hc vin qun y

B mn Lao v Bnh phi

p n thi tuyn nghin cu sinh

Chuyn ngnh :

ni h hp

i tng Thc s

NCS / ThS
Cu 1 Nguyn 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

1,0
1,0
0,5
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
___
10,0

Cu
2:

Cu
3:

NCS / ThS
Cn 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
- Cc phng php chn on:
+ 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...
Chn on phn bit trn dch mng phi do
lao v ung th?
Lao
th
- Tui: tr
- Ton thn: C th c hi chng
suy kit
nhim c lao
- Dch mng phi:
+ Thng dch thanh t
huyt thanh
+ G gim < 0,6g/lt
> 0,8g/lt
+ L 70%
(+)

Ung

0,5
0,5
0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
___
10,0

0,5
0,5

- Cao
- Gy st,
0,5
+ Thng
mu
+ G tng
+ T bo l

1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
2

- Xquang: c th c TN phi
u phi
- Phn ng Mantoux (+)
(-) tnh
- ELISA (+), khng th lao (+)
(+)
- M bnh MP: (+) lao
- Cy BK / DMP: (+), PCR (+)
c quan
- VS tng gi u
gi th hai
- Tin trin tt
nhanh, tn ti lu

- C th c
- Mantoux
- Marker K
- (+) ung th
- C th c K
khc
- VS tng

- Dch ti to

Cu
4:

NCS / ThS
Lm sng, cn lm sng TDMP do
Mesothelioma

Cu
5:

- 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 tng
Tiu chun chn on trn dch mng phi do
lao. iu tr trn dch mng phi do lao?
- Tui : tr

0,5
0,5
___
10,0

0,5
0,5
0,5
0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
___
10,0

0,25
3

- 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
+ Phc iu tr lao: Phc 2RHZS (E) /
6HE
+ Corticoid
+ Tp th khi ht dch

Cu
6:

NCS / ThS
Tiu 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

0,25
0,5
1,0
1,0
0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
1,0
0,5
0,5
___
10,0

0,25
0,25
0,5
0,5
0,5
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
____
4

- Tp biu m hnh thoi (song

10,0

dng)
Cu
7:

Cu
8:

- Tp hn hp
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 = 10.000100.000/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 mn
NCS / ThS

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
___
10,0

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

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
5

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
+ Marker

0,5
1,0
1,0
0,5
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

2,0
0,25
0,5
0,5
0,5
0,5
0,5
0,5

+ Phn loi ca WHO 1999:

. Th n: TxN 0M0
. Giai on 0: T isN 0M0
.
IA: T1N 0M0

0,25
0,5
0,5
0,5
6

.
.
.
.
.
.

Cu
10:

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 0-3M1

0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

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 dch

NCS / ThS
Cu1 Cc khi u phi mc c tnh thp v u phi
1:
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:

1,0
1,0
0,5
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
___
10,0

0,5
1,5
1,5
1,5
0,5
0,5
0,5
0,5
7

. 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
vng
Cu
12

Nu 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
ngc

Cu
13:

1,0
1,0
1,0
___
10,0

0,5
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
1,0
1,0
1,0
___
10,0

NCS / ThS
Hnh 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:

1,0
1,0
0,75
0,75
0,5
8

Cu
14:

. 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 php
Phn bit ph phi huyt ng v ph phi
tn thng?
Ph phi huyt ng
phi tn thng
- Nguyn nhn:
. Suy tim
khun
. Qu ti nc, dch
. Nghn tc ng mch phi
c, du ho

1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

Ph
. Sc nhim
. Virut
. Hi, kh

1,0
1,0
1,0
0,5
0,5

. Tro ngc
d dythc qun
. cao >
3000m. Dng

1,0
1,0
1,0

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

Cu
15:

1,0
1,0
1,0
___
10,0

- Xt nghim m:
. Protein khng tng
. Tng
- Xquang:
. Vng trung tm
. Ngoi
vi
. Hi phc
. X ho
NCS / ThS
Lm sng, cn lm sng vim phi do ph
cu v PQ-PV?
9

Cu1
6:

- 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 hai
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

1,0
1,0
1,0
1,0
1,0
1,0
0,5
1,0
1,0
1,0
0,5
___
10,0

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
1,0
1,0
1,0
1,0
0,5
0,5
___
10,0
10

Cu
17:

Cu
18:

+ 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 chm
NCS / ThS
Lm 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-Kuhn

0,5
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
1,0
0,5
0,5
0,5
___
10,0

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

1,5
1,5
1,0
1,0
1,0
1,0
1,0
11

-Theo nguyn nhn:

+ Nguyn pht
+ Th pht v v cn

Cu
19:

NCS / ThS
iu 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 php

Cu
20:

1,0
1,0
__
10,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

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

0,5
1,0
1,0
0,5
0,5
0,5
0,5
0,5
1,0
12

+ 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 phng

Cu
21:

NCS / ThS
Lm 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 phi

Cu
22:

1,0
0,5
1,0
0,5
1,0
___
10,0

0,5
1,0
0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
___
10,0

Nguyn nhn v iu tr p xe phi ?

- Nguyn nhn :
+ Vi khun ym kh
+ Vi khun i kh
+ Amip
- iu tr:
+ Ni khoa:
. Khng sinh ph rng, KS

1,0
1,0
1,0
1,0
13

. 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
. D ph qun-mng phi

Cu
23:

0,5
0,5
0,5
___
10,0

NCS / ThS
C ch bnh sinh p xe phi?
-

Cu
24:

1,0
1,0
1,0
0,5
1,0

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 di

1,5
1,5
1,5
1,5
1,0
1,0
1,0
1,0
___
10,0

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

0,5
1,0
1,0
1,0
1,0
0,5
1,0
14

chng amip
- Chn on phn bit:
+ Hang ung th
+ Kn kh nhim khun
+ Gin PQ hnh ti cc b
+ Hang nm
+ Hang lao

Cu
25:

NCS / ThS
iu 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
. Thi gian iu tr 4-6 tun
. 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
. D ph qun-mng phi

Cu
26:

1,0
1,0
1,0
1,0
___
10,0

1,0
1,0
1,0
0,5
1,0
1,0
1,5
1,0
1,0
1,0
___
10,0

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

1,0
1,0
1,0
15

- 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

Cu
27:

1,0
1,0
0,5
0,5
0,5
0,5
1,0
0,5
0,5
___
10,0

NCS / ThS
Lm 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
- Ri lon thng kh tc nghn khng hi phc
iu tr COPD:
- iu tr d phng
- iu tr t bng pht
- iu tr bin chng
- Phu thut gim th tch phi

Cu
28:

1,0

0,5
1,0
1,0
0,5
0,5
0,5
0,5
1,0
1,0
1,0
1,5
1,0
1,0
___
10,0

Cc giai on COPD (GOLD 2006), iu tr

COPD ?
- Nu c cc giai on GOLD 2006

1,0
16

. 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 <30% SLT hoc <50% +
suy tim, suy
h hp. Gae.<70%

Cu
29:

iu tr COPD:
- iu tr d phng
. B thuc l
. iu tr bnh tai mi hng
. Tp th
. Vitamin v chng Oxy ho
- iu tr t bng pht:
. Chng nhim khun
. Chng tc nghn HH
. Chng suy tim phi
- iu tr bin chng
- Phu thut gim th tch phi
NCS / ThS
Bnh sinh hen ph qun ?
Ni c 3 c ch chnh:
- C ch vim ng th:
. Cc t bo vim
. Cc yu t gy vim, Cytokin...
- C ch tng tnh phn ng PQ:
. Do vim
. C a
- C ch thn kinh:
. H Adrenergic
. H Cholinnergic
. H NANC
-Cc c ch khc

Cu
30:

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

2,0
2,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

nh ngha GINA (2005) v hen ph qun?

