Simulated Question and Answer on "Professional Practice Ability" of Attending Physicians in Gastroenterology Department

20 17 simulated question and answer of "professional practice ability" of attending physicians in gastroenterology.

Simulation problem 1:

1. The most reliable method for diagnosing active ulcer bleeding is ().

A. gastric juice analysis B.X-ray barium meal examination

C. fecal occult blood D. emergency gastroscopy E. hemoglobin determination

2. The most important thing to prevent the recurrence of duodenal ulcer is ()

A. Inhibition of gastric acid B. Application of mucosal protective agent

C. Quit smoking D. Eliminate HPE. pay attention to the diet

3. Male, 45 years old, 400ml hematemesis and 400g black stool. Physical examination: the sclera is yellowish, the liver is untouched, the spleen and ribs are below and beside, the bowel sounds are active, and the mobile dullness is positive. The diagnosis may be ()

A. Gastric cancer bleeding B. Peptic ulcer bleeding

C. Bleeding from esophageal varices D. Bleeding from liver cancer E. Bleeding from biliary tract

4. In the drugs to reduce gastric acid, H2 receptor antagonist is ().

A. Cimetidine B. Omeprazole

C. atropine d aluminum hydroxide e lansoprazole

5.48 years old, with a history of cirrhosis for 5 years. The most likely diagnosis of sleep disorder, flapping flutter and abnormal EEG is ()

A. Hepatic encephalopathy stage I B. Hepatic encephalopathy stage II

C. Hepatic encephalopathy stage III D. Hepatic encephalopathy stage IV E. Subclinical hepatic encephalopathy

6. Male, years old, has had regular epigastric pain every spring and autumn for 8 years, accompanied by acid regurgitation and belching, and the pain has disappeared regularly in the past 2 months. Gastroscope: A small niche shadow was seen on the small curved side of the gastric antrum, and the mucosa of the gastric antrum was red and white, mainly red. The diagnosis result is ()

A. Gastric ulcer complicated with atrophic gastritis B. Chronic superficial gastritis

C. chronic superficial antritis D. gastric ulcer complicated with superficial gastritis E. gastric ulcer

7. Female, 28 years old, has abdominal distension and enlarged abdominal circumference in recent 2 months. Physical examination: the moving voiced sound is positive, and the bump diagnosis can touch the mass with unclear boundary of the right lower umbilicus. The erythrocyte sedimentation rate was 40mm/h, and the routine Rivanda test (+) was used for peritoneal effusion, and the cell count was 600? 106/L, lymph node cells 1.60, no cancer cells were found, and the most likely disease was ().

A. Peritoneal cancer B. Tuberculous peritonitis exudative type

C. Adhesive tuberculous peritonitis D. Mixed tuberculous peritonitis E. Peritoneal metastasis of ovarian cancer

8. A 30-year-old woman had recurrent epigastric pain for 3 years. Recently, she had abdominal distension with vomiting, and a large amount of vomit and food were separated from meals. Acid-fast therapy is ineffective. Physical examination: there is a watery sound in the upper abdomen. The most likely diagnosis is ()

A. Gastric mucosal prolapse B. Duodenal stasis

C. peptic ulcer complicated with pyloric obstruction D. gastric cancer E. gastroptosis

9. The main pathological type of tuberculous peritonitis is ()

A. exudation type B. adhesion type

C. cheese type D. exudation type+adhesion type E. adhesion type+cheese type

10. Male, 25 years old, drank 200g liquor and ate a lot of meat. The pain in the left upper abdomen was unbearable and radiated to the left back, accompanied by nausea and vomiting. Physical examination: heart and lung (-), abdominal weakness, left upper abdominal tenderness, no muscle tension, laboratory test: WBC 10.0? 109/L, neutral 0.85, blood amylase 0 su unit, the first choice for treatment is ().

A. Atropine B. Demerol

C. cimetidine d colloidal bismuth subcitrate e dexamethasone

1 1. The most common cause of upper gastrointestinal bleeding is ()

A. Peptic ulcer B. Biliary tract diseases

C. Acute erosive gastritis D. Laceration of gastric mucosa E. Rupture of esophageal varices caused by liver cirrhosis

12. It is best to choose () when patients with hepatic coma have convulsions.

A. chlorpromazine B. morphine

C. paraformaldehyde d diazepam e thiopental sodium

13. Male, 36 years old, the unit physical examination found that AFP increased > 0? G/L, normal liver function, HBsAg(+)HBeAg(+)HBcAb(+), the most likely diagnosis is () 0? G/L, normal liver function, HBsAg(+)HBeAg(+)HBcAb(+), the most likely diagnosis is ().

