Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Enarm Curso Electronico
Enarm Curso Electronico
El adenocarcinoma
El carcinoma epidermoide
El carcinoma de clulas pequeas
El carcinoma de clulas grandes
3.- El tiempo en que ocurre la falla heptica despus de una ingesta txica de
paracetamol es a las:
a)
b)
c)
d)
En ayunas
Con alimentos ricos en grasas
Con vegetales
Con agua
El hgado
La vescula biliar
La medula sea
El colon
Vancomicina
Ciprofloxacino
Ampicilina
Trimetoprim con sulfametoxazol
tratamiento de primera eleccin- para esta situacin clnica, al ser antibiticos muy eficaces
para el tratamiento de otras infecciones.
8.- El antdoto especfico para los casos de intoxicacin con acetaminofen es:
a) La N-acetilcisteina
b) La fisiostigmina
c) La atropina
d) El carbn activado
Respuesta correcta: A, la N-acetilcisteina.
La ingesta de dosis txicas de paracetamol puede provocar una lesin heptica grave, que
caractersticamente suele presentarse de forma retardada (mxima alteracin de la funcin
heptica a las 72-96 h tras la ingesta) tras un perodo sin apenas sntomas. El tratamiento se
realiza mediante la descontaminacin gastrointestinal, con administracin de carbn activado
(dentro de la primera hora tras la ingesta). En caso de detectarse niveles txicos en sangre
(segn el nomograma de Rumack-Matthew), realizados a las 4 h de la ingesta, est indicada la
administracin del antdoto, la N-acetilcistena.
Fernandez A, Mintegi S y Cols.
Intoxicacion por paracetamol en menores de 6 meses: erros de dosificacin.
An Pediatr (Barc) 2004; 60(2):177-179
9.- Las clulas de Reed-Sternberg son caractersticas de:
a)
b)
c)
d)
El linfoma no Hodgkin
El linfoma de Hodgkin
La leucemia linfocitica
La leucemia mieloblastica
10.- El tratamiento de eleccin para tratar la infeccin por Helycobacter pylori es:
a)
b)
c)
d)
Los aldehdos
El benceno
El butadieno
Los hidrocarburos aromticos policclicos
12.- En la intoxicacin con metanol que metablito responsable de producir ceguera es:
a)
b)
c)
d)
El formaldehdo
cido frmico
Etilenglicol
Formol
El corazn
El sistema nervioso central
El rin
El hgado
Estafilococo aureus
Bacillus cereus
Estreptococo beta hemoltico
Salmonella
El perro
El gato
El hombre
Las plantas
Hepatomegalia
Bradicardia
Enuresis
Signos extrapiramidales
A nivel del ojo, la Atropina produce midriasis, ya que relaja el msculo circular del iris,
bloqueando el tono parasimptico de este msculo. La midriasis que se produce es muy grande
y esto lleva a que el paciente tenga fotofobia. Tambin la Atropina produce aumento de la
presin ocular especialmente en pacientes con glaucoma de ngulo estrecho, por lo que en
estos casos estara contraindicada, ya que su accin midritica hace que el iris se repliegue
hacia el ngulo iridio-corneal obstruyendo el drenaje del humor acuoso. Por ltimo los
anticolinrgicos producen sequedad ocular por que ellos disminuyen la secrecin lagrimal. Los
anticolinrgicos aumentan la frecuencia cardaca porque bloquean los receptores muscarnicos
tipo M2 del ndulo sinusal, con esto se anula la accin del Vago en el corazn y queda
predominando la accin del simptico. Esta taquicardia va a ser mucho ms importante en el
adulto joven ya que ellos tienen un predominio del tono vagal, en cambio, en el recin nacido y
el anciano el tono vagal no es de mucha importancia por lo que el aumento de la frecuencia
cardaca no ser tan serio. La Atropina produce vasodilatacin cutanea de las reas de rubor,
esto se conoce como rubor atropnico y sirve para diagnosticar la intoxicacin por Atropina.