Chn on v iu tr hen c tnh?
17

nh ngha GINA (2005):

- Vim ng th
- Cc t bo : L, E...
- Tng tnh phn ng PQ c th hi phc
Chn on hen c tnh
+ Cn kh th lin tc trn 24 gi
+ Khng p ng vi cc thuc iu tr thng
thng
+ Suy HH.
+ Suy tim phi
+ Hi chng no HH
+Ni c cc biu hin phi
- iu tr:
+ Th Oxy Sp 02 90%
+ Kh dung thuc GPQ
+ Tim truyn TM Diaphylin, salbutamol
+ Truyn corticoid liu cao
+ iu tr suy tim
+ khng sinh
+ Th my

Cu
31:

0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
0,5
0,5
1,0
0,5
1,0
0,5
0,5
0,5
___
10,0

NCS / ThS
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 : Test d
nguyn, test gng sc, phun m Axetylcholin...
+ Test hi phc ph qun (+) tnh
+ Xt nghim mu : E tng trong hen ngoi sinh

0,5
0,5
1,0
0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
18

+ m: E tng, t bo ph qun, tinh th

charcotleyden
+ IgE mu tng, test phn hu TB Mast (+)
tnh...
- iu tr hen ph qun:
+ Cc nhm thuc chng vim thuc dng
Corticoid, cc dng thuc v cch dng
+ Nhm thuc chng co tht: Salbutamol,
Terbutalin, Xanthyl... Cc dang thuc v cch
dng
+ Nhm chng d ng: Dimedrol, Zaditen,
Clarytin...
+ Cc bin php khc: Gim ho, long m, th
Oxy...
ng y: Ecvatin, cy ch
Catgut...
Ni soi ra PQ-PN
Phu thut

Cu
32:

0,5
0,5
0,5
0,25
0,25
0,25
0,25
___
10,0

NCS / ThS
Hy nu ni dung cc hi chng Xquang: ph
qun, mch mu?
- Hi chng PQ:
+ nh ngha
+ Nguyn nhn
+ Cc du hiu Xquang:
. Du hiu trc tip
. Gin tip (kh cm, xp phi, gim phn b
mch mu)
- Hi chng mch mu:
-nh ngha
-Cc du hiu Xquang:
. Gim phn b mch phi
. Tng phn b mch phi
. Tng mch mu trung tm v gim ngoi
vi
-Cc bin i khc:

0,5
0,5
1,0
1,0
0,5
1,0
1,0
1,0
0,5
0,5
19

Cu
33:

+ rn phi: . Rn phi to
. Rn phi b
. Hnh nh ng nhm v con
du
+ phi:
. Tng sng
. Ti m
. Gin bt thng M v TM
. Dch chuyn hng i ca
mch mu
Ni dung cc hi chng Xquang: HC m k, HC
hang ?
Hi chng m k:
+ nh ngha
+ Nguyn nhn v phn loi
+ c im
+ Cc du hiu Xquang:
. Cc ng Kerley: ABCDF
Hi chng hang:
+ nh ngha
+ Nguyn nhn
+ Hnh nh Xquang:
. Thnh hang
. Lng hang
. Hnh nh t ong
. Hnh nh a kn kh phi
. Hnh nh a hang

Cu
34:

0,5
0,5
0,5
0,5
0,5
___
10,0

0,5
2,0
1,0
2,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
___
10,0

NCS / ThS
Ch nh, chng ch nh, tai bin sinh thit
mng phi v thao tc k thut Castelain ?
- Ch nh: Chn on cc trn dch mng
phi thanh t, mu, huyt thanh mu
- Chng ch nh:
+ Tng chy mu, ang iu tr chng ng
mu
+ Trn dch mng phi do bnh tim , gan, thn
+ Dy dnh mng phi
+ M mng phi (tng i)
+ Bnh ton thn qu nng
- Tai bin:
+ Trn kh mng phi
+ Ngt xu

1,0
0,5
0,5
0,5
0,5
0,5
1,0
1,0
20

Cu
35:

+ Chy mu
+ Dch thm ra
di da
+ Di cn ng chc kim
+ Sinh thit nhm
ph tng
+ Nhim khun
+ Gy kim
- Thao tc k thut: Ni c trnh t cc bc :
Chun b bnh nhn, Tin t Gy t
m kim ct bnh phm ht dch kim
tra
Ch nh, chng ch nh, tai bin ca soi
mng phi ?

Cu
36:

- Ch nh:
+ Trn dch mng phi sau sinh thit mng
phi khng r nguyn nhn
+ Trn kh mng phi
+ Sinh thit phi-mng phi
+ Ni soi iu tr: ct u phi, u trung tht,
hu giao cm, ct phi,gy dnh mng phi,
iu tr nhit ng, bt talc, Laser
- Chng ch nh:
+ Dy dnh mng phi, khoang mng phi <
10 cm
+ Kh cm
+ Ri lon mu chy, mu ng
+ Kh th, suy h hp
+ Suy tim, cao p ng mch phi
+ Tnh trng ton thn qu nng
- Tai bin:
+ St
+ Trn kh di da
+ Trn kh mng phi
+ M mng phi
+ Chy mu
+ Di cn theo ng
chc kim
+ Tc kh mch
+ T vong
NCS / ThS
Ch nh, chng ch nh, tai bin sinh thit
phi ?
- Ch nh:
Sinh thit phi ht
+ Ung th phi ngoi vi
+ Cc khi ng c cha r nguyn nhn
+ Chn on phn bit u phi vi kn, p xe,

1,0
1,0
2,5
___
10,0

1,0
0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
1,0
1,0
1,0
1,0
___
10,0

1,0
1,0
1,0
21

TDMP khu tr...

Sinh thit phi ct
+ U > 2cm, cch thnh ngc < 4 cm
+ chn on bnh phi m k lan to mn
tnh
- Chng ch nh:
+ Kh ph thng bong bng
+ Tng chy mau
+ Nghi u mch mu
+ Cao p ng mch phi
+ Suy tim, suy h hp
+ Ct b 1 phi, FEV1 < 1 lt
- Tai bin:
+ Chy mu
+ Trn kh MP
+ Nhim khun
+ Gy kim
+ Sock

Cu
37:

1,0
1,0

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,25
0,25
___
10,0

NCS / ThS
Ch nh, chng ch nh, tai bin v u nhc
im ca soi ph qun ng cng?
- Ch nh:
+ Chn on cc bnh ung th ph qun, lao
ph qun
+ Ho mu cha r nguyn nhn

1,0
0,5
22

Cu3
8:

+ Chn on nguyn nhn xp phi v hi

chng ti m 1/2 lng ngc
+ Sinh thit ph qun, ra ph qun chn
on
+ iu tr: Ly d vt, iu tr Laser, ra
ph qun iu tr
- Chng ch nh:
+ Tnh trng ton thn qu nng
+ Tin s ng kinh
+ Suy tim , phnh quai ng mch ch, nhp
tim > 100 ln / pht, lon nhp tim, nhi mu c
tim, tng huyt p...
+ Vim cng t sng c, vim khp thi dnghm
+ Kh qun b chn p, di lch
- Tai bin:
+ Ng c thuc t
+ Chy mu
+ Tt huyt p
+ Phn x co
tht ph qun
- u nhc im:
+ u im: gp d vt, ra ph qun, t v
t stent
+ Nhc : Khng nhn r thu trn v cc phn
thu
Ch nh, chng ch nh, li ch, tai bin v
k thut soi ph qun ng mm ?

0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
1,0
1,0
1,0
1,0
___
10,0

- Ch nh:
+ chn on:
. Hnh thi, sinh thit v chi ph qun, sinh
2,0
thit xuyn thnh
. Ra ph qun chn on t bo v min dch 1,0
+ iu tr: ra ph qun-ph nang iu
tr, iu tr Laser, gii phng n tc
1,0
- Chng ch nh : Tr khi ton thn rt
1,0
nng
- Li ch:
1,0
+ Khc phc nhc im ca soi ph qun ng
1,0
cng
1,0
+ nh tp ung th, ch nh phu thut
- Tai bin: Nh soi ph qun ng cng
1,0
___
- K thut: Tin t gy t a ng soi
10,0
quan st lm cc k thut sinh thit, chi...
NCS / ThS
23

Cu
39:

Cu
40:

Lm sng, cn lm sng, chn on v chn

on phn bit lao phi th k?
- Lm sng:
+ Cch khi pht thng cp tnh
+ Ho ko di, kh th
+ Khm phi c ran n, ran m i xng, g
vang
+ C th thy lao cc c quan khc: Gan , lch,
hch , cc mng
+ Cc th lm sng: Hng-thanh qun, thng
hn, phi-mng phi, mng no, th mu, ngi
gi
- Cn lm sng:
+ Xquang: Tn thng nt dng ht k , i
xng, ri u t nh xung
+ Phn ng Mantoux (-) tnh
+ ELISA (+), PCR (+) tnh
+ BK m c th (+) tnh, cy mu (+) tnh
+ M tng, VS tng. Soi y mt thy c hc
mc
+ Sinh thit phi xuyn thnh, sinh thit hch
hoc mng phi, chn on m bnh (+) tnh
- Chn on xc nh: Dng tnh 2 ngun
bnh phm + lm sng v Xquang
- Chn on phn bit: Ung th th k, phi
tim, ph qun - ph vim, bi phi , thm
nhim bch cu...
Cn c chn on v chn on phn bit lao
phi tn mn?
- Cn c chn on:
+ Lm sng: Khi pht lng l hoc cp tnh
+ C th c tn thng c quan khc
+ Xquang: Ni c c im ca 3 th
+ Mantoux (-) tnh trong lao k, (+) tnh mnh
2 th laokhc
+ ELISA (+), PCR (+) tnh
+ BK m (+) tnh, cy mu (+) tnh
+ M bnh (+) tnh
+ L tng, VS tng
+ iu tr lao c hiu qu
- Chn on phn bit: + Ung th di cn
+ Suy tim huyt
phi
+ Ph qun-ph vim

