Comisión Interinstitucional para la Formación de Recursos Humanos para la Salud

(CIFRHS)
Subsecretaría de Integración y Desarrollo del Sector Salud Dirección General de Calidad y
Educación en Salud
 English Test Questions and Answers (ENARM) 2021.

1. Which of the following pathogens causes mucopurulent endocervicitis?

• Neisseria gonorrhoeae

• Herpes simplex virus

• Human papilloma virus

• Gardnerella vaginalis

• Hemophilus influenzae

2. 30-year-old housewife, sterilized two years ago, presents with vaginal discharge:
homogeneous and thin, pH: 6, potassium hydroxide test: fishy odor and presence of
"key cells”. What is the most likely diagnosis?

• Bacterial vaginosis

• HPV infection

• Vaginal candidiasis

• Lues

• Trichomoniasis

3. In most cases, the sinus and atrioventricular nodes are supplied by the artery:

• Right coronary

• Branches of the circumflex

• Marginal

• Left coronary

• Interventricular

4. Which of the following corresponds to one of the essential functions of Public Health?

• Promoting social responsibility for health

• Developing secondary prevention

• Development of social determinants of health

• Promote the development of health infrastructure

• Promote health surveillance

5. Male, 55 years old, 3 months ago he presented epigastralgia and abundant diarrhea.
History of untreated pituitary tumor. Laboratory: moderate hypercalcemia. Upper
endoscopy: multiple ulcers in the first portion of the duodenum. What is the most probable
diagnosis?

• Zollinger-Ellison Syndrome

• Chronic duodenitis

• Duodenal peptic ulcers

• Duodenal neoplasia

• Carcinoid syndrome

6. When a flaccid NB is received in a servo-control, is not breathing spontaneously, has a

HR: 80 X' and is born bathed in clear amniotic fluid, what is the first action to be taken?

• Aspirate and ventilate at positive pressure

• Position, dry and stimulate

• Intubate via endotracheal tube and aspirate

• Ventilation and cardiac massage

• Aspirate and give free-flow oxygen

7. What is the most frequent route of entry of hazardous industrial agents or substances to
which workers are exposed?

• Inhalation

• Cutaneous

• Oral

• Percutaneous

• Immersion
 8. A 10-year-old male presents with occasional "wheezing" and dry cough once a week or
with seasonal changes. He denies nocturnal symptoms. History: Asthmatic mother and
brother. Examination: scarce expiratory wheezing, without nasal flaring or retractions.
Spirometry: reversible obstructive pattern. Forced expiratory minute volume >
80% .What is the treatment of choice?

• Inhaled B2 adrenergic

• Inhaled corticosteroid

• Oral methylxanthine

• Oral leukotriene inhibitor

• Inhaled antimuscarinic

9. Which of the following statements defines a situation of high fertility and mortality rates
to one of low rates; as well as the change from a pattern in which infectious-contagious
diseases predominate to one in which the main causes of death are chronic degenerative
diseases?

• Epidemiological transition

• Epidemiological curve

• Endemic channel

• Endemic pattern variation

• Endemic curve

10. In the treatment of diabetic neuropathy, which of the following drugs acts as a selective
serotonin and norepinephrine reuptake inhibitor?

• Duloxetine

• Mexiletine

• Desipramine

• Gabapentin

• Pregabalin
 11. Most first trimester miscarriages are caused by chromosomal abnormalities. Which of
the following abnormalities is the most common?

• Autosomal trisomy

• Balanced translocation

• Monosomy 45X

• Triploidy

• Mosaicism

12. A 42-year-old male underwent surgery for preoperative diagnosis of acute appendicitis.
At surgery: cecal appendix with a 2 cm yellowish, hard, hard tumor located at the tip that
involves the meso with the rest of the appendix apparently normal. What is the
therapeutic approach to be followed?

• Right hemicolectomy

• Total colectomy

• Cecostomy plus appendectomy

• Appendectomy

• Ileostomy

13. What is the compression/breathing ratio in neonatal cardiopulmonary resuscitation?

3/1

3/2

6/1

6/2

4/2

14. Which of the following findings is compatible with nephrotic syndrome?

• Edema, hypoalbuminemia and proteinuria greater than 3 grams in 24/hs urine.

• Arterial hypertension, hematuria and hematic casts in urine.

• Bipalpebral edema, hypoalbuminemia, and hyaline casts in urine.

• Foamy urine, hypertension and granular casts in urine

• Dyslipidemia, proteinuria of 1.5 grams in 12-hour urine and albuminemia.

15. A 26-year-old woman presented 24 hours ago with abdominal pain in the epigastrium
radiating to the right iliac fossa after 3 hours, accompanied by nausea without vomiting.
Examination: BP: 100/60 mmHg. Pulse: 100X'. T°: 38.5°C. Painful abdomen in right
iliac fossa Mc Burney (+). Normal hemogram. According to Alvarado's scale, what is the
best course of action?

• Multislice helical tomography

• Observation and control hemogram

• Analgesics and ambulatory control

• Appendectomy

• Exploratory laparotomy

16. What is the name given to the table, graph, formula or other system used to specify all
possible values of a discrete random variable along with their probabilities?

• Probability distribution

• Cumulative distribution

• Binomial parameters

• System distribution

• Continuous distribution

17. Through what mechanism does citizen oversight contribute to improving dialogue,
understanding and respect between representatives of the population, the State and civil
society?

• Citizen Health Surveillance Committees

• Community participation

• Social empowerment
• Municipal Council

• Prefecture

18. 5-year-old boy presents: polyuria, craving for water, constipation. Examination: poor
nutritional status, dehydrated, decreased muscle strength. Laboratory: hypochloremia,
hypokalemia and hypocalcemia. Glucose in urine: (-). Proteinuria (-). Which segment of
the renal tubule is affected?

• Ascending loop of Henle

• Proximal convoluted tubule

• Distal convoluted tubule

• Medullary collecting tubule

• Cortical collecting tubule

19. In which line of the anal canal is chronic anal fissure most frequently located?

• Back half

• Previous average

• Left side

• Right side

• Toothed

20. Which of the following populations are considered at high risk for tuberculosis
infection and should receive preventive treatment?

• HIV (+) contacts with PPD larger than 5mm

• Chronic smokers with pulmonary fibrosis

• Oral drug users

• Recent tuberculin converters larger than 5 mm

• Health personnel with PPD reaction greater than 5 mm

21. What is the scoring system used in the initial assessment of critical patient
severity, which assesses acute physiology and chronic health?
• APACHE II

• Glasgow

• SAPS II

• MPM

• Ranson

22. What is the instrument used to define whether a given number of cases
corresponds to an epidemic?

• Endemic channel

• Epidemic line

• Epidemiological curve

• Epidemic ratio

• Relationship cases time

23. A 65-year-old woman presents with genital dystopia and urine leakage on Valsalva
maneuver. Examination: Bp point at +3, according to the classification of pelvic organs.
What type of genital dystopia does she present?

• Rectocele

• Cystocele

• Hysterocele

• Urethrocele

• Enterocele

24. 50-year-old male presents with foamy urine. History: DM-2 10 years ago. HT 2 years
ago without treatment. Examination: BP: 160/90 mmHg. Slight pallor, edema +/+++ in
lower limbs. Laboratory: proteinuria ++. What is the most recommended
antihypertensive drug?

