shuyuej/English-MedExpQA-Benchmark · Datasets at Hugging Face

D stringlengths 5 162	question stringlengths 123 1.06k	B stringlengths 5 237	label stringclasses 5 values	A stringlengths 1 159	C stringlengths 5 185	E stringlengths 4 155
Value in normal limits, leave natural evolution of labor.	Woman 40 weeks gestation in labor with 6 cm dilation. She presents a decelerative fetal pattern in cardiotocographic recordings, so it is decided to perform a fetal blood smear to assess fetal well-being. Result 7.22. The correct conduct is:	Pre-pathological value repeat microtome 15-20 minutes.	B	Severe acidosis. Urgent cesarean section.	Moderate acidosis. Repeat microtome in 1-2 hours.	Repeat at the time of possible error in obtaining the shot.
Daily plasmapheresis.	A 19-year-old girl with no medical history of interest, except for a self-limited case of influenza 3 weeks earlier, who comes to the emergency department with petechiae and ecchymosis of spontaneous onset. On physical examination the patient was in good general condition, afebrile, normotensive and oriented in time and space. There were petechiae scattered throughout the lower extremities and abdomen and small ecchymoses in decubitus areas. No lymphadenopathy or splenomegaly were palpated. Laboratory tests showed the following findings: Hb 12.6 g/dL, leukocytes 5,500/mm3, platelets 7000/mm3. The peripheral blood smear showed normal erythrocyte morphology, normal differential leukocyte count and the planetary count was concordant with the autoanalyzer figure without platelet aggregates. Biochemistry and proteinogram, beta 2 microglobulin and LDH are normal. Which of the following do you think is the most appropriate initial treatment?	Weekly Rituximab.	A	Platelet transfusion.	Cyclophosphamide in 4-day pulses every 21 days.	Prednisone at 1 mg/day for 2-3 weeks.
Fifth cervical and fourth thoracic nerve.	A 42-year-old woman with breast cancer has metastases at the level of the intervertebral foramina between the 4th and 5th cervical vertebrae and between the 4th and 5th thoracic vertebrae. Which spinal nerves will be injured?	Fifth cervical and fifth thoracic nerves.	D	Fourth cervical and fourth thoracic nerves.	Fourth cervical and fifth thoracic nerves.	Third cervical and fourth thoracic nerve.
Fibrosing Crohn's disease.	A 59-year-old woman presents with chronic watery diarrhea of 4 months' duration. On endoscopy, the mucosa showed no relevant features. In particular, no ulcers or friable areas were observed. A biopsy of the transverse colon was performed. Histopathology revealed a thickened area below the superficial lining epithelium, which was more evident by Masson's trichrome technique and involved epithelial atrophy and denudation. There was also a clear increase in intraepithelial lymphocyte density. The diagnosis of the intestinal lesion is?	Pseudomembranous colitis.	C	Chronic ulcerative colitis.	Collagenous colitis.	None
Dilated cardiomyopathy of ischemic origin.	A 78-year-old patient with no past history who consults for asthenia and dyspnea of 3 months of evolution, which has progressed to rest in the last few days. In the previous days he also refers chest pain with anginal characteristics with small efforts. On examination, blood pressure of 110/80 mmHg, heart rate of 85 bpm and auscultation with a rough systolic murmur in the right second intercostal space and crackles in both lung bases. Which of the following is the most likely diagnosis?	Aortic stenosis.	B	Mitral insufficiency.	Aortic insufficiency.	None
Phosphate tubular reabsorption.	In a 30-year-old female patient a calcium level of 11 mg/dl (normal less than 10.5 mg/dl) is found during a routine company examination. PTH determination was 45 pg/ml (VN 10-55 pg/ml). The history is unremarkable except for the fact that the mother and paternal grandfather were diagnosed with hyperparathyroidism and underwent surgery, although they remained hypercalcemic. Which test is most useful in confirming the diagnosis?	1,25-OH 2D.	C	25-OH D.	Urine calcium/creatinine ratio.	PTHrP.
Spironolactone is contraindicated in the management of this pathology.	A 58-year-old male with a history of arterial hypertension of 6 years of evolution, who consults for poor control of blood pressure figures despite receiving treatment with an angiotensin-converting enzyme inhibitor, a diuretic and a calcium antagonist. On consultation she presented with blood pressure of 149/100 mmHg. Laboratory tests: creatinine 1.2 mg/dl, potassium 2.2 mEq/l and compensated metabolic alkalosis; the rest of the biochemical study, blood count, coagulation and urinary sediment were normal. Mark the correct statement:	In most cases the anatomical substrate is bilateral hyperplasia of the adrenal cortex.	C	The origin of hypertension in this case is excessive aldosterone secretion caused by autonomic hyperfunction of the adrenal medulla.	CT scan is part of the diagnostic study in case of biochemical confirmation.	None