0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
1,0
1,0
1,0
1,0
1,0
___
10,0

0,5
0,5
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
24

+ Bi phi
+ Lao + HIV / AIDS
+ Sacoidose
+Thm nhim bch
Cu
41:

Cu
42:

0,5
___
10,0

cu
NCS / ThS
Lm sng, cn lm sng ca ph vim lao v
ph qun-ph vim lao ?
- Ph vim lao:
+ Khi pht cp tnh, trn c th suy gim
min dch
+ au ngc, kh th, ho mu
+ Hi chng ng c, hi chng hang
+ Xquang: m 1 hoc nhiu thu + ph hu
mnh
+ Bch cu tng, VS tng, Mantoux (-) tnh
+ BK (+) tnh .
+ Tin trin nng tng t, c th t vong
- Ph qun-ph vim lao
+ Khi pht cp tnh, trn c th suy gim
min dch
+ Ho nhiu, kh th, ho mu
+ Khm phi ging ph qun-ph vim
+ Xquang: hnh nh vim phi m, c th
c ph hu, nhanh chng qui t v ph hu v
chuyn th ph vim lao
+ BK (+), Mantoux (-) tnh, VS tng
+ Tin trin nng c th t vong
Lm sng, th lm sng v cn lm sng ca
lao phi thm nhim ?
- Lm sng:
+ Triu chng rm r hoc thm lng tu
th lm sng
+ Hi chng nhim c lao
+ Ho ko di, ho mu, au ngc vng nh
phi
+ Khm: hi chng ng c, hi chng
hang khu tr vng nh phi, thng i lp vi
hnh nh Xquang
- Th lm sng: + Th khu tr (cc v tr)
+ Thm nhim Assmann
+ Th tam gic
+ Th tinh vn

1,0
0,5
0,5
1,0
1,0
0,5
0,5
1,0
1,0
0,5
1,0
1,0
0,5
___
10,0

0,5
0,5
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
25

Cu
43:

Cu
44:

+ Thu vim lao

+ Ph qun-ph vim lao
1,0
+ Ph vim lao
1,0
- Cn lm sng:
0,5
+ Xquang: Ni c c im hnh nh ca
0,5
cc th LS trn
0,5
+ Cy BK m (+) tnh, soi m AFB (+) tnh ___
+ Mantoux (+) tnh, ELISA (+) tnh
10,0
+ Bch cu tng hoc gim, L tng, VS tng
+ PCR (+) tnh, khng th khng lao (+) tnh
NCS / ThS
c im ca cc th: u lao, lao hang, lao x
phi ?
- U lao:
1,0
+ L 1 b u c v bc x ho d = 1-4 cm 0,5
+ C ch: . T thm nhim b u trung
0,5
tm
1,0
. T 1 hang y
+ Cc th: X ho, gi u, nhiu lp
0,5
+ Lm sng rt t triu chng ch yu da
vo Xquang v
1,0
tin s
+ Tin trin: n nh hoc to dn ra hoc
nhuyn ho ph
1,0
hu
1,0
- Lao hang:
1,0
+ L th lao ch c 1 hang bit lp, do lao
thm nhim ph
1,0
hu, b tr
0,5
+ Lm sng t triu chng, Xquang: hang 2-4
cm
1,0
+ Tin trin: lan trn, ho mu, thnh lao x
___
hang
10,0
- Lao x phi:
+ L th cui cng ca cc lao phi khng c
hang
+ Lm sng c th n nh (x di chng),
hoc cha n nh
+ Bin chng: ho mu, gin PQ, vim phi, kh
ph thng,
tm ph mn
Lm sng, cn lm sng lao x hang ?
26

Cu
45:

- L th cui cng ca cc lao phi c hang

- Xquang: 4 c im: . Hang x
. T chc x mnh
. Huyt lao lan trn
. Dy dnh MP
- Lm sng:
+ Mn tnh 12 thng ti din tng t
+ Nhim c lao r, suy mn
+ Ho nhiu, ho mu, au ngc, kh th
+ Hi chng hang in hnh
- Tin trin v bin chng: ko di - suy kit t vong
- Bin chng: . Kh ph thng, tm ph mn
. Gin ph qun, lao ph qun
. Ho mu nng
. Lan trn c quan khc, thoi
ho bt
- m: t chng Erlikh: Nhiu BK, si n hi
Ca+, tinh th
Cholesterin
- Mantoux (+) tnh hoc (-) tnh , VS tng
- Khng th khng lao (+) tnh, PCR (+) tnh,
ELISA (+) tnh
NCS / ThS
Nu ngha ca cc phng php chn on
lao phi? Phc iu tr lao?
Cc phng php:
- Chn on lm sng: BS, TS, khm gi tr
nh hng
- Xquang: Cc c im tn thng c gi
tr gi
- Vi sinh: Cy BK xc nh chn on , soi
AFB hng chn on xc nh. Ni c cc
PP mi
- Phn ng Mantoux v ELISA pht hin d
ng lao v sc khng lao
- M bnh - t bo chn on m bnh =
quyt nh chn on. TB: hng xc nh
chn on
- Ni soi sinh thit: quan st v chn on, sinh
thit v cy BK
- Xt nghim mu v dch mng phi: Gi tr

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
1,0
0,5
___
10,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
27

Cu
46:

Cu
47:

gi chn on
- iu tr th: khi AFB (-) tnh
Phc iu tr:
Phc ngn hn: 2HRZS (E) / 6HE hoc 4RH
Phc ti tr : 2HRZS (E) / 1HRZE / 5R3H3E3
hoc 5RH
Bnh sinh v c im lao tin pht v hu
tin pht ?

1,0
___
10,0

Bnh sinh
- Lao tin pht: . Qu trnh p ng khng c
hiu
. Qu trnh p ng c hiu
- Lao hu tin pht: 3 c ch:. Tin thng t lao
tin pht
. Ti hot ng ni
lai
. Ti nhim ngoi
lai
c im
Lao tin pht
Lao hu tin
pht
+ Mn cm t chc cao
+ c min
dch 1 phn
+ Sng x nhim di
+ Khu tr thu trn
v phn
MP v 2/3 di phi
thu 6
+ t triu chng lm sng
+ Nhiu triu
chng lm sng
hn
+ Lan trn ng mu
+ Lan trn 3 ng
v bch huyt
+ a s tin trin tt
+Tn thng xut
tit, tng
sinh , hoi t
NCS / ThS

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

K tn cc PP chn on lao phi? Nu ngha

ca Xquang, Mantoux, ELISA, PCR trong chn
on lao phi ?
- Lm sng: Gi chn on, nh hng lm
cc xt nghim

1,0
28

- Xquang: Gi cc tn thng c bn nh nt ,
thm nhim, hang, x vi, lan trn, mn tnh
- Mantoux: Khng nh nhim lao, (+) mnh c
ngha h tr chn on v chn on phn
bit lao hch.
m tnh ngi HIV (+) v suy gim min dch
- ELISA: C khng th khng lao
- PCR: Xc nh c VK lao (sng, cht) trong
bnh phm
- Vi sinh: Soi AFB trc tip.Nui cy BK(+) chn
on xc
nh lao
- iu tr th: Lao phi AFB (-) tnh
- M bnh: Chn on xc nh
-Ni soi PQ, mng phi
-Xt nghim mu v dch MP

Cu
48:

2,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
___
10,0

NCS / ThS
Lm sng, iu tr lao phi + HIV/AIDS?
- Lm sng:
+ Lm sng nhim HIV/AIDS:
. Nhim khun

1,0
29

. Sng hch
. Tiu chy
+ Lm sng lao phi:
. St ko di, gy st
. Cc triu chng c nng HH
. Hi chng ng c, c th c HC TDMP
. C th c tn thng lao cc c quan khc
bn ngoi phi
- iu tr lao phi + HIV/AIDS
+ iu tr lao phi
+ iu tr HIV
+ iu tr tng cng min dch
+ iu tr nhim trng c hi

Cu
49:

0,5
1,0
1,0
0,5
1,5
1,5
0,5
0,5
___
10,0

c im lm sng, Xquang lao phi +

HIV/AIDS ?
- Lm sng:
+ Lm sng nhim HIV/AIDS:
. Nhim khun c hi
. Sng hch
. Tiu chy
+ Lm sng lao phi:
. St ko di, gy st
. Cc triu chng c nng HH
. Hi chng ng c, c th c HC TDMP
. C th c tn thng lao cc c quan khc
bn ngoi phi
- Xquang:
+ Tn thng khng in hnh
+ Tn thng thm nhim lan trn, tn mn,
ph hu hang
+ Hch rn phi
+ C th km hnh nh TDMP, mng tim
NCS / ThS

Cu
50

1,0
1,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
1,0
1,0
0,5
----10,0

Chn on v iu tr lao phi + HIV/ AIDS?

