codnis Sefaseba da testuri gamocda. testis dizaini da misi Sedgenis ...
codnis Sefaseba da testuri gamocda. testis dizaini da misi Sedgenis ...
codnis Sefaseba da testuri gamocda. testis dizaini da misi Sedgenis ...
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samedicino gazeTi Tebervali 2010 gv.6<br />
<strong>da</strong>narTi 1<br />
`ganvrcobiTi Sesatyvisobis~ testebis nimuSebi klinikuri konteqstiT<br />
SeniSvna: CamonaTvalTa sii<strong>da</strong>n TiToeuli varianti SeiZleba miesa<strong>da</strong>gos erT an<br />
ramodenime sakiTxs an arcerTs!<br />
1. Tema: infeqciuri <strong>da</strong>avadebebi<br />
variantebis CamonaTvali:<br />
A. Treponema pallidum<br />
B. Rubella virus<br />
C. Human papilloma virus<br />
D. Human herpes virus 8<br />
E. Candi<strong>da</strong> albicans<br />
F. Epstein-Barr virus<br />
G. Cytomegalovirus<br />
H. Coxsackie A virus<br />
I. Coxsackie B virus<br />
qvemoT CamoTvlil SemTxvevebs miusa<strong>da</strong>geT Sesaba<strong>misi</strong> gamomwvevi variantebis<br />
CamonaTvali<strong>da</strong>n<br />
1. 16 wlis biWi sunTqvis gaZnelebiT. sisxlis wneva 100/70, taqikardia, wnevis mateba<br />
sauRle venebSi, gulis tonebis moyrueba, filtvebi sufTa.<br />
2. HIV+ mamakaci TeTrkideebiani laqebiT enis gverdiT ze<strong>da</strong>pirze. laqebi Znelad<br />
ifxikeba.<br />
3. HIV+ mamakaci enaze TeTri nadebiT. nadebi advilad scildeba.<br />
4. 32 wlis qali makulo-papularuli gamonayariT tanze, xelis- <strong>da</strong> fexisgulebze,<br />
meWeWisebri gamonayariT vulvaze <strong>da</strong> anusis irgvliv.<br />
5. 11 wlis gogona wvrili vezikuluri gamonayriT xelebze <strong>da</strong> fexebze <strong>da</strong> loyis<br />
lorwovanis <strong>da</strong>wylulebiT.<br />
swori pasuxebia: 1 - I (Coxsackie B virus); 2 - F (Epstein-Barr virus);<br />
3 - E (Candi<strong>da</strong> albicans); 4 - A (Treponema pallidum); 5 - H (Coxsackie A virus)<br />
2. Tema: RviZlis <strong>da</strong>avadebebi<br />
variantebis CamonaTvali:<br />
A. A hepatiti<br />
B. B hepatiti<br />
C. C hepatiti<br />
D. hemoqromatozi<br />
E. vilsonis <strong>da</strong>avadeba<br />
F. avtoimunuri hepatiti<br />
G. pirveladi biliaruli cirozi<br />
H. masklerozebeli qolangiti<br />
qvemoT CamoTvlil aRwerilobebs miusa<strong>da</strong>geT Sesaba<strong>misi</strong> <strong>da</strong>avadeba variantebis<br />
CamonaTvali<strong>da</strong>n<br />
1. saSualo asakis qali uCivis leTargias <strong>da</strong> qavils. gamokvlevisas gamovlin<strong>da</strong><br />
mxolod hepatosplenomegalia. RviZlis fermentebi momatebuli, gansakuTrebiT<br />
ki tute fosfataza <strong>da</strong> g-GT. aris antimitoqondriuli antisxeulebic<br />
2. 13 wlis biWi msubuqi intensivobis mwvave hepatitis niSnebiT. gamoxatulia<br />
tremori <strong>da</strong> swavlis unaris moSla. virusuli <strong>da</strong> avtoimunuri serologia negatiuri.<br />
3. 20 wlis mamakaci anamnezSi wylulovani kolitiT. amJamad saxezea sisuste, wona-<br />
