2025年住院醫(yī)師規(guī)培-江西-江西住院醫(yī)師規(guī)培(兒外科)歷年參考題庫典型考點含答案解析一、單選題（共35題）1.新生兒肺炎最常見的病原體是？【選項】A.金黃色葡萄球菌B.大腸埃希菌C.肺炎鏈球菌D.病毒性肺炎【參考答案】C【解析】新生兒肺炎以細菌性肺炎為主，肺炎鏈球菌是導致細菌性肺炎最常見的病原體（占60%-70%）。大腸埃希菌多見于早產(chǎn)兒肺炎，金黃色葡萄球菌多見于院感肺炎，病毒性肺炎多由呼吸道合胞病毒或腺病毒引起。2.先天性幽門肥厚性狹窄患兒最常見的首發(fā)癥狀是？【選項】A.嘔吐咖啡樣物B.腹瀉伴黏液便C.進行性加重的腸套疊D.惡心伴腹脹【參考答案】A【解析】先天性幽門肥厚性狹窄患兒80%在生后2-6周出現(xiàn)非進行性嘔吐，嘔吐物含未消化奶渣，嘔吐后癥狀緩解。咖啡樣物提示胃出血，但該病出血罕見（僅2%）。腸套疊多見于6月齡以下嬰兒，伴果醬樣便。3.兒童急性淋巴細胞白血病化療后出現(xiàn)嚴重骨髓抑制時，首選的升白藥物是？【選項】A.青霉素GB.粒細胞集落刺激因子C.碳青霉烯類D.硫酸亞鐵【參考答案】B【解析】化療后骨髓抑制首選G-CSF治療。青霉素類用于細菌感染，碳青霉烯類為廣譜抗生素，硫酸亞鐵用于糾正缺鐵性貧血。G-CSF可促進中性粒細胞恢復，減少感染風險。4.3歲患兒因急性闌尾炎行闌尾切除術，術后出現(xiàn)發(fā)熱伴右下腹壓痛，最可能的并發(fā)癥是？【選項】A.切口疝B.腸梗阻C.腹腔膿腫D.破傷風【參考答案】C【解析】術后3-7天發(fā)熱伴壓痛提示腹腔膿腫。切口疝多見于術后6個月以上，腸梗阻多因粘連引起（術后2周后出現(xiàn)），破傷風需傷口污染及梭菌感染。5.新生兒硬腫癥治療中，糾正低體溫的首選措施是？【選項】A.加溫箱復溫B.輸注葡萄糖C.靜脈注射腎上腺素D.糾正代謝性酸中毒【參考答案】A【解析】新生兒硬腫癥復溫首選梯度加溫箱（32-34℃→28℃→25℃）。腎上腺素用于呼吸衰竭，葡萄糖糾正低血糖，酸中毒需結(jié)合血氣分析處理。6.兒童先天性巨結(jié)腸的病理基礎是？【選項】A.腸壁神經(jīng)節(jié)細胞缺失B.腸黏膜淋巴濾泡增生C.腸腔狹窄D.腸系膜淋巴結(jié)腫大【參考答案】A【解析】先天性巨結(jié)腸（Hirschsprung病）因距肛門2-6cm腸段神經(jīng)節(jié)細胞缺失導致腸段狹窄，出現(xiàn)便秘、腹脹、嘔吐。腸黏膜淋巴濾泡增生見于慢性特發(fā)性腹瀉。7.兒童急性腎小球腎炎出現(xiàn)少尿時，首選的檢查是？【選項】A.尿常規(guī)B.尿培養(yǎng)C.核素掃描D.血清肌酐【參考答案】A【解析】尿常規(guī)是診斷急性腎炎的必查項目，可見蛋白尿（++-+++）、紅細胞增多（<5個/HP）、管型尿。尿培養(yǎng)排除感染性因素，核素掃描用于排查腎動脈狹窄，血清肌酐反映腎小球濾過功能。8.兒童肥胖癥營養(yǎng)不良性貧血的糾正首選？【選項】A.鐵劑B.維生素B12C.葉酸D.胰島素【參考答案】A【解析】肥胖癥合并缺鐵性貧血（占肥胖兒童30%），因鐵攝入不足、吸收差（肥胖兒童胃酸減少）及需求增加（脂肪組織消耗鐵）。維生素B12缺乏多見于巨幼細胞性貧血，葉酸用于妊娠期貧血。9.兒童急性淋巴細胞白血病化療后出現(xiàn)肝脾腫大，最可能的并發(fā)癥是？【選項】A.粒細胞減少B.腦膜白血病C.骨髓纖維化D.肝臟脂肪變性【參考答案】B【解析】化療后骨髓抑制期（1-2周）易發(fā)生肝脾腫大，實為白血病細胞浸潤肝臟、脾臟的表現(xiàn)。腦膜白血病多見于L-1細胞系（占75%），骨髓纖維化多見于L-2細胞系（占25%），肝臟脂肪變性見于肥胖兒童。10.新生兒腸套疊的典型臨床表現(xiàn)是？【選項】A.嘔吐伴果醬樣便B.腹痛伴發(fā)熱C.肛門停止排氣D.惡心伴腹脹【參考答案】A【解析】新生兒腸套疊以果醬樣血便為特異性表現(xiàn)（占90%），伴劇烈腹痛（嬰兒蜷縮、踢腿）、嘔吐（非噴射性）、腹部包塊（右下腹）。發(fā)熱多見于感染性腸套疊，肛門停止排氣為腸梗阻表現(xiàn)。11.先天性腸閉鎖的典型臨床表現(xiàn)不包括以下哪項？【選項】A.進行性腹脹B.嘔吐物含膽汁C.持續(xù)性腸鳴音減弱D.