Trac Nghiem Ls Tieu Hoa (HVQY)

Trc Nghim Lm Sng Tiu Ho
TRC NGHIM LM SNG TIU HO Mt s lu : * i vi cu chn -S th mi cu c nhiu vi cc ny bn phi chn xem l ng or sai: V d: 14. Vng da huyt tn (-S): - Thiu mu() - Vng da() - Lch to() - Phn bc mu(S) - Nc tiu vng() Trong cc s c cc nh ng or sai m bn phi chn V d: Vim: b thc qun nhn (S), c hnh rng ca nh (), cc np nim mc th (), nh (S), st nhau (S), khng c phng hng r rng (), c khi b gin on r (S). * Hi vng ti liu ny s gip ch cho cc b cng c kin thc ni tiu ho. Thn! ********************* 1. Triu chng vim thc qun (thm t, nhm t vo cu sau): - .... nut. - Co tht .... lm cho kh th vo. - au ngay khi...., nng rt, au lan ra sau lng. - Chy ..... - Nn ra ..... - C khi vim nng gy ri lon ....., lon nhp th, suy tim 2. Chp Xquang thc qun vim c cc du hiu (-S): a. Vim: b thc qun nhn (- S), c hnh rng ca nh (-S), cc np nim mc th (-S), nh (-S), st nhau (-S), khng c phng hng r rng (-S), c khi b gin on r (-S). b. Lot thc qun: thnh thc qun c hnh ng thuc di (-S), c qung ph n (S) pha nn (-S) v hnh quy t nim mc (-S), v pha thnh i din ng thuc c hnh gin rng (-S). 3. Chn on vim thc qun (thm t, nhm t ph hp): Chn on vim thc qun da vo: a. Sau cc ...... nu trn bnh nhn thy kh ......
b. Hi chng Plummer- Vinson: kh nut km theo cm gic ....... hng. c. au, nng rt vng ...... d. ....... thc qun thy tn thng. 4. Bin chng ca vim thc qun (thm t, nhm t ph hp): a. .......: au d di kh tr c ......., au kh tr vng sau xng c, thng v ........., mch nhanh nh kh th, nhit cao 380-390C. b. ...... mng phi. c. Vim quanh ....... d. ....... thc qun. 5. iu tr thc qun vim (thm t, nhm t ph hp): a. R a ming, thc qun, d dy ....... axid, kim gy bng, dng sonde d dy ...... b. Nu ...... th dng dung dch axid lactic long hoc vi nc limonat. c. Nu ...... th dng dung dch bicacbonat 2%, cho bnh nhn ung sa. Cn phong b quanh thn khi b ng c ...... v .... gy tan mu. 6. K cc yu t thun li dn ti ung th thc qun (-S): a. Nghin ru, thuc l. b. Cc bnh vim cp tnh ng tiu ho. c. n thc n qu nng, qu lnh trong mt thi gian di d. Sau bng hoc sau chn thng thc qun. e. Sau bnh ti tha thc qun, co tht thc qun f. Sau nhim trng mn: lao, giang mai thc qun g. Sau suy tim. 7. Triu chng ung th thc qun (thm t, nhm t ph hp): Ti ch bnh din ra .... vi cc triu chng: - Cm gic ....v .... - Cm gic vng vng trong ..... - .......: lc u ..... nhng khng au, v sau ...... km theo au, lc u ..... thc n rn, v sau ....... lng. - au m , nn dc theo ...... - Ming .... - Ging ...... do u chn p vo dy thn kinh qun ngc. 8. Triu chng K thc qun ton thn (thm t, nhm t ph hp): - Mt mi, km n, ......, nn mu. - ...... st. - ...... xanh nht. - Km theo du hiu ..... ging khn ho nh ch ku. - Cc du hiu phi- ph qun: ...... - Cc du hiu .......: au ngc, st, ho. - Biu hin ......: cm gic kh th ngt ngt do chn p sau xng c. - Biu hin d dy: .......... 9. Cc yu t ni sinh (-S):
a. Virus, vi khun v c t ca chng. b. Ur mu cao, tng thyroxin, tng ng mu. c. Thuc aspirin, APC, ru, ch, caf d. Chn thng s no, u no, sau phu thut thn kinh, tim, shock, phi cp, x gan. 10. Cc yu t ni sinh (-S): a. Cc cht n mn: mui kim loi nng nh ng, km thu ngn, kim axid sunfuric b. Cc yu t ni sinh trn vo mu gy ra vim d dy cp, cc bnh nhim khun cp nh cm, si, bch hu, thng hn c. Bng, nhim phng x ( 1000 R- 2500R), cc stress nng, chn thng s no, u no d. D ng thc n tm, s,c, hn. 11. Vim d dy c th c cc triu chng rm r sau (thm t, cm t ph hp): a. au vng ..... cn co, nng rt, c khi .... m ch kh tiu. b. Bun nn hoc ...., n xong ...., nn ht. c. Li b, ming hi, st ..... d. G ......au. e. C th b ..... 12. Chn on (+) vim d dy da vo (thm t, nhm t ph hp): a. Lm sng: au thng v ....., nng rt. b. Xquang: khng thy ..... ch thy .... c. Soi d dy v sinh thit: ..... 13. Chn on phn bit (-S): a. Vim ty cp: da vo amylaza mu, nc tiu tng cao. b. Thng d dy; thy lim hi khi Xquang bng c. Vim ti mt cp: st, s thy ti mt to d. Cn au cp ca lot d dy: Xquang c lot e. Phn bit vi vim rut tha (st, Macburney (+)) f. Phn bit vi si niu (i but) 14. Vng da huyt tn (-S): - Thiu mu. - Vng da. - Lch to. - Phn bc mu. - Nc tiu vng. 15. Vng da do tc mt (-S): - au h sn phi lan ln vai phi. - St, rt run, nng. - Khi st ht vng da. - Phn vng. - Nc tiu trong.
16. Vng da do vim gan cp (-S): - St. - au h sn phi. - Vng da, khi vng da cn st. - Nc tiu vng. - Phn vng. 17. bnh nhn vng da, tc mt (-S): - Kh ng m, ngy ng gt. - Nga ton thn. - Nhp tim nhanh. - Phn vng. - Nc tiu vng. 18. Xt nghim Bilirubin mu (-S): - Huyt tn: bilirubin trc tip tng. - Tc mt: bilirubin ton phn tng - Tc mt bilirubin gin tip tng 19. au bng xut hin khi (-S): a. Tng rng gin t ngt qu mc. b. Nhu ng tng rng co bp qu mc c. Mng bng b kch thch: thng d dy d. Kch thch bnh l cc tng: p xe gan, vim ty cp e. Khng r l do: sau n nh mi ngy, au bng, i ngoi th ht 20. au do lot d dy (-S): a. C chu k n vo ht au b. au lan ra sau lng, sang phi c. Khi n vo im thng v ngoi cn au (+) d. Nn xong ht au 21. au do giun chui ng mt (-S): a. Nm thng v nga au b. Nm chng mng: au c. Cho ung nabicacbonat au d. Khi au bng c th nn ra giun 22. au do vim d dy cp (-S): a. au c chu k b. au lan xuyn c. n vo au d. i au e. G vng thng v khng au 23. - au do si niu: lan ln ngc, ln vai phi (-S) - au do si mt: lan xung b phn sinh dc, i but (-S)
24. Nguyn nhn no gy bnh tm v khng gin (-S): - Chn thng tm thn - Bng nhit, ho cht - Vim nim mc thc qun - Lot thc qun - Xc thc qun - Cc bnh nhim trng: cm, st, bch hu - Tro ngc d dy, thc qun 25. Triu chng no gp trong bnh tm v khng gin (-S): - Nut kh: lc u vi thc n rn v sau vi c thc n lng - au ngc: au di mi c, lan ra sau lng - Cm gic p, tc ngc - , tr - Nn - Xquang c hnh nh gin to thc qun v tht hp tm v nht thi lm u di thc qun nhn nh hnh thoi - Soi thc qun: pht hin c on hp ca thc qun 26. Triu chng no gp trong vim thc qun (-S): - Kh nut - au nng rt ngay sau khi nut, nng rt lan ra sau lng - Co tht c hng lm kh ht vo - Chy nc bt - Nn ra mu - C khi vim nng gy ri lon tim mch, lon nhp th, suy kit c th - Xquang thc qun: thy vim hoc lot - Soi thc qun: thy nim mc , mch mu cng t c nhng mng biu m bong ra thy lot, hoi t 27. Cc bin chng ca vim thc qun (-S): - Thng - Hi chng Plummer- Vinson (nut kh km theo cm gic nn hng) - au nng rt vng gia c - Xquang thc qun thy tn thng - Vim mng phi - Vim mng tim - Vim quanh thc qun - Hp thc qun 28. Triu chng lm sng (thm nhm t): a. Cm gic ........., hi, nhc u, mt , cm thy ng ming vo (bui sng), bun nn, nn .... tht thng. b. Nng rt vng thng v xut hin .... c bit r sau khi n ung mt s th nh .... gia v chua cay hoc ngt.
c. au vng thng v khng d di thng ch l cm gic kh chu, m thng xuyn tng ln ... e. Thc th: th trng gy cht t hoc bnh thng, da ..., c vt n ca ... trn ra li, l lot chy mu .... Li ..., au tc vng thng v khi .... 29. Xt nghim dch v (thm nhm t ph hp): a. Trong vim d dy ... nng acid clohydric gim nhng khi lng dch tit bnh thng hoc hi tng. b. Trong vim ... d dy: lng dch tit v nng acid clohydric gim nhiu dn ti v toan. 30. Xquang vim d dy (-S): a. Hnh nh cc np nim mc th b. Nim mc th ng u c. B cong ln nham nh d. B cong ln c hnh rng ca 31. Ni soi pht hin c cc th (thm nhm t ph hp): a. ....: thng c tng tit, nim mc xung huyt, ph n i khi xut huyt lm m. b. ....: ngoi vim d dy th ph i thc th c np nim mc th to cn c th ni cc, th khm, th polyp, th gi u, cn phn bit vi ung th. c. ....: cc tn thng nim mc hnh trn, nng c b r. d. ....: mi u nim mc phng, khng mt v sau dn mt np, teo, nht mu). 32. Hnh nh m hc ca vim d dy mn th nng (-S): a. Lp m xung huyt, ph n b. Xm nhim t bo vim c. Trc biu m d. Cc tuyn vn bnh thng v s lng v hnh thi 33. Hnh nh m bnh hc vim teo d dy (-S): a. Rt t bch cu trong t chc m b. Gim s lng tuyn v cc tuyn teo nh 34. Hnh lon sn rut (-S): a. Nu cc t bo tuyn ca d dy c hnh thi ging nh t bo tuyn ca rut b. L th nh hn ca vim teo d dy 35. Tin trin ca vim d dy mn (-S): a. Vim d dy mn tin trin nhanh b. Hnh thi nim mc thay i mau l t vim ph i ti vim teo (-S) th teo n thun, th teo lon sn(-S) 36. Cc bin chng ca vim d dy mn (-S): a. Ung th d dy b. Xut huyt tiu ho c. Vim quanh d dy, t trng d. Vim ti mt mn e. Vim ty mn
f. Vim rut tha cp 37 Ngoi vic iu tr cc thuc vim d dy mn cn iu tr cc bnh kt hp (-S): a. Vim nhim rng, ming b. Vim tai, mi hng c. Ty giun, sn 38. S thng gp lot d dy- t trng (-S): a. Lot d dy t trng l bnh t ph bin trong cc bnh tiu ho b. Mi la tui u gp biu hin lot d dy t trng (-S) nhng hay gp tui gi v tr (-S). c. Nam gii hay gp nhiu hn n gii d. Thnh th gp t hn nng thn e. Thi chin tranh gp t hn th bnh f. Lot t trng gp nhiu hn lot d dy 39. Cc yu t thun li gy bnh (-S): a. Yu t thn kinh: cc kch thch thn kinh cng thng qu mc ko di b. n ung qu nhiu dinh dng nh m, vitamin (-S), gi gic n khng hp l (-S), ung ru nhiu, n gim t nhiu (-S), thc n nu nh qu (-S). 40. Gii phu bnh (thm t, nhm t ph hp): a. lot .... lot mi: lot c hnh trn hoc hnh bu dc, ming rng, y thu nh dn, quanh lot c phn ng vim xung huyt, mm mi. b. lot ...: qu trnh x pht trin mnh, y lot rng, quanh b lot tr nn dm d, cng chc. 41. Triu chng lm sng (-S): a. au:- Thng v: + Lot d dy au khi i (-S). + Lot hnh t trng au khi no (-S). - au lan xuyn ra sau lng, sang phi: lot hnh t trng (-S). au lan ln ngc, sang tri: lot d dy (-S). - im au (+) khi c cn au l im thng v gp trong lot d dy (-S). im au (+) l mn v hnh t trng gp trong lot hnh t trng (-S). b. Ri lon tiu ho: - i ngoi hay to gp trong lot d dy (-S). - i ngoi phn lng hay gp trong lot hnh t trng (-S). 42. Bin chng ca lot (-S): a. Lot d dy: - Thng - Hp mn v - Vim d dy - Xut huyt - Ung th khng gp b. Lot hnh t trng: - Thng
- K ho - Hp mn v - Vim quanh t trng - Xut huyt tiu ho 43. Nu cc nguyn tc iu tr bnh lot (thm cc t, nhm t cn thit): a. (.......): ngh ngi, n ung, thuc men. b. (......): ng thuc, ng liu lng, ng thi gian. c. (......): khng my mc rp khun cho mi bnh nhn ging nhau. 44. K cc nhm thuc iu tr lot d dy t trng (-S): a. Gim tit, gim toan: - Atropin - Belladon b. Thuc c ch th cm th H2 ti d dy: - Cimetidin. - Ranitidin - Nisatidin - Omeprazon - Trymo ( c. Bng se nim mc: - Denol - Maalox - Histidin 45. Cc thuc nam y (-S): - Mt ong - L khi - Cao d cm - Ch dy - n s 12 - Chui tiu 46. S thng gp ca ung th d dy (-S): a. Tui thng gp: 50-60 tui b. Gii n gp nhiu hn nam: t l n /nam l 2/ 1,5 c. C a d b ung th d dy: - Ngi c nhm mu B - Ngi c vim d dy th teo - Bnh polyp to trn 2cm - Yu t gia nh: gia nh c ngi b ung th t l gp ung th d dy gp 4 ln gia nh khng c ngi b ung th 47. Triu chng c nng ca ung th d dy (-S): a. Cc ri lon tiu ho: - y bng sau n, kh tiu, lc u thnh thong, sau lin tc
- n ngon ming - Bun nn v nn sau khi n b. au: mt chu k c. Thiu mu n thun, a phn en d. Suy nhc, mt mi, cn khng st e. St dai dng khng tm c l do c th 48. Triu chng thc th ca K d dy: a. C khi u trn rn hoc ngang rn. b. Cc triu chng do bin chng gy ra (thm nhm t): - (......): nn ra thc n c. - (......): bng cng nh g, chong, mt vng c trc gan. - (......): nn mu a phn en. c. Cc du hiu ca di cn ung th d dy (thm nhm t): - (......): gan to, mt gan ln nhn. - (......): s thy hch h thng n tri. 49. Triu chng Xquang ung th tm v v phnh v c hnh nh (thm t): a. on cui thc qun v tm v c (...) lam nham, khc khuu. b. i hng ca lung (.....) khi i qua tm v. c. Thay i gc (.....). d. Du hiu Hammer: chp vi cn quang kp thy r (....) qua tm v ging nh nc sui trn ln cc hn lng sui. e. Mt hi phnh v: do thiu nng (.....) lm thot hi ra ngoi. f. C hnh (.....) phnh v trong t th Trendelenburg hoc c s tng khong cch gia hnh hi phnh v v vm honh. 50. Triu chng ni soi ca ung th d dy (thm cm t, t cn thit): a. Th lot: thng l mt s (.....) lot si, (.....) mo m, khng u, y bn, (....), b cao, dy, nham nh, c nhiu ht to nh (.....), thng c chy mu trn b (.....), nim mc xung quanh lot nht mu v np (.....) ng li cch xa lot. b.Th si: thng l mt (.....) s s, to nh khng u, khng c cung, trn mt v gia cc (....) c ng cht hoi t ln vi dch nhy (.....). y v nim mc xung quanh cc (.....) u cng v khng c (......). 51. Chn on ung th d dy giai on sm (-S): Da vo cc triu chng c nng, thc th: - Bnh nhn trn 40 tui - t nhin n kh tiu - au vng thng v d di - au c chu k r - Mt mi - a to ( - Thiu mu 52. Chn on ung th d dy giai on mun (-S):
- C khi u vng thng v - Khi u di ng d dng - di cn: + Hch Troisier (-S). + Hch nch (-S). + Hch bn (-S). - Xquang, ni soi r tn thng ung th 53. S thng gp (-S): - Xut huyt tiu ho l cp cu ni- ngoi khoa - N gp nhiu hn nam - Tui hay gp 20-50 tui - Gp khi thay i thi tit: xun- h- thu- ng - Cm cm - Sau khi ung corticoid ( - Chn ng mnh tinh thn, qu bc tc, qu lo ngh 54. Cc nguyn nhn xut huyt tiu ho (-S): - Lot d dy- t trng - Ri lon chc nng d dy - Ung th d dy - Vim d dy - Do suy gan - Tng p lc tnh mch ca - Bnh ng mt - Bnh mu - Sau chn thng s no - Sau suy h hp nng - Sau suy thn nng - Sau bng nng - Ri lon chc nng i trng - Hp tm v 55. Xut huyt tiu ho c tin lng tt (-S): a. Nn mu hoc a phn en vi khi lng t. b. o huyt p v s mch bnh nhn 3h / ln trong 24h nu mch huyt p dao ng c. Xt nghim hng cu, Hb, hematocrit 3h/ln, cc xt nghim ln sau tng ln so vi ln trc d. Ton trng bnh nhn tnh to, d chu, i nhiu, c cm gic i, thm n e. Khng nn na, phn ng khun, cui bi c mu vng 56. Xut huyt tiu ho tin lng d dt (-S): - Nn ra mu, a phn en vi s lng ln ko di - o huyt p, s mch bnh nhn 3h/ln trong 24h, nu mch huyt p khng dao ng n nh - Xt nghim hng cu, Hb, hematocrit 3h/ln cc xt nghim ln sau cao hn ln
trc - Ton trng: mt, hong ht, vt v, i t, v niu - iu tr rt tch cc, c truyn mu cng nhm, mu ti 500-1000ml m bnh nhn vn tip tc nn mu, a phn en nhiu ln Bnh sau ct on d dy. 57. S thng gp (-S): a. Sau ni v trng: - Th gii gp: 30-35% (-S) - Vit Nam gp: trn 30% (-S) b.Sau ct 2/3 d dy: 2-3% c. Sau ct d dy v ct dy X: 10% d. Sau ct dy X, ni v trng hoc m thng mn v 4% 58. Nguyn nhn (thm nhm t cho y ): a. Do ct on cha (2/3) d dy cn li nhiu phn d dy tit (....). b.Do ct cha ht 2 thn dy (.....) sau ct dy X v ct hang v. c.Do u Adenome ca tuyn (....) hi chng Zollinger- Ellison loi u ny gy tng tit, cn u ty th cn lot ti pht. d.Do ch ct b lot nhng cn li phn (.....) , cn nim mc hang v cn tit (....) kch thch tit HCl. 59. Triu chng (-S): a. au do lot ming ni c c im: - au gim hn trc khi m - au khu tr bn tri ng trng gia, ngang rn hoc thp hn - au nhiu hn khi n vng ngang rn pha bn tri b. Nn: thng i km vi au. Tnh cht nn gn ging nh hp mn v c. Ni soi bng ng mm: thy tn thng lot vng ming ni 60. iu tr (-S): a. Nu au khng nh hng nhiu ti sinh hot, cng tc th iu tr ni khoa nh lot hnh t trng b.Nu trc y ni v trng th m li ct dy X c.Nu ct 2/3 d dy th m li kt hp ct 2 nhnh dy X i vo d dy 61. Lm sng th x gan cn b tt (-S): a. C nng: - Ri lon tiu ho: n khng tiu, y bng, chng hi - au d di vng h sn phi - Chy mu cam khng r nguyn nhn - Nc tiu trong - Suy gim tnh dc: nam lit dng, n v kinh, v sinh b.Thc th: - C gan hi to v chc, lch to hi qu b sn - C sao mch lng, ngc, bn tay son
- Lng nch, b phn sinh dc bnh thng - Mng tay kh trng - nam gii tinh hon teo nho, v to ( 62. Lm sng ca x gan cn b (-S): a. Ton thn: - Gy st nhiu - Chn tay khng khiu - Huyt p cao b. C nng: - Ri lon tiu ho tng t - Mt mi thng xuyn, t ng, gim tr nh - Chy mu cam, chy mu chn rng c. Thc th: - Da mt hng ho - Nhiu m xut huyt bn chn, tay, vai, ngc - C c chng, tun hon bng h - Gan thng teo, chc, b sc, mt gan c u cc - Ph 2 chn - Lch to hn bnh thng 63. Thi gian sng thm cho cc bnh nhn x gan mt b nh sau tu theo th bnh (-S): - X gan do ru v virus sng thm: 8 nm 4 nm 2 nm - X gan mt th pht sng thm: 6 nm 8 nm 10 nm - X gan mt tin pht sng thm: 10 nm 7 nm 64. D phng x gan (-S): a. Phng nga vim gan virus B, C b.Chng thi quen ung ru c.Ch n ung cht d.Phng nhim sn l gan nh: khng n c sng e.iu tr tt cc bnh ng mt g.Thn trng khi dng cc thuc c th gy hi cho gan h.D phng v iu tr tt cc bnh vim gan cp, mn 65. xc nh vim gan mn c 2 yu t sau (-S):
a. V thi gian: tnh trng tn thng gan vim: - Trn 4 thng - Trn 6 thng - Trn 9 thng b. Tn thng bnh l: + Ch yu l thm nhim khong ca v quanh khong ca: - Bch cu a nhn trung tnh - Bch cu n nhn, lympho + Thoi ho t bo nhu m gan nng nh tu theo loi bnh: - C th c x ho Fibrosis nht nh - Cu trc tiu thu gan o ln - Cha c u cc tn to gan 66. Triu chng lm sng ca vim gan mn tn ti (-S): + Hoc nhiu bnh khng c triu chng lm sng + C bnh nhn thy: - Hi au tc h sn phi - Chn n, bun nn - Mt mi, st cn khng r l do - Khng au u tr nh tt, ng tt - Gan to di h sn phi 4,5cm, mt mm - Khng c lch to - Khng c tun hon bng h - Khng ph n - C sao mch - C bn tay son 67. Ho sinh vim gan tn ti (-S): - Chc nng gan bt thng: + Phosphataza kim tng + Bilirubin tng - Men gan SGOT, SGPT tng cao gp 5 ln bnh thng - Nghim php BSP ri lon nh - Globulin min dch IgA, IgM tng mnh, ko di - in di albrumin bnh thng, gamma globulin tng nh - Khng c khng th khng c trn, khng nhn - Khng nguyn HBs (AgHBs) c th (+) 68. Tin trin v tin lng vim gan mn tn ti (-S): a. Vim gan mn tn ti thng l nh (-S): - Tin lng tt (-S). - Khng tin ti x gan (-S). - Sau nhiu nm c th hi phc, lnh hn (-S). b.Vim gan mn tn ti c th tr thnh vim gan mn tn cng (-S):