• Enalapril

• Methyldopa
• Carvedilol

• Nicardipine

• Verapamil

25. What is the central alteration in the pathophysiology of hypertensive disorders

of pregnancy?

• Reduction of uteroplacental perfusion

• Genetic, immunological or inflammatory disorder

• Maternal vascular disease

• Failure of zygote nesting

• Excessive gestational trophoblasts

26. What information should the physician provide to the mother in the presence of
vaginal fold protrusion as a skin patch in a newborn?

• It is normal

• Requires surgery
• It is an adenoma

• It is a malformation

• It is a cyst

27. What is the initial treatment of umbilical granuloma?

• Cauterization with silver nitrate

• Surgical removal

• Topical antibiotic

• Daily healing with antiseptics

• Observation and reevaluation

28. What is the first-line treatment in primary generalized tonic-clonic seizures?

• Valproic acid
• Phenytoin

• Carbamazepine
• Phenobarbital

• Primidone

29. What is the most commonly used procedure for airway resuscitation in a
hospitalized patient with severe respiratory distress?

• Endotracheal intubation

• Cricothyroidotomy

• Cricothyroid puncture

• Tracheostomy

• Oxygen with Venturi mask

30. Hyaline membrane disease is characterized by the fact that it occurs more
frequently in the ……newborn and its main cause is...

• premature/surfactant deficiency.

• term/surfactant deficiency.

• premature/meconium aspiration.

• term/ meconium aspiration.

• GEG/hypoglycemia.

31. 38-year-old woman, large multiparous. Consultation for sensation of a lump in the vagina.
Examination: evidence of prolapse of the anterior and posterior walls of the vagina, with
the most distal portion of the prolapse being less than 1 cm distal to the plane of the
hymen. According to the classification of pelvic organs POP-Q. In what stage is the
prolapse?

• II
• 0

• IV

• III
• I

32. What are the diagnostic criteria for osteoporosis according to WHO in women over 65
years of age?

• Bone densitometry less than -2.5 SD at any location

• Pathological hip fractures

• Anterior wedging of the vertebrae

• Pathologic fractures of the wrist and hip

• Bone densitometry less than -1.5 SD at the femoral neck.

33. 13-year-old adolescent girl with a BMI of 15, hospitalized for dehydration and
malnutrition. The mother reports that her daughter frequently makes herself vomit.
What is the medio internal?

• Hypochloremic alkalosis

• Metabolic acidosis

• Hyperchloremic alkalosis

• Hyperkalemic acidosis

• Hypochloremic acidosis

34. A 38-year-old woman is admitted to the emergency room for a traffic accident.
Examination: right lower limb in adduction, flexed and in internal rotation. What is the
most likely diagnosis?

• Posterior hip dislocation

• Femoral head fracture

• Acetabular fracture

• Anterior hip dislocation

• Ischiopubic ramus fracture

35. Increased haptoglobin, lactate dehydrogenase, indirect bilirubin and reticulocytes

indicate anemia due to ...

• hemolysis.

• chronic renal failure.

• primary spinal cord disorder.

• nutritional deficiency.

• chronic liver disease.

36. A 25-year-old woman presents with arthralgias and foamy urine. Examination: butterfly
wing erythema, peripheral edema (++). Laboratory: ANA: (+), complement C3:
decreased. He starts treatment with oral corticosteroid at high doses. What effect does
he expect to find?

• Decreased T lymphocyte production.

• Increased release of interleukin I.

• Decreased gluconeogenesis

• Increased permeability of capillaries

• Decreased mobilization of fatty acids

37. What is the most frequent causative microorganism in malignant otitis externa?

• Pseudomona aeruginosa

• Streptococcus pneumoniae

• Haemophylus influenzae

• Staphylococcus aureus
• Moraxella catarrhalis

38. What injury does ultrasound detect in patients with blunt abdominal trauma?

• Hepatic

• Retroperitoneal duodenal

• Ureteral

• Pancreatic

• Renal

39. Immediate pregnant woman with a diagnosis of fetal macrosomia. During the revision of
the vaginal canal there is evidence of: tearing involving mucosa, vaginal submucosa,
perineal body and anal sphincter. What is the degree of vaginal tearing?
• III

• II

• I

• IV

• 0

40. A 30-year-old married woman consults for mucopurulent genital discharge, pain in the
hypogastrium and iliac fossa, no menstrual delay. Examination: pulse 98 X',
mucopurulent vaginal discharge, intense pain on palpation of the uterus and mobilization
of the uterine cervix, no palpable tumors and normal cul-de-sac. What is the most likely
diagnosis?

• Pelvic inflammatory disease

• Trichomoniasis vaginalis

• Herpetic vaginitis

• Bacterial vaginosis

• Candidiasis vulvovaginitis
 41. What is the cardiovascular complication in a child with obesity?

• Hypertension

• Hypotension

• Arrhythmias

• Heart failure

• Ventricular hypertrophy

42. What is the most frequent site of distant metastasis of papillary thyroid
carcinoma?
• Lung

• Heart

• Esophagus

• Diaphragm

• Trachea

43. What is an absolute indication for tonsillectomy in the child?

Sleep apnea

Recurrent tonsillitis

Severe halitosis

Probable malignant neoplasm

Peritonsillar phlegmon

44. What is the most important criterion for the diagnosis of pelvic abscess?

• Palpable painful adnexal tumor

• History of acute pelvic disease

• Fever

• Pain on palpation of the cul-de-sac

• Leukocytosis with left shift

45. Immediate evaluation of the newborn shows an excavated abdomen and severe
respiratory distress with cyanosis. CXR: circular radiolucent images in the left
hemithorax. What is the diagnostic suspicion?

• Diaphragmatic hernia

• Hydrothorax

• Pneumothorax

• Annular pancreas

• Serous pleuritis

46. A 27-year-old woman, G2P1001, with a 31-week gestational age, attended routine
prenatal care. Her pregnancy has been uncomplicated, with a history of subserosal
fibroids diagnosed in previous ultrasounds and only one active fetus. Examination:
uterine height of 38 cm. What is the most probable complication associated with the
presence of fibroids?

• Preterm delivery

• Placenta previa

• Polyhydramnios

• Gestational hypertension

• Premature rupture of membranes

47. 39-year-old primigravida at 41 weeks gestation by first trimester ultrasound. She comes
to the emergency room because of her gestational age, denies pain and contractions.
Fetal movements were present, a non-stress test was performed, which showed
and an ultrasound with normal ILA, deciding on cervical ripening with misoprostol.
What is the WHO recommended dose in micrograms intravaginally?

• 25 every 6 hours

• 25 every 2 hours

• 50 every 2 hours

• 50 every 6 hours

• 25 every 4 hours

48. What is the pathogenesis in cardiogenic pulmonary edema?

• Increased hydrostatic pressure

• Alteration of the vascular endothelium

• Increased oncotic pressure

• Alteration of surfactant substance

• Alveolar collapse

49. A 28-year-old woman presented four days ago with bilateral lumbar pain, increased
temperature, dysuria, pollakiuria and vomiting. Examination: PPL (+). What is the most
likely diagnosis?

• Acute pyelonephritis

• Acute cystitis

• Acute urethritis

• Mechanical low back pain

• Acute salpingitis

50. 45 year old diabetic patient on irregular treatment, 4 days ago she presented with
abdominal pain in the right upper quadrant, sensation of thermal elevation and yellowish
coloration of the skin and mucous membranes. Examination: jaundice of skin and
mucous membranes. BP: 90/60mmHg. Pulse: 110 X'. T°: 39°C. Painful abdomen on
 palpation in the right upper quadrant, Blumberg(-) Murphy(+) sign. Ultrasound:
cholelithiasis and choledocholithiasis. What is the therapeutic approach to follow?

