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#76
10.07.2006, 21:45
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Ответ А
For patients with noncardioembolic ischemic stroke or TIA, antiplatelet agents rather than oral anticoagulation are recommended to reduce the risk of recurrent stroke and other cardiovascular events (Class I, Level of Evidence A). Aspirin (50 to 325 mg/d), the combination of aspirin and extended-release dipyridamole, and clopidogrel are all acceptable options for initial therapy (Class IIa, Level of Evidence A). А blood pressure - само собой.. 
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#79
11.07.2006, 08:31
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Цитата:
 , я обычно набираю все сразу.
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#80
11.07.2006, 15:52
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Цитата:
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#83
11.07.2006, 18:47
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Аспирин должен назначаться обязательно, поэтому непонятно, почему не нужно удостовериться в его назначении.
Остается ежечасный осмотр? Дабы не упустить..
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#85
11.07.2006, 19:20
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The correct answer is D. Patients treated with tissue plasminogen activator for stroke are at high risk for intracranial hemorrhage. They should have frequent neurological checks for at least the first 24 hours. Every 6 hours (choice E) is not adequate.
Antiplatelet agents such as aspirin (choice A) and anticoagulants such as intravenous heparin (choice B) are contraindicated for 24 hours following tissue plasminogen activator administration. Following the administration of tissue plasminogen activator, systolic blood pressure should be kept below 180 mm Hg to reduce the risk of intracranial hemorrhage. However, the blood pressure should not be medically lowered more than necessary as this will reduce blood flow to the brain (choice C).
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#86
11.07.2006, 19:28
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A 70-year-old woman comes to the emergency department with a 2-day history of a right-sided facial rash and right eye pain. She has no significant medical history and is on no medications. She is unaware of her childhood diseases and prior immunizations. She states that her husband recently had "the flu and a bout of pink eye." Physical examination shows a vesicular rash on her right scalp and forehead, right upper eyelid, right side of the nose, and the tip of the nose. The visual acuity of the right eye is 20/50 and the left eye is 20/20. There is no relative afferent papillary defect. The intraocular pressure is 15mm Hg in both eyes. The conjunctiva is diffusely red and injected, and slit lamp examination reveals multiple small epithelial dendrites on the cornea of the right eye. The most appropriate next step in management is to
A. obtain herpes simplex antigen detection studies B. prescribe oral acyclovir C. prescribe oral antibacterial therapy D. prescribe topical acyclovir cream for the skin and topical acyclovir drops for the eye E. prescribe topical antibiotic cream for the skin and a topical antibiotic ointment for the eye
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#88
11.07.2006, 19:57
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Я тоже за D. Мне кажется, что оральный ацикловир в роговицу не проникнет..
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#89
11.07.2006, 21:41
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The correct answer is B. The dermatomal distribution of a vesicular rash should lead you to the diagnosis of herpes zoster. Herpes zoster ophthalmicus is zoster in the V1 distribution presenting with ocular involvement. Oral acyclovir therapy was found in randomized clinical trials to reduce viral shedding from vesicular skin lesions, decrease systemic dissemination of the virus, and ameliorate the incidence and severity of the most common ocular complications (dendritic keratitis, uveitis, and stromal keratitis).
Herpes simplex antigen detection studies (choice A) would not be helpful for herpes zoster. Oral antibacterial therapy (choice C) would be inappropriate for the management of herpes zoster, which is a viral infection. Topical antiviral drops (choice D) have not been found to be effective for the treatment of herpes zoster ophthalmicus. A topical antibiotic (choice E) may be used on the skin or in the eye to prevent secondary bacterial infection, but this is not the most appropriate next step in management.
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#90
11.07.2006, 21:52
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A 5-year-old boy is brought to the clinic by his mother because of the new onset of a flaky scalp and patches of hair loss. He just started preschool 2 months ago and his teacher noted the alopecia during a nap break. His past medical and birth history are insignificant, and he is not on any medications at this time. He has 1 cat and 1 dog at home. On examination, there are multiple circular patches of alopecia studded with black dots on the surface of the scalp. After examining the boy, the mother shows you lesions on her right shoulder. There is an annular erythematous plague with central clearing. The edge is slightly raised and there are tiny vesicles and a fine scale. There is mild lymphadenopathy appreciated. The best next diagnostic step is to
A. exam the boy's hair microscopically with potassium hydroxide B. inquire about autoimmune diseases in the family and obtain a thyroid function test C. perform a punch biopsy of the boy's scalp D. perform a Wood's light exam of the boy's scalp E. refer him to psychiatry for trichotillomania
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Линейный вид
