tule44_facit.pdf

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KUNSKAPSPROV FR

UTLNDSKA LKARE

TULE 44

7 februari 2011

SVAR


2/22

1

INNEHLL:

Tema sid

A Medicin 2

B Pediatrik 6

C Obstetrik & Gynekologi 10

D Psykiatri 13

E Kirurgi 16


3/22

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______________________________________________________________________

SVAR: A MEDICIN________________________________________________________________________

A1 SVAR:

Feokromocytom.(1 pong)

________________________________________________________________________

A2 SVAR:

A. P-Fe samt endera P-ferritin eller TIBC. (1 pong)B. Gastroskopi och koloskopi. F-Hb ger inte pong. (1 pong)

(totalt 2 pong)________________________________________________________________________

A3 SVAR:

Akut sarkoidos. (Sarkoidos r ocks rtt)(1 pong)

________________________________________________________________________

A4 SVAR:

Lkemedelsbiverkan, vervikt, metabolt syndrom, NASH (fettlever), kroniskjrnmedicinering (sekundr hemokromatos). (3 rtt =2 pong, 2 rtt = 1pong)(totalt 2 pong)

________________________________________________________________________

A5 SVAR:

A. Poly-mono, totalvita, albuminhalt, cytologi, odling, TBC-odling. (2 pong fr 3rtt, 1 pong fr 2 rtt)

B. Maligna celler i ascites samt lg proteinhalt vid portal hypertension och hg vid

malign ascites. (1 pong)(totalt 3 pong)

________________________________________________________________________

A6 SVAR:

Njurartrstenos (p bas av fibromuskulr dysplasi).(1 pong)

________________________________________________________________________


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3

________________________________________________________________________

A7 SVAR:

A. Skickar patienten till nrmaste akutmottagning p sjukhus omgende. (1 pong)

B. Indikation fr trombolys kan freligga, om bldning kan uteslutas med CT-skalle.Oavsett detta angelget med snabb utredning, dr ven duplex carotider ska ing.(1 pong)

(totalt 2 pong)________________________________________________________________________

A8 SVAR:

A. Antibiotikakur och rntgenkontroll efter 4-6 veckor. (1 pong)B. Ej inlggningsfall p grund av opverkat AT och vitalparametrar vsentligen u a.

Indikation fr antibiotika p grund av auskultationsfynd som tyder p pneumoni.

Lungrntgen fr att utesluta bakomliggande lungcancer. (2 pong fr 3 rtta svar,1 pong fr 2 rtta svar.)

(totalt 3 pong)________________________________________________________________________

A9 SVAR:

Essentiell Trombocytemi (ET), Polycytemia Vera (PV), KML, Myelofibros (MF)samt reaktiv trombocytos vid inflammatorisk sjukdom, infektion, bldning,

postoperativt eller malignitet. (2 pong fr 3 rtt, 1 pong fr 2 rtt)(totalt 2 pong)

________________________________________________________________________

A10 SVAR:

Waran (fr emboliprofylax) och beta-blockerare (el verapamil) fr frekvensreglering.(totalt 2 pong)

________________________________________________________________________

A11 SVAR:

Forcerad diures, styrning av urin Ph, dialys. (2 rtt = 2 pong. 1 rtt = 1 pong)(totalt 2 pong)________________________________________________________________________

A12 SVAR:

ACE-hmmare/AII-blockare. (1 pong) samt remiss till kardiologen fr preop

utredning. (1 pong)

(totalt 2 pong)________________________________________________________________________


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4

________________________________________________________________________

A13 SVAR:

Mb Buerger (el trombangitis obliterans)

(1 pong)________________________________________________________________________

A14 SVAR:

A. Vnstersidigt sknkelblock. (1 pong)B. Akut PCI (1 pong)C. Syrgas, ASA, Betablockad. Nitroglycerin, Morfin Plavix, LMWH. (2 pong) Fr

2 pong mste syrgas, ASA, betablockad samt 2 lkemedel till finnas med. 3-4 avdessa =1 pong. Annars 0 pong.