Provoca disminucin de la secrecin bronquial farngea, nasal y salival. Disminuye el tono y la
contraccin vesical y de los urteres: Esta accin de la atropina favorece la retencin urinaria
(enuresis) y en la intoxicacin atropnica se producir un globo vesical. En general la atropina
produce: Sequedad de la cavidad oral, visin borrosa, fotofobia, taquicardia, intolerancia al
calor, constipacin y retencin urinaria.
17.- Segundo enunciado. El tratamiento de este paciente es a base de:
a)
b)
c)
d)
N-acetilcisteina
Atropina
Carbn activado
Fisiostigmina
Loratadina
Metoclopramida
Ranitina
Paracetamol
Atropina
Fisiostigmina
Difenhidramina
cido valproico
La dexametasona
La prednisolona
La hidrocortisona
La lidocana
Delante de la retina
Detrs de la retina
No forma imagen
Borrosa
El timolol
La acetazolamida
La pilocarpina
La atropina
Garrapata
Serpiente
Alacrn
Viuda negra
Artritis gotosa
Artritis sptica
Artritis traumtica
Artritis reumatoide
10
Serotonia
Triptamina
Bufotenina
Histamina
11
Quinolonas
Tetraciclinas
Macrolidos
Cloranfenicol
12
b) Cataratas
c) Desprendimiento de retina
d) Retinopatia hipertensiva
Respuesta correcta: A, glaucoma.
La principal causa de ceguera en Mxico es la retinopata diabtica, le sigue muy de cerca el
glaucoma (que segn informes de la OMS, es la principal causa de ceguera irreversible en el
mundo). Tan solo en Mxico existen cerca de tres millones de personas diagnosticadas con
glaucoma, al menos dos millones que padecen la enfermedad pero no lo saben y otros dos
millones en riesgo de desarrollarla (Sociedad Mexicana de Oftalmologa y de la Academia
Americana de Oftalmologa).
31.- El mecanismo de accin del ondasetron es:
a)
b)
c)
d)
Antimalaricos
AINEs
Esteroides
Drogas modoficadoras de la enfermedad
Streptococo pneumoniae
Haemophilus influenzae
Stafilococo aureus
Meningococo
13
6
11
31
13
V y VI
VII y VIII
VIII y IX
IX y X
14
El pptido C
El glucagon
Peptisa
Secretina
15
d) Desferoxamina
Respuesta correcta: D, desferoxamina.
La desferoxamina tiene una accin quelante al unirse al hierro, con el que forma un complejo
soluble llamado feroxamina que se elimina por la va renal. Un grado de desferoxamina
quema 85 mg de hierro ferrico. Puede producir hiportensin.
41.- La marformacin mas asociada a la arteria umbilical nica es:
a)
b)
c)
d)
Cardiaca
Renal
Digestiva
Cromosomica
Sexual
Fecal-oral
Vertical
Sanguinea
Fenilalanina
Tirosina
Histidina
Cistina
16
Flumazenil
Desferoxamina
Naloxona
N-acetilcisteina
Anticolinergico
Colinergico
Actua en los receptores GABA
Provoca broncoconstriccin
17
Asbesto
Cromo
Anilinas
Aminas
18
Tiamina
Vitamina B12
cido flico
Hierro
Trisomia
Enfermedad autosomica recesiva
Enfermedad autosomica dominante
Patologia mitocondrial
Inversion pericentrica
19
Qururgico
Enema
Estimulacin
De deja en observacin por 24 hrs.
Epidermoide
Adenocarcinoma
Mixto
Indiferenciado
20
a)
b)
c)
d)
Tetraloga de Fallot
Transposicin de grandes vasos
Conducto arterioso persistente
Comunicacin auricular
21
b) -2.0
c) -2.5
d) 2.0
Respuesta correcta: C, -2.5.
