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EXAM´S JUSTIFICATION

ENGLISH 7

NOTA: REDAC DACCIÓ CIÓN CASOS CLÍNI NICOS INGLÉ GLÉSS FUE A PR PROPÓSI OPÓSITO ALA ERRORE RORESS NOT A: LA RE DAC CIÓ N DE LOS CA SOS CLÍ NI COS EN IN GLÉ OPÓSI TO MAL A Y CON ER RORE DE SSINTÁ INTÁ XIS, C ONJ UGA CIÓ N, ETC. PUES EEN N EL ENA RM VIEN E RED ACT AD O AUN PPEOR, EOR, A PESA R DE LLA A INTÁXIS, CONJ ONJUGA UGACIÓ CIÓN, ENARM VIENE REDACT ACTAD ADO PESAR PÉSIMA REDAC ACCIÓN NECESA CESARIO INTENTA ENTAR CAPTAR PREGU EGUNTA NTAND NDO PÉS IMA RED AC CIÓN ES NE CESA RIO INT ENTA R CAPT AR QUÉ ES LO QUE SE EESTÁ STÁ PR EGU NTA ND O. CASE 1

35-YEAR-OLD MAN WITH SMOKING HISTORY, HE COMES TO THE EMERGENCY ROOM FOR EPIGASTRIC PAIN, WHICH IS ALERTED WITH FOOD INTAKE (PAINFUL HUNGER) HE REFERRES ALSO THAT MANY TIMES THE PAIN AWAKES HIM AT NIGHT. EF: TA 120/80 MMHG, FC 76 LPM, FR 20 RPM, HYDRATED MUCOSA, PAIN TO PALPATION IN EPIGASTRY. WITH THE PREVIOUS DATA THE DIAGNOSIS IS: REFLUX ESOPHAGITIS GASTRIC ULCER DUODENAL ULCER BILIAR COLIC

CASE 2

THE DIAGNOSIS IS CONFIRMED WITH: ENDOSCOPY WITH BIOPSY DETERMINATION OF BLOOD IN FECES MAGNETIC RESONANCE UREA TEST IN BREATHE PA PARA RA FINE FINESS ENA ENARM RM SI SOLICI SOLICITAN TAN PRUE RUEBA BA MAS UTIL: URE UREA A EN ALI ALIENT ENT ENTO, O, SI PIDE PIDEN N DIA DIAGNOS GNOS GNOSTIC TIC TICO O CO CONFIR NFIR NFIRMA MA MATORI TORI TORIO: O: BI BIOPSI OPSI OPSIA A

CASE 3

A 10 MONTHS OLD MAN IS BROUGHT TO THE EMERGENCY ROOM BY HIS PARENTS BECAUSE OF THE PRESENCE OF FEVER, DISFAGIA, DYSPNEA, DROOLING AND INSPIRATORY STRIDOR DURING THE LAST 6 HOURS. AT THE PHYSICAL EXAMINATION THE PATIENT IS SITTING UPRIHT, TEMP 39°C, PULMONARY FIELDS ARE CLEAR. NO CYANOSIS. WHICH IS THE MOST PROBABLE DIAGNOSIS IN THIS PATIENT? ACUTE AMIGDALITIS EPIGLOTITIS PHARINGITIS SIALOADENITIS CASE 4

WHICH ASPECT IN THE MANAGEMENT OF THIS PATIENT IS OF PREEMINENT CONCERN? AIRWAY MANAGEMENT ADEQUATE NUTRITION TEMPERATURE CONTROL

SOON VACCINATION

PRIMER PASO EN EL TRATAMIENTO: ESTABILIZAR VIA AEREA CASE 5

IF AFTER THE INITIAL NEONATAL RESUSCITATION MANOEUVRES WITH POSITIVE PRESSURE HAS BEEN APPLIED TO A NEWBORN OF 38 WEEKS OF GESTATION, THE HEARTRATE IS 70 PER MINUTE, THE FOLOWING SHOULD BE PRACTICED: ENDOTRACHEAL INTUBATION CARDIAC COMPRESSIONS ADMINISTRATION OF OXYGEN HELMET ADRENALINE ADMINISTRATION

