quizzes Flashcards
A 24 year old male comes to see you because he has notices a yellow coloration in his eyes, he also refers to feel exhausted and he had been having very little appetite and feels nausea. His vital signs are BP 110/70 mmHg, HR 88 bpm, RR 16 bpm, T 37.8ºC. His physical examination is remarkable for having yellow coloration + on his oral mucosa and eyelids conjunctiva, he has tenderness on the right upper quadrant in his abdomen, no rebound. What would you request to be done according to your clinical suspicion?
- Coagulation test and liver function test
- Complete blood count and liver function tests
- Blood chemistry of 6 elements and complete blood count
- Liver function test and tumoral biomarkers
Complete blood count and liver function tests
The lab test shows white blood cells 11,000/uL, neutrophils 60%, lymphocytes 40%, AST 445 U/L (20-60), ALT 370 U/L (20-70), total bilirubin 8.5 mg/dL, indirect 4.3 mg/dL, direct 4.2 mg/dL, GGT 24 U/L (12-40), alkaline phosphatase 95 mg/dL (40-120). According to these results, the interpretation indicates:
- It is an obstructive pattern of canalicular origin
- It definitively indicates there is hemolysis
- It is not conclusive and a biopsy should be done
- It shows an hepatocellular damage
Hepatocellular damage
According to your clinical suspicion, what would be the next request in order to get a diagnosis?
- Request an hepatic viral panel
- Order a CT abdominal scan
- Request an ERCP
- Perform an hepatic biopsy
Hepatic viral panel
A 42 year old woman comes to the emergency department for having intense abdominal pain, located in the upper abdomen, especially in the right upper quadrant, radiated ipsilaterally to the back, she also states that she has been vomiting green in the last 24 hours, she has been having the pain increasingly over the last 72 hours. Her vital signs are BP 120/80 mmHg, HR 94 bpm, RR 20 bpm, T 37.2ºC. Her physical examination is remarkable for having pain in the right upper quadrant with positive Murphy sign. What would you request to be done according to your clinical suspicion?
- Request an hepatic viral panel and abdominal CT-scan
- Order a complete blood count (CBC) and abdominal US
- CBC, hepatic function test and abdominal US
- Request oncogenic markers, viral panel and abdominal CT-scan
.- CBC, hepatic function test and abdominal US
The lab test shows blood cells 12,000/uL, neutrophils 82%, AST 22 U/L (20-60), ALT 35 U/L (20-70), total bilirubin 2.5 mg/dL, indirect 0.3 mg/dl, direct 2.2 mg/dL, GGT 220 U/L (12-40), alkaline phosphatase 110 mg/dL (40-120), the interpretation indicates:
- It shows an hepatocellular damage
- It is an obstructive pattern of canalicular origin
- It is not conclusive and a biopsy should be done
- It definitively indicates hemolysis
Obstructive pattern of canalicular origin
The requested imaging study reveals a thickened gall bladder wall (5 mm), and images inside the gallbladder that suggests stones, the common bile duct does not appear to be dilated (3 mm). What is the first thing to do in this patient?
- Release her to her home she is fine
- Request an ERCP and then to the operating room
- Give her anti-inflammatory and schedule her for surgery
- Start on antibiotics and send her home
- Give her anti-inflammatory and schedule her for surgery
An 82 year old man comes is brought to the emergency department because he is not responding to stimuli, the family states that he has lost a lot of weight in the last 3 months, he has not been eating well, and he constantly complains of abdominal pain. His vital signs are BP 90/50 mmHg, HR 112 bpm, RR 24 bpm, T 38.5ºC. He appears yellow in his sclera, his palms, his lips, he tends to be asleep and responds poorly to stimuli. His physical examination shows pain in the epigastrium and right upper quadrant, rebound is doubtful, but also, the patient is not responding well to stimuli, so most likely abdominal rebound is positive. What would you request to be done according to your clinical suspicion?
- CBC, hepatic liver test, lipase and abdominal CT-scan
- Hepatic function test, viral panel and abdominal US
- CBC, hepatic viral panel, ERCP and abdominal US
- Hepatic function test, oncogenic markers and abdominal CT-scan
- CBC, hepatic liver test, lipase and abdominal CT-scan
The lab shows white blood cells 22,000/uL, neutrophils 82%, AST 130 U/L (20-60), ALT 112 U/L (20-70), total bilirubin 22.5 mg/dL, indirect 3.3 mg/dl, direct 19.2 mg/dL, GGT 445 U/L (12-40), alkaline phosphatase 520 mg/dL (40-120), the interpretation indicates:
- It shows an hepatocellular damage
- It definitively indicates there is hemolysis
- It is not conclusive and a biopsy should be done
- It is an obstructive pattern of canalicular origin
- It is an obstructive pattern of canalicular origin
He is showing fever, pain and jaundice, this triad is compatible with what disease?
