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#601
24.08.2006, 18:40
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Не могу не включиться в дискуссию
 .Вот ведь и хочется сделать МРТ... Но: 2 часа УЖЕ прошло. Пока отвезут, да пока возьмут, да пока сделают (20 мин минимум само исследование) - вот и прошел "золотой час"! В общем, хочется сказать "А". Хотя и страшновато, в 88-то лет... 
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#608
24.08.2006, 19:05
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Яна Сергеевна, Вы правы! Если через 2 часа после инфаркта на КТ он не виден, то его размер, скорее всего не превышает допустимый для тромболизиса. Крови нет. A. administer tissue plasminogen activator
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#609
24.08.2006, 19:13
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The correct answer is A. This patient is most likely having an acute stroke. She has a major neurological deficit, which is not rapidly improving, is within 3 hours of symptom onset, and has no intracranial blood or known systemic bleed. Acute strokes are rarely visible on CT. Tissue plasminogen activator is the standard of care for this case, not aspirin (choice D).
The patient should be treated acutely. You should not wait until the patient can be seen by a neurologist in the morning (choice B). The patient has a pacemaker, which is an absolute contraindication to MRI (choice C). It would be extremely unlikely that her symptoms are being caused by a seizure and thus there is no role for phenytoin in this case (choice E).
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#610
24.08.2006, 19:13
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A 21-year-old woman comes to the clinic to "discuss contraception options." This is the first time you have met this patient and she tells you that she is "allergic" to latex condoms, and that she has had both local and anaphylactic reactions to them in the past. She has had 6 sexual partners in the past 5 years, and is now in a monogamous relationship with a man that she plans to marry. She is generally healthy and has no complaints at this time. She was hospitalized for a single episode of pelvic inflammatory disease 3 years ago. She has no other medical conditions, exercises 3 times a week, does not smoke cigarettes, and has "a couple of beers" on the weekend with her friends. Her mother has hypothyroidism and her father has gout. She is 157 cm (5 ft 2 in) tall and weighs 50 kg (110 lb). Her blood pressure is 110/70 mm Hg and pulse is 60/min. Physical and pelvic examinations are normal. You obtain a Pap smear and tell her to return in 2 weeks for you discuss the results of the test and contraception. At the return visit, after you tell her that the Pap smear results were normal, the most appropriate next step is to
A. advise her to use condoms made out of animal membranes and use petroleum jelly on the condom to decrease the irritation B. fit her for a diaphragm that can be inserted before intercourse and taken out immediately after intercourse C. give her a prescription for oral contraceptive pills D. schedule an appointment to insert an intrauterine device E. tell her that she does not need contraception because she is probably infertile from pelvic inflammatory disease
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#612
24.08.2006, 19:54
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Тоже задачка, которая мне нравится. Только я не буду варианты ответов публиковать, а то неинтересно совсем.
50-летняя женщина с симптомами прогрессирующей одышки и продуктивным кашлем с выделением желтой мокроты с прожилками крови. Помимо этого, предъявляет жалобы на артралгии, насморк, небольшую лихорадку. При осмотре - корочки на слизистой носа. Аускультативно - по всей поверхности сухие хрипы с участкаим эгофонии. Пульс 110/мин, ЧД 19/мин, АД 140/90. В крови - гемоглобин 12 г/дл, гематокрит 36, лейкоциты 12,8 и 15 палочек, BUN 30 мг/дл, креатинин 1,6 натрий 138, калий 4,2. В моче - 3+ протеин, с эритроцитами. Лейкоцит. эстераза -. Мокрота на Бк отрицательна. На рентгене - сейчас залью, но идеи уже принимаются  .
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#613
24.08.2006, 20:38
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Too complicated for an old man like myself ( I meant #610)!
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#614
24.08.2006, 20:42
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Цитата:
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#615
24.08.2006, 20:43
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Цитата:
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Линейный вид