Chn on:
30

-Hi chng nhim c lao + nhim HIV/AIDS

-Hi chng suy gim min dch
-Triu chng LS lao + nhim trng c hi
-Xquang: ng c ri rc, lan trn nhanh
-BK (+) tnh, VSS tng, Mantoux (-), XN khc ...
iu tr:
-Phc chng lao
-iu tr nhim trng c hi
-Tng cng min dch c th
-iu tr HIV/AIDS

Cu
51:

1,0
1,5
1,5
1,0
1,0
1,0
1,0
1,0
1,0
10,0

C s vi khun hc iu tr lao? Phn loi

thuc iu tr lao?
- C s vi khun hc:
+ S lng BK v t bin khng thuc:
nghim 1

Th
Th

nghim 2

0,5
0,5
2,0

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
- Phn loi thuc iu tr:
+ Loi trit khun: R, Z
+ Dit khun: H, R, Z, S
+ Ngng khun: E v cc thuc khc

1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

NCS / ThS
31

Cu
52:

C s dc l ca iu tr lao? Mc ch v
nguyn tc ca iu tr lao ?
C s dc l:
+ Liu lng thuc:
. Nng thuc: Ti a, ti
thiu c ch
. H s vt
+ Thi gian tim tng
Mc ch:
+ Dit ht BK tn thng
+ Dp tt ngun ly cho cng ng
Nguyn tc iu tr:
+ Phi hp thuc
+ Dng ng liu
+ Dng u n, ng gi
+ thi gian
+ iu tr 2 giai on
+ iu tr c kim sot

Cu
53:

1,0
0,5
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
___
10,0

Mc ch v nguyn tc iu tr lao?iu tr
lao khng thuc?
Mc ch
+ Dit ht BK tn thng
+ Dp tt ngun ly cho cng ng
Nguyn tc iu tr:
+ Phi hp thuc
+ Dng ng liu
+ Dng u n, ng gi
+ thi gian
+ iu tr 2 giai on
+ iu tr c kim sot
iu tr lao khng thuc
- Ni c khng thuc tin pht v th pht
- Ni c a khng thuc
- Nguyn tc iu tr : Theo khng sinh .
Thay phc khc
B sung thm 2 nhm
thuc:
Marcrolid (Azithromyxin)
Ofloxacin

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,25
0,25
0,25
0,25
___
10,0
32

NCS / ThS
Cu
54:

C ch bnh sinh ca lao tin pht v lao hu

tin pht?
-Lao tin pht:
-Qu trnh p ng khng c hiu:
. Giai on BK xm nhp
. Qu trnh hnh thnh phc b s nhim
. C ch lan trn tin d ng
-Qu trnh p ng c hiu:
. Hnh thnh min dch qua trung gian bo
. Tng cm mun
-Lao hu tin pht: 3 c ch:
-Tin thng t lao tin pht sang
-Ti hot ng ni lai
-Ti nhim ngoi lai

Cu
55:

1,0
1,0
1,0
1,0
1,0
1,0
2,0
2,0
___
10,0

Chn on v iu tr lao s nhim (tin

pht)?
Chn on:
- Tin s tip xc
- St ko di, st cn, thiu mu, m hi m
- Cc du hiu d ng lao: nt ban , vim
mng tip hp mng nc
- Hi chng ng c, c th c HC PQ khu tr
(do hch chn p) c th c HC TDMP
- Mantoux:
. Chuyn t (-) sang (+) tnh: Chn on xc
nh
. Mantoux (+) tnh
- BK m , dch ra PQ, dch ra d dy
- Soi PQ: d hch PQ
- Xquang phi:
. Huyt Gohn
. Hch rn phi
. Trn dch MP
iu tr:
- Tr em: phc 3 thuc 2RHZ/6HE

1,0
1,0
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,5
1,5
___
33

- Ngi ln : Phc 4 thuc 2SRHZ/6HE

10,0

NCS / ThS
Cu
56:

Lm sng, Xquang ca lao phi hu tin pht?

- Lm sng:
+ Hi chng nhim trng, nhim c (st ko
di, st cn, m hi trm)
+ Ho ko di > 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 trn

Cu
57:

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

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

1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
34

Cu
58:

+ 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 dch
NCS / ThS
Nu 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

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:

0,5
0,5
___
10,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

1,0
0,5
1,0
1,0
1,0
0,5
0,25
35

+ 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

0,5
0,5
0,25
0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

NCS / ThS
Cu
60:

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 nh

1,5
1,5
1,5
1,5
1,0
1,0
1,0
1,0
___
10,0

36

hc vin qun y

B mn Lao v Bnh phi

p n thi tt nghip bc s N Tr
Chuyn ngnh :

ni h hp

Cu
1:

TN/ NT
Nhng 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 (+)
tnh

1,0
1,0
0,5
0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
0,5
1,0
1,0
___
10,0

37

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
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
0,5
0,5
0,5
___
10,0
38

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 on

Cu
4:

0,5
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
1,0
1,0
___
10,0

Cn c chn on COPD? iu tr COPD?

- Cn c chn on COPD:
+ Chn on VPQ mn
+ Chn on KPT

1,0
0,5
39

+ 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-mihng
+ Tp th
+ Vitamin v chng gc oxy ho
Cu
5:

0,5
0,5
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
1,0
0,5
0,5
___
10,0

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:
mng phi:
. G gim
G tng
. L 70%
C t bo l
. ADA tng
LDH tng
+ Phn ng Mantuox (+)
ng Mantuox (-)
+ VS tng gi u
gi th hai
+ Xquang: c th c
c u phi
thm nhim/NM phi
+ M bnh: (+) lao
tnh ung th
+ PCR (+), cy BK (+)
(+)
+ Tin trin: khi
to nhanh,

+ Dch
.
.
.
+ Phn

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0

+ VS tng 1,0
+ C th
+ Dng

0,5
0,5
___
10,0

+ Marker K
+ Dch ti
40

tn ti
lu, xu dn
- iu tr TDMP do lao: Theo 4 nguyn tc
- Phc chng lao: 2HRZS (E) / 6HE
Cu
6:

Cu
7:

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)
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 phi

0,5
0,5
1,0
1,5
1,0
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
1,0
___
10,0

2,0
1,0
1,0
1,0
1,0
1,0
2,0
1,0
___
10,0
41

Cu
8:

Cu
9:

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, sock
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

0,50
0,50
0,50
0,50
0,50
0,50
2,0
0,50
0,50
0,50
0,50
0,50
0,50
0,25
0,25
0,25
0,25
0,25
0,75
___
10,0

1,0
1,0
1,0
1,0
1,0
1,0
42

- Tai bin:
+ Trn kh mng phi
0,5
+ Sock mng phi ph giao cm
0,5
+ Chy mu
0,5
+ Dch thm qua ng chc kim
0,5
+ Nhim khun v di cn ung th qua ng chc 0,5
kim
0,5
+ Sinh thit nhm ph tng
0,5
+ Gy kim
0,5
+ au
___
10,0
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 ht

hc vin qun y
cp I

B mn Lao v Bnh phi

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
2,0
1,0
0,5
1,0
1,0
___
10,0

p n thi tuyn BSNT + chuyn khoa

Chuyn ngnh :

ni h hp

CKI + NT / Tuyn
43

Cu
1:

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)

Cu
2:

Gii thch gin venn? Tiu chun chn on

COPD v t bng pht COPD ?

Cu
3:

- 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
phc
CKI + NT / Tuyn
Tiu chun chn on HPQ? Triu chng ca
hen c tnh ?

1,0
1,0
1,0
2,0
1,0
1,0
1,0
1,0
1,0
___
10,0

2,0
0,5
0,5
0,5
0,5
2,0
2,0
1,0
1,0
___
10,0

44

Cu
4:

- 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 ti
Chn on xc nh, phn bit gin ph
qun?

