Este documento presenta tres resúmenes: 1. Se describe el caso de una mujer de 78 años que ingresa a urgencias con cefalea, náuseas, vómitos y otros síntomas. El diagnóstico más probable es metabólico. 2. Se analiza la relación entre síntomas psiquiátricos y episodios frecuentes de angina en pacientes con enfermedad cardiaca isquémica. Aquellos con ansiedad o depresión tienen un mayor riesgo de angina frecuente. 3. Se define la muerte cardiaca

1. 1. Simulacro ENARM 2010
MUJER DE 78 AÑOS, LLEVADA A URGENCIAS POR CEFALEA INTENSA, NÁUSEA,
VÓMITOS, TRASTORNOS DE LA MEMORIA,APATÍA Y SOMNOLENCIA.
ANTECEDENTES DE DIABETES MELLITUS Y ENFERMEDAD ARTICULAR DE TIPO
DEGENERATIVO AMBAS BAJO TRATAMIENTO MÉDICO. E.F.: TEMP 38º C, TA
140/90 MMHG, RCR, CAMPOS PULMONARES CLAROS, EXTREMIDADES CON
DISMINUCIÓN DE FUERZA MUSCULAR 3/5 EN HEMICUERPO IZQUIERDO,
REFLEJOS DE ESTIRAMIENTO MUSCULAR CONSERVADO. DISMINUCIÓN DE
CAMPOS VISUALES. B.H. Y Q.S. NORMALES.
1.- EL AGENTE CAUSAL MÁS PROBABLE EN ESTE PACIENTE ES:
a) BACTERIANO.
b) VIRAL.
c) NEOPLASICO
d) METABÓLICO.
2.- EL MÉTODO MÁS SENSIBLE PARA CORROBORAR EL DIAGNÓSTICO EN
ESTE PACIENTE ES:
a) PUNCIÓN LUMBAR.
b) RESONANCIA MAGNETICA
c) HEMOGLOBINA GLUCOSILADA.
d) ANGIOGRAFÍA
ANXIETY, DEPRESSION LINKED TO ANGINA FREQUENCY IN HEART PATIENTS
NEW RESEARCH SHOWS THAT ISCHEMIC HEART DISEASE PATIENTS WHO
SUFFER SIGNIFICANT ANXIETY HAVE CLOSE TO A 5-FOLD INCREASED RISK
OF EXPERIENCING FREQUENT ANGINA AND THOSE WITH DEPRESSION HAVE
MORE THAN A 3-FOLD INCREASED RISK FOR THESE EPISODES. THIS
OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND ANGINA
UNDERLINES THE IMPORTANCE OF TREATING ANXIETY AND DEPRESSION IN
CARDIAC PATIENTS. PSYCHOSOCIAL FACTORS: THE RESEARCHERS
EXAMINED 5 PSYCHOSOCIAL FACTORS THAT MIGHT AFFECT ANGINA
FREQUENCY: ANXIETY; DEPRESSION; NEUROTICISM (TENDENCY TO
EXPERIENCE NEGATIVE EMOTIONS SUCH AS SADNESS, ANGER, OR GUILT);
ALEXITHYMIA (IMPAIRED ABILITY TO EXPRESS INNER FEELINGS); AND
SOMATOSENSORY AMPLIFICATION (TENDENCY TO EXPERIENCE A SOMATIC
SENSATION AS INTENSE, NOXIOUS, AND DISTURBING). THERE WAS MORE
ANXIETY AND DEPRESSION AMONG PATIENTS WITH FREQUENT ANGINA. FOR
INSTANCE, 22% OF PATIENTS WITH NO ANGINA HAD CLINICALLY
SIGNIFICANT ANXIETY, DEFINED AS A SCORE OF 16 OR GREATER ON THE
BECK ANXIETY INVENTORY SCALE, COMPARED WITH 38% FOR PATIENTS
WITH MONTHLY ANGINA AND 64% FOR THOSE WITH WEEKLY OR DAILY
ANGINA. OTHER PSYCHOSOCIAL FACTORS WERE ALSO INCREASED AMONG
PATIENTS WITH MORE FREQUENT ANGINA. FOR EXAMPLE, 38% OF PATIENTS

2. WITH WEEKLY OR DAILY ANGINA HAD A HIGH LEVEL OF ALEXITHYMIA
COMPARED WITH 17% OF PATIENTS WITH MONTHLY ANGINA AND 14% OF
THOSE WITHOUT ANGINA. HOWEVER, AFTER ADJUSTMENT FOR DEGREE OF
MYOCARDIAL ISCHEMIA, GREATER ANXIETY SCORE (ODDS RATIO, 1.39 PER
HALF–STANDARD DEVIATION INCREASE IN ANXIETY SCORE) AND GREATER
DEPRESSION SCORE (OR, 1.51 PER HALF–STANDARD DEVIATION INCREASE
IN DEPRESSION SCORE) WERE THE ONLY PSYCHOSOCIAL FACTORS
SIGNIFICANTLY ASSOCIATED WITH MORE FREQUENT ANGINA. AS EXPECTED,
PREVIOUS CORONARY REVASCULARIZATION WAS ALSO SIGNIFICANTLY
ASSOCIATED WITH FREQUENT ANGINA. PATIENTS WITH AT LEAST MODERATE
ANXIETY SYMPTOMS EXPERIENCED A 4.7-FOLD INCREASED RISK OF HAVING
MORE FREQUENT ANGINA. PATIENTS WITH CLINICALLY RELEVANT
DEPRESSIVE SYMPTOMS HAD A 3.2-FOLD INCREASED RISK OF EXPERIENCING
MORE FREQUENT ANGINA. BIOLOGICAL FACTORS: NOT EVERY PATIENT WITH
CORONARY ARTERY DISEASE DEVELOPS ANGINA. UP TO 45% OF THESE
PATIENTS HAVE ASYMPTOMATIC ISCHEMIA. SEVERAL BIOLOGICAL FACTORS
MIGHT EXPLAIN THE DISCREPANCY BETWEEN CORONARY ARTERY DISEASE
AND ANGINA SEVERITY, ACCORDING TO THE AUTHORS. FOR EXAMPLE,
METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY MAY
INFLUENCE PAIN LEVELS.
3.- WHAT HAS NEW RESEARCH DEMONSTRATED ABOUT ISCHEMIC HEART
DISEASE PATIENTS WITH DEPRESSION?
a) THIS PATIENTS HAVE MORE INCREASED RISK OF EXPERIENCING
FREQUENT ANGINA.
b) THIS PATIENTS HAVE MORE INCREASED RISK OF THIS EPISODES.
c) A PATIENTS HEART DISEASE IS NOT RELATED WITH ANY PSYCHIATRIC
DISEASE.
d) THERE IS NO OBSERVED LINK BETWEEN PSYCHIATRIC SYMPTOMS AND
ANGINA.
4.- WHAT RELATIONSHIP WAS FOUND BETWEEN PSYCHIATRIC SYMPTOMS
AND PATIENTS WITH FREQUENT ANGINA?
a) THIS PATIENTS HAD CLINICALLY SIGNIFICANT ANXIETY.
b) THIS PATIENTS HAD A 16 SCORE OR GREATER ON THE BECK ANXIETY
INVENTORY SCALE.
c) THIS PATIENTS SUFFERED FROM WEEKLY OR DAILY ANGINA.
d) THIS PATIENTS HAD MORE ANXIETY AND DEPRESSION.
5.- WHAT PSYCHOSOCIAL FACTORS INCREASED AMONG PATIENTS WHO
SUFFERED OF FREQUENT ANGINA?
a) ALEXITHYMIA.
b) ANXIETY.

