Медицина с картинками (одобрен автоматически)

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10 нояб 2026

Teenager, after attempted suicide with intake of tricyclic antidepressant, manifested cardiorespiratory arrest. During resuscitation cardiopulmonary, the following rhythm was observed in heart monitor. The analysis of the cardiac monitor allows us to confirm that the electrocardiographic tracing demonstrates rhythm of

Patient, 49 years old, male, farmer, comes to the consultation complaining of a lesion on the face that started as a papule, later evolving into painless ulceration. The first lesion appeared 3 months ago, followed by two more with the same characteristics. Associated with the appearance of the lesions, he developed weight loss, which he was unable to quantify, but he noticed that his clothes were looser than usual. He hasn't presented a similar picture before. He reports smoking and alcohol consumption since childhood. Does not mention medication use. During the physical examination, ulcerated lesions with raised edges and a grainy background were seen in the lower labial and mental region. A scraping was taken for direct examination and biopsy of the lesion. In both exams, yeast-like forms with multiple small, rudder-wheel buddings were found. Negative Montenegro reaction. What is the diagnosis and treatment of choice?

A 57-year-old male patient arrives at the emergency room complaining of palpitations that began three days ago, associated with dizziness and dyspnea. She reports using methimazole 10 mg/day for a month due to a diagnosis of hyperthyroidism. He has also been taking enalapril 20 mg for high blood pressure since he was 45 years old. On examination: Blood pressure = 110 x 70 mmHg; Heart rate = 160 BPM; Respiratory rate = 26 irmp; tachycardic, irregular heart rhythm, in two beats, without murmurs; physiological breath sounds with bibasal crackles; abdomen free, painless, positive bowel sounds; locomotor system without changes. Peripheral oxygen saturation of 87%. ECG requested in figure 1. Oxygen supplementation and cardiac monitoring installed. Select the alternative that identifies the arrhythmia and the action to be taken in the emergency room.

A 57-year-old patient goes to the Basic Health Unit complaining of the appearance, a month ago, of a reddish lesion on his right arm. She sought medical attention, when she was prescribed nystastin cream for 14 days and fluconazole 150 mg in a single dose, with no improvement in her condition. He reports that he subsequently developed pain in his right elbow, and was diagnosed with tendinitis and prescribed anti-inflammatory drugs. He reports that he has no other illness and does not use medication. Physical examination shows an erythematous macule with raised erythematous edges and an atrophic center. What is the diagnostic hypothesis and workup to be carried out?

A 14-year-old female patient receives medical care due to macroscopic hematuria accompanied by mild myalgia, adynamia and mild hyperthermia (axillary temperature = 37.8°C). The mother informs that the patient had an upper airway infection about a month ago, which resolved after treatment with amoxicillin for seven days. At the time of this first consultation, the patient presents with arterial hypertension (Blood pressure = 150x110 mmHg), the fundus is normal and there are no other changes on the physical examination. The patient is hospitalized because the first laboratory tests already show elevated serum creatinine (8.4 mg/dL) and she quickly progresses to oligoanuria, edema and worsening renal function. The macroscopic hematuria regresses, but microscopic hematuria persists, with the presence of hematic casts and the patient also starts to present proteinuria (3g/24 h). Clinical-laboratory investigation does not show the presence of vasculitis or systemic disease. Serum complement dosage (C3, CH50) is normal; antinuclear antibodies absent, negative antinuclear factor test. The patient underwent a renal biopsy - a fragment with 30 glomeruli, with proliferation of Bownan's capsule epithelial cells and infiltration by macrophages and lymphocytes, configuring the presence of epithelial crescents in 70% of the glomeruli, some with a fibrocellular appearance. The immunofluorescence of the renal biopsy, reproduced below, shows linear deposition of IgG - there are no mesangial deposits; Negative immunofluorescence for IgM, IgA and C3. Based on the clinical history, evolution and renal biopsy and immunofluorescence, the question is what is the mechanism responsible for glomerular damage?

Patient, 25 years old, second pregnancy, with previous cesarean section (G2P1C1), uneventful prenatal care, was admitted in labor and presents progress according to the partogram, shown below. In the tenth hour of evolution, she presents regular uterine activity of 5 contractions/45 seconds/10 minutes/strong and fetal heartbeat of 150 bpm. Analyzing the partogram, what is the diagnosis and management of the case?

