I85PREP
⌘ K
ENAM Administration Cycle A study materials
ENAM Administration Cycle A study resources

ENAM Administration Cycle A practice questions

One question at a time. Build your ENAM Administration Cycle A understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Medicina Interna

A 62-year-old man with type 2 diabetes has an eGFR of 28 mL/min/1.73 m². Which antihyperglycemic agent class should be avoided because it requires adequate renal function to be effective and safe?

  1. DPP-4 inhibitors
  2. SGLT2 inhibitors
  3. Biguanides (metformin) Correct answer.
  4. GLP-1 receptor agonists

Explanation

Metformin is renally cleared and accumulates in chronic kidney disease, raising the risk of lactic acidosis; it is generally contraindicated below an eGFR of about 30 mL/min/1.73 m². Other agents require dose adjustment but remain usable at this level.

Question 2Medicina Interna

Which finding on physical examination is most characteristic of an exudative pleural effusion?

  1. Stony dullness to percussion Correct answer.
  2. Absent breath sounds
  3. Tracheal deviation toward the effusion
  4. Decreased tactile fremitus

Explanation

Stony dullness is a classic sign of pleural fluid, and exudates are typically associated with inflammatory pleuritis. The other listed signs occur with effusions generally and do not distinguish exudate from transudate.

Question 3Medicina Interna

A patient presents with sudden-onset tearing chest pain radiating to the back, a blood pressure difference of 25 mmHg between arms, and a widened mediastinum on chest radiograph. What is the most appropriate immediate next step?

  1. Transthoracic echocardiography
  2. D-dimer testing
  3. Urgent CT angiography of the aorta Correct answer.
  4. Troponin and serial ECGs

Explanation

The presentation is classic for acute aortic dissection, and CT angiography is the diagnostic study of choice in a hemodynamically stable patient. Delay for less specific tests risks catastrophic rupture.

Question 4Medicina Interna

Which laboratory pattern is most consistent with iron deficiency anemia?

  1. High ferritin, high TIBC, normal transferrin saturation
  2. Normal ferritin, normal TIBC, low transferrin saturation
  3. Low ferritin, high TIBC, low transferrin saturation Correct answer.
  4. High ferritin, low TIBC, high transferrin saturation

Explanation

Iron deficiency produces depleted stores (low ferritin), compensatory increased iron-binding capacity (high TIBC), and reduced saturation. This distinguishes it from anemia of chronic disease, where ferritin is normal or high.

Question 5Medicina Interna

A 70-year-old woman with atrial fibrillation has a CHA₂DS₂-VASc score of 4 and no bleeding risk factors. What is the recommended antithrombotic strategy?

  1. Oral anticoagulation with a DOAC or warfarin Correct answer.
  2. Dual antiplatelet therapy
  3. Aspirin monotherapy
  4. No antithrombotic therapy

Explanation

A CHA₂DS₂-VASc score of 2 or higher in women (or 1 in men) warrants oral anticoagulation to prevent cardioembolic stroke. Antiplatelet therapy is inferior for stroke prevention in nonvalvular AF.

Question 6Medicina Interna

Which spirometric finding confirms a diagnosis of COPD in a symptomatic patient with appropriate risk factors?

  1. Increased residual volume alone
  2. Post-bronchodilator FEV₁/FVC ratio below 0.70 Correct answer.
  3. Pre-bronchodilator FEV₁/FVC ratio below 0.80
  4. Reduced diffusing capacity alone

Explanation

Airflow obstruction that persists after bronchodilator administration, defined as FEV₁/FVC < 0.70, establishes COPD. Other measures may support the diagnosis but do not define it.

Question 7Medicina Interna

A patient with decompensated heart failure has hyponatremia and worsening renal function. Which diuretic strategy is most appropriate for symptom relief?

  1. Thiazide monotherapy
  2. Intravenous loop diuretic at escalating doses Correct answer.
  3. Oral fluid restriction without diuretics
  4. Spironolactone alone

Explanation

Loop diuretics are the mainstay for volume overload in acute decompensated heart failure; intravenous dosing with escalation addresses diuretic resistance. Other agents are adjuncts or inadequate alone.

Question 8Medicina Interna

Which serologic marker is most specific for systemic lupus erythematosus?

  1. Antinuclear antibody
  2. Anti-histone antibody
  3. Anti-double-stranded DNA antibody Correct answer.
  4. Rheumatoid factor

Explanation

Anti-dsDNA antibodies are highly specific for SLE and correlate with disease activity and nephritis. ANA is sensitive but not specific, and the other antibodies point to different conditions.