Because of the radiological features described, I need a hip MRI before making a therapeutic decision.	You evaluate a 66-year-old patient with groin pain accentuated by prolonged standing for a few days per month. A plain radiograph of the hips shows narrowing of the femoroacetabular joint space, sclerosis and ostephytes.	Start treatment with weak opioids that have shown evidence in stopping the progression of the disease.	C	I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis.	Treatment with paracetamol, explaining that the evolution is very variable and the surgical indication depends on the functionality and pain control.	None
Dysthymia.	A 19-year-old female university student comes to the clinic accompanied by her parents, reporting feeling progressively more asthenic in the last two months, with loss of appetite and weight and with greater difficulty in concentrating on her studies. The anamnesis also highlights that she has lost interest in going out with friends, has ideas of death without self-harming ideation and pessimistic cognitions of the future. Her weight is 90% of that considered ideal for age and gender. She does not present weight phobia or body image distortion. The most appropriate diagnosis is:	Anxiety disorder.	E	Anorexia nervosa.	Borderline personality disorder.	Major depressive disorder.
Administration of oral furosemide.	In a patient with known advanced chronic kidney disease (CKD G4, eGFR 20 ml/min) who comes to the emergency department for general weakness and is found to have severe hyperkalemia (K 7 mEq/l) with electrocardiographic abnormalities. What would be the first measure to take?	Placement of a catheter to initiate dialysis.	C	Administration of cation exchange resins.	Administration of intravenous calcium gluconate.	None
Anti-DNA antibodies.	A 26-year-old woman consults for a feeling of generalized weakness that has progressively set in over the course of three weeks, becoming particularly intense in the last two days. For the last couple of years, she reports episodes of joint pain in the hands that have required the use of anti-inflammatory drugs, as well as the appearance of an erythematous lesion of unclear cause in the neckline area, mainly in summer. In the physical examination there was only an evident cutaneous-mucosal pallor and a heart rate of 100 bpm. The hemogram shows: Hb 6 gr/dL, Hto 27 %, MCV 105 fL, 3,420 leukocytes/mm3 (2300 neutrophils/mm3, 800 lymphocytes/mm3, 250 monocytes/mm3, 50 eosinophils/mm3, 20 basophils/mm3), platelets 170,000/mm3. Biochemistry: AST 30 IU/L, ALT 35 IU/L, GGT 59 IU/L, alkaline phosphatase 105 IU/L, LDH 490 IU/L, urea 20 mg/dL, creatinine 0.8 mg/dL. Taking into account the available information, indicate which of the following additional analytical parameters you would need to know in order to make the most appropriate immediate decision:	Antinuclear antibodies.	C	Vitamin B12.	Direct Coombs' test.	None
Intravenous antibiotic therapy and evacuative (therapeutic) thoracentesis if any germ is isolated in the pleural fluid culture.	A 64-year-old male presents with fever, cough, dyspnea and right pleuritic pain of 1 week's evolution. Chest X-ray shows a loculated right pleural effusion occupying two thirds of the hemithorax. During thoracentesis, a yellowish fluid is drawn and analysis shows: leukocytes 15,000/uL, 92% neutrophils, glucose 30 mg/dL, pH 7, lactate dehydrogenase 3500 U/L, adenosine deaminase 45 U/L and absence of germs on GRAM stain. What is the most appropriate next course of action in this patient?	Intravenous antibiotic therapy and repeat diagnostic thoracentesis in 24 hours.	E	Intravenous antibiotic therapy.	Intravenous antibiotic therapy and repeat diagnostic thoracentesis if there is no improvement in 48 hours.	Intravenous antibiotic therapy and placement of a chest tube or catheter to drain all pleural fluid.
Clostridium difficile.	A 52-year-old patient is admitted to the Hospital for severe pneumonia. With appropriate antibiotic treatment, the patient's respiratory symptoms improved. After 4 days of stay in the ward, his evolution is complicated by the appearance of a severe diarrhea. What is the most frequent microorganism responsible for this condition?	The bacterium itself causing pneumonia that has become resistant to the antibiotic.	D	Salmonella enterica.	Campylobacter jejuni.	Yersinia enterocolitica.
Fracture in green stem of ulna.	A 7-year-old boy brought to the emergency department after falling off a swing onto his right hand. He has no history of interest. He presents with fork dorsum deformity of the wrist and functional impotence, with normal distal neurovascular status. What lesion would you expect to find on the urgent x-ray you request?	Radial head fracture.	C	Fracture - dislocation of Monteggia.	Epiphysiolysis of the distal radius.	None
Subacute thyroiditis.	A 30-year-old woman comes to the clinic reporting anxiety, weight loss of about 6 kg and a feeling of "nervousness" in the last three months. In the physical examination she has tachycardia, hyperreflexia and absence of goiter. In the blood test TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are low. A scintigraphy shows an absence of uptake in the thyroid region. What seems to you the most likely diagnosis?	Hyperthyroidism due to Graves' disease.	A	Factitious thyrotoxicosis.	Ovarian teratoma (ovarian stromal tumor).	None