- Ngi vim gan mn tn ti ung ru nhiu (-S). - Bi nhim thm HBV, virus Delta, virus C (-S). - Nhng ngi vim gan mn tn ti vc xt nghim HbsAg (+) tin lng tt hn ngi vim gan mn th tn ti c xt nghim HbsAg (-) 69. iu tr vim gan mn th tn ti (-S): a. n ung cht b: m, vitamin (-S), tng m (-S). b. Dng corticoid (S) ch cn cho vitamin B1, C, nhun mt (-S). c. Ngh ngi trong t tin trin (-S). d. Khm nh k 6-12 thng / ln (-S). 70. Gii phu bnh vim gan mn hot ng (thm nhm t ph hp): a. Khong ca b thm nhim dy c cc t bo (....) lm cho khong ca (....) thm nhim pht trin vo trong (.....) gan. b. Hoi t t bo gan ra khong ca, lp t bo gii hn b (.....) tng ch to nn hnh nh nham nh ra khong ca, hoi t kiu (....). 71. Gii phu bnh vim gan mn hot ng (thm nhm t ph hp): a. Ni thu gan c hoi t tng quanh cc tnh mch (....) vi nhng biu hin ti to ca gan nh: t bo gan xp thnh hnh (...) hay hnh gi (....), nhng trng hp nng c th thy hnh nh t bo (....) xp thnh (....) nhiu thu. b. Cc vch ngn m (....) lan to nh cc ngn tay, lan t cc khong ca vo su trong (.....) gan. c. C th thy trn cng mt mnh (....) c hnh nh vim gan mn hot ng v hnh nh (....) gan. 72. Triu chng lm sng ca vim gan mn hot ng (thm t, nhm t ph hp): a. (.....): tng t nh triu chng vim gan mn th tn ti nhng mc nng n hn, ko di hn. Ngoi ra thy vng da, ph n c khi chy mu. b.(.....): mt kinh, a lng c mu do vim lot i trng kt hp, trn dch ph mc, thiu mu, suy thn, kh gic mc, kh ming. 73. Cc xt nghim vim gan mn hot ng (-S): a. Sinh ho gan: - Gros, Maclagan (-) (-S). - Men transaminaza tng gp 5 ln ch s bnh thng (-S. - Bilirubin mu gim trong t tin trin (-S). - Phosphataza kim gim nh (-S). - Gamma globulin tng cao vt 25% c khi ln 70% (-S). - T l prthrombin thng gim giai on mun (-S). b. Xt nghim min dch: - Globulin min dch tng nht l IgG (-S). - mt s bnh nhn tm thy HbsAg v HbeAg trong huyt thanh (-S). - C th khng thy khng th khng c trn, khng th khng nhn hoc khng th khng ti lp th (- S). 74. K cc phng php thm d vi vim gan mn hot ng c c cc hnh
nh tn thng sau (thm on t cho ): a. (....): gan to hn bnh thng, mu sc loang l, ch nht mu, ch rc, mt gan nhn nheo nhng trng hp nng gn nh ni cc d nhm vi x gan. b. (.....): c hnh nh m bnh hc ni k trong phn gii phu bnh l. c. (.....): kch thc gan tng nhng nhu m gan cha c bin i r rt. Ung th gan nguyn pht. 75. S thng gp v yu t lin quan K gan nguyn pht (-S): - T l mc K gan: 5-6% tng s cc K (-S). - Tui hay gp: trn 70 tui (-S). - Nam gp t hn n (-S). - Cc yu t lin quan: + Nm mc: aflatoxin v luteoskynin (-S). + Virus B, C (-S). - Cc cht c, ho cht: + Cht da cam (2,4.5T v 2,4D) (-S). + Cht trng (2-4D picbrem) (-S). + Cht xanh (mui axenic) (-S). - Vai tr tin ung th gan: 65-80% K gan gy ra sau x gan (-S). - Mt s yu t ang tip tc nghin cu: + Dinh dng km (-S). + Ging ngi (-S). + Vn di truyn (-S). 76. Mt s triu chng khu gi K gan khi pht (-S): - Ri lon tiu ho nh: n t, chm tiu c th c bnh nhn n nhiu ln nhng khng bo m li gy i (-S). - Tc nng hay hi au vng h sn phi y l triu chng sm thng c ch (-S). - Gy st cn, mt mi r l do (-S). - Tnh c s thy c mt khi u vng h sn phi. Ton trng vn bnh thng v c mt khi u nn bnh nhn i khm (-S). - Hoc bnh nhn khm bnh v l do khc, qua khm xt ton thn thy thuc pht hin gan to (-S). 77. Giai on ton pht ca K gan nguyn pht cc triu chng sau thuc nhm triu chng c nng hay thc th (thm cc nhm t): a. (................): - Ri lon tiu ho: bng c th chng to, sau n thy tc bng y hi, i khi c bun nn, nn. - Mt mi tng nhiu, khng lao ng c, gy st cn nhanh 5-6kg/ thng. - au tc vng h sn phi c khi au d di nh cn au qun gan nhng thng xuyn lin tc hn. b. (....................):
- Gan to ton b hay mt phn, cng mt gh gh, n au, di ng hn ch. - Lch khng s thy hoc i khi thy di b sn tri 2-3cm chc. - C th c c chng, tun hon bng h. - Gy, c bp teo nh, suy kit. - Da vng rm, xanh bng, vng bn. - Ph, xut huyt, sao mch, bn tay son. - C cn au bng nh vim phc mc cp. 78. Cc k thut chn on no cho bit cc hnh nh tn thng K gan nguyn pht di y (thm cm t ph hp): a. (.....): bng gan to, vm honh phi ln cao, di ng c honh km. b. (......): cho bit khu vc tng ti mu hoc hnh nh bin dng ca thn ng mch ln trong gan. c. (......): cho bit v tr tn thng ca u, K gan. d. (.....): tm khi u tng m, gim m. e. (....): thy trn mt gan c u cc to, nh mu trng ng, xung quanh khi u c mch mu ni r (tng ti mu), hoc trn mt gan c u cc sn si nh hoa supl hoc nh chm nho d chy mu. Kt hp sinh thit lm m bnh hc. f. (.......): nh lng alphafeto Protein (AFP). Bnh thng AFP< 5ng/ml. Trong K gan AFP> 100ng/ml. Arginaza bnh thng Arginaza >120 UI, trong K gan Arginaza gim < 30UI. 79. Chn on xc nh K gan nguyn pht da vo (-S): Lm sng: a. Gan to chm, mm, trn mt gan khng c u cc to cng (-S). b. C th suy sp chm 1-1,5kg/1 nm, n ung bnh thng (-S). c. au vng mi c (-S). 80. Da vo cc xt nghim nghi ng K gan nguyn pht (-S): a. U gan cng kt hp AFP> 100ng/ml (-S). b. U gan kt hp vi sinh thit gan c t bo ung th (-S). c. U gan kt hp vi Arginaza <30 n v quc t (-S). 81. Nh cc k thut no phn bit K gan vi cc bnh khc ca gan (thm t, nhm t thch hp): a. U nang gan gan (......). b. p xe gan (.....). c.X gan ph i (....). d.Gan to mt (.....). e.Giang mai gan (....). g.Lao gan (..... ) h.Gan to trong bnh tim (.....). j.U nang sn, u mu, nm gan (......)
BI CNG CHUYN MC
Sch ni tiu ha sau i hc HVQY - Posted by giapxac at 04/07/2010 video thc tp y php - Posted by [rau]_muong at 03/06/2011 Lot D Dy T Trng - Posted by Digoxin at 07/08/2008 nc tiu vng - Posted by eagerkill at 15/05/2011 Thc mc triu chng ni tiu ha - Posted by liem1286 at 22/03/2011 thay i ni dung bi: Digoxin, 05-08-2008 lc 10:11 AM L do: Sai th phi sa. C tt c 2 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :
#2 05-08-2008, 08:27 PM Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
Digoxin
: Trc Nghim Lm Sng Tiu Ho
TRC NGHIM LM SNG TIU HO(Phn 2)
82. Chng vng da (icterus) l tnh trng nhim sc t mu vng da v nim mc do (-S): - Tng caroten huyt - Tng Bilirubin huyt ton phn - Tng Bilirubin huyt trc tip - Tng Bilirubin huyt gin tip n c - Tng sn xut hc t Melanin 83. Sc t da ca cc chng tc c quyt nh bi s lng ca (-S): - Melanin - Oxyhemoglubin - Hemoglubin kh - Caroten - Bilirubin huyt 84. Chng vng da (icterus) l mt triu chng ch im bnh l (-S) : - Thiu mu - Tc mt
C tt c 2 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :
- Tn thng t bo gan - Huyt tn - Si c ti mt ( 85. Ngun gc Bilirubin c sn xut t (-S): - Phn ln t hng cu gi - Globin - Hem (. - Acid glucoroni - Phn nh t cc t bo dng hng cu ang trng thnh trong tu xng (). 86. Bilirubin gin tip uc chuyn thnh Bilirubin trc tip bng cch lin hp vi acid glucoronic (-S): - Trong mu - Trong ng mt v trong ti mt - Trong ni bo tung ca t bo gan - Trong ni bo tung ca t bo kupffer - Trong lng rut 87. Chuyn ho Bilirubin rut.Sau khi sc t mt ( Bilirubin-Acid glucorocid) xung rut cng vi Acid mt tham gia tiu ho thc n; sn phm chuyn ho ca sc t mt c ti hp thu t nim mc rut non vo tun hon ca di dng (-S): - Stercobilirubin - Stercobilinogen - Bilirubin-Acid glucoronin - Urobilinogen - Urobilirubin 88. Lm sng chn on vng da da vo (-S): - Da vng, nim mc mt khng vng - Da vng, nim mc mt vng - Phn vng - Phn bc mu hoc sm mu ( - Nc tiu vng hoc/v sm mu 89. Cn lm sng chn on vng da da vo (-S): - Bilirubin gin tip c trong nc tiu - Bilirubin trc tip c trong nc tiu - Urobilirubin nc tiu > 0,2 mg/ l - Bilirubin huyt tng - Stercobilin c trong phn 90. Chn on vng da truc gan (huyt tn) da vo (-S): - Gan to mm n au tc - Lch to.
- Hi chng thiu mu - Phn bc mu - Nc tiu sm mu 91. Chn on vng da trong gan (vim gan vi rt cp) da vo (-S): - Lch to n au tc - Gan to mm, n au tc - Hi chng nhim trng nhim c - Khi xut hin vng da thng vn st ( - Tng Bilirubin huyt gin tip chim u th 92. Chn on vng da sau gan (si ng mt ch) da vo (-S): - Cn au qun gan ( - Khi xut hin vng da thng ht st - Phn sm mu - Nc tiu sm mu - Tng Bilirubin trc tip chim u th 93.Chn on vng da sinh l tr s sinh da vo (-S): - Vng da ,vng nim mc mt xut hin t ngay sau sinh n ngy th 15 sau sinh - Vng da,vng nim mc mt xut hin t ngy th 2 sau sinh n ngy th 15 th ht - Gim hot ca Enzyme (Tranferase-Bilirubin-Glucoronyl) chuyn Bilirubin gin tip thnh Bilirubin trc tip - Gim hot tnh ca Enzyme (Tranferase-Bilirubin-Glucoronyl) chuyn Bilirubin gin tip thnh Bilirubin trc tip - Tng Bilirubin huyt gin tip chim u th. 94.Chn on vng da nh do dng thuc (Cloramphenycol, Methyltestosterol, Flafasvidic) da vo (-S): - Vng da xut hin sau dng mt trong cc thuc trn - Vng da khng mt i khi ngng thuc - Vng da km gim bi xut BSP, tng Phosphastase kim trong mu - Vng da km theo GPT,GOT tng trong mu - Tng Bilirubin huyt gin tip chim u th 95. C trung t do l (-S): - Tnh trng bng chng hi - Tnh trng dch xut hin kh tr ti mt v tr no trong bng - Tnh trng dch xut hin gia l thnh v l tng trong bng -Tnh trng bng to do lp m dui da bng dy ln 96. C trung dch thm (-S): - Dch c trung mu vng chanh v c
- T trng ca dch c trng > 1,016 ( - nh lung protein trong dch c trng < 25 g/l ( - Xt nghim dch c trng : S lng t bo bch cu < 250 t bo/mm3 - Dch c trng c phn ng Rivalta dng tnh 97. C trng dch tit (-S): - Dch c trng trong, mu vng nht hoc khng mu - T trng dch c trng <1,016 - Dch c trng c phn ng Rivalta dung tnh - nh lng protein trong dch c trung > 25 g/l - Xt nghim dch c trng s lung t bo bch cu >1000 TB/mm3 98. Chn on c trng t do mc t (c lng <1lt) da vo (-S): - Da bng cng, rn li, bng b sang hai bn t th BN nm - Du hiu sng v dng tnh - G bng c vng thp - G bng; ranh gii c trong l mt ng cong c nh quay xung di - Du hiu cc ni dng tnh 99. Chn on c trng t do mc va/ nhiu (c lng 1 n 5 lt/ trn 5 lt) da vo (-S): - Da bng cng, rn li, bng s xung di ra trc t th BN ng . - G bng : c vng cao . - G bng : ranh gii c trong l mt ng cong c nh quay xung di - Du hiu sng v dng tnh - S bng khng u: ch mm, ch cng, ch chc 100. Chn on c trng t do nguyn nhn do x gan da vo (-S): - Dch c trng khng mu hoc vng nht - C trng t do ng thi c tun hon bng h - T trng dch c trng > 1,016 - Phn ng Rivanta dng tnh - S lng t bo bch cu trong dch c trng >1000 TB/ mm3 101. Chn on c trng t do nguyn nhn do suy tim da vo (-S): - C trng t do v ph mm n lm hai chi di, ph tng vo bui chiu - C tng t do xut hin cng gan to mm, phn hi gan tnh mch c dng tnh. - Dch c trng mu vng chanh v c - T trng dch c trng > 1,016 - nh lng protein trong dch c trng >25 g/ l 102.c im c trng t do nguyn nhn do vim cu thn mn, hi chng thn h (-S): - C trng t do v ph mm ton thn n lm, ph tng vo bui sng
- C trng t do xut hin cng gan to mm, phn hi gan tnh mch c dng tnh - Dch c trng c v mu vng chanh - Phn ng Rivanta ca dch c trng dng tnh. - Xt nghim t bo dch c trng s lng bch cu < 250 TB/ mm3 103. Nu cc c im ca triu chng lm sng vim ng mt (-S): a. au bng d di vng h sn phi khng lan b. St va phi khng rt run c. Vng da m, khi vng da ht st d. Khm xt: - Th trng gy st - Gan to 1-3cm di h sn phi, mm - Ti mt to 104. Cc xt nghim thm d vim ng mt (-S): a. Xt nghim mu: - Bch cu a nhn trung tnh tng - Bch cu a nhn trung tnh gim - Tc mu lng tng ( - Tc mu lng gim b.Sinh ho mu: - Bilirubin mu kt hp tng - Bilirubin t do tng 105. Thm cc nhm t vo cc bin chng vim ng mt cho hp: a. Thm mt (...........). b. Vim ti mt (...........) c. p xe gan (........). d. Nhim khun (......). e. Sc (...........). f. X gan (...........). g. Chy mu (...........) lai vim do si. 106. Cc du hiu sau l triu chng no ca vim ti mt cp (thm t, nhm t cho ph hp): a. (............): - St: bao gi cng c st 390-400 C. - Vng da nim mc nh 10% khi c tn thng ng mt. - n vng h sn phi c phn ng co cng v au. - S thy ti mt to v au. b. (.............):
- au h sn phi: + c cn au qun gan tng dn. + c khi au m ngi gi. - Bun nn hoc nn l triu chng hay gp. - Nc tiu vng khi c tn thng ng mt ch km theo. 107. Cc k thut thm d no thy vim ti mt cp c cc du hiu sau (thm t, nhm t ph hp): a. (................): - Bch cu tng 10.000, t l bch cu a nhn trung tnh tng cao. - Amylaza bnh thng nu c cao phi ngh n vim ty kt hp. b. (..............): - C im r rt khi n u d siu m vo ti mt, l im Murphy siu m. - Thnh ti mt dy trn 0,3cm, bnh thng di 0,3cm. - Nhiu khi ti mt c hnh 2 b, 2 lp m cch nhau bi lp gim m. - Nu c si thy nt m m v bng cn m. c. (..................): - C tim cn quang: + Vim ti mt: nu ng mt ch ngm thuc khng nhn thy ti mt. + Khng ngh ti vim ti mt nu hnh nh ti mt r. - Chp khng chun b thng, nghing phi pht hin si ti mt. 108. Chn on xc nh vim ti mt cp da vo (-S): a. Da vo lm sng: - au h sn tri (S). - Khng st (S). - S ti mt khng to (S). b. Da vo: - Xquang: ti mt khng nhn thy (). - Siu m: thnh ti mt dy > 3cm. (). - Soi bng: ti mt cng to, xung huyt, dnh (). 109. Chn on phn bit vim ti mt cp vi bnh no c nhng biu hin sau (thm t, nhm t ph hp): a. (.............): gan to au, rung gan (+), Ludlow (+). b. (..............): st, au h sn phi, vng da, khi vng da ht st, men gan SGOT,SGPT tng cao. c. (.............): au h sn phi, st, vng da, khi vng da vn st. 110. Vim ti mt cp c cc th bnh sau (-S): a. Vim ti mt cp nc b. Th vim ti mt cp mng m c. Vim ti mt cp hoi t d. Vim ti mt cp c si cholesterol
e. Vim ti mt cp sau nhim khun mu, thng hn, hi lu dch ty vo ng mt, n c thai thng th 6-7 t gp 111. Cc bin chng no ca vim ti mt cp c cc du hiu sau (thm t, nhm t ph hp): a. (..........): gan to, mm v au st, vng da. b. (..............): vim ti mt cp c th dn ti tnh trng ti mt b thng hoc ti mt cng to, thnh ti mt c nhiu m mt, thm mt gy nn vim mng bng mt. c. (.......................): - S thy mt m qunh vng ti mt, st cao. - Hoc mt apxe di c honh: bnh cnh ca m su v phn ng ca rmng phi. d. (..................): vim ti mt cp c th dn ti tnh trng d mt vo t trng, i trng, d dy. 112. Cc triu chng di y thuc nhm du hiu c nng, ton thn v thc th ca vim ti mt mn (thm t, nhm t ph hp): a. (.........................): - Mt mi nhiu. - Suy nhc thn kinh, d kch thch mt ng. - Gy st dn c trng hp gy st n mc lo ngi. - Ri lon kinh nguyt. - Ri lon tun hon: nh trng ngc, kh th khi gng sc. - C trng hp vng da nh. b. (...........................): - au vng h sn phi thnh cn. Cn au ko di vi ngy nhng cng c trng hp cn au ko di hng tun, hng thng. - C th km theo co tht i trng, a phn lng c nhy. - St nh, c khi khng st ch cm thy gai gai rt. 113. S dng k thut thm d no bit c cc du hiu di y ca vim ti mt mn (thm t, nhm t ph hp): a.(.................): Chp ti mt c thuc cn quang thy hnh ti mt y thuc cn quang nhng nh hoc hnh ti mt ch hi ngm thuc cn quang nhng khng thay i hnh th hoc hnh nh ti mt co tht hoc hnh nh ti mt y. b.(.................): - Mt B c qunh, c, mu xanh do Bilirubin chu tc dng ca axid do vim. - Mt B c albumin tng, bnh thng < 0,8g/l, c t bo m. c.(...................): Nhn thy: - Ti mt vim dnh vi t chc xung quanh
- Thnh ti mt dy ln, mu trng c nhng t chc dnh dy hn v chc hn. d.(................): - Thnh ti mt dy 0,8-1cm, hnh ti mt c th bnh thng nhng phn ln l bin dng (hnh 2 ti, hnh mc cu). - Th tch ti mt c th b thu nh (vim x teo). - Thnh ti mt b vi ho to thnh hnh mt vng cung m m km theo hnh bng cn m rng (hnh v s). 114. Chn on xc nh vim ti mt mn da vo (-S): a. au vng ti mt, khng r cn au qun b. Hi chng nhim khun khng r rt c. Ri lon tiu ho khng c hiu d. Ly dch mt: mt B c vi khun hoc thay i thnh phn mt l du hiu c bn nht chn on e. Siu m v soi bng c hnh nh vim ti mt mn 115. D phng v iu tr vim ti mt mn (-S): a. D phng: - n tng m, tng thc n quay rn - Khi vim ti mt cp cn c iu tr tch cc, khi khi cn c iu dng ko di ( b. iu tr: - n ch t rau - Chm hoc chm nng vo giai on au - Lm gin c bng papaverin 0,04 x 4v /24h, t 7 ngy - Ht dch mt lm lu thng mt - Dng khng sinh cn thit theo khng sinh - Nu ti mt c si v vim nn m ct ti mt 116. S thng gp (-S): - Si mt ng hng th 2 trong cc bnh gan mt, 90% cc bnh vim ng mt do si gy nn - Vit Nam si ng mt ln 95%, si ti mt 4-5% - Cc nc u- M si ti mt 80%, si ng mt nhiu hn - S phn b si mt trn th gii ph thuc vo 2 yu t ging ni v ch n ung 117. Cc triu chng sau thuc nhm triu chng no ca vim ng mt do si (c nng, thc th). a. (..................): - au:
+ au kiu cn au qun gan. + au thng xy ra sau ba n nhiu m hoc au v 22h. + au thng km theo nn, khng dm th mnh. + Cn au ko di vi ngy. - Ri lon tiu ho: chm tiu, bng chng hi, s m, to bn, a chy sau ba n. - Cn au na u (migraine): au na u d di, nn nhiu. - St: do c vim ng mt, ti mt. - Vng da kiu tc mt: vng da, nc tiu vng, phn bc mu. b. (..................): - Gan to: + Mp m hoc di b sn phi 5-6 cm + Mt gan nhn. + B gan t. + Mt chc. - Ti mt to: + To cng vi gan to. + au khi s nn. + C th c co cng b sn phi. 118. Th lm sng ca si mt (-S): a. Th in hnh: c cn au qun gan. - Rt in hnh: + au, st, vng da ti pht nhiu ln (-S). + Khng c hi chng tc mt (-S). - in hnh: + au, st, vng da (-S). + Hi chng tc mt khng y (-S). - in hnh t: + au, st, vng khng ti pht nhiu ln (-S). + Hi chng tc mt khng biu hin lm sng (-S). b. Th khng in hnh: khng c cn au qun gan nhng thiu cc du hiu khc: - C hi chng tc mt (vng da, gan to, ti mt to) nhng khng c cn au qun gan hoc au nh h sn phi (-S). - C cn au qun gan in hnh nhng khng c vng da, khm khng c gan to, khng c ti mt to (-S). 119. Hy cho bit v tr si nm u khi lm sng c nhng triu chng sau (thm nhm t ph hp): a. (...............): cc triu chng lm sng au, st, vng da v hi chng tc mt. b. (............): triu chng y nh trn nhng mt s trng hp khng in hnh v ng Choledoque gin rt to lm cho triu chng gim bt hoc khng c.