(totalt 4 pong)

________________________________________________________________________

A15 SVAR:

Addisons sjukdom.(1 pong)

________________________________________________________________________

A16 SVAR:

A. Polymyalgia reumatika. (1 pong)B. Det r viktigt att frga om temporalisarteritsymptom som: (1) ny typ av

huvudvrk, (2) mhet ver tinningarna, (3) skalpmhet, (4) tuggclaudikatio.(3 rtt = 2 pong, 2 rtt = 1 pong)

(totalt 3 pong)________________________________________________________________________

A17 SVAR:

A. HI, Pnk, meningokocker, listeria (1 pong fr tre rtta svar); Ampi +cefot, alt.meronem. (1 pong fr ett av dessa bda alternativ)

B.

Blod och liquor. (1 pong endast om bda med i svaret)(totalt 3 pong)________________________________________________________________________

A18 SVAR:

Kostgenomgng med reducering av ev strre K-kllor, Natriumbikarbonat (eg omacidos, men det behver ej anges), Resonium, reducering av ev lkemedel som kange hyperkalemi. (3 rtt = 2 pong, 2 rtt = 1 pong)(totalt 2 pong)

________________________________________________________________________


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________________________________________________________________________

A19 SVAR:

A. Nefrotiskt syndrom. (1 pong)

B. Serum-albumin (lgt) (1 pong), dygnsmngd albumin i urinen (hgt). (1 pong)Inte rtt fr enbart krea, urea eller njurbiospi.(totalt 3 pong)

________________________________________________________________________


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6

________________________________________________________________________

SVAR: B PEDIATRIK________________________________________________________________________

B1 SVAR:

Eftersom barnet r normalstort, antas vikten vara 10 kg. 200 ml Ringer-Acetat(alternativt 0,9% NaCl), iv eller intraossest om iv ej mjligt, p hgst 20 minuter.Alt. 1 ml/kg/min i 20 minuter. (OK att svara 20 ml/kg och inte rkna ut summanutifrn barnets uppskattade vikt.(2 pong)

________________________________________________________________________

B2 SVAR:

A. 10-12 mnaderB. 10-12 (18) mnaderC. 2 rD. 3 r(2 pong)

________________________________________________________________________

B3 SVAR:

A. Apgar 3

B. Apgar 9(2 pong)________________________________________________________________________

B4 SVAR:

A. BlspunktionB. Rent prov, undvika verdiagnostikC. Stas och dilatation, dilatation(totalt 2 pong)

________________________________________________________________________

B5 SVAR:

Blodstatus, ANA, Rheumafaktor (men den r mycket sllan positiv hos barn),Borreliatitrar (eventuellt ven yersiniatitrar samt antistreptolysin). JIA,

barnreumatism samt Borreliaartrit. ven andra reaktiva artriter kan godknnas.(2 pong)

________________________________________________________________________


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7

________________________________________________________________________

B6 SVAR:

A. Ett ryggmrgsbrck.B. Frlamningar i nedre extremiteterna, inkontinens.C. Tcka det med sterila kompressser fr att frhindra infektion och uttorkning.(totalt 2 pong)

________________________________________________________________________

B7 SVAR:

Snabb andning, svettningar vid matning, matningssvrigheter, dlig viktuppgng,alternativt pltsligt fr snabb viktuppgng p grund av dem, oro/ngestuttryck iansiktet.

(2 pong)________________________________________________________________________

B8 SVAR:

Tanken ska g till neurodegenerativa sjukdomar och annat allvarligt; remiss tillbarnklinik.(2 pong)

________________________________________________________________________

B9 SVAR:

A. Prolongerad ikterus p grund av brstmjlk. Gallvgsstas, t.ex gallvgsatresi,ev ven infektion och hemolys.

B. Bilirubin och konjugerat bilirubin skall tas akut p misstanke leverstas, framfr alltgallvgsatresi. Ev gallvgsscint. Det r viktigt fr prognosen att detta tgrdas stidigt som mjligt.

