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#993
26.12.2006, 00:10
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Âñ¸ âåðíî, àíàìíåç ó÷èòûâàåòñÿ ïðè íàçíà÷åíèè ýñòðîãåí-ãåñòàãåííûõ ïðåïàðàòîâ. Íî äëÿ òîãî, ÷òî áû çíàòü êàêèå ïîêàçàòåëè îòñëåæèâàòü. Êñòàòè â ýòîì êîìïëåêñå áîëåå îïàñíû ñ ó÷åòîì àíàìíåçà èìåííî ýñòðîãåíû, à íàçíà÷åíèå èõ âñå æå íåîáõîäèìî(ïàðàäîêñ!) èñõîäÿ èç àíàìíåçà!
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#994
26.12.2006, 06:32
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Ëþáàÿ ãîðìîíîçàìåñòèòåëüíàÿ òåðàïèÿ ïîâûñèò ðèñê ñîñóäèñòûõ êàòàñòðîô è ðàêà ìîëî÷íîé æåëåçû, ò.å íå ñíèçèò morbidity and mortality, à ïîâûñèò. Âàðèàíòû îò  äî Å îòïàäàþò!!!
Äðóãèå ñðåäñòâà ëå÷åíèÿ ïîñòìåíîïàóçàëüíûõ ñèìïòîìîâ íàäî ïîèñêàòü. À âîò îñòåîäåíñèòîìåòðèÿ - òî, ÷òî íóæíî!!! Ëå÷åíèå ïîñòìåíîïàóçàëüíîãî îñòåîïîðîçà (áåç ãîðìîíîâ) ðåàëüíî ìîæåò ïðîäëèòü æèçíü è óëó÷øèòü å¸ êà÷åñòâî. A. annual bone density surveys!
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#995
28.12.2006, 07:17
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The correct answer is C. This patient is postmenopausal and not on hormone replacement therapy (HRT). Accelerated bone loss and osteoporosis are top among the increased risks that such women have. Bisphosphonates are a class of drugs that are taken orally and act to inhibit osteoblast formation and/or function. Their precise mechanism(s) of action are unknown. This, in addition to estrogen and progesterone replacement will reduce her long-term morbidity and mortality.
Annual bone density surveys (choice A) are a monitoring tool. These tests are not therapeutic in any way and in order to reduce long-term morbidity, some intervention is required. Bone density surveys are the standard monitoring tool for following the progression of osteoporosis. It is appropriate to treat with estrogen and progesterone replacement (choice B) together since the progesterone offsets the unopposed estrogen. However bisphosphonate therapy is absent from this regimen. Because the beneficial effects of progesterone on estrogen action is lost with estrogen replacement and bisphosphonate therapy (choice D) alone, it is incorrect. Replacing estrogen alone (choice E) is inadequate since this increases her risk for endometrial cancer dramatically.
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#996
28.12.2006, 07:19
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A 76-year-old woman is brought to the hospital by her son because of "rapid breathing." She has advanced Alzheimer disease and is unable to give a coherent history. She was recently diagnosed with breast cancer. She lives alone, but normally has a health care aide during the day. The aide was not available when the son tried to reach her to ask if anything happened. The son has not seen his mother in 2 months. An accentuated fall in systolic blood pressure during inspiration would most likely suggest
A. anxiety B. cardiac tamponade C. myocardial infarction D. senile aortic stenosis E. sepsis
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#997
28.12.2006, 07:24
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Pulsus parodoxus - B.
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#1001
28.12.2006, 17:30
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The correct answer is B. This question describes pulsus paradoxus, which is when there is an accentuated fall in systolic blood pressure (>10 mm Hg) during inspiration. There is usually a small decrease in blood pressure during inspiration, but it is exaggerated in cardiac tamponade because the external compression caused by fluid accumulation around the heart leads to impaired ventricular filling, reduced left ventricular stroke volume, and a reduction in systolic blood pressure. Cardiac tamponade can occur acutely after trauma or develop chronically from the accumulation of pericardial fluid malignancies (she has breast cancer), uremia, infections, collagen vascular diseases, or radiation.
All of the other choices, anxiety (choice A), myocardial infarction (choice C), senile aortic stenosis (choice D), and sepsis (choice E), may be associated with tachypnea, but are not usually direct causes of pulsus paradoxus.
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#1002
28.12.2006, 17:39
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A 26-year-old man comes to the office because of an 11-day history of crampy abdominal pain, non-bloody diarrhea, bloating, and increased flatus. He went on a camping trip 3 weeks ago where he and his friends cooked their own food and drank water from streams. He tells you that two of the three other guys that he went with have similar symptoms. They are both patients of yours too. His temperature is 37.2 C (99.0 F), blood pressure is 110/70 mm Hg, and pulse is 60/min. Physical examination shows mild diffuse abdominal tenderness and guaiac negative stool. Examination of a wet mount of a stool sample under the microscope fails to reveal leukocytes. The most appropriate next step is to
A. ask him to bring in 5 stool samples over the next 5 days B. obtain a sample of duodenal fluid C. obtain a stool sample for ova and parasites D. prescribe a 5-day course of metronidazole E. reassure him that this condition is self-limited and that no treatment is indicated F. tell him to advise his friends to schedule an appointment
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#1003
28.12.2006, 21:04
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Âîäè÷êè îí èç ðó÷üÿ ïîïèë
È ëÿìáëèþ ïîäöåïèë. Ïàöèåíò ñòðàäàåò 11 äíåé, ëîãè÷íî íàçíà÷èòü ëå÷åíèå : D. prescribe a 5-day course of metronidazole
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#1005
29.12.2006, 16:11
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Öèòàòà:
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Ëèíåéíûé âèä
