Examen Único de Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único de Residencias en Salud - Córdoba Medicina) Exam - Examen Único de Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único de Residencias en Salud

Question 1

A 58-year-old man presents to the emergency department with 90 minutes of crushing substernal chest pain radiating to the left arm and diaphoresis. An ECG shows 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. The nearest primary percutaneous coronary intervention (PCI) facility is located 3 hours away. According to Argentine and international cardiology guidelines, what is the most appropriate immediate reperfusion strategy?

Immediate intravenous fibrinolytic therapy (e.g., tenecteplase or alteplase) within 10 minutes of diagnosis, followed by transfer to a PCI-capable center Emergency interfacility transfer for primary percutaneous coronary intervention without administering fibrinolysis Administration of high-dose intravenous unfractionated heparin and observation in the coronary care unit Urgent coronary artery bypass graft (CABG) surgery consultation without medical reperfusion

Correct Answer:

Immediate intravenous fibrinolytic therapy (e.g., tenecteplase or alteplase) within 10 minutes of diagnosis, followed by transfer to a PCI-capable center

Question 2

A 64-year-old woman with ischemic cardiomyopathy and a left ventricular ejection fraction of 28% (NYHA Class II) is evaluated in the outpatient clinic. Her blood pressure is 125/78 mmHg, heart rate is 68 bpm, and serum creatinine is 1.0 mg/dL with potassium 4.2 mEq/L. She is currently taking enalapril 10 mg twice daily and carvedilol 25 mg twice daily. According to guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), which medication modification is most appropriate to reduce mortality?

Discontinue carvedilol and initiate verapamil for better rate and blood pressure control Switch enalapril to sacubitril/valsartan (ARNI) after a 36-hour washout period, and add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin) Add digoxin and furosemide while keeping her current enalapril and carvedilol doses unchanged Discontinue enalapril and replace it with amlodipine to optimize afterload reduction

Correct Answer:

Switch enalapril to sacubitril/valsartan (ARNI) after a 36-hour washout period, and add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin)

Question 3

A 71-year-old woman with a history of hypertension and type 2 diabetes mellitus presents for routine evaluation. An ECG reveals asymptomatic atrial fibrillation with a ventricular response of 84 bpm. Her echocardiogram shows normal left ventricular function and a mildly enlarged left atrium. Her CHA2DS2-VASc score is calculated. What is the recommended strategy regarding stroke prevention?

Prescribe dual antiplatelet therapy with aspirin and clopidogrel Prescribe aspirin 100 mg daily as monotherapy for antiplatelet stroke prophylaxis Initiate oral anticoagulation with a direct oral anticoagulant (DOAC, e.g., apixaban, rivaroxaban, dabigatran) or a vitamin K antagonist Withhold antithrombotic therapy because the atrial fibrillation is asymptomatic

Correct Answer:

Initiate oral anticoagulation with a direct oral anticoagulant (DOAC, e.g., apixaban, rivaroxaban, dabigatran) or a vitamin K antagonist

Question 4

A 52-year-old man presents to the emergency room with severe headache, blurred vision, and confusion. His blood pressure is 220/130 mmHg. Fundoscopic examination reveals bilateral flame-shaped retinal hemorrhages, soft exudates, and papilledema. Urinalysis reveals proteinuria and microscopic hematuria. What is the diagnosis and the target blood pressure reduction in the first hour?

White-coat hypertension; prescribe oral enalapril and discharge with outpatient follow-up in 24 hours Hypertensive urgency; administer sublingual nifedipine immediately to normalize blood pressure to < 120/80 mmHg within 30 minutes Hypertensive emergency; reduce systolic blood pressure to < 100 mmHg within the first 15 minutes using high-dose intravenous hydralazine Hypertensive emergency (malignant hypertension); reduce mean arterial pressure (MAP) by no more than 20% to 25% within the first hour using intravenous antihypertensive therapy

Correct Answer:

Hypertensive emergency (malignant hypertension); reduce mean arterial pressure (MAP) by no more than 20% to 25% within the first hour using intravenous antihypertensive therapy

Question 5

A 45-year-old man with a history of bicuspid aortic valve presents with a 3-week history of low-grade fever, night sweats, fatigue, and weight loss. On examination, a new 3/6 diastolic murmur is audible at the left sternal border, and subungual splinter hemorrhages are noted. Three separate sets of blood cultures obtained over 24 hours grow Streptococcus gallolyticus (formerly S. bovis). In addition to echocardiography and tailored antibiotic therapy, which diagnostic evaluation is mandatory?

Complete colonoscopy to evaluate for colorectal adenoma or carcinoma Diagnostic lumbar puncture to rule out cryptococcal meningitis Urgent bone marrow biopsy to assess for acute myeloid leukemia Endoscopic retrograde cholangiopancreatography (ERCP) for biliary tract evaluation

Correct Answer:

Complete colonoscopy to evaluate for colorectal adenoma or carcinoma

Question 1

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Prepare with the Examen Único de Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único de Residencias en Salud - Córdoba Medicina) Exam practice quiz. This question bank includes 100 questions covering year-old, presents, examination, serum, and fever. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Examen Único de Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único de Residencias en Salud - Córdoba Medicina) Exam

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Examen Único de Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único de Residencias en Salud - Córdoba Medicina) Exam

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