Nguyen Tac Noi Khoa Harrison 17th- Phan Tu Luong Gia

Bn dch ca Din n Y khoa

www.diendanykhoa.com

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Nguyn tc ni khoa Harrison Ti bn ln th 17 Phn t lng gi

Nhm dch www.diendanykhoa.com.

Ch bin: Phm Ngc Minh

Bin dch: Nguyn Vn Ngha( lovesnn1909).

Hong Th Duy( duyhtdk)

Nguyn nh c ( mo li rhm)

Trungbach12hoa

inh V Phng Tho( blueocean)

Nguyn c Trng (truongyhn)

Nguyn Th Thanh Huyn (midbeo)

Trn Huyn ( whiskey_lullaby)

Phm Anh Khoa (Meo meo)

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Chng 1: GII THIU V Y HC LM SNG

Lovesnn1909 - Midbeo

Chng 2: DINH DNG

Blueocean

Chng3: UNG TH V HUYT HC

Lovesnn1909

Chng 4: BNH TRUYN NHIM.

Meo meo

Chng 5: TIM MCH.

Duyhtdk

Chng 7: TIT NIU.

Lovesnn1909

Chng 8: TIU HA.

Trungbach12hoa

Chng 9: C XNG KHP V MIN DCH

Whisley_lullaby

Chng 10: NI TIT-CHUYN HA.

Midbeo

Chng 11: THN KINH.

Truongyhn

Chng 12: DA LIU.

Mo li rhm

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Mc Lc

Chng I:.................................................................................................................................................................. 5

GII THIU V Y HC LM SNG ................................................................................................................... 5

Chng II: DINH DNG .................................................................................................................................... 42

Chng III: UNG TH V HUYT HC ........................................................................................................... 61

Chng IV: BNH TRUYN NHIM ............................................................................................................... 173

Chng V: TIM MCH ....................................................................................................................................... 341

Chng VII: TIT NIU ..................................................................................................................................... 473

Chng VIII: BNH TIU HA ........................................................................................................................ 538

Chng IX: ........................................................................................................................................................... 638

C XNG KHP V MIN DCH ................................................................................................................ 638

Chng X: ............................................................................................................................................................ 727

NI TIT V CHUYN HA ........................................................................................................................... 727

Chng XI: ........................................................................................................................................................... 832

THN KINH ........................................................................................................................................................ 832

Chng XII: ......................................................................................................................................................... 923

DA LIU .............................................................................................................................................................. 923

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CHNG I:

GII THIU V Y HC LM SNG

Lovesnn1909

Midbeo

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CC CU HI

1. Mt ngi n ng 45 tui b mc kt ngoi tri lnh c m sau trn l

tuyt. ng c a ti trung tm cp cu ca bn bng my bay trong tnh

trng m man v mt cm gic cc ngn bn tay phi ( atlats hnh I-36). X

tr ban u tt nht ca bn l gi?

A . Nitroglycerine tnh mch.

B . Nifedipin ng ming.

C . Nhanh chng lm m.

D . Phu thut m.

E . Dn nitroglycerine ti ch.

2. Xt nghim mu c trong phn (FOBT) cho thy t l t vong ngi

mc ung th i trng gim t 8,8/1000 ngi xung cn 5,9/1000 ngi trong

hn 13 nm. T l gim gn nh tuyt i yu t nguy c trong can thip

nghin cu cng ng ny l bao nhiu?

A . 50%

B . 30%

C . 3%

D . 0,3%

E . 0%

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3. Bin php d phng tng tui th trung bnh ln nht dn s mc

tiu l g?

A . Luyn tp th dc thng xuyn nam gii t 40 tui.

B . Gip nhng ph n ht thuc t 35 tui b thuc.

C . Chp v ph n t 50 n 70 tui.

D . Lm xt nghim pht knh u v.

E . Lm PSA v thm trc trng cho nam gii trn 50 tui.

4. Tt c cc bnh nhn sau y nn sng lc v lipid tr?

A . Nam gii 16 tui b i tho ng typ 1.

B . Mt thiu n 16 tui bt u ht thuc.

C . Ph n 48 tui bt u thi k tin mn kinh.

D . Nam gii 62 tui khng c tin s bnh l.

5. Mt ph n 46 tui phn nn vi bc s v cm gic lo lng. B thy

mnh lun c cm gic lo lng ngay c trng hc. Bnh nhn lun trnh ni

chuyn trc tip trong cng ng v gn y lo lng n mc gp kh khn

trong cng vic v giao tip x hi. B rt kh ng vo ban m v lun lun

bn chn nh c ci g thc y hot ng. Bnh nhn s hu mt cng

ty bt ng sn suy gim hot ng k t khi suy thoi trong nn kinh t a

phng. Gn y b trnh tm nh gim gi.Thay vo b tr hon vi cc

i tc ca mnh v thy rng cng thng thn kinh n mc khng th ni

chuyn vi khch hng ca mnh B c 2 a con 16 v 12 tui , chng rt thch

hot ng th thao. B qu lo lng v kh nng thng tch ca bn tr v

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khng cho chng tham gia cc hot ng th thao. Bn nghi ng bnh nhn b

ri lon lo u. Tt c nhng iu sau y u ng v chn on bnh tr?

A . tui khi pht triu chng thng trc 20 tui

B . Hn 80% nhng bnh nhn ny s ng thi c ri lon nh trm cm

nng, ri lon lng cc hay m nh x hi.

C . Ri lon hong s, kh th, nhp tim nhanh,v nh trng ngc l ph bin.

D . Thc nghim cho thy sinh l bnh ca ri lon lo u lin quan n lin kt

ca benzodiazepine ta cc th th GABA.

E . Phng php iu tr ri lon lo u l kt hp thuc v liu php tm l, t

l ht triu chng hon ton l him.

6. Nhng tho dc no sau y c hiu qu tt nht trong iu tr cc triu

chng ca ph i tin lit tuyn?

A . Ru Sait John.

B . Gingko.

C . Cy kava.

D . L c.

E . Khng c tho dc no c hiu qu.

7. c im no sau y tiu biu cho mt ph n tr b chn n tm cn?

A . Trm cm.

B . Tnh chp nhn.

C . Lo lng.

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D . Ngi cu ton.

E . Bc ng.

8. Ti sao cn phi phi hp vitamin B6 vi isoniazid?

A . Nhu cu vitamin B6 cao hn bnh nhn b lao.

B . Isonazid gy tch carboxyl ca nhm -carboxyl trong cc enzyme ph

thuc vitamin K.

C . Isoniazid tng tc vi pyridoxal phosphate.

D . Isonazid gy km hp th vitamin B6.

E . Isoniazid chuyn homocysteine thnh cystathionine.

9. S ph bin tng huyt p nhng ngi trn 65 tui M l:

A . 10-35%

B . 35-60%

C . 60-85%

D . > 85%

10. Bnh tiu dng lin quan ti tt c cc vn sau y ngi cao tui

tr?

A . Tai bin mch no.

B . Suy gim nhn thc.

C . Gim cc nguy c.

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D . Nhi mu c tim.

E . Tiu khng t ch.

11. iu no sau y nh gi tui th v tin lng bnh nhn lo

khoa?

A . Tnh trng cc chc nng.

B . Tui th ca nhng ngi thn .

C . Tnh trng hn nhn.

D . S lng bnh tt.

E . Tnh trng kinh t x hi.

12. Tiu chun chn on m sng nh l nguyn nhn gy ra tnh trng

nhm ln cc bnh nhn nhp vin bao gm tt c nhng iu sau y tr:

A . Kch ng.

B . Mc thay i thc.

C . Khng c thc.

D . Tnh trng dao ng tinh thn.

E . Km ch .

13. Vic gim cc yu t nguy c ngi cao tui gm nhng iu sau y

tr:

A . thanh thi creatinin

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C . Lo s b ng.

D . Tin s b ng.

E . Tng huyt p.

F . Bnh l tm thn.

14. Lot do t giai on 1 (ban trn da khng m i, ph n , cng chc

im xng chu p lc) c th tin trin thnh giai on 4 (vi y mt

dy ca da, hoi t m, cng nh tn thng su vo c, xng v gn) cn bao

nhiu thi gian?

A . Vi gi

B . 1-2 ngy

C . 1-2 tun

D . 1-2 thng

15. Mt ph n 74 tui than phin b sn nc tiu khi ho, ci hay i thang

my ca hng ca mnh.B ph nhn tnh trng ung nhiu v tiu nhiu. B

thng 4 a con v m u x t cung hn 20 nm trc. B b tng ng

huyt nh vi ch n c kim sot. Cn lm g kim sot tt nht cho

tnh trng ca b?

A . Bi tp bng quang( i tiu 2h /ln).

B . Doxazosin cng vi finasteride.

C . Metformin

D . Oxybutynin

E . Phu thut.

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16. Mt ngi n ng 42 tui b suy thn giai on cui chy thn nhn to

v c dng mt thuc cho bun nn v i ma mn tnh . Hn tun qua,

ng mi bt u my mi khng t ch, nhn nh, v li th ra. iu ny c

th l tc dng ph do thuc chng nn no sau y?

A. Erythromycin

B. Methylprednisolone

C. Ondansetron

D. Prochlorperazine

E. Scopolamine

17. Nguyn nhn ph bin no sau y gy ra ho ko di lin tc hn 3 thng

ngi khng ht thuc?

A. Hen suyn

B. Bnh tro ngc d dy

C. Lisinopril

D. Nhim Mycoplasma

E. Chy dch mi sau.

18. Mt ngi n ng 64-tui nghin ru n phng cp cu v thnh

thong ho ra mu, ho tng dn, v st trong vi tun qua. CT lng ngc ca ng

thy s bt thng thy di bn phi. ng cng bnh nhn nhim lao khi

trong t vi nm trc y. Kim tra m thy c mi thi mu xanh, v c dy

mu. Nhum Gram cho thy nhiu bch cu a nhn v kt hp cc vi khun

gram dng v m. Chn on c th l g?

A. Ung th ph qun.

B. p xe phi do nhiu loi vi khun.

C. Lao phi

D. Vim ni tm mc van ba l.

E. U ht Wegener.

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19. Mt ngi n ng 74 tui vi ung th biu m nhnh ph qun sau ca

ph qun chnh tri pht trin biu hin bng ho ra mu nhiu(ho ra mu 1L)

trong khi nhp vin. Tt c nhng iu sau y nn c xem xt trong iu tr

ban u ngoi tr

A. Thuyn tc ng mch ph qun

B. Gim ho.

C. t in trc tip qua soi ph qun.

D. t bnh nhn t th nm nghing bn phi.

E. t ni kh qun ca ph qun gc bn phi di ni soi ph qun

20. Mt bnh nhn vi protein niu c kt qu sinh thit thn l v cc mao

mch cu thn v tng sn t bo cnh cu thn. Bnh nhn c kh nng b bnh

gi?

A. Bnh tiu ng.

B. Nhim HIV.

C. a u ty xng.

D. Lupus ban h thng.

E. U ht Wegener .

21. Mt ph n 35 tui n phng khm ca bn v kh th. C y c da hi

xanh, thn mnh, t chi ca c tm, v c cht nhy mng. Chn on no c

nhiu kh nng nht?

A.Khuyt tt vch ngn tm nh

B.Vim c tim.

C.Hi chng Raynaud.

D. Nhim trng huyt

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E. Co tht do nhit lnh

22. Mt ngi n ng 43 tui b bnh gan do ru than phin kh th khi

ngi dy. Khm thy c tun hon bng h ngc v ban lng bn tay.

bo ha oxy ng mch ca ng gim t 96% n 88% khi thay i t th t

nm sang ngi .Phi RRFN r v ting tim r. Khm bng thy gan b sc

nhng khng c dch hay g c vng thp. ng b ph vng thp 1 +. Nguyn

nhn c kh nng nht gy kh th?

A. Bnh thuyn tc huyt khi mn tnh

B. Suy tim sung huyt

C. R ng tnh mch phi

D. Tng p lc tnh mch ca.

E. Khuyt tt vch ngn tm tht

23. Mt ph n 30 tui than phin b ph phn thp v trng bng. N thay

i hng ngy v ti t hn khi thi tit nng. C ph nhn hi th ngn, kh

th, kh th khi gng sc, vng da, tiu c bt, hoc tiu chy. Triu chng ca

c xy ra c lp vi chu k kinh nguyt. Khm thy ng ch ph thp 2 +,

tnh mch c xp , phn hi gan tnh mch c m tnh, T1 T2 bnh thng

khng c ting tim bt thng, phi r ro ph nang r, bng mm khng

chng, v da bnh thng. Xt nghim chuyn ha hon ton trong gii hn

bnh thng, v xt nghim nc tiu khng c protein niu. Chn on thch

hp l?

A. X gan

B. Suy tim sung huyt

C. Ph theo chu k .

D. Ph t pht

E. Tiu ha km hp thu

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F. Hi chng thn h

24. Tt c cc yu t sau y lin quan vi mt nguy c lon nhp tim tm

tht vi lo u / hong s trong mt bnh nhn phn nn v nh trng ngc,

ngoi tr

A. Tin s suy tim sung huyt

B. Tin s bnh ng mch vnh

C. Tin s ca bnh tiu ng

D. Hi hp ko di > 15 pht

E. nh trng ngc kch thch bng ethanol

25. Mt ngi ph n 25 tui khe mnh ti phng khm ca bn thng

th nm thai k. Huyt p ca c l 142/86 mmHg. Bc tip theo bn nn

lm?

