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test responses MIR 2010 (17 of 17) Answers

See previous entry to see the rest of the answers

Question No. 37.

A woman of 76 years without other background hypertension consultation painless jaundice and pruritus with anorexia. Analytically highlights a bilirubin of 12 mg / dl (direct bilirubin was 9.5). Abdominal ultrasound shows dilated intra and extrahepatic bile duct, together with a unique 2-cm nodule located peripherally on the anterior left lobe. Tc confirmed the findings, further demonstrating the presence of a mass in the pancreatic head of 3.5 cm. The fine needle aspiration biopsy confirmed the diagnosis of adenocarcinoma. Bring the best therapeutic option:

1. Chemo / radiotherapy adjuvant to radical surgery conditioning the initial response.

2. Percutaneous external drainage gift palliative, with eventual conversion to internal drainage in case of intolerance or complications.

3. Surgical biliary bypass with or without prophylactic gastrojejunostomy on the basis of intraoperative findings.

4. Metallic biliary stent by endoscopic retrograde cholangiography with the option of palliative chemotherapy.

5. Pancreaticoduodenectomy cephalic or radiofrequency ablation of liver injury alcoholization.

I think the correct answer is 4 but the two are injured unresectable pancreatic adenocarcinoma with synchronous hepatic metastasis has no indication for surgery because they did not prolong survival and has a high morbidity. Bypass surgery have more complications than placing a self-expanding metallic stent that has a 6-month average permeability is similar to the median survival of a patient with liver metastases from pancreatic adenocarcinoma.

Question No. 39.

Which of gastric neoplasms in its infancy, can be considered as first treatment for the eradication of H. pylori with antibiotics and inhibitor of proton pump:

1. Diffuse-type gastric adenocarcinoma

2. Intestinal type gastric adenocarcinoma

3. Gastric MALT lymphoma

4. High grade gastric lymphoma

5. Gastric Hodgkin lymphoma

I think the correct answer is 3 this question can be answered by removing the remainder either have surgery or chemotherapy or both.

Question No 74

Ten days after having her hemithyroidectomy a patient with a thyroid nodule of 1.5 cm received the following report pathology "highly cellular follicular pattern without capsular invasion and infiltrating adjacent blood vessels and nerves. " Tick \u200b\u200bthe correct answer:

1. Since there is no capsular invasion is not required further surgery.

2. Follicular pattern is an indication of prophylactic cervical lymph node.

3. This is a follicular carcinoma and requires completion thyroidectomy.

4. The report provides complete security papillary carcinoma of the thyroid remnant.

5. The measurement of plasma calcitonin able to distinguish between papillary and follicular carcinoma.

I think the correct answer is 3 2.4 and 5 responses are clearly false. The question occurs between 1 and 2. The wording of 1 is correct in cases of follicular carcinoma without capsular invasion can to complete a total thyroidectomy. But if there is evidence of poor prognosis and the possibility of metastasis, as in this case it is best to complete the thyroidectomy and perform a scan with radioactive iodine to rule out metastasis or treated if present.

Question No. 92

A man of 30 years suffers a fall from a height of 2 meters standing. On arrival to the emergency room on a stretcher conscious and oriented, with clear urine bladder catheterization. Shows swelling of the left heel and slight tingling in left anterior thigh and scrotum and dysesthesias in both feet. The patient was dismissed the orderly with a handshake with a pat on the shoulder simultaneously. The rotation of the legs on the stretcher holding his ankles is painless and compression of the pelvis is asymptomatic. Here:

1. I sit at the table to explore the cervical spine.

2. Refer to radiology for assessment of the lower extremities (feet, femurs, pelvis).

3. Palpate the abdomen and collectively we will ride to feel the thoracolumbar spine.

4. We place a cervical collar and forward to radiology to study the image of the lower limbs and spine.

5. Request an abdominal ultrasound.

I think the correct answer is 3 the patient by the mechanism of injury, foot drop, "for a calcaneal fracture and neurological symptoms suggests a low spinal cord injury and fracture of the lumbar spine. The injury is not high because he moves his arms. Neither seems a pelvic injury in the absence of pain on movement or palpation. If a suspected pelvic injury in the primary evaluation of all multiple trauma (ATLS) should perform a scan of the spine rotating block to avoid causing further injury. Abdominal tenderness also part of the initial assessment. Abdominal ultrasound may be indicated in hemodynamically unstable patients are suspected abdominal injuries but in any case is made after the initial assessment.

Question No 122

circumferential face a deep burn of trunk and limbs What is the emergency treatment of choice?

