{"id":1969,"date":"2022-07-05T12:51:52","date_gmt":"2022-07-05T05:51:52","guid":{"rendered":"https:\/\/ykhoataynguyen.com\/site\/?p=1969"},"modified":"2022-07-06T00:00:24","modified_gmt":"2022-07-05T17:00:24","slug":"de-thi-ket-thuc-hoc-phan-noi-cs-thuc-hanh-y3","status":"publish","type":"post","link":"https:\/\/ykhoataynguyen.com\/site\/de-thi-ket-thuc-hoc-phan-noi-cs-thuc-hanh-y3\/","title":{"rendered":"\u0110\u1ec0 THI K\u1ebeT TH\u00daC H\u1eccC PH\u1ea6N N\u1ed8I CS th\u1ef1c h\u00e0nh (Y3)"},"content":{"rendered":"<p><strong>KHOA Y D\u01af\u1ee2C<\/strong> <strong>\u0110\u1ec0 THI K\u1ebeT TH\u00daC H\u1eccC PH\u1ea6N<\/strong><\/p>\n<p><strong>B\u1ed9 m\u00f4n N\u1ed9i<\/strong> <strong>M\u00f4n th\u1ecb: N\u1ed9i c\u01a1 s\u1edf th\u1ef1c h\u00e0nh. L\u1edbp Y3 K17<\/strong><\/p>\n<p><em><strong>Th\u1eddi gian: 60 ph\u00fat <\/strong><\/em><\/p>\n<p><strong>C\u00e2u 1:<\/strong> ( 5 \u0111i\u1ec3m) B\u1ec7nh nh\u00e2n n\u1eef, 52 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u1edbi l\u00fd do: M\u1ec7t v\u00e0 kh\u00f3 th\u1edf khi \u0111i l\u1ea1i xu\u1ea5t hi\u1ec7n trong m\u1ed9t th\u00e1ng g\u1ea7n \u0111\u00e2y. Kh\u00e1m: Ph\u00f9 2 chi d\u01b0\u1edbi, gan to hai th\u00f9y, m\u1ec1m. M\u1ecfm tim \u0111\u1eadp \u1edf lu\u00ean s\u01b0\u1eddn 5-6 tr\u00ean \u0111\u01b0\u1eddng n\u00e1ch tr\u01b0\u1edbc tr\u00e1i. Rung miu v\u00e0 ti\u1ebfng th\u1ed5i t\u00e2m thu nghe r\u00f5 \u1edf m\u1ecfm tim lan ra n\u00e1ch tr\u00e1i.<\/p>\n<p><strong>C\u00e2u 1a<\/strong>. C\u1ea7n h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m th\u00eam tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng n\u00e0o n\u1eefa \u0111\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n b\u1ec7nh tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y. Gi\u1ea3i th\u00edch.<\/p>\n<p><strong>C\u00e2u 1b.<\/strong> Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9 b\u1ec7nh l\u00fd tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y. Gi\u1ea3i th\u00edch<\/p>\n<p><strong>C\u00e2u 1c.<\/strong> C\u1ea9n ch\u1ec9 \u0111\u1ecbnh hai c\u1eadn l\u00e2m s\u00e0ng n\u00e0o \u0111\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n n\u00e0y. Gi\u1ea3i th\u00edch<\/p>\n<p><strong>C\u00e2u 1d<\/strong>. K\u1ebft qu\u1ea3 CLS \u0111\u00e3 c\u00f3:<\/p>\n<ul>\n<li>c\u00f4ng th\u1ee9c m\u00e1u: RBC = 3 x 10<sup>6<\/sup>\/ mm<sup>3<\/sup>; Hct = 32%; Hb= 9.2 g\/dL; WBC= 8.4 x 10<sup>3<\/sup>\u00a0\/ mm<sup>3<\/sup>\u00a0; %NEU = 72%; %LYM =28%; PLT = 156 x 10<sup>3<\/sup>\/ mm<sup>3<\/sup><\/li>\n<li>SA tim: Ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i ( LVEF ) = 35%<\/li>\n<li>XQ ti m ph\u1ed5i: B\u00f3ng tim to to\u00e0n b\u1ed9; d\u1ea5u hi\u1ec7u \u1ee9 m\u00e1u \u1edf \u00bd b\u00ean d\u01b0\u1edbi hai tr\u01b0\u1eddng ph\u1ed5i.<\/li>\n<\/ul>\n<p>H\u00e3y ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 CTM v\u00e0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh l\u00fd tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y. Gi\u1ea3i th\u00edch<\/p>\n<p><strong>C\u00e2u 2:<\/strong> ( 5 \u0111i\u1ec3m ) BN n\u1eef, 75 tu\u1ed5i, nh\u1eadp vi\u1ec7m v\u1edbi l\u00fd do: N\u00f4n ra m\u00e1u v\u00e0 \u0111i c\u1ea7u ph\u00e2n \u0111en.