I85PREP
⌘ K
Panama ECBM Medical Licensure study materials
Panama ECBM Medical Licensure study resources

Panama ECBM Medical Licensure practice questions

One question at a time. Build your Panama ECBM Medical Licensure 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 58-year-old man with type 2 diabetes has an eGFR of 28 mL/min/1.73 m². Which oral antihyperglycemic agent should be avoided because it requires adequate renal function to be safe and effective?

  1. Glimepiride
  2. Metformin Correct answer.
  3. Linagliptin
  4. Empagliflozin

Explanation

Metformin is cleared renally and accumulates when eGFR falls below 30 mL/min/1.73 m², increasing the risk of lactic acidosis, so it is contraindicated at this level of function. Linagliptin is predominantly biliary and needs no dose adjustment, while the other agents have different renal considerations.

Question 2Medicina Interna

A patient presents with fatigue, weight loss, and hyperpigmentation of the skin creases and oral mucosa. Which laboratory finding is most characteristic of primary adrenal insufficiency?

  1. Low serum cortisol with elevated ACTH Correct answer.
  2. Elevated aldosterone with suppressed renin
  3. High cortisol with normal ACTH after dexamethasone suppression
  4. Elevated serum cortisol with low ACTH

Explanation

In primary adrenal insufficiency the adrenal cortex cannot produce cortisol, so the loss of negative feedback raises ACTH, which also drives melanocyte-stimulating activity and hyperpigmentation. Aldosterone is also deficient, producing hyponatremia and hyperkalemia.

Question 3Medicina Interna

A 65-year-old woman has a blood pressure of 158/94 mmHg on two occasions. Which class of antihypertensive is first-line for uncomplicated hypertension in older adults according to major guidelines?

  1. Alpha-1 blockers
  2. Direct renin inhibitors
  3. Thiazide-type diuretics Correct answer.
  4. Central alpha-2 agonists

Explanation

Thiazide-type diuretics, along with ACE inhibitors, ARBs, and calcium channel blockers, are recommended first-line for uncomplicated hypertension. They are particularly effective in older adults and reduce cardiovascular events.

Question 4Medicina Interna

A 24-year-old college student develops fever, sore throat, and posterior cervical lymphadenopathy. A heterophile antibody test is positive. Which finding on examination is most consistent with this diagnosis?

  1. White plaques on the tongue that scrape off
  2. Exudative pharyngitis with palatal petechiae Correct answer.
  3. Vesicles on the palate and uvula
  4. Koplik spots on the buccal mucosa

Explanation

Infectious mononucleosis from Epstein-Barr virus commonly causes exudative pharyngitis with palatal petechiae and posterior cervical adenopathy. Koplik spots indicate measles, palatal vesicles suggest herpangina, and removable plaques suggest candidiasis.

Question 5Medicina Interna

A 70-year-old man has an acute ischemic stroke with onset 90 minutes ago and no contraindications. Which intervention provides the greatest benefit for restoring perfusion?

  1. Intravenous thrombolysis with alteplase Correct answer.
  2. Sublingual aspirin
  3. Intravenous heparin infusion
  4. Permissive hypertension

Explanation

Intravenous thrombolysis with alteplase within 4.5 hours of symptom onset improves functional outcomes in eligible patients. Aspirin is given after 24 hours or as an alternative when thrombolysis is contraindicated, and heparin has no proven benefit acutely.

Question 6Medicina Interna

Which finding is most consistent with nephrotic syndrome?

  1. Hyperkalemia with metabolic acidosis
  2. Oliguria with elevated BUN-to-creatinine ratio
  3. Hematuria with red blood cell casts
  4. Proteinuria greater than 3.5 g per day with hypoalbuminemia Correct answer.

Explanation

Nephrotic syndrome is defined by heavy proteinuria (>3.5 g/day), hypoalbuminemia, edema, and hyperlipidemia. Red blood cell casts and hematuria indicate a nephritic pattern rather than nephrotic.

Question 7Medicina Interna

A patient with chronic obstructive pulmonary disease has a resting oxygen saturation of 88% on room air and a hematocrit of 54%. Which management is most appropriate?

  1. Prophylactic antibiotics continuously
  2. Routine oral corticosteroids indefinitely
  3. No supplemental oxygen unless saturation falls below 80%
  4. Long-term home oxygen therapy Correct answer.

