Inglés Clase 5

English Clinical Cases
PUEP - ENARM
Dr. Julio Herrera-Zamora Dr. Julio Herrera-Zamora
Case 1
A 12-year-old man arrives to the Emergency Department of your hospital after getting a direct
trauma in the knee while playing baseball. On the interrogation the mother reports that the
patient has had bruising without explanation. On physical examination, numbness, hyperthermia
and volume increase. Laboratory findings: Hb: 11 g/dL, platelets: 230,000 cells/L, PT 12, aPTT
52, INR 1.1. He undergoes an arthrocentesis with bloody findings
Case 1
A 12-year-old man arrives to the Emergency Department of your hospital after getting a direct
trauma in the knee while playing baseball. On the interrogation the mother reports that the
patient has had bruising without explanation. On physical examination, numbness, hyperthermia
and volume increase. Laboratory findings: Hb: 11 g/dL, platelets: 230,000 cells/L, PT 12, aPTT
52, INR 1.1. He undergoes an arthrocentesis with bloody findings.
Case 1
knee: rodilla
bruising: hematoma
numbness: entumecimiento o insensibilidad
Prothrombin time (PT): Tiempo de Protrombina
Activated partial thromboplastin time (aPTT): Tiempo de Tromboplastina Parcial activado
Undergoes: Someterse a
Bloody findings: Hallazgos sanguinolentos
Case 1
Q1. 1. Which of the following has a deficiency of factor IX?
A) Hemophilia A
B) Hemophilia B
C) Hemophilia C
D) von Willenrand disease
Case 1-Q1. Review
Hereditary hemophilia is a disease linked to the X chromosome; therefore, women are carriers
of the disease and males who suffer from it.
It is characterized by deficiency or dysfunction of coagulation proteins, Factor VIII in hemophilia
A and Factor IX in hemophilia B.
The pathognomonic clinical manifestation in hemophilia are hemorrhages at the articular level
called hemarthrosis. It starts with a feeling of numbness or pressure in the affected joint (aura)
in combination with any of the following: a) increase in volume and local temperature; b) pain;
or c) functional disability. Large joints are the most affected.
therefore: por lo tanto
carriers: portadoras
joints: articulaciones
Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento Hemofilia A y B en Población > 16
años del Segundo y Tercer Nivel de Atención.
Revisión Caso 1 – P1
La hemofilia hereditaria es un padecimiento ligado al cromosoma X, por lo tanto, las mujeres
son portadoras de la enfermedad y los varones quienes la padecen.
Se caracteriza por deficiencia o disfunción de proteínas de la coagulación, Factor VIII en la
Hemofilia A y Factor IX en la B.
La manifestación clínica patognomónica en hemofilia son las hemorragias a nivel articular

denominadas hemartrosis. Inicia con sensación de entumecimiento o presión en la articulación
afectada (aura) en combinación con cualquiera de lo siguiente: a) aumento de volumen y de
temperatura local; b) dolor; o c) incapacidad funcional. Las articulaciones grandes son las más
afectadas.
Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento Hemofilia A y B en Población > 16 años del
Segundo y Tercer Nivel de Atención.
Case 1
Q2. Which is the most affected site in this disease?
A) Shoulders
B) Elbows
C) Hip
D) Muscles
shoulder: hombros
elbows: codos
hip: cadera
Case 1-Q2. Review
The most affected sites by hemorrhage are the joints (70% to 80%), more frequent in knees,
ankles and elbows, less frequent in shoulders, hips and carps. In muscles (10 to 20%), other sites
(5%) and intracranial hemorrhage ≤ 5%.
more: más
ankles: tobillos
less: menos
Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento Hemofilia A y B en Población > 16 años del Segundo
y Tercer Nivel de Atención.
Los sitios más afectados por hemorragia son las articulaciones (70% a 80%), más frecuente en
rodillas, tobillos y codos, menos frecuente en hombros, cadera y carpos. En músculos (10 a
20%), otros sitios (5%) y hemorragia intracraneal ≤ 5%.
Case 1
Q3. Which of the following will be altered in this disease?
A) Hemoglobin
B) Platelets
C) Activated partial thromboplastin time
D) Prothrombin time
Case 1-Q3. Review
Screening studies include complete blood count (BHC) with platelet count, activated partial
thromboplastin time (aPTT) and prothrombin time (TP). Patients with suspected hemophilia
have normal platelet count, prolonged aPTT and normal PT.
screening: escrutinio
Los estudios de escrutinio incluyen: Biometría Hemática Completa (BHC) con cuenta de
plaquetas, Tiempo de Tromboplastina Parcial activado (TTPa) y Tiempo de Protrombina (TP). Los
pacientes con sospecha de hemofilia presentan cuenta de plaquetas normal, TTPa prolongado y
TP normal.
Case 1
Q4. The level of the factor is at 25%, how would you classify the severity of this patient?
A) Mild
B) Moderate
C) Severe
D) Letal
mild: leve
Case 1-Q4. Review
The severity of hemophilia is classified according to the plasma levels of activity of factors VIII or
IX in: severe <1%, moderate of 1-5% and mild between 5-40%. Individuals with factor VIII levels
between 40 and 50% are not well defined.
between: entre
La gravedad de la hemofilia se clasifica de acuerdo a los niveles plasmáticos de actividad de los
factores VIII o IX en: grave <1%, moderada de 1-5% y leve entre 5-40%. Los individuos con
niveles de factor VIII entre 40 y 50% no están bien definidos.
Case 1
Q5. If there is a muscular hematoma that is not treated properly, which site can be presented
more easily a compartment syndrome?
A) Iliopsoas
B) Forearm flexor
C) Long adductor
D) External vast
properly: adecuadamente
forearm: antebrazo
Case 1-Q5. Review
The most common location for muscle hematoma is in the iliopsoas and the flexor of the
forearm, if not treated properly, can trigger a compartment syndrome that may require
emergency surgical treatment. The iliopsoas hematoma can be complicated by crural nerve
palsy and if it affects the right side, it can be confused with appendicitis.
trigger: desencadenar
palsy: parálisis
La localización más común de los hematomas musculares es en el iliopsoas y el flexor del
antebrazo este último, de no tratarse adecuadamente, puede desencadenar un síndrome
compartimental que puede requerir de un tratamiento quirúrgico de urgencia. El hematoma del
iliopsoas puede complicarse con parálisis del nervio crural y si afecta el derecho se puede
confundir con apendicitis.
Case 1
Q6. Once the bleeding is controlled and the replacement treatment is completed, when does
rebleed is considered?
A) 12 hours
B) 24 hours
C) 48 hours
D) 72 hours
bleeding: sangrado
Case 1-Q6. Review
It is necessary to consider as rebleeding the one that appears 72 hours after controlling the
hemorrhage and concluded the replacement treatment.
It is usually associated with an inappropriate treatment, either by dose or time of treatment.
either: o bien
Hay que considerar como resangrado al que se presenta 72 horas después de controlar la
hemorragia y concluido el tratamiento de reemplazo.
Por lo general está asociado a un tratamiento no adecuado, ya sea por dosis o tiempo de
tratamiento.
Case 1
Q7. Which of the following is not a mechanism of desmopressin?
A) Increase factor VIII levels

