• Renato Eduardo Gómez Mota.

• A 60-year-old woman with stable chronic angina. Cardiac catheterization is

performed finding lesion in anterior descending oronary, so angioplasty and stent
placement are performed. Two hours after the procedure refers to precordial
pain. The examination shows arterial hypotension, tachycardia, tachypnea,
paradoxical pulse and jugular engorgement. No murmurs are detected. An
electrocardiogram is taken that shows alternating complexes
What is the most likely clinical diagnosis?
A. Acute thrombosis of the stent.
B. Cardiac tamponade.
C. Pulmonary thromboembolism.
D. Acute myocardial infarction.
What is the management that should be established immediately in this patient?
A. Therapeutic catheterization.
B. Ilb/la inhibitors and unfractionated heparin.
C. Thrombolysis and vasopressors.
D. Pericardial drainage
• A 35-year-old man who enters the emergency department after a car
accident 30 minutes ago. Clinically with respiratory distress data. The
chest x-ray shows a completely radiolucent peripheral area on the
right side, with the ipsilateral lung collapsed. Based on the history and
radiological findings, the presence of:
• A. Pneumothorax.
• B. Pneumopericardium.
• C. Hemothorax.
• D. Pulmonary contusion.
A 45-year-old man who has been dedicated to masonry since the age
of 15 began 8 months ago with cough and progressive dyspnea.
Physical examination is irrelevant. In its chest plate round nodular
opacities of 0.8 cm are observed in both hemithorax predominantly in
the middle and lower lobe.
What is the most likely diagnosis?
A Lung cancer
B Mesothelioma
C Silicosis
D Pulmonary tuberculosis
• A 54-year-old man, sedentary and with a history of systemic arterial hypertension
for 10 years, in treatment. He goes to consult with his general practitioner
because he reports excessive tiredness, drowsiness in the day and sometimes
morning headaches in addition, he has noticed a decrease in his work
performance.
• He currently lives alone but his previous partner complained that he snored a lot.
The physical examination highlights BMI of 28 and "neck in bull".
• What is the most likely diagnosis?
• A Metabolic syndrome
• B Obstructive sleep apnea
• C Primary hypothyroidism
• D Cushing's syndrome
• A 65-year-old man with a history of smoking for 30 years at the rate of 20
cigarettes / day, comes for presenting cough with long-term expectoration
and occasional difficulty breathing, today he presented it while exercising
(jogging). The examination is: RR: 23 x1, HR: 98 bpm, BP: 110/60 mm Hg, T:
37.6°C, also presents hypoventilation and generalized wheezing. Basic
paraclinicals are performed in which it stands out: Hb 16g/dI, Hto 48%, Leu
7,800.
• What is the most likely diagnosis?
• A Chronic bronchitis
• B Exacerbated asthma
• C Pulmonary emphysema
• D Acute pneumonia
• Serial clinical case. A 20-year-old patient, with no history of lung
disease, begins his current condition with pain in the right hemithorax
accompanied by dyspnea. Auscultation is a decrease in respiratory
sounds and increased sonority to percussion in the same hemithorax.
Arterial blood gases are normal. First statement. The most likely
diagnosis is:
• a Lobar pneumonia
• b Pleural effusion
• c Chylothorax
• d Spontaneous pneumothorax
antibiotic therapy
antibiotic therapy

• The appropriate treatment for this patient consists of:

• a) Antibiotic therapy
• b) Lymphatic diversion
• c) Drainage with water seal
• d) Thoracotomy
• A 29-year-old man, who after a quarrel suffers a stab wound in the right
hemithorax. The patient arrives at the emergency room on his own.
Anxious, polypneic, able to respond coherently. Nasal tips are placed. To
auscultation with decreased respiratory sounds in affected hemithorax,
dullness to percussion in it. No obvious bleeding. Weak radial pulse.
Generalized pallor. BP 100/60 mmHg, HR 115 bpm, RR 25 rpm x1.
• What is the most likely diagnosis?
• A Massive Hemothorax
• B Cardiac tamponade
• C Open pneumothorax
• D Tension pneumothorax
• The appropriate treatment for this patient consists of:
• a) Antibiotic therapy
• b) Lymphatic diversion
• c) Drainage with water seal
• d) Endothoracic pleural drainage