3. c) SOMATOSENSORY AMPLIFICATION.
d) NOXIOUS.
6.- WHAT ADJUSTMENT FOR DEGREE WAS THERE AFTER MYOCHARDIAL
ISCHEMIA?
a) ANXIETY AND DEPRESSION DECREASED.
b) DEPRESSION AND ANXIETY INCREASED.
c) ANXIETY AND DEPRESSION REMAINED THE SAME.
d) THERE WAS NO SIGNIFICANT CHANGES.
7.- WHAT BIOLOGICAL FACTORS EFFECTS PATIENTS WITH ANGINA?
a) EVERY PATIENT WITH CORONARY ARTERY DISEASE DEVELOPS ANGINA.
b) PREVIOUS CORONARY REVASCULARIZATION WAS ALSO ASSOCIATED WITH
FREQUENT ANGINA.
c) SOME OF THIS PATIENTS HAVE ASYMPTOMATIC ISQUEMIA.
d) METABOLIC NEUROPATHY OR ISCHEMIC REGIONAL NERVE INJURY ARE
NOT RELATED.
MUJER DE 31 AÑOS. ES ATENDIDA EN CONSULTA POR PRESENTAR ACTIVIDAD
UTERINA REGULAR Y DOLOROSA. ACTUALMENTE CURSA EMBARAZO GEMELAR
DE 33 SEMANAS . NIEGA SANGRADO TRANSVAGINAL, SALIDA DE LÍQUIDO
TRANSVAGINAL. REFIERE MOVIMIENTOS FETALES PRESENTES.
ANTECEDENTES: G:3, P:2, DIABETES GESTACIONAL MANEJADA CON DIETA Y
METFORMINA CON BUEN CONTROL GLICÉMICO. E.F.: PRODUCTO ÚNICO
LONGITUDINAL PÉLVICO, DORSO DERECHA. CON FCF 130 LPM. TACTO
VAGINAL 1 CM DE DILATACIÓN CON 80% BORRRAMIENTO.
8.- EL TRATAMIENTO DE PRIMERA ELECCIÓN PARA ESTA PACIENTE ES:
a) INHIBIDORES DE LA SINTESIS DE PROSTAGLANDINAS.
b) BETAMIMÉTICOS.
c) NIFEDIPINO.
d) REPOSO.
NIÑA DE 4 AÑOS, INGRESA AL SERVICIO DE URGENCIAS POR DOLOR
ABDOMINAL CONSTANTE DE 48 HORAS DE EVOLUCIÓN. SU MADRE LE DIÓ
PARACETAMOL AYER, SIN EMBARGO EL DOLOR PERSISTE Y SE AGREGARON
VÓMITO VERDOSO Y FIEBRE DE 39°C. ANTECEDENTES: OPERADA DE
HIPERTROFIA PILÓRICA A LOS 2 MESES. E.F.: TA/ 100/60, FC 120LPM, FR 30
RPM, TEMPERATURA 38.7°C. ABDOMEN CON DOLOR A LA PALPACIÓN MEDIA Y
RESISTENCIA, TIMPÁNICO, PERISTALSIS NULA.
9.- EL DIAGNÓSTICO DE MÁS PROBABILIDAD ES:

4. a) OCLUSIÓN INTESTINAL BAJA.
b) INVAGINACIÓN INTESTINAL.
c) OCLUSION POR ADHERENCIAS.
d) APENDICITIS COMPLICADA.
10.- EL TRATAMIENTO INMEDIATO PARA ESTA PACIENTE ES:
a) ADMINISTRAR SONDA A DERIVACIÓN.
b) LAPAROTOMIA EXPLORADORA.
c) SOLUCIONES PARENTERALES.
d) OBSERVACIÓN.
HOMBRE DE 45 AÑOS. ATENDIDO EN LA CONSULTA POR PRESENTAR
EXPECTORACIÓN CON SANGRE. ANTECEDENTES: TABAQUISMO POSITIVO, 42
CAJETILLAS AL AÑO. TOS CRÓNICA CON EXPECTORACIÓN MUCOSA
ABUNDANTE, DE 3 AÑOS DE EVOLUCIÓN. E.F.: TA 130/80 MM HG, FC 88 LPM,
FR 14 RPM, TEMP 37ºC. DISMINUCIÓN DE AMPLEXIÓN Y AMPLEXACIÓN. RX
DE TÓRAX MUESTRA OPACIDAD HILIAR DERECHA.
11.- EL SIGUIENTE ESTUDIO QUE SE DEBE REALIZAR EN ESTE PACIENTE
PARA CONFIRMAR EL DIAGNÓSTICO ES:
a) CITOLOGÍA EN EXPECTORACIÓN.
b) LAVADO, CEPILLADO BRONQUIAL POR BRONCOSCOPÍA.
c) TOMA DE BIOPSIA TRANSBRONQUIAL POR BRONCOSCOPIA.
d) TOMA DE BIOPSIA TRANSTORÁCICA CON AGUJA FINA.
12.- EN ESTE PACIENTE EL REPORTE ANATOMOPATOLÓGICO MÁS PROBABLE
ES:
a) CARCINOMA EPIDERMOIDE.
b) ADENOCARCINOMA.
c) LINFOMA DE HODGKIN.
d) CARCINOMA DE CELULAS PEQUEÑAS.
13.- EN ESTE PACIENTE, UNA VEZ TRATADO, USTED ESPERA QUE PUEDA
TENER:
a) EDEMA DE MIEMBROS INFERIORES.
b) ASCITIS.
c) CRISIS CONVULSIVAS.
d) ARRITMIAS CARDIACAS.
HOMBRE DE 40 AÑOS. ATENDIDO EN LA CONSULTA EXTERNA POR DOLOR

