 繼續教育考題
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1.
(A) |
Which of the following
descriptions is WRONG for esophageal perforation or rupture? |
| A | The most common cause nowadays
is spontaneous rupture |
| B | Can occur as a complication of
esophagoscopy or the insertion of a S-B tube |
| C | The perforation site of
Boerhaave's syndrome is often located in the lower third of
esophagus |
| D | Patients often develop fever
and a chest pain that is aggravated by inspiration |
2.
(C) |
Which of the following
statements is WRONG regarding mediastinitis? |
| A | Most cases of acute
mediastinitis are either due to esophageal perforation or occur
after median sternotomy for thoracic surgery. |
| B | Most patients present with a
history that extends over a couple of days with gradual worsening
pain. |
| C | The patients typically are
elderly females |
| D | The patient may develop edema
of the neck and face, with occasional crepitus over anterior chest |
3.
(D) |
Which of the following
descriptions of esophageal rupture or perforation is WRONG? |
| A | Delayed diagnosis is
common |
| B | Elevated amylase level in the
pleural fluid may be helpful for the diagnosis |
| C | CxR may show evidence of
pneumomesiastinum or hydropneumothorax |
| D | Pleural effusions and lower
lobe consolidation are not common |
4.
(D) |
Which of the following
descriptions of chronic mediastinitis is true? |
| A | Most cases are due to
tuberculosis or histoplasmosis, but sarcoidosis, silicosis, and
other fungal diseases are at times causative |
| B | Patients with granulomatous
mediastinitis are usually asymptomatic |
| C | Those with fibrosing
mediastinitis usually have signs of compression of some mediastinal
structure such as the superior vena cava or large airways, phrenic
or recurrent laryngeal nerve paralysis |
| D | All of the above |
5.
(C) |
Which of the following
descriptions of the pathogen of mediastinitis is WRONG? |
| A | This is often a mixed
infection, with obligate anaerobes usually outnumber facultative
organisms by 10:1 |
| B | Streptococcus species are the
most common facultative organisms |
| C | Clostridium species are the
most common strict aerobes. |
| D | Other organisms implicated
include Pseudomonas aeruginosa, and species of Fusobacterium,
Peptostreptococcus, and Staphylococcus. |
6.
(D) |
The criteria for the
diagnosis of acute descending mediastinitis include the
following: |
| A | Clinical evidence of severe
oropharyngeal infection |
| B | Characteristic
roentgenographic features of mediastinitis |
| C | Documentation of mediastinal
infection at operation |
| D | All of the above |
7.
(D) |
When should
mediastinitis be considered in the differential diagnosis? |
| A | In any patient with severe
chest pain after a dental abscess |
| B | In patients with chest
discomfort after an upper respiratory infection. |
| C | In a patient with bilateral
empyema |
| D | All of the above |
8.
(D) |
What factors may
predispose a patient to mediastinitis? |
| A | The presence of diabetes
mellitus |
| B | An immunocompromised
state |
| C | Alcoholism and severe
vomiting |
| D | All of the above |
9.
(A) |
What is the diagnostic
test of choice for mediastinitis? |
| A | CT scan or MRI of the
chest |
| B | Mediastoscopy |
| C | Chest sonography |
| D | Neck sonography |
10.
(B) |
Which description
is WRONG regarding the management of mediastinitis? |
| A | Patients should be referred to
a tertiary institution whenever the resources at the initial
hospital are not sufficient to manage their care. |
| B | The mortality rate in most
series is about 10% |
| C | Patients may need prolonged
antibiotic therapy |
| D | Repeated CT scans are
essential to follow the progress of
therapy |
Case Discussion