<\/p>\n<ul>\n<li><strong>B\u1ec7nh s\u1eed:<\/strong>c\u00e1ch nh\u1eadp vi\u1ec7n 3 ng\u00e0y, b\u1ec7nh nh\u00e2n \u0111\u1ed9t ng\u1ed9t n\u00f4n ra m\u00e1u t\u01b0\u01a1i l\u1eabn m\u00e1u c\u1ee5c b\u1ea7m \u0111en 2 l\u1ea7n\/ ng\u00e0y, m\u00f5i l\u1ea7n kho\u1ea3ng 300ml, kh\u00f4ng k\u00e8m \u0111au b\u1ee5ng, kh\u00f4ng bu\u1ed3n n\u00f4n tr\u01b0\u1edbc \u0111\u00f3 k\u00e8m theo ch\u00f3ng m\u1eb7t nhi\u1ec1u. Sau \u0111\u00f3 kho\u1ea3ng 1 ng\u00e0y, b\u1ec7nh nh\u00e2n ti\u00eau ph\u00e2n \u0111en s\u1ec7t m\u00f9i kh\u1eafm 2 l\u1ea7n \/ ng\u00e0y. \u1ede nh\u00e0 ch\u01b0a \u0111i\u1ec1u tr\u1ecb g\u00ec n\u00ean nh\u1eadp vi\u1ec7n.<\/li>\n<li><strong>Th\u0103m kh\u00e1m l\u00fac nh\u1eadp vi\u1ec7n: <\/strong>T\u1ec9nh t\u00e1o, da ni\u1ec7t nh\u1ee3t, v\u00e0ng nh\u1eb9 k\u1ebft m\u1ea1c m\u1eaft, l\u1ea1nh tay ch\u00e2n, kh\u1ed1ng xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da. M\u1ea1ch 102 \u00a0l\/p, HA: 90\/60 mmHg, Nh\u1ecbp th\u1edf 25 l\/\/p, nhi\u1ec7t \u0111\u1ed9:. 37<sup>o<\/sup> Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 quanh r\u1ed1n v\u00e0 h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p, chi\u1ec1u cao gan 9cm theo \u0111\u01b0\u1eddng trung \u0111\u00f2n, l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m.<\/li>\n<li><strong>Ti\u1ec1n s\u1eed:<\/strong>THA 8 n\u0103m nay \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c b\u1eb1ng amlodipin 5mg\/ ng\u00e0y. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2\u00a0ph\u00e1t hi\u1ec7n g\u1ea7n 1 n\u0103m nay, \u0111ang \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c b\u1eb1ng Metformin 500 mg x 2 vi\u00ean \/ ng\u00e0y. U\u1ed1ng Aspirin 81 mg x 1 vi\u00ean \/ ng\u00e0y t\u1eeb khi ph\u00e1t hi\u1ec7n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Kh\u00f4ng ghi nh\u1eadn ti\u1ec1n c\u0103n nhi\u1ec1m si\u00eau vi B, C v\u00e0 b\u1ec7nh gan\/ Th\u00f3i quen \u0103n u\u1ed1ng: \u0103n nh\u1ea1t, ki\u00eang ng\u1ecdt kho\u1ea3ng 1 \u00a0n\u0103m nay, kh\u00f4ng h\u00fat thu\u1ed1c, kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u<\/li>\n<\/ul>\n<ul>\n<li><strong>CLS \u0111\u00e3 c\u00f3:<\/strong><\/li>\n<\/ul>\n<p>+ Sinh h\u00f3a m\u00e1u:<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"285\">Ch\u1ec9 s\u1ed1<\/td>\n<td width=\"283\">L\u01b0\u1ee3ng<\/td>\n<td width=\"283\">\u0110\u01a1n v\u1ecb<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Glucose m\u00e1u \u0111\u00f3i<\/td>\n<td width=\"283\">175<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">AST<\/td>\n<td width=\"283\">93<\/td>\n<td width=\"283\">U\/L<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">ALT<\/td>\n<td width=\"283\">46<\/td>\n<td width=\"283\">U\/L<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Billirubin TP<\/td>\n<td width=\"283\">1,45<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Billirubin TT<\/td>\n<td width=\"283\">0,67<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Billirubin GT<\/td>\n<td width=\"283\">0,78<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Ure<\/td>\n<td width=\"283\">4,3<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Creatinin<\/td>\n<td width=\"283\">1,2<\/td>\n<td width=\"283\">mg\/dL<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Albumin<\/td>\n<td width=\"283\">28<\/td>\n<td