生后24小時內(nèi)停止排氣排便【參考答案】B【解析】先天性腸閉鎖多見于空腸或回腸，典型表現(xiàn)為生后24小時內(nèi)無排氣排便、進行性腹脹、嘔吐（早期為胃內(nèi)容物，后期含膽汁）、持續(xù)腸鳴音減弱。選項B（嘔吐物含膽汁）更符合腸套疊特征，為易混淆點。12.新生兒黃疸出現(xiàn)膽紅素腦病時，意識狀態(tài)最可能表現(xiàn)為？【選項】A.安靜嗜睡B.意識模糊伴肌張力增高C.煩躁不安D.驚厥持續(xù)狀態(tài)【參考答案】B【解析】膽紅素腦病（核黃疸）典型表現(xiàn)為意識障礙（如嗜睡或煩躁）、肌張力異常（先增高后降低）、擁抱反射減弱、角弓反張。選項B（意識模糊伴肌張力增高）為早期表現(xiàn)，選項D（驚厥持續(xù)狀態(tài)）多見于晚期，需注意病程分期差異。13.關于急性闌尾炎的手術治療，下列哪項是錯誤的？【選項】A.急診手術首選腹腔鏡闌尾切除術B.腹腔沖洗液淀粉酶升高提示闌尾穿孔C.合并彌漫性腹膜炎時需行腸造口術D.闌尾系膜淋巴結(jié)轉(zhuǎn)移需擴大切除范圍【參考答案】A【解析】急性闌尾炎手術適應癥中，腹腔鏡手術適用于粘連嚴重或診斷不明確者，非急診首選。選項A違背“緊急情況下開腹探查優(yōu)先”原則，為易錯選項。14.維生素D缺乏性佝僂病患兒出現(xiàn)“O”型腿時，最可能對應的磷酸鹽缺乏是？【選項】A.磷酸鈣B.磷酸氫鈣C.磷酸三鈣D.磷酸二氫鉀【參考答案】B【解析】佝僂病骨骼改變與鈣磷代謝失衡相關，磷酸氫鈣是骨基質(zhì)形成必需成分，缺乏導致骨礦化障礙。選項A（磷酸鈣）是骨鹽成分，但磷酸鹽整體缺乏才會引發(fā)佝僂病，需區(qū)分具體缺乏類型。15.感染性休克早期（休克代償期）的血壓特征是？【選項】A.收縮壓＞90mmHg，脈壓差＞20mmHgB.收縮壓＜90mmHg，脈壓差＜20mmHgC.收縮壓＞90mmHg，脈壓差＜20mmHgD.收縮壓＞100mmHg，脈壓差＞30mmHg【參考答案】C【解析】休克代償期血壓表現(xiàn)為收縮壓＞90mmHg但低于正常（＜100mmHg），脈壓差＜20mmHg（心率＞100次/分）。選項D（收縮壓＞100mmHg）不符合代償期標準，選項B（收縮壓＜90mmHg）為失代償期表現(xiàn)。16.兒童燒傷面積計算中，手掌法對應燒傷百分比是？【選項】A.9%B.5%C.10%D.8%【參考答案】A【解析】手掌法計算燒傷面積為5%（手掌面積占體表總面積5%），但需注意五指并攏時為9%（掌心+五指）。選項B（5%）為掌心單獨計算值，選項A（9%）為完整手掌法標準答案。17.先天性膈疝的典型影像學表現(xiàn)是？【選項】A.膈肌中斷伴肝下見胃泡影B.膈肌下見游離氣體C.肺不張伴縱隔移位D.膈頂見腸管走行【參考答案】A【解析】先天性膈疝多見于右側(cè)，典型表現(xiàn)為膈肌中斷（呈波浪狀或斷裂），患側(cè)肺不張，肝下見胃泡影（B項為腸梗阻表現(xiàn)）。選項D（膈頂見腸管）多見于食管閉鎖合并膈疝，非典型表現(xiàn)。18.急性腎盂腎炎的常見病原體是？【選項】A.大腸埃希菌（90%）B.葡萄球菌（70%）C.克雷伯菌（50%）D.銅綠假單胞菌（30%）【參考答案】A【解析】大腸埃希菌（90%）為急性腎盂腎炎主要病原體，其次為變形桿菌、克雷伯菌等。選項B（70%）為尿路感染總體數(shù)據(jù)，選項C（50%）與實際發(fā)病率不符。19.神經(jīng)母細胞瘤的病理特征中，最具有診斷意義的是？【選項】A.腫瘤邊界清晰B.融合性生長模式C.堿性磷酸酶陽性D.神經(jīng)節(jié)細胞巢【參考答案】D【解析】神經(jīng)母細胞瘤特征性病理表現(xiàn)為Homer-Wright小體（神經(jīng)節(jié)細胞巢），融合性生長模式（選項B）為轉(zhuǎn)移特征，堿性磷酸酶（選項C）多見于骨肉瘤。20.先天性幽門肥厚性狹窄的典型嘔吐特征是？【選項】A.晨起噴射狀嘔吐B.餐后立即嘔吐C.嘔吐物含咖啡渣樣物D.嘔吐后癥狀緩解【參考答案】B【解析】幽門肥厚導致胃排空障礙，表現(xiàn)為餐后立即嘔吐（非晨起或餐后2小時），嘔吐物不含膽汁（與腸梗阻鑒別）。選項A（晨起噴射狀）多見于腦膜刺激征，選項C（咖啡渣樣物）為上消化道出血表現(xiàn)。21.先天性膽道閉鎖的病理生理機制主要與哪種因素相關？【選項】A.膽管發(fā)育異常導致肝內(nèi)外膽管阻塞B.