B) Stimulates platelet adhesion
C) Increase factor IX levels
D) Increase von Willebrand factor levels
increase: aumenta
Case 1-Q7. Review
Desmopressin is a synthetic analogue of vasopressin, its mechanism of action is multifactorial: it
increases plasma levels factor VIII and von Willebrand Factor, stimulates platelet adhesion and
increases the expression of tissue factor. Desmopressin does not affect the serum levels of
factor IX, therefore it is not indicated in hemophilia B.
La desmopresina es un análogo sintético de la vasopresina, su mecanismo de acción es
multifactorial: incrementa los niveles plasmáticos de F VIII y del Factor de von Willebrand,
estimula la adhesión plaquetaria e incrementa la expresión del factor tisular. La desmopresina
no afecta los niveles séricos de F IX por lo tanto no está indicada en hemofilia B.
Case 1
Q8. Which of the following medications is indicated for pain control in this patient?
A) Acetylsalicylic acid
B) Acetaminophen
C) Ibuprofen
D) Naproxen
Case 1-Q8. Review
Acetaminophen, with or without narcotic analogues, is effective in controlling pain. Medications
such as acetylsalicylic acid (AAS) or nonsteroidal anti-inflammatory drugs (NSAIDs) cause
platelet dysfunction.
El acetaminofén, con o sin análogos narcóticos, es eficaz para controlar el dolor. Medicamentos
como ácido acetil salicílico (AAS) o anti- inflamatorios no esteroideos (AINEs) causan disfunción
plaquetaria.
Case 2
A 27-year-old woman is admitted at your hospital with a 2 months story of painful neck lymph
nodes, night sweats, fever and weight loss of 6 kg. On physical examination: 2cm bilateral neck and
underarm lymphadenopathy. The spleen is not palpable, and the liver is not enlarged. A chest
radiograph shows mediastinal widening (2/3 diameter).
Laboratory findings: Hb 10 g/dL, WBC 3,400 cells/mm3 (500 total lymphocytes), platelets 213 000
cells/L, erythrocyte sedimentation rate (ESR) 56 mm/hr. A lymph node biopsy was performed.
Case 2
A 27-year-old woman is admitted at your hospital with a 2 months story of painful neck lymph
nodes, night sweats, fever and weight loss of 6 kg. On physical examination: 2cm bilateral neck
and underarm lymphadenopathy. The spleen is not palpable, and the liver is not enlarged. A chest
radiograph shows mediastinal widening (2/3 diameter).
Laboratory findings: Hb 10 g/dL, WBC 3,400 cells/mm3 (500 total lymphocytes), platelets 213 000
cells/L, erythrocyte sedimentation rate (ESR) 56 mm/hr. A lymph node biopsy was performed.
Case 2
weight loss: Pérdida de peso
underarm: Axila
spleen: Bazo
widening: ensanchamiento
Case 2
Q1. Which is the most common subtype of this disease?
A) Nodular sclerosis
B) Mixed cellularity
C) Lymphocyte-rich
D) Lymphocyte depleted
Case 2-Q1. Review
It represents 70% of the Hodgkin Linformas. It is more frequent in developed countries, in high
socioeconomic strata. There is no predominance of gender, the average age is 15 to 34 years. In
80% of cases there is mediastinal component, voluminous disease in 54%, splenic and
pulmonary infiltration in 5%, bone marrow in 3% and liver in 2%. The most frequent clinical
stage is II, and B symptoms occur in 40% of cases.
developed countries : Países desarrollados
gender: género
average: promedio
bone marrow: médula ósea
Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento Linfomas de Hodgkin en Población de 16 años o más
en ambos sexos en el Segundo y Tercer Nivel de Atención.
Representa el 70% de los Linformas Hodgkin. Es más frecuente en países desarrollados, en
estratos socioeconómicos altos. No hay predominio de género, la edad promedio es de 15 a 34
años. En el 80% de los casos hay componente mediastinal, enfermedad voluminosa en 54%,
infiltración esplénica y pulmonar en 5%, médula ósea en 3% y del hígado en 2%. El estadio
clínico más frecuente es el II, y se presentan síntomas B en el 40% de casos.
Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento Linfomas de Hodgkin en Población de 16 años o
más en ambos sexos en el Segundo y Tercer Nivel de Atención.
Case 2
Q2. Which is the most common type of lymphoma in patients with HIV/AIDS?
A) Nodular sclerosis
B) Mixed cellularity
C) Lymphocyte-rich
Case 2-Q2. Review
Classical mixed cellularity Hodgkin lymphoma comprises 10 to 25% of all Hodgkin lymphoma, is
the most frequent in patients with HIV / AIDS and in developing countries.
El Linfoma Hodgkin clásico de celularidad mixta comprende 10 a 25% de todos los Linfoma
Hodgkin, es el más frecuente en enfermos con VIH/SIDA y en países en desarrollo.
Case 2
Q3. You find a lymph node in the liver, which is the stage of this patient according to the
classification of Ann Arbor modified in Costwolds?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Case 2-Q3. Review
Stage III corresponds to localization of the disease in ganglionic regions on both sides of the
diaphragm. In turn, these stages can be divided into:
A. Without systemic symptoms.
B. With systemic symptoms (fever> 38 °, diaphoresis, weight loss of> 10% in the last 6 months).
X. Bulky disease. Ganglion> 10 cm in the maximum diameter or mediastinal tumor greater than
a third of the internal diameter of the thorax on radiography, measured between T5 / T6.
bulky disease: Enfermedad voluminosa
l estadio III corresponde a localización de la enfermedad en regiones ganglionares a ambos
lados del diafragma. A su vez este estadios se pueden dividir en:
A. Sin síntomas sistémicos.
B. Con síntomas sistémicos (fiebre > 38°, diaforesis, pérdida de peso de > 10% en los últimos 6
meses).
X. Enfermedad voluminosa. Ganglio > 10 cm en el diámetro máximo o tumor mediastinal > de
una tercera parte del diámetro interno del tórax en la radiografía, medido entre T5/T6.
Case 2
Q4. Which immunophenotype do the Hodgkin/Reed-Sternberg cells express?
A) CD30
B) CD45
C) CD68
D) CD75
Case 2-Q4. Review
Hodgkin / Reed-Sternberg cells express CD30 in almost all cases and CD15 in the majority (75-
80%). They are negative for CD45, J chain, CD75 and specific markers for macrophages (epitome
PG-M1 of the CD68 molecule), but of variable intensity and usually in few neoplastic cells.
almost: casi
Las células de Hodgkin/Reed-Sternberg expresan CD30 en casi todos los casos y CD15 en la
mayoría (75-80%). Son negativas para CD45, cadena J, CD75 y marcadores específicos para
macrófagos (epítome PG-M1 de la molécula CD68), pero de intensidad variable y usualmente en
pocas células neoplásicas.
Case 2
Q5. Which of the following is not a prognostic factor for Hodgkin lymphoma according to the
International Prognostic Score?
A) Age <45 years