Question 9Medicina Interna

A 55-year-old man has a fasting glucose of 118 mg/dL and an HbA1c of 6.0%. What is the most appropriate interpretation?

  1. Overt diabetes mellitus
  2. Prediabetes based on impaired fasting glucose Correct answer.
  3. Type 1 diabetes mellitus
  4. Normal glucose tolerance

Explanation

A fasting glucose of 100–125 mg/dL defines impaired fasting glucose, a form of prediabetes, when HbA1c is below 6.5%. This warrants lifestyle intervention and monitoring.

Question 10Medicina Interna

Which electrolyte abnormality is most commonly associated with prolonged vomiting?

  1. Hypocalcemia with respiratory alkalosis
  2. Hypernatremia with metabolic acidosis
  3. Hyperkalemia with metabolic acidosis
  4. Hypokalemia with metabolic alkalosis Correct answer.

Explanation

Vomiting causes loss of hydrogen and chloride ions, producing metabolic alkalosis, and renal potassium wasting leads to hypokalemia. Volume depletion activates aldosterone, further driving potassium loss.

Question 11Medicina Interna

A patient with cirrhosis presents with confusion, asterixis, and a serum ammonia of 120 µmol/L. Which initial therapy is most appropriate?

  1. Lactulose with correction of precipitants Correct answer.
  2. Haloperidol
  3. Furosemide
  4. Rifaximin alone

Explanation

Hepatic encephalopathy is treated with lactulose to reduce ammonia absorption, alongside correction of triggers such as infection, bleeding, or electrolyte disturbance. Rifaximin is typically added for secondary prophylaxis.

Question 12Medicina Interna

Which physical finding is most specific for ascites?

  1. Anorexia
  2. Weight gain
  3. Shifting dullness on percussion Correct answer.
  4. Abdominal distension

Explanation

Shifting dullness reflects free peritoneal fluid and is a reliable sign of ascites on examination. The other findings are nonspecific symptoms or signs.

Question 13Medicina Interna

A 68-year-old smoker has hemoptysis and a 3 cm spiculated mass on chest imaging. What is the most appropriate next diagnostic step?

  1. Observation with PET scan in 6 months
  2. Repeat chest radiograph in 3 months
  3. CT-guided core biopsy or bronchoscopy Correct answer.
  4. Empiric antibiotics

Explanation

A spiculated mass in a smoker is highly suspicious for lung cancer and requires tissue diagnosis via bronchoscopy or CT-guided biopsy. Delay risks progression.

Question 14Medicina Interna

Which finding best distinguishes diabetic ketoacidosis from hyperosmolar hyperglycemic state?

  1. Glucose above 400 mg/dL
  2. Significant ketonemia with metabolic acidosis Correct answer.
  3. Dehydration
  4. Elevated serum osmolality

Explanation

DKA is characterized by ketone body accumulation producing high anion gap metabolic acidosis, whereas HHS typically lacks significant ketosis. Hyperglycemia, hyperosmolality, and dehydration occur in both.

Question 15Medicina Interna

A patient on high-dose corticosteroids develops new hyperglycemia. What is the most appropriate management principle?

  1. HbA1c is the best immediate monitoring tool
  2. Fasting glucose is typically the most affected value
  3. Postprandial glucose is disproportionately elevated and may require prandial insulin Correct answer.
  4. Steroid-induced hyperglycemia is always permanent

Explanation

Glucocorticoids increase hepatic gluconeogenesis and insulin resistance, predominantly raising postprandial glucose. Prandial or basal insulin is often needed, and the effect resolves when steroids are stopped.

Question 16Medicina Interna

Which criterion supports a diagnosis of infective endocarditis from blood cultures?

  1. Negative cultures after 24 hours
  2. Growth only in anaerobic bottles
  3. One positive culture with a skin contaminant
  4. Two positive cultures with a typical organism in the absence of another source Correct answer.

Explanation

The modified Duke criteria accept persistently positive cultures with a typical organism as a major microbiologic criterion. Single cultures of contaminants or negative cultures do not qualify.

Question 17Medicina Interna

A patient presents with acute monoarthritis of the knee and a synovial fluid white cell count of 60,000/µL. What is the most important next step?