Explanation

Long-term oxygen therapy improves survival in COPD patients with chronic hypoxemia (PaO2 ≤55 mmHg or saturation ≤88%) and can reduce secondary polycythemia. Oxygen should be titrated to a target saturation of 88–92% in those at risk of hypercapnia.

Question 8Medicina Interna

Which electrolyte abnormality most commonly causes peaked T waves and a widened QRS complex on ECG?

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

Explanation

Hyperkalemia initially produces tall peaked T waves and, as it worsens, QRS widening and a sine-wave pattern that can progress to cardiac arrest. Hypokalemia causes flattened T waves and U waves, while hypocalcemia prolongs the QT interval.

Question 9Medicina Interna

A 45-year-old woman has a 6-month history of fatigue, cold intolerance, weight gain, and constipation. TSH is elevated and free T4 is low. Which is the most likely cause?

  1. Graves disease
  2. Hashimoto thyroiditis Correct answer.
  3. Pituitary adenoma
  4. Subacute thyroiditis

Explanation

Elevated TSH with low free T4 indicates primary hypothyroidism, most often caused by Hashimoto thyroiditis in iodine-sufficient regions. Graves disease and subacute thyroiditis cause thyrotoxicosis, and a pituitary adenoma would produce low or inappropriately normal TSH.

Question 10Medicina Interna

A 62-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4. Which anticoagulation strategy is recommended?

  1. Oral anticoagulation with a DOAC or warfarin Correct answer.
  2. Clopidogrel monotherapy
  3. No anticoagulation
  4. Aspirin alone

Explanation

A CHA2DS2-VASc score of 2 or more in men indicates sufficient stroke risk to warrant oral anticoagulation, using a direct oral anticoagulant or warfarin. Antiplatelet therapy alone is inadequate for stroke prevention in atrial fibrillation.

Question 11Medicina Interna

A 30-year-old man presents with sudden-onset severe headache described as the worst of his life. Non-contrast head CT is normal, but the clinical suspicion remains high. What is the most appropriate next step?

  1. Lumbar puncture for xanthochromia Correct answer.
  2. Empiric antibiotics for meningitis
  3. MRI of the brain without contrast
  4. Reassurance and discharge

Explanation

A normal non-contrast CT does not exclude a subarachnoid hemorrhage, especially beyond 6 hours from onset. Lumbar puncture showing xanthochromia or persistently elevated red blood cells supports the diagnosis, and CT angiography may follow.

Question 12Medicina Interna

A 55-year-old woman with rheumatoid arthritis on methotrexate and prednisone develops fever, cough, and bilateral interstitial infiltrates. Which opportunistic infection should be strongly considered?

  1. Streptococcus pneumoniae pneumonia
  2. Mycoplasma pneumoniae infection
  3. Influenza A pneumonia
  4. Pneumocystis jirovecii pneumonia Correct answer.

Explanation

Immunosuppression with corticosteroids and disease-modifying agents predisposes to Pneumocystis jirovecii pneumonia, which presents with fever, dry cough, hypoxemia, and bilateral interstitial infiltrates. Typical bacterial pathogens are also possible but less specifically linked to this immunosuppressed pattern.

Question 13Medicina Interna

A patient with cirrhosis and ascites has a serum-ascites albumin gradient of 1.5 g/dL. What does this gradient indicate?

  1. Pancreatic ascites
  2. Tuberculous peritonitis
  3. Peritoneal carcinomatosis
  4. Portal hypertension Correct answer.

Explanation

A serum-ascites albumin gradient of 1.1 g/dL or greater indicates portal hypertension as the cause of ascites, such as cirrhosis or cardiac failure. A low gradient suggests peritoneal processes such as malignancy, tuberculosis, or pancreatitis.

Question 14Medicina Interna

A 68-year-old man has a hemoglobin of 10.5 g/dL, a mean corpuscular volume of 72 fL, and a ferritin of 8 ng/mL. What is the most likely diagnosis?

  1. Thalassemia minor
  2. Anemia of chronic disease
  3. Vitamin B12 deficiency
  4. Iron deficiency anemia Correct answer.

Explanation

Microcytic anemia with a markedly low ferritin confirms iron deficiency, as ferritin is the most specific marker of iron stores. Anemia of chronic disease usually has normal or high ferritin, and B12 deficiency is macrocytic.

