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Examen Integrado - Medicina study materials
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Examen Integrado - Medicina practice questions

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Question 1Medicina Interna

Which finding on serum protein electrophoresis is most characteristic of nephrotic syndrome due to a primary glomerulopathy?

  1. Absence of the alpha-1 band with a low total protein
  2. Selective hypoalbuminemia with a compensatory alpha-2 globulin rise Correct answer.
  3. Polyclonal hypergammaglobulinemia with a beta-gamma bridge
  4. A dense monoclonal spike in the gamma region

Explanation

In nephrotic-range proteinuria, albumin is lost preferentially, and hepatic synthesis of larger alpha-2 proteins such as alpha-2 macroglobulin increases because they are not filtered. This produces low albumin with a relative alpha-2 elevation. A monoclonal spike suggests a plasma cell disorder rather than a primary glomerulopathy.

Question 2Medicina Interna

A patient with type 2 diabetes has an eGFR of 32 mL/min/1.73 m2 and persistent albuminuria. Which medication class slows progression of diabetic kidney disease in this setting?

  1. Loop diuretics
  2. SGLT2 inhibitors Correct answer.
  3. Thiazolidinediones
  4. Alpha-glucosidase inhibitors

Explanation

SGLT2 inhibitors reduce intraglomerular pressure and have demonstrated kidney and cardiovascular protection in diabetic kidney disease, including in patients with reduced eGFR. Loop diuretics and other glucose-lowering classes do not provide this specific renoprotection.

Question 3Medicina Interna

Which laboratory pattern is most consistent with primary hyperaldosteronism?

  1. Low aldosterone with high renin
  2. High aldosterone with suppressed renin Correct answer.
  3. Low aldosterone with low renin
  4. High aldosterone with high renin

Explanation

Autonomous aldosterone production expands volume and suppresses renin, giving high aldosterone with low renin. This distinguishes primary from secondary hyperaldosteronism, where renin is elevated.

Question 4Medicina Interna

A 68-year-old with atrial fibrillation is found to have a serum sodium of 128 mEq/L and a serum osmolality of 262 mOsm/kg. Which initial step is most appropriate?

  1. Assess volume status and urine osmolality before treatment Correct answer.
  2. Restrict free water and start demeclocycline empirically
  3. Give intravenous furosemide alone to raise the sodium
  4. Rapid correction with hypertonic saline regardless of symptoms

Explanation

Hyponatremia management depends on whether it is hypo-osmolar and on the patient's volume status and urine concentrating ability. Determining volume status and urine osmolality guides whether fluid restriction, saline, or other therapy is appropriate.

Question 5Medicina Interna

Which feature best distinguishes an acute arterial occlusion from an acute deep vein thrombosis of the leg?

  1. Presence of pitting edema
  2. Sudden onset of pain
  3. Absence of palpable distal pulses Correct answer.
  4. Elevated D-dimer

Explanation

Acute arterial occlusion compromises inflow, producing pallor, pulselessness, and pain, whereas venous thrombosis typically preserves arterial pulses and causes swelling. Loss of pulses points to arterial compromise.

Question 6Medicina Interna

Which finding is most typical of a tension pneumothorax on examination?

  1. Dullness to percussion with crackles
  2. Hyperresonance with absent breath sounds on the affected side Correct answer.
  3. Bilateral inspiratory wheeze
  4. Tracheal deviation toward the affected side

Explanation

Air trapped under pressure in the pleural space produces hyperresonance and absent breath sounds on the affected side. Mediastinal structures shift away from the affected side, not toward it.

Question 7Medicina Interna

A 30-year-old presents with episodic headache, palpitations, and diaphoresis with markedly elevated blood pressure during attacks. Which test is the most appropriate initial biochemical screen for pheochromocytoma?

  1. Serum cortisol
  2. Plasma free metanephrines Correct answer.
  3. Plasma renin activity
  4. Urinary 5-HIAA

Explanation

Plasma free metanephrines are highly sensitive for pheochromocytoma and are the preferred initial biochemical test. Cortisol, renin, and 5-HIAA assess different endocrine entities.