A. C phi tr li phng khm ca bn trong 2 tun kim tra huyt p

B. Bt u dng thuc c ch men chuyn angiotensin.

C. Bt u dng thuc chn beta.

D. Kim tra li p huyt khi ngi ngh trong 6 gi.

E. Kim tra li huyt p khi nm nghing trong 6 h.

26. Mt ph n 33 tui b bnh tiu ng v tng huyt p c a n

bnh vin vi cn git tun th 37 ca thai k. Huyt p ca c l 156/92

mmHg. C c protein niu4 +. Qun l phi bao gm tt c nhng iu sau y,

ngoi tr

A. Sinh ngay.

B. Labetalol tnh mch

C. Magnesium sulfate tnh mch

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D. Phenytoin tnh mch

27. Nhng ri lon chc nng van tim c kh nng gy t vong khi mang

thai?

A. H van ng mch ch

B. Hp van ng mch ch

C. H van hai l

D. Hp van hai l

E. H van ba l .

28. Mt ph n 27 tui c chn tri ph nhanh trong tun th 20 ca thai k

ca mnh. Kt qu siu m cho thy c huyt khi tnh mch su tnh mch

chu tri (DVT). X tr thch hp bao gm:

A. Nm ngh trn ging.

B. Ly huyt khi bng catheter.

C. Dng enoxaparin.

D. S dng b lc tnh mch ch di

E. Coumadin

29. Trong cc yu t sau y nn sng lc thng quy ph n cho bnh

tiu ng thai k?

A. Tui> 25 nm

B. BMI> 25 kg/m2

C. Tin s gia nh ca bnh tiu ng

D. Ngi M gc Phi

E. Tt c cc trn

30. Tt c nhng iu sau y phi c lm thng quy nh gi bnh

nhn tri qua phu thut tim c nguy c cao hoc trung bnh, ngoi tr

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A . ECG 12 chuyn o c bn.

B . X-quang lng ngc.

C . Bnh s chi tit.

D . Khm.

E . Lm test gng sc.

31. Mt bnh nhn nam 69 tui b tiu ng kim sot, suy tim v thng

tim t lu. Hin ti bnh nhn c st, gim th lc mt tri tng dn ln bt u

t hn 6 h trc. Cc ch s sinh tn: nhit 101,3oF, nhp tim 105 ln/pht,

huyt p 125/85mmHg. Xt nghim no sau y l tt nht chn on?

A. Cy mu.

B. Pht mu lam knh.

C. MRI s no.

D. Bng v bnh thp.

E. Xt nghim khng th trong mu.

32. . Mt qu bom bn pht n trung tm thnh ph Boston. Trong thnh

phn qu bom c cha TNT v cesium-137. c tnh c 30 ngi b cht ngay

lp tc. Tm bay xa ca bi phng x l 0.5 dm, vi liu phng x l 1.8 Gy.

c tnh c khong 5000 ngi tip xc vi tia beta v gamma. Hu ht h

khng c cc biu hin thng tch bn ngoi, nhng c khong 60 ngi c

bng chng ca tn thng nhit. Phng php thch hp nht iu tr cho

cc trng hp b thng l g?

A. Tt c nhng ngi tip xc vi phng x cn c iu tr bng kali

iodua.

B. Tt c nhng ngi tip xc vi phng x cn c iu tr bng xanh

ph.

C. Tt c nhng ngui ny nn c kh x trc khi a n trung tm cp

cu gn nht trnh nhim x vo nhn vin y t.

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D. Nhng ngi b thng nng nn c chuyn n bnh vin sau khi g b

qun o, v nguy c nhim x sang nhn vin y t l thp.

E. Vi mc nhim x ny th khng cn kim tra hay iu tr no khc.

33. Mt s nn nhn c a ti phng cp cu sau mt v khng b nh

ga. V n lm pht tn vo khng kh mt cht khng r l cht g, nhng

mt s ngi thy c mi ging cy ci nga hoc ti t chy. Trc khi c

a ti phng cp cu, qun o ca h c b i, v h c tm vi

hoa sen. Khi ti phng cp cu, h khng c cc biu hin r rng tr kch thch

mt. Vi gi sau hu ht h cm thy nght mi, au xoang v cm gic bng

l mi. Bt u sau khi tip xc v n, h thy cc vt lan ta da

c bit l c, nch v b phn sinh dc ngoi. Mt s ngi cn c phng

rp da. Ngoi ra cn khn ging, ho, kh th. Tc nhn ha hc c s

dng trong v khng b l g?

A. Chlorine

B. Cyanide

C. Mustard gas

D. Phosgene oxime

E. Soman

34. Mt tc nhn ha hc c s dng trong mt cuc tn cng khng b

trung tm mua sm thc phm. Mt s nn nhn cht trc khi lc lng y

t c mt. Nhng ngi sng st k rng mnh thy kh nhn, pha trc nh

c mu en. H cng c biu hin tng tit nc bt v nc mi. Mt s

ngi cn thy kh th v th kh kh. Nhng ngi b nh hng nhiu nht

b bt tnh v sau c biu hin ng kinh tng dn. Loi thuc no sau y

nn c dng cho nhng ngi ny?

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A. Atropine, 6 mg tim bp

B. 2-Pralidoxime chloride, 1800 mg tim bp

C. Diazepam, 5 mg tnh mch

D. A v B

E. B v C

F. Tt c cc loi thuc trn

35. Mt a tr 7 thng tui c a ti phng khm. a tr c thai k

khe mnh, khng c tai bin chu sinh. B m a tr cho rng c bt thng

a tr, b rt hiu ng v c th c mi chut. Kim tra thy a tr c tt

u nh, gim sc t v chm. Cc xt nghim cn thit c tin hnh chn

on. Lm th no ngn chn tnh trng ny a tr?

A. Sng lc th xeton niu lc a tr 6 thng tui.

B. Sng lc phenylalanin mu lc a tr mi sinh.

C. Sng lc bt thng NST lc tr mi sinh.

D. Sng lc di truyn b m a tr trc khi sinh tr.

E. Ly mu mu dy rn lc ngi m mang thai 2 thng kim tra glutamin

synthetase.

36. Mt ph n 35 tui tin s thoi ha khp n bnh vin do nc tiu

sm mu bt u t vi tun qua. Bnh nhn b vim cc khp hng, u gi,

vai trong khong 2 nm. Khm lm sng thy c ta c cc vt sc t mu nu-

xm c hai tai. Ri lon no sau y l thch hp nht?

A. Alkapton niu

B. Hawkinsin niu

C. Homocystin niu

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D. Tng acid amin mu typ 1.

E. Tryptophan niu.

37. T l bt thng nhim sc th thai nhi l?

A. 0.01%

B. 0.10.5%

C. 12%

D. 25%

E. 1025%

38. Tnh trng trong ph h sau y di truyn theo kiu no?

A. Di truyn ln lin kt NST X.

B. Di truyn tri lin kt NST X.

C. Di truyn ln trn NST thng.

D. Di truyn tri trn NST thng.

E. Khng th xc nh c do cc thng tin trong ph h l cha .

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39. Mt ngi n ng 32 tui b st khng r nguyn nhn . u tin bnh

nhn ch n tnh trng kh t 3 thng trc v trong 6 tun qua ng ta c

st hng ngy, nhit cao nht l 39.40C. ng ta b st 4.5kg. ng ta than

phin rng cm thy au khp v au c khng c hiu. ng ta khng c ban

ngoi da v khng tip xc vi ngi m. phng khm bc s, nhit bnh

nhn c lc ln n 38.30C. Cc xt nghim c thc hin nhng khng

cho kt qu c hiu. Cng thc mu cho bch cu 15.7G/L trong 80% BC

ht, 15% BC lympho, 2% BC mono, 3% BC a acid. Lam mu ngoi vi cho kt

qu bnh thng. hematocrit 34.7%, mu lng(ESR) l 57mm/h. Chc nng gan,

thn bnh thng. Cc xt nghim HIV, EBV, cytomegalovirus( CMV) m tnh.

Cy mu, Xquang ngc v th nghim PPD cng m tnh. cc trng hp st

khng r nguyn nhn trong cc nhm sau y, nhm no kh nng xc nh

chn on l ln nht?

A. Thuc hoc cc thc ung khc.

B. Hi chng st chu k di truyn, v d nh st a Trung Hi gia nh.

C. Nhim khun.

D. Khi u.

E. Bnh vim khng do nhim trng.

40. Tnh trng thiu oxy mn tnh gy ra cc bin i sinh ha cung cp

oxy n cc m khng b gim. So vi nhng ngi sng cao tng ng

mc nc bin th nhng thay i no sau y s c mt ngi khe mnh

sng lu di vng cao?

A. Nhit c bn 7.45.

C. Tng sn xut 2,3DPG t hng cu.

D. tp trung hemoglobin< 10mg/dL.

E. PCO2 ng mch

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41. Mt bnh nhn b nhim toan chuyn ha, khong trng anion gim,

khong trng thm thu tng. Nguyn nhn thch hp nht gy ra tnh trng ny

l do nhim c loi thuc no sau y?

A. Lithium.

B. Methanol.

C. Oxycodone.

D. Propylene glycol.

E. Salicylate.

42. Pht biu no sau y v tc dng ca thuc khi s dng qu liu so vi

liu tham kho l ng?

A. Tc dng ca thuc bt u sm hn, t nh sm hn v thi gian tc dng

ko di hn.

B. Tc dng ca thuc bt u sm hn, t nh mun hn v thi gian tc

dng ko ngn hn.

C. Tc dng ca thuc bt u sm hn, t nh mun hn v thi gian tc

dng ko di hn.

D. Tc dng ca thuc bt u mun hn, t nh sm hn v thi gian tc

dng ko ngn hn.

E. Tc dng ca thuc bt u mun hn, t nh mun hn v thi gian tc

dng ko di hn.

43. u l yu t gp phn chnh vo nhu cu nng lng lc ngh ngi?

A. M m.

B. Mc luyn tp.

C. Khi nc c th.

D. Nhp tim lc ngh ngi.

E. Khng c yu t no trn.

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P N

1. Cu tr li l C. Bnh nhn ny b t cng nghim trng ng c tn

thng su trong m, bao gm c vi mch mu. Bin php iu tr cc thuc

gin mch ti ch hay tim tnh mch khng c hiu qu trong trng hp ny.

Quyt nh phu thut m hoi t v ct lc l tt nht giai on mn

tnh hn l cp tnh trong trng hp khng c nhim trng. Bc u, gim

au bng cc ch phm thuc phin v gi m tch cc l bin php iu tr ch

yu.

2. Cu tr li l D. N l quan trng gim nguy c tng i ca mt th

thut so vi nguy c tuyt i ca th thut . ARR l 0.88% - 0.59% = 0.29%

(tnh trn 1000 ngi). Gim nguy c tng i trong trng hp ny l ~ 30%.

iu ny c th c d on, do th thut ny c th lm gim 30% t

vong do ung th i trng nu c trin khai rng ri trong cng ng. Tuy

nhin, ARR l rt nh; t l 1/ARR tng ng vi s lng bnh nhn cn

iu tr phng t vong do ung th i trng. Trong trng hp ny con s

l 330. Do , khi thc hin th thut ny rng ri trong cng ng, c th

cn n mt lng ln bnh nhn phng vi s can thip (FOBT) .

3. Cu tr li l B. D on tng tui th l con s trung bnh p dng cho

ton cng ng ch khng cho c nhn ring r. Do chng ta thng khng hiu

c bn cht thc s ca nguy c mc bnh, sng lc v cc thay i v li

sng thng mang li li ch cho mt t l nh dn chng. i vi sng lc

bng xt nghim, cc trng hp dng tnh gi cng c th lm tng nguy c

xt nghim chn on. Trong khi th nghim Pap ch gip sng thm trung bnh

2 n 3 thng, i vi cc bnh nhn ung th c t cung th n li c th lm

bnh nhn sng thm nhiu nm. Tui th trung bnh tng khi chp tuyn v ( 1

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thng), PSA( 2 tun), luyn tp (1 n 2 nm),thp hn so vi vic b thuc l(

3 n 5 nm).

4. Cu tr li l B. D n gio dc quc gia dnh cho ngi ln v

Cholesterol hin nay khuyn nn sng lc lipid tt c nhng ngi trn 20

tui. Vic th nghim bao gm tng lng cholesterol, triglycerid, LDL v

HDL. Vic ny nn c thc hin c 5 nm mt ln. Tt c cc bnh nhn i

tho ng typ 1 cn c theo di cht ch cht bo phng nguy c tim

mch bng cch kt hp theo di lipid mu km vi cc nguy c khc xc

nh mc nguy c v khuyn co iu tr.

5. Cu tr li l C. Ri lon lo u tng qut thng biu hin cc triu

chng trc nm 20 tui, t l mc khong 5%. Nhng bnh nhn ny thng

k mnh c cm gic lo lng v m nh x hi v nhng iu t thi th u.

Trn lm sng, nhng bnh nhn ny lo lng lin tc, qu mc v khng c thc

t, c ch cc hot ng bnh thng. Thm vo , bnh nhn thng c kch

thch v mt ng. Tuy nhin, cc ri lon nh nh trng ngc, kh th, nhp

tim nhanh l rt him. V mt sinh l bnh hc, c th l do gim vai tr ca

cc th th GABA trong vic gn vi Benzodiazepam. iu tr nn phi hp

thuc v cc bin php tm l. Cc loi thuc c s dng c th l

benzodiazepin, buspirone v cc thuc chng co git vi thuc tnh ca h

GABAergic chng hn gabapentin, tiagabine, divalproex.