c. (................): khng c triu chng tc mt, ch c au rt t nhng st nhiu v ko di, khm thng thy ti mt to v au. d. (.................): thng nm ng gan tri, triu chng au rt t nhng st ko di. Triu chng tc mt r nhng khng c ti mt to. 120. Chn on si mt v lm sng c 3 tnh hung : A: triu chng lm sng in hnh; B: triu chng lm sng khng in hnh; C: ngi bnh i vin v cp cu do bin chng. Hy xem cc nhm triu chng sau thuc tnh hung no (A,B,C). a. Nhm 1: (A-B-C) - C cn au qun gan, khng hong n, khng tc mt. - Hoc c hi chng tc mt nhng au qun gan khng r. b. Nhm 2: (A-B-C) - Cn au qun gan: st, vng da, nim mc. - Hi chng tc mt; gan to, ti mt to, phn bc mu. - Bnh ti pht nhiu ln. - Chn on ng si mt 75-85% (ng Vn Chung). c. Nhm 3: (A-B-C) - Vim phc mc cp: nhim trng nng, bng cng v au. - Sc nhim khun: st cao, huyt p h, mch nhanh nh, ht hong. - Vim ti mt cp: st, ti mt to, au. - Chy mu tiu ho: nn mu c hnh thi nh rut bt ch. - Vim ty cp: au bng, nn, chng bng - Hoc v au m h sn phi, ri lon tiu ho khng r nguyn nhn. 121. Chn on phn bit si mt vi nhng trng hp tc mt (-S): a. U u ty: - Tc mt t t ngy cng gim - au vng h sn phi (S), khng st - Xquang: khung t trng gin rng b. Vim ty mn th tc mt: - Triu chng nh u u ty - Chn on kh ( - Phi m thm d xc nh ( c. Vim vi ti mt qun tin pht: - Giai on u c vng da tc mt, km theo st v au h sn phi - Cui cng dn ti x gan lch to - Thng t trng dch mt vn bnh thng - Chp ng mt vn bnh thng khng tc - Chn on bng siu m v sinh thit gan d. Ung th bng Water v ng mt: - C hi chng tc mt i khi st
- Tin trin nhanh, gy st ( - C tin s au h sn phi - Chp ng mt hoc siu m xc nh 122. Chn on phn bit si mt vi nhng trng hp vng da khng do tc mt (S): a. Vim gan virus(-S) b. Vim gan mn: - C nhiu t st, vng da(-S) - au nh vng h sn tri (-S). c. Bin chng ca lot d dy t trng (thng, dnh vo ng mt gy ra): - Nhng t st, vng da (-S). - au h sn tri (-S). d. Huyt tn: v d bnh Gilbert hoc Dubinjohnson (-S). 123. Phn bit si mt vi nhng trng hp au h sn phi l bnh no khi gp cc triu chng sau (thm nhm t ph hp): a. (..................): - au h sn phi d di, chng mng d chu. - Cng c st, vng da, chn on da vo siu m mt. b. (...................): - au thng v c chu k: au lc i, au lc no. - Khng st, khng vng da. - Chn on da vo Xquang d dy. c. (.............): - au h sn phi, nu n thng xy ra lc hnh kinh, c thai - Khng st, khng vng da. - Chn on da vo ly dch mt nh pht: b ri lon. 124. S thng gp (-S): a. Vim ty cp him gp khong 1-2% cc cp cu v au bng. b. Vim ty cp xy ra mi la tui nhng hay gp ngi di 30 tui c. Gii: nam gp nhiu hn n 125. Nguyn nhn vim ty cp (-S): a. Cha r nguyn nhn b. Mt s yu t thun li: - Ngi gy - Ngi bo - n nhiu m, m, trng - Ngi b si mt - Ngi b giun ln ng mt
- Lot d dy - X gan 126. Cc thuyt v c ch bnh sinh vim ty cp (-S): a. Thuyt v gii phu: v dch ty, dch mt cng vo bng Valter nn khi c tc mt lm tro ngc mt ln ng Wirsung chuyn pepsinogene thnh pepsin, pepsin hot ng gy tiu hu nhu m ty (vim ty cp) b. Thuyt v ri lon lu thng dch ty c. Thuyt v ri lon chuyn ho: - Ri lon chuyn ho m - Ri lon chuyn ho ng d. Cc thuyt khc: - Nhim c ru - Nhim khun - D ng - Chn thng bng 127. Triu chng c nng ca vim ty cp (-S): a. au bng: - V tr au: thng v (-S), h chu tri (-S). - Tnh cht au: + au lan ln ngc (-S). + au d di, t ngt, ko di khng dt cn (-S). + C khi au qun nh au si mt (-S). b. Nn: - Khi au c nn nhiu, nn xong ht au (-S). - Nn kch lit dai dng kh cm (-S). - Cht nn l dch mt, c khi nn c mu (-S). - Nn nhiu gy ri lon nc, in gii (-S). c. Chng bng, b trung, i tin: - Cm gic bng cng, tc th, khng trung tin c (-S). - C th a lng 5% s bnh nhn (-S). 128. Nhng du hiu ton thn, thc th ca vim ty cp (-S): a. Triu chng thc th ngho nn (-S). b. Ton thn: - Da mt trng bch (-S). - Da vng (t gp) (-S). - Mch chm (-S). - Huyt p lc u tng sau h (-S). - Thn nhit gim (S), hoc tng cao (-S). - V m hi, kh th, s (-S).
c. Nhn bng thy: - Cc vt xanh lc quanh rn (du hiu Callen). (-S) - Du hiu xut huyt thnh bng bn tri (du hiu Gray- Turozer). (-S) d. Khm bng: - Chng nh, vng thng v phn ng nh. (-S) - im sn sng lng bn tri au. (-S) - G vang gia bng, c vng thp. (-S) 129. Cc kt qu xt nghim vim ty cp (-S). a. Mu: - Amylaza mu gim. (-S) - Canxi mu tng. (-S) - ng mu cao. (-S) - Lipid mu bnh thng. (-S) - Lipaza tng cao. (-S) - Bch cu a nhn tng. (-S) - Ur mu tng. (-S) b. Nc tiu: - S lng nc tiu gim. (-S) - C tr ht, protein (+). (-S) - Amylaza niu tng cao. (-S) - ng niu (+). (-S) - C hng cu niu. (-S) c. T s: crearance amylaza x 100 trn 5% (-S) crearance creatinin 130. Cc kt qu thu c sau y v xt nghim ca vim ty cp cho bit k thut thm d no (vit thm cm t ph hp): a. (...........): - i trng gin to cha y hi. - C th thy hnh cn quang bn phi (si ti mt). - Hai du hiu (-): + Khng c lim hi. + Khng c du hiu mc nc, mc hi. b. (....................): - Khung t trng gin rng, - D dy b y ra trc. 131. Chn on xc nh vim ty cp da vo (-S): a. Lm sng: - au bng m , xy ra sau ba n thnh son (-S). - au bng km theo nn,nn xong au (-S). b. Xt nghim mu, nc tiu:
- Amynaza mu v trong nc tiu tng cao (-S). - T s: crearance amylaza < 5% (-S) crearance creatinin c. Xquang bng; - i trng gin cha y hi (-S). - Thy lim hi, thy mc nc, mc hi. (-S) d. Soi bng: thy vt nn. (-S) 132. Phn bit vim ty cp vi nhng tn thng hay bnh no c nhng biu hin triu chng sau (thm cc nhm t thch hp): a. (...............): - au bng d di, c co cng thnh bng. - Xquang bng: c hnh lim hi. b. (..............): - au tht bng, nn nhiu. - Xquang bng thy: mc nc, mc hi. c. (...........): - C th c tam chng Charot: au, st, vng da. - Soi bng thy tn thng gan mt. - Siu m thy hnh si gan mt. 133.Vim ty cp th ph n (-S): - au bng d di khng nm yn tnh c. - Tnh trng chung t thay i. - Nn nhiu, c phn ng thnh bng. - Chn on da vo amylaza mu cao. 134. Vim ty cp th hoi t xut huyt (-S): - au bng d di, c biu hin chong, mch nhanh nh, huyt p gim. - Khng nn, da nim mc bnh thng. - Bng mm, khng c phn ng thnh bng, ct cn au d. - Chn on xc nh nh m hoc gii phu thi th. - T l t vong: 25-30% 135. Vim ty cp nung m (-S): - Khng au bng, khng co cng bng, khng lit rut. - Hi chng nhim trng: st cao, mi kh, li bn, mun hn sau vi ngy. - Chn on xc nh khi phu thut c nhiu m bng u kim mu trng, vng khu tr vng u ty, c khi gy p xe di c honh. 136. Bin chng ca vim ty cp (-S): - p xe ty: st cao dao ng, suy sp. - Nang gi tuyn ty. - R.
- Vim tnh mch gnh. - Tc rut. - Tc mt. - Vim d dy. - Nhim khun. - Bnh c th chuyn thnh mn tnh km theo tn thng ni tit gy i ng. - Basedose. 137. Nguyn nhn vim ty mn cha r, c th l (-S): - Sau vim ty cp ti pht nhiu ln. - Si ng mt. - Tn thng cc mch ma ca tuyn ty. - Bnh t min. - Ri lon chuyn ho: n ung khng hp l, suy dinh dng. - Sau nhim c: ch, ru, thu ngn, phospho - Sau phu thut gan, ng mt. - Sau thng lot ca d dy vo ty. - Yu t di truyn. 138. Gii phu bnh l vim ty mn: hnh nh no thuc vi th, i th (thm t, cm t ph hp): a. (........): - S thy tuyn ty cng chc. - Mt tuyn ty khng u ri rc cc nang (kystes). - Tn thng ton b ty hoc khu tr ch u ty, thn, ui ty. b. (..............): - Tng sinh ca t chc lin kt quanh tiu thu, trong tiu thu. - Cc mch mu x ho. - Mt s si thn kinh tng sn. - Cc lp biu m ca tuyn mt. - Cc ti sinh hnh thnh cc xoang nh p vo ng dn dch ty. - ng ty c ch gin, c th c si. - Cc tiu o Langehans c th teo x ho. 139. Tnh cht au bng ca vim ty mn (-S): - au vng thng hoc h sn phi - au lan ln ngc. - au gim khi bnh nhn dui thng. - Tnh cht cn au: + au lm rm, cng c lc au d di + Mi ln au ko di vi ngy, hng tun.
+ Cn au ti pht khi n king m hoc cc cht chua cay. 140. C ch sinh au bng pht sinh khi (-S): a. Tng rng b cng gin qu mc b. Khi nhu ng co bp ca tng rng tng qu mc gy tng p lc cao hn bnh thng: hp mn v, tc rut, si mt c. Mng bng b kch thch: thng d dy, vim mng bng, chn thng bng d. Kch thch bnh l i vi ni tng: p xe gan. Vim ty cptc ng ln cc dy thn kinh giao cm ni tng gy ra au 141. K 3 tng cc v tr au sau ( thm nhm t ph hp): a. au vng thng v: - (.............) - (................) - (...............) b. au h sn phi: - (.........) - (..........) - (..........) c. au h chu phi: - (...........) - (..........) - (..........) 142. K cc hon cnh xy ra cc tn thng sau (thm nhm t ph hp): a. Thng tng rng: d dy, rut(...........) b. au qun gan thn: (...........) c. Vim ty cp: (................) 143. Hng au lan ca cc bnh sau (thm nhm t ph hp): a. Lot d dy: (................) b. Lot hnh t trng: (....................) c. Si mt: ( ...................) d. Si niu: (.................) 144. Tnh cht au bng (thm t, nhm t ph hp): a. y, nng, m ch, kh tiu: gp trong (.........) trng lc d dy. b. Cm gic rt bng: do tnh trng (..........) ca nim mc d dy. (..........) nh st t hoc (..........) d dy gp trong vim d dy cp. c. au thc s: tu bnh, tu cm gic ca mi ngi c th gp au nh (.........) trong thng tng rng, (........) trong xon rut cp, (........ ) trong dnh tng, bnh mn. d. au qun: l cm gic c bit, au thnh (.....) mt v tr (..........) tri ln ri du dn cho n cn sau, gia cc cn au l thi k ht (.....) hoc (.........) thng gp
trong qun (.......), qun (.....). 145. Cc yu t nh hng ti cn au bng, gp trong bnh no (thm t, nhm t ph hp): a. Vn ng: au tng khi vn ng gp trong (.........) b. n ung: n no au tng gp trong (........) c. Thuc men: au bng nhng khi tim Atropin th au gp trong (........) 146. Cc biu hin km theo au gp trong bnh no (thm t, nhm t ph hp): a. Ri lon tiu ho: (........). b. Vng da: (.........). c. Nn ma, thc n c: (..........) d. i ra mu: (...........) 147. Tnh trng ton thn ca ngi bnh au bng gi cho ta bnh g (thm t, nhm t ph hp): a. Tnh trng sc gp trong cc bnh: (...............) b. Vng da, vng mt trong (..................) c. Suy mn: (..............). d. Nhim khun: (...........). 148. K 3 du hiu au bng cp ngoi khoa (thm t, nhm t ph hp): - (..............) - (...............) - (............) 149. Cc gi tr thm trc trng, m o nu (thm t, nhm t ph hp): a. Ti cng Douglas au: (..............) b. C mu theo tay (..............) 150. au thng v cp cu ngoi khoa (-S): a. Nu cc triu chng thng d dy (-S): - Xy ra t t, au nh - Bng mm, cn vng c trc gan - Ton trng: sc, b trung i tin - Xquang: c lim hi 1 hoc 2 bn b. Vim ty cp chy mu: - au t ngt vng thng v sau n - Sc nng - Bng mm, im Mayo Robson (-) - Amylaza mu v nc tiu bnh thng
thay i ni dung bi: Digoxin, 05-08-2008 lc 09:16 PM L do: Sai th phi sa.
Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :
Digoxin
TRC NGHIM LS TIU HO(Phn 3)
151. Nu triu chng cn au d dy cp (do lot hoc vim d dy) (-S): - au nhiu vng h sn phi c th c nn - au khng co cng thnh bng, khng mt vng c trc gan - Tin s au bng khi i 152. Nu triu chng ri lon vn ng mt (-S): - Khng c cn au qun gan - Khng st, khng vng da - Hay gp nam tr tui 153. K cc trng hp au bng ni khoa chuyn thnh ngoi khoa c cc triu chng sau (-S): a. p xe gan: - au h sn tri tu mc - St cao, dao ng, mi kh, li bn - Gan to, khng au - Khi p xe v vo mng bng gy vim mng bng cp (bng ngoi khoa cn m cp cu ngay) b. Si mt: - C cn au qun gan: st nng, rt, vng da, tam chng ny duy nht 1 ln (S) - Vim lan to rng, thm mt phc mc, ti mt cng to do v phi m cp cu ngay
154. K cc bnh au bng di v h chu ca cc bnh ngoi khoa c cc triu chng sau (-S): a. Vim rut tha cp: - au m vng h chu tri - Khng c biu hin tnh trng nhim khun - Khng nn, khng b trung i tin - im Macburney au - Thm ti cng bn phi au b. U nang bung trng xon: - au h chu d di, t ngt - Ton trng bnh thng - S thy khi u, theo di thy u to nhanh c. Cha ngoi d con b v: - C du hiu thai nghn, t ngt au vng bng di h chu - Ton trng bnh thng - Thm m o: ti cng Douglas cng phng au, c mu theo tay 155. au ton bng ca cc bnh ngoi khoa vi biu hin triu chng sau (-S): a. Thng rut do thng hn: - ang iu tr thng hn t nhin au bng d di - Ton trng bnh thng - C phn ng thnh bng, mt vng c trc gan - Xquang: c lim hi di c honh phi b. Tc rut: - au qun bng tng cn, km theo nn, chng bng, b trung i tin - Quai rut khng ni - Xquang c hnh mc nc, mc hi cc quai rut 156. Cc bnh sau y c xp vo loi au bng khng c v tr nht nh ca cc bnh ni khoa (-S): - au bng do giun a - Nhim trng, nhim c thc n - au qun thn do si - au bng do d ng gp trong bnh vim thnh mch d ng (Schoelein Henoch) 157. K cc bnh au bng mn tnh ngoi bnh vim lot d dy t trng. Vit (-S) cho cc bnh sau: - Lao rut - Vim i trng mn - Vim mng bng do lao - VIm phn ph ph n
- Cc khi u bng (u rut, u d dy, u gan, u ty) 158. Cc bnh au bng khng c v tr nht nh ca cc bnh ni khoa c cc triu chng sau (-S): a. au bng do giun a: - au vng quanh rn, nn, bun nn - Th phn khng c trng giun a b. Nhim trng nhim c thc n: - C biu hin ca tnh trng nhim trng, nhim c thc n. - Khng au bng, khng nn, khng a lng - C du hiu mt nc c. au qun thn do si: - au qun vng thn vn ng - au lan ln trn - C km theo i but, i rt, i ra mu d. au bng do d ng gp trong bnh vim thnh mch d ng (Schoelein Heroch): - au bng m ko di - Sng cc khp, xut huyt di da di dng m chi - a lng c khi a phn en 159. Cc bnh au bng mn (ngoi bnh vim lot d dy t trng) c cc triu chng sau (-S): a. Lao rut: - au d di vng h chu phi - Nhim trng nhim c lao,c khi km theo lao cc c quan khc nh: phi, thn - Ri lon i tin c du hiu bn tc rut (Koenig) b. Vim i trng mn: - au qun dc i trng - Ri lon i tin (phn c nhy mu) c. Vim mng bng do lao: - Nhim khun, nhim c lao - au bng d di tng cn - S thy mng chc ri rc, g ch c, ch trong d. Vim phn ph ph n: - au d di h chu, h v - Ri lon kinh nguyt, ra kh h 160. To bn chc nng gp trong cc bnh sau (-S) a. To bn thi gian ngn: - Cc bnh tm l ton thn, trng thi nhim khun sau phu thut - To bn do thuc: an thn, thuc phin, cc thuc phong b thn kinh, vin st
- Do phn x: to bn i km cc bnh si thn, si mt, ph, vim - Do nhim c ch b. To bn mn tnh: - Do thi quen ngh nghip ngi nhiu, t hot ngkhng i tin ng gi, qun i tin lm mt phn x i ngoi - Ch n ung nhiu rau, khu phn nhiu - Do suy nhc thn kinh lm gim trng lc c, gim nhu ng rut gy to bn - Ri lon tm thn: lo lng,bn chn qun i tin mt phn x mt rn 161. Cc bnh sau y c xp vo nhm to bn c tn thng thc th (-S): a. Bnh lot khng tng tit axid gy to bn b. Do cn tr ng i ca phn c. Do cc bnh i trng: to qu, di qu d. Vim i trng mn e. Cc cn tr i tin do t pha ngoi vo trc trng, thai to, u t cung, u tuyn tin lit f. Tr ni, tr ngoi g. Cc dy dnh sau m trong bng h. U no,vim mng no, tng p lc s no v tn thng tu sng cng gy nn to bn cng nn, nhc u 162. Nguyn nhn a chy cp tnh (-S): a. Nhim khun b. Nhim c c. Do thuc d. Do d ng e. Do cm xc mnh, chn thng tinh thn 163. Cc bnh thuc nhm a chy mn tnh c nhng triu chng sau (-S): a. Lao rut: - i tin nhiu ln, phn nho, t di dng - Khng au bng, khng nhim c lao - Pht hin bng chp cn quang rut hoc tm khun lao trong phn b. Vim i trng mn; - Phn to lng tht thng - Phn khng ln nhy m c. Cc bnh c tn thng thc th khc: - Ung th i trng: xc nh bng soi, Xquang - Polyp i trng: xc nh bng soi, Xquang - Bnh vim cui hi trng: xc nh bng Xquang - Vim trc trng xut huyt
d. Vim ty mn: - a to bn ko di, phn t nc, phn long m, si c - Phi xt nghim dch ty thng qua t trng - Xt nghim men ty trong mu tng - Xquang ty thy hnh si hoc vt vi ho 164. Nhm triu chng sau y ngh ti bnh g (thm t, nhm t ph hp): - Nn nhiu, lc u nn ra thc n, v sau nn ra dch mt, nn xy ra cng lc vi au bng. - au bng d di, tng cn, khng i ngoi, khng trung tin. - Khm bng c triu chng rn b hoc chng hi, au v g vang trng. - Xquang bng c mc nc, mc hi hoc c rt nhiu hi cc quai rut. Ngh ti bnh: (...............) 165. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): Tnh cht c im au bng ging nh trong tc rut nhng c thm: - Chy mu ra hu mn. - S bng, thm trc trng c th thy don rut lng thnh mt u mm. - Chiu chp khung i trng c baryt thy hnh nh inh ba hoc cng cua Ngh ti bnh: (................) 166. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): - Nn nhiu cng lc vi au bng v thng xy ra sau ba n. - D dy ni ln thnh u mm vng thng v, c nhu ng km theo - Du hiu c ch lc i (+) - Chp d dy: y d dy hnh chu v sa xung ngang hai gai mo chu trc trn Ngh ti bnh: (.................) 167. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): - Nn. - au bng. - a lng. - C khi nn n thun hoc kt hp au bng. Ngh ti bnh: (......................) 168. Nhm triu chng sau ngh ti bnh g (thm t,nhm t ph hp): - Nn vt, nn rt nhiu. - Nhc u d di, to bn. - Soi y mt: c ph n vng mc. - Chc ng sng tht lng, ly nc no tu xt nghim thy c s phn ly t bo vi albumin (s lng t bo khng tng hoc tng t cn albumin tng nhiu), glucoza bnh thng. Ngh ti bnh: (..............)
169. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): Nn, nhc u v to bn ging nh trong u no nhng c nhng triu chng ca mng no: - Cng gy. - Du hiu Kernig (+) - Du hiu Babinsky (+) - Chc ng sng tht lng thy dch no tu chy nhanh, t bo albumin, glucoza thay i tu theo mi loi vim mng no. Ngh ti bnh : (..................) 170. Gi g khi gp nhng triu chng sau n gii: - Nn t v n thun n gii. - C trng hp nn rt nhiu, dai dng - C du hiu thai nghn: tt kinh, v thm, thch n chua Ngh ti: (....................) 171. Tnh mch ca v tnh mch ch ni nhau (-S): a. Vng ni tm v, thc qun: ni tnh mch vnh v (h ca) vi tnh thc qun di (h ch). Khi tng p lc tnh mch th vng ni ny d v b. Vng ni quanh rn : tnh mch rn (Arantius) ni vi tnh mch gan (h ca) v tnh mch thnh bng sau (h ch) c. Vng ni tnh mch quanh trc trng: tnh mch trc trng di (h ca) vi tnh mch trc trng di v gia (h ch) d. Vng ni thnh bng sau: cc nhnh (tnh mch ca) chy trong mc treo trng ni tnh mch bng sau (h ch) nhng vng c cc tng dnh vi thnh bng trong mc Told v mc Treitz. Bnh thng cc vng ni ny khng c gi tr chc nng, trong tng p lc tnh mch ca cc tnh mch vng ni ny gin to, c th v gy chy mu 172. Tng p lc tnh mch ca c cc triu chng c nng di y (-S): - Kh tiu, dai dng xy ra sau khi n (khng c bnh d dy) - Chng bng v cm gic y bng vng thng v: xy ra chm sau n bt k thc n g - Cm gic y cng rut thng xuyn (c khi khng to) - Gy mn dn dn v bt u c du hiu thiu vitamin (trong khi n ung vn y , n vn ngon) () - a chy c chu k, khng km theo au bng, st, cc triu chng ny xy ra dn dn sm hn nhng than phn ca bnh nhn v: gim kh nng lao ng chn tay, tr c - Cm gic kh chu, au chu k vng thng v, h sn tri - Chy mu ti pht: ming, li, nn mu, a mu 173. Triu chng thc th ca tng p lc tnh mch ca nh sau (-S):
- Lch to: 100% (S), lu ngy lch to gy ra thiu mu. vng da - Tun hon bng h di da bng ni ln, mu xanh - C trng: c trng t do (bng to b, rn li, mt np nhn, t th nga, g trong vng rn, c vng thp 174. Chn on tng p lc tnh mch ca xc nh bng cc du hiu sau (-S): a. Du hiu thc th: - C trng khu tr - Tun hon bng h - Lch nh b. Thm d: - Soi thc qun: thy tnh mch khng gin - Soi bng: dy chng trn xung huyt, c dch bng - Xquang: chp tnh mch, thn tnh mch ca (trn 2cm) vng ni tnh mch thc qun gin - o p lc tnh mch ca: tng trn 10cm nc 175. Lm sng suy gan cp c nhng biu hin sau (-S): a. Bnh nhn m man, li b, co git, vng thc b.Ri lon tiu ho: nn lin tc, a lng nhiu c. Xut huyt thnh tng m, mng di da, c chy mu cam, nn mu a phn en d. Da, nim mc khng vng e. Khng st 176. Triu chng xt nghim ca suy gan cp (-S): - Glucoza mu tng - Prothrombin mu tng - Cholesteol ester/ ton phn gim - Bilirubin mu tng cao - Urobilin niu gim - Men chuyn amin: SGOT nht l SGPT tng cao - NH3 mu tng nhiu trong khi ur c mu xu hng gim bnh nhn vn tiu tin tt - T l t vong cao 177. Cc du hiu lm sng suy gan mn (-S) - Chn n, s m, y bng,phn lng - Ph n 2 chn: c trng to - Xut huyt: chy mu li, mu cam, nn mu, a mu - Da vng nh, khng vng - Thn kinh, ni tit: + ng ngon + tnh dc gim
- Cc triu chng lm sng khc: + Sao mch + Bn tay son + Da kh, lng tc rng 178. Triu chng xt nghim ca suy gan mn (-S): * Suy nhu m gan: - Hng cu, huyt sc t, tiu cu, bchcu gim - T l prothrombin gim - Fibrrin mu gim - A/G < 1 - Cholesterol ester / ton phn tng - Glucoza mu tng - NH3 mu tng trn 30 micromol/l * Biu hin tiu hu t bo gan: - Men chuyn amin: SGOT nht SGPT tng cao - Phosphataza kim gim * Nc tiu: - Urobilinogen gim - Xut hin bilirubin niu 179. Triu chng lao mng bng th c chng c cc biu hin sau (-S): - St: thng st vo bui sng c th st cao 390-400 C hoc st nh 3705- 380 C thm ch c bnh nhn khng cm thy st - n ung km: chn n, y bng, kh tiu - Khng mt mi, khng gy st - au bng m , v tr au khng r rng - Khng ra m hi trm - i ngoi c khi phn lng, c khi phn to - Khm ton th: + C th c hch mm, di ng, khng au vng dc c c n chm + C c trng, tun hon bng h, lch to + C trn dch ph mc + Dy dnh mng ngoi tim 180. Th b u ho ca lao mng bng c nhng biu hin sau (-S): * Bnh nhn c triu chng nh th c trng nhng: - St nh vo sng sm hoc khng st - Triu chng tiu ho r hn: au bng, chng hi, si bng,i ngoi phn lng mu vng * Thm khm bng:
- S bng vng cng, vng mm, n tay vo vng cng thy ting lc sc ca hi di ng - G bng thy bng c u 181. Th x dnh c cc triu chng sau (-S): * C nng: - Triu chng bn tc rut: bng chng au, trung tin c au - Triu chng tc rut: au bng, chng hi, b trung i tin * Thc th: bng cng, lm lng thuyn 182. Cc xt nghim bnh nhn lao mng bng (-S): a. Xt nghim mu: - Hng cu gim ( - Bch cu tng (bch cu a nhn trung tnh tng) - Tc mu lng gim b. Phn ng Mantoux (+) i khi (-) c. Xquang c th thy tn thng lao d. Soi bng vi th c chng thy: c cc trng nh, c, bng ri rc tr li trn nn phc mc bnh thng 183. Xt nghim dch c trng bnh nhn lao mng bng (-S): - Phn ng Rivalta (-) - nh lng albumin di 30g/l - T l glucoza trong dch c chng/ glucoza mu di 0,9 - T bo lymphoxid trn 50% - C th tm thy vi khun lao trong dch c chng bng soi trc tip, cy mi trng Loweenstein, tim chut lang 184. Chn on xc nh lao mng bng da vo (-S): a. Lm sng: - C hi chng nhim c lao: + St nh v sng + Ra m hi trm, gy st cn, mt mi - au bng qun tng cn - Bng c c trng, c mng chc b. Da vo xt nghim: - Mu: + Bch cu tng (ch yu bch cu lym pho) + Mu lng gim - Xt nghim dch c trng: + Rivalta (-) + Albumin trn 30g/l
+ Lymphoxid di 50% - Phn ng Mantoux (+) - Soi bng, sinh thit khng thy tn thng lao 185. Th bnh no ca lao mng bng khi chn on nhm vi cc bnh sau (thm t, nhm t ph hp): - X gan c trng (c trng, tun hon bng h, lch to) - U nang bung trng Th bnh: (...........) 186. Th bnh no ca lao mng bng khi chn on c th nhm vi cc bnh sau (thm t, nhm t ph hp): - Khi dnh ca hch trong bng: lympho sarcom (nh soi bng v sinh thit chn an). - Khi u trong bng (nh soi bng). Th bnh: (...........). 187. Lao mng bng tin trin theo 3 cch di y tu theo th bnh (A: th c trng; B: th b u ho; C: th x dnh). - L th nh nht nu c iu tr sm, ng phc th a s khi. Nu khng c iu tr tt th s chuyn sang th b u ho hoc x dnh ho). Th: (A-B-C - Th ny gy ra nhng p xe a phng v c th v ra thnh bng hoc d phn ra ngoi. Th: (A-B-C) - Th ny lm dnh cc on rut, lm tht rut gy hi chng bn tc hoc tc rut phi can thip ngoi khoa, c th gy vim dnh quanh gan, mt, tc vi trng. Th: (A-B-C) 188. Nguyn tc iu tr lao phc mc c 4 nguyn tc sau (-S): a. Dit vi khun lao bng khng sinh c hiu b. Kt hp corticoid liu php c. Nng c th bng ch n ung giu m v sinh t d. Ch nh phu thut p dng khi lao mng bng gy tc rut do dnh x dy
Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn : #4 05-08-2008, 08:44 PM Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
Digoxin
TRC NGHIM LS TIU HO(Phn cui) 189. Nu nhng ng m vi khun lao ti rut (-S): - Ch yu l ng tiu ho: do nut m, ri, cht nhy cha vi khun lao - ng mu - ng bch mch - ng mt - ng tip xc: lao mng bng - ng tnh dc 190. Triu chng lm sng thi k khi pht lao rut (-S): a. Ton thn: - Gy, xanh xao - Mt mi, ra m hi trm - St nh vo sng sm b. Triu chng v tiu ho: - i ngoi lng phn, thuc cm a khng c tc dng - Xen k a lng l to bn - au bng tng cn khng c v tr c nh - au bng mt i ngoi, i ngoi c du au - au bng thng c si bng 191. Triu chng lm sng thi k khi pht ca lao rut (-S): a. Th lot tiu trng, i trng: - au bng nhiu, st cao, a lng ko di - Bng hi to c nhiu hi, s bng thy u cc - Phn long, mi hi thi, mu vng c ln m, nhy v t mu - Suy kit nhanh, xanh xao, bing n, s n vo au bng a lng b.Th to hi manh trng: - Bnh nhn ht a lng li a to, phn c nhy mu m khng bao gi phn bnh
thng - Khng nn ma v au bng - Khm h chu phi c mt khi u mm, di ng km c.Th hp rut: - Sau n thy au bng tng ln - ng thi bng ni cc u cc v c du hiu rn b - Sau 10-15 pht nghe thy ting hi di ng trong rut v c cm gic hi i qua ch hp, khng c du hiu Koenig - Khm bng ngoi cn au khng c du hiu g 192. Cc triu chng ca lao rut di y ng hay sai (-S): a. Xt nghim mu: - Bch cu a nhn trung tnh tng cao - Tc mu lng tng b. Cc xt nghim khc: - Phn ng Mantoux (-) - Tm trc khun lao trong phn: ch c ngha l lao rut khi tm thy trc khun lao trong phn nhng khngthy trc khun lao trong m - Xquang (chp Transit rut c ung Geobarin): + i trng c hnh khng u ch to ch nh + Vng hi- manh - i trng ngm thuc u hoc khng u, c hnh ng thuc nh + Hnh lot rut non: hnh ng thuc c nh, trn hoc hnh bu dc + Hnh tiu trng bin dng ch to, nh (hnh ng n) - Ni soi ng mm thy: + Cc ht lao nh cc ht k mu trng ri rc trn nim mc + Nhng lot nng, b mng, mu tm bm 193. Chn on xc nh lao rut da vo nhng hi chng sau (-S): a. Hi chng tn thng rut: * Lm sng; - au bng chng hi, c du hiu Koenig - Bing n, gy st, xanh xao - a to ko di, phn c nhy mu * Xt nghim: - Xquang rut: + i trng c thnh cng nham nh + Tiu trng khng c ch to ch nh - Soi v sinh thit thy tn thng lao thnh rut
b. Hi chng nhim lao; - Lm sng: + St bui sng + Ra m hi trm, mt mi ( - Xt nghim mu: lympho tng cao, mu lng tng - Mantoux (-) - Tm trc khun lao trong phn (+), trong m (+) 194. Chn on phn bit lao rut vi cc bnh sau (-S): a. Mt s bnh gy a chy: - Nhim khun (v d: Salmonella) - Ung th manh trng - Bnh Crohn - Hi chng rut kch thch b. Cc bnh c khi u h chu phi d nhm vi lao manh trng: - U amp - p xe rut tha - Lng rut hi manh trng 195. Vim i trng mn thng do cc nguyn nhn sau (-S): - Di chng ca cc bnh nhim khun ng rut cp: thng hn, l trc khun, l amp v cc nhim trng khc - Nguyn nhn di ng - Nguyn nhn t min (vim i trng lot khng c hiu) - Ri lon thn kinh thc vt (lc u l ri lon chc nng v sau tn thng nn lot mn - Sau cc trng hp nhim c: thyroxin, asen, photpho, nhim toan mu, ur mu cao 196. Triu chng ton thn ca bnh vim i trng mn nh sau (-S): - Mt mi - Ng t - Chn n - Thiu mu (da nim mc nht nht) - y bng - Gim tr nh - Hay cu gt - St cao lin tc 197. Triu chng c nng ca vim i trng mn (-S): a. au bng: -V tr au: xut pht au thng hai h chu, vng gc gan, gc lch, dc khung i
trng - Tnh cht au: +au qun tng cn + au bng mt i ngoi, i ngoi c khng gim au + Cn au bng d ti pht b. Ri lon i tin: - Thng a lng nhiu ln, phn ln nhy mu - To bn xen k - To bn sau bi phn c nhy mu - Mt rn, a gi - Sau i ngoi au trong hu mn 198. Du hiu thc th ca vim i trng mn (-S): - n h chu phi c th c ting c ch - Chng hi, mt trung tin, trung tin c khng bt chng bng - n dc khung i trng khng au - C th s thy thng xch ma h chu phi nh mt ng chc t di ng 199.Xt nghim vim i trng c nhng du hiu sau (-S): a. Xt nghim mu: - Hng cu gim - Bch cu tng, mu lng tng b. Xt nghim phn: - C th thy hng cu, t bo m - Albumin ho tan (-) - C th thy trng k sinh trng (+) - Cy phn tm vi khun gy bnh (+) - Tm thy amp trong phn 200. Chn on xc nh vim i trng mn du hiu g c nhng biu hin sau (thm t, nhm t ph hp): - (.........): b kit l, cc vim rut cp. - (.............): xut pht t vng h chu, au qun hay ti pht. - (............): mt rn, a lng, phn c nhy mu. - (........): + c t bo m +c albumin ho tan +cy phn tm thy vi khun gy bnh - (............): c hnh nh xp a. - (............): thy tn thng vim lot. 201. Phn bt vim i trng mn vi ri lon chc nng i trng da vo (-S): - C au bng - Phn to. lng, khng c nhy mu
- Xt nghim albumin ho tan (+) - Soi v sinh thit i trng khng thy tn thng vim lot 202. Phn bit vim i trng mn vi polp i trng da vo cc yu t sau (-S): - N gp nhiu hn nam - Thng gp ngi trn 50 tui - Thng c triu chng au bng - Tnh c xt nghim phn thy mu vi th - C khi i ngoi ra mu - Soi i trng thy polp (yu t xc nh) 203. Chn on phn bit vim i trng mn vi ung th i trc trng da vo cc yu t sau (-S): - Gp n nhiu hn nam, tui ngoi 40 - Cc bnh i trng d dn ti ung th: + Polp lan to + Cc polp gi, vim i trng xut huyt, sau l - V tr ung th thng trc trng, i trng xch ma - Triu chng ph thuc v tr u: + au bng khng c khu tr r rt + Chn n, bun nn xen k to lng, thng c mu trong phn + Nu ung th i trng xch ma a gi, tc rut - Khm bng: khng s thy u rn - Thm trc trng, m o thy c mt khi u c nh - Xt nghim mu: hng cu, huyt sc t tng - Xt nghim phn khng thy mu vi th - Chp khung i trng thy hnh nh: + Hp i trng + Khuyt i trng + Cng i trng 204. Chn on phn bit vim i trng mn vi lao rut (lao hi manh trng) da vo cc du hiu sau (-S): - C hi chng nhim lao - Ri lon c nng rut: a lng 2-3ln/24h - au bng lm rm i ngoi c vn au - Bing n, si bng - Th hp rut cn au bng c tnh cht c bit: + Sau khi n bnh nhn thy au bng, khi bng ni ln cc u cc v c du hiu rn b + Sau 15 pht nghe thy ting hi di ng trong rut ng thi trung tin c au (hi chng Koenig)
- Khm im au h chu phi ti y c mt khi u mm, nhn, hi au, di ng theo chiu ngang - Xquang c du hiu Starling - Xt nghim phn c mu, m 205. Nhn mu sc ca phn, phn mu vng sm gp trong trng hp (-S): - BN n nhiu tht - BN huyt tn - BN tc mt - BN vim gan cp - BN rut kch thch th lng, phn chuyn qua rut gi qu nhanh Bilirubin cha kp chuyn thnh stercobilin ra ngoi b oxy ho to thnh 206. Cc mu sc trng bch, en ca phn gp trong cc bnh (-S): - Phn mu trng bch gp trong bnh huyt tn - Phn mu trng bch gp trong bnh tc mt - Phn mu trng bch gp trong bnh vim gan cp. - Phn en bng, nho, khm gp trong trng hp ung thuc c cht st, Bismuth ( - Phn en khng bng, nho, khm gp trong xut huyt ng tiu ho trn 207. Xt nhim phn tm thc n cha tiu ca BN (-S) : - Glucid c gi l bnh thng nu trong phn cn mt vi ht tinh bt hoc acid hu c c t 14-16 mEq/ 100g phn - Protein c gi l bnh thng nu trong phn cn mt hai si c ang tiu ho d - Protein c gi l bnh thng nu trong phn c mt t protein ho tan - Lipid c gi l bnh thng nu 95% c hp thu vo mu cn 5% thi theo phn - Lipid thi theo phn di dng: m trung tnh 25%, Acid bo 38%,x phng kim 37% 208. Xt nghim phn tm k sinh trng ng rut (-S): - Amib dng ln hot ng khng c trong phn - Amib dng nh hot ng c trong phn - Amib dng bo nang c trong phn - Trng roi (Trichomonas intestinalis) tm thy trong phn thng th bo nang - Trng lng (Balantidium coli) tm thy trong phn thng th u trng 209. Xt nghim phn tm thy cc loi giun cc dng (-S): - Giun a : Tm thy u trng giun a trong phn - Giun mc: Tm thy u trng v trng giun mc trong phn - Giun kim : Tm thy trng giun kim quanh hu mn - Giun tc : Tm thy u trng giun tc trong phn - Giun ln: Tm thy u trng giun ln trong phn.
210. Xt nghim phn tm thy cc loi sn cc dng (-S) - Sn l rut (Fasciolopsis buski): tm thy trng sn trong phn - Sn l gan nh (Clonorchis sinensis): tm thy u trng sn trong phn - Sn l gan ln (Fasciola hepatica ): tm thy u trng trong phn - Sn dy ln (Toenia solium ): tm thy t sn mang trng trong phn - Sn dy b (Toenia saginata): tm thy t sn mang trng trong phn 211. S thng gp lot ming ni sau phu thut d dy, t trng (-S): - Sau ni v trng: + Th gii gp 30-35% + Vit Nam gp 20% - Sau ct dy X, ni v trng hoc m thng mn v: 5-10% - Sau ct 2/3 d dy: 2-3% (L S Lim: 1988) - Sau ct d dy v ct dy X: 10% 212. Nhng nguyn nhn gy lot ming ni (thm nhm t ph hp): - Do ct on (............) 2/3 d dy m cn li nhiu phn d dy tit axid. - Do ct (.............) 2 thn dy thn kinh X, sau ct dy X v ct hang v. - Do u (............) ca tuyn ty (hi chng Zollinger Ellison) loi u ny gy tng tit gastrin, cn u ty th cn lot ti pht. - Do ch ct b lot cn li phn nim mc (..............) (cn nim mc hang v th cn tit gastrin kch thch tit HCl + pepsin). 213. Triu chng lot ming ni (-S): - Xut hin sau m 3 thng ti 1 nm, c khi 20-30 nm sau - au do lot ming ni c c im: + au gim hn trc khi phu thut + au khu tr bn tri ng trng gia, ngang rn hoc thp hn + au nhiu hn khi n vo vng ngang rn pha bn tri - Nn: + Thng khng i km vi au + Tnh cht nn gn ging nh hp mn v - Ni soi bng ng soi mm: thy tn thng lot vng ming ni
Digoxin
Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
y l ti liu do b mn tiu ho son, bn tho, a copy t my mt cu trng mnh. Post ln tha ny k bit cc thy c kin g khng, ch s cc thy ni l l ht b mt th cht, nhng thit ngh cng ging nh b mn k sinh trng vy cng cng b ti liu test cho sinh vin ri ng k, vy th cc ti liu test ny cng b vi sv cng c thi nh? Hn na trong mc li gii thiu ca thy Li cn ni l phc v vic hc ca sinh vin m.V th m post th ny cng l mong ti cc b sv nhanh v tin li gip cho vic hc tt hn thi phi k? Mong rng nu cc thy bit s ng h v cho php. thay i ni dung bi: Digoxin, 06-08-2008 lc 06:38 PM L do: Sai th phi sa.
Digoxin
p n Trc Nghim Ls Tiu Ho
P N TRC NGHIM TIU HO(Phn 1)
1. Triu chng vim thc qun (thm t, nhm t vo cu sau): - (Kh) nut. - Co tht (c hng) lm cho kh th vo. - au ngay khi (nut), nng rt, au lan ra sau lng. - Chy (nc bt). - Nn ra (mu). - C khi vim nng gy ri lon (tim mch), lon nhp th, suy tim 2. Chp Xquang thc qun vim c cc du hiu (-S): a. Vim: b thc qun nhn (S), c hnh rng ca nh (), cc np nim mc th (), nh (S), st nhau (S), khng c phng hng r rng (), c khi b gin on r (S). b. Lot thc qun: thnh thc qun c hnh ng thuc di (S), c qung ph n () pha nn () v hnh quy t nim mc (), v pha thnh i din ng thuc c hnh gin rng (S). 3. Chn on vim thc qun (thm t, nhm t ph hp): Chn on vim thc qun da vo: a. Sau cc (nguyn nhn) nu trn bnh nhn thy kh (nut). b. Hi chng Plummer- Vinson: kh nut km theo cm gic ( nn) hng. c. au, nng rt vng (gia c). d. (Xquang, ni soi) thc qun thy tn thng. 4. Bin chng ca vim thc qun (thm t, nhm t ph hp): a. (Thng): au d di kh tr c (thng on thc qun c), au kh tr vng sau xng c, thng v (thng on thc qun ngc), mch nhanh nh kh th, nhit cao 380-390C. b.(Vim) mng phi. c. Vim quanh (thc qun). d. (Hp) thc qun. 5. iu tr thc qun vim (thm t, nhm t ph hp): a. R a ming, thc qun, d dy (loi tr tc nhn) axid, kim gy bng, dng sonde d dy (bi du thc vt vaselin). b. Nu (bng kim mnh) th dng dung dch axid lactic long hoc vi nc limonat. c. Nu (bng do axid) th dng dung dch bicacbonat 2%, cho bnh nhn ung sa. Cn phong b quanh thn khi b ng c (axid axtic) v (axid) gy tan mu. 6. K cc yu t thun li dn ti ung th thc qun (-S): a. Nghin ru, thuc l. () b. Cc bnh vim cp tnh ng tiu ho. (S) c. n thc n qu nng, qu lnh trong mt thi gian di ().
