1. The key points for identifying incarcerated hernia and strangulated hernia are: ()

A. The size of the deep (internal) annular opening

B. Yes No shock

C. Time of inability to return

D. Whether there is intestinal obstruction

E. Whether there is blood supply disorder

2. The most common clinical external abdominal hernia is: ()

A. Indirect inguinal hernia

B. Femoral hernia

C. Umbilical hernia

D. Direct inguinal hernia

E. Direct hernia

3. Scrotal mass, negative light transmission test, disappears after lying down, more common in: () < /p>

A. Testicular hydrocele

B. Spermatic hydrocele

C. Communicating hydrocele

D. Indirect inguinal hernia

E. Testicular tumor

4. Male, 6 months old. When crying, a lump bulges in the right groin and disappears when calm. Best treatment The method is: ()

A. Press the deep inguinal ring with a bandage and observe

B. High ligation of the hernia sac

C. Perform anterior wall strengthening Hernia repair

D. Hernia repair with posterior wall strengthening

E. Tension-free hernia repair

5. Caused by fluid entering the abdominal cavity after rupture The solid abdominal organs with the most severe peritoneal irritation are: ()

A. Adrenal glands

B. Kidneys

C. Liver

E. Spleen

6. When there is a closed abdominal injury, the diagnosis of abdominal visceral injury is not supported: ()

A. Early shock

B. Peritoneal irritation sign

C. Pneumoperitoneum sign

D. Positive shifting dullness

E. Active bowel sounds

Reference answers and analysis

1. Reference answer E. Analysis: This question tests the knowledge points of Surgery - Abdominal Hernia - Clinical Type, and it is a memory-type question. Strangulated hernia is transformed from incarcerated hernia, and the former is actually an extension of the latter's pathological process. Incarcerated hernia has no arterial blood supply disorder, while strangulated hernia has blood supply disorder. Therefore, the key point to distinguish between incarcerated hernia and strangulated hernia is whether there is blood circulation disorder (pair E). The size of the deep (inner) annular opening is related to whether incarceration occurs; shock can be seen in patients with advanced strangulated hernia; the longer the hernia block cannot be retracted, the higher the chance of strangulated hernia, but the deep (inner) annular opening The size (Error A), the presence or absence of shock (Error B), and the time it cannot be returned (Error C) cannot be used as the key points for identifying incarcerated hernia and strangulated hernia. When the content of the hernia is an intestinal loop, intestinal obstruction can occur in both incarcerated hernia and strangulated hernia. Therefore, the presence or absence of intestinal obstruction (False D) cannot be used as the key point of differentiation between the two. To sum up, choose E for this question.

2. Refer to answer A. Analysis: This question tests the knowledge points of surgery - external abdominal hernia - inguinal hernia, and is a memory-type question. The most common clinical external abdominal hernia is indirect inguinal hernia (A pair), with an incidence rate of approximately 75% to 90% of all external abdominal hernias. Followed by femoral hernia (B error), the incidence rate is about 3% to 5% of external abdominal hernia; incisional hernia (seventh edition of Huangjiasi Surgery P1284) accounts for the third place of external abdominal hernia, with an incidence rate of about 1.5%. Umbilical hernia (P317) (C wrong) refers to a hernia in which the hernia sac protrudes through the umbilical ring, which is clinically rare. Abdominal hernia (E) is a general term for all external abdominal hernias except inguinal hernia and femoral hernia, accounting for about 15% of all external abdominal hernias. To sum up, choose A for this question.

3. Refer to answer D. Analysis: This question tests the knowledge points of surgery - abdominal external hernia - clinical manifestations and diagnosis, and is a memory-type question. Scrotal mass, the light transmittance test is negative, disappears after lying down, and is more common in indirect inguinal hernia (D pair). Because the contents of the hernia are mostly intestine, mesentery, and omentum rather than liquid, the light transmission test is negative. The scrotal mass of testicular hydrocele (A error) does not disappear after lying down; the mass of communicating hydrocele (C error) disappears after lying down, and both light transmittance tests are positive. Spermatic hydrocele (B error) appears as a small mass in the inguinal canal, and the mass can move when the ipsilateral testis is pulled. The typical manifestations of testicular tumors (E error) are swelling or hardening of the testicles, and negative light transmission test. To sum up, choose D for this question.

4. Refer to answer A. Analysis: This question tests the knowledge points of surgery-abdominal hernia-treatment and is a memory-type question. In male children, when crying, a lump bulges in the right groin, which disappears on its own when calm (suggesting inguinal hernia), and should be considered to be a right inguinal hernia. The child is under one year old, so the best treatment is to compress the deep inguinal ring with a bandage and undergo conservative observation and treatment (pair A). Because the abdominal muscles of infants and young children gradually strengthen as their bodies grow, hernias may disappear on their own.

High ligation of the hernia sac as soon as possible (B error) is mainly used for children over one year old and patients with strangulated hernia; hernia repair with strengthening of the anterior wall (C) and hernia repair with strengthening of the posterior wall (D Wrong) and tension-free hernia repair (False E) are common treatments for inguinal hernia in adults, but they are not the best treatment for this child. To sum up, choose A for this question.

5. Refer to answer D. Analysis: This question tests the knowledge points of surgery-abdominal injuries-clinical manifestations, and is a memory-type question. After the abdominal organs rupture, liquids such as digestive juice or blood enter the abdominal cavity, which can cause peritoneal irritation. Among them, gastric juice, bile, and pancreatic juice are the most stimulating digestive juices. The peritoneal irritation sign caused by the influx of liver bile into the abdominal cavity after the liver (wrong C) is ruptured is not as strong as the peritoneal irritation caused by the influx of pancreatic juice into the abdominal cavity after the rupture of the pancreas (right D). After the adrenal gland (A error), kidney (B error) and spleen (E error) rupture, the fluid flowing into the abdominal cavity is mainly blood. The blood has the least irritation to the peritoneum, so the peritoneal irritation sign is not obvious. To sum up, choose D for this question.

6. Refer to answer E. Analysis: This question tests the knowledge points of surgery-abdominal injury-diagnosis and is a memory-type question. Injury to abdominal viscera often manifests as diminished or absent bowel sounds. When intestinal motility is enhanced, bowel sounds can reach more than 10 times per minute, but the tone is not particularly high-pitched, which is called active bowel sounds (E is wrong, the correct answer to this question). It is seen in acute gastroenteritis, after taking laxatives, or in the gastrointestinal tract. During heavy bleeding. Injuries to the liver, spleen and other organs can lead to massive intra-abdominal bleeding, early shock (A pair), shifting dullness (+) (D pair), etc. Injuries to the gastrointestinal tract often lead to overflow of digestive juices, and overflowing digestive juices It can irritate the peritoneum and cause obvious peritoneal irritation sign (B pair); abdominal organ damage can lead to slowed intestinal peristalsis and intestinal paralysis, thus causing pneumoperitoneum sign (C pair). To sum up, choose E for this question.