A.b. chronic active hepatitis

C. Late stage of liver cirrhosis D. Stage II of liver cancer E. Subclinical liver cancer

14. Which best represents portal hypertension ()?

A. Spleen enlargement B. Varicose veins of lower esophagus

C. Abdominal varicose veins D. Hemorrhoidal varicose veins E ascites

15. Male, years old, with a feeling of fullness in the upper abdomen for two years and loss of appetite for half a year. Gastroscopy showed that the mucosa of gastric antrum was grayish white with vascular network penetrating. Preliminary diagnosis ()

A. Chronic superficial sinusitis B. Chronic atrophic sinusitis

Chronic gastritis D. Early gastric cancer E. Acute gastric mucosal lesion

16. The index indicating the prognosis of acute pancreatitis is ().

A. blood calcium is lower than 1.75mmol/LB. Serum amylase was higher than 0U(Somogi).

C. The clearance rate of amylase and creatinine is more than 3 times that of normal. D. serum amylase does not decrease when it rises for more than 5 days. E. Blood potassium and magnesium are decreased at the same time.

17. Male, 37 years old, diagnosed as duodenal ulcer by gastroscopy due to recurrent epigastric pain, HP(+). Which of the following drugs should be selected for the most appropriate treatment ()

A. omeprazole +CBS+ antibiotic B. omeprazole+atropine

C. sucralfate+atropine+antibiotics D. prostaglandin+sucralfate E. famotidine+antibiotics

18. AFP positive rate of primary hepatocellular carcinoma ()

A. 100%B.80~90%

c . 70 ~ 90% d . 60 ~ 70% e . 60 ~ 60%

19. The clinical manifestation of decompensated cirrhosis is ()

A. Esophageal and gastric varices

C. Peritoneal fluid leakage D. Black skin E. emaciation, anemia and malnutrition.

20. The pathological tissue of peptic ulcer damage to which layer ()

A. Mucosal layer B. Submucous layer

C. Mucosal muscularis and serosa muscularis

2 1. Male, 47 years old, with a history of peptic ulcer 13 years, recurred in recent 3 months, but failed after 2 months of medical treatment. What kind of examination should be performed to ensure that the diagnosis is most helpful ()

A. Repeated fecal occult blood test B. Endoscopic biopsy

C. gastric juice analysis d barium penetration Eb ultrasound

22. The first choice for Crohn's disease of colon ()

A. metronidazole B. sulfasalazine

C. amoxicillin prednisone azathioprine

23. The valuable laboratory test to distinguish acute edematous pancreatitis from necrotizing pancreatitis is ().

A. Serum amylase B. Serum lipase

C. Urinary amylase D. Serum iron albumin E. Serum bilirubin

24. The earliest clinical manifestation of patients with hepatic coma in prodromal stage (Ⅰ stage) is ().

A. Flapping tremor B. Personality change

C. Abnormal EEG D. Dyslexia E. Positive pyramidal tract sign

25. Patients with acute pancreatitis, laboratory examination can appear ().

A. Serum lipase B decreased and blood calcium increased.

C. high serum iron albumin D. decreased blood sugar E. decreased blood urea nitrogen

26. About the treatment of hepatic encephalopathy, which of the following is wrong ()?

A. Diet is forbidden in protein. B. morphine is forbidden when fidgeting.

C. oral metronidazole D. soapy water enema E. giving branched-chain amino acids

27. Male, 47 years old, with chronic epigastric pain and diarrhea, failed to receive systemic anti-ulcer treatment. The gastric juice analysis showed that BAO was 20mmol/L, MAO was 66mmol/L, and the diagnosed patient was ().

