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#61
10.07.2006, 19:13
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A 37-year-old woman comes to the office because of a 3-month history of "tiredness". She says that she has not felt like herself for "quite some time now" but this fatigue is making it difficult to just get out of bed. She has been calling in sick to work a couple of times and week and her supervisor recommended that she "seek help." She has no other symptoms, does not have any chronic medical conditions, does not take any medication, and has not recently suffered a concussion. She denies severe psychological stress. Her temperature is 37.2 C (99.0 F), blood pressure is 110/70 mm Hg, pulse is 65/min, and respirations are 15/min. Her physical examination is unremarkable. A complete blood count is normal. The most appropriate next step is to
A. order a biochemical profile B. order a chest x-ray C. prescribe fluoxetine D. reassure her that this will pass and schedule a follow-up visit in 1 week E. refer her to a psychiatrist 
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#62
10.07.2006, 19:38
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A.....
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#64
10.07.2006, 19:54
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Ðèñêóþ íàðâàòüñÿ, íî âñ¸ æå...:)
Ó÷àñòêîâûé òåðàïåâò - Å
Ó÷àñòêîâûé ïñèõèàòð - D "Íîâîèñïå÷¸íûé ÂÎÏ" - C À ÿ ñîìíåâàþñü - A ëèáî B, B ëèáî A... 
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#66
10.07.2006, 20:15
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Öèòàòà:
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#68
10.07.2006, 20:18
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Öèòàòà:
), è êàê ðàç ïîäîéäåò âðåìÿ äëÿ D.
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#69
10.07.2006, 20:20
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Õîòÿ êëèíè÷åñêè, ó÷èòûâàÿ, ñëîæíîñòü âñòàòü óòðîì èç ïîñòåëè, à íå óòîìëåíèå, âîçíèêàþùåå ïðè êàêîé-ëèáî äåÿòåëüíîñòè,áîëüøå ïîõîæå íà ïñèõèàòðèþ è ñîîòâåñòâåííî Å, ÷òîáû íå ïðîïóñòèòü êàêóþ-òî ñîìàòè÷åñêóþ áîëåçíü âíà÷àëå íóæíî ñäåëàòü áèîõèìèþ, ïîñìîòðåòü ïå÷åíî÷íûå äåëà, æåëåçî, ýëåêòðîëèòû, ÊÔÊ òî åñòü À.
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#70
10.07.2006, 20:24
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ß áû òîæå À (ïå÷åíî÷íûå ïðîáû, Ig íà Inf. Mono). Ïåðâîå, ÷òî ïðèõîäèò â ãîëîâó ïðè òàêîé äëèòåëüíîé èñòîðèè "óñòàëîñòè" è íåáîëüøîé òåìïåðàòóðå, îòñóòñòâèè êàêèõ áû-òî íè áûëî äðóãèõ êëèíè÷åñêèõ ñèìïòîìîâ.
(Ñàìà áîëåëà òî÷íî òàê æå, ïðè÷åì, áûëà óâåðåíà, ÷òî ìíå ïðîñòî íàäî â îòïóñê. Êîëëåãà óãîâîðèë ñäàòü êðîâü. )
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#71
10.07.2006, 20:28
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Öèòàòà:
ß, êñòàòè ñêàçàòü, òîæå î tbc äóìàë...
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#72
10.07.2006, 21:11
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The correct answer is A. The initial evaluation of a patient with fatigue includes a thorough history and physical examination, a complete blood count, and a biochemical profile. These will evaluate the patient for causes of fatigue such as anemia, uremia, diabetes mellitus, adrenal insufficiency, hypokalemia, hyponatremia, and hepatitis. If these tests are negative, thyroid function tests and the evaluation for an infection and an occult malignancy are indicated. If all studies are negative, a nutritional deficiency, depression, a chronic viral infection, or chronic fatigue syndrome should be considered. Even if chronic fatigue syndrome is suspected, routine laboratory studies must be performed to exclude other causes of her symptoms.
A chest x-ray (choice B) is used to evaluate a cardiopulmonary process. Since this patient does not have symptoms that seem directly related to these systems, a chest x-ray is not the most appropriate next step. It may be indicated in the future because fatigue may be associated with cardiopulmonary processes, but a biochemical profile should be ordered next. Fluoxetine (choice C) is used to treat depression and while it is possible that this patient is depressed, she requires an evaluation with laboratory studies for her fatigue. She does not complain of any other symptoms of depression, such as difficulty sleeping, change in concentration, guilt, worthlessness, and suicidal ideation. Reassurance and a scheduled follow-up visit in 1 week (choice D) is inappropriate. An evaluation for her fatigue is indicated because a 3-month history of "tiredness" is not normal. Referring her to a psychiatrist (choice E) may be indicated in the future, but at this time she requires an evaluation for fatigue.
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#73
10.07.2006, 21:25
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A 75-year-old man is admitted to the hospital from the emergency department after presenting with an aphasia and right hemiparesis. Laboratory studies sent on admission are all normal and a CT scan of the head is negative for hemorrhage or acute infarction. Tissue plasminogen activator is administered. Two hours following the administration of tissue plasminogen activator his examination is somewhat improved. When reviewing the admission orders, you should make sure that they include
A. aspirin, 325 mg per day B. intravenous heparin C. maintain systolic blood pressure under 130 mm Hg D. neuro checks every hour E. neuro checks every 6 hours
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#75
10.07.2006, 21:41
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A....
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Ëèíåéíûé âèä
