dap an dh, sdh

hc vin qun y p n thi tuyn nghin cu sinh

B mn Lao v Bnh phi Chuyn ngnh: ni h hp i tng Thc s

Cu 1NCS / ThSNguyn nhn trn dch mng phi thanh t? Cc phng php chn on xc nh lao mng phi? Nguyn tc iu tr lao mng phi?

- Nguyn nhn:

+ Ni 4 nguyn nhn chnh: lao , ung th, tim mch, vi khun v virut

+ Ni cc nguyn nhn him gp: Do bnh l gan, thn; HC Meidgs; Collagen; Nm v k sinh trng...

- Cc phng php chn on:

+ Lm sng: tui tr, hi chng nhim c lao

+ Xquang: Trn dch + c th c thm nhim nhu m phi

+ Dch mng phi : G gim, L ( 70%

+ Cy BK dch mng phi (+) tnh. PCR (+) tnh

+ M bnh mng phi (+) tnh

+ Mantoux (+) tnh, ELISA (+) tnh

+ Mu: L tng, VS tng / h

- Nguyn tc iu tr: Ni c 4 nguyn tc

+ Ht tho dch sm

+ Phc iu tr lao: Phc 2RHZS (E) / 6HE

+ Corticoid

+ Tp th khi ht dch

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1,0

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___

10,0

Cu 2:NCS / ThSCn c chn on trn dch mng phi do ung th? Phng php chn on trn dch mng phi ung th?

- Cn c chn on:+ Tui cao

+ Dch mng phi : Dch thanh t hoc mu , G tng , LDHtng...

+ T bo K (+) tnh

+ Xquang (chun v CT-scan) : C th c u

+ M bnh (+) tnh

+ Phn ng Mantoux (-) tnh

+ Cc Marker ung th (+) tnh

+ VS tng gi th 2

+ Dch ti lp nhanh, tn ti lu


+ Lm sng ( nh hng

+ Sinh ho: LDH, a. Hyaluronic...

+ Marker ung th

+ Ni soi, sinh thit mng phi, sinh thit hch...

+ Ni soi ph qun

+ M bnh - TBH

+ Phn ng Mantoux, VS

+ Xquang chun v CT, MRI...0,5

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10,0

Cu 3:Chn on phn bit trn dch mng phi do lao v ung th?

Lao Ung th

- Tui: tr - Cao- Ton thn: C th c hi chng - Gy st, suy kit

nhim c lao

- Dch mng phi:

+ Thng dch thanh t + Thng huyt thanh

mu

+ G gim < 0,6g/lt + G tng > 0,8g/lt

+ L ( 70% + T bo l (+)

- Xquang: c th c TN phi - C th c u phi

- Phn ng Mantoux (+) - Mantoux (-) tnh

- ELISA (+), khng th lao (+) - Marker K (+)

- M bnh MP: (+) lao - (+) ung th

- Cy BK / DMP: (+), PCR (+) - C th c K c quan

khc

- VS tng gi u - VS tng gi th hai

- Tin trin tt - Dch ti to nhanh, tn ti lu

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Cu 4:NCS / ThSLm sng, cn lm sng TDMP do Mesothelioma

- Lm sng:+ Trn dch mng phi huyt thanh mu mn tnh

+ Tui > 50 , tip xc Aming

+ Kh th, au ngc t t tng dn

+ Co ko lng ngc

+ C th c ngn di trng

+ Tin trin nng, thi gian sng 8-14 thng

- Cn lm sng:+ Xquang: Hnh nh c trng: hi chng Tobias Escudero

Hoc Surgent kurillski, trn phim chun v CT

+ Soi mng phi: Hnh nh u lan to 2 l mng phi. 3 giai on

+ M bnh: 3 tp: Biu m, trung m v hn hp

+ LDH > 600 UI/ ml, a. Hyaburonic > 120 (g/ ml

+ TBH: a dng, t bo trung biu m tng

+ Cc Marker ung th (+)

+ Phn ng Mantoux (-), VS tng0,5

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0,5

1,0

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0,5

0,5

___

10,0

Cu 5:Tiu chun chn on trn dch mng phi do lao. iu tr trn dch mng phi do lao?

- Tui : tr

- Ton thn: C th c hi chng nhim c lao

- Dch mng phi:

+ Thng dch thanh t

+ G gim < 0,6g/lt

+ L ( 70%

- Xquang: c th c thm nhim phi

- Phn ng Mantoux (+) tnh

- ELISA (+) tnh, khng th lao (+) tnh

- M bnh : (+) tnh lao

- Cy BK/DMP: (+) tnh, PCR (+) tnh

- VS tng gi u

- Tin trin tt

+ iu tr : Ni r iu tr theo nguyn tc+ Ht tho dch sm


+ Corticoid

+ Tp th khi ht dch

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0,25

0,5

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1,0

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10,0

Cu 6:NCS / ThSTiu chun chn on TDMP do ung th. Cc hnh nh Xquang v tip m bnh Mesothelioma?Tiu chun chn on

- Tui : cao- Ton thn: gy st, suy kit

- Dch mng phi:+ Thng huyt thanh mu

+ G tng > 0,8g / lt, LDH tng...

+ T bo l (+)

- Xquang: C th c u phi

- Phn ng Mantoux (-) tnh

- Marker ung th (+)

- M bnh mng phi (+) tnh ung th

- C th tm c ung th c quan khc

- VS tng gi th hai

Cc hnh nh Xquang:- Du hiu Tobias Escudero,

- Du hiu Surgent kurillski

- Ti m na lng ngc

Tp m bnh:- Tp biu m hnh ng

- Tp biu m hnh thoi (song dng)

- Tp hn hp0,25

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10,0

Cu 7:Phn loi trn dch mng phi theo hnh thi t bo, theo v tr v tin trin?

- Theo hnh thi t bo:

+ Tng L: Khi L >75%

+ Tng E: Khi E > 10%

+ Tng N:Khi N >50%

+ Trn dch MP huyt thanh mu:HC = 10.000-100.000/mm3+ Trn dch MP mu: HC > 100.000/mm3+ Ni c tiu chun trn dch mng phi thanh t: Protein, P/U Rivalta, Bilirubin, LDH, TB, t trng, Fibrin ...

+ Trn dch mng phi dng chp v dng dng chp: Lipit, Triglycerit, Cholesterol, t trng ...

+ Tiu chun trn dch mng phi dch tit: Protein, P/U Rivalta, Bilirubin, LDH, TB, t trng ...

- Theo v tr:

+ Trn dch mng phi th t do

+ Th khu tr: thnh ngc, rnh lin thu, th honh, trung tht, gian thu

-Theo tin trin:+ TDMP cp

+ TDMP mn1,0

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1,0

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0,5

0,5

0,5

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10,0

Cu 8: NCS / ThS

Lm sng, cn lm sng KPQ?

- Lm sng

+ Triu chng h hp

+ Triu chng ton thn v cn u

+ Triu chng di cn xa

+ Cc th lm sng : . HC Pancoasct-tobias

. Vim phi

. Xp phi

. Hen, ni tit

. Trung tht

. Huyt hc

- Cn lm sng

+ Xquang: Trung tm, ngoi vi

c im khi u: a cung, tua, gai

Cc tn thng lan rng trong lng ngc

+ CT lng ngc: U trung tm, ngoi vi

Hnh nh u theo phn loi t bo-m bnh

+ M bnh-t bo

+ Ni soi

+ Mu

+ Marker0,5

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0,5

0,25

0,25

___

10,0

Cu 9:NCS / ThS

Phn loi giai on ca KPQ?

- Phn loi

+ Ni c th no l TNM

+ Phn loi cu Moutain 1986:.

. Th n TxN 0M0 , g0: T isN 0M0. Giai on I : T1N 0M0, T2N 0M0. Giai on II : T1N 1M0, T2N 1M0. Giai on IIIA: T1-3N 2M0, T3N 0M0, T2N 1M0. Giai on IIIB : T1-4N 3M0, T4N 0-3M0, . Giai on IV : T1-4N 0-3M1+ Phn loi ca WHO 1999:

. Th n: TxN 0M0 . Giai on 0: T isN 0M0 . IA: T1N 0M0 . IB : T2N 0M0 . II: T1N 1M0,

. IIB: T2N 1M0 . IIIA: T1-3N 2M0, T3N 0M0, T3N 1M0 . IIIB : T1-4N 3M0, T4N 0-3M0 . IV :T1-4N 0-3M12,0

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Cu 10:Cc phng php chn on v iu tr KPQ?- Cc phng php chn on

+ Lm sng: Gi

+ Xquang nh hng , phn ng Mantoux v VSS

+ Tm t bo K trong m

+ Du n K: CEA; Cyfra 21-1

+ Chn on m bnh t bo bng cc KT sinh thit: hch ,

STMP, sinh thit PQ, trung tht, soi MP

- Cc phng php iu tr KPQ

+ Phu thut

+ Ho cht

+ Tia x

+ Ni soi

+ iu tr triu chng

+ Tng cng min dch1,0

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10,0

Cu11:NCS / ThSCc khi u phi mc c tnh thp v u phi lnh tnh?

- U c tnh thp:

-Nu nh ngha

- Carcinom biu m tuyn ph qun:

. K biu m tuyn kn: xa, tin trin chm, hay ti pht

. Carcinoma nhy dng biu b: PQ ln, xm ln ti ch

-U Carcinoid ph qun: 95% lnh tnh, d ti pht. M bnh ging K t bo nh. nh lng 5HIAA / nc tiu.

- c im chung:

. Khu tr trung tm

. D chy mu

. Ni soi hnh nh qu du

. Tin trin chm di cn xng, gan

-U lnh tnh:-U tuyn, u m, u x, u mch, u thn kinh

-Hacmatom (u lon sn)

-Cc u khc: Polip, u nh, u x m bo sc t vng0,5

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Cu 12Nu gi tr ca cc phng php xm nhp chn on KPQ?

- Soi ph qun quan st: m t cc hinh nh

- Sinh thit xuyn thnh PQ

- Sinh thit nim mc PQ

- Chi PQ

- Ra PQ

- Chc ht kim nh xuyn thnh kh-PQ

- Soi mng phi quan st

- Sinh thit MP thnh

- Sinh thit MP tng

- Sinh thit MP m

- Chc, sinh thit hch di cn

- Sinh thit phi chc ht v ct qua thnh ngc0,5

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Cu 13:NCS / ThSHnh nh Xquang ca KPQ? Ch nh iu tr phu thut trong KPQ?- Hnh nh Xquang ca KPQ

+ Th trung tm

+ Th ngoi vi

+ Hnh nh khi u:

. c im bn trong

. B khi u

. Thi gian nhn i

+ Cc du hiu khc:

. Vim bch mch ung th

. Xp phi

. Xm ln thnh ngc, ct sng, lit honh...

- Ch nh iu tr phu thut trong KPQ+ KPQ khng t bo nh

+ Giai on ( IIIA+Khi Karmofsky >50, FEV1 (1 lt, tnh trng tim mch, chc nng gan thn cho php1,0

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Cu 14:Phn bit ph phi huyt ng v ph phi tn thng?Ph phi huyt ng Ph phi tn thng- Nguyn nhn:

. Suy tim . Sc nhim khun

. Qu ti nc, dch . Virut

. Nghn tc ng mch phi . Hi, kh c, du ho

. Tro ngc d dy-

thc qun

. cao > 3000m. Dng

nhiu thuc h p

- p lc mao qun phi:

. > 18mmHg . < 18 mmHg

- Cung lng tim: . Gim . Tng

- Tn thng mng ph nang-mao mch:

. Khng . C

- Xt nghim m:

. Protein khng tng . Tng

- Xquang:

. Vng trung tm . Ngoi vi

. Hi phc . X ho1,0

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Cu 15:NCS / ThSLm sng, cn lm sng vim phi do ph cu v PQ-PV?- Lm sng, cn lm sng Vim phi do ph cu

+ Hi chng nhim khun: t ngt, st cao, rt run, au ngc, ho m r st...

