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    Rafael Terceiro
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    IM 7 soluções

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    24 views104 pages

    IM 7 Soluções

    Uploaded by

    Rafael Terceiro

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 104
    RURLEREVSERGId man whois HEV postive comes tothe physician for mmunizetions pir ST MDTNGRIGHTASTS BAUME eck curing autumn. He plans to engage n ypical {burt acres n mavcpcitar areas Ae ates hy ace arrarorra fray, Tes ears age, he nad prmuoeocal posurons ad racved oe prauracaees febysscchrce vac, 2a ta tre He eave eres boost yeas age at he hapa Aah 8 Vacches 4 years ago He has aap cided (Searatane sve se se win nama inte. Examination shove to sonore Gh SNGSSoN EDS TNRSSEDIMGIG!S ares) ed [sv undeacitie pasa iV val lead Wc linen vaccinations te most props eo |A) Human papilomavius C) Messis. mumps ublavius 1) Meningococat ) Rabes F) Novaccnes ae iat at his ime Comet Anan 8 Inenea 2 espslory wal ness met can he complcated by over respratary tract focton andlor bates supentectos, especial elder or mmunocansromsed Dates, Sram nclie fever chit. cough myaigas, mlese, headaches, nausea and vorng. The Cees Disease Convo ecommends anil ntbenza Ws ‘acinabon fr a palons greet fran 8 maths of age. The inhsea vacie Is avaabin a a Uva or Quadra iamascuarTyecton of acvaled wiv Oa 2 Nasa “Spray oto atenvaod vic nacvatedintvenza nus vacie can be salely aanstered va larusciar maton o patents wth FV Who ay bea hos sk or severe hess andintuenzalated conplcatons iniverza sa seasonal nes, typealy ect patents om Mola fa 0 early sping mons Ths pat is vaveing dung Pe ‘tua ments and should Yecawe the vacinalon or iienea vi InconectAnsiers: A.C, D,E,andF Huan paptiomavius (4P¥) (Choioe A) ssewalyWansmed ands assocated th gona wars slong wih premalgnant and malgrant estos fhe ceva, anogental and ‘ropnarynpeal egans. HPY vaceines have sgncany deceased the incdence and prevalence of HPV and protect agans MPa malignanles sven a8 cea ana anal auamous cl carcinona The vacene shou doa bs adrnstred tore re tania years because he mma estan most tusk an he oie O Soe Bev ME Inonea sa espotory wal ness mat canbe complcated by ower respratary act ioctons and bate superintecton, espacial elder or mmunocanpromsed Patents Sram lie fever chs. cough, malas, malase, headaches, nausea, and org. The Cees lr Disease Coa econmnas anal aber Ws Waecraton foal patonts greato han 6 mortise age. The influorza vane fs avalabo as a vate quacralekirramusclareyechon of activa vius oa a nasal ‘ray of yo atlenvatod nes. nacivatednfuenca vrs vaccne canbe seely adnstored via inamuscular mein o patents wih HV. wo may beat anger rik forsee ithess and infuonzalaed compleatons Inlucnza sa seasonal ness, peal ale patent rem Hola fal fo ea spig mons. Ths palont is vaveling ding Pe ‘uturnn ment ad snould recone th vacematon er nfo ws, InconectAnaners:A,C,D,E,and F Huran papilomavius (HPY) (Choice A) s sexs arsed ais associat wth gonial vars long with preraignant and malgrant sions ofthe cerca anogenital and ‘roar yngea rogers HPV vaccines have sgnfeanydactesed the inadeneo and prevalca of HPV and protic agans HPV olatod malignancies suchas caveat and al Squamous call carcinoma The vaca shel! loa bo adrnistared before he tang years because he ime expanse Ismostebust nd he cna of Sonal acy ay fcr during the teenage years HPV vacne fol specienly recommended pri fav oasis: mumps rubella (MMR) vu (Choice C)vacin sa ve aterutod vaccine that involves two doses: one at 12 o 15 mots and one botwo the iN vaceme canbe seey en fo unvacated HIV costs patents wth D4 cal counts 200mm? Gcesters of MMR va 46 yours of age While ee no usualy necessary patents Yi Meningococcal (Choice D) vaccine i a conjugate vaccine at's nica forall chen, wh an adel serogroup B vacine cated for al Inseased sk or marngocacal disease a9 ormitery, rata lung) Meningoccecalvacina s ol necessary prt oematores ave ren ore 1D years of age at Rabies (CteiceE) vaccine, whic sevalable a ave atlerusted a actuated vaccine, maybe advsable fox ravers visting particular high sk aaa (og, pars of Arca cr Eeutern Ass but ent oily requred fat amatonal Favesrs abes may be ansmiecm eveaping costes high ane bites most common oy dogs Pe Sxposure propnyias wih tes vaccine S gornsivedn asers of Cree veruscuar Inecions. Panis win HIV can sefey ecoNe acivalod fables Yarcre No vaccine (Choke Fis ncorect Patents with iV can sally receive inacvated infuenza vaccine