width=\"283\">g\/L<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Na<sup>+<\/sup><\/td>\n<td width=\"283\">143<\/td>\n<td width=\"283\">\u00b5mol\/L<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">K<sup>+<\/sup><\/td>\n<td width=\"283\">3<\/td>\n<td width=\"283\">\u00b5mol\/L<\/td>\n<\/tr>\n<tr>\n<td width=\"285\">Cl<sup>&#8211;<\/sup><\/td>\n<td width=\"283\">106<\/td>\n<td width=\"283\">\u00b5mol\/L<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>+ Huy\u1ebft h\u1ecdc: RBC: 2,74 \u00a0x 10<sup>6<\/sup>\/\u00b5L; Hb: 10 g\/L; Hct: 30,2%; WBC: 11,4 x 10<sup>3<\/sup>\/\u00b5L;<\/p>\n<p>%NEU: 80%; PLT 115 x 10<sup>3<\/sup>\/\u00b5L<\/p>\n<p>+ Vi sinh: HbsAg (-); Anti HCV (+).<\/p>\n<p>&nbsp;<\/p>\n<p>+SATQ: vi\u00eam gan m\u1ea1n, d\u00e3n nh\u1eb9 \u0111\u01b0\u1eddng m\u1eadt trong v\u00e0 ngo\u00e0i gan, s\u1ecfi t\u00fai m\u1eadt. K\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u1ecf t\u1ee7y r\u00f5<\/p>\n<p>+ N\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean: d\u00e3n TM th\u1ef1c qu\u1ea3n \u0111\u1ed9 II, RC(+). D\u00e3n nh\u1ecf t\u0129nh m\u1ea1ch t\u00e2m v\u1ecb, b\u1ec7nh l\u00fd d\u1ea1 d\u00e0y do t\u0103ng \u00e1p l\u1ef1c TM c\u1eeda.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>C\u00e2u 2a<\/strong>. C\u00e2n khai th\u00e1c th\u00eam g\u00ec nh\u1eefng g\u00ecv\u1ec1 b\u1ec7nh s\u1eed v\u00e0 ti\u1ec1n s\u1eed \u1edf b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<p><strong>C\u00e2u 2b<\/strong>. Ph\u00e2n t\u00edch v\u00e0 bi\u1ec7n lu\u1eadn c\u00e1c CLS v\u1ec1 \u0111\u01b0\u1eddng m\u00e1u, BIL m\u00e1u, men gan, creatinin m\u00e1u.<\/p>\n<p><strong>C\u00e2u 2c<\/strong>. T\u1eadp h\u1ee3p nh\u1eefng h\u1ed9i ch\u1ee9ng tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y<\/p>\n<p><strong>C\u00e2u 2d.<\/strong> H\u00e3y ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u00f4 v\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b\u1ec7nh l\u00fd tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>KHOA Y D\u01af\u1ee2C \u0110\u1ec0 THI K\u1ebeT TH\u00daC H\u1eccC PH\u1ea6N B\u1ed9 m\u00f4n N\u1ed9i M\u00f4n th\u1ecb: N\u1ed9i c\u01a1 s\u1edf th\u1ef1c h\u00e0nh. L\u1edbp Y3 K17 Th\u1eddi gian: 60 ph\u00fat C\u00e2u 1: ( 5 \u0111i\u1ec3m) B\u1ec7nh nh\u00e2n n\u1eef, 52 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u1edbi l\u00fd do: M\u1ec7t v\u00e0 kh\u00f3 th\u1edf khi \u0111i l\u1ea1i xu\u1ea5t hi\u1ec7n trong m\u1ed9t th\u00e1ng g\u1ea7n \u0111\u00e2y. &hellip;<\/p>\n","protected":false},"author":17,"featured_media":1581,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117],"tags":[],"class_list":["post-1969","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-de-thi"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1969","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1969"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1969\/revisions"}],"predecessor-version":[{"id":2025,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1969\/revisions\/2025"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/1581"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1969"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1969"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1969"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}