• Endoscopic cholangiopancreaticotrophic endoscopy

• Open cholecystectomy

• Exploration of biliary tract

• Open cholecystostomy

• Biliodigestive bypass

55-year-old woman with a diagnosis of varicose veins, reporting erythema, heat and pain in
the affected veins, which can be palpated as an indurated cord. How many weeks is
anticoagulation advisable?

• Six

• Four

• Three

• Two

• A

51. An 18 year-old woman presented four days ago with colicky pain in the epigastric region
that after eight hours was located in the right iliac fossa, as well as nausea, vomiting and
hyporexia. Examination: T: 38°C; P: 90 X'; BP: 120/70mmHg; FR: 20 X'. Abdomen: RHA
present, in the right iliac fossa there is an 8x5cm tumor of hard consistency with defined
borders, not painful. What is your diagnostic impression?

• Appendicular plastron

• Blind cancer

• Ascending colon cancer

• Ovarian cyst to twisted pedicle

• Right tuboovarian abscess

 52. Which of the following is most frequently associated with polycystic ovary
syndrome in obese patients?

• Infertility

• Type I diabetes

• Hypoglycemia

• Hypocholesterolemia

• Hypermenorrhea

53. The district of San Juan de Lurigancho has a population of 1'000,000 inhabitants and
in 2017 there were 800 cases of dengue fever, of which 80 patients died. What is the
case fatality rate?

• 10 deaths per 100 dengue cases

• 80 deaths per 100,000 inhabitants

• 800 deaths per 100,000 inhabitants

• 100 deaths per 100 dengue cases

• 8 deaths per 1,000 inhabitants

54. Newborn presenting with bilious vomiting and progressive abdominal distension.
What is the probable diagnosis?

• Intestinal atresia

• Pyloric hypertrophy

• Midgut volvulus

• Meconium ileus

• Necrotizing colitis

55. What portion of the pancreas is within the C-shaped concavity of the duodenum?
• Head

• Collar

• Unciform process

• Body

• Cola

56. The pathophysiological triad of bronchial asthma is characterized by:

• Bronchospasm-mucus edema-bronchial hypersecretion

• Bronchoconstriction-mucus bleeding-bronchorrhea

• Bronchospasm-mucus phlogosis-scarce bronchial secretion

• Bronchoconstriction - mucosa with epithelial desquamation - bronchoconstriction -

bronchorrhea

• Bronchospasm - mucosal edema - mucopurulent secretion

57. 43-year-old woman, history of normal delivery, has a new partner. BP 140/90mmHg,
Catamenial regimen: 4-7/ 28 -32 days. Heavy bleeding during the first days, with
moderate anemia, occasional smoker and BMI 30 and hypercholesterolemia. PAP and
transvaginal ultrasound normal. Which of the following alternatives is the most
appropriate to avoid pregnancy?

• IUD plus levonorgestrel

• T for Copper

• Combined oral contraceptives

• Condom

• Depot contraceptives

58. A 35 year-old man comes to the emergency room for presenting hypertensive crisis with
blood pressure values above 200/100 mmHg, a situation that has been repeated on
several occasions. He had a history of abdominal pain, for which an abdominal CT scan
 was requested and a tumor was found on the left kidney. What test is requested to clarify
the diagnosis?

• Urinary methanephrines

• Plasma cortisol

• Serum renin

• Erythropoietin

• Aldosterone

59. What is the first step in the planning process in measuring the overall health status of the
community?

• Measuring or assessing the burden of disease

• Determination of the causes of disease

• Measuring the effectiveness of interventions

• The implementation of the actions

• Monitoring or supervision of activities

60. A 20-year-old woman, shy since childhood, presents serious interpersonal problems;
lately she feels attracted to a classmate, but as she considers herself awkward and
unattractive, she is embarrassed and prefers not to answer him every time he speaks to
her.
What personality disorder does he/she present?

• Evitativa

• Paranoid
• Schizoid

• Antisocial

• Dependent
 61. 25-year-old female, chronic alcoholic, reports a 3-week menstrual delay. Pregnancy test
(+). In addition to maxillary hypoplasia, what other effect on the product can occur due to
alcohol consumption during pregnancy?

• Mental retardation

• Gastroschisis

• Phocomelia

• Deafness

• Glaucoma

62. Infant 5 months old, presented since 3 days ago: rhinorrhea, sneezing and fever. Today
he was brought in for respiratory distress. Examination: T: 38.5°C, HR: 160X', FR: 70X',
SatO2: 85%, irritability, perioral cyanosis, subcostal, intercostal and supraclavicular
retraction; sub crepitant and inspiratory and expiratory wheezing. What is the diagnosis?

• Bronchiolitis

• Pneumonia

• Common cold

• Acute laryngitis

• Asthmatic crisis

63. What is the most frequent cause of testicular torsion in children?

• Undescended testicle

• Testicular tumor

• Attachment to the scrotal wall

• Epididymitis

• Epididymal cyst
 64. 2-year-old boy with cellulitis of the right leg. He evolves with general malaise, lethargy,
T: 39.5ºC, RR: 48X', HR: 196X', BP: 50/35 mmHg, cold extremities and slow capillary
filling. Examination: Leukocytes: 28,000 x mm3, rods: 12%. He has received fluids
followed by dopamine at appropriate doses without favorable clinical response. What is
the next therapeutic measure?

• Adrenaline

• Milrinona

• Dobutamine

• Atropine

• Vasopressin

65. What is the drug of choice in the management of organophosphorus poisoning?

• Atropine

• Pilocarpine

• Adrenaline

• Acetylcholine

• Meperidine

66. In the first week of refeeding the malnourished infant, what complication may occur?

• Hypophosphatemia

• Hyponatremia

• Hypercalcemia

• Hyperkalemia

• Hypernatremia

67. What is the mechanism of action of sulfonamides?

• Competitive inhibition of dihydropteroate synthase.

• Inhibition of DNA gyrase

• Transpeptidase Inhibition

• Binding to the 30S ribosomal subunit

• Hepatic CYP enzyme inhibition

68. What is the type of shock presenting in a patient with decreased mean
arterial pressure, thready pulse, cold extremities and slow capillary refill?

• With low cardiac output

• With high vascular resistance

• With high cardiac output

• With low vascular resistance

• Mixed

69. 25-year-old woman, with two children of normal delivery, sexually active. She presents
with chronic pelvic pain. FUR two weeks ago. PAP negative, transvaginal ultrasound:
normal uterus and thickening of both tubes. Of the following alternatives, which is the
safest contraceptive method?

• Combined oral contraceptives

• Device with levonorgestrel

• Bilateral tubal blockage

• Natural methods

• Barrier methods

70. What is the pathophysiology of the induction of gastric disease produced by

NSAID consumption?
• Interruption of prostaglandin synthesis

• By inflammatory response

• Due to increased bicarbonate secretion

• By increased epithelial cell proliferation.

• By increased mucin secretion

71. What is the most frequent complication of spinal anesthesia in patients who are not well
hydrated?

• Hypotension

• Bradycardia

• Headache
• Paresthesia’s

• Unconsciousness

72. What sign differentiates severe from moderate dehydration in children?

• Low intensity heart sounds

• Slow capillary filling

• Dry oral mucosa

• Irritability

• Polypnea

73. Regarding iron metabolism, which of the following statements is correct?

• Iron is transported in the plasma as ferritin

• Iron of animal origin is found as non-heme.