B) Male gender
C) Hemoglobin <10.5 g / dL
D) Albumin <40 g / L
Case 2-Q5. Review
According to the IPS (International Prognostic Score) for advanced Hodgkin lymphoma, 7 prognostic factors
are recognized:
1. Age:> 45 years,
2. Gender: Male
3. EC: IV
4. Hemoglobin: <10.5 g / dL
5. Leukocytes:> 15 x 109 / L
6. Lymphopenia: <0.6 x 109 / L or <8% of the differential
7. Albumin: <40 g / L
De acuerdo al IPS (International Prognostic Score) para Linfoma de Hodgkin avanzado, se reconocen 7
factores pronóstico:
1. Edad: > 45 años,

2. Género: Masculino
3. EC: IV
4. Hemoglobina: < 10.5 g/dL
5. Leucocitos: > 15 x 109/L
6. Linfopenia: < 0.6 x 109/L o <8% de la diferencial
7. Albúmina: < 40 g/L
Case 2
Q6. Which of the following is not part of the treatment of this disease?
A) Dacarbazine
B) Cyclophosphamide
C) Doxorubicin
D) Bleomycin
Case 2-Q6. Review
Currently the standard is the combined treatment with four cycles of chemotherapy with a type
ABVD scheme (doxorubicin, bleomycin, vinblastine and dacarbazine) plus field radiotherapy
affected in a total dose of 20-30 Gy.
currently: actualmente
Actualmente el estándar es el tratamiento combinado con cuatro ciclos de quimioterapia con
un esquema tipo ABVD (doxorubicina, bleomicina, vinblastina y dacarbazina), más radioterapia
de campo afectado en una dosis total de 20-30 Gy.
Case 2
Q7. Which of the following is related to pulmonary toxicity?
A) Dacarbazine
B) Bleomycin
C) Doxorubicin
D) Vinblastine
Case 2-Q7. Review
A broad spectrum of bleomycin‐induced pulmonary toxicities have been well described as a
complication of Hodgkin's lymphoma treated with ABVD chemotherapy, the most common
variant of which is bleomycin‐induced pneumonitis. It occurs in 10% of patients receiving
bleomycin and carries a mortality risk of 10%‐20%.
A broad: un amplio
Literature: Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine. Sixth Edition
Un amplio espectro de toxicidad pulmonar inducida por bleomicina ha sido bien descrito como
una complicación del tratamiento del linfoma de Hodgkin (quimioterapia ABVD). La variante más
común es la neumonitis inducida por bleomicina. Ocurre en el 10% de los pacientes que reciben
bleomicina y tiene un riesgo de mortalidad del 10% al 20%.
Bibliografía: Medicina de bolsillo: Manual de Medicina Interna del Hospital General de Massachusetts. Sexta
edicón.
Case 2
Q8.Which is the variety of worse prognosis?
A) Lymphocytic predominance
B) Nodular sclerosis
C) Mixed cellularity
Case 2-Q8. Review
Lymphocyte depleted represents 5% to 15% of cases of Hodgkin lymphoma and is the variety
with the worst prognosis.
La depleción linfocítica representa del 5 al 15% de los casos de Linfoma de Hodgkin y es la
variedad con peor pronóstico.
Case 3
A 23-year-old woman arrives to the emergency room of your hospital due to prolonged bleeding
after a dental procedure early that day. She has made manual pressure with several gauze package
without success. Her medical records include heavy and prolonged menses. As a child, she had
several episodes of unexplained nosebleeds. Laboratory findings with normal PT, PTT, and platelet
count.
Case 3
A 23-year-old woman arrives to the emergency room of your hospital due to prolonged bleeding
after a dental procedure early that day. She has made manual pressure with several gauze
package without success. Her medical records include heavy and prolonged menses. As a child,
she had several episodes of unexplained nosebleeds. Laboratory findings with normal PT, PTT, and
platelet count.
Case 3
Early: temprano
Gauze package: paquete de gasas
Menses: menstruación
Nosebleeds: epistaxis
Case 3
Q1. What kind of inheritance does this disease have?
A) Autosomal dominant
B) Autosomal recessive
C) Heredity linked to the dominant X chromosome
D) Heredity linked to the recessive X chromosome
Inheritance: Herencia
Case 3-Q1. Review
The VWF is encoded in the short arm of chromosome 12, the gene that encodes it is large, 178
kb with 52 exons, the transmission of the disease is autosomal (mainly dominant), so the
inheritance is not related to the sex, equally affects men and women.
Encode: codificado
Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento Enfermedad de von Willebrand Hereditaria.
Personas de todas las edades. Segundo y Tercer Nivel de Atención.
El FvW se codifica en el brazo corto del cromosoma 12, el gen que lo codifica es de gran tamaño,
178 kb con 52 exónes, la transmisión de la enfermedad es autosómica (principalmente
dominante), por lo que la herencia no está relacionada con el sexo, afecta por igual hombres y
mujeres.
Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento Enfermedad de von Willebrand Hereditaria.
Case 3
Q2. Which of the following is not a screening test for this disease?
A) Blood count and platelet count

B) Bone marrow smear
C) Peripheral blood smear
D) Activated Partial Thromboplastin Time
Smear: frotis
Case 3-Q2. Review
The screening tests for vWD are: Complete blood count (BHC) with platelet count and peripheral
blood smear, Prothrombin time (PT), Activated partial thromboplastin time (aPTT).
Las pruebas de tamizajes para EvW son: Biometría hemática completa (BHC) con cuenta de
plaquetas y frotis de sangre periférica, tiempo de Protrombina (TP), tiempo de Tromboplastina
Parcial activado (TTPa).
Case 3
Q3. Which is the most frequent location of this disease?
A) Mucocutaneous bleeding
B) Joint Hemarthrosis
C) Muscular hematoma
D) Hematuria
Case 3-Q3. Review
Von Willebrand disease (VWD) is a hereditary condition characterized by mucocutaneous
hemorrhages of variable intensity. Primarily affects primary hemostasis in its interaction with
von Willebrand Factor (VWF), platelets, and vascular endothelium.
La Enfermedad de von Willebrand (EvW) es un padecimiento hereditario que se caracteriza por
hemorragias mucocutáneas de intensidad variable. Afecta primordialmente la hemostasia
primaria en su interacción con el Factor de von Willebrand (FvW), plaquetas, y endotelio
vascular.
Case 3
Q4. Which of the following statements is false about the VWF?
A) VWF increases three to five times during pregnancy