+ Hi chng ng c

+ Xquang: Tn thng tn trng gii hn gii phu: thu, phn thu, ph qun hi.

+ Xt nghim m, phn ng sng v ph cu, PCR, ELISA

+ iu tr bng khng sinh p ng tt

- Lm sng, cn lm sng PQPV

+ Thng gp tr em, ngi gi c suy gim min dch

+ Hi chng nhim trng

+ Hi chng suy HH

+ Hi chng ng c + Hi chng ph qun

+ Xquang: hnh nh "VP m"

+ Xt nghim m: VK, VR hoc c hai1,0

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Cu16:c im lm sng, cn lm sng vim phi m k, VP Bnh vin, VP ngi suy gim min dch?- Lm sng, cn LS vim phi m k

+ Thng do VR hoc cc VK thuc nhm gy VP KH

+ Hi chng nhim khun

+ Hi chng vim long ng HH

+ Hi chng ng c (c th khng pht hin)

+ Xquang: hnh nh li-nt thu di

+ Cng thc mu: BC gim, L tng cao

+ Khng p ng iu tr khng sinh nu do VR

+ p ng khng sinh nhm Macrolid, Quinolon

- Lm sng, cn lm sng vim phi Bnh vin

+ Vim phi sau (48 72 h vo vin

+ Ngi gi, mc bnh tiu ng, hn m, t ni kh qun, m kh qun

+ Cc biu hin lm sng ging vim phi cng ng nng

- Lm sng, cn lm sng vim phi suy gim min dch

+ Xy ra ngi suy gim min dch do: nhim HIV/AIDS, mc bnh mn tnh, ung th, dng thuc corticoid

+ Do VK, VR t bo khng l, Pneumocystis carinii

+ Lm sng khng in hnh

+ iu tr p ng chm0,5

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Cu 17:NCS / ThSLm sng, cn lm sng ca gin ph qun ?

-Bnh s mn tnh-Ho khc m s lng m nhiu ( 200ml (th t )

-Ho ra mu ti din (th kh)

- St tng m tng, st gim m gim

-Ran n, ran m khu tr thng xuyn

- Ngn di trng (khi nung m phi)

- Hnh nh Xquang:

+ trn sng, c th c hang mc kh-dch

+ Mch mu xt li, th tch phi gim

+ Hnh nh vim quanh gin

+ Hnh nh dy thnh PQ

+ Chp HRCT v chp PQ cn quang cho chn on xc

nh GPQ

- Mt s th lm sng c bit:

+ Hi chng Kartagener

+ Hi chng Williams-Campbell

+ Hi chng Mounier-Kuhn0,5

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Cu 18:Phn loi gin PQ (lm sng, Xquang, c ch bnh sinh)?- Theo lm sng:

+ Th kh

+ Th t

- Theo Xquang:

+ Hnh tr

+ Hnh kn

+ Hnh trng ht

-Theo gii phu: + Tn thng cc b

+ Tn thng lan to

-Theo nguyn nhn:

+ Nguyn pht

+ Th pht v v cn1,5

1,5

1,0

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10,0

Cu 19:NCS / ThSiu tr ni khoa, ch nh ngoi khoa GPQ ?

-iu tr ni khoa

- Chng nhim khun: KS ph rng, KS

- Long m

- Vn ng h hp liu php

- Ni soi PQ ht dch m

- iu tr bin chng: Ho mu: truyn mu, gy tc M ph

qun

- iu tr d phng

- Ch nh ngoi khoa

- iu tr ni khoa tht bi, ho mu ti pht nhiu ln

- Bin chng ho mu nng, iu tr ni khoa khng kt qu

- Gin PQ khu tr

- Tnh trng ton thn cho php1,0

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10,0

Cu 20:Cn c chn on gin ph qun? Cc PP iu tr GPQ?

Cn c chn on gin PQ:

-Lm sng:

+ Bnh s mn tnh

+ Ho khc nhiu m ( 200ml / 24h (th t)

+ Ho mu ti din ( th kh )

+ Ngn tay di trng ( khi nung m phi )

+ Hi chng ph qun + ran n khu tr thng xuyn

- Xquang phi chun:

+ trn sng, vim quanh gin

+ Mch mu phi xt li, gim th tch phi

+ Dy thnh PQ

- Chn on xc nh: HRCT hoc chp PQ cn quang

Cc PP iu tr GPQ:

- iu tr ni khoa

- iu tr ni soi

- iu tr bin chng ho ra mu

- iu tr ngoi khoa

- iu tr d phng0,5

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Cu 21:NCS / ThSLm sng, cn lm sng, iu tr p xe phi ?

-Lm sng, cn lm sng:- Hi chng nhim trng

- Du hiu c m, hoc khc m m, m mu Chocola

(p xe do amip )

- Ngn di trng

- Hi chng ng c c th c HC hang

- C th c trn m v kh MP

- Xquang: Hnh nh hang c mc kh-dch

- Xt nghim m tm VK, amip

- iu tr:

+ Ni khoa:

. Khng sinh ph rng, KS

. VK ym kh dng Metronidazol 4-6 tun

. Dn lu t th, soi PQ ht m, chc ht qua da.

+ Phu thut:

. Ho mu nng

. Mn tnh

. D ph qun-mng phi0,5

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Cu 22:Nguyn nhn v iu tr p xe phi ?

- Nguyn nhn :

+ Vi khun ym kh

+ Vi khun i kh

+ Amip

- iu tr:

+ Ni khoa:


. VK ym kh v amip dng Metronidazol

. Thi gian iu tr 4-6 tun

. Dn lu t th

. Soi PQ ht m

. Chc ht qua da.

+ Phu thut: Ch nh khi

. Ho mu nng

. Mn tnh, iu tr ni khng kt qu


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10,0

Cu 23:NCS / ThSC ch bnh sinh p xe phi?

- Ht xung phi vi khun t ming-hng

- Tc nghn PQ

- Vim phi ht ( sc thc n, bn, nc ...)

- Nhim khun huyt

- Nhi huyt phi

- Chn thng, vt thng

- p xe do amip

- Khun lc ng HH di1,5

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1,5

1,5

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Cu 24:Chn on xc nh v chn on phn bit p xe phi?

- Chn on xc nh:

+ Hi chng nhim trng, nhim c

+ Ho khc m, c m

+ HC ng c, HC hang, HC trn m MP, ngn di trng

+ Xquang: hnh nh p xe c mc kh nc

+ Xt nghim m v dch chc ht p xe

+ p ng vi iu tr khng sinh, hoc thuc chng amip

- Chn on phn bit:

+ Hang ung th

+ Kn kh nhim khun

+ Gin PQ hnh ti cc b

+ Hang nm

+ Hang lao0,5

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Cu 25:NCS / ThSiu tr ni khoa, ch nh ngoi khoa p xe phi?

+ Ni khoa:

. Khng sinh ph rng

. KS

. Vi khun ym kh v amip dng Metronidazol


. Dn lu t th + long m

. Soi ph qun ht m

. Chc p xe qua da

+ ch nh ngoi khoa:

. Ho mu nng

. p xe mn tnh


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Cu 26:Cn c chn on COPD? iu tr COPD t bng pht?

Cn c chn on:

- Chn on vim PQ mn

- Chn on kh ph thng

- Vim PQ mn+KPT

- Ri lon thng kh tc nghn khng hi phc

iu tr COPD t bng pht:

- Khng sinh ph rng

- Corticoid

- Lu thng ng th:

. Thuc gin PQ

. Long m

. V rung

- Gim p lc ng mch phi

- iu tr suy tim.

- iu tr bin chng

-Oxy liu php 1,0

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Cu 27:NCS / ThSLm sng, cn lm sng, iu tr COPD?

Lm sng, cn lm sng:

- Ngi > 40 tui

- Tin s nghin thuc l, thuc lo, tip xc bi

- Ho khc m mn tnh 3 thng/ nm, ( 2 nm lin tip

- Kh th tng dn

- Hi chng PQ

- Hi chng KPT

- Xquang:

+ Hnh nh kh thng phi

+ Hnh nh phi bn


iu tr COPD:

- iu tr d phng

- iu tr t bng pht

- iu tr bin chng

- Phu thut gim th tch phi0,5

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1,0

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Cu 28:Cc giai on COPD (GOLD 2006), iu tr COPD ?

- Nu c cc giai on GOLD 2006

. Giai on I : FEV1 > 80% SLT, Gaensler < 70%. Giai on II: 50% ( FEV1 < 80% SLT, Gae. < 70%. Giai on III: 30% ( FEV1 < 50% SLT, Gae. < 70%. Giai on IV: ( FEV1 3 tun. iu tr khng sinh thng khng

+ Ho mu

+ C th c cc triu chng c nng HH khc: kh th, au ngc...

+ C th triu chng ca TDMP km theo

- Xquang:

+ V tr: vng cao( nh phi, phn thu 6)

+ Cc tn thng c bn: thm nhim

nt, x, vi, co ko

ph hu hang

lan trn1,0

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1,0

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___

10,0

Cu 57: ngha ca test Mantoux, soi m trc tip, nui cy m trong chn on lao?Nguyn tc iu tr lao khng thuc?

- ngha ca test Turberculin:- Dng tnh:

+ Pht hin trng thi d ng lao

+ Chng t c th nhim lao

+ Gi chn on: nu (+) tnh mnh trong lao hch

- m tnh :

+ Khng nhim lao,

.+Suy gim min dch do bnh hoc do dng thuc

- Soi m trc tip:+ AFB (+): c trc khun khng cn-toan trong m

+ AFB m (+) tnh + Xquang nghi lao : chn on xc nh

lao phi

- Nui cy m : Chn on xc nh

+ Pht hin BK sng

+ Khng sinh

-Nguyn tc iu tr lao khng thuc:

-B cc thuc b khng

-iu tr theo khng sinh

-Thay phc mi, thm nhm khng sinh (Ofloxacin)

-iu tr ko di + nng sc min dch1,0

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Cu 58:NCS / ThSNu tm tt c s khoa hc ca iu tr lao?

C s vi khun hc:

+ S lng BK v t bin khng thuc: Th nghim 1

Th nghim 2

Kt lun ca 2 th nghim

+ Chuyn ho ca BK (ni c 4 qun th):

A: Ngoi bo sinh sn

B: Ngoi bo sinh sn chm

C: Ni bo sinh sn chm

D: Ni bo khng sinh sn

C s dc l: + Liu lng thuc:

. Nng thuc: Ti a, ti thiu c ch

. H s vt

+ Thi gian tim tng

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Cu 59: ngha ca PP ni soi v m bnh trong chn on lao? M t cu trc ca nang lao?Nguyn tc iu tr lao ?

- Ni soi:

+ Ly dch ra XN AFB trc tip, PCR lao , nui cy BK

+ Chn on d hch lao cnh PQ vo ng th

+ Sinh thit chn on lao PQ

+ Sinh thit xuyn thnh PQ chn on lao k

- M bnh : Tm c cu trc ca nang lao: chn on xc nh

- Cu trc nang lao:

+ V cu trc nang lao

+ T chc b u

+ T bo bn lin

+ T bo Langhans

+ T bo Lympho v TB x

Nguyn tc iu tr lao :+ Phi hp thuc

+ Dng ng liu

+ Dng u n, ng gi

+ thi gian

+ iu tr 2 giai on

+ iu tr c kim sot

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Cu 60: NCS / ThS ngha ca cc PP: ni soi, m bnh, t bo, vi hun hc trong chn on lao phi?