- Gallbladder stones
- Hepatitis
- Cholangitis
- Pancreatic cancer
- Cholangitis
If this is not addressed promptly, he most likely would develop, aside from the jaundice, fever and pain, two more signs, which are loss of consciousness and shock. These symptoms correspond to what?
- Becks triad
- Reynauld’s pentad
- Virchow’s triad
- Charcot’s pentad
.
- Reynauld’s pentad
diarrhea over the las two days, non bloody, non mucous, in a number of 6 depositions per day, with abdominal pain, nausea and nausea. He starts he ate chorizo in a small town he was passing by. His vital signs are BP 120/70 mmHg, HR 76 bpm, RR 18 rpm, T 37.2˚C, his physical examination is remarkable for having regular hydration state, pain over the mid-gastrium area, non rebound, and increased bowel sounds. According to this patient, which microorganism is it most likely responsible for?
- Entero- hemorrhagic E. Coli
- Entamoeba histolytica
- Yersinia pestis
- Entero-toxigenic E. Coli
Entero-toxigenic E. Coli
According to his hydration state and vital signs, what is the most appropriate measure to hydrate him?
Hospitalize him and start an IV solution
Drink electrolyte solutions at home
Start an IV solution at his house
Hospitalize him and keep him fasting
Drink electrolyte solutions at home
What other recommendation you make to this patient?
Eat soft diet and avoid dairy for one week
Eat a lot of fat and dairy food
Keep him on a fasting state for 2 more days
Eat soft diet and sodas for two weeks
Eat soft diet and avoid dairy for one week
A 62 year old woman is rough to your medical office for having water diarrhea (non bloody, non mucous) since yesterday, the family members state that she ate shellfish at an ambulant place, just she ate there, they stop counting her depositions when she had 20 yesterday, with about 10 vomits. Vital signs BP 80/40 mmHg, HR 120 bpm, RR 22 rpm, T 36.6˚C. Her physical examination is remarkable for being very dehydrated, she tends to be asleep, with poor response to stimuli, pain in middle abdomen, no rebound, increased bowel sounds. According to this patient, which microorganism is it most likely responsible for?
Salmonella typhi
Campylobacter jejuni
Vibrio cholerae
Entero-invasive E. Coli
Vibrio cholerae
According to her hydration state and vital signs, what is the most appropriate measure to hydrate him?
Hospitalize her and start an IV solution
Drink electrolyte solutions at home
Start an IV solution at her house
Hospitalize her and keep her fasting
Hospitalize her and start an IV solution
What other measure needs to be taken to stop the vomit?
Take her to the operating room
Give her peptobismol
Take her to abdominal x-ray
Give her ondansetron
Give her ondansetron
What measure would it be appropriate to establish in order to stop the diarrhea to avoid this patient to keep dehydrating more?
Give her loperamide
Tell her to drink soda
Give her metoclopramide
Give her ondansetron
Give her loperamide
A 48 year old woman with a history of recent diagnosis of DM2 and hypertension, comes to the emergency department because she has been feeling very weak and with an intense abdominal pain, she states that since she had a throat infection and the cough wouldn’t stop, she had been given multiple broad spectrum antibiotics and antihistamines, and she had been with bloody and mucous diarrhea since 4 days ago. Her vital signs are BP 90/50 mmHg, HR 110 bpm, RR 22 rpm, T 38.5˚C, on physical examination she looks pale, with oral mucosa very dehydrated, distended abdomen, with intense pain in four quadrants, especially in left flank, rebound it doubtful, and bowel sounds are increased. According to this patient, which microorganism is it most likely responsible for?
Salmonella typhi
Clostridium difficile
Entamoeba histolytica
Entero-hemorrhagic E. Coli
Clostridium difficile
According to the microorganism responsible for this, what data made you suspect of it?
Antihistamines
Fever
Antibiotics
DM2
Antibiotics
In order to correct her vital signs, what would be an appropriate measure to establish in this patient?
Tell her to drink lots of water at home
Hospitalize her and operate her
Tell er to drink sodas a herbal tea
Hospitalize her and star IV solution
Hospitalize her and star IV solution
A 56 year old woman comes to see you because she says she feels very tired
and has trouble breathing specially when lying down. At questioning her
more, she says a while ago the doctor told her she had hypertension, but
since she dos not feel bad, she didn’t believe him, sometimes she has
headaches and chest pain, but she attributes this to being “overweight”. Her
vital signs are BP 180/100 mmHg, HR 90 bpm, RR 26 bpm, T 37.2°C. Height
1.50 m, weight 125 kg. She is has pale color in her lips, especially when she
climbs a stair flight, a murmur is heard at the mitral zone, and fine crackles
are heard over both pulmonary bases. According to your clinical suspicion,
what would you after hearing those lung sounds?