B) Caucasians have on average higher levels than African-Americans
C) Blood group O has lower levels
D) It increases up to three times in infections
Statements: declaraciones
Case 3-Q4. Review
The situations that affect VWF levels are: ABO blood group, Lewis, race, age, epinephrine,
inflammatory mediators and endocrine hormones (particularly those associated with the
menstrual cycle and pregnancy). The VWF increases in pregnancy (three to five times). The black
race has on average higher levels than white or Caucasian.
The plasma VWF varies according to the ABO blood group, with lower levels of the O group.
Pregnancy: Embarazo
Las situaciones que afectan los niveles del FvW son: grupo sanguíneo ABO, Lewis, raza, edad,
epinefrina, mediadores inflamatorios y hormonas endócrinas (particularmente las asociadas con
el ciclo menstrual y el embarazo). El FvW se incrementa en el embrazo (tres a cinco veces). La
raza negra tiene en promedio niveles más altos que la blanca o caucásica.
El FVW en plasma varía de acuerdo al grupo sanguíneo ABO, teniendo niveles más bajos los del
grupo O.
Case 3
Q5. Which is the differential diagnosis recommended to consider when approaching this
disease?
A) Hemophilia A
B) Hemophilia B
C) Bernard-Soulier syndrome
D) Glanzmann thrombasthenia
Case 3-Q5. Review
There are two hereditary diseases, phenotypically, difficult to distinguish from the EvW: mild
hemophilia A and platelet EvW also called Pseudo von Willebrand. t is recommended to consider
mild Hemophilia A as a differential diagnosis of VWD. In this case, the type of inheritance, linked
to the X chromosome, may point towards hemophilia A.
Existen dos padecimientos hereditarios, fenotipicamente, difíles de distinguir de la EvW:
Hemofilia A leve y EvW plaquetaria llamado también Pseudo von Willebrand. Se recomienda
considerar como diagnóstico diferencial de EvW a la hemofilia A leve. En este caso el tipo de
herencia, ligada al cromosoma X, puede orientar hacia hemofilia A.
Case 3
Q6. Which is the dose of vWF for a minor surgery?
A) FvW 20 IU / kg only dose

B) FvW 40 IU / kg daily or every third day
C) FvW 60 IU / kg to start surgery
D) FvW 80 IU / kg single dose
Case 3-Q5. Review
The dose dose of vWF for a minor surgery 30-60 IU / kg of VWF daily or every third day, to reach
FVIII levels: C> 30 U / dl until full healing is achieved (2-4 days) .
To reach: Alcanzar
Achieve: Lograr
La dosis de FvW es de 30-60 UI/kg de FvW diario o cada tercer día, para alcanzar niveles FVIII:C >
30 U/dl hasta alcanzar cicatrización completa (2-4 días) .
Case 4
A 5-year-old Down's Syndrome boy arrives to your office accompanied by his mother due to 3
month history paleness, fever and fatigue episodes. On interrogation the mother refers that the
patient has presented petechiae and small lesions in the oral mucosa and on two occasions he has
presented scattered ecchymosis without previous trauma. On physical examination, spleen
enlargement and rest unremarkable. Laboratory findings: Hb 7.5 g/dL, WBC 25,000 cells/mm3 ,
platelets 24 × 109/L. WBC differential is notable for 89 percent blasts.
Case 4
A 5-year-old Down's Syndrome boy arrives to your office accompanied by his mother due to 3
month history paleness, fever and fatigue episodes. On interrogation the mother refers that the
patient has presented petechiae and small lesions in the oral mucosa and on two occasions he has
presented scattered ecchymosis without previous trauma. On physical examination, spleen
enlargement and rest unremarkable. Laboratory findings: Hb 7.5 g/dL, WBC 25,000 cells/mm3 ,
platelets 24 × 109/L. WBC differential is notable for 89 percent blasts.
Case 4
scattered: Disperso o diseminado
Case 4
Q1. Which of the following mutations is related to a favorable prognosis?
A) EVI-1
B) AML with t(6:9) (p23; q34)
C) FLT3 mutations
D) AML with t(9:11) (p22; q23)
Case 4-Q1. Review
Favorable prognosis:
AML with the t (15:17) (q22; q12-21)

AML with the inversion (16) (p13q22) or t (16:16) (p13; q22)
AML with t (8:21) (q22; q23)
AML with t (9:11) (q22; q23)
AML in patients with Down syndrome
Literature: Guía de Práctica Clínica: Diagnóstico Oportuno de la Leucemia Aguda en Pediatría en el Primer y
Segundo Nivel de Atención.
Pronóstico favorable:
LAM con la t(15:17) (q22; q12-21)

LAM con la inversión (16) (p13q22) o t(16:16) (p13; q22)
LAM con t(8:21)(q22; q23)
LAM con t(9:11)(q22; q23)
LAM en pacientes con Síndrome de Down
Bibliografía: Guía de Práctica Clínica: Diagnóstico Oportuno de la Leucemia Aguda en Pediatría en el Primer y
Case 4
Q2. Which of the following mutations is related to a unfavorable prognosis?
A) EVI-1
B) AML with t(6:9) (p23; q34)
C) FLT3 mutations
D) AML with t(9:11) (p22; q23)
Case 4-Q2. Review
Unfavorable prognosis:
AML with monosomy 7 or -7q

AML with complex karyotype
AML that evolves from a myelodysplastic syndrome
AML that persists after two cycles of intensive chemotherapy
AML secondary to previous treatment
Pronóstico desfavorable:
LAM con monosomía 7 o -7q

