Examination requirements

Etiology, clinical manifestations, diagnosis and treatment of upper gastrointestinal bleeding.

Overview of test sites

1. Etiology of upper gastrointestinal bleeding.

2. The relationship between bleeding volume and clinical manifestations. Estimation of bleeding volume. Judgment of active bleeding.

3. Indications for emergency blood transfusion. Usage and dosage of hemostatic drugs, adverse reactions of vasopressin. The continuous compression of three-lumen double balloon catheter can not exceed 24 hours. Hemostatic measures for non-varicose upper gastrointestinal bleeding.

Examination questions over the years

1. Which of the following does not support esophageal variceal bleeding?

A. have a history of hepatitis 10 years or more.

B. Coffee-like substance with epigastric pain and vomiting.

C. spider nevus

D. splenomegaly

E. Mobile voiced positive

Answer: b

(2 ~ 5 questions * * * with alternative answers)

A. Esophageal variceal bleeding

B. Acute gastritis bleeding

C. Reflux esophagitis bleeding

D. Esophageal cardia mucosal tear syndrome

E. peptic ulcer bleeding

The most likely cause of gastrointestinal bleeding in the following patients is

2. A 25-year-old male suffered from rhythmic pain in the right upper abdomen for 3 years, and his eating was relieved with acid reflux. A week ago, the pain suddenly increased, accompanied by melena, 2 ~ 4 times a day.

Answer: e

Comments: Rhythmic pain in the right upper abdomen can be relieved by eating. Acid regurgitation is the clinical feature of duodenal ulcer, and melena suggests upper gastrointestinal bleeding.

A 3.64-year-old woman suddenly vomited blood about 800 ~ 1000ml after eating hard objects, with red color and hematemesis. At that time, her heart rate was 1 10 beats/min, BP.

13/6.5kPa(90/50mmHg), with a history of chronic liver disease, usually accompanied by pain and abdominal distension in the liver area.

A: A.

Test comments: There is a history of chronic liver disease, which is caused by eating hard objects. Esophageal variceal bleeding should be considered.

4. Female, 56 years old, with intermittent epigastric pain or discomfort for more than 10 days. I had a cerebral infarction last year and my left side was paralyzed. I took aspirin a week ago, and the pain in my left upper abdomen worsened. Yesterday, I had black stool twice.

Answer: b

Comments: I have a history of taking non-steroidal anti-inflammatory drugs, which may be acute gastritis bleeding.

5. Male, 52 years old, with frequent acid regurgitation, heartburn and burning sensation behind sternum for 3 years. In the past two days, the symptoms have worsened, with 4 black stools and esophageal hiatus hernia in the past.

Answer: c

Question comments: Acid reflux, heartburn and burning sensation behind the sternum are the characteristics of gastroesophageal reflux disease, and previous esophageal hiatus hernia is more likely to support this disease.

6. Female, 85 years old, was sent to the emergency department because of massive hematemesis and black stool. Previous coronary heart disease, renal arteriosclerosis. Immediately give blood transfusion, rehydration and corresponding hemostasis measures. The most meaningful reference index for guiding the patient's liquid intake and infusion speed is

A. Central venous pressure

B. Elbow venous pressure

C. blood pressure

D. heart rate

E. urine volume

A: A.

Comments: Central venous pressure can better reflect the blood volume, which is helpful to guide the volume expansion treatment of patients with hypovolemia.

7. An effective and reliable method to determine the cause of upper gastrointestinal bleeding is

A. Three-cavity tube compression test

B ultrasound examination

C. fiber optic endoscopy

D. selective celiac arteriography

E. x-ray barium meal examination

Answer: c