- Liver function test and hepatic US
- Echocardiogram
- Achestx-ray
- Oncogenic markers and abdominal CT
Achestx-ray
According to her vital signs, ¿what would you have to address first?
- Her breathing
- Her temperature
- Her weight
- Her blood pressure
Her blood pressure
It corresponds to one of the risk factors to develop heart failure in this patient © - Hypertension O - Obesity - Age - Headache
Hypertension
The fine crackles are due to:
- Disfunction of AV valves
- Pulmonary capillary fluid overload
- Loss of intravascular proteins
Pulmonary capillary fluid overload
In this patient, according to NYHA what stage is she in?
OI
Oll
OIll
OI
III
To perform the diagnosis of cardiac failure, what ejection fraction needs to be set?
- > 35%
- 53%
- > 53%
- < 35%
< 35%
What symptom is known indirectly according to the number of pillow the patient sleeps with? - Tachypnea - Orthopnea - Bradypnea - Traumatopnea
Orthopnea
All of the correspond to the etiology of acute heart failure except: • - Deep venous thrombosis - Arrythmias - Hypertension - Pulmonary embolism
Deep venous thrombosis
What happens to the kidney when a patient has heart failure?
- It activates the renin-angiotensin-aldosterone axis
- Nothing happens
- It activates the vasopressin axis
- The BP increases because it decreases the venous return
It activates the renin-angiotensin-aldosterone axis
When the renin-angiotensin-aldosterone axis is activated, what happens to blood pressure? - It decreases - Nothing - Drops - It increases
It increases
According to the patient’s shortness of breath specially when lying down, what
imaging study would be he|pful to determine the patient’s situation?
Chestx-ray
Arteriography
OCT scan
O MRI
Chest x-ray
In order to ease the symptoms matching the chest x-ray, what would be appropriate tto prescribe to this patient? - B-blockers - ACE inhibitors - Ca antagonists - Diuretics
Diuretics
According to your clinical suspicion, what study would you request in order to establish the diagnosis? EKG Coronaryography Echocardiogram Cardiacenzymes
Echocardiogram
The study reveals an ejection fraction of 25%, what is the main diagnosis of the patient? - Heart failure - Pneumonia - Coronary artery disease - Deep venous thrombosis
Heart failure
A 55 year old woman is brought to the emergency department for having fever over
the past three days, the family member states that her mother hadn’t eaten quite
well, and she tends to be asleep. Her medical background is relevant for having long
standing uncontrolled type 2 diabetes and hypertension. Her vital signs reveal BP
90/50 mmHg, HR 120 bpm, RR 22 rpm, T 39.2°C, 02 sat 93%. Her physical
examination is remarkable for dehydrated oral mucosa, she is hyporespontsive, she
tends to fall asleep. Her blood work reveals leukocytes 20,000, neutrophils 84%,
glucose 850, BUN 50, creatinine 1.5. Name the acute complication of type 2
diabetes mellitus that is seen in this patient
- Ketoacidosis
- Hyperosmolar state
- Retinopathy
- Nephropathy
Hyperosmolar state
According to the vital signs the patient most likely have which one of the next?
- Kidney failure
- Retinopathy
- Heart failure
- Sepsis
Sepsis
According to this type of diabetes, what is the main pathophysiology characteristic of this disease? - Insulin resistance - Destroy of B cells in pancreas - Glucose resistance - Destroy of alfa cells
Insulin resistance
According to ADA, it corresponds to one of the ways to establish the diabetes
diagnose
- Measure one glucose above 90 mg/dI
- Measure two random glucose ≥ 126 mg/dI
- Measure one glucose after meal ≥ 200 mg/dI
- Measure two glucose after meal ≥ 126 mg/dI
Measure two random glucose ≥ 126 mg/dI
When insulin becomes either insufficient or deficient, what metabolic pathway switches on? - Glucogenolysis - Glucolysis - Gluconeogenesis - Glucogenogenesis
Gluconeogenesis
After treating the patient, she is released to her home and you prescribe an oral
hypoglycemic drug that acts by increasing the sensitivity of insulin, which of these
medications is the correct one?
Metformin
Glibenclamide
C DPP4-inh
SGLT-2-inh
Metformin
A 52 vear old male comes to see you because he is complaining of going to many
time to urinate and also he noted he is drinking a lot more water than usual. He
weights 120 kg and height 1.75 m. His fasting capillary glucose is 250 mg/dI. What is
the pathophysiology of polyuria?