Los resultados de una densitometria osea dan bajo dos puntajes:
Puntuacin T: este nmero muestra la cantidad sea que tiene en comparacin con un adulto
joven del mismo gnero con masa sea mxima. Una puntuacin superior a -1 se considera
normal. Una puntuacin entre -1 y 2,5 se clasifica como osteopenia, la primera fase de la
prdida sea. Una puntuacin inferior a 2,5 se define como osteoporosis. La puntuacin T se
utiliza para calcular el riesgo que tiene de desarrollar una fractura.
Puntuacin Z: este nmero refleja la cantidad sea que tiene en comparacin con otras
personas de su grupo etario y del mismo tamao y gnero.
59.- La imagen radiologica en sol naciente es ms frecuente en el:
a)
b)
c)
d)
Ostesarcoma
Fibrosarcoma
Mieloma multiple
Condrosarcoma
22
patients with osteosarcoma were treated by amputation but the cure rate was under 10% and
almost all patients died within a year from diagnosis. Today, for localised osteosarcoma at onset
(80% of cases) treated in specialized bone tumour centres with pre- and postoperative
chemotherapy associated with surgery, the percentage of patients cured varies between 60%
and 70%. Surgery is conservative (limb salvage) in more than 90% of patients. Prognosis is
more severe (cure rate about 30%) for tumours located in the axial skeleton and in patients with
metastasis at onset.
Picci P.
Osteosarcoma (Osteogenic sarcoma)
Orphanet Journal of Rare Diseases 2007, 2:6
61.- El agente responsable mas frecuente del resfriado comn es:
a)
b)
c)
d)
Rinovirus
Influenzae
Coronavirus
Arenavirus
Suplementos de hierro
cido flico
Cianocobalamina
Eritropoyetina
23
orally is affected by the iron salt form (eg, ferrous sulfate, ferrous gluconate), the amount
administered, the dosing regimen, and size of iron stores. Foods that enhance iron absorption
include protein from meat and vitamin C. Foods that may inhibit absorption include unrefined
grains, soy, coffee, cocoa, herb teas, red wine, calcium, and some proteins (eg, soy, eggs,
casein).
63.- El tratamiento del granuloma inguinal es con:
a)
b)
c)
d)
Tetraciclinas
Quinolonas
Penicilina
Carbapenem
Hepatitis cronica
Hepatocarcinoma
Cirrosis
Colestasis
Leucotrienos
Tromboxanos
Prostaglandinas
Prostacilcinas
24
synthetase, which leads to the formation of prostacyclin (PGI2) and its stable end product
PGF1alpha. Prostacyclin is a vasodilator, a potent inhibitor of platelet aggregation, and also
markedly potentiates the permeability-increasing and chemotactic effects of other mediators.
Thromboxane-prostacyclin imbalance has been implicated as an early event in thrombus
formation in coronary and cerebral blood vessels.
66.- Caso clnico seriado. Se presenta a urgencias un preescolar con sialorrea, miosis,
alteraciones conductuales, su padre es campesino dedicado a la siembra y cosecha.
Primer enunciado: el diagnstico mas probable es intoxicacin por:
a)
b)
c)
d)
Organofosforados
Nitrititos
Plomo
Mercurio
Fisiostigmina
Atropina
Acetilcolina
Desferoxamina
25
succinylcholine, and tranquilizers of the reserpine and phenothiazine types are contraindicated.
Hyperglycemia is common in severe poisonings.
68.- El acido rico es el producto final de:
a)
b)
c)
d)
ADN
ARN
Purinas
Pirimidinas
Piocolecisto
Colecistitis aguda
Coledocolitiasis
Colangitis
El colon ascendente
El colon transverso
El ciego
El rectosigmoides
26
c) Muscarinico
d) Simpaticomimetico
Respuesta correcta: A, anticolinergico.