Question 15Medicina Interna

A 40-year-old woman has episodic palpitations, headaches, and diaphoresis with blood pressure spikes to 210/110 mmHg. Which test is the most appropriate initial screening?

  1. Serum aldosterone-to-renin ratio
  2. Overnight dexamethasone suppression test
  3. 24-hour urinary free cortisol
  4. Plasma free metanephrines Correct answer.

Explanation

The combination of paroxysmal hypertension, headache, palpitations, and diaphoresis suggests pheochromocytoma, for which plasma free metanephrines are the most sensitive initial test. The other tests screen for primary aldosteronism or Cushing syndrome.

Question 16Medicina Interna

A 75-year-old woman is admitted with community-acquired pneumonia. Which finding best predicts severe disease and need for intensive care?

  1. White blood cell count of 12,000/µL
  2. Productive cough
  3. Respiratory rate of 32 breaths per minute Correct answer.
  4. Temperature of 38.2°C

Explanation

A respiratory rate of 30 breaths per minute or more is a CURB-65 and severe-pneumonia criterion indicating high mortality risk and possible need for intensive care. Mild fever, modest leukocytosis, and productive cough are common and less discriminating.

Question 17Medicina Interna

A patient with heart failure with reduced ejection fraction is started on sacubitril-valsartan. Which prior medication must be stopped before initiating therapy to avoid angioedema?

  1. Metoprolol
  2. An ACE inhibitor Correct answer.
  3. Spironolactone
  4. Furosemide

Explanation

Sacubitril-valsartan must not be combined with an ACE inhibitor because the combination markedly increases the risk of angioedema. A washout period of at least 36 hours is recommended when switching from an ACE inhibitor.

Question 18Medicina Interna

A 28-year-old woman has recurrent episodes of symmetric weakness triggered by carbohydrate meals. During an attack, serum potassium is low. Which diagnosis is most likely?

  1. Hypokalemic periodic paralysis Correct answer.
  2. Guillain-Barré syndrome
  3. Hyperkalemic periodic paralysis
  4. Myasthenia gravis

Explanation

Hypokalemic periodic paralysis presents with episodic flaccid weakness triggered by carbohydrate-rich meals or rest, accompanied by low serum potassium. Hyperkalemic periodic paralysis is triggered by fasting and exercise, and both myasthenia and Guillain-Barré have different patterns.

Question 19Medicina Interna

A 60-year-old man with alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. Which treatment should be given immediately?

  1. Naloxone
  2. Intravenous thiamine Correct answer.
  3. Intravenous glucose alone
  4. Oral folate

Explanation

The triad of confusion, ataxia, and ophthalmoplegia suggests Wernicke encephalopathy, a thiamine deficiency emergency. Thiamine should be given before or with glucose to prevent precipitation or worsening of the encephalopathy.

Question 20Medicina Interna

A 50-year-old woman has a positive antinuclear antibody test and meets criteria for systemic lupus erythematosus. Which antibody is most specific for lupus and associated with a lower risk of nephritis?

  1. Anti-Smith antibody Correct answer.
  2. Anti-histone antibody
  3. Anti-centromere antibody
  4. Anti-double-stranded DNA

Explanation

Anti-Smith antibody is highly specific for systemic lupus erythematosus and is not associated with nephritis, whereas anti-double-stranded DNA correlates with renal involvement. Anti-histone antibodies suggest drug-induced lupus, and anti-centromere antibodies suggest limited scleroderma.

Question 21Medicina Interna

A patient with a history of gastrectomy develops paresthesias, loss of vibration sense, and a macrocytic anemia. Which deficiency explains this presentation?

  1. Iron deficiency
  2. Vitamin D deficiency
  3. Vitamin C deficiency
  4. Vitamin B12 deficiency Correct answer.

Explanation

Vitamin B12 is absorbed with intrinsic factor produced by gastric parietal cells; after gastrectomy, deficiency causes macrocytic anemia and subacute combined degeneration of the spinal cord. Iron deficiency causes microcytic anemia without sensory loss.

Question 22Medicina Interna

A 66-year-old man with chronic kidney disease has a creatinine of 3.2 mg/dL and is being considered for intravenous contrast. Which measure best reduces the risk of contrast-induced nephropathy?