6. Cu tr li l D. Do cc sn phm thc vt c chp nhn s dng rng

ri trong y hc phng Ty (v d Digoxin, taxol, penicillin), khng nn ngc

nhin khi cc tho dc khc phc c chng minh trong cc th nghim

lm sng l c hiu qu. V d, cy Saint John c hiu qu hn gi dc nh

n trung bnh trong chng trm cm; c ch cn cha r nhng s chuyn ha

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mt s cht dn truyn thn kinh b c ch bi cht ny. Cc sn phm Kava c

tc dng chng cng thng. Cht chit xut ca cy Serona repens, c

chng minh l lm gim tiu m v dng nc tiu bnh nhn ph i tin

lit tuyn. Chit xut t cy c c nh hng n chuyn ha androgen, bao

gm c ch gn dihydrotestosterone vi th th androgen.

7. Cu tr li l D. c im quan trng nht ca bnh nhn chn n tm l

l s t chi n duy tr trng lng c th thp. Hi chng ny xy ra 1/

200 bnh nhn. Nhng bnh nhn ny thng thiu cn r rt, hu nh khng

c kinh nguyt, v thng lin quan n vic n ung v . T l t vong l

5% mi thp k. Nguyn nhn gy ri lon n ung nghim trng l cha c

bit nhng c th lin quan n s kt hp ca cc yu t v sinh l, tm l, vn

ha. Bnh nhn thng bt u b m nh hoc cu ton v ch n. Khi gim

cn nhiu, bnh nhn lo ngi v s tng cn v tham gia thc hin ch n

king khem nghim ngt. Ri lon ny ch yu ch xut hin cc nn vn ha

trong gi tr b gim, gi nh hng ca vn ha ln ri lon ny. Chng

hu n tm thn nhng bnh nhn tip tc duy tr trng lng c th bnh

thng nhng tham gia vo vic n ung qu mc sau l b p li ri lon

purging c t l cao hn nhng bnh nhn m tui th u hoc cha m bo

ph. iu ny l khng r rng cho d chn n tm thn l bnh c tnh di

truyn.

8. Cu tr li l C. Mt s loi thuc gm isoniazid cha lao, L-dopa cha

parkinson, penicillamine s dng trong bnh x cng b, thc y s thiu ht

vitamin B6 bng cch phn ng vi 1 nhm carbonyl trong 5-pyridoxal

phosphate, m l mt cofactor trong chui phn ng chuyn ha acid amin.

Nhng thc n cha vitamin B6 gm cc cy h u, la m v tht. S thiu

ht vitamin B6 gy ra vim li, vim tit b nhn, vim ming, ( cng c

thy trong thiu ht cc vitamin nhm B khc). Thiu mu hng cu nh, nhc

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sc c th do enzym u tin trong tng hp hem i hi pyridoxal phosphate

nh mt cofactor. Tuy nhin vitamin B6 cn cho chuyn homocystein thnh

cystathionin. Do thiu ht vitamin ny c th lm tng nguy c bnh tim

mch do kt qu ca tng homocystin trong mu.

9. Cu tr li l C. Tng huyt p v i tho ng l nhng bnh mn tnh

quan trng nht c t l mc tng theo tui. nhng ngi trn 65 tui, t l

tng huyt p t 60 n 85%. Nhng con s ny c th tng trong tng lai gn

khi t l bo ph v tui th trung bnh ngy cng tng. Cc s liu gn y cho

thy t l bnh nhn cao tui b cao huyt p khng c kim sot Hoa K

ngy cng tng. iu ny cho thy s gim nhn thc ngi ln tui. Nhng

d kin ny cng c ngha quan trng v tn s mc bnh tim mch v t

qu ngi ln tui.

10. Cu tr li l B. T l mc tiu ng ngi ln tui l 18 -21%. T l

ny c th s gia tng cng vi tnh trng bo ph ngi ln tui ngy cng

tng. Tiu ng c lin quan vi s suy gim v th cht trong khi cao huyt

p c lin quan vi s suy gim nhn thc. Tuy nhin, c hai ri lon ny

thng c mt ngi cao tui. Tiu ng v t qu lun kt hp vi vic

gim kh nng phc hi chc nng ngi cao tui.

11. Cu tr li l A. Tnh trng chc nng, c nh ngha l kh nng mt

bnh nhn c th t phc v cc nhu cu bn thn hng ngy, y l ch s rt

quan trng trong tin lng. S suy gim chc nng nn c tm kim s h

tr y t v mt tr nh, trm cm, thay i s h tr x hi. Sng lc tnh trng

ny bao gm nh gi cc hot ng hng ngy, dng i v s thng bng, nhn

thc, tm nhn, thnh lc, dinh dng v rng ming.

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12. Cu tr li l A. M sng c th l nguyn nhn gy nm vin ko di v

c th e da n tnh mng. N thng c chn on khng y . Phng

php nh gi s ln ln (CAM) c nhy v c hiu rt cao nh gi m

sng. Mt quan nim sai lm l tt c cc bnh nhn m sng c biu hin kch

ng. Trong thc t, m sng thng c lin quan n gim nhn thc v bnh

nhn c th biu hin thi bng quan hn l kch ng, hiu chin hay lo

lng. Mt tiu chun quan trng chn on khc l tnh trng tinh thn ca

bnh nhn bin i nhanh, cp tnh t tnh trng tinh thn c s ca bnh nhn.

13. Cu tr li l E. T l t ng tng ln theo tui v c tc ng ng k

n t l t vong v t l bnh. Khong 3-5% cc bnh nhn b ng s dn n

gy xng v y l yu t nguy c ph thuc vo s b tr chm sc nh

dng lo. Tt c nhng ngi cao tui nn c nh gi nguy c ny hng

nm v c hi v tnh trng t ng trong nhng ln n bnh vin kim tra.

phng tnh trng ny cn kt hp a ngnh gia y t, hn ch cc loi thuc

hng thn (c bit l benzodiazepin), kim tra th lc thng xuyn, tp

dng sinh hng ti n nh dng i kim tra cht ch cc trng hp lin

quan n t ng trong qu kh.

14. Cu tr li l B. Kim tra sc khe cho tt c cc bnh nhn nm bt

ng ti ging hoc c b phn b bt ng phi gm thm khm cn thn cc

v tr thng b l lot do t . Gt chn, mt c chn, xng cng, vng hng,

mu chuyn ln xng i l nhng vng hay b nht, chim khong 80%. Lc

y v m l cc yu t c nh hng. ngi trng thnh, v cc bnh

nhn nh dng lo, t l t vong do lot vt thng tng gp 4 ln. Bin

chng nhim trng gm c vim xng ty v nhim khun huyt. Mt tn

thng v hi c th tin trin su sc , d nhim khun v rt kh qun l

cc vt lot t th nm giai on 4 trong mt thi gian rt ngn m khng c s

chm sc tch cc vt thng v s gim ti nhn vin y t.

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15. Cu tr li l E. Bnh nhn ny khng kim sot c trong vn tiu

tin, dn n do ri lon chc nng c tht niu o, ph bin ph n v khng

ph bin nam gii. iu ny thng xy ra khi c cc hot ng lm tng p

lc bng. Cc nguy c ph bin nht l giai on trc sinh, phu thut ph

khoa, mn kinh. Cc bi tp Kegel c th c ch, nhng phu thut c coi l

c hiu qu nht. Oxybutynin v cc bi tp kim sot bng quang i khi c

hiu qu. Cc thuc chn -adrenergic v 5- -reductase c s dng cho bnh

ph i tin lit tuyn nam gii. Theo di st ng huyt v bnh tiu ng

rt hu ch nhng bnh nhn cao tui m khng kim sot tiu tin, nhng

bnh nhn ny khng miu t a niu v tin s phu thut vng chu t bnh

nhn vo cc nguy c cng thng khng kim sot.

16. Cu tr li l D. Bnh nhn ny c tnh trng ri lon thn kinh mn tnh

m c th khng th phc hi. Prochlorperazine l mt tc nhn khng

dopaminergic c tc ng ti th th D2 ca dopamin t gy c ch nn.

Nhm tc nhn ny l rt c hiu qu trong iu tr cc trng hp nn do

thuc, c cht, v chuyn ha. Tuy nhin, nhng tc nhn ny i t do qua

hng ro mu no v c th gy ra lo lng, tng tit sa, ri lon kh nng sinh

dc, cc phn ng ri lon trng lc. Tnh trng ri lon thn kinh mn tnh

ny l nghim trng nht trong cc biu hin nhim c thn kinh.

Erythromycin l mt prokinetic c th lm cho tnh trng bun nn, nn tr nn

trm trng hn. Ondansetron hot ng th th 5-HT3 v khng c tc dng

i khng dopaminergic. Scopolamine l mt thuc i khng cholinergic m

c th gy m sng, sng s, cc tc dng ph khc trn h thn kinh nhng

khng gy ra ri lon vn ng thn kinh. Glucocorticoid cng khng gy ra

tnh trng ny.

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17. Cu tr li l D. Ho mn tnh c nh ngha l tnh trng ho ko di qu

8 tun. Nhim Mycoplasma c th gy ra ho cp tnh hoc ho dai dng trong 8

tun. Hen suyn, bnh tro ngc v chy mi mn tnh l 3 nguyn nhn ph

bin nht gy ho mn tnh nhng ngi khng ht thuc, khng dng cc

thuc c ch men chuyn (ECA). Tt c cc loi thuc c ch men chuyn, k

c lisinopril c th gy ra mn tnh, c th do thay i chuyn ha bradykinin.

Nhng bnh nhn b ho do dng thuc c ch men chuyn c th chuyn sang

dng thuc c ch th th angiotensin m khng gy ho.

18. Cu tr li l B. Mi thi v nhum Gram thy a dng chng vi khun

gi y l mt p xe phi do nhiu chng vi khun bao gm c vi khun ym

kh v Streptococcus viridans. Cc vi khun ym kh gy ra mi thi ca m,

di. Biu hin lm sng nh, ko di l c trng ca tnh trng ny, v tin s

bnh nhn nghin ru l mt yu t nguy c r rng. Thy di phi phi l v

tr ph bin nht ca tnh trng p xe phi, sau l thy trn phi phi v thy

di phi tri. Vim ni tm mc c th gy p xe phi do t cu. Bnh nhn

ny c nguy c ca lao phi( TB) tuy nhin, m c th khng thi v khng

xut hin m thy trn knh hin vi. Cc tn thng hang lao thng thy

trn. U ht Wegener c th gy ra cc hang nhng thng s lng nhiu v

m khng c mi thi. Ung th phi t bo vy cng c th gy ra nhim trng

th pht mc d y khng phi l c trng ca vi khun k kh.

19. Cu tr li l D. Ho ra mu trong nhng trng hp ny bt ngun t

ng mch ph qun do ng mch ch hoc ng mch lin sn cp mu m

khng phi do ng mch phi. Do c p lc cao, s chy mu c th xy ra t

ngt v nhiu. Gy thuyn tc ng mch dinh dng cho ph qun vng nghi

ng c th lm ngng chy mu. Thuc gim ho c th gip lm gim tc ng

ca ho ln lp di nim mc. Ni soi ph qun t in trc tip c th mang

li li ch i vi c khi u d v. t ng ni kh qun chn lc ti v tr ph

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qun chnh phi c th h tr phi phi khng chy mu. Gy tc ph qun ph

phi bng cc thuc chng ng c th gy ra suy h hp. Bnh nhn nn c

nm trong t th phi khng chy mu trn, khng phi l di, mc ch l

phng chy mu vo phi khng c chy mu.

20. Cu tr li l B. Mt bin th ca x cng tiu cu thn thng c

chn on bnh thn HIV, vi biu hin protein niu v suy thn bn cp. i

tho ng thng gy ra dy mng y cu thn, x cng ng mch. a u ty

gy ra protein niu do lm lng ng chui nh vo tiu cu thn, ng thn, v

s tng tch m ti thn. Knh hin vi th hin cc protein amyloid bng nhum

Congo. SLE gy ra vim cu thn tng sinh mng do lng ng phc hp

min dch. U ht Wegener v vim a vi mch gy ra vim cu thn hoi t.

21. Cu tr li l A. Bnh nhn ny c tm trung ng, l do bo ha oxy

mu ng mch. tm trung ng, da v nim mc b nh hng. Tm ngoi vi

l do gim th tch dch do cc nguyn nhn khc nhau v d nh h huyt p,

suy tim( nhi mu c tim, vim c tim), nhim trng huyt, hoc co mch ngoi

vi nh trong hi chng Raynaud, tip xc vi lnh. nhng trng hp ny,

cc u chi b nh hng nhiu nht. Bnh nhn trong cu hi b hi chng

Eisenmenger i chiu shunt phi-tri do gim bo ha oxy mu. Cc

nguyn nhn khc gy tm trung ng l bnh phi nng, d dng ng tnh

mch phi, thng kh ph nang km , bt thng v hemoglobin.