Eaucatona Object: Annual fuerza vinusvaccnston recommended fr all patents grater han 6 morhs of age Inacivstedntuenza vis vaccine canbe setely fsmnistred a mtamuseasrjacon a patent wth HV whomay bea higher neefar severe hess aos nhuensa alates compleators While ne spestealy recammendes forts avel igeie patnts snoula race a nhuanas vaccination dung hs autre movin pat te hel nue Searen| 2. m92:yearoi woman s rough 0 he emeraency department 30 mines ater sh was found contd her HomeThe wearer has Deen extranet and the Temperature nner room was O7-F Sho nas mulhnarct Wascult dome and ad a myoca’da infrcon 30 wars apo shes supers. Her tmparature Is 30°C (102°) pulse 120m and raul espatons ae simi, analood pressure N50 mm 9 Examination shows Sy mucous membranes Tare sno jp. veNeUs tense ug cat clon Age 28 aco rinse iio0d fhagae Which othe foleweg age oatea cxmgos she rest ely expanain fo hangs MPs pa” |) Decreased airway easly 8B) Deceased barator ) Decreased mucoeary clearance 1) Decreased thyod ncn E) Dastoic cardacdytuncton F) impared cain response to exercise 6) imparea Tynphoeyefuncien © Ay imparogtnist 1) incressed ung compliance 41) Rona saz wastg Comet Answer Heat stoke i charactorzedby an creased body temperature hat occurs when he body is exposed te high envronmentalanoeatures and high huni, Excessive heat texpesure oe inesoases core body toneraive lado cordovasculr and now ogc stanton wih secondary cycA, achyanea. and hypotension Vasoslaton ot Sper Blood vssels may leedo muti gan syle faut, indudng hepatic and eral scherna shabdonyO}is, and diserynatedinavascda” coagulation Treatment includes ceaing othe patent win fans orice wae coninuous cre tegeres moon. and supe of sas, breatung. and creuaton rat stoke general eauses reursoge symptans io be Qagnased, wheres Nea exhaust presents sma ttn ma neurlone examiaton Heat Soke common ach Youny ste 0 ‘der patints win pared themorsdatory capac, 85 exkdenced by mpared Ts blged vessel don, ad Yeduces ably o Sweat dsc he aby to sate est InconctAnsners:A, 8,0, FG land Decreased away elastctly (Choice A) and iezaase ung complance (Choe) related increased age subsaqgerl load to the ss of aeclr surface area caused by collapse Of seo and fever seas fr gas exchange. Ths can lad to symptoms ike enphysem anc chron obstuctve puronary Gsse50 Norma! barerex actwaton oles changes othe heat rate in esponse to bleed pressure Nermaly decreased bleed pressure woul eat 2 increase heatale to estore mean arora pressure. Int sting of an ageelted docrese in barorefex savy (choice 8) hal fate dows net etease as expecied in esparsa to Jeceasod 1008 Pressure when can caure syncope ighnesdocness nd aterd mental status Ths pave tachjcacie making the scar ese ely Decreased mucociary clearance (Crate C) can lee to an increased rsk or aspraton preumona This atts mcreasedhody temperatures kal secondary to external sources, and ear lings ques against paeumons as source of er preseniaton Ouases eyo tneton (Che Deans yee wos rosea wings an snp sch as Wagga etary, ge, costpaton Naot, arco Diastolic cardiac dstuncion (Choice E) woud present wth ss o heat alureincuding volme overload, pulmonary edns, loner exam edema, and ascites, Impaired carciac response o exercise (Chole F) wou lead to deceased exorcise obxance wih symoloms such as dyspnea on exertion. ghthesdedness, and syncope Impaiced T-mghooytefuncton (Choice G) woud result in mpaed tsar immunty, which can make a patent susceptible to infectens. This pants fevers ikl secondary to teromal sources. ater fan an nection Renal sat wasting (Chace J) can occur inte seting of 21-nyroeyse decency leading to consol and aldosterone decency. These patents as yc present wi kaos, Piperksem, 26 hyposoiomie Eaucatonal Objective mses themoreguaory capac caused by increase age resus in inpares ts, dod vessel davon, and reduces aby wo sweat. Decreased by to assipate neat esus nan ncoased Sk or het tke 3, A32,paccold woman trough he emerDency department because of eve and conten for 4nows. She nas a5 year nstvy systemic lupus erbematosus, She Nad evesora meng mening 3 yare apo, Carer medatins Incase nyonychovoqun. HSB Is0° 07 ExaManion SNM SS ISSEn CoreteospnarTaeranansliShOWSIEousness A Gam stan shows grar-togatve Glococa, WHC OTs folowng mocransms se MostIKOY cause O these inangs? 