A. Intestinal obstruction
B. Obesity
C. Abdominal effusion
D. artificial pneumoperitoneum
2. Abdominal wall kneading feeling is more common in:
A. Gastrointestinal perforation
B. rupture of liver and spleen
C. Tuberculous peritonitis
D. Acute cholecystitis
3. Small intestinal obstruction, peristalsis waves often appear in:
A. Upper abdomen
B. Lower abdomen
C. Left abdomen
D. navel
4. Abdominal examination is very common in patients with hypercortisolism:
A. Wen Zi
B. White stripes
C. Light red stripes
D. blue-black pigmentation
5. Patients with painless gallbladder enlargement and progressive jaundice should first consider:
A. Cholecystitis
B. Gallbladder stones
C. pancreatitis
D. Pancreatic cancer
6. Signs of special significance in the diagnosis of hepatic echinococcosis are:
A. Hepatomegaly
B. Liver tremor
C. tenderness in the liver area
D. Abdominal effusion
Reference answers and analysis
1. Answer C. Analysis: (1) This question examines the knowledge points of diagnostics-abdominal examination-abdominal appearance. (2)① Abdominal effusion is also called ascites clinically. When lying down, the abdominal wall is relaxed, and the liquid sinks to both sides of the abdominal cavity, so that the lateral abdominal wall is obviously raised and the abdominal shape is flat and wide, which is called frog abdomen. When lying on the side or sitting, the lower abdomen bulges due to the downward movement of liquid (C pair). ② Abdominal pneumatosis is mostly in the gastrointestinal tract. A large amount of pneumatosis can make the whole abdomen swell and make the abdomen spherical, and the waist on both sides is not obvious. Its shape has no obvious change when moving the body position, which can be seen in intestinal obstruction or intestinal paralysis caused by various reasons (a mistake). ③ Pneumoperitoneum is located in abdominal cavity, which is called pneumoperitoneum. It is found in gastrointestinal perforation or therapeutic artificial pneumoperitoneum, and there is no obvious change in abdominal shape when moving body position (D error). Obesity can cause the whole abdomen to swell, and the abdomen is spherical or oval (B wrong). Therefore, this question chooses C.
2. Answer C. Analysis: (1) This question examines the knowledge points of diagnostics-abdominal examination-abdominal palpation. (2)① Acute diffuse peritonitis caused by acute gastrointestinal perforation or organ rupture, abdominal muscle spasm caused by peritoneal stimulation, and the abdominal wall is often obviously tense and even stiff as a plate, which is called tabular abdomen (AB malocclusion). ② Tuberculous inflammation or other chronic diseases, which develops slowly, moderately irritates the peritoneum, thickens the peritoneum, and the intestine and mesentery adhere to form an elastic abdominal wall, which is not easy to collapse. It is called soft initial sensation (C pair) and can also be seen in peritoneal metastatic cancer. ③ Local abdominal wall tension is often caused by inflammation of internal organs in abdominal cavity spreading to peritoneum. For example, acute pancreatitis is common in upper abdomen or left upper abdominal muscle tension, acute cholecystitis is common in right upper abdominal muscle tension (D- error), and acute appendicitis is common in right lower abdominal muscle tension. Therefore, this question chooses C.
3. Answer D. Analysis: (1) This question examines the knowledge points of intestinal peristalsis wave in diagnostics-abdominal examination-visual examination. (2) The peristalsis caused by small intestinal obstruction is more common in umbilical region (D pair). In severe obstruction, the swollen intestinal loop is tubular and horizontally arranged in the middle of the abdomen, forming a multi-layer trapezoidal intestinal type, and obvious intestinal peristalsis waves can be seen, running in different directions, one after another, and the whole abdomen expands. When the distal colon is obstructed, its large intestine type is mostly located around the abdomen, and the cecum expands into a ball, which is more prominent with the arrival of each peristaltic wave. If intestinal paralysis occurs, the peristalsis wave disappears. Therefore, choose D in this question.
4. Answer A. Analysis: (1) This question examines the knowledge points of diagnostics-abdominal examination-visual inspection of abdominal lines. (2)① White stripes are silvery white stripes, which can be seen in obese or puerperal women (B error). ② Stretch marks appeared in the lower abdomen and iliac region, which were pale blue or pink during pregnancy and turned silvery white after delivery and lasted for a long time (C- error). ③ Purple tattoo is a common sign of hypercortisolism, which appears not only in the lower abdomen and buttocks, but also in the outer thighs and shoulders and backs (a pair). Therefore, choose a in this question.
5. Answer D. Analysis: (1) This question examines the knowledge points of diagnostics-abdominal examination-pancreatic palpation. (2)① Both cholecystitis and cholecystolithiasis can cause pain in the right upper abdomen (AB error). ② Acute pancreatitis often has metastatic pain in the right lower abdomen, without jaundice (C error). ③ The palpation of the pancreas was hard and lumpy, and the surface was not smooth and seemed to have nodules, which might be pancreatic cancer. Cancer occurs in the head of the pancreas (pancreatic head cancer), and compression of the common bile duct leads to biliary obstruction, jaundice deepens progressively, and the gallbladder is obviously enlarged, but there is no tenderness, which is called Courvoisier sign positive (D pair). Therefore, choose D in this question.
6. Answer B. Analysis: (1) This question examines the knowledge points of diagnostics-abdominal examination-liver palpation. (2) Press the surface of hepatic cyst with the palm of your hand for a moment, and if you feel slight vibration, it is called hepatic tremor, which is found in hepatic echinococcosis (also known as hepatic echinococcosis). The mechanism is that most subcapsules in the capsule float and hit the capsule wall to form tremor (B pair). Localized hepatomegaly is seen in liver abscess, liver tumor and liver cyst (including liver hydatid disease) (a mistake). Therefore, choose B in this question.
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