A. Alveolar cell carcinoma is the most common lung center.
B. Lung cancer that begins under the bronchi of the lobes (which should be lung segments) is called peripheral lung cancer.
Among all types of lung cancer, adenosquamous carcinoma has the lowest incidence and the worst prognosis.
D. Undifferentiated cancer, large cell cancer is the most common, usually peripheral lung cancer.
E squamous cell carcinoma and undifferentiated small cell carcinoma are sensitive to radiotherapy and chemotherapy.
Answer: e
27-28
A. seal the chest wound first.
B. Pleurocentesis
C. Both
D. neither
Tension pneumothorax (_ _ _)
Combined thoracoabdominal injury (_ _ _)
Answer: B|A
The following statement about small cell lung cancer is wrong.
A. Small cell lung cancer is a malignant tumor completely different from non-small cell lung cancer.
B. Small cell lung cancer is a disease that needs systematic treatment.
C. Small cell lung cancer is not suitable for surgical treatment.
D. Small cell lung cancer is not a surgical disease.
E. The median survival time of small cell lung cancer is related to the tumor load range.
Answer: c
30 Common distant metastasis sites of lung cancer do not include:
A. Mediastinal lymph nodes
B. Liver
C. adrenal gland
D. bone
E. brain
A: A.
3 1 Which of the following is true about the characteristics of lung cancer:
A. Squamous cell carcinoma is not sensitive to radiotherapy and chemotherapy
B. Squamous cell carcinoma is prone to hematogenous metastasis
C. Hematogenous metastasis of adenocarcinoma only occurs in the late stage.
D. undifferentiated small cell lung cancer is not sensitive to radiotherapy and chemotherapy
E. adenocarcinoma is sensitive to radiotherapy and chemotherapy
Answer: c
Which of the following is not a common route of metastasis and spread of esophageal cancer:
A. Lymphatic metastasis
B. it spreads up and down the submucosa to the whole circumference.
C. Direct invasion of surrounding organs
D. Planting transfer
E. blood transfer
Answer: d
The following statement about closed thoracic drainage is wrong.
A. If there is gas in the pleural cavity, it is advisable to drain it on the anterior pleural cavity of the second intercostal space in the central locking line.
B. If the pleural cavity is liquid, choose the 6th-8th intercostal intubation between the axillary midline and the posterior axillary line for drainage.
C. In order to keep the lumen unobstructed, the drainage tube should be squeezed frequently.
D. When extubating, the patient takes a deep breath and holds his breath, and then quickly pulls out the drainage tube.
E. the patient should take a prone position.
Answer e (semi-recumbent position)
34. The late symptoms of lung cancer do not include
A. Vein dilation of the face, neck, upper limbs and upper chest.
B. harsh
C. Massive pleural effusion
D. myasthenia gravis
E. cervical sympathetic nerve syndrome
Answer: d
35. A patient came to the clinic and suddenly had chest pain in his right side and had difficulty breathing. Physical examination: the trachea shifts to the left, the right chest wall bulges, respiratory movement and tactile tremor weaken, percussion drums and auscultation breath sounds disappear. Suspected pneumothorax. Its x-ray performance should be
A round or oval light-transmitting day with fine stripe texture inside.
B The right lung is compressed, and a straight line can be seen at the outer edge of the compressed lung.
C) A circular transparent area can be seen in the lower lobe of the right lung, and the liquid level can be seen.
D. an eccentric cavity can be seen in the right lung.
E. nothing unusual.
Answer: b
36. The following statement about closed thoracic drainage is wrong.
A. If there is gas in the pleural cavity, it is advisable to drain it on the anterior pleural cavity of the second intercostal space in the central locking line.
B. If the pleural cavity is liquid, choose the 6th-8th intercostal intubation between the axillary midline and the posterior axillary line for drainage.
C. In order to keep the lumen unobstructed, the drainage tube should be squeezed frequently.
D. When extubating, the patient takes a deep breath and holds his breath, and then quickly pulls out the drainage tube.
E. the patient should take a prone position.
Answer: e
37. Which of the following should be considered?
A. Pleural effusion is clear and does not solidify after standing, and its specific gravity is
B. pleural effusion is about the color of blood, red blood cells >; 10× 10 10/ liter
C. Pleural effusion is yellow-green, with specific gravity >; 1.0 18, white blood cells higher than 500× 106/L, pH.
D. Pleural effusion smells, and its specific gravity is >; 1.0 18, WBC 10× 108/ L, pH.
E. bloody pleural effusion, red blood cells >; 5.0× 108/L, cholesterol content increased, LDH >；; 500 international units/liter
Answer: e
38. Regarding the treatment of hemothorax, the following statement is incorrect.
One, lung contusion should be done according to the situation of segmental or lobectomy.