BY

CEPHALIC

OJO OJO,, CUA CUANDO NDO LA FC ES MENO MENOR R A 100 PRI PRIMERO MERO SE APLI APLICA CA PRESI RESION ON POSITI OSITIVA VA CO CON N BOLSA MASC MASCARIL ARIL ARILLA, LA, SI A PESA PESAR R DE EST ESTO O PERSIS PERSISTE, TE, EN ENTON TON TONCES CES SE INT INTUBA, UBA, SOL SOLO O DE DESPU SPU SPUES ES DE INTUB INTUBAR, AR, SI PE PERSI RSI RSISTE STE SE INIC INICIAN IAN MAN MANIOB IOB IOBRAS RAS DE C COMP OMP OMPRESI RESI RESION. ON.

CASE 6

17-DAY-OLD NEWBORN PRESENTING NEONATAL MENINGITIS, ACCORDING TO THE AGEM THE ELECTIVE TRETATMENT IS THE COMBINATION OF: GENTAMICIN PLUS AMPICILIN CEFTAZIDIME PLUS DICLOXACILIN AMIKACIN PLUS VANCOMYCIN AMPICILIN PLUS CEFOTAXIME OJO OJO,, EN NE NEONAT ONAT ONATO O EST ESTA A CON CONTRA TRA TRAINDI INDI INDICAD CAD CADO O CEFA CEFALOSP LOSP LOSPORIN ORIN ORINA A (PRIME (PRIMEROS ROS 28 DIAS DE VIDA) ASI QUE DES DESCAR CAR CARTAM TAM TAMOS OS B Y D D.. EN ENTRE TRE A Y C SE PPRE RE REFIERE FIERE A (P (PEDI EDI EDIATRI ATRI ATRIA A NEL NELSON SON SON)) CASE 7

4 YEAR OLD FEMALE PATIENT WHO ARRIVES TO THE EMERGENCY ROOM WITH DYSPNEA , COUGH AND IRRITABILITY DUE TO FOREGIN BODY ASPIRATION, A BRONCHOSCOPY FOR REMOVAL OF THE FOREGIN BODY IS PERFORMED, HOWEVER AFTER FEW MINUTES SHE STARTS WITH WHEEZING, AND AFONIA YOU SUSPECT THE FOLLOWING COMPLICATION: BRONCHOSPASM EDEMA WITH SUBGLOTIC STENOSIS LARINGOMALACIA ATELECTASIA

CASE 8

12 YEAR OLD MALE WITH PAIN IN THE MIDDLE RIGHT LEG THAT HAS PRESENTED INCREASE IN VOLUME, HE HAS NO SIGNIFICANT BACKGROUND AN X-RAY IS PERFORMED FINDING AN IMAGE WITH PERIOSTIC SPICULATED REACTION IMAGE IN THE FEMUR DIAFISIS, ACCORDING TO THE PRESENTATION AND AGE YOU DIAGNOSE: OSTEOSARCOMA EWIG´S SARCOMA OSTEOCONTROMA OSGOOD SCHLATER