膽汁酸代謝障礙引發(fā)膽汁淤積C.膽囊結(jié)石阻塞膽總管D.胰腺導管發(fā)育異常【參考答案】A【解析】先天性膽道閉鎖的病因是膽道發(fā)育異常，導致肝內(nèi)外膽管阻塞，無法正常排出膽汁，引發(fā)肝細胞損傷和膽色素代謝異常。選項B描述的是膽汁淤積的后果而非病因；選項C是膽石癥的表現(xiàn)；選項D與胰腺疾病相關，與膽道閉鎖無關。22.新生兒壞死性小腸結(jié)腸炎（NEC）最常見于哪種手術后的患兒？【選項】A.胃腸吻合術B.頸部手術C.肛門閉鎖修復術D.頸椎融合術【參考答案】C【解析】NEC多見于出生后2-6周接受腸道手術的患兒，尤其是肛門閉鎖或直腸肛門畸形術后，因腸道解剖異常和菌群失調(diào)誘發(fā)。選項A常見于先天性腸閉鎖，選項B、D與腸道無關。23.兒童急性淋巴細胞白血?。ˋLL）的化療方案中，哪種藥物屬于烷化劑類？【選項】A.羥基脲B.長春新堿C.環(huán)磷酰胺D.阿糖胞苷【參考答案】C【解析】環(huán)磷酰胺是經(jīng)典的烷化劑，通過DNA烷基化干擾DNA復制；羥基脲為嘧啶類似物，長春新堿是植物堿類，阿糖胞苷為嘌呤類似物。24.兒童急性腎損傷（AKI）的病因中，占比最高的為？【選項】A.腎前性因素B.腎實質(zhì)性病變C.腎間質(zhì)疾病D.感染性因素【參考答案】A【解析】約50%-60%的AKI為腎前性因素（如脫水、休克），其次為腎實質(zhì)性病變。選項B為第二位病因，需注意區(qū)分。25.兒童燒傷面積計算中，成人手掌面積占比為？【選項】A.9%B.5%C.7%D.10%【參考答案】B【解析】成人手掌面積（掌側(cè)）約為體表面積的5%，用于估算燒傷面積；成人全掌約為9%，兒童手掌面積比例略小于成人。26.兒童呼吸道異物窒息的急救措施中，首要步驟是？【選項】A.物理排痰B.高滲鹽水霧化C.海姆立克急救法D.氧氣吸入【參考答案】C【解析】海姆立克法適用于清醒患者，能快速排出氣道異物；若已喪失意識需行心肺復蘇。選項A、B、D適用于非氣道異物或已出現(xiàn)并發(fā)癥的情況。27.兒童糖尿病酮癥酸中毒（DKA）的典型實驗室檢查結(jié)果為？【選項】A.血糖＞13.9mmol/L，血酮體＞3mmol/LB.血糖＜7mmol/L，血酮體＜0.6mmol/LC.尿糖++，尿酮體++D.血鈉＞145mmol/L，血氯＜95mmol/L【參考答案】A【解析】DKA特征為高血糖（＞13.9mmol/L）、高血酮（＞3mmol/L）及代謝性酸中毒；選項C為糖尿病早期表現(xiàn)，選項D為高滲狀態(tài)。28.兒童先天性髖關節(jié)脫位的典型體征為？【選項】A.梨狀窩空虛B.大轉(zhuǎn)子上移C.外旋試驗陽性D.腹股溝區(qū)壓痛【參考答案】A【解析】髖關節(jié)脫位時，梨狀窩空虛是典型體征；大轉(zhuǎn)子上移（B）見于股骨頸骨折；外旋試驗（C）用于鑒別髖臼發(fā)育不良；腹股溝區(qū)壓痛（D）多見于髖關節(jié)滑膜炎。29.兒童急性喉炎的并發(fā)癥中，最常見的是？【選項】A.聲帶水腫B.喉梗阻C.喉淀粉樣變性D.聲帶麻痹【參考答案】B【解析】急性喉炎主要因聲門下水腫導致進行性喉梗阻，需及時干預；選項A為早期表現(xiàn)，選項C、D為慢性病變。30.兒童過敏性紫癜的實驗室檢查中，特異性升高的指標為？【選項】A.血小板計數(shù)＞100×10?/LB.血清C3補體成分C.抗核抗體（ANA）陽性D.血清免疫球蛋白IgE【參考答案】B【解析】過敏性紫癜特征為血清C3補體成分降低（50%-70%病例），ANCA陰性；選項A為血小板減少，C為自身免疫病，D為特應性過敏。31.先天性幽門肥厚性狹窄患兒，嘔吐物不含膽汁，首選手術方式是？【選項】A.胃十二指腸吻合術B.胃空腸吻合術C.幽門成形術D.胃部分切除術【參考答案】B【解析】先天性幽門肥厚性狹窄患兒嘔吐物不含膽汁提示嘔吐為非bilioustype，首選手術為胃空腸吻合術（B）。幽門成形術（C）適用于輕度狹窄且無嚴重并發(fā)癥者，胃部分切除術（D）適用于廣泛性肥厚或合并其他畸形。胃十二指腸吻合術（A）適用于十二指腸畸形導致的嘔吐。32.新生兒壞死性小腸結(jié)腸炎（NEC）的感染性病因中，最常見病原體是？【選項】A.大腸桿菌B.葡萄球菌C.克雷伯菌D.