1. There are five alternative answers to each of the following questions: A, B, C, D and E. Please choose the best answer and black the box with the letter corresponding to the corresponding question number on the answer sheet.
1.★ Charcot triad includes
A. Pain, fever and jaundice
B. chills, fever and jaundice
C. Pain, fever and convulsions
D. Pain, anemia and jaundice
E. fever, jaundice and shock
Answer: solution a: choledocholithiasis: stones originate from the common bile duct, and a few can come from intrahepatic bile duct or gallbladder. When stones block the common bile duct and are complicated with infection, it will cause acute cholangitis. The clinical manifestations are as follows: (1) Charcot triad ① right upper abdominal colic: paroxysmal knife-like colic under xiphoid process, which can be reflected to the right shoulder and back; (2) chills and high fever: after cholangitis, the infection spreads upward, and bacteria and toxins enter the blood stream through the gap of the liver, causing toxic reactions; (3) Jaundice: Jaundice is caused by stone obstruction, increased biliary pressure and bile flowing into the hepatic sinus from the capillary bile duct, which usually occurs 12 ~ 48 hours after onset. Patients with deep jaundice have clay-colored stools.
2.★ The statement about pancreatic cancer is incorrect.
A. the age of predilection is between 20 and 30 years old.
B. Most of them are pancreatic head cancer.
C. From the perspective of tissue types, the cancers with vascular components are the most.
Extensive infiltration of surrounding tissues and organs, and early lymphatic metastasis.
Early diagnosis of the disease is difficult, the surgical resection rate is low and the prognosis is poor.
Answer: One answer: Pancreatic cancer is a common cancer of digestive system, and it is on the rise year by year. The most common age is between 40 and 70 years old, with more men than women.
3.★ Typical clinical manifestations of acute obstructive suppurative cholangitis are
A. Paroxysmal colic in the right upper abdomen
B. Gallbladder enlargement and tenderness
C. Murphy sign positive
D. Raynaud's five sign positive
E. Charcot triad: affirmative answer to solution D: Typical manifestations are Raynaud's Five Signs: right epigastric pain, chills and high fever, jaundice, shock and mental symptoms.
4.★ The statement about detecting amylase in blood and urine to diagnose pancreatitis is incorrect.
A. The serum amylase value began to increase at 3 ~ 12 hours after onset, reached the peak at 24 ~ 48 hours, and returned to normal within 7 days.
B. Urine amylase rises slightly at night, but the duration is longer than that of blood amylase.
C the value of amylase is not necessarily proportional to the severity of the disease.
In severe necrotizing pancreatitis, blood and urine amylase values do not increase.
E. None of the above statements are correct.
The exact answer: E solution: The determination of pancreatin is of great significance for diagnosis. The value of serum amylase began to increase at 3 ~ 12 hours after onset, reached the peak at 24 ~ 48 hours, and returned to normal within 7 days. Serum amylase value higher than 300u/dl (normal value 40 ~ 180 u/dl, Somoggi method) indicates this disease. Urinary amylase increased a little later, but the duration was longer than that of blood amylase. Urinary amylase is obviously increased (normal value is 80 ~ 300 u/dl, Somoggi method), which has diagnostic significance. Amylase value is not necessarily proportional to the severity of the disease. In severe necrotizing pancreatitis, the amylase value in blood and urine will not increase.
5.★ Cholesterol stones are prone to occur in
A. Common bile duct
B. Left hepatic duct
C. Right hepatic duct
D. intragallbladder
E. None of the above
Answer: D problem solution: rote learning.
6.★ Which of the following is not the clinical feature of biliary ascariasis?
A. Upper abdominal drilling top pain
B. the abdominal signs are not obvious at the time of attack.
C. Patients in remission stage of colic are completely normal.
D. Early chills and high fever.
E. jaundice may occur in the late stage.
Answer: the solution to problem d: just memorize it.
