Еще одна пилюлька Hескучина

[Alexey D]

В вопросе про бактериальный эндокардит - B
Про злоупотребляющих докторов, наверное, - С?

[exomen]

Повеселим коллег-анестезиологов.
Among physicians with history of substance abuse, which of the following is MOST likely to be a risk factor for relapse?
A- Abuse f fentanyl
B- Age greater than 40
C- Male sex
D- History of smoking

D - только веселья ради...

[yananshs]

The correct answer is B. This patient has a diagnosis suspicious for infective endocarditis. This disease is an infection of the endocardium which produces vegetations that may be seen on an echocardiograph as a mass. If left untreated, endocarditis is fatal. The majority of cases of IE occur in patients with abnormal valves who have not had recent procedural intervention. The diagnosis is made on the Duke criteria, which are modifications of the prior Von Reyn criteria. There are 2 major and 5 minor criteria and for diagnosis 2 major or 1 major and 2 minor or 5 minor criterias are required. For this patient who has the presence of 3 minor (fever, conjunctival hemorrhage, and Osler nodes), a major criteria is required. This is definitive echocardiographic evidence of infection.

An echocardiograph showing mitral regurgitation (choice A) is supportive of the diagnosis, but not definitive since this patient has been told in the past that he had a valvular disorder. Since the MR is not known to be new, it is not definitive evidence of IE infection, but rather, is supportive, and so a valvular mass is best in confirming the diagnosis.

Any systemic inflammatory reaction will elevate the ESR (choice C). Therefore, this test is of minimal use in confirming IE. It is not present as one of the duke criteria.

A positive V/Q scan (choice D) is evidence of a pulmonary embolism. It is common with IE to have septic pulmonary infarcts from vegetations being sent to the distal arterial tree, but not to have "pulmonary emboli," which are venous events.

The other major diagnostic criterias for IE is positive blood cultures for typical organisms causing IE from two separate cultures. The presence of a single positive culture (choice E) is of no diagnostic value.

[yananshs]

Сообщение от papadoctor

Повеселим коллег-анестезиологов.
Among physicians with history of substance abuse, which of the following is MOST likely to be a risk factor for relapse?
A- Abuse f fentanyl
B- Age greater than 40
C- Male sex
D- History of smoking

А, наверное. Понятия не имею какой кайф можно получить абьюзая фентанил.

[yananshs]

A 25-year-old Caucasian woman with no past medical history presents to the emergency department for the fifth time with a complaint of chest palpitations, shortness of breath, distal paresthesias, and nausea. A full metabolic and cardiac workup is unremarkable. Urine toxicology is also negative. You diagnose this patient as having a panic attack. Appropriate pharmacotherapy for this patient may include
A. haloperidol
B. lithium
C. naltrexone
D. paroxetine
E. valproic acid

[papadoctor]

Сообщение от yananshs

А, наверное. Понятия не имею какой кайф можно получить абьюзая фентанил.

Don't even think to try.Much more habit forming than Morphine! Though the answer is correct!

[Dr.]

Сообщение от yananshs

A 25-year-old Caucasian woman with no past medical history presents to the emergency department for the fifth time with a complaint of chest palpitations, shortness of breath, distal paresthesias, and nausea. A full metabolic and cardiac workup is unremarkable. Urine toxicology is also negative. You diagnose this patient as having a panic attack. Appropriate pharmacotherapy for this patient may include
A. haloperidol
B. lithium
C. naltrexone
D. paroxetine
E. valproic acid

D. paroxetine

[Aladdyn]

D. Единственным препаратом, назначаемым при панических атаках из перечисленных является пароксетин. Нейролептики, вальпроат и антагонисты опиатов не назначаются. Тем более литий, который, насколько я знаю, в настоящее время для лечения депрессий вообще не используется.

[yananshs]

Литий используется. И очень широко. Но, конечно не для лечения панических атак.

[yananshs]

The correct answer is D. Selective serotonin reuptake inhibitors in the higher dosing range are the treatment of choice for panic disorder. Benzodiazepines may also be used in the initial phases of treatment while selective serotonin reuptake inhibitors are being titrated.

Antipsychotics such as haloperidol (choice A) have no demonstrated efficacy in the treatment of panic attacks.

Lithium (choice B) may be used as a mood stabilizer in patients with bipolar disorder or as an augmentation strategy for unipolar depression. It has no indication in the treatment of panic disorder.

Naltrexone (choice C) is an opiate antagonist that has a specific use in the treatment of opiate and alcohol dependence. It cannot be used as antipanic prophylaxis.

Valproic acid (choice E) may also be used as a mood stabilizer in patients with bipolar disorder and may be more effective than lithium for patients with rapid cycling bipolar disorder. It has no indication in the treatment of panic disorder.

[yananshs]

A 12-year-old boy is brought to the office because of "really strange episodes" that have been occurring over the past few months. He tells you that he is unable to remember the entire event, but he can piece it together from the stories other people tell him. The episodes start with an internal feeling of detachment, then he sits motionless and stares at the wall, and finally he begins to make repeated "picking" movements with both hands. He is very confused for up to a half-hour following the event. People try to talk to him and wave their hands in front of his face while this is happening, but he does not respond. The most likely diagnosis is
A. absence seizures
B. complex partial seizures
C. generalized tonic-clonic seizures
D. myoclonic seizures
E. simple partial seizures

[exomen]

A - абсанс, бедный мальчик.

[Aladdyn]

Думаю, В. Височная эпилепсия. Учитывая кратковременное отключение сознания, ауру и стереотипные вынужденные движения. Единственной альтернативой может быть А.

[Tim Vetrov]

Мне кажется, это не А, потому что судороги ведь не генерализованные...
Все-таки В.

[Alexey D]

Присоединяюсь, В.