Question 8Medicina Interna

Which electrocardiographic change is most consistent with severe hyperkalemia?

  1. Prominent U waves
  2. Prolonged QT interval
  3. Diffuse ST elevation
  4. Peaked T waves with widening of the QRS Correct answer.

Explanation

Hyperkalemia causes peaked T waves early and, as it worsens, QRS widening and sine-wave morphology. U waves and prolonged QT are more typical of hypokalemia.

Question 9Medicina Interna

Which statement about the mechanism of action of metformin is correct?

  1. It stimulates pancreatic insulin secretion
  2. It inhibits intestinal glucose absorption exclusively
  3. It blocks renal glucose reabsorption
  4. It reduces hepatic gluconeogenesis and improves insulin sensitivity Correct answer.

Explanation

Metformin works primarily by decreasing hepatic gluconeogenesis and improving peripheral insulin sensitivity. It does not act mainly by stimulating insulin release or by blocking renal glucose reabsorption.

Question 10Medicina Interna

A patient on warfarin has an INR of 8.5 with no bleeding. Which management is most appropriate?

  1. Hold warfarin and give oral vitamin K Correct answer.
  2. Transfuse fresh frozen plasma immediately
  3. Start intravenous heparin as a bridge
  4. Continue the same dose and recheck in one week

Explanation

An INR above 8 in a patient without bleeding is managed by withholding warfarin and giving low-dose oral vitamin K, with monitoring. Plasma transfusion is reserved for serious bleeding.

Question 11Medicina Interna

Which feature most strongly suggests a diagnosis of infective endocarditis rather than a noninfectious cause of fever with a murmur?

  1. A history of rheumatic fever
  2. Persistent fever with new regurgitant murmur and positive blood cultures Correct answer.
  3. Elevated erythrocyte sedimentation rate
  4. Splenomegaly alone

Explanation

The combination of fever, a new or changing regurgitant murmur, and persistently positive blood cultures is the hallmark of infective endocarditis. Isolated inflammatory markers or splenomegaly are nonspecific.

Question 12Medicina Interna

A patient presents with polyuria, polydipsia, and a serum glucose of 520 mg/dL with a pH of 7.20 and ketonuria. Which diagnosis is most likely?

  1. Hyperosmolar hyperglycemic state
  2. Diabetic ketoacidosis Correct answer.
  3. Lactic acidosis unrelated to diabetes
  4. Alcoholic ketoacidosis

Explanation

Marked hyperglycemia with acidosis and ketonuria indicates diabetic ketoacidosis. Hyperosmolar hyperglycemic state lacks significant ketosis and acidosis, and the other conditions do not explain the glucose and ketones together.

Question 13Medicina Interna

Which finding is most characteristic of a transudative pleural effusion?

  1. Low pleural fluid protein with heart failure as a common cause Correct answer.
  2. Pleural fluid LDH above two-thirds the upper limit of serum
  3. Pleural fluid protein-to-serum ratio above 0.5
  4. Pleural fluid glucose below 60 mg/dL

Explanation

Transudative effusions arise from hydrostatic or oncotic imbalances, such as heart failure, and have low protein and low LDH by Light's criteria. Exudates show high protein or LDH ratios and are more often inflammatory.

Question 14Medicina Interna

Which pattern of liver enzymes is most typical of chronic alcohol-related liver injury?

  1. ALT greater than AST with ALT above 1000
  2. AST greater than ALT with both mildly elevated Correct answer.
  3. Isolated marked elevation of alkaline phosphatase
  4. Predominant rise in total bilirubin with normal enzymes

Explanation

Alcohol-related liver injury classically produces an AST-to-ALT ratio greater than 2, often with both enzymes mildly elevated. Marked ALT elevations above 1000 suggest viral or ischemic hepatitis.

