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#856
29.09.2006, 22:20
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A and C simultaneously ( real life answer)
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#859
29.09.2006, 23:29
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?????E
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#860
29.09.2006, 23:30
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Цитата:
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#861
30.09.2006, 06:49
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Пациент вменяем, и дал согласие на операцию при свидетелях. Мнением сына в такой ситуации можно пренебречь.
E. proceed with a below-the-knee amputation.
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#862
30.09.2006, 17:47
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Насчет вменяемости не совсем ясно. Честно - незнаю, что это за медицинские документы в которых пациент выражает пожелание не применять агрессивных мер лечения, т.е. операции. Но раз он такое указал, то не смотря на видимую его адекватность и согласие надо принять решение D
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#863
02.10.2006, 19:51
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The correct answer is E. Clearly the most appropriate line of management at this time is the below-the-knee amputation. The patient is competent and has given his informed consent.
A psychiatry consultation (choice A) is not necessary in this case. Although the patient has some dementia with some memory deficits, 3 physicians and a nurse think him capable of making his own decisions. Even though the patient has indicated in his advance directive that he would not like any “aggressive measures,” this does not go into effect until the patient loses complete decision making capacity. Asking the son to find another physician to care for his father (choice B) is another option, but the son has no legal standing in this situation, since he is disagreeing with his father's wishes. Consulting the hospital attorney (choice C) is not necessary as there is no legal issue for the hospital. Discharging the patient from hospital (choice D) would be unethical..
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#864
02.10.2006, 19:52
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Цитата:
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#865
02.10.2006, 22:28
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хм-м
Спасибо Яне Сергеевне за особое разъяснение. Но по моему мнению( скромному) пациент может сейчас быть адекватен, а через час скажет(или вернее ни чего не скажет) что ни какого согласия не давал. А родственники завопят "хотели зарезать" дедушку! Бывал в таком переплете, повторных бесед со следователем не желаю! Так что уж извините, но российская реалия D.
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#867
03.10.2006, 05:21
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Цитата:
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#868
09.10.2006, 16:49
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A 19-year-old woman comes to the student health service complaining that since the new semester has begun, she finds herself unable to focus and concentrate as well as before. She attributes this largely to feeling fatigued. She denies any other symptoms such as sadness, sleeplessness, or loss of libido. She has no other medical issues. Her medications are only oral contraceptive pills. She has never been pregnant and denies current pregnancy. She has a history of long menses, often lasting 8 days. Laboratory studies show:
Hct 31% MCV 69um3 Ferritin 10mcg/L The most appropriate next step is to A. administer iron, intravenously B. administer vitamin B12, intravenously C. advise her to take folate tablets D. change her oral contraceptive formulation to estrogen only E. tell her to take oral iron tablets
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Линейный вид