病毒性腸炎病原體【參考答案】A【解析】NEC感染性病因中，大腸桿菌（A）占60%-70%，其次為克雷伯菌（C）。葡萄球菌（B）多見于敗血癥合并NEC，病毒性腸炎病原體（D）多引起腹瀉而非NEC。需注意區(qū)分細菌性腸炎與NEC的病理機制差異。33.兒童急性淋巴細胞白血病（ALL）標準治療方案中，誘導緩解階段主要使用的化療藥物不包括？【選項】A.環(huán)磷酰胺B.阿糖胞苷C.羥基脲D.依托泊苷【參考答案】C【解析】ALL誘導方案通常包含環(huán)磷酰胺（A）、阿糖胞苷（B）、依托泊苷（D）及地塞米松等。羥基脲（C）主要用于慢性髓系白血病或骨髓增生異常綜合征，非ALL標準方案。需注意與ALL緩解后強化療方案的藥物差異。34.先天性巨結(jié)腸患兒行Hartman's肛門成形術的適應癥是？【選項】A.6月齡內(nèi)進展性便秘B.肛門閉鎖合并直腸狹窄C.短腸綜合征D.胃腸道反復感染【參考答案】B【解析】Hartman's肛門成形術（B）適用于肛門閉鎖合并直腸狹窄的先天性巨結(jié)腸患兒。6月齡內(nèi)進展性便秘（A）多行造口二期手術，短腸綜合征（C）和胃腸道感染（D）與肛門成形術無直接關聯(lián)。需明確手術適應癥與病理分型的對應關系。35.兒童急性腎損傷（AKI）的分期中，尿量減少持續(xù)48小時屬于？【選項】A.第1期B.第2期C.第3期D.第4期【參考答案】B【解析】AKI分期：第1期（腎血流量減少，尿量正常或輕度減少）；第2期（腎小球濾過率下降，尿量減少持續(xù)24-48小時）；第3期（少尿或無尿持續(xù)48小時以上）；第4期（終末期腎?。Ｐ枳⒁饽蛄繙p少的持續(xù)時間與分期的對應關系。二、多選題（共35題）1.新生兒黃疸的典型表現(xiàn)及實驗室檢查特征包括以下哪些？【選項】A.生后24小時內(nèi)出現(xiàn)黃疸，血清總膽紅素水平＞12.9mg/dLB.常伴皮膚彈性下降及低體溫C.膽汁淤積性黃疸以直接膽紅素升高為主D.光療可有效降低未結(jié)合膽紅素E.血清白蛋白＜30g/L提示易發(fā)生膽紅素腦病風險【參考答案】ACD【解析】A.正確。生理性黃疸多在生后24小時后出現(xiàn)，但病理性黃疸可早至出生后24小時內(nèi)，總膽紅素＞12.9mg/dL提示嚴重程度。C.正確。膽汁淤積性黃疸的直接膽紅素（結(jié)合型）升高為主，結(jié)合膽紅素可隨尿排出。D.正確。光療通過將未結(jié)合膽紅素轉(zhuǎn)化為水溶性形式排出，適用于未結(jié)合膽紅素升高者。B.錯誤。皮膚彈性下降及低體溫是新生兒脫水表現(xiàn)，與黃疸無直接關聯(lián)。E.錯誤。白蛋白＜28g/L為膽紅素腦病風險因素，而非30g/L。2.先天性幽門肥厚性狹窄的典型臨床表現(xiàn)及檢查不包括以下哪項？【選項】A.哺乳后嘔吐呈噴射狀，嘔吐物含未消化奶瓣B.腹部立位X光示胃泡擴張呈"雙泡征"C.胃鏡可見胃竇黏膜增厚及胃體排空延遲D.胎兒期已出現(xiàn)羊水過少E.血清胃泌素水平顯著升高【參考答案】BD【解析】B.錯誤。幽門肥厚性狹窄典型X光表現(xiàn)為"單泡征"（胃泡擴張），"雙泡征"見于胃食管反流。D.錯誤。該病多見于出生后2-6周，胎兒期羊水過少多與胎兒腸道閉鎖相關。A.正確。噴射狀嘔吐伴奶瓣是典型臨床表現(xiàn)。C.正確。胃鏡可見肥厚黏膜呈"鉛管樣"改變。E.正確。胃泌素水平升高促進胃酸分泌，加重幽門痙攣。3.關于新生兒肺炎的病原學特征，正確描述是？【選項】A.金黃色葡萄球菌多見于出生后7天內(nèi)B.支原體肺炎占早產(chǎn)兒肺炎的15%-30%C.病毒性肺炎以腺病毒最常見D.B族鏈球菌肺炎多見于足月兒E.混合感染率＞50%【參考答案】BCE【解析】B.正確。早產(chǎn)兒因免疫系統(tǒng)不成熟，支原體肺炎發(fā)病率可達15%-30%。C.正確。腺病毒是病毒性肺炎最常見病原（占60%-70%）。A.錯誤。金黃色葡萄球菌肺炎多見于出生后7天至3個月（"早發(fā)型"）。D.錯誤。B族鏈球菌肺炎多見于出生后24小時內(nèi)（"早發(fā)型"）。E.正確。早產(chǎn)兒肺炎多因多病原共同作用，混合感染率＞50%。4.先天性心臟畸形中，需行急診手術的是？【選項】A.室間隔缺損（直徑＜5mm）B.法洛四聯(lián)癥（肺動脈壓力＞50mmHg）C.肺動脈狹窄（壓力梯度＞50mmHg）D.