Question 15Medicina Interna

A patient has a serum calcium of 11.8 mg/dL with an inappropriately normal parathyroid hormone level. Which cause should be considered first?

  1. Chronic kidney disease with hypocalcemia
  2. Vitamin D deficiency
  3. Hypoparathyroidism
  4. Primary hyperparathyroidism Correct answer.

Explanation

Hypercalcemia with a nonsuppressed or elevated parathyroid hormone points to primary hyperparathyroidism. In PTH-independent hypercalcemia, PTH is suppressed.

Question 16Medicina Interna

Which feature is most consistent with a diagnosis of systemic lupus erythematosus?

  1. Anti-histone antibodies alone
  2. Anti-double-stranded DNA antibodies Correct answer.
  3. Rheumatoid factor positivity alone
  4. Anti-Jo-1 antibodies

Explanation

Anti-double-stranded DNA antibodies are highly specific for SLE and correlate with disease activity. Anti-histone antibodies suggest drug-induced lupus, while anti-Jo-1 suggests polymyositis.

Question 17Medicina Interna

A patient with a known history of gout presents with an acutely swollen, hot first metatarsophalangeal joint. Which finding on joint aspiration confirms the diagnosis?

  1. Elevated white cell count alone
  2. Gram-positive cocci in clusters
  3. Positively birefringent rhomboid crystals
  4. Negatively birefringent needle-shaped crystals Correct answer.

Explanation

Gout is confirmed by negatively birefringent needle-shaped monosodium urate crystals under polarized light. Positively birefringent rhomboid crystals indicate pseudogout.

Question 18Medicina Interna

Which of the following is the most appropriate first-line treatment for an uncomplicated urinary tract infection in a woman with normal renal function?

  1. Oral acyclovir
  2. Oral fluconazole
  3. Intravenous vancomycin
  4. Oral nitrofurantoin Correct answer.

Explanation

Nitrofurantoin is a first-line oral agent for uncomplicated cystitis because it concentrates in the urine and covers common uropathogens. Vancomycin, fluconazole, and acyclovir are not appropriate for this indication.

Question 19Medicina Interna

Which finding most strongly suggests a diagnosis of hemolytic anemia rather than anemia from blood loss?

  1. Low reticulocyte count
  2. Elevated lactate dehydrogenase with low haptoglobin Correct answer.
  3. Low mean corpuscular volume
  4. High serum ferritin

Explanation

Hemolysis releases LDH and consumes haptoglobin, producing elevated LDH with low haptoglobin. Blood loss does not typically lower haptoglobin.

Question 20Medicina Interna

A patient with a history of peptic ulcer disease presents with sudden severe epigastric pain and a rigid abdomen. Which diagnosis is most likely?

  1. Gastroesophageal reflux disease
  2. Acute pancreatitis
  3. Perforated peptic ulcer Correct answer.
  4. Acute cholecystitis

Explanation

Sudden severe epigastric pain with a rigid, board-like abdomen suggests perforation with peritonitis, a known complication of peptic ulcer disease. Pancreatitis and cholecystitis typically evolve more gradually.

Question 21Medicina Interna

Which of the following is the most appropriate initial test to evaluate suspected obstructive sleep apnea?

  1. Awake arterial blood gas
  2. Chest radiograph
  3. Overnight polysomnography Correct answer.
  4. Spirometry with bronchodilator response

Explanation

Overnight polysomnography is the standard diagnostic test for obstructive sleep apnea, quantifying apneas and hypopneas. Other tests do not assess sleep-disordered breathing.

Question 22Medicina Interna

A patient with severe sepsis has a mean arterial pressure of 55 mm Hg despite adequate fluid resuscitation. Which vasopressor is the first-line agent?

  1. Norepinephrine Correct answer.
  2. Vasopressin
  3. Dopamine
  4. Phenylephrine

Explanation

Norepinephrine is the recommended first-line vasopressor in septic shock because it restores vascular tone with a favorable balance of alpha- and beta-adrenergic effects. Other agents are added or substituted in specific circumstances.

