Preguntas de Cirugía (Segundo Examen Parcial, Tercer Año, Noviembre 2019) PDF

# Universidad Central de Venezuela ## Segundo Examen Parcial, Tercer Año, Noviembre 2019 ### 1. En la colecistitis aguda el hallazgo al examen físico que confirma el diagnóstico es: - [ ] Ictericia - [ ] Vesícula palpable y dolorosa - [x] Dolor a la palpación en el hipocondrio derecho - [ ] Fiebr...

# Universidad Central de Venezuela ## Segundo Examen Parcial, Tercer Año, Noviembre 2019 ### 1. En la colecistitis aguda el hallazgo al examen físico que confirma el diagnóstico es: - [ ] Ictericia - [ ] Vesícula palpable y dolorosa - [x] Dolor a la palpación en el hipocondrio derecho - [ ] Fiebre - [ ] Taquicardia ### 2. Masculino de 19 años quien refiere inicio de su enfermedad actual hace 12 horas caracterizada por dolor periumbilical, anorexia y vómitos. El dolor se localiza luego en cuadrante inferior derecho del abdomen. Al examen físico se aprecia dolor en el punto de McBurney y defensa. ¿Cuál de los siguientes explica la localización del dolor?: - [ ] La inflamación del peritoneo visceral produce dolor localizado - [x] El dolor en el punto de McBurney es por distensión del apéndice - [ ] Las fibras amielínicas llevan la señal dolorosa a través de los nervios espinales lumbares - [ ] El dolor a la descompresión aparece por afectación del peritoneo parietal ### 3. ¿Cuál de los siguientes no es un signo grave en Abdomen Agudo? - [ ] Diaforesis - [ ] Palidez - [ ] Hipotensión - [x] Abdomen en tabla ### 4. Masculino de 55 años acude a la emergencia con cuadro clínico de 8 horas de evolución caracterizado por dolor abdominal difuso. Al examen físico se aprecia paciente deshidratado, con FC 115x'; PA: 95/60mmHg, Fr: 22x; SO2: 93% con cánula nasal a 4 lts/min. El abdomen se presenta en tabla. Los rayos X demuestran neumoperitoneo. Siempre se deben mejorar las condiciones del paciente antes de llevarlo a quirófano. ¿Qué debemos hacer? - [x] Colocar antibioticoterapia urgente para evitar infecciones. - [x] Colocar acceso venoso central vía femoral. - [x] Administrar cristaloides endovenosos por vía periférica. - [x] Asegurar vía aérea con tubo endotraqueal. - [ ] Ordenar TAC de tórax. ### 5. Con relación al paciente anterior y los hallazgos radiológicos. ¿Cuál afirmación es cierta? - [ ] No se necesitan más estudios radiológicos. - [ ] Se debe ordenar TAC con contraste baritado para confirmar el diagnóstico. - [x] Ecosonograma abdominal para confirmar el diagnóstico. - [ ] Iniciar esteroides urgentemente. ### 6. Femenino de 35 años quien refiere dolor abdominal en cuadrante superior derecho horas después de una cena copiosa. El dolor fue de inicio agudo. Ha tenido dolores similares en otras oportunidades. ¿Cuál es el origen más probable de dicha sintomatología? - [ ] Ulcera perforada. - [ ] Apendicitis aguda. - [ ] Obstrucción intestinal - [x] Cólico biliar. - [ ] Diverticulitis. ### 7. Paciente conocido con enfermedad diverticular. Refiere cinco días con dolor en cuadrante inferior izquierdo del abdomen. Ha tenido fiebre y diarreas desde hace 12 horas. Al examen físico se aprecia dolor en el cuadrante descrito sin defensa. El manejo inicial debe incluir: - [ ] Laparoscopia diagnóstica - [ ] Exploración por laparotomía - [ ] Enema baritado - [x] Colonoscopia - [ ] TAC abdomen y pelvis ### 8. Masculino de 70 años quien presenta dolor abdominal súbito de muy fuerte intensidad. Es levado a la emergencia y encontramos al paciente con FC: 114; FR 31; 18.300 blancos y pH 7.25. Abdomen con defensa. El diagnóstico más probable es: - [ ] Apendicitis aguda - [x] Pancreatitis aguda - [ ] Embolismo de la arteria mesentérica superior - [ ] Úlcus péptico perforado - [ ] Diverticulitis aguda ### 9. En referencia a la apendicitis aguda seleccione la afirmación correcta: - [x] Representa un cuadro de abdomen