  1. Reassurance and discharge
  2. Intra-articular corticosteroid injection
  3. Gram stain and culture with empiric antibiotics Correct answer.
  4. NSAID monotherapy

Explanation

A synovial white count above 50,000/µL suggests septic arthritis, which requires urgent Gram stain, culture, and empiric antibiotics to prevent joint destruction.

Question 18Medicina Interna

Which is the most common cause of community-acquired pneumonia requiring hospitalization in adults?

  1. Mycoplasma pneumoniae
  2. Streptococcus pneumoniae Correct answer.
  3. Legionella pneumophila
  4. Chlamydia psittaci

Explanation

Streptococcus pneumoniae remains the leading cause of community-acquired pneumonia across severity levels. The other organisms cause atypical or zoonotic pneumonia less frequently.

Question 19Medicina Interna

A patient with a history of peptic ulcer disease presents with melena and a hemoglobin of 7 g/dL. After resuscitation, what is the most appropriate next step?

  1. Upper endoscopy within 24 hours Correct answer.
  2. Barium swallow
  3. Empiric H. pylori eradication alone
  4. Colonoscopy first

Explanation

Upper endoscopy allows identification and endoscopic hemostasis of a bleeding peptic ulcer and should follow hemodynamic stabilization. Imaging and empiric therapy do not address active bleeding.

Question 20Medicina Interna

Which feature best differentiates Crohn disease from ulcerative colitis?

  1. Continuous mucosal involvement from the rectum
  2. Presence of crypt abscesses
  3. Bloody diarrhea
  4. Transmural inflammation with skip lesions Correct answer.

Explanation

Crohn disease is characterized by transmural, discontinuous inflammation that can affect any part of the GI tract, whereas ulcerative colitis is continuous and mucosal. Crypt abscesses and bloody diarrhea occur in both.

Question 21Medicina Interna

A patient with hypertension and hypokalemia has an elevated aldosterone-to-renin ratio. What is the most likely diagnosis?

  1. Primary hyperaldosteronism Correct answer.
  2. Pheochromocytoma
  3. Renal artery stenosis
  4. Cushing syndrome

Explanation

A high aldosterone-to-renin ratio with hypertension and hypokalemia indicates autonomous aldosterone secretion, typical of primary hyperaldosteronism. Renin is suppressed, unlike in secondary causes.

Question 22Medicina Interna

Which vaccine is specifically recommended for adults with functional or anatomic asplenia?

  1. Yellow fever vaccine
  2. Rabies vaccine
  3. Hepatitis A vaccine
  4. Pneumococcal conjugate vaccine Correct answer.

Explanation

Asplenia markedly increases the risk of invasive pneumococcal disease, so pneumococcal vaccination is specifically indicated. The other vaccines are not targeted to asplenia.

Question 23Medicina Interna

A patient develops fever, rash, and eosinophilia after starting allopurinol. What is the most likely diagnosis?

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

Explanation

DRESS syndrome presents with fever, rash, eosinophilia, and internal organ involvement, classically triggered by allopurinol. It differs from SJS by prominent eosinophilia and multiorgan involvement.

Question 24Medicina Interna

A patient with chronic kidney disease has a bicarbonate of 18 mEq/L and normal anion gap. What is the most appropriate management?

  1. Intravenous normal saline
  2. Oral sodium bicarbonate supplementation Correct answer.
  3. Loop diuretics
  4. Potassium-sparing diuretics

Explanation

Metabolic acidosis in CKD is treated with oral alkali to slow progression and reduce bone and muscle catabolism. Saline worsens acidosis, and diuretics are not the primary therapy.

Question 25Medicina Interna

Which finding on urinalysis is most suggestive of glomerulonephritis?

  1. Broad granular casts
  2. White cell casts
  3. Hyaline casts
  4. Red cell casts Correct answer.

Explanation

Red cell casts indicate glomerular bleeding and are a hallmark of glomerulonephritis. Other casts reflect tubular or interstitial processes.

Question 26Medicina Interna

A 72-year-old woman has a hemoglobin of 10.5 g/dL, a mean corpuscular volume of 72 fL, and a ferritin of 8 ng/mL. Which is the most likely cause of her anemia?

  1. Iron deficiency Correct answer.
  2. Vitamin B12 deficiency
  3. Chronic kidney disease
  4. Hemolytic anemia

Explanation

Microcytic anemia with a low ferritin indicates depleted iron stores, the hallmark of iron deficiency. Ferritin is the most specific single test for iron deficiency in adults.

Question 27Medicina Interna

A 24-year-old man has a blood pressure of 150/95 mmHg, hypokalemia, and metabolic alkalosis. Which screening test is most appropriate to evaluate for primary aldosteronism?

