Еще одна пилюлька Hескучина

[Dr.]

Сообщение от audovichenko

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А вот наш ответ . Кстати, можно на компьютере, можно на КПК.

[Dtver]

To Dr. по поводу:
"Правда, тут я ограничен 2001 годом, может быть и устарело"

Если верить следующему:
Long-acting nitrates such as isosorbide mononitrate also reduce portal pressures but have not demonstrated efficacy in reducing the risk of variceal bleeding when used alone.
Current Medical Diagnosis & Treatment, 45th Ed
то пока все в силе, поэтому, видимо, Д.

[yananshs]

The correct answer is D. Non-selective beta antagonists such as nadolol have been shown to decrease the risk of an initial variceal bleed (through a reduction in splanchnic blood flow) in someone with esophageal varices (primary prevention).

Aspirin (choice A), an antiplatelet agent, has no role in the primary prevention of variceal bleeding.

Atorvastatin (choice B), an HMG Co-A Reductase antagonist used in the management of hyperlipidemia, has no role in the primary prevention of variceal bleeding.

Nitrates such as isosorbide mononitrate (choice C) should not be started as monotherapy for the primary prevention of variceal bleeding in cirrhotics since it has been associated with increased mortality when used alone. However, it can be used in combination with beta antagonists.

Warfarin (choice E), an oral anticoagulant against vitamin K dependent clotting factors, has no role in the primary prevention of variceal bleeding.

[yananshs]

An otherwise healthy 18-year-old boy is brought to the emergency department after being involved in a large motor vehicle accident. On initial observation, he is awake, alert, and oriented with a Glasgow coma score is of 15. Vital signs are stable with a blood pressure of 100/70 mm Hg and a heart rate of 98/min. He has multiple abrasions over his body, a head laceration over his right temple, and a large hematoma over his left thigh. Distal pulses in his left foot are weak but present. C-spine films of his neck are negative for any cervical fractures or dislocations. A pelvic x-ray is also normal. A radiograph of his left leg reveals a comminuted fracture of the femur. He is evaluated by the orthopedic and vascular services. The patient is admitted to the surgery ward and scheduled for angiography of his left leg. In the radiology suite, he suddenly becomes unresponsive. His blood pressure is found to be 200/100 mm Hg, his heart rate is 50/min, and his respirations are irregular. His right pupil is fixed and dilated. The most appropriate next steps in the correct order are
A. CT scan of the head, intubation, mannitol administration
B. CT scan of the head, phenytoin bolus, thiamine
C. intubation, CT scan of the head, mannitol administration
D. intubation, mannitol administration, CT scan of the head
E. intubation, mannitol administration, MRI of the head

[riltsov]

D. intubation, mannitol administration, CT scan of the head

[riltsov]

В связи с наличием «светлого промежутка» предполагаю, что у пациента субдуральная гематома. His right pupil is fixed and dilated что обусловлено brain herniation. Наиболее логичная последовательность действий в варианте - D. Состояние является угрожающим жизни, поэтому вначале лечение - intubation, mannitol administration, потом диагностика - CT scan of the head. Происхождение гипертензии в данном контексте мне не понятно. Может быть это опечатка?

[Dr.]

Давайте пока и я закину задачку, актуальную в наших условиях .

An 84-year-old woman is brought to the office by her daughter, who is your patient. The mother has just moved in with the family
because she can no longer care for herself due to progressive, long-standing dementia. The daughter hopes you will help take care of
her mother. On physical examination the mother does not respond to your words or to the physical examination. You notice that she
smells of urine. On examination of the pelvis there is a diffuse erythematous rash extending over the perineum and the medial
thighs bilaterally. You suspect the rash relates to urinary incontinence. The daughter is present at the mother's examination. Which
of the following is the most appropriate statement to the daughter?

(A) "How long have you left your mother in this condition?"
(B) "His is a rash caused by urine. My nurse will insert a Foley catheter."
(C) "This rash should respond to cleansing with mild soap and drying with a clean towel three times a day."
(D) "You should take better care of your mother."
(E) "Your mother needs to wear diapers."

[yananshs]

c......

[Anna_Shvedova]

Я за E. С тоже подходит, но ведь причину-то надо устранить.
Да уж, очень актуально в наших условиях

[riltsov]

Вариант C. Корректный комментарий, в котором указан способ избавления от высыпаний и подчеркивается необходимость ухаживать за матерью. Рекомендация одевать памперс не будет способствовать изменению отношения дочери к своей матери. Одеть памперс и оставить в нем мать на сутки очень просто. Лучше ухаживать за матерью иначе, более чутко.

[vosk]

а почему бы не собрать анамнез?
(A) "How long have you left your mother in this condition?"
а потом рекомендации
Dmitry Voskovets

[Dr.]

Правильный все же С . От того, что в этом состоянии она 3 мес или начиная от конца войны между Севером и Югом ничего не изменится

[Dr.]

A 22-year-old man with a seizure disorder has had
increasing cough and shortness of breath for 3
days and fever for 1 day. He has foul-smelling
sputum. He had a generalized tonic-clonic seizure
1 week ago. His temperature is 39.4EC (103EF).
Crackles are heard on auscultation of the chest.
An x-ray of the chest shows a right upper-lobe
infiltrate of the lung. Which of the following is the
most likely cause?
(A) Chemical pneumonitis
(B) Pneumonia secondary to anaerobes
(C) Pneumonia secondary to gram-negative
aerobes
(D) Pneumonia secondary to gram-positive
aerobes
(E) Pneumonia secondary to Mycoplasma
pneumoniae

[Mara___dok]

Вариант D.

[Anna_Shvedova]

В. анаэробы

А про дочки-матери - грустная и жизненная задачка