This document contains 140 clinical case summaries presented by Dr. Juan Carlos Díaz Torre, a pediatric neonatologist. Each case presents brief patient information and scenarios followed by multiple choice questions regarding diagnosis, treatment, or management. The cases cover a wide range of topics including infectious diseases, obstetrics, psychiatry, surgery, and more.

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
(11)
Dr. Juan Carlos Díaz Torre
Pediatra Neonatólogo
dr_diaz_torre@hotmail.com
(779) 100 - 40 - 26
DR.JCDT
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Case # 121
The antimalarial agent mefloquine
(Lariam) would be contraindicated in
which one of the following patients?
a) A 50-year-old female with chronic
renal failure and a creatinine
clearance of 50 mg/min

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b) A 25-year-old female at 32 weeks
gestation
c) A 65-year-old male with controlled
hypertension who takes metoprolol
(Lopressor) and aspirin

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d) A 55-year-old male with COPD who
uses inhaled albuterol
(Ventolin, Proventil) and ipratropium
bromide (Atrovent)
e) A 45-year-old male with epilepsy
controlled with phenytoin (Dilantin)

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Case # 122
Recent studies and meta-analyses have
shown that supplementation with a
particular vitamin may do more harm
than good. This has resulted in a reversal
in the recommendation for its use in
patients with known coronary artery
disease, and a recommendation for
caution in its use in general for elderly
patients.

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This is true of which one of the
following?:
a) Vitamin B 6
b) Vitamin A
c) Vitamin C

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d) Vitamin B 12
e) Vitamin E

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Case # 123
In early February, you receive a call from
your office nurse. Her 5-month-old
daughter has been ill for several days.
What started as a mild upper respiratory
infection has progressed and she now
has profuse rhinorrhea, a temperature of
100.2° F (37.9° C), and audible wheezing.
In spite of an almost nonstop cough, she
does not appear acutely ill.

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The organism responsible for this child’s
illness is most likely to be:
a) Mycoplasma pneumoniae
b) Bordetella pertussis
c) Respiratory syncytial virus

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d) Group B Streptococcus
e) Parainfluenza virus 3

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Case # 124
Of the following, which is the most
frequent cause of seizures in the elderly?
a) Stroke
b) Head trauma
c) Dementia

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d) Alcohol withdrawal
e) Hypoglycemia

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Case # 125
A 4-week-old full-term male is brought
to your office by his parents. They report
that their child started vomiting just
after his 1-week visit. The parents are
concerned because they think the
vomiting is worsening, occurring after
every feeding, and “shooting across the
room.”

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You note that the baby is afebrile, but
has not gained any weight since birth.
Based on this information, the most
likely diagnosis is:
a) Meningitis
b) Formula intolerance

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c) Inappropriate feeding
d) Pyloric stenosis
e) Viral gastroenteritis

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Case # 126
A 32-year-old gravida 3 para 2 is in labor
at term following an uncomplicated
prenatal course. As you deliver the fetal
head it retracts against the perineum.
Downward traction fails to free the
anterior shoulder. The most appropriate
course of action would be to:

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a) Have an assistant apply fundal
pressure
b) Place the mother’s thighs on her
abdomen
c) Apply increasingly strong
downward traction to the fetal
head

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c) Deliberately fracture the clavicle
of the fetus
d) Begin an intravenous
nitroglycerin drip

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Case # 127
A 14-year-old male is brought to your
office by his mother to establish care.
The patient has been diagnosed with
asthma, but has not been on any
medications for the past year. When
questioned, he reports that his asthmatic
symptoms occur daily and more than
one night per week.

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On examination, he is found to have a
peak expiratory flow of 75%. Based on
these findings, the most accurate
classification of this patient’s asthma is:

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a) Mild persistent
b) Moderate persistent
c) Severe persistent
d) Mild intermittent

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Case # 128
Which one of the following Papanicolaou
(Pap) test results is most likely to indicate
a cancerous lesion?
a) High-grade squamous intraepithelial
lesion (HSIL)
b) Atypical glandular cells not
otherwise specified (AGC-NOS)

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c) Low-grade squamous intraepithelial
lesion (LSIL)
d) Atypical squamous cells cannot
exclude high-grade intraepithelial
lesion (ASC-H)
e) Atypical squamous cells of
undetermined significance (ASC-US)

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Case # 129
A 72-year-old female has stable but
moderately severe COPD requiring 2 L of
continuous oxygen. She plans to attend
the college graduation of her first
grandchild, and wants to fly to avoid a 12
hour car ride. Her PaO2 on room air is 55
mm Hg. According to the Federal Air
Regulations, she MUST:

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a) Find a form of transportation other
than air travel
b) Bring a medical certificate from you
certifying that she is cleared to fly
without oxygen
c) Arrange through the airline for
oxygen to be available on board and
in the airports

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d) Undergo preflight testing,
including pulmonary function
testing and high-altitude
simulation testing, before she
can be cleared to fly
e) Bring her own oxygen from home