  1. Plasma aldosterone-to-renin ratio Correct answer.
  2. Renal artery Doppler ultrasound
  3. 24-hour urinary free cortisol
  4. Serum metanephrines

Explanation

Primary aldosteronism is screened with the plasma aldosterone-to-renin ratio; a high ratio with suppressed renin suggests autonomous aldosterone secretion. Hypokalemia and metabolic alkalosis are classic supporting features.

Question 28Medicina Interna

A 58-year-old man with type 2 diabetes has an eGFR of 45 mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 350 mg/g. Which medication class is most appropriate to slow progression of his kidney disease?

  1. Angiotensin-converting enzyme inhibitor Correct answer.
  2. Alpha-1 blocker
  3. Loop diuretic
  4. Calcium channel blocker

Explanation

In diabetic kidney disease with albuminuria, ACE inhibitors reduce intraglomerular pressure and slow progression. They are indicated when albuminuria is present regardless of blood pressure.

Question 29Medicina Interna

A 35-year-old woman has a deep vein thrombosis and reports two prior miscarriages. Which laboratory finding would most strongly support antiphospholipid syndrome?

  1. Low protein C activity
  2. Prolonged prothrombin time
  3. Elevated D-dimer
  4. Persistently positive anticardiolipin antibodies Correct answer.

Explanation

Antiphospholipid syndrome requires a clinical event (such as thrombosis or pregnancy loss) plus persistent antiphospholipid antibodies. Anticardiolipin antibodies must be positive on two occasions at least 12 weeks apart.

Question 30Medicina Interna

A 62-year-old man with a history of myocardial infarction presents with sudden-onset severe dyspnea and a systolic murmur at the left sternal border. Which is the most likely diagnosis?

  1. Ventricular septal rupture Correct answer.
  2. Pulmonary embolism
  3. Aortic dissection
  4. Pericardial tamponade

Explanation

Ventricular septal rupture is a mechanical complication of myocardial infarction that typically presents within days with a new harsh systolic murmur and cardiogenic shock. It occurs most often after anterior infarction.

Question 31Cirugía

¿Cuál es el volumen corriente inicial recomendado en la ventilación mecánica de un paciente adulto sin lesión pulmonar, calculado según el peso predicho?

  1. 12 a 15 ml/kg de peso predicho
  2. 2 a 3 ml/kg de peso predicho
  3. 10 a 12 ml/kg de peso real
  4. 6 a 8 ml/kg de peso predicho Correct answer.

Explanation

La ventilación protectora utiliza el peso predicho (basado en talla y sexo) y no el peso real, con un volumen corriente inicial de 6 a 8 ml/kg. Volúmenes mayores aumentan el riesgo de lesión pulmonar inducida por el ventilador.

Question 32Cirugía

En la evaluación inicial del paciente politraumatizado, ¿cuál es la primera medida ante un neumotórax a tensión con inestabilidad hemodinámica?

  1. Descompresión inmediata con aguja o toracostomía Correct answer.
  2. Colocación de vendaje compresivo torácico
  3. Intubación orotraqueal electiva
  4. Solicitar tomografía computarizada urgente

Explanation

El neumotórax a tensión es una emergencia que compromete la vida y requiere descompresión inmediata sin esperar estudios de imagen. La descompresión con aguja en el segundo espacio intercostal o la toracostomía digital alivia la presión.

Question 33Cirugía

¿Cuál es el signo clínico más característico de la apendicitis aguda en su presentación típica?

  1. Dolor lumbar irradiado a genitales
  2. Dolor periumbilical que migra a la fosa ilíaca derecha Correct answer.
  3. Dolor epigástrico que mejora con la ingesta
  4. Dolor en hipocondrio derecho con ictericia

Explanation

El dolor de la apendicitis comienza por irritación visceral periumbilical y migra a la fosa ilíaca derecha al comprometerse el peritoneo parietal. Este patrón migratorio es un hallazgo clásico.

Question 34Cirugía

En la colecistitis aguda litiásica, ¿cuál es el hallazgo ecográfico más sensible para el diagnóstico?

  1. Presencia de gas en la pared vesicular
  2. Aumento del tamaño hepático
  3. Signo de Murphy ecográfico con pared vesicular engrosada Correct answer.
  4. Dilatación de la vía biliar principal

Explanation

El Murphy ecográfico junto con engrosamiento de la pared vesicular y colelitiasis es el conjunto de hallazgos más sensible para colecistitis aguda. La distensión y el líquido pericolecístico complementan el diagnóstico.