(2 pong)________________________________________________________________________

B10 SVAR:

A. Hypoglykemi.B. IV glukos 10%-ig glukos minst 1 ml/kg.(2 pong)

________________________________________________________________________

B11 SVAR:

Invagination. Ultraljud, ev bukversikt. Colonrtg med kontrast och reponering. Kirurgiom kontrastrntgen med reponeringsfrsk ej lser invaginatet.(2 pong)

________________________________________________________________________


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________________________________________________________________________

B12 SVAR:

A. Obstruktiv bronkit. (1 pong)B. Inhal adrenalin/selektiv beta-2-agonist. (1 pong)(totalt 2 pong)

________________________________________________________________________

B13 SVAR:

Hftledsluxation. Remiss ortoped samt von Rosen skena.(2 pong)

________________________________________________________________________

B14 SVAR:

A. Streptokockinfektion gr A. (1 pong)B. Odling eller snabbtest Strep A. (1 pong)(totalt 2 pong)

________________________________________________________________________

B15 SVAR:

Obstipation. Klinisk diagnos, per rektum us. Klyx och exempelvis laktulos.(2 pong)

________________________________________________________________________

B16 SVAR:

A. 3-5 r, opverkat, normalt, normalt, < 10, CRP u a, SR u a.B. Destruktion i reticuloendoteliala systemet, antikroppsfrmedlad destruktion.(totalt 2 pong)

________________________________________________________________________

B17 SVAR:

A. H infl, polio, kikhosta, difteri, stelkramp, pneumokocker.B. Inga.(totalt 2 pong)

________________________________________________________________________

B18 SVAR:

A. Expansiv process/tumr -> hgt intrakraniellt tryck.B. Ataxi, gonmotorik, abducenspares, balanssvrigheter.C. Remiss till barnklinik.(totalt 2 pong)________________________________________________________________________


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________________________________________________________________________

B19 SVAR:

Coxitis simplex, ultraljud hfter.

(2 pong)________________________________________________________________________

B20 SVAR:

Hjrndem. Glukos, Na, B-Ketoner, S-osmolaritet.(2 pong)

________________________________________________________________________


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________________________________________________________________________

SVAR: C OBSTETRIK & GYNEKOLOGI________________________________________________________________________

C1 SVAR:

A. Oligomenorr. (1 pong)B. Hypofys (Prolactin); Hypothalamus (FSH, LH); Thyroidea (TSH); Ovarier (A4,

testosteron). (4 pong)C. Clomifencitrat. (1 pong)(totalt 6 pong)

________________________________________________________________________

C2 SVAR:

A. Ca 1,7%. (1 pong)B. vervikt/fetma, DM bland nra slktingar, hgre maternell lder, multiparitet,

tidigare barn med fdelsevikt 4500 g, visst etniskt ursprung.(5 pong)(totalt 6 pong)

________________________________________________________________________

C3 SVAR:

A. Smnstrningar i kombination med vasomotorsymtom. (2 pong)B. Transcutan. (1 pong)

(totalt 3 pong)________________________________________________________________________

C4 SVAR:

A. Graviditetshepatos/ICP. (1 pong)B. IUFD (ca 1-2 %). (1 pong)(totalt 2 pong)

________________________________________________________________________

C5 SVAR:

Rut br utredas med kolposkopi och nytt cytologprov inom 6 mnader.(totalt 2 pong)

________________________________________________________________________

C6 SVAR:

Placenta previa, vasa previa, tidigare operationer p corpus uteri, hinder ifrlossningskanalen som dislocerar fregende fosterdel, tidigare prolaps- ellerinkontinensoperation, tidigare sfinkterskada, misstnkt disproportion.(totalt 4 pong)

________________________________________________________________________


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________________________________________________________________________

C7 SVAR:

Genom att ge GnRH-agonistbehandling.

(1 pong)________________________________________________________________________

C8 SVAR:

Ordnar med en tid p frlossningen fr igngsttning inom en vecka.(2 pong)

________________________________________________________________________

C9 SVAR:

Fertiliteten kan vara reducerad p grund av endometriosen, men den reduceras intesrskilt mycket ytterligare p grund av att ett sjukt ovarium avlgsnas.(2 pong)

________________________________________________________________________

C10 SVAR:

Intrauterin fosterdd.(1 pong)

________________________________________________________________________

C11 SVAR:

Dubbeldos p-piller, IUD.(2 pong)

________________________________________________________________________

C12 SVAR:

XO(1 pong)

________________________________________________________________________C13 SVAR:

A. Intrauterin tillvxthmning, intrauterin fosterdd, missbildningar, mentalretardation. (3 pong)

B. Hjas 25-50 g. (1 pong)(totalt 4 pong)

________________________________________________________________________


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________________________________________________________________________

C14 SVAR:

NaCl-lsning som nsspray eller nsskljvtska

(1 pong)________________________________________________________________________

C15 SVAR:

Endometrieresektion, endometrieablation, hysterektomi.(3 pong)

________________________________________________________________________


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________________________________________________________________________

SVAR: D PSYKIATRI________________________________________________________________________

D1 SVAR:

Nedsatt funktion socialt och i studierna. Vanfrestllningar. Desorganiserat tal.Neologismer. Misstnkt hallucinatoriskt beteende.(3 pong)

________________________________________________________________________

D2 SVAR:

Hereditet, droger, suicidalitet, farlighet, tidigare psykiska besvr och vrdkontakter.