  1. Intravenous sodium bicarbonate alone
  2. N-acetylcysteine alone
  3. Adequate hydration with isotonic saline Correct answer.
  4. High-dose furosemide

Explanation

Adequate peri-procedural hydration with isotonic saline is the best-supported intervention to reduce contrast-induced nephropathy. Furosemide and N-acetylcysteine have not consistently shown benefit, and bicarbonate is not superior to saline.

Question 23Medicina Interna

A 35-year-old man with a history of intravenous drug use presents with fever and a new holosystolic murmur at the left sternal border that intensifies with inspiration. Which valve is most likely affected?

  1. Aortic valve
  2. Tricuspid valve Correct answer.
  3. Mitral valve
  4. Pulmonary valve

Explanation

Infective endocarditis in people who inject drugs most commonly affects the tricuspid valve, producing a holosystolic murmur that increases with inspiration (Carvallo sign) and often septic pulmonary emboli. Left-sided valves are affected in other risk groups.

Question 24Medicina Interna

A 55-year-old man has a pleural effusion. Analysis shows a pH of 7.15, glucose of 40 mg/dL, and a positive Gram stain. What is the most appropriate management?

  1. Chest tube drainage with antibiotics Correct answer.
  2. Observation with repeat imaging in 48 hours
  3. Thoracentesis alone without drainage
  4. Diuresis with furosemide

Explanation

A pleural fluid pH below 7.20, low glucose, and positive Gram stain indicate a complicated parapneumonic effusion or empyema, which requires prompt chest tube drainage plus antibiotics. Simple thoracentesis alone is insufficient because the infected fluid reaccumulates.

Question 25Medicina Interna

A 42-year-old woman presents with hypertension, hypokalemia, and metabolic alkalosis. Which confirmatory test best establishes the diagnosis of primary aldosteronism?

  1. An elevated aldosterone-to-renin ratio with suppressed renin Correct answer.
  2. A high plasma metanephrine level
  3. An elevated plasma cortisol after ACTH stimulation
  4. A low aldosterone with elevated renin

Explanation

Primary aldosteronism is confirmed by an elevated aldosterone concentration with suppressed renin, giving a high aldosterone-to-renin ratio. The combination of hypertension, hypokalemia, and metabolic alkalosis is the classic presentation.

Question 26Medicina Interna

A 58-year-old man with type 2 diabetes has an eGFR of 52 mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 350 mg/g. Which medication class slows progression of his kidney disease and reduces cardiovascular events?

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

Explanation

In diabetic kidney disease with albuminuria, blockade of the renin-angiotensin system with an ACE inhibitor or ARB reduces proteinuria and slows decline in glomerular filtration rate. Diuretics and alpha-blockers control blood pressure but do not confer the same renoprotection.

Question 27Medicina Interna

Which arterial blood gas finding is most characteristic of an acute metabolic acidosis with appropriate respiratory compensation?

  1. Low pH with a primary decrease in bicarbonate and a secondary fall in PaCO2 Correct answer.
  2. High pH with a primary increase in bicarbonate and a secondary rise in PaCO2
  3. Normal pH with normal bicarbonate and normal PaCO2
  4. Low pH with a primary increase in PaCO2 and a secondary rise in bicarbonate

Explanation

Metabolic acidosis lowers serum bicarbonate, which lowers pH; the appropriate response is hyperventilation, lowering PaCO2. A primary rise in PaCO2 with elevated bicarbonate describes metabolic alkalosis, not acidosis.

Question 28Medicina Interna

A 70-year-old woman is admitted with fever, productive cough, and a right lower lobe infiltrate. Which parameter is most useful for estimating the severity of community-acquired pneumonia at the bedside?

  1. Serum ferritin
  2. CURB-65 score Correct answer.
  3. Body mass index
  4. Erythrocyte sedimentation rate

Explanation

CURB-65 uses confusion, urea, respiratory rate, blood pressure, and age to stratify pneumonia severity and guide site of care. The other listed parameters are not validated severity instruments for pneumonia.

Question 29Medicina Interna

A 46-year-old woman has a 3-month history of diffuse neck pain and palpitations. Examination reveals a tender, enlarged thyroid and mild tremor. TSH is suppressed and free T4 is elevated. Which diagnosis is most likely?