22. Cu tr li l C. Bnh nhn x gan c nguy c b r ng-tnh mch phi.

iu ny gy ra kh th khi ng gim khi nm. V tr r thng y phi,

tng dng shunt phi tri khi bnh nhn ng. t th nm, nh phi c

ti mu tt hn nn ci thin tnh trng thiu oxy v kh th. D dng ng

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tnh mch phi bm sinh cng c th gy ra tnh trng ny. Khuyt tt vch lin

tht khng gy ra tnh trng ny cho n khi c dng shunt phi-tri.

23. Cu tr li l D. Bnh nhn c ph tng ln khi thi tit nng nhiu gi

y l ph v cn. Ph v cn xy ra ch yu ph n v c c trng bi

ph tng phn, c th c trng bng, ph vo ban ngy tng ln khi ng lu

hoc thi tit nng. Ph c lin quan n chu k kinh nguyt v c lin quan

n vic tng tit estrogen gy gi nc. Suy tim sung huyt, x gan v hi

chng thn h c loi tr nh tin s bnh tt v khm, cc xt nghim. Ban

u cn khuyn bnh nhn v s cn thit ca vic nm vi gi mi ngy, cng

nh bp chn vo bui sng. Ph v cn c th lin quan n hot ng bt

thng ca h renin-angiotensin, v thuc c ch men chuyn c th cn n

khi iu tr duy tr khng c hiu qu. Thuc li niu c th c hiu qa ban u

nhng b mt tc dng khi dng lin tc.

24. Cu tr li l D. nh trng ngc l mt triu chng thng c bnh

nhn k rng c cm gic p mnh, dn dp ngc. nh trng ngc c th

do tim, thn kinh, cc nguyn nhn khc( nhim c gip, thuc, ru, c ph,

cocain) hoc khng r nguyn nhn. Trong khi hu ht cc ri lon nhp tim

khng gy ra nh trng ngc, bnh nhn tim mch m nh trng ngc c cc

nguy c ca lon nhp tm nh hoc tht. Ni chung, cc bnh nhn phn nn v

tnh trng nh trng ngc ko di qu 15 pht thng l do nguyn nhn v

thn kinh. Hu ht cc bnh nhn hi hp khng c ri lon nhp nghim trng.

Tin s bnh nhn, khm lm sng, theo di Holter, in tm c th s dng

nh gi tnh trng lon nhp.

25. Cu tr li l D. Huyt p 140/90mmHg trong tam c nguyt th hai r

rng l bt thng. Trong tam c nguyt th hai, huyt p gim do gim sc cn

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mch h thng. tng huyt p c lin quan n s gia tng bnh tt v t l t

vong chu sinh. Chn on b tr hon c th gy hi ti bnh nhn. Huyt p nn

c o t th ngi v t th nm nghing 1 bn c th lm gim huyt p.

Vic chn on cn thc hin o huyt p hai ln cch nhau t nht 6h. Tng

huyt p c th gy ra do tin sn git, tng huyt p mn tnh, tng huyt p

thai k, hoc bnh thn tng huyt p. Nu c chn on tng huyt p, bnh

nhn nn c hhuyt p an ton v nguy c sn khoa cao nn c xem xt.

26. Cu tr li l D. Bnh nhn ny c sn git nng v s cu cha phi

c thc hin cng nhanh cng tt. sn git nh khi c tng huyt p mi khi

pht km protein niu sn ph mang thai sau 20 tun. sn git nng c cc

triu chng thn kinh trung ng( k c ng kinh), tn huyt p, protein niu

nng, suy thn, ph phi, gim tiu cu, ng mu ri rc ni mch. iu tr cho

b m mang thai b sn git nng trc 37 tun lm gim bnh sut ca m,

nhng lm tng nguy c non. Qun l cht ch tnh trng tng huyt p,

thng dng labetalol, lm gim nguy c ca t qu. Thuc c ch men

chuyn v chn th th angiotensin khng nn dng do n c kh nng nh

hng n s pht trin bo thai. Cn co git do sn git nn c kim sot

bng Magiesium sulfate, n c chng minh l c hiu qu vt tri so vi

phenytoin.

27. Cu tr li l D. Hp van hai l c lin quan n ph phi cp, lon nhp

nh, nguy c t vong cho m. Nguyn nhn c th lin quan n s gia tng

cung lng tim v th tch mu lu thng tron thi k mang thai. t t do lon

nhp tim hoc tng p lc phi c th xy ra. Bnh nhn hp hai l nn c

kim sot cht ch nhp tim. Th thut thng tim qua bng c th c thc

hin trong thi k mang thai. Gim sc cn mch h thng trong thi k mang

thai lm cho van hai l, ba l v van ng mch ch tro ngc ni chung thc

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hin c v suy tim thng khng c kh nng xy ra. Nu van M ch b hp

nghim trng, th thut tch van tim qua bng c th cn n.

28. Cu tr li l C. Thi k mang thai gy ra tnh trng tng ng, v huyt

khi tnh mch xy ra khong 1/2000 ph n mang thai. DVT xy ra chn

tri nhiu hn chn phi do p lc tnh mch chu tri. Khong 25% ph n

mang thai m b DVT c t bin yu t V Leiden, m cng nhy cm vi tin

sn git. t bin G20210A prothrombin (d hp v ng hp), v t bin

C677 Methylenetetrahydrofolate kh( ng hp) l nhng yu t nguy c ca

DVT ph n c thai. Coumadin b chng ch nh trong tam c nguyt th

nht v th hai do nguy c d tt thai nhi. Heparin trng lng phn t thp l

phng php iu tr thch hp, nhng c th chuyn sang heparin ng tim

truyn nu c th gy t ngoi mng cng. Bnh nhn nn c khuyn i li

ch khng phi l nm ngh nhiu ti ging. Khng c vai tr ca s tiu cc

huyt khi ti ch hoc b lc tnh mch ch di trong thai k.

29. Cu tr li l E. i tho ng thi k c lin quan n t l bnh tt

m v t l mc bnh v t vong tr s sinh. Ph n b tiu ng thai k c

nguy c tin sn git, tr sinh ra to hn. Tr s sinh c nguy c h ng huyt

v tn thng. iu tr thch hp c th lm gim nhng nguy c ny. Ch c

nhng bnh nhn c nguy c thp (tui

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hay cao. Xquan ngc khng c vai tr trong trng hp ny c chng

minh cho thy tin s tim phi v khm sc khe trong gii hn bnh thng.

31. Cu tr li l A. M t ngt mt bnh nhn c st v nguy c cao

nhim trng ni mch l vim ni tm mc cho n khi chng minh c tnh

trng khc. Ngay c khi nhim trng huyt nguyn pht trong trng hp khng

c cc ht si tim c th dn n vim ni nhn ni sinh hoc tc ng mch

trung tm vng mc. bnh nhn ny c th cn nhc n tnh trng vim tnh

mch huyt khi nhim trng mt. t qu, giang mai, vim mch v cc

bnh mu c tnh c th gy ra m cp tnh, nhng t khi c st cao cp tnh.

32. Cu tr li l D. Phn ln thit hi ban u lin quan n mt qu bom

"bn" l sc mnh ca v n ch khng phi l bc x. Sau mt cuc tn cng

khng b, iu quan trng l xc nh tt c nhng ngi c th tip xc vi

bc x. iu tr ban u cho nhng ngi ny cn duy tr n nh v iu tr

ngi b thng nghim trng nht trc. Nhng ngi b chn thng nng

nn loi b qun o trc khi vn chuyn n phng cp cu. Nhng ngi c

nhng vt thng nh c th c kh x mt cch an ton m khng lm tng

nguy c bin chng y khoa phi c vn chuyn n mt khu vc tp trung

cho kh nhim. Mt cn c xem xt phng thc iu tr l tng liu phng

x m ngi tip xc. Vi liu 50%. Phng php iu tr

tim nng ca tip xc vi bc x bao gm s dng cc yu t kch thch,

truyn h tr. Truyn mu v cy ghp t bo gc ty xng c th c xem

xt trong trng hp gim ton b cc dng t bo mu nghim trng m khng

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hi phc. Tuy nhin, iu ny ang gy tranh ci, do thiu kinh nghim v ch

nh ny. Sau v n l phn ng ht nhn Chernobyl, khng c trng hp cy

ghp ty xng no thnh cng.

33. Cu tr li l C. Kh m tt (m tc lu hunh) l mt tc nhn gy

phng rp da c s dng nh mt tc nhn ha hc trong chin tranh v

khng b k t chin tranh th gii th I. Trong Chin tranh th gii th I, n

gy ra 70% ca 1,3 triu ngi b git cht bi chin tranh ha hc, nhng tng

th, t l t vong ca n ch l 1,9%. M tc lu hunh bao gm hai thnh phn

hi v cht lng c th gy ra tn thng cho biu m b mt. Tuy nhin, nhng

nh hng ca m tt b tr hon vi gi sau khi tip xc. Nhng nh hng u

tin khi tip xc vi m tt lin quan n mi, xoang, v hng. Cc triu chng

thng gp bao gm bng cc l mi, chy mu cam, vim au xoang, v au

hng. Tn thng ng h hp trn c th gy ra vim thanh qun v ho

khng m. ng h hp di n gy ra ho v kh th, nhng him khi c

xut huyt phi .Mng gi c th hnh thnh v gy tc nghn ng th. Mt l

c quan nhy cm nht, biu hin sm hn da. Cc triu chng ca mt bao

gm kch ng, vim kt mc, s nh sng, co tht mi, au, v tn thng gic

mc. Ban da bt u t 2 gi n 2 ngy sau khi tip xc v biu hin r nht

nhng vng m p, m t nh nch, c, y chu v b phn sinh dc. Cc

mn nc nh c th pht trin, kt hp li to thnh bng nc. Cc bng

nc ny thng ln, cha cht lng mu vng nht. T vong sau khi tip xc

vi kh m tt thng l do nhim trng huyt v suy h hp, mc d tip xc

vi liu cao c th dn n suy ty xng sau 7-21 ngy tip xc. Phosgene

oxime cng l mt tc nhn lm phng rp da c th biu hin cc triu chng

tng t, nhng n c th c phn bit vi kh m tt bi mi cay nng c

trng. Hn na, Phosgene biu hin cc triu chng ngay lp tc v au. Clo l

mt loi kh gy tn thng phi vi biu hin ph phi khng do tim mch l

ch yu. Cyanide l mt cht gy ngt vi cc triu chng khi pht nhanh

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chng, k c t vong. Soman l mt tc nhn thn kinh s gy ra cc triu chng

cholinergic ca nc bt, co ng t, co cng c, v cc tng tit dch. Cc triu

chng c tc dng nhanh, suy h hp v t vong trong vng vi pht tip xc.

34. Cu tr li l F. Nhng ngi ny tip xc vi cht c thn kinh cha

phospho (Soman, sarin, Tabun, cyclosarin, v VX) tc ng ca n da trn s

c ch synap thn kinh acetylcholinesterase. Cc triu chng l do s hot ng

qu mc ca h cholinergic. Cc triu chng biu hin theo th t h thng c

quan c tip xc. Khi c cht thn kinh s dng dng hi, c quan u

tin thng b nh hng l mt vi co ng t v cm thy rng th gii ang

"i mu en," nh c bo co trong cuc tn cng khng b tu in ngm

Tokyo, trong sarin c s dng.Tip xc cc c cht cha phospho qua

ng vm hng gy ra s mi,tng tit nc bt, v chy nc di. Tng tit

ph qun v ho thng xuyn xy ra. Sau khi ht phi cht c, n nhanh chng

c hp th vo mu qua mng ph nang mao mch.ng tiu ha thng

nhanh chng b nh hng khi cc tc nhn trong mu, dn n tiu chy, chut

rt, bun nn v i ma. Khi ci cht xy ra do cht c thn kinh thng l do

h thng thn kinh trung ng (CNS) b nh hng bi cc thuc

ny. Acetylcholine v th th ca n c phn phi rng ri trong no, v tip

xc vi s lng ln ca cc tc nhn cha phospho dn n bt tnh nhanh

chng, ng kinh, v ngng th trung tm.Cht c thn kinh c thi gian bn

hy ngn trong h tun hon, do nu can thip c thc hin nhanh chng,

cc triu chng c ci thin nhanh chng, m khng c cc triu chng ti

pht sau . iu tr ban u cho cht c thn kinh l dng atropine, c sn

trn ton th gii.Atropine tc ng mt cch nhanh chng ti cc th th

acetylcholine muscarinic gim bt ngng th trung tm nhng khng o

ngc nhng tc ng thn kinh c. Ngoi ra iu tr khng cholinergic kt hp

vi atropine, s dng oximes cng c ngh sau khi tip xc vi kh c.

Oximes v d nh 2-pralidoxime (2-PAM) kch hot li cholinesterase khi

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phc li chc nng enzym bnh thng. nhng bnh nhn c cc biu hin

c tnh thn kinh trung ng nghim trng v co git, benzodiazepin, nh

diazepam l s la chn iu tr. Thuc chng co git in hnh, chng hn nh

phenytoin, carbamazepin, phenobarbital, v acid valproic khng hiu qu trong

iu tr cc cn ng kinh gy ra bi cht c thn kinh.

