1. Patient, male, 67 years old. Repeated coughing and expectoration for 20 years, chills, fever, expectoration of pus and sputum, and shortness of breath after catching cold 1 week ago. Physical examination: body temperature 37.5 ℃, shortness of breath, decreased respiratory sounds of both lungs, more moist rales, mild edema of lower limbs. The main treatment measures are:
A. Diuretics Moderate diuresis
B. Give antispasmodic and antiasthmatic drugs
C. Give antitussive and expectorant medicine
D. Control pulmonary infection
E. Low concentration continuous oxygen inhalation
2. The patient, male, 27 years old, came to the hospital with fight, chest pain and dyspnea. Chest X-ray showed fracture of left ribs 5 and 6, cyanosis of face, subcutaneous emphysema of chest, blood pressure of 80/60mmHg, trachea shifted to the right, percussion drum sound, and respiratory sound of injured side disappeared. The first treatment principle was:
A. Thoracic puncture, exhaust and decompression
B. Blood transfusion and fluid replacement
C. Send to operating room for closed drainage
D. Adhesive tape fixation
E. Internal fixation of ribs
3. The patient, male, 35 years old, had low fever, fatigue, night sweating for 2 weeks, coughing and hemoptysis for 3 days, and was suspected to be pulmonary tuberculosis. The gold standard for diagnosis of the disease is:
A. Tuberculin test
B. Mycobacterium tuberculosis examination of sputum
C. ESR
D. Chest CT
E. Pulmonary function
4. Male, 69 years old. Because of coronary heart disease, after taking aspirin, nausea, vomit about 300ml of coffee like substance, excrete 200g of black stool, dizziness, palpitations, no abdominal pain, physical examination: BP105/80mmHg, P102 times/minute, low heart sound, regular rhythm, clear breathing sound of both lungs, soft abdomen, abdominal positive pressure pain, no rebound pain, liver and spleen untouched. The most likely diagnosis of the cause of bleeding is:
A. Peptic ulcer
B. Rupture of esophageal varices
C. Gastric cancer
D. Esophageal and cardiac mucosal tear syndrome
E. Acute gastric mucosal lesion
5. Male, 37 years old. In the past month, fresh blood stool has been discharged frequently, with a small amount of blood not mixed with feces, accompanied by tenesmus, a feeling of dropping anus, no fever, no abdominal pain, and thin stool. The most likely diagnosis is:
A. Rectal cancer
B. Acute necrotizing enteritis
C. Gastric cancer
D. Intestinal tuberculosis
E. Crohn disease
Answer and analysis:
1. [Answer] D. Analysis: (1) This question is about the treatment of chronic obstructive pulmonary disease. (2) According to the question stem, this case can be diagnosed as chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD), which is complicated with pulmonary infection, leading to an acute attack. The main treatment is to control pulmonary infection. So choose D.
2. [Answer] A. Analysis: (1) This question examines the treatment of tension pneumothorax. (2) The patient suffered from rib fracture, cyanosis, subcutaneous emphysema, decreased blood pressure, combined with the trachea moving to the right, percussion drum sound, considered to be tension pneumothorax, at this time, exhaust and decompress first. So choose A.
3. [Answer] B. Analysis: (1) This question examines the diagnosis of pulmonary tuberculosis. (2) Tuberculosis can be diagnosed when Mycobacterium tuberculosis is found in sputum, which is the gold standard for the diagnosis of pulmonary tuberculosis. So select B for this question.
4. [Answer] E. Analysis: (1) This question examines the diagnosis of acute gastritis. (2) The patient has a history of taking NSAIDs and has hematemesis and melena. Upper gastrointestinal bleeding caused by acute gastric mucosal lesions should be considered first (E pair). Most of the acute gastritis caused by drugs and stress can show endoscopic acute erosion and bleeding, and in severe cases, acute ulcer and massive bleeding occur. Peptic ulcer is a chronic disease, and acute abdominal pain will occur only when peptic ulcer perforation occurs (wrong A); The patients with esophageal varices rupture are mainly seen in some patients with abnormal liver function. The liver of the patient in question is not enlarged (B error); Gastric cancer is mainly characterized by chronic abdominal pain, which is located in the middle and upper abdomen, and patients are often accompanied by cachexia (C error); Esophageal and cardiac mucosal tear syndrome first involves retching or vomiting, followed by hematemesis and melena. Most patients only show painless bleeding. When the amount of bleeding is large, it can cause hemorrhagic shock, which can eventually lead to death. When the tear is serious, esophageal hiatus (D error) may also occur. So choose E for this question.
5. [Answer] A. Analysis: (1) This question examines the diagnosis of colorectal cancer in the digestive system. (2) Most rectal cancer patients have frequent defecation, a sense of endless defecation, a sense of anal ptosis, blood in the stool, and a thin or deformed stool after intestinal stenosis. The patient's performance conforms to the clinical characteristics of rectal cancer (A pair). Abdominal pain and diarrhea are the main symptoms of acute necrotizing enteritis, intestinal tuberculosis and Crohn's disease (BDE error); Stomach cancer patients often have positive fecal occult blood test (C error). Therefore, select A for this question.