agudo oclusivo - [ ] Es la segunda causa de abdomen agudo - [ ] La fiebre puede estar presente en 70% de los pacientes - [ ] El dolor es mediado por fibras viscerales eferentes - [ ] La TAC tiene una sensibilidad y especificidad de 95% ### 10. Masculino de 68 años quien acude a la emergencia por presentar melena. Se encuentra obnublado. No tiene historia de abuso de alcohol pero si de consumo de AINES. El lugar probable del sangrado es: - [ ] Divertículo colónico - [x] Angiodisplasia del colon - [ ] Úlcera duodenal - [ ] Fístula aortoentérica - [ ] Várices esofágicas ### 11. En cuanto a la colecistitis aguda seleccione la afirmación correcta: - [ ] El ECO abdominal tiene una sensibilidad de 75% para su diagnóstico - [ ] No existe manera semiológica de diferenciarlo del cólico vesicular - [ ] Representa un cuadro de abdomen agudo infeccioso - [ ] Se asocia en un 70% con ictericia - [x] El hallazgo ecosonográfico más importante para su diagnóstico es la presencia de litiasis. ### 12. En cuanto a la hemorragia digestiva, cual de las siguientes es falso? - [ ] La mortalidad es mayor al 30% - [ ] Más del 20% requieren cirugía - [ ] Más de la mitad se resuelven espontáneamente - [ ] El ángulo de Treitz es un punto importante para su clasificación - [x] c y d son correctas ### 13. En cuanto a las causas de hemorragia digestiva superior, cual es la incorrecta: - [ ] Se pueden dividir en origen varicoso y no varicoso - [x] La úlcera péptica es la causa más frecuente - [ ] Las varices esofágicas representan el 10% - [ ] El 80% de los casos son de origen no variceal - [ ] Ninguna de las anteriores ### 14. ¿Cuál de las siguientes es causa más frecuente de sangrado masivo colónico? - [ ] Cáncer - [ ] Colitis ulcerativa - [ ] Diverticulosis - [x] Diverticulitis - [ ] Colitis granulomatosa ### 15. Seleccione la opción con las causas más frecuentes de hemorragia digestiva superior: - [x] Úlcera gástrica, úlcera duodenal, lesión de Dieulafoy - [ ] Síndrome de Mallory-Weiss, gastritis erosiva, úlcera gástrica. - [ ] Úlcera gástrica, várices esofágicas, Síndrome de Mallory-Weiss - [ ] Úlcera duodenal, úlcera gástrica, gastritis erosiva - [ ] Úlcera duodenal, cáncer gástrico, várices esofágicas. ### 16. En cuanto a la hemorragia digestiva, cual de las siguientes es leisc: - [ ] La causa mas frecuente de hemorragia digestiva inferior es la enfermedad diverticular - [ ] El 80% de la hemorragia digestiva inferior esta localizada en el colon - [ ] El 50% aproximadamente de las hemorragias digestiva inferior es por enfermedad inflamatoria - [ ] El tratamiento se basa en la evaluación inicial electiva y reposición de la volemia - [x] La evaluación física se fundamenta en el descargar la presencia de shockhipovolémico ### 17. En referencia a los métodos diagnósticos para la hemorragia digestiva, es cierto: - [ ] La sangre oculta en heces es un estudio de pesquisa - [ ] La arteriografía es el estudio gold standard para hemorragia digestiva - [ ] Para poder realizar el diagnostico a través de la Gammagrafía es necesario una tasa de sangrado de 0.1 ml/min - [ ] La sensibilidad y especificidad de la endoscopia no supera el 80% - [x] Ninguna de las anteriores. ### 18. En cuanta a la hemorragia digestiva superior, es cierto: - [x] Los AINES son causa fundamental de úlcera péptica - [ ] Dentro de los factores de riesgo que incrementa la morbilidad se encuentra las enfermedades cardiovasculares - [ ] No están descifrados agentes bacterianos causantes de úlcera péptica - [ ] La edad del paciente en un episodio de hemorragia digestiva no tiene valor alguno - [ ] Solo A y B son correctas ### 19. La hernia que protruye por encima de la línea de Malgaigne y se hace presente durante la maniobra de Landivar es: - [ ] Hernia encarcerada - [ ] Hernia indirecta - [x] Hernia femoral - [ ] Hernia directa - [ ] Secretina ### 20. Un paciente de sexo femenino de 45 años, conocide con el diagnóstico de litiasis vesicular, consulta por coloración amarillenta de la piel, y mucosas, concomitantemente dolor en hipocondrio derecho y fiebre de 39,5". En este paciente todas las siguientes son ciertas excepto: - [ ] Los estudios a realizar al ingreso deben incluir bilirrubina total y fraccionada, GGT, fosfatasa alcalina. - [ ] El eco abdominal tiene una sensibilidad de 87% en el diagnóstico - [ ] La CPRE puede ser diagnóstica y terapéutica - [x] Es poco probable que se trate de litiasis biliar - [ ] Ninguna de las anteriores ### 21. Si la paciente presenta bilirrubina total en 1,5gr/dl, a predominio de la directa, fosfatasa alcalina en 110 mg/dl y vías biliares no dilatadas con abundantes cálculos en la vesícula, cual es el próximo paso a seguir. - [x] CPRE - [ ] Colagioresonancia o ecoendoscopia - [ ] Colangiografíaintraoperatoria por laparoscopia - [ ] Colangiografiatransparietohepática - [ ] Ninguna de las anteriores ### 22. En cuanto al pólipo vesicular, indique lo falso: - [ ] Representa un factor de riesgo para cáncer de vesícula. - [ ] No hay manera de diferenciarlos ecosonograficamente de los cálculos vesiculares. - [ ] Las lesiones mayores a 1 cm requieren colecistectomia profiláctica. - [x] Los pólipos de colesterol no son lesiones susceptibles de transformación neoplásica. ### 23. "Por lo general son asintomaticas" refers to: - [ ] Obesidad - [ ] Cardiopatías - [ ] EPOC - [ ] Exposición a radiaciones ionizantes - [ ] Tumores intraabdominales ### 24. In regards to inguinal hernias, which of the following is correct: - [ ] They are located below the Poupart's ligament - [ ] The protruding inguinal ring is inferior to the inguinal ligament - [ ] They are hernias that generally do not ascend - [ ] They are divided into direct and indirect - [ ] They are generally accompanied by umbilical hernias ### 25. Of the following statements, which is correct: - [ ] The Littre hernia is one that contains the appendix - [ ] The Malgaigne line is used to differentiate an inguinal hernia from an umbilical hernia - [ ] Petit's triangle hernias are located in the mesogastric region - [ ] Strangulation is an acute complication of hernias. ### 26. What are the signs of a strangulated hernia: - [ ] Increased volume and pain in the area. - [ ] Tachycardia, hypotension and pain in the area - [ ] Increased volume, pain and changes in the color of the area - [ ] Tachycardia, nausea and pain in the area ### 27. Hernias are defined as: - [ ] The protrusion of the aponeurosis accompanied by a viscera through an anatomical orifice - [ ] The protrusion of the peritoneum accompanied by a viscera through an anatomical orifice - [ ] The protrusion of peritoneum, whether or not it is accompanied by a viscera, through an anatomical orifice. - [ ] The protrusion of viscera through a defect in the abdominal wall ### 28. What characteristics that differentiate congenital neck masses from cervical thyroid masses are NOT true: - [ ] They are fixed to the visceral plane of the neck - [ ] They are located under the thyroid cartilage, either on one side or both sides of the trachea. - [ ] They rise with protrusion of the tongue - [ ] They can cause dysphonia in the course of the illness - [ ] They can diminish the radiological lumen of the trachea. ### 29. The palpation of the thyroid gland is performed using the following methodology: - [ ] Patient position: - [ ] Examiner position: - [ ] Direction of the exam: ### 30. The Pemberton Maneuver is carried out by asking the patients to: - [ ] Take a deep breath, perform a Valsalva maneuver, and occlude the nostrils - [ ] Blow with force and press the waist with force for three seconds - [ ] Raise your upper extremities up above your head for 1 minute - [ ] Stick out your