5. INTENSO EN PRIMER ORTEJO DEL PIE DERECHO Y FIEBRE. ANTECEDENTES:
SE ENCUENTRA EN QUIMIOTERAPIA POR PADECER DE LEUCEMIA
GRANULOCÍTICA CRÓNICA. E.F.: TA 130/70 MM HG, FC 120 LPM, FR 14 RPM,
TEMP 38ºC. EL DEDO REFERIDO ESTA INFLAMADO MUY DOLOROSO AL MENOR
ESTÍMULO. LABORATORIO: LEUCOCITOS 25,000/MM3, ÁCIDO ÚRICO 14
MG/DL. CREATININA SERICA 0.9 MG/DL.
14.- LA EXPLICACIÓN MÁS PROBABLE DE ESTE CUADRO CLÍNICO ES:
a) INGESTIÓN ABUNDANTE DE CARNES ROJAS.
b) AUMENTO DE RECAMBIO TISULAR.
c) DISMINUCIÓN EN LA ELIMINACIÓN RENAL DE ÁCIDO ÚRICO.
d) CONSECUENCIA DEL TRATAMIENTO ANTINEOPLASICO.
LACTANTE DE 2 MESES DE EDAD. ES ATENDIDO EN LA CONSULTA POR
PRESENTAR ADENOMEGALIA EN REGIÓN AXILAR DERECHA CON DOLOR E
INMOVILIZACIÓN DE LA ARTICULACIÓN. REFIERE LA MADRE QUE TIENE
ESQUEMA COMPLETO DE VACUNACIÓN. E.F.: MASA DE 3 CM EN AXILA CON
CAMBIOS DE COLOR Y AUMENTO DE TEMPERATURA EN LA REGIÓN.
TEMPERATURA 37.3º, FC. 124LPM, FR 36 RPM.
15.- LA PRINCIPAL SOSPECHA CLÍNICA EN ESTE CASO ES:
a) ABSCESO AXILAR.
b) TUBERCULOMA.
c) LIPOMA.
d) INFECCIÓN.
16.- ESTUDIO MAS SENSIBLE PARA REALIZAR EL DIAGNÓSTICO:
a) REVISAR EL ESQUEMA DE VACUNACIÓN.
b) TOMA DE BIOPSIA.
c) APLICACIÓN DE PPD.
d) BAAR POR SONDA OROGÁSTRICA.
SUDDEN CARDIAC DEATH (SCD) IS DEFINED AS THE UNEXPECTED NATURAL
DEATH FROM CARDIAC CAUSES WITHIN A SHORT TIME PERIOD IN A PERSON
WITHOUT A CARDIAC CONDITION THAT WOULD APPEAR FATAL. SCD IS
RESPONSIBLE FOR APPROXIMATELY 300,000 FATALITIES IN THE UNITED
STATES ALONE. IT IS ESTIMATED THAT 50% OF ALL CARDIAC DEATHS ARE
SUDDEN, AND THIS PROPORTION HAS REMAINED CONSTANT DESPITE THE
OVERALL DECLINE IN CARDIOVASCULAR MORTALITY DURING THE LAST
DECADES. IN APPROXIMATELY THREE FOURTHS OF CASES, SCD IS CAUSED
BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF), ALTHOUGH IN
PATIENTS WHO HAVE UNDERLYING CONGESTIVE HEART FAILURE (CHF), A
SIGNIFICANT PROPORTION OF SCD IS THE CONSEQUENCE OF BRADYCARDIC
EVENTS OR ELECTROMECHANICAL DISSOCIATION. THIS ARTICLE
SUMMARIZES THE CURRENT KNOWLEDGE ON RISK STRATIFICATION IN

6. PATIENTS WHO HAVE STRUCTURAL HEART DISEASE, NOTABLY CORONARY
ARTERY DISEASE AND NONISCHEMIC CARDIOMYOPATHY. ALTHOUGH OTHER
TYPES OF STRUCTURAL HEART DISEASE AND INHERITED ION CHANNEL
ABNORMALITIES ARE ALSO ASSOCIATED WITH A RISK OF SCD, THE RISK
STRATIFICATION STRATEGIES AND DATA IN THESE ENTITIES ARE DIVERSE
AND BEYOND THE SCOPE OF THIS ARTICLE. THE MAGNITUDE OF THE
PROBLEM IN SPECIFIC SUBGROUPS OF PATIENTS PRONE TO SCD WAS
ADDRESSED BY MYERBURG IN A REVIEW OF THE POPULATION IMPACT OF
EMERGING IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR (ICD) TRIALS. THE
HIGHEST INCIDENCE OF SCD OCCURRED IN SURVIVORS OF OUT-OF-
HOSPITAL CARDIAC DEATH AND HIGH-RISK POST INFARCTION SUBGROUPS,
BUT THE GREATEST ABSOLUTE NUMBER OF SCD EVENTS (POPULATION
ATTRIBUTABLE RISK) OCCURRED IN LARGER SUBGROUPS OF PATIENTS AT
SOMEWHAT LOWER RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR
DYSFUNCTION, CHF, OR ANY PRIOR CORONARY EVENTS. THE CHALLENGE IS
TO IDENTIFY RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF
PATIENTS AT RELATIVELY LOW RISK, WHICH APPLIES, FOR EXAMPLE,
DIRECTLY TO SURVIVORS OF MYOCARDIAL INFARCTION, IN AN ERA WHEN
THE PROGNOSIS HAS IMPROVED SUBSTANTIALLY IN COMPARISON WITH
PRIOR SERIES ANTEDATING THE WIDESPREAD USE OF REPERFUSION
THERAPY. AMONG PATIENTS SUFFERING FROM CARDIAC ARREST, MOST HAVE
SOME FORM OF STRUCTURAL HEART DISEASE, WITH MOST PATIENTS
SUFFERING FROM CORONARY ARTERY DISEASE, BUT ACUTE MYOCARDIAL
INFARCTION IS SEEN IN LESS THAN HALF. IN A SERIES OF 151 HEARTS FROM
MEN WHO DIED FROM SUDDEN CARDIAC DEATH, THE PRESENCE OF ACUTE
THROMBUS/PLAQUE RUPTURE OR EROSION WAS NOTED IN 67% OF PATIENTS
AGED 30 TO 39, BUT THIS PROPORTION DECLINED WITH AGE AND WAS
PRESENT IN ONLY 31% OF PATIENTS AGES 60 TO 69.
17.- IN MOST CASES SCD WAS
a) CAUSED BY VENTRICULAR TACHYCARDIA (VT)
b) CAUSED BY FIBRILLATION (VF)
c) CAUSED BY VENTRICULAR TACHYCARDIA (VT) AND FIBRILLATION (VF)
d) CAUSED BY BRADYARDIC EVENTS AND ELECTROMECHANICAL
DISSOCIATION
18.- THE RISK STRATIFICATION STRATEGIES AND DATA OF SCD
a) ARE INCLUDED WITH DETAIL AND EXAMPLES IN THIS ARTICLE
b) COMPARATIVE DETAILS AND EXAMPLES ARE INCLUDED IN THIS ARTICLE
c) ONLY SCD RISK STRATEGIES ARE INCLUDED IN THIS ARTICLE
d) SCD RISK STRATIFICATION STRATEGIES AND INFORMATION IS NOT THE
OBJECTIVE OF THIS ARTICLE
19.- THE GREATEST NUMBER OF SCD OCURRED IN

