※ 引述《pinknatty (小龍)》之銘言：
: 一位37歲男性工人從工地掉下來,理學檢查時病人意識清楚,但發現尿道口有血跡,而且
: 陰囊有血腫,會陰有瘀傷,接下來你最先要安排何種檢查?
: A. Intravenous pyelogram
: B. cystography
: C. retrograde urethrogram
: D. contrast-enhanced CT
: 考選部答案: C
: 建議答案: C.D皆對
我補充Schwartz's principles of surgery 8ed 的資料 跟你申覆結果一樣
申覆理由:
Pelvis
Blunt injury to the pelvis frequently produces complex fractures. Plain
x-rays will reveal gross abnormalities, but CT scans may be necessary to
assess the pelvic for stability. Surgeons should be aware that
life-threatening hemorrhage can be associated with pelvic fractures.
因此病人跌倒, 除了泌尿道有可能受傷外, 也應注意pelvic fractures. 本題沒有
x-ray, 無法得知pelvic bone的狀況, 況且依題意病人算stable, 除了做retrograde
urethrogram外, 也應做contrast-enhanced CT來評估病人的pelvic fracture. 故建議答
案為C或D
ps: 要不要我用Schwartz's的資料寄出去, 你用Sabinston的資料寄出去好了 XD
參考資料:
Schwartz's principles of surgery 8ed
: 以下資料摘錄自Sabinston textbook of surgery
: chapter 20 -management of acute trauma- abdominal trauma-pelvic fracture
: <<Injuries to the Urethra>>
: Disruption of the urethra is a rare injury in women. It is found mostly in
: men, """frequently after either pelvic fractures or straddle injuries""".
: <<Pelvic Fractures>>
: Unstable pelvic fractures are accompanied, most of the time, by """major
: retroperitoneal hemorrhage"""…. CT scan of the pelvis provides information on
: displacement of the sacroiliac joint, acetabular fractures, and sacral
: fractures; however it should not be performed in a hemodynamically unstable
: patient.
: Because of the high incidence of associated intra-abdominal injuries,
: supraumbilical DPL should be performed; however there is an approximately 35%
: rate of false-positive results with DPL in the presence of retroperitoneal
: hematoma. """Stable patients are best evaluated with an abdominal CT scan."""
: 依上述,病人的意識狀態清楚,應屬於hemodynamically stable,且懷疑pelvic fracture
: 應該要做abdominal CT吧?!
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◆ From: 118.169.70.25
※ 編輯: surgeoner 來自: 118.169.70.25 (02/23 10:11)