It is a pattern of lateral bulbar lesion.	A man presents on neurological examination with a thermoalgesic sensory deficit in the left leg associated with a loss of vibratory and positional sensitivity in the right leg. At the same time he presents with clumsiness and loss of distal strength in the right leg and a right plantar cutaneous reflex in extension. Which of the following statements is correct:	It is a hemimedullary syndrome.	B	It is a centromedullary syndrome type syringomyelia.	It is a pattern of transverse medullary lesion.	None
Venous Doppler ultrasound.	65-year-old man with a history of pancreatic neoplasm undergoing chemotherapy. What diagnostic test is more cost-effective to confirm the diagnostic suspicion?	Magnetic resonance imaging.	D	D-dimer.	Phlebography.	Helical CT.
Gabapentin.	A 10-year-old boy with brief episodes of distractions (< 1 minute) in which he does not respond to calls and blinks. An EEG shows spike-wave discharges at 3 cycles per second. First-line elective treatment would with:	Carbamazepine.	A	Valproate.	Phenytoin.	Clonazepam.
Kidney-pancreas transplant.	A 72-year-old woman with no past history of interest. After a complicated renal colic, a 2 cm cystic lesion in the tail of the pancreas, together with multiple bilateral renal cystic lesions, is found by chance in the abdominal CT scan. Endoscopic ultrasonography shows a polycystic lesion formed by multiple vesicles with central calcification in the tail of the pancreas with no connection to the duct of Wirsung. Fluid analysis is compatible with a serous cystadenoma. Of the following, which is the most correct attitude regarding the management of this patient:	Endoscopic ultrasonography-guided puncture and ethanolization of the puncture.	C	Surgical resection (corporocaudal pancreatectomy).	Follow-up of the lesion by MRI.	None
Ferritin.	A 25-year-old female patient with a history of skin rash after sun exposure and occasional polyarthritis in the joints of the hands, controlled with non-steroidal anti-inflammatory drugs, presents with general malaise, progressive feeling of generalized weakness and pallor for the last 15 days. Laboratory tests showed hemoglobin 7 g/dL, MCV 108 mm/h, 150,000 platelets/mm3, 3000 leukocytes/mm3, elevated LDH, undetectable haptoglobin. In the case of choosing a single diagnostic test indicate which of the following determinations should be performed first:	Antinuclear antibodies (ANA).	A	Direct Coombs test.	Vitamin B12.	Folic acid.
Carotid ultrasound.	A 70-year-old woman with a history of anorexia, weight loss, discomfort in the musculature and proximal joints plus pain in the temporomandibular region who comes to the emergency department for unilateral loss of vision (hand movement), sudden and painless onset (afferent pupillary defect). What test would you request first for diagnostic purposes?	C-reactive protein.	B	Lumbar puncture.	Magnetic Resonance Angiography.	None
IgA myeloma with Bence-Jones proteinuria.	A 68-year-old patient consults for edema and asthenia. Laboratory tests showed creatinine 5 mg/dL, hemoglobin 10 g/dL and marked hypogammaglobulinemia in serum at the expense of IgG, IgA and IgM. A urinalysis reveals the presence of kappa light chains. What is your diagnostic suspicion?	Nephrotic syndrome.	A	Kappa light chain deposition disease.	Amyloidosis.	Light chain myeloma.
Respiratory alkalosis due to lack of chloride.	A 24-year-old woman is found lying in the street by passers-by. On arrival of the emergency team she was found with an oxygen saturation of 88% breathing room air and on examination with pinpoint pupils. She was transferred to the emergency room of the nearest hospital, where the baseline arterial blood gases showed: pH 7.25, PaC02 60 mmHg, Pa02 58 mmHg, bicarbonate 26 mEq/1 and base excess of -1. In blood sodium was 137 mEq/1 and chloride 100 mEq/1:	Metabolic acidosis.	C	Partial respiratory failure.	Pure respiratory acidosis.	Blood gases can only be venous blood.
Intravenous corticosteroids.	A 2-month-old infant with an upper respiratory tract cold of 3 days of evolution, who begins with moderate respiratory distress and pulmonary auscultation with expiratory wheezing. Oxygen saturation is 89 %. Respiratory syncytial virus is isolated in the nasopharyngeal exudate. Which of the following treatments do you consider more indicated for this condition?	Nebulized salbutamol.	C	Oral rivabirin.	Supplemental oxygen.	None
Drug-induced thrombopenia.	A 67-year-old female patient on ticlopidine treatment comes to the emergency department with headache, asthenia and petechiae in the lower extremities. Laboratory tests showed hemoglobin 8.2 g/dL, MCV 100 fl, platelets 25000/ul and leukocytes 7500/ul with normal formula. The reticulocyte count was elevated and the blood smear showed numerous schistocytes. Coagulation studies (APTT, PT and fibrinogen) are normal. The biochemistry shows LDH 2700 IU/l and bilirubin 2.6 mg/dl. What is the most likely diagnosis?	Thrombotic thrombocytopenic purpura.	B	Autoimmune thrombocytopenic purpura.	Bone marrow aplasia.	Disseminated intravascular coagulation.