LAM con cariotipo complejo
LAM que evoluciona de un síndrome mielodisplásico
LAM que persiste después de dos ciclos de quimioterapia intensiva
LAM secundaria a tratamiento previo
Case 4
Q3. Which is the most common manifestation of infiltration in Acute Lymphoblastic Leukemia?
A) Splenomegaly
B) Hepatomegaly
C) Lymphadenopathy
D) Mediastinal Mass
Case 4-Q3. Review
Within the more frequent manifestations of infiltration in the Acute Lymphoblastic Leukemia:
Splenomegaly 68%
Hepatomegaly 63%
Lymphadenopathy 50%
Mediastinal Mass in Acute Lymphoblastic Leukemia lineage T 25%
Bone pain 23%
Infiltration to testicles 3%
Dentro de las manifestación de infiltración más frecuente en la Leucemia linfoblástica aguda
Esplenomegalia 68%
Hepatomegalia 63%
Linfadenopatía 50%
Masa Mediastinal en Leucemia linfoblástica aguda estirpe T 25%
Dolor óseo 23%
Infiltración a testículos 3%
Case 4
Q4. Which is the most common manifestation of infiltration in Acute myeloid leukemia?
A) Splenomegaly
B) Hepatomegaly
C) Granulocytic sarcoma
D) Disseminated intravascular coagulation
Case 4-Q4. Review
In acute myeloid leukemia, the most frequent manifestation of infiltration is granulocytic
sarcoma or chloroma from 2 to 14%. It may involve bone, periosteum, soft tissues, lymph nodes
or skin; Some of its frequent locations are orbits and paranasal sinuses.
En la leucemia mieloide aguda, la manifestación de infiltración más frecuente es el sarcoma
granulocítico o cloroma del 2 al 14%. Puede involucrar hueso, periostio, tejidos blandos, ganglios
linfáticos o piel; algunas de sus localizaciones frecuentes son órbitas y senos paranasales.
Case 4
Q5. In which patients is intracranial hemorrhage most common?
A) M1
B) M2
C) M3
D) M4
Case 4-Q5. Review
La hemorragia grave vinculada con coagulación intravascular diseminada puede surgir en
cualquier tipo de LAM, pero es particularmente común en LAM M3 y M5. La hemorragia
intracraneal es la complicación hemorrágica más frecuente en los pacientes LAM M3.
Severe hemorrhage associated with disseminated intravascular coagulation can occur in any
type of AML, but is particularly common in AML M3 and M5. Intracranial hemorrhage is the
most common hemorrhagic complication in AML M3 patients.
Case 5
A 63-year-old man arrives to your office due to weakness, weight loss of 6 kg in the last 3 months
without diet, pathological fractures, headache and blurred vision. On interrogation he refers
multiple infections recently. Laboratory findings: normocytic normochromic anemia, calcium 13
mg/dL and creatinine 2.1 mg/dL. Serum monoclonal protein is requested: 33 g/L.
Case 5
A 63-year-old man arrives to your office due to weakness, weight loss of 6 kg in the last 3 months
without diet, pathological fractures, headache and blurred vision. On interrogation he refers
multiple infections recently. Laboratory findings: normocytic normochromic anemia, calcium 13
mg/dL and creatinine 2.1 mg/dL. Serum monoclonal protein is requested: 33 g/L.
Case 5
Blurred vision: Visión borrosa
Case 5
Q1. Which are the prognostic determinations that are required for the prognosis of multiple
myeloma?
A) Calcium and albumin

B) Calcium and β2-microglobulin
C) Albumin and β2-microglobulin
D) Monoclonal protein
Case 5-Q1. Review
The determination of Beta2-microglobulin and albumin are required to establish the
international prognostic index in patients with multiple myeloma. According to the Multiple
Myeloma staging system, a Beta2-microglobulin value <3.5 mg / dL and albumin> 3.5
corresponds to Stage EI, a level of beta-2-microglobulin> 5.5 mg / dL corresponds to an EC III and
the ECII when the values do not correspond to EC I or II.
Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

La determinación de Beta2-microglobulina y albúmina se requieren para establecer el índice pronóstico
internacional en los pacientes con Mieloma Múltiple. De acuerdo con el sistema de estadificación del
Mieloma Múltiple, un valor de Beta2-microglobulina < 3.5 mg/dL y albúmina >3.5 corresponde a Estadio EI,
un nivel de beta-2-microglobulina > 5.5 mg/dL corresponde a un EC III y el ECII cuando los valores no
corresponden ni a EC I ni II.
Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Case 5
Q2. Which of the following associations does not suggest multiple myeloma?
A) Papillary Edema
B) Uremic syndrome
C) Hypercalcemia
D) Fatigue
Suggest: Sugiere
Case 5-Q2. Review
Papillary edema, uremic syndrome and hypercalcemia are associated with multiple myeloma,
fatigue is not related.

El edema de papila, síndrome uremico e hipercalcemia se asocian con mieloma múltiple, la
fatiga no está relacionada.

Case 5
Q3. Which is the treatment in a patient who will not be transplanted?
A) Melphalan + prednisone + lenalidomide

B) Lenalidomide + Dexamethasone
C) Melphalan + Prednisone + Thalidomide
D) Bortezomib + Dexamethasone
Case 5-Q3. Review
The treatment for a patient that will not be transplanted is based on Melfalan, Prednisone and
Thalidomide

El tratamiento para un paciente que no será transplantado es a base de Melfalan, Prednisona y
Talidomida.

Case 5
Q4. Which of the following is not considered a risk factor for multiple myeloma?
A) Low BMI
B) Family background
C) Age> 60 years
D) African Americans
Body mass index (BMI): índice de masa corporal

Case 5-Q4. Review
Risk factors for multiple myeloma are considered to be antecedents of first degree relatives with
Multiple Myeloma, obesity (BMI> 30 Kg/m2), age older than 60 years, therefore individuals who
have these factors and who have symptoms suggestive of the disease should be referred to the
specialist (hematology or oncology). The highest incidence occurs in the African Americans .

Se consideran factores de riesgo para mieloma múltiple los antecedentes de familiares en
primer grado de Mieloma Múltiple, la obesidad (IMC >30 Kg/m2), edad mayor de 60 años, por lo
tanto los individuos que tengan estos factores y que tengan síntomas sugestivos de la
enfermedad deberán ser derivados al especialista (hematología u oncología). La mayor
incidencia se da en la raza negra.

Case 5
Q5. Which of the following is a favorable risk cytogenetic alteration?
A) Deletion 13 or aneuploidy
B) t (14; 20) by FISH
C) t (11; 14) by FISH
D) Hypodiploidy
Case 5-Q5. Review
The favorable risk cytogenetic alterations are:
Absence of unfavorable risk alterations

Hyperdiploidy
t (11; 14) by FISH
t (6; 14) by FISH

Las alteraciones citogenéticas de riesgo favorable son:
Ausencia de alteraciones de riesgo desfavorable

Hiperdiploidía
t(11;14) por FISH
t(6;14) por FISH

Case 6
A 12-year-old girl arrives to your office due to chronic history of microcytic anemia. On the
interrogation, she refers lightheadedness, weakness and leg cramps. On physical examination
pallor of mucous membranes and hepatomegaly. A blood count was requested finding Hb 6.2
mg/dL, Hct 22%, Plq 280,000 cells/mm3.
Case 6
A 12-year-old girl arrives to your office due to chronic history of microcytic anemia. On the
interrogation, she refers lightheadedness, weakness and leg cramps. On physical examination
pallor of mucous membranes and hepatomegaly. A blood count was requested finding Hb 6.2
mg/dL, Hct 22%, Plq 280,000 cells/mm3.
Case 6
lightheadedness: Mareo
weakness : Debilidad
leg cramps : Calambres en piernas
Case 6
Q1. Who forms hemoglobin H?
A) 2 α chains and two β chains

