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#797
14.09.2006, 21:48
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Нет, на самом деле, - это Вы нашли. Главное ведь - этиология, а тут-то я и забуксовал. Про моракселл забыл, в чем и признался...
Главное, впрочем, результат. Думаю, что D - это то, что надо. Ждем ответ Яны. 
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#798
14.09.2006, 21:57
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Цитата:
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#799
14.09.2006, 22:06
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Цитата:
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#800
14.09.2006, 22:54
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The correct answer is D. This patient has an infection with Moraxella catarrhalis, a Gram-negative diplococcus that is part of the normal flora of the upper respiratory tract. It is a common cause of otitis media and sinusitis in children and should be treated with amoxicillin-clavulanate, cefprozil, cefuroxime, or a macrolide (erythromycin).
It this patient had a pharyngeal infection with Streptococcus pyogenes, a Gram-positive cocci, appropriate treatment would be needed to prevent the development of rheumatic fever (choice A). Moraxella catarrhalis is not typically associated with rheumatic fever. Bronchopulmonary infections and bacteremia are commonly seen in healthy adolescents and young adults with this infection (choice B) is incorrect. Moraxella catarrhalis causes bronchopulmonary infections in individuals with chronic lung disease and rarely leads to bacteremia in children. It very rarely causes bronchopulmonary infections and bacteremia in healthy adolescents and young adults. If this patient had an infection with Haemophilus influenzae type b, a Gram-negative rod (or coccobacillus), the full routine recommended immunization series would most likely have prevented this infection (choice C). However, this patient has an infection with Moraxella catarrhalis, a Gram-negative diplococcus, which is not part of the routine recommended immunization series. The responsible bacteria rarely produces Б-lactamase that mediates resistance to penicillins (choice E) is incorrect. Moraxella catarrhalis produces Б-lactamase that mediates resistance to penicillins in almost 100% of strains.
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#801
14.09.2006, 22:55
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A 36-year-old man is brought to the emergency department after being extricated from a motor vehicle crash. He is brought in by ambulance and it is reported that he was a restrained passenger in a high-speed motor vehicle accident. He was conscious at the scene but his legs were pinned under the collapsed car. After being cut free, he was transported to the hospital. A rapid assessment reveals that the patient has no drug allergies and had not drunk alcohol prior to the crash. He is awake and alert with a Glasgow Coma score of 15/15. His temperature is 37.0 C (98.6 F), blood pressure is 160/100 mm Hg, pulse is 110/min, and respirations are 24/min. He denies pain in his neck on palpation and has full range of motion. Physical examination shows clear lungs, regular heart sounds, an open right humerus fracture, and bilateral lower extremity injuries. His left leg is intact but swollen and erythematous. The medical technicians report that the left leg was the pinned leg. His right leg appears to have an open femur fracture. He has 2+ radial pulses bilaterally. His left foot is cool compared with his right. The most ominous physical finding would be
A. loss of deep tendon reflexes on the left B. loss of dorsalis or posterior tibial pulses C. pale color D. paraesthesias to touch E. tenderness on palpation
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#802
15.09.2006, 03:59
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Какой кошмар! Нужно срочно перенести вопрос в тему "Автолюбители"! И вообще -нервные клетки не восстанавливаются(С). Эй тобишь.(А)
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#803
15.09.2006, 06:42
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Синдром длительного сдавления. Во-первых, нерв раньше артерии повреждается от сдавления, во-вторых, отечная поврежденная мышца не ответит на рефлекс.
A. loss of deep tendon reflexes on the left.
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#804
15.09.2006, 10:59
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Цитата:
Цитата:
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#805
15.09.2006, 22:11
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Если бы все вопросы и оттветы были, как в № 791, то хоть завтра можно тесты сдавать
 Сорри за офф, кто-нибудь знает, верна ли информация, что в России теперь нет центра по сдаче USMLE? И с чем это связано? Уважаемая Яна, а то, что Вы нам любезно предлагаете, - это step2 или 3?
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#806
16.09.2006, 08:31
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Цитата:
Вэб сайт [Ссылки доступны только зарегистрированным пользователям ]
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#807
16.09.2006, 17:20
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The correct answer is B. This patient likely has a compartment syndrome. Because portions of the body such as the leg have fascial compartments that are relatively noncompliant, tissue injury usually results in massive increases in pressure. Once the pressure is great enough to overcome arterial pulsations, ischemia and necrosis are imminent.
The loss of deep tendon reflexes on the left (choice A) is an early sign of compartment syndrome and in conditions such as gluteal compartment syndrome, is the most sensitive indicator of early compartment syndrome. Since it is the most sensitive finding, it does not portend imminent loss of tissue. Pale color (choice C) and paraesthesias to touch (choice D) are also findings in compartment syndrome but are not as ominous as loss of pulses. Classically, of the six "Ps" of compartment syndrome: pallor, pain, paresthesia, pulselessness, poikilothermia, and paralysis, these two are the most nonspecific. Because of the nature of the patient's injuries, tenderness on palpation (choice E) is going to be present. Such a nonspecific finding is common to a majority of injuries and is not necessarily representative of an injury severe enough to cause a compartment syndrome. USMLE Step3
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#808
16.09.2006, 17:22
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A 53-year-old man who has been taking amoxicillin-clavulanate for 10 days for chronic sinusitis is brought to the emergency department by his wife because of the development of increasing fever and a red, swollen right eye over the past 12 hours. His temperature is 38.7 C (101.6 F). Physical examination shows periorbital edema and erythema, conjunctival injection, chemosis, and proptosis. Cranial nerve examination and extraocular movements are normal. Nasal examination shows purulent material in the superior meatus and a diffusely congested mucosa. The most likely explanation for these new symptoms is
A. an allergic reaction to amoxicillin-clavulanate B. contiguous spread of infection from the ethmoid sinus through the lamina papyracea C. contiguous spread of inflammation or infection from the sinuses to the meninges D. development of a frontal subperiosteal abscess E. development of a tumor in the cavernous sinus
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#809
16.09.2006, 20:20
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тромбоз кавернозного синуса?
не.. В (абсцесс/флегмона глазницы) люблю пороть горячку.. Третья редакция: необязательно абсцесс/флегмона. Может быть просто реакт. отек клетчатки глазницы...
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Линейный вид
