CURSOS INGLÉS - ENARM

Quiz # 17 – Básicos/Intermedios

Nombre: ________________________________________________ Grupo: ______________________

Apellido paterno/ Apellido materno/ Nombre(s)

Profesor(a): _____________________________________________

Current best estimates indicate that many more men are treated for prostate cancer aggressively than is likely
necessary to save a life from the disease. The challenge has been to identify those men who do not need immediate
therapy, which is usually decided based on age, comorbidities, and cancer factors like the PSA, stage, amount of
cancer in the biopsy, and Gleason grade. Research is ongoing to develop biomarkers and additional tests that can
better risk-stratify men so that this decision is easier and more accurately informed. Today, the healthy man who is
ideal for active surveillance has a low grade (Gleason 6 or under), low-risk prostate cancer (low PSA and stage),
that appears to be low in volume (small amount of cancer found on biopsy, for example), and who is not eager to
undergo therapy right away due to concerns about potency preservation or urinary symptoms. Active surveillance
might also be a good choice for older men with limited life expectancy. In addition, if a man is currently battling
other serious disorders or diseases, such as heart disease, long-standing high blood pressure, or poorly controlled
diabetes, his doctors might feel it is in his best interest to hold off on therapy and avoid its potential complications.
That’s because many of the treatment options for prostate cancer can be difficult to endure, and better outcomes are
seen in men who are otherwise healthy.

1. Among men who have prostate cancer,

a) too many receive aggressive treatments.
b) many have received the necessary treatment.
c) more than many have been saved from death.

2. Biomarkers could be used:

a) to develop additional diagnostic tests.
b) as the main tool to stratify cancer risk.
c) in addition to existing information.

3. Active surveillance is recommended:

a) for healthy young men and older men who already have cancer.
b) to postpone treatment when other disorders are present.
c) when potency preservation is an important preoccupation.

4. One winter evening you are evaluating a 68-year-old woman who is complaining of shortness of breath in the
emergency department. She has a medical history significant for chronic obstructive pulmonary disease (COPD)
and hypertension. Her medications include an ipratropium and albuterol inhaler and furosemide. Following a series
of albuterol nebulizer treatments, her respiratory function returns to baseline. Her temperature is 37.0 C, blood
pressure is 146/87 mm Hg, pulse is 89/min, and respirations are 22/min. She has diminished breath sounds
bilaterally, but otherwise her lungs are clear to auscultation. Prior to her discharge, she should receive:
A. a tetanus booster D. vaccination against Haemophilus influenzae
B. vaccination against hepatitis B E. vaccination against varicella
C. vaccination against influenza

5. A 7-year-old boy is brought to your office by his mother because of "tea-colored urine" for the last several days.
He has also had some nausea and vomiting, and his eyes appear swollen when he wakes up in the morning. The eye
swelling tends to resolve over the course of the day. He is generally very healthy and there is no family history of
any chronic diseases. His temperature is 36.7 C, blood pressure is 130/90 mm Hg, pulse is 96/min, and respiratory
rate is 16/min. Physical examination is unremarkable. A urinalysis shows red cell casts. At this time the most
appropriate study to confirm your diagnosis is:

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 A. antinuclear antibody D. renal ultrasound
B. antistreptolysin O antibody E. urine culture
C. renal biopsy

6. A 19-YEAR-OLD WOMAN IS BROUGHT TO THE EMERGENCY DEPARTMENT BY HER ROOMMATE BECAUSE

OF CONFUSION. THE PATIENT IS UNCOOPERATIVE, SO THE ROOMMATE TRIES TO GIVE YOU AS MUCH
INFORMATION AS POSSIBLE. SHE TELLS YOU THAT SHE KNOWS THAT THE PATIENT HAS BEEN SMOKING
POT, DRINKING ALCOHOL, AND "DOING SOME OTHER DRUGS" SINCE SHE FAILED HER PRE-MEDICAL
CHEMISTRY COURSE LAST SEMESTER. SHE HAS BEEN MAKING MONTHLY TRIPS TO HER GRANDFATHER'S
HOUSE LATELY, TAKING HIM TO THE DOCTOR AND THEN THE PHARMACY TO PICK UP HIS MEDICATIONS
THAT ARE PRESCRIBED FOR VARIOUS CONDITIONS, SUCH AS HYPERTENSION, GOUT, INSOMNIA,
DEPRESSION, NASAL CONGESTION, AND BACK PAIN FROM PROSTATE CANCER. HER TEMPERATURE IS 37.0
C, BLOOD PRESSURE IS 90/60 MM HG, PULSE IS 40/MIN, AND RESPIRATIONS ARE 6/MIN. SHE LAPSES INTO
COMA DURING THE PHYSICAL EXAMINATION, MAKING IT VERY DIFFICULT TO EVALUATE HER;
HOWEVER, YOU NOTE THAT SHE HAS MIOSIS. THE GRANDFATHER'S MEDICATION THAT IS MOST LIKELY
RESPONSIBLE FOR THIS PATIENT'S CONDITION IS
A. INDOMETHACIN D. PSEUDOEPHEDRINE
B. NORTRIPTYLINE E. SUSTAINED-RELEASE OXYCODONE
C. PHENELZINE