房間隔缺損（直徑＞20mm）E.肝靜脈回流障礙【參考答案】BC【解析】B.正確。法洛四聯(lián)癥伴嚴重肺動脈高壓時（＞50mmHg），因右向左分流導致缺氧危象，需急診姑息手術（如Blalock-Taussig術）。C.正確。嚴重肺動脈狹窄（壓力梯度＞50mmHg）可致右心衰竭，需急診介入或手術。A.錯誤。室間隔缺損＜5mm可隨訪觀察。D.錯誤。ASD＞20mm建議3歲內(nèi)手術，但非急診。E.錯誤。肝靜脈回流障礙（如門靜脈狹窄）需擇期手術。5.兒童急性淋巴細胞白血?。ˋLL）的化療方案中，下列哪項為標準方案核心？【選項】A.環(huán)磷酰胺+甲氨蝶呤+長春新堿B.美法侖+多柔比星+環(huán)磷酰胺C.環(huán)磷酰胺+阿糖胞苷+地塞米松D.長春新堿+多柔比星+順鉑E.羥基脲+甲氨蝶呤+氟尿嘧啶【參考答案】C【解析】C.正確。兒童ALL標準方案（如COAP方案）核心為環(huán)磷酰胺+阿糖胞苷+地塞米松，聯(lián)合化療后5年生存率達80%-90%。A.錯誤。甲氨蝶呤主要用于中樞神經(jīng)系統(tǒng)預防。B.錯誤。美法侖+多柔比星+環(huán)磷酰胺適用于急性髓系白血病（AML）。D.錯誤。順鉑非兒童白血病常規(guī)用藥。E.錯誤。羥基脲+甲氨蝶呤+氟尿嘧啶用于骨髓增生異常綜合征。6.關于兒童急性腎小球腎炎的典型表現(xiàn)，錯誤的是？【選項】A.前驅(qū)感染多由鏈球菌引起B(yǎng).常伴血尿（＞5000/μl）C.水腫呈非凹陷性D.高血壓嚴重時出現(xiàn)急性腎衰竭E.血清補體C3在8周內(nèi)恢復正常【參考答案】BC【解析】B.錯誤。典型尿常規(guī)顯示尿紅細胞＞5000/μl（呈彌漫性紅細胞增多），但非特異性血尿（＜5000/μl）提示其他病因。C.錯誤。水腫為全身性凹陷性水腫，以眼瞼及下肢為著。A.正確。鏈球菌感染（如咽炎、扁桃體炎）是主要誘因。D.正確。嚴重高血壓可致腎灌注不足，出現(xiàn)少尿、氮質(zhì)血癥。E.正確?！秲和毙阅I小球腎炎診療指南》明確血清C3在8周內(nèi)恢復。7.新生兒腸套疊的典型臨床表現(xiàn)不包括以下哪項？【選項】A.腹痛伴嘔吐（多呈噴射狀）B.排血性便（果醬樣）C.腹部立位X光示"假性腸梗阻"D.病程超過48小時死亡率達10%E.病毒感染為常見病因【參考答案】E【解析】E.錯誤。腸套疊最常見病因是腸道功能紊亂（如腸套疊綜合征），病毒感染（如輪狀病毒）僅占5%-10%。A.正確。陣發(fā)性腹痛伴噴射狀嘔吐是典型表現(xiàn)。B.正確。排血性便呈果醬樣，含未消化食物殘渣。C.正確.X光示充氣腸祥、空氣swallowed征、假性腸梗阻表現(xiàn)。D.正確.48小時后腸壞死風險顯著增加，死亡率達10%。8.兒童急性喉炎的氣道管理原則不包括？【選項】A.保持氣道通暢優(yōu)先于氧療B.氧療濃度＞40%可能加重缺氧C.嚴重缺氧需行氣管插管D.糖皮質(zhì)激素可抑制炎癥反應E.呼吸機支持適用于合并呼吸衰竭【參考答案】B【解析】B.錯誤。兒童急性喉炎氧療濃度通?！?0%，＞40%可能抑制呼吸驅(qū)動。A.正確.保持氣道通暢（如頭位調(diào)整、霧化吸痰）是首要措施。C.正確.嚴重缺氧（血氧飽和度＜85%）需緊急氣管插管。D.正確.糖皮質(zhì)激素（如地塞米松）可減輕氣道水腫。E.正確.呼吸衰竭需機械通氣支持。9.關于兒童糖尿病酮癥酸中毒的急救處理，錯誤的是？【選項】A.立即靜脈輸注等滲葡萄糖B.補充電解質(zhì)（以生理鹽水為主）C.糖尿病友需暫停胰島素治療D.監(jiān)測血酮體及血氣分析E.糾正低鉀血癥優(yōu)先于補液【參考答案】E【解析】E.錯誤.糖尿病酮癥酸中毒治療順序：1.補液（生理鹽水500ml/h）→2.糾正電解質(zhì)紊亂（低鉀先補鉀）。A.正確.初始階段可輸注等滲葡萄糖（5%-10%葡萄糖）以降低血糖增速。B.正確.生理鹽水（500ml/h）優(yōu)先，總量＞2000ml/24h。C.正確.胰島素治療需暫停，待血糖＜13.9mmol/L后恢復。D.正確.血酮體＞3mmol/L及血氣分析（pH＜7.3）提示病情危重。10.兒童急性淋巴細胞白血病的骨髓抑制期主要并發(fā)癥不包括？【選項】A.粒細胞減少性發(fā)熱B.血小板減少性出血C.脫發(fā)D.感染（如肺炎）E.