A. Gastric ulcer B. Duodenal ulcer

C. Retrobulbar duodenal ulcer

28. In addition to which of the following drugs, patients with peptic ulcer should not use ().

A. Diazepam B. Prednisone

C. indomethacin e aspirin

29. According to WHO standards, the suspicious diagnosis is Crohn's disease ()

A. Local intestinal lesions, paving stone-like changes in mucosa B. Discontinuous intestinal lesions with longitudinal ulcers

C. Full-thickness inflammatory bowel disease with mass and stenosis D. Segmental bowel disease, longitudinal ulcer E. Intermittent bowel disease, full-thickness inflammation and non-caseous granuloma

30. The auxiliary examination item with the most diagnostic value for liver cancer is ().

A.b. determination of alpha-fetoprotein

C. determination of carcinoembryonic antigen D. determination of alanine aminotransferase E. fat balance test

3 1. Drugs with better effect in treating acute hemorrhagic necrotizing pancreatitis ()

A. Octreotide B. Adrenal glucocorticoid

C.H2 receptor antagonist D. proton pump blocker E. anticholinergic drugs

32. Male, 2 years old, with a history of liver cirrhosis for 3 years and recent abdominal distension. After taking furosemide tablets, sleep disorder, confusion and abnormal EEG appeared three days later. The most likely diagnosis is ().

A. Subclinical hepatic encephalopathy B. Hepatic encephalopathy phase I

C. hepatic encephalopathy II D hepatic encephalopathy III E hepatic encephalopathy IV

33. The most common clinical manifestation of Crohn's disease is ().

A. Abdominal pain and diarrhea B. Intestinal obstruction

C. High fever D. Abdominal mass E. Perianal and rectal lesions

34. Upper gastrointestinal bleeding shock, the first treatment is ().

A. insert a gastric tube and inject hemostatic drugs. B. lie on your back, raise your lower limbs and give oxygen.

C. Emergency gastroscope hemostasis D. Actively replenish blood volume E. Intravenous injection of omeprazole

35.36-year-old male, chronic diarrhea for 5 years, with a small amount of pus and blood in stool. Colonoscopy showed erosion and small ulcers on the surface of his rectum and sigmoid colon. The first choice for treatment ()

A. Hydrocortisone retention enema B. Prednisone oral administration

C. oral metronidazole D. oral furazolidone E. oral sulfasalazine

36. Male, 36 years old, abdominal distension, edema of both lower limbs for half a year, aggravation of 1 month, scanty urine near 1 week, physical examination: no flatulence in jugular vein, heart rate 104 beats/min, large abdominal distension, ascites sign (+), liver and spleen not touched. Urine routine protein (+), red blood cells 0 ~ 1/HP, white blood cells 0 ~ 2/HP, urine sodium 1.8g/24h (normal 3 ~ 5g, 24h), blood urea nitrogen 16mmol/L, most likely ().

A. Chronic nephritis complicated with uremia B. Constrictive pericarditis

C. Glomerular nephropathy complicated with uremia D. Cirrhosis complicated with hepatorenal syndrome E. Chronic congestive heart failure

37. The patient was a 40-year-old male, who suffered from abdominal discomfort for more than 2 years. After eating, his symptoms were obvious, including abdominal distension and hiccups. Physical examination of the upper abdomen showed mild tenderness. Gastroscopy showed that the gastric mucosa was mainly gray and white, and submucosal vessels were visible. The diagnosis should be ().

A. Chronic superficial gastritis B. Chronic atrophic gastritis

C. gastric ulcer d gastric cancer e gastric neurosis

38. The key link in the treatment of acute pancreatitis is ()

A. Inhibition of pancreatic secretion B. Antishock therapy

C. massive use of anti-turbulence D. analgesia and spasmolysis E. correction of water, salt, acid-base imbalance

39. chronic gastritis What kind of bacterial infection is related to the onset ()

A. Escherichia coli B. Salmonella

C. Campylobacter jejuni D. Helicobacter pylori E. Halophilic bacteria

40. The treatment of hepatic encephalopathy ineffective measures are ()

A. Wash intestines with weak acid solution B. Stop eating in protein.

C. oral neomycin D. intravenous drip of dopamine E. intravenous drip of arginine

1.D

2.D

3.C

4.A

5.B

6.D

7.D

8.C

9.B

10.A

1 1.A

12.D

13.E

14.B

15.B

16.A

17.A

18.C

19.C

20.C

2 1.B

22.B

23.D

24.B

25.C

26.D

27.D

28.A

29.D

30.B

3 1.A

32.C

33.A

34.D

35.E

36.D

37.B

38.A

39.D

40.D

Simulation question 2:

1. Which of the following descriptions about amylase is correct ()

A. The increase of urine amylase is later than that of blood amylase. B. When abdominal pain occurs, the amylase in blood and urine increases simultaneously.

