Детский вариант пилюльки

[Alon]

Это стандарная задача, основа работы акушер-гинеколога и неонатолога.
Ответ написан, по-видимому, до выхода последних рекомендации ([Ссылки доступны только зарегистрированным пользователям ]) и основан на устаревшем подходе ([Ссылки доступны только зарегистрированным пользователям ]).
Хотя верно все-равно "С"

[dr.Ira]

A 19-year-old college student comes to the student health service because of a 12-hour history of increased frequency and burning on urination. For the past 6 hours she has felt the need to urinate, but can only produce a "few drops" at each attempt. She is otherwise in good health and had a periodic health maintenance examination just 2 months ago. She does mention that since that check up she has started seeing a new boyfriend and they have recently begun to have intercourse. A urine dip is positive for nitrites. In addition to sending a urine specimen for culture and sensitivity, the most appropriate next step is to
A. advise the patient that she should abstain from sexual intercourse
B. advise the patient that she should drink increased amounts of cranberry juice to help acidify her urine
C. advise the patient that she should empty her bladder both before and after intercourse
D. give the patient a prescription for ampicillin tablets
E. tell the patient to return in 2 days when you will have the preliminary results of the urine culture and its sensitivities

[riltsov]

E. tell the patient to return in 2 days when you will have the preliminary results of the urine culture and its sensitivities

Логично сначала установить природу возбудителя, а потом назначать лечение. Тем более, потому что новый бойфрэнд мог её наградить гонококком.

[Mara___dok]

Ответ Д.

[OrFun]

Children with cystitis usually do not require special medical care other than appropriate antibiotic therapy and symptomatic therapy if the voiding symptoms are marked.
Видимо , Д ? Правда это про маленьких детей .

[yananshs]

Наверное, Д?

[dr.Ira]

The correct answer is D. This patient has classic signs and symptoms of a urinary tract infection (UTI). Symptoms include dysuria, frequency, and urgency. UTIs are common, especially with the onset of sexual relations with a new partner. The most common causes of UTIs include E. coli, Enterococcus, and Proteus. Since the urine dip is positive for nitrites, she should be given a prescription for ampicillin.

It is inappropriate to advise the patient to abstain from sexual intercourse (choice A). Sexual intercourse does not need to be avoided when a patient has a UTI.

Advise the patient that she should drink increased amounts of cranberry juice to help acidify her urine (choice B) and advise the patient that she should empty her bladder both before and after intercourse (choice C) are both suggestions that may be helpful for prevention of future UTIs. However, the patient still needs treatment for her current infection.

UTIs should be treated in order to avoid advancement to pyelonephritis, therefore it is inappropriate to (choice E) tell the patient to return in 2 days when you will have the preliminary results of the urine culture and its sensitivities. If sensitivity returns and the organism is not sensitive to what you prescribe, treatment can be altered.

[yananshs]

A 3-year-old boy is brought to the office because of a 3-day history of fever and vomiting followed by watery diarrhea. The father tells you that the child is very lethargic and seems dehydrated. He attends daycare 5 days a week and 4 other children have had similar symptoms over the past month. The patient appears moderately dehydrated. When you go to examine him you notice that there is a moderate amount of stool spilling out from the sides of the diaper. The father is very embarrassed when he sees this and tells you that he just changed the diaper before coming into the examination room. He is concerned because this "outbreak" has occurred a few other times and he is wondering what can be done to stop the spread of infection. You advise the father to provide plenty of fluids. You should also tell him that:
A. Antiviral therapy is indicated at this time
B. Boiling all drinking water at the daycare center will eliminate future outbreaks of this infection
C. Meticulous laundering of the bedding and clothing of the caregivers and children will stop the spread of infection
D. The patient must be kept home from daycare until his stool can be contained by diapers
E. Vaccination against rotavirus should be given to all of the children and staff at the daycare center

[OrFun]

Наверное , Е Остальные ответы мне кажутся ...забавными ...

[Mara___dok]

Я не знала,что есть вакцина от ротавирусной инфекции.

[yananshs]

Ответ Е - не подходит.
A recommended, approved vaccine is not currently available in the United States (choice E). A vaccine is available, but it has been associated with cases of intussusception and it is therefore recommended that administration be suspended until further studies are done.
Какие еше варианты?

[Mara___dok]

Я думаю,что ответ В.

[yananshs]

К сожалению, нет.
Boiling all drinking water (choice B) is not helpful because the rotavirus is shed in the stool of infected individuals and is easily spread on contaminated hands and objects. The current recommendation to prevent the spread of rotavirus is careful hand washing. 70% ethanol solution is also recommended to inactivate the rotavirus.

Но правильный ответ к этой задачке будет правильным, наверное, только в США.

[Mara___dok]

Ну мы,по моему,все перебрали.Осталось Д.

[riltsov]

Вариант D., в целом, подходит. Больного ребенка необходимо изолировать от здоровых – это важная часть противоэпидемических мероприятий.
Но! Вспышка в детском саду уже произошла, заболели 5 детей! Путь передачи фекально-оральный, вирус устойчив во внешней среде. Кроме изоляции больных детей необходимо: Meticulous laundering of the bedding and clothing of the caregivers and children will stop the spread of infection

Мой ответ C.!