• Iron absorption occurs in the distal duodenum.

• 30% of functional iron is found in hemoglobin and myoglobin.

• Iron absorption is regulated by cryoglobulin.

74. In a pregnant woman diagnosed with HIV on HAART, delivery by cesarean section will
be performed when...

• gestation is at term and without prenatal control.

• cervical dilatation is greater than 4 cm.

• premature rupture of membranes is greater than four hours.

• gestation is a fetal death.

• arrives in the second stage of labor and with prenatal control.

75. A 25 year-old woman, refers since 3 weeks ago dry cough, chest pain in the posterior
aspect of the right hemithorax that increases with deep breathing. Examination: vocal
vibrations and vesicular murmur abolished at the base of the right hemithorax. Chest X-
ray: right pleural effusion. Negative sputum BK. ADA in pleural fluid increased. What
study is requested to confirm the diagnosis?

• Pleural biopsy

• AGA

• BK in gastric juice

• Pulmonary CT

• Chest MRI

76. A 48-year-old woman, with a family history of hypothyroidism, is admitted to the hospital
because of sepsis secondary to bronchopneumonia, remaining fasting for 7 days.
Considering the family history of hypothyroidism, a thyroid hormonal study was
performed; she was reported to be a euthyroid patient. What would be the hormonal
result NOT related to her diagnosis?

• Decreased TSH
• Normal TSH

• Normal T4

• T3 low

• rT3 high

77. What is the most characteristic symptom of phlyctenule keratoconjunctivitis?

• Ocular itching

• Edema

• Hyperemia

• Watery discharge

• Mucous secretion

78. What is the most frequent cause of embolisms of cardiac origin?

• Mitral disease with atrial fibrillation

• Acute myocardial infarction

• Dilated cardiomyopathy

• Subacute infective endocarditis

• Aortic insufficiency

79. A 35-year-old male suddenly presented 5 days ago with general malaise, fever,
intermittent chills every 2 days, concomitant myalgias and arthralgias. On the fourth day
of illness, pruritic exanthema with generalized lymphadenopathy without
hepatosplenomegaly. Background: at home his brother with confirmed dengue fever.
What is the contraindicated course of action?

• Use of metamizole for fever control

• Careful replenishment of fluids and electrolytes

• Urgent request for CBC and platelet counts

• Use of acetaminophen for fever control

• Request Ig M for dengue

80. A woman with a history of cesarean section 4 days ago. She presents with confirmed
febrile sensation (39°C), tachycardia, foul-smelling genital bleeding, pain and uterine
subinvolution, the diagnosis is puerperal endometritis. What is the appropriate
treatment?

• Clindamycin - gentamicin - ampicillin

• Sodium penicillin - metronidazole - doxycycline

• Gentamicin - norfloxacin - clindamycin

• Ciprofloxacin - clindamycin - penicillin

• Amikacin - cefuroxime - penicillin

81. Which gastric glandular cells secrete hydrochloric acid?

• Parietales

• Interleaved

• Mucinous

• Mother

• Main

82. What is the most recommended approach to achieve successful participatory

management in primary health care facilities?

• Open system

• Closed system

• Of subsystems

• By objectives
• Contingencies

83. 50-year-old male, with a history of long-standing bronchiectasis, nephrotic syndrome one
year ago, presenting dysphagia with gastroesophageal reflux. Imaging study: change in
motility, diffuse esophageal rigidity and loss of distensibility. What is the most likely
diagnosis?

• Amyloidosis

• Drug-induced esophagitis

• Scleroderma

• Dermatomyositis

• Candidiasis

84. In the case of severe dehydration with diarrhea shock in children, what is the initial
treatment measure?

• Physiological saline solution 20 ml/kg in bolus

• Ringer Lactate 200 ml/kg

• Polyelectrolyte solution 10 cc/kg in bolus

• Fresh frozen plasma 20 cc/kg full drip

• Hypersodium 10 cc/Kg jet

85. What is the most frequent anorectal malformation in males?

• Recto-vesical fistula

• Recto-urethral prostatic fistula

• Recto-urethral bulbar fistula

• Perineal cutaneous fistula

• Imperforate anus without fistula

 86. Biliary ileus is the mechanical obstruction of the small intestine as a consequence of
the passage of one or more stones through a cholecystoenteric fistula.
What is the most frequent communication?

• Cholecystoduodenal

• Cholecystogastric

• Cholecystocolonic

• Cholecystojejunal

• Cholecystoileal

87. Which of the following entities presents with elevated direct bilirubin in neonates?

• Cytomegalovirus

• Hypothyroidism

• Spherocytosis

• Breastfeeding

• ABO Incompatibility

88. 80-year-old male diagnosed with prostate cancer with Cleason classification 6:
early stage disease and small tumor size (established by biopsy).
What is a useful strategy in patients expected to survive less than 10 years?

• Observation
• Prostatectomy

• Chemotherapy

• Brachytherapy

• Radiotherapy
 89. What is the most effective measure to reduce the risk of uterine infection after
cesarean section?

• Antibiotic prophylaxis

• Perineal shaving

• Reduction of operating time

• Surgeon skill and dexterity

• Oxytocic’s in the perioperative period

90. What is the initial treatment of dysmenorrhea in adolescent girls?

• Non-steroidal anti-inflammatory drugs

• Systemic steroids

• Oral contraceptives

• Oxytocic’s

• Antiemetics

91. What is the most frequent complication of open appendectomy for acute
perforated appendicitis plus generalized peritonitis?

• Surgical site infection

• Atelectasis

• Aspiration pneumonia

• Urinary tract infection

• Pile phlebitis

92. What is the most frequent complication of the use of an intrauterine device?

• Pelvic pain

• Hypomenorrhea
• Vaginal dryness

• Dysmenorrhea

• Dysphasia

93. A 17-year-old adolescent with a body mass index of 26 on nutritional

assessment. What is his diagnosis?

• Overweight

• Normal

• Obesity

• Extreme thinness

• Morbid obesity

94. Pregnant woman at term with a large fetus who presents with shoulder dystocia
during the second stage of labor. What is the initial measure to be taken?

• Maternal thigh hyperflexion

• Clavicle fracture
• Anterior shoulder counter-rotation

• Vigorous fetal head traction

• Intense fundal pressure

95. In the conceptual framework of the Commission on Social Determinants of Health.

Which of the following corresponds to a structural determinant?

• Education

• Governance

• Policies

• Social cohesion

• Biological factors
 96. What is the therapeutic range in mg/kg/day of iron in infants with
hypochromic microcytic anemia?

• 3a6

• 5 a 10

• 1a3

D. 10 to 15

E. 15 a 20

97. Multigestation of 24 weeks, history of myomectomy; she presents severe acute lower
abdominal pain of sudden onset. Examination: VF: normal, pain in hypogastrium, UA: 34
cm, FLC: normal. TV: cervix unchanged, no gynecorrhage. CBC, urine test and CRP
normal. What is the most likely diagnosis?