Si kleba, qavili, tkivili marjvena ferdqveSa areSi <strong>da</strong> gar<strong>da</strong>mavali siyviTle.<br />
4. 30 wlis qali anoreqsiiT, gulisreviTa <strong>da</strong> sisustiT. gamokvleviT gamovlin<strong>da</strong><br />
palmaruli eriTema <strong>da</strong> telangieqtaziebi. RviZlis transaminazebi momatebuli.<br />
aris gluvi kunTis sawinaaRmdego antisxeulebi.<br />
5. 42 wlis mamakaci sisustiT, leTargiiT, impotenciiT <strong>da</strong> xelisa <strong>da</strong> muxlis saxsrebis<br />
tkiviliT. gamokvlevisas SeimCneva kanis gamuqeba-gauxeSeba <strong>da</strong> hepatomegalia.<br />
swori pasuxebia: 1 - G (pirveladi biliaruli cirozi); 2 - E (vilsonis <strong>da</strong>avadeba);<br />
3 - H (masklerozebeli qolangiti); 4 - F (avtoimunuri hepatiti); 5 - D (hemoqromatozi).<br />
3. Tema: dermatologia<br />
variantebis CamonaTvali<br />
A. bulozuri impetigo<br />
B. vulgaruli pemfigusi<br />
C. bulozuri pemfigoidi<br />
D. herpetiformuli dermatiti<br />
E. xelis, fexisa <strong>da</strong> piris Rrus <strong>da</strong>avadeba<br />
F. bulozuri epidermolizi<br />
G. Cutyvavila (varicela)<br />
qvemoT CamoTvlil SemTxvevebs miusa<strong>da</strong>geT Sesaba<strong>misi</strong> diagnozi variantebis<br />
CamonaTvali<strong>da</strong>n<br />
1. axalSobili, romlis kani kontaqtisas ifareba bulozuri buStukebiT.<br />
2. 70 wlis qali fexebze didi zomis <strong>da</strong>Wimuli buStukebiT. buStukebs gaaCniaT<br />
eriTematozuli safuZveli <strong>da</strong> zogierT maTganSi aRiniSneba sisxliani SigTavsi.<br />
3. mozardi intensiuri qavana vezikularuli gamonayriT dunduloebze, i<strong>da</strong>yvebze,<br />
muxlebsa <strong>da</strong> wvivebze. irkveva, rom mas aqvs SeteviTi defekacia.<br />
4. 60 wlis qali sxeulsa <strong>da</strong> piris RruSi dune, advilad <strong>da</strong>zianebadi buStukebiTa<br />
<strong>da</strong> eroziebiT.<br />
swori pasuxebia: 1 - F (bulozuri epidermolizi); 2- C (bulozuri pemfigoidi);<br />
3 - D (herpetiformuli dermatiti); 4 - B (vulgaruli pemfigusi).<br />
klinikuri mimdinareoba, garTulebaTa<br />
meqanizmi, <strong>da</strong>avadebis simZime, samkurnalo<br />
RonisZiebebis winaswar gaTvaliswinebuli<br />
Tu gauTvaliswinebeli efeqtebi.<br />
testebi agebuli un<strong>da</strong> iyos klinikuri<br />
konteqstiT.<br />
zoga<strong>da</strong>d, meqanizmebTan <strong>da</strong>kavSirebuli<br />
testi (<strong>da</strong>narTi 2,b) <strong>da</strong>iwyeT klinikuri<br />
suraTis aRweriT: simptomebiT, CivilebiT,<br />
laboratoriuli monacemebis miTi-<br />
TebiT, Semdeg <strong>da</strong>sviT erT-erTi aseTi ki-<br />
Txva:<br />
- riT aixsneba miRebuli <strong>da</strong>kvirvebis/<br />
analizis Sedegebi?<br />
- sad ganviTardeba <strong>da</strong>zianeba?<br />
- romeli paTogenuri agenti gamoiwvev<strong>da</strong><br />
<strong>da</strong>saxelebul movlenebs?<br />
- romeli maCvenebeli gaizrdeba/<br />
<strong>da</strong>qveiTdeba?<br />
- ra cvlilebebi gamovlindebo<strong>da</strong><br />
biofsiiT?<br />
diagnostika<br />
diagnostikasTan <strong>da</strong>kavSirebiT Sedgenilma<br />
