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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