d. Sau bng hoc sau chn thng thc qun. () e. Sau bnh ti tha thc qun, co tht thc qun (). f. Sau nhim trng mn: lao, giang mai thc qun (). g. Sau suy tim. (S) 7. Triu chng ung th thc qun (thm t, nhm t ph hp): Ti ch bnh din ra (t t) vi cc triu chng: - Cm gic (nng) v (tc ngc). - Cm gic vng vng trong (c hng). - (Kh nut): lc u (kh nut) nhng khng au, v sau (kh nut) km theo au, lc u (kh nut khi n) thc n rn, v sau (kh nut c thc n) lng. - au m , nn dc theo (xng c). - Ming (hi). - Ging (khn) do u chn p vo dy thn kinh qun ngc. 8. Triu chng K thc qun ton thn (thm t, nhm t ph hp): - Mt mi, km n, (kht), nn mu. - (Gy) st. - (Da) xanh nht. - Km theo du hiu (thanh- kh qun) ging khn ho nh ch ku. - Cc du hiu phi- ph qun: (st, ho, khc m ln mu m). - Cc du hiu (mng phi): au ngc, st, ho. - Biu hin (hp tm v): cm gic kh th ngt ngt do chn p sau xng c. - Biu hin d dy: (au thng v, bun nn, nng rt, , nn ra mu). 9. Cc yu t ni sinh (-S): a. Virus, vi khun v c t ca chng. () b. Ur mu cao, tng thyroxin, tng ng mu. (S) c. Thuc aspirin, APC, ru, ch, caf() d. Chn thng s no, u no, sau phu thut thn kinh, tim, shock, phi cp, x gan. (S) 10. Cc yu t ni sinh (-S): a. Cc cht n mn: mui kim loi nng nh ng, km thu ngn, kim axid sunfuric(S) b. Cc yu t ni sinh trn vo mu gy ra vim d dy cp, cc bnh nhim khun cp nh cm, si, bch hu, thng hn() c. Bng, nhim phng x ( 1000 R- 2500R), cc stress nng, chn thng s no, u no() d. D ng thc n tm, s,c, hn. () 11. Vim d dy c th c cc triu chng rm r sau (thm t, cm t ph hp): a. au vng (thng v d di) cn co, nng rt, c khi (m ) m ch kh tiu.
b. Bun nn hoc (nn nhiu), n xong (nn ngay), nn ht. c. Li b, ming hi, st (390-400C). d. G (vng thng v) au. e. C th b (tru tim mch). 12. Chn on (+) vim d dy da vo (thm t, nhm t ph hp): a. Lm sng: au thng v (t ngt khng theo chu k), nng rt. b. Xquang: khng thy (hnh lot) ch thy (nim mc th). c. Soi d dy v sinh thit: (tn thng nim mc d dy). 13. Chn on phn bit (-S): a. Vim ty cp: da vo amylaza mu, nc tiu tng cao. () b. Thng d dy; thy lim hi khi Xquang bng () c. Vim ti mt cp: st, s thy ti mt to (). d. Cn au cp ca lot d dy: Xquang c lot () e. Phn bit vi vim rut tha (st, Macburney (+)) (S) f. Phn bit vi si niu (i but) (S) 14. Vng da huyt tn (-S): - Thiu mu. () - Vng da. () - Lch to. () - Phn bc mu. (S) - Nc tiu vng. () 15. Vng da do tc mt (-S): - au h sn phi lan ln vai phi. () - St, rt run, nng. () - Khi st ht vng da. (S) - Phn vng. (S) - Nc tiu trong. (S) 16. Vng da do vim gan cp (-S): - St. () - au h sn phi. () - Vng da, khi vng da cn st. (S) - Nc tiu vng. () - Phn vng. (S) 17. bnh nhn vng da, tc mt (-S): - Kh ng m, ngy ng gt. () - Nga ton thn. () - Nhp tim nhanh. (S) - Phn vng. (S)
- Nc tiu vng. () 18. Xt nghim Bilirubin mu (-S): - Huyt tn: bilirubin trc tip tng. (S) - Tc mt: bilirubin ton phn tng () - Tc mt bilirubin gin tip tng (S) 19. au bng xut hin khi (-S): a. Tng rng gin t ngt qu mc. () b. Nhu ng tng rng co bp qu mc () c. Mng bng b kch thch: thng d dy () d. Kch thch bnh l cc tng: p xe gan, vim ty cp () e. Khng r l do: sau n nh mi ngy, au bng, i ngoi th ht (S) 20. au do lot d dy (-S): a. C chu k n vo ht au (S) b. au lan ra sau lng, sang phi (S) c. Khi n vo im thng v ngoi cn au (+) (S) d. Nn xong ht au () 21. au do giun chui ng mt (-S): a. Nm thng v nga au (S) b. Nm chng mng: au (S) c. Cho ung nabicacbonat au () d. Khi au bng c th nn ra giun () 22. au do vim d dy cp (-S): a. au c chu k (S) b. au lan xuyn (S) c. n vo au (S) d. i au () e. G vng thng v khng au (S) 23. au do si niu: lan ln ngc, ln vai phi (S). - au do si mt: lan xung b phn sinh dc, i but (S). 24. Nguyn nhn no gy bnh tm v khng gin (-S): - Chn thng tm thn () - Bng nhit, ho cht () - Vim nim mc thc qun () - Lot thc qun () - Xc thc qun () - Cc bnh nhim trng: cm, st, bch hu () - Tro ngc d dy, thc qun (S)
25. Triu chng no gp trong bnh tm v khng gin (-S): - Nut kh: lc u vi thc n rn v sau vi c thc n lng () - au ngc: au di mi c, lan ra sau lng () - Cm gic p, tc ngc () - , tr () - Nn () - Xquang c hnh nh gin to thc qun v tht hp tm v nht thi lm u di thc qun nhn nh hnh thoi () - Soi thc qun: pht hin c on hp ca thc qun () 26. Triu chng no gp trong vim thc qun (-S): - Kh nut () - au nng rt ngay sau khi nut, nng rt lan ra sau lng () - Co tht c hng lm kh ht vo () - Chy nc bt () - Nn ra mu () - C khi vim nng gy ri lon tim mch, lon nhp th, suy kit c th () - Xquang thc qun: thy vim hoc lot () - Soi thc qun: thy nim mc , mch mu cng t c nhng mng biu m bong ra thy lot, hoi t () 27. Cc bin chng ca vim thc qun (-S): - Thng () - Hi chng Plummer- Vinson (nut kh km theo cm gic nn hng) (S) - au nng rt vng gia c (S) - Xquang thc qun thy tn thng (S) - Vim mng phi () - Vim mng tim () - Vim quanh thc qun () - Hp thc qun () 28. Triu chng lm sng (thm nhm t): a. Cm gic (nng bng, chng hi), hi, nhc u, mt , cm thy ng ming vo (bui sng), bun nn, nn (to lng) tht thng. b. Nng rt vng thng v xut hin (sau hoc trong khi n) c bit r sau khi n ung mt s th nh (bia, ru vang trng) gia v chua cay hoc ngt. c. au vng thng v khng d di thng ch l cm gic kh chu, m thng xuyn tng ln (sau khi n) e. Thc th: th trng gy cht t hoc bnh thng, da (kh trc vy), c vt n ca (rng) trn ra li, l lot chy mu (li). Li (b trng), au tc vng thng v khi (g hoc n su)
29. Xt nghim dch v (thm nhm t ph hp): a. Trong vim d dy (nh) nng acid clohydric gim nhng khi lng dch tit bnh thng hoc hi tng. b. Trong vim (teo) d dy: lng dch tit v nng acid clohydric gim nhiu dn ti v toan. 30. Xquang vim d dy (-S): a. Hnh nh cc np nim mc th () b. Nim mc th ng u (S) c. B cong ln nham nh () d. B cong ln c hnh rng ca () 31. Ni soi pht hin c cc th (thm nhm t ph hp): a. (Vim long): thng c tng tit, nim mc xung huyt, ph n i khi xut huyt lm m. b. (Vim ph i): ngoi vim d dy th ph i thc th c np nim mc th to cn c th ni cc, th khm, th polyp, th gi u, cn phn bit vi ung th. c. (Vim d dy lot trt): cc tn thng nim mc hnh trn, nng c b r. d. (Vim teo d dy): mi u nim mc phng, khng mt v sau dn mt np, teo, nht mu). 32. Hnh nh m hc ca vim d dy mn th nng (-S): a. Lp m xung huyt, ph n () b. Xm nhim t bo vim () c. Trc biu m () d. Cc tuyn vn bnh thng v s lng v hnh thi () 33. Hnh nh m bnh hc vim teo d dy (-S): a. Rt t bch cu trong t chc m (S) b. Gim s lng tuyn v cc tuyn teo nh () 34. Hnh lon sn rut (-S): a. Nu cc t bo tuyn ca d dy c hnh thi ging nh t bo tuyn ca rut () b. L th nh hn ca vim teo d dy (S) 35. Tin trin ca vim d dy mn (-S): a. Vim d dy mn tin trin nhanh (S) b. Hnh thi nim mc thay i mau l t vim ph i ti vim teo (S) th teo n thun, th teo lon sn (). 36. Cc bin chng ca vim d dy mn (-S): a. Ung th d dy () b. Xut huyt tiu ho () c. Vim quanh d dy, t trng () d. Vim ti mt mn () e. Vim ty mn ()
f. Vim rut tha cp (S) 37 Ngoi vic iu tr cc thuc vim d dy mn cn iu tr cc bnh kt hp (-S): a. Vim nhim rng, ming () b. Vim tai, mi hng () c. Ty giun, sn () 38. S thng gp lot d dy- t trng (-S): a. Lot d dy t trng l bnh t ph bin trong cc bnh tiu ho (S). b. Mi la tui u gp biu hin lot d dy t trng () nhng hay gp tui gi v tr (S). c. Nam gii hay gp nhiu hn n gii (). d. Thnh th gp t hn nng thn (S). e. Thi chin tranh gp t hn th bnh (S). f. Lot t trng gp nhiu hn lot d dy (). 39. Cc yu t thun li gy bnh (-S): a. Yu t thn kinh: cc kch thch thn kinh cng thng qu mc ko di (). b. n ung qu nhiu dinh dng nh m, vitamin (S), gi gic n khng hp l (), ung ru nhiu, n gim t nhiu (), thc n nu nh qu (S). 40. Gii phu bnh (thm t, nhm t ph hp): a. lot (non) lot mi: lot c hnh trn hoc hnh bu dc, ming rng, y thu nh dn, quanh lot c phn ng vim xung huyt, mm mi. b. lot (c): qu trnh x pht trin mnh, y lot rng, quanh b lot tr nn dm d, cng chc. 41. Triu chng lm sng (-S): a. au:- Thng v: + Lot d dy au khi i (S). + Lot hnh t trng au khi no (S). - au lan xuyn ra sau lng, sang phi: lot hnh t trng (). au lan ln ngc, sang tri: lot d dy (). - im au (+) khi c cn au l im thng v gp trong lot d dy (). im au (+) l mn v hnh t trng gp trong lot hnh t trng (). b. Ri lon tiu ho: - i ngoi hay to gp trong lot d dy (S). - i ngoi phn lng hay gp trong lot hnh t trng (S). 42. Bin chng ca lot (-S): a. Lot d dy: - Thng (). - Hp mn v (). - Vim d dy (). - Xut huyt ().
- Ung th khng gp (S). b. Lot hnh t trng: - Thng (). - K ho (S). - Hp mn v (). - Vim quanh t trng (). - Xut huyt tiu ho (). 43. Nu cc nguyn tc iu tr bnh lot (thm cc t, nhm t cn thit): a. (Ton din): ngh ngi, n ung, thuc men. b. (H thng): ng thuc, ng liu lng, ng thi gian. c. (Tnh cht c bit bnh nhn): khng my mc rp khun cho mi bnh nhn ging nhau. 44. K cc nhm thuc iu tr lot d dy t trng (-S): a. Gim tit, gim toan: - Atropin (). - Belladon (). b. Thuc c ch th cm th H2 ti d dy: - Cimetidin (). - Ranitidin (). - Nisatidin (). - Omeprazon (S). - Trymo (S). c. Bng se nim mc: - Denol (). - Maalox (S). - Histidin (S). 45. Cc thuc nam y (-S): - Mt ong (). - L khi (). - Cao d cm (). - Ch dy (). - n s 12 (). - Chui tiu (S). 46. S thng gp ca ung th d dy (-S): a. Tui thng gp: 50-60 tui (). b. Gii n gp nhiu hn nam: t l n /nam l 2/ 1,5 (S). c. C a d b ung th d dy: - Ngi c nhm mu B (S).
- Ngi c vim d dy th teo (). - Bnh polyp to trn 2cm (). - Yu t gia nh: gia nh c ngi b ung th t l gp ung th d dy gp 4 ln gia nh khng c ngi b ung th (). 47. Triu chng c nng ca ung th d dy (-S): a. Cc ri lon tiu ho: - y bng sau n, kh tiu, lc u thnh thong, sau lin tc (). - n ngon ming (S). - Bun nn v nn sau khi n (). b. au: mt chu k (). c. Thiu mu n thun, a phn en (). d. Suy nhc, mt mi, cn khng st (S). e. St dai dng khng tm c l do c th (). 48. Triu chng thc th ca K d dy: a. C khi u trn rn hoc ngang rn (). b. Cc triu chng do bin chng gy ra (thm nhm t): - (Hp mn v): nn ra thc n c. - (Thng): bng cng nh g, chong, mt vng c trc gan. - (Xut huyt tiu ho): nn mu a phn en. c. Cc du hiu ca di cn ung th d dy (thm nhm t): - (Di cn vo gan): gan to, mt gan ln nhn. - (Di cn hch Troisier): s thy hch h thng n tri. 49. Triu chng Xquang ung th tm v v phnh v c hnh nh (thm t): a. on cui thc qun v tm v c (b) lam nham, khc khuu. b. i hng ca lung (Baryte) khi i qua tm v. c. Thay i gc (His). d. Du hiu Hammer: chp vi cn quang kp thy r (Baryte) qua tm v ging nh nc sui trn ln cc hn lng sui. e. Mt hi phnh v: do thiu nng (tm v) lm thot hi ra ngoi. f. C hnh (khuyt) phnh v trong t th Trendelenburg hoc c s tng khong cch gia hnh hi phnh v v vm honh. 50. Triu chng ni soi ca ung th d dy (thm cm t, t cn thit): a. Th lot: thng l mt s () lot si, (hnh dng) mo m, khng u, y bn, (hoi t), b cao, dy, nham nh, c nhiu ht to nh (khng u), thng c chy mu trn b ( lot), nim mc xung quanh lot nht mu v np (nim mc) ng li cch xa lot. b.Th si: thng l mt (khi u) s s, to nh khng u, khng c cung, trn mt v gia cc (u si) c ng cht hoi t ln vi dch nhy (mu). y v nim mc xung quanh cc (u si) u cng v khng c (nhu ng).
51. Chn on ung th d dy giai on sm (-S): Da vo cc triu chng c nng, thc th: - Bnh nhn trn 40 tui (). - t nhin n kh tiu (). - au vng thng v d di (S). - au c chu k r (S). - Mt mi (). - a to (S). - Thiu mu (). 52. Chn on ung th d dy giai on mun (-S): - C khi u vng thng v (). - Khi u di ng d dng (S). - di cn: + Hch Troisier (). + Hch nch (S). + Hch bn (S). - Xquang, ni soi r tn thng ung th (). 53. S thng gp (-S): - Xut huyt tiu ho l cp cu ni- ngoi khoa (). - N gp nhiu hn nam (S). - Tui hay gp 20-50 tui (). - Gp khi thay i thi tit: xun- h- thu- ng (). - Cm cm (). - Sau khi ung corticoid (). - Chn ng mnh tinh thn, qu bc tc, qu lo ngh (). 54. Cc nguyn nhn xut huyt tiu ho (-S): - Lot d dy- t trng (). - Ri lon chc nng d dy (S). - Ung th d dy (). - Vim d dy (). - Do suy gan (). - Tng p lc tnh mch ca (). - Bnh ng mt (). - Bnh mu (). - Sau chn thng s no (). - Sau suy h hp nng (). - Sau suy thn nng (). - Sau bng nng (). - Ri lon chc nng i trng (S).
- Hp tm v (S). 55. Xut huyt tiu ho c tin lng tt (-S): a. Nn mu hoc a phn en vi khi lng t (). b. o huyt p v s mch bnh nhn 3h / ln trong 24h nu mch huyt p dao ng (S). c. Xt nghim hng cu, Hb, hematocrit 3h/ln, cc xt nghim ln sau tng ln so vi ln trc (). d. Ton trng bnh nhn tnh to, d chu, i nhiu, c cm gic i, thm n (). e. Khng nn na, phn ng khun, cui bi c mu vng (). 56. Xut huyt tiu ho tin lng d dt (-S): - Nn ra mu, a phn en vi s lng ln ko di (). - o huyt p, s mch bnh nhn 3h/ln trong 24h, nu mch huyt p khng dao ng n nh (S). - Xt nghim hng cu, Hb, hematocrit 3h/ln cc xt nghim ln sau cao hn ln trc (S). - Ton trng: mt, hong ht, vt v, i t, v niu (). - iu tr rt tch cc, c truyn mu cng nhm, mu ti 500-1000ml m bnh nhn vn tip tc nn mu, a phn en nhiu ln (). 57. S thng gp (-S): a. Sau ni v trng: - Th gii gp: 30-35% (). - Vit Nam gp: trn 30% (S). b.Sau ct 2/3 d dy: 2-3% (). c. Sau ct d dy v ct dy X: 10% (S). d. Sau ct dy X, ni v trng hoc m thng mn v 4% (S). 58. Nguyn nhn (thm nhm t cho y ): a. Do ct on cha (2/3) d dy cn li nhiu phn d dy tit (axid). b.Do ct cha ht 2 thn dy (X) sau ct dy X v ct hang v. c.Do u Adenome ca tuyn (ty) hi chng Zollinger- Ellison loi u ny gy tng tit, cn u ty th cn lot ti pht. d.Do ch ct b lot nhng cn li phn (nim mc hang v) , cn nim mc hang v cn tit (gastrin) kch thch tit HCl. 59. Triu chng (-S): a. au do lot ming ni c c im: - au gim hn trc khi m (S). - au khu tr bn tri ng trng gia, ngang rn hoc thp hn (). - au nhiu hn khi n vng ngang rn pha bn tri (). b. Nn: thng i km vi au. Tnh cht nn gn ging nh hp mn v ().
c. Ni soi bng ng mm: thy tn thng lot vng ming ni (). 60. iu tr (-S): a. Nu au khng nh hng nhiu ti sinh hot, cng tc th iu tr ni khoa nh lot hnh t trng (). b.Nu trc y ni v trng th m li ct dy X (S). c.Nu ct 2/3 d dy th m li kt hp ct 2 nhnh dy X i vo d dy (). 61. Lm sng th x gan cn b tt (-S): a. C nng: - Ri lon tiu ho: n khng tiu, y bng, chng hi (). - au d di vng h sn phi (S). - Chy mu cam khng r nguyn nhn (). - Nc tiu trong (S). - Suy gim tnh dc: nam lit dng, n v kinh, v sinh (). b.Thc th: - C gan hi to v chc, lch to hi qu b sn (). - C sao mch lng, ngc, bn tay son (). - Lng nch, b phn sinh dc bnh thng (S). - Mng tay kh trng (). - nam gii tinh hon teo nho, v to (). 62. Lm sng ca x gan cn b (-S): a. Ton thn: - Gy st nhiu (). - Chn tay khng khiu (). - Huyt p cao (S). b. C nng: - Ri lon tiu ho tng t (S). - Mt mi thng xuyn, t ng, gim tr nh (). - Chy mu cam, chy mu chn rng (). c. Thc th: - Da mt hng ho (S). - Nhiu m xut huyt bn chn, tay, vai, ngc (). - C c chng, tun hon bng h (). - Gan thng teo, chc, b sc, mt gan c u cc (). - Ph 2 chn (). - Lch to hn bnh thng (). 63. Thi gian sng thm cho cc bnh nhn x gan mt b nh sau tu theo th bnh (-S): - X gan do ru v virus sng thm:
8 nm (S). 4 nm (). 2 nm (S). - X gan mt th pht sng thm: 6 nm (). 8 nm (S). 10 nm (S). - X gan mt tin pht sng thm: 10 nm (S). 7 nm (). 64. D phng x gan (-S): a. Phng nga vim gan virus B, C (). b.Chng thi quen ung ru (). c.Ch n ung cht (). d.Phng nhim sn l gan nh: khng n c sng (). e.iu tr tt cc bnh ng mt (). g.Thn trng khi dng cc thuc c th gy hi cho gan (). h.D phng v iu tr tt cc bnh vim gan cp, mn (). 65. xc nh vim gan mn c 2 yu t sau (-S): a. V thi gian: tnh trng tn thng gan vim: - Trn 4 thng (S). - Trn 6 thng (). - Trn 9 thng (S). b. Tn thng bnh l: + Ch yu l thm nhim khong ca v quanh khong ca: - Bch cu a nhn trung tnh (S). - Bch cu n nhn, lympho (). + Thoi ho t bo nhu m gan nng nh tu theo loi bnh: - C th c x ho Fibrosis nht nh (). - Cu trc tiu thu gan o ln (S). - Cha c u cc tn to gan (). 66. Triu chng lm sng ca vim gan mn tn ti (-S): + Hoc nhiu bnh khng c triu chng lm sng (). + C bnh nhn thy: - Hi au tc h sn phi (). - Chn n, bun nn (). - Mt mi, st cn khng r l do (). - Khng au u tr nh tt, ng tt (S).
- Gan to di h sn phi 4,5cm, mt mm (S). - Khng c lch to (). - Khng c tun hon bng h (). - Khng ph n (). - C sao mch (S). - C bn tay son (S). 67. Ho sinh vim gan tn ti (-S): - Chc nng gan bt thng: + Phosphataza kim tng (S). + Bilirubin tng (S). - Men gan SGOT, SGPT tng cao gp 5 ln bnh thng (S). - Nghim php BSP ri lon nh (). - Globulin min dch IgA, IgM tng mnh, ko di (S). - in di albrumin bnh thng, gamma globulin tng nh (). - Khng c khng th khng c trn, khng nhn (). - Khng nguyn HBs (AgHBs) c th (+) (). 68. Tin trin v tin lng vim gan mn tn ti (-S): a. Vim gan mn tn ti thng l nh (): - Tin lng tt (). - Khng tin ti x gan (). - Sau nhiu nm c th hi phc, lnh hn (). b.Vim gan mn tn ti c th tr thnh vim gan mn tn cng (): - Ngi vim gan mn tn ti ung ru nhiu (). - Bi nhim thm HBV, virus Delta, virus C (). - Nhng ngi vim gan mn tn ti vc xt nghim HbsAg (+) tin lng tt hn ngi vim gan mn th tn ti c xt nghim HbsAg (-) (S). 69. iu tr vim gan mn th tn ti (-S): a. n ung cht b: m, vitamin (), tng m (S). b. Dng corticoid (S) ch cn cho vitamin B1, C, nhun mt (). c. Ngh ngi trong t tin trin (). d. Khm nh k 6-12 thng / ln (). 70. Gii phu bnh vim gan mn hot ng (thm nhm t ph hp): a. Khong ca b thm nhim dy c cc t bo (n nhn tng bo) lm cho khong ca (rng to ra) thm nhim pht trin vo trong (tiu thu) gan. b. Hoi t t bo gan ra khong ca, lp t bo gii hn b (ph hu) tng ch to nn hnh nh nham nh ra khong ca, hoi t kiu (mi gm). 71. Gii phu bnh vim gan mn hot ng (thm nhm t ph hp): a. Ni thu gan c hoi t tng quanh cc tnh mch (trung tm) vi nhng biu
