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#1
10.08.2006, 18:50
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The correct answer is B. This patient has complex partial seizures, which are characterized by automatisms ("picking" movements with hands, chewing, swallowing), that are preceded by an aura. The sequence of events is as follows: aura, behavioral arrest or a motionless stare, automatisms, and postictal confusion. The patient has an impairment of consciousness. These seizures occur in a focal region of the brain, often the temporal lobe.
Absence seizures (choice A), also called petit mal seizures, are generalized seizures that consist of a brief loss of consciousness and automatisms. Postural control is maintained. There is no postictal confusion. Generalized tonic-clonic seizures (choice C) are characterized by a sudden contraction of the muscles followed by periods of contraction and relaxation, and finally, relaxation. There is postictal unresponsiveness, excess salivation, and bowel and bladder incontinence. Myoclonic seizures (choice D) consist of the sudden contraction of one part of the body or may involve the entire body. It is caused by cortical dysfunction. Simple partial seizures (choice E) are characterized by motor, autonomic, sensory, or psychic symptoms. An aura may precede the seizure. Consciousness is maintained. 
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#2
10.08.2006, 18:52
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A 27-year-old woman comes to the office for a periodic health maintenance examination. She is healthy and has no specific complaints. She works at an advertising agency, has a "live-in" boyfriend, exercises a few times a week, eats a low-fat diet, and rarely drinks alcohol. She smokes a pack of cigarettes every 3 days. Her Pap smears have always been normal. The last one was 2 years ago. She currently uses condoms for birth control, but lately her boyfriend has been "nagging" her to "go on the pill." She is 157 cm (5 ft 2 in) tall and weighs 54 kg (119 lb). Her blood pressure is 120/80 mm Hg and pulse is 60/min. Physical and pelvic examinations are unremarkable. In discussing oral contraceptive pills (OCPs) with this patient, you should inform her that:
A. Condoms do not need to be used to prevent chlamydial infections B. Her menstrual periods will become longer and heavier C. She must stop smoking before you prescribe oral contraceptive pills D. Oral contraceptive pills decrease the risk for gonococcal pelvic inflammatory disease E. Oral contraceptive pills increase the risk for ovarian cancer
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#6
10.08.2006, 19:48
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C - хотя бы потому, что ничто другое не подходит. И вообще, это хорошее дело - побудить девушку бросить курить.
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#8
10.08.2006, 20:15
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А. Эта информация необходима пациентке при принятии решения об оральной контрацепции. Относительно курения: пациентка относится ко 2-й группе риска по повышению тромбообразования (меньше 20 сигарет в день, возраст до 35 лет, отсутствие ожирения), где потенциальная польза превышает риск лечения. В и Е не сответствуют истине, эффект от ОСР обратный. D - если и соответствует, все равно вряд ли эта информация будет полезна пациентке.
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#9
10.08.2006, 20:18
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A. Condoms do not need to be used to prevent chlamydial infections?
Are you sure?  Я тоже все время попадала в эту ловушку - забывала прочитать "not".
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#11
10.08.2006, 20:48
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А - неправда, В - неправда, С - мало курит, действительно (хотя в душе я согласен с Антоном Владимировичем), D - тоже ерунда какая-то, Е - неправда.
Загадочная загадка. Все-таки, С. Присоединяюсь к коллегам-противникам курения.
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#12
10.08.2006, 21:48
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D. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID.
[Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] Не очень шикарный был вопрос. Sorry. The correct answer is D. OCPs have many beneficial effects, and one is that they decrease the risk for PID. This is thought to be due to the effects that OCPs have on the endometrium and cervix leading to increased endocervical mucus that resists the spread of gonococcal infection from the cervix to the endometrium and then the fallopian tubes. OCPs have been associated with an increased risk of chlamydial infections and therefore, condoms SHOULD be used to prevent chlamydial infections (choice A). This increased risk may be associated with the fact that OCPs widen the ectocervix , increasing the area of mucus-secreting cells and making the individual more susceptible to chlamydial infections. It is incorrect to inform her that her menstrual periods will become longer and heavier (choice B) because OCPs are typically associated with shorter, less painful, and scanty menses. Smoking in women that are over the age of 35 is a relative contraindication to the use of OCPs. While smoking may increase the risk of complications in women under 35, it is not a contraindication to their use. You should advise her that it is best if she quits (in general and because of the OCPs), but it is not correct to inform her that she must stop smoking before you prescribe oral contraceptive pills (choice C). Oral contraceptive pills have been associated with a decreased risk for ovarian cancer, not an increased risk (choice E).
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