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#811
17.09.2006, 21:41
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Мне кажется, что вариант D.
Вариант В тоже вроде подходит. Но... синусит хронический, и вдруг развивается такая картина на фоне 10 дней приема антибиотика, это вызывает сомнения. 
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#812
17.09.2006, 21:53
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Речь скорее всего идет об этмоидите ( во всяком случае, это первое, о чем бы я подумала, если бы речь шла о ребенке.) А учитывая, что основные возбудители хр. синусита - Staphylococcus aureus, coagulase-negative Staphylococcus, anaerobic bacteria, and gram-negative bacteria, амоксициллин вовсе не препарат выбора. Поэтому, ничего удивительного, если правильным будет ответ B.
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#813
17.09.2006, 22:18
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Скорее все-таки вариант D.У взрослых,по-моему,этмоидитов не бывает.
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#814
17.09.2006, 22:34
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У детей конечно часто бывают внутриглазничные осложнения синуситов. Но они встречаются и у взрослых. В задаче не указано, каким был синусит.. этмоидит, фронтит или пансинусит.. Этмоидиты, насколько мне известно у взрослых бывают...
Наличие поднадкостничного абсцесса лобной области представляется мне сомнительным.. (все-таки плотность стенки лобного синуса гораздо выше, чем глазничной пластинки решетчатой кости... Поднадкостничные абсцессы дают одонтогенные очаги инфекции, за счет того, что сам очаг инфекции расположен внутрикостно и происходит распространение воспаления по гаверсовым каналам. Если очаг воспаления расположен в лобной пазухе, я подозреваю у него будут несколько другие пути распространения.. ) Пе-ес: я не ЛОР Пе-пе-ес: вот http://forums.rusmedserv.com/showthread.php?t=15940
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#815
17.09.2006, 22:40
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Брукса, спасибо!
Действительно, в задаче не указано, какой именно синусит. Что касается этмоидита, то у взрослых он бывает. Но изолированным он вообще бывает очень редко, чаще сочетается с фронтитом. Да - внутренняя стенка глазницы самая тонкая, и распространение инфекции через lamina papyracea встречается очень часто. Но все-таки возраст+сроки...
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#816
17.09.2006, 22:46
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Цитата:
с которым она сообщается, а не через кость...
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#817
17.09.2006, 22:57
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>>D<<
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#818
17.09.2006, 23:16
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Цитата:
Пе-ес Я тоже не ЛОР))) Пе-пе-ес Др.Ира - там был амоксициллин-клавуланат, это сочетание во многих случаях подходит.
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#820
18.09.2006, 20:59
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The correct answer is B. This patient most likely has developed orbital cellulitis, which is one of the most common complications of sinusitis. Orbital cellulitis develops by direct spread of infection from the ethmoid sinus through the lamina papyracea (the very thin bone that separates the orbit from the ethmoid sinus). A CT scan or MRI should be obtained and the treatment consists of intravenous antibiotics and possibly surgical drainage of the ethmoid sinus. Blindness and meningitis may occur if this is not treated aggressively.
An allergic reaction to amoxicillin-clavulanate (choice A) is an unlikely explanation for his symptoms because of the lack of a rash and the presence of such localized symptoms (one eye). It is unlikely that this patient's symptoms are caused by the direct spread of inflammation or infection from the sinuses to the meninges (choice C) because he does not have a headache or a stiff neck. This patient's symptoms are more consistent with orbital cellulitis than meningitis, but both are complications of sinusitis. The development of a frontal subperiosteal abscess (choice D), which is a complication of frontal sinusitis, typically presents with a tender, "doughy" swelling on the forehead. It is also called Pott's puffy tumor. This diagnosis is inconsistent with this patient's presentation. The development of a tumor in the cavernous sinus (choice E) is an unlikely explanation for this patient's symptoms because it is usually associated with ophthalmoplegia and 3rd cranial nerve abnormalities. Also, it is extremely unlikely that this patient would have developed a tumor so quickly.
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#821
18.09.2006, 21:21
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A 27-year-old woman comes to the clinic because of abdominal and pelvic pain for 2 weeks each month for the past 6 years. She and her husband have been unable to conceive despite trying for the past 2 years. She describes the pain as being most severe during each period; the pain is sometimes associated with nausea. She has no significant past medical history. Her last menstrual period was 8 days ago. General physical and pelvic examinations are normal. A hysterosalpingogram performed as an outpatient demonstrates a normal uterus with normal fallopian tubes and spillage into the peritoneum. Given this history, the next step in establishing a diagnosis is
A. a chromosome analysis B. a colposcopy C. a fiber optic fallopian tube cannulation D. in vitro fertilization E. a laparoscopy
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даже взрослых могу лечить (чуть-чуть). |
#824
22.09.2006, 17:12
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The correct answer is E. This patient has a history of intermittent abdominal pain and infertility consistent with a diagnosis of endometriosis. Laparoscopy will reveal characteristic ⌠powder-burn■ lesions and filmy or dense adhesions. Symptoms associated with endometriosis include fatigue, painful bowel movements with periods, back pain with periods, and intestinal upset with periods.
A chromosome analysis (choice A) would detect a genetic cause of infertility, but this is much less likely than endometriosis in this patient. A colposcopy (choice B) would provide a closer look at the cervix, but would not address the clinical concerns of endometriosis. Fiber optic fallopian tube cannulation (choice C) is not an established treatment or diagnostic tool for endometriosis. In vitro fertilization (choice D) is not a means to establish a diagnosis of endometriosis. This procedure is often used by women with severe endometriosis to get pregnant. Keep in mind that many women with endometriosis eventually do conceive. Moreover, hormonal treatment of endometriosis can aid in conception.
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#825
22.09.2006, 17:13
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A 21-year-old college student comes to the emergency department because of a 30-minute history of difficulty in breathing, and a sharp left-sided chest pain that came on suddenly when he was walking back to his dormitory after biology class. He says that he is generally very healthy and has never experienced anything like this in the past. He is 188 cm (6 ft 2 in) tall and weighs 70 kg (154 lb). His temperature is 37.0 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 75/min, and respirations are 22/min. Physical examination shows decreased breath sounds, decreased tactile fremitus, and increased resonance to percussion on the left side. The cardiac examination is normal. You order a chest x-ray and go to see the next patient. You hear a radiology technician call for help as you finally get to sit down to write your notes. You run over to the patient and find that it is your "shortness of breath and chest pain" patient and that he has not had the chest x-ray yet. He is now cyanotic and has severe dyspnea. Examination shows tracheal deviation and distended neck veins. The most appropriate immediate management is
A. draw an arterial blood gas B. endotracheal intubation C. insert a chest tube on the left side D. insert a needle into the left 2nd intercostal space E. obtain a chest x-ray at the bedside
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Линейный вид