- Ni soi:

+ Ly dch ra XN AFB trc tip, PCR lao , nui cy BK

+ Chn on d hch lao cnh PQ vo ng th

+ Sinh thit chn on lao PQ

+ Sinh thit xuyn thnh PQ chn on lao k

- M bnh t bo:

+ T bo: tm cc thnh phn ca nang lao

+ M bnh: cu trc ca nang lao: chn on xc nh

- Vi khun:

+ Soi AFB trc tip: chn on xc nh c bit khi kt hp vi Xquang phi

+ Nui cy BK: Chn on xc nh1,5

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hc vin qun y p n thi tt nghip bc s N Tr

B mn Lao v Bnh phi Chuyn ngnh: ni h hp Cu 1: TN/ NTNhng cn c chn on vim phi t cu v VP virut?

- Cn c chn on vim phi t cu:

+ Hi chng nhim trng, nhim c cp, nng

+ Hi chng ng c khng H , c th TDMP + TKMP

+ Xquang: Thm nhim lun chuyn

Nhiu p xe rim mng

TD + TKMP

Khi hp thu li bng kn kh

+ Xt nghim vi sinh m, mu (+) tnh

- Cn c chn on VP virut:

+ Xut hin trong v dch

+ Hi chng nhim trng

+ Vim long ng HH trn

+ Hi chng ng c khng in hnh

+ c im Xquang : thm nhim nht khu tr hoc lan to, bin chuyn nhanh, tu nguyn nhn

+ BC thng gim, L tng, VS tng

+ Xt nghim b th v phn lp virut (+) tnh1,0

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Cu 2:TN/ NT

Bnh sinh ca hen ph qun? lm sng v x l hen c tnh?

- Bnh sinh HPQ:

+ Vim ng th:

. Cc t bo vim

. Cht trung gian ho hc gy vim, cytokin

+ Tng tnh phn ng PQ:

. Do vim, c a

+ Ri lon h thn kinh t ng

. H giao cm

. H ph giao cm

. H NANC- Lm sng v x tr hen c tnh:+ Lm sng hen c tnh: Bnh nhn HPQ:

. Xut hin kh th nng.

. Ko di trn 24 gi iu tr cc thuc thng thng khng kt qu

. Suy HH

. Suy tim.

. HC no-HH.

+ X tr:

. Th Oxy lu lng ln cho n khi Sp02 ( 90%

.Thuc gin PQ.

. Corticoid ng kh dung v TM liu cao.

. iu tr suy tim.

. Bi ph in gii.

. Khng sinh.

. t ni kh qun; M kh qun; Th my, 1,0

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Cu 3:TN/ NT

Cc PP chn on ung th PQ? Phn loi ung th PQ theo TNM?

- Cc PP chn on (nu c c im cc triu chng v gi tr ca triu chng trong chn on):

-Lm sng:

+ Cc triu chng h thng, ton thn

+ Cc triu chng HH

+ Cc triu chng xm ln trong lng ngc

+ Cc triu chng di cn xa

- Xquang: XQ chun v CT, MRI: Ni c im khi K

- Cc k thut ni soi,sinh thit ly bnh phm

- Chn on m bnh, t bo

- Cc du n K

- Cng thc mu, mu lng

- Phn ng Mantoux

- Phn loi ung th ph qun theo TNM

+ Nu c bng phn loi theo Moutain 1986

. TNM

. 4 giai on0,5

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Cu 4:Cn c chn on COPD? iu tr COPD?

- Cn c chn on COPD:

+ Chn on VPQ mn

+ Chn on KPT

+ Vim PQ mn+KPT

+ Ri lon thng kh tc nghn khng hi phc

-iu tr COPD:

-iu tr t bng pht:+ Khng sinh ph rng

+ Thuc gin PQ: Cc dng thuc v cch dng

+ Corticoid: Cc dng thuc v cch dng

+ Long m

+ Th Oxy

+ V Rung

+ iu tr t bin chng

-iu tr d phng:

+ Vacxin phng NK HH, iu tr bnh tai-mi-hng

+ Tp th

+ Vitamin v chng gc oxy ho1,0

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Cu 5:TN/ NT

Phn bit TDMP do lao v ung th? iu tr trn dch mng phi do lao?

TDMP do lao TDMP do ung th

+ Dch mng phi: + Dch mng phi:

. G gim . G tng

. L ( 70% . C t bo l

. ADA tng . LDH tng

+ Phn ng Mantuox (+) + Phn ng Mantuox (-)

+ VS tng gi u + VS tng gi th hai

+ Xquang: c th c + C th c u phi

thm nhim/NM phi

+ M bnh: (+) lao + Dng tnh ung th

+ PCR (+), cy BK (+) + Marker K (+)

+ Tin trin: khi + Dch ti to nhanh,

tn ti lu, xu dn

- iu tr TDMP do lao: Theo 4 nguyn tc

- Phc chng lao: 2HRZS (E) / 6HE1,0

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Cu 6: Cn c chn on lao phi? Nguyn tc v phc iu tr lao phi?

- Cn c:

+ Ton thn: Hi chng nhim c lao

+ C nng: Ho ko di, ho mu

+ Thc th: triu chng khu tr nh hoc phn thu 6

+ Xquang: khu tr nh, t/c mn tnh, ph hu, lan trn

+ Phn ng Mantoux : (+), ELISA (+)

+ VS tng, L tng

+ m: Soi AFB (+), cy BK (+)

+ PCR (+), cy Bactec (+)

- Nguyn tc iu tr:

+ Phi hp thuc

+ Dng ng liu

+ u n , ng gi

+ thi gian

+ iu tr 2 giai on v c kim sot

- Phc iu tr: 2 phc (ngn hn v ti tr)0,5

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Cu 7:TN/ / NT

Chn on phn bit cc bnh c tn thng hang phi? Cc phng php iu tr p xe phi?

-Chn on phn bit : ( ni tm tt lm sng, cn lm sng)+ p xe phi

+ Lao phi c hang

+ Kn kh phi

+ Gin ph qun v kn ph qun

+ Vim phi t cu

+ Ung th ph hu

- Phng php iu tr p xe phi:

+ Ni khoa: Thuc + dn lu

+ Ngoi khoa: phu thut ct thu phi2,0

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Cu 8:Ch nh, chng ch nh v tai bin Soi ph qun ng cng?

- Ch nh:+ Trong chn on: . U ph qun

. Nhim khun phi-ph qun

. Bnh phi m k

. Lao ph qun

. Ho mu ko di

. Theo di theo ghp phi, m phi

+ iu tr: Ly d vt . Ht dch ph qun. t ct u v t stent. Ra ph qun-ph nang

- Chng ch nh:+ ang nhim khun, tin s ng kinh

+ D ng thuc t

+ Ri lon mu ng, mu chy

+ Bnh l tim mch nng, phnh quai ng mch ch

+ ang suy HH nng do bnh l HH

+ Thoi khp c, tui qu cao, th trng qu yu

- Tai bin:+ Thiu oxy mu

+ Chy mu

+ Nhim khun

+ Co tht ph qun

+ Trn kh mng phi

+ Cc tai bin khc: d ng thuc, gy kim, sock0,50

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Cu 9:TN/ NT

Ch nh, chng ch nh, tai bin ca Sinh thit mng phi kim Castelain?

- Ch nh:

Cc trn dch mng phi dch thanh t, huyt thanh mu v mu

- Chng ch nh:+ Tng chy mu

+ M mng phi (khng do lao)

+ Trn dch do suy tim, x gan

+ Qu dy mng phi

+ Tin s ng kinh, th trng qu yu

- Tai bin:

+ Trn kh mng phi

+ Sock mng phi ph giao cm

+ Chy mu

+ Dch thm qua ng chc kim

+ Nhim khun v di cn ung th qua ng chc kim

+ Sinh thit nhm ph tng

+ Gy kim

+ au1,0

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Cu 10:Ch nh, chng C , tai bin ca Sinh thit phi ht v ct qua thnh ngc?

- Sinh thit phi ht:+ Ch nh . U phi ngoi vi

. Cc tn thng ng c phi

. Phn bit p xe v kn phi hoc TDMP cc b

. U trung tm (di CT)

+ Chng ch nh: . Kh ph thng bong bng

. U mch mu

. Cao p ng mch phi

. Suy tim , suy h hp

. Bnh nhn ct 1 bn phi hoc tn thng 2 phi

+ Tai bin: Trn kh MP, sock ph giao cm, chy mu, t vong

- Sinh thit phi ct:+ Ch nh:. U phi > 2cm, cch mng phi khng qu 4cm

. Chn on bnh phi m k lan to

+ Chng ch nh: Nh sinh thit phi ht

+ Tai bin: Nh sinh thit phi ht0,5

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hc vin qun y p n thi tuyn BSNT + chuyn khoa cp I

B mn Lao v Bnh phi Chuyn ngnh: ni h hp Cu 1:CKI + NT / Tuyn

Tiu chun chn on vim ph qun cp v mn tnh? iu tr VPQ mn tnh ?

-Tiu chun chn on vim ph qun cp:+ C hi chng nhim trng cp

+ Hi chng ph qun

+ Xquang khng c tn thng nhu m v mng phi

- Tiu chun chn on vim ph qun mn:

+ Ho khc ( 3 thng / nm, ( 2 nm lin tip

+ Nghin thuc v yu t nguy c

+ Xquang: hnh nh phi bn

+ Ri lon tc nghn hoc hn hp

- iu tr vim ph qun mn:

+ D phng l chnh

+ iu tr t bng pht (3 hi chng)1,0

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Cu 2:Gii thch gin venn? Tiu chun chn on COPD v t bng pht COPD ?

- V c gin venn v gii thch

- Tiu chun chn on t bng pht COPD:+ C hi chng nhim trng

+ Hi chng ph qun

+ Suy h hp

+ Suy tim phi

- Tiu chun chn on COPD:+ Ni c tiu chun chn on vim ph qun mn

+ Ni c tiu chun chn on kh ph thng

+ Xquang: hnh nh phi bn + gin phi

+ Thng kh phi: ri lon tc nghn khng hi phc2,0

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Cu 3:CKI + NT / Tuyn

Tiu chun chn on HPQ? Triu chng ca hen c tnh ?

- Tiu chun chn on hen ph qun:+ Bnh s mn tnh

+ Kh th thnh cn

+ Cn kh th t ct hoc sau iu tr thuc chng co tht PQ

+ Cn kh th ti din chu k

+ Tin s d ng, hoc vim xoang v polip mi

+ Khm phi c hi chng ph qun co tht v hi chng gin phi cp

+ Xquang: hnh nh gin phi cp

+ Mu: E tng. m: E tng, t bo ph qun v tt Charcotleyden

+ Thng kh phi: Ri lon tc nghn hoc hn hp

+ Cc test chn on hen (+) (gng sc, d nguyn, Histamin...)

- Hen ph qun c tnh:+ Cn hen nng lin tc > 24h iu tr cc thuc thng thng khng kt qu, c suy h hp v tru tim mch

+ Cc du hiu nguy kch: th nhanh nng, phi nghe yn tnh. Huyt p tng chuyn sang tt huyt p. Tm ti0,5

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Cu 4:Chn on xc nh, phn bit gin ph qun?

- Chn on xc nh:+ Bnh s mn tnh

+ Th kh: ho mu ti din

+ Th t: m ( 300ml/24h, c 3 lp

+ Khm phi thng xuyn c ran khu tr

+ CT-Scan hoc chp ph qun cn quang : (+)

- Chn on phn bit:

+ Vim ph qun mn

+ Lao phi

+ Ung th ph qun

+ p xe phi

Trnh by ngn gn, r rng1,0

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Tiu chun chn on ung th ph qun? Cc PP iu tr KPQ?

Chn on:

- Yu t nguy c: Tui cao, ht thuc...

- Lm sng: ging triu chng cc loi bnh h hp

- Triu chng c trng: ho mu mu mn chn, cc du hiu chn p (hi chng trung tht, xp phi...)