0,5
0,5
1,0
0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

- Chn on xc nh:
1,0
+ Bnh s mn tnh
1,0
+ Th kh: ho mu ti din
1,0
1,0
+ Th t: m 300ml/24h, c 3 lp
1,0
+ Khm phi thng xuyn c ran khu tr
+ CT-Scan hoc chp ph qun cn quang : (+)
1,0
- Chn on phn bit:
1,0
+ Vim ph qun mn
1,0
+ Lao phi
1,0
+ Ung th ph qun
1,0
+ p xe phi
___
Trnh by ngn gn, r rng
10,0

Cu

CKI + NT / Tuyn
Tiu chun chn on ung th ph qun? Cc PP
45

5:

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 tr

Cu
6:

1,0
0,5
1,0
0,5
0,5
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
___
10,0

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 qu

1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
1,0
1,0
0,5
___
10,0

46

CKI + NT / Tuyn
Cu
7:

Chn 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 khoa

Cu
8:

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

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 thuc

1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
___
10,0
47

Cu
9:

CKI + NT / Tuyn
Lm sng v cn lm sng TDMP do lao v
ung th ?
Lao
Ung th
1,0
- Ton thn: C th c hi chng
suy kit
nhim c lao
- Dch mng phi:
+ Thng dch thanh t
huyt thanh
+ G gim < 0,6g/lt
> 0,8g/lt
+ L 70%
(+)
- Xquang: c th c TN phi
u phi
- Phn ng Mantuox (+)
- ELISA (+), khng th lao (+)
th (+)
- M bnh MP: (+) lao
- Tui: tr
- Cy BK/ DMP: (+), PCR (+)
K c quan
- VS tng gi u
gi th hai
- Tin trin tt
nhanh, tn ti lu

- Gy st,

+ Thng
mu
+ G tng
+ T bo l

0,5
0,5
1,0
1,0
1,0
1,0
1,0
0,5
1,0

- C th c

0,5
1,0
- (-) tnh
- Marker ung ___
10,0
- (+) ung th
- Tui cao
- C th thy
khc
- VS tng
- Dch ti to

48

CKI + NT / Tuyn
Cu
10:

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 thut

0,25
0,5
0,5
0,25
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
0,5
0,5
0,5
__
10,0

49

Cu :
11

CKI + 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:

0,25
0,5
1,0
0,5
0,5
0,5
0,5
0, 25
1,0
0,5
0,5
0,5
0,5
0,5

0,5
0,25
0,25
0,25
0,25
0,25
0,25

50

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

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

Cu
12:

10,0

CKI + NT / Tuyn
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 thut

Cu
13:

0,25
0,25

1,0
0,5
1,5
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

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

1,0
1,0
1,0
0,5

51

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 thut

Cu
14:

1,0
1,0
0,5
0,5
1,0
0,5
___
10,0

CKI + NT / Tuyn
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
tiu thu
+ -antitrypsin, ht thuc l
chng ca

1,5
+ Trung tm

1,5

+ Thng l bin

1,0
1,0
1,0

VPQM
Triu chng:
+ C th tui tr
30-40 tui
+ Ho khc m t
l chnh
+ Kh th tng dn
hin chm
+ Gy, th chm mi
(th hng thi)
+ HC KPT + HC ph qun
+ Tm ph mn mun
mn sm
+ Xquang: KPT l ch yu
nh phi bn
Cu
15:

0,5
1,0
0,5

+ Cao tui : sau

+ Ho khc m
+ Kh th xut

1,0
1,0
1,0
1,0
___
10,0

+ Ph tm ti
( xanh ph)
+ HC ph qun
+ Tm ph
+ Xquang: Hnh

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:
52

+ 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 pht

hc vin qun y

B mn Lao v Bnh phi

1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
3,0
1,5
___
10,0

p n thi tuyn nghin cu sinh

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

Cu

1,0
1,0
2,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

Lm sng v cn lm sng ca bnh ung th

53

2:

Cu
3:

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 cao
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

Cu

1,0
1,0
0,5
1,0
0,5
0,5
0,5
1,5
1,0
1,0
0,5
1,0
___
10,0

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

Cc th Xquang phi hay gp trong ung th PQ?

54

4:

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 sn

Cu
5:

1,0
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

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 lt

0,5
0,5
1,0
1,0
1,0
1,0
2,0
2,0
1,0
___
10,0

55

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

Cu
7:

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

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:

0,5
0,5
0,5
0,5
1,0
0,5
0,5
0,5
1,0
0,5
1,0
56

Phc chng lao

Corticoid
Ht tho dch sm
Tp th khi ht dch

Cu
8:

1,0
1,0
1,0
__
10,0

Cc cn c chn on trn dch mng phi do

lao?
0,25
- 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
- Xquang: c th c thm nhim phi
- Phn ng Mantoux (+) tnh
- Bch cu L tng, VS tng gi u
- ELISA (+) tnh, khng th lao (+) tnh
- M bnh ( sinh thit mng phi) : (+) tnh lao
- Tui : tr
- Tin trin tt di tc dng ca iu tr lao

Cu
9:

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

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

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
57

- 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 sc

1,0
1,0
___
10,0

Cu1 c im lm sng, sinh ho, t bo dch MP

0:
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

Cu
11:

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

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.

0,25
0,25
0,5
0,5
1,0
1,0
1,0
58

- 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
- Phn ng Mantoux (-) tnh
- 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 lu

Cu
12:

0,5
1,0
1,0
0,5
1,0
0,5
1,0
___
10,0

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:

0,25
0,25
0,25
0,25

59

Lao
th
- Tui: tr
- Ton thn: C th c hi chng
suy kit
nhim c lao
- Dch mng phi:
+ Thng dch thanh t
mu
+ G gim < 0,6g/lt
0,8g/lt
+ L 70%
(+)
- Xquang: c th c TN phi
phi
- Phn ng Mantuox (+)
tnh
- ELISA (+), khng th lao (+)
- M bnh MP: (+) lao
- Cy BK / DMP: (+), PCR (+)
c quan
- VS tng gi u
gi th hai
- Tin trin tt
nhanh, tn ti

Ung
0,5
- Cao
- Gy st,

+ Thng HT
+ G tng >
+ T bo l
- C th c u
- Mantoux (-)
- Marker (+)
- (+) ung th
- C th c K

0,5
0,5
0,5
1,0
0,5
1,0
0,5
1,0
1,0
1.0
1,0
__
10,0

khc
- VS tng
- Dch ti to
lu

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
1,0
+ Xquang
+ M bnh t bo
1,0
+ Vi sinh
+ Xt nghim mu v 1,0
DMP
1,0
+ Tuberculin v ELISA
+ iu tr th
60

chn on

Cu
14:

- 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 trn
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

Cu
15

1,0
0,5
1,0
1,0
0,5
1,0
1,0
___
10,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

NCS / 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

1,0
61

+ 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 dch

Cu
16:

1,0
1,0
1,0
1,5
1,5
1,0
1,0
1,0
___
10,0

Cc phng php chn on lao phi? Nu phng php chn on lm sng v vi sinh?
- Cc phng php chn on:
+ Lm sng
+ Ni soi
+ Xquang
+ M bnh t bo
+ Vi sinh
+ Xt nghim mu v
DMP
+ Tuberculin v ELISA
+ iu tr th
chn on
- 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

62

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
+ Xquang
+ Vi sinh
DMP
+ Tuberculin v ELISA
chn on

1,0
+ Ni soi
1,0
+ M bnh t bo
1,0
+ Xt nghim mu v 1,0
+ iu tr th

- 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
bo

0,5
1,0
1,0
1,0

1,0
1,0
0,5
___
10,0

63

Cu
18:

NCS / BS
Phc 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 sc

Cu
19:

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
___
10,0

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

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
64

+ Bnh tim mch

+ Chn thng
+ Nguyn nhn khc:
Cu
20:

0,25
___
10,0

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 dch

0,5
1,0
1,0
0,5
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
10,0

65

Cu
21:

NCS / BS
Phn 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 thut

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
0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

66

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:
. Khng sinh ph rng, KS
. 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
. D ph qun-mng phi

Cu
23:

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

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

0,5
1,0
1,0
0,5
0,5
0,5
1,0
1,0
67

+
+
+
+
+
+

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

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

Cu
25:

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

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

1,0
1,0
1,0
1,0
1,0
1,0
0,5
68

+
+
+
+

T pht (nguyn pht, th pht)

t, va, nhiu
Khu tr, ton th
H, kn, van

1,0
0,5
1,0
1,0
___
10,0

Cu
26:

Cu
27:

NCS / BS
Chn 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...
Lm sng, cn lm sng lao hch ngoi vi?

