This document contains a series of clinical cases and questions related to various medical conditions. Each case provides brief details about a patient and their symptoms, and is followed by multiple choice questions testing knowledge of the case. The cases cover topics like premenstrual syndrome, diabetes, blood typing in pregnancy, sleep disorders, bullying, prostate exams, skin infections, urinary tract infections, gastrointestinal issues, and COPD.

1. CURSO DE INGLÉS
ENGLISH COURSE
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
1

2. BRIEF CLINICAL CASES
CASOS CLÍNICOS BREVES
(9)
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
2

3. DR.JCDT
3
CASE # 81
Over the past year, a 27-year-old female
has had marked feelings of anxiety,
tension, and irritability during the week
preceding most menstrual cycles,
accompanied by extreme fatigue and
insomnia. She has regularly missed several
days of work each month because of
fatigue.

4. DR.JCDT
4
She has no previous history of any health
or mental problems, and within a few days
of the onset of her period she is back to
normal.
Which one of the following is true
concerning this condition?:

5. DR.JCDT
5
a) Oral contraceptive pills are consistently
effective in the treatment of this
condition
b) Alprazolam (Xanax) is an effective first-
line agent for treatment of this
condition
c) This condition is a variation of a
depressive disorder

6. DR.JCDT
6
d) Neither biologic nor psychological
factors play a part in this condition
e) This problem can be effectively treated
with serotonergic antidepressants

7. DR.JCDT
7
CASE # 82
An 81-year-old retired electrical engineer
whose wife is a diabetic was
experimenting with his wife’s glucose
meter and found that his glucose level was
198 mg/dL. He used her strips and lancets,
and started his own log. After a week, he
brings the log to you. His premeal glucose
levels range from about 150 mg/dL to 250
mg/dL.

8. DR.JCDT
8
A review of his medications shows none
that would be likely to increase his glucose
level. A physical examination does not
suggest glucose intolerance secondary to a
process other than diabetes. His
hemoglobin A1c is 9.0%. Additional
laboratory studies should be performed
before prescribing which one of the
following for this patient?:

9. DR.JCDT
9
a) Metformin (Glucophage)
b) Glimepiride (Amaryl)
c) Miglitol (Glyset)
d) Insulin NPH (Humulin N)

10. DR.JCDT
10
CASE # 83
A 23-year-old gravida 3 para 1 at 28 weeks
gestation whose blood type is O-negative
is antibody positive (D antibody) on a
routine 28-week screen.
Which one of the following best describes
the clinical significance of this finding?:

11. DR.JCDT
11
a) The fetus HAS hemolytic disease and
requires appropriate monitoring and
treatment
b) The current fetus is NOT at risk for
hemolytic disease, but subsequent
pregnancies may be at risk

12. DR.JCDT
12
c) The fetus is AT RISK for hemolytic
disease only if the biological father is
Rh-negative
d) The fetus is AT RISK for hemolytic
disease only if the biological father is
Rh-positive

13. DR.JCDT
13
CASE # 84
A 5-year-old African-American male
presents with behavior problems noted in
the first 3 months of kindergarten. The
mother explains that the child does not
pay attention and often naps in class. He
averages 10 hours of sleep nightly and is
heard snoring frequently.

14. DR.JCDT
14
The mother has a history of attention-
deficit disorder and takes atomoxetine
(Strattera). The boy’s examination is
within normal limits except for his being in
the 25th percentile for weight and having
3+ tonsillar enlargement.
The most reasonable plan at this point
would include which one of the
following?:

15. DR.JCDT
15
a) Polysomnography
b) An electroencephalogram
c) Methylphenidate (Ritalin)
d) Atomoxetine

16. DR.JCDT
16
CASE # 85
A 16-year-old male is brought to your
office by his mother for “stomachaches.”
On review of systems, he also complains of
headaches, occasional bedwetting, and
trouble sleeping. His examination is within
normal limits.

17. DR.JCDT
17
His mother says that he is often in the
nurse’s office at school, and doesn’t seem
to have any friends. After some questions
from you, he admits to being called names
and teased at school.
Which one of the following would be most
appropriate?:

18. DR.JCDT
18
a) Explain that these symptoms are a
stress reaction and will lessen with
time
b) Explain that he must try to conform to
be more popular
c) Order a TSH level
d) Explore whether his school counselor
has a process to address this problem

19. DR.JCDT
19
CASE # 86
You are evaluating a 68-year-old male with
obstructive urinary symptoms.
Which one of the following medications
may lead to falsely depressed levels of
prostate-specific antigen (PSA)?

20. DR.JCDT
20
a) Terazosin (Hytrin)
b) Tamsulosin (Flomax)
c) Doxazosin (Cardura)
d) Lycopene
e) Finasteride (Proscar

21. DR.JCDT
21
CASE # 87
The most appropriate initial treatment for
scabies in an 8-year-old male is
a) Trimethoprim/sulfamethoxazole
(Bactrim, Septra) orally for 10 days
b) 0.5% malathion lotion (Ovide)

22. DR.JCDT
22
c) 5% permethrin cream (Elimite)
d) 5% precipitated sulfur in petroleum

23. DR.JCDT
23
CASE # 88
A 3-year-old female presents with urinary
frequency, dysuria, and fever to 39.0° C
(102.2° F). She denies nausea, vomiting,
fever, and flank pain. There is no prior
history of urinary infection and no family
history of urinary tract abnormalities.

24. DR.JCDT
24
Urethral catheterization reveals
bacteriuria and a urine culture reveals
>100,000 colony-forming units of
Escherichia coli. She is started on
appropriate antibiotic therapy. Evaluation
to rule out anatomic abnormalities should
include:

25. DR.JCDT
25
a) Renal ultrasonography and voiding
cystourethrography (VCUG) only if she
has recurrent infections
b) Renal ultrasonography only if she has
recurrent infections
c) Renal ultrasonography for this primary
episode of infection

26. DR.JCDT
26
d) Renal ultrasonography and VCUG for
this primary episode of infection
e) Renal ultrasonography and cystoscopy
only if she has recurrent infections

27. DR.JCDT
27
CASE # 89
A slender 22-year-old female is concerned
about a recent weight loss of 10 lb,
frequent mild abdominal pain, and
significant diarrhea of 2 months’ duration.
Her physical examination is unremarkable,
and laboratory studies reveal only a
moderate microcytic, hypochromic
anemia.

28. DR.JCDT
28
Based on this presentation, which one of
the following is the most likely diagnosis?:
a) Villous adenoma
b) Ulcerative colitis
c) Infectious colitis
d) Celiac disease
e) Irritable bowel syndrome

29. DR.JCDT
29
CASE # 90
A 73-year-old white male has severe COPD
manifested by repeated hospital
admissions, 30-step dyspnea on exertion,
asthenia, and a resting pO of 58 mm Hg.
Of the following, which intervention will
most likely positively affect his survival?:

30. DR.JCDT
30
a) Inhaled corticosteroids
b) Beta – Agonists
c) Oxygen supplementation
d) Pulsed antibiotic therapy

31. DR.JCDT
31
Continuará……

32. Gracias por su atención
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 – 40 - 26
DR.JCDT
32