• Degenerated myoma

• Acute appendicitis

• Threatened preterm labor

• Placental abruption

• Acute pyelonephritis

98. 19-year-old woman, FUR 2 weeks ago; CR 5/30; with subacute onset pain in
hypogastrium and left iliac fossa of moderate intensity. Examination: VF: normal, pain on
palpation of the mentioned regions without peritoneal signs, without leucorrhea or
gynecorrhage. TV: no pain on cervical mobilization, mild pain in left adnexa, no masses.
What is the most probable diagnosis?

• Ovulatory pain

• Meckel's diverticulum

• Left adnexitis

• Ovarian cyst to twisted pedicle

• Ectopic ovarian pregnancy

99. 35-year-old woman; G0P0, LMP: 3 days ago, C.R. 5/28, history of dysmenorrhea and
dyspareunia; with severe pelvic pain. Exam: VF: normal, soft abdomen with pain on deep
palpation in hypogastrium, without rebound. TV: right adnexal tumor. Laboratory: normal.
Ultrasound: right unilocular adnexal mass of 5 cm, with "ground-glass appearance". What
is the most probable diagnosis?

• Endometriosis

• Ovarian cyst to twisted pedicle

• Ectopic Pregnancy

• Tuboovarian abscess

• Hemorrhagic follicle

100. What is the gold standard test for the diagnosis of endometriosis?

• Laparoscopic biopsy

• Exploratory laparotomy

• Magnetic resonance imaging

• Ultrasound

• Hysteroscopy

101. Which of the following is the most common cause of chronic pelvic pain?

• Endometriosis

• Gastrointestinal

• Myofascial syndrome

• Adherences

• Cystitis
 102. What is the theory that postulates: "endometriosis is caused by seeding or
implantation of endometrial cells through transtubal regurgitation during menstruation"?

• Transplantation

• From peritoneal flow current

• Of coelomic metaplasia

• Induction

• Immunological

103. In a vaginal delivery without eventualities or birth canal injuries, after complete
delivery she presents with vaginal bleeding greater than usual; the patient reports
palpitations and dizziness. Examination: decreased blood pressure and tachycardia.
What is the initial handling?

• Intravenous Oxytocin

• Rüsch ball placement

• Arterial embolization

• Hypogastric artery ligation

• Misoprostol sublingual route

104. What is the ideal test to confirm the diagnosis of placental accreta in posteriorly
located placentas in obese patients?

• Magnetic resonance imaging

• Doppler ultrasound

• 2D ultrasound
• Transvaginal ultrasound

• Tomography
 105. In a 24-week pregnant woman with IUGR. What test should be ordered to determine
the probable cause?

• Fetal karyotype

• Fetal neurosonography

• Doppler ultrasound

• Fetoscopy

• Cordocentesis

106. 20-year-old pregnant woman, G2P1001, 35 weeks of gestation, with loss of

amniotic fluid 24 hours ago. Exam: BP: normal, pulse: 100 X', T: 38 °C, UA: 30 cm, DU:
sporadic with uterine irritability and persistent FLC: 170 X'. TV: 3 cm dilatation. What is
the most appropriate course of action?

• Chance of vaginal delivery

• Antibiotic therapy

• Emergency cesarean section

• NSAIDS

• Tocolysis

107. Pregnant of 36 weeks due to FUR, asymptomatic, with UA: 35 cm, FLC: normal,
and ultrasound report indicating gestational age, fetal weighting of 2650 g and Phelan
index: 30 cm. Which of the following alternatives is the cause of the described picture?

• Parvovirus B-19 infection

• Renal malformations

• Trisomy 18

• Fetal polycythemia

• Intrauterine growth restriction

 108. In relation to Rh isoimmunization, which is the correct alternative?

• Immunoglobulin dose should be increased if severe feto-maternal hemorrhage

is suspected.

• Prophylaxis with anti-D immunoglobulin in < 72 hours postpartum if the

newborn is also Rh (-).

• MCL PI is useful for noninvasive diagnosis of fetal anemia.

• In case of sensitization, titers lower than 1:64 indicate low risk of fetal anemia.

• Prophylaxis with anti-D immunoglobulin at week 24 if the indirect Coombs' test is

negative.

109. 50-year-old woman presenting with cohorting bleeding. Spectroscopy: vagina with
blood in small amount and hard and infiltrating lesion of the posterior lip of the cervix that
involves up to the distal third of the vagina but not the pelvic wall. According to FIGO it
corresponds to stage:

• IIIa

• IIb

• IIIb

• IIa

• Ib 2

110. Woman with twin pregnancy of 20 weeks gestational age. Ultrasound: FETUS 1
active, 400 g, with vertical well greater than 11 cm, preserved fetal morphology and
slightly distended bladder; FETUS 2 active, 295 g, with vertical well greater than 1 cm,
bladder not visible, rest of morphology without alterations. What is the diagnosis?

• Fetal fetal fetal transfusion syndrome

• Discordant fetal growth

• Selective IUGR

• Chromosomopathy in Fetus 2

• Sequence anemia polycythemia

 111. What sign is evident in the ultrasound performed during the first trimester
in a monochorionic twin pregnancy?

• T

• Delta

• Lambda

• Double spout

• Alpha

112. Pregnant at term with no risk factors in the active phase of labor. Uterine
contractions of regular intensity and FLC: normal. After amniotomy, she presents
gynecorrhage in regular quantity and sudden alteration in fetal heart rate. What is the
probable diagnosis?

• Previous Vasa

• Placenta previa

• Placental accretion

• Acute fetal distress

• Placental abruption

113. What is the ultrasound finding that can predict placental accrete?

• Gestational sac implanted in the lower uterine segment in the 1st trimester

• Presence of normal and hypoechoic retroplacental area

• Absence of vascular lacunae within the placenta in the 2nd trimester.

• Thickness of retroplacental myometrium greater than 4 mm

• 1st trimester finding of "Swiss cheese-like" placenta

 114. Pregnant of 36 weeks, admitted for uterine contraction-type abdominal pain with no
other symptoms. BP: 140/90 mmHg, pain on palpation of the uterus with increased and
persistent tone, FLC: 108 X'. TV: softened cervix, no gynecorrhage, what is the most
likely diagnosis?

• Placental abruption

• Threatened preterm labor

• Acute fetal distress

• Probable placental accreta

• Preeclampsia with signs of severity

115. A 37-year-old woman presents with a breast lump 3 cm in diameter, not very mobile
and of increased consistency, not adhered to deep planes. What is the ultrasound finding
that suggests a probably benign breast nodule?

• Wider than tall

• Rear acoustic shadow

• Spiculations

• Microcalcifications

• Branched pattern

116. Regarding the use of exclusive breastfeeding as a method for family planning,
which is the correct alternative?

• Decreases GnRH secretion from the hypothalamus.

• Reduces Prolactin concentration

• It is not effective after 2 months after birth.

• Increases LH release

• Requires avoidance of intercourse near the time of ovulation.

 117. Regarding barrier methods of contraception, which is the correct
alternative?

• Latex allergy can cause anaphylaxis, potentially life-threatening

• Female condom breakage is more frequent than with male condom use

• The use of water-based lubricants increases the risk of breakage.

• Condoms do not protect against cervical neoplasia

• In HIV, condoms with nonoxynol-9 are more effective

118. Regarding the use of intrauterine devices as a contraceptive method, which

is the correct statement?

• If in an intrauterine pregnancy, the IUD guidewire is not visible, it is left in place.

• IUD causes early miscarriages by interfering with implantation

• Is much less effective than tubal sterilization.