肝脾腫大【參考答案】E【解析】E.錯誤.骨髓抑制期因白血病細胞浸潤，肝脾常增大，而非縮小。A.正確.粒細胞減少（＜0.5×10^9/L）易導致發(fā)熱。B.正確.血小板減少（＜20×10^9/L）引發(fā)皮膚瘀斑或出血。C.正確.化療藥物（如蒽環(huán)類）導致毛發(fā)生長周期受抑制。D.正確.中性粒細胞＜0.5×10^9/L時感染風險顯著增加。11.先天性幽門肥厚性狹窄的病因與發(fā)病機制主要涉及以下哪些方面？【選項】A.胃泌素相關因素B.幽門括約肌持續(xù)痙攣C.胃酸分泌減少D.胃黏膜增生【參考答案】A、C【解析】1.胃泌素相關因素：幽門黏膜增生導致胃泌素分泌異常，刺激幽門括約肌持續(xù)收縮。2.胃酸分泌減少：胃酸分泌不足可減少胃黏膜對胃泌素的負反饋調(diào)節(jié)，加重幽門括約肌痙攣。錯誤選項：B（幽門括約肌痙攣是病理結(jié)果而非病因）、D（胃黏膜增生是病理表現(xiàn)）。12.先天性腸旋轉(zhuǎn)不良的典型臨床表現(xiàn)不包括以下哪項？【選項】A.新生兒期急性腸梗阻B.腸套疊C.腸鳴音活躍D.腹脹與嘔吐【參考答案】C【解析】1.新生兒期急性腸梗阻（A）：因腸道位置異常導致腸祥嵌頓或扭轉(zhuǎn)。2.腸套疊（B）：部分病例可合并腸套疊，表現(xiàn)為果醬樣血便。3.腹脹與嘔吐（D）：典型機械性腸梗阻表現(xiàn)。錯誤選項：C（腸鳴音活躍多見于單純性腸梗阻，而非腸旋轉(zhuǎn)不良的病理狀態(tài)）。13.先天性膽總管囊性擴張癥（Caroli?。┑闹委熢瓌t中，正確的是？【選項】A.早期行肝葉切除術B.膽管支架置入術適用于合并感染者C.膽腸吻合術需在1歲以上進行D.3歲以上保守治療為主【參考答案】B、C【解析】1.膽管支架置入術（B）：適用于膽管炎急性期，可緩解梗阻和感染。2.膽腸吻合術（C）：1歲以上患兒可耐受，避免膽管損傷。錯誤選項：A（肝葉切除術適用于晚期或合并肝膿腫）、D（3歲以上仍需手術干預）。14.先天性巨結(jié)腸的病理機制主要與以下哪項相關？【選項】A.神經(jīng)節(jié)細胞缺失B.腸道菌群失調(diào)C.胰島素抵抗D.膽汁酸代謝異?！緟⒖即鸢浮緼、B【解析】1.神經(jīng)節(jié)細胞缺失（A）：結(jié)腸黏膜下神經(jīng)叢先天性缺如或發(fā)育不良。2.腸道菌群失調(diào)（B）：致病菌過度增殖導致短鏈脂肪酸合成減少。錯誤選項：C（與代謝性堿中毒相關）、D（與膽汁酸腹瀉無關）。15.先天性髖關節(jié)脫位的治療中，以下哪項描述正確？【選項】A.6個月以下行Pavlik吊帶治療B.1歲以上行髖關節(jié)復位術C.新生兒篩查陽性者需早期干預D.3歲以上保守治療為主【參考答案】A、C【解析】1.6個月以下（A）：Pavlik吊帶可矯正髖關節(jié)角度，避免股骨頭脫位。2.新生兒篩查陽性者（C）：需在6周內(nèi)行超聲評估，早期干預。錯誤選項：B（1歲以上復位成功率降低）、D（3歲以上需考慮截骨術）。16.先天性膈疝的典型影像學特征不包括以下哪項？【選項】A.膈肌連續(xù)性中斷B.肺發(fā)育不良C.腸管漂浮于胸腔內(nèi)D.肝臟右移【參考答案】B【解析】1.膈肌連續(xù)性中斷（A）：CT可見膈肌缺損。2.腸管漂?。–）：胃、腸等腹腔內(nèi)臟器進入胸腔。3.肝臟右移（D）：因膈肌升高導致肝臟位置異常。錯誤選項：B（肺發(fā)育不良多見于胎兒期膈疝，非典型表現(xiàn)）。17.先天性臍茸（臍竇）感染時，首選的抗生素是？【選項】A.青霉素GB.復方新諾明C.環(huán)丙沙星D.阿奇霉素【參考答案】B【解析】1.復方新諾明（B）：含磺胺甲噁唑和甲氧芐啶，覆蓋常見腸道細菌及厭氧菌。錯誤選項：A（青霉素G對鏈球菌有效，但臍茸易合并厭氧菌感染）、C（環(huán)丙沙星僅對革蘭氏陰性菌有效）、D（阿奇霉素對非典型病原體有效）。18.先天性腸閉鎖的病理變化中，正確的是？【選項】A.閉鎖段腸管擴張B.腸壁神經(jīng)節(jié)細胞增生C.閉鎖端呈盲端D.腸腔內(nèi)大量黏液【參考答案】A、C【解析】1.閉鎖段擴張（A）：胚胎期腸道發(fā)育停滯導致近端腸管擴張。2.盲端形成（C）：閉鎖端無開口，腸腔中斷。錯誤選項：B（神經(jīng)節(jié)細胞缺失是神經(jīng)節(jié)細胞增生相反病理）、D（黏液增多見于先天性巨結(jié)腸）。