Question 23Medicina Interna

Which finding on cerebrospinal fluid analysis is most consistent with bacterial meningitis?

  1. Normal cell count with elevated glucose
  2. Lymphocytic pleocytosis with normal glucose
  3. Neutrophilic pleocytosis with low glucose and high protein Correct answer.
  4. Eosinophilic pleocytosis

Explanation

Bacterial meningitis classically produces a neutrophilic pleocytosis, low CSF glucose, and elevated protein. Viral meningitis more often shows lymphocytic pleocytosis with normal glucose.

Question 24Medicina Interna

Which electrocardiographic finding is most characteristic of acute pericarditis?

  1. Peaked T waves in precordial leads
  2. Reciprocal ST depression in all leads
  3. Diffuse concave ST elevation with PR depression Correct answer.
  4. Delta wave with a short PR interval

Explanation

Acute pericarditis typically shows widespread concave ST elevation and PR segment depression without reciprocal changes. A delta wave indicates pre-excitation.

Question 25Medicina Interna

A patient develops fever, rash, and eosinophilia two weeks after starting a new medication, with involvement of the liver and kidneys. Which diagnosis best fits this presentation?

  1. Stevens-Johnson syndrome
  2. Drug reaction with eosinophilia and systemic symptoms Correct answer.
  3. Serum sickness
  4. Contact dermatitis

Explanation

Drug reaction with eosinophilia and systemic symptoms (DRESS) presents with fever, rash, eosinophilia, and internal organ involvement, typically weeks after drug exposure. Stevens-Johnson syndrome involves mucosal blistering and epidermal detachment rather than eosinophilic multiorgan involvement.

Question 26Medicina Interna

Which laboratory finding is most characteristic of nephrotic syndrome?

  1. Urinary protein excretion greater than 3.5 g per day Correct answer.
  2. Hyperkalemia with a rising creatinine over days
  3. Metabolic alkalosis with hypokalemia
  4. Urinary red blood cell casts on microscopy

Explanation

Nephrotic syndrome is defined by heavy proteinuria, conventionally above 3.5 g per 24 hours, together with hypoalbuminemia and edema. Red cell casts point to a nephritic picture, and electrolyte disturbances are not defining features.

Question 27Medicina Interna

A 68-year-old with atrial fibrillation has a CHA2DS2-VASc score of 4. Which long-term therapy most reduces the risk of cardioembolic stroke?

  1. Clopidogrel 75 mg daily
  2. Verapamil for rate control
  3. An oral anticoagulant such as apixaban Correct answer.
  4. Aspirin 81 mg daily

Explanation

Anticoagulation with a direct oral anticoagulant or warfarin is indicated when the CHA2DS2-VASc score is 2 or higher in men, because it substantially lowers cardioembolic stroke risk. Antiplatelet agents provide far weaker protection and do not address stasis-related thrombus in the atrium.

Question 28Medicina Interna

Which physiologic change occurs in the lungs at high altitude and helps explain the development of high-altitude pulmonary edema?

  1. Hypoxic pulmonary vasoconstriction Correct answer.
  2. Diffuse bronchodilation
  3. Reduced cardiac output
  4. Increased alveolar surfactant production

Explanation

Alveolar hypoxia triggers hypoxic pulmonary vasoconstriction, and an exaggerated uneven response raises capillary pressure in overperfused lung regions, favoring edema. This mechanism underlies both the prevention benefit of vasodilators and the patchy radiographic pattern.

Question 29Medicina Interna

A patient with type 1 diabetes has a blood glucose of 780 mg/dL, serum osmolality of 340 mOsm/kg, and minimal ketonuria. Which condition is most likely?

  1. Diabetic ketoacidosis
  2. Lactic acidosis
  3. Hyperosmolar hyperglycemic state Correct answer.
  4. Alcoholic ketoacidosis

Explanation

Marked hyperglycemia with very high serum osmolality and little or no ketosis characterizes the hyperosmolar hyperglycemic state, which occurs most often in older patients with residual insulin. Ketoacidosis usually shows substantial ketones and acidosis.

