DR. J

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Dr. Juan Carlo

s Díaz T

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CURSO DE INGLÉS

ENGLISH COURSE

Dr. Juan Carlos Díaz TorrePediatra Neonatólogodr_diaz_torre@hotmail.com

(779) 100 - 40 - 26

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DR. J

CDT

Dr. Juan Carlo

s Díaz T

orre

BRIEF CLINICAL CASES CASOS CLÍNICOS BREVES

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Dr. Juan Carlos Díaz Torre

Pediatra Neonatólogodr_diaz_torre@hotmail.com(779) 100 - 40 - 26

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DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 10

A 28-year-old primigravida is at 20 weeks gestation by dates but her fundal height is consistent with a 26-week gestation. She has had episodes of vomiting during the pregnancy that were more severe than the physiologic vomiting typically seen in pregnancy.

DR. J

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Dr. Juan Carlo

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CASE # 10

A sonogram performed at about 5 weeks gestation for vaginal bleeding was normal and showed a single fetus.

Which one of the following would be most appropriate at this point?

DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 10

a) Expectant management

b) A repeat sonogram c) MRI of the pelvis d) A serum HCG level

DR. J

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Dr. Juan Carlo

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CASE # 11

A 24-year-old male, new to your practice, presents for a mental health evaluation. The patient has a past history of schizophrenia, diagnosed several years ago.Which one of the following, if present, would lead to a reconsideration of this diagnosis?

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Dr. Juan Carlo

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CASE # 11

a) Loose associations

b) Elated mood

c) Social dysfunction

d) Auditory hallucinations

e) Incoherent speech

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Dr. Juan Carlo

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CASE # 12

A previously healthy 22-year-old female presents for her regular prenatal checkup at 38 weeks gestation. She has a blood pressure of 145/95 mm Hg today and this is unchanged 1 hour later. Her blood pressure was normal before pregnancy. She is otherwise feeling well.

DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 12

She has moderate edema at the ankles and 3+ reflexes at the knees and ankles.

A urinalysis for protein is normal.

Given this presentation, which one of the following is the most likely diagnosis?

DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 12

a) Unmasked chronic hypertension

b) Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome

c) Preeclampsia

d) Essential hypertension

e) Gestational hypertension

DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 13

A 72-year-old female with longstanding diabetes mellitus presents to your office. During the review of systems, she complains of difficulty voiding and frequent “dribbling.” A urinalysis is negative for infection and her post-void residual volume is 250 mL.

DR. J

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Dr. Juan Carlo

s Díaz T

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CASE # 13

Which one of the following is the most likely cause of this patient’s urinary incontinence?

a) Excess urine output due to hyperglycemia

b) A grade II cystocele

DR. J

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Dr. Juan Carlo

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CASE # 13

a) Atrophic vaginitis

b) Asymptomatic bacteriuria

c) Autonomic neuropathy

DR. J

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Dr. Juan Carlo

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CASE # 14

A 3-year-old male is brought to your office the day after he was stung by a honeybee. He has developed a significant local reaction, with redness and swelling around the site of the sting on his forearm, and also has had some swelling of his lips for “a couple of hours.”

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Dr. Juan Carlo

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CASE # 14

His mother removed the stinger and gave him some oral diphenhydramine (Benadryl). The local reaction has now almost resolved and he has not had any hives or respiratory distress.

Which one of the following is true concerning this situation?

DR. J

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Dr. Juan Carlo

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CASE # 14

a) Systemic corticosteroids would be the initial treatment of choice if the child develops respiratory distress with his next sting

b) An antibiotic that covers Streptococcus pyogenes and Streptococcus aureus should be administered

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Dr. Juan Carlo

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CASE # 14

c) If venom immunotherapy is begun, it should be stopped after 2 years of treatment

d) The child is at high risk for a systemic reaction if he is stung again in the future

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Dr. Juan Carlo

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CASE # 14

e) Skin tests are not helpful in confirming the presence of insect sting allergy

DR. J

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Dr. Juan Carlo

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CASE # 15

Which one of the following is characteristic of the first stage of labor?

