外科学上大题（Major problems in surgery）

外科学上大题(Majorproblemsinsurgery)

0complicationsoflumbarspinalanesthesiaandcomplications

ofepiduralblock:

Answer:spinalanesthesia:intraoperative:bloodpressure

drops,heartrateslowsdown.Respiratorydepression.Nausea

andvomiting.Postoperativeheadacheafterlumbaranesthesia.

Urinaryretention.Purulentmeningitis.Neurological

complicationsafterlumbarspinalanesthesia..Epidural

anesthesia:intraoperative:totalspinalanesthesia.Toxic

reactionoflocalanesthetics.Decreasedbloodpressure.

Respiratorydepression.Nauseaandvomiting.Postoperative

nerveinjury.Epiduralhematoma.Anteriorspinalartery

syndrome.Epiduralabscess.Catheterpokingdifficultor

broken.

1thepurposeofpremedication:

Answer:(1)stabilizethepatient,smood,relievethe

psychologicalreactionssuchasnervousness,anxietyandfear,

sothatitcancooperatefully.Atthesametime,itcanalso

enhancetheeffectofgeneralanesthesia,reducethedosageof

generalanestheticsanditssideeffects.Amnesiacanbe

inducedbysomeundesirablestimuli.Improvingpainthreshold

andreducingthepaincausedbyprimarydiseasesorinvasive

operationbeforeanesthesia.(3)inhibitthesecretionof

salivaandrespiratorysecretions,keeptheairwaysmoothand

dry,andpreventaspiration.(4)toeliminatetheadverse

reactionscausedbysurgeryoranesthesia,andtoinhibitthe

sympatheticnervestimulationcausedbyagitationorpain,so

astomaintainthestabilityofhemodynamics.

2brieflydescribethecomplicationsofgeneralanesthesia

Answer:1regurgitationandaspiration2respiratorytract

obstruction(upperrespiratorytractobstruction:tongue

retropulsionandforeignbodyobstruction,laryngealedema;

lowerrespiratorytractobstruction:catheterremoval,twist

cathetertoodeep,secretionsandvomitingandaspirationafter

blockageoftracheaandbronchus)3hypoventilation(C02

retention)456inhypoxiahypotensionandhypertensionin7

highfever,convulsionsandconvulsions

3brieflydescribethecommoncausesoflocalanesthetic

toxicity:

Answer:adosemorethanthepatient'stolerance.Bmistakenly

injectedintobloodvessel.TheCsiteisrichinbloodvessels,

rapidlyabsorbed,notreduced,ornotaddedepinephrine.D

patientshaveweakconstitutionandlowtolerance.

Preventivemeasuresoftoxicreactionof4localanesthetics:

Answer:adoseshouldnotexceedthelimitbeforeinjection

shouldbesuckedbackwithoutblood,accordingtothespecific

circumstancesoftheapplicationsiteandreducedosage,adding

properdosageofepinephrine,andgivenpremedicationsuchas

diazepamorbarbiturates.

5typesandfunctionsofnarcoticdrugsandtheir

representativedrugs:

Answer:kindsofnarcoticdrugsandtheirfunctions.1.

inhalationanestheticsaregenerallyusedforgeneral

anesthesiamaintenance,andsometimesforanesthesiainduction,

representedbyether,isoflurane,etc..2.intravenous

anesthetics,generalanesthesiainduction,shortoperation

anesthesia,controlofconvulsionsandpediatricbasic

anesthesia.Representative:MJuseofpropofol,ketamine

(ketamine),3.musclerelaxants,canblocktheconductionof

nervemuscleandskeletalmusclerelaxation,noanesthetic

effect,canmakethepatient，smindandfeelingtodisappear,

donotproduceamnesia.Representative:Xianlin7,receptor

agonistsandantagonists:pilocarpine,atropineandsoon.4.

narcoticanalgesics,actingonthelimbicsystemofthebrain,

canrelievetensionandanxiety,causeeuphoria,increasepain

threshold,andrelievepain.Representative:diazepam,

morphine,pethidine.5,localanesthetics,blockingperipheral

nerveconductionimpulse.Delegates:lidocaine,tetracaine,

procaine,bupivacaine,ropivacaine,etc..

