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#31
12.09.2006, 14:24
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Добрый день!
Насколько я знаю,введение пневмококковой вакцины не рекомендуется до двух лет,поэтому скорее всего ответ - С. 
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#32
13.09.2006, 09:16
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The correct answer is A. The 2-month visit is the visit of first vaccines. The initial vaccines are DTaP, Hib-Hep B, IPV, and pneumococcal vaccines.
A bagged urine specimen (choice B) is not routinely obtained. A complete blood count (choice C) is usually done at about the 9 month visit, not at 2 months. After the initial set of vaccines, the patient may be sent home with a follow up in 2 months. Without the vaccines, it is inappropriate management to send him home for a return visit in 2 months (choice D) or with a return visit in 3 weeks (choice E).
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#33
13.09.2006, 09:22
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A 3-year-old boy with fever
A 3-year-old boy is brought to the office because of a 2-day history of fever, nausea, weakness, and "yellow skin." He has always been a healthy child, rarely having more that a sore throat or ear infection. The family has not traveled recently and no other family members are sick. A couple of children in his childcare center are sick and a parent of one of the other children has similar symptoms. His temperature is 38.1 C (100.6 F). Physical examination shows icteric skin and conjunctiva but is otherwise unremarkable. Laboratory studies show:
IgM Anti-HAV Positive HbsAg Negative HCV-Ag Negative You should advise the mother that: A. Hepatitis vaccination that is routinely recommended for all children in the United States would have prevented this illness B. Her son can return to childcare 5 days after the onset of symptoms C. Household contacts should receive immune globulin within 2 weeks after last exposure D. It is likely that her child was sexually abused by his friend's father E. There is a 30% chance that her son will develop chronic hepatitis
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#34
13.09.2006, 09:25
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Цитата:
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#35
13.09.2006, 09:34
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Александр,спасибо за объяснение.
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#38
13.09.2006, 14:01
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А разве в США вакцинация против гепатита А не включена в календарь?
Я, вообще-то, скорее за А; во всяком случае, я против того, чтобы всем контактным вводить иммуноглобулин в такой ситуации. В новых СП, насколько я помню, предусмотрена вакцинация контактных.
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#39
13.09.2006, 14:27
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Ребенок уже болен(вероятно, он не был вакцинирован ранее). Поэтому вакцину Вы ему вводить не будете. Вариант А не подходит.
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#41
13.09.2006, 15:52
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Цитата:
Если бы написано было "в мире", то этот пункт однозначно не годится, т.к. в международный календарь входит только вакцина против гепатита В. В США, как мне кажется, вакцинируют по календарю и от гепатита А. Так что вариант "А" вполне приемлем.
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#42
13.09.2006, 16:32
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The correct answer is C. This patient has an infection with the hepatitis A virus, which is usually transmitted by the fecal-oral route. Since young children tend to put many things in their mouths, including dirty fingers, it is not hard to imagine how they can contract this disease. It can also occur from contaminated food and water, international travel, and rarely through homosexual activity. The treatment is supportive. Household contacts should receive immune globulin within 2 weeks after last exposure.
The hepatitis vaccination that is routinely recommended for all children in the United States would have prevented this illness (choice A) is incorrect. The hepatitis B vaccine, not the hepatitis A vaccine, is routinely recommended for children in the U.S. Ну и, кроме всего прочего, он ведь уже заболел, так что уж теперь говорить, что могло бы быть ( не быть ), если бы... It is incorrect to advise her that her son can return to childcare 5 days after the onset of symptoms (choice B). Children can return to childcare 7 days after the onset of symptoms. While the hepatitis A virus may be transmitted through homosexual activity, you should not advise her that it is likely that her child was sexually abused by his friend's father (choice D). Close contact, not necessarily sexual contact, and fecal-oral transmission are the most likely sources of infection. Since you have absolutely no evidence that this child has been sexually abused, it is inappropriate to say this to the mother at this time. Since hepatitis A is not associated with chronic infection, it is incorrect to tell the mother that there is a 30% chance that her son will develop chronic hepatitis (choice E). P.S. В Израиле привика от гепатита А а в календаре прививок с 1998 г. ( Гепатит В с 1992 г.)
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#44
13.09.2006, 18:23
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The mother of a 3-year-old patient of yours, calls the office after the child banged his head against the coffee table in their family room. The mother is absolutely frantic, saying that her son has been "screaming and crying" for the past 45 minutes and that she cannot calm him down. She tells you that he did not lose consciousness. You advise her to bring him into the office, even though you just finished seeing your last patient and were just planning on leaving for the evening. When they arrive, you notice that the boy's eyes appear very red from crying, but that he has calmed down. The mother is still very concerned. They have both been patients of yours for many years, and they have always been very healthy and compliant. You notice that there is a 0.5-cm edematous area on the back of his head. The skin is intact over the wound. The remainder of the physical examination, including a complete neurologic and funduscopic examination, is unremarkable. After calming the mother down, the most appropriate next step is to
A. advise them to go to the emergency department for observation B. obtain a skull radiograph C. order a CT scan of the head D. recommend regular monitoring and observation for any abnormalities, and if they arise, that they should go to the emergency department E. report the case to the child protective service agency
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