- Triu chng di cn trong lng ngc v di cn xa

- Hi chng cn u

- Xquang: khi u a cung, tua gai (CT-scan)

- Soi ph qun: u si, cht hp

- M bnh: chn on xc nh, TBH (+)

- Phn ng Mantuox (-) tnh, mu lng tng

- Cc Marker ung th (+) tnh

Cc phng php iu tr ung th ph qun:

- Phu thut: ch nh giai on < IIIa- Tia x

- Ho cht

- iu tr h tr1,0

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Cu 6:Tiu chun chn on vim phi do ph cu v PQPV?

- Do ph cu:+ Hi chng nhim khun cp

+ au ngc + m mu r st

+ Hi chng ng c in hnh

+ Xquang: thu vim

+ Cy mu v m (+), in di min dch i lu (+)

+ iu tr Penixilin c hiu qu

- Ph qun-ph vim:+ Hi chng nhim trng cp

+ Hi chng suy h hp

+ Hi chng ph qun+ng c ri rc i xng

+ Hnh nh vim phi m trn Xquang

+ iu tr khng sinh c kt qu1,0

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Cu 7:CKI + NT / TuynChn on xc nh, phn bit p xe phi? Cc bin php iu tr ?

- Chn on xc nh:+ Hi chng nhim trng cp tnh

+ c m + ngn di trng

+ Xquang: hnh hang c mc kh+dch

- Chn on phn bit:+ Kn kh p xe ho

+ Gin ph qun

+ M mng phi thng vi ph qun

+ Hang ung th

+ Hang lao nhim khun

- iu tr p xe phi:+ Ni khoa

+ Ngoi khoa1,0

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Cu 8:Tiu chun chn on Trn dch mng phi do lao? Nguyn tc v bin php iu tr ?

- Chn on+ Dch mng phi: G gim, L( 70%

+ Phn ng Mantoux (+), ELISA (+)

+ Xquang: c th c thm nhim phi

+ Mu: L tng, VS tng

+ M bnh: (+) nang lao

+ Cy dch mng phi : BK (+)+ Cy Bactec (+) hoc PCR (+)

+ iu tr n nh

+ Tui tr, tin s tip xc lao

- Nguyn tc iu tr trn dch mng phi do lao

+ Ht tho dch sm

+ Phc chng lao

+ Corticoid

+ Tp th khi ht dch

- Vit r phc v cch dng thuc1,0

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Cu 9:CKI + NT / TuynLm sng v cn lm sng TDMP do lao v ung th ?

Lao Ung th

- Ton thn: C th c hi chng - Gy st, suy kit

nhim c lao

- Dch mng phi:


mu


+ L ( 70% + T bo l (+)


- Phn ng Mantuox (+) - (-) tnh

- ELISA (+), khng th lao (+) - Marker ung th (+)


- Tui: tr - Tui cao

- Cy BK/ DMP: (+), PCR (+) - C th thy K c quan

khc


- Tin trin tt - Dch ti to nhanh, tn ti lu1,0

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Phn loi, nguyn nhn, triu chng v x tr trn kh MP?

-Phn loi nguyn nhn:

+ Ni khoa, ngoi khoa

+ Nguyn pht, th pht+ Kn, h van

+ t, va, nhiu

+ Khu tr v ton b

-Nguyn nhn+ Ngoi khoa: vt thng, chn thng ngc

+ Ni khoa: Lao, COPD, HPQ, p xe phi, vim phi t cu..

+ Do th thut: sinh thit phi, mng phi, chc ht MP...

+ Khng r nguyn nhn

-Triu chng:

+ Ton thn: C th sc, suy HH

+ C nng: au x ngc, ho khan, kh th

+ Thc th: Tam chng Gaillard

HC bnh kim kh

+ Xquang: c im Xquang TKMP

Du hiu Bernou

+ o p lc khoang MP

-X tr:

+ Chng sc, gim au, iu tr suy HH

+ Chc ht kh, dn lu kh MP

+ X tr TKMP th van

+ Soi MP can thip

+ Phu thut0,25

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Cu :11CKI + NT / Tuyn ngha ca cc phng php chn on lao phi bng lm sng, Xquang v vi sinh? K n iu tr lao phi mi ngi tr 50 kg ?

ngha:

- Lm sng: Gi tr: nh hng + Hi chng nhim c lao

+ Ho khc m ko di > 3 tun iu tr KS khng kt qu

+ Ho mu

+ au ngc khu tr

+ Hi chng ng c, HC hang, hoc ngho triu chng

- Xquang: Gi tr: nh hng

+Cc c im: tn thng mn tnh, khu tr vng cao, ph

hu, lan trn

- Phng php vi sinh: Gi tr: Xc nh chn on

+ Soi AFB m trc tip

+ Nui cy:

. Mi trng Lowenstein

. Mi trng lng BACTEC, MGIT

+ PCR lao

- K n:

+ Lao mi: 2RHZS(E) / 6HE. Hoc 4RH

+ Tn cng:

1) Streptomyxin 1g ( 1l TB (th test)

2) Rifampyxin 0,3g ( 2v

3) INH 0,1g ( 3v

4) PZA 0,5g ( 3v

Nu d ng S thay = E: Ethambutol 0,4g ( 2v

+ Cng c:

6HE: 1) INH 0,1g ( 3v

2) Ethambutol 0,4g ( 2v

4RH: 1) Rifampyxin 0,3g ( 2v

2) INH 0,1g ( 3v0,25

0,51,0

0,5

0,5

0,5

0,5

0, 251,00,5

0,50,50,5

0,5

0,5

0,25

0,25

0,250,25

0,25

0,25

0,25

0,25

10,0


Chn on xc nh, chn on phn bit v cc bin php iu tr lao hch ngoi vi?

-Chn on xc nh:

+ Lm sng+ Phn ng Mantoux thng (+) tnh mnh

+ Chc hch: soi AFB (+), cy BK (+)

+ Sinh thit hch chn on m bnh thy nang lao in hnh

- Chn on phn bit

+ Vim hch

+ Bnh hch c tnh, Hodgkin v Non Hodgkin

+ Hch di cn ung th

- Cc bin php iu tr

+ Khng sinh chng lao + Corticoid

+ Chc ht dch b u v iu tr ti ch d hch

+ Phu thut1,0

0,5

1,5

1,0

1,0

1,0

1,0

1,0

1,0

1,0

___

10,0

Cu 13:Phn loi mc ho ra mu? Vit phc cp cu HRM?

- Phn loi mc HRM:

+ Nh ( 50ml/24h

+ Va 50-200 ml/24h

+ Nng ( 200 ml/24h. Hoc 600ml/48h

- Phc cp cu HRM

+ Bt ng tuyt i, n lng , ngui, nm nghing sang bn

tn thng

+ Th Oxy

+ An thn, trn tnh

+ Gim ho

+ Cm mu: co mch

+ Truyn mu ti cng nhm

+ Khng sinh chng nhim khun

+ iu tr cn nguyn

+ Cc PP can thip: Soi PQ, tc mch PQ

+ Phu thut1,0

1,0

1,0

0,50,5

1,0

0,51,0

1,0

0,5

0,5

1,0

0,5

___

10,0


C ch v triu chng ca kh ph thng tip A v B?

C ch:

Kh ph thng tp A Kh ph thng tp B

+ KPT a tuyn nang + Trung tm tiu thu

+ (-antitrypsin, ht thuc l + Thng l bin chng ca

VPQM

Triu chng:

+ C th tui tr + Cao tui : sau 30-40 tui

+ Ho khc m t + Ho khc m l chnh

+ Kh th tng dn + Kh th xut hin chm

+ Gy, th chm mi + Ph tm ti

(th hng thi) ( xanh ph)

+ HC KPT + HC ph qun + HC ph qun

+ Tm ph mn mun + Tm ph mn sm

+ Xquang: KPT l ch yu + Xquang: Hnh nh phi bn

1,5

1,5

1,0

1,0

1,0

1,0

1,0

1,0

1,0

___

10,0

Cu 15: ngha ca PP chn on lao phi bng: Ni soi, m bnh, xt nghim mu v DMP, iu tr th? Vit phc iu tr lao phi ?- Ni soi:

+ Ly dch ra PQ: Soi AFB, XN PCR lao, nui cy BK

+ Sinh thit PQ: Sinh thit xuyn thnh PQ: chn on m bnh

- M bnh: Pht hin nang lao chn on xc nh

- Xt nghim mu: BC tng, L% tng, VS tng: nh hng chn on

- Xt nghim DMP:+ Soi AFB trc tip: t c gi tr, Se thp

+ PCR lao : chn on xc nh

+ Nui cy BK

+ Xt nghim sinh ho, t bo: Dch tit, tng L, gim G

- Phc iu tr lao:

+ 2SRHZ (E)/6HE ( hoc 4RH ): lao mi

+ 2SRHZE/RHZE/5R3H3E3 : lao ti pht1,0

1,0

1,0

0,5

0,5

0,5

0,5

0,5

3,0

1,5

___

10,0

hc vin qun y p n thi tuyn nghin cu sinh

B mn Lao v Bnh phi Chuyn ngnh: ni h hp i tng bc s

Cu 1:Hi chng cn u trong ung th ph qun: nh ngha, c ch, biu hin lm sng, cn lm sng?

- nh ngha: Do u bi tit cc cht a peptit c tc dng sinh hc

- C ch: tc dng ging Hocmn, ph thuc vo khi u

- Lm sng, cn LS:

+ Hi chng cn u t chc lin kt, xng khp

+ Hi chng cn u ni tit

+ Hi chng cn u tn thng TK c

+ Hi chng cn u tn thng cm gic vn ng ngoi vi

+ Hi chng cn u huyt hc

+ Hi chng cn u ngoi da

+ Hi chng thn h, vim cu thn

1,0

1,0

2,0

1,0

1,0

1,0

1,0

1,0

1,0

___

10,0

Cu 2:Lm sng v cn lm sng ca bnh ung th ph qun?

- Lm sng:+ Ni c cc triu chng c trng: Ho mu mu mn chn, au ngc khu tr ko di...

+ Cc biu hin chn p trong lng ngc: Hi chng trung tht, HC xp phi, HC Pancoast - Tobias...

+ Cc biu hin di cn xa

+ Cc hi chng cn u

+ Triu chng ton thn

+ Yu t nguy c

- Cn lm sng:+ Xt nghim mu thng qui: BC tng, VS tng / gi th 2

+ Xquang chun v CT: U a cung, tua, gai, khe nt...+ Chn on t bo: trong m , hch ...

+ Soi PQ chn on m bnh: Qua sinh thit ph qun, sinh thit phi...

+ Phn ng Mantoux: (-) tnh

+ Cc Marker ung th: Tng cao1,0

1,0

0,5

1,0

0,5

0,5

0,5

1,5

1,0

1,0

0,5

1,0

___

10,0

Cu 3:NCS / BS

nh ngha, phn loi m bnh (WHO 1987), nguyn nhn v cc phng php iu tr KPQ?