B) 2 α chains and two γ chains
C) 2 α chains and two δ chains
D) 4 β chains
Case 6-Q1. Review
Hemoglobin H is formed by 4 β chains.
Literature: Manual CTO de Medicina y Cirugía, ENARM-México, 4ta ed. Tomo Hematología.
La hemoglobina H está formada por 4 cadenas β.
Bibliografía: Manual CTO de Medicina y Cirugía, ENARM-México, 4ta ed. Tomo Hematología.
Case 6
Q2. Which is the chain of hemoglobin that is synthesized on chromosome 16 and is very
important for adult hemoglobin?
A) Alpha
B) Beta
C) Delta
D) Gamma
Case 6-Q2. Review
The two copies of the α-globin gene are found on each chromosome 16.
Las dos copias del gen α-globina se encuentran en cada cromosoma 16.
Case 6
Q3. Who forms hemoglobin F?
A) 2 α chains and two β chains

B) 2 α chains and two γ chains
C) 2 α chains and two δ chains
D) 4 β chains
Case 6-Q3. Review
Hemoglobin F is composed of 2 α chains and two γ chains.
La hemoglobina F está conformada por 2 cadenas α y dos cadenas γ.
Case 7
A 32-year-old woman arrives to your office due to easy bruising and gingival bleeding. On
interrogation she reports her symptoms began one day prior to presentation and has never
occurred before, she denies the use of medications, but she refers to have noticed extremity
petechiae. On physical exam, there is mild bleeding of the gums. Laboratory findings: Hb: 14 g/dL,
leukocytes: 8,100 cells/mm3 , platelets: 3,000 cells/L. Peripheral blood smear demonstrates
enlarged platelet. Blood chemistry and liver function tests are normal.
Case 7
A 32-year-old woman arrives to your office due to easy bruising and gingival bleeding. On
interrogation she reports her symptoms began one day prior to presentation and has never
occurred before, she denies the use of medications, but she refers to have noticed extremity
petechiae. On physical exam, there is mild bleeding of the gums. Laboratory findings: Hb: 14 g/dL,
leukocytes: 8,100 cells/mm3 , platelets: 3,000 cells/L. Peripheral blood smear demonstrates
enlarged platelet. Blood chemistry and liver function tests are normal.
Case 7
before: antes
denies: niega
gums: encías
Case 7
Q1. Which is the most likely diagnosis?
A) Acute Leukemia
B) Primary immune thrombocytopenia
C) Thrombotic microangiopathy
D) Drug-induced thrombocytopenia
Case 7-Q1. Review
The symptoms of Primary Immune Thrombocytopenia are mainly hemorrhagic, when they
occur, they are petechiae, purpura, mucosal hemorrhages (wet purple): urinary tract,
gastrointestinal tract, oral cavity, epistaxis; which reduces the quality of life.
Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Los síntomas de la Trombocitopenia Inmune Primaria son principalmente hemorrágicos, cuando
se presentan, son petequias, púrpura, hemorragias de mucosas (púrpura húmeda): tracto
urinario, gastrointestinal, cavidad oral, epistaxis; lo que reduce la calidad de vida.
Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Case 7
Q2. According to the Buchanan and Adix Scale, how is this patient classified when presenting
hematuria?
A) Stage 2
B) Stage 3 under risk
C) Stage 3 high risk
D) Stage 4
Case 7-Q2. Review
Stage 3 High risk: Epistaxis ≥ 5 minutes, hematuria, hematochezia, painful oral purpura
significant menorrhagia.
Stage 1: few petechiae (≤100 total) and / or ≤ small bruises (≤3 cm in diameter), without
mucosal hemorrhage.
Stage 2: Many petechiae (> 100 total) and / or> 5 large bruises (≥3cm in diameter).
Stage 3 low risk: Hematological crusts in nasal passages, non-painful oral purpura, oral / palatal
petechiae, buccal purple in molars only, mild epistaxis, duration ≤ 5 minutes.
Stage 4: Mucosal hemorrhage or suspicion of internal bleeding (cerebral, pulmonary, muscular,
joint), which requires immediate medical attention or intervention.
crusts: costras

Grado 3 alto riesgo: Epistaxis ≥ 5 minutos, hematuria, hematoquecia, púrpura oral dolorosa,
menorragia significativa.
Grado 1: pocas petequias (≤100 totales) y/o ≤ pequeños hematomas (≤3 cm de diámetro), sin
hemorragia de mucosas.
Grado 2: Muchas petequias (>100 total) y/o >5 hematomas grandes (≥3cm de diámetro).
Grado 3 low risk: Costras hemáticas en fosas nasales, púrpura oral no dolorosa, petequias oral/
palatinas, purpura bucal en molares solamente, epistaxis leve, duración ≤ 5 minutos.
Grado 4: Hemorragia mucosa o sospecha de hemorragia interna (cerebral, pulmonar, muscular,
articular), que requiere atención o intervención médica inmediata.

Case 7
Q3. From when it is considered persistent primary immune thrombocytopenia.
A) 1 month
B) 2 months
C) 3 months
D) 12 months
Case 7-Q3. Review
Phases of the disease:
PIT of recent diagnosis the platelet count is <100x109 / L, with duration <3 months.
Persistent PIT when platelet count is maintained <100x109 / L for 3 to 12 months from
diagnosis, including those who do not achieve spontaneous remission or who do not have
sustained complete remission without medication.
Chronic PIT platelet count <100x109 / L beyond 12 months, from the diagnosis.

Fases de la enfermedad:
TIP de reciente diagnóstico la cuenta de plaquetas es <100x109/L, con duración <3 meses.
TIP persistente cuando cuenta de plaquetas se mantiene <100x109/L por 3 a 12 meses a partir
del diagnóstico, incluyendo a los que no alcanzan remisión espontánea o que no tienen remisión
completa sostenida sin medicamentos.
TIP crónica cuenta de plaquetas <100x109/L más allá de los 12 meses, a partir del diagnóstico.

Case 7
Q4. Which is the indication for treatment in primary immune thrombocytopenia?
A) Only in case of bleeding regardless of platelet count

B) If platelets <10 000
C) If platelets less than 30 000 (or <50 000 if active bleeding)
D) If platelets less than 50 000 (or <100 000 if active bleeding)
regardless: independientemente
Case 7-Q4. Review
The recommendation, for the adult, with newly diagnosed TIP is to give treatment when the
platelet count is ≤ 30,000 cells/L, even if they do not present mucosal hemorrhage. Do not
treat these patients if the platelet count is> 50,000 cells/L.