Question 30Medicina Interna

Which statement best describes the mechanism of action of low-dose aspirin in secondary prevention of myocardial infarction?

  1. It irreversibly inhibits platelet cyclooxygenase-1, reducing thromboxane A2 production Correct answer.
  2. It activates antithrombin III
  3. It antagonizes vitamin K-dependent clotting factors
  4. It directly blocks platelet glycoprotein IIb/IIIa receptors

Explanation

Aspirin acetylates cyclooxygenase-1 in platelets, and because platelets cannot synthesize new enzyme, thromboxane A2 generation is suppressed for the platelet lifespan. This underlies both the antithrombotic benefit and the bleeding risk.

Question 31Medicina Interna

Which finding is most consistent with a diagnosis of primary hypothyroidism rather than central hypothyroidism?

  1. Normal free thyroxine with an elevated thyroid-stimulating hormone
  2. Low free thyroxine with a low or inappropriately normal thyroid-stimulating hormone
  3. Low free thyroxine with an elevated thyroid-stimulating hormone Correct answer.
  4. High free thyroxine with an elevated thyroid-stimulating hormone

Explanation

In primary thyroid failure the pituitary responds appropriately with a raised thyroid-stimulating hormone, so low free thyroxine with high TSH confirms the gland as the site of disease. Central hypothyroidism instead shows low thyroxine without an adequate TSH rise.

Question 32Medicina Interna

A patient with cirrhosis presents with confusion, asterixis, and a serum ammonia of 110 micromol/L after a gastrointestinal bleed. Which treatment is most appropriate first-line therapy?

  1. Intravenous furosemide
  2. Lactulose titrated to two or three soft stools daily Correct answer.
  3. Spironolactone
  4. Oral ciprofloxacin

Explanation

Lactulose is first-line therapy for hepatic encephalopathy; it acidifies the colon and traps ammonia, and dosing is titrated to soft stools. Precipitating factors such as bleeding should also be treated, but lactulose remains the initial pharmacologic step.

Question 33Medicina Interna

Which finding on joint aspiration most strongly suggests septic arthritis rather than an acute gout flare?

  1. Needle-shaped negatively birefringent crystals
  2. A synovial white cell count above 50,000 per microliter with a Gram stain showing organisms Correct answer.
  3. A positive antinuclear antibody test
  4. A synovial white cell count of 2,000 per microliter

Explanation

Synovial fluid in septic arthritis is typically highly inflammatory, often above 50,000 white cells per microliter, and identification of organisms on Gram stain or culture is definitive. Crystal analysis instead confirms gout or pseudogout.

Question 34Medicina Interna

Which vaccination is specifically recommended for adults with functional or anatomic asplenia to prevent overwhelming infection?

  1. Yellow fever vaccination
  2. Live attenuated intranasal influenza vaccination
  3. Pneumococcal vaccination in addition to meningococcal and Haemophilus influenzae type b vaccination Correct answer.
  4. Hepatitis A vaccination alone

Explanation

Asplenic patients are at high risk for encapsulated organisms, so pneumococcal, meningococcal, and Haemophilus influenzae type b immunizations are indicated. Live vaccines are generally avoided in immunocompromised hosts.

Question 35Medicina Interna

A patient with chronic obstructive pulmonary disease has a resting arterial oxygen tension of 52 mm Hg while breathing room air and cor pulmonale. Which intervention most improves survival?

  1. Inhaled short-acting beta-agonist as needed
  2. Regular chest physiotherapy
  3. Oral theophylline
  4. Long-term continuous oxygen therapy Correct answer.

Explanation

Long-term oxygen therapy improves survival in COPD with severe resting hypoxemia, conventionally defined as a PaO2 at or below 55 mm Hg, or with cor pulmonale at slightly higher values. Bronchodilators relieve symptoms but have not been shown to reduce mortality.