tongue, after the examiner palpates the thyroid gland with their fingers - [ ] Place the blood pressure cuff on the right arm for 3 minutes ### 31. The Trousseau sign is a: - [ ] Spasm of the tarsus due to hypercalcemia - [ ] Involuntary contraction of the masseter when percussing the Tinel points - [ ] Auscultation of Korotkoff sounds 10 mm above systolic pressure - [ ] Palmar erythema after compressing the wrist area for 30 seconds - [ ] None of the above ### 32. The basic study after the clinical history and physical exam for a thyroid nodule should include (put a number to indicate the order in which they would be performed): - [1] Imaging studies: - Ultrasonido, gammagrafia - [2] Laboratory tests: - T4 libre, TSH, niveles de anticuerpos - [3] Histological study: - VARE, CAPS ### 33. The characteristic of external hemorrhoids is: - [ ] They bleed, do not hurt, and they do not thrombose - [ ] They hurt, they bleed, and they thrombose - [x] They get thrombus and they hurt, they bleed - [ ] They do not hurt, they do not bleed, and they do not thrombose ### 34. A patient who consults for fever, pain, and increased perianal volume, the most likely diagnosis is: - [ ] Perianal fistula - [ ] Acute anal fissure - [ ] Thrombosed hemorrhoids - [ ] Anal abscess ### 35. A patient consults for severe anal pain and recurrent bleeding after a bowel movement of hard consistency. This suggests a diagnosis of: - [ ] Perianal fistula - [x] Acute anal fissure - [ ] Thrombosed hemorrhoid - [ ] Perianal abscess ### 36. Clinical characteristics of external hemorrhoids: - [ ] They are seen in the clinical inspection of the perianal region. - [x] They hurt when they thrombose - [ ] Their characteristic sign is painless bleeding - [ ] They produce a moist anus and itching - [ ] They are located below the dentate line ### 37. Female patient, 40 years old, who presents a thyroid nodule of 20mm. If you could only perform one study, which would you do? - [ ] PET-SCAN (CT PET) - [ ] Axial tomography - [ ] Fine needle aspiration biopsy - [x] High-resolution ultrasound - [ ] Nuclear magnetic resonance ### 38 Of the following, which is the most indicative that a thyroid nodule is malignant: - [ ] Dysphonia - [ ] Massive weight loss - [ ] Positive Pemberton sign - [ ] Lateral neck lymphadenopathy of the same side as the nodule - [x] Thyroid nodules with a TI-RADS classification of III ### 39. Male patient, 30 years old, with a lateral tumor of the neck zone II of 30 mm, palpable with a thrill and a bruit on ausculation. What diagnosis do you suggest: - [ ] Tumor of the parotid gland - [ ] Branchial cyst - [x] Tumor of the carotid body - [ ] Metastasis of papillary thyroid cancer - [ ] Metastasis of laryngeal cancer ### 40. According to BIRADS, answer correctly: - [ ] BIRADS 1: Result Benign (normal) - [ ] BIRADS 2: Probably benign - [ ] BIRADS 3: Suspicious for malignancy - [x] BIRADS 4: Suggestive of malignancy - [ ] BIRADS 5: Malignancy confirmed ### 41. In regards to acute appendicitis, which of the following is correct: - [ ] It is a surgical emergency - [ ] Its healing takes more than 6 hours - [ ] There are no semiological differences in the defense and abdominal contracture - [ ] It's a chronic condition - [ ] It's usually accompanied by nausea and vomiting ### 42. Which of the following statements is true for acute appendicitis? - [ ] It represents a case of occlusive acute abdomen - [ ] It's the second most common cause of acute abdomen - [ ] Fever may be present in 70% of patients - [ ] Pain is mediated by visceral afferent fibers - [ ] The CT scan has a sensitivity and specificity of 95% ### 43. Regarding acute cholecystitis, choose the correct statement: - [ ] The ultrasound has a 75% sensitivity for the diagnosis - [ ] There is no semiological way to differentiate it from biliary colic - [ ] It is a case of infectious acute abdomen - [ ] It is associated with jaundice in 70% of cases - [x] The most important sonographic finding for its diagnosis is the presence of gallstones ### 44. The most important diagnostic criterion for the diagnosis of obstructive acute abdomen is the presence of: - [ ] Radiological findings - [ ] The severity of the symptoms - [x] The finding of a sentinel loop - [ ] All of the above - [ ] The CT scan has a high sensitivity and specificity for this diagnosis ### 45. With respect to Obstructive Acute Abdomen, which of the following is incorrect: - [ ] It is more common than non-obstructive causes - [ ] The sentinel loop is a very useful radiological finding - [ ] The most common cause of obstruction is malignancy - [ ] A sentinel loop is a radiographic sign of obstruction - [ ] The CT scan is very sensitive and specific for this diagnosis of obstruction ### 46. Regarding acute abdomen, choose the correct statement: - [ ] It is often not possible to diagnose an acute abdomen by doing a physical examination - [ ] An exploratory laparotomy may be needed in a case of acute abdomen if the diagnosis is uncertain - [ ] An exploratory laparotomy can be a diagnostic method. - [ ] Clinical history is the only clue for the diagnosis - [ ] The CT scan can only be used to confirm the diagnosis. ### 47. A 25-year-old male patient who presents with a clinical history of 5 hours of evolution characterized by abdominal pain that is severe, intermittent and localized in the right lower quadrant, with a palpable mass that does not improve with analgesics. The vital signs are: FC 115x'; PA: 95/60mmHg, Fr: 22x; SpO2: 93% with nasal cannula at 4 Lts/min. The abdomen is presented as a tabla. What should we do for this patient? - [ ] Provide analgesia medications to alleviate pain and inflammation - [ ] Start antibiotic treatment - [ ] Place a peripheral venous line - [x] Place a central venous line - [ ] Start immediate surgery ### 48. Which of the following factors describes the pathophysiology of hydrocholecystis? - [ ] Abnormal hepatic bile secretion - [x] Obstruction by a calculus in the cystic duct - [ ] Obstruction by a calculus in the common bile duct - [ ] Cancer of the hepatic duct. - [ ] Both b and d ### 49. The most frequent cause of acute cholecystitis is: - [ ] Obstruction of the cystic duct - [x] Superinfection by Escherichia coli - [ ] Multiple gallstones - [ ] Salmonella infection - [ ] Chemical inflammation from the release of lysolecithin and other local tissue factors ### 50. Which of the following conditions must be present for cholangitis to occur? - [ ] Presence of bacteria in bile - [ ] Biliary obstruction - [ ] Immunosuppression - [x] Presence of bacteria and biliary obstruction simultaneously - [ ] None of the above ### 51. Which of the following is the most appropriate initial study for evaluating obstructive jaundice: - [x] MRCP (Magnetic Resonance Cholangio Pancreatography) - [ ] Abdominal Ultrasound - [ ] Abdominal CT - [ ] Transparietohepatic cholangiography - [ ] Endoscopic Retrograde Cholangiopancreatography (ERCP) ### 52. All of the following are causes of abnormal uterine bleeding, EXCEPT: - [ ] Trauma - [ ] Malnutrition - [ ] Cervical cancer - [x] Endometrial polyps - [ ] Uterine fibroids ### 53. A male patient, 34 years old, consults for painless rectal bleeding. He has a history of constipation. There is no weight change, and no family history of colorectal cancer. The most likely diagnosis is: - [ ] Anal fissure - [ ] Colorectal cancer - [x] Hemorrhoids - [ ] Diverticular disease complicated with diverticulitis. - [ ] Thrombosed hemorrhoids ### 54. A female patient, 24 years old, consults due to abdominal pain in the right iliac fossa and hypogastrium, with 10 hours of evolution, describing it as