testma (<strong>da</strong>narTi 2,g) gamosacdelSi<br />
un<strong>da</strong> gamoavlinos laboratoriuli <strong>da</strong> instrumentuli<br />
kvlevebiT miRebuli<br />
maCveneblebis, avadmyofis Civilebis interpretaciis<br />
<strong>da</strong> diferencialuri diagnostikis<br />
unari. am tipis kiTxvebiT vlindeba<br />
miRebuli <strong>codnis</strong> integraciis unari.<br />
Cveulebriv, aseTi testi iwyeba pacientis<br />
mdgomareobis aRweriT (mieTiTeba<br />
asaki, sqesi, simptomebi, niSnebi, <strong>da</strong>avadebis<br />
xangrZlivoba, garegani <strong>da</strong>TvalierebiT,<br />
laboratoriuli <strong>da</strong> instrumentuli<br />
gasinjviT miRebuli maCveneblebi <strong>da</strong> sxv.)<br />
<strong>da</strong> mTavrdeba SekiTxviT:<br />
- romelia yvelaze Sesaferisi diagnozi?<br />
- ra <strong>da</strong>matebiTi RonisZiebaa saWiro<br />
diagnozisaTvis?<br />
- ra a<strong>da</strong>sturebs <strong>da</strong>saxelebul diagnozs?<br />
pacientis marTva<br />
pacientis marTvasTan <strong>da</strong>kavSirebuli<br />
testi (<strong>da</strong>narTi 2,d) afasebs mwvave <strong>da</strong><br />
qronikuli SemTxvevebis marTvis principebs<br />
ambulatoriul <strong>da</strong> stacionarul<br />
pirobebSi. am tipis SekiTxvebiT SeiZleba<br />
Sefasdes farmakoTerapiuli ga<strong>da</strong>wyvetilebis<br />
unari, mkurnalobis sxva<strong>da</strong>sxva<br />
meTodis erTdroulad gamoyenebis<br />
unari <strong>da</strong> sxv. <strong>testis</strong> bolos, Cveulebriv,<br />
<strong>da</strong>ismis SekiTxva:<br />
- romeli Semdgomi gziT un<strong>da</strong> warimarTos<br />
mkurnaloba?<br />
- ra mkurnaloba iqneba yvelaze efeqturi?<br />
- romel mkurnalobas <strong>da</strong>uniSnavdiT?<br />
- ra <strong>da</strong>xmarebaa saWiro pirvel rigSi?<br />
<strong>da</strong>narTi 2<br />
calkeul klinikur saqmianobasTan <strong>da</strong>kavSirebuli <strong>testis</strong> nimuSebi<br />
a) <strong>da</strong>avadebaTa prevenciasTan <strong>da</strong>kavSirebuli <strong>testis</strong> nimuSebi<br />
1. 15 wlis biWs futkris kbenis Semdeg orjer ganuviTar<strong>da</strong> mwvave anafilaqsiuri<br />
Soki. romelia yvelaze Sesaferisi profilaqtikuri RonisZieba?<br />
A. kortikosteroidebis <strong>da</strong>niSvna zafxulis ganmavlobaSi<br />
B. grZelvadiani profilaqtikuri antihistaminuri Terapia<br />
C. <strong>da</strong>mcveli tansacmeli<br />
*D. desesitizacia futkris Sxamis eqstraqtiT<br />
E. zafxulis TveebSi sjobs gaCerdes saxlis pirobebSi<br />
2. 33 wlis qalma, pirveli orsuloba, orsulobis 38-e kviras spontanurad imSobiara.<br />
axalSobili gogona iwonis 2460g-s, aReniSneba hepatosplenomegalia, Ria<br />
ductus arteriosus, kataraqta. orsulobis me-8 kviras de<strong>da</strong>s ganuviTar<strong>da</strong> makulopapuluri<br />
gamonayari, gaudid<strong>da</strong> kisris limfuri kvanZebi, uCio<strong>da</strong> yelis tkivils,<br />
arTralgias. <strong>da</strong>asaxelebuli movlenebi erTi kviris Semdeg spontanurad gaqra.<br />