35. Cu tr li l B. a tr ny c nhng du hiu lm sng c

in ca Phenylpyruvic niu, mt ri lon chuyn ha axit amin c di truyn

ln, trong phenylalanine khng th chuyn i thnh tyrosine. y l ri

lon di truyn ph bin nht ca qu trnh chuyn ha axit amin. Trng

hp khng c iu tr hoc khng c pht hin, thng a tr vn sinh

ra bnh thng nhng s nhanh chng c du hiu ca bnh ny, bao gm tt

nh u, chm pht trin tm thn, v ng kinh. a tr c mi hi nh

chut l do phenylacetate tch t trong da, tc, v nc tiu. c tnh

ca phenylalanine l do c ch

36. Vn ti cc axit amin khc cn thit cho tng hp protein bnh thng,

myelin, v cht dn truyn thn kinh. Sng lc phenylalanine trong mu thc

hin trc khi n 3 tun tui (thng c thc hin khi sinh) ngn chn

cc triu chng. iu tr bao gm hn ch phenylalanine trong ch n

ung sut i, b sung tyrosine. Nu pht hin lc mi sinh, tr em b nh

hng khng pht trin cc bin chng ni trn. Ph n mang thai c hi chng

ny phi duy tr kim sot cht ch trc v trong thi k mang thai trnh

cc khuyt tt bm sinh nh tt nh u, chm pht trin th cht v tam thn

tr.

37. Cu tr li l A. Alkapton niu l mt ri lon him gp do thiu ht

hemogentisic oxydase axit dn n bi tit alkapton trong nc tiu v tch ly

cc m b oxy ha. Bnh nhn c th tui ba mi, bn mi vi bnh

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vim khp v nc tiu m mu.Vim khp thng cc khp ln nh hng,

u gi,vai, lng.Cc sc t mu xm nu l c trng v c th lin quan

n mng cng v tai. Chn on nn c nghi ng bnh nhn c nc tiu

ti mu. Hawkinsin niu l mt ri lon lin quan n chuyn ha acid amin

trong khim khuyt enzym dioxygenase 4-hydroxyphenylpyruvat dn n

tht bi trong giai on trng. Khng ging nh hu ht cc ri lon axit amin,

l tnh trng di truyn tri. Tryptophan niu gy chm pht trin tr tu, nhy

da, v mt iu ha, tuy nhin, cc khim khuyt enzyme dn n kiu

hnh ny khng c xc nh tng aciamin mu typ 1 gy ra do khim

khuyt ca nh. Hyperprolinemia loi I l gy ra bi mt khim khuyt

enzym oxidaseproline v thng l lnh tnh. Homocystin niu c gy ra

bi mt khim khuyt -synthase cystathionine v dn n chm pht trin tr

tu.

38. Cc t bo trong c th ngi cha 46 nhim sc th(NST), 22 cp NST

thng v 1 cp NST gii tnh XX n v XY nam. t bin v s lng

hoc cu trc cc NST l ph bin v c tnh xy ra khong 10-25% cc thai

nhi. y l nhng nguyn nhn ph bin nht gy xy thai. nhng a tr

sng st, n gy ra cc d tt bm sinh v chm pht trin tm thn.

39. Cu tr li l A. Cc thng tin trong ph h l xc nh y l di

truyn n gen. V d in hnh bnh nhn Hemophilia A hoc lon dng c

Duchenne. Bnh di truyn ln lin kt NST X c c trng bi t l mc

bnh nam cao hn n. Tnh trng c di truyn t ngi n ng b bnh cho

tt c cc con gi ng ta. Khng bao gi truyn trc tip t b sang con trai. Cc

tnh trng c th di truyn qua con gi kiu hnh bnh thng mang gen bnh,

nu iu xy ra th tt c cc nam gii mang bnh c lin quan n nhau

thng qua n gii nh trong trng hp ny.

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40. Cu tr li l C. St khng r nguyn nhn (FUO) c nh ngha l tnh

trng st >38.30C( 1010F) trong> 3 tun lin tip m khng tm c nguyn

nhn sau khi xc nh cc nguyn nhn c th gy ra. Cc xt nghim nn c

thc hin l cng thc mu, lam mu ngoi vi, ESR, PCR, in gii, creatinin,

chc nng gan, xt nghim nc tiu, cc enzym, c. Ngoi r cn kim tra

ring bit i vi tng bnh v d VDVL cho bnh giang mai, HIV, CMV,

EBV, th nghim PPD, m, mu, nu thch hp. nh gi tng th cn kim

tra cc bnh vim nhim. Nhng xt nghim ny bao gm khng th khng

nhn, yu t dng thp, ferritin, st v transferitin. Trong mt s nghim cu ln

th nguyn nhn gy FUO ph bin nht l cc bnh nhim trng. Nhng nghin

cu gn y cho t l FUO do nhim trng l 32-36%. Nhim trng ph bin

nht gy FUO l lao ngoi phi. Cc nguyn nhn virus v nm cng ph bin.

Thm vo , cc p xa trong bng, sau phc mc, p xa thn v cnh ct

sng cng cn xem xt n. trong nhng nghin cu trc , khi u l nguyn

nhn ph bin th hai gy FUO. Tuy nhin nh s pht trin v cc phng

php chn on khi u hin nay, t l FUO do khi u gim xung.

41. Tnh trng thiu oxy mn tnh, gp nhng ngi sng trn cao lu ngy

gy ra mt s thay i trong ng cong phn ly oxy lm cho tng phn ly oxy

(gim i lc) v oxy c cung cp n cc m b thiu oxy nhiu hn. iu

ny t c nh tng sn xut 2,3-dyphosphoglycerate(2,3-DPG) t hng cu.

4 yu t lm gim i lc hemoglobin v oxy l nhit tng, tng p sut ring

phn ca C02( hiu ng Bohr), tng 2,3-DPG, tng tnh acid. Nhng thay i

ngc li s lm tng i lc oxy-hemoglobin t gim cung cp oxy ra ngoi

vi. Nam gii khe mnh thch nghi vi cao 1400m s c pH/PaCO2 l

7.43/34 v n gii l 7.44/33. tp trung hemoglobin s tng ln do tnh

trng thieeusc oxy s kch thch sn xut Erythropoietin.

42. Cu tr li l E. Nhng bnh nhn ngi dn tc thiu s c kt qu chm

sc sc khe km hn trong cc bnh c th phng v iu tr nh tim mch,

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hen suyn, tiu ng , ung th v cc bnh khc. Nguyn nhn gy ra nhng

s khc bit ny l a yu t, bao gm cc diieuf kin x hi( gio dc, kinh t

x hi, mi trng) v tip cn cc dch v chm sc sc khe( thng n khi

bnh nng). Tuy nhin, cng c s khc bit r rng v chng tc trong h

thng chm sc sc khe. Nhng khc bit ny c thy cc bnh v tim

mch, thn, ung th, tiu ng, iu tr gim nh. Loi b nhng khc bit ny

cn s thay i ca cc yu t trong h thng y t, mc cung cp dch v, v

bnh nhn.

43. Cu tr li l A. Lithium c ch vn chuyn ion qua mng t bo, dn n

i tho nht do thn v tng clorua gi to. iu ny c th gy ra nhim toan

chuyn ha vi khong trng anion thp. Cc di chng bao gm, bun nn, nn,

bnh no, mt iu ha, hn m, co git, lon nhp tim, ri lon vn ng.

Nhng trng hp nghim trng c iu tr bng ra rut, hydrat ha v c

khi cn n chy thn. nhim c salicylat khong trng thm thu bnh thng

cng nh nhim toan chuyn ha vi khong trng anion tng ln, nhim kim

hp v c khi l nhim toan chuyn ha vi khong trng anion bnh thng.

Ng c methanol c lin quan n m v c c trng bi nhim toan

chuyn ha tng khong trng anion, lactat v ceton bnh thng, khong trng

thm thu tng. Ng c Propylene glycol gy ra nhim toan chuyn ha tng

khong trng anion, tng lactat v khong trng thm thu. Ch c cc bt

thng v in gii lin quan n qu liu cc ch phm thuc phin l gy ra

nhim toan h hp nguyn pht c b.

44. Cu tr li l B. Cc trng hp lm sng trong cu hi l critical. Hiu

qu ca thuc xut hin sm hn, t nh sau , v thi gian tc dng ko di

hn trong trng hp qu liu thuc, so vi cc gi tr tham chiu. Do , khi

mt bnh nhn ung mt lng c cht m cc triu chng cha xut hin,

ngay sau nn tin hnh kh c khn cp v cc triu chng c xu hng xy

ra nhanh chng. Mt li thng gp trong thc t l bnh nhn sau khi c

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gii c cc ch phm lin quan n thuc phin hoc benzodiazepam s c

theo di t cht ch hn. Tuy nhin thi gian bn hy ca cc c cht thng

ko di hn cc cht i khng, naloxon hoc flumazenil cn c dng liu b

sung sau vi gi phng hn na nguy c nh hng n h TK trung

ng hoc trm cm sinh l.

45. Cu tr li l C. gi trng lng c th n nh, cn cn i gia

lng nng lng a vo v nng lng tiu th. Nng lng tiu th gm hai

thnh phn chnh: Nng lng tiu dng lc ngh ngi v cho cc hot ng th

lc. Ngoi ra cn dnh cho tiu ha thc n v sinh nhit t run c. Nng lng

tiu th lc ngh ngi c th tnh theo cng thc 900+10w( w: trng lng c

th theo kg) nam gii v 700+7w n gii. Cng thc ny c hay i ty

theo mc hot ng th lc. Yu t quyt nh chnh cho nng lng lc

ngh ngi l khi lng c bp.

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[2011]

Blueocean

Din n y khoa

[7/2011}

Chng II: DINH DNG

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A. CC CU HI

II-1. Bnh nhn n 19 tui, b chng bing n sau phu thut vim rut tha

cp. Hu phu c bin chng ARDS, vn cn t ni kh qun trong 10 ngy.

Ngy hu phu th 10, c ta b h vt thng. Cn lm sng: BC 4000/ul, Hct

35%, albumin 2.1 g/dl, protein ton phn 5.8g/dl, transferrin 54 mg/dl, lng Fe

gn 88mg/dl. Bn khi u ch dinh dng cho bnh nhn vo ngy th 11.

Cu no di y ng vi nguyn nhn v iu tr tnh trng km dinh dng

trn bnh nhn ny:

A. C ta b suy dinh dng, v h tr dinh dng nn khi u t t

B. C ta b thiu dinh dng, h tr dinh dng nn tn cng.

C. C ta b suy dinh dng, thiu dinh dng. Trong thiu dinh dng tri

hn nn h tr dinh dng nn tn cng.

D. C ta b suy dinh dng, thiu dinh dng. Trong suy dinh dng tri

hn nn h tr dinh dng nn t t.

II-2. Bn khm 1 bnh nhn theo di 2 tun sau iu tr ti bnh vin. Bnh

nhn hi phc sau vim phi bnh vin do pseudomonas spp. Trong qu trnh

nm vin b bin chng huyt khi tnh mch su. Hin ti bnh nhn c

tim tnh mch piperacillin/tazobactam v tobramycin qua catheter, warfarin,

lisinopril, hydrochlorothiazide v metoprolol. Cn lm sng sng nay cho thy

INR 8.2. Lc xut vin INR n nh 2.5. khng tin cn bnh gan. Nguyn nhn

tng INR no di y ph hp:

A. B qu liu thuc

B. Bnh nhn b huyt khi tnh mch su ti pht, nh hng n kt qu xt

nghim.

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C. Thiu vitamin K v cn c b sung

D. Liu warfarin c cho lc xut vin khng ph hp

II-3. Bnh nhn nam 51 tui, nghin ru, nhp vin v xut huyt tiu ha trn.

T tin cn xa v khm, c v nh chy mu t li. ng ta say ru v than

mi c. Xem li h s bn thy ng ta b xut huyt khp cch y 6 thng v

khng theo di sau . ng ta khng dng thuc g. CLS c TC 250 000, INR

0.9. Xut huyt lan ta chn. iu tr no di y l ng cho ri lon nn

ca bnh nhn:

A. Folate

B. Niacin

C. Thiamine

D. Vitamin C

E. Vitamin K

II-4. Trong ICU bn gp 1 bnh nhn n 57 tui vi vim ty cp, suy thn c

thiu niu. Nhp th 26l/p, tim 125 l/p, nhit 37.20C. Khm thy bng mm,

nhu ng rut bnh thng. CT scan thy ty vim khng xut huyt. im s

APACHE-I l 28. Khi quyt nh khi u dinh dng cho bnh nhn ny, cu

no sau y l ng:

A. rut ngh ngi l c s quan trng ca iu tr vim ty cp

B. Dinh dng ngoi rut trong vng 24h lm gim nguy c nhim trng v t

vong

C. Nui n ng rut h tr chc nng ca rut tit cc hormon d dy rut

kch thch hot ng dinh dng ng rut.

D. Trong hi chng p ng vim ton thn, vic nui n c th khng c

khi u v bnh nhn c th nhp t trong 7 ngy u tin.

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II-5. Nng lng tiu hao lc ngh (REE) c c tnh bng tng nng lng

cn trong tnh trng cn bng nng lng. 2 bnh nhn vi cn nng n nh,

bnh nhn no vi tiu hao nng lng lc ngh cao nht: Bnh nhn A: nam 40

tui, nng 90kg, ngi 1 ch. Hay bnh nhn B, nam 40 tui, nng 70kg v hot

ng nhiu.

