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#211
15.03.2007, 16:23
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The correct answer is A. The 2-month visit is the visit of first vaccines. The initial vaccines are DTaP, Hib-Hep B, IPV, and pneumococcal vaccines.
A bagged urine specimen (choice B) is not routinely obtained. A complete blood count (choice C) is usually done at about the 9 month visit, not at 2 months. After the initial set of vaccines, the patient may be sent home with a follow up in 2 months. Without the vaccines, it is inappropriate management to send him home for a return visit in 2 months (choice D) or with a return visit in 3 weeks (choice E). 
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#212
15.03.2007, 16:24
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A 3-year-old boy is brought to the office because of a 2-day history of fever, nausea, weakness, and "yellow skin." He has always been a healthy child, rarely having more that a sore throat or ear infection. The family has not traveled recently and no other family members are sick. A couple of children in his childcare center are sick and a parent of one of the other children has similar symptoms. His temperature is 38.1 C (100.6 F). Physical examination shows icteric skin and conjunctiva but is otherwise unremarkable. Laboratory studies show:
IgM Anti-HAV Positive HbsAg Negative HCV-Ag Negative You should advise the mother that: A. Hepatitis vaccination that is routinely recommended for all children in the United States would have prevented this illness B. Her son can return to childcare 5 days after the onset of symptoms C. Household contacts should receive immune globulin within 2 weeks after last exposure D. It is likely that her child was sexually abused by his friend's father E. There is a 30% chance that her son will develop chronic hepatitis
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#213
15.03.2007, 16:30
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Цитата:
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#214
15.03.2007, 16:39
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Цитата:
Задача http://forums.rusmedserv.com/showpos...9&postcount=33 Мой ответ http://forums.rusmedserv.com/showpos...3&postcount=38 Правильный ответ http://forums.rusmedserv.com/showpos...3&postcount=42 Но все же http://forums.rusmedserv.com/showpos...3&postcount=43 Так что правильный ответ, ИМХО, слегка устарел.
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. Но - хозяин-барин.|
#216
15.03.2007, 16:44
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A 17-year-old girl comes to the office for a follow-up visit after being diagnosed with iron deficiency anemia. She has been patient of yours since birth and has always been very healthy. At the last visit, which was 6 weeks ago, she complained of fatigue and she had pale skin and mucus membranes. She is sexually active with one partner and they use condoms for contraception. Initial laboratory studies showed:
Hemoglobin 9.5 g/dL Hematocrit 30% Ferritin 5 ng/ml You advised her to begin taking ferrous sulfate and to eat a well balanced, iron-containing diet with meat. The results of her laboratory studies today show that she is responding to therapy. The most appropriate next step is to A. advise her to consider oral contraceptive pills to decrease her menstrual blood loss B. check the mean corpuscular hemoglobin (MCV) and red cell distribution width (RDW) C. discontinue the ferrous sulfate, but tell her to continue to eat a well-balanced, iron containing diet D. do a colonoscopy to check for a source of blood loss E. make no changes in her current treatment plan
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#217
15.03.2007, 17:54
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C учетом этого:
Цитата:
Цитата:
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#218
15.03.2007, 18:15
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Цитата:
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#220
15.03.2007, 18:49
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Я тоже за А.
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#221
15.03.2007, 22:25
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Е.
По-моему железодефицит лечится не менее 8 недель . в данном случае есть ответ на терапию этим приепаратом , значит , пусть дальше его и получает . 
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#222
16.03.2007, 16:25
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The correct answer is E. This patient most likely has iron deficiency anemia because she had a low hemoglobin and hematocrit that is responding to ferrous sulfate therapy and an iron-containing diet. A poor diet and heavy menstrual bleeding are the most likely cause of iron deficiency anemia in a woman of childbearing age. Therapy with ferrous sulfate should be continued for 2-3 more months.
The best next step is to have her continue her current treatment plan, not to advise her to consider oral contraceptive pills to decrease her menstrual blood loss (choice A). The history does not tell you that she has very heavy menstrual bleeding, and even though she has sexual intercourse with one partner, you would first need to discuss this a lot more before advising her to use OCPs. The treatment for iron deficiency anemia is ferrous sulfate and increased dietary intake of iron, not OCPs. OCPs may prevent anemia, but they do not treat it. The Centers for Disease Control and Prevention recommend that you check the mean corpuscular hemoglobin (MCV) and red cell distribution width (RDW) (choice B) if the anemia does not respond to ferrous sulfate and you are sure that the patient is compliant. Since she is responding to therapy, this is not necessary at this time. It is incorrect for her to discontinue the ferrous sulfate but, telling her to continue to eat a well-balanced, iron containing diet (choice C) because even though she is responding to therapy, it is recommended that she continue for 2-3 more months on ferrous sulfate to replenish iron stores. A colonoscopy to check for a source of blood loss (choice D) is not necessary at this time in this patient with iron deficiency anemia that is responding to therapy. The most likely cause of iron deficiency in this patient is heavy menstrual bleeding and possibly a poor diet. If this patient was a postmenopausal woman or a man with iron deficiency anemia, you must think of a gastrointestinal bleed as the cause of anemia. Fecal occult blood testing and a colonoscopy should be considered for these other patients.
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#223
04.03.2012, 11:51
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Давно мы что-то пилюлек не принимали...
 Вот, к примеру, такая... Мальчик год и месяц. Заболел пять дней назад. Т 39.5, сопли, "свистит". Сегодня появилась сыпь. Известно, что пару дней назад он был осмотрен врачом; был поставлен д-з Пневмония и назначен амоксициллин. Родители амоксициллин не давали, лечили только ингаляциями с альбутеролом. Периодически ребенку делаются такие ингаляции, т.к. он страдает Weezing baby syndrome. При осмотре Т 37.6, ЧДД 45/мин, небольшой инспираторный стридор без выраженного респираторного дистресса. ОАК в норме, СРБ чуть повышен, снимок пневмонию не подтверждает. Ваши предложения по д-зу: A. Pityriasis lichenoides et varioliformis acuta (PLEVA) B. Varicella C. Viral exanthem due to parainfluenza virus D. Gianotti-Crosti syndrome
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#224
04.03.2012, 14:33
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Фотки какие то маленькие у меня открываются..Я б за последний ответ проголосовала, может еще какие то факты?
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Линейный вид