7. a) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT HIGHER RISK,
INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY
PRIOR CORONARY EVENTS.
b) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER AND HIGHER
RISK, INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF,
OR ANY PRIOR CORONARY EVENTS.
c) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK,
INCLUDING PATIENTS WITH RIGHT VENTRICULAR DYSFUNCTION, CHF, OR
ANY PRIOR CORONARY EVENTS.
d) LARGER SUBGROUPS OF PATIENTS AT SOMEWHAT LOWER RISK,
INCLUDING PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, CHF, OR ANY
PRIOR CORONARY EVENTS
20.- THE CHALLENGE IS TO IDENTIFY
a) RISK FACTORS FOR SCD AMONG THE SMALL GROUP OF PATIENTS AT
RELATIVELY LOW RISK
b) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT
RELATIVELY HIGH RISK
c) RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT
RELATIVELY LOW RISK
d) NON-RISK FACTORS FOR SCD AMONG THE LARGE GROUP OF PATIENTS AT
RELATIVELY LOW RISK
21.- THE HIGHEST RISK GROUP OF PATIENTS SUFFERING FROM CARDIAC
ARREST WHO HAD SOME FORM OF STRUCTURAL HEART DISEASE AND
CORONARY ARTERY DISEASE WERE
a) YOUNGER MEN
b) MIDDLE AGED MEN
c) OLDER MEN
d) OF ALL ADULT AGES
MUJER 82 AÑOS. ATENDIDA EN URGENCIAS POR DOLOR EN EPIGASTRIO
INTENSO QUE SE ACOMPAÑA DE NÁUSEA Y VÓMITO EN POZOS EN CAFÉ. HA
TENIDO EVACUACIONES MELÉNICAS Y CON SANGRE FRESCA ASÍ COMO
DISTENSIÓN ABDOMINAL . TIENE ANTECEDENTES DE ENFERMEDAD
ARTICULAR DEGENERATIVA TRATADA CON AINES. E.F.: TA 80/40 MMHG, FC
120 LPM, RCR, CAMPOS PULMONARES CLAROS, ABDOMEN DOLOROSO A LA
PALPACIÓN, CON REBOTE POSITIVO Y PERISTALSIS AUSENTE.
22.- EL ESTUDIO INICIAL PARA CORROBORAR EL DIAGNÓSTICO ES:
a) RX DE ABDOMEN DE PIE Y DECÚBITO.
b) ENDOSCOPÍA.

8. c) TAC DE ABDOMEN.
d) COLONOSCOPÍA.
23.- EL TRATAMIENTO DEFINITIVO EN ESTE PACIENTE ES:
a) BLOQUEADORES DE BOMBA DE PROTONES.
b) LAVADO GÁSTRICO.
c) CIRUGÍA.
d) SUSPENDER AINES.
APPENDICITIS: SELECTIVE USE OF ABDOMINAL CT REDUCES NEGATIVE
APPENDECTOMY RATE APPENDICITIS ACCOUNTS FOR OVER 3% OF THE
DISEASES THAT INVOLVE THE DIGESTIVE SYSTEM, IS THE MOST COMMON
ACUTE SURGICAL PROBLEM OF THE ABDOMEN, AND APPENDECTOMY IS THE
FIFTH MOST COMMON SURGICAL PROCEDURE PERFORMED ON THE
GASTROINTESTINAL TRACT. IT IS ALSO ONE OF THE MOST DIFFICULT
DISEASE PROCESSES TO DIAGNOSE ACCURATELY. RATES OF NEGATIVE
APPENDECTOMY RANGE FROM 20% TO 44%. THESE RATES ARE EVEN HIGHER
IN WOMEN OF CHILDBEARING AGE, RANGING FROM 25% TO AS HIGH AS
52%. REPORTED PERFORATION RATES RANGE FROM 15% TO 37%. THESE
RATES OF NEGATIVE APPENDECTOMY HAVE BEEN CONSIDERED ACCEPTABLE
BECAUSE THE MORBIDITY ASSOCIATED WITH COMPLICATED APPENDICITIS
IS SIGNIFICANTLY HIGHER THAN THAT OF NON-THERAPEUTIC
APPENDECTOMY. NUMEROUS DIAGNOSTIC TOOLS HAVE BEEN IMPLEMENTED
IN AN EFFORT TO REDUCE THE HIGH RATE OF NEGATIVE APPENDECTOMY
WHILE AT THE SAME TIME NOT INCREASE THE PERFORATION RATE. SOME OF
THESE TOOLS INCLUDE CLINICAL SCORING SYSTEMS, ULTRASOUND,
COMPUTERIZED DECISION SUPPORT, VARIOUS LABORATORY TESTS, AND
OTHER, NON-TRADITIONAL METHODS. THESE VARIOUS MODALITIES HAVE
ALL YIELDED MIXED RESULTS AS TO THEIR USEFULNESS IN CLINICAL
PRACTICE. STUDIES HAVE SHOWN THAT HELICAL COMPUTERIZED
TOMOGRAPHY (CT) SCANNING OF THE ABDOMEN HAS BEEN SUCCESSFUL IN
REDUCING NONTHERAPEUTIC APPENDECTOMY RATES TO AS LOW AS 3%.
THESE RESULTS PROVIDE EVIDENCE THAT THERE MAY FINALLY BE A
DIAGNOSTIC TOOL THAT CAN BE EFFECTIVE IN REDUCING RATES OF
NONTHERAPEUTIC APPENDECTOMY WHILE NOT INCREASING THE MORBIDITY
AND MORTALITY ASSOCIATED WITH APPENDICITIS.
24.- WHAT IS RELATION OF APPENDICITIS WITH OTHER GASTROINTESTINAL
TRACT DISEASES?
a) IS ONE OF THE LESS COMMON SURGICAL PROCEDURES OF THE
GASTROINTESTINAL TRACT.
b) IT HAS NO RELATION WITH OTHER GASTROINTESTINAL TRACT DISEASES.
c) IT HAS THE HIGHEST INDEX OF MORBILITY.
d) IS THE FIFTH MOST COMMON SURGICAL PROCEDURE OF THE
GASTROINTESTINAL TRACT.