-nh ngha: + KPQ = ung th phi nguyn pht

+ Ung th phi th pht

-Phn loi: + K biu m PQ dng biu b

+ K biu m PQ dng tuyn

+ K biu m PQ t bo ln

+ K biu m PQ t bo nh

-Nguyn nhn: + Thuc l

+ Yu t ngh nghip, mi trng

+ Tnh trng vim mn tnh HH

+ Cc cht tc ng gen

-Cc phng php iu tr: + Phu thut

+ X tr

+ Ho cht

+ Nng sc min dch

0,5

0,5

1,0

1,0

1,0

1,0

1,0

1,0

1,0

1,0

0,25

0,25

0,25

0,25

____

10,0

Cu 4:Cc th Xquang phi hay gp trong ung th PQ? Nhng hnh nh nh hng c tnh ?- Cc th Xquang hay gp:

+ Th trung tm

+ Th ngoi vi

+ Th gi vim phi

+ Th xp phi

- Cc hnh nh gi c tnh :

+ B: a cung, tua, gai, khe nt

+ V tr+ Thi gian nhn i: T 29 n 480 ngy

+ Vi ho: ngoi vi

+ Hang: thnh dy, b trong khng u

+ Cc tn thng khc:

. Hch rn phi, trung tht

. Vim bch mch ung th

. ng cong Morton

. Lit honh

. Xm ln xng sn1,0

1,0

1,0

1,0

1,0

1,0

0,75

0,5

0,5

1,0

0,25

0,25

0,25

0,25

0,25

___

10,0

Cu 5:NCS / BS

Phn loi KPQ theo TNM? Ch nh phu thut vi KPQ?

- Phn loi:( Ni c phn loi ca Moutain 1986)

. Th n TxN 0M0 , g0: T isN 0M0. Giai on I : T1N 0M0, T2N 0M0. Giai on II : T1N 1M0, T2N 1M0. Giai on IIIA: T1-3N 2M0, T3N 0M0, T2N 1M0. Giai on IIIB : T1-4N 3M0, T4N 0-3M0, . Giai on IV : T1-4N 0-3M1- Ch nh phu thut:

+ Loi khng t bo nh

+ Giai on ( IIIA+ Karnoftsky > 50; FEV1 > 1,5 lt0,5

0,5

1,0

1,0

1,0

1,0

2,0

2,0

1,0

___

10,0

Cu 6:Cc PP chn on ung th PQ, gi tr ca cc PP ?

- Cc PP chn on KPQ

+ Lm sng: Gi chn on

. Triu chng HH

. Triu chng ton thn v h thng

. Triu chng di cn xa

- Xquang, CT: Gi

+ Hnh nh khi ung th: a cung, tua gai.....

+ Cc tn thng lin quan

+ Hnh nh xm ln v lan rng ca ung th lng ngc

- Tm TB K trong m

- Mantoux : Nu (+) cn phn bit vi lao

- Mu lng: Tng nhanh gi th hai

- Cc k thut ly bnh phm trong chn on m bnh, t bo chn on xc nh

+ Sinh thit hch

+ Sinh thit MP, soi MP

+ Soi PQ sinh thit

- Cc marker ung th:

+ CEA

+ Cyfra 21-1

0,5

0,5

0,5

1,0

1,0

1,0

0,5

0,5

0,5

1,0

1,0

1,0

0,5

0,5

___

10,0

Cu 7:NCS / BS

c im lm sng, sinh ho, t bo dch MP trong TDMP do lao?Nguyn tc iu tr TDMP do lao ?- c im lm sng:

+ Thng tui tr

+ Hi chng nhim c lao + HC TDMP- Sinh ho + Dch MP thng mu vng chanh +Dch tit: Glucose gim < 0,6g / lt

P > 30g/lt; LDH > 200UI

LDHDMP/ht > 0,6; PDMP/ht > 0,5, Phn ng Rivalta (+) tnh

Bilirubin tng

- T bo: L ( 70%

S lng TB ( 1.000 TB.mm3

-Nguyn tc iu tr:Phc chng lao

Corticoid

Ht tho dch sm

Tp th khi ht dch0,50,50,50,51,00,50,5

0,51,0

0,51,0

1,0

1,0

1,0

__

10,0

Cu 8 :Cc cn c chn on trn dch mng phi do lao?

- Ton thn: C th c hi chng nhim c lao

- Dch mng phi:+ Thng dch thanh t

+ G gim < 0,6g/lt

+ L ( 70%

+ Bilirubin tng, ADA tng

+ Cy BK/DMP: (+) tnh (mi trng Loewentein, h thng Bactec)

+ PCR (+) tnh


- Phn ng Mantoux (+) tnh

- Bch cu L tng, VS tng gi u


- M bnh ( sinh thit mng phi) : (+) tnh lao

- Tui : tr

- Tin trin tt di tc dng ca iu tr lao0,25

0,25

0,5

1,0

0,5

1,0

1,0

1,0

1,0

1,0

0,5

1,0

0,5

0,5

___

10,0

Cu 9:NCS / BS

Nguyn tc iu tr TDMP do lao? Vit phc iu tr TDMP do lao. Tc dng ph ca cc thuc chng lao trong phc ?

Nguyn tc:

- Ht dch sm

- iu tr KS chng lao

- Corticoid

- Tp th khi ht dch

Phc :

- 2SRHHZ (E)/6HE (hoc 4RH)+Corticoid

Tc dng ph:

-S : Sc phn v, ic, RL tin nh, c vi thn

- R: D ng, c vi gan, thn, i huyt cu t

- H: Vim dy TK ngoi vi, c gan, ri lon tm thn

- Z: Tng axit uric mu, gout

- E: M mu, gim th lc, thi sc1,0

1,0

1,0

1,0

1,0

1,0

1,0

1,0

1,0

1,0

___

10,0

Cu10:c im lm sng, sinh ho, t bo dch MP trong TDMP ung th? iu tr TDMP ung th?

- c im lm sng:

+ Triu chng ton thn, h thng

+ Triu chng HH

+ Triu chng di cn xa v di cn trong lng ngc+ Hi chng TDMP

+ Dch ti lp nhanh, tn ti lu

- c im DMP, sinh ho, t ba:

+ Thng dch huyt thanh mu

+ Dch tit: Tng LDH, A. hyaluronic....

+ TB 1.000/ml; nhiu thnh phn t bo, tng E+ T bo c tnh trong DMP

- iu tr:

+ iu tr ung th ni chung

+ Chc tho DMP

+ Gy dnh MP, bm bt talc

1,0

1,0

1,0

1,0

1,0

1,0

1,0

0,5

1,0

0,5

0,5

0,5

___

10,0

Cu 11:NCS / BS

Cc PP chn on trn dch mng phi do ung th ?

- Tui cao, ton thn: gy st, suy kit

- C nng: au ngc tng hn, c th ho mu

- Thc th: C th khm c HC ph qun cht hp, HC trung tht, cc HC cn u hoc cc triu chng biu hin ung th ca cc c quan khc ...

- Dch mng phi:+ Thng dch thanh t hoc huyt thanh mu

+ G tng > 0,8g / lt, LDH tng, axit Hyaluronic tng...

+ T bo l (+), nhiu thnh phn t bo.

- M bnh ( sinh thit mng phi) : (+) tnh hoc (+) tnh cc c quan khc .

- Ni soi mng phi thy u si, chn on t bo - m bnh (+)

- Xquang: C th c u phi


- Cc Marker ung th (+)

- C th tm c ung th c quan khc

- VS tng gi th hai

- Tin trin: dch ti to nhanh, tn ti lu0,25

0,25

0,5

0,5

1,0

1,0

1,0

0,5

1,0

1,0

0,5

1,0

0,5

1,0

___

10,0

Cu 12:NCS / BS

Cc PP iu tr TDMP do ung th; Phn bit TDMP do lao v ung th?

- Cc PP iu tr TDMP do ung th:

+ iu tr ho cht

+ Tng cng min dch

+ Bm thuc vo khoang MP (Interferon ( ) trong TDMP do u

trung biu m MP c tnh

+ Gy dnh MP

- Phn bit:Lao Ung th- Tui: tr - Cao- Ton thn: C th c hi chng - Gy st, suy kit

nhim c lao

- Dch mng phi:

+ Thng dch thanh t + Thng HT mu


+ L ( 70% + T bo l (+)


- Phn ng Mantuox (+) - Mantoux (-) tnh

- ELISA (+), khng th lao (+) - Marker (+)


- Cy BK / DMP: (+), PCR (+) - C th c K c quan

khc


- Tin trin tt - Dch ti to nhanh, tn ti

lu

0,25

0,25

0,25

0,25

0,5

0,5

0,5

0,5

1,0

0,5

1,0

0,5

1,0

1,0

1.0

1,0

__

10,0

Cu 13:NCS / BS

Cc PP chn on lao phi ?c im LS,Xquang ca lao phi ?

- Cc phng php chn on lao:+ Lm sng + Ni soi

+ Xquang + M bnh t bo

+ Vi sinh + Xt nghim mu v DMP

+ Tuberculin v ELISA + iu tr th chn on

- c im lm sng:

+ Ngi tr, c yu t nguy c (tip xc, i tho ng...)

+ Ton thn: c th c hi chng nhim c lao

+ C nng: Ho ko di, ho mu, au ngc nh phi

+ Thc th: triu chng khu tr nh phi

- c im Xquang:+ Tnh cht mn tnh

+ Khu tr nh phi

+ Thng ph hu v lan trn1,0

1,0

1,0

1,0

1,0

0,5

1,0

1,0

0,5

1,0

1,0

___

10,0

Cu 14: ngha ca test Turberculin, soi m trc tip, nui cy m trong chn on lao phi hu tin pht?

- ngha ca test Turberculin:- Dng tnh:

+ Pht hin trng thi d ng lao

+ Chng t c th nhim lao nu (+) tnh

+ Gi chn on: nu (+) tnh mnh trong lao hch

- m tnh :

+ Khng nhim lao,

+ Trong suy gim min dch do bnh hoc do dng c ch MD+ Trong lao k v lao cp tnh

- Soi m trc tip:+ AFB (+): c trc khun khng cn-toan trong m. Ni c ngha chn on khi AFB (+) hoc (-) + AFB m (+) tnh + hnh nh Xquang nghi mc lao : chn on xc nh

- Nui cy m : Chn on xc nh

+ Pht hin BK sng

+ Khng sinh

1,0

1,0

1,0

1,0

1,0

1,01,01,01,0

1,0

___

10,0

Cu 15NCS / BS

c im lm sng, Xquang ca lao phi tin pht? C ch lao tin pht?

- c im lm sng:

+ Hi chng nhim trng ko di

+ Nhim c: st cn, m hi trm, thiu mu

+ Ho ko di

+ C th c HC TDMP hoc sng hch ngoivi

- Xquang:+ Phc b s nhim

+ Hoc huyt Gold, hch rn phi, trung tht n c

+ Hnh nh TDMP (c th gp)

- C ch:+ Nhim lao ( lao bnh

+ Ph thuc vo c lc ca BK, s lng BK v p ng min dch1,0

1,0

1,0

1,0

1,5

1,5

1,0

1,0

1,0

___

10,0

Cu 16: Cc phng php chn on lao phi? Nu phng php chn on lm sng v vi sinh?


+ Lm sng + Ni soi




- Chn on lm sng: da vo tin s, bnh s v khm thc th.+ Ngi tr, c yu t nguy c (tip xc, i tho ng...)

+ Ton thn: c th c hi chng nhim c lao

+ C nng: Ho ko di, ho mu, au ngc nh phi

+ Thc th: triu chng khu tr nh phi. Cc triu chng ny thng i lp vi hnh nh Xquang

- Phng php chn on vi sinh:+ Soi trc tip: Nhum Zill-Nelsen AFB (+) tnh

+ Thun nht m: AFB (+) tnh

+ Nui cy mi trng: Loewenstein BK (+) tnh , h thng Bactec, MGIT (+) tnh AFB .

+ Tim truyn ng vt gy c lao thc nghim

+ PCR (+) tnh 1,0

1,0

1,0

1,0

0,5

0,5

0,5

0,5

1,0

1,0

1,0

0,5

0,5

___

10,0

Cu 17:NCS / BS

Cc phng php chn on lao phi? Nu phng php chn on Xquang v m bnh-t bo?

Cc phng php :

+ Lm sng + Ni soi




- Phng php Xquang:

+ Chp phi thng, nghing, chiu in phi, nhm pht hin nhng c im tn thng lao phi : . Tnh cht mn tnh

. Khu tr nh phi

. Thng ph hu v lan trn

+ Chp CT nhm xc nh v phn bit tn thng lao vi ung th, vim phi, xp phi v cc tn thng khc...