diffuse, continuous, and moderate intensity. She also has a fever of 38.3°C and anorexia. On physical examination, her findings are: FC 109 bpm, soft abdomen, with pain on palpation in the hypogastrium and right iliac fossa, a positive Murphy sign and tenderness on rebound pain in the right iliac fossa. The gynecological examination shows cervical motion tenderness and mucopurulent leukorrhea. All of the following are correct except: - [ ] The hematology complete has a sensitivity of 45%. - [x] The ESR has a sensitivity of 45% - [ ] Culdocentesis confirms the diagnosis and is therapeutical. - [ ] The beta subunit of hCG is part of the diagnostic algorithm ### 55. Which of the following statements is true for acute appendicitis, EXCEPT; - [ ] Pain that is preceded by vomiting after eating starts in the epigastrium and after 4 to 6 hours, migrates to the right iliac fossa - [ ] The semiological chronicity of Murphy's sign depends on the intestinal innervation as well as the degree of inflammation of the inflamed appendix - [ ] Rovsing's sign is positive if when we palpate the right iliac fossa deeply, if the patient experiences a visceral type of pain when the cecum is distended - [ ] The appearance of fever from the onset of abdominal pain is characteristic of acute appendicitis. ### 56. The signs that indicate a diagnosis of obstructive acute abdomen are: - [ ] Increased intensity and frequency of sounds, abdominal distension, and fever. - [ ] Abdominal distension, abdomen as a board, pneumoperitoneum, and oral intolerance. - [x] Absence of bowel movements, metallic bowel sounds, air-fluid level, and a coin-stack appearance - [ ] Fecaloid vomiting, melena, abdominal distension, and anorexia. ### 57. A 57-year-old female patient with a history of constipation consults for fever, abdominal pain of a visceral type in the left iliac fossa, and a palpable mass in that area. What is the likely diagnosis? - [ ] Acute enterocolitis - [x] Complicated diverticular disease with diverticulitis - [ ] Uncomplicated colon tumor - [ ] Twisted ovarian tumor ### 58. One day past mid-cycle, a 17-year-old girl presents with sudden pain in the right lower quadrant of the abdomen. On abdominal examination, she has tenderness in the right lower quadrant and the rectal examination also shows tenderness on the right side. Her temperature is 37.2°C, and her white blood cells are 10,000/mm3. What is the most likely diagnosis? - [ ] Acute appendicitis - [x] Pelvic inflammatory disease - [ ] Urinary tract infection - [ ] Ruptured ovarian follicle ### 59. A 21-year-old woman attends her annual appointment. She reports having had a mass in her left breast for 3 months, and that her maternal grandmother was diagnosed with breast cancer at age 70. On physical examination, a firm, non-tender, well-defined nodule is palpated in the 12 o'clock position on his left breast. There are no other abnormalities. What is the most likely diagnosis? - [ ] Fibroadenoma - [x] Breast cyst - [ ] Breast cancer. - [ ] Paget's disease - [ ] Phyllodes tumor. ### 60. A 76-year-old woman is seen for her annual checkup after 5 years. She reports an increase in the size of her left breast, a 5 kg weight loss in 10 months, and fatigue. On physical examination, there is thickening of the skin on the lateral side of the left breast with enlarged pores, and a mass of 5 cm in size. Two large lymph nodes are palpable and adhered to the skin. What is the name for the visible change in the skin? - [ ] Retraction of the nipple - [x] Paget's disease - [ ] Mondor's disease - [ ] Orange peel. ### 61 Mammography is considered the screening study of choice for breast cancer because: - [x] It allows the detection of clinically non-palpable malignant lesions - [ ] It allows the visualization of the entire breast tissue through oblique mediolateral