A. Bnh nhn A

B. Bnh nhn B

C. REE ging nhau

D. Khng thng tin tnh REE

II-6. Tt c nhng c im lm sng di y thng gp bnh nhn bing

n ngoi tr:

A. Bing n lin quan nghi nghip

B. Bp mo hnh tng

C. n say sa

D. Th dc nhiu

E. Him khi thy i

F. Thu rt x hi

II-7. Bn chn on bing n cho 1 trong s nhng bnh nhn mi ca bn. Khi

phi hp chng trnh iu tr vi bc s tm thn. c im no gi bnh

nhn nn iu tr ni tr thay v ngoi tr

A. Mt kinh

B. Cng iu lng thc n nhp

C. S tng cn 1 cch phi l

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D. Thi quen ung thuc x

E. Cn nng < 75% cn nng mong i

II-8. Ngy nm vin th 16 ca bnh nhn v gia c 49 tui, hi phc sau

ngng ru v m sng. 9 ngy u b ta nm trong ICU, nhng hin ti tnh

to v tip xc tt. B ta c vt lot do nm lu lnh, BMI 19 kg/m2,

albumin 2.9 g/dl v thi gian prothrombin 18s ( bnh thng). Bnh nhn ny c

suy dinh dng khng?

A. Cha th xc nh c, cn thm thng tin.

B. Khng. Cho b ta ung ru nhiu, thi gian prothrombin s di ra.

C. Khng. B ta c mc tiu dng nng lng lc ngh thp v trng thi tm

thn bnh thng chng t tng phn vi suy dinh dng.

D. C. mc albumin thp ny him thy x gan v c v nguyn nhn l suy

dinh dng.

II-9. Bnh nhn nam 42 tui tham kho kin ca bn v b sung vitamin E.

ng ta c c rng liu cao vitamin E s ci thin nhu cu tnh dc v lm

chm tin trnh lo ha. ng ta khng b thiu vitamin E. Bn gii thch cho ng

ta rng nhng yu cu ny khng da vo bng chng tin cy. Nhng tc dng

ph khc ng ta nn c bit:

A. Huyt khi tnh mch su

B. Xut huyt

C. Qung g

D. Bnh thn kinh ngoi bin

E. Bnh vng mc

II-10 . Do quanh trung tm ung bu, bn thy 1 bnh nhn vi hi chng

carcinoid. V tng chuyn ha trytophan thnh serotonin, bnh nhn ny xut

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hin thiu niacin. Nhng tr li di y l triu chng ca hi chng pellagra

ngoi tr:

A. Vim da

B. Sa st tr tu

C. Tiu chy

D. Ri lon chuyn ha m

E. Vim li

II-11. Bnh nhn n 86 tui vi COPD, suy tim sung huyt v tiu ng type

2 nhp vin v t cp COPD. c t ni kh qun v iu tr vi

glucocorticoid v kh dung albuterol. Tip tc iu tr vi glargine insulin,

aspirin, pravastatin, furosemide, enalapril v metoprolol. Ngy nhp vin th 8,

c nui n tnh mch vi catheter TM di n. Nhu cu insulin tng vo

ngy th 9 v ng huyt tng. Ngy th 10, c ran phi v nhu cu oxi tng.

X quang ngc thy ph phi 2 bn. CLS c K, Mg, P v creatinin bnh

thng. Natri niu < 10mEq/dl. Nhng thay i trong ch dinh dng di

y ci thin tnh trng th tch ca bnh nhn ngoi tr:

A. Kt hp Glucose v lipid trong hn hp nui n ngoi ng tiu ha.

B. Gim hm lng Natri ca hn hp nui n < 40mEq/ngy

C. Tng lng protein trong hn hp nui n ngoi ng tiu ha.

D. Gim lng glucose ton phn.

II-12. 1 Nghin cu mi c cng b cho thy li ch ca 25mg/ngy ca

vitamin X. Khuyn co c lng nhu cu trung bnh ca vitamin X l

10mg/ngy, 2 lch chun di tng s c cng b trong nghin cu ny.

Gii hn trn cho php ca vitamin X cha bit. Bnh nhn ca bn mun bit

liu c an ton khi dng vitamin X vi liu 25mg/ngy. Cu tr li no di y

thch hp nht:

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A. Trn c lng nhu cu trung bnh 2 lch chun c nh ngha l gii

hn trn cho php.

B. 25mg/ngy l liu qu nhiu vi vitamin X

C. 25mg/ngy c thng k l khong an ton ca c lng nhu cu trung

bnh.

D. Nghin cu khng c thit k c lng an ton v vy khng nh

hng n thc hnh.

II-13. S gia tng hormon no di y ph hp vi nh hng ca chn n:

A. Cortisol

B. GnRH

C. Leptin

D. T4

E. TSH

II-14. Pht biu no di y ng v chn n v cung n:

A. Bnh nhn vi di nhm dng thuc x ca chng cung n thng nng

cn hn bnh nhn di nhm khng dng thuc x.

B. Bnh nhn vi di nhm gii hn ca chng bing n cm xc km bn

vng hn di nhm dng thuc x.

C. Bnh nhn vi di nhm gii hn ca chng bing n lm dng thuc gy

nghin nhiu hn di nhm dng thuc x.

D. T l t vong ca cung n thp hn chn n.

II-15. Bnh nhi t phng t vn, vi nhm triu chng gm tiu chy, rng tc,

hy c,, trm cm, ban phn b mt, chi v y chu. a tr c thiu nng

sinh dc v ln. Bn chn on l thiu km v cn lm sng cng c chn on

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(Zn < 70ul/dl). Du chng lm sng no khc c th biu hin trn bnh nhn

ny:

A. Phnh bc tch ng mch ch

B. Thiu mu nhc sc

C. H ng huyt

D. Gim sc t tc

E. Hng cu to

II-16. Bn ang trn 1 chuyn i t thin vng ngho ca Trung Quc. Bn

khm 1 a tr 8 tui, m n than rng b vng v v xanh xao. B tng c

nhiu t tiu chy v vim phi. S vng v ca b r rt hn vo bui sng

khi b i ra ngoi v lm nhng cng vic vt. Bn khm thy kt mc kh vi

nhng m trng biu m sng ha trn cng mc. Nguyn nhn ca nhng

triu chng trn b ny l g:

A. Gim bch cu ht t min

B. Rubella bm sinh

C. Tht iu tiu no type 1

D. Thiu vitamin A

E. Thiu vitamin B1

II-17. Sau khi b mc cn trn ni mt mnh trong 8 ngy, ngi i b 26 tui

c a n bnh vin vi gy c xng i. Anh ta khng n, ung bt c

th g trong 6 ngy qua.Du hiu sinh tn trong gii hn bnh thng. CN

79.5kg, st 1.8kg so vi cn nng cch y 6 thng. Cn lm sng c creatinine

2.5mg/dl, BUN 52 mg/dl, glucose 96mg/dl, albumin 4.2 mg/dl, Cl 105 mEq/l,

ferritin 173 ng/ml. pht biu no di y ng v nguy c suy dinh dng ca

anh y:

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A. Anh ta c suy dinh dng nng lng protein do tc st cn.

B. Anh ta c suy dinh dng nng lng protein do tng ferritin

C. Anh ta c nguy c nhng ngi bnh thng c th chu i 7 ngy

D. Anh ta khng suy dinh dng v khng c h ng huyt sau 6 ngy

khng n ung g.

II-18. Bn ang i trong ICU, gp 1 bnh nhn ang t ni kh qun, va hi

phc sau t qu v c lit d dy do tiu ng. Khi ht m cho bnh nhn

vo bui sng, b ta ho nhiu vi m mu xanh c. Bn lo lng v kh nng

vin phi ht. Nhng bin php no di y c ch trong vic phng nga vim

phi ht bnh nhn c t ni kh qun ngoi tr:

A. Kt hp dinh dng trong v ngoi rut.

B. Nm u cao 30

C. Hng dn cho bc s nhng phng php tin b

D. Nui n sau gc Treitz.

II-19. c im no di y tng ng vi tiu chun phn bit gia chng

chn n v cung n:

A. n ung say sa

B. Bt thng in gii

C. T gy ra i

D. Nh cn.

II-20. Bn ang a ra li khuyn cho bnh nhn hi phc sau 1 thi gian di

chn n. l bnh nhn n 22 tui, chn n 8 nm, vi BMI thp 17kg/m2 v

nhiu xt nghim bt thng trong sut thi gian ny. c im no ca chn

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n di y t c kh nng ci thin nht mc d iu tr thnh cng lu di

cho tnh trng ri lon ny:

A. V kinh

B. Chm lm trng d dy

C. Lng t

D. Khi lng xng thp

E. Ph i tuyn nc bt

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B.. P N

II-1 C. C 2 type ln ca suy dinh dng nng lng Protein l suy dinh

dng nng v thiu dinh dng. Vic phn bit 2 type ny v cng quan trng

trn nhng bnh nhn suy dinh dng, n nh hng trc tip n vic iu tr

ca bn. Bnh nhn ny b thiu dinh dng suy kit do tnh trng bing n,

tress phu thut, 10 ngy nhn i. Bnh nhn ny b suy dinh dng nng cng

nh thiu dinh dng quan trng, gim lng protein huyt thanh.Thiu dinh

dng tri hn v bnh nhn mi b i, protein huyt thanh gim nghim trng.

Liu php dinh dng mnh c ch nh cho thiu dinh dng

So snh gia suy dinh dng v thiu dinh dng

Suy dinh dng

nng

Thiu dinh

dng

Nguyn nhn

Thi gian

din tin

c im lm

sng

Cn lm sng

Gim nng lng

nhp vo

Thng/nm

S xut hin

thiu n

CN < 80% chun

theo chiu cao

Np da c tam

u < 3mm

Chu vi c gia

cnh tay < 15cm

Ch s Creatinin

Gim protein

nhp trong sut

trng thi stress

Tun

Nui dng tt

Tc d rng*

Chm

Albumin huyt

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Din tin lm

sng

T vong

Tiu chun

chn on

cao < 60% chun

p ng duy tr

hp l vi stress

ngn hn

Thp tr khi kt

hp vi bnh nn

Np da c tam

u < 3mm

Chu vi c gia

cnh tay < 15cm

thanh < 2.8 g/dl

Tng lng st

gn < 200ug/dl

Lympho

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non mn tnh, bt thng cu trc ng mt, sau ct rut non, hay sau liu

php khng sinh ph rng. Nh l hu qu ca s gim vi khun ng rut,

khng sinh c th gy nn thiu vitamin K. Qu liu v dng thuc sai c th

gii thch hp l nhng t ngh ti l nguyn nhn chnh nh dng khng sinh.

Huyt khi tnh mch cp tnh c th lm gim lng protein ng mu ( nht l

protein C v S), nhng INR khng b nh hng.

II-3 D. Bnh nhn c ban xut huyt quanh nang lng ca bnh Scobut ( thiu

vitamin C). Ti Hoa K, scobut l bnh ch yu nhng ngi nghin ru v

ln tui vi lng titamin C nhp < 10mg/ngy. Vi nhng triu chng khng

c hiu ca mi c, nhng bnh nhn ny c th gim kh nng to lin kt m

t nhin v c th chy mu nhiu v tr gm da v li. INR bnh thng

khng phi l du hiu ca thiu vitamin K. Thiu thiamin, niacin, folate cng

tm thy bnh nhn nghin ru. Thiu thiamin gy nn bnh thn kinh ngoi

bin (beri- beri). Thiu folate gy thiu mu hng cu to v gim tiu cu. Thiu

niacin gy bnh pellagra, vi c tnh vim li v nhim sc t, ban trn da

c bit thy r nhng vng phi by nh sng.

II-4 C. Trc kia, rut ngh ngi quan trng trong iu tr. Tuy nhin, gi tr

ca vic thm 1 lng nh dinh dng ng rut cng c chp nhn rng

ri. S tnh ton thi gian ca dinh dng ng rut rt quan trng. Mc d

dinh dng ng rut c th ci thin t vong, n li lm tng nguy c nhim

trng. Bnh nhn vi p ng vim ton thn nng khng c kh nng nhp qua

ng ming t y trong tun u tin ca thi gian nm vin. V th

dinh dng ng rut nn c xem xt sm cho nhng bnh nhn bnh nng.

II-5 B. Nhng bnh nhn vi cn nng n nh. Nng lng tiu hao lc ngh

(REE) c tnh nu bit gii, cn nng, mc hot ng. Vi nam: REE =

900+10w, v vi n: REE = 700+7w, w l cn nng, tnh bng kg. REE sau

c hiu chnh cho mc hot ng bng cch chia cho 1.2 nu ngi 1 ch, 1.4

cho hot ng va phi, v 1.8 cho nhng ngi hot ng nng. Bnh nhn A

c REE l 2160 kcal/ngy. Bnh nhn B l 2880 kcal/ngy. Vi cng cn nng,

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mc hot ng cao hn s lm tng REE nhiu hn l vi cng mc hot ng

m cn nng ln hn 20kg

II-6 A. Chn n t gp nam hn n, thng thy hn nn vn ha c ngun

thc n phong ph, v ni m thn hnh gy thng quyn r hn. Nhng ngi

nh din vin ma bale, hay nhng ngi hot ng ngh thut thng c nhiu

nguy c bing n hn. Nhng bnh nhn bing n, khi cn nng mt i tng,

ngh rng thc n chi phi i sng tinh thn. Bnh nhn bing n c th m

nh vic tm nhng sch nu n, nhng toa thuc v c khuynh hng v ra ch

n lin quan ngh nghip. Nhng bnh nhn ny tr nn thu rt x hi, v c

th n say sa ging nh nhng bnh nhn cung n. i khi h than i hay

mi c v s tp luyn th dc nhiu t li cn nng mt.