1. Start antibiotic treatment

2. Tetanus prophylaxis

3. Debridement

4. Debridement and grafting

5. Longitudinal escharotomies

I think the correct answer is 5 deep circumferential burns if not treated quickly can lead to respiratory restrictive in the chest and limb ischemia. The longitudinal escharotomy is the initial treatment to prevent these complications.

Question No. 150

Child year and a half to go to emergency room with abdominal pain and jaundice. On examination, palpable abdominal mass. When an ultrasound revealed the presence of a choledochal cyst What therapeutic approach adopted?

1. There will be a puncture percutaneous peritoneal lavage to check the cyst containing bile to allow drainage to improve abdominal pain.

2. Indicate a radical resection of all sustiruirla bilair route for a loop of intestine.

3. It should mention an exploratory laparotomy and drainage of the cyst and when referring dilation remove the drain.

4. There will be a cyst from magnetic resonance to define and indicate a laparotomy for resection of the cyst and bile duct anastomsosis.

5. It is necessary HIDA scintigraphy to delineate the cyst and to perform percutaneous drainage safely.

I think the correct answer is 4 choledochal cyst is a rare condition but treatment is surgical and consists of resection of the cyst and hepaticoyeyunosotmía. La from magnetic resonance is necessary to choose the proper technique for the four classes of existing choledochal cyst (Todani classification).

Question No 162

Mark the correct statement about the technique of sentinel node in breast cancer.

1. There should be performed in patients with palpable nodules.

2. It does not prevent the completion of axillary lymph node dissection.

3. Marking is done by Spear of an axillary node.

4. Useful for detection of axillary lymph healthy.

5. Is performed simultaneously in both arms.

I think the answer is 1, the sentinel node technique is designed using a gamma camera to detect the first lymph node draining a breast tumor that has been injected with a radioisotope few hours earlier. It is considered that if this node is negative lymphadenectomy is not necessary. This eliminates the answers 2.3, 4. The sentinel node can be healthy but the goal of the technique is not healthy but ganlios detect the first draining lymph node tumor mama.No be realized simultaneously in both arms. If the node is palpable need not reach you by other methods.

Question No. 171

Which

the following is not a form of presentation of breast cancer?

1. Eczema of the nipple-areola.

2. Microcalcifications on mammography

3. Generalized swelling of the breast

4. Axillary lymph node

5. Nodule with calcification mammographic image lunate in eggshell.

I think the answer is correct by eliminating the 5 others, 1. Paget's disease of the nipple, 2. microcalcifications typical of early diagnosis of breast cancer, 3. Inflammatory breast carcinoma, 4. occult breast carcinoma presented a metastatic lymph node. If you are radiologist know that eggshell calcification is a sign of benignity.

Question No 213

A 41 year old man, presented with a right thyroid nodule aspiration is performed with fine needle. The cytological analysis will allow us:

1. Distinguish between follicular adenoma and minimally invasive follicular carcinoma.

2. Identify areas of capsular or vascular invasion of follicular carcinoma.

3. Recognize the G cell hyperplasia associated with familial medullary cancer.

4. Distinguish between Hurthle cell tumor and a follicular adenoma oxifilia.

5. Identify the typical cytologic features of papillary carcinoma

I think the correct answer is 5 FNA does not permit a histological study if not cytology therefore eliminate questions 1, 2. The 3 seems to have been filling since it is irrelevant. The 4 could raise doubts if there are pathologist perola most logical answer is 5 because the papillary carcinoma is the most common.

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surgery MIR exam 2010 (8 of 17)

Within the MIR initiative http://emilienko.blogspot.com/ 2.0 I have reviewed the exam and I chose 17 questions from surgery or that may be related with it, there are several gastroenterology or oncology that hopefully meet other students.
all the answers are already surgery on this link or Wikisanidad 2.0 MIR project

Question 1 Women 83 years with a history of diabetes mellitus, hiatus hernia, duodenal ulcer and inguinal hernia. Follow standard treatment with metformin, omeprazole, and iron anemia for months. Go to the emergency department with nausea, abdominal cramping, vomiting and constipation than 48 hours of onset. Physical examination diffusely distended and painful abdomen without signs of peritoneal irritation. Decreased bowel sounds. No palpable masses. Laboratory tests: Hb 8.5 g / dl, MCV 80, Palquetas 240000/uL, 10.200/ul leukocytes (81% granulocytes), pH 7.31, HCO3 17 mmol / L, amylase 150U / L (28-100), LDH 252 U / L, Creatinine 1.1 mg / dL. Normal rest. Radiology of the abdomen: see image1. His tentative diagnosis is:

1. Constipation secondary to iron therapy

2. Acute Pancreatitis

3. acute Gastristis

4. Ileus secondary to ionic alterations.

5. Mechanical intestinal obstruction at the distal ileum and cecum.

I think the answer is 5 think there is no doubt that the Rx shows a dilated distal small bowel with no gas in the colonic frame, if we add the absence of previous surgery, the operation is hernorrafia extraperitoneal and gives no adhesions. Anemia at 83 focuses on gastrointestinal tumor colon probably has no right under the VCM treatment with iron. I think it's a question easily resolved because there are other possible answers.