La recomendación, para el adulto, con TIP de nuevo diagnóstico es dar tratamiento cuando la
cuenta de plaquetas sea ≤ 30x109/L, aún si no presentan hemorragia en mucosas. No tratar a
estos pacientes si la cuenta de plaquetas es >50x109/L.

Case 7
Q5. Which is the most appropriate initial treatment for this patient?
A) Immunoglobulin followed by prednisone

B) Plasmapheresis
C) Rituximab
D) Splenectomy
Case 7-Q5. Review
The treatment options recommended as first-line treatment include corticosteroids, intravenous
immunoglobulin (IgG IV) and anti-D immunoglobulin.
Prednisone at 1mg/kg/ day or dexamethasone 40mg/day for 4 days is usually the initial dose in
patients in whom corticosteroid treatment is not contraindicated, with long courses over short
courses being preferred.

Las opciones de tratamiento recomendadas como tratamiento de primera línea incluyen
corticoesteroides, inmunoglobulina intravenosa (IgG IV) e inmunoglobulina anti D.
Prednisona a 1 mg/kg/día o dexametasona 40 mg/día por 4 días, son usualmente la dosis inicial
en pacientes en quienes no está contraindicado el tratamiento con corticoesteroides,
prefiriéndose cursos largos sobre los cursos cortos.

Case 7
Q6.Which is a side effect of rituximab?
A) Hepatotoxicity
B) Anorexia
C) HBV reactivation
D) Nephrotoxicity
Case 7-Q6. Review
The main side effects of rituximab are: reaction to the application, serum sickness, HBV
reactivation, progressive multifocal leukoencephalopathy.
sicknesss: enfermedad

Los principales efectos adversos del rituximab son: reacción a la aplicación, enfermedad del
suero, reactivación VHB, leucoencefalopatía multifocal progresiva.

Case 7
Q7. Which is not a side effect of cyclophosphamide?
A) Hepatotoxicity
B) Neutropenia
C) Infertility
D) Secondary tumors
Case 7-Q7. Review
The main side effects of cyclophosphamide are: neutropenia, nausea, vomiting, infertility and
secondary tumors.

Los principales efectos adversos de la ciclofosfamida son: neutropenia, náuseas, vómito,
infertilidad y tumores secundarios.

Case 7
Q8. Which is an adverse effect of aziatropine?
A) Hepatotoxicity
B) Nephrotoxicity
C) Headache
D) Virilization
Case 7-Q8. Review
The main adverse effects of azathioprine are: hepatotoxicity, neutropenia, infection and
pancreatitis.

Los principales efectos adversos de la aziatropina son: hepatotoxicidad, neutropenia, infección y
pancreatitis.

Case 7
Q9. Which of the following is not an adverse effect of mycophenolate mofetil?
A) Nausea
B) Vomiting
C) Headache
D) Diarrhea
Case 7-Q9. Review
The main adverse effects of mycophenolate mofetil are:
headache, diarrhea, nausea, anorexia and infections.

Los principales efectos adversos del micofenolato mofetilo son: cefalea, diarrea, nausea,
anorexia e infecciones.

Case 7
Q10. Which of the following is not an adverse effect of ciclosporin?
A) Hypertension
B) Gingival hyperplasia
C) Hepatotoxicity
D) Paresthesias
Case 7-Q10. Review
The main adverse effects of cyclosporine are: nephrotoxicity, hypertension, tremor, paresthesias
and gingival hyperplasia.
tremor: temblor

Los principales efectos adversos de la ciclosporina son: nefrotoxicidad, hipertensión, temblor,
parestesias e hiperplasia gingival.

Case 8
A 32-year-old man arrives to the emergency room of your hospital due to headache, blurred
vision, weakness in the left side and fever. On the interrogation, he denies intaking medication.
On physical examination he is pale and slightly jaundiced. There is no peripheral adenopathy, the
spleen is not palpable, and the liver is not enlarged.
Laboratory findings: Hb 6.4 g/dL, Corrected reticulocytes: 9%, leukocyte count: 10,000, platelets:
8,200, haptoglobins: undetectable, LDH 955 U/l, unconjugated bilirubin: 4mg/dl, creatinine:
1mg/dl. Direct Coombs test: negative. PT and aPTT normal. Peripheral blood smear: 3 schistocytes
per field.
Case 8
A 32-year-old man arrives to the emergency room of your hospital due to headache, blurred
vision, weakness in the left side and fever. On the interrogation, he denies intaking medication.
On physical examination he is pale and slightly jaundiced. There is no peripheral adenopathy, the
spleen is not palpable, and the liver is not enlarged.
Laboratory findings: Hb 6.4 g/dL, Corrected reticulocytes: 9%, leukocyte count: 10,000, platelets:
8,200, haptoglobins: undetectable, LDH 955 U/l, unconjugated bilirubin: 4mg/dl, creatinine:
1mg/dl. Direct Coombs test: negative. PT and aPTT normal. Peripheral blood smear: 3 schistocytes
per field.
Case 8
intaking : Ingesta
slightly : Ligeramente
jaundiced : Ictérico
Case 8
Q1. Which is the most likely diagnosis?
A) Thrombotic thrombocytopenic purpura

B)Primary immune thrombocytopenia
C) Paroxysmal Nocturnal Hemoglobinuria.
D) Disseminated intravascular coagulopathy
Case 8-Q1. Review
Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic
microangiopathy characterized by microangiopathic hemolytic anemia, severe
thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-
thrombi.
La púrpura trombocitopénica trombótica (TTP) es una microangiopatía trombótica rara y
potencialmente mortal caracterizada por anemia hemolítica microangiopática, trombocitopenia
grave e isquemia de órganos asociada a trombos ricos en trombos de plaquetas microvasculares
diseminados.
Case 8
Q2. Which is the pathophysiology of this disease?
A) Enzymopathy
B) Membrane disorde
C) Antibodies against ADAMTS 13
D) Antibodies against PF4
Case 8-Q2. Review
Thrombotic thrombocytopenic purpura Is specifically related to a severe deficiency in
ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member
13), the specific von Willebrand factor-cleaving protease. ADAMTS13 deficiency is most
frequently acquired via ADAMTS13 autoantibodies, but rarely, it is inherited via mutations of the
ADAMTS13 gene.
La púrpura trombocitopénica trombótica está relacionada específicamente con una deficiencia
grave de ADAMTS13 (una desintegrina y metaloproteasa con trombospondina tipo 1, miembro
13), la proteasa específica del factor de von Willebrand. La deficiencia de ADAMTS13 se
adquiere con mayor frecuencia a través de autoanticuerpos ADAMTS13, pero rara vez se hereda
a través de mutaciones del gen ADAMTS13.
Case 8
Q3. Which is the most appropriate initial treatment for this patient?
A) Corticosteroids
B) Plasmapheresis
C) Rituximab
D) Splenectomy
Case 8-Q3. Review
The treatment of choice in thrombotic thrombocytopenic purpura is plasmapheresis with
plasma exchange.
El tratamiento de elección en la púrpura trombocitopénica trombótica es la plasmaféresis con