9. 25.- WHY CAN APPENDICITIS END IN A COMPLICATED PERFORATION?
a) BECAUSE IS THE MOST COMMON ACUTE SURGICAL PROBLEM OR THE
ABDOMEN.
b) BECAUSE IT IS ONE OF THE MOST DIFFICULT DISEASE PROCESSES TO
DIAGNOSE ACURATELY.
c) BECAUSE APPENDECTOMY IS THE FIFTH MOST COMMON SURGICAL
PROCEDURE PERFORMED ON THE GASTROINTESTINAL TRACT.
d) BECAUSE OF THE LACK OF DIAGNOSTIC TOOLS.
26.- WHAT ARE THE RATES OF NEGATIVE APPENDECTOMY?
a) THESE RATES ARE EVEN LOWER IN WOMEN OF CHILDBEARING AGE.
b) THESE RATES ARE NOT CONSIDERED ACCEPTABLE.
c) THESE RATES ARE EVEN HIGHER IN WOMEN WHO ARE NOT IN
CHILDBEARING AGE.
d) THESE RATES ARE EVEN HIGHER IN WOMEN OF CHILDBEARING AGE.
27.- WHICH OF THE NEXT DIAGNOSTIC TOOLS HAS SUCCESFULLY REDUCED
NONTHERAPEUTIC APPENDECTOMY?
a) SCORING SYSTEMS.
b) HELICAL COMPUTERIZED TOMOGRAPHY.
c) ULTRASOUND.
d) LABORATORY TESTS.
28.- WHAT IS THE FINAL RESULT OF THIS STUDY?
a) THE HELICAL COMPUTERIZED TOMOGRAPHY CAN PREVENT
NONTHERAPEUTICAL APPENDECTOMY.
b) THE RATES OF NONTHERAPEUTICAL APPENDECTOMY HAVE INCREASED.
c) APPENDICITIS IS THE FIFTH MOST COMMON SURGICAL PROCEDURE
PERFORMED ON THE GASTROINTESTINAL TRACT.
d) NUMEROUS DIAGNOSTIC TOOL HAVE BEEN IMPLEMENTED IN AN EFFORT
TO REDUCE THE RISK OF NONTHERAPEUTICAL APPENDECTOMY.
MUJER DE 23 AÑOS. ASISTE A URGENCIAS POR PRESENTAR SALIDA DE
LÍQUIDO TRANSVAGINAL DE INICIO SÚBITO POSTERIOR A UNA RELACIÓN
SEXUAL. ACTUALMENTE CURSA SU PRIMER EMBARAZO Y ESTÁ EN LA SEMANA
39 DE GESTACIÓN. E.F.: PRODUCTO LONGITUDINAL CEFÁLICO DORSO
IZQUIERDA. FCF EN 140 LPM. GENITALES HÚMEDOS. SE VISUALIZA CÉRVIX
CERRADO FORMADO Y POSTERIOR. NO HAY LÍQUIDO EN FONDO DE SACO.

10. 29.- EL MÉTODO MÁS SENSIBLE Y ESPECÍFICO PARA ESTABLER EL
DIAGNÓSTICO EN ESTA PACIENTE ES:
a) CRISTALOGRAFÍA .
b) INYECCIÓN DE PIGMENTO POR AMNIOCENTESIS Y OBSERVACIÓN DE FUGA
HACIA CANAL VAGINAL.
c) PRUEBA DE NITRAZINA.
d) PH VAGINAL.
MUJER DE 25 AÑOS. ES ATENDIDA EN CONSULTA PARA CONTROL PRENATAL.
13 SEMANAS DE GESTACIÓN POR FUR. ULTRASONIDO TRANSABDOMINAL SE
OBSERVA LA PRESENCIA DE DOS FETOS DENTRO DE UN SACO GESTACIONAL.
SE APRECIA UNA MEMBRANA DIVISORIA DELGADA QUE AL UNIRSE A LA
PLACENTA FORMA UNA IMAGEN EN “T”.
30.- LA CAUSA MÁS PROBABLE DE ESTE HALLAZGO ES:
a) SEPARACIÓN ANTES DE LA DIFERENCIACIÓN DEL TROFOBLASTO (ANTES
DÍA 3).
b) SEPARACIÓN DESPUÉS DE LA DIFERENCIACIÓN DEL TROFOBLASTO PERO
ANTES DE LA FORMACIÓN DEL AMNIOS (DIA 3 – .
c) SEPARACIÓN DE TROFOBLASTO Y DIVISIÓN POSTERIOR A LA FORMACIÓN
DEL AMNIOS (DIA 8-13) .
d) SEPARACION POSTERIOR A LA FORMACIÓN DEL AMNIOS (DÍAS 10 A 15).
A 71-YEAR-OLD MAN PRESENTED WITH A 2-WEEK HISTORY OF PAIN AND
SWELLING OF HIS LEFT ARM. EXAMINATION REVEALED A CRAGGY, MOBILE
MASS WITH IRREGULAR BORDERS IN THE EXTENSOR COMPARTMENT OF THE
LEFT ARM MEASURING 6 × 4 CM. ULTRASONOGRAPHY OF THE LEFT ARM
DEMONSTRATED THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS
LOCATED IN THE LONG AXIS OF THE LEFT TRICEPS MUSCLE, MEASURING 5 ×
3 CM. THIS LED TO FURTHER RADIOLOGIC EVALUATION IN THE FORM OF MRI
OF THE LEFT ARM. MRI SHOWED INTERMEDIATE SIGNAL MASS IN THE
TRICEPS MUSCULATURE ON T1-WEIGHTED IMAGES WITH FAT SATURATION.
THIS LESION IS CONFINED TO THE EXTENSOR COMPARTMENT OF THE ARM. A
PRESUMPTIVE DIAGNOSIS OF SOFT TISSUE SARCOMA WAS MADE. AN
INCISIONAL BIOPSY WAS PERFORMED. THIS WAS FOUND TO BE CONSISTENT
WITH METASTATIC SQUAMOUS CELL CARCINOMA WITH A POSSIBLE LUNG
PRIMARY, FURTHER SUPPORTED DUE TO A POSITIVE CK7 AND NEGATIVE
CK20 STAIN ON IMMUNOHISTOCHEMISTRY. CT SCAN OF THE CHEST
REVEALED A LESION MEASURING 4 × 2 CM IN THE LEFT UPPER LOBE. FIBER-
OPTIC BRONCHOSCOPY AND BIOPSY CONFIRMED THE DIAGNOSIS OF STAGE
IV SQUAMOUS CELL CARCINOMA OF THE LUNG. HE UNDERWENT PALLIATIVE
RADIOTHERAPY TO THE MASS IN THE ARM, 20 GY IN 4 FRACTIONS. THIS
PROVIDED GOOD RELIEF FROM PAIN AND SWELLING WITHIN 2 WEEKS OF
COMPLETING TREATMENT. SYSTEMIC THERAPY WAS NOT OFFERED ON THE
BASIS OF POOR AND DETERIORATING PERFORMANCE STATUS.
UNFORTUNATELY, THE PATIENT DIED WITHIN 10 WEEKS OF PRESENTATION.
INTRAMUSCULAR METASTASES IN CANCER PATIENTS ARE RARE. THIS IN