- Phng php chn on m bnh - t bo :+ Chn on m bnh: Tm thy nang lao in hnh nh cc k thut sinh thit mng phi (trong lao mng phi) , sinh thit hch (trong lao hch), sinh thit PQ (lao PQ)...

+ Chn on t bo: Tm thy cc tn thng khng in hnh ca nang lao (TB bn lin, Langhans, Lympho) dch MP, hch v cc t chc khc khi chc ht...

+ Ni c cc k thut sinh thit v chc ht t bo1,0

1,0

1,0

1,0

0,5

1,0

1,0

1,0

1,0

1,0

0,5

___

10,0

Cu 18: NCS / BSPhc iu tr lao mi, nu cc tc dng chnh , ph ca cc thuc?

Phc :

- 2SRHZ (E)/6HE hoc 4RH

- Tn cc thuc v hm lng

Tc dng:

S: Dit BK ngoi bo

R: Dit v trit BK ni v ngoi bo

H: Dit BK ni v ngoi bo

Z: Dit v trit BK ni bo

E: Km BK

Tc dng ph:

S: Sc phn v, tin nh, ic tai, c vi thn

R: c vi gan, thn, ri lon tiu ho, tan huyt, d ng

H: Vim dy TK ngoi vi, hoi t TB gan, ri lon tm thn

Z: Tng axit uric mu, gout

E: M mu, gim th lc th sc1,0

1,0

1,0

1,0

1,0

1,0

1,0

1,0

0,5

0,5

0,5

0,5

___

10,0

Cu 19:Nu nguyn tc x tr ho mu, cn nguyn ho mu?

- Nguyn tc:

+ Bt ng tuyt i, n lng ngui

+ Gim ho.

+ Trn tnh an thn

+ Cm mu: thuc co mch, truyn mu ti cng nhm, tc mch

+ Khng sinh chng bi nhim

+ iu tr nguyn nhn

- Cn nguyn ho mu:

+ Lao phi

+ Gin PQ

+ KPQ

+ p xe

+ Nm

+ K sinh trng

+ Bnh tim mch

+ Chn thng

+ Nguyn nhn khc:1,0

1,0

1,0

1,0

1,0

1,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,25

0,25

___

10,0

Cu 20:NCS / BS

Cn c chn on gin ph qun? Cc phng php iu tr gin ph qun ? -Chn on:-Bnh s mn tnh

-Th kh: Ho mu ti din

-Th t: khc m nhiu ( 3lp, ngn di trng)

-Ran n khu tr thng xuyn

-Chn on xc nh bng HRCT hoc chp PQ cn quang

-iu tr: -Ni khoa:

+ iu tr triu chng: ho mu, m

+ S dng khng sinh

+ Ra PS, kh dung

+ iu tr bin chng v can thip mch

-Ngoi khoa: Phu thut khi:

+Gin PQ khu tr

+ Ho ra mu nng

+ iu tr ngoi khoa tht bi

-D phng:

+ iu tr bnh tai mi-hng

+ Trnh lnh, bi

+ Vitamin, vc xin, nng sc min dch0,5

1,0

1,0

0,5

1,0

1,01,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

10,0

Cu 21:NCS / BSPhn loi v nguyn tc x tr ho ra mu? Cc bin php x tr ho ra mu nng?

- Phn loi:

+ Nh: < 50 ml / 24h

+ Va: 50 - 200 ml / 24h

+ Nng: > 200 ml / 24h hoc 600 ml / 48h

- Nguyn tc:+ Bt ng tuyt i, n lng ngui

+ Gim ho

+ Trn tnh an thn

+ Cm mu: thuc co mch, truyn mu ti cng nhm, tc mch

+ Khng sinh chng bi nhim

+ iu tr nguyn nhn- Cc bin php x tr ho mu nng:+ Nm u thp, nm nghing sang bn tn thng

+ Chng suy HH,th Oxy, chng n tc

+ An thn mnh (Coktailytic)

+ Co mch:

. Dng tinh cht hu yn

. Co mao mch: Wincinol

+ Truyn mu ti cng nhm

+ Soi PQ nt PQ dn lu vng chy mu bm dung dch Adrenalin pha long

+ Tc ng mch PQ

+ Truyn dch chng tru tim mch

+ Gy tc mch

+ Phu thut0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,50,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5___

10,0

Cu 22:Nguyn nhn v iu tr p xe phi ?

- Nguyn nhn :

+ Vi khun ym kh

+ Vi khun i kh

+ Amip

- iu tr:

+ Ni khoa:


. VK ym kh v amip dng Metronidazol


. Dn lu t th

. Soi PQ ht m

. Chc ht qua da.

+ Phu thut: Ch nh khi

. Ho mu nng

. Mn tnh, iu tr ni khng kt qu


1,0

1,0

1,0

1,0

1,0

1,0

0,5

1,0

0,5

0,5

0,5

___

10,0

Cu 23:Phn loi TKMP, cch xc nh? Lm sng ca TKMP t pht?

- Phn loi TK:+ Ni khoa, ngoi khoa

+ T pht (nguyn pht, th pht)+ t, va, nhiu

+ Khu tr v ton b

+ H, kn, van- Cch xc nh: o p lc khoang MP bng bm tim thu tinh, my kuss, soi MP- Lm sng TKMP t pht:

+ Khi pht t ngt, c th sc

+ au x ngc thng sau gng sc.

+ Kh th nhanh nng

+ Ho khan

+ Lng ngc bn TK cng vng

+ Tam chng Gaillard

+ Hi chng bnh kim kh: TK h hoc th van

0,5

1,01,00,5

0,5

0,5

1,0

1,0

1,0

0,5

0,5

0,5

1,0

0,5

___

10,0

Cu 24:NCS / BS

Lm sng ca TKMP t pht?Cc bin php x tr TKMP?

- Lm sng TKMP t pht:

+ Khi pht t ngt, c th sc

+ au x ngc thng sau gng sc.

+ Kh th nhanh nng

+ Ho khan

+ Lng ngc bn TK cng vng

+ Tam chng Gaillard

+ Hi chng bnh kim kh: TK h hoc th van

- Cc bin php x tr TKMP

+ Chng sc: tr tim, truyn dch

+ Chng suy HH : th Oxy

+ Ht kh bng kim nh

+ Dn lu kh: kn, mt chiu

+ Soi lng ngc: t, ct bng kh, gy dnh MP

1,0

1,0

0,5

0,5

0,5

1,0

0,5

1,0

1,0

1,0

1,0

1,0

___

10,0

Cu 25:Nguyn nhn v cch phn loi TKMP?

- Nguyn nhn:+ Ngoi khoa: chn thng, vt thng

+ Ni khoa:

. COPD, HPQ.

. V bng kh

. Lao phi, KPQ

. p xe phi, vim phi t cu

+ Khng r nguyn nhn

- Cch phn loi

+ Ni khoa, ngoi khoa

+ T pht (nguyn pht, th pht)+ t, va, nhiu

+ Khu tr, ton th

+ H, kn, van1,0

1,0

1,0

1,0

1,0

1,0

0,5

1,0

0,5

1,0

1,0

___

10,0

Cu 26:NCS / BSChn on v x tr trn kh mng phi?

- Chn on trn kh mng phi:+ Ton thn: c th c tnh trng sock

+ C nng: au nh x ngc, kh th, ho khan

+ Thc th: tam chng Gaillard, c th c hi chng bnh kim kh

+ Xquang: tng sng, mt vn phi, gin khong gian sn, y tim v trung tht

. Trn kh mng phi khu tr c th c du hiu Bernou.

. CT-scan chn on phn bit

+ Chc d mng phi xc nh v o p lc khoang mng phi chn on TKMP kn, h, van...

- X tr trn kh mng phi:+ Ch nh ht v dn lu kh

+ Soi mng phi iu tr

+ iu tr nguyn nhn

+ iu tr triu chng: Chng sock, tru tim mch, au, ho...1,0

1,0

1,0

1,0

1,0

1,0

1,5

0,5

0,5

0,5

1,0

___

10,0

Cu 27:Lm sng, cn lm sng lao hch ngoi vi?

- Lm sng:

+ Triu chng ton thn: C th c HC nhim c lao hoc khng c triu chng g

+ Triu chng ti ch:

. Ni c 3 th: thm nhim, b u, x ho

. Sng nhiu hch, thnh chui 2 bn c, thnh m ni khc. Th lao hch b u th hch sng to, , v v d m.

+ Tin trin:

. Mn tnh.

. Th b u th sng - hoi t - r ht hch ny n hch khc, li so dm d xu x.

. C th lan trn n cc c quan v b phn khc hoc vo mu gy nhim khun mu lao...

+ Tin s tip xc hoc c yu t nguy c

- Cn lm sng:+ Phn ng Mantoux (+) tnh mnh

+ Xt nghim mu: L tng, VS tng

+ Chn on m bnh: (+) tnh (nang lao in hnh)

+ Chn on t bo: Thy c cc thnh phn ca nang lao

+ Chn on vi sinh: Cy BK (+) tnh hoc PCR (+) tnh

+ Xquang c th thy vi ho phi, hch rn phi v trung tht sng to, hoc tn thng lao nhu m phi0,25

1,0

1,0

0,25

0,5

0,5

1,0

1,0

1,0

1,0

0,5

1,0

1,0

___

10,0

Cu 28:NCS / BS

Chn on xc nh v phn bit lao hch ngoi vi?

Chn on xc nh:


+ Triu chng ti ch:



+ Tin trin:

. Mn tnh tng t

. Th b u th sng - hoi t - d ht hch ny n hch khc, li so dm d xu x.



+ Phn ng Mantoux (+) tnh mnh





+ Xquang c th thy vi ho phi, hch rn phi v trung tht sng to, hoc tn thng lao nhu m phi- Chn on phn bit lao hch ngoi vi:+ Vim hch do vi khun vi rt

+ Bnh hch c tnh Hodgkin v Non Hodgkin

+ Hch di cn ung th

+ Cc u lnh tnh0,25

1,0

1,0

0,25

0,5

0,5

1,0

1,0

0,5

1,0

0,5

1,0

0,5

0,25

0,25

0,25

0,25

___

10,0

Cu 29:NCS / BS

Chn on v iu tr lao hch ngoi vi?

Chn on xc nh:


+ Triu chng ti ch:



+ Tin trin:

. Mn tnh tng t

. Th b u th sng - hoi t - d ht hch ny n hch khc, li so dm d xu x.



+ Phn ng Mantoux (+) tnh mnh





+ Xquang c th thy vi ho phi, hch rn phi v trung tht sng to, hoc tn thng lao nhu m phi- Chn on phn bit lao hch ngoi vi:+ Vim hch do vi khun vi rt

+ Bnh hch c tnh Hodgkin v Non Hodgkin

+ Hch di cn ung th

+ Cc u lnh tnh

- iu tr:+ Ni khoa:. Phc chng lao: 2HRZS (E) / 6HE + Corticoid (th thm nhim v b u)

. iu tr ti ch: i vi lao hch b u, c th chc ht m v bm thuc iu tr

+ Ngoi khoa: Phu thut hch c nguy c hoi t hoc chch rch ch ng

0,25

0,5

0,5

0,25

0,5

0,5

1,0

1,0

0,5

1,0

0,5

1,0

0,5

0,25

0,25

0,25

0,25

0,5

0,25

0,25

___

10,0

Cu 30:NCS / BS

Nu cc ch s thm d thng kh phi? ri lon thng kh hn ch ?

