The document contains 20 brief clinical cases presented by Dr. Juan Carlos Díaz Torre, a pediatric neonatologist. Each case presents a medical scenario and potential answers for the appropriate next step. The cases cover topics in obstetrics, psychiatry, dermatology, emergency medicine, and oncology. Screening for melanoma is discussed in the final case, noting that screening is not clinically proven to reduce mortality from the disease.

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
(2)
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
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CASE # 10
A 28-year-old primigravida is at 20 weeks
gestation by dates but her fundal height is
consistent with a 26-week gestation. She
has had episodes of vomiting during the
pregnancy that were more severe than the
physiologic vomiting typically seen in
pregnancy.

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CASE # 10
A sonogram performed at about 5 weeks
gestation for vaginal bleeding was normal
and showed a single fetus.
Which one of the following would be most
appropriate at this point?

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CASE # 10
a) Expectant management
b) A repeat sonogram
c) MRI of the pelvis
d) A serum HCG level

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CASE # 11
A 24-year-old male, new to your
practice, presents for a mental health
evaluation. The patient has a past history
of schizophrenia, diagnosed several years
ago.
Which one of the following, if
present, would lead to a reconsideration
of this diagnosis?

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CASE # 11
a) Loose associations
b) Elated mood
c) Social dysfunction
d) Auditory hallucinations
e) Incoherent speech

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CASE # 12
A previously healthy 22-year-old female
presents for her regular prenatal checkup
at 38 weeks gestation. She has a blood
pressure of 145/95 mm Hg today and this
is unchanged 1 hour later. Her blood
pressure was normal before pregnancy.
She is otherwise feeling well.

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CASE # 12
She has moderate edema at the ankles
and 3+ reflexes at the knees and ankles.
A urinalysis for protein is normal.
Given this presentation, which one of the
following is the most likely diagnosis?

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CASE # 12
a) Unmasked chronic hypertension
b) Hemolysis, elevated liver enzymes, low
platelets (HELLP) syndrome
c) Preeclampsia
d) Essential hypertension
e) Gestational hypertension

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CASE # 13
A 72-year-old female with longstanding
diabetes mellitus presents to your office.
During the review of systems, she
complains of difficulty voiding and
frequent “dribbling.”
A urinalysis is negative for infection and
her post-void residual volume is 250 mL.

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CASE # 13
Which one of the following is the most
likely cause of this patient’s urinary
incontinence?
a) Excess urine output due to
hyperglycemia
b) A grade II cystocele

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CASE # 13
a) Atrophic vaginitis
b) Asymptomatic bacteriuria
c) Autonomic neuropathy

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CASE # 14
A 3-year-old male is brought to your office
the day after he was stung by a honeybee.
He has developed a significant local
reaction, with redness and swelling
around the site of the sting on his forearm,
and also has had some swelling of his lips
for “a couple of hours.”

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CASE # 14
His mother removed the stinger and gave
him some oral diphenhydramine
(Benadryl). The local reaction has now
almost resolved and he has not had any
hives or respiratory distress.
Which one of the following is true
concerning this situation?

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CASE # 14
a) Systemic corticosteroids would be the
initial treatment of choice if the child
develops respiratory distress with his
next sting
b) An antibiotic that covers
Streptococcus pyogenes and
Streptococcus aureus should be
administered

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CASE # 14
c) If venom immunotherapy is begun, it
should be stopped after 2 years of
treatment
d) The child is at high risk for a systemic
reaction if he is stung again in the
future

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CASE # 14
e) Skin tests are not helpful in
confirming the presence of insect
sting allergy

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CASE # 15
Which one of the following is
characteristic of the first stage of labor?
a) An episiotomy should be performed
during this stage of labor
b) Uterine shape changes from discoid to
globular, along with a rise in fundal
height

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CASE # 15
c) In the absence of anesthesia, this stage
of labor typically lasts 20–50 minutes
d) Regular uterine contractions are
confirmed
e) In the absence of anesthesia, each
contraction stimulates the urge to
push

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CASE # 16
A 65-year-old white female develops a
burning pain in the left lateral thorax,
followed 2 days later by an erythematous
vesicular rash. Of the following, the best
treatment is:

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CASE # 16
a) Topical capsaicin (Zostrix)
b) Oral corticosteroids
c) Topical corticosteroids
d) Topical acyclovir (Zovirax)
e) Oral valacyclovir (Valtrex)

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CASE # 16
Which one of the following would be most
appropriate to treat a dental infection
requiring antibiotic therapy?

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CASE # 16
a) Cefixime (Suprax)
b) Penicillin
c) Dicloxacillin (Dynapen)
d) Erythromycin
e) Tetracycline

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CASE # 17
You are consulted for medical management
of a 45-year-old male, previously unknown
to you, who is hospitalized in the
psychiatric unit with paranoid
schizophrenia. His fasting blood glucose
level is 180 mg/dL.
Which one of the following medications is
the most likely cause of the hyperglycemia?

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CASE # 17
a) Alprazolam (Xanax)
b) Chlorpromazine (Thorazine)
c) Olanzapine (Zyprexa)
d) Haloperidol (Haldol)
e) Thiothixene (Navane)

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CASE # 18
A 22-year-old male presents to the
emergency department several hours after
a rugby match in which he was struck in
the face. His nose is bleeding.
On examination the patient has a
depression in his nose on the side of
impact and an outward displacement on
the opposite side.

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CASE # 18
Internal inspection reveals a purple area of
swelling and fluctuance on the left side of
the nasal septum. The remainder of the
examination demonstrates no findings to
suggest other facial or periorbital trauma.
Which one of the following would be most
appropriate at this time?

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CASE # 18
a) Immediate CT imaging to assess for
facial and mandibular fracture
b) Incision and drainage of the swollen,
fluctuant area
c) Immediate plain radiographs of the
nose and orbits

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CASE # 18
d) Immediate closed reduction of the
nasal fracture
e) Discharge with pain medication, ice
packs, and head elevation, with
referral to a specialist in 1 week

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CASE # 19
A 30-year-old gravida 3 para 2 at 28 weeks
gestation is a restrained passenger in a
high-speed motor vehicle accident. After
initial stabilization in the field with
supplemental oxygen and intravenous
fluids, she is brought into the emergency
department on a backboard and wearing a
cervical collar. Until you are able to rule
out a spinal injury, in what position should
the patient be kept?

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CASE # 19
a) Supine
b) Supine, with the uterus manually
deflected laterally
c) Prone
d) Trendelenburg’s pattern
e) Left lateral decubitus

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CASE # 20
Your hospital administrator asks you to
develop a community screening program
for melanoma.
Which one of the following is true
concerning screening for this disease?

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CASE # 20
a) Screening for melanoma is not
indicated since screening takes too
much time
b) No definite clinical evidence has
shown that screening for melanoma
reduces mortality

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CASE # 20
c) Screening for melanoma is not
indicated since the disease is rare
d) Because of sunbathing, female
patients are the most important
population to screen

36. 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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