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medicina forense > quizzes > Flashcards

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1
Q

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
A

Complete blood count and liver function tests

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2
Q

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
A

Hepatocellular damage

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3
Q

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
A

Hepatic viral panel

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4
Q

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
A

.- CBC, hepatic function test and abdominal US

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5
Q

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
A

Obstructive pattern of canalicular origin

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6
Q

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
A
  • Give her anti-inflammatory and schedule her for surgery
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7
Q

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
A
  • CBC, hepatic liver test, lipase and abdominal CT-scan
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8
Q

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
A
  • It is an obstructive pattern of canalicular origin
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9
Q

He is showing fever, pain and jaundice, this triad is compatible with what disease?

  • Gallbladder stones
  • Hepatitis
  • Cholangitis
  • Pancreatic cancer
A
  • Cholangitis
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10
Q

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
A

.

- Reynauld’s pentad

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11
Q

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
A

Entero-toxigenic E. Coli

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12
Q

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

A

Drink electrolyte solutions at home

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13
Q

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

A

Eat soft diet and avoid dairy for one week

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14
Q

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

A

Vibrio cholerae

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15
Q

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

A

Hospitalize her and start an IV solution

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16
Q

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

A

Give her ondansetron

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17
Q

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

A

Give her loperamide

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18
Q

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

A

Clostridium difficile

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19
Q

According to the microorganism responsible for this, what data made you suspect of it?

Antihistamines

Fever

Antibiotics

DM2

A

Antibiotics

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20
Q

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

A

Hospitalize her and star IV solution

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21
Q

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
A

Achestx-ray

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22
Q

According to her vital signs, ¿what would you have to address first?

  • Her breathing
  • Her temperature
  • Her weight
  • Her blood pressure
A

Her blood pressure

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23
Q 
It corresponds to one of the risk factors to develop heart failure in this patient
©
- Hypertension
O
- Obesity
- Age
- Headache
A

Hypertension

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24
Q

The fine crackles are due to:

  • Disfunction of AV valves
  • Pulmonary capillary fluid overload
  • Loss of intravascular proteins
A

Pulmonary capillary fluid overload

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25
Q

In this patient, according to NYHA what stage is she in?

OI
Oll
OIll
OI

A

III

26
Q

To perform the diagnosis of cardiac failure, what ejection fraction needs to be set?

  • > 35%
  • 53%
  • > 53%
  • < 35%
A

< 35%

27
Q 
What symptom is known indirectly according to the number of pillow the patient
sleeps with?
- Tachypnea
- Orthopnea
- Bradypnea
- Traumatopnea
A

Orthopnea

28
Q 
All of the correspond to the etiology of acute heart failure except:
• 
- Deep venous thrombosis
 - Arrythmias
- Hypertension
- Pulmonary embolism
A

Deep venous thrombosis

29
Q

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
A

It activates the renin-angiotensin-aldosterone axis

30
Q 
When the renin-angiotensin-aldosterone axis is activated, what happens to blood
pressure?
- It decreases
- Nothing
- Drops
- It increases
A

It increases

31
Q

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

A

Chest x-ray

32
Q 
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
A

Diuretics

33
Q 
According to your clinical suspicion, what study would you request in order to
establish the diagnosis?
EKG
Coronaryography
Echocardiogram
Cardiacenzymes
A

Echocardiogram

34
Q 
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
A

Heart failure

35
Q

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

A

Hyperosmolar state

36
Q

According to the vital signs the patient most likely have which one of the next?

  • Kidney failure
  • Retinopathy
  • Heart failure
  • Sepsis
A

Sepsis

37
Q 
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
A

Insulin resistance

38
Q

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

A

Measure two random glucose ≥ 126 mg/dI

39
Q 
When insulin becomes either insufficient or deficient, what metabolic pathway
switches on?
- Glucogenolysis
- Glucolysis
- Gluconeogenesis
- Glucogenogenesis
A

Gluconeogenesis

40
Q

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

A

Metformin

41
Q

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

A

The kidney sugar absorption threshold had been reached

42
Q 
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

A glycosylated hemoglobin

43
Q

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

A

Streptococcuspneumoniae

44
Q

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

A

ß-lactamic

45
Q

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

A

Nosocomial

46
Q

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

A

Atypical

47
Q 
According to this type of pneumonia, what microorganism is responsible for this?
Pseudomona eruginosa
Legionella pneumophila
Staphylococcus aureus
Mycoplasmapneumoniae
A

Mycoplasmapneumoniae

48
Q 
What are the substances produced by neutrophils responsible of making a patient
very ill and with fever?
Leukocytes
Integrins
Endothelin
Cytokines
A

Cytokines

49
Q 
What would be a good marker to anticipate the prognosis of the disease?
Glycosylated hemoglobin
Reactive protein "C"
Procalcitonin
Creatinine
A

Procalcitonin

50
Q 
Covid pneumonia is classified as what type of pneumonia?
Typical
Atypical
Nosocomial
ICU
A

Atypical

51
Q

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

A

Another glucose test

52
Q 
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
A

Diabetes

53
Q

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

A

To eat less carbohydrates and walk 15 min everyday

54
Q 
What pharmacological treatment should be initiated?
Insulin
Biguanids (metformin)
SGLT-2 inh (dapagliflozin)
Thiazolidinediones(pioglitazone)
A

Biguanids (metformin)

55
Q 
What is the best measurement to make a follow up?
 Complete blood count
Urine test
EKG
HbA1C
A

HbA1C

56
Q

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

A

Hyperosmolar state

57
Q 
Since this patient has type 2 DM uncontrolled and according to his vital signs, what is the clinical diagnosis?
Sepsis
Pneumonia
Ketoacidosis
Coronary ischemia
A

Sepsis

58
Q

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

A

Insulin

59
Q 
This patient also is found to have Charcot's foot, this is caused by which
complication?
Nephropathy
Neuropathy
Retinopathy
Vascular atrophy
A

Neuropathy

60
Q 
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
A

Infection is present

medicina forense (6 decks)

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