projections - [ ] Microcalcifications are the only absolute sign of breast cancer - [ ] It is indicated for patients over 35 years old ### 62. A hypertrophic scar is: - [ ] A synonym for keloid - [ ] More common on the face. - [ ] Has a genetic predisposition. - [ ] It does not exceed the limits of the incision - [x] It worsens with the use of steroids. ### 63. Nicotine intake affects wound healing because: - [ ] It increases fibroblast proliferation. - [ ] It increases platelet adhesion - [ ] It displaces oxygen - [x] It reduces oxidative metabolism. - [ ] It reduces oxygen transport. ### 64. Most surgical site infections are clinically evident: - [ ] In the first two days after surgery - [ ] Five days or more - [ ] When there is fever in the first few hours after surgery - [ ] One month after surgery - [ ] When the patient has not shaved properly ### 65. When describing a breast mass, the following should be noted in detail - [ ] Size, Location, Mobility, Extension - [ ] Location, Mobility, Pain - [ ] Pain, breast asymmetry - [ ] Asymmetry, Nipple discharge - [ ] Axillary lymph nodes. ### 66. A 13-year-old girl is referred by her physician for evaluation of a breast lump. The lump is growing rapidly, and on physical examination, it is about 8 cm long and retracted. She began menstruating a year ago. What is the next step? - [ ] Mastectomy - [ ] Incisional biopsy - [ ] Mammography - [x] Breast Ultrasound - [ ] It is normal to find this kind of mass because it is part of the developmental process. ### 67. Paget’s disease of the breast is caused by: - [ ] Atopic dermatitis of the nipple - [ ] An invasive ductal carcinoma that extends to the epidermis of the nipple - [ ] An invasive lobular carcinoma that causes ulceration and nipple inversion - [ ] Invasion of lymphatic vessels of the dermis - [x] Intraductal papilloma of the subareolar region that causes a blue-green discharge. ### 68. According to BIRADS, answer correctly: - [ ] BIRADS 1: Result Benign (normal) - [ ] BIRADS 2: Probably Benign - [ ] BIRADS 3: Suspicious for malignancy - [ ] BIRADS 4: Suggestive of malignancy - [x] BIRADS 5: Malignancy confirmed ### 69. Regarding acute appendicitis, which of the following is correct?: - [ ] It is a surgical emergency. - [ ] Its healing takes more than 6 hours. - [ ] There are no semiological differences between defense and abdominal contracture - [ ] It is a chronic condition - [ ] It is usually accompanied by nausea and vomiting ### 70. In regard to Acute Cholecystitis, choose the correct statement: - [ ] The Ultrasound has a 75% sensitivity for the diagnosis - [ ] There is no semiological way to differentiate it from biliary colic - [ ] It is a case of infectious acute abdomen - [ ] It is associated with jaundice in 70% of cases. - [x] The most important sonographic finding for its diagnosis is the presence of gallstones. ### 71. The sentinel loop is a radiographic sign of obstruction: - [x] It is often the most important radiological finding in obstructive acute abdomen. - [ ] It should be the first diagnostic procedure. - [ ] It is the most frequent cause of the obstruction. - [ ] The CT scan has a high sensitivity and specificity for the diagnosis of obstruction - [ ] The CT scan alone is enough to understand the diagnosis of obstruction. ### 72. In regards to acute abdomen, select the correct statement: - [ ] It is not often possible to diagnose an acute abdomen with only the clinical examination - [ ] Exploratory laparotomy may be needed in a case of acute abdomen if the diagnosis is uncertain - [ ] An exploratory laparotomy can be diagnostic. - [ ] Clinical history is the only clue for the diagnosis - [ ] The CT scan is only useful to confirm the diagnosis. ### 73. A 25-year-old male patient presents with 5 hours of evolution history characterized by abdominal