• T380A copper IUD reduces the amount of menstrual bleeding and pelvic pain

• The levonorgestrel-releasing IUD is for continuous use for 10 years.

119. A 34-year-old woman with a 10-year-old son born by cesarean section and two
subsequent induced abortions for which she underwent uterine curettage. She presents
with amenorrhea of three years of evolution and genital desire. What is the most probable
diagnosis?

• Asherman's syndrome

• Rokitanski syndrome

• Androgen insensitivity syndrome

• Premature ovarian failure

• Bilateral hydrosalpinx
 120. Patient diagnosed with Asherman's syndrome, what is the initial
therapeutic approach?

• Surgical hysteroscopy

• Uterine curettage

• Dilatation with Hegar spark plugs

• Bakri intrauterine balloon placement

• Levonorgestrel-releasing IUD insertion

121. 14-year-old female patient with primary amenorrhea, complains of colicky pelvic
pain; sexual development and FSH are normal. Examination: tumor protruding through
the vulva. Pelvic ultrasound:
Dilated uterus, thickened endometrial cavity and anecogenic image in the vagina. What is the
most likely diagnosis?

• Imperforate hymen

• Vaginal sarcoma

• Submucous myomas

• Endometriosis

• Gardner cysts

122. Female, 19 years old, FUR 7 weeks ago, presented with severe abdominal pain
and dizziness. Examination: BP: 70/50 mmHg, pulse: 102 X', T: 37 °C; diffuse abdominal
pain with generalized peritoneal reaction. TV: cervix unchanged, uterus difficult to
evaluate due to pain, no gynecorrhage. Laboratory: normal hemogram and urine test.
What is the most probable diagnosis?

• Ectopic pregnancy

• Stage III PID

• Abortion in progress

• Ruptured tubo-ovarian abscess

• Gynecologic septic shock

 123. Which is the correct alternative regarding Adenomyosis?

• Patients are generally asymptomatic

• Presence of ectopic endometrial glands in uterine serosa

• Clinical diagnosis is easy and simple

• There is symmetry of the anterior and posterior wall of the uterus.

• Ultrasound shows hyperechoic spaces in the myometrium.

124. According to the international classification of ovarian tumors (IOTA), which of the
following corresponds to the ultrasound description of a probably benign cystic mass?

• Thin capsule multilocular tumor with diameter <10 cm="" font="">

• Tumor with at least four internal papillary structures

• Bilateral irregular solid tumor

• Presence of tension ascites

• At Doppler intratumorally vascular flow greatly increased.

125. What is the ultrasonographic feature that differentiates corpus luteum from ectopic
pregnancy?

• The corpus luteum usually does not have a thick echogenic ring.

• Ectopic pregnancy is usually located within the ovarian tissue.

• Color Doppler has high sensitivity and specificity to differentiate between them.

• Power Doppler has great value in differentiating them through the "ring of fire".

• The corpus luteum does not move together with the ovary during manipulation.
 126. What is the most common type of fibroid degeneration in pregnancy?

• Meaty

• Hyaline

• Myxoid

• Cystic
• Hemorrhagic

127. 39-year-old woman, G2 P1001, without menstrual delay, with sporadic mild pelvic
pain. Examination: globular uterus. Ultrasound: enlarged uterus; on the posterior aspect
there is an intramural nodule of precise contours of 5 cm that in its central region has an
anechoic area of irregular but defined borders. What is the probable diagnosis?

• Hyaline degeneration of a leiomyoma

• Arteriovenous malformation

• Focal adenomyosis

• Severe endometriosis

• Chronic ectopic pregnancy

128. 41-year-old woman with hypermenorrhea. Normal gynecological examination.

Ultrasound: uterine cavity containing scanty collection that allows differentiating a 1.5 cm
homogeneous sessile nodule on the posterior aspect of the endometrium, more
echogenic than the surrounding myometrium. Color Doppler shows vascular pedicle in
the central area of its base. What is the probable diagnosis?

• Endometrial polyp

• Incomplete abortion

• Arteriovenous malformation

• Uterine synechia

• Submucous myoma
 129. Which of the following malformations is present in Cantrell's pentalogy?

• Omphalocele
• Cystic hygroma

• Holoprosencephaly

• Gastroschisis

• Megavejiga

130. 31-year-old woman with distension and diffuse abdominal pain, dizziness,
shortness of breath and decreased urine volume 24 hours ago with history of IVF.
Examination: dry mucous membranes, tachypnea and distension with abdominal
dullness. Transvaginal ultrasound: ovarian volume > 10cc and abundant free fluid. What
is the most likely diagnosis?

• Ovarian hyperstimulation syndrome

• Ovarian cancer

• Pelvic inflammatory disease

• Ectopic pregnancy

• Pulmonary thromboembolism

131. A 22-year-old woman presents with intermittent pelvic pain since 3 months ago,
increasing in the last 15 days. Examination: AVF uterus, 7 cm; right adnexa normal and
left adnexa with a 7 cm mass, slightly painful. Transvaginal ultrasound: adnexa Left
complex mass (cystic and solid) with very echogenic internal area that leaves shadow.
Absence of Doppler flow. No free fluid. What is the most likely diagnosis?

• Dermoid cyst

• Ovarian cancer

• Hydrosalpinx

• Endometrioma

• Tuboovarian abscess
 132. 26-year-old woman with amenorrhea and mild pelvic pain. Examination: slightly
enlarged uterus, unchanged cervix and very scanty dark brown bleeding. Ultrasound:
defined gestational sac with fetus of 15 mm NCL, no evidence of cardiac activity, no
retrochronal hematomas. What is the diagnosis?

• Retained abortion

• Threat of abortion

• Normal pregnancy

• Incipient gestation

• Imminent abortion

133. A 20-year-old pregnant woman attends her prenatal check-up. Ultrasound:

amniotic fluid with vertical well greater than 1 cm. What is the probable cause that
explains the case?

• Chronologically prolonged gestation

• Malformations of the fetal nervous system

• Fetal macrosomia

• Fetal duodenal atresia

• Rh isoimmunization

134. A 25-week pregnant woman indicates that she is concerned about whether the fetus
has any fetal malformations. Which of the following is a normal finding on a four-chamber
view?

• The most anterior cardiac chamber is the right ventricle.

• The aorta artery is in relation to the right atrium.

• The heart should be rotated to the left with an axis of 60° +/- 20°.

• The mitral valve is more apical than the tricuspid valve.

• The heart should occupy approximately one quarter of the thorax.
 135. A 6-week pregnant woman attended a check-up with an ultrasound scan that
showed no abnormal gestation. One week later, she returns with "heavy vaginal bleeding
with large clots" since 8 hours ago, associated with pelvic pain. At the moment, this last
symptom has subsided. Examination: 7 cm uterus and closed cervix with little bleeding.
Ultrasound: linear endometrium 4 mm thick. What is the diagnosis?

• Complete abortion

• Incomplete abortion

• Threat of abortion

• Ectopic pregnancy

• Inevitable abortion

136. Pregnant of 34 weeks, since 3 weeks ago pruritus in palms of hands and soles
of feet that 2 days ago became generalized. BP: 110/70 mmHg, T: 36.8 °C, mild
jaundice; FLC: normal. Liver profile: increased alkaline phosphatase and bilirubin,
transaminases; CBC, platelets, glucose and creatinine normal. What is the probable
diagnosis?