Question 35Cirugía

¿Cuál es el criterio de reanimación inicial con líquidos en el paciente quemado adulto según la fórmula de Parkland?

  1. 2 ml/kg por cada 1% de superficie corporal quemada en 24 horas
  2. 4 ml/kg por cada 1% de superficie corporal quemada en 24 horas Correct answer.
  3. 8 ml/kg por cada 1% de superficie corporal quemada en 24 horas
  4. 1 ml/kg por cada 1% de superficie corporal quemada en 8 horas

Explanation

La fórmula de Parkland indica 4 ml/kg de cristaloides por cada 1% de superficie corporal quemada en las primeras 24 horas, administrando la mitad en las primeras 8 horas. Se calcula desde el momento de la lesión.

Question 36Cirugía

Un paciente presenta dolor abdominal, fiebre y leucocitosis tras una cirugía colorrectal hace 5 días. ¿Cuál es la complicación más probable a descartar?

  1. Hernia incisional estrangulada
  2. Colecistitis acalculosa
  3. Obstrucción intestinal por bridas
  4. Dehiscencia anastomótica con absceso intraabdominal Correct answer.

Explanation

En el postoperatorio temprano de cirugía colorrectal, la dehiscencia anastomótica con colección intraabdominal es la complicación grave más probable ante fiebre y dolor. Requiere evaluación urgente con imagen.

Question 37Cirugía

¿Cuál es la indicación quirúrgica absoluta en la pancreatitis aguda biliar?

  1. Pancreatitis leve con litiasis vesicular tras la resolución del episodio
  2. Hiperamilasemia aislada sin dolor
  3. Colangitis con obstrucción persistente de la vía biliar Correct answer.
  4. Pancreatitis edematosa sin complicaciones

Explanation

La colangitis con obstrucción biliar persistente requiere descompresión urgente mediante CPRE o cirugía. En pancreatitis leve la colecistectomía se realiza durante la misma hospitalización, pero no de forma emergente.

Question 38Cirugía

¿Cuál es la complicación más frecuente de la cirugía de tiroides?

  1. Hipocalcemia por hipoparatiroidismo transitorio Correct answer.
  2. Lesión del nervio laríngeo recurrente
  3. Hematoma cervical con compromiso de la vía aérea
  4. Crisis tirotóxica

Explanation

La hipocalcemia por lesión o manipulación de las glándulas paratiroides es la complicación más frecuente tras la tiroidectomía total. Suele ser transitoria y se monitoriza con calcio sérico.

Question 39Cirugía

En una hernia inguinal incarcerada con signos de estrangulación, ¿cuál es la conducta adecuada?

  1. Reducción manual forzada y observación
  2. Analgesia y reevaluación en 24 horas
  3. Cirugía urgente con resección del segmento necrótico si procede Correct answer.
  4. Uso de braguero y control ambulatorio

Explanation

La estrangulación es una urgencia quirúrgica que exige exploración y resección del intestino no viable. La reducción forzada puede reintroducir asas necróticas a la cavidad.

Question 40Cirugía

¿Cuál es el estudio inicial de elección ante sospecha de trauma abdominal cerrado con paciente hemodinámicamente estable?

  1. Lavado peritoneal diagnóstico
  2. Laparotomía exploradora inmediata
  3. Ecografía FAST seguida de tomografía con contraste Correct answer.
  4. Radiografía simple de abdomen

Explanation

En el paciente estable, la ecografía FAST orienta y la tomografía con contraste define lesiones de órganos sólidos y retroperitoneo. La laparotomía se reserva para inestabilidad o peritonitis.

Question 41Cirugía

¿Cuál es la causa más frecuente de obstrucción intestinal en el adulto operado previamente?

  1. Hernia inguinal
  2. Invaginación intestinal
  3. Bridas o adherencias Correct answer.
  4. Tumor colorrectal

Explanation

Las adherencias postoperatorias son la causa más frecuente de obstrucción del intestino delgado en adultos con cirugía previa. El manejo inicial suele ser conservador si no hay signos de estrangulación.

Question 42Cirugía

¿Cuál es el marcador bioquímico más útil en el seguimiento del carcinoma medular de tiroides?

  1. TSH
  2. Calcitonina Correct answer.
  3. Anticuerpos antiperoxidasa
  4. Tiroglobulina

Explanation

La calcitonina es el marcador del carcinoma medular de tiroides, derivado de las células C parafoliculares. Su elevación orienta al diagnóstico y sirve para monitorizar recidivas.