II-7 E. Da trn hng dn thc hnh ca hip hi tm thn Hoa K, iu tr

ni tr c t ra cho nhng bnh nhn cn nng < 75% cn nng mong i

theo tui v chiu cao, ri lon chuyn ha nng (nh l ri lon in gii, nhp

tim nhanh, h huyt p) hay bnh nhn c vn tm thn nghim trng i km

( nh t t, lm dng cht). Ngng sm hn cho iu tr ni tr nu bnh

nhn st cn nhanh hay cn nng < 80% mong i. V kinh, cng iu lng

thc n n vo, hay s ly li cn nng, l 1 phn trong cc tiu chun chn

on bing n, v thuc x khng thng gp trong nhm ny. Hi phc cn

nng n 90% cn nng d on l ch ca liu php dinh dng.

II-8 A. Tc ng qua li gia bnh v dinh dng rt phc tp, v th, nhiu

nghin cu lm sng v cn lm sng phn nh c bnh nn v tnh trng dinh

dng. c lng dinh dng trn 1 bnh nhn yu cu tch hp ca tin s,

khm, o, v xt nghim. Albumin thp c th do bnh gan nn v khng cn

thit ch nh iu tr dinh dng. Bnh nhn ny c nguy c cao suy dinh

dng, nhng tnh trng hin ti c th phn nh suy dinh dng hay di chng

ca nghin ru mn.

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II-9 B. Liu cao vitamin E ( > 800mg/ngy) c th lm gim kt tp tiu cu v

cn tr chuyn ha vitamin K. Liu 400mg/ngy c th lm tng t vong t bt

c nguyn nhn no. Tha vitamin E khng lin quan vi tng nguy c huyt

khi tnh mch. Bnh thn kinh ngoi bin v bnh sc t vng mc c th thy

thiu vitamin E. Thiu vitamin A gy nn qung g.

II-10 D. Pellagra ( thiu niacin) l ri lon thng gp nht trong s nhng

ngi c ch n ng cc ch yu nhng cng thng thy bnh nhn

nghin ru. Trytophan c chuyn thnh niacin vi hiu sut 60:1. V th,

nhng bnh nhn vi khim khuyt bm sinh trong hp thu trytophan hay tng

chuyn trytophan thnh serotonin s dn n thiu niacin. Triu chng sm ca

pellagre bao gm: bing n, d kch thch, au bng, nn i v vim li. Vim

m o v vim thc qun cng c th gp. Vim da, tiu chy, sa st tr tu dn

n t vong. Ri lon chuyn ha m khng phi l triu chng ca hi chng

pellagra.

II-11. C Vn chuyn ha thng gp nht lin quan n dinh dng ngoi

rut l qu ti dch v tng ng huyt. ng u trng kch thch ngng

insulin cao hn cho n bnh thng, l bng chng ngy nhp vin th 9

trong tnh hung ny. Insulin trong mu cao kch thch hocmon chng li niu

v chng li natri dn n natri v dch, cng nh tng vn chuyn ni bo

K, Mg, P. Tng cn v natri niu thp bnh nhn vi chc nng thn bnh

thng khng phi l him gp. Cung cp Natri trong gii hn 40 mEq/ngy, s

dng hn hp nui n ngoi rut gm glucose v lipid s lm gim ng dch.

Gim glucose ton phn s lm gim nhu cu insulin cao. ng dch trong

tnh hung ny khng c iu chnh bng lng protein thp.

II-12 C. c lng nhu cu trung bnh (EAR) l tng lng cht dinh dng

c lng tng ng vi mt na nhm ngi c hiu v tui v gii. N

khng hu dng trn lm sng c lng dinh dng y v n l nhu cu

trung bnh cho 1 nhm. 50% c th trong nhm di nhu cu ny, v 50% c

nhu cu cao nhn nhu cu ny. 1 ngi nhn nhu cu c lng trung bnh ca

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vitamin s c 50% nguy c nhp thiu. Khu phn n c ngh ( RDA)

c nh ngha da trn thng k khi trn EAR 2 lch chun m bo

rng nhu cu cho hu ht c th c p ng. Trn ca ny s dng liu trn

EAR 2 lch chun, l RDA. D liu t gii hn cho php trn thng

khng tng xng thit lp gi tr cho gii hn trn cho php. Vic khng

a ra c gii hn trn cho php khng hm rng nguy c khng tn ti.

II-13 A. Vic iu ha ca hu ht h ni tit b ri lon bnh nhn bing n.

V kinh do vng di i phn nh s gim tit GnRH. Lng leptin huyt

thanh gim do gim khi m m, v c cho l yu t iu chnh gy nhng

ri lon ni tit khc lin quan ti chn n. Xt nghim chc nng tuyn gip

bt thng ( T3, T4, TSH, T3 o). Cortisol huyt thanh v cortisol t do

trong nc tiu 24h thng cao m khng l hu qu ca cng v thng thn.

II-14 D. T sut ca bing n (AN) l 5% mi 10 nm, v thp hn nhng

bnh nhn cung n (BN). T vong hu nh gin tip bi st cn v suy dinh

dng kt hp vi chn n (AN). C 2 di nhm ca cung n l dng thuc

x v khng dng thuc x. bnh nhn khng dng thuc x thng nng cn

hn v t c ri lon in gii. Cng c 2 di nhm ca chn n (AN): gii hn

v dng thuc x. bnh nhn vi di nhm dng thuc x thng cm xc

khng n nh v c nhng vn khc nh lm dng thuc.

II-15 D. Km trong mu thp l hu qu thng gp nht ca ch n ngho

km, mc d c vi loi thuc c th c ch hp thu km (natri vaproate,

penicillamine, ethambutol). Thiu km mn tnh nng thng c m t tr

em vng Trung ng nh l nguyn nhn ca thiu nng sinh dc v ln. Gim

sc t lng tc cng l 1 phn ca hi chng ny. Thiu mu nhc sc c th

thy trong ri lon tng hoc gim vitamin, bao gm ng c km v gim Cu.

Gim Cu thng kt hp vi phnh bc tch ng mch ch. Gim ng huyt

khng tng quan vi gim Zn. Hng cu to thng kt hp vi thiu folate hay

vitamin B12.

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II-16 D. Thiu vitamin A vn cn l vn tr em vi ch n ngho nn

ko di 1 s vng thuc Chu , Chu Phi, Trung Quc. Tr b kh mt vi

bng chng l b qung g. N cng c im Bitot (m trng vng cng mc).

Thiu vitamin A lm gim kh nng phn ng vi nhim trng. T vong trn

nhng tr thiu vitamin A v cn bn l cao hn khi c nhim trng vi tiu

chy, si, l, st rt hay bnh ng h hp. B sung vitamin A ci thin t l t

vong. Tht iu tiu no type 1 khng kt hp vi bnh l mt. Gim bch

cu ht t min c th gii thch cho nhng t nhim trng ti pht, nhng tp

hp nhng im Bitot v nhim trng ti pht th khng phi l nguyn nhn.

Rubella bm sinh gy nn c thy tinh th bm sinh, khng phi l im Bitot.

Thiu vitamin B1 (thiamin) gy bnh beri beri kt hp vi suy tim cung lng

cao hay bnh thn kinh ngoi bin.

II-17 C. Nng lng tch tr ngi nam nng 70kg gm 15kg m, 6kg protein

v 500mg glycogen. Trong sut ngy u tin nhn n, hu ht nng lng cn

thit c cung cp bi tiu th glycogen gan. Nhng ngy nhn n sau

nng lng tiu dng lc ngh gim trn 25% ( vi iu kin l hin khng c

tnh trng nhim trng). Nu c ung nc v khng c nhim trng, 1 ngi

bnh thng c th nhn i trong 1 thng. 1 ngi c dinh dng tt c th

chu ng i 7 ngy trong khi c tnh trng p ng vim ton thn(SRI).

Ngi i b ng di trong tnh hung ny nhn i 6 ngy, c b tr tt

cho tnh trng nhn i ngoi tr c suy gim chc nng thn nh. St hn 10%

cn nng trong vng 6 thng gi tnh trng suy dinh dng nng lng

protein. Ferritin ca bnh nhn ch tng nh mc d phn ng p ng vim

ton thn thc s lm tng tc mt m. Tuy nhin ng ta khng c gi no

khc rng ang chu ng hi chng p ng vim ton thn. SRI thng gy

nn tng ng huyt, ch khng phi h ng huyt.

II-18 C. Ht kh qun gy nn ho v tro ngc d dy v gy bt lng kh qun

him khi bo v i vi h hp. Nhng bin php phng chng c hiu qu

gm: nm u cao 30 , chm sc iu dng, kt hp dinh dng trong v

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ngoi rut, s dng nui n sau dy chng gc Treitz. Nhng nghin cu gn

y gi rng ht lin tc trn vng bt trong kh qun c th lm gim

vim phi ht.

II-19 D. Chn n(AN) v cung n (BN) l 2 thc th lm sng khc nhau

nhng c cng c tnh. Nhiu bnh nhn vi BN c tin cn chn n, v bnh

nhn vi AN tng gn vi ch n v v thi b tr bt thng bng

thuc x. im khc nhau then cht gia AN v BN ph thuc vo cn nng:

bnh nhn vi AN thng thiu cn ng k trong khi bnh nhn vi BN

thng c cn nng bnh thng hay qu cn. S hin din ca ri lon in

gii dn n lm tng t l t vong cho c 2 ri lon trn.

II-20 D. Gn 25-50% bnh nhn chn n hi phc hon ton vi 1 vi di chng

tm sinh l. Tuy nhin nhiu bnh nhn kh khn ko di trong duy tr cn

nng, trm cm v xo trn n ung. Gn 5% bnh nhn t vong mi 10 nm

thng do ri lon sinh l ca i ko di hay t vn. Hu nh nhng xo trn

sinh l kt hp vi chn n s c ci thin khi ly li cn nng. 1 ngoi l l

mt khi lng xng s khng phc hi hon ton khi chn n xy ra thi k

thanh nin (thi k hnh thnh xng cao nht). Sc khe tm l cng c ci

thin vi iu tr ng, mc d nhng bnh nhn ny vn c nguy c trm cm,

ti pht hay pht trin thnh cung n.

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7/1/2011

< duyhidk>

CHNG III: UNG TH V HUYT HC

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Chng III: Ung th v huyt hc

CC CU HI

HNG DN: CHN MT CU TR LI NG NHT CHO MI CU

HI

1. Mt bnh nhn nam 73 tui n phng khm do au lng tng ln, au bt

u t 3 thng trc. au khu tr vng tht lng v au tng ln vo bui

ti, khi bnh nhn nm. au ci thin vo ban ngy, khi i li. Tin s bnh

nhn c tng huyt p v thi thong ht thuc. Khm lm sng bnh thng.

Kt qu xt nghim thy tng Phosphatase kim. Chp xquang vng tht

lng cho thy c tn thng tiu xng t sng tht lng L3. Tnh trng

no sau y l c kh nng nht?

A. Ung th d dy

B. Ung th phi t bo nh.

C. Sacom xng

D. Ung th tuyn ty

E. Ung th tuyn gip.

2. Bnh nhn khu vc no sau y cn c kim tra s thiu ht enzym

G6PD khi bt u s dng loi thuc c nguy c gy tan mu gin tip?

A. Braxil.

B. Nga.

C. ng nam .

D. Nam u.

E. Chu phi vng gn xa mc Sahara.

F. Khng c vng no trn.

3. Tt c cc yu t sau l ph thuc vitamin K ngoi tr?

A. Yu t X.

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B. Yu t VII.

C. Protein C.

D. Protein S.

E. Yu t VIII.

4. Mt bnh nhn nam 31 tui b Hemophilia A c tha nhn c i mu i

th dai dng. Bnh nhn khng c chn thng gn y v tin s khng c

bt c bnh no v ng tit niu. Khm lm sng khng c g c bit.

Hematocrit l 28%. Tt c cc yu t sau iu tr Hemophilia A ngoi

tr ?

A. Desmopressin ( DDAVP)

B. Huyt tng ti ng lnh.(FFP)

C. Cht kt ta lnh.

D. Yu t VIII ti t hp.

E. Huyt tng tinh ch.

5. Pht biu no v t l mc bnh v nhng nguy c ca ung th t bo gan l

ng ?

A. Nhng c cht to ra bi nm Aspergillus c bit l Aflatoxin B c

mi lin quan cht ch vi s mc bnh ung th t bo gan v c th c thy

nhng loi thc la bo qun trong iu kin m, nng.

B. chu M, t l mc ung th t bo gan ang gim xung.

C. Vim gan nhim m khng do ru khng lm tng t l ung th t

bo gan.

D. Di 5% cc trng hp ung th t bo gan chu M khng c x

gan .

E. Nguy c pht trin thnh ung th t bo gan nhng bnh nhn vim

gan C l 50%.

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6. Bn ang nh gi tiu bn mu ngoi vi mt bnh nhn thiu mu. Nng

Lactat dehydrogenase huyt thanh tng ln v c hemoglobin niu. Bnh

nhn ny c th c tnh trng no ? ( Bng III-6, Atlat).

A. Bu gip.

B. Hng cu n trong phn.

C. Ting tim T2 mechanical.

D. Lch to.

E. Dy vm s.

7. Tt c cc enzym b thiu ht m dn n ri lon chuyn ha porphyrin

c di truyn tri( AD) hoc ln (AR). iu no sau y him xut hin

nht?