11. ITSELF IS QUITE PECULIAR BECAUSE MUSCULAR MASS ACCOUNTS FOR
APPROXIMATELY 50% OF TOTAL BODY WEIGHT. IT IS THOUGHT THAT
MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT, AND
ACCUMULATION OF LACTIC ACID AND OTHER METABOLITES CONTRIBUTE TO
THE RARE OCCURRENCE OF THIS PHENOMENON. THE TRUE INCIDENCE OF
MUSCULAR METASTASIS REMAINS UNKNOWN, BUT AN AUTOPSY SERIES
SUGGESTS THAT ITS INCIDENCE COULD BE AS LOW AS 0.8%. LUNG
CARCINOMA SEEMS TO BE THE UNDERLYING PRIMARY CANCER IN MOST OF
THESE CASES. MANY OTHER TUMORS, SUCH AS KIDNEY, STOMACH,
PANCREAS, THYROID GLAND, BREAST, OVARY, PROSTATE, AND BLADDER
CANCERS HAVE ALSO BEEN SPORADICALLY DESCRIBED IN ASSOCIATION
WITH INTRAMUSCULAR SECONDARIES. HOWEVER, PRIMARY PRESENTATION
OF AN INTRAMUSCULAR METASTASIS, SUCH AS DEMONSTRATED BY OUR
PATIENT, REMAINS AN EXCEPTIONALLY UNUSUAL OCCURRENCE. THE MOST
FREQUENT PRESENTATION OF MUSCULAR METASTASIS IS PAIN WITH OR
WITHOUT SWELLING. DIAGNOSIS, EVEN WITH RADIOLOGIC IMAGING IS
OFTEN TRICKY BECAUSE IT CAN BE CONFUSED WITH AN ABSCESS OR SOFT
TISSUE TUMORS.
31.- WHY WAS THE RADIOLOGIC EVALUATION DONE?
a) BECAUSE OF THE PRESENCE OF DEEP OVOID HYPERECHOIC MASS
LOCATED IN THE LONG AXIS OF THE RIGHT TRICEPS MUSCLE.
b) BECAUSE OF THE RESULTS OF THE ULTRASONOGRAPHY
c) BECAUSE DIAGNOSIS WITH RADIOLOGIC IMAGING IS OFTEN TRICKY.
d) BECAUSE OF THE CLINICAL HISTORY OF THE PATIENT.
32.- WHY ARE THE INTRAMUSCULAR METASTASES IN CANCER PATIENTS
RARE?
a) BECAUSE THE AMOUNT OF THE MUSCULAR MASS ACCOUNTS FOR
APPROXIMATELY 50% OF THE TOTAL BODY WEIGHT.
b) DUE TO THE MUSCULAR CONTRACTILE ACTIONS, LOCAL PH ENVIRONMENT,
AND ACCUMULATION OF LACTIC ACID AND OTHER METASTASIS.
c) BECAUSE THE PATIENTS DIE WITHIN 10 WEEKS OF PRESENTATION
d) BECAUSE PATIENTS LEAD AN ACTIVE LIFE
33.- WHAT KIND OF CANCER DID THE 71-YEAR-OLD PATIENT HAVE?
a) LUNG CARCINOMA.
b) KIDNEY CANCER
c) PROSTATE CANCER
d) BREAST CANCER
34.- HOW WAS THE PATIENT’S CANCER CONFIRMED?