CASE 9

10 YEAR OLD GIRL WHO PRESENTS COUGH, FEVER, AXILARY ADENOPATHY AND BILATERAL CERVICAL. CHEST X-RAY WITH MULTIPLE PULMONARY INFILTRATES. THE PROBABLE DIAGNOSIS IS HODKIN LYMPHOMA NO HODGKIN LYMPHOMA HISTOPLASMOSIS PULMONARY TUBERCULOSIS CAS CASO O AMBIG MBIGUO, UO, PER PERO O DEST DESTACA ACA TOS+ TOS+FIE FIE FIEBRE+ BRE+ BRE+PERD PERD PERDIDA IDA DE PESO +A +ADEN DEN DENOPA OPA OPATIAS TIAS + INFIL INFILTRA TRA TRADOS DOS PUL PULMON MON MONARE ARE ARESS (CON INFLIL INFLILTRA TRA TRADO DO DOSS PULM PULMONA ONA ONARE RE RESS DESC DESCART ART ARTAMO AMO AMOSS LOS LIN LINFOM FOM FOMAS) AS) INFILT INFILTRAD RAD RADOS OS MÁS COM COMUNE UNE UNESS EN HIS HISTOPL TOPL TOPLASM ASM ASMOSI OSI OSIS, S, EN TB HAY CAVITA CAVITACI CI CIONE ONE ONESS YCO YCOMPLE MPLE MPLEJO JO DE G GHON HON

CASE 10

MALE PATIENT 68 YEARS OLD HAS DM2 SINCE AGE 40 HIS CONTROL HAS BEEN ACEPTABLE WITH LOW CALORIE DIET AND 1G OF TOLBUTAMIDE PER DAY. FOR THREE DAYS HE PRESENTED INTESE POLYUURIA THAT LED TO SEVERE DEHYDRATATION, IS ADMITTED TO ER WHERE MULTIPLE BLULB PNEUMONIA IS DETECTED. LABS: GLUC 600, NA 125, PH 7.26, HC03 14 BUN 80, CR 5.5 SERUM OSMOLARITY 315MOSMOL/L. THE DIAGNOSIS IS: DIABETIC KETOACIDOSIS HIPERGLICEMIA LACTIC ACIDOSIS HYPEROSMOLAR STATUS NON KETOTIC PRIN PRINCIP CIP CIPAL AL DE DESEN SEN SENCADE CADE CADEN NANTE DEL CUA CUADRO DRO ES EL PPROCE ROCE ROCESO SO INFE INFECCIO CCIO CCIOSO SO ((NE NE NEUM UM UMONÍA) ONÍA) EST ESTAN AN PRE PREGUN GUN GUNTAN TAN TANDO DO DI DIAGN AGN AGNÓSTI ÓSTI ÓSTICO, CO, SI, EL CAS CASO O ES UN CUA CUADRO DRO TIPIC TIPICO O DE CETO CETOACI ACI ACIDOSI DOSI DOSISS DIA DIABÉTI BÉTI BÉTICA CA

CASE 11

A 44 YEAR OLD WOMAN DIABETIC FOR 6 YEARS, BEGINS HER CONDITION WITH A PICTURE OF SUDEN APPEARANCE, CHARACTERIZED BY EDEMA OF THE LEFT PELVIC LIMB, SEVERE PAIN, HIPEREMIA AN HYPERTHERMIA. THE MOST PROBABLE DIAGNOSIS IS PHLEBITIS OF THE INTERNAL SAPHENOUS DEEP VEIN THROMBOSIS VENOUS INSUFFICIENCY ACUTE ARTERIAL INSUFFICIENCY

CASE 12

A 29 YEAR OLD MALE IN WHOM A MITRAL VALVE PROSTHESIS WAS IMPLANTED, PRESENTING HEMIPARESIA IN LEFT BODY OF SUDDEN APPREARANCE. THE MOST PROBABLE DIAGNOSIS IS STROKE ADAMS SYNDROME STROKE OR CEREBRAL EMBOLISM INTRAPARECHYMATOUS CERERAL HEMORRHAGE SUBARACHNOID HEMORRHAGE RES RESPUE PUE PUESTA STA POR LÓGIC LÓGICA, A, ANTE ANTECEDE CEDE CEDENTE NTE DE REMP REMPLAZ LAZ LAZO O VALV VALVULA ULA ULAR R SIEMP SIEMPRE RE PREDI PREDISPO SPO SPONE NE A UN RIE RIESGO SGO DE EM EMBOLI BOLI BOLISM SM SMO, O, NO TIENE ANTECE ANTECEDE DE DENTES NTES PA PARA RA SOSPE SOSPECH CH CHAR AR STR STROKE OKE ADA ADAMS MS NI DATO DATOSS DE HEMO HEMORRAG RRAG RRAGIA IA INTRA INTRAPARE PARE PARENQ NQ NQUIM UIM UIMATO ATO ATOSA, SA, LA HE HEMORR MORR MORRAGI AGI AGIA A SUBAR SUBARACNO ACNO ACNOIDE IDE IDEA A CU CURSA RSA CON DOL DOLOR OR INTE INTENS NS NSO O SU SUBITO, BITO, NO CON HEM HEMIPA IPA IPARESIA RESIA LA CU CUAL AL ES CAR CARACTE ACTE ACTERIS RIS RISTICA TICA DE STRO STROKE KE CASE 13