Question 43Cirugía

En la hemorragia digestiva alta no varicosa, ¿cuál es la medida inicial tras la estabilización hemodinámica?

  1. Cirugía de urgencia inmediata
  2. Transfusión de plaquetas profiláctica en todos los casos
  3. Suspensión de todo tratamiento antisecretor
  4. Endoscopia digestiva alta en las primeras 24 horas Correct answer.

Explanation

Tras estabilizar al paciente, la endoscopia temprana (idealmente en 24 horas) permite diagnóstico y tratamiento hemostático. La cirugía se reserva para fracaso del tratamiento endoscópico.

Question 44Cirugía

¿Cuál es el signo radiológico característico de la perforación de víscera hueca en la radiografía de abdomen de pie?

  1. Dilatación de asas con haustras
  2. Calcificaciones en hipocondrio derecho
  3. Niveles hidroaéreos múltiples
  4. Aire libre subdiafragmático Correct answer.

Explanation

El neumoperitoneo se visualiza como aire libre subdiafragmático en la radiografía en bipedestación. Es un signo de perforación de víscera hueca que requiere cirugía urgente.

Question 45Cirugía

¿Cuál es el tratamiento de elección en la trombosis venosa profunda proximal no complicada?

  1. Compresión elástica aislada
  2. Trombectomía quirúrgica de entrada
  3. Anticoagulación con heparina de bajo peso molecular Correct answer.
  4. Observación con ecografía seriada

Explanation

La anticoagulación es el pilar del tratamiento de la trombosis venosa profunda proximal para prevenir embolia pulmonar y recidiva. Los filtros de vena cava se reservan para contraindicación de anticoagulación.

Question 46Cirugía

Un paciente con cirrosis presenta hematemesis y signos de shock. Antes de la endoscopia, ¿qué fármaco debe iniciarse de forma precoz?

  1. Metoclopramida
  2. Amlodipino
  3. Paracetamol
  4. Octreótido o terlipresina Correct answer.

Explanation

En la hemorragia por varices esofágicas se inician vasoconstrictores esplácnicos como octreótido o terlipresina antes de la endoscopia. También se administra profilaxis antibiótica.

Question 47Cirugía

¿Cuál es la indicación principal de la cirugía en la enfermedad inflamatoria intestinal de Crohn?

  1. Fístulas, estenosis sintomáticas o abscesos complicados Correct answer.
  2. Reflujo gastroesofágico refractario
  3. Toda colitis leve al diagnóstico
  4. Dispepsia funcional asociada

Explanation

La cirugía en la enfermedad de Crohn se reserva para complicaciones como estenosis, fístulas, abscesos o fracaso del tratamiento médico. No es curativa y se busca preservar intestino.

Question 48Cirugía

¿Cuál es la complicación metabólica tardía más frecuente tras bypass gástrico en Y de Roux?

  1. Hiperpotasemia
  2. Acidosis metabólica hiperclorémica
  3. Déficit de hierro y vitamina B12 Correct answer.
  4. Hipercalcemia

Explanation

La malabsorción tras bypass gástrico condiciona déficits de hierro, vitamina B12, calcio y vitaminas liposolubles. El déficit de hierro es especialmente frecuente, sobre todo en mujeres.

Question 49Cirugía

En el síndrome compartimental abdominal, ¿cuál es el umbral de presión intraabdominal que define hipertensión intraabdominal en el adulto?

  1. Mayor de 5 mmHg
  2. Mayor de 40 mmHg
  3. Mayor de 25 mmHg
  4. Mayor de 12 mmHg de forma sostenida Correct answer.

Explanation

Se define hipertensión intraabdominal con presión sostenida mayor de 12 mmHg; el síndrome compartimental añade disfunción orgánica nueva. La descompresión se plantea según gravedad y disfunción.

Question 50Cirugía

¿Cuál es la actitud recomendada ante una masa mamaria palpable en una mujer de 55 años?

  1. Mamografía aislada sin estudio adicional
  2. Tratamiento antibiótico empírico
  3. Mamografía y ecografía con valoración citohistológica si procede Correct answer.
  4. Observación clínica durante un año

Explanation

Toda masa palpable en la mujer posmenopáusica requiere estudio por imagen y confirmación tisular si es sospechosa. La triple evaluación incluye clínica, imagen y anatomía patológica.