1,0
1,0
1,0
1,0
1,0
1,0
1,5
0,5
0,5
0,5
1,0
___
10,0

- Lm sng:
+ Triu chng ton thn: C th c HC nhim
c lao hoc khng c triu chng g
0,25
+ Triu chng ti ch:
. Ni c 3 th: thm nhim, b u, x ho
1,0
. Sng nhiu hch, thnh chui 2 bn c, thnh
m ni khc. Th lao hch b u th hch
1,0
sng to, , v v d m.
+ Tin trin:
0,25
69

Cu
28:

. 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 phi
NCS / BS
Chn on xc nh v phn bit lao hch
ngoi vi?
Chn on xc nh:
+ 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 tng t
. Th b u th sng - hoi t - d 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
+ 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

0,5
0,5
1,0
1,0
1,0
1,0
0,5
1,0
1,0
___
10,0

0,25
1,0
1,0
0,25
0,5
0,5
1,0
1,0
0,5
1,0
0,5
1,0
0,5
70

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 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

Cu
29:

0,25
0,25
0,25
0,25
___
10,0

NCS / BS
Chn on v iu tr lao hch ngoi vi?
Chn on xc nh:
+ 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 tng t
. Th b u th sng - hoi t - d 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
+ Phn ng Mantoux (+) tnh mnh
+ Xt nghim mu: L tng, VS tng
+ Chn on m bnh: (+) tnh (nang lao
in hnh)

0,25
0,5
0,5
0,25
0,5
0,5
1,0
1,0
0,5
1,0
0,5
1,0
71

+ 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 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

0,5
0,25
0,25
0,25
0,25

0,5
0,25
0,25
___
10,0

NCS / BS
Cu
30:

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
FEV1
FEF25
FEF75
FEF50
FEF25-57
PEF
Ch s Gaensler
Tiffeeau
- Sc cn ng th

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
72

- DLCO
- Ri lon thng kh hn ch
VC < 80% LT
FVC < 80% LT

Cu
31:

0,5
1,0
1,0
___
10,0

NCS / BS
Nu 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
FEV1
FEF25
FEF75
FEF50
FEF25-57
PEF
Ch s Gaensler
Tiffneau

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
73

- 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%

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

0,5
0,5
0,5
0,5
0,5
___
10,0

0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
0,5
74

- Cc ch s ri lon TK hn hp: Nu cc ch 1,5

s ca
1,5
+ Ri lon TK hn ch
___
+ Ri lon thng kh tc nghn
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.

0,25
0,25
0,5
0,5
0,5
0,5
1,0
75

. 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.

Cu
34:

0,5
1,0
1,5

1,0
1,0
0,5
0,5
___
10,0

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:

0,5
1,0
1,0
0,5
0,5
0,5
76

Cu
35:

Cu
36:

. 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 qunph 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...
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
kh

0,5
1,0
1,0
0,5
1,0
1,5
0,5
___
10,0

2,0
1,0
1,0
1,0
2,0
0,5
1,0
1,5
___
10,0

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.

1,0
1,0
1,0
77

- 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

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
2,0
1,0
1,0
1,0
0,5
0,5
___
10,0

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

NCS / BS
Cu
38:

Tiu chun chn on COPD ?

- Thng tui > 40
78

- 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 khng hi phc
Ri lon thng kh tc
nghn
Ri lon thng kh hn hp
Test hi phc PQ m tnh
Cu
39:

0,5
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

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

NCS / BS
79

Cu
40:

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 khoa

1,0
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

80

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 khoa

1,0
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

81

Cu
42:

NCS / BS
Lm sng, cn lm sng, chn on v iu
tr p xe phi?
2,0
- 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 nh

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

82

NCS / BS
Cu
43:

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 thut

0,5
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

83

NCS / BS
Cu
44:

Nguyn nhn, bnh sinh hen ph qun?

- Nguyn nhn:
+ Cc yu t gy vim ng th:
.Cc d nguyn: . Phn hoa
0,75
. Con mt nh
0,75
. Phn v lng gia sc
0,5
. Thc n l
0,5
. VK, VR
0,5
+ Cc yu t nguy c
. Tng Atopy
0,5
. Nhim VR ng HH: VR hp bo HH 0,5
. Vim xoang mn
0,5
- Bnh sinh hen ph qun
+ C ch vim ng th:
. Cc TB : Lympho, i thc bo, E
1,0
. Cc cht trung gian gy vim,
1,0
Cytokin...
+ C ch tng phn ng PQ:
1,0
. Vim
1,0
. C a
+ Ri lon iu ho thn kinh:
0,5
. Giao cm,
0,5
. Ph giao cm
0,5
. H khng giao cm, khng ph
giao cm
___
10,0

84

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

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

1,0
1,0
1,0
1,0
1,0
1,0
0,5
1,0
1,0
1,0
0,5
___
10,0

0,5
0,5
1,0
0,5
0,5
1,0
0,5
0,5
0,5
85

+ 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
1,0
1,0
0,5
0,5
0,5
0,5
___
10,0

NCS / BS
Cu
47:

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 vng

Cu
48:

1,0
1,0
1,0
1,0
1,0
2,0
1,0
1,0
1,0
___
10,0

Lm sng,cn lm sng, bin chng ca vim

phi do phcu?
86

- 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...

Cu
49:

1,0
1,0
0,5
0,5
1,0
1,0
1,0
___
10,0

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 phng

Cu
50:

1,0
1,0
1,0
1,0

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
___
10,0

Lm sng, cn lm sng, iu tr vim phi

t cu v ph qun-ph vim ?
87

Cu
51:

- 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 mch
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

1,0
1,0
0,5
0,5
0,5
1,0
1,0
0,5
1,0
1,0
1,0
1,0
___
10,0

0,5
0,25
0,5
0,5
0,5
0,5
0,5
0,5
0,25
0,5
88

. 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,Aminoglucozid

Cu
52:

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

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

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
89

+ Phn loi Karnosky > 50%

Cu
53:

Cu
54:

1,0
___
10,0

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%
- Xquang: c th c thm nhim phi
- Phn ng Mantuox (+) tnh
- ELISA (+) tnh, khng th lao (+) 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
+ Phc iu tr lao: Phc 2RHZS (E) /
6HE
+ Corticoid
+ Tp th khi ht dch
NCS / BS

0,25
0,25
0,5
0,5
1,0
0,5
0,5
1,0
1,0
1,0
0,5
0,5
0,5
1,0
0,5
0,5
10,0

Chn on phn bit trn dch mng phi do

lao v ung th?

Lao
Ung th
- Tui: tr
- Ton thn: C th c hi chng
suy kit
nhim c lao
+ Thng dch thanh t
huyt thanh
+ G gim < 0,6g/lt
> 0,8g/lt

0,5
- Cao
- Gy st,
+ Thng
mu
+ G tng

0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
90

+ L 70%
(+) tnh
- Xquang: c th c TN phi
u phi
- Phn ng Mantoux (+)
(-) tnh
- ELISA (+), khng th lao (+)
ung th (+)
- M bnh MP: (+) lao
ung th
- Cy BK / DMP: (+), PCR (+)
c K c

+ T bo l

0,5
- C th c 1,0

- Mantoux
- Marker

1,0
___
10,0

- (+) tnh
-C th tm
quan

khc
- VS tng gi u
gi th hai
- Tin trin tt
to nhanh,

- VS tng
- Dch ti
tn ti

lu v xu dn
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
- Phn ng Mantoux (-) tnh
- 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 bnh

0,5
0,5
0,5
1,0
0,5
1,0
0,5
1,0
0,5
0,5
1,0
0,5
1,0
0,5
0,5
91

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 chng khu tr nh hoc
phn thu 6
+ Xquang: khu tr nh phi, tnh cht mn
tnh, ph hu v
lan trn
+ Phn ng Mantoux : (+), ELISA (+)
+ VS tng, L tng
+ m: Soi AFB (+), cy BK (+) ( Loewentein)
+ PCR (+), cy Bactec (+)
- Nguyn tc iu tr:
+ Phi hp thuc
+ u n
+ ng liu, ng gi
+ thi gian
+ iu tr 2 giai on v c kim sot
- Phc iu tr:
Ngn hn: 2HRZS (E) / 6HE
Ti tr: 2HRZS (E) / 1RZH/ 5R3H3E3