(2 pong)________________________________________________________________________

D3 SVAR:

Schizofreni.(2 pong)

________________________________________________________________________

D4 SVAR:

Inlggning p psykiatrisk klinik, eventuellt med std av LPT.(2 pong)________________________________________________________________________

D5 SVAR:

Drogscreening.(1 pong)

________________________________________________________________________

D6 SVAR:

Lab.statusSomatiskt status, inkl. neurologstatusAvdelningsobservationer av omvrdnadspersonalen

Neuropsykologisk utredningKuratorsutredningFunktionsbedmning av arbetsterapeut(4 pong)

________________________________________________________________________


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________________________________________________________________________

D7 SVAR:

A. Antipsykotika (neuroleptika). (1 pong)B. T.ex. haloperidol, olanzapin eller risperidon. (1 pong)(totalt 2 pong)

________________________________________________________________________

D8 SVAR:

Egentligen fr tidigt att yttra sig om detta, men systern br informeras om attbehandling tminstone kan frbttra tillstndet avsevrt.(2 pong)

________________________________________________________________________

D9 SVAR:

Egentlig depression. (1 pong)Minskat intresse, aptitstrning, smnstrning, brist p energi,koncentrationssvrigheter. (2 pong)Symptom sedan minst tv veckor. (1 pong)(totalt 4 pong)

________________________________________________________________________

D10 SVAR:

Suicidtankar/planer.(1 pong)

________________________________________________________________________

D11 SVAR:

Hypothyreos.(1 pong)

__________________________________________________________________________

D12 SVAR:Beror primrt p eventuell suicidrisk. Om sdan bedms freligga, br patientenlggas in p psykiatrisk klinik. Annars behandling i ppenvrd, primrvrd eller

psykiatri.(2 pong)

________________________________________________________________________


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________________________________________________________________________

D13 SVAR:

A. Antidepressiva lkemedel, t.ex. SSRI. (1 pong)B. T.ex. citalopram. (1 pong)C. T.ex. sexuella biverkningar, viktuppgng. (2 pong)D. KBT. (1 pong)(totalt 5 pong)

________________________________________________________________________

D14 SVAR:

A. Panikattacker/paniksyndrom. (1 pong)B. Upprepade panikattacker, dvs avgrnsade episoder av intensiv rdsla med

andnd, hjrtklappning, kallsvettning, yrsel och illamende. (1 pong). ngslan

fr nya attacker, oro fr betydelsen av dessa. (1 pong)(totalt 3 pong)

________________________________________________________________________

D15 SVAR:

Empati, respekt. Noggrann information.(1 pong)

________________________________________________________________________

D16 SVAR:

Viktigt att informera/undervisa personalen om panikattacker och paniksyndrom.(1 pong)

________________________________________________________________________

D17 SVAR:

Remiss till primrvrd.(2 pong)

________________________________________________________________________

D18 SVAR:

SSRI. KBT.(2 pong)

________________________________________________________________________


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________________________________________________________________________

SVAR: E KIRURGI________________________________________________________________________

E 1 SVAR:

B.(1 pong)

________________________________________________________________________

E 2 SVAR:

E. Coli.(1 pong)

________________________________________________________________________

E 3 SVAR:

Endast om det ger lokala besvr.(1 pong)

________________________________________________________________________

E 4 SVAR:

Det frhjda trycket i njurbcken och uretr.

(1 pong)________________________________________________________________________

E 5 SVAR:

Ngot dygn.(1 pong)

________________________________________________________________________

E 6 SVAR:

Blscancer.(1 pong)

________________________________________________________________________

E 7 SVAR:

Degenerativa frndringar gr menisken skr och lttskadad utan strretrauma.(1 pong)

________________________________________________________________________


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________________________________________________________________________

E 8 SVAR:

Avaskulr nekros.