7. A 14-month-old male baby is brought to your office by his concerned mother for recurrent diarrhea over the past
2 months. He has also developed a scaly rash around his mouth, on the cheeks and on buttocks. He has been
exclusively breast-fed for about 8 months and has been started on a gradual weaning process over the last four
months. He is otherwise, a healthy child. There is no family history of eczema. On examination, he is afebrile and
vitals are stable. Physical examination shows lesions around the ano-genital area as shown below:

Similar lesions are seen over his cheeks and around the mouth. Which of the following is indicated in this patient at
this time?
A) Exclusive breastfeeding D) Glucagon level
B) Serum lead level E) Sweat chloride Level
C) Serum zinc level

8. In determining fulminant hepatic failure, which of the following parameters should be closely monitored because
it is best for predicting progression to failure?
A) AST and ALT D) Prothrombin time
B) Alkaline phosphate E) White blood cell count
C) Bilirubin

9. A 60-YEAR-OLD WOMAN PRESENTS TO A PHYSICIAN COMPLAINING OF SWELLING IN HER NECK. HER

PAST MEDICAL HISTORY IS SIGNIFICANT FOR RHEUMATOID ARTHRITIS AND SJÖGREN SYNDROME.
PHYSICAL EXAMINATION REVEALS A MILDLY NODULAR, FIRM, RUBBERY GOITER. TOTAL SERUM
THYROXINE (T4) IS 10 MG/DL, AND THIRD-GENERATION THYROID-STIMULATING HORMONE (TSH) TESTING
SHOWS A LEVEL OF 1.2 MIU/ML. ANTITHYROID PEROXIDASE ANTIBODY TITERS ARE HIGH. WHICH OF THE
FOLLOWING IS THE MOST LIKELY DIAGNOSIS?
A. EUTHYROID SICK SYNDROME C. HASHIMOTO’S THYROIDITIS
B. GRAVES’S DISEASE D. SILENT LYMPHOCYTIC THYROIDITIS

10. A 22-year-old woman, gravida 4, para 3, at 38 weeks' gestation comes to the labor and delivery ward with a
gush of fluid. Sterile speculum examination reveals a pool of fluid that is nitrazine positive and forms ferns when
viewed under the microscope. The fetal heart rate is in the 150s and reactive. An ultrasound demonstrates that the
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Material didáctico propiedad del Mtro. Jorge E. Suárez. Prohibida la reproducción parcial o total de este material sin autorización.
fetus is in the breech position. A cesarean delivery is performed. During the operation, the physician, who has
received no recent immunizations, is stuck with a needle that had been used on the patient. Which of the following
is this physician at greatest risk of contracting?
A. HIV D. Scabies
B. Hepatitis B E. Syphilis
C. Hepatitis C

Case 1

An 8-year-old boy is brought to the ER of your hospital because of a history of jaundice and pain in the right
hypochondrium. His mother reports that yesterday he had nausea and vomited after taking a drug. She does not
know which drug it was. Liver function tests are elevated.

11. Which is the drug that this patient most likely took?
A) Phenytoin
B) Acetaminophen
C) Valproic acid
D) Zinc

12. How many hours have passed since ingestion of the drug?
A) 12 hours
B) 24 hours
C) 36 hours
D) 72 hours

13. What is the toxic dose of acetaminophen?

A) 25 mg/kg/dose
B) 50 mg/kg/dose
C) 100 mg/kg/dose
D) 150 mg/kg /dose

14. The name of the active metabolite of this drug is:

A) 10-11 Epoxide
B) delta-9-tetrahydrocannabinol
C) benzoylecgonine
D) N-acetyl-p-benzoquinoneimine

15. Which is the specific antidote for acetaminophen toxicity?

A) Acetylcysteine
B) Sodium bicarbonate
C) Methylene blue
D) Atropine

16. Which is the initial dose of the antidote in this kind of toxicity?
A) 35 mg/kg/dose
B) 70 mg/kg/dose
C) 140 mg/kg/dose
D) 1 g/kg/dose

17. The maintenance dose of the antidote in this kind of toxicity is:
A) 15 mg/kg/dose for a total of 17 doses
B) 35 mg/kg/dose for a total of 17 doses
C) 70 mg/kg/dose for a total of 17 doses
D) 150 mg/kg/dose for a total of 17 doses

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Material didáctico propiedad del Mtro. Jorge E. Suárez. Prohibida la reproducción parcial o total de este material sin autorización.
18. Which of the following injuries is caused by toxicity with this drug?
A) Injury of zone I at the hepatic level
B) Central-lobular necrosis
C) Steatosis
D) Liver liquefaction

End of Case 1

19. Which is the specific antidote for benzodiazepine toxicity?

A) Octreotide
B) Flumazenil
C) Atropin
D) D-penicillamine

20. Which of the following clinical manifestations are observed in anticholinergic toxicity?
A) Mydriasis, respiratory and neurological depression
B) Sialorrhea, bronchorrhea and epiphora
C) Fever, miosis and tachycardia
D) Flushing, mydriasis, hallucinations, dry mucous membranes

21. The scientific name of the violinist spider is:

A) Loxosceles reclusa
B) Centruroides suffusus
C) Latrodectus mactans
D) Heloderma suspectum

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Material didáctico propiedad del Mtro. Jorge E. Suárez. Prohibida la reproducción parcial o total de este material sin autorización.