Because he is drinking more water
The kidney sugar absorption threshold had been reached
O He is getting a kidney infection
O He is falling into a hyperosmolar state
The kidney sugar absorption threshold had been reached
After getting his capillary glucose, what need to be done in order to establish the diagnosis? - Nothing, with that is enough - A urine test is needed - Another fasting measure is needed - A glycosylated hemoglobin
A glycosylated hemoglobin
A 65 year old female comes to the emergency department for having four days ago,
general malaise, fever and since yesterday she has productive cough. According to
this clinical setting, what microorganism is the one responsible for this?
Staphylococcus aureus
Streptococcus viridans
Streptococcuspneumoniae
Pseudomona aeruginosa
Streptococcuspneumoniae
After establishing the diagnosis you have to prescribe antibiotics, which one is
indicated as a first choice according the suspected etiology?
- Fuoroquinolones
- Tetracyclines
- ß-lactamic
- Penicillin
ß-lactamic
A 60 year old male had a previous history of having surgery 5 days ago, an inguinal
hernia was repaired, he was otherwise well but he arrives because he had been
feeling very ill since yesterday, with fever and productive cough. According to this
clinical scenario, what type of pneumonia does this patient have?
Community acquired
Nosocomial
Atypical
OICU
Nosocomial
A 25 year old male comes to see you because he has been feeling very tired and with
sore throat and mild cough. He has been taking a lot of cough syrups without any
improvement. His physical examination is remarkable for having some rales in both
lungs. According to this clinical setting, what type of pneumonia this patient
corresponds to?
Typical
Atypical
Nosocomial
ICU
Atypical
According to this type of pneumonia, what microorganism is responsible for this? Pseudomona eruginosa Legionella pneumophila Staphylococcus aureus Mycoplasmapneumoniae
Mycoplasmapneumoniae
What are the substances produced by neutrophils responsible of making a patient very ill and with fever? Leukocytes Integrins Endothelin Cytokines
Cytokines
What would be a good marker to anticipate the prognosis of the disease? Glycosylated hemoglobin Reactive protein "C" Procalcitonin Creatinine
Procalcitonin
Covid pneumonia is classified as what type of pneumonia? Typical Atypical Nosocomial ICU
Atypical
54 year old woman comes to seek medical attention because she has been feeling
tired over the last week. She weights 90 kg and her height is 1.55. You request
laboratories that show glucose in a fasting state of 220 mg/dI. According to ADA
diagnostics criteria, what do you request according to your clinical suspicion?
Urine test
EKG
Another glucose test
CAchestx-ray
Another glucose test
The results of the other test show she has in a fasting state glucose level of 250 mg/dl, what is your diagnosis? Diabetes Insulin resistance Kidney failure Ketoacidosis
Diabetes
What are the main recommendations you give to the patient in order to start non-
pharmacologicaltreatment?
To enroll in a gym and begin intermittent fasting
To buy nutritional supplements and swim everyday
Just to avoid fast food and she will be fine
To eat less carbohydrates and walk 15 min everyday
To eat less carbohydrates and walk 15 min everyday
What pharmacological treatment should be initiated? Insulin Biguanids (metformin) SGLT-2 inh (dapagliflozin) Thiazolidinediones(pioglitazone)
Biguanids (metformin)
What is the best measurement to make a follow up? Complete blood count Urine test EKG HbA1C
HbA1C
62 year old male is brought to the ER for being disoriented and sleepy most of the
time, at physical examination he only opens the eyes when spoken to, he only
pronounces sounds and he tends to be asleep, he looks very dehydrated. His
background is relevant for having long time type2 DM uncontrolled. His vital signs
show BP 90/50 mmHg, HR 110 bpm, RR 24 rpm, T 38.5°C, his lab tests show
leucocytes 22,000, neutrophil count 82%, glucose 840 mg/dI. According to the
patient’s clinical state, he shows signs of what complication of diabetes?
Ketoacidosis
Nephropathy
Coronary disease
Hyperosmolar state
Hyperosmolar state
Since this patient has type 2 DM uncontrolled and according to his vital signs, what is the clinical diagnosis? Sepsis Pneumonia Ketoacidosis Coronary ischemia
Sepsis
According to your clinical suspicion of the DM complication which is shown, the
main objective is to lower is blood glucose, what is the treatment in order to achieve
this?
Metformin
Glibenclamide
Insulin
O Pioglitazone
Insulin
This patient also is found to have Charcot's foot, this is caused by which complication? Nephropathy Neuropathy Retinopathy Vascular atrophy
Neuropathy
In this patient, what is the meaning of the lab values of leukocytes and neutrophil count? Nothing, they are normal It is because of hyperglycemia it is due to neuropathy Infection is present
Infection is present