Question 2.

linked to the image Question # 1. The most appropriate initial clinical management for the patient would be:

1. NPO, nasogastric suction probe and fluid therapy with KCl. Request emergency abdominal CT.

2. Enemas until complete resolution. Repeat Rx control.

3. Fluid therapy with bicarbonate 1 / 6 M, NaCl and KCl intravenously.

4. NPO 8h. tolerance test and discharged via lactulose and oral domperidone.

5. Analgesia and omeprazole intravensoso. If not better assess urgent gastroscopy.

I think the answer is 1. Aspiration and the volume and electrolyte replacement is the mainstay of treatment of mechanical intestinal obstruction. CT is necessary to objectify the cause of obstruction without surgery prior to surgical indication in this case is indicated. The acidosis is treated with volume expansion and intervention to resolve the case, there may be intestinal necrosis. The second most likely answer is 3 but without the aspiration and does not refer to the TC, is the trap of bicarbonate and probably have been answered as correct by many, see the official response.

Question 3.

72 year old with no medical or surgical history of interest because of dyspnea at rest and fatigue from a month earlier. Does not mention changes in bowel habits. On arrival to the emergency room is hemodynamically stable. Analytical requested that presents in her blood count, Hb 7.6 g / dl, MCV 72, and Htco% to 26%. The patient was admitted for tests. Image 2 shows an axial section of CT scan of the patient. "In relation to radiological test carried out which of the following statements is true?

1.Se eccentric wall thickening observed at the ascending colon consistent with adenocarcinoma.

2.Presencia minimum of colon wall thickening with diffuse mucosal hyperemia compatible with ulcerative colitis.

3, has been identified a fluid collection with air-fluid level compatible with perforated diverticulitis.

fecaloma 4.Se see a bulky proximal colonic obstruction.

5.Presenta minimal physiological strain of intestinal apparatus compatible with normal aging.

I think the answer is 1. Do not think it is a question with response options.

Question 4.

linked to the image Question No. 2.

earlier in the patient which would be the steps to follow below:

1.Colocación nasogastric tube.

2.Drenaje PCI.

3.Antibioterapia broad spectrum.

4.Colocación rectal probe.

5.Pancolonoscopia biopsy

I think the answer is 5. The patient has no symptoms of intestinal blockage and if the correct diagnosis of the above is adenocarcinoma of the colon, the correct answer to this is the colonocospia with biopsy and subsequent surgical treatment. If the patient showed symptoms occlusive appropriate response would be 1 because the surgery is urgent and no preoperative biopsy was performed. The piece serves as a biopsy right hemicolectomy and definitive treatment.

Question No. 31:

In a patient with liver trauma by CT, the most important criteria for suspending the conservative treatment and proceed to surgery is:

1 . That there are changes in the radiological control procedures.

2.What are evident pain, ileus and abdominal distension. 3.What

occur hemodynamic instability.

4.Presencia of leukocytosis.

5.Presencia hematocrit less than 30%

I think the correct answer is 3 manuals in all trauma is clear that response, the rest of the symptoms, signs and radiological images are not related to the failure of conservative treatment.

Question No 32

In laparoscopic surgery what is the most widely used gas for the creation of pneumoperitoneum?

1.Oxígeno

2.Argón.

3.Oxido nitrous.

4.Helio.

5-carbon dioxide.

There is no doubt that the answer is 5. is the only gas that is explosive and it is expelled through breathing.

Question No 33

In relation to the indications of surgery for inflammatory bowel disease indicate the wrong answer:

1.Muchos patients with Crohn's disease are require surgery at some point in its evolution.

2.The

surgical indications Crohn's disease limited to complications.

3.La toxic megacolon usual solution is surgery.

4.In the surgical treatment of ulcerative colitis resection should be limited to the segment of colon. 5.The

extraintestinal complications of the lower limbs usually resolve after resection of affected intestine, with the exception of spondylitis and liver complications. Ceo

the correct answer is 4 the rest of the answers to all true, the surgery of ulcerative colitis is total resection of the colon. Mucosal resection of colon cures the disease it produces effects. There are techniques for sphincter preservation surgery but at least should be a subtotal colectomy and we must remember that almost all patients with ulcerative proctitis have while working.