Value in normal limits, leave natural evolution of labor.

Woman 40 weeks gestation in labor with 6 cm dilation. She presents a decelerative fetal pattern in cardiotocographic recordings, so it is decided to perform a fetal blood smear to assess fetal well-being. Result 7.22. The correct conduct is:

Pre-pathological value repeat microtome 15-20 minutes.

B

Severe acidosis. Urgent cesarean section.

Moderate acidosis. Repeat microtome in 1-2 hours.

Repeat at the time of possible error in obtaining the shot.

Daily plasmapheresis.

A 19-year-old girl with no medical history of interest, except for a self-limited case of influenza 3 weeks earlier, who comes to the emergency department with petechiae and ecchymosis of spontaneous onset. On physical examination the patient was in good general condition, afebrile, normotensive and oriented in time and space. There were petechiae scattered throughout the lower extremities and abdomen and small ecchymoses in decubitus areas. No lymphadenopathy or splenomegaly were palpated. Laboratory tests showed the following findings: Hb 12.6 g/dL, leukocytes 5,500/mm3, platelets 7000/mm3. The peripheral blood smear showed normal erythrocyte morphology, normal differential leukocyte count and the planetary count was concordant with the autoanalyzer figure without platelet aggregates. Biochemistry and proteinogram, beta 2 microglobulin and LDH are normal. Which of the following do you think is the most appropriate initial treatment?

Weekly Rituximab.

A

Platelet transfusion.

Cyclophosphamide in 4-day pulses every 21 days.

Prednisone at 1 mg/day for 2-3 weeks.

Fifth cervical and fourth thoracic nerve.

A 42-year-old woman with breast cancer has metastases at the level of the intervertebral foramina between the 4th and 5th cervical vertebrae and between the 4th and 5th thoracic vertebrae. Which spinal nerves will be injured?

Fifth cervical and fifth thoracic nerves.

D

Fourth cervical and fourth thoracic nerves.

Fourth cervical and fifth thoracic nerves.