19.先天性胃食管反流的治療中，以下哪項不正確？【選項】A.6個月以下嬰兒可嘗試體位治療B.1歲以上患兒可長期使用質(zhì)子泵抑制劑C.奶瓶喂養(yǎng)角度需＞30°D.癥狀消失后立即停用抑酸藥【參考答案】D【解析】1.體位治療（A）：俯臥位或頭高腳低位可減少反流。2.質(zhì)子泵抑制劑（B）：1歲以上患兒可長期使用以減少復發(fā)。3.奶瓶角度（C）：30°以上可減少反流。錯誤選項：D（需逐漸減量，避免癥狀反彈）。20.先天性膽道閉鎖的病理生理過程中，錯誤的是？【選項】A.膽汁淤積導致肝細胞壞死B.膽管壁纖維化C.肝臟體積進行性縮小D.膽囊擴張【參考答案】D【解析】1.膽汁淤積（A）：膽汁酸沉積損傷肝細胞。2.膽管纖維化（B）：慢性炎癥導致膽管壁增厚。3.肝臟萎縮（C）：長期膽汁淤積導致肝纖維化和肝體積減小。錯誤選項：D（膽囊因膽道閉鎖無法正常排空，通常不擴張）。21.先天性膽道閉鎖的診療中，正確的描述是（）【選項】A.新生兒期即可行膽總管空腸吻合術B.影像學檢查首選腹部超聲C.病理確診需通過肝活檢D.2-6月齡為手術最佳時機E.PTC檢查顯示肝內(nèi)膽管擴張【參考答案】BDE【解析】B.腹部超聲是先天性膽道閉鎖首選影像學檢查，可評估肝內(nèi)外膽管情況；D.手術最佳時機為2-6月齡，此時肝功能尚可且并發(fā)癥較少；E.PTC檢查可顯示肝內(nèi)膽管擴張，但需注意對膽管損傷風險；A錯誤，新生兒期手術易導致膽汁性肝硬變；C錯誤，確診主要依靠影像學，肝活檢創(chuàng)傷大。22.新生兒腸套疊的典型臨床表現(xiàn)不包括（）【選項】A.突發(fā)劇烈哭鬧伴噴射性便血B.腹部包塊以右下腹多見C.肛門指檢可聞及空氣過水聲D.WBC計數(shù)通常升高E.病程超過48小時易發(fā)生腸壞死【參考答案】B【解析】B.新生兒腸套疊包塊多位于左下腹（梅克爾憩室部位），右下腹多見于Meckel's憩室異位開口；A.噴射性便血為典型癥狀；C.肛門指檢可探測套疊端；D.炎癥反應致WBC升高；E.超過48小時壞死風險顯著增加。23.關于先天性巨結(jié)腸的病理生理機制，正確的是（）【選項】A.病變腸段神經(jīng)節(jié)細胞缺失B.腸腔內(nèi)黏液栓形成致腸梗阻C.肛門括約肌壓力正常D.患兒多伴先天性心臟畸形E.病理確診需腸壁全層活檢【參考答案】ADE【解析】A.腸神經(jīng)節(jié)細胞缺失導致動力障礙；D.50%病例合并心臟畸形（如室間隔缺損）；E.黏液栓是典型病理特征，全層活檢可確診；B錯誤，黏液栓是結(jié)果而非機制；C錯誤，肛門括約肌壓力增高。24.新生兒肺炎的常見病原體包括（）【選項】A.肺炎鏈球菌B.呼吸道合胞病毒C.大腸埃希菌D.葡萄球菌E.病毒性肺炎多由腸道病毒引起【參考答案】ABE【解析】A.肺炎鏈球菌為最常見細菌；B.呼吸道合胞病毒（RSV）占病毒性肺炎首位；E.腸道病毒（如EV71）是病毒性肺炎主要病原；C.大腸埃希菌多見于早產(chǎn)兒敗血癥；D.金黃色葡萄球菌多見于院感或免疫低下兒。25.關于先天性心臟病合并先天性畸形，以下正確的是（）【選項】A.法洛四聯(lián)征必合并室間隔缺損B.動脈導管未閉多合并VSDC.罕見畸形包括心臟神經(jīng)節(jié)缺如D.45%的室間隔缺損合并PDAE.房室管畸形需注意心內(nèi)膜墊缺損【參考答案】CDE【解析】C.心臟神經(jīng)節(jié)缺如（CNDA）是罕見但致命畸形；D.45%的室間隔缺損（VSD）合并動脈導管未閉（PDA）；E.房室管畸形本質(zhì)是心內(nèi)膜墊發(fā)育異常；A錯誤，法洛四聯(lián)征典型畸形為肺動脈狹窄+VSD；B錯誤，PDA更常見于VSD合并病例。26.新生兒腸壞死的高危因素不包括（）【選項】A.胎齡<32周B.母親糖尿病史C.胎便排出時間延遲>48小時D.留置鼻胃管E.母親吸煙史【參考答案】D【解析】D.鼻胃管可能損傷黏膜但非直接高危因素；A.胎齡?。?lt;32周）腸道發(fā)育差；B.母親糖尿病致胎兒胰島素抵抗；C.胎便延遲增加壞死風險；E.吸煙導致胎盤血流灌注不足。27.關于先天性腸閉鎖的手術方式，正確的是（）【選項】A.腸造口術適用于所有病例B.病變近端腸管切除+端端吻合C.