Question No 36

A 87 year old patient with a history of chronic bronchitis and heart failure, has been diagnosed with acute gallstone cholecystitis. After four days of treatment with oral intake, serum therapy and piperaciliana / tazobactam, the patient continued with fever, persistent abdominal pain and leukocytosis.

The proper attitude at this point would be:

1.Tratamiento surgery (cholecystectomy urgent)

2-biliary drainage by percutaneous cholecystostomy.

3.Sustituir the piperaciliana / tazobactam and cefotaxime + metronidazole.

4.Sustituir the piperaciliana / tazobactam and amikacin + clindamycin.

5.Add gentamicin.

I think the answer is 2 although the treatment of acute cholecystitis is cholecystectomy, this requires that the patient is a surgical candidate, in this case is an elderly patient with pre-existing conditions that increase surgical risk ASA IV would be a fig a urgent intervention. In these cases, cholecystectomy cholecystitis can heal, and after recovery, to assess the elective surgery as the patient's situation

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surgery exam answers 2010

Under the initiative http://emilienko.blogspot.com/ MIR 2.0 I have reviewed the exam and I chose 17 questions from surgery or that may be related with it, there are several gastroenterology or oncology that hopefully meet other students. The hanging will go as the answer and Emilienko (Emilio Dominguez) the hang of Wikisanidad.

Question 1 Female 83 years old with a history of diabetes mellitus, hiatus hernia , duodenal ulcer and inguinal hernia. Follow standard treatment with metformin, omeprazole, and iron anemia for months. Go to the emergency department with nausea, abdominal cramping, vomiting and constipation than 48 hours of onset. Physical examination diffusely distended and painful abdomen no signs of peritoneal irritation. Decreased bowel sounds. No palpable masses. Laboratory tests: Hb 8.5 g / dl, MCV 80, Palquetas 240000/uL, 10.200/ul leukocytes (81% granulocytes), pH 7.31, HCO3 17 mmol / L, amylase 150U / L (28-100), LDH 252 U / L, creatinine 1.1 mg / dL. Normal rest. Radiology of the abdomen: see iamgen1. His tentative diagnosis is:
1. Constipation secondary to iron therapy
2.
Acute Pancreatitis 3. Acute Gastristis
4. Ileus secondary to ionic alterations.
5. Mechanical intestinal obstruction at the distal ileum and cecum.

I think the answer is 5 think there is no doubt that the Rx shows a dilated distal small bowel with no gas in the colonic frame, if we add the absence of previous surgery, the extraperitoneal operation is hernorrafia and gives no adhesions. Anemia at 83 focuses on gastrointestinal tumor colon probably has no right under the VCM treatment with iron. I think it's a question easily resolved because there are other possible answers.

Question 2. Question
linked to the image # 1. The most appropriate initial clinical management for the patient would be:
1. NPO, nasogastric tube with suction and fluid therapy with KCl. Request emergency abdominal CT.
2. Enemas until complete resolution. Repeat Rx control.
3. Fluid therapy with bicarbonate 1 / 6 M, NaCl and KCl intravenously.
4. NPO 8h. tolerance test and discharged via lactulose and oral domperidone.
5. Analgesia and omeprazole intravensoso. If not better assess urgent gastroscopy.
I think the answer is 1. Aspiration and the volume and electrolyte replacement is the mainstay of treatment of mechanical intestinal obstruction. CT is necessary to objectify the cause of obstruction without surgery prior to the indication for surgery in this case is indicated. The acidosis is treated with volume expansion and intervention to resolve the case, there may be intestinal necrosis. The second most likely answer is 3 but omits the vacuum and makes no reference to the TC, is the trap of bicarbonate and probably have been answered as correct by many, see the official response. Tomorrow

more and better to me very late .....
Sweet dreams after so much stress and dream of the first post ....

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Union MIR temporary posts for the MIR 2010

initiative of Emilio Dominguez Duran have made a temporary posts in order to assess whether the correct answer given by the MIR 2011, under the theory and practice standard of our specialties. In this link you can consult colleagues who have given to this initiative and specialties are covered: Anatomy, Endocrinology, Geriatrics, Gynecology, Nephrology, Pulmonology, Rheumatology, Orthopedics, Urology.

From Sunday morning will begin posting in various blogs reasoned responses and the whole test is centralized in the blog: http://emilienko.blogspot.com

luck to the new MIR encouragement to all participants. See you tomorrow ....