6brieflydescribetheclinicalmanifestationofcompensatory

stageofshock:

Answer:becausethebody(searlycompensatoryability

correspondingtoeffectivecirculatingbloodvolumereduction,

patientswithcentralnervoussystemexcitabilityof

sympatheticadrenalaxis,asfollows:thespiritofexcitement,

nervous,excitedoragitated,pale,coldlimbsfaint,heart

rate,pulsepressuredifferenceofrespiratoryrate,urine

volumedecreased.

7treatmentpointsofshock:

Answer:thegeneralemergencytreatmentofthebloodvolume

supplementtheactivetreatmentoftheprimarydisease,

correctingacid-baseimbalancetheapplicationofvasoactive

drugtherapyforDICandimprovethemicrocirculationand

applicationofcorticosteroidsandotherdrugs

Contentsandsignificanceofgeneralsurveillanceofshock8:

Answer:1.mentalstate,mentalstatecanreflecttheperfusion

ofbraintissue.Thepatientwasindifferentorirritability,

dizziness,vertigoorfromsupinetosittingsyncope,often

saidinsufficientbloodsupplytothebrain.Two

Limbtemperature,color,limbtemperatureandcolorcanreflect

thesituationofbodysurfaceperfusion.Limbswarm,dryskin,

lightpressurenailsorlipswhenthelocaltemporarypaleand

loosepressurequicklyturnedtoruddy,indicatingthatshock

hasimproved.3.bloodpressure,systolicbloodpressure,90,

pulsepressure"20"isthepresenceofshock,butbloodpressure

isnotthemostsensitiveindicatorofshock.4.pulserate,

pulseratechangeoccursbeforebloodpressurechanges,pulse

ratehasbeenrestored,andlimbswarm,oftenmeansimprovement.

5.urinevolume,ausefulindicatorofrenalbloodperfusion,

urinevolume"25ml/h”,increasedproportion,indicatingthe

presenceofrenalbloodflowcontractionandinsufficientblood

supply,urinevolumemaintainedatmorethan30ml/h,indicating

thatshockhasbeencorrected.

Therapeuticprincipleofsepticshockin9.

Answer:theprincipleisshock,beforecorrecting,shouldfocus

onthetreatmentofshock,whilethetreatmentofinfection,

shockcorrection,focusingonthetreatmentofinfection.(1)

supplementthebloodvolume:first,theinfusionofbalanced

saltsolution,withtheappropriatecolloidalsolution.(2)

controlinfection,useantibioticsanddealwithprimary

infectionfoci.(3)tocorrectacid-baseimbalance,andto

supplement5%200mlofsodiumbicarbonatethroughanothervein

routewhilesupplyingbloodvolume.(4)theuseof

cardiovasculardrugs,throughthecapacityofcongestion,

correctacidosisaftertheuseofvasodilatordrugs,andcan

becombinedwithanisodamine,dopamine,hydroxylamineand

otherdrugs.(5)corticosteroidtherapy,butfortheearly

stage,thedosageshouldbelarge,shouldnotexceed48hours.

(6)nutritionalsupport,DICtreatment,maintenanceof

importantorganfunction.

10treatmentprincipleofacutecerebralhernia:

Answer:fastinfusionofhypertonicdrugstoreduce

intracranialpressure,inordertoeasethedisease,fightfor

time.Afterthediagnosis,accordingtotheconditionofthe

rapidcompletionofcraniotomypreparation,surgeryassoonas

possibletoremovethecause,suchastheremovalof

intracranialhematomaorresectionofbraintumors.Ifitis

difficulttodiagnoseorconfirmthecauseofthedisease,we

canchoosepalliativesurgery,lateralventricledrainage,

cerebrospinalfluidshuntanddecompression

Surgicalindicationsof11gastriculcer:

