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#1201
16.02.2007, 12:11
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Цитата:
So, again, somethimes difficult to say, what they are driving at. I think, it's just one more question on physiology- what's lost, what's should be repleated, what's the treatment for normal gap acidisis... btw, hypertonic solution is also used in normo- natriemic patients , for example, in ARDS.  But the point of hypo-Na differential and correction is quite valid.
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#1202
16.02.2007, 12:18
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Цитата:
...ацидоз при диаррее- обычно как раз гиперхлоремический (в отличие от рвоты) а ацидоз по определению- потому, что бикарбонат низкий, и клинически описана его потеря. ... поскольку нам не сказано, что именно за бикарбонат имеется в виду, ответ- либо бикарбонат, либо- изотонический р-р (тогда бикарбонат когда- нибудь восстановится за счет дыхательной компенсации )
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#1204
16.02.2007, 15:10
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Цитата:
Из них "парагемолитический" вызывает "тонкокишечную" диаррею. [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ]
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#1205
16.02.2007, 16:37
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Цитата:
Про применение гипертонического расствора у пациентов с ARDS и CHF читал. Убедительных данных о пользе получено не было нигде. Исходя из логики тестовых вопросов нужно действовать от простого к сложному от неотложного к плановому и от дешевого к дорогому. Думаю все-таки нужно сначала дать изотонический натрий хлорид, хотя напрактике наверное легче использовать LR.
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#1207
16.02.2007, 19:34
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The correct answer is E. This patient has true hyponatremia and his exam suggests that his volume status is hypovolemic. A low urine sodium suggests that he is retaining all of his filtered sodium in an attempt to relieve his hyponatremia. The therapy is repletion of volume and salt. One half of the total sodium deficit should be repleted in the first 12 hours, with the remainder given over the remaining 24 hours. The sodium should rise by no more than 0.5 mEq/L/hour (12 mEq/day). The rate of correction is done in this manner to decrease the possibility of central pontine demyelinosis.
Fluid restriction (choice A) is the treatment of choice for hypervolemic hyponatremia (congestive failure or cirrhosis) and with the syndrome of inappropriate anti-diuretic hormone (SIADH). Intravenous bicarbonate (choice B) is not necessary to correct this patient's acid-base deficit. Although his bicarbonate is low, this is likely a result of his diarrhea and until his pH is known, there is no reason for concern. There is, in genera, little indication for intravenous hypertonic saline (choice C) as it is dangerous and can cause great harm when used to correct hyponatremia if extreme care is not taken. Intravenous hypotonic saline (choice D) will aggravate the hyponatremia by giving free water.
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#1208
16.02.2007, 19:39
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A 27-year-old heavy vehicle driver comes to the office because he is "not feeling well and has been losing weight" during the past few months. He also reports that he is feeling increasingly tired. He drives long hours on his job, smokes heavily, and admits to "moderate" amounts of alcohol intake. He has never seen a doctor before and denies any past medical or surgical history. His temperature is 37.0 C (98.6 F), blood pressure is 110/80 mm Hg, pulse is 70/min, and respirations are 16/min. Abdominal examination shows a vague abdominal mass in the midline that is not pulsatile and non-tender. Rectal examination is unremarkable. Scrotal examination shows an enlarged right testicle without sensation. The factor in this patient's history and examination that is most helpful for diagnosing the etiology of the abdominal mass is
A. alcohol intake B. his job C. non-pulsatile nature of abdominal mass D. scrotal examination findings E. smoking
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#1209
16.02.2007, 22:03
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Предполагаю рак яичка.
Вот если бы пациент был трубочистом, ответ был бы совсем очевиден. Думаю из представленных вариантов наиболее логичный - B. his job
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#1211
16.02.2007, 22:41
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Цитата:
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#1212
16.02.2007, 23:02
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The correct answer is D. Loss of testicular sensation and enlarged testis is diagnostic of testicular carcinoma. In advanced stages, testicular carcinoma spreads by lymphatics to the paraaortic lymph nodes. These lymph nodes are palpable in the midline of a thin person without any prominent pulsations.
Alcohol (choice A) and smoking (choice E) have no diagnostic value in evaluating paraaortic lymphadenopathy. Increased temperature in the scrotum for a long time as in heavy vehicle long distance drivers may predispose them to testicular carcinoma. Job history (choice B) by itself is not diagnostic, hence it is incorrect. Palpable, non-pulsatile paraaortic lymph nodes (choice C) may be seen with other cancers, but are not diagnostic of the specific primary pathology.
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#1213
16.02.2007, 23:02
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A 31-year-old woman comes to the office with a 5-day history of a red, painful right eye. She complains of photophobia, tearing, and decreased visual acuity and denies any history of trauma. She has had several similar episodes in the past. On examination, her visual acuity is 20/30 in the right eye, both pupils react normally, the conjunctiva is diffusely injected, and there is a watery discharge from the right eye. Fluorescein staining shows uptake in the right cornea, but the cornea is otherwise clear. The left eye is normal. The most likely cause of these findings is
A. acute angle closure glaucoma B. allergic keratoconjunctivitis C. bacterial conjunctivitis D. herpes simplex virus keratitis E. subconjunctival hemorrhage
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#1214
17.02.2007, 00:24
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Судя по асимметричному поражению роговицы и рецидивированию, D (герпетический кератит).
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#1215
17.02.2007, 11:13
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Цитата:
Мы с Вами знаем, что не может быть clinical pearls, о которых нигде ничего не написано .Все-таки иногда очень тяжело корректировать гипонатремию только с помощью изотонического раствора. Нас очень ограничивает объем, особенно у маловесных детей. Например, если перелить литр физ. раствора мужчине из задачки (представив, что весит он 80 кг), то уровень его натрия увеличится меньше чем на 1mmol/L или что-то вроде того. Цитата:
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Линейный вид
