|
#61
10.07.2006, 19:13
|
||||
|
||||
|
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 
|
|
#62
10.07.2006, 19:38
|
|||
|
|||
|
A.....
|
|
#64
10.07.2006, 19:54
|
||||
|
||||
|
Рискую нарваться, но всё же...:)
Участковый терапевт - Е
Участковый психиатр - D "Новоиспечёный ВОП" - C А я сомневаюсь - A либо B, B либо A... 
|
|
#66
10.07.2006, 20:15
|
||||
|
||||
|
Цитата:
|
|
#68
10.07.2006, 20:18
|
|||
|
|||
|
Цитата:
), и как раз подойдет время для D.
|
|
#69
10.07.2006, 20:20
|
|||
|
|||
|
Хотя клинически, учитывая, сложность встать утром из постели, а не утомление, возникающее при какой-либо деятельности,больше похоже на психиатрию и соотвественно Е, чтобы не пропустить какую-то соматическую болезнь вначале нужно сделать биохимию, посмотреть печеночные дела, железо, электролиты, КФК то есть А.
|
|
#70
10.07.2006, 20:24
|
|||
|
|||
|
Я бы тоже А (печеночные пробы, Ig на Inf. Mono). Первое, что приходит в голову при такой длительной истории "усталости" и небольшой температуре, отсутствии каких бы-то ни было других клинических симптомов.
(Сама болела точно так же, причем, была уверена, что мне просто надо в отпуск. Коллега уговорил сдать кровь. )
|
|
#71
10.07.2006, 20:28
|
||||
|
||||
|
Цитата:
Я, кстати сказать, тоже о tbc думал...
|
|
#72
10.07.2006, 21:11
|
||||
|
||||
|
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.
|
|
#73
10.07.2006, 21:25
|
||||
|
||||
|
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
|
|
#75
10.07.2006, 21:41
|
|||
|
|||
|
A....
|
Линейный вид
