Еще одна пилюлька Hескучина

[ksn1968]

Только откроешь ДК, а там всё "сладкое" уже съели! Антон, Вас можно дисквалифицировать в этом конкурсе. Здесь в основном "любители"(т.е нашенские) отвечают на ненашенские тесты, а ВЫ "профи" (т.е. ихний дохтур) эти тесты уже проходили.
ПС. присоединяюсь к В

[Anton Verbine]

Сообщение от ksn1968

... Вас можно дисквалифицировать в этом конкурсе.

...ну так не только меня можно, а и еше кое-кого...
...голубчик ksn1968, так ведь не на корову играем... чисто на интерес...
Я действительно сдал уже свой "Борд", однако- нахожусь во временном отрыве от внутренних болезней, а мозги требуют ...

[yananshs]

The correct answer is B. According to the United States Preventative Services Task Force, including a few direct questions about abuse may be recommended in adult patients. Because of the high prevalence of domestic violence (DV) and the wide range of clinical settings in which it can be seen, a few direct questions may be a part of preventative care. Because of this prevalence, the belief that routine screening is not indicated (choice D) is simply not true. If screening is limited to high risk patients only (choice C), then a substantial number of DV cases would be missed as the ⌠risk factors■ for DV are loose and not clearly validated in the same way as risk factors for cardiovascular disease have been. The belief that women are more likely to report domestic violence to a non-medical person (choice E) is false. A number of studies have shown that if a physician takes the time to address the issue of possible DV, the woman is more likely to report it to them than to a non-physician. It is a key component of the interview that the patient be made to feel comfortable and interviewed alone (choice A).

[yananshs]

A 21-year-old woman comes to the university health clinic complaining of a 2-week history of fatigue, lethargy, and fever. She has also noticed a mild sore throat. Her past medical history is otherwise unremarkable and she takes only oral contraceptive pills for birth control and acne. Her temperature is 39.0 C (100.4 F), blood pressure is 120/75 mm Hg, pulse is 82/min, and respirations are 18/min. She appears somewhat ill, but in no clear distress. Her pharynx appears erythematous and she has mild splenomegaly. Supportive therapy and avoidance of contact sports is the appropriate treatment if laboratory studies show
A. leukopenia with atypical leukocytosis
B. positive culture for group A beta-hemolytic Streptococcus
C. positive Mycoplasma PCR
D. positive RNA p24 antigen PCR
E. positive serum HSV PCR

[doctor Asya]

Ответ D.

[Artemij Okhotin]

A. leukopenia with atypical leukocytosis

[riltsov]

Сложная задачка я не уверен в ответе.
Контактный спорт нужно избегать в связи с спленомегалией.

Допустим, это инфекционный мононуклеоз и ответ A. leukopenia with atypical leukocytosis

[Anton Verbine]

Сообщение от riltsov

Допустим, это инфекционный мононуклеоз и ответ A. leukopenia with atypical leukocytosis

Soglasen

[yananshs]

The correct answer is A. This patient has infectious mononucleosis caused by the Epstein-Barr virus. This disease can present in a very similar manner to infectious pharyngitis caused by the group A beta hemolytic streptococcus. These patients typically present with more mild symptoms of fever and sore throat and in many cases have splenomegaly. The classic laboratory finding is leukopenia with atypical leukocytosis. The treatment of mono typically includes supportive therapy with avoidance of contact sports (to avoid splenic rupture).

A positive culture for group A beta-hemolytic Streptococcus (choice B) would represent infection with a bacteria that causes bacterial pharyngitis, not mononucleosis. Although the presentations of the 2 diseases may be similar, their causative agents are quite dissimilar. Antibiotics are used to group A beta-hemolytic Streptococcus.

A positive mycoplasma PCR (choice C) represents infection with Mycoplasma pneumonia, a common cause of atypical community acquired pneumonia in this age group. Antibiotics are used to treat this infection.

A positive RNA p24 antigen PCR (choice D) would represent evidence of infection with the HIV virus. Antiviral therapy is used to treat HIV.

A positive serum HSV PCR (choice E) indicates active herpes virus infection. These agents are responsible for a number of human diseases, including pharyngitis, but the symptoms are much milder. Herpes virus infection does not cause infectious mono. Antiviral therapy is used to treat HSV.

[yananshs]

A 39-year-old man comes to the office complaining of a 3-day history of severe abdominal pain and cramps that are relieved with bowel movements. He also reports loose, watery stools two to five times per day. He has had similar symptoms in the past and recalls the first incident being nearly 12 years ago. He tells you that he has been told that he has irritable bowel syndrome. He states that he has never had any other "tests" and was only prescribed various medications, some of which seemed to have helped. On examination, he appears to be in mild distress. His temperature is 38.3 C (101.0 F). He has mild guarding in his left lower quadrant but no rebound tenderness. He is tender to direct palpation in his left lower and left middle quadrants. The most appropriate next step in this patient's care is to
A. prescribe corticosteroids and see the patient in two weeks
B. prescribe loperamide and see the patient in two weeks
C. order a stool Gram stain and culture
D. schedule the patient for an immediate colonoscopy
E. schedule an immediate CT scan of the abdomen

[Aladdyn]

D. schedule the patient for an immediate colonoscopy

[vosk]

я бы не отвечал А или В, так как не рискнул бы отпустить пациента с таким стулом на 2 недели. Е - не знаю, чем может быть полезна.
Остается С или D. В наших условиях наверно сразу бы взяли мазки, посевы, чем-нибудь полечили.
пусть так и будет для разнообразия. С.
Dmitry Voskovets

[riltsov]

Inflammatory bowel disease.

Да, нужна колоноскопия, но можно ли её делать при таком обострении? И нужна ли она срочно?

Если предполагаем кишечную инфекцию (дизентерию, например), вначале можно покрасить и посеять (stool Gram stain and culture). Но анамнез указывает на IBD.

Для разнообразия выберу E. schedule an immediate CT scan of the abdomen
Неинвазивно и информативно.

[Nancy]

С, думаю.

[Artemij Okhotin]

Сделать простой рентген, исключить токсический мегаколон, затем колоноскопию с биопсией. Поскольку рентген не предлагают, сделаем КТ.