a) An episiotomy should be performed during this stage of labor

b) Uterine shape changes from discoid to globular, along with a rise in fundal height

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Dr. Juan Carlo

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CASE # 15

c) In the absence of anesthesia, this stage of labor typically lasts 20–50 minutes

d) Regular uterine contractions are confirmed

e) In the absence of anesthesia, each contraction stimulates the urge to push

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Dr. Juan Carlo

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CASE # 16

A 65-year-old white female develops a burning pain in the left lateral thorax, followed 2 days later by an erythematous vesicular rash. Of the following, the best treatment is:

DR. J

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Dr. Juan Carlo

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CASE # 16

a) Topical capsaicin (Zostrix)

b) Oral corticosteroids

c) Topical corticosteroids

d) Topical acyclovir (Zovirax)

e) Oral valacyclovir (Valtrex)

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Dr. Juan Carlo

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CASE # 16

Which one of the following would be most appropriate to treat a dental infection requiring antibiotic therapy?

DR. J

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Dr. Juan Carlo

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CASE # 16

a) Cefixime (Suprax)

b) Penicillin

c) Dicloxacillin (Dynapen)

d) Erythromycin

e) Tetracycline

DR. J

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Dr. Juan Carlo

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CASE # 17

You are consulted for medical management of a 45-year-old male, previously unknown to you, who is hospitalized in the psychiatric unit with paranoid schizophrenia. His fasting blood glucose level is 180 mg/dL. Which one of the following medications is the most likely cause of the hyperglycemia?

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Dr. Juan Carlo

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CASE # 17

a) Alprazolam (Xanax)

b) Chlorpromazine (Thorazine)

c) Olanzapine (Zyprexa)

d) Haloperidol (Haldol)

e) Thiothixene (Navane)

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Dr. Juan Carlo

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CASE # 18

A 22-year-old male presents to the emergency department several hours after a rugby match in which he was struck in the face. His nose is bleeding. On examination the patient has a depression in his nose on the side of impact and an outward displacement on the opposite side.

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Dr. Juan Carlo

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CASE # 18

Internal inspection reveals a purple area of swelling and fluctuance on the left side of the nasal septum. The remainder of the examination demonstrates no findings to suggest other facial or periorbital trauma.

Which one of the following would be most appropriate at this time?

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Dr. Juan Carlo

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CASE # 18

a) Immediate CT imaging to assess for facial and mandibular fracture

b) Incision and drainage of the swollen, fluctuant area

c) Immediate plain radiographs of the nose and orbits

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Dr. Juan Carlo

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CASE # 18

d) Immediate closed reduction of the nasal fracture

e) Discharge with pain medication, ice packs, and head elevation, with

referral to a specialist in 1 week

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Dr. Juan Carlo

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CASE # 19

A 30-year-old gravida 3 para 2 at 28 weeks gestation is a restrained passenger in a high-speed motor vehicle accident. After initial stabilization in the field with supplemental oxygen and intravenous fluids, she is brought into the emergency department on a backboard and wearing a cervical collar. Until you are able to rule out a spinal injury, in what position should the patient be kept?

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Dr. Juan Carlo

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CASE # 19

a) Supine

b) Supine, with the uterus manually deflected laterally

c) Prone

d) Trendelenburg’s pattern

e) Left lateral decubitus

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Dr. Juan Carlo

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CASE # 20

Your hospital administrator asks you to develop a community screening program for melanoma.

Which one of the following is true concerning screening for this disease?

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Dr. Juan Carlo

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CASE # 20

a) Screening for melanoma is not indicated since screening takes too much time

b) No definite clinical evidence has shown that screening for melanoma reduces mortality

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Dr. Juan Carlo

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CASE # 20

c) Screening for melanoma is not indicated since the disease is rare d) Because of sunbathing, female patients are the most important population to screen

DR. J

CDT

Dr. Juan Carlo

s Díaz T

orreGracias por su atención

Dr. Juan Carlos Díaz Torre Pediatra Neonatólogo

dr_diaz_torre@hotmail.com(779) 100 – 40 - 26

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