C. blood amylase can only last for 48 hours. The level of amylase reflects the severity of the disease. E. The activity of total amylase in normal serum comes from pancreas.

2. Female, 46 years old, obese, with intermittent abdominal pain in the right upper right, and relaxation in the right back for one year, which seems to be related to eating greasy food, and the physical examination is asymptomatic. Generally speaking, which of the following checks is the first choice ()

A. Gastroscopy and B-ultrasound examination of liver and gallbladder

C.CT, D.MRI and E. Laparoscopy

3. Which of the following drugs has the best inhibitory effect on gastric acid secretion ()

A. cimetidine B. atropine

C. sucralfate d prostaglandin EE Colloidal bismuth subcitrate (CBS)

4. It is generally believed that anticholinergic drugs are not suitable for treating gastric ulcer, mainly because ()

A. cause dry mouth B. cause dysuria

C. cause blurred vision D. cause gastric antrum retention E. cause facial flushing.

5. Male, 30 years old, with dull pain in upper abdomen for more than 2 years. Anorexia, emaciation and fatigue in the last six months. After two gastroscopy examinations, the mucosa on the greater curvature of the stomach was pale, and the biopsy mucosa was moderately atypical hyperplasia. The best treatment for this patient is ()

A. supplement trace elements zinc and selenium B. oral pepsin mixture

C. oral misoprostol D. fluid replacement and intensive supportive treatment E. gastroscopy follow-up depends on the progress of the disease

6. The most common cause of cirrhosis in China is ().

A. toxic hepatitis B. Viral hepatitis

C. alcoholic hepatitis d malnutrition e schistosomiasis

7. A 35-year-old man with chronic epigastric pain suffered from upper gastrointestinal bleeding once a year, but did not respond to H2 receptor blockers. X-ray of barium meal shows multiple ulcers in the lower duodenum, and fasting serum gastrin is 500 ng/L. The diagnosis should be considered ().

A. Retrobulbar duodenal ulcer B. Compound ulcer

C.Zollinger-Elligon syndrome D. Kroha's disease E. Active duodenal ulcer

8. Acute hemorrhagic necrotizing pancreatitis with intestinal paralysis, () drugs should not be used.

A. Octreotide B. Adrenal glucocorticoid

C.H2 receptor antagonist D. proton pump blocker E. anticholinergic drugs

9. Which of the following is not the clinical manifestation of portal hypertension ()

A. Ascites B. Esophageal varices

C. Spleen enlargement D. Peripheral hemogram pancytopenia E. Spider nevus, liver palm

10. The active period of chronic gastritis is judged according to ().

A. Gastric mucosal erosion B. Gastric mucosal bleeding

C. neutrophils in gastric mucosa D. gastric mucosa is mainly lymphocytes and plasma cells E. gastric mucosa has? Excessive information?

1 1. Which of the following is more suitable for ulcerative colitis ()?

A. it is often manifested as pain in the right lower abdomen. B. Lesions often start from the terminal intestine and spread upward.

C. the small intestine is often affected. Normal intestinal mucosa can be seen between the diseased intestinal segments. E. purulent blood is rare.

12. Female, 26 years old, with low fever. Diarrhea for 3 months, the stool is mushy and there is no purulent blood. Paroxysmal periumbilical pain in recent 1 week. Physical examination: touch 4cm on the right lower abdomen? 5cm bag. Medium quality, light touch pain, hyperactivity of bowel sounds. The ESR was 67mm/h, and PPD skin test was strongly positive. The most likely disease is ().

A. Intestinal tuberculosis B. Colorectal cancer

C. Right ovarian cyst, appendicitis, periappendiceal abscess

13. The main clinical manifestation of primary liver cancer is ()

A. Progressive emaciation and fatigue B. Jaundice, ascites, hepatosplenomegaly

C. pain in liver area, progressive enlargement of liver D. fever, jaundice, cachexia E. ascites with blood, enlargement of liver.