Answer:thestrictmedicalmeasures,includingHPfor8-12

weeks.Theulcernothealingorshort-termrecurrenceofulcer

bleeding,cicatricialpyloricobstruction,perforationof

ulcerandgastriculcerpenetratingtooutsidethehugeorhigh

gastricandduodenalulcerulcer.Theulcercannotbeexcluded

ormalignanthavemalignanttransformation

12brieflydescribetheroleandusageofcorticosteroidsin

thetreatmentofshock:

Answer:corticosteroidscanbeusedforsepticshockandother

severeshock.Itsmainfunctionsareasfollows:1.Blocking

theactivationofareceptor,dilatingbloodvessels,reducing

peripheralvascularresistanceandimprovingmicrocirculation.

2.Protectionoflysosomesincellstopreventlysosomal

rupture.3,increasemyocardialcontractility,increase

cardiacoutput.4,improvemitochondrialfunctionandprevent

leukocyteagglutination.5,promotegluconeogenesis,make

lacticacidintoglucose,reduceacidosis.

Usage:generallyadvocatehighdoseintravenousdrip,droponce.

Usuallyonly1-2times.

13Whataretheindicationsofsurgicalexplorationforblunt

abdominaltrauma?:

Answer:1abdominalpainandperitonealirritationsignshave

progressiveaggravatingrangeofpeople.2bowelperistalsis

graduallydiminished,disappeared,orobviousabdominal

distension.3thegeneralconditionofthebodydeteriorated,

thirsty,irritability,pulserateincreased,orbody

temperatureandwhitebloodcellcountincreased.4the

progressivedecreaseofRBCcount.5bloodpressurechanges

fromstabletounstableorevendecreased.6gastrointestinal

bleedingpatients.7activetreatmentofshock,butthe

situationisnotimprovedorevenworse.

14treatmentofhyperkalemia:

Answer:1disableallpotassiumcontainingdrugsorsolutions.

2decreaseofserumpotassiumconcentration,usingmeasures:

first,promoteK+intocells:infusionofsodiumbicarbonate

solution,glucoseandinsulin,ofteninputsolutionwith10%

100ml11.2%ofcalciumgluconatesodiumlactatesolution50ml25%

glucosesolutiongas400mladdedinsulin20U,24hourslow

intravenousinfusion.Two,theuseofcationexchangeresin,

promotepotassiumexcretedfromthedigestivetract.Three.

Dialysistherapy:peritonealdialysisandhemodialysis.

3intravenousinjectionofcalciumgluconatesolutioncan

relievethemyocardialtoxicityinthetreatmentofarrhythmia.

15majorpostoperativecomplicationsofhyperthyroidism:

Answer:1.postoperativedyspneaandasphyxia.A.incisionof

bloodpressureforcedtrachealB.laryngealedemaC.tracheal

collapseD.bilateralrecurrentlaryngealnerveinjury.2.

recurrentlaryngealnerveparalysis:laryngealnervecloseto

thethyroid,ifthesurgerycancauseinjuryofrecurrent

laryngealnerveparalysis,unilateralinjury,cancausevoice

change,bothsidesofinjurycancausedyspnea,severeasphyxia.

3.paralysisofthesuperiorlaryngealnerve:iftheinjuryis

causedbytheoperation,itcanalsocausethetonesandhiof

thevoice.4.handfootconvulsion:whenthethyroidglandof

thethyroidglandwasmistakenlydamagedandthebloodcalcium

concentrationdroppedtolessthan2mmol/l,theexcitability

ofthenervemuscleincreasedsignificantly.5.

hyperthyroidismthyroidcrisis,themostseriouscomplications

occurredintheuntreatedorpoorlycontrolledpatientswith

hyperthyroidism,infection,surgery,traumaorsudden

withdrawal,appearhighfever,sweating,tachycardia,

arrhythmia,severevomitinganddiarrhea,clinicalfeaturesof

consciousnessdisordersyndrome.