A 24-year-old woman has been presenting progressive dyspnea on exertion, dry cough, sputum with occasional streaks of blood. Denies feverish episode. On physical examination, he presented blood pressure = 110 x 70 mmHg; radial pulse = 110 bpm; jugular stasis. On lung auscultation, fine crackles were evident at the lung bases; cardiac auscultation with hypophonesis of B1, splitting and hyperphonesis of B2, soft diastolic murmur on the left sternal border and diastolic rumbling murmur in the mitral focus. Upon examination of the abdomen, the liver was palpable 4 cm from the right costal margin and the spleen was impalpable. Perimalleolar edema was detected in the extremities. The patient underwent a chest X-ray in a posteroanterior view, which is illustrated below. The finding marked by the arrow on the chest x-ray is indicative of

A 12-month-old infant is taken to the Emergency Room by his mother with reports of intense crying, swelling in the leg and falling out of his crib approximately 8 hours ago. He has a history of TBI two months ago, also due to falling from his crib, according to his mother. An x-ray was taken, the image of which is reproduced below. The indication for hospitalization for this child will be made considering the most likely diagnosis to be

A male patient, 55 years old, smoker 60 packs/year, with a chronic cough for more than 10 years, reports that about three months ago he observed the presence of blood in the secretion eliminated by coughing. She also reports loss of around 15% of her usual weight in the same period, anorexia, adynamia and night sweats. The chest x-ray taken at the time of the consultation is shown below. What is the most likely diagnostic hypothesis in this case?

A 48-year-old man, hypertensive, obese, arrives at the Emergency Room complaining of episodes of precordial chest pain, without irradiation, which started in the last two days, and has worsened for 24 hours. The pain lasts from 5 to 15 minutes, being precipitated by intense exertion, such as climbing stairs, and is relieved by rest. The patient reports not feeling pain at the time of the anamnesis. Use captopril and oral hypoglycemic medication regularly. He denies any history of coronary disease and an electrocardiogram was considered normal by his cardiologist at his last appointment, 6 months ago. On examination, he appears anxious, but in good general condition, pulse = 85 bpm, regular, full, BP = 140x80 mmHg, peripheral pulses are palpable and symmetrical, extremities are well perfused. Lung and heart auscultations are within normal limits. His electrocardiogram on admission shows the following findings. What is the most appropriate approach for the patient?

A 24-year-old patient, first pregnancy, goes to a prenatal medical appointment at the health center. At this prenatal consultation, the doctor calculated the gestational age considering her first ultrasound at 12 weeks, concluding that she is 41 weeks and 6 days pregnant. During the pelvic examination, the uterine cervix was observed to be soft, posterior, 30% effaced, closed external os, high and mobile presentation. During the fetal palpation maneuver (Leopold-Zweifel), it was noticed that there was good fetal mobility, signaling a normal amount of amniotic fluid. Fearing postdatism, the doctor sent the patient to be admitted to the Maternity Hospital. Once there, she underwent cardiotocography, the image of which is reproduced below. What action should be proposed for this patient?

A 25-year-old first pregnancy comes to the Maternity Hospital when labor begins at 1 p.m. and its progress is recorded in the partogram below. The patient completes the first period of labor at 6:30 pm. The second period had already lasted 45 minutes, when the fetus began to show type II decelerations. What is the diagnosis of this case and the most appropriate obstetric management?

An 81-year-old woman, a smoker for 60 years, was admitted to a general hospital with severe dyspnea, which resulted in death two days after admission. Upon admission, a diagnosis of pulmonary embolism and deep vein thrombosis in the right lower limb was made. Properly filling out the death certificate is:

A three-year-old child, born at term, not regularly monitored in Child Care, was taken by the mother for an appointment at the Basic Health Unit after suffering a fracture in her right forearm two months ago. After medical evaluation, it was observed: low stature for age, scoliosis, disproportion of the upper and lower segment relationship, muscular hypotonia and small umbilical hernia. The doctor requested x-rays of the hand, wrist and lower limbs, shown below. The diagnosis and the radiological alteration that confirms it are, respectively:

A 54-year-old man, with a history of dyslipidemia, high blood pressure and a history of early familial cardiovascular disease (father had a myocardial infarction at age 50), was admitted to the Emergency Room of a hospital with a history of pain in the epigastric region for approximately five hours, in tightness, of strong intensity, unrelated to food and without factors for improvement, accompanied by nausea and vomiting. He had received 200 mg of AAS at the hospital of origin. On examination, he was pale, sweaty and drowsy. Axillary temperature = 35.8 oC, blood pressure = 80x50 mmHg, heart rate = 118 bpm, respiratory rate = 16 bpm. Decreased peripheral perfusion. Heart auscultation revealed normophonetic sounds, without murmurs. There was jugular turgidity at 45°. Lung auscultation revealed no rales. The admission electrocardiogram is shown below. Given the patient's clinical condition, the diagnostic hypothesis, the probable cause of shock and the recommended initial treatment are, respectively:

A 64-year-old man, suffering from high blood pressure and diabetes for over 20 years, sought the Emergency Department with complaints of dyspnea on medium exertion, which progressed to dyspnea on light exertion, in addition to paroxysmal nocturnal dyspnea, emergence of limb edema lower, soft, cold and ascending and also palpitations, for about two days. The patient states that he had stopped taking chronic medications 30 days ago and consumed alcohol and food in excess three days ago. Denies chest pain. The physical examination showed the patient to be in good general condition, conscious and oriented, slightly tachypneic at rest. Axillary temperature = 36 oC, blood pressure = 135x75 mmHg, heart rate = 122 bpm, respiratory rate = 22 bpm, capillary blood glucose = 321 mg/dL. Cardiac auscultation revealed normophonetic sounds, irregular heart rhythm in three beats, with the presence of B3, with a heart rate of 122 bpm, with a systolic murmur of tricuspid regurgitation. Jugular turgidity at 45th present. Lung auscultation revealed crackling rales at the bases. In the lower limbs there was 2+/4+ edema, soft, cold and painless. The patient had an echocardiogram performed three months ago with the following findings: enlargement of the heart chambers, concentric hypertrophy of the left ventricle, moderate tricuspid insufficiency and an ejection fraction of 35%. The electrocardiogram from the current admission is reproduced below. Based on the data presented, it can be stated that:

A 42-year-old man, a street vendor, was admitted to formal employment in commerce and seeks the Basic Health Unit to find out how to proceed in relation to a change identified in the admission exams, reproduced in the chest x-ray shown above. In the anamnesis, he reports a dry cough for more than six months, constant, daily, never treated. He denies fever, dyspnea, hemoptysis and weight loss. He has no other complaints. He has high blood pressure, controlled with hydrochlorothiazide. He has been a smoker, with a smoking history of 20 packs/year, for 22 years. His family history includes a brother with pulmonary tuberculosis who was treated last year. Denies any other pathological history or family history of the disease. The physical examination is normal. The most appropriate management for this patient at this time is:

Regarding the Rede Cegonha indicators, the Family Health Strategy teams in your city presented the graph above. The management goal is to reach 80% of registered pregnant women. The consultant from the Department of Health, which has limited financial resources, recommends an awareness and training workshop in order to reverse the current situation. Among the team members, which is the preferred target audience for the workshop to have the most effect?

A 56-year-old woman, former smoker (40 packs/year), presents with dyspnea on exertion and a morning cough with clear sputum. He uses inhaled salbutamol to relieve dyspnea. On physical examination, the patient has a pulse = 85 bpm, respiratory rate = 24 bpm, pulmonary auscultation shows reduced vesicular sounds at the base, without adventitious sounds. No other changes on physical examination. Come to the outpatient review appointment with a chest X-ray and arterial blood gas analysis on room air. After evaluating the exams, pharmacological treatment was prescribed and prolonged home oxygen therapy was indicated – 1L/min for at least 15h/day. Based on this information, the gasometric result that justified the indication of oxygen therapy is:

A 30-year-old first pregnancy, 38 weeks of gestation and uneventful prenatal care, is admitted to the Maternity Hospital in labor. On physical examination upon admission, blood pressure = 100 x 60 mmHg, uterine height = 35 cm, uterine dynamics - 2 contractions in 10 minutes, fetal heart rate = 140 bpm. Upon vaginal examination, thin cervix, 3 cm dilation, cephalic presentation, intact pouch. Analyzing the evolution of labor, according to the partogram shown above, the diagnostic hypothesis and correct conduct, after 10 hours of observation, are, respectively:

Медицина с картинками (одобрен автоматически)

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