14. The patient was a 32-year-old male with dull pain in the upper abdomen for 3 years. Pain attacks are related to diet and emotional changes. He has abdominal distension, mostly after meals, and mild tenderness in his upper abdomen. Gastroscopy found choroidal blood vessels in gastric antrum mucosa, and his stomach trouble was ()

A. Peptic ulcer B. Gastric cancer

C. Gastric mucosal prolapse D. Chronic atrophic gastritis E. Chronic superficial gastritis

15. The characteristic lesion of acute hemorrhagic necrotizing pancreatitis is ()

A. A palpable mass in the upper abdomen B. Periumbilical and lateral abdomen are blue-purple.

C. Jaundice D. Abdominal pain spread to the waist and back E. Abdominal pain lasted for more than a week

16. When liver cells in liver cirrhosis are seriously necrotic, the most obvious increase is ().

A. serum ALTB Serum AST

C. Serum indirect bilirubin D. Serum albumin E. Serum total cholesterol

17. The formation time of pseudocyst in acute pancreatitis is ().

A. 3-4 hours after illness B. 24 hours after illness

C. 3-4 days after illness D. 3-4 weeks after illness E. 3-4 months after illness

18. The most important manifestation in the diagnosis of pyloric obstruction is ().

A. Abdominal pain is relieved after vomiting. B. The vomit contains bile.

C. Excessive bowel sounds D. Abdominal distension E. None of the above.

19. The most valuable for the diagnosis of liver cirrhosis is ().

A. Spleen enlargement and B-mode ultrasonic echo of liver are rough and uneven.

C. Hepatic palmar and spider nevus D. Abnormal liver function test E. Barium filling defect at the lower end of esophagus through esophagus.

20. Male, 38 years old, with epigastric discomfort, pain and acid reflux for nearly half a month. Two hours ago, the upper abdominal pain worsened, and then vomiting was about 150ml. After hematemesis, the pain eased slightly. The most likely disease is ().

A. Hemorrhagic pancreatitis B. Chronic gastritis

C. cholecystitis d peptic ulcer e gastric cancer

2 1. The purpose of fasting and gastrointestinal decompression in patients with acute pancreatitis is ()

A. reduce pepsin secretion B. reduce gastric acid secretion

C. Reduce amylase secretion D. Reduce lipase secretion E. Reduce bile secretion

22. 1 patient with ascites repeatedly vomited blood and black stool 6 days ago, and got better after rescue treatment. In recent days, he has been very sleepy and can't recognize people. Which of the following complications may occur in patients ()

A. Anemia B. Hemorrhagic shock

C. azotemia D. electrolyte disorder E. hepatic encephalopathy

23. The rhythmic pain of gastric ulcer is characterized by ()

A. The pain occurs within 1/2 ~ 1 hour after meals. B. Fasting pain

C. Pain during meals D. Pain at night E. Pain after meals for 3 to 4 hours.

24. The most diagnostic value for subclinical hepatic encephalopathy is ().

A. Visual evoked potential B. Somatic evoked potential

C. EEG D. Simple intelligence test E. Blood ammonia

25. The most common complication of liver cirrhosis is ()

A. Hepatic encephalopathy B. Primary liver cancer

C. Upper gastrointestinal bleeding D. Hepatorenal syndrome E. Spontaneous peritonitis

A 26.25-year-old man suddenly felt dizzy and broke out in a cold sweat before going to bed at night, then vomited blood about 100ml, followed by black stool 1 time, about 300ml, and went to the hospital immediately. The most common disease of upper gastrointestinal bleeding is ().

A. Acute gastritis B. Chronic gastritis

C. Peptic ulcer D. Gastric cancer E. Stress ulcer

27. The characteristics of peptic ulcer complicated with upper gastrointestinal bleeding are incorrect ().

A. There must be hematemesis. B. There must be black stool

C. hematemesis is often brown. D. the pain is relieved after bleeding. There may be fever and azotemia after bleeding.

28. Male, 38 years old, has been in good health, with epigastric pain 4 hours after drinking, and dyspnea 40 times/minute after 14 hours. The most appropriate diagnosis is ().