Thoracotomy should be performed for progressive hemothorax.
C, a small amount of hemothorax can be treated conservatively
D, pleural effusion above should be early thoracic puncture or closed drainage.
Within a few days after the bleeding stops, the coagulated hemothorax should be cut open to remove the blood clot.
Correct answer: a
39, about the pathophysiological changes of tension pneumothorax, the following statement is incorrect.
A, trachea, bronchus or lung injury to form a valve, gas with each inhalation into the pleural cavity and accumulation increased, resulting in pleural cavity pressure higher than atmospheric pressure.
Causing mediastinal flutter
C, the injured lung is severely atrophied, the mediastinum is obviously displaced to the healthy side, and the healthy side lung is compressed, resulting in vena cava reflux disorder.
D. Intrathoracic pressure higher than atmospheric pressure drives gas into mediastinum to form mediastinal emphysema.
E, enter the soft tissue of chest wall, and form subcutaneous emphysema on face, neck and chest.
Correct answer: b
Analysis of the answer: mediastinal flutter is common in abnormal breathing during flail chest. However, in open pneumothorax, the pressure of the affected chest is always consistent with atmospheric pressure, so the healthy chest is negative pressure when inhaling, and the mediastinum shifts to the healthy side; When exhaling, the chest is positive, the mediastinum shifts to the affected side, and mediastinal flapping can also occur with respiratory movement.
40, progressive hemothorax does not include
A, pulse is accelerated, blood pressure drops, blood pressure does not rise after rehydration or drops after recovery.
B, thoracic drainage for 3 hours, more than 200 ml/hour.
C, Hb, RBC decreased continuously.
D, chest X-ray shadow gradually increased.
E. The ratio of red blood cells to white blood cells in the puncture fluid smear is 100: 1.
Correct answer: e
4 1, the first-aid measures for open pneumothorax are as follows.
A, tracheal intubation immediately, respirator assisted breathing.
B, rapid blood transfusion, infusion to correct shock
C, immediate debridement.
D, immediately cover the wound with sterile sealing material.
E, immediately closed thoracic drainage.
Correct answer: D.
42, rib fracture treatment principle, the following statement is incorrect.
First, analgesia
B, clean respiratory secretions, get out of bed early.
C. Open reduction and internal fixation as soon as possible.
D, fix the chest
E, prevention and treatment of complications
Correct answer: C.
43, flail chest obvious breathing difficulties, should be tracheal intubation mechanical ventilation to support breathing indications are
A. respiratory frequency >; 35 times per minute or 55 mm Hg
E, all of the above
Correct answer: e
44. A male patient, aged 18, came to see a doctor for "tearing pain in his right chest caused by being hit by a teammate while playing basketball". Physical examination: sweating profusely, panic-like, shortness of breath, left deviation of trachea, right drum sound and disappearance of breathing sound. The most likely diagnosis of this patient is
First, rib fracture
Tension pneumothorax
Rib fracture with hemothorax
Rib fracture with tension pneumothorax
E. rupture of aortic aneurysm
Correct answer: b
45.25 minutes ago, a 22-year-old male patient was stabbed in the left chest. When I went to see the doctor, I was emotional and pale, and then I became indifferent. Physical examination, weak pulse, blood pressure can not be measured. A 2cm long wound can be seen in the left chest 2cm beside the fourth costal sternum, and the heart sound is far away and weak. The most likely diagnosis is
First, the heart penetrating injury
B, left pneumothorax
Left hemothorax
Left hemopneumothorax
E. Combined thoracoabdominal injury
Correct answer: a
46, lung blast injury, also known as blast injury, the following clinical features, is incorrect.
First, the main pathological changes are alveolar rupture and intra-alveolar hemorrhage, followed by pulmonary edema and emphysema.
B, damage factors are limited to the ground explosion shock wave.
C, the main clinical manifestations are chest pain, chest tightness, hemoptysis, dyspnea, and bloody foamy liquid in the mouth and nose.
D, auscultation can be heard and the lungs are wet, and X-ray examination can show patchy shadows.