Question 36Medicina Interna

Which finding is most characteristic of an upper motor neuron lesion?

  1. Areflexia with flaccid tone
  2. Hyperreflexia with a Babinski sign Correct answer.
  3. Sensory loss in a dermatomal pattern
  4. Fasciculations with muscle atrophy

Explanation

Upper motor neuron lesions produce increased tone, hyperreflexia, and extensor plantar responses because cortical inhibition of the cord is lost. Lower motor neuron lesions instead cause flaccidity, atrophy, and fasciculations.

Question 37Medicina Interna

A patient develops muscle weakness, polyuria, and palpitations while taking furosemide. Which electrolyte abnormality best explains these findings?

  1. Hypokalemia Correct answer.
  2. Hyperkalemia
  3. Hypernatremia
  4. Hypercalcemia

Explanation

Loop diuretics increase distal sodium delivery and cause potassium and magnesium wasting, producing hypokalemia with weakness, arrhythmia, and polyuria from impaired concentrating ability. Potassium should be repleted and monitored.

Question 38Medicina Interna

A patient presents with sudden painless loss of vision in one eye described as a curtain descending, lasting minutes and resolving. Which mechanism best explains this symptom?

  1. Optic neuritis
  2. Retinal artery embolism from a carotid or cardiac source Correct answer.
  3. Vitreous hemorrhage
  4. Acute angle-closure glaucoma

Explanation

Transient monocular visual loss with a curtain pattern is amaurosis fugax, reflecting temporary retinal ischemia from an embolus, often from the internal carotid artery. It is a warning sign for stroke and warrants urgent vascular and cardiac evaluation.

Question 39Medicina Interna

A patient with a known mechanical mitral valve develops fever and a new regurgitant murmur. Which finding on echocardiography would most strongly support prosthetic valve endocarditis?

  1. Increased left ventricular wall thickness
  2. Trace mitral regurgitation
  3. Mild left atrial enlargement
  4. A mobile echodensity on the valve with a new paravalvular leak Correct answer.

Explanation

A mobile vegetation together with a new paravalvular leak indicates infection with dehiscence of the prosthesis, which is a major echocardiographic criterion. Chronic chamber changes do not establish active infection.

Question 40Medicina Interna

A patient with a recent myocardial infarction develops a new holosystolic murmur at the apex with pulmonary edema and hypotension. Which complication is most likely?

  1. Ventricular septal defect
  2. Pericardial tamponade
  3. Papillary muscle rupture with acute mitral regurgitation Correct answer.
  4. Left ventricular free wall rupture

Explanation

Papillary muscle rupture after infarction causes acute severe mitral regurgitation, presenting with a new holosystolic murmur, flash pulmonary edema, and cardiogenic shock. The posteromedial papillary muscle is most vulnerable because of its single blood supply.

Question 41Cirugía

A 24-year-old man presents with right lower quadrant pain, anorexia and low-grade fever. On examination there is tenderness at McBurney's point with guarding. Which diagnosis is most likely?

  1. Acute pancreatitis
  2. Left ureteral colic
  3. Acute appendicitis Correct answer.
  4. Acute cholecystitis

Explanation

Pain migrating to the right lower quadrant with anorexia, low-grade fever and localized peritoneal signs at McBurney's point is the classic presentation of acute appendicitis. Cholecystitis and pancreatitis produce epigastric or right upper quadrant pain, and ureteral colic causes colicky flank pain radiating to the groin.

Question 42Cirugía

Which finding on physical examination is most characteristic of acute cholecystitis?

  1. Blumberg sign
  2. Psoas sign
  3. Rovsing sign
  4. Murphy sign Correct answer.

Explanation

Murphy sign is inspiratory arrest on deep palpation of the right upper quadrant and reflects an inflamed gallbladder. Rovsing and psoas signs are associated with appendicitis, and Blumberg sign indicates rebound peritoneal irritation.