  1. Hashimoto thyroiditis
  2. Subacute (De Quervain) thyroiditis Correct answer.
  3. Toxic multinodular goiter
  4. Graves disease

Explanation

Subacute thyroiditis presents with a painful, tender thyroid, thyrotoxicosis from follicular destruction, and suppressed TSH with elevated free T4. Graves disease and toxic multinodular goiter cause thyrotoxicosis without a tender thyroid, and Hashimoto thyroiditis is typically painless and often hypothyroid.

Question 30Medicina Interna

A 62-year-old man with decompensated heart failure has a serum sodium of 128 mEq/L and is clinically euvolemic. Which initial fluid strategy is most appropriate?

  1. Fluid restriction Correct answer.
  2. Rapid infusion of 0.9% saline
  3. Hypertonic 3% saline bolus
  4. Free water intake

Explanation

Hypervolemic and euvolemic hyponatremia in heart failure reflect excess total body water relative to sodium, so fluid restriction is the initial step. Saline and free water worsen the dilutional state, and hypertonic saline is reserved for symptomatic severe hyponatremia.

Question 31Medicina Interna

A 34-year-old man with a history of recurrent peptic ulcer disease presents with severe epigastric pain radiating to the back. CT shows a fluid collection around the pancreas. Which etiology of acute pancreatitis is most likely in this patient?

  1. Gallstone disease Correct answer.
  2. Alcohol use
  3. Hypertriglyceridemia
  4. Hypercalcemia

Explanation

Gallstones and alcohol are the two leading causes of acute pancreatitis; in a patient with recurrent ulcer disease and no alcohol history, gallstone disease remains the most common cause overall. Hypertriglyceridemia and hypercalcemia are less common causes.

Question 32Medicina Interna

A 55-year-old man with type 2 diabetes and a prior myocardial infarction has an LDL cholesterol of 145 mg/dL on maximally tolerated statin. Which additional therapy most reduces cardiovascular risk?

  1. Niacin
  2. Cholestyramine
  3. Fenofibrate
  4. Ezetimibe Correct answer.

Explanation

Adding ezetimibe to maximally tolerated statin therapy further lowers LDL and improves cardiovascular outcomes in high-risk patients. Fibrates, niacin, and bile acid sequestrants do not provide the same outcome benefit in this setting.

Question 33Medicina Interna

A 29-year-old woman has a 2-day history of dysuria, frequency, and suprapubic discomfort without fever or flank pain. Urinalysis shows nitrites and leukocyte esterase. Which is the most appropriate initial management?

  1. Intravenous ceftriaxone
  2. Oral nitrofurantoin Correct answer.
  3. Observation without antibiotics
  4. Oral fluconazole

Explanation

Uncomplicated cystitis in a woman is treated with oral antibiotics such as nitrofurantoin. Parenteral ceftriaxone is reserved for pyelonephritis, fluconazole is for fungal infection, and untreated bacterial cystitis risks progression.

Question 34Medicina Interna

A 60-year-old man with long-standing hypertension presents with sudden tearing chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. Which imaging study is the initial test of choice?

  1. Contrast-enhanced CT angiography of the chest Correct answer.
  2. Exercise stress testing
  3. Transthoracic echocardiography
  4. Chest radiograph

Explanation

Aortic dissection is suspected with abrupt tearing pain and interarm blood pressure difference; contrast-enhanced CT angiography is the initial diagnostic test of choice. Echocardiography and radiography are less sensitive, and stress testing is contraindicated.

Question 35Medicina Interna

A 48-year-old woman presents with fatigue, arthralgias, and hyperpigmentation of the skin. Blood pressure is 90/60 mmHg and she reports salt craving. Which laboratory finding best supports primary adrenal insufficiency?

  1. Elevated ACTH with low cortisol Correct answer.
  2. Low ACTH with elevated cortisol
  3. Elevated ACTH with elevated cortisol
  4. Low ACTH with low cortisol

Explanation

Primary adrenal insufficiency causes cortisol deficiency with loss of feedback, producing elevated ACTH. Secondary adrenal insufficiency shows low ACTH with low cortisol, and Cushing syndrome shows elevated cortisol.

Question 36Medicina Interna

A 65-year-old man with atrial fibrillation is started on warfarin. Three days later he develops painful, dusky toes with a mottled appearance. Which underlying condition best explains this complication?

