Embed Size (px)
Citation preview
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
CURSO DE INGLÉS
ENGLISH COURSE
Dr. Juan Carlos Díaz TorrePediatra Neonató[email protected]
(779) 100 - 40 - 26
1
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
BRIEF CLINICAL CASES CASOS CLÍNICOS BREVES
(11)
Dr. Juan Carlos Díaz Torre
Pediatra Neonató[email protected]
(779) 100 - 40 - 26
2
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
3
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
4
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
5
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)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
6
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
7
This is true of which one of the following?:
a) Vitamin B 6
b) Vitamin A
c) Vitamin C
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
8
d) Vitamin B 12
e) Vitamin E
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
9
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
10
The organism responsible for this child’s illness is most likely to be:
a) Mycoplasma pneumoniae
b) Bordetella pertussis
c) Respiratory syncytial virus
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
11
d) Group B Streptococcus
e) Parainfluenza virus 3
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
12
Case # 124
Of the following, which is the most frequent cause of seizures in the elderly?
a) Stroke
b) Head trauma
c) Dementia
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
13
d) Alcohol withdrawal
e) Hypoglycemia
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
14
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.”
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
15
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
16
c) Inappropriate feeding
d) Pyloric stenosis
e) Viral gastroenteritis
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
17
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:
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
18
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
19
c) Deliberately fracture the clavicle of the fetus
d) Begin an intravenous nitroglycerin drip
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
20
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
21
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:
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
22
a) Mild persistent
b) Moderate persistent
c) Severe persistent
d) Mild intermittent
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
23
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)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
24
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)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
25
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:
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
26
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
27
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
28
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
29
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
30
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
31
c) Antibiotic therapy
d) Excision of the lateral nail plate combined with lateral matricectomy
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
32
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
33
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
34
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
35
d) No testing is required in the absence of jaundice or gastrointestinal symptoms
e) She should be offered testing because sexual transmission is possible
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
36
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
37
a) A C-reactive protein level
b) A chest radiograph
c) A CBC
d) Oxygen saturation by pulse oximetry
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
38
Case # 134
The elderly patient may process medications differently than a younger adult.
Which one of the following is LEAST affected by aging?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
39
a) Absorption
b) Distribution
c) Compliance
d) Metabolism
e) Excretion
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
40
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
41
a) Lithotripsy
b) Laparoscopic cholecystectomy
c) Open cholecystectomy
d) Observation
e) Treatment with ursodeoxycholic acid (Actigall)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
42
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
43
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.
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
44
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
45
c) Continue the benazepril through the pregnancy and delivery
d) Discontinue the benazepril and monitor closely throughout the pregnancy for signs ofpreeclampsia or fetal growth restriction
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
46
Case # 137
Which one of the following is the preferred treatment for patients with obsessive-compulsive disorder?
a) Valproic acid (Depakene)
b) Alprazolam (Xanax)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
47
c) Fluoxetine (Prozac)
d) Lithium carbonate
e) Amitriptyline (Elavil)
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
48
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
49
a) Polyglactin 910 (Vicryl)
b) Silk
c) Plain catgut
d) Polypropylene
e) Chromic catgut
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
50
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
51
a) Prothrombin time (PT)
b) Activated partial thromboplastin time (aPTT)
c) Bleeding history
d) Bleeding time
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
52
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?
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
53
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
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orre
54
d) Breast milk should be thawed in boiling water
e) Refreezing breast milk destroys some proteins
DR.
JCDT
Dr. Juan Carlo
s Díaz T
orreGracias por su atención
Dr. Juan Carlos Díaz Torre Pediatra Neonatólogo
[email protected](779) 100 – 40 - 26
55
