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#1
11.09.2006, 16:53
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Äåòñêèé âàðèàíò ïèëþëüêè
Óâ. ïåäèàòðû!
Íà ôîðóìå òåðàïåâòîâ åñòü ïèëþëüêà îò Íåñêó÷èíà. Ïðåäëàãàþ ó íàñ íà ôîðóìå åå äåòñêèé âàðèàíò. Äëÿ íà÷àëà âîò òàêîé âîïðîñ: 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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Äóìàþ, ÷òî ýòî ñèíäðîì ðàçäðàæåííîé òîëñòîé êèøêè, ò.å. D.
Ñ äðóãîé ñòîðîíû, íå âïîëíå ïîíÿòíà ëîêàëèçàöèÿ áîëåé. Ì.á. è ãàñòðèò èëè äóîäåíèò, òîãäà E. Íî âîîáùå ãîâîðÿ, äëÿ ãàñòðèòà õàðàêòåðíà áîëåçíåííîñòü ïðè ïàëüïàöèè. Íåò, âñå-òàêè D.
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- âàðèàíò Ñ|
#5
11.09.2006, 17:17
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Íàñ÷åò ÍßÊà, ìåíÿ îñòàíîâèë ñîâåðøåííî ñïîêîéíûé æèâîò ïðè ïàëüïàöèè, äà è ïðè ðåêòàëüíîì îáñëåäîâàíèè âñå õîðîøî.
Íåìíîãî ñìóùàåò, ïðàâäà, òîò ôàêò, ÷òî åé êàæåòñÿ, ÷òî ïîõóæå îò æèðíîé ïèùè (ýòî âåäü òåñò, à â òåñòå, êàê â ñêàçêå ïðî Àëèñó, âñå íå ïðîñòî òàê), íî âñå ðàâíî ôèçèêàëüíî ïðè ÍßÊå ÷òî-òî äîëæíî íàõîäèòüñÿ...
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#6
11.09.2006, 17:24
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Òèì, òîæå âåðíî. Îäíàêî õàðàêòåð ó ìåíÿ äóðíîé - ñàìûé "íàïðàøèâàþùèéñÿ" âàðèàíò îòìåòàþ ñðàçó è èùó ïîäâîõ))) Êðîìå òîãî, ÷òî ïðè ïàëüïàöèè æèâîò ñïîêîéíûé è íîðìû ïðè ðåêòàëüíîì èññëåäîâàíèè, âñå îñòàëüíîå ïðè íàëè÷èè äèàðåè ñ êðîâüþ î÷åíü ïîõîæå íà ÍßÊ. Õîòÿ âïîëíå âîçìîæåí è âîñïàëèòåëüíûé ïðîöåññ.
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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 âîïðîñà ïðî ñóäîðîãè.
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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Å,À,Ñ,D.Ïî ïîâîäó âòîðîãî âîïðîñà,êîíå÷íî,ìîæíî äèñêóòèðîâàòü.Íî ðåáåíîê äî ãîäà ñ âïåðâûå âîçíèêøèìè ñóäîðîãàìè âñå-òàêè äîëæåí áûòü ãîñïèòàëèçèðîâàí.
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#13
11.09.2006, 20:18
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Öèòàòà:
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#14
11.09.2006, 20:36
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Öèòàòà:
...àõ, äà: ECCD
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Ëèíåéíûé âèä