pain that is severe, intermittent and localized in the right lower quadrant, with a palpable mass that does not improve with analgesics. His vital signs are: FC 115x'; PA: 95/60mmHg, Fr: 22x; SpO2: 93% with nasal cannula at 4 Lts/min. His abdomen is presented as a tabla. What should we do for this patient? - [ ] Provide analgesia medications to alleviate pain and inflammation - [ ] Start antibiotic treatment - [ ] Place a peripheral venous line - [x] Place a central venous line - [ ] Start immediate surgery ### 74. Which of the following factors describes the pathophysiology of hydrocholecystitis? - [ ] Abnormal hepatic bile secretion - [x] Obstruction by a calculus in the cystic duct - [ ] Obstruction by a calculus in the common bile duct - [ ] Cancer of the common hepatic duct - [ ] b and d are correct ### 75. The most frequent cause of acute cholecystitis is: - [ ] Obstruction of the cystic duct - [x] Superinfection by Escherichia coli - [ ] Multiple gallstones - [ ] Salmonella infection - [ ] Chemical inflammation from the release of lysolecithin and other local tissue factors ### 76. Which of the following conditions must be present for cholangitis to occur? - [ ] Presence of bacteria in bile - [ ] Biliary obstruction - [ ] Immunosuppression - [x] Presence of bacteria and biliary obstruction simultaneously - [ ] None of the above ### 77. Which of the following is the most appropriate initial study for evaluating obstructive jaundice? - [x] MRCP (Magnetic Resonance Cholangio Pancreatography) - [ ] Abdominal Ultrasound - [ ] Abdominal CT - [ ] Transparietohepatic cholangiography - [ ] Endoscopic Retrograde Cholangiopancreatography (ERCP) ### 78. All of the following are causes of abnormal uterine bleeding, EXCEPT: - [ ] Trauma - [ ] Malnutrition - [ ] Cervical cancer - [x] Endometrial polyps - [ ] Uterine fibroids ### 79. A male patient, 34 years old, consults for painless rectal bleeding. He has a history of constipation. There is no weight change, and no family history of colorectal cancer. The most likely diagnosis is: - [ ] Anal fissure - [ ] Colorectal cancer - [x] Hemorrhoids - [ ] Diverticular disease complicated with diverticulitis - [ ] Thrombosed hemorrhoids ### 80. A female patient, 24 years old, consults due to abdominal pain in the right iliac fossa and hypogastrium, with 10 hours of evolution, describing it as diffuse, continuous, and moderate intensity. She also has a fever of 38.3°C and anorexia. On physical examination, her findings are: FC 109 bpm, soft abdomen, with pain on palpation in the hypogastrium and right iliac fossa, a positive Murphy sign and tenderness on rebound pain in the right iliac fossa. The gynecological examination shows cervical motion tenderness and mucopurulent leukorrhea. All of the following are correct except: - [ ] The hematology complete has a sensitivity of 45%. - [x] The ESR has a sensitivity of 45% - [ ] Culdocentesis confirms the diagnosis and is therapeutical. - [ ] The beta subunit of hCG is part of the diagnostic algorithm ### 81. Which of the following statements is true for acute appendicitis, EXCEPT; - [ ] Pain that is preceded by vomiting after eating starts in the epigastrium and after 4 to 6 hours, migrates to the right iliac fossa - [ ] The semiological chronicity of Murphy's sign depends on the intestinal innervation as well as the degree of inflammation of the inflamed appendix - [ ] Rovsing's sign is positive if when we palpate the right iliac fossa deeply, if the patient experiences a visceral type of pain when the cecum is distended - [ ] The appearance of fever from the onset of abdominal pain is characteristic of acute appendicitis. ### 82. The signs that indicate a diagnosis of obstructive acute abdomen are: - [ ] Increased intensity and frequency of sounds, abdominal distension, and fever. - [ ]