AND ANTIBIOTIC TREATMENT
PRESCRIBE PENICILLIN OVER THE TELEPHONE AND HAVE THE MOTHER APPLY WARM SOAKS FOR
15 MINUTES FOUR TIMES A DAY
SUGGEST PURCHASE OF BACITRACIN OINTMENT TO APPLY TO THE LESION THREE TIMES A DAY
CASO CLÍNICO

6. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
12. _A 10 YEAR OLD BOY, THE STAR PITCHER FOR THE SALT LAKE CITY LITTLE LEAGUE BASEBALL
TEAM, HAD A SORE THROAT ABOUT 2 WEEKS AGO BUT DID NOT TELL ANYONE BECAUSE HE
WAS AFRAID HE WOULD MISS THE PLAY-OFFS. SINCE SEVERAL CHILDREN HAVE BEEN
DIAGNOSED WITH RHEUMATIC FEVER IN THE AREA, HIS MOTHER IS WORRIED THAT HE MAY BE
AT RISK AS WELL. YOU TELL HER THAT SEVERAL CRITERIA MUST BE MET TO MAKE THE
DIAGNOSIS BUT THE MOST COMMON FINDING IS WHICH OF THEFOLLOWING?
CARDITIS
POLYARTHRITIS
ERYTHEMA MARGINATUM
CHOREA
CASO CLÍNICO
13. _A 14 YEAR OLD GIRL, ANGRY AT HER MOTHER FOR TAKING AWAY HER MP3 PLAYER,TAKES
AN UNKNOWN QUANTITY OF A FRIEND'S PILLS. WITHIN THE FIRST HOUR SHE IS SLEEPY, BUT IN
THE EMERGENCY CENTER SHE DEVELOPS HYPOTENSION AND A WIDENED QRS COMPLEX OF
130 MS ON HER ECG. THE THERAPY YOU WOULD INITIATE FOR THIS INGESTION IS WHICH OF
THE FOLLOWING?
N-ACETYLCYSTEINE
NALOXONE AND N-ACETYLCYSTEINE
INTENSIVE CARE UNIT ADMISSION AND SODIUM BICARBONATE
INTRAVENOUS DEFEROXAMINE
CASO CLÍNICO
14. _FOR THE PAST YEAR, A 12 YEAR OLD BOY HAS HAD RECURRENT EPISODES OF SWELLINGOF
HIS HANDS AND FEET, WHICH HAS BEEN GETTING WORSE RECENTLY. THESE EPISODES OCCUR
FOLLOWING EXERCISE AND EMOTIONAL STRESS, LAST FOR 2 TO 3 DAYS, AND RESOLVE
SPONTANEOUSLY. THE LAST EPISODE WAS ACCOMPANIED BY ABDOMINAL PAIN, VOMITING,
AND DIARRHEA. THE RESULTS OF ROUTINE LABORATORY WORKUP ARE NORMAL. AN OLDER
SISTER AND A MATERNAL UNCLE HAVE HAD SIMILAR EPISODES, BUT THEY WERE NOT GIVEN A
DIAGNOSIS. HE PRESENTS TODAY WITH ANOTHER EPISODE. WHICH OF THE FOLLOWING IS THE
MOST LIKELY DIAGNOSIS?
SYSTEMIC LUPUS ERYTHEMATOSUS

7. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CASO CLÍNICO
CONGENITAL NEPHROTIC SYNDROME
ANGIOEDEMA
HENOCH-SCHÖNLEIN PURPURA
CASO CLÍNICO
15. _A 15 YEAR OLD GIRL WITH SHORT STATURE, NECK WEBBING, AND SEXUAL INFANTILISM IS
FOUND TO HAVE COARCTATION OF THE AORTA. ¿A CHROMOSOMAL ANALYSIS LIKELY WOULD
DEMONSTRATE WHICH OF THE FOLLOWING?
MUTATION AT CHROMOSOME 15Q21.1
TRISOMY 21
X0 KARYOTYPE
DEFECT AT CHROMOSOME 4P16
CASO CLÍNICO
16. _A 65 YEAR OLD MAN IS ADMITTED WITH RECTAL BLEEDING. HE NOTICED A SIGNIFICANT
AMOUNT OF BLOOD IN THE TOILET AFTER GOING TO THE BATHROOM THIS MORNING ANDHAD
SOME MILD CRAMPING JUST BEFORE THAT BOWEL MOVEMENT. HIS PAST MEDICAL HISTORY IS
POSITIVE FOR CORONARY ARTERY DISEASE (HE HAD STENTS PLACED AND IS ON ASPIRIN AND
CLOPIDOGREL) AND OSTEOARTHRITIS FOR WHICH HE HAS BEEN TAKING IBUPROFEN. HE DENIES
WEIGHT LOSS AND HASNO PREVIOUS HISTORY OF BLEEDING. ON EXAMINATION HE IS SLIGHTLY
DIAPHORETIC. VITAL SIGNS ARE BP 124/72 AND PULSE 88 WITH THE PATIENT SUPINE, BP94/52
AND PULSE 110 WITH THE PATIENT STANDING. ABDOMEN IS NONTENDER AND NONDISTENDED.
NG ASPIRATE IS NEGATIVE FOR OCCULT BLOOD. AFTER ESTABLISHING TWO LARGE-BORE
INTRAVENOUS LINES, ADMINISTERING AN IV FLUID BOLUS AND OTHERWISE STABILIZING THE
PATIENT, WHAT WILL BE THE MOST IMPORTANT STUDY TO PERFORM?
UPPER ENDOSCOPY
AIR-CONTRAST BARIUM ENEMA
COLONOSCOPY
CT SCAN OF THE ABDOMEN

8. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CASO CLÍNICO
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
17. _A 60 YEAR OLD WOMAN WITH DEPRESSION AND POORLY CONTROLLED TYPE 2 DIABETES
MELLITUS COMPLAINS OF EPISODIC VOMITING OVER THE LAST 3 MONTHS. SHE HAS CONSTANT
NAUSEA AND EARLY SATIETY. SHE VOMITS ONCE OR TWICE ALMOST EVERY DAY. IN ADDITION,
SHE REPORTS SEVERAL MONTHS OF MILD ABDOMINAL DISCOMFORT LOCALIZED TO THE UPPER
ABDOMEN. THE PAIN SOMETIMES AWAKENS HER AT NIGHT. SHE HAS LOST 3 KG OF WEIGHT.
HER DIABETES HAS BEEN POORLY CONTROLLED (GLYCOSYLATED HEMOGLOBIN WAS 9.5).
CURRENT MEDICATIONS ARE GLYBURIDE, METFORMIN, AND AMITRIPTYLINE. HER PHYSICAL
EXAMINATION IS NORMAL EXCEPT FOR MILD ABDOMINAL DISTENTION AND EVIDENCE OF A
PERIPHERAL SENSORY NEUROPATHY. COMPLETE BLOOD COUNT, SERUM ELECTROLYTES, BUN,
CREATININE, AND LIVER FUNCTION TEST ARE ALL NORMAL. GALLBLADDER SONOGRAM IS
NEGATIVE FOR GALLSTONES. UPPER GI SERIES AND CT SCAN OF THE ABDOMEN ARE NORMAL.
WHAT IS THE BEST NEXT STEP EVALUATION OF THIS PATIENT'SSYMPTOMS?
BARIUM ESOPHAGRAM
SCINTIGRAPHIC GASTRIC EMPTYING STUDY
COLONOSCOPY
SMALL BOWEL BIOPSY
CASO CLÍNICO
18. _A 56 YEAR OLD WOMAN BECOMES THE CHIEF FINANCIAL OFFICER OF A LARGE COMPANY
AND, SEVERAL MONTHS THEREAFTER, DEVELOPS UPPER ABDOMINAL PAIN THAT SHE ASCRIBES
TO STRESS. SHE TAKES AND OVER-THE-COUNTER ANTACID WITH TEMPORARY BENEFIT. SHE
USES NO OTHER MEDICATIONS. ONE NIGHT SHE AWAKENS WITH NAUSEA AND VOMITS A
LARGE VOLUME OF COFFEE GROUNDS-LIKE MATERIAL; SHE BECOMES WEAK AND DIAPHORETIC.
UPON HOSPITALIZATION, SHE IS FOUND TO HAVE AN ACTIVELY BLEEDING DUODENAL ULCER.
WHICH OF THE FOLLOWING STATEMENTS ISTRUE?
THE MOST LIKELY ETIOLOGY IS ADENOCARCINOMA OF THE DUODENUM
THE ETIOLOGY OF DUODENAL ULCER IS DIFFERENT IN WOMEN THAN IN MEN
THE LIKELIHOOD THAT SHE HARBORS HELICOBACTER PYLORI IS GREATER THAN 50%
ORGANISMS CONSISTENT WITH H PYLORI ARE RARELY SEEN ON BIOPSY IN PATIENTS WITH
DUODENAL ULCER

9. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
19. _A 50 YEAR OLD PATIENT WITH LONG STANDING CHRONIC OBSTRUCTIVE LUNG DISEASE
DEVELOPS THE INSIDIOUS ONSET OF ACHING IN THE DISTAL EXTREMITIES PARTICULARLY THE
WRISTS BILATERALLY. THERE IS A 5 KG WEIGHT LOSS. THE SKIN OVER THE WRISTS IS WARM AND
ERYTHEMATOUS. THERE IS BILATERAL CLUBBING. PLAIN FILM OF THE FOREARMS REVEALS
BILATERAL PERIOSTEAL THICKENING, POSSIBLE OSTEOMYELITIS, BUT NO JOINT ABNORMALITY.
WHICH OF THE FOLLOWING IS THE MOST APPROPRIATE MANAGEMENT OF THISPATIENT?
START VANCOMYCIN
OBTAIN CHEST X RAY
ASPIRATE BOTH WRISTS
BEGIN METHOTREXATE THERAPY
CASO CLÍNICO
20. _A 76 YEAR OLD WOMAN PRESENTS WITH WORSENING DYSPNEA FOR THE PAST 4 WEEKS.
SHE HAS NOTICED FATIGUE, 4 KG LOSS, AND OCCASIONAL NIGHT SWEATS. ONEXAMINATION
SHE IS MILD RESPIRATORY DISTRESS. HER RR IS 22, AND HER BP IS 134/76. SHE HAS MILD
GENERALIZED LYMPHADENOPATHY, WITH THE LARGEST NODE MEASURING 1.5 CM. LUNG
EXAMINATION REVEALS BIBASILAR DULLNESS WITHOUT RALES OR WHEEZES. HER NECK
VEINS ARE NOT DISTENDED. CXR SHOWS MODERATE LEFT-SIDED PLEURAL EFFUSION. A
THORACENTESIS IS PERFORMED, REVEALING MILKY FLUID. PLEURAL FLUID PROTEIN AND LDH
DEMONSTRATE EXUDATIVE EFFUSION. THE PLEURAL FLUID COUNT IS 4800/MM3 WITH 14%
NEUTROPHILS, 12% MESOTHELIAL CELLS, AND 74% LYMPHOCYTES. PLEURAL FLUID
TRIGLYCERIDE IS 170 MG/DL. WHAT IS THE LIKELY CAUSE OF THIS PATIENT'SILLNESS?
TUBERCULOSIS
LUNG CANCER
LYMPHOMA
PNEUMONIA WITH PARAPNEUMONIC EFFUSION
CASO CLÍNICO

10. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
21. _A 40 YEAR OLD ALCOHOLIC DEVELOPS COUGH AND FEVER. CHEST X RAY, SHOWN BELOW,
SHOWS AN AIR FLUID LEVEL IN THE SUPERIOR SEGMENT OF THE RIGHT LOWER LOBE. WHICH OF
THE FOLLOWING IS THE MOST LIKELY ETIOLOGICAGENT?
STREPTOCOCCUS PNEUMONIAE
HAEMOPHILUS INFLUENZAE
LEGIONELLA PNEUMOPHILA
ANAEROBES
CASO CLÍNICO
22. _A 29 YEAR OLD G3 P2 PRESENTS TO THE EMERGENCY CENTER WITH COMPLAINTS OF
ABDOMINAL DISCOMFORT FOR 2 WEEKS. HER VITAL SIGNS ARE: BLOOD PRESSURE 120/70
MMHG, PULSE 90 BEATS PER MINUTE, TEMPERATURE 36.9°C, RESPIRATORY RATE 18 BREATHS
PER MINUTE. A PREGNANCY TEST IS POSITIVE AND AN ULTRASOUND OF THE ABDOMEN AND
PELVIS REVEALS A VIABLE 16 WEEK GESTATION LOCATED BEHIND A NORMAL APPEARING
10X6X5.5 CM UTERUS. BOTH OVARIES APPEAR NORMAL. NO FREE FLUID IS NOTED. WHICH OF
THE FOLLOWING IS THE MOST LIKELY CAUSE OF THESEFINDINGS?
ECTOPIC OVARIAN TISSUE
FISTULA BETWEEN THE PERITONEUM AND UTERINE CAVITY
PRIMARY PERITONEAL IMPLANTATION OF THE FERTILIZED OVUM
TUBAL ABORTION
CASO CLÍNICO
23. _A 22 YEAR OLD HAS JUST BEEN DIAGNOSED WITH TOXOPLASMOSIS. YOU TRY TO
DETERMINE WHAT HER RISK FACTORS WERE. THE HIGHEST RISK ASSOCIATION IS WHICH OF
THE FOLLOWING?
EATING RAW MEAT
EATING RAW FISH
OWNING A DOG

11. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CASO CLÍNICO
HAVING VIRAL INFECTIONS IN EARLY PREGNANCY
CASO CLÍNICO
24. _A 5 YEAR OLD BOY IS BROUGHT INTO THE ER IMMEDIATELY AFTER ANUNFORTUNATE
ALTERCATION WITH A NEIGHBOR’S IMMUNIZED CHIHUAHUA THAT OCCURRED WHILE THE
CHILD WAS ATTEMPTING TO DRESS THE DOG AS A SUPERHERO. THE FULLY IMMUNIZEDCHILD
HAS A SMALL, IRREGULAR, SUPERFICIAL LACERATION ON HIS RIGHT FOREARM THAT HAS
STOPPED BLEEDING. HIS NEUROMUSCULAR EXAMINATION IS COMPLETELY NORMAL, AND
HIS PERFUSION IS INTACT, MANAGEMENT SHOULD INCLUDE WHICH OF THEFOLLOWING?
IRRIGATION AND ANTIMICROBIAL PROPHYLAXIS
TETANUS BOOSTER IMMUNIZATION AND TETANUS TOXOID IN THE WOUND
COPIOUS IRRIGATION
PRIMARY RABIES VACCINATION FOR THE CHILD
CASO CLÍNICO
25. _AUNT MARY IS HELPING HER FAMILY MOVE TO A NEW APARTMENT. DURING THE
CONFUSION, 3 YEAR OLD JIMMY IS NOTED TO BECOME LETHARGIC. THE CONTENTS OFAUNT
MARY’S PURSE ARE STREWN ABOUT ON THE FLOOR. IN THE ER, THE LETHARGIC JIMMY IS
FOUND TO HAVE MIOSIS, BRADYCARDIA, AND HYPOTENSION. HE DEVELOPS RESPIRATORY
DEPRESSION THAT PROGRESSES TO APNEA, AND HAS TO BE INTUBATED. HIS CONDITION
WOULD MOST LIKELY BENEFIT FROM WHICH OF THE FOLLOWINGTHERAPIES?
DEFEROXAMINE
NALOXONE
N-ACETYLCYSTEINE
CROTALIDAE POLYVALENT IMMUNE FAB

12. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
26. _AS A CITY PUBLIC HEALTH OFFICER, YOU HAVE BEEN CHARGED WITH THE TASK OF
SCREENING HIGH-RISK CHILDREN FOR LEAD POISONING. WHICH OF THE FOLLOWING IS THEBEST
SCREEN FOR THIS PURPOSE?
ERYTHROCYTE PROTOPORPHYRIN LEVELS
CBC AND BLOOD SMEAR
BLOOD LEAD LEVEL
ENVIRONMENTAL HISTORY
CASO CLÍNICO
27. _A 15 YEAR OLD IS PARTICIPATING IN HIGH SCHOOL FOOTBALL PRACTICE. HE HAD
COMPLAINED OF HEADACHE AND NAUSEA EARLIER IN PRACTICE, BUT KEPT PLAYINGAFTER
A CUP OF WATER. HE IS NOW CONFUSED AND COMBATIVE. HE IS DIZZY AND SWEATING
PROFUSELY. HIS TEMPERATURE IS 41°C. THERAPY SHOULD CONSIST OF WHICH OF THE
FOLLOWING?
PROVIDE ORAL REHYDRATION SOLUTIONS
ADMINISTER ACETAMINOPHEN RECTALLY
INITIATE WHOLE BODY COLD WATER IMMERSION
TELL HIM TO TAKE A SHOWER AND REST UNTIL THE NEXT DAY’S PRACTICE
CASO CLÍNICO
28. _A 18 YEAR OLD G1 AT 8 WEEKS GESTATION COMPLAINS OF NAUSEA AND VOMITING
OVER THE PAST WEEK OCCURRING ON A DAILY BASIS. NAUSEA AND EMESIS ARE ACOMMON
SYMPTOM IN EARLY PREGNANCY. WHICH OF THE FOLLOWING SIGNS OR SYMPTOMS WOULD
INDICATE A MORE SERIOUS DIAGNOSIS OF HYPEREMESIS GRAVIDARUM?
HYPOTHYROIDISM
HYPOKALEMIA
WEIGHT GAIN

13. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
DIARRHEA
CASO CLÍNICO
29. _A 32 YEAR OLD G2 P1 PRESENTS TO LABOR AND DELIVERY AT 34 WEEKS OF GESTATION,
COMPLAINING OF REGULAR UTERINE CONTRACTIONS ABOUT EVERY 5 MINUTES FOR THE PAST
SEVERAL HOURS. SHE HAS ALSO NOTICED THE PASSAGE OF A CLEAR FLUID FROM VAGINA. A
NURSE PLACES THE PATIENT ON AN EXTERNAL FETAL MONITOR AND CALLS YOU TO EVALUATE
HER STATUS. THE EXTERNAL FETAL MONITOR DEMONSTRATES A REACTIVE FETAL HEART RATE
TRACING, WITH REGULAR UTERINE CONTRACTIONS OCCURRING ABOUT 3 TO 4 MINUTES. ON
STERILE SPECULUM EXAMINATION, THE CERVIX IS VISUALLY CLOSED. A SAMPLE OF POOLED
AMNIOTIC FLUID SEEN IN THE VAGINAL VAULT IS FERN AND NITRAZINE POSITIVE. THEPATIENT
HAS A TEMPERATURE OF 38.8°C, PULSE 102 BEATS PER MINUTE, BLOOD PRESSURE100/60
MMHG, AND HER FUNDUS IS TENDER TO DEEP PALPATION. HER ADMISSION BLOOD WORK
COMES BACK INDICATING A WBC OF 19,000. THE PATIENT IS VERY CONCERNED BECAUSE SHE
HAD PREVIOUSLY DELIVERED A BABY AT 35 WEEKS WHO SUFFERED FROM RESPIRATORY
DISTRESS SYNDROME (RDS). YOU PERFORM A BEDSIDE SONOGRAM, WHICH INDICATES
OLIGOHYDRAMNIOS AND A FETUS WHOSE SIZE IS APPROPRIATE FOR GESTATIONAL AGE AND
WITH CEPHALIC PRESENTATION. WHICH OF THE FOLLOWING IS THE MOST APPROPRIATE NEXT
STEP IN THE MANAGEMENT OF THIS PATIENT?
ADMINISTER BETAMETHASONE
ADMINISTER TOCOLYTICS
ADMINISTER ANTIBIOTICS
PERFORM EMERGENT CESAREAN SECTION
CASO CLÍNICO
30. _A 30 YEAR OLD G1P0 WITH A TWIN GESTATION AT 25 WEEKS PRESENTS TO LABOR AND
DELIVERY COMPLAINING OF IRREGULAR UTERINE CONTRACTIONS AND BACK PAIN. SHE
REPORTS AN INCREASE IN THE AMOUNT OF HER VAGINAL DISCHARGE, BUT DENIES ANY
RUPTURE OF MEMBRANES. SHE REPORTS THAT EARLIER IN THE DAY SHE HAD SOME VERY LIGHT
VAGINAL BLEEDING, WHICH HAS NOW RESOLVED. ON ARRIVAL TO LABOR AND DELIVERY, SHE IS
PLACED ON AN EXTERNAL FETAL MONITOR, WHICH INDICATES UTERINE CONTRACTIONSEVERY
2 TO 4 MINUTES. SHE IS AFEBRILE AND HER VITAL SIGNS ARE ALL NORMAL. HER GRAVID UTERUS

14. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
IS NONTENDER. THE NURSE CALLS YOU TO EVALUATE THE PATIENT. WHICH OF THE FOLLOWING
IS THE MOST APPROPRIATE FIRST STEP IN THE EVALUATION OF VAGINAL BLEEDING IN THIS
PATIENT?
VAGINAL EXAMINATION TO DETERMINE CERVICAL DILATATION
ULTRASOUND TO CHECK PLACENTAL LOCATION
URINE CULTURE TO CHECK FOR URINARY TRACT INFECTION
LABS TO EVALUATE FOR DISSEMINATED INTRAVASCULAR COAGULOPATHY
CASO CLÍNICO
31. _A MATERNAL FETAL MEDICINE SPECIALIST IS CONSULTED AND PERFORMS AN IN DEPTH
SONOGRAM ON A 30 YEAR OLD G1 AT 28 WEEKS WITH A TWIN GESTATION. THE SONOGRAM
INDICATES THAT THE FETUSES ARE BOTH MALE, AND THE CHORIONICITY IS DIAMNIOTIC AND
MONOCHORIONIC. TWIN B IS NOTED TO HAVE OLIGOHYDRAMNIOS AND TO BE MUCH
SMALLER THAN TWIN A. WHICH OF THE FOLLOWING WOULD BE A FINDING MOST LIKELY
ASSOCIATED WITH TWIN A?
CONGESTIVE HEART FAILURE
ANEMIA
HYPOVOLEMIA
HYPOTENSION
CASO CLÍNICO
32. _A ONE-DAY-OLD NEWBORN PRESENTS PERSISTENT VOMITING. HE HAS NOT EVACUATED
ANYTHING. HE WAS BORN TO TERM AND DID NOT HAVE BREATHING DIFFICULTIES. A
NASOGASTRIC TUBE IS EASILY PASSED TO YOUR STOMACH. AN ABDOMINAL X-RAY IS ORDERED,
WHICH IS SHOWN IN FIGURE 3. WHAT IS THE MOST LIKELY DIAGNOSIS OF THISINFANT?
ADRENOGENITAL SYNDROME
PYLORIC STENOSIS

15. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
DUODENAL ATRESIA
ESOPHAGEAL ATRESIA WITH DISTAL TRACHEOESOPHAGEAL ATRESIA
CASO CLÍNICO
33. _ A TWO-YEAR-OLD PRESCHOOLER REFUSES TO MOVE HIS LEFT ARM AND KEEPS IT FLEXED
AT THE ELBOW, WITH THE FOREARM PRONATED. HIS FATHER HAD SPUN AROUND HOLDINGTHE
CHILD'S FOREARMS. THERE IS NO OTHER HISTORY OF TRAUMA. THE MOST LIKELY DIAGNOSISIS:
CLAVICLE FRACTURE
SALTER TYPE IV FRACTURE OF THE DISTAL HUMERUS
DISLOCATION OF THE RADIAL HEAD
TORUS FRACTURE OF THE DISTAL PORTION OF THE RADIUS
CASO CLÍNICO
34. _FEMALE PATIENT OF 15 YEARS OF AGE WHO COMES TO THEEMERGENCY SERVICE FOUR
HOURS AFTER INGESTING ASPIRIN. AFTER THE QUESTIONING YOU CALCULATE THAT YOU
INGESTED APPROXIMATELY 150 MG / KG. THE PHYSICAL EXAMINATION IS COMPLETELY
NORMAL. WHICH OF THE FOLLOWING TREATMENTS WOULD BE THE MOSTUSEFUL?
INDUCE VOMITING
ADMINISTER N-ACETYLCYSTEINE
ADMINISTER A CATHARTIC
ADMINISTER IV FLUIDS TO INCREASE URINE PRODUCTION
CASO CLÍNICO
35. _A GIRL OF 5 MONTHS OF AGE HAS A PICTURE OF TWO DAYS OF RHINORRHEA AND A DAYOF
FEVER AND WORSENING COUGH. SHE HAD BEEN WELL BEFORE THAT TIME AND HAD NOTHAD

16. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CASO CLÍNICO
SIMILAR SYMPTOMS. ON PHYSICAL EXAMINATION, IT HAS INSPIRATORY STRIDOR. WHAT OF
THE FOLLOWING SHOULD BE TAKEN INTO ACCOUNT IN THE DIFFERENTIAL DIAGNOSIS?
ACUTE BRONCHIOLITIS
ACUTE LARYNGOTRACHEOBRONCHITIS
A FOREIGN BODY IN THE RESPIRATORY TRACT
LARYNGOMALACIA
CASO CLÍNICO
36. _A TWO-WEEK-OLD INFANT IS TAKEN TO THE EMERGENCY DEPARTMENT WITH A DAY'S
VOMIT. ON PHYSICAL EXAMINATION THE BABY IS VERY LETHARGIC, WITH POOR BLOOD SUPPLY
AND APPEARS MODERATELY DEHYDRATED. ELECTROLYTE NUMBERS: SODIUM 115,POTASSIUM
6.0 AND CARBON DIOXIDE 15. THE GLUCOSE IS 40. WHICH OF THE FOLLOWING IS THE MOST
LIKELY DIAGNOSIS?
CONGENITAL ADRENAL HYPERPLASIA
DUODENAL ATRESIA
GASTROENTERITIS
PYLORIC STENOSIS
CASO CLÍNICO
37. _AN 18-MONTH-OLD CHILD PRESENTS WITH A TWO-DAY EPISODE OF INTERMITTENT
VOMITING AND IRRITABILITY. IN THE PHYSICAL EXAMINATION IT SEEMS UNCOMFORTABLE, IT
HAS FULLNESS IN THE LOWER RIGHT QUADRANT OF THE ABDOMEN AND IN THE DIAPER THERE
ARE FECES IN "RASPBERRY JELLY". WHICH OF THE FOLLOWING IS THE MOST LIKELY DIAGNOSIS?
GASTROENTERITIS
INTUSSUSCEPTION
MECKEL'S DIVERTICULUM
VOLVULUS

17. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
38. _AN INFANT OF THREE DAYS OF AGE IS TAKEN TO THE CLINIC DUE TO CONSTIPATION.
EVACUATION HAS NOT BEEN DOCUMENTED, SHE HAS BEEN WELL FED TO THE MOTHER'S
BREAST AND HAS NOT HAD VOMITING. HIS MOTHER THINKS THAT HIS ABDOMEN IS
DISTENDED. ON PHYSICAL EXAMINATION, THE BABY'S WEIGHT EQUALS HER BIRTH WEIGHT.
YOUR ABDOMEN IS DISTENDED AND THERE ARE NO OTHER ABNORMAL DATA. WHICH OF THE
FOLLOWING IS THE MOST LIKELY DIAGNOSIS?
ESOPHAGEAL ATRESIA
FUNCTIONAL CONSTIPATION
HIRSCHSPRUNG'S DISEASE
MATERNAL BREAST FEEDING FAILURE
SERIOUS CLINICAL CASE
CASO CLÍNICO
39. _WOMAN OF 32 YEARS OF AGE, FIRST, CURRENTLY CURSING WITH HER FIRST PREGNANCYOF
33 WEEKS OF GESTATION. GOING TO URGENT CONSULTATION WHEN PERCATARIZING YOUR
TUMORATION IN A RIGHT MOM AND CHANGING THE COLORING OF THE SKIN. THE
EXPLORATION IS MAMA RIGHT NOMINE OF 2.5 CENTIMETERS OF DIAMETER IN THE EXTERNAL
UPPER CUADRANTE, WITH BORDERS BAD DEFINITIONS, FIXED AND INDOLORUS. THE MOST
PROBABLE CLINICAL DIAGNOSIS IS:
CYCLICAL MASTALGIA
BREAST CANCER
FIBROCHEMICAL MASTOPATHY
FIBROADENOMA
40. _THE TREATMENT CONSISTS OF:
INDICATE AINES
SUPPRESSION OF METILXANTINES
PERFORM TUMORECTOMY OR MASTECTOMY

18. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CORREOCIFRADONOREENVÍO/CUALQUIERUSONOREQUISITADOSEPROCEDERÁAIRRUMPIRPROCESO.
TAMOXIFEN
CASO CLÍNICO
41. _WOMAN OF 32 YEARS OF AGE WITH PREGNANCY OF 32 SDG AND WHO DURING HER
ASSESSMENT INTEGRATES THE DIAGNOSIS OF ASYMPETOMA BACTERIURIA. DOES NOT HAVE A
SPECIFIC BACTERIAL ISOLATION REPORT OR ANTIBIOGRAM. IN THIS CASE THE FOLLOWING
TREATMENT SHOULD BE INDICATED:
AZITHROMYCIN
NITROFURANTOIN
OFLOXACINE
AMIKACINA
CASO CLÍNICO
42. _WOMAN OF 24 YEARS OLD WITH PREGNANCY IN THE SECOND QUARTER OF GESTATION.
GOES TO PRENATAL CONSULTATION REFERRING NÁUSEAS, CASUAL VOMITING,FREQUENTLY
ASKED AND TENDENCY TO CONSTIPATION. TO EXPLORATION WITHOUT ALTERATIONS.
UROCULTIVE POSITIVE REPORT IS REPORTED THE DIAGNOSIS OF THE PATIENTIS:
NERVOUS COLITIS
ASYMPTOMATIC BACTERIURIA
PIELONEFRITIS
GRAVITY HYPERHEMESIS
CASO CLÍNICO
43. _FARMER OF 43 YEARS OF AGE, WITH A BACKGROUND OF CHRONIC ALCOHOLISM. REFERRED
FOR ONE WEEK HIPERTERMIA QUANTIFIED ABOVE 38.5 ° C OF VESPERTINE PREDOMININE,
ABDOMINAL PAIN IN FLANCO RIGHT AND DIARRHEA ONLY IN 1 OR 2 OCCASIONS. TO THE PHYSICAL
EXPLORATION TEMPERATURE OF 39 ° C, DYSNÉICO, GENERALIZED INTENSE ++, GLOBAL ABDOMEN
WITH PAINFUL HEPATOMEGALIA, WITH EDGE AT 5CM BELOW THE COSTAL REBORDE. LABORATORY
STUDIES REVEAL NORMOCYTIC NORMOCYTIC ANEMIA, LEUKOCYTOSIS, ELEVATED HEPATIC
ENZYMES AND ELEVATION OF ALKALINE PHOSPHATASE. THETHORAX

19. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
RADIOGRAPHY SHOWS ELEVATION OF THE RIGHT HEMIDIAPHRAGM. AS PART OF THE PATIENT
STUDY PROTOCOL SHALL BE REQUESTED AT THIS TIME:
COMPUTED TOMOGRAPHY
RADIOGRAPHY OF ABDOMEN
A LIVER ULTRASOUND
A VIRAL PANEL OF HEPATITIS
CASO CLÍNICO
44. _MAN OF 54 YEARS OF AGE, WITH A BACKGROUND OF CROHN'S DISEASE WHICH HAS
ALREADY BEEN TREATED WITH GLUCOCORTICOIDS AND MESALAZINE WITHOUT CLINICAL
IMPROVEMENT WHY SINCE 1 WEEK STARTED HANDLING WITH INFLIXIMAB.CORRESPONDS
TO THE MECHANISM OF ACTION OF THE MEDICINALPRODUCT INDICATED IN THISPATIENT:
INHIBITS THE CELLULAR IMMUNE SYSTEM
INHIBITS REDUCTASE DIHYDROFOLATE
ACT AGAINST THE TUMOR NECROSIS FACTOR
INHIBITS THE SYNTHESIS OF NUCLEIC ACIDS
CASO CLÍNICO
SERIOUS CLINICAL CASE
45. _WOMAN OF 70 YEARS OLD, HOSPITALIZED SINCE 24 HRS WITH SUSPECTED CANCER OF THE
BODY OF PANCREAS. IT IS PRESENTED IN 100% OF THE PATIENTS WITH CANCER OF THE BODY OF
THE PANCREAS:
WEIGHTLOSS
ABDOMINAL OR PERSISTENT LOW BACK PAIN
ANOREXY
JAUNDICE
46. _TO CONFIRM THE DIAGNOSIS, THE FOLLOWING STUDY SHALL BE INDICATED OF
FIRST INTENTION:
TUMOR MARKER LEVELS CA 19-9

20. . DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
ANALYSIS OF BRUSHING AND PANCREATIC JUICE OBTAINED ENDOSCOPICALLY
USG OF PANCREAS, LIVER AND BILIARY
HELICOIDAL TOMOGRAPHY IN ARTERIAL PHASE AND PORTAL
CASO CLÍNICO
47. _MALE OF 60 YEARS OLD, WITH DIAGNOSIS OF ADENOCARCINOMA OF PANCREAS. OF THE
BACKGROUND AND RISK FACTORS THAT SHOULD BE INVESTIGATED, THE MOST IMPORTANTIS:
TOBACCO
HEREDITARY PANCREATITIS
ANTECEDENT OF ACUTE PANCREATITIS
DIABETES MELLITUS TYPE 2
CASO CLÍNICO
SERIOUS CLINICAL CASE
48. _A 43-YEAR OLDER ALCOHOL, WHICH COMES TO HIS OFFICE FOR SUBMITTING ABDOMINAL
TRANSFERAL PAIN IN HIGHER HALF OF THE ABDOMEN, OF SEVERE INTENSITY, ACCOMPANIEDBY
NAUSEA THAT PRECEDES VOMITING IN NUMBER OF 10 OF GASTROBILIAR CONTENT IN THE LAST
12 HRS. THE LABORATORIES REPORT TOTAL BILIRUBINS OF 4 MG / DL, ALKALINE PHOSPHATASE
OF 359 IU / DL AND LIGHT ELEVATION OF HEPATIC ENZYMES. THE MOST PROBABLE CLINICAL
DIAGNOSIS:
ALCOHOL HEPATITIS
ACUTE PANCREATITIS
ACUTE LITHIASIC CHRONIC CHOLECTISTITIS
PERFORATED DUODENAL ULCER
49. _THE INITIAL TREATMENT CONSISTSOF:
HYDRATING THE PATIENT

21. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
PRACTICE COLLECISTECTOMY
CASO CLÍNICO
50._WOMAN OF 32 YEARS OF AGE, WITH RECENT DIAGNOSIS OF ASTHMA. DURING THE
INTERROGATION IT WILL BE IMPORTANT TO INVESTIGATE THE BACKGROUND OF THE
FOLLOWING ILLNESS THAT HAS DEMONSTRATED TO INCREASE IN GREATER PROPORTION THE
RISK OF PRESENTING ASTHMA IN THE ADULTS WHEN IT IS NOT ADEQUATELY TREATED
DURING THE CHILDHOOD:
ATOPIC DERMATITIS
URTICARIA
ALLERGIC CONJUNCTIVITIS
ALLERGIC RHINITIS
CASO CLÍNICO
51._MAN 42 YEARS OF AGE HOSPITALIZED FOR PRESENTING RESTRICTIVE PLEURAL SPILL.
EVACUATING ENDOPLEURAL PROBE WAS PRESENTED, PRESENTING IMPORTANT
IMPROVEMENT. THE FOLLOWING IS A CRITERIA OF WITHDRAWAL OF THE ENDOPLEURAL
PROBE:
VOLUME OF PLEURAL LIQUID LESS THAN 50 ML
VOLUME OF PLEURAL LIQUID LESS THAN 100 ML
PLACE GRAHAM PATCH
MANAGE ANTIBIOTICS
VOLUME OF PLEURAL LIQUID LESS THAN 150 ML
VOLUME OF PLEURAL LIQUID LESS THAN 200 ML

22. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CASO CLÍNICO
52. _A 65-YEAR-OLD MAN WITH A TABACQUER INDEX OF 23 AND A CHRONIC OBSTRUCTIVE
PULMONARY DISEASE OF 20 YEARS OF EVOLUTION. GO TO CONSULTATION BY PRESENCE OF TOS
DISNEIZANTE, PURULENTA EXPECTORACIÓN AND FEVER. TO THE PHYSICAL EXPLORATION IMC
34, TEMPERATURE 38 ° C, OROPHARINGE ERYTHEMATOSA, LUNG FIELDS WITH DIFFUSED
ESTERTORS AND BILATERAL PARAVERTEBRAL PREDOMINAL SIBILANCES. THE OBESITY
PRESENTED BY THE PATIENT CONTRIBUTES TO THEIR PULMONARY PATHOLOGY BECAUSE IT
CAUSES:
INCREASING THE DISTENSIBILITY OF THE THORACIC WALL
DECREASE OF FUNCTIONAL RESIDUAL CAPACITY
INCREASE IN THE SPIRATORY RESERVE VOLUME
LESS RESPIRATORY WORK
CASO CLÍNICO
53. _A 25-YEAR-OLD MAN WHO COMES TO CONSULTATION WHEN HE HAS A VERY BAD
CONTROL OF HIS ALLERGIC RHINITIS. DURING HIS ASSESSMENT, HE FINDS THAT THE BASIS OF
HIS TREATMENT HAS BEEN EXCLUSIVELY WITH ANTIHISTAMINES. YOU CONSIDER STARTING
TREATMENT WITH NASAL STEROIDS, WHICH MUST BE INDICATED FROM THE FOLLOWINGLEVEL
OF CARE:
FIRST LEVEL OF ATTENTION
SECOND LEVEL OF ATTENTION
THIRD LEVEL OF ATTENTION
NOT INDICATED
CASO CLÍNICO
SERIOUS CLINICAL CASE

23. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
54. _A 36-YEAR-OLD MAN WHO BEGAN A HYPOCALORIC DIET SINCE 5 MONTHS HAVING LOST
UNTIL THE DATE OF 25 KG. CURRENTLY HE IS OBSESSED BY SEEING MORE THAN DELAYED
THAN FOR 15 DAYS IS SUBJECT TO A MORE STRICT REGIME CONSUMING FOODS EASY TO
ELIMINATE AND THREE OR FOUR TIMES A WEEK HAVE AFTERNOON FOOD AFTER WHICH
VOMITING IS INDUCED. HE HAS BEGUN TO EXERCISE AND SAYS HE HAS NO CONTROL OVER
THE FOOD. THE TREATMENT THAT THIS PATIENT SHOULD BEGIN IS TOBEGIN:
TREATMENT WITH ANSIOLITHTICS AND ANTIDEPRESSANTS
BEHAVIORAL COGNITIVE THERAPY
ANALYTICAL PSYCHOTHERAPY
HYPNOTHERAPY AND ACUPUNCTURE
55. _AS PART OF THE IMMEDIATE STUDY OF THE PATIENT YOU SHOULDREQUEST:
PROOF OF THYROID FUNCTION
ELECTROLYTES SÉRICOS
SKULL IMAGE STUDIES
ELECTROENCEPHALOGRAM
CASO CLÍNICO
56. _AT THE HEALTH CENTER WHERE YOU ARE INDICATED TO DEVELOP THE REFERENCE GUIDE
OF THE MOST COMMON PSYCHIATRIC SICKNESSES IN YOUR STATE. YOU WILL BEGIN THEGUIDE
WITH THE PSYCHIATRIC ADULT DISORDER WITH A HIGHER FREQUENCY AMERITA
HOSPITALIZATION IN MEXICO:
PHARMACODEPENDENCE
DEMENTIA
SCHIZOPHRENIA
MENTAL RETARDATION
CASO CLÍNICO

24. DIA-MEDICINA 3 ESPECIALIDADES 2019: INGLÉS 2019
CORREO CIFRADO NO REENVÍO/ CUALQUIER USO NO REQUISITADO SE PROCEDERÁ A IRRUMPIR PROCESO.
57. _SENIL WOMAN WHO IS FOUND ON THE STREET WITH LOSS OF THE STATE OF ALERT SO IT
IS TAKEN IMMEDIATELY TO THE EMERGENCY SERVICE. DURING YOUR ASSESSMENT YOU ARE
FOUND WITH PHYSICAL ABUSE DATA. THE PATIENT WAKES UP, REMAINING DISORIENT AND
WITHOUT BE ABLE TO PROVIDE PERSONAL DATA OR HER FAMILY MEMBERS. IN THEHOSPITAL,
AN AREA IS FOUND TO HOSPITALIZE SENIOR ADULT VICTIMS OF ABUSE. TO BE ABLE TO ENTER
THAT AREA, THE AGE OF THE PATIENT SHALL BE OF AT LEAST:
70 YEARS
65 YEARS
60 YEARS
55 YEARS
CASO CLÍNICO
58. _YOU ARE CURRENTLY IN CHARGE OF THE ATTENTION CLINIC OF THE ELDERLY ADULT,
WHERE YOU HAVE BEEN COMMITTED TO PUT MAIN ATTENTION TO THE DIAGNOSIS OF THE
PATIENT WITH MALTREATMENT. FROM THE TYPES OF MALTREATMENT TO PATIENTS INTHIS
AGE GROUP, THE LESS FREQUENT CAUSE IS:
PHYSICAL
PSYCHOLOGICAL
SEXUAL
NEGLIGENCE AND ABANDONMENT