A 12 YEAR OLD MAN ARRIVES TO THE ER WITH INTENSE PALPITATIONS, HE IS SCARED AND REFFERS THAT HIS HEART IS GOING TO GET OUT HIS CHEST, AN EKG IS PERFORMED, REPORTING SUPRAVENTRICULAR PAROXISTIC TACHICARDIA IMMEDIATE AND INITIAL TREATMENT CONSIST OF PERFORM VAGAL STIMULATION

ADMINISTER VERAPAMIL ADMINISTER ADENOSINE 6MG PERFORM CARDIOVERSIÓN TRA TRATAMIE TAMIE TAMIENT NT NTO O INME INMEDIA DIA DIATO TO E INICIAL = ESTIM ESTIMULAC ULAC ULACION ION VAGAL VAGAL,, NO ES UNA TAQUI TAQUICAR CAR CARDIA DIA INE INESTAB STAB STABLE, LE, EL PACIE PACIENTE NTE ESTA CON CONCIEN CIEN CIENTE TE SOLO ASU ASUSTAD STAD STADO, O, NO REP REPORT ORT ORTAN AN TA ALTE ALTERAD RAD RADA, A, PRI PRIMER MER MERO O POR PASO PASOS, S, PPASO ASO 1 EST ESTIM IM IMULACI ULACI ULACION ON V VAGA AGA AGAL, L, NO FUN FUNCION CION CIONA? A? PAS PASO O 2 ADE ADENOSI NOSI NOSINA NA IV 6 Y LUEG LUEGO O 112MG, 2MG, NO FUN FUNCION CION CIONA? A? CARDI CARDIOVE OVE OVERSI RSI RSION ON CASE 14

BEST SCREENING TESTO TO DISTINGUISH BETWEEN IRON DEFICENCY ANEMIA AND CHRONIC DISEASE ANEMIA IN A PATIENT WHO GOES TO THE EXTERNAL CONSULTATION TO ASESES A SYMPTOM OF FATIGUE AND MICROCYTIC ANEMIA IS DETECTED SERUM FERRITIN RETICULOCYTE COUNT IRON DEFICIENCY PERCENTAGE OF TRASFERRIN SATURATION

CASE 15

35 YEAR OLD MALE PATIENT WHO COMES WITH DOCTOR FOR PRESENTIG STATES OF MANIA AN MAYOR DEPRESSION HE HAS HISTORY OF EXTREME EXPENSES, HE CONSIDER HIMSELF AS A GREAT BUYE, HE ALSO HAS MULTIPLE SEXUAL PARTNERS. ACCORDING TO MANIFESTATIONS THE MOST PROBABLE CLINICAL PICTURE IS BIPOLAR TYPE I SCHIZOID BIPOLAR TYPE II SCHIZOPHRENIA ES EVIDE EVIDENTE NTE EL EPISO EPISODIO DIO MANI MANIACO ACO (HIP (HIPERSE ERSE ERSEXU XU XUALID ALID ALIDAD, AD, GAST GASTOS OS EXESI EXESIVOS VOS VOS)) LO CUAL NOS DA EELL D DX X DE BIPOL BIPOLAR AR 1

