外科学考试题A卷英文版带答案

(A)

PartI

Direction: In this part there are five questions. For each question there are four possible answers marked A, B, C and D. Choose the best answer and mark the letter of your choice on the ANSWER SHEET.

1. A 35 year old male manual labourer sustained a displaced subcapital hip fracture after falling at work. The fracture was reduced and fixed with 3 cannulated screws. Five months after the operation, he presents to your clinic with worsening hip pain. What is the most likely diagnosis?

a) Nonunion

b) Osteonecrosis

c) Loosening of the cannulated screws

d) Malunion

e) Osteomyelitis

2. A 75 year old lady slips on a throw rug in her living room and falls. An X-ray

reveals a displaced subcapital hip fracture. Prior to her fall, the patient lived alone, per formed all ADLs independently and enjoyed golfing. The most appropriate management of this fracture is:

a) Moore’s unipolar hemiarthroplasty

b) Bedrest for 6 weeks

c) Reduction with internal fixation using 3 cannulated screws

d) Bipolar hemiarthroplasty

e) Total hip replacement

3. All of the following regarding Achilles tendon rupture are true, EXCEPT: a) Positive Thompson’s test

b) Palpable gap over Achilles tendon

c) Weak plantar flexion

d) May occur secondary to steroid injection

e) Treat by casting foot in dorsiflexion

4. bony metastasis is not seen in which carcinoma ?

a) testis

b) breast

c) pelvis

d) bronchus

5. which of the following is NOT a typical symptom in a patient with a

musculoskeletal tumor?

a) nighttime pain

b) warmth over the lesion

c) distal edema

d) tenderness PartII

1. What are the four classes of shock?

2. How do you repair ureteral transection?

3. What are some advantages of the external skeletal fixator?

4. What are some advantages to using minmally invasive surgery? 5. What is Calot's triangle?

答案

PartI

1.b 2.d 3.e 4.a 5.d

PartII

1. Class I (<15% or 750cc blood loss) - mild anxiety, normal vital signs.

Class II (15%-30% or 750-1500cc blood loss) - normal systolic BP with increased pulse pressure, tachycardia, tachypnea, anxiety.

Class III (30%-40% or 1500-2000cc blood loss) - tachycardia >120, tachypnea >30 RR, decreased pulse pressure, confusion.

Class IV (>40% or >2000cc blood loss) - tachy >140, tachypnea >35RR, decreased pulse pressure, confused and lethargic, no urine output.

2. There are several ways to repair an accidental transection; the one I prefer is an interrupted, primary repair using 5-0 dacron sutures over a 6fr. Double-J silastic stent. The stent is removed via cytsocopy 6 weeks after the repair. I always leave a drain behind (but some do not). 3. Adjustable, less invasive, implants can be removed w/o general

anesthesia, good for use in fx with a lot of overlying osft tissue injury.

4. less blood loss, less scarring, shorter hospital stays, decreased pain, earlier resumption of normal activities.

5. The hepatobiliary triangle (or cystohepatic triangle) is an anatomic space bordered by the common hepatic duct medially, the cystic duct inferiorly and the superior border to the cystic artery.