A. Thiu ht 5-ALA dehydratase.

B. Porphiryl cp tnh tng cn.

C. Porphyrin do thiu ht enzym trong hng cu.

D. Porphyrin biu hin da( PCT).

E. Porphyrin variegate.

8. Mt bnh nhn n 55 tui b mt kt hp tin trin. Khm lm sng ch

n rung git nhn cu, lon ngn nh v kim tra ngn tay ch mi .

Bnh nhn cng c dng i khng vng. MRI cho thy teo thy tiu no hai

bn. nh lng huyt thanh cho thy s c mt ca khng th khng Yo.

Nguyn nhn thch hp nht gy ra tnh trng ny l?

A. Ung th phi khng phi t bo nh.

B. Ung th phi t bo nh.

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C. Ung th v.

D. U lympho khng Hodgkin.

E. Ung th rut kt.

9. Mt ph n 36 tui ngi M gc Phi b lupus ban h thng hin ang c

t cp ca vng da v chng ng lm. Khi u bnh nhn c nhp tim

nhanh, huyt p h, ti nht, kh th v kh nh thc mt cht. Khm lm

sng thy lch to. Hemoglobin ban u l 6g/dL, bch cu 6300/l, v tiu

cu 294000/L. Bilirubin ton phn 4g/dL. Hng cu li 18%.

Haptoglobin khng xc nh c. Chc nng thn bnh thng trn xt

nghim nc tiu. Bn s loi tr iu no trn kt qu lam knh mu ngoi

vi ca bnh nhn ny?

A. Thiu mu hng cu to v PMN vi phn nhiu nhn.

B. Tiu hng cu dy.

C. Mnh v hng cu.

D. Nhng t bo hnh lim.

E. Nhng t bo hnh bia.

10. Bn ang nghin cu nguyn nhn gy thiu mu mt bnh nhn. ng 50

tui v nh lng Hematocrit thng khong 25%. Hematocrit ca bnh

nhn 1 nm trc l 47%. Th tch trung bnh hng cu(MCV) l 80, lng

hemoglobin trung bnh hng cu( MCH) l 25, nng huyt sc t trung

bnh hng cu (MCHC) l 25. Hng cu li 5%. Trn tiu bn mu ngoi

vi cho thy mt s lng ln t bo mu bt mu nhiu. Ferritin l

340g/dL. u l nguyn nhn gy ra thiu mu bnh nhn ny?

A. Thiu st trong tng sinh ty to mu.

B. Tan mu ngoi mch.

C. Tan mu trong lng mch.

D. Thiu mu thiu st.

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E. Chy mu ng tiu ha.

11. Tt c cc yu t sau c lin quan n thiu mu gim sn hng cu n

thun (PRCA) ngoi tr ?

A. Khi trung tht trc.

B. Ri lon m lin kt.

C. Tin nguyn hng cu khng l.

D. Erythropoietin thp.

E. Nhim Parvovirus B19.

12. Mt bnh nhn nam 73 tui, c a n bnh vin sau 3 tun st v tnh

trng kh . Tin s bnh nhn ch ch n tng huyt p v c kim

sot bng li tiu Thiazid. Bnh nhn ht 1 bao thuc mi ngy v lm lut

s. Khm lm sng thy c ting thi tm thu vng van hai l. Kt qu xt

nghim cho thy c thiu mu nh, tng bch cu, v lc c hng cu trong

mu nc tiu sch. Cy mu thy mc ln Streptococcus bovis v siu m

tim cho thy 1 khi si < 1cm van hai l. Xt nghim no c ch nh

bnh nhn ny sau ?

A. Ni soi rut kt.

B. CT scan s no.

C. CT scan pht hin nghn mch phi

D. Sinh thit thn.

E. Test sng lc c cht

13. Mt bnh nhn n 58 tui c a ti phng cp cu do vng da. Qu

trnh vng da bt u khong 3 ngy trc. Tnh trng ny tr nn tin trin

thm vo thi im hin ti. ng thi vi tnh trng vng da tng ln, bnh

nhn cng c phn mu t st, nga. Chng khng c lin quan n au

bng, st, n lnh hoc m hi vo bui ti. Bnh nhn c tin s ung

ru nhiu, nhng king t 10 nm trc. Trong khm lm sng, bnh

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nhn khng st, cc du hiu sinh tn bnh thng. Nhu ng rut bnh

thng. G thy chiu cao gan 12 cm v s thy vng h sn phi. Lch

khng s thy. Xt nghim chc nng gan: AST: 122IU/L, ALT: 168IU/L,

Phosphatase kim: 483U/L, Bilirubin ton phn 22,1 mg/dL. Trong

Bilirubin trc tip l 19,2 mg/dL. Siu m bng vng h sn phi khng

thy ti mt to v gin ng mt trong gan. Chn on thch hp l?

A. Ung th ng mt.

B. Vim ti mt.

C. Ung th ti mt.

D. Ung th t bo gan.

E. Ung th tu.

14. Mt bnh nhn nam 81 tui c a ti bnh vin do thay i tnh trng

tinh thn. Bnh nhn c con trai pht hin l m v lm i. Tin s bnh

nhn b ung th tuyn tin lit di cn. Bnh nhn c iu tr bng

Goserelin tim trong c. Khm lm sng bnh nhn khng st, huyt p

110/50 mmHg, nhp tim 110 ln/pht. Bnh nhn p ng ti thiu vi kch

thch ch st vo xng c. Bnh nhn c nim mc kh. Khm lm sng h

thn kinh thy bnh nhn khng c tri gic. Phn x hu hng bnh thng

v p ng rt au c t chi. Trng lc hu mn trc trng bnh thng.

Kt qu xt nghim cho creatinin 4,2mg/dL, Calci 12,4meq/L, Albumin

2,6g/L. Tt c cc x tr sau l thch hp ngoi tr?

A. Mui ng trng

B. Pamidronate

C. Li tiu Furosemid khi bnh nhn c th tch dch bnh thng.

D. Calcitonin.

E. Dexamethason.

15. Pht biu no sau y miu t mi lin h gia ung th tinh hon v cc cht

ch im trong mu?

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A. Ung th tinh hon seminom sn xut ra AFP hoc -hCG hn 90%

cc trng hp.

B. C hn 40% cc khi u t bo mm khng seminoma khng to ra cc

cht ch im t bo.

C. C -hCG v AFP nn c nh lng nh gi s tin trin ca

khi u.

D. nh lng cc marker khi u mt ngy sau phu thut c p dng

trong quyt nh ct b ton b khi u.

E. Vai tr ca -hCG b hn ch do n c cu to ging nh hormon to

hong th LH.

16. Mt ph n b ung th v ang iu tr bng Tamoxifen c a ti bnh

vin do bun nn v nn. Bnh nhn chu ng tt vi c iu tr nhng 3

ngy nay bnh nhn thy bun nn, nn v au bng. Cc triu chng ny

khng lin quan n n ung. Bnh nhn khng c st hay pht ban. Cc loi

thuc bnh nhn dng bao gm: Tamoxifen, Alendronate, Megestrol acetat, mt

t Vitamin. Khm bng cho thy khng c phn ng thnh bng, cm ng phc

mc. Nhu ng rut bnh thng. Phim Xquang v CT scan bng khng pht

hin c g bt thng. Kt qu xt nghim cho bch cu bnh thng, Na+

130 meq/L, K+ 4,9 meq/L, Cl

- 99meq/L, HCO3

- 29 meq/L, BUN 15 mg/dL,

Creatinin 0,7mg/dL. u l bc tip theo c thc hin theo di bnh

nhn ny?

A. Cho thuc chng nn.

B. Soi bng.

C. nh lng Cortisol mu.

D. Chp rut non hng lot.

E. Ni soi tiu ha trn.

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17. Mt ph n 62 tui, tin s khe mnh c a n phng khm ca bn

sau 3 thng ni soi rut kt. Pht hin thy 2 khi u khng cung kch

thc 1,3 cm, u tuyn nhung mao i trng ln m c ct b trong

lc tin hnh ni soi. u l bc tip theo c thc hin qun l bnh

nhn ny ?

A. Ni soi i trng sau 3 thng.

B. Ni soi i trng sau 1 nm.

C. Ni soi i trng sau 10 nm.

D. Ct b mt phn i trng.

E. Kim tra li mt ln na.

18. Pht biu no sau y v bnh tng hng cu v cn l ng ?

A. S tng Erythropoietin trong mu khng c ngha chn on.

B. Thng chuyn thnh bnh bch cu cp.

C. S tng s lng tiu cu c lin quan cht ch vi tnh trng huyt

khi.

D. Aspirin nn c s dng cho tt c c bnh nhn phng nguy c

huyt khi.

E. Th thut trch mu tnh mch ch c lm sau khi Hydroxyurrea v

Interferon khng c hiu qu.

19. Mt ph n 52 tui c nh gi mt khi bng trn phim chp ct lp,

ng thi c c trng v c th l mt khi u mng bng nhng khng c

nhng bt thng khc. Kt qu chc d cho thy y l ung th tuyn

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nhng khng th phn bit thm bi bc s gii phu bnh. Khm cn thn

vng ngc v xng chu khng thy c g bt thng khc. Mc CA-125

tng ln. Siu m vng chu v X quang tuyn v thy bnh thng. Pht

biu no sau y l ng ?

A. So snh vi mt ph n khc b K bung trng giai on tng t,

bnh nhn ny c th c thi gian sng t hn.

B. Phu thut ct b mt phn c ch nh.

C. Phu thut ct b mt phn kt hp vi s dng Cisplatin v Paclitaxel

c ch nh.

D. Phu thut ct b tuyn v, bung trng hai bn s lm tng thi gian

sng ca bnh nhn.

E. Di 1% nhng bnh nhn mc bnh ny s c thi gian sng thm 2

nm sau iu tr.

20. Mt bnh nhn n 34 tui, tin s thiu mu hng cu hnh lim c a

ti bnh vin do mt mi, th nng, ng lm. Bnh nhn khng c au ngc

cng nh au xng. Bnh nhn khng i du lch trong thi gian gn y.

ng ch , a con gi 4 tui ca bnh nhn b cm lnh 2 tun trc.

Khm lm sng thy bnh nhn c m kt mc, khng vng da, nhp tim

hi nhanh. Khm bng khng thy g bt thng. Kt qu xt nghim :

Hemoglobin 3g/dL, ng c s l 8g/dL, bch cu v tiu cu bnh

thng. Hng cu li khng xc nh c. Bilirubin ton phn l 1.4

mg/dL, LDH gii hn trn ca khong bin i bnh thng. Trn lam

mu ngoi vi cho thy mt vi t bo hnh lim nhng tng th khng c

hng cu li. Bnh nhn c truyn 2 n v hng cu khi v c a

ti bnh vin. Sinh thit ty xng cho thy cc t bo tu bnh thng

nhng khng thy c cc t bo tin nguyn hng cu. Di truyn t bo hc

bnh thng. Bc tip theo c thc hin bnh nhn ny l ?

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A. Sp xp thay mu.

B. Xc nh loi m ca nhng ngi trong gia nh c th ghp ty.

C. Kim tra lng Parvovirus.

D. Bt u iu tr bng Prednisolon v Cyclosporin.

E. Bt u s dng khng sinh ph rng.

21. Mt ph n 21 tui, ang mang thai, n t Bc u trnh by rng vo thi

im 3 thng ca thai k ln mang thai u tin c ta c mt mi, xanh xao

v vng da. Trc bnh nhn vn thy khe mnh. Kt qu xt nghim :

Hb 8g/dL, hng cu li 9%, bilirubin gin tip 4.9 mg/dL, Haptoglobin

khng xc nh c. Khm lm sng ch n bnh nhn c lch to v t

cung bnh thng. Trn tiu bn mu ngoi vi thy c t t bo mu. Chn

on thch hp nht l( Xem bng III-21) ?

A. Polyp i trng.

B. Thiu ht G6PD.

C. Chng hng cu hnh bia di truyn.

D. Nhim Parvovirus B19.

E. Ban xut huyt v huyt khi do gim tiu cu.

22. Mt bnh nhn b bch cu cp dng lympho( ALL) cm thy au ngc v

kh th. Bnh nhn k rng thy kh th t 1 ngy trc v khng lin

quan n ho. Khng c mi lin h vi bnh tt, v trc khi xut hin cc

triu chng ti h h hp bnh nhn ch cm thy mt mi. Phim chp

xquang cho thy m khong k ri rc m khng c ph phi, bng tim

bnh thng. Kt qu kh mu ng mch PaO2 54 mmHg, trong khi phn

p oxy mu ng mch l 97%. Nng CO bnh thng. Cc kt qu xt

nghim sau c mong i c bnh nhn ny ngoi tr ?

A. t bin gen BCR-ABL.

B. T bo Blast > 100.000/L.

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C. Nng LDH tng ln.

D. nht mu tng .

E. Methemoglobin mu.

23. Mt ngi n ng 48 tui c nh gi ti trung tm chm sc khn cp

v mt hch trn phim chp ngc. 3 tun trc bnh nhn c chn on

vim phi sau 3 ngy st, ho v m. Phim chp ngc cho thy mt khi

nh thy di phi phi thm nhim vo ph nang, v thy trn phi

tri c mt khi kch thc 1.5 cm. Bnh nhn c iu tr bng khng

sinh v hin khng cn cc triu chng. Phim chp ngc li cho thy khi

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Nguyen Tac Noi Khoa Harrison 17th- Phan Tu Luong Gia