Cc ch s

- Nu cc ch s o th tch:

VC

FVC

RV

TLC

- Cc n v o lu lng

FEV1FEF25FEF75FEF50FEF25-57PEF

Ch s Gaensler

Tiffeeau

- Sc cn ng th

- DLCO- Ri lon thng kh hn ch

VC < 80% LT

FVC < 80% LT0,5

1,0

0,5

0,5

1,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

1,0

1,0

___

10,0

Cu 31: NCS / BSNu cc ch s thm d thng kh phi, RLTK tc nghn?

Cc ch s

- Nu cc ch s o th tch:

VC

FVC

RV

TLC

- Cc n v o lu lng

FEV1FEF25FEF75FEF50FEF25-57PEF

Ch s Gaensler

Tiffneau

- Sc cn ng th

- Ri lon thng kh tc nghn

FEV1 < 80% LT

Gaensler < 70%

Hoc Tiffneau < 75%

FEF 25, 50, 75 (FEF 25-75% (0,5

1,0

0,5

0,5

1,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

___

10,0

Cu 32:NCS / BS

Nu cc ch s thm d thng kh phi, ri lon thng kh hn hp?Cc ch s

- Nu cc ch s o th tch: VC

FVC

RV

TLC

- Cc n v o lu lng FEV1 FEF25 FEF75 FEF50 FEF25-75 PEF

Ch s Gaensler, Tiffneau

- Sc cn ng th- Cc ch s ri lon TK hn hp: Nu cc ch s ca + Ri lon TK hn ch

+ Ri lon thng kh tc nghn

0,5

1,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

1,0

0,5

1,5

1,5

___

10,0

Cu 33:NCS / BS

Trnh by hi chng ph qun v HC trn dch mng phi?

- Hi chng ph qun:

+ Triu chng ton thn: Tu theo tng nguyn nhn gy bnh+ Triu chng c nng: Kh th, ho m, mu, au ngc, tu theo tng nguyn nhn

+ Triu chng thc th: Ch yu l nghe phi pht hin c cc hi chng PQ:

. Hi chng PQ co tht: Nghe c ral rt, ral ngy lan to.

. HC Ph qun cht hp: Nghe c ting Wheezing

. HC ph qun n tc: Nghe c ral m

+ Nguyn nhn ca hi chng ph qun: Ni c cc nguyn nhn tu theo tng HC ph qun (hen PQ, K PQ, GPQ, COPD...)

- Hi chng trn dch mng phi+ Ton thn: Thng c st

+ C nng: au ngc , kh th, ho khan, lin quan vi thay i t th

+ Thc th: HC 3 gim, c th nghe c ting c mng phi giai on u v giai on dch hp thu. TDMP mc nhiu c th nghe c ting thi MP v ting d ku.

+ Cn lm sng:

. Xquang: M thun nht y phi, mt gc sn honh, gin khong gian sn, y tim v trung tht. TDMP th t do mc trung bnh thng c ng cong Damoiseu

. Ni c cc hnh nh TDMP khu tr: Rnh lin thy b, rnh lin thu ln, vm honh, trung tht, thnh ngc...

. Xt nghim DMP: Sinh ho, t bo, vi khun.

+ Ni c phn loi nguyn nhn TDMP.

0,25

0,25

0,5

0,5

0,5

0,5

1,0

0,5

1,0

1,5

1,0

1,0

0,5

0,5

___

10,0

Cu 34:NCS / BS

Hi chng ng c v hang?

- Hi chng ng c:+ Khi nim HC ng c

+ Hi chng ng c in hnh:

. Gii thch c rung thanh tng, g c, RR ph nang gim

. Ni c c im, ngha ting thi ng v ral n

+ Hi chng ng c khng in hnh: Ni c triu chng v cc c im ca cc HC ng c khng in hnh:

. ng c khu tr

. ng c ri rc

. ng c co ko

. ng c din rng

+ Nguyn nhn ca hi chng ng c:

. Vim phi thu cp, thu vim lao

. HC ng c khng in hnh gp trong: Lao phi, HC Loeffler... Lao tn mn, ph qun-ph vim, x phi, xp phi, vim phi giai on t ho...

- Hi chng hang:+ Khi nim: Nu c nh ngha, c im, c ch

+ Hi chng hang in hnh: Ni c c im, ngha ca ting thi hang + HC ng c + tam chng Laennec

+ Hi chng hang khng in hnh: Ni c c ch v c im tn thng ca HC hang cm, HC hang ti thiu, HC hang che lp.

+ Nguyn nhn ca hi chng hang: Lao phi c hang, p xe phi, ung th ph hu...0,5

1,0

1,0

0,5

0,5

0,5

0,5

1,0

1,0

0,5

1,0

1,5

0,5

___

10,0

Cu 35:Hi chng trung tht v trn kh mng phi (ton thn, c nng, thc th )?

- Hi chng trung tht:+ nh khu trung tht

+ Lm sng cc hi chng chn p trung tht:

. Trung tht trc

. Trung tht gia

. Trung tht sau

+ Cc hi chng trung tht hay gp

- Hi chng trn kh mng phi

+ Ton thn: C th c tnh trng Sock

+ C nng: au nh x ngc, kh th, ho khan

+ Thc th: Tam chng Gaillard, HC bnh kim kh2,0

1,0

1,0

1,0

2,0

0,5

1,0

1,5

___

10,0

Cu 36:NCS / BS

Nguyn nhn, lm sng, cn lm sng, iu tr vim PQ cp?

- Nguyn nhn:

. Virut, vi khun

. Yu t nguy c v thun li.

- Lm sng : Giai on khi pht

Giai on ton pht v vim long

Ni c cc th lm sng

- Cn lm sng:

. Xquang: Khng thy tn thng nhu m v mng phi

. XN Mu: BC c th tng hoc gim, VS tng

. Ni c cc XN khc

- iu tr: Ni c nguyn tc v cch dng cc thuc

iu tr d phng

1,0

1,0

1,0

1,0

2,0

1,0

1,0

1,0

0,5

0,5

___

10,0

Cu 37:Lm sng, cn lm sng, chn on v iu tr vim PQ mn?

- Lm sng: Ni c tui, cch khi pht v tin trin v bin chng ca VPQ mn

- Cn lm sng

+ Xquang: Hnh nh phi bn

+ Thng kh phi: Ni c ri lon thng kh tc nghn

+ Ni c cc xt nghim m, mu

- Chn on xc nh:

Ho khc ( 3thng / nm, 2 nm lin tip tr ln. Khm phi c HC ph qun. Xquang: Hnh nh phi bn. Tin s ht thuc, mc cc bnh ng HH trn

- Chn on phn bit: Ni c nhng triu chng khc bit ca cc bnh sau:

+ Lao phi

+ Gin PQ

+ Hen ph qun

+ Ung th ph qun

+ Kh ph thng

- iu tr:

+ iu tr t bng pht: Chng nhim khun, lu thng ng th, iu tr tm ph mn .+ D phng

1,0

1,0

1,0

1,0

1,5

0,5

0,5

0,5

0,5

0,5

1,0

1,0

___

10,0

Cu 38:NCS / BS

Tiu chun chn on COPD ?

- Thng tui > 40

- Nghin thuc l, tip xc bi

- Vim ph qun mn: Ho khc ( 3 thng / nm

( 2 nm lin tip

Hi chng PQ

Xquang: hnh nh phi bn

- Kh ph thng: Kh th tng dn

HC kh ph thng

Xquang: Phi tng sng

Vm honh h thp

Gin khong gian sn

nh phi trn

Tim hnh git nc


Ri lon thng kh tc nghn

Ri lon thng kh hn hp

Test hi phc PQ m tnh0,5

0,5

0,75

0,75

0,5

0,75

0,75

0,75

0,5

0,75

0,5

0,5

0,5

0,5

0,5

0,5

0,5

____

10,0

Cu 39:Bnh sinh v lm sng, cn lm sng ca gin ph qun?

- Bnh sinh:+ Thng mc bnh HH lm tng p lc ng th t nh

+ Vng xon bnh l ca PQ s Cole (1984)

+ Gin PQ cnh tn thng x

+ Cc HC: Katagener, Mulierkun- Lm sng:

Triu chng ton thn: C th ngn di trng

C nng : Ni c th kh v th t

Thc th: Ni c ral khu tr thng xuyn

- Cn lm sng:

Xquang: Hnh nh trn Xquang chun v CT, chp PQ cn quang

Xt nghim mu v thng kh phi

1,0

1,0

1,0

1,0

1,0

2,0

1,0

1,0

1,0

___

10,0

Cu 40:NCS / BS

Bnh sinh, phn loi, chn on v iu tr gin ph qun?

- Bnh sinh:+ Thng mc bnh HH lm tng p lc ng th t nh

+ Vng xon bnh l ca PQ s Cole (1984)

+ Gin PQ cnh tn thng x

+ Cc HC: Katagener, Mulierkun- Phn loi:

+ Theo lm sng: th kh, th t

+ Theo nguyn nhn: bm sinh, mc phi

+ Theo gii phu: cc b, lan to

+ Theo Xquang: hnh ng, ti, trng ht, hn hp

- Chn on:+ Chn on xc nh: Lm sng+Xquang HRCT hoc chp PQ cn quang

+ Chn on phn bit: Vim ph qun mn, lao phi, p xe phi .

- iu tr:+ D phng

+ iu tr ni khoa t bng pht

+ iu tr ngoi khoa1,0

1,0

1,0

1,0

0,5

0,5

0,5

1,0

1,0

1,0

0,5

0,5

0,5

___

10,0

Cu 41:NCS / BS

Tiu chun chn on, chn on phn bit, iu tr gin ph qun?

- Tiu chun chn on:

+ Bnh s mn tnh + yu t nguy c

+ Th lm sng:. Th kh: ho mu ti din

. Th t: m ( 300ml/24h, 3 lp

. Gin PQ cnh tn thng x

+ Khm phi: thng c ran m, ran n khu tr thng xuyn

+ Xquang: Ni c cc hnh nh trn phim chp ph qun cn quang : Hnh ng, hnh ti, hnh chm nho

Ni c cc hnh nh GPQ trn phim HRCT: Hnh nhn, hnh ng ray, ng nhm, ng tay o, hnh ti...

- Chn on phn bit:. Vim ph qun mn, COPD

. Lao phi

. p xe phi, KPQ

- iu tr:

+ D phng

+ iu tr ni khoa t bng pht

+ Ngoi khoa1,0

1,0

1,0

1,0

1,0

1,0

1,5

0,5

0,5

0,5

0,25

0,5

0,25

___

10,0

Cu 42:NCS / BS

Lm sng, cn lm sng, chn on v iu tr p xe phi?

- Lm sng: Ni c triu chng 3 giai on

- Cn lm sng:

. Xquang: Ni c hnh nh in hnh v khng in hnh

. Xt nghim: m, mu

- Chn on:+ Chn on xc nh: .HC nhim khun, ngn di trng

. c m hoc khi m hoc ho mu

. Xquang: Hnh hang c mc kh-dch

. Soi cy m xc nh nguyn nhn

+ Chn on phn bit:

. Gin ph qun

. M mng phi thng ph qun

. Kn kh nhim khun

. Hang ung th

. Hang lao bi nhim

- iu tr:+ Ni khoa:

. Khng sinh

. Cc phng php dn lu

. iu tr triu chng+ Ngoi khoa: Ch nh2,0

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

0,5

1,0

___

10,0

Cu 43:NCS / BS

Chn on v iu tr p xe phi ?

-Chn on:+ Hi chng nhim trng

+ Hi chng ng c

+ C th c HC hang

+ C th c HC TDMP hoc TD + TKMP phi hp+ Du hiu c m

+ Ngn tay di trng

+ Xquang phi: hnh hang c mc kh-nc

+ Xt nghim m v dch soi PQ: chn on vi sinh, amip

- iu tr:

+ Khng sinh ph rng theo khng sinh

+ Dn lu t th v dn lu p xe

+ Soi PQ ht m

+ Chc ht, dn lu dch m MP

+ Truyn dch, m

+ Phu thut0,5

1,0

0,5

0,5

1,0

0,5

1,0

0,5

1,0

1,5

0,5

0,5

0,5

0,5

___

10,0

Cu 44:NCS / BS

Nguyn nhn, bnh sinh hen ph qun?