hin ti to ca gan nh: t bo gan xp thnh hnh (hoa hng) hay hnh gi (tuyn), nhng trng hp nng c th thy hnh nh t bo (hoi t) xp thnh (cu ni) nhiu thu. b. Cc vch ngn m (lin kt) lan to nh cc ngn tay, lan t cc khong ca vo su trong (ni thu) gan. c. C th thy trn cng mt mnh (sinh thit) c hnh nh vim gan mn hot ng v hnh nh (x) gan. 72. Triu chng lm sng ca vim gan mn hot ng (thm t, nhm t ph hp): a. (Triu chng v gan): tng t nh triu chng vim gan mn th tn ti nhng mc nng n hn, ko di hn. Ngoi ra thy vng da, ph n c khi chy mu. b.(Cc triu chng ngoi gan): mt kinh, a lng c mu do vim lot i trng kt hp, trn dch ph mc, thiu mu, suy thn, kh gic mc, kh ming. 73. Cc xt nghim vim gan mn hot ng (-S): a. Sinh ho gan: - Gros, Maclagan (-) (S). - Men transaminaza tng gp 5 ln ch s bnh thng (). - Bilirubin mu gim trong t tin trin (S). - Phosphataza kim gim nh (S). - Gamma globulin tng cao vt 25% c khi ln 70% (). - T l prthrombin thng gim giai on mun (). b. Xt nghim min dch: - Globulin min dch tng nht l IgG (). - mt s bnh nhn tm thy HbsAg v HbeAg trong huyt thanh (). - C th khng thy khng th khng c trn, khng th khng nhn hoc khng th khng ti lp th (S). 74. K cc phng php thm d vi vim gan mn hot ng c c cc hnh nh tn thng sau (thm on t cho ): a. (Soi bng): gan to hn bnh thng, mu sc loang l, ch nht mu, ch rc, mt gan nhn nheo nhng trng hp nng gn nh ni cc d nhm vi x gan. b. (Sinh thit gan): c hnh nh m bnh hc ni k trong phn gii phu bnh l. c. (Siu m gan): kch thc gan tng nhng nhu m gan cha c bin i r rt. 75. S thng gp v yu t lin quan K gan nguyn pht (-S): - T l mc K gan: 5-6% tng s cc K (). - Tui hay gp: trn 70 tui (S). - Nam gp t hn n (S). - Cc yu t lin quan: + Nm mc: aflatoxin v luteoskynin (). + Virus B, C ().
- Cc cht c, ho cht: + Cht da cam (2,4.5T v 2,4D) (). + Cht trng (2-4D picbrem) (). + Cht xanh (mui axenic) (). - Vai tr tin ung th gan: 65-80% K gan gy ra sau x gan (). - Mt s yu t ang tip tc nghin cu: + Dinh dng km (). + Ging ngi (). + Vn di truyn (). 76. Mt s triu chng khu gi K gan khi pht (-S): - Ri lon tiu ho nh: n t, chm tiu c th c bnh nhn n nhiu ln nhng khng bo m li gy i (). - Tc nng hay hi au vng h sn phi y l triu chng sm thng c ch (). - Gy st cn, mt mi r l do (S). - Tnh c s thy c mt khi u vng h sn phi. Ton trng vn bnh thng v c mt khi u nn bnh nhn i khm (). - Hoc bnh nhn khm bnh v l do khc, qua khm xt ton thn thy thuc pht hin gan to (). 77. Giai on ton pht ca K gan nguyn pht cc triu chng sau thuc nhm triu chng c nng hay thc th (thm cc nhm t): a. (Triu chng c nng): - Ri lon tiu ho: bng c th chng to, sau n thy tc bng y hi, i khi c bun nn, nn. - Mt mi tng nhiu, khng lao ng c, gy st cn nhanh 5-6kg/ thng. - au tc vng h sn phi c khi au d di nh cn au qun gan nhng thng xuyn lin tc hn. b. (Triu chng thc th): - Gan to ton b hay mt phn, cng mt gh gh, n au, di ng hn ch. - Lch khng s thy hoc i khi thy di b sn tri 2-3cm chc. - C th c c chng, tun hon bng h. - Gy, c bp teo nh, suy kit. - Da vng rm, xanh bng, vng bn. - Ph, xut huyt, sao mch, bn tay son. - C cn au bng nh vim phc mc cp. 78. Cc k thut chn on no cho bit cc hnh nh tn thng K gan nguyn pht di y (thm cm t ph hp): a. (Xquang): bng gan to, vm honh phi ln cao, di ng c honh km. b. (Chp ng mch chn lc): cho bit khu vc tng ti mu hoc hnh nh bin
dng ca thn ng mch ln trong gan. c. (Chp gan vi ng v phng x): cho bit v tr tn thng ca u, K gan. d. (Siu m gan): tm khi u tng m, gim m. e. (Soi bng): thy trn mt gan c u cc to, nh mu trng ng, xung quanh khi u c mch mu ni r (tng ti mu), hoc trn mt gan c u cc sn si nh hoa supl hoc nh chm nho d chy mu. Kt hp sinh thit lm m bnh hc. f. (Cc xt nghim ho sinh): nh lng alphafeto Protein (AFP). Bnh thng AFP< 5ng/ml. Trong K gan AFP> 100ng/ml. Arginaza bnh thng Arginaza >120 UI, trong K gan Arginaza gim < 30UI. 79. Chn on xc nh K gan nguyn pht da vo (-S): Lm sng: a. Gan to chm, mm, trn mt gan khng c u cc to cng (S). b. C th suy sp chm 1-1,5kg/1 nm, n ung bnh thng (S). c. au vng mi c (S). 80. Da vo cc xt nghim nghi ng K gan nguyn pht (-S): a. U gan cng kt hp AFP> 100ng/ml (). b. U gan kt hp vi sinh thit gan c t bo ung th (). c. U gan kt hp vi Arginaza <30 n v quc t (). 81. Nh cc k thut no phn bit K gan vi cc bnh khc ca gan (thm t, nhm t thch hp): a. U nang gan gan (phn bit nh siu m, soi bng). b. p xe gan (soi bng, siu m, x gan). c.X gan ph i (soi bng, sinh thit gan). d.Gan to mt (soi bng, sinh thit gan). e.Giang mai gan (soi bng, AFP). g.Lao gan (soi bng, sinh thit gan ) h.Gan to trong bnh tim (khm tim, nh lng AFP). j.U nang sn, u mu, nm gan (soi bng, siu m, m thm d)
#8 07-08-2008, 07:44 AM
C tt c 4 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny : Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
Digoxin
P N TRC NGHIM LS TIU HO(Phn 2)
82. Chng vng da (icterus) l tnh trng nhim sc t mu vng da v nim mc do (-S): - Tng caroten huyt (S). - Tng Bilirubin huyt ton phn (). - Tng Bilirubin huyt trc tip (). - Tng Bilirubin huyt gin tip n c (S). - Tng sn xut hc t Melanin (S ). 83. Sc t da ca cc chng tc c quyt nh bi s lng ca (-S): - Melanin (). - Oxyhemoglubin (). - Hemoglubin kh (). - Caroten (S). - Bilirubin huyt (S). 84. Chng vng da (icterus) l mt triu chng ch im bnh l (-S) : - Thiu mu (S). - Tc mt (). - Tn thng t bo gan (). - Huyt tn (). - Si c ti mt (S). 85. Ngun gc Bilirubin c sn xut t (-S): - Phn ln t hng cu gi (). - Globin (). - Hem (). - Acid glucoroni (S). - Phn nh t cc t bo dng hng cu ang trng thnh trong tu xng (). 86. Bilirubin gin tip uc chuyn thnh Bilirubin trc tip bng cch lin hp vi acid glucoronic (-S): - Trong mu (S).
- Trong ng mt v trong ti mt (S). - Trong ni bo tung ca t bo gan (). - Trong ni bo tung ca t bo kupffer (S). - Trong lng rut (S). 87. Chuyn ho Bilirubin rut.Sau khi sc t mt ( Bilirubin-Acid glucorocid) xung rut cng vi Acid mt tham gia tiu ho thc n; sn phm chuyn ho ca sc t mt c ti hp thu t nim mc rut non vo tun hon ca di dng (-S): - Stercobilirubin (S). - Stercobilinogen (S). - Bilirubin-Acid glucoronin (S). - Urobilinogen (). - Urobilirubin (S). 88. Lm sng chn on vng da da vo (-S): - Da vng, nim mc mt khng vng (S). - Da vng, nim mc mt vng (). - Phn vng (S). - Phn bc mu hoc sm mu (). - Nc tiu vng hoc/v sm mu (). 89. Cn lm sng chn on vng da da vo (-S): - Bilirubin gin tip c trong nc tiu (S). - Bilirubin trc tip c trong nc tiu. (). - Urobilirubin nc tiu > 0,2 mg/ l (S). - Bilirubin huyt tng (). - Stercobilin c trong phn (S). 90. Chn on vng da truc gan (huyt tn) da vo (-S): - Gan to mm n au tc (S). - Lch to (). - Hi chng thiu mu () - Phn bc mu (S). - Nc tiu sm mu (). 91. Chn on vng da trong gan (vim gan vi rt cp) da vo (-S): - Lch to n au tc (S). - Gan to mm, n au tc (). - Hi chng nhim trng nhim c (). - Khi xut hin vng da thng vn st (S). - Tng Bilirubin huyt gin tip chim u th (S). 92. Chn on vng da sau gan (si ng mt ch) da vo (-S): - Cn au qun gan (). - Khi xut hin vng da thng ht st (S).
- Phn sm mu (S). - Nc tiu sm mu (). - Tng Bilirubin trc tip chim u th (). 93.Chn on vng da sinh l tr s sinh da vo (-S): - Vng da ,vng nim mc mt xut hin t ngay sau sinh n ngy th 15 sau sinh (S). - Vng da,vng nim mc mt xut hin t ngy th 2 sau sinh n ngy th 15 th ht (). - Gim hot ca Enzyme (Tranferase-Bilirubin-Glucoronyl) chuyn Bilirubin gin tip thnh Bilirubin trc tip (S). - Gim hot tnh ca Enzyme (Tranferase-Bilirubin-Glucoronyl) chuyn Bilirubin gin tip thnh Bilirubin trc tip () - Tng Bilirubin huyt gin tip chim u th (). 94.Chn on vng da nh do dng thuc (Cloramphenycol, Methyltestosterol, Flafasvidic) da vo (-S): - Vng da xut hin sau dng mt trong cc thuc trn (). - Vng da khng mt i khi ngng thuc (S). - Vng da km gim bi xut BSP, tng Phosphastase kim trong mu (). - Vng da km theo GPT,GOT tng trong mu (S). - Tng Bilirubin huyt gin tip chim u th (). 95. C trung t do l (-S): - Tnh trng bng chng hi ( S). - Tnh trng dch xut hin kh tr ti mt v tr no trong bng (). - Tnh trng dch xut hin gia l thnh v l tng trong bng (). -Tnh trng bng to do lp m dui da bng dy ln (S). 96. C trung dch thm (-S): - Dch c trung mu vng chanh v c (S). - T trng ca dch c trng > 1,016 (S). - nh lung protein trong dch c trng < 25 g/l (). - Xt nghim dch c trng : S lng t bo bch cu <.250 t bo/mm3 (). - Dch c trng c phn ng Rivalta dng tnh (S). 97. C trng dch tit (-S): - Dch c trng trong, mu vng nht hoc khng mu (S). - T trng dch c trng <1,016 (S). - Dch c trng c phn ng Rivalta dung tnh (). - nh lng protein trong dch c trung > 25 g/l (). - Xt nghim dch c trng s lung t bo bch cu >1000 TB/mm3 (). 98. Chn on c trng t do mc t (c lng <1lt) da vo (-S):
- Da bng cng, rn li, bng b sang hai bn t th BN nm (S). - Du hiu sng v dng tnh (S). - G bng c vng thp (). - G bng; ranh gii c trong l mt ng cong c nh quay xung di (). - Du hiu cc ni dng tnh (S). 99. Chn on c trng t do mc va/ nhiu (c lng 1 n 5 lt/ trn 5 lt) da vo (-S): - Da bng cng, rn li, bng s xung di ra trc t th BN ng .(). - G bng : c vng cao (S). - G bng : ranh gii c trong l mt ng cong c nh quay xung di (). - Du hiu sng v dng tnh (). - S bng khng u: ch mm, ch cng, ch chc (S). 100. Chn on c trng t do nguyn nhn do x gan da vo (-S): - Dch c trng khng mu hoc vng nht (). - C trng t do ng thi c tun hon bng h (). - T trng dch c trng > 1,016 (S). - Phn ng Rivanta dng tnh (S). - S lng t bo bch cu trong dch c trng >1000 TB/ mm3 (S). 101. Chn on c trng t do nguyn nhn do suy tim da vo (-S): - C trng t do v ph mm n lm hai chi di, ph tng vo bui chiu (). - C tng t do xut hin cng gan to mm, phn hi gan tnh mch c dng tnh. (). - Dch c trng mu vng chanh v c (S). - T trng dch c trng > 1,016 (S). - nh lng protein trong dch c trng >25 g/ l (S). 102.c im c trng t do nguyn nhn do vim cu thn mn, hi chng thn h (-S): - C trng t do v ph mm ton thn n lm, ph tng vo bui sng (). - C trng t do xut hin cng gan to mm, phn hi gan tnh mch c dng tnh (S). - Dch c trng c v mu vng chanh (S). - Phn ng Rivanta ca dch c trng dng tnh.(S). - Xt nghim t bo dch c trng s lng bch cu < 250 TB/ mm3 (). 103. Nu cc c im ca triu chng lm sng vim ng mt (-S): a. au bng d di vng h sn phi khng lan (S). b. St va phi khng rt run (S). c. Vng da m, khi vng da ht st (S).
d. Khm xt: - Th trng gy st (). - Gan to 1-3cm di h sn phi, mm (). - Ti mt to (). 104. Cc xt nghim thm d vim ng mt (-S): a. Xt nghim mu: - Bch cu a nhn trung tnh tng (). - Bch cu a nhn trung tnh gim (S). - Tc mu lng tng (). - Tc mu lng gim (S). b.Sinh ho mu: - Bilirubin mu kt hp tng (). - Bilirubin t do tng (S). 105. Thm cc nhm t vo cc bin chng vim ng mt cho hp: a. Thm mt (phc mc). b. Vim ti mt (hoi t). c. p xe gan (nh). d. Nhim khun (mu). e. Sc (mt). f. X gan (mt). g. Chy mu (ng mt) lai vim do si. 106. Cc du hiu sau l triu chng no ca vim ti mt cp (thm t, nhm t cho ph hp): a. (Thc th): - St: bao gi cng c st 390-400 C. - Vng da nim mc nh 10% khi c tn thng ng mt. - n vng h sn phi c phn ng co cng v au. - S thy ti mt to v au. b. (C nng): - au h sn phi: + c cn au qun gan tng dn. + c khi au m ngi gi. - Bun nn hoc nn l triu chng hay gp. - Nc tiu vng khi c tn thng ng mt ch km theo. 107. Cc k thut thm d no thy vim ti mt cp c cc du hiu sau (thm t, nhm t ph hp): a. (Xt nghim mu): - Bch cu tng 10.000, t l bch cu a nhn trung tnh tng cao. - Amylaza bnh thng nu c cao phi ngh n vim ty kt hp.
b. (Siu m): - C im r rt khi n u d siu m vo ti mt, l im Murphy siu m. - Thnh ti mt dy trn 0,3cm, bnh thng di 0,3cm. - Nhiu khi ti mt c hnh 2 b, 2 lp m cch nhau bi lp gim m. - Nu c si thy nt m m v bng cn m. c. (Xquang): - C tim cn quang: + Vim ti mt: nu ng mt ch ngm thuc khng nhn thy ti mt. + Khng ngh ti vim ti mt nu hnh nh ti mt r. - Chp khng chun b thng, nghing phi pht hin si ti mt. 108. Chn on xc nh vim ti mt cp da vo (-S): a. Da vo lm sng: - au h sn tri (S). - Khng st (S). - S ti mt khng to (S). b. Da vo: - Xquang: ti mt khng nhn thy (). - Siu m: thnh ti mt dy > 3cm. (). - Soi bng: ti mt cng to, xung huyt, dnh (). 109. Chn on phn bit vim ti mt cp vi bnh no c nhng biu hin sau (thm t, nhm t ph hp): a. (p xe gan): gan to au, rung gan (+), Ludlow (+). b. (Vim gan virus): st, au h sn phi, vng da, khi vng da ht st, men gan SGOT,SGPT tng cao. c. (Vim ng dn mt): au h sn phi, st, vng da, khi vng da vn st. 110. Vim ti mt cp c cc th bnh sau (-S): a. Vim ti mt cp nc (). b. Th vim ti mt cp mng m (). c. Vim ti mt cp hoi t (). d. Vim ti mt cp c si cholesterol (). e. Vim ti mt cp sau nhim khun mu, thng hn, hi lu dch ty vo ng mt, n c thai thng th 6-7 t gp (). 111. Cc bin chng no ca vim ti mt cp c cc du hiu sau (thm t, nhm t ph hp): a. (Vim ng mt): gan to, mm v au st, vng da. b. (Vim mng bng ton th): vim ti mt cp c th dn ti tnh trng ti mt b thng hoc ti mt cng to, thnh ti mt c nhiu m mt, thm mt gy nn vim mng bng mt. c. (Vim mng bng khu tr):
- S thy mt m qunh vng ti mt, st cao. - Hoc mt apxe di c honh: bnh cnh ca m su v phn ng ca rmng phi. d. (R mt vi ng tiu ho): vim ti mt cp c th dn ti tnh trng d mt vo t trng, i trng, d dy. 112. Cc triu chng di y thuc nhm du hiu c nng, ton thn v thc th ca vim ti mt mn (thm t, nhm t ph hp): a. (Du hiu ton thn, thc th): - Mt mi nhiu. - Suy nhc thn kinh, d kch thch mt ng. - Gy st dn c trng hp gy st n mc lo ngi. - Ri lon kinh nguyt. - Ri lon tun hon: nh trng ngc, kh th khi gng sc. - C trng hp vng da nh. b. (Du hiu c nng): - au vng h sn phi thnh cn. Cn au ko di vi ngy nhng cng c trng hp cn au ko di hng tun, hng thng. - C th km theo co tht i trng, a phn lng c nhy. - St nh, c khi khng st ch cm thy gai gai rt. 113. S dng k thut thm d no bit c cc du hiu di y ca vim ti mt mn (thm t, nhm t ph hp): a.(Xquang): Chp ti mt c thuc cn quang thy hnh ti mt y thuc cn quang nhng nh hoc hnh ti mt ch hi ngm thuc cn quang nhng khng thay i hnh th hoc hnh nh ti mt co tht hoc hnh nh ti mt y. b.(Ly dch mt): - Mt B c qunh, c, mu xanh do Bilirubin chu tc dng ca axid do vim. - Mt B c albumin tng, bnh thng < 0,8g/l, c t bo m. c.(Soi bng): Nhn thy: - Ti mt vim dnh vi t chc xung quanh - Thnh ti mt dy ln, mu trng c nhng t chc dnh dy hn v chc hn. d.(Siu m ti mt): - Thnh ti mt dy 0,8-1cm, hnh ti mt c th bnh thng nhng phn ln l bin dng (hnh 2 ti, hnh mc cu). - Th tch ti mt c th b thu nh (vim x teo). - Thnh ti mt b vi ho to thnh hnh mt vng cung m m km theo hnh bng cn m rng (hnh v s).
114. Chn on xc nh vim ti mt mn da vo (-S): a. au vng ti mt, khng r cn au qun (). b. Hi chng nhim khun khng r rt (). c. Ri lon tiu ho khng c hiu (). d. Ly dch mt: mt B c vi khun hoc thay i thnh phn mt l du hiu c bn nht chn on (). e. Siu m v soi bng c hnh nh vim ti mt mn (). 115. D phng v iu tr vim ti mt mn (-S): a. D phng: - n tng m, tng thc n quay rn (S). - Khi vim ti mt cp cn c iu tr tch cc, khi khi cn c iu dng ko di (). b. iu tr: - n ch t rau (S). - Chm hoc chm nng vo giai on au (). - Lm gin c bng papaverin 0,04 x 4v /24h, t 7 ngy (). - Ht dch mt lm lu thng mt (). - Dng khng sinh cn thit theo khng sinh (). - Nu ti mt c si v vim nn m ct ti mt (). 116. S thng gp (-S): - Si mt ng hng th 2 trong cc bnh gan mt, 90% cc bnh vim ng mt do si gy nn (). - Vit Nam si ng mt ln 95%, si ti mt 4-5% (). - Cc nc u- M si ti mt 80%, si ng mt nhiu hn (S). - S phn b si mt trn th gii ph thuc vo 2 yu t ging ni v ch n ung () 117. Cc triu chng sau thuc nhm triu chng no ca vim ng mt do si (c nng, thc th). a. (C nng): - au: + au kiu cn au qun gan. + au thng xy ra sau ba n nhiu m hoc au v 22h. + au thng km theo nn, khng dm th mnh. + Cn au ko di vi ngy. - Ri lon tiu ho: chm tiu, bng chng hi, s m, to bn, a chy sau ba n. - Cn au na u (migraine): au na u d di, nn nhiu. - St: do c vim ng mt, ti mt.
- Vng da kiu tc mt: vng da, nc tiu vng, phn bc mu. b. (Thc th): - Gan to: + Mp m hoc di b sn phi 5-6 cm + Mt gan nhn. + B gan t. + Mt chc. - Ti mt to: + To cng vi gan to. + au khi s nn. + C th c co cng b sn phi. 118. Th lm sng ca si mt (-S): a. Th in hnh: c cn au qun gan. - Rt in hnh: + au, st, vng da ti pht nhiu ln (). + Khng c hi chng tc mt (S). - in hnh: + au, st, vng da (). + Hi chng tc mt khng y (). - in hnh t: + au, st, vng khng ti pht nhiu ln (S). + Hi chng tc mt khng biu hin lm sng (). b. Th khng in hnh: khng c cn au qun gan nhng thiu cc du hiu khc: - C hi chng tc mt (vng da, gan to, ti mt to) nhng khng c cn au qun gan hoc au nh h sn phi (). - C cn au qun gan in hnh nhng khng c vng da, khm khng c gan to, khng c ti mt to (). 119. Hy cho bit v tr si nm u khi lm sng c nhng triu chng sau (thm nhm t ph hp): a. (Si bng Vater): cc triu chng lm sng au, st, vng da v hi chng tc mt. b. (Si ng mt ch): triu chng y nh trn nhng mt s trng hp khng in hnh v ng Choledoque gin rt to lm cho triu chng gim bt hoc khng c. c. (Si ng ti mt v ti mt): khng c triu chng tc mt, ch c au rt t nhng st nhiu v ko di, khm thng thy ti mt to v au. d. (Si ng mt ln trong gan): thng nm ng gan tri, triu chng au rt t nhng st ko di. Triu chng tc mt r nhng khng c ti mt to. 120. Chn on si mt v lm sng c 3 tnh hung : A: triu chng lm sng in hnh; B: triu chng lm sng khng in hnh; C: ngi bnh i vin v cp cu do