  1. Von Willebrand disease
  2. Hemophilia A
  3. Protein C deficiency Correct answer.
  4. Glucose-6-phosphate dehydrogenase deficiency

Explanation

Warfarin initially lowers protein C, a vitamin K-dependent anticoagulant, before factor levels fall, creating a transient hypercoagulable state that can cause warfarin-induced skin necrosis. Hemophilia, von Willebrand disease, and G6PD deficiency do not produce this phenomenon.

Question 37Medicina Interna

A 52-year-old man with cirrhosis presents with hematemesis. Endoscopy shows bleeding esophageal varices. After initial resuscitation and octreotide, which intervention most reduces rebleeding and mortality?

  1. Transjugular intrahepatic portosystemic shunt
  2. Oral lactulose
  3. Prophylactic antibiotics Correct answer.
  4. Intravenous proton pump inhibitor

Explanation

Prophylactic antibiotics reduce bacterial infection, rebleeding, and mortality in patients with variceal hemorrhage and should be given routinely. PPIs and lactulose do not address variceal bleeding, and TIPS is reserved for refractory or recurrent bleeding.

Question 38Medicina Interna

A 38-year-old woman has a 6-month history of symmetric small-joint pain and morning stiffness lasting 90 minutes. Examination shows swelling of the metacarpophalangeal joints bilaterally. Which serologic test is most specific for rheumatoid arthritis?

  1. Antineutrophil cytoplasmic antibody
  2. Rheumatoid factor
  3. Anti-cyclic citrullinated peptide antibody Correct answer.
  4. Antinuclear antibody

Explanation

Anti-cyclic citrullinated peptide antibody has high specificity for rheumatoid arthritis and predicts erosive disease. Rheumatoid factor is sensitive but less specific, and ANA and ANCA are associated with other conditions.

Question 39Medicina Interna

A 72-year-old man with known coronary artery disease presents with 45 minutes of substernal chest pressure and diaphoresis. ECG shows ST-segment elevation in leads V2-V4. Which is the most appropriate immediate reperfusion strategy?

  1. Coronary artery bypass grafting
  2. Fibrinolytic therapy
  3. Primary percutaneous coronary intervention Correct answer.
  4. Exercise stress testing

Explanation

ST-elevation myocardial infarction is treated with emergent reperfusion, and primary percutaneous coronary intervention is preferred when available within the recommended time window. Fibrinolysis is an alternative only when PCI cannot be performed promptly, and surgery and stress testing are not acute reperfusion strategies.

Question 40Medicina Interna

A 68-year-old woman with a 40-pack-year smoking history presents with progressive dyspnea and weight loss. Chest CT shows a central mass, and biopsy reveals small cell lung carcinoma. Which paraneoplastic syndrome is most strongly associated with this tumor?

  1. Hypoglycemia from insulinoma
  2. Carcinoid syndrome
  3. Hypercalcemia of malignancy
  4. Syndrome of inappropriate antidiuretic hormone secretion Correct answer.

Explanation

Small cell lung carcinoma is a neuroendocrine tumor that frequently causes ectopic ADH secretion and SIADH. Hypercalcemia is more typical of squamous cell carcinoma, and carcinoid syndrome and insulinoma are unrelated.

Question 41Cirugía General

¿Cuál es el tiempo máximo recomendado de isquemia caliente en una torsión testicular antes de indicar orquiectomía por necrosis?

  1. 48 horas
  2. 12 horas
  3. 24 horas
  4. 6 horas Correct answer.

Explanation

La viabilidad testicular disminuye de forma marcada tras aproximadamente 6 horas de isquemia caliente; pasado ese punto la necrosis es frecuente y la orquiectomía suele ser necesaria. La detorsión con fijación se intenta cuando el cuadro es más breve.

Question 42Cirugía General

Un paciente presenta dolor abdominal en fosa ilíaca derecha con signo de Blumberg positivo y leucocitosis. ¿Cuál es el diagnóstico más probable?

  1. Apendicitis aguda Correct answer.
  2. Colecistitis aguda
  3. Diverticulitis sigmoidea
  4. Pancreatitis aguda

Explanation

El dolor migratorio a fosa ilíaca derecha con irritación peritoneal localizada y leucocitosis es el patrón clásico de apendicitis aguda. La ecografía o tomografía confirman el diagnóstico.

