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#901
27.10.2006, 18:48
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Цитата:
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#902
27.10.2006, 19:51
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The correct answer is A. This patient has some type of facial pain syndrome. Since the pain is constantly present, it is not a typical trigeminal neuralgia. The patient should have a MRI and be evaluated by a neurologist.
A neurosurgical consult (choice B) is not indicated at this time. Patients with facial pain which cannot be controlled medically or have a clear surgical etiology should be seen by a neurosurgeon. Intravenous prochlorperazine (choice C) and zolmitriptan (choice E) are used for the acute treatment of migraine headaches. This patient does not describe the typical migraine headache, which is throbbing and worsened by light, certain foods, and other factors. It may also be preceded by an aura. Soft cervical collar and metaxalone (choice D) are used to treat headaches from cervical muscle spasms. This patient most likely has a facial pain syndrome that should be evaluated by a neurologist.
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#903
27.10.2006, 19:51
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A 66-year-old woman comes to the office for a periodic health maintenance examination. She has always been very healthy and generally comes to the office once a year. She is a retired accountant, who travels to exotic countries every year, exercises 3 times a week, smokes a pack of cigarettes a day, and "enjoys a good steak" every other night. Last years mammogram, flexible sigmoidoscopy, and Pap smear were all unremarkable. Even though her mammograms and clinical breast examinations have always been normal, she is very concerned about her risk of breast cancer. She does not have a family history of breast cancer, but she has many friends and neighbors with the disease. You try to discuss ischemic heart disease with her, but she keeps steering the conversation back to "dying from breast cancer." After you answer all of her specific questions about breast cancer you should
A. explain that even though she is very concerned about breast cancer, she should be more concerned about dying from ischemic heart disease at her age B. explain that even though ischemic heart disease mortality has been decreasing in women over the past 30 years, she should still try to quit smoking and decrease her dietary cholesterol C. recommend mammograms twice a year to put her mind at ease D. tell her that even though ischemic heart disease is the leading cause of death in men in her age group, but not women in her age group, she should try to quit smoking and decrease her dietary cholesterol E. tell her that she should not be so concerned about breast cancer because she has had normal mammograms and clinical breast examinations and does not have a family history
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#904
27.10.2006, 23:09
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Думаю, что
E. tell her that she should not be so concerned about breast cancer because she has had normal mammograms and clinical breast examinations and does not have a family history. И если это возымеет эффект, потом поговорить о профилактике ИБС, хотя непонятно, как она может отреагировать на это. Dmitry Voskovets
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#905
27.10.2006, 23:58
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Я бы склонился все-таки к B. А - это сильно, но несколько неверно. E - это верно, но недостаточно.
Столько курить... так и помереть недолго, несмотря на всю статистику.
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#906
28.10.2006, 03:01
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..B..
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#907
28.10.2006, 09:52
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Разрываюсь между А и В.
Всё-таки В, в этом ответе, по крайней мере назваются конкретные факторы риска, а не просто "concerned about" в общем виде...
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#908
28.10.2006, 17:06
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A is very inappropriate statement!
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#909
30.10.2006, 17:25
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Как это ни странно:
The correct answer is A. Even though ischemic heart disease (IHD) is the leading cause of death in women ages 65-74, most women still believe that there is a greater risk of dying of breast cancer. In this age group, IHD, lung and gastrointestinal cancers, chronic obstructive pulmonary disease, and cerebrovascular disease pose greater threats to women's lives than breast cancer. This patient should be told that she should try to quit smoking and decrease her dietary cholesterol in an effort to decrease her risk of IHD, lung and gastrointestinal cancers, chronic obstructive pulmonary disease, and cerebrovascular disease. It is incorrect to explain that even though ischemic heart disease mortality has been decreasing in women over the past 30 years, she should still try to quit smoking and decrease her dietary cholesterol (choice B) because IHD has been decreasing in men but increasing in women. It is understandable that this patient is so concerned about her risk of breast cancer, given that many friends and neighbors with the disease, however, mammograms twice a year (choice C) is not the appropriate answer to put her mind at ease. It is incorrect to tell her that even though ischemic heart disease is the leading cause of death in men in her age group, but not women in her age group, that she should try to quit smoking and decrease her dietary cholesterol (choice D) because IHD is the leading cause of death in women aged 65-74. It is inappropriate to tell her that she should not be so concerned about breast cancer because she has had normal mammograms and clinical breast examinations and does not have a family history (choice E). You need to try to be compassionate and understanding and realize that she is concerned because she sees and hears about breast cancer from her friends and neighbors. Part of your job is to educate patients about common misconceptions and not to criticize their ideas and beliefs. Many women her age do suffer from breast cancer, but she should be told that the leading cause of death in her age group is IHD, lung and gastrointestinal cancers, chronic obstructive pulmonary disease, and cerebrovascular disease.
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#910
30.10.2006, 17:27
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A 4-year-old boy is admitted to the hospital earlier in the day because of fever, irritability, and erythema of the hands and feet for the past week. His mother has been giving him aspirin to reduce his temperature. His physical examination on admission showed a temperature of 39.7 C (103.4 F), bilateral conjunctival injection, an enlarged right-sided cervical lymph node (1.8-cm), fissured lips, a red tongue with red papillae, pharyngeal hyperemia, erythematous and edematous palms and soles, and a confluent, blanching erythematous rash on the trunk. Intravenous fluids were started, the aspirin therapy was continued, and laboratory studies were ordered. These laboratory studies finally returned and showed an erythrocyte sedimentation rate of 28mm/h and a platelet count of 490,000/mm3. The patient is extremely uncomfortable and now shows desquamation of the fingers and toes. The most appropriate therapy at this time is
A. corticosteroids B. ibuprofen C. intravenous gammaglobulin D. oxacillin E. penicillin V
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#915
01.11.2006, 20:02
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Болезнь Кавасаки, тем более есть подсказка в виде продолжении терапии аспирином)) Ответ C - внутривенно гаммаглобулин
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Линейный вид