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Case # 130
Which one of the following criteria is
most likely to signify that an individual
has bulimia nervosa rather than anorexia
nervosa?
a) The absence of at least three
consecutive menstrual cycles in a
postmenarchal nonpregnant female

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b) Recurrent episodes of binge eating
c) Intense fear of weight gain or becoming
fat, even though underweight
d) Denial of the seriousness of the
current low body weight
e) Refusal to maintain a body weight
greater than normal for age and
height

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Case # 131
Painful ingrown toenails that display
granulation tissue and lateral nail fold
hypertrophy are best treated by
a) Removal of the entire nail
b) Cotton-wick elevation of the affected
nail corner

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c) Antibiotic therapy
d) Excision of the lateral nail plate
combined with lateral matricectomy

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Case # 132
A 36-year-old female makes an
appointment because her husband of 12
years was just diagnosed with hepatitis C
when he tried to become a blood donor
for the first time. He recalls multiple
blood transfusions following a
motorcycle crash in 1988.

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His wife denies past liver disease, blood
transfusions, and intravenous drug use.
She has had no other sexual partners.
The couple has three children.
Which one of the following is the best
advice about testing the wife and their
three children?

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a) No testing is required if her husband
has normal liver enzyme levels
b) No testing is required because tests
have low sensitivity
c) All family members should be tested
because of possible household fecal-
oral spread

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d) No testing is required in the absence
of jaundice or gastrointestinal
symptoms
e) She should be offered testing
because sexual transmission is
possible

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Case # 133
You are evaluating a 5-month-old with
fever, tachypnea, and mild respiratory
distress in the emergency department.
You hear mild basilar rales. The child
does not appear toxic.
Which one of the following tests would
be the most appropriate as an initial
study?

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a) A C-reactive protein level
b) A chest radiograph
c) A CBC
d) Oxygen saturation by pulse oximetry

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Case # 134
The elderly patient may process
medications differently than a younger
adult.
Which one of the following is LEAST
affected by aging?

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a) Absorption
b) Distribution
c) Compliance
d) Metabolism
e) Excretion

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Case # 135
A 72-year-old Asian female is found to
have asymptomatic gallstones on
abdominal ultrasonography performed to
evaluate an abdominal aortic aneurysm.
Which one of the following would be the
most appropriate management for the
gallstones?

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a) Lithotripsy
b) Laparoscopic cholecystectomy
c) Open cholecystectomy
d) Observation
e) Treatment with ursodeoxycholic acid
(Actigall)

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Case # 136
A 34-year-old African-American female
presents to you for preconception
counseling regarding the management of
her chronic hypertension. Her blood
pressure has been well controlled on
benazepril (Lotensin), 20
mg/day, without any side effects. The
patient’s blood pressure was 145/95 mm
Hg prior to beginning benazepril.

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She has been pregnant once before, and
her physician switched her to
methyldopa (Aldomet) during that
pregnancy, but she suffered from
drowsiness and a dry mouth during much
of that time. The pregnancy and delivery
were otherwise uncomplicated. She has
no history of diabetes mellitus, renal
insufficiency, or asthma. She is a
nonsmoker.

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Which one of the following would you
do when she becomes pregnant?
a) Switch to atenolol (Tenormin) until
after delivery
b) Switch to long-acting nifedipine
(Procardia) until after delivery

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c) Continue the benazepril through
the pregnancy and delivery
d) Discontinue the benazepril and
monitor closely throughout the
pregnancy for signs of
preeclampsia or fetal growth
restriction

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Case # 137
Which one of the following is the
preferred treatment for patients with
obsessive-compulsive disorder?
a) Valproic acid (Depakene)
b) Alprazolam (Xanax)

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c) Fluoxetine (Prozac)
d) Lithium carbonate
e) Amitriptyline (Elavil)

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Case # 138
When repairing a perineal laceration
after a vaginal delivery, which one of the
following suture materials decreases
both wound dehiscence and postpartum
perineal pain?

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a) Polyglactin 910 (Vicryl)
b) Silk
c) Plain catgut
d) Polypropylene
e) Chromic catgut

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Case # 139
A 40-year-old female is scheduled for a
cholecystectomy and you wish to
estimate her risk for postoperative
bleeding.
Which one of the following provides the
most sensitive method for identifying her
risk?

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a) Prothrombin time (PT)
b) Activated partial thromboplastin
time (aPTT)
c) Bleeding history
d) Bleeding time

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Case # 140
A mother is nearing the end of maternity
leave. She asks for your advice regarding
breastfeeding her infant after she returns
to work.
Which one of the following would be
accurate advice?

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a) Breast milk should be stored in glass
bottles
b) Separation of breast milk indicates
spoilage
c) Breast milk in a refrigerator at work is
a health hazard

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d) Breast milk should be thawed in
boiling water
e) Refreezing breast milk destroys some
proteins

55. 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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