• Intrahepatic cholestasis of pregnancy

• HELLP Syndrome

• Acute fatty liver of pregnancy

• Acute viral hepatitis

• Prurigo of pregnancy

137. 55 year old patient comes to the emergency room with moderate to severe
abdominal pain. Examination: arrhythmic heart sounds. Abdomen: soft, depressible,
peritoneal reaction. Acute mesenteric occlusion due to embolism or arterial thrombosis
is suspected. What is the supporting test for definitive diagnosis?

• Angiography

• Phlebography

• Ultrasonography
• Tomography

• Scintigraphy

138. A 45-year-old male presents with chronic abdominal pain with a diagnosis of peptic
ulcer with no response to medical treatment. He has received several series of therapy
for Helicobacter pylori. What is the recommended surgical indication to avoid further
recurrence?

• Trochlear vagotomy and antrectomy

• Vagotomy plus pyloroplasty

• Selective vagotomy

• Parietal cell vagotomy

• Subtotal gastrectomy

139. A 34-year-old woman comes to the emergency room for abdominal pain of sudden
onset after exertion. Examination: diffuse abdominal pain, mild peritoneal reaction and
irreducible painful tumor in the left inguino-crural region. Surgery was indicated and in
the procedure a crural hernia was found where the antimesenteric portion of the intestine
was trapped inside the hernial sac. This type of hernia is called:

• Ritcher

• Spiegel

• Petit

• Littre

• Nyhus

140. What is one of the most frequent germs causing spontaneous

bacterial peritonitis in adults?

• Klebsiella pneumoniae

• Proteus mirabilis

• Enterobacter cloacae

• Mycobacterium tuberculosis
• Bacteroides fragilis

141. What is the most frequent metabolic disorder after gastrectomy?

• Anemia

• Fat malabsorption

• Osteoporosis

• Metabolic alkalosis

• Metabolic acidosis

142. What are the cells in the stomach that secrete intrinsic factor?

• Parietales

• Mucosa

• Main

• D cells

• G Cells

143. What is a cause of hyperazoemia when parenteral nutrition (PN) is administered?

• Dehydration

• Excessive insulin administration

• Prolonged administration of PN

• Septicemia

• Excess glucose concentration

 144. Body mass index (BMI: kg/m2) measurement of 35 - 39.9, is classified
as:

• Obesity II

• Obesity I

• Normal

• Overweight

• Obesity III

145. The ureter, in relation to the uterine artery and the uterus travels to:

• 1 cm below the artery and 1 cm lateral to the cervix

• 1 cm above the artery and 2 cm lateral to the cervix

• 2 cm between artery and cervix

• 1cm above the artery and 1cm from the uterine body

• 2 cm above the artery and 2 cm from the uterine body

146. What is an appropriate procedure in the treatment of a Bartholin's gland cyst

or abscess?

• Incision and drainage

• Gland excision and drainage

• Excision of the gland without drainage

• Wide-margin excision around the gland

• Needle aspiration

147. When is ovarian cystectomy a surgical alternative?

• In pre-menopausal women

• Functional cysts
• Cysts larger than 3 cm

• In recurrence to puncture in a young woman

• When accompanied by endometriosis in a young woman

148. What is the most common general surgical disorder in pregnancy?

• Acute appendicitis

• Cholecystitis

• Thrombosed hemorrhoids

• Rectal prolapse

• Complicated diverticulitis

149. What analytical studies are useful in the diagnosis of placental abruption?

• Fibrinogen and platelet counts

• Blood count, hemoglobin and hematocrit

• Clotting and bleeding time

• C-Reactive Protein and blood count

• C Reactive Protein and platelet counts

150. What is an advantage of using laparoscopy in pregnancy?

• Decreased fetal depression due to reduced need for narcotics

• Reduced risk of fetal acidosis due to the effects of CO2 pneumoperitoneum.

• Decreased uterine blood flow

• Reduced risk of premature delivery

• Better visualization with the pregnant uterus

 151. What is the effect of pneumoperitoneum in a pregnant woman
undergoing laparoscopic surgery?

• Enhances venous stasis of the lower extremities

• No alteration of maternal and fetal blood gases.

• No effect, so it is not necessary to reduce intraabdominal pressure.

• Frequently produces subcutaneous emphysema.

• It is better tolerated by the fetus in the first trimester.

152. Hepatic hemorrhage or rupture in HELLP syndrome in eclamptic pregnant

women occurs primarily:

• Within 48 hours after delivery

• Any time during the second trimester of pregnancy

• Within 72 hours after delivery

• As an effect of the compressive process of the expulsive period

• Always associated with seizures

153. What is the optimal time to perform laparoscopic cholecystectomy in a

pregnant woman with very symptomatic and recurrent cholecystitis?

• Second quarter

• First quarter

• In any quarter

• Surgery is contraindicated

• Immediately after delivery

154. Divided pancreas is a congenital anomaly characterized by:

• A double pancreatic drainage

• Lack of union between body and tail of the pancreas

• Atrophy of the duct of Sartorini

• Being a cause of retrograde cholangitis

• Be associated with choledochal cyst.

155. What is the ideal age range for pectus excavatum repair?

• Between 10 and 14 years of age

• Between 2 and 6 years old

• In newborns

• In adolescence

• After puberty

156. What is an anomaly associated with common bile duct cysts in children?

• Duodenal atresia

• Cryptorchidism

• Pectus excavatum

• Umbilical hernia

• Meckel's diverticulum

157. Type III biliary atresia affects:

• The right and left hepatic ducts

• The common hepatic duct

• The common bile duct

• The entire biliary tree

• The intrahepatic and extrahepatic biliary tree

158. The newborn was evaluated and found to be very irritable, with bilious vomiting that
did not allow an adequate examination. The abdominal radiograph shows a "double
bubble" image. Duodenal atresia is diagnosed. What is the surgical treatment of choice?

• Duodenoduodenostomy

• Gastroduodenostomy

• Ladd Technique

• Resection of the affected segment

• Duodenal pexy

159. What is the usual clinical presentation of Meckel's diverticulum?

• Gastrointestinal bleeding

• Intestinal obstruction

• Invagination

• Incarceration

• Abdominal mass

160. What are the anomalies most frequently associated with high anorectal
malformation?

• Urological

• Cardiovascular

• Digestive

• Pulmonary

• Hosea
 161. What are the clinical manifestations that distinguish intussusception from
acute appendicitis in preschool children?

• Colicky pain, interspersed periods without pain, absence of peritonitis.

• Nausea, vomiting, permanent abdominal pain

• Diarrhea, early and persistent vomiting

• Fever, diarrhea , nausea and vomiting

• Irritability, nausea and vomiting, diarrhea

162. In what situation is post-trauma resuscitation thoracotomy indicated?

• Precordial penetrating wounds

• Chest wounds by firearm

• Blunt thoracic trauma

• Cardiac tamponade

• Stab wound trauma to the thorax without vital signs

163. What is a risk factor for the development of abdominal aortic

aneurysm?