12. a) THROUGH THE MRI.
b) WITH IMMUNOHISTOCHEMISTRY
c) THROUGH FIBER-OPTIC BRONCHOSCOPY AND BIOPSY
d) THROUGH OBSERVATION OF THE SWELLING AND THE PAIN PRESENTED BY
THE PATIENT
35.- WHY WASN’T SYSTEMATIC THERAPY OFFERED?
a) BECAUSE THE PATIENT WAS TOO OLD TO RESIST THE THERAPY
b) BECAUSE THE PALLIATIVE RADIOTHERAPY PROVIDED GOOD RELIEF FROM
PAIN AND SWELLING.
c) BECAUSE THE PATIENT SHOWED VERY LITTLE IMPROVEMENT.
d) THE PATIENT DIED 10 WEEKS AFTER THE FIRST PRESENTATION.
NIÑO DE 5 AÑOS. ES ATENDIDO EN LA CONSULTA POR PRESENTAR
MORETONES EN PIERNAS SIN ANTECEDENTE DE TRAUMATISMO.
ANTECEDENTES: HACE 2 MESES CON HIPOREXIA, BAJA DE PESO, SANO
PREVIAMENTE. E.F.: TA 110/65 MM HG, FC 120 LPM, FR 28 RPM. PÁLIDO ++,
HIPOACTIVO. SE PALPA HÍGADO A DOS CENTÍMETROS POR ABAJO DEL
BORDE COSTAL. LABORATORIO: HB 9G/DL, LEUCOCITOS 25, 000 PREDOMINO
DE LINFOCITOS 50%, PLAQUETAS 100,000.
36.- EL DIAGNÓSTICO MAS PROBABLE CON ESTE PACIENTE ES:
a) ANEMIA APLÁSICA.
b) HISTIOCITOSIS X.
c) LEUCEMIA LINFOBLÁSTICA.
d) PÚRPURA TROMBÓTICA.
37.- EL SIGUIENTE PASO EN LA ATENCIÓN DE ESTE PACIENTE QUE DEBE
REALIZAR USTED ES:
a) INICIAR ESQUEMA DE QUIMIOTERAPIA.
b) TRANSFUNDIRLE PAQUETE GLOBULAR.
c) DERIVAR AL HEMATÓLOGO.
d) ANÁLISIS MÉDULA ÓSEA.
ENDOMETRIAL CANCER IN THE UNITED STATES ENDOMETRIAL CANCER
REFERS TO SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE
ENDOMETRIUM, OR LINING OF THE UTERUS. ENDOMETRIAL CANCERS ARE
THE MOST COMMON GYNECOLOGIC CANCERS IN THE UNITED STATES, WITH
OVER 35,000 WOMEN DIAGNOSED EACH YEAR IN THE U.S. THE MOST
COMMON SUBTYPE, ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS
WITHIN A FEW DECADES OF MENOPAUSE, IS ASSOCIATED WITH EXCESSIVE
ESTROGEN EXPOSURE, OFTEN DEVELOPS IN THE SETTING OF ENDOMETRIAL
HYPERPLASIA, AND PRESENTS MOST OFTEN WITH VAGINAL BLEEDING.
ENDOMETRIAL CARCINOMA IS THE THIRD MOST COMMON CAUSE OF

13. GYNECOLOGIC CANCER DEATH (BEHIND OVARIAN AND CERVICAL CANCER
CLINICAL EVALUATION: ROUTINE SCREENING OF ASYMPTOMATIC WOMEN IS
NOT INDICATED, SINCE THE DISEASE IS HIGHLY CURABLE IN ITS EARLY
STAGES. RESULTS FROM A PELVIC EXAMINATION ARE FREQUENTLY NORMAL,
ESPECIALLY IN THE EARLY STAGES OF DISEASE. CHANGES IN THE SIZE,
SHAPE OR CONSISTENCY OF THE UTERUS AND/OR ITS SURROUNDING,
SUPPORTING STRUCTURES MAY EXIST WHEN THE DISEASE IS MORE
ADVANCED. •A PAP SMEAR MAY BE EITHER NORMAL OR SHOW ABNORMAL
CELLULAR CHANGES. •ENDOMETRIAL CURETTAGE IS THE TRADITIONAL
DIAGNOSTIC METHOD. BOTH ENDOMETRIAL AND ENDOCERVICAL MATERIAL
SHOULD BE SAMPLED. •IF ENDOMETRIAL CURETTAGE DOES NOT YIELD
SUFFICIENT DIAGNOSTIC MATERIAL, A DILATION AND CURETTAGE (D&C) IS
NECESSARY FOR DIAGNOSING THE CANCER. •HYSTEROSCOPY ALLOWS THE
DIRECT VISUALIZATION OF THE UTERINE CAVITY AND CAN BE USED TO
DETECT THE PRESENCE OF LESIONS OR TUMOURS. IT ALSO PERMITS THE
DOCTOR TO OBTAIN CELL SAMPLES WITH MINIMAL DAMAGE TO THE
ENDOMETRIAL LINING (UNLIKE BLIND D&C). •ENDOMETRIAL BIOPSY OR
ASPIRATION MAY ASSIST THE DIAGNOSIS. •TRANSVAGINAL ULTRASOUND TO
EVALUATE THE ENDOMETRIAL THICKNESS IN WOMEN WITH
POSTMENOPAUSAL BLEEDING IS INCREASINGLY BEING USED TO EVALUATE
FOR ENDOMETRIAL CANCER. •RECENTLY, A NEW METHOD OF TESTING HAS
BEEN INTRODUCED CALLED THE TRUTEST, OFFERED THROUGH GYNECOR. IT
USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING OF
THE UTERUS. THIS METHOD IS LESS PAINFUL THAN A PIPELLE BIOPSY AND
HAS A LARGER LIKELIHOOD OF PROCURING ENOUGH TISSUE FOR TESTING.
SINCE IT IS SIMPLER AND LESS INVASIVE, THE TRUTEST CAN BE PERFORMED
AS OFTEN, AND AT THE SAME TIME AS, A ROUTINE PAP SMEAR, THUS
ALLOWING FOR EARLY DETECTION AND TREATMENT. •ONGOING RESEARCH
SUGGESTS THAT SERUM P53 ANTIBODY MAY HOLD VALUE IN IDENTIFYING
HIGH-RISK ENDOMETRIAL CANCER.[4]
38.- ENDOMETRIAL CANCER REFERS TO:
a) SPECIFIC TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM,
OR LINING OF THE UTERUS.
b) SEVERAL TYPES OF MALIGNANCY WHICH NEVER ARISE FROM THE
ENDOMETRIUM, OR LINING OF THE UTERUS.
c) ALL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM.
d) SEVERAL TYPES OF MALIGNANCY WHICH ARISE FROM THE ENDOMETRIUM,
OR LINING OF THE UTERUS.
39.- ENDOMETRIOID ADENOCARCINOMA, TYPICALLY OCCURS WITHIN:
a) EXCESSIVE ESTROGEN.
b) A LOT OF DECADES OF MENOPAUSE.
c) ALWAYS PRESENTS VAGINAL BLEEDING.
d) ALWAYS DEVELOPS IN THE SETTING OF ENDOMETRIAL HYPERPLASIA.