'A) Connon yarabie mnunedecency ) impateacelmedated mmunty 1) Leukeeyte adhesion deisincy ) Phagocyc col oedative meabotsm deficiency Comet Answer B Deficiency of teminal onpanets of complements he most ihely cause of his patents recent an recut infection wth Neisseria mening. The presence of fever, nuchal Fait, ona ceebrospeel hud anys demonstrating oram-negatve dolocacs & logrostc ft bacieral enlgtsDehoency oie coneement aco (69, CS°C9) pas {te oration of tre momerane atleck complex (MAC) and predspoxes pti fo mechan wit Meson species, though incon tend Yo oct wih Uncommon sereypes ‘We he complement cascade cn be acted wa the Gawsca ec. a aletnaive pathways, each pabwey canvelges on he Same poet wneedy Cs deaved fo release C30 bra Gab The 63 convertase comglex subsequent leads fo acivaton of CS, n formation af CSa rd CSO. he la of rch complexes win, C7. CB, sna C9 to fom We HMAC. The NAG ceses a isnsmeniane pore tha ierizes wih fhe eget fe cela membrane, leash Wo ce vss. Seeing fo termina compere’ decency Usk Stas wah deteminaton of te CHs0, a dannostc test at measures the abt of ho patent serum to Wse sheep enivocytes coated with antbodos Broce apart eytvocyt> membrane proteins Bacau he test measures te actu ofa’ C109. 3 Geldency aan port wi ead to an abnormal est. though cates wh frhnal complement atcency, ts CHSO concentration le vty deceased 0 even 270 In adaion fo Weatng hoc. uh eaten shoul ncide vacchaton against! meng Intvontae, and S pretmonice InconecAnsners:A,C,D, and Common vratie inrasosencency (Chole A) classe resents me secon our decades of a eeu Sngpumonary nocbons bu does nt predspose patients to Inecton wth #2 maningigs Diagnosis made by measing serum Immunopouin concenatons, hich are decreased Hie tration off narra alarkcompiex MAC) ene pedsposes patio mechon win ssa species athough mfsctons tena fo orc! wh uncom steypes Whi the complement cascace can be acvaled va the classical lac of aterhatve pata, each patwey converges othe same part ubeteby C3is Ona eles C38 Bana Cab Toe C3 convertase corglex subsequent leds acivaton Of CS wit format of CSa ard CSb hele of whch compleses wi Co C7. C8, era Co forme HMAC: The NAC costes a tanememtrans por hat eres wh fe mort fe celaar membrana, laxan fo else. Screening for termina compere’ decency Usy Star wah determination of he CH6O, a daghostc tot that measures the cl fo patents savur i se sheep envoys coded wih antbedes veces agar eryPvoryte membrane proens Because hs est measures the act of faciors C1-C8_ a defcency at any port les to an abnormal est, hough im pstens wih frmnal complement Sstosncy, to CHAO concertraton willbe vary dociessad o even 270 In dono Weaing econ, luther eament shoud nicude vaccnaion aganst mong Intuenrae, and S pretmonie Inconect Answers: A, CD, and Common vantie immunodeficiency (Choice ) classe present inte scons ofurth decades of ifs a ecurent sinepumonary inlecbon bt das nt pradsposa patents to Infection wih meninges Diagnosis made by messing serum immunogicbuin concentrations, vic are decreased, Impated col. madste immunity (Chace C) may rte abroad range of condos, em acquired conditions leading to lymphocyte cystunction such as HIV to gant conons Sen as loukacye adhesion datency cone granulomatous disease, and many offers Mediators Incudng chemetherary drug and manodonalansbadas targeting specne Dopultion of mae cals, may so ead To pared cl-medited many The frsngs are as verse asthe condone a lead fo mmmunodeircy, bul none specticaly Dredspose patents trecurert Neves factions Leukocyte adhesion decency (Chace D)is usualy characteed by recurent batt nectons and delayed detachment ofthe umbilical ord. Paints have naa cancetvabons of neutohis, but the cls ere une to efecvely mart fo tes of fachon Pagocye cel oxdtvemetebosm deficiency (Choice E) deserbes conc grnulonistous Gsease. Decency NADPH oxidase nhs We respratry bust win phagocyte fells suchas neon eveby leading oan creased suscep 10 calaaseposave ogansms, We mening cease postive ecient necons wih Eis ‘ipa in solston would be unasual x bis asease Eavcatonal Ob. Detelency of he terminal complement fates prevents he fomaton of he WAG, which ec caroonent in he complement cascade tng 10 formation eta pce nse membvane of patogenc organs, Decency predisposes To ecure iecians with Messe Spees Y 4 Aprovicus neathy 25.yorot4 man comes tothe physician because of 10. day stor of ever sere throat, and generalizes fatigue. He thos no masicatons. He became ‘eranlysebve wn anes tera partner & vss 499 and does net use condoms He doesnot de ravenous Sige He tempertie © 37 C00") psa le Samm Tespratons ate 4m. and blood pressure is 12876 nm Hg. Thee se nurerous erythematous maculs overt upper dest Examination shons mate, ss an

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