7. ★★★★★★ Female, 62 years old, sustained pain in the right upper abdomen for 6 hours, accompanied by chills, high fever and jaundice. There have been similar attacks in the past. Physical examination: body temperature 39.2℃, blood pressure 70/50mmHg, heart rate 120 beats/min, apathy, yellow staining of sclera skin, tension of right upper abdominal muscle, tenderness positive. The white blood cell is 24× 109/L, and the maximum possible diagnosis is
A. Acute gastric perforation
B. Acute pancreatitis
C. Acute cholecystitis
D. Acute obstructive suppurative cholangitis
E. None of the above
Answer: D solution: [diagnosis] 1. Biliary tract diseases occur frequently, especially gallstones. 2. Typical manifestations are Raynaud's Five Signs: right epigastric pain, chills and high fever, jaundice, shock and mental symptoms. 3, right upper abdominal muscle tension, tenderness, rebound pain, liver swelling, tapping pain, sometimes touching the swollen and tender gallbladder. 4. When the white blood cell count is more than 20× 109/L and the platelet count is lower than 100× 109/L, the lower the platelet count, the worse the prognosis. 5. Hypertension and purulent bile were found during operation.
8. ★★★★★★ The patient was a 42-year-old female with pain in the right upper abdomen for 2 days, accompanied by chills, and her temperature was 38.8℃. In recent days, her sclera has turned yellow and her skin has turned yellow one after another. Indicating that the possible disease is
A. choledocholithiasis
B. Acute gastric perforation
C. Acute cholecystitis
D. Acute viral hepatitis
E. Acute pancreatitis
Answer: Solution A: According to age, sex, medical history, especially the history of multiple acute attacks, combined with typical clinical features, such as Charcot triad, it is not difficult to judge whether there is cholelithiasis.
9. ★★★★★★ Female, 50 years old, suddenly felt colic in the right upper abdomen 1 hour after eating greasy food, accompanied by pain in the right shoulder. Which examination should be the first choice for definite diagnosis?
A. oral cholecystography
B. venocholangiography
C.b-ultrasound examination
D. Power Transmission Council
E. endoscopic retrograde cholangiopancreatography
Answer: Scheme C: The typical triad of Charcot-Marie-Tooth syndrome can be diagnosed, and auxiliary examination is needed to further clarify the location of stones and the degree of bile duct lesions. B-ultrasound is preferred. CT, PTC, ERCP, etc. You can choose according to the situation. At the same time, stones are divided into three types: cholesterol stones, bile pigment stones and mixed stones. X-ray plain film only shows mixed stones, but not the first two.
10.★ Within 12 hours after the onset of acute pancreatitis, the examination items with great diagnostic significance are as follows
A. blood calcium
B. blood sugar
C. blood amylase
D. blood lipase
E. urinary amylase
Answer: solution c: the serum amylase value is higher than 300u/dl (normal value is 40 ~ 180 u/dl, Somoggi method), which indicates this disease. Urinary amylase increased a little later, but the duration was longer than that of blood amylase.
11.★★★★★ Male, with epigastric discomfort and loss of appetite for three months. From 1 month, jaundice gradually worsened, weight decreased, the whole body was obviously yellow stained, and the liver was not touched. When inhaling deeply, you can feel the bottom of the swollen gallbladder without tenderness. Test: blood bilirubin 15mg/dl, urine test: bilirubin positive. Most likely
A. Hepatitis
B. cholelithiasis
C. Pancreatic head cancer
D. Chronic pancreatitis
E. Liver cancer
Answer: Question C: The incidence of pancreatic cancer is hidden, and the first symptoms are epigastric pain, fullness discomfort and jaundice. Because the parts of cancer are different, there are great differences. Cancer of the head of pancreas: Due to the compression of the common bile duct and duodenum, most patients show painless obstructive jaundice, which is getting worse, with muddy stool, itchy skin and hepatobiliary enlargement.
Two, the following provides a number of cases, each case consists of several questions. Please choose the best answer from the five alternative answers A, B, C, D and E under each question according to the information provided in the stem of each question, and put a black mark in the box corresponding to the letter of the corresponding question number on the answer sheet.
Male, 42 years old, had severe epigastric pain and radiated to his back five hours ago, accompanied by several nausea and vomiting, and the pain did not relieve after vomiting. He also showed symptoms of shock and asked about his medical history. He overeated at the party seven hours ago.