Antidepresivo tricclico derivado de la dibenzazepina. Acta bloqueando la recaptacin de
neurotransmisores por la membrana neuronal, con lo que se potencian los efectos de stos
ltimos. Presenta actividad anticolinrgica que puede ser aprovechable para el tratamiento de
ciertas patologas (enuresis), o ser la causa de muchos de sus efectos secundarios.
72.- La primera causa de muerte materna en Mxico es:
a)
b)
c)
d)
Prednisona
IECAs
Diureticos
AINEs
27
Agudeza visual
Fondo de ojo
Campimetria
Tonometria
Esplenectoma
Asma
EPOC
SIDA
Glucagon
Insulina
Paraquat
Atropina
28
Pralidoxima
Fisiostigmina
Atropina
Malation
Prematurez
Infeccion intestinal
Invaginacion intestinal
Ablactacion
29
Vascular
Neurologica
Metablica
Idiopatica
30
with ED. Trauma that affects the neurologic or vascular components can also lead to ED. Men
with severe Peyronie disease, an inflammatory vasculitis, may have enough scar tissue in the
corpora to impede blood flow. Men with sleep disorders commonly experience ED. Another
important consideration is the hormonal status of the patient. Hypogonadism that results in low
testosterone levels adversely affects libido and erectile function. Hypothyroidism is a very rare
cause of ED. Most patients with ED have multiple etiological factors; thus, assessing how much
each is contributing to the problem is difficult. Because most men with ED have an organic
cause, a thorough evaluation is necessary to correctly identify the specific etiology in any given
individual.
81.- El antecedente de mayor importancia para cncer de colon es:
a)
b)
c)
d)
Antecedentes familiares
Edad joven
Sndrome de intestino irritable
Antecedente de exposicin a la capsaicina
a) 7-dehidroxicolesterol a colecalciferol
b) Vitamina D3 a 25-hidroxicolecalciferol
c) 25-hidroxicolecalciferol a 24,25-dihidroxycolecalciferol
d) 1,25-dihidroxicolecalciferol a vitamina D3
Respuesta correcta: A, 7-dehidroxicolesterol a colecalciferol.
Vitamin D3, which is also called cholecalciferol, is produced in the skin of mammals from 7dehidrocholesterol by the action of sunlight. The action involves the rapid formation of
previtamin D3, which is then converted more slowly to vitamin D3 (cholecalciferol). In the liver,
vitamin D3 is converted to 25-hydroxyvholecalciferol (calcidiol, 25-OHD3). The 25hydroxycholecalciferol is converted in the cells of the proximal tubules of the kidneys to the
more active metabolite 1,25-dihydroxycholecalciferol, which is also called calcitriol or 1,25(OH)2D3.
Rion
Higado
Pulmon
Piel
31
Colagena
Proteoglucanos
Condoitrinsulfato
Cartilago
Ampicilina y amikacina
Vancomicina y carbapenem
Amoxicilina y penicilina sintetica
Amikacina y clindamicina
32
The incidence of early-onset (< 5 days) neonatal bacterial infection is 45 per 1000 live births. If
rupture of the membranes occurs more than 24 hours prior to delivery, the infection rate
increases to 1 per 100 live births. If there is early rupture of membranes with chorioamnionitis,
the infection rate increases further to 1 per 10 live births. Irrespective of membrane rupture,
infection rates are five times higher in preterm than in term infants. Early-onset bacterial
infections appear most commonly on day 1 of life, and the majority of cases appear at less than
12 hours. Respiratory distress due to pneumonia is the most common presenting sign. Other
features include unexplained low Apgar scores without fetal distress, poor perfusion, and
hypotension. Late-onset bacterial infection (at more than 5 days of age) presents in a more
subtle manner, with poor feeding, lethargy, hypotonia, temperature instability, altered perfusion,
new or increased oxygen requirement, and apnea. Late-onset bacterial sepsis is more often
associated with meningitis or other localized infections. Low total white counts, absolute
neutropenia (< 1000/mL), and elevated ratios of immature to mature neutrophils are suggestive
of neonatal bacterial infection. Thrombocytopenia is also a common feature. Other laboratory
signs are hypoglycemia or hyperglycemia with no change in glucose administration,
unexplained metabolic acidosis, and elevated C reactive protein. In early-onset bacterial
infection, pneumonia is invariably present; chest x-ray films show infiltrates, but these infiltrates
cannot be distinguished from those resulting from other causes of neonatal lung disease.
