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#1
11.09.2006, 16:53
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Детский вариант пилюльки
Ув. педиатры!
На форуме терапевтов есть пилюлька от Нескучина. Предлагаю у нас на форуме ее детский вариант. Для начала вот такой вопрос: A 17-year-old woman comes to the office complaining of a 3-month history of "crampy" abdominal pain along with alternating episodes of constipation and diarrhea. She reports that the pain has been worse recently since starting a new job, which she describes as "high stress." Pain also seems worse with eating fatty meals. Her temperature is 37.0 C (98.6F), blood pressure is 120/72 mm Hg, pulse is 63/min, and respirations are 10/min. Physical examination reveals a soft, non-tender, non-distended abdomen with normal bowel sounds and without organomegally. Her rectal exam reveals normal tone. The correct diagnosis would be supported by finding A. a biopsy with transmural intestinal inflammation B. fistula formation within the abdomen C. a history of bloody diarrhea D. a normal colonoscopy E. positive H. pylori antibody titers 
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#2
11.09.2006, 16:59
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Думаю, что это синдром раздраженной толстой кишки, т.е. D.
С другой стороны, не вполне понятна локализация болей. М.б. и гастрит или дуоденит, тогда E. Но вообще говоря, для гастрита характерна болезненность при пальпации. Нет, все-таки D.
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- вариант С|
#5
11.09.2006, 17:17
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Насчет НЯКа, меня остановил совершенно спокойный живот при пальпации, да и при ректальном обследовании все хорошо.
Немного смущает, правда, тот факт, что ей кажется, что похуже от жирной пищи (это ведь тест, а в тесте, как в сказке про Алису, все не просто так), но все равно физикально при НЯКе что-то должно находиться...
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#6
11.09.2006, 17:24
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Тим, тоже верно. Однако характер у меня дурной - самый "напрашивающийся" вариант отметаю сразу и ищу подвох))) Кроме того, что при пальпации живот спокойный и нормы при ректальном исследовании, все остальное при наличии диареи с кровью очень похоже на НЯК. Хотя вполне возможен и воспалительный процесс.
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#7
11.09.2006, 17:56
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Explanation:The correct answer is D. This patient has irritable bowel syndrome (IBS). This is the most common functional GI disorder. It is characterized by abdominal pain with alternating diarrhea and constipation. It is often related to stress or exercise. Diagnosis is made by history and thoughtful exclusion of other organic diseases. Colonoscopy, if performed, should be normal. Indication for colonoscopy would be to differentiate irritable bowel syndrome from inflammatory bowel disease.
Transmural inflammation (choice A) and fistula formation (choice B) is typical of Crohn disease. Crohn disease is characterized by inflammation of any part of the gastrointestinal tract (mouth to anus). Patients often have lesions, which are not continuous, described as skip lesions. The inflammation is transmural, which means that it involves all layers of the mucosal wall contrary to UC. Patients typically present with non-bloody diarrhea, weight loss, and abdominal pain. Bloody diarrhea (choice C) is a finding in ulcerative colitis (UC). UC is characterized by inflammation limited to the colon and rectum and is typically described as continuous (as opposed to "skip" lesions). Bloody diarrhea is the typical presenting symptom. H. pylori (choice E) may be a cause of abdominal pain and its eradication is recommended if it is discovered incidentally, but routine serology checks in the work-up of abdominal pain is of unproved benefit.
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#8
11.09.2006, 18:06
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4 вопроса про судороги.
Q1] The parents of a 2-year-old come in to discuss their child's febrile seizures. The child has experienced four seizures, each associated with fever (usually from an ear infection). Each seizure lasted less than 2 minutes and was generalized tonic-clonic. The child was usually post-ictal for about 60 minutes but then returned to his normal level of mental function. The parents are concerned about the long-term significance for these seizures, specifically about any permanent brain damage and retardation. They ask if their child should be on medication to prevent the seizures. Which one of the following should you tell them? A) Children with a history of febrile seizures usually go on to a more complicated seizure pattern as they age. B) Children with a history of febrile seizures typically perform less well on standardized school tests. C) Children with febrile seizures typically are growth retarded. D) Children with febrile seizures are at greater risk for premature death than the general public. E) Most children who experience febrile seizures develop normally. Q2] You receive a telephone call from a worried mother. She says her 8 month old son just had a seizure lasting for 2 minutes.The seizure has subsided.He is feeding well. His temp 103 RR: 34/min She asks you what needs to be done. You say: A] Take him immediately to the nearest ER B] This is nothing serious. Stay calm C] Give antipyretics to the child and monitor the temp. Q3] Mother in Q2 asks you what is the risk of her child developing a recurrent febrile seizure now. You say: A] There is no such risk in your child B] Risk is increased if his family member has a h/o febrile seizure C] He will definitely have an increased risk since he already had one febrile seizure Q4] Mother in Q2 also asks you, " Doctor. I am very worried. Does this episode of seizure increase my son's risk of developing future epilepsy?" You should say: A] Your child is definitely at increased risk of developing epilepsy B] Your son will be at an increased risk if father has history of febrile seizures. C] If another seizure occurs during this illness then he will be at increased risk D]He will not have increased risk of developing future epilepsy.
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#12
11.09.2006, 20:06
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Е,А,С,D.По поводу второго вопроса,конечно,можно дискутировать.Но ребенок до года с впервые возникшими судорогами все-таки должен быть госпитализирован.
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#13
11.09.2006, 20:18
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Цитата:
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#14
11.09.2006, 20:36
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Цитата:
...ах, да: ECCD
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Линейный вид