(1 pong)________________________________________________________________________

E 9 SVAR:

Lig. fibulotalare anterior.(1 pong)

________________________________________________________________________

E 10 SVAR:

N. radialis.(1 pong)

________________________________________________________________________

E 11 SVAR:

Glucocortikoider.(1 pong)

________________________________________________________________________

E 12 SVAR:

Collum femoris fraktur.(1 pong)

________________________________________________________________________

E 13 SVAR:

Hallus valgus.(1 pong)

________________________________________________________________________

E 14 SVAR:

Punktion, ev. kombinerad med lokal cortisoninjektion.(1 pong)

________________________________________________________________________

E 15 SVAR:

Artrit.(1 pong)

________________________________________________________________________


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________________________________________________________________________

E 16 SVAR:

Cauda equina syndrom.

(1 pong)________________________________________________________________________

E 17 SVAR:

MR(1 pong)

________________________________________________________________________

E 18 SVAR:

A. Tryckmhet vid calcaneus frmre mediala deldenna mhet kan frstrkasom trna samtidigt dorsalflekteras. (1 pong)

B. Inflammerad s.k. hlsporre. (1 pong)(totalt 2 pong)

________________________________________________________________________

E 19 SVAR:

Tendovaginit, dr m. abduktor pollicis longus och m. extensor pollicis brevisgemensamt passerar en trng kanal radirt i handleden.(1 pong)

________________________________________________________________________

E 20 SVAR:

En knlig och relativt vlavgrnsad, ibland rdaktig och mindre tilltalandebindvvsproliferation i cutis i rrvvnad.(1 pong)

________________________________________________________________________

E 21 SVAR:

A. En blodtrycksmanchett fstes runt ankeln och blses upp. Med dopplermtareregistreras trycket d luften slpps ur manchetten.(1 pong)

B. Normalt 1,1-1,0. Sjunker vid kande ischemi, vid vilovrk r kvoten under 0,3.(1 pong)

(totalt 2 pong)________________________________________________________________________

E 22 SVAR:

Subjektiva, som svljningsbesvr, samt kosmetiska.

(1 pong)________________________________________________________________________


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________________________________________________________________________

E 23 SVAR:

A. Rektums framvgg buktar in i vagina p grund av en svaghet i septum

rektovaginale. (1 pong)B. Svrigheter att tmma tarmen, d avfringen gr mot vagina istllet fr motanus. (1 pong)

(totalt 2 pong)________________________________________________________________________

E 24 SVAR:

Hga halter gallsalter i blodet.(1 pong)

________________________________________________________________________

E 25 SVAR:

Syrgasmttnaden i denna perifera vvnad.(1 pong)

________________________________________________________________________

E 26 SVAR:

Gasknister vid frsiktig palpation av drabbade mjukdelar.(1 pong)

________________________________________________________________________

E 27 SVAR:

Ingen ny dos.(1 pong)

________________________________________________________________________

E 28 SVAR:

Invation av lymfkrtlar.(1 pong)________________________________________________________________________

E 29 SVAR:

Trombocyter och fibrin.(1 pong)

________________________________________________________________________


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________________________________________________________________________

E 30 SVAR:

MRSA r en smittsam antibiotikaresistent infektion.

(1 pong)________________________________________________________________________

E 31 SVAR:

Palpabel utspnd gallblsa som tecken p gallstas.(1 pong)

________________________________________________________________________

E 32 SVAR:

Ulcers colit.(1 pong)

________________________________________________________________________

E 33 SVAR:

Frsk bldning per rectum.(1 pong)

________________________________________________________________________

E 34 SVAR:

AndningenATLS-principen.(1 pong)

________________________________________________________________________

E 35 SVAR:

Precancerst tillstnd, dr det normala skivepitelet i esofagus r omvandlat tillcylinderepitel inom ett omrde > 4 cm frn cardia.(1 pong)

________________________________________________________________________E 36 SVAR:

Den mekaniska lper risk att snabbt utveckla cirkulationssvikt i tarmvggen medgangrn och perforation som fljd.(1 pong)

________________________________________________________________________


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________________________________________________________________________

E 37 SVAR:

De kan ocks kombineras med terapeutiska tgrder i samma seans.

(1 pong)________________________________________________________________________

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tule44_facit.pdf