bin chng. Hy xem cc nhm triu chng sau thuc tnh hung no (A,B,C). a. Nhm 1: (B) - C cn au qun gan, khng hong n, khng tc mt. - Hoc c hi chng tc mt nhng au qun gan khng r. b. Nhm 2: (A) - Cn au qun gan: st, vng da, nim mc. - Hi chng tc mt; gan to, ti mt to, phn bc mu. - Bnh ti pht nhiu ln. - Chn on ng si mt 75-85% (ng Vn Chung). c. Nhm 3: (C) - Vim phc mc cp: nhim trng nng, bng cng v au. - Sc nhim khun: st cao, huyt p h, mch nhanh nh, ht hong. - Vim ti mt cp: st, ti mt to, au. - Chy mu tiu ho: nn mu c hnh thi nh rut bt ch. - Vim ty cp: au bng, nn, chng bng - Hoc v au m h sn phi, ri lon tiu ho khng r nguyn nhn. 121. Chn on phn bit si mt vi nhng trng hp tc mt (-S): a. U u ty: - Tc mt t t ngy cng gim (S). - au vng h sn phi (S), khng st (). - Xquang: khung t trng gin rng (). b. Vim ty mn th tc mt: - Triu chng nh u u ty (). - Chn on kh (). - Phi m thm d xc nh (). c. Vim vi ti mt qun tin pht: - Giai on u c vng da tc mt, km theo st v au h sn phi (). - Cui cng dn ti x gan lch to (). - Thng t trng dch mt vn bnh thng (). - Chp ng mt vn bnh thng khng tc (). - Chn on bng siu m v sinh thit gan (). d. Ung th bng Water v ng mt: - C hi chng tc mt i khi st (). - Tin trin nhanh, gy st (). - C tin s au h sn phi (S). - Chp ng mt hoc siu m xc nh (). 122. Chn on phn bit si mt vi nhng trng hp vng da khng do tc mt (S): a. Vim gan virus ().
b. Vim gan mn: - C nhiu t st, vng da (). - au nh vng h sn tri (S). c. Bin chng ca lot d dy t trng (thng, dnh vo ng mt gy ra): - Nhng t st, vng da (). - au h sn tri (S). d. Huyt tn: v d bnh Gilbert hoc Dubinjohnson (). 123. Phn bit si mt vi nhng trng hp au h sn phi l bnh no khi gp cc triu chng sau (thm nhm t ph hp): a. (Giun ln ng mt): - au h sn phi d di, chng mng d chu. - Cng c st, vng da, chn on da vo siu m mt. b. (Lot d dy, t trng): - au thng v c chu k: au lc i, au lc no. - Khng st, khng vng da. - Chn on da vo Xquang d dy. c. (Ri lon hot ng ti mt): - au h sn phi, nu n thng xy ra lc hnh kinh, c thai - Khng st, khng vng da. - Chn on da vo ly dch mt nh pht: b ri lon. 124. S thng gp (-S): a. Vim ty cp him gp khong 1-2% cc cp cu v au bng (). b. Vim ty cp xy ra mi la tui nhng hay gp ngi di 30 tui (). c. Gii: nam gp nhiu hn n (S). 125. Nguyn nhn vim ty cp (-S): a. Cha r nguyn nhn (). b. Mt s yu t thun li: - Ngi gy (S). - Ngi bo (). - n nhiu m, m, trng (). - Ngi b si mt (). - Ngi b giun ln ng mt (). - Lot d dy (). - X gan (). 126. Cc thuyt v c ch bnh sinh vim ty cp (-S): a. Thuyt v gii phu: v dch ty, dch mt cng vo bng Valter nn khi c tc mt lm tro ngc mt ln ng Wirsung chuyn pepsinogene thnh pepsin, pepsin hot ng gy tiu hu nhu m ty (vim ty cp) ().
b. Thuyt v ri lon lu thng dch ty (). c. Thuyt v ri lon chuyn ho: - Ri lon chuyn ho m (). - Ri lon chuyn ho ng (S). d. Cc thuyt khc: - Nhim c ru (). - Nhim khun (). - D ng (). - Chn thng bng (). 127. Triu chng c nng ca vim ty cp (-S): a. au bng: - V tr au: thng v (), h chu tri (S). - Tnh cht au: + au lan ln ngc (S). + au d di, t ngt, ko di khng dt cn (). + C khi au qun nh au si mt (). b. Nn: - Khi au c nn nhiu, nn xong ht au (S). - Nn kch lit dai dng kh cm (). - Cht nn l dch mt, c khi nn c mu (). - Nn nhiu gy ri lon nc, in gii (). c. Chng bng, b trung, i tin: - Cm gic bng cng, tc th, khng trung tin c (). - C th a lng 5% s bnh nhn (). 128. Nhng du hiu ton thn, thc th ca vim ty cp (-S): a. Triu chng thc th ngho nn (). b. Ton thn: - Da mt trng bch (S). - Da vng (t gp) (). - Mch chm (S). - Huyt p lc u tng sau h (). - Thn nhit gim (S), hoc tng cao (). - V m hi, kh th, s (). c. Nhn bng thy: - Cc vt xanh lc quanh rn (du hiu Callen). () - Du hiu xut huyt thnh bng bn tri (du hiu Gray- Turozer). () d. Khm bng: - Chng nh, vng thng v phn ng nh. () - im sn sng lng bn tri au. ()
- G vang gia bng, c vng thp. () 129. Cc kt qu xt nghim vim ty cp (-S). a. Mu: - Amylaza mu gim. (S) - Canxi mu tng. (S) - ng mu cao. () - Lipid mu bnh thng. (S) - Lipaza tng cao. () - Bch cu a nhn tng. () - Ur mu tng. () b. Nc tiu: - S lng nc tiu gim. () - C tr ht, protein (+). () - Amylaza niu tng cao. () - ng niu (+). () - C hng cu niu. () c. T s: crearance amylaza x 100 trn 5% () crearance creatinin 130. Cc kt qu thu c sau y v xt nghim ca vim ty cp cho bit k thut thm d no (vit thm cm t ph hp): a. (Xquang chp bng khng chun b): - i trng gin to cha y hi. - C th thy hnh cn quang bn phi (si ti mt). - Hai du hiu (-): + Khng c lim hi. + Khng c du hiu mc nc, mc hi. b. (Chp d dy): - Khung t trng gin rng, - D dy b y ra trc. 131. Chn on xc nh vim ty cp da vo (-S): a. Lm sng: - au bng m , xy ra sau ba n thnh son (S). - au bng km theo nn,nn xong au (S). b. Xt nghim mu, nc tiu: - Amynaza mu v trong nc tiu tng cao (). - T s: crearance amylaza < 5% (S) crearance creatinin c. Xquang bng; - i trng gin cha y hi (). - Thy lim hi, thy mc nc, mc hi. (S)
d. Soi bng: thy vt nn. () 132. Phn bit vim ty cp vi nhng tn thng hay bnh no c nhng biu hin triu chng sau (thm cc nhm t thch hp): a. (Thng d dy, tng rng): - au bng d di, c co cng thnh bng. - Xquang bng: c hnh lim hi. b. (Tc rut): - au tht bng, nn nhiu. - Xquang bng thy: mc nc, mc hi. c. (Cn au bng gan mt): - C th c tam chng Charot: au, st, vng da. - Soi bng thy tn thng gan mt. - Siu m thy hnh si gan mt. 133.Vim ty cp th ph n (-S): - au bng d di khng nm yn tnh c. (S) - Tnh trng chung t thay i. () - Nn nhiu, c phn ng thnh bng. (S) - Chn on da vo amylaza mu cao. () 134. Vim ty cp th hoi t xut huyt (-S): - au bng d di, c biu hin chong, mch nhanh nh, huyt p gim. () - Khng nn, da nim mc bnh thng. (S) - Bng mm, khng c phn ng thnh bng, ct cn au d. (S) - Chn on xc nh nh m hoc gii phu thi th. () - T l t vong: 25-30% () 135. Vim ty cp nung m (-S): - Khng au bng, khng co cng bng, khng lit rut. (S) - Hi chng nhim trng: st cao, mi kh, li bn, mun hn sau vi ngy. () - Chn on xc nh khi phu thut c nhiu m bng u kim mu trng, vng khu tr vng u ty, c khi gy p xe di c honh. () 136. Bin chng ca vim ty cp (-S): - p xe ty: st cao dao ng, suy sp. () - Nang gi tuyn ty. () - R. () - Vim tnh mch gnh. () - Tc rut. () - Tc mt. () - Vim d dy. (S) - Nhim khun. () - Bnh c th chuyn thnh mn tnh km theo tn thng ni tit gy i ng. ()
- Basedose. (S) 137. Nguyn nhn vim ty mn cha r, c th l (-S): - Sau vim ty cp ti pht nhiu ln. () - Si ng mt. () - Tn thng cc mch ma ca tuyn ty. () - Bnh t min. () - Ri lon chuyn ho: n ung khng hp l, suy dinh dng. () - Sau nhim c: ch, ru, thu ngn, phospho() - Sau phu thut gan, ng mt. () - Sau thng lot ca d dy vo ty. () - Yu t di truyn. () 138. Gii phu bnh l vim ty mn: hnh nh no thuc vi th, i th (thm t, cm t ph hp): a. (i th): - S thy tuyn ty cng chc. - Mt tuyn ty khng u ri rc cc nang (kystes). - Tn thng ton b ty hoc khu tr ch u ty, thn, ui ty. b. (Vi th): - Tng sinh ca t chc lin kt quanh tiu thu, trong tiu thu. - Cc mch mu x ho. - Mt s si thn kinh tng sn. - Cc lp biu m ca tuyn mt. - Cc ti sinh hnh thnh cc xoang nh p vo ng dn dch ty. - ng ty c ch gin, c th c si. - Cc tiu o Langehans c th teo x ho. 139. Tnh cht au bng ca vim ty mn (-S): - au vng thng hoc h sn phi (). - au lan ln ngc. (S) - au gim khi bnh nhn dui thng. (S) - Tnh cht cn au: + au lm rm, cng c lc au d di (). + Mi ln au ko di vi ngy, hng tun. () + Cn au ti pht khi n king m hoc cc cht chua cay. (S) 140. C ch sinh au bng pht sinh khi (-S): a. Tng rng b cng gin qu mc () b. Khi nhu ng co bp ca tng rng tng qu mc gy tng p lc cao hn bnh thng: hp mn v, tc rut, si mt()
c. Mng bng b kch thch: thng d dy, vim mng bng, chn thng bng () d. Kch thch bnh l i vi ni tng: p xe gan. Vim ty cptc ng ln cc dy thn kinh giao cm ni tng gy ra au () 141. K 3 tng cc v tr au sau ( thm nhm t ph hp): a. au vng thng v: - (D dy) - (T trng) - (Ty tng) b. au h sn phi: - (Gan) - (Mt) - (a trng gc gan) c. au h chu phi: - (Rut tha) - (Manh trng) - (Niu qun gia bn phi) 142. K cc hon cnh xy ra cc tn thng sau (thm nhm t ph hp): a. Thng tng rng: d dy, rut(xy ra t ngt) b. au qun gan thn: (xy ra sau lao ng gng sc) c. Vim ty cp: (xy ra sau ba n thnh son) 143. Hng au lan ca cc bnh sau (thm nhm t ph hp): a. Lot d dy: (au lan sau lng, sang tri) b. Lot hnh t trng: (au lan ln ngc, sang phi) c. Si mt: (au h sn phi, lan ln ngc, ln vai phi) d. Si niu: (au mng sn, lan xung b phn sinh dc) 144. Tnh cht au bng (thm t, nhm t ph hp): a. y, nng, m ch, kh tiu: gp trong (gim) trng lc d dy. b. Cm gic rt bng: do tnh trng (qu cm) ca nim mc d dy. (Nng) nh st t hoc (cn co) d dy gp trong vim d dy cp. c. au thc s: tu bnh, tu cm gic ca mi ngi c th gp au nh (dao m) trong thng tng rng, (xon vn) trong xon rut cp, (nhoi nhi m ) trong dnh tng, bnh mn. d. au qun: l cm gic c bit, au thnh (tng cn) mt v tr (nht nh) tri ln ri du dn cho n cn sau, gia cc cn au l thi k ht (au) hoc (gim hn) thng gp trong qun (gan), qun (thn). 145. Cc yu t nh hng ti cn au bng, gp trong bnh no (thm t, nhm t ph hp): a. Vn ng: au tng khi vn ng gp trong (si niu) b. n ung: n no au tng gp trong (lot d dy)
c. Thuc men: au bng nhng khi tim Atropin th au gp trong (tng co bp rut) 146. Cc biu hin km theo au gp trong bnh no (thm t, nhm t ph hp): a. Ri lon tiu ho: (bnh d dy, rut). b. Vng da: (si mt, vim gan siu vi trng). c. Nn ma, thc n c: (hp mn v) d. i ra mu: (si niu, lao thn) 147. Tnh trng ton thn ca ngi bnh au bng gi cho ta bnh g (thm t, nhm t ph hp): a. Tnh trng sc gp trong cc bnh: (thng tng rng, chy mu nhiu trong bng, vim ty cp hoi t) b. Vng da, vng mt trong (bnh gan mt) c. Suy mn: (bnh ung th, lao, HIV). d. Nhim khun: (apxe gan, vim mng bng). 148. K 3 du hiu au bng cp ngoi khoa (thm t, nhm t ph hp): - (Thnh bng cng nh g) - (Mt vng c trc gan do thng tng rng) - (Du hiu rn b do tc rut) 149. Cc gi tr thm trc trng, m o nu (thm t, nhm t ph hp): a. Ti cng Douglas au: (vim mng bng, chy mu trong) b. C mu theo tay (lng rut) 150. au thng v cp cu ngoi khoa (-S): a. Nu cc triu chng thng d dy (-S): - Xy ra t t, au nh (S) - Bng mm, cn vng c trc gan (S) - Ton trng: sc, b trung i tin () - Xquang: c lim hi 1 hoc 2 bn () b. Vim ty cp chy mu: - au t ngt vng thng v sau n () - Sc nng () - Bng mm, im Mayo Robson (-) (S) - Amylaza mu v nc tiu bnh thng (S)
#9 07-08-2008, 07:47 AM Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
Digoxin
P N TRC NGHIM TIU HO(Phn 3)
151. Nu triu chng cn au d dy cp (do lot hoc vim d dy) (-S): - au nhiu vng h sn phi c th c nn (S) - au khng co cng thnh bng, khng mt vng c trc gan () - Tin s au bng khi i (S) 152. Nu triu chng ri lon vn ng mt (-S): - Khng c cn au qun gan (S) - Khng st, khng vng da () - Hay gp nam tr tui (S) 153. K cc trng hp au bng ni khoa chuyn thnh ngoi khoa c cc triu chng sau (-S): a. p xe gan: - au h sn tri tu mc (S) - St cao, dao ng, mi kh, li bn () - Gan to, khng au (S) - Khi p xe v vo mng bng gy vim mng bng cp (bng ngoi khoa cn m cp cu ngay) () b. Si mt: - C cn au qun gan: st nng, rt, vng da, tam chng ny duy nht 1 ln (S) - Vim lan to rng, thm mt phc mc, ti mt cng to do v phi m cp cu ngay () 154. K cc bnh au bng di v h chu ca cc bnh ngoi khoa c cc triu chng sau (-S): a. Vim rut tha cp:
- au m vng h chu tri (S) - Khng c biu hin tnh trng nhim khun (S) - Khng nn, khng b trung i tin (S) - im Macburney au () - Thm ti cng bn phi au () b. U nang bung trng xon: - au h chu d di, t ngt () - Ton trng bnh thng (S) - S thy khi u, theo di thy u to nhanh () c. Cha ngoi d con b v: - C du hiu thai nghn, t ngt au vng bng di h chu () - Ton trng bnh thng (S) - Thm m o: ti cng Douglas cng phng au, c mu theo tay () 155. au ton bng ca cc bnh ngoi khoa vi biu hin triu chng sau (-S): a. Thng rut do thng hn: - ang iu tr thng hn t nhin au bng d di () - Ton trng bnh thng (S) - C phn ng thnh bng, mt vng c trc gan () - Xquang: c lim hi di c honh phi (). b. Tc rut: - au qun bng tng cn, km theo nn, chng bng, b trung i tin () - Quai rut khng ni (S) - Xquang c hnh mc nc, mc hi cc quai rut () 156. Cc bnh sau y c xp vo loi au bng khng c v tr nht nh ca cc bnh ni khoa (-S): - au bng do giun a () - Nhim trng, nhim c thc n () - au qun thn do si () - au bng do d ng gp trong bnh vim thnh mch d ng (Schoelein Henoch) () 157. K cc bnh au bng mn tnh ngoi bnh vim lot d dy t trng. Vit (-S) cho cc bnh sau: - Lao rut () - Vim i trng mn () - Vim mng bng do lao () - VIm phn ph ph n () - Cc khi u bng (u rut, u d dy, u gan, u ty) () 158. Cc bnh au bng khng c v tr nht nh ca cc bnh ni khoa c cc triu chng sau (-S): a. au bng do giun a:
- au vng quanh rn, nn, bun nn () - Th phn khng c trng giun a (S) b. Nhim trng nhim c thc n: - C biu hin ca tnh trng nhim trng, nhim c thc n.() - Khng au bng, khng nn, khng a lng (S) - C du hiu mt nc () c. au qun thn do si: - au qun vng thn vn ng () - au lan ln trn (S) - C km theo i but, i rt, i ra mu () d. au bng do d ng gp trong bnh vim thnh mch d ng (Schoelein Heroch): - au bng m ko di (S) - Sng cc khp, xut huyt di da di dng m chi () - a lng c khi a phn en () 159. Cc bnh au bng mn (ngoi bnh vim lot d dy t trng) c cc triu chng sau (-S): a. Lao rut: - au d di vng h chu phi (S) - Nhim trng nhim c lao,c khi km theo lao cc c quan khc nh: phi, thn () - Ri lon i tin c du hiu bn tc rut (Koenig) () b. Vim i trng mn: - au qun dc i trng () - Ri lon i tin (phn c nhy mu) () c. Vim mng bng do lao: - Nhim khun, nhim c lao () - au bng d di tng cn () - S thy mng chc ri rc, g ch c, ch trong () d. Vim phn ph ph n: - au d di h chu, h v (S) - Ri lon kinh nguyt, ra kh h () 160. To bn chc nng gp trong cc bnh sau (-S) a. To bn thi gian ngn: - Cc bnh tm l ton thn, trng thi nhim khun sau phu thut () - To bn do thuc: an thn, thuc phin, cc thuc phong b thn kinh, vin st () - Do phn x: to bn i km cc bnh si thn, si mt, ph, vim () - Do nhim c ch () b. To bn mn tnh:
- Do thi quen ngh nghip ngi nhiu, t hot ngkhng i tin ng gi, qun i tin lm mt phn x i ngoi () - Ch n ung nhiu rau, khu phn nhiu (S) - Do suy nhc thn kinh lm gim trng lc c, gim nhu ng rut gy to bn () - Ri lon tm thn: lo lng,bn chn qun i tin mt phn x mt rn () 161. Cc bnh sau y c xp vo nhm to bn c tn thng thc th (-S): a. Bnh lot khng tng tit axid gy to bn (S) b. Do cn tr ng i ca phn () c. Do cc bnh i trng: to qu, di qu () d. Vim i trng mn () e. Cc cn tr i tin do t pha ngoi vo trc trng, thai to, u t cung, u tuyn tin lit () f. Tr ni, tr ngoi () g. Cc dy dnh sau m trong bng () h. U no,vim mng no, tng p lc s no v tn thng tu sng cng gy nn to bn cng nn, nhc u () 162. Nguyn nhn a chy cp tnh (-S): a. Nhim khun () b. Nhim c () c. Do thuc () d. Do d ng () e. Do cm xc mnh, chn thng tinh thn () 163. Cc bnh thuc nhm a chy mn tnh c nhng triu chng sau (-S): a. Lao rut: - i tin nhiu ln, phn nho, t di dng () - Khng au bng, khng nhim c lao (S) - Pht hin bng chp cn quang rut hoc tm khun lao trong phn (). b. Vim i trng mn; - Phn to lng tht thng () - Phn khng ln nhy m (S) c. Cc bnh c tn thng thc th khc: - Ung th i trng: xc nh bng soi, Xquang () - Polyp i trng: xc nh bng soi, Xquang () - Bnh vim cui hi trng: xc nh bng Xquang () - Vim trc trng xut huyt () d. Vim ty mn: - a to bn ko di, phn t nc, phn long m, si c (S)
- Phi xt nghim dch ty thng qua t trng () - Xt nghim men ty trong mu tng (S) - Xquang ty thy hnh si hoc vt vi ho () 164. Nhm triu chng sau y ngh ti bnh g (thm t, nhm t ph hp): - Nn nhiu, lc u nn ra thc n, v sau nn ra dch mt, nn xy ra cng lc vi au bng. - au bng d di, tng cn, khng i ngoi, khng trung tin. - Khm bng c triu chng rn b hoc chng hi, au v g vang trng. - Xquang bng c mc nc, mc hi hoc c rt nhiu hi cc quai rut. Ngh ti bnh: (tc rut) 165. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): Tnh cht c im au bng ging nh trong tc rut nhng c thm: - Chy mu ra hu mn. - S bng, thm trc trng c th thy don rut lng thnh mt u mm. - Chiu chp khung i trng c baryt thy hnh nh inh ba hoc cng cua Ngh ti bnh: (lng rut) 166. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): - Nn nhiu cng lc vi au bng v thng xy ra sau ba n. - D dy ni ln thnh u mm vng thng v, c nhu ng km theo - Du hiu c ch lc i (+) - Chp d dy: y d dy hnh chu v sa xung ngang hai gai mo chu trc trn Ngh ti bnh: (hp mn v) 167. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): - Nn. - au bng. - a lng. - C khi nn n thun hoc kt hp au bng. Ngh ti bnh: (nhim trng, nhim c thc n) 168. Nhm triu chng sau ngh ti bnh g (thm t,nhm t ph hp): - Nn vt, nn rt nhiu. - Nhc u d di, to bn. - Soi y mt: c ph n vng mc. - Chc ng sng tht lng, ly nc no tu xt nghim thy c s phn ly t bo vi albumin (s lng t bo khng tng hoc tng t cn albumin tng nhiu), glucoza bnh thng. Ngh ti bnh: (tng p lc s no) 169. Nhm triu chng sau ngh ti bnh g (thm t, nhm t ph hp): Nn, nhc u v to bn ging nh trong u no nhng c nhng triu chng ca