CASE 16

49-YEAR-OLD FEMALE, WHO INITIATES PAIN IN EPIGASTRIC AND RITHG HYPOCHONDRIA RADIATING TO THE BACK, AFTER INGESTIN ABUNDANT FOOD AND ALCOHOL. SHE PRESENTS JAUNDICE. THE US SHOWS A 6MM GALLBLADDER WALL, WITH NO APPARENT STONES. THE MOST PROBABLE DIAGNOSIS IS PANCREATITIS CHOLECYSTITIS CHOLELITHIASIS GALLBLADER DISKINESIA

CASE 17

YOU ASSIST AS A RESCUER TO AN EVENT BECAUSE OF AN ACCIDENT A 20 YEAR OLD MALE ATHLETE WHO CRASHES IN A CURVE AGAINST A VEHICLE. WHEN YOU ARRIVE YOU FIND BREATHING DIFFICULTY. TA 90/50, 120 BPM, 30RPM, TEGUMENTS PALLOR, WEAK AND FAST PULSE. BY THE PREVIOUS CLINICAL DATA YOU PROBABLE SUPECT INJURY BRAIN, DIRECT TRAUMA TO THE HEAD OF THE SPINAL CORD BY THE FALL HEMORRHAGIC FROM CLOSED TRAUMA OF THE LUNG FOR POSIBLE PENETRATION TEG TEGUME UME UMENTO NTO NTOSS PALID PALIDOS OS + TAQU TAQUICAR ICAR ICARDIA DIA + HIPOT HIPOTENSI ENSI ENSION= ON= CH CHOQUE OQUE HEM HEMORR ORR ORRAGIC AGIC AGICO O HASTA DE DEMOST MOST MOSTRA RA RAR R LO C CON ON ONTRA TRA TRARIO RIO CASE 18

35-YEAR OLD MALE PATIENT WITH STRANGE BODY SENSATION AND PAIN AT THE TIME OF DEFECATION WICH DISAPPEARS MINUTES LATER, THE MOST PROBABLE DIAGNOSIS IS GRADE I HEMORRHOIDS GRADE II HEMORRHOIDS GRADE III HEMORRHOIDS

GRADE IV HEMORRHOIDS

CASE 19

7 YEAR OLD MALE PATIENT PRESENTS OCULAR ITCHING AND INTENSE TEARING, THE MOTHER REFERS THAT HE PREVIOUSLY PRESENTED THE SAME DISCOMFORT AND REPEATEDLY TREATS HIM WITH CHLORAMPHENICOL WITH RELATIVE IMPROVEMENT, THE CHILD IS CONCERNED THAT HE PRCEIVES MORE DISCOMFOT ON HOT DAYS. TO THE OCULAR EXPLORATION, HYPEREMIC CONJUNCTIVES ARE SEEN WITH MULTIPLE GIANT PAPILLAE IN THE UPPER TARSUS WICH RESEMBLE A COBBLESTONE AS WELL AS ABUNDANT AQUEOUS SECRETION. WHAT’S YOUR DIAGNOSIS CONJUNTIVITIS BACTERIANA EPITELIAL KERATITIS ALLERGIC CONJUNCTIVITIS HERPETIC CONJUNCTIVITIS

CASE 20

THE OPTIC CORRECTION OF FARSIGHTNESS (HYPERMETROPIA) IS DONE BY THE FOLLOWINTG TYPE OF LENSES NEGATIVE POSITIVE FLAT MIRRORS LENSES CYLINDRICAL LENSES