0,50
0,50
0,50
1,0
1,0
1,0
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

92

Cu
57

NCS / BS
ngha ca cc phng php chn on lao
phi? Phng php quyt nh ?
- Chn on lm sng: Da vo bnh s, tin
s, khm bnh...
cho gi tr nh hng
- Xquang: Cc c im tn thng : Khu tr
nh phi, mn tnh, ph hu lan trn c
gi tr gi
- Vi sinh: Cy BK quyt nh chn on
Soi AFB hng chn on xc nh
(Nu 3 ln (+) )
- Phn ng Mantoux v ELISA pht hin d
ng lao v sc khng lao
- M bnh -tbo:chn on m bnh l quyt
nh chn on(lao MP, lao hch, cc TD do
lao...)
- TB: hng xc nh chn on
- Ni soi sinh thit: Trc tip quan st v chn
on, qua sinh thit v cy BK hoc lm
PCR
- Xt nghim mu v dch mng phi: Gi tr
gi chn on
- iu tr th: khi AFB (-) tnh
Phc iu tr:
Ngn hn: 2HRZS (E) / 6HE
Ti tr: 2HRZS (E) / 1RZH/ 5R3H3E3

1,0
1,0
0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

93

Cu
58:

NCS / BS
Nguyn nhn ho mu? x tr ho mu nng?
- Nguyn nhn ho mu:
+ Lao phi
+ Gin PQ
+ KPQ
+ p xe
+ Nm
+ K sinh trng
+ Bnh tim mch
+ Chn thng
+ Nguyn nhn khc:
- 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
+ Phu thut

Cu
59:

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

Cc bin php x tr v iu tr ho mu do lao

?
+ Bt ng
+ Nm u thp, nm nghing sang bn tn
thng
+ Chng suy HH,th Oxy, chng n tc
+ An thn
+ Gim ho
+ Co mch cm mu
. Dng tinh cht hu yn

0,5
1,0
1,0
1,0
1,0
1,0
0,5
94

. Co mao mch: Wincinol

+ Nu khng :
. Truyn mu ti cng nhm
. Tc ng mch PQ
+ Truyn dch chng tru tim mch
+ iu tr khng sinh chng lao
+ Khng sinh chng bi nhim
Cu
60:

0,5
0,5
1,0
1,0
1,0
___
10,0

NCS / BS
Nu hm lng, liu lng, tc dng chnh v ph
ca cc thuc chng lao mi ?
- Streptomyxin
+ Hm lng: 1g
+ Liu lng: 15mg/kg
+ Tc dng: Dit BK ngoi bo
+ Tc dng ph: Sc phn v, tin nh, ic
tai, c vi thn
- Rifampyxin
+ Hm lng: 0,3g
+ Liu lng: 10mg/kg
+ Tc dng: Dit v trit BK ni v ngoi bo
+ Tc dng ph: c vi gan, ri lon tiu ho,
tan huyt, d ng
- INH
+ Hm lng: 0,05; 0,1; 0,3
+ Liu lng: 5mg/kg
+ Tc dng: Dit BK ni v ngoi bo
+ Tc dng ph: Vim dy TK ngoi vi, hoi t
TB gan, RL tm thn
- PZA
+ Hm lng: 0,5g
+ Liu lng: 25mg/kg
+ Tc dng: Dit v trit BK ni bo
+ Tc dng ph: Tng axit uric mu, gout
- Ethambutol:
+ Hm lng: 0,4g, 0,2g, 0,25g
+ Liu lng: 15mg/kg
+ Tc dng: Km BK
+ Tc dng ph: M mu, gim th lc th sc

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
0,5
0,5
0,5
0,5
0,5
0,5
___
10,0

95

hc vin qun y

B mn Lao v Bnh phi

p n thi tt nghip CKII ni chung

Chuyn ngnh :

ni h hp

Cu1: Phn loi vim phi, phn bit vim phi do ph

cu v vim phi khng in hnh?
- Phn loi:
+ Vim phi cng ng
+ Vim phi Bnh vin
+ Vim phi ngi suy gim min dch
+ Vim phi cc vng a l chuyn bit
- Phn bit :
VP do ph cu
VP khng
in hnh
+ Nguyn nhn: do ph cu + Nguyn nhn:
.Mycoplasma P.
. Legionella P .
. Chlamydiae,
Coxiella Bernetti
+ Thng tn thng c
+ Tn thng m k
thu phi gy vim phi
thu, ph nang vim Fibrin
bch cu
+ Khi pht t ngt, cp
+ Sau vim long ng HH trn
tnh, HC nhim trng r
m mu r st
+ Hi chng ng c
+ Thng ch c ran
n
in hnh
+ Xquang: Tn thng c
+ Xquang: Tn thng
nn phi

0,5
0,5
0,5
0,5
1,0
1,0

1,5
1,5

1,0
1,0
1,0
___
96

h thng thng thu

khng h thng,
khng thun nht
phi c PQ hi, tn trng
hnh li nt
gii hn thu v phn thu
+ Mu : BC tng , N tng
+ Mu : BC bnh thng
hoc gim
+ Ngng kt t lnh (-)
+ Ngng kt t lnh : (+)

Cu
2:

10,0

CKII / TN
c im lm sng, cn lm sng vim phi
m k, VP Bnh vin v VP ngi suy gim min
dch?
- c im lm sng, cn lm sng vim
phi m k:
+ Lm sng:
. Thng sau vim ng HH trn
. Ho khan hoc t m
. Khng c HC ng c in hnh: thng ch
c ran n
+ Cn lm sng:
. Xt nghim mu: Do virut: BC gim, L tng, VS
tng
. Xquang: Hnh nh li nt nn phi
- c im lm sng, cn LS vim phi
Bnh vin:
+ Lm sng: sau 48-72 gi nhp vin
+ Thng xy ra ngi hn m, t ni kh qun,
bnh l tim mch, i tho ng
+ Lm sng: tn thng nng, rng, c cc triu
chng HH v ngoi HH
+ Thng do VK khng thuc, iu tr kh khn, t
vong cao
- Vim phi ngi suy gim min dch
+ Xut hin ngi suy gim min dch do
HIV/AIDS, mc bnh c tnh, iu tr Corticoid
+ Lm sng khng in hnh: HC nhim trng
khng r
+ Tn thng nng, rng, lan to
+ iu tr p ng km. T vong cao

1,0
0,5
0,5
0,5
1,5
0,5
1,0
1,0
1,0
1,0
0,5
0,5
0,5
___
10,0

97

Cu
3:

CKII / TN
Bnh sinh, lm sng, cn lm sng ca bnh bi
phi Silic. Bin php phng v iu tr?
- Bnh sinh:
+ c im bi Silic
+ Thuyt min dch
+ Ph nang vim
- Lm sng:
+ Kh th tng dn
+ au ngc, ho khan
+ C th c triu chng ca VPQ
+ R ro ph nang gim
- Cn lm sng:
+ Ri lon TK hn ch
+ Xquang: Hnh nh li-nt: nt l ch yu
(Nu r cc hnh nh)
- Bin php d phng:
+ Gim nng bi Silic t do trong mi trng
sn xut
+ Hn ch nhim bi
- iu tr:
+ iu tr triu chng
+ Ra ph qun-ph nang th tch ln

Cu
4:

Phn loi giai on ung th ph qun theo TNM?

Ch nh v chng ch nh phu thut KPQ?
- Phn loi: Nu c bng phn loi 1986
+ Ni c th no l TNM
+ Phn loi cu Montain 1986:.
. Th n TxN 0M0 , g0: T isN 0M0
. Giai on I : T1N 0M0, T2N 0M0
. Giai on II : T1N 1M0, T2N 1M0

1,0
1,0
1,0
0,5
0,5
0,5
0,5
1,0
1,0
0,75
0,75
0,75
0,75
___
10,0

1,0
1,0
1,0
1,0
98

. 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:
+ Ung th PQ khng t bo nh
+ Giai on : IIIa
+ Phn loi Karmosky > 50%
- Chng ch nh:
+ T bo nh
+ Giai on IIIb

1,0
1,0
1,0
0,5
1,0
0,5
0,5
0,5
___
10,0

Cu
5:

CKII / TN
c im lm sng theo th v theo v tr ca
ung th ph qun? Cc bin php iu tr KPQ?
c im lm sng :
+ Th Pancoast - Tobias
+ Th vim phi
+ Th xp phi
+ Th hen
+ Th gi lao
+ Th ni tit
+ Th trung tht
+ Th huyt hc
- Theo v tr:
+Th trung tm:
. U kh qun v cc ph qun ln
. Vim phi di cht hp
. Ho khc m, ho mu, kh th
+ Ung th ph qun ngoi vi:
. Lm sng ngho nn
. au ngc ch yu
. Ho khc m, ho mu: t gp
. U ln ngoi vi: c HC 3 gim hoc g c, RR ph
nang gim
Cc bin php iu tr ung th ph qun:
+ Phu thut
+ Ho cht
+ Tia x
+ Tng cng min dch

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
0,5
0,5
0,5
0,5
___
10,0
99

Cu
6:

Bnh sinh hen ph qun?