Question 43Cirugía General

¿Cuál de los siguientes hallazgos es más característico de la hernia inguinal indirecta?

  1. Es más frecuente en mujeres mayores
  2. Se exterioriza por el anillo inguinal profundo Correct answer.
  3. Se exterioriza medial a los vasos epigástricos inferiores
  4. Se localiza en el triángulo femoral

Explanation

La hernia inguinal indirecta protruye a través del anillo inguinal profundo y recorre el conducto inguinal. Su relación con los vasos epigástricos es lateral, lo que la distingue de la directa.

Question 44Cirugía General

¿Cuál es el estudio inicial de elección ante sospecha de colelitiasis sintomática no complicada?

  1. Tomografía computarizada abdominal
  2. Gammagrafía hepatobiliar
  3. Colangiopancreatografía retrógrada endoscópica
  4. Ecografía abdominal Correct answer.

Explanation

La ecografía abdominal es no invasiva, accesible y sensible para detectar cálculos vesiculares y signos de colecistitis. Es el estudio inicial recomendado en la colelitiasis sintomática.

Question 45Cirugía General

Un paciente con pancreatitis aguda presenta hipocalcemia, equimosis periumbilical y deterioro respiratorio. ¿Qué complicación debe sospecharse?

  1. Pseudoquiste pancreático
  2. Obstrucción intestinal alta
  3. Necrosis pancreática infectada Correct answer.
  4. Trombosis de la vena porta

Explanation

La necrosis pancreática extensa, especialmente si se infecta, produce un cuadro séptico con hipocalcemia y signos hemorrágicos periumbilicales. La tomografía con contraste y la punción guiada confirman la infección.

Question 46Cirugía General

¿Cuál es la indicación quirúrgica absoluta en la úlcera péptica perforada?

  1. Tratamiento con inhibidores de bomba exclusivamente
  2. Cierre primario o parche de Graham urgente Correct answer.
  3. Erradicación de Helicobacter pylori ambulatoria
  4. Observación con sonda nasogástrica durante 48 horas

Explanation

La perforación libre de una úlcera péptica constituye una emergencia quirúrgica que requiere cierre del defecto, frecuentemente con parche de Graham, y lavado peritoneal. El tratamiento médico aislado no controla la peritonitis química.

Question 47Cirugía General

¿Cuál es el signo clínico más sugestivo de obstrucción intestinal mecánica?

  1. Vómitos fecaloideos con distensión abdominal Correct answer.
  2. Ictericia indolora progresiva
  3. Melena con dolor epigástrico
  4. Diarrea acuosa profusa

Explanation

La obstrucción mecánica produce distensión, dolor cólico, vómitos y ausencia de gases; los vómitos fecaloideos indican obstrucción distal prolongada. La radiografía muestra niveles hidroaéreos.

Question 48Cirugía General

En un paciente con hemorragia digestiva alta por varices esofágicas, ¿cuál es la medida farmacológica inicial más adecuada?

  1. Loperamida oral
  2. Metoclopramida intravenosa
  3. Amitriptilina oral
  4. Terlipresina intravenosa Correct answer.

Explanation

Los análogos de la somatostatina como la terlipresina reducen el flujo esplácnico y la presión portal, controlando la hemorragia varicosa. Se combinan con ligadura endoscópica.

Question 49Cirugía General

¿Cuál es el criterio de Ranson que se evalúa al ingreso en la pancreatitis aguda?

  1. Calcio sérico menor de 8 mg/dL
  2. Leucocitos mayores de 16.000/mm³ Correct answer.
  3. Descenso del hematocrito mayor del 10%
  4. Secuestro de líquidos mayor de 6 litros

Explanation

Los criterios de Ranson al ingreso incluyen edad, leucocitos, glucemia, LDH y AST. La leucocitosis superior a 16.000/mm³ es uno de ellos.

Question 50Cirugía General

¿Cuál es la complicación más temida de la colecistectomía laparoscópica?

  1. Lesión de la vía biliar Correct answer.
  2. Infección del sitio quirúrgico
  3. Hernia umbilical
  4. Íleo paralítico prolongado

Explanation

La lesión de la vía biliar es la complicación más grave y específica de la colecistectomía laparoscópica. La visión crítica de seguridad reduce su incidencia.