• Arterial hypertension

• Female gender

• Alcoholism

• Previous heart disease

• Stroke

164. Male, 23 years old, with sick time of 6 hours, presenting progressive dyspnea.
Examination: jugular ingurgitation, blood pressure 90/60 mm Hg, trachea deviated to
the side.
What is the emergency surgical management?
• Needle decompression

• Thoracic tubular drain

• Pericardiocentesis

• Exploratory thoracotomy

• Thoracoscopy

165. What is the most common benign lung neoplasm?

• Hamartoma

• Teratoma

• Blastoma

• Neuroma

• Xanthoma

166. In which of the following cases is surgical removal of aspergilloma indicated?

• Recurrent hemoptysis

• Respiratory insufficiency

• Localized lesion

• In neoformed cavity

• In recurrence

167. Which coagulation factors are blocked in their activation by warfarin?

• II,VII,IX,X

• I,XII,V,IX

• IV,V,X,XI

• III,V,VII,X
• III,V,VI,X

168. What is the Beck triad found in penetrating heart injuries suggestive of
cardiac tamponade?

• Hypotension, neck veins distension, decreased heart sounds

• Hypotension, abolition of heart sounds, total circulatory collapse.

• Decreased heart sounds, venous distension of the neck, tachycardia

• Hypotension, abolition of heart sounds, orthopnea.

• Abolition of heart sounds, hypotension, chest pain

169. 24-year-old male, with open thoracic stab wound in the right
subscapular region, radiologically with an approximate hemothorax of 1200
cc.
What is the first recommended indication?

• Thoracostomy with thoracic drainage tube

• Urgent replenishment of blood volume with plasma and crystalloids.

• Drainage thoracostomy plus exploratory thoracotomy

• Evacuative thoracentesis

• Immediate exploratory thoracotomy

170. An atrial septal defect in adults older than 40 years is inoperable

when pulmonary vascular resistance is greater than:

• 12 U/ml

• 6 U/ml

• 8 U/ml

• 4 U/ml
• 10 U/ml

171. Normal adult intracranial pressure, in mmHg varies between:

A. 4 - 14

B. 20 – 24

C. 22 – 28

D. 25 – 30

E. 34 - 40

172. A 28-year-old woman comes to the emergency room with a sudden and intense
headache, "thundering", nausea and vomiting. On interrogation, she refers that the pain
is "the most intense of all her life"; according to these data, what is your first diagnostic
suspicion?

• Subarachoid hemorrhage

• Migraine

• Meningitis

• Transient ischemic attack

• Intracranial tumor

173. Patient reports low back pain, pain in the right thigh, associated with decreased
strength in the lower limb on the same side. At what level is the disc lesion located?

• L4

• L2

• L3

• L5
• S1

174. The presence of large intracerebral hematoma is related to rupture of aneurysm

located in the brain:

• Middle cerebral bifurcation

• Internal carotid artery bifurcation

• Rear communicator

• Previous Communicator

• Anterior choroidal

175. What is the entity where posterior (seborrheic) blepharitis with Meibomian gland
dysfunction is frequent?

• Sjögren's syndrome

• Giant papillary conjunctivitis

• Bacterial keratitis

• Stye

• Dacryocystitis

176. Diabetic retinopathy is primarily a microangiopathy in which small vessels are

vulnerable to damage by high glucose levels. In descriptive classification in medical
practice proliferative diabetic retinopathy is characterized by:

• Papillary and extra papillary neovascularization.

• Microaneurysms, spot and speckle hemorrhages, and exudates

• Retinopathy of the macula with vision-threatening edema

• White cottony foci, venous alterations, deep retinal hemorrhages

• Retinal detachment, significant and persistent vitreous hemorrhage

 177. The Snellen visual acuity test is characterized by:

• Be briefer

• It is longer
• Equal number of letters in the different lines

• More complex scoring system

• 4 m test distance with many scales

178. In the clinical classification of age-related macular degeneration (AMD), the

advanced AMD category is characterized by:

• Neovascular AMD or any degree of geographic atrophy

• Drusites only, without pigment anomalies.

• Large drusen (> 125 um) or any pigmentary abnormality of AMD

• Medium drusen (>63 um, but < 125 um) without pigmentary abnormalities of AMD

• No drusen and no AMD pigmentary abnormalities

179. Which knee ligament is affected depending on the mechanism of direct blow on the
anterior tibia with the knee flexed, by hyperflexion or hyperextension ("splash injury")?

• Posterior cruciate

• Inner side

• External side

• Anterior cruciate

• Rotuliano
 180. In the initial care of the polytraumatized patient, when confronted
with evidence of a displaced pelvic fracture, what is the initial course of
action?

• Stabilizing the hip with a sheet

• Internal surgical stabilization

• Pressure on both iliac crests

• Fixing with external tutors

• Retrograde cystography

181. What is the initial treatment of fractures of the middle third of the clavicle?

• Immobilization with sling

• Hanging plaster on the affected side

• Splint for abduction of the affected limb

• Traction and bloodless reduction

• Crude reduction with plate and screw

182. A 25-year-old male falls with the upper limb in extension and external rotation, and
the shoulder is abducted. On examination he presents with the epaulette sign, which
nerve is most likely to be affected?

• Axillary (circumflex)

• Supra scapular

• Sub scapular

• Dorsal of the scapula

• Medium

183. What is the most common fracture location in children?

• Distal forearm

• Clavicle

• Phalanges of the hand

• Ankle

• Tibia

184. A 45 year-old man comes to the clinic because of pelvic pain that makes it difficult
for him to walk. Radiological examination of the area shows calcifications in "corn
rosettes". What is his probable diagnosis?

• Chondrosarcoma

• Osteosarcoma

• Desmoplastic fibroma

• Tumor metastasis

• Ewing's sarcoma

185. Which of the non-displaced fractures of the wrist bones may require surgical
treatment?

• Scaphoid

• Semilunar

• Trapeze

• Pyramidal

• Large bone

186. What is a complication of surgical intervention in patients with

Dupuytren's disease?

• Digital nerve injury

• Radial artery injury

• Ulnar artery injury

• Median ligament injury

• Wrist bone necrosis

187. Which of the injuries are related to and result from direct trauma to the arm
or a fall with the arm in extension, especially in the elderly?

• Humeral diaphysis fracture

• Shoulder dislocation

• Fracture of humeral epiphysis

• Luxo fracture of humeral head

• Multisegmental humeral fracture

188. Fournier's gangrene is a soft tissue infection that can involve

the genitals, usually caused by agents:

• Polymicrobials

• Anaerobes

• Aerobes

• Gram positive

• Gram negative

189. What is a complication of benign prostatic hypertrophy?

• Damage and loss of bladder function

• Prostate cancer

• Bladder cancer

• Kidney cancer

• Nephrolithiasis
 190. Older men more often present with absence of erectile function that is
secondary to:

• Vascular insufficiency

• Prostate adenoma

• Hypogonadism

• Testicular hypoplasia

• Varicocele

191. What is the most common type of stone found in urolithiasis?

• Calcium oxalate

• Magnesium phosphate

• Combined calcium phosphate and ammonium phosphate

• Ammonium phosphate

• Mixed

192. What is the cause of the visceral symptoms presented by a patient with
obstructiveuret. eral lithiasis?

• Increased pressure in the proximal collecting system

• Pyelonephritis

• Vesicoureteral Reflux

• Increased pressure in the distal collecting system

• Abnormality of bladder trigone

 193. What is the degree of injury in renal trauma with a tear >1 cm deep in the
renal cortex, without rupture of the collecting system or urinary extravasation?

• III

• IV

• II

• I

• V

194. Which of the following pathologies is a cause of male sterility?

• Varicocele

• Epididymal cyst

• Hydrocele

• Unilateral testicular hypoplasia

• Hydronephrosis

195. How long is it recommended to postpone pregnancy in patients

undergoing bariatric surgery?

• 2 years

• 1 year

• 6 months

• 5 years

• 3 years