CASE 21

A SOCCER PLAYER WHO IS INJURED WHEN RUNNING, STOPPING ABRUPTLY AND ROTATING ON HIS OWN KNEE TO PHYSICAL EXPLORATION THERE IS A SIGN OF POSITIVE ICEBERG THE MOST PROBABLE DIAGNOSIS IS MENISCAL INJURY HEMARTHROSIS ANTERIOR CRUCIATE LIGAMENT INJURY COLATERAL LIGAMENT INJURY EL SIGNO DEL TEMP TEMPAN AN ANO O DE HIELO ES PO POSITIV SITIV SITIVO O EN CASO CASOSS DE DERR DERRAME AME ARTI ARTICUL CUL CULAR, AR, SI, PRO PROBABL BABL BABLEME EME EMENTE NTE TEN TENGA GA LESI LESION ON ASOCI ASOCIADA ADA (PR (PROBAB OBAB OBABLE LE LEMEN MEN MENTE TE MENIS MENISCAL CAL CAL), ), SIN EMBA EMBARGO RGO SE H HACE ACE HIN HINCAPI CAPI CAPIÉ É EN SIG SIGNO NO PPOR OR LO C CUAL UAL LA RE RESP SP SPUES UES UESTA TA CO CORRE RRE RRECTA CTA ES H HEM EM EMARTR ARTR ARTROSIS. OSIS. CASE 22

WICH OF THE FOLLOWING FACTS IS CONSIDERED A PHYSIOLOGICAL MODIFICATION AS A RESULT OF PREGNANCY INCREASED INTESTINAL MOTILITY (DIS (DISMINU MINU MINUYE YE EEN N EEMBA MBA MBARAZ RAZ RAZO) O) INCREASED GLOMERULAR FILTRATION DECREASED PROLACTIN SECRETION (AU (AUMEN MEN MENTA TA EEN N EM EMBA BA BARAZO RAZO RAZO)) DECREASED PLASMATIC VOLUMEN (AU (AUMEN MEN MENTA TA V VOLU OLU OLUMEN MEN EN EMB EMBAR AR ARAZO) AZO)

CASE 23

22 YEAR OLD PATIENT WITH SMALL TRANSVAGINAL BLEEDING, WHO GOES TO THE ER WITH A B HGC OF 1800 UI WITH 6 WEEKS OF AMENORREA, WITH SEVERE ABDOMINAL PAIN, IS PERFORMED A TRANSVAGINAL USG WHERE NO GESTATION DATA, ONLY THICKENING OF THE ENDOMETRIUM 13MM. WHAT IS THE DIAGNOSIS ECTOPIC PREGNANCY THREAT OF ABORTION

INEVITABLE ABORTION MOLAR PREGNANCY

CASE 24

FEMALE OF 35 YEARS WICH COURSES WITH HER 38 WEEK OF GESTATION WITH A HISTORY OF HYPERTENSION, SHE STARTS 2 HOURS AGO WITH TRANSVAGINAL HEMORRHAGE AND HYPOGASTRIC PAIN. WITH THIS DATA WHAT THE DIAGNOSIS OF THE PATIENT IS: PLACENTA PREVIA PLACENTAL ABRUPTION UTERIN RUPTURA MUCUS PLUG EJECTION

CASE 25

48 YEAR OLD FEMALE PATIENT WITH A HISTORY OF HAVING RECEIVED ANTIBIOTICS (AMOXILILIN FOR 7 DAYS) PRESENTS VULVAR PRURITUS, LEUKORRHEA, REDNESS OF INTROIT VULVA AND WHITE LUMPY FLOW, WHAT IS THE PRESUMPTIVE DIAGNOSIS? CANDIDIASIS GENITAL HERPES TRICHOMONA GARDENELLA VAGINALIS

CASE 26

FIVE-YEAR-OLD CHILD WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER, SHORT STATURE, MICROCEPHALY, SMALL EYES, SHORT PALPEBRAL AREA, THIN UPPER LIP WITH FLAT FILTRUM. WHAT IS THE SUBSTANCE THAT MOST LIKELY HAS COMPULSIVELY CONSUMED THE MOTHER DURING PREGNANCY? ALCOHOL MARIJUANA BENZODIAZEPINES COCAINE

CASE 27

18-YEAR-OLD WOMAN COMES TO THE EMERGENCY ROOM (BMI...