A. Acute gastritis B. Right lobe pneumonia

C. Acute intestinal obstruction D. Acute edematous pancreatitis E. Acute hemorrhagic necrotizing pancreatitis complicated with adult respiratory distress syndrome

29. The main manifestation of chronic gastritis is ()

A. serum anti-parietal cell antibody is positive. B. the serum intrinsic factor antibody is negative.

C. The acidity of gastric juice is normal D. The serum gastrin content is low E. About 10% becomes cancerous.

30. Male, 42 years old, with epigastric pain 12 hours, abdominal distension and vomiting, and a past history of peptic ulcer. Physical examination: upper abdominal tenderness, blood amylase 750SomogyiU. The most likely diagnosis is ()

A. Acute perforation of peptic ulcer B. Acute pancreatitis

C. Acute intestinal obstruction D. Acute myocardial infarction E. Acute gastroenteritis

3 1. Among the following drugs used for maintenance treatment of gastroesophageal reflux disease, the best effect is ().

A. Cisapride

C. aluminum hydroxide d, cimetidine e and omeprazole

32. The most important factor in the pathogenesis of peptic ulcer is ().

A. pepsin B. ethanol

C. Stomach acid D. Bile reflux E. Irregular diet

33. Male, 38 years old, with epigastric pain 12 hours, persistent abdominal distension and vomiting, underwent appendectomy five years ago. Physical examination: tenderness in the upper abdomen, gray-purple spots on the skin of the lateral abdomen, and blood amylase of 250U (somogyi). The most likely diagnosis is ().

A. Acute intestinal obstruction B. Acute pancreatitis edema type

C. Acute perforation of peptic ulcer D. Acute myocardial infarction E. Acute hemorrhagic necrotizing pancreatitis

34. The diagnosis of gastric malignant ulcer is the most valuable ()

A. Persistent positive fecal occult blood B. Analysis of gastric juice

C. The diameter of the niche shadow is larger than 2.0cmD, and the gastroscopy shows that the ulcer is irregular and uneven. E. The exfoliated cells have nuclear variation cells.

35. A 34-year-old male patient was diagnosed with duodenal ulcer by X-ray barium meal examination three years ago. Upper abdominal pain loses its rhythm 1 month, which is more severe and radiates to the back. Taking various antacids is ineffective and has a good appetite. RBC:4000？ 109/L, HB: 130 g/L, this situation may be ().

A. Chronic perforation of duodenal ulcer B. Malignant transformation of gastric ulcer

C. compound ulcer D. gastrinoma E. prolapse of gastric mucosa

36. The clinical manifestations of acute pancreatitis are wrong ()

A. A palpable mass in the upper abdomen B. There may be tenderness and rebound pain in the abdomen.

C. Abdominal pain radiates to the back. Abdominal signs are parallel to pathological severity. E. Abdominal signs are parallel to abdominal pain.

37. Male, 40 years old, with persistent jaundice and itchy skin for 9 months. Physical examination: the body temperature is 39℃, 5cm below the liver rib, with moderate hardness, slightly uneven surface, tenderness (+) and alpha-fetoprotein (-). Which examination is the most valuable for diagnosis ()?

A. White blood cell count and classification B. Determination of blood r- glutamyltranspeptidase

C. Chest fluoroscopy D. Radionuclide scanning E. Abdominal B-ultrasound examination

38. Tuberculous peritonitis often occurs in ()

A. B.4 1~50 ~ 50 years old under 40 years old

C.5 1~60 ~ 60 years old D.6 1~70 ~ 70 years old E.7 1 above.

39. Regarding the treatment of chronic atrophic gastritis, the following statement is incorrect ().

A. Colloidal bismuth is selected to eliminate Helicobacter pylori B. If the acid is low and indigestion is obvious, dilute hydrochloric acid can be taken orally.

C. oral sucralfate protects gastric mucosa D. pernicious anemia requires lifelong injection of vitamin B 12. E. patients with intestinal metaplasia should be treated by surgery.

40. The following clinical manifestations that do not support the diagnosis of irritable bowel syndrome are ()

A. defecate more than 3 times a day. B. defecate less than 3 times a week

C. lump/hard stool D. watery stool E. smooth stool discharge, no feeling.

1.A

2.B

3.A

4.D

5.E

6.B

7.C

8.E

9.E