Еще одна пилюлька Hескучина

[Melnichenko]

Ожирелая женщина в постменопаузе ( экстрагонадная несоотвествующая возрасту гиперэстрогения) -В

[vosk]

кажется очевидно, что ни "С", ни "D", ни "F".
принимая во внимание, что она refuses to give a sexual history, я рискну ответить "А"
Dmitry Voskovets

[papadoctor]

Рак шейки , обычно не кровит и риск больше у .... чересчур активно - неразборчивых дам. Надо исключать рак эндометрия, который так и должен начать проявляться. Би.В.

[Alexey D]

Cогласен с папой доктором.

[Melnichenko]

Уверена, что многие подписаны на этот сайт. Там сейчас очень симпатичная картинка.[Ссылки доступны только зарегистрированным пользователям ]

[Alexey D]

Прошу прощения, на какой сайт?

[yananshs]

http://master.emedicine.com/asp/email.asp?mm_email={cemail}&type=weeklyphoto

[Alexey D]

По-прежнему, ничего. Даже после регистрации

[yananshs]

The correct answer is B. Since endometrial cancer is the most common gynecologic malignancy in the United States, and it typically presents with vaginal bleeding in a postmenopausal woman, you should be concerned that this is the cause. This patient is obese and has a history of hypertension, which are both risk factors for endometrial cancer. A dilatation and curettage can be performed in the hospital to help establish a diagnosis.

Cervical cancer (choice A) is a less likely cause of bleeding in this postmenopausal obese woman. The classic presentation of carcinoma of the cervix, is bleeding following sexual intercourse. Discharge and pain may be present. It may, however, be asymptomatic until later stages. Diabetes, hypertension, and obesity are not known risk factors for cervical cancer.

Endometriosis (choice C) presents in many ways, but patients will usually complain of pelvic pain and more specifically, dysmenorrhea. Endometriosis most commonly affects women between the ages of 30 and 40. Postmenopausal bleeding is not a symptom of endometriosis.

Ovarian cancer (choice D) is usually asymptomatic until late in the disease course. The presentation of ovarian cancer varies, but in later stages it can present as a pelvic mass with ascites and bowel obstruction.

Primary vaginal cancers (choice E) are rare. Most neoplastic diseases found in the vagina are due to metastases from cervical cancer. It is more likely that this patients postmenopausal bleeding is caused by uterine cancer than by vaginal cancer.

Vulvar cancer (choice F) typically presents with local pruritus, vulvar bleeding, or a mass in the vulva. It is not typically associated with postmenopausal vaginal bleeding.

[yananshs]

A 31-year-old woman comes to the office for a follow-up visit. Two weeks ago, the patient underwent an echocardiogram for the evaluation of a systolic murmur. Her valves appeared normal but the echocardiogram disclosed elevated right ventricular systolic and diastolic pressures consistent with pulmonary hypertension. She has no primary lung disease and reports no symptoms of dyspnea or tachypnea. Her other past medical history is unremarkable and she takes only oral contraceptive pills for medications. The most appropriate next step in the management of this patient is to
A. prescribe calcium channel blockers, orally
B. prescribe nitric oxide, inhaled
C. prescribe prostaglandin, intravenously
D. refer the patient for oxygen diffusion capacity testing
E. refer the patient for vasodilator response testing

[exomen]

я думаю-Е или D. Но D нужно для выявления причин нарушения газообмена или для опеределения объема операции при резекции легкого у дыхательного хроника с эмфиземой.
А Е. как раз и поможет узнать стоит ли давать кальциевые блокаторы, остальные препараты здесь не актуальны.
Евгений

[riltsov]

По-видимому, у пациентки первичная легочная гипертензия. Препаратами первого ряда, безусловно, будут calcium channel blockers, хотя могут применяться и nitric oxide и prostaglandin и даже силденафил. Она asymptomatic, поэтому немедленное назначение лечения не может рассматриваться как most appropriate next step. Oxygen diffusion capacity test применяется для определения функции легких, уместен при вторичной легочной гипертензии на фоне заболевания легких. Поэтому согласен, что правильный ответ E. refer the patient for vasodilator response testing.

[yananshs]

The correct answer is E. The management of patients with pulmonary hypertension focuses on three issues: is the disease secondary to primary pulmonary disease (secondary pulmonary hypertension), is the patient responsive to vasodilator therapy, and, can the pulmonary pressures be made normal with medication. For this patient, the assumption is, given her age and lack of medical history, that her pulmonary hypertension is primary. In addition to pulmonary function testing to help verify this assumption, vasodilator testing to determine whether the pulmonary vasculature is responsive or not is the first step in the management of such patients.

Calcium channel blockers (choice A), inhaled nitric oxide (choice B) or intravenous prostaglandin (choice C) are all agents used in the management of primary pulmonary hypertension. The choice of these agents depends on whether the patient is vasodilator responsive and the side effect profile. Systemic agents such as calcium antagonists and prostaglandins are associated with often profound systemic hypotension which limits their utility is normalizing pulmonary pressures.

Referring the patient for oxygen diffusion capacity testing (choice D) is not necessary. Standard spirometry as part of a full battery of pulmonary function tests are indicated to assess whether the hypertension is primary or secondary, but diffusion testing is only useful in cases where hypoxemia coexists with existing pulmonary disease.

[yananshs]

A 53-year-old man who is status post renal transplant 3 years earlier, returns to the clinic for routine follow up for multiple warts on his hands and feet. Since his last visit 1 month ago he has been using large amounts of salicylic acid 40% plasters to treat his widespread warts. He tells you in passing that over the past week he has developed ringing in his ears. He currently takes many medications, including prednisone, cyclosporine, and lansoprazole. His temperature is 38.3 C (101.0 F), blood pressure is 110/80 mm Hg, and pulse is 105/min. Physical examination shows approximately 20 verrucous papules on the plantar surface of the feet as well as involvement of multiple fingers on the hands. The most appropriate next step in the management of this patient is to
A. discontinue cyclosporine
B. discontinue lansoprazole
C. discontinue topical wart therapy
D. refer him for an audiology exam
E. tell him to continue current therapy until he sees an otolaryngologist about this problem

[papadoctor]

Сообщение от Melnichenko

Уверена, что многие подписаны на этот сайт. Там сейчас очень симпатичная картинка.[Ссылки доступны только зарегистрированным пользователям ]

That one of thyroglossal cyst?