orsulobis Semdgomi periodi mimdinareob<strong>da</strong> garTulebis gareSe. orsulobis<br />
periodSi Catarebuli romeli gamokvleva mogvcem<strong>da</strong> nayofis mdgomareobis<br />
prognozirebis saSualebas?<br />
A. amniocentezi kariotipis gansazRvriT<br />
B. herpes simplex virusis kultura<br />
*C. wiTuras seriuli titrebi<br />
D. Sardis analizi citomegalovirusze<br />
E. testi sifilisze<br />
b) <strong>da</strong>avadebaTa ganviTarebis meqanizmebTan <strong>da</strong>kavSirebuli <strong>testis</strong> nimuSi<br />
10 wlis gogonas yelis tkivilis <strong>da</strong>wyebi<strong>da</strong>n 14 dReSi ganuviTar<strong>da</strong> makrohematuria.<br />
mas aReniSneba sisxlis arteriuli wneva 170/100 mmHg <strong>da</strong> qve<strong>da</strong> kidurebis<br />
SeSupeba. sisxlSi Sardovanas azotis koncentracia aris 3.2 mg/dl. ra mizezi<br />
gamoiwvev<strong>da</strong> <strong>da</strong>saxelebul movlenebs?<br />
A. aortis koarktacia<br />
B. endoTeliumi<strong>da</strong>n warmoqmnili relaqsaciis faqtoris produqciis <strong>da</strong>qveiTeba<br />
C. aldosteronis produqciis gazr<strong>da</strong><br />
D. kateqolaminebis produqciis gazr<strong>da</strong><br />
*E. gazrdili intravaskuluri moculoba<br />
g) diagnostikasTan <strong>da</strong>kavSirebuli <strong>testis</strong> nimuSi<br />
52 wlis mamakacs 2 dRea, rac aReniSneba dispnea <strong>da</strong> xvela Cirqovani naxveliT. 30<br />
welia, rac yoveldRiurad eweva <strong>da</strong>axloebiT erT yuT sigarets. sxeulis temperaturaa<br />
37.2 O C. sunTqvis dros distanciazec ismis stvena <strong>da</strong> xixini. leikocitebis<br />
raodenobaa 9000/mm 3 . gramis meTodiT naxvelSi gamovlin<strong>da</strong> didi raodenobiT<br />
neitrofilebi <strong>da</strong> gram-pozitiuri diplokokebi. romelia yvelaze Sesaferisi<br />
diagnozi?<br />
A. asTma<br />
B. bronqoeqtazia<br />
*C. bronqiti<br />
D. filtvis embolia<br />
E. streptokokuli pnevmonia<br />
d) pacientis marTvasTan <strong>da</strong>kavSirebuli <strong>testis</strong> nimuSi<br />
15 wlis biWs, romelic adre arafers uCio<strong>da</strong>, aReniSneba mwvave movliTi xasia-<br />
Tis tkivilebi periumbilikalur mi<strong>da</strong>moSi; ramdenime saaTSi tkivilebi gax<strong>da</strong><br />
mudmivi <strong>da</strong> ga<strong>da</strong>inacvla marjvena qve<strong>da</strong> kvadrantSi. vadmyofs <strong>da</strong>ewyo pirRebineba<br />
<strong>da</strong> miiyvanes ga<strong>da</strong>udebeli samedicino <strong>da</strong>xmarebis departamentSi. muceli Rrma<br />
palpaciiT mtkivneuli iyo marjvena qve<strong>da</strong> kvadrantSi. sisxlSi leikocitebis<br />
raodenoba - 15 000/mm 3 , SardSi – 3 leikociti/mxedvelobis velSi. ra proceduris<br />
Catarebaa saWiro pirvel rigSi?<br />
A. mkurnaloba saxlis pirobebSi; klinikaSi <strong>da</strong>brundeba, Tu tkivilebi moimatebs<br />
B. bariumis oyna<br />
C. muclis CT-skanireba<br />
D. intravenuri pielografia <strong>da</strong> cistografia<br />
*E. muclis qirurgiuli gamokvleva
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