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#91
25.09.2006, 15:02
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49-е
50-с (больше похоже на пилоростеноз) 51-d (Узи) 
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#93
27.09.2006, 18:39
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53. A 2-year-old boy who has recently become one of your patients is brought to the clinic by his mother for a follow-up visit of a
chromosome analysis done 1 month ago. This child has minor dysmorphic features, and growth and developmental delay. Chromosome analysis showed a small unbalanced chromosome translocation, with extra chromosomal material at the tip of chromosome 3. The cytogenetics laboratory requested blood samples from both parents for follow-up studies. The parents are divorced, and the mother has custody of the child. The relationship between the parents is hostile. The mother has been tested and has normal chromosomes without evidence of translocation. At today's visit, she reacts angrily when the issue of contacting the child's father for testing is raised. She states that he abandoned them, and that he has no interest in his child. She refuses to cooperate in contacting the father, who could be a translocation carrier. You do not know the father, but an office worker told you that he lives in a nearby town. The mother says that he is living with a new girlfriend. Which of the following is the most appropriate next step? (A) Attempt to identify the father's physician and work with that physician to obtain chromosome studies on the father (B) Contact the father by telephone and arrange for him to give a blood sample at a local hospital (C) Document your attempts to work with the mother but proceed no further, since you have no physician-patient relationship with the father (D) Help the mother deal with her anger and educate her regarding the potential benefit to her son and others if the father's chromosome studies are done (E) Send the father a letter (expressing few details about the patient) and suggest that he contact your office for an appointment and further discussion of his child 54. An 18-month-old white infant is brought to the clinic because of pallor and irritability. Her mother says the infant's diet consists almost exclusively of whole milk, approximately 40 oz per day. On physical examination, the infant has a pulse of 160/min, respirations of 50/min, and normal heart sounds with a grade 2/6 systolic ejection murmur. Liver is palpable 3 cm below the right costal margin. Laboratory studies show: Blood Hematocrit 13% Hemoglobin 3 g/dL Mean corpuscular volume 48 µm3 Platelet count 400,000/mm3 Reticulocyte count 0.8% (N=0.5-1.5% of red cells) WBC 12,000/mm3 Following appropriate evaluation, which of the following is the most appropriate treatment? (A) Administration of oral folate therapy (B) Administration of parenteral iron therapy (C) Administration of parenteral vitamin B12 (cyanocobalamin) therapy (D) Transfusion with packed erythrocytes (E) Transfusion with whole blood 59. A 3-year-old boy is brought to the office by his father because of a 3-month history of decreased activity, poor appetite, sporadic vomiting, clumsiness and speech regression. Since his birth his family has lived in an old area of the city where there is demolition of old buildings. Examination of a peripheral blood smear is likely to show which of the following? (A) Basophilic stippling of erythrocytes (B) Degranulation of eosinophils (C) Diminished numbers of platelets (D) Howell-Jolly bodies (E) Macrocytic erythrocytes
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Е, наверное
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#98
27.09.2006, 21:12
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59-А.Похоже на отравление свинцом.Ожидаем базофильную зернистость эритроцитов.
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#99
27.09.2006, 21:26
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Цитата:
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#100
27.09.2006, 21:34
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По поводу уха,там кажется травма три дня назад?
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#102
27.09.2006, 22:04
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53-Е
54-анемия связана скорее всего с микрокровотечениями при молочном перекорме.Перевести oral folate therapy не получается.нужна коррекция препаратами железа.В тяжелых случаях переливание эритроцитарной массы. 59-А. Пойду совершенствовать свой английский.
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#103
27.09.2006, 22:17
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Меня все-таки очень смущает эта анемия...Либо для детей нормативы очень отличаются от "взрослых", либо ребенок на грани гибели... Гемоглобин - 3 г/дл, это 30 г/л, гематокрит вообще ни в какие ворота не лезет...
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#104
27.09.2006, 22:24
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Да,Наиля,я согласна,наверное тут есть какой-то подвох.Но один раз наблюдала девочку подростка,которая все лето пила козье молоко и больше почти ничего не ела.Гемоглобин был 60 г\л.В стационаре,где она лежала никаких причин анемии так и не нашли.Лечили парентеральным введением железа.Может быть и талассемия,а про молоко сказано,чтобы нас запутать?
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Линейный вид
