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#1126
29.01.2007, 21:03
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Цитата:
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#1127
29.01.2007, 21:24
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с большой долей вероятности у ребенка болезнь Гиршспрунга, потребующая оперативного лечения. не знаю, надо ли делать клизму для подтверждения. пусть для разнообразия будет
D. laparotomy Dmitry Voskovets
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#1131
29.01.2007, 22:26
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The correct answer is B. Clinically, the paucity of meconium, and the presence of abdominal distension in a neonate, are suspicious for meconium plug syndrome. The "bubbly" appearance on the left abdomen reinforces this consideration. Meconium plug syndrome is more common in infants after labor induction with magnesium sulfate. A water-soluble contrast enema will reveal a spindly plug of meconium in the colon, and often will serve also as a therapeutic enema. Differential considerations include small left colon syndrome, which may coexist with meconium plug syndrome. Also, if therapeutic contrast enema fails to resolve symptoms, Hirschprung's disease or cystic fibrosis must be considered. Do not confuse these entities with meconium ileus.
Conservative treatment such as bowel rest (choice A) is not the appropriate management. A contrast study is necessary to evaluate for meconium plug syndrome. Failure to diagnose and treat may result in perforation. Conservative treatment such as intravenous fluid resuscitation (choice C) is not appropriate. A contrast study is necessary to evaluate for meconium plug syndrome. A laparotomy (choice D) is not indicated for meconium plug syndrome or small left colon syndrome. An ultrasonography (choice E) is a useful screening tool for intussusception, but not for meconium plug syndrome.
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#1132
29.01.2007, 22:27
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A 74-year-old man with severe chronic obstructive pulmonary disease is admitted to the hospital because of pneumonia. He has a long smoking history with at least 2 packs per day for 45 years. He was diagnosed with chronic obstructive pulmonary disease 6 years ago. He is currently home oxygen dependent. His last FEV1 was 18% of predicted. Earlier in the day, he came to your office with fever and a cough. A chest radiograph disclosed a left lower lobe infiltrate. You admitted him to the hospital for antibiotics and intravenous fluids. About 16 hours after the admission, you are called in because he has developed severe shortness of breath. You note that his temperature is 39.8. C (103.6 F), blood pressure is 140/95 mm Hg, pulse is 98/min, and respirations are 38/min. He appears dyspneic, is sitting upright in bed, and appears to be in moderate distress. His oxygen saturation on 6L face mask is 74%. Physical examination shows very minimal air movement and much decreased breath sounds bilaterally. His fingers and lips are cyanotic. He is speaking in gasping breaths. The most appropriate intervention at this time is to
A. administer a nebulized beta agonist agent B. deliver a nebulized anticholinergic agent C. perform endotracheal intubation D. prescribe morphine sulfate, intravenously E. start continuous positive airway pressure (CPAP)
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#1138
30.01.2007, 00:07
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C. COPD с пневмонией. Сатурация 74% на 6 л/мин кислорода через маску, т.е. PaO2 однозначно ниже 60. Неинвазивная вентиляция здесь - не метод выбора, т.к. причина гипоксии - не только/столько утомление дыхательной мускулатуры.
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#1140
30.01.2007, 11:58
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Цитата:
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Линейный вид