(12~ 14*** with peduncle)
12. ★★★★★ The most likely diagnosis is
A. Acute appendicitis
B. Acute necrotizing pancreatitis
C. Gastric cancer with perforation
D. Acute renal colic
E. Acute cholecystitis Answer: Question B: Clinical manifestations of acute pancreatitis: abdominal pain, nausea, vomiting, abdominal distension and signs of peritonitis caused by paralytic intestinal obstruction. Abdominal pain is the main symptom. Abdominal pain is very serious. According to the different parts of the pancreas affected by inflammation, the head of the pancreas is mainly in the right upper abdomen and radiates to the right shoulder. The pancreatic tail is mainly in the left upper abdomen and radiates to the left upper shoulder; Involvement of the whole pancreas can lead to banded low back pain. Abdominal pain is persistent and accompanied by paroxysmal aggravation. Abdominal pain may not be obvious when severe pancreatic necrosis is accompanied by shock. Biliary pancreatitis can cause mild jaundice. Severe patients go into shock. Some patients take sudden shock as the main manifestation, which is called fulminant pancreatitis. A few patients may have blue-brown spots on the waist (gray-tuner sign) or blue changes around the navel (Karen sign).
13. ★★★★★ The most valuable experimental examination at this time is
A. White blood cell count
B. Determination of urinary amylase
C. determination of blood amylase
D. platelet count
E. Determination of blood electrolytes
Answer: Scheme C: Diagnostic method: 1. Determination of pancreatic enzyme: The determination of pancreatic enzyme is of great significance for diagnosis. The value of serum amylase began to increase at 3 ~ 12 hours after onset, reached the peak at 24 ~ 48 hours, and returned to normal within 7 days. Serum amylase value higher than 300u/dl (normal value 40 ~ 180 u/dl, Somoggi method) indicates this disease. Urinary amylase increased a little later, but the duration was longer than that of blood amylase. Urinary amylase is obviously increased (normal value is 80 ~ 300 u/dl, Somoggi method), which has diagnostic significance. Amylase value is not necessarily proportional to the severity of the disease. In severe necrotizing pancreatitis, the amylase value in blood and urine will not increase. 2. Abdominal puncture: Abdominal puncture is feasible for those who have signs of peritonitis and are difficult to diagnose. Puncture fluid is often bloody in severe pancreatitis and purulent in complicated infection. The increase of amylase value in puncture fluid has diagnostic significance. If it is significantly higher than the serum amylase level, it means that pancreatitis is serious.
14. ★★★★★★ It is prohibited in the treatment of acute pancreatitis.
A. anticholinergic drugs
B. morphine analgesia
C5- fluorouracil
D. calcium agent
E. antibiotics
Answer: Scheme B: Important knowledge point-morphine is forbidden when treating pancreatitis, so as not to cause sphincter spasm of Oddi.
A 50-year-old woman, who was found to have multiple small stones in her gallbladder by B-ultrasound health examination, suddenly had abdominal pain in her right upper right after eating roast duck a day ago, accompanied by nausea radiating to her right shoulder.
(15~ 16*** with peduncle)
15. ★★★★★★ The most likely diagnosis of this patient is
A. Acute gastritis
B. Acute duodenitis
C. Acute cholecystitis
D. Acute pancreatitis
E. Acute appendicitis Answer: Question C Answer: The diagnosis of acute cholecystitis mainly depends on the medical history and typical clinical manifestations: the main manifestation is persistent pain in the right upper abdomen with paroxysmal aggravation, which can radiate to the right shoulder and back. Most patients have digestive tract symptoms such as nausea and vomiting, and have systemic symptoms such as chills and fever. There is generally no chills and jaundice. In the early stage of inflammation, Murphy's sign is positive when the gallbladder has no obvious swelling. After the illness gets worse, the swollen gallbladder can be touched in the right upper abdomen with obvious tenderness, while suppurative and gangrenous cholecystitis has muscle tension and rebound pain. White blood cell count and neutrophil ratio increased significantly.
16. ★★★★★ Which examination should be the first choice for diagnosis?
A. oral cholecystography
B. venocholangiography
C.b-ultrasound examination
D. Power Transmission Council
E. endoscopic retrograde cholangiopancreatography
Answer: Question C: B-ultrasound examination can confirm the diagnosis, showing that the gallbladder is enlarged and the gallbladder wall is thickened, and most of them can find gallbladder stones.