recambio plasmático
Case 8
Q4. Which is the most common cause?
A) Autoimmune diseases
B) Idiopathic
C) Associated with drugs
D) Associated with infections
Case 8-Q4. Review
The etiology is unknown (idiopathic), although there are cases with a history of upper
respiratory infection, relationship with anovulatory drugs, antibiotics, pregnancy (HELLP
syndrome, consisting of hemolysis, alteration of liver enzymes, thrombocytopenia and
preeclampsia), systemic lupus erythematosus, cyclosporin and mitomycin.
La etiología es desconocida (idiopática) , aunque existen casos con antecedentes de infección
respiratoria alta, relación con fármacos anovulatorios, antibióticos, embarazo (síndrome HELLP,
consistente en hemolisis, alteración de enzimas hepáticos, trombopenia y preeclampsia), lupus
eritematoso sistémico, ciclosporina y mitomicina.
Case 8
Q5. Which of the following statements of this disease is true?
A) The detection of specific antibodies and schistocytes is pathognomonic

B) Presence of microangiopathic hemolytic anemia with thrombocytopenia is enough to initiate
treatment
C) The classical pentad of anemia, thrombocytopenia, fever, neurological and renal failure; occurs
in almost all the patients
D) Blood transfusion is contraindicated
Case 8-Q5. Review
Presence of microangiopathic hemolytic anemia with thrombocytopenia is enough to initiate
treatment in this disease, even if the patient does not meet the other criteria.
La presencia de anemia hemolítica microangiopática con trombocitopenia es suficiente para
iniciar el tratamiento de esta enfermedad, incluso si el paciente no cumple con los otros
criterios.
Extra Questions
L
PUEP - ENARM
Extra Question
Q1. Point out the correct answer with respect to the following: The moral obligation to act for the
benefit of others.
A) Autonomy
B) Beneficence
C) Non-maleficence
D) Justice
Extra Question
Q2. Point out the correct answer with respect to the following: Do not produce damage and
prevent it.
A) Autonomy
B) Beneficence
C) Non-maleficence
D) Justice
Extra Question
Q3. Point out the correct answer with respect to the following: Ability to act under the direction of
decisions that can be made.
A) Autonomy
B) Beneficence
C) Non-maleficence
D) Justice
Extra Question
Q4. Point out the correct answer with respect to the following: Equity in the distribution of
charges and benefits.
A) Autonomy
B) Beneficence
C) Non-maleficence
D) Justice
Extra Question
Q5. Which is the FIRST site of fracture frequency in older adults?
A)Hip
B) Head
C) Ankle
D) Hand
Extra Question
Q6. Which is the second site of fracture frequency in older adults?
A)Hip
B) Head
C) Ankle
D) Hand
Extra Question
Q7. Which is the scale that assesses gait and balance (risk of falls)?
A) Lawton Brody
B) Tinneti
C) Braden
D) Ensrud
Extra Question
Q8. Which is the scale that values the collapse of the caregiver?
A) Braden
B) Zarit
C) Katz
D) Lawton Brody
Extra Question
Q9. Which is the scale that assesses the functionality and independence of the geriatric patient?
A) Braden
B) Zarit
C) Katz
D) Lawton Brody
Extra Question
Q10. Which is the adverse effect of digoxin in geriatric patients?
A) Arthralgia
B) Delirium
C) Depression
D) Orthostatic hypotension
Vocabulary Review
L
PUEP - ENARM
knee: rodilla
bruising: hematoma
numbness: entumecimiento o insensibilidad
Prothrombin time (PT): Tiempo de Protrombina
Activated partial thromboplastin time (aPTT): Tiempo de Tromboplastina Parcial activado
Undergoes: Someterse a
Bloody findings: Hallazgos sanguinolentos
therefore: por lo tanto
carriers: portadoras
joints: articulaciones
shoulder: hombros
elbows: codos
hip: cadera
more: más
ankles: tobillos
less: menos
screening: escrutinio
mild: leve
between: entre
properly: adecuadamente
forearm: antebrazo
trigger: desencadenar
palsy: parálisis
bleeding: sangrado
either: o bien
increase: aumenta
weight loss: Pérdida de peso
underarm: Axila
spleen: Bazo
widening: ensanchamiento
developed countries : Países desarrollados
gender: género
average: promedio
bone marrow: médula ósea
bulky disease: Enfermedad voluminosa
almost: casi
currently: actualmente
A broad: un amplio
Early: temprano
Gauze package: paquete de gasas
Menses: menstruación
Nosebleeds: epistaxis
Inheritance: Herencia
Encode: codificado
Smear: frotis
Statements: declaraciones
Pregnancy: Embarazo
To reach: Alcanzar
Achieve: Lograr
scattered: Disperso o diseminado
Blurred vision: Visión borrosa
Suggest: Sugiere
Body mass index (BMI): índice de masa corporal
lightheadedness: Mareo
weakness : Debilidad
leg cramps : Calambres en piernas
before: antes
denies: niega
gums: encías
crusts: costras
regardless: independientemente
sicknesss: enfermedad
tremor: temblor
intaking : Ingesta
slightly : Ligeramente
jaundiced : Ictérico

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English Clinical Cases

La manifestación clínica patognomónica en hemofilia son las hemorragias a nivel articular

A) Increase factor VIII levels

bulky disease: Enfermedad voluminosa

A) Age <45 years

1. Edad: > 45 años,

A) Blood count and platelet count

A) VWF increases three to five times during pregnancy

A) FvW 20 IU / kg only dose

AML with the t (15:17) (q22; q12-21)

LAM con la t(15:17) (q22; q12-21)

AML with monosomy 7 or -7q

LAM con monosomía 7 o -7q

A) Calcium and albumin

Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

A) Melphalan + prednisone + lenalidomide

Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Body mass index (BMI): índice de masa corporal

Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Absence of unfavorable risk alterations

Literature: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

Ausencia de alteraciones de riesgo desfavorable

Bibliografía: Guía de Práctica Clínica: Diagnóstico y Tratamiento de Mieloma Múltiple.

A) 2 α chains and two β chains

A) 2 α chains and two β chains

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

A) Only in case of bleeding regardless of platelet count

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

A) Immunoglobulin followed by prednisone

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Literature: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

Bibliografía: Guía de Práctica Clínica: Diagnóstico Y Tratamiento de Trombocitopenia Inmune Primaria.

A) Thrombotic thrombocytopenic purpura

El tratamiento de elección en la púrpura trombocitopénica trombótica es la plasmaféresis con

A) The detection of specific antibodies and schistocytes is pathognomonic

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