Question 43Cirugía

A patient has a deep partial-thickness burn involving approximately 18% of the total body surface area. Using the Parkland formula, what volume of crystalloid should be given in the first 8 hours after the burn?

  1. Twice the calculated 24-hour total
  2. The entire 24-hour total
  3. One quarter of the calculated 24-hour total
  4. Half of the calculated 24-hour total Correct answer.

Explanation

The Parkland formula calculates 4 mL/kg per percent TBSA over 24 hours, with half given in the first 8 hours from the time of injury and the remainder over the next 16 hours. The first 8-hour portion is therefore half of the total.

Question 44Cirugía

Which parameter is the most sensitive early indicator of hemorrhagic shock in a previously healthy adult?

  1. Urine output
  2. Hemoglobin concentration
  3. Systolic blood pressure
  4. Heart rate Correct answer.

Explanation

Tachycardia is an early compensatory response to acute blood loss, whereas blood pressure is maintained until class III hemorrhage and hemoglobin falls only after hemodilution. Urine output falls later as renal perfusion declines.

Question 45Cirugía

A 55-year-old woman has a firm, painless breast mass fixed to the skin with peau d'orange. Which feature most strongly suggests malignancy rather than a benign lesion?

  1. Fixation to surrounding tissue Correct answer.
  2. Bilateral symmetry
  3. Smooth mobile borders
  4. Cyclical tenderness

Explanation

Malignant tumors invade surrounding structures, producing fixation, skin dimpling and peau d'orange from lymphatic obstruction. Benign lesions such as fibroadenomas are typically mobile with smooth borders.

Question 46Cirugía

Which type of hernia carries the highest risk of strangulation?

  1. Umbilical hernia in an adult
  2. Direct inguinal hernia
  3. Femoral hernia Correct answer.
  4. Sliding hiatal hernia

Explanation

Femoral hernias pass through the narrow, rigid femoral ring, which constricts the neck and predisposes to incarceration and strangulation. Inguinal and umbilical hernias have wider defects and lower strangulation rates.

Question 47Cirugía

A 68-year-old man has painless gross hematuria. Which diagnosis must be excluded first?

  1. Acute cystitis
  2. Benign prostatic hyperplasia
  3. Urothelial bladder carcinoma Correct answer.
  4. Nephrolithiasis

Explanation

Painless gross hematuria in an older adult is a classic presentation of urothelial malignancy and warrants cystoscopy and imaging. Cystitis causes dysuria, BPH causes obstructive symptoms, and stones cause colicky pain.

Question 48Cirugía

Which finding best indicates that a patient with acute abdominal pain requires immediate surgical exploration?

  1. Localized tenderness without guarding
  2. Rigid abdomen with absent bowel sounds Correct answer.
  3. Hyperactive bowel sounds with colic
  4. Mild distension with tympanitic percussion

Explanation

A rigid, silent abdomen indicates generalized peritonitis, usually from a perforated viscus, and mandates urgent laparotomy. Localized tenderness without guarding and colicky hyperactive sounds suggest less advanced pathology.

Question 49Cirugía

A patient develops fever, tachycardia and hypotension on the third postoperative day after colorectal surgery. Which complication is most likely?

  1. Paralytic ileus
  2. Wound seroma
  3. Anastomotic leak Correct answer.
  4. Atelectasis

Explanation

An anastomotic leak typically presents on postoperative days 3 to 7 with fever, tachycardia, abdominal pain and sepsis. Atelectasis usually causes early hypoxia, while seroma and ileus do not produce septic shock.

Question 50Cirugía

Which maneuver is used to reduce a nursemaid's elbow in a young child?

  1. Supination of the forearm with flexion of the elbow Correct answer.
  2. Traction with internal rotation of the shoulder
  3. Axial loading of the forearm
  4. Hyperextension of the elbow with pronation

Explanation

Nursemaid's elbow is a radial head subluxation reduced by supinating the forearm while flexing the elbow, which reseats the annular ligament. Hyperextension and axial loading may worsen the injury.