14. 40.- RESULTS FROM A PELVIC EXAMINATION ARE:
a) ALWAYS CHANGES IN THE SIZE AND NEVER IN SHAPE
b) SOMETIMES NORMAL, ESPECIALLY IN THE EARLY STAGES OF THE DISEASE.
c) CHANGES IN THE SIZE, SOMETIMES THE SHAPE BUT NEVER THE
CONSISTENCY OF THE UTERUS
d) CHANGES IN THE SIZE, SHAPE BUT NEVER IN THE CONSISTENCY OF THE
UTERUS
41.- CLINICAL METHOD FOR EVALUATION:
a) A PAP IS THE BEST OPTION YOU CAN USE.
b) ENDOMETRIAL CURETTAGE IS NOT THE TRADITIONAL DIAGNOSTIC
METHOD.
c) HYSTEROSCOPY ALLOWS THE DIRECT VISUALIZATION OF THE UTERINE
CAVITY.
d) ENDOMETRIAL BIOPSY OR ASPIRATION ALWAYS ASSIST IN THE
DIAGNOSIS.
42.- HOW IS THE DEVELOPEMENT OF THIS NEW METHOD?
a) IT USES THE HUGE FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING
OF THE UTERUS.
b) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE UTERUS.
c) IT USES THE SMALL UNFLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE
LINING OF THE UTERUS.
d) IT USES THE SMALL FLEXIBLE TAO BRUSH TO BRUSH THE ENTIRE LINING
OF THE UTERUS.
MUJER DE 25 AÑOS. TRABAJA EN UN ASILO DE ANCIANOS. ES ATENDIDA EN
URGENCIAS POR PRESENTAR DESDE HACE 24 HORAS, MALESTAR GENERAL,
CEFALEA INTENSA, VÓMITO, DIARREA, MIALGIAS Y FIEBRE. G:2 , C:1. CURSA
CON EMBARZO DE 22 SEMANAS. E.F.: PESO 63 KGS. TEMP. 38.3° C . FCF:
128 LPM.
43.- LO MÁS PROBABLE ES QUE EL AGENTE CAUSAL SEA:
a) ROTAVIRUS.
b) ADENOVIRUS INTESTINAL.
c) ASTROVIRUS.
d) NOROVIRUS.
MUJER DE 33 AÑOS. EMBARAZADA, INGRESA A URGENCIAS CON ACTIVIDAD
UTERINA. REFIERE HABER INICIADO CON CEFALEA HACE 4 HORAS Y
ACTIVIDAD UTERINA REGULAR. G: 4, P:3. CURSA CON EMBARZO DE 35.4

15. SEMANAS, TOMA HIDRALAZINA Y ALFAMETILDOPA E.F.: PESO 74 KGS. TA
140/90 MM/HG. FU: 32 CMS. PRODUCTO CEFÁLICO CON FCF: 128 LPM. TACTO
VAGINAL: CERVIX, SEMIBORRADO SIN DILATACIÓN.
44.- PARA CORROBORAR EL DIAGNÓSTICO SE DEBE DE REALIZAR :
a) PRUEBAS DE FUNCION HEPÁTICA.
b) DEPURACIÓN DE CREATININA.
c) DETERMINACIÓN DE ÁCIDO ÚRICO.
d) PROTEÍNAS EN ORINA.
HOMBRE DE 89 AÑOS. LLEVADO A URGENCIAS POR UN VECINO YA QUE
PRESENTA DESDE HACE UNA SEMANA TOS CON EXPECTORACIÓN VERDE-
AMARILLENTA. HA PRESENTADO ALTERACIONES EN EL ESTADO DE
CONCIENCIA, FIEBRE, ASTENIA, ADINAMIA E HIPOREXIA Y OLIGURIA DE 5
DIAS DE EVOLUCIÓN. E.F.: PESO 45KG, TEMP 39 º C, FC 110 LPM, MUCOSAS
ORALES DESHIDRATADAS, RCR DE BAJA INTENSIDAD, CAMPOS PULMONARES
CON ESTERTORES CREPITANTES DISEMINADOS. GIORDANO DUDOSO
BILATERAL, EXTREMIDADES INFERIORES Y SUPERIORES HIPOTRÓFICAS Y
ESCARA EN REGIÓN SACRA.
45.- EL PRINCIPAL PROBLEMA DE ESTE PACIENTE ES:
a) ISQUEMIA CEREBRAL TRANSITORIA.
b) DEMENCIA SENIL.
c) INFECCIÓN DE VIAS URINARIAS.
d) SÍNDROME DE ABANDONO.
46.- EL MANEJO MÉDICO INICIAL EN ESTE PACIENTE ES:
a) HOSPITALIZACIÓN, HIDRATACIÓN Y PENICILINA BENZATÍNICA Y
DESINFLAMATORIOS.
b) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS RESPIRATORIAS.
c) HIDRATACIÓN Y MANEJO DE LA INFECCIÓN DE VÍAS URINARIAS.
d) HOSPITALIZACIÓN Y OBSERVACIÓN.
RECIÉN NACIDO DE TÉRMINO. ES ATENDIDO EN LA CONSULTA A LOS 3 DÍAS
POR NOTAR LA MADRE ENROJECIMIENTO INTENSO DE SU OMBLIGO Y LLANTO
CONSTANTE. ANTECEDENTES: NACIDO CON PARTERA. E.F.: TA 94/52 MM HG,
FC 160 LPM, FR 50 POR MINUTO, TEMPERATURA DE 39°C. DECAÍDO,
RECHAZA EL PECHO, LLENADO CAPILAR DE 4 SEGUNDOS.
47.- EL DIAGNÓSTICO MAS PROBABLE EN ESTE CASO ES:
a) ONFALITIS.
b) PERITONITIS.
c) SEPSIS.
d) ERITEMA DEL NEONATO.

16. 48.- LOS MICROORGANISMOS MAS COMUNES EN ESTOS CASOS SON:
a) ANAEROBIOS.
b) GRAM POSITIVOS.
c) GRAM NEGATIVOS.
d) VIRUS.
RECIÉN NACIDO DE 40 SEMANAS DE GESTACIÓN. APGAR DE 3 AL MINUTO.
ANTECEDENTES: MADRE SIN CONTROL PRENATAL, OBRERA, GESTA 8, LLEGÓ
A URGENCIAS POR NO SENTIR MOVIMIENTOS DEL BEBÉ. E.F.: TA 50/20 MM
HG, FC < 100 LPM, FR 10 RPM, TEMPERATURA 37.5°C. LLENADO CAPILAR > 4
SEG.
49.- EL MANEJO INMEDIATO PARA ESTE PACIENTE ES:
a) HABLARLE AL PEDIATRA E INICIAR MANIOBRAS.
b) ADMINISTRAR ADRENALINA E INICIAR MANIOBRAS.
c) ADMINISTRAR ATROPINA E INICIAR MANIOBRAS.
d) VENTILACIÓN Y COMPRESIÓN CARDIACA