Third cervical and fourth thoracic nerve.

Fibrosing Crohn's disease.

A 59-year-old woman presents with chronic watery diarrhea of 4 months' duration. On endoscopy, the mucosa showed no relevant features. In particular, no ulcers or friable areas were observed. A biopsy of the transverse colon was performed. Histopathology revealed a thickened area below the superficial lining epithelium, which was more evident by Masson's trichrome technique and involved epithelial atrophy and denudation. There was also a clear increase in intraepithelial lymphocyte density. The diagnosis of the intestinal lesion is?

Pseudomembranous colitis.

C

Chronic ulcerative colitis.

Collagenous colitis.

None

Dilated cardiomyopathy of ischemic origin.

A 78-year-old patient with no past history who consults for asthenia and dyspnea of 3 months of evolution, which has progressed to rest in the last few days. In the previous days he also refers chest pain with anginal characteristics with small efforts. On examination, blood pressure of 110/80 mmHg, heart rate of 85 bpm and auscultation with a rough systolic murmur in the right second intercostal space and crackles in both lung bases. Which of the following is the most likely diagnosis?

Aortic stenosis.

B

Mitral insufficiency.

Aortic insufficiency.

None

Phosphate tubular reabsorption.

In a 30-year-old female patient a calcium level of 11 mg/dl (normal less than 10.5 mg/dl) is found during a routine company examination. PTH determination was 45 pg/ml (VN 10-55 pg/ml). The history is unremarkable except for the fact that the mother and paternal grandfather were diagnosed with hyperparathyroidism and underwent surgery, although they remained hypercalcemic. Which test is most useful in confirming the diagnosis?

1,25-OH 2D.

C

25-OH D.

Urine calcium/creatinine ratio.

PTHrP.

Spironolactone is contraindicated in the management of this pathology.

A 58-year-old male with a history of arterial hypertension of 6 years of evolution, who consults for poor control of blood pressure figures despite receiving treatment with an angiotensin-converting enzyme inhibitor, a diuretic and a calcium antagonist. On consultation she presented with blood pressure of 149/100 mmHg. Laboratory tests: creatinine 1.2 mg/dl, potassium 2.2 mEq/l and compensated metabolic alkalosis; the rest of the biochemical study, blood count, coagulation and urinary sediment were normal. Mark the correct statement:

In most cases the anatomical substrate is bilateral hyperplasia of the adrenal cortex.

C

The origin of hypertension in this case is excessive aldosterone secretion caused by autonomic hyperfunction of the adrenal medulla.

CT scan is part of the diagnostic study in case of biochemical confirmation.

None

Because of the radiological features described, I need a hip MRI before making a therapeutic decision.

You evaluate a 66-year-old patient with groin pain accentuated by prolonged standing for a few days per month. A plain radiograph of the hips shows narrowing of the femoroacetabular joint space, sclerosis and ostephytes.

Start treatment with weak opioids that have shown evidence in stopping the progression of the disease.

C

I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis.

Treatment with paracetamol, explaining that the evolution is very variable and the surgical indication depends on the functionality and pain control.

None

Dysthymia.

A 19-year-old female university student comes to the clinic accompanied by her parents, reporting feeling progressively more asthenic in the last two months, with loss of appetite and weight and with greater difficulty in concentrating on her studies. The anamnesis also highlights that she has lost interest in going out with friends, has ideas of death without self-harming ideation and pessimistic cognitions of the future. Her weight is 90% of that considered ideal for age and gender. She does not present weight phobia or body image distortion. The most appropriate diagnosis is:

Anxiety disorder.

E

Anorexia nervosa.

Borderline personality disorder.

Major depressive disorder.

Administration of oral furosemide.

In a patient with known advanced chronic kidney disease (CKD G4, eGFR 20 ml/min) who comes to the emergency department for general weakness and is found to have severe hyperkalemia (K 7 mEq/l) with electrocardiographic abnormalities. What would be the first measure to take?

Placement of a catheter to initiate dialysis.

C

Administration of cation exchange resins.

Administration of intravenous calcium gluconate.

None

Anti-DNA antibodies.