Indicationsforoperationof16twelvefingerulcers:

Themaincomplicationsareacuteperforation,massive

hemorrhageandcicatricialpyloricobstruction,andrefractory

ulcerswhicharenottreatedbyregularmedicaltreatment.The

latterisrarebecauseoftheeffectivenessofdrugtherapy.

17brieflydescribethepathologicaltypesofesophageal

carcinoma:

Answer:1,medullarytype:wallthickeningandcavityexpansion

ontheloweredgeofthetumor,aslopingshapeuplift.2,early

umbrellatype:tumorbodyisoval,flat,masslike,mushroom

likeshapetothecavity.3,ulcertype:mucosaisdeepandclear

edgeofthetumorulcer.Inthemuscularlayer,thedegreeof

obstructionismild.4,constrictivetype:thetumorshowed

obviousannularstenosis,involvingalltheesophagusdiameter,

earlierobstruction.

18Whatarethefactorsthataffectfracturehealing?

Answer:thesystemicfactors:AageBhealthstatusoflocal

factors:thedamageofAfracturesofthetypeandnumberof

bloodsupplyofBCsofttissueeffectsofDtreatmentmethod

ofsofttissueembeddedinEinfection:ArepeatedBmanual

reductionandopenreduction,softtissueandperiosteal

strippingoverCdebridementofopenfractures,excessive

removalofbonefragmentsinDfractureforcontinuousbone

tractiontractionEfracturefixation,theeffectstillunder

shearandrotationalforcefracturesFprematureand

inappropriateexercise.

19whatarethecommoncomplicationsofgastroduodenalulcer?

Answer:1)acuteperforation2)acutemassivehemorrhage3)

pyloricobstruction4)canceration

20brieflydescribetheclinicalhealingstandardoffracture

Answer:1localtendernessandpercussionpain2longitudinal

localabnormalactivityof3X-rayshowedacontinuousbone

fracture,thefracturelinehas4fuzzyexternalfixationafter

removaloftheupperlimb,canforwardflat1kgsforoneminute,

thelowerlimbscannotcrutchesontheflatwalkfor3minutes,

notlessthan30.Continuousobservationof2weeksatthe

fracturedeformation.

Thedifferentialdiagnosisofherniaandinguinalherniain21.

Answer:indirectinguinalherniainchiIdrenandyoungadults,

theherniacontentshighlightinguinalfemoralcanalandinto

thescrotum,theappearanceofellipseorpearshaped,inthe

herniaringonblockafterdeepherniablockisnolonger

outstanding,theherniasacinfrontofthespermaticcord,and

hernianeckinlateraltotheinferiorepigastricarteryit

happened,incarceratedinguinalherniaismoreopportunities;

morecommonintheelderly,theherniacontentsfrom

Hesselbach'striangleisprominent,notintothescrotum,the

appearanceofasemicircleintheherniaringonblockafter

blockdeepherniaisstillprominent,theherniasacintherear

andthespermaticcord,thehernianeckintheabdominalwall

theinnersideoftheartery,incarceratedfeweropportunities.

Indicationsandcontraindicationsofsurgicaltreatmentfor

hyperthyroidism22

Answer:thesecondaryhyperthyroidismorhighfunctionadenoma;

themoderateandsevereprimaryhyperthyroidism,long-term

medicationinvalid,relapseafterstopping,orunwillingto

long-terminhalation;thelargegland,accompaniedbysymptoms

ofoppression,orothertypesofsubsternalgoiterand

hyperthyroidism;antithyroiddrugtherapyafterrelapseor311

orinsistonlong-termmedicationisdifficult.

Becauseofhyperthyroidismcancauseprematureormiscarriage

ofpregnantwomen,earlyandmidpregnancyhavetheabove

indications,shouldalsobesurgicaltreatment.