空腸-升結(jié)腸吻合術可避免盲端綜合征D.短腸綜合征需行回腸-橫結(jié)腸吻合E.肛門閉鎖需先做結(jié)腸灌洗【參考答案】BC【解析】B.病變近端腸管切除+端端吻合是標準術式；C.空腸-升結(jié)腸吻合可避免盲端綜合征；A錯誤，腸造口僅用于暫時性腸道減壓；D.短腸綜合征需回腸-空腸吻合；E.肛門閉鎖需術前結(jié)腸灌洗。28.新生兒壞死性小腸結(jié)腸炎（NEC）的病理分期中，死亡多見于（）【選項】A.I期（黏膜充血水腫）B.II期（黏膜壞死伴潰瘍）C.III期（全層壞死伴穿孔）D.IV期（全身炎癥反應）E.V期（多器官衰竭）【參考答案】E【解析】E.V期（多器官衰竭）是主要死亡期；C期（全層壞死）即達終末期；A.I期屬可逆階段；B.II期治療可逆轉(zhuǎn)；D.IV期屬終末期表現(xiàn)。29.關于先天性幽門肥厚性狹窄，以下正確的是（）【選項】A.病因與病毒感染相關B.胃排空時間延長至>4小時C.X線檢查可見“鳥嘴”征D.5%病例合并先天性心臟病E.病理確診需胃壁全層活檢【參考答案】ACDE【解析】A.胃幽門括約肌增生與病毒感染相關；C.X線可見典型“鳥嘴”狀狹窄；D.5%合并先天性心臟病（如室間隔缺損）；E.胃壁肌層增生為特征性改變；B錯誤，正常胃排空時間約2-4小時。30.新生兒膿毒癥休克時，下列哪項不符合《新生兒急救指南》處理原則（）【選項】A.立即建立靜脈雙通道B.首選頭孢曲松聯(lián)合甲氧芐啶C.糾正低血壓首選等滲鹽水D.需監(jiān)測中心靜脈壓E.抗生素療程不少于14天【參考答案】B【解析】B.首選頭孢曲松聯(lián)合氨芐西林，甲氧芐啶僅用于銅綠假單胞菌感染；A.雙通道可快速補液擴容；C.等滲鹽水是糾正低血壓的首選；D.監(jiān)測CVP指導液體管理；E.病原菌不同療程需調(diào)整。31.先天性幽門肥厚性狹窄患兒首選的檢查方法是？【選項】A.腹部立位片B.胃空腸雙腔管造影C.超聲心動圖D.腹部CT【參考答案】B【解析】胃空腸雙腔管造影是診斷先天性幽門肥厚性狹窄的“金標準”，可清晰顯示胃竇部狹窄及胃壁肥厚。腹部立位片可見胃泡擴張，但無法明確病變部位；超聲心動圖用于排查心臟并發(fā)癥；腹部CT僅作為輔助檢查。32.關于小兒肺炎鏈球菌肺炎的并發(fā)癥，正確的是？【選項】A.膿胸B.膿氣胸C.肺肉質(zhì)化D.肺不張【參考答案】ABD【解析】肺炎鏈球菌肺炎易并發(fā)膿胸（A）、膿氣胸（B）和肺肉質(zhì)化（C）。肺不張（D）多見于病毒性肺炎或機械通氣不當導致的肺順應性下降，與肺炎鏈球菌關系較小。33.小兒急性腎小球腎炎的典型臨床表現(xiàn)不包括？【選項】A.血尿（多形性、持續(xù)性）B.高血壓（以收縮壓升高為主）C.水腫（晨起眼瞼及雙下肢水腫）D.發(fā)熱（伴皮疹）【參考答案】D【解析】急性腎小球腎炎典型表現(xiàn)為血尿（A）、高血壓（B）和水腫（C），發(fā)熱多由原發(fā)感染或并發(fā)癥引起，非直接癥狀。鏈球菌感染后發(fā)熱是疾病前驅(qū)期表現(xiàn)，但發(fā)熱本身不屬典型臨床表現(xiàn)。34.小兒腸套疊的典型三聯(lián)征是？【選項】A.腹痛→嘔吐→便血B.嗜睡→脫水→腹肌緊張C.腹痛→果醬樣便→腹部包塊D.嘔吐→發(fā)熱→呼吸急促【參考答案】C【解析】腸套疊三聯(lián)征為陣發(fā)性腹痛（逐漸加重）、果醬樣血便（距病起24-48小時出現(xiàn)）和腹部包塊（右下腹）。其他選項：A順序錯誤，B為脫水晚期表現(xiàn)，D為感染或重癥表現(xiàn)。35.關于小兒先天性心臟畸形手術時機，錯誤的是？【選項】A.法洛四聯(lián)癥：出生后3-6個月B.動脈導管未閉：1-2歲C.房間隔缺損：學齡期D.畸形矯正術：5-8歲【參考答案】C【解析】房間隔缺損（ASD）手術適應證為：①合并心衰或肺動脈高壓；②學齡期后巨大缺損（>30mm）。單純ASD手術多在學齡期前完成（3-6歲），延遲至學齡期（C）可能增加遠期并發(fā)癥風險。三、判斷題（共30題）1.先天性幽門肥厚性狹窄的首選手術方式是胃空腸吻合術?！具x項】A.正確B.錯誤【參考答案】A【解析】先天性幽門肥厚性狹窄的典型手術是胃空腸Ryugan吻合術，通過曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠置曠