A 26-year-old woman consults for a feeling of generalized weakness that has progressively set in over the course of three weeks, becoming particularly intense in the last two days. For the last couple of years, she reports episodes of joint pain in the hands that have required the use of anti-inflammatory drugs, as well as the appearance of an erythematous lesion of unclear cause in the neckline area, mainly in summer. In the physical examination there was only an evident cutaneous-mucosal pallor and a heart rate of 100 bpm. The hemogram shows: Hb 6 gr/dL, Hto 27 %, MCV 105 fL, 3,420 leukocytes/mm3 (2300 neutrophils/mm3, 800 lymphocytes/mm3, 250 monocytes/mm3, 50 eosinophils/mm3, 20 basophils/mm3), platelets 170,000/mm3. Biochemistry: AST 30 IU/L, ALT 35 IU/L, GGT 59 IU/L, alkaline phosphatase 105 IU/L, LDH 490 IU/L, urea 20 mg/dL, creatinine 0.8 mg/dL. Taking into account the available information, indicate which of the following additional analytical parameters you would need to know in order to make the most appropriate immediate decision:

Antinuclear antibodies.

C

Vitamin B12.

Direct Coombs' test.

None

Intravenous antibiotic therapy and evacuative (therapeutic) thoracentesis if any germ is isolated in the pleural fluid culture.

A 64-year-old male presents with fever, cough, dyspnea and right pleuritic pain of 1 week's evolution. Chest X-ray shows a loculated right pleural effusion occupying two thirds of the hemithorax. During thoracentesis, a yellowish fluid is drawn and analysis shows: leukocytes 15,000/uL, 92% neutrophils, glucose 30 mg/dL, pH 7, lactate dehydrogenase 3500 U/L, adenosine deaminase 45 U/L and absence of germs on GRAM stain. What is the most appropriate next course of action in this patient?

Intravenous antibiotic therapy and repeat diagnostic thoracentesis in 24 hours.

E

Intravenous antibiotic therapy.

Intravenous antibiotic therapy and repeat diagnostic thoracentesis if there is no improvement in 48 hours.

Intravenous antibiotic therapy and placement of a chest tube or catheter to drain all pleural fluid.

Clostridium difficile.

A 52-year-old patient is admitted to the Hospital for severe pneumonia. With appropriate antibiotic treatment, the patient's respiratory symptoms improved. After 4 days of stay in the ward, his evolution is complicated by the appearance of a severe diarrhea. What is the most frequent microorganism responsible for this condition?

The bacterium itself causing pneumonia that has become resistant to the antibiotic.

D

Salmonella enterica.

Campylobacter jejuni.

Yersinia enterocolitica.

Fracture in green stem of ulna.

A 7-year-old boy brought to the emergency department after falling off a swing onto his right hand. He has no history of interest. He presents with fork dorsum deformity of the wrist and functional impotence, with normal distal neurovascular status. What lesion would you expect to find on the urgent x-ray you request?

Radial head fracture.

C

Fracture - dislocation of Monteggia.

Epiphysiolysis of the distal radius.

None

Subacute thyroiditis.

A 30-year-old woman comes to the clinic reporting anxiety, weight loss of about 6 kg and a feeling of "nervousness" in the last three months. In the physical examination she has tachycardia, hyperreflexia and absence of goiter. In the blood test TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are low. A scintigraphy shows an absence of uptake in the thyroid region. What seems to you the most likely diagnosis?

Hyperthyroidism due to Graves' disease.

A

Factitious thyrotoxicosis.

Ovarian teratoma (ovarian stromal tumor).

None

It is a pattern of lateral bulbar lesion.

A man presents on neurological examination with a thermoalgesic sensory deficit in the left leg associated with a loss of vibratory and positional sensitivity in the right leg. At the same time he presents with clumsiness and loss of distal strength in the right leg and a right plantar cutaneous reflex in extension. Which of the following statements is correct:

It is a hemimedullary syndrome.

B

It is a centromedullary syndrome type syringomyelia.

It is a pattern of transverse medullary lesion.

None

Venous Doppler ultrasound.

65-year-old man with a history of pancreatic neoplasm undergoing chemotherapy. What diagnostic test is more cost-effective to confirm the diagnostic suspicion?

Magnetic resonance imaging.

D

D-dimer.

Phlebography.

Helical CT.

Gabapentin.