- Nguyn nhn:

+ Cc yu t gy vim ng th:

.Cc d nguyn: . Phn hoa

. Con mt nh

. Phn v lng gia sc

. Thc n l

. VK, VR

+ Cc yu t nguy c . Tng Atopy

. Nhim VR ng HH: VR hp bo HH

. Vim xoang mn

- Bnh sinh hen ph qun

+ C ch vim ng th:

. Cc TB : Lympho, i thc bo, E

. Cc cht trung gian gy vim, Cytokin...

+ C ch tng phn ng PQ:

. Vim

. C a

+ Ri lon iu ho thn kinh:

. Giao cm,

. Ph giao cm

. H khng giao cm, khng ph giao cm0,75

0,75

0,5

0,5

0,5

0,5

0,5

0,5

1,0

1,0

1,0

1,0

0,5

0,5

0,5

___

10,0

Cu 45:NCS / BS

Lm sng, cn lm sng hen ph qun?

- Lm sng: + M t c cn hen in hnh

+ Ni c cc loi cn hen

+ Cc th lm sng:

. Hen tr em

. Hen gng sc

. Hen ngh nghip

- Cn lm sng:+ Xt nghim mu: BC v N tng (hen nhim trng), E tng (hen ngoi sinh)

+ m: TB ph qun, E, tinh th Charcott - Leyden

+ Thng kh phi: ri lon tc nghn hoc hn hp, test hi phc PQ (+) tnh

+ Xquang: Hnh nh gin phi cp

+ Cc test chn on hen : test gng sc, d nguyn, phun m Axetylcholin (+) tnh

+ Test phn hu Mastocyd (+) tnh, IgE mu tng

1,0

1,0

1,0

1,0

1,0

1,0

0,5

1,0

1,0

1,0

0,5

___

10,0

Cu 46:Cc cn c chn on hen ph qun? iu tr hen ph qun?

- Cn c chn on:+ Bnh s mn tnh

+ Kh th thnh cn

+ Cn t ct hoc sau iu tr thuc gin ph qun

+ Cc cn ti din c chu k

+ C tin s d ng hoc vim xoang, polip mi...

+ Khm phi c hi chng ph qun co tht+HC gin phi cp

+ Xquang: hnh nh gin phi cp

+ Ri lon thng kh tc nghn c hi phc hoc ri lon thng kh hn hp

+ Cc test chn on hen (+) tnh

+ Xt nghim mu : E tng. m: E tng, t bo ph qun, charcotleyden

- iu tr hen ph qun:

+ Cc nhm thuc chng vim v cc dng Corticoid

+ Thuc chng co tht PQ: nhm Salbutamol, Xanthin,

Terbutalin...

+ Chng d ng: Dimedrol, Zaditen...

+ Cc thuc khc: khng sinh, an thn, gim ho, long m...

+ ng y: Vin hen, vin mt ln, Ecvatin, chm cu, cy ch..

+ Ngoi khoa: ct hch giao cm c v quanh PQ

0,5

0,5

1,0

0,5

0,5

1,0

0,5

0,5

0,5

0,5

1,0

1,0

0,50,5

0,5

0,5

___

10,0

Cu 47:NCS / BS

Bnh sinh v gii phu bnh l ca vim phi do ph cu?

-Bnh sinh:

+ C ch ht+ V Polysacharid ca ph cu ngn cn thc bo

+ Hin tng opsonin ho

+ Lan trn theo l Kohl ( tn trng gii hn thu v phn

thu

+ C ch lin quan vi thiu ht (globulin

- Gii phu bnh:

+ Ph nang vim bch cu+Fibrin

+ Can ha

+ Can ho xm

+ Can ho vng1,0

1,01,01,0

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1,0

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10,0

Cu 48:Lm sng,cn lm sng, bin chng ca vim phi do phcu?

- Lm sng:+ Ton thn: Hi chng nhim khun cp, t ngt, rt run

+ C nng: au chi ngc, m r st

+ Thc th: Hi chng ng c in hnh

+ Tin trin: Cn bnh bin

- Cn lm sng:

+ Xt nghim mu: BC tng, N tng, VS tng

+ Cy vi khun/ mu, m (+) tnh

+ Xquang: thu vim gii hn r

+ PCR (+)

+ in di min dch i lu (+)

- Bin chng:+ Ti phi: trn dch mng phi, mng ngoi tim

+ Bin chng xa: vim mng no, vim ni tm mc, vim

khp, vim phc mc, vim ni nhn cu...

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1,0

1,0

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0,5

1,0

1,0

1,0

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Cu 49:NCS / BS

Chn on v iu tr vim phi do ph cu?

- Chn on:+ Hi chng nhim khun cp

+ au chi ngc , m r st

+ Hi chng ng c in hnh

+ Xquang: m thu phi gii hn r

+ Cy mu v m (+) ph cu khun

+ in di min dch i lu hoc PCR (+) tnh

+ iu tr Penixilin c hiu qu

- iu tr:

+ Khng sinh (ni y )

+ B sung nc v in gii

+ iu tr triu chng

+ iu tr bin chng

+ iu tr d phng1,0

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1,0

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0,5

0,5

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10,0

Cu 50: Lm sng, cn lm sng, iu tr vim phi t cu v ph qun-ph vim ?

- Vim phi t cu:+ Lm sng:

. Hi chng nhim khun cp, ho, kh th, au ngc, m m

. Hi chng ng c khng in hnh km theo trn dch MP hoc trn dch + trn kh MP

+ Cn lm sng. Xquang: Thm nhim lun chuyn

Nhiu p xe rim mng

Thng c TD + TKMP

. BC tng, N tng, VS tng . Cy mu v m (+) tnh t cu

+ iu tr:

. Khng sinh mnh v khng sinh ( 4-6 tun

. Truyn dch, tr tim , iu tr triu chng

- Ph qun-ph vim:

+ Lm sng:

. Thng tr em, ngi gi, suy gim min dch

. Cp tnh: hi chng nhim trng, nhim c + HC PQ v HC ng c ri rc. Thng c suy h hp

+ Cn lm sng: Xquang: hnh nh vim phi m. Cy m hoc mu: Lin cu (+) tnh

+ iu tr : Khng sinh mnh hoc khng sinh phi hp Corticoid, chng suy h hp v tru tim mch1,0

1,0

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1,0

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1,0

1,0

1,0

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Cu 51: NCS / BS

Lm sng, cn lm sng, chn on v iu tr vim phi do virut v Mycoplasma pneumoniae ?

- Vim phi virut:+ St + HC vim long ng HH, au c khp

+ Ho khan, tc ngc

+ Khm phi HC ng c khng in hnh

+ Xquang: bng m khng h thng

+ Mu: BC gim, L tng, VS tng

+ Chn on:

. Xy ra trong v dch

. Hi chng vim long ng HH

. Hi chng ng c khng in hnh (lm sng v Xquang)

. Bch cu gim, L tng, VS tng

. Phn lp virut, chn on huyt thanh v b th (+) tnh

+ iu tr: D phng: vacxin, iu tr triu chng, nng sc min dch

- Vim phi Mycoplasma P. :

+ khi pht thng sau vim hng, vim PQ

+ St, au u, ni ban + hi chng vim long ng HH, au c khp

+ Ho khan. C th km vim gan, vim d dy - rut, gan lch to

+ Khm phi c hi chng ng c khng in hnh, hi chng ph qun + triu chng c quan khc: hch, thn kinh, tim...

+ Xquang: hnh nh li nt thu di phi

+ Bch cu tng, N tng, M tng

+ Tin trin chm v ko di

+ Chn on:

. Lm sng: tn thng phi + cc c quan. n nh sau iu tr khng sinh

. Phn lp Mycoplasma P. (+) / m

. Ngng kt t lnh (+),IgM (+),PCR (+), in di min dch (+)

+iu tr:khng sinh nhm Macrolid, (lactam,Aminoglucozid0,5

0,25

0,5

0,5

0,5

0,5

0,5

0,5

0,25

0,5

0,5

0,5

0,5

0,5

0,5

0,25

0,25

0,5

0,5

0,5

0,5

0,5

___

10,0

Cu 52:NCS / BS

Phn loi TNM v ch nh phu thut KPQ?

- Phn loi: Nu c bng phn loi 1986 + Ni c th no l TNM

+ Phn loi cu Moutain 1986:.

. Th n TxN 0M0 , g0: T isN 0M0. Giai on I : T1N 0M0, T2N 0M0. Giai on II : T1N 1M0, T2N 1M0. Giai on IIIA: T1-3N 2M0, T3N 0M0, T2N 1M0. Giai on IIIB : T1-4N 3M0, T4N 0-3M0, . Giai on IV : T1-4N 0-3M1- Ch nh phu thut:

+ KPQ biu m khng t bo nh

+ Giai on : ( IIIa+ Phn loi Karnosky > 50%

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1,0

1,0

1,0

1,0

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Cu 53:Lm sng, cn lm sng trn dch mng phi do lao?iu tr TDMP do lao ?

Lm sng, cn lm sng:

- Tui : tr- Ton thn: C th c hi chng nhim c lao

- Dch mng phi:+ Thng dch thanh t

+ G gim < 0,6g/lt

+ L ( 70%


- Phn ng Mantuox (+) tnh


- M bnh : (+) tnh lao

- Cy BK / DMP: (+) tnh, PCR (+) tnh

- VS tng nhanh gi u

- Tin trin tt

iu tr: + Ht tho dch sm


+ Corticoid

+ Tp th khi ht dch0,25

0,25

0,5

0,5

1,0

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0,5

1,0

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0,510,0

Cu 54:NCS / BS

Chn on phn bit trn dch mng phi do lao v ung th? Lao Ung th- Tui: tr - Cao- Ton thn: C th c hi chng - Gy st, suy kit

nhim c lao


mu


+ L ( 70% + T bo l (+) tnh


- Phn ng Mantoux (+) - Mantoux (-) tnh

- ELISA (+), khng th lao (+) - Marker ung th (+)

- M bnh MP: (+) lao - (+) tnh ung th

- Cy BK / DMP: (+), PCR (+) -C th tm c K c

quan khc


- Tin trin tt - Dch ti to nhanh,

tn ti lu v xu dn

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Cu 55:Lm sng, cn lm sng TDMP ung th?

- c im lm sng:

+ Triu chng ton thn v h thng

+ Triu chng HH

+ Triu chng di cn xa

+ Hi chng TDMP ti lp nhanh , tn ti lu

- Cn lm sng:

- Xquang:

+ Hnh nh TDMP

+ Hnh nh tn thng nhu m phi: u phi, u trung tht, vim bch mch ung th,

+ Du hiu Tobias escudero, Surgent Kurillski


- c im dch MP, sinh ho, t bo:

. Dch tit, LDH tng, axit Hyaluronic tng...

. Nhiu thnh phn t bo

. T bo K dng tnh

. Cc Marker ung th (+) tnh

. Sinh thit MP chn on m bnh (+) tnh

- Soi mng phi :

. Hnh nh ni soi

. Sinh thit MP tng, thnh chn on m bnh0,5

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0,50,5

10,0

Cu 56:NCS / BS

Cn c chn on lao phi? Nguyn tc iu tr lao? Phc iu tr lao?

- Cn c chn on lao phi:

+ Ton thn: Hi chng nhim c lao

+ C nng: Ho ko di, ho mu, au ngc khu tr nh phi

+ Thc th: triu c

dap an dh, sdh

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