Three, the following provides a number of groups of questions, each group of questions with five alternative answers listed in front of the question. Please choose an answer that is closely related to the test question type, and black the box corresponding to the letter of the question number on the answer sheet. Each alternative answer can be selected once, multiple times or not.
(17~ 18 question * * * with alternative answers)
A. choledocholithiasis
B. Ampullary carcinoma
C. Pancreatic head cancer
D. cholecystitis
E. hilar tumors
17.★ What is not accompanied by gallbladder enlargement is: Answer: E solution: key recitation
18.★ Right epigastric colic with jaundice is: answer: one solution: key recitation
(19~2 1 question * * * with alternative answers)
A. Abdominal pain in the left upper abdomen is prominent, which is reflected in the back, especially at night.
B. painless obstructive jaundice
C. emaciation anemia D. hepatobiliary swelling and tenderness
E. Periumbilical blue change (Coulomb sign)
19.★ Acute hemorrhagic necrotizing pancreatitis: Answer: E.
20.★ pancreatic head cancer: the exact answer is B.
2 1.★ Pancreatic body cancer: The correct answer to this question: One solution: brain contusion and laceration are quite different due to different injury sites and degrees. The damage of consciousness disorder appeared immediately at that time, and the coma lasted for more than 30 minutes, which could last for days, weeks and months. Changes of vital signs: Intracranial pressure is increased due to brain edema, and there are many Cushing reactions such as slow pulse, slow breathing and high blood pressure. Respiratory and circulatory failure will occur in the late stage. The temperature of critically ill patients is often around 39℃; If the hypothalamus is damaged, the body temperature can continue to rise or reach above 40℃ (central high fever). Focal symptoms and signs: such as anterior central gyrus injury, contralateral limb spasm, paralysis, tendon reflex enhancement, Pap's sign positive, etc. If the brain contusion occurs in the "quiet area" of the cerebral cortex, that is, the edge of the functional area, there is no focal disease. Meningeal irritation sign: due to brain tissue and blood vessel injury and subarachnoid hemorrhage, patients may have severe headache, stiff neck, Kleber's sign and Brucella's sign. Generally, after 5 ~ 7 days, it gradually decreases with the cessation of bleeding and the absorption of hematocele. Neck stiffness gradually disappeared around 1 week. Headache and vomiting: headache symptoms can only be stated after the patient is awake; If you have persistent headache and frequent vomiting after injury, you should investigate the causes and do CT examination to determine whether there is hematoma in your brain. The clinical manifestations of brain contusion and laceration vary with injury factors and injury sites. CT and MRI have definite significance in the diagnosis of brain contusion and laceration. The structure of skull base is complex, which can be diagnosed according to the history of trauma, subcutaneous ecchymosis, cerebrospinal fluid leakage and brain nerve injury. X-rays are of little significance. CT scan can clearly show the fracture site by adjusting the window width and window spacing, which is of great value. Fracture of anterior cranial fossa: subconjunctival hemorrhage, ecchymosis under eyelid, bloody cerebrospinal fluid flowing from nose or mouth, which may be complicated with olfactory nerve injury. Fracture of anterior cranial fossa is easy to cause subconjunctival hemorrhage and delayed eyelid subcutaneous blood stasis, commonly known as "panda eye". Fracture of middle cranial fossa: hemorrhagic cerebrospinal fluid of external auditory canal, ipsilateral nerve paralysis, deafness, tinnitus, etc. Fracture of posterior cranial fossa: ecchymosis gradually appeared under the skin behind the ear and occipital region, cerebrospinal fluid leaked to sternocleidomastoid muscle and under the skin behind the mastoid, and cranial nerve injury was rare.
(Questions 22-24 * * * with alternative answers)
A. Acute pancreatitis
B. Cholelithiasis secondary to cholangitis
C. acute obstructive suppurative cholangitis
D. Acute gastritis
E. acute cholecystitis
22.★ The Charcot triad appears in: Answer: Solution B: Memory.
23.★ Murphy's sign appears in: answer: e solution: memorization.
24.★ Renault Five Signs appear in: Answer: C Problem Solution: Recitation.