Contraindications:thesymptomsofainyoungpatientswith.B

arelighterthanthoseofelderlypatientswith.Corthosewith

severeorganicdiseaseswhocannottoleratesurgery

Treatmentprincipleof23chemicalburns

Answer:1immediatelyreleasedbychemicalsubstancesstained

clothing,sustainedalotofwaterrinse,timeshouldbelonger,

payspecialattentiontothoroughlyrinsetheeyeandfacial

features,neutralizingagentisnotthebest;2early

transfusioncanbeslightlymore,andaddadiureticto

eliminatetoxicsubstances;3deepburnshouldbeearly

excisionofnecrotictissueandskin.4hasbeenidentifiedas

toxicchemicalstotheinjured,shouldusetheappropriate

detoxificationmachineorantagonist.

24todiscussthelocationandmethodofcloseddrainageof

pleuralcavity.

Answer:thelocationofcloseddrainageofpleuralcavitycan

bedeterminedaccordingtothesignsandchestX-ray

examinationresults.Intheloweffusionbetweentheaxillary

midlineandtheposterioraxillary1ineofthe6-8intercostal

tubedrainage;multiproductgas,inthepleuralcavitybefore

theupperdrainageshouldbe,oftenchoosethemidclavicular

linethe2intercostal;empyemaoftenchooselowpus

accumulation.Forthepleuralcavitydrainagetubedrainage

shouldbeselectedwithhardtexture,thediameterof1.5-2em

rubbertube,noteasytoplugandfoldunobstructeddrainage;

pleuralcavitydrainagetubeforexhaustisusedwithsoft

texture,diameterof1cmplasticpipe,whichcanreachtheaim

ofdrainage,andcanreducelocalirritation.Relievethepain.

25whatisthecompartmentsyndrome?Howshouldwedealwith

it?

Answer:asymptomoflimbmuscleswellingwasseriouslyrich,

themainmanifestationofearlylimbshowedpersistentsevere

pain;afingerortoeflexion,passiveextensionfingerortoe,

cancauseseverepain;limbskinisslightlyred,slightly

elevatedtemperature,swellingandtenderness.Oncethe

diagnosisisconfirmed,theincisionshouldbedone

immediately.

26indicationsofcommonbileductexploration.

Answer:commonbileductexplorationindication:gallbladder

stonesandmultiplesmallcysticductpatency;withobstructive

jaundicehistory;intraoperativepalpationofcommonbileduct

stones,tumors,roundworm,intraoperativecholangiographyor

intraoperativeu1trasonographyshowedbileductstones;bile

ductdilatationwasfoundinapuncture;thesedimentparticles

ofpurulentbileorbileductsurgery.

Mainclinicalmanifestationsof27casesofforamenmagnum

hernia:

Answer:1theearlysymptomsareneckpain,localtenderness

afterneck,neckhard,forcedheadposition,whichiscaused

bycompressionofthe1〜2nerverootofneck.Morethan2

unconsciousdisturbance,littlechangeinthepupil,andno

paralysisofthe1imbs,butthebreathingdisorderisobvious

andprominent,eveninconsciousstatecanoccurrespiratory

arrest,whichisthemaindifferencewithherniationof

tentoriumcerebellihiatushernia.3patientswithchronic

foramenmagnumherniationcannothavethesymptomsofcerebral

herniaforalongtime.Inacutecough,constipation,hard

struggle,intheprocessofmedicaltreatmentoflumbar

puncturecerebrospinalfluidpressureorfastreleasenecktest,

asuddenriseinintracranialpressurecausedbyrespiratory

arrest,shouldbeavoided.

Clinicalmanifestationsofintracranialhypertensionin28:

Answer:aheadache:isoneofthemostcommonsymptomsof

intracranialpressureincreased,varyingdegrees,inthe

morningoreveningheavier,morepartsintheforeheadandthe

temporal,canbefromthenecktothefrontoftheneckradiation

totheorbit.Bvomiting:whenthepainissevere,itcanbe

accompaniedbynauseaandvomiting,andthevomitingisjetlike.

Copticnerveedema:Thisisoneoftheimportantobjective

signsofincreasedintracranialpressure.Theopticnerve

papillawascongested,theedgewasblurred,thecentral

depressiondisappeared,theopticdiscwasraised,andthevein

wasdistended.These3eventsaretypicalofintracranial

hypertension,referredtoas"threesignofincrease