Trnh by c cc c ch chnh trong hen ph
qun
- C ch t bo ca vim:
+ T bo Mast
+ T bo E
+ i thc bo
+ T bo biu m
+ T bo L
+ Cc trung gian ho hc
- C ch thn kinh t ng: A, C v NANC
- Tnh tng p ng ph qun
- C ch khc

Cu
7:

CKII / TN
Cc th lm sng theo nguyn nhn v triu
chng ca hen ph qun ?
- Theo nguyn nhn:
+ Hen ngoi sinh
+ Hen ni sinh
+ Hen hn hp
- Theo triu chng:
+ Hen m
+ Th ho
+ Hen km theo st, tng huyt p, TDMP, tng E...
+ Hen khng triu chng
+ Hen tng tit

Cu
8:

1,0
1,0
1,0
1,0
1,0
1,0
2,0
1,0
1,0
___
10,0

2,0
2,0
1,0
1,0
1,0
1,0
1,0
1,0
___
10,0

nh ngha v giai on COPD (Gold 2003)?

- nh ngha COPD:
. V gin venn v gii thch
. nh ngha: . Tc nghn lu lng th khng hi
phc
. Do vim, do hi kh c
- Giai on COPD: theo Gold 2003
. Giai on 0 ( nguy c): ho khc mn tnh, TKP
bnh thng
. Giai on I ( nh ): FEV1 80%, Gaensler < 70%

2,0
1,0
1,0
1,0
1,0
1,0
1,0
100

. Giai on II ( va ): 50% FEV1 < 80%, Gaensler

< 70%
. Giai on III ( nng) : 30% FEV1 < 50%,
Gaensler < 70%
. Giai on IV (rt nng) : FEV1 < 30%, Gaensler <
70%
Hoc 50% FEV1 km
suy HH, TPM

Cu
9:

1,0
1,0
___
10,0

CKII / TN
Cn c chn on COPD? iu tr COPD?
Cn c:
+ Ni c tiu chun chn on vim ph qun
mn:
. Ho khc > 3 thng / nm
. Lin tip 2 nm
. Nghin ht thuc, ht khi c hi
. Khm phi hi chng PQ
. Xquang: Hnh nh phi bn
+ Ni c tiu chun chn on kh ph thng:
. Kh th t t tng dn
. Bin dng lng ngc
. G phi vang
+ Xquang: hnh nh phi bn + gin phi
+ Thng kh phi: ri lon tc nghn khng hi
phc
iu tr COPD:
+ iu tr d phng:
. iu tr trit vim mi-hng
. Dng Vacxin a gi
. Dng Vitamin A, C, E
. Tp th
. B thuc l, trnh khi c hi
+ iu tr t bng pht:
. Chng nhim trng

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
1,0
1,0
0,5
0,5
0,5
0,5
0,5
0,5
0,5
101

. Lu thng ng th v chng suy HH

. iu tr suy tim

Cu
10:

0,5
___
10,0

CKII / TN
Phn loi dch mng phi theo hnh thi t bo,
theo v tr v tin trin?
- Theo hnh thi t bo:
+ Tng L: >75%
+ Tng E: > 10%
+ Tng N: >50%
+ Trn dch MP huyt thanh mu: HC = 10.000100.000/mm3
+ Trn dch MP mu : Khi HC / DMP >
100.000/mm3
+ Ni c tiu chun ca trn dch mng phi
thanh t
+ Trn dch mng phi dng chp v dng dng
chp
+ Trn dch mng phi dch tt
- Theo v tr:
+ Trn dch mng phi t do
+ Khu tr: thnh ngc, rnh lin thu, th honh,
trung tht, gian thu
-Theo tin trin:
+ Cp
+ Mn

0,5
0,5
0,5
0,5
0,5
2,0
1,5
1,5
0,5
1,0
0,5
0,5
___
10,0

102

Cu
11:

CKII / TN
Cc nguyn nhn trn dch mng phi? Phn
bit TDMP do lao v ung th?
Nguyn nhn
+ Do lao
+ Do bnh l c tnh:
. U trung biu m c tnh
. Ung th di cn
. Bnh mu c tnh
+ Do vi khun, virut v k sinh trng
+ Do bnh l tim mch, gan, thn
+ Do Colagen
+ Do hi chng Meigds
+ Do chn thng
+ Cc nguyn nhn him gp
Chn on phn bit
Lao
Ung th
- Ton thn: C th c hi chng
- Gy st,
suy kit
nhim c lao
- Dch mng phi:

0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5
0,5

0,25
0,25
0,5
103

+ Thng dch thanh t

huyt thanh mu
+ G gim < 0,6g/lt
0,8g/lt
+ L 70%
(+)
- Xquang: c th c TN phi
phi
- Phn ng Mantoux (+)
- ELISA (+), khng th lao (+)
- M bnh MP: (+) lao
- Tui: tr
- Cy BK / DMP: (+), PCR (+)
quan khc
- VS tng gi u
th hai
- Tin trin tt
nhanh, tn ti lu

Cu
12:

+ Thng

0,5
0,5
+ G tng >
0,5
0,5
0,5
+ T bo l
0,25
- C th c u 0,25
0,5
0,5
- (-) tnh
- Marker K (+) ___
10,0
- (+) ung th
- Cao
- C th K c
- VS tng gi
- Dch ti to

CKII / TN
ngha ca Test Mantoux, vi sinh v m bnh hc
trong chn on lao phi ?
- Test Mantuox:
+ Pht hin d ng lao
+ (+) tnh
+ (-) tnh
+ Hiu ng Booster
Xt nghim vi sinh:
+ Soi trc tip
+ Cy BK: Loewenstein, Bactec...
+ PCR
- M bnh hc: Trnh by c
+ Cc k thut ly bnh phm: ST mng phi,
ph qun, hch
+ Tiu chun chn on m bnh

1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,5
1,5
___
10,0

104

Cu
13:

c im lm sng v Xquang lao phi? Chn

on lao phi AFB (-) tnh ?
c im lm sng
+ Lm sng:
. Ton thn: Hi chng nhim c lao
. C nng: Ho ko di, ho mu, au ngc khu tr
. Thc th : Khm c HC hang, HC ng c
khu tr nh phi
.Yu t nguy c: Tin s i tho ng, dng
Corticoid, tip xc, mc cc bnh mn tnh khc...
+ Xquang: Tn thng mn tnh, khu tr nh
phi, ph hu, lan trn.
. i lp gia hnh nh Xquang v lm sng
Chn on lao phi AFB (-) tnh:
+ Cn c Xquang, lm sng, Mantoux, VS ...
+ Soi ph qun, ra ph qun cy BK v lm PCR
+ PCR m, ELISA, khng th khng lao
+ iu tr th

Cu
14:

0,5
0,5
1,0
1,0
2,0
1,0
1,0
1,0
1,0
1,0
___
10,0

CKII / TN
C s khoa hc ca iu tr lao?
- C s vi khun hc:
+ S lng BK v t bin khng thuc:
. Trnh by 2 th nghim ni ln s t bin
khng thuc
. Ni c t l khng ca cc thuc
+ Chuyn ho ca BK:
. Ni c 4 qun th BK
. Ni c c im sinh hc ca BK
- C s dc l hc:
+ Liu lng thuc:
. Ni c cc nng thuc
. Ni c h s vt
+ Thi gian tim tng
+ Ni c l do phi hp thuc, dng ng liu,
dng 1 ln, dng ko di, iu tr cch qung...
trong nguyn tc iu tr lao

1,5
1,0
2,0
1,0
1,5
1,0
1,0
1,0
___
10,0
105

Cu
15

Phn loi theo hot tnh ca thuc chng lao? Mc

ch v nguyn tc iu tr lao?Khng thuc
tin pht, th pht v nguyn tc iu tr lao
khng thuc ?
Phn loi:
- Ni c yu cu ca 1 thuc chng lao
- Ni c phn loi thuc:Trit khun, dit khun,
khng khun
Mc ch iu tr lao:
+ Dit ht BK tn thng
+ Khi bnh, dp tt ngun ly cho cng ng
Nguyn tc iu tr:
+ Phi hp thuc
+ Dng ng liu
+ Dng u n, ng gi
+ thi gian
+ iu tr 2giai on
+ iu tr c kim sot
Khng thuc:
- nh ngha khng thuc tin pht v th pht
- Nguyn tc iu tr lao khng thuc

0,5
0,5
1,0
1,0
1,0
1,0
1,0
1,0
1,0
1,0
0,5
0,5
___
10,0

106