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#121
18.10.2006, 22:56
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112-Е
113-Д Potassium-это Калий,я надеюсь. 114-Д 
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#123
22.11.2006, 11:20
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A healthy 12-year-old boy is brought to the clinic for a sports participation physical examination. He is planning on trying out for the junior varsity football team. He is going into seventh grade and his school recently switched the high school to seventh through twelfth grade. His mother tells you that he is very concerned because he has "not yet reached puberty" and he is afraid that he is going to be "harassed" by the older boys. Physical examination shows no pubic hair and a preadolescent penis and testes. The remainder of the physical examination is unremarkable. The mother and patient want to know "what is going on." At this time you should
A. advise him that he should consider taking male hormones, such as testosterone B. explain that puberty usually starts by 10 years old and that he is most likely developmentally delayed C. recommend that he go for genetic testing to evaluate him for a genetic disease D. tell him that he should be looking for testicular enlargement as the first sign of puberty E. tell them that everybody is different and there is no particular, predictable pattern of development
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#124
22.11.2006, 11:27
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Скорее всего Е.
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#127
24.11.2006, 23:51
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Explanation:
The correct answer is D. Puberty usually refers to the time between the development of secondary sexual characteristics and rapid growth and the end of somatic growth. It may occur at different times, but often follows a predictable pattern. The first sign of puberty in boys is testicular enlargement, which often occurs at 11.6 years of age. 11-12 years old is the average age of pubertal development in boys. But the normal range is 9-14 years. Therefore, this boy needs reassurance that he is within the normal range and since he is anxiously awaiting puberty, he should be told what to look for as the first sign. Advising him that he should consider taking male hormones, such as testosterone (choice A) is inappropriate because he is well within the normal range of development at this time. The average age of the onset of puberty is 11-12 years, but the range is from 9-14 years. It is incorrect to explain that puberty usually starts by 10 years old and that he is most likely developmentally delayed (choice B) because the average age of onset is 11-12 years, but the range is from 9-14 years. It is premature to tell him that he is delayed. Recommending that he go for genetic testing to evaluate him for a genetic disease (choice C) is incorrect because he is only 12 years old and the normal range for the onset of puberty is 11-12, and the range is 9-14 years. If the remainder of the physical examination is unremarkable, and he has had no previous problems, genetic testing at this time is inappropriate. Even though development may occur at different ages, there is often a predictable pattern of pubertal development called Tanner stages. It is therefore incorrect to tell them that everybody is different and there is no particular, predictable pattern of development (choice E). In males, stage I refers to a preadolescent with no pubic hair, stage II refers to testicular enlargement and scant pubic hair, stage III refers to penile enlargement, greater testicular enlargement and curling of pubic hair, stage IV refers to greater penile enlargement, darkening of the scrotum, and adult-type pubic hair (but less of it), and stage V refers to adult size penis and testes and adult distribution of pubic hair.
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#129
25.11.2006, 00:15
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Думаю, что правильный ответ - Д - именно из-за этой фразы
Цитата:
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#130
25.11.2006, 12:57
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You are the doctor covering the newborn nursery, when a new baby is brought in from the delivery room. The baby was born full term, there were no complications at the time of delivery, and the baby appears well now. The Apgar scores were 9 at 1 minute and 9 at 5 minutes. You review the mother's prenatal history and discover that she had a vaginal swab positive for group B Streptococcus. Upon further review of the records, you note that the mother received one dose of ampicillin three hours prior to delivery, had rupture of membranes for 5 hours, and did not have a fever. The most appropriate initial management of this baby is
A. close observation only B. complete blood count with differential C. complete blood count with differential and blood culture D. complete blood count with differential, blood culture, and lumbar puncture E. complete blood count with differential, blood culture, lumbar puncture, and chest x-ray
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#132
26.11.2006, 15:21
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Скорее всего -А.Только я не понимаю зачем мама ребенка получала ампициллин.
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#135
29.11.2006, 12:04
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Explanation:
The correct answer is C. According to the guidelines written by the American Academy of Pediatrics in reference to babies born of mothers with group B Strep, if a baby is born at greater than 35 weeks gestation, appears well, but the mother received less than 2 doses of antibiotics (either ampicillin or penicillin) a limited evaluation is indicated. This evaluation includes a CBC, with differential and a blood culture with close clinical observation for at least 48 hours. No antibiotic therapy needs to be started on the baby if all results are normal and the baby continues to appear well. Close observation only (choice A) would be appropriate for this child only if the mother had received at least 2 doses of antibiotics prior to the delivery. If this had been the case, no laboratory evaluation, and no therapy would be indicated, just close clinical observation for at least 48 hours. A CBC with differential but no blood culture (choice B) is not a complete work-up for this baby. As stated above, the guidelines indicate that for a baby born to a group B Strep-positive mother who received less than 2 doses of intrapartum antibiotics, both a CBC and blood culture are indicated. A more complete work-up such as CBC with differential, blood culture, and lumbar puncture (choice D) would be indicated in this baby if there were any signs of sepsis such as prematurity, fever, hypothermia, irritability, or low platelets. If there is a concern of sepsis, after the above tests are done, the baby should be started on empiric antibiotic therapy with ampicillin plus an aminoglycoside or a third-generation cephalosporin. If all the laboratory results and clinical course are unremarkable, and the cultures do not grow, the antibiotic therapy is usually stopped after 48 to 72 hours. Tachypnea is another sign of sepsis in a neonate. If this baby was tachypneic, a CBC with differential, blood culture, lumbar puncture, and chest x-ray (choice E) would all be indicated. After those tests were completed the baby should be started on empiric antibiotic therapy. If the respiratory distress continues, the baby should be evaluated for possible transfer to the neonatal intensive care unit.
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