E, treatment is mainly to keep the airway open, correct hypoxemia, prevent and treat pulmonary edema and pulmonary infection. Correct answer: b
Answer analysis: lung blast injury can be divided into ① gas blast injury according to the classification of conductive media. Generally speaking, lung blast injury and its clinicopathological features refer to this kind of blast injury. ② Underwater blast injury. The damage caused by shock wave during underwater explosion is called underwater blast injury. Because the density of water is about 800 times that of air, there is no obvious compressibility and dispersion, so compared with air shock wave, underwater shock wave has the characteristics of fast propagation speed (3 ~ 4 times that of gas shock wave) and long propagation distance. Therefore, compared with the ground explosion, the underwater explosion of TNT with the same mass has a pressure difference of about 200 times at the same distance. Its clinical and pathological features are different from those of gas explosion injury. Pathologically, the gas-containing organs (lung, gastrointestinal tract) are seriously damaged, while the fluid-containing organs (gallbladder, bladder) are slightly damaged, with a high mortality rate of 40% ~ 70%, while the gas-blast injury is mostly less than 20%. ③ Solid blast injury. The shock wave transmitted by solid is called solid shock wave, which is usually transmitted by solid objects such as steel plates. Its amplitude is small, but its acceleration is large, and its action time is often within a few milliseconds. Most of the shock waves spread on the deck of ships and tanks are caused by mines, deep-water bombs and mine explosions. One is that the slight displacement and acceleration in an instant cause harm to the contact parts of people; Secondly, the obvious macroscopic movements such as bending and vibration caused people to be thrown into the air, water or hit hard objects such as bulkheads and armor, causing injuries.
47, about the clinical characteristics of traumatic asphyxia, the following statement is incorrect.
A, the main reason for the injury is that blunt violence acts on the chest or the chest and upper abdomen are violently squeezed.
B, the mechanism is that the glottis is closed, the intrathoracic pressure rises sharply, and the blood in the superior vena cava flows backwards, leading to the rupture and bleeding of peripheral veins and capillaries.
C. Purple-blue petechiae and ecchymosis appear on the skin of face, neck and upper chest, and ecchymosis or bleeding appears on the oral cavity and bulbar conjunctiva.
D, most of the injured have temporary disturbance of consciousness, and those with ruptured intracranial veins may be in a coma or die. E, serious need for emergency surgery.
Correct answer: e
Answer analysis: According to the pathogenesis of traumatic asphyxia, no surgical treatment is needed. The treatment mainly adopts oxygen inhalation, dehydration treatment during brain edema, cardiopulmonary resuscitation and assisted breathing rescue for asphyxiated people.
48, about the clinical characteristics of rib fracture, the following statement is incorrect.
A, the 4th to 7th ribs are more prone to fracture.
B, rib fracture will cause damage to the internal organs and diaphragm in the chest cavity.
Hemothorax and pneumothorax are common complications of rib fracture.
The ribs of the elderly are osteoporotic and not easy to fracture.
E, multiple rib fractures can cause abnormal respiratory movement.
Correct answer: D.
49. Regarding the location and age of rib fracture, the following statement is incorrect.
A, the 1 ~ 3 rib is thick and short, and it is not easy to fracture.
B, the 4th to 7th ribs are long and thin, and they are the easiest to break.
C, the costal cartilage at the front end of the 8th ~10 rib forms a costal arch connected with the sternum, which is not easy to fracture.
D, the ribs of children are not easy to fracture, and the ribs of the elderly are easy to fracture.
E, 1 1, 12, the front end of the rib is free and not fixed, and it is easy to fracture.
Correct answer: e
50, about the pathophysiological characteristics of hemothorax, the following statement is incorrect.
A, blood loss and signs of shock
B, hematocele, pressure increases, forcing the lungs to collapse, and pushing the mediastinum to the healthy side, affecting respiratory and circulatory functions.
C, due to the defibrasion of lung, heart and diaphragm movement, hematocele is more solidified.
D, after the blood clot is organized, fibrous tissue is formed to bind the lung and chest, restrict respiratory movement and damage respiratory function.
E, hematocele is easy to be complicated with infection, forming empyema.
Correct answer: C.
Answer analysis: the movement of lung, heart and diaphragm has the function of defibrasion, and the hemothorax does not coagulate. However, a large amount of blood accumulates in a short time, and the effect of defibrination is not ideal, and it can be solidified into a blood clot.