Definitive diagnosis is made by positive cultures from blood, CSF, and the like. Early-onset
infection is most often caused by group B b-hemolytic streptococci (GBS) and gram-negative
enteric pathogens (most commonly E coli). Another organism to consider is Haemophilus
influenzae. Late-onset sepsis is caused by coagulase-negative staphylococci (most common in
infants with indwelling central venous lines), Staphylococcus aureus, GBS, Enterococcus,
Pseudomonas, and other gram-negative organisms.A high index of suspicion is important in the
diagnosis and treatment of neonatal infection. Because the risk of infection is greater in the
preterm infant and because respiratory disease is a common sign of infection, any preterm
infant with respiratory disease requires blood cultures and broad-spectrum antibiotic therapy for
4872 hours pending the results of cultures. An examination of CSF should be performed when
infection is highly suspected on a clinical basis (eg, associated hypotension, persistent
metabolic acidosis, neutropenia) or if the blood culture is positive. Antibiotic coverage should be
directed initially toward suspected organisms. Early-onset sepsis is usually caused by GBS or
gram-negative enteric organisms; broad-spectrum coverage, therefore, should include
ampicillin plus an aminoglycoside or third-generation cephalosporineg, ampicillin, 100150 mg/kg/d divided every 12 hours, and gentamicin, 2.5 mg/kg/dose every 1224 hours
(depending on gestational age), or cefotaxime, 100 mg/kg/d divided every 12 hours. Lateonset infections can also be caused by the same organisms, but coverage may need to be
expanded to include staphylococci. In particular, the preterm infant with an indwelling line is at
risk for infection with coagulase-negative staphylococci, for which vancomycin is the drug of
choice in a dosage of 1015 mg/kg every 824 hours depending on gestational and postnatal
ages. Other supportive therapy includes the administration of intravenous immune globulin
(500750 mg/kg) to infants with known overwhelming infection. The duration of treatment for
proved sepsis is 1014 days of intravenous antibiotics.
86.- Un preescolar de 4 aos que para levantarse del piso lo hace en fases, es decir
trepndose desde sus piernas tiene diagnstico de:
a)
b)
c)
d)
Distrofia de Duchenne
Distrofia de Emeri-Dreyfuss
Enfermedad de Steinert
Enfermedad de Landouzy-Dejerine
33
Duchenne muscular dystrophy is the most common hereditary neuromuscular disease affecting
all races and ethnic groups. Its incidence is 1:3,600 liveborn infant boys. This disease is
inherited as an X-linked recessive trait. The abnormal gene is on the X chromosome at the
Xp21 locus and is one of the largest genes identified. Infant boys are only rarely symptomatic at
birth or in early infancy, although some are already mildly hypotonic. Early gross motor skills,
such as rolling over, sitting, and standing, are usually achieved at the appropriate ages or may
be mildly delayed. Poor head control in infancy may be the first sign of weakness. Distinctive
facies are not a feature because facial muscle weakness is a late event. Walking is often
accomplished at the normal age of about 12 monts, but hip girdle weakness may be seen in
subtle form as early as the 2nd year. Toddlers may assume a lordotic posture when standing to
compensate for gluteal weakness. An early Gowers sign (the child to use the hands to
climb up the legs in order to assume an upright position) is often evident by age 3 yr
and is fully expressed by age 5 or 6 yr. A Trendelenburg gait, or hip waddle, appears at this
time.