A 10-year-old boy with brief episodes of distractions (< 1 minute) in which he does not respond to calls and blinks. An EEG shows spike-wave discharges at 3 cycles per second. First-line elective treatment would with:

Carbamazepine.

A

Valproate.

Phenytoin.

Clonazepam.

Kidney-pancreas transplant.

A 72-year-old woman with no past history of interest. After a complicated renal colic, a 2 cm cystic lesion in the tail of the pancreas, together with multiple bilateral renal cystic lesions, is found by chance in the abdominal CT scan. Endoscopic ultrasonography shows a polycystic lesion formed by multiple vesicles with central calcification in the tail of the pancreas with no connection to the duct of Wirsung. Fluid analysis is compatible with a serous cystadenoma. Of the following, which is the most correct attitude regarding the management of this patient:

Endoscopic ultrasonography-guided puncture and ethanolization of the puncture.

C

Surgical resection (corporocaudal pancreatectomy).

Follow-up of the lesion by MRI.

None

Ferritin.

A 25-year-old female patient with a history of skin rash after sun exposure and occasional polyarthritis in the joints of the hands, controlled with non-steroidal anti-inflammatory drugs, presents with general malaise, progressive feeling of generalized weakness and pallor for the last 15 days. Laboratory tests showed hemoglobin 7 g/dL, MCV 108 mm/h, 150,000 platelets/mm3, 3000 leukocytes/mm3, elevated LDH, undetectable haptoglobin. In the case of choosing a single diagnostic test indicate which of the following determinations should be performed first:

Antinuclear antibodies (ANA).

A

Direct Coombs test.

Vitamin B12.

Folic acid.

Carotid ultrasound.

A 70-year-old woman with a history of anorexia, weight loss, discomfort in the musculature and proximal joints plus pain in the temporomandibular region who comes to the emergency department for unilateral loss of vision (hand movement), sudden and painless onset (afferent pupillary defect). What test would you request first for diagnostic purposes?

C-reactive protein.

B

Lumbar puncture.

Magnetic Resonance Angiography.

None

IgA myeloma with Bence-Jones proteinuria.

A 68-year-old patient consults for edema and asthenia. Laboratory tests showed creatinine 5 mg/dL, hemoglobin 10 g/dL and marked hypogammaglobulinemia in serum at the expense of IgG, IgA and IgM. A urinalysis reveals the presence of kappa light chains. What is your diagnostic suspicion?

Nephrotic syndrome.

A

Kappa light chain deposition disease.

Amyloidosis.

Light chain myeloma.

Respiratory alkalosis due to lack of chloride.

A 24-year-old woman is found lying in the street by passers-by. On arrival of the emergency team she was found with an oxygen saturation of 88% breathing room air and on examination with pinpoint pupils. She was transferred to the emergency room of the nearest hospital, where the baseline arterial blood gases showed: pH 7.25, PaC02 60 mmHg, Pa02 58 mmHg, bicarbonate 26 mEq/1 and base excess of -1. In blood sodium was 137 mEq/1 and chloride 100 mEq/1:

Metabolic acidosis.

C

Partial respiratory failure.

Pure respiratory acidosis.

Blood gases can only be venous blood.

Intravenous corticosteroids.

A 2-month-old infant with an upper respiratory tract cold of 3 days of evolution, who begins with moderate respiratory distress and pulmonary auscultation with expiratory wheezing. Oxygen saturation is 89 %. Respiratory syncytial virus is isolated in the nasopharyngeal exudate. Which of the following treatments do you consider more indicated for this condition?

Nebulized salbutamol.

C

Oral rivabirin.

Supplemental oxygen.

None

Drug-induced thrombopenia.

A 67-year-old female patient on ticlopidine treatment comes to the emergency department with headache, asthenia and petechiae in the lower extremities. Laboratory tests showed hemoglobin 8.2 g/dL, MCV 100 fl, platelets 25000/ul and leukocytes 7500/ul with normal formula. The reticulocyte count was elevated and the blood smear showed numerous schistocytes. Coagulation studies (APTT, PT and fibrinogen) are normal. The biochemistry shows LDH 2700 IU/l and bilirubin 2.6 mg/dl. What is the most likely diagnosis?

Thrombotic thrombocytopenic purpura.

B

Autoimmune thrombocytopenic purpura.

Bone marrow aplasia.

Disseminated intravascular coagulation.