mng no: - Cng gy. - Du hiu Kernig (+) - Du hiu Babinsky (+) - Chc ng sng tht lng thy dch no tu chy nhanh, t bo albumin, glucoza thay i tu theo mi loi vim mng no. Ngh ti bnh : (vim mng no) 170. Gi g khi gp nhng triu chng sau n gii: - Nn t v n thun n gii. - C trng hp nn rt nhiu, dai dng - C du hiu thai nghn: tt kinh, v thm, thch n chua Ngh ti: (thai nghn) 171. Tnh mch ca v tnh mch ch ni nhau (-S): a. Vng ni tm v, thc qun: ni tnh mch vnh v (h ca) vi tnh thc qun di (h ch). Khi tng p lc tnh mch th vng ni ny d v () b. Vng ni quanh rn : tnh mch rn (Arantius) ni vi tnh mch gan (h ca) v tnh mch thnh bng sau (h ch) (S) c. Vng ni tnh mch quanh trc trng: tnh mch trc trng di (h ca) vi tnh mch trc trng di v gia (h ch) (S) d. Vng ni thnh bng sau: cc nhnh (tnh mch ca) chy trong mc treo trng ni tnh mch bng sau (h ch) nhng vng c cc tng dnh vi thnh bng trong mc Told v mc Treitz. Bnh thng cc vng ni ny khng c gi tr chc nng, trong tng p lc tnh mch ca cc tnh mch vng ni ny gin to, c th v gy chy mu (). 172. Tng p lc tnh mch ca c cc triu chng c nng di y (-S): - Kh tiu, dai dng xy ra sau khi n (khng c bnh d dy) () - Chng bng v cm gic y bng vng thng v: xy ra chm sau n bt k thc n g (S) - Cm gic y cng rut thng xuyn (c khi khng to) () - Gy mn dn dn v bt u c du hiu thiu vitamin (trong khi n ung vn y , n vn ngon) () - a chy c chu k, khng km theo au bng, st, cc triu chng ny xy ra dn dn sm hn nhng than phn ca bnh nhn v: gim kh nng lao ng chn tay, tr c () - Cm gic kh chu, au chu k vng thng v, h sn tri (S) - Chy mu ti pht: ming, li, nn mu, a mu () 173. Triu chng thc th ca tng p lc tnh mch ca nh sau (-S): - Lch to: 100% (S), lu ngy lch to gy ra thiu mu. vng da ()
- Tun hon bng h di da bng ni ln, mu xanh () - C trng: c trng t do (bng to b, rn li, mt np nhn, t th nga, g trong vng rn, c vng thp () 174. Chn on tng p lc tnh mch ca xc nh bng cc du hiu sau (-S): a. Du hiu thc th: - C trng khu tr (S) - Tun hon bng h () - Lch nh (S) b. Thm d: - Soi thc qun: thy tnh mch khng gin (S). - Soi bng: dy chng trn xung huyt, c dch bng (). - Xquang: chp tnh mch, thn tnh mch ca (trn 2cm) vng ni tnh mch thc qun gin () - o p lc tnh mch ca: tng trn 10cm nc (). 175. Lm sng suy gan cp c nhng biu hin sau (-S): a. Bnh nhn m man, li b, co git, vng thc () b.Ri lon tiu ho: nn lin tc, a lng nhiu () c. Xut huyt thnh tng m, mng di da, c chy mu cam, nn mu a phn en () d. Da, nim mc khng vng (S) e. Khng st (S) 176. Triu chng xt nghim ca suy gan cp (-S): - Glucoza mu tng (S) - Prothrombin mu tng (S) - Cholesteol ester/ ton phn gim () - Bilirubin mu tng cao () - Urobilin niu gim () - Men chuyn amin: SGOT nht l SGPT tng cao (). - NH3 mu tng nhiu trong khi ur c mu xu hng gim bnh nhn vn tiu tin tt () - T l t vong cao () 177. Cc du hiu lm sng suy gan mn (-S) - Chn n, s m, y bng,phn lng () - Ph n 2 chn: c trng to () - Xut huyt: chy mu li, mu cam, nn mu, a mu () - Da vng nh, khng vng (S) - Thn kinh, ni tit: + ng ngon (S) + tnh dc gim ()
- Cc triu chng lm sng khc: + Sao mch () + Bn tay son () + Da kh, lng tc rng () 178. Triu chng xt nghim ca suy gan mn (-S): * Suy nhu m gan: - Hng cu, huyt sc t, tiu cu, bchcu gim () - T l prothrombin gim () - Fibrrin mu gim () - A/G < 1 () - Cholesterol ester / ton phn tng (S) - Glucoza mu tng (S) - NH3 mu tng trn 30 micromol/l () * Biu hin tiu hu t bo gan: - Men chuyn amin: SGOT nht SGPT tng cao () - Phosphataza kim gim (S) * Nc tiu: - Urobilinogen gim (S) - Xut hin bilirubin niu () 179. Triu chng lao mng bng th c chng c cc biu hin sau (-S): - St: thng st vo bui sng c th st cao 390-400 C hoc st nh 3705- 380 C thm ch c bnh nhn khng cm thy st (S) - n ung km: chn n, y bng, kh tiu () - Khng mt mi, khng gy st (S) - au bng m , v tr au khng r rng () - Khng ra m hi trm (S) - i ngoi c khi phn lng, c khi phn to () - Khm ton th: + C th c hch mm, di ng, khng au vng dc c c n chm () + C c trng, tun hon bng h, lch to (S) + C trn dch ph mc () + Dy dnh mng ngoi tim () 180. Th b u ho ca lao mng bng c nhng biu hin sau (): * Bnh nhn c triu chng nh th c trng nhng: - St nh vo sng sm hoc khng st (S) - Triu chng tiu ho r hn: au bng, chng hi, si bng,i ngoi phn lng mu vng () * Thm khm bng:
- S bng vng cng, vng mm, n tay vo vng cng thy ting lc sc ca hi di ng (). - G bng thy bng c u (S) 181. Th x dnh c cc triu chng sau (-S): * C nng: - Triu chng bn tc rut: bng chng au, trung tin c au () - Triu chng tc rut: au bng, chng hi, b trung i tin () * Thc th: bng cng, lm lng thuyn () 182. Cc xt nghim bnh nhn lao mng bng (-S): a. Xt nghim mu: - Hng cu gim () - Bch cu tng (bch cu a nhn trung tnh tng) (S) - Tc mu lng gim (S). b. Phn ng Mantoux (+) i khi (-) () c. Xquang c th thy tn thng lao () d. Soi bng vi th c chng thy: c cc trng nh, c, bng ri rc tr li trn nn phc mc bnh thng (S) 183. Xt nghim dch c trng bnh nhn lao mng bng (-S): - Phn ng Rivalta (-) (S) - nh lng albumin di 30g/l (S) - T l glucoza trong dch c chng/ glucoza mu di 0,9 () - T bo lymphoxid trn 50% () - C th tm thy vi khun lao trong dch c chng bng soi trc tip, cy mi trng Loweenstein, tim chut lang (). 184. Chn on xc nh lao mng bng da vo (-S): a. Lm sng: - C hi chng nhim c lao: + St nh v sng (S) + Ra m hi trm, gy st cn, mt mi () - au bng qun tng cn (S) - Bng c c trng, c mng chc () b. Da vo xt nghim: - Mu: + Bch cu tng (ch yu bch cu lym pho) () + Mu lng gim (S) - Xt nghim dch c trng: + Rivalta (-) (S) + Albumin trn 30g/l ()
+ Lymphoxid di 50% (S) - Phn ng Mantoux (+) () - Soi bng, sinh thit khng thy tn thng lao (S) 185. Th bnh no ca lao mng bng khi chn on nhm vi cc bnh sau (thm t, nhm t ph hp): - X gan c trng (c trng, tun hon bng h, lch to) - U nang bung trng Th bnh: (th c trng ca lao mng bng) 186. Th bnh no ca lao mng bng khi chn on c th nhm vi cc bnh sau (thm t, nhm t ph hp): - Khi dnh ca hch trong bng: lympho sarcom (nh soi bng v sinh thit chn an). - Khi u trong bng (nh soi bng). Th bnh: (th b u ho ca lao mng bng). 187. Lao mng bng tin trin theo 3 cch di y tu theo th bnh (A: th c trng; B: th b u ho; C: th x dnh). - L th nh nht nu c iu tr sm, ng phc th a s khi. Nu khng c iu tr tt th s chuyn sang th b u ho hoc x dnh ho). Th: (A). - Th ny gy ra nhng p xe a phng v c th v ra thnh bng hoc d phn ra ngoi. Th: (B) - Th ny lm dnh cc on rut, lm tht rut gy hi chng bn tc hoc tc rut phi can thip ngoi khoa, c th gy vim dnh quanh gan, mt, tc vi trng. Th: (C) 188. Nguyn tc iu tr lao phc mc c 4 nguyn tc sau (-S): a. Dit vi khun lao bng khng sinh c hiu () b. Kt hp corticoid liu php () c. Nng c th bng ch n ung giu m v sinh t () d. Ch nh phu thut p dng khi lao mng bng gy tc rut do dnh x dy ()
C tt c 2 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny : #10 07-08-2008, 07:48 AM Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit
Digoxin
P N TRC NGHIM LS TIU HO(Phn cui)
P N TRC NGHIM TIU HO(Phn cui) 189. Nu nhng ng m vi khun lao ti rut (-S): - Ch yu l ng tiu ho: do nut m, ri, cht nhy cha vi khun lao () - ng mu () - ng bch mch () - ng mt () - ng tip xc: lao mng bng () - ng tnh dc (S) 190. Triu chng lm sng thi k khi pht lao rut (-S): a. Ton thn: - Gy, xanh xao () - Mt mi, ra m hi trm () - St nh vo sng sm (S) b. Triu chng v tiu ho: - i ngoi lng phn, thuc cm a khng c tc dng () - Xen k a lng l to bn () - au bng tng cn khng c v tr c nh (S) - au bng mt i ngoi, i ngoi c du au () - au bng thng c si bng () 191. Triu chng lm sng thi k khi pht ca lao rut (-S): a. Th lot tiu trng, i trng: - au bng nhiu, st cao, a lng ko di () - Bng hi to c nhiu hi, s bng thy u cc (S) - Phn long, mi hi thi, mu vng c ln m, nhy v t mu () - Suy kit nhanh, xanh xao, bing n, s n vo au bng a lng () b.Th to hi manh trng: - Bnh nhn ht a lng li a to, phn c nhy mu m khng bao gi phn bnh
thng () - Khng nn ma v au bng (S) - Khm h chu phi c mt khi u mm, di ng km () c.Th hp rut: - Sau n thy au bng tng ln () - ng thi bng ni cc u cc v c du hiu rn b () - Sau 10-15 pht nghe thy ting hi di ng trong rut v c cm gic hi i qua ch hp, khng c du hiu Koenig (S) - Khm bng ngoi cn au khng c du hiu g () 192. Cc triu chng ca lao rut di y ng hay sai (-S): a. Xt nghim mu: - Bch cu a nhn trung tnh tng cao (S) - Tc mu lng tng () b. Cc xt nghim khc: - Phn ng Mantoux (-) (S) - Tm trc khun lao trong phn: ch c ngha l lao rut khi tm thy trc khun lao trong phn nhng khngthy trc khun lao trong m () - Xquang (chp Transit rut c ung Geobarin): + i trng c hnh khng u ch to ch nh () + Vng hi- manh - i trng ngm thuc u hoc khng u, c hnh ng thuc nh (S) + Hnh lot rut non: hnh ng thuc c nh, trn hoc hnh bu dc () + Hnh tiu trng bin dng ch to, nh (hnh ng n) () - Ni soi ng mm thy: + Cc ht lao nh cc ht k mu trng ri rc trn nim mc () + Nhng lot nng, b mng, mu tm bm () 193. Chn on xc nh lao rut da vo nhng hi chng sau (-S): a. Hi chng tn thng rut: * Lm sng; - au bng chng hi, c du hiu Koenig () - Bing n, gy st, xanh xao () - a to ko di, phn c nhy mu (S) * Xt nghim: - Xquang rut: + i trng c thnh cng nham nh() + Tiu trng khng c ch to ch nh (S) - Soi v sinh thit thy tn thng lao thnh rut () b. Hi chng nhim lao;
- Lm sng: + St bui sng (S) + Ra m hi trm, mt mi () - Xt nghim mu: lympho tng cao, mu lng tng () - Mantoux (-) (S) - Tm trc khun lao trong phn (+), trong m (+) (S) 194. Chn on phn bit lao rut vi cc bnh sau (-S): a. Mt s bnh gy a chy: - Nhim khun (v d: Salmonella) () - Ung th manh trng () - Bnh Crohn () - Hi chng rut kch thch (S) b. Cc bnh c khi u h chu phi d nhm vi lao manh trng: - U amp () - p xe rut tha () - Lng rut hi manh trng (S) 195. Vim i trng mn thng do cc nguyn nhn sau (-S): - Di chng ca cc bnh nhim khun ng rut cp: thng hn, l trc khun, l amp v cc nhim trng khc () - Nguyn nhn di ng () - Nguyn nhn t min (vim i trng lot khng c hiu) () - Ri lon thn kinh thc vt (lc u l ri lon chc nng v sau tn thng nn lot mn) () - Sau cc trng hp nhim c: thyroxin, asen, photpho, nhim toan mu, ur mu cao() 196. Triu chng ton thn ca bnh vim i trng mn nh sau (-S): - Mt mi () - Ng t () - Chn n () - Thiu mu (da nim mc nht nht) (S) - y bng () - Gim tr nh () - Hay cu gt () - St cao lin tc (S) 197. Triu chng c nng ca vim i trng mn (-S): a. au bng: -V tr au: xut pht au thng hai h chu, vng gc gan, gc lch, dc khung i trng ()
- Tnh cht au: +au qun tng cn () + au bng mt i ngoi, i ngoi c khng gim au (S) + Cn au bng d ti pht () b. Ri lon i tin: - Thng a lng nhiu ln, phn ln nhy mu () - To bn xen k () - To bn sau bi phn c nhy mu () - Mt rn, a gi () - Sau i ngoi au trong hu mn () 198. Du hiu thc th ca vim i trng mn (-S): - n h chu phi c th c ting c ch () - Chng hi, mt trung tin, trung tin c khng bt chng bng (S) - n dc khung i trng khng au (S) - C th s thy thng xch ma h chu phi nh mt ng chc t di ng (S) 199.Xt nghim vim i trng c nhng du hiu sau (-S): a. Xt nghim mu: - Hng cu gim (S) - Bch cu tng, mu lng tng () b. Xt nghim phn: - C th thy hng cu, t bo m () - Albumin ho tan (-) (S) - C th thy trng k sinh trng (+) () - Cy phn tm vi khun gy bnh (+) () - Tm thy amp trong phn (S) 200. Chn on xc nh vim i trng mn du hiu g c nhng biu hin sau (thm t, nhm t ph hp): - (Tin s): b kit l, cc vim rut cp. - (au bng): xut pht t vng h chu, au qun hay ti pht. - (Ri lon i tin): mt rn, a lng, phn c nhy mu. - (Xt nghim phn): + c t bo m +c albumin ho tan +cy phn tm thy vi khun gy bnh - (Xquang chp khung i trng): c hnh nh xp a. - (Soi v sinh thit i trng): thy tn thng vim lot. 201. Phn bt vim i trng mn vi ri lon chc nng i trng da vo (-S): - C au bng () - Phn to. lng, khng c nhy mu () - Xt nghim albumin ho tan (+) (S)
- Soi v sinh thit i trng khng thy tn thng vim lot () 202. Phn bit vim i trng mn vi polp i trng da vo cc yu t sau (-S): - N gp nhiu hn nam (S) - Thng gp ngi trn 50 tui () - Thng c triu chng au bng (S) - Tnh c xt nghim phn thy mu vi th () - C khi i ngoi ra mu () - Soi i trng thy polp (yu t xc nh) () 203. Chn on phn bit vim i trng mn vi ung th i trc trng da vo cc yu t sau (-S): - Gp n nhiu hn nam, tui ngoi 40 (S) - Cc bnh i trng d dn ti ung th: + Polp lan to () + Cc polp gi, vim i trng xut huyt, sau l () - V tr ung th thng trc trng, i trng xch ma () - Triu chng ph thuc v tr u: + au bng khng c khu tr r rt () + Chn n, bun nn xen k to lng, thng c mu trong phn () + Nu ung th i trng xch ma a gi, tc rut () - Khm bng: khng s thy u rn (S) - Thm trc trng, m o thy c mt khi u c nh () - Xt nghim mu: hng cu, huyt sc t tng (S) - Xt nghim phn khng thy mu vi th (S) - Chp khung i trng thy hnh nh: + Hp i trng () + Khuyt i trng () + Cng i trng () 204. Chn on phn bit vim i trng mn vi lao rut (lao hi manh trng) da vo cc du hiu sau (-S): - C hi chng nhim lao () - Ri lon c nng rut: a lng 2-3ln/24h () - au bng lm rm i ngoi c vn au (S) - Bing n, si bng () - Th hp rut cn au bng c tnh cht c bit: + Sau khi n bnh nhn thy au bng, khi bng ni ln cc u cc v c du hiu rn b () + Sau 15 pht nghe thy ting hi di ng trong rut ng thi trung tin c au (hi chng Koenig) () - Khm im au h chu phi ti y c mt khi u mm, nhn, hi au, di ng theo
chiu ngang () - Xquang c du hiu Starling () - Xt nghim phn c mu, m () 205. Nhn mu sc ca phn, phn mu vng sm gp trong trng hp (-S): - BN n nhiu tht (). - BN huyt tn (). - BN tc mt (S). - BN vim gan cp (S). - BN rut kch thch th lng, phn chuyn qua rut gi qu nhanh Bilirubin cha kp chuyn thnh stercobilin ra ngoi b oxy ho to thnh (S). 206. Cc mu sc trng bch, en ca phn gp trong cc bnh (-S): - Phn mu trng bch gp trong bnh huyt tn (S). - Phn mu trng bch gp trong bnh tc mt (). - Phn mu trng bch gp trong bnh vim gan cp (). - Phn en bng, nho, khm gp trong trng hp ung thuc c cht st, Bismuth (S). - Phn en khng bng, nho, khm gp trong xut huyt ng tiu ho trn (S). 207. Xt nhim phn tm thc n cha tiu ca BN (-S) : - Glucid c gi l bnh thng nu trong phn cn mt vi ht tinh bt hoc acid hu c c t 14-16 mEq/ 100g phn (). - Protein c gi l bnh thng nu trong phn cn mt hai si c ang tiu ho d (). - Protein c gi l bnh thng nu trong phn c mt t protein ho tan (S). - Lipid c gi l bnh thng nu 95% c hp thu vo mu cn 5% thi theo phn (). - Lipid thi theo phn di dng: m trung tnh 25%, Acid bo 38%,x phng kim 37% (). 208. Xt nghim phn tm k sinh trng ng rut (-S): - Amib dng ln hot ng khng c trong phn (S). - Amib dng nh hot ng c trong phn (). - Amib dng bo nang c trong phn (). - Trng roi (Trichomonas intestinalis) tm thy trong phn thng th bo nang (S). - Trng lng (Balantidium coli) tm thy trong phn thng th u trng (S). 209. Xt nghim phn tm thy cc loi giun cc dng (-S): - Giun a : Tm thy u trng giun a trong phn (S). - Giun mc: Tm thy u trng v trng giun mc trong phn (). - Giun kim : Tm thy trng giun kim quanh hu mn (). - Giun tc : Tm thy u trng giun tc trong phn (S).
- Giun ln: Tm thy u trng giun ln trong phn. (). 210. Xt nghim phn tm thy cc loi sn cc dng (-S): - Sn l rut (Fasciolopsis buski): tm thy trng sn trong phn (). - Sn l gan nh (Clonorchis sinensis): tm thy u trng sn trong phn (S). - Sn l gan ln (Fasciola hepatica ): tm thy u trng trong phn (S). - Sn dy ln (Toenia solium ): tm thy t sn mang trng trong phn (). - Sn dy b (Toenia saginata): tm thy t sn mang trng trong phn (). 211. S thng gp lot ming ni sau phu thut d dy, t trng (-S): - Sau ni v trng: + Th gii gp 30-35% () + Vit Nam gp 20% () - Sau ct dy X, ni v trng hoc m thng mn v: 5-10% () - Sau ct 2/3 d dy: 2-3% (L S Lim: 1988) () - Sau ct d dy v ct dy X: 10% () 212. Nhng nguyn nhn gy lot ming ni (thm nhm t ph hp): - Do ct on (cha ) 2/3 d dy m cn li nhiu phn d dy tit axid. - Do ct (khng ht) 2 thn dy thn kinh X, sau ct dy X v ct hang v. - Do u (adenome) ca tuyn ty (hi chng Zollinger Ellison) loi u ny gy tng tit gastrin, cn u ty th cn lot ti pht. - Do ch ct b lot cn li phn nim mc (hang v) (cn nim mc hang v th cn tit gastrin kch thch tit HCl + pepsin). 213. Triu chng lot ming ni (-S): - Xut hin sau m 3 thng ti 1 nm, c khi 20-30 nm sau () - au do lot ming ni c c im: + au gim hn trc khi phu thut (S) + au khu tr bn tri ng trng gia, ngang rn hoc thp hn () + au nhiu hn khi n vo vng ngang rn pha bn tri () - Nn: + Thng khng i km vi au (S) + Tnh cht nn gn ging nh hp mn v () - Ni soi bng ng soi mm: thy tn thng lot vng ming ni ()

Trac Nghiem Ls Tieu Hoa (HVQY)

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Trc Nghim Lm Sng Tiu Ho

: Trc Nghim Lm Sng Tiu Ho

TRC NGHIM LM SNG TIU HO(Phn 2)

C tt c 2 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

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C tt c 2 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

: Trc Nghim Lm Sng Tiu Ho

TRC NGHIM LS TIU HO(Phn 3)

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

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Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

: Trc Nghim Lm Sng Tiu Ho

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Cc thnh vin ni li cm n n Digoxin v bi vit c gi tr ca bn :

Tham gia : Nov 2007 n t : HVQY Bi gi : 1,508 Cm n : 281 c cm n 5,709/1,080 bi vit

C tt c 3 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

p n Trc Nghim Ls Tiu Ho

P N TRC NGHIM TIU HO(Phn 1)

C tt c 3 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

C tt c 3 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

C tt c 3 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

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C tt c 3 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

C tt c 4 thnh vin gi li cm n n Digoxin cho bi vit c gi tr ny :

P N TRC NGHIM LS TIU HO(Phn 2)

P N TRC NGHIM LS TIU HO(Phn 2)