87.- El grupo de frmacos de eleccin para el tratamiento de la hipertensin arterial
pulmonar es:
a)
b)
c)
d)
Calcioantagonistas
IECAs
Vasodilatadores
Nitratos
Foscarnet
Anfotericina B
Gangiclovir
Aciclovir
34
be given every 2 weeks during maintenance treatment of CMV retinitis, but it is significantly
nephrotoxic.
89.- El medicamento de leccin para el tratamiento de crisis convulsivas en una paciente
eclmptica es:
a)
b)
c)
d)
Diazepam
Fenobarbital
Sulfato de magnesio
Fenitoina
35
Fase intensiva:
Medicamentos
separados
Isoniacida
Rifampicina
Pirazinamida
Fase de sostn:
Medicamentos
separados
Isoniacida
Rifampicina
TMP-SMX
Amoxicilina
Cloranfenicol
Ciprofloxacino
36
Hemorroides grado I
Hemorroides grado II
Hemorroides grado III
Hemorroides grado IV
Derecha
Izquierda
No afecta
Arriba
Acetilcolina
Adrenalina
Serotonia
Norepinefrina
37
a) Cloranfenicol
b) TMP-SMX
c) Vancomicina
d) Ceftriaxona
Respuesta correcta: A, cloranfenicol.
Antimicrobial therapy is directed toward treatment of active infection or used prophylactically to
protect those exposed to the infective organism through close contact. Drugs effective in
treating active meningococcal infection include penicillin G, chloramphenicol in patients who
are allergic to penicillin, and some cephalosporins (ie, cefotaxime, ceftriaxone, cefuroxime)
used to treat pediatric patients. Meningococcal resistance to penicillins has occurred; the
mechanism of resistance involves altered penicillin-binding proteins. Sulfonamides have a
limited role in meningococcal infections because of the resistance of serogroups A, B, and C.
Duration of treatment is dictated by clinical response and manifestation of disease, although 1014 days should be sufficient with a sensitive organism. Individuals with at least 4 hours of close
contact during the week before onset of illness have an increased risk of being infected.
Individuals at risk include housemates, daycare contacts, cellmates, or individuals exposed to
infected nasopharyngeal secretions (eg, through kissing, mouth-to-mouth resuscitation,
intubation, suctioning). Rifampin and ciprofloxacin are commonly used for chemoprophylaxis.
Other agents include ceftriaxone and azithromycin. A single dose of intramuscular ceftriaxone
may be used in children or adults. Spiramycin is the primary prophylactic regimen used in many
European countries. Vaccination with monovalent A; monovalent C; bivalent A-C; or
quadrivalent A, C, Y, and W-135 vaccine should be an adjunct to antibiotic chemoprophylaxis of
susceptible contacts in epidemics. The eradication of carriage is also indicated in the index case
unless third-generation cephalosporins have been used. A single intramuscular dose of an oily
suspension of chloramphenicol has been shown to be as effective as 5 days of penicillin in
persons with meningococcal meningitis, and this may be useful in resource-poor countries.
Barquet N, Domingo P, Cayla JA.
Oral Antibiotics and Outcome in Meningococcemia
Arch Intern Med 2000;160(14):2220-2223
98.- El agente relacionado con la leucemia es:
a)
b)
c)
d)
Anilina
Asbesto
Nitratos
Benceno
38
han descrito bajo peso de nacimiento, retardo mental serio y en la formacin de hueso y dao
en la mdula sea. En ratas se predujeron abortos sutiles o leves. Se ha determinado que el
benceno es un reconocido carcingeno en seres humanos y otros mamferos lactantes.
La exposicin de larga duracin a altos niveles de benceno en el aire puede producir
leucemia, as como tambin un cncer de clon.
39
d) Histamina
Respuesta correcta: C, glutamato.
The aminoacid glutamate is the main excitaotry transmitter in the brain and spinal cord, and it
has been calculated that is the transmitter responsable for 75% of the excitatory transmission in
the brain. Aspartate is apparently a transmitter in pyramidal cells and spiny stellate cells in the
visual cortex, but has not been studied in as great detail.
40