重庆医科大学第一临床学院 2020—2021 学年第 2 学期

《外科学 Surgery 2》考试答卷

适用年级及专业：2016 级留学生本科 考试时长：150 分钟 考试方式：闭卷

学号 ARIZKA SUCI 姓名 2016510016 年级

题号 一 二 三 四 五 总分
审核
满分 20 20 20 10 30 100

得分

评卷人签名

Ⅰ. Answer questions
1. Briefly describe the principles of treatment of joint tuberculosis. (20
Marks)

JOINT TB management :
a. standard quadruple therapy
b. rifampicin
c. isoniazid
d. pyrazinamide
e. ethambutol

- Control the infection : anti-tubercular drugs,

Rest
Building up patient’s resistance
- Care the affected part : proper positioning of the joint
Mobilization and exercise
Treatment are :
a. Persistant effusions or synovial pannus
b. Spinal instability or multiple vertebral involvement
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 c. Severe khyposcoliosis
d. Cord/nerve compression
e. Large abcess

2. Conservative therapy of upper tract urinary calculus. (20 Marks)

Therapy of upper tract urinary calculus are

Conservative therapy indication :
-Stone diameter less than 6 mm
-No infection
-No obstruction
- adequate water intake
- spasmolysis and alleviate pain : atropine progesteronetramadol pethidine
- anti-infection
-adjust urine PH
-Treatment based on etiology correcting metabolic disorder

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3. Please describe the pathophysiological changes of Tension pneumothorax. (20
Marks)

Pathophysiological changes of tension pneumothorax are

- Total collapse of lung on injuried site and pressure also to the lung on
normal side because of the mediastinal shift
- Mediastinal shift toward normal side and the higher pressure effect on great
vessels and venous return causing circulatory and rrspiratory failure

4. Describe the clinical manifestations of concussion？ (10 Marks)

Clinical manifestation of concussion are

-Short-term loss of consciousness < 0,5 hour
-Retrograde amnesia : can not recall the experience a period of time before injury
-No neurological deficit
-Dizziness, headache, vomiting and nausea : vomiting and nausea is not due to
raised ICP but tdue to disturbance of vegetative nerve
-CSF examination is normal
-The diagnosis depends on clinical presentations

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-CT,MRI scan is normal

II. Case analysis

5. 1). What is the most likely primary diagnosis? (6 Marks. Please answer in less
than 20 words)

The most likely primary diagnosis is fracture of the left lower extremity, which is
broken in the fibula and tibia

2). On physical examination, which signs may be found to support your diagnosis.
(6 Marks. Please answer in less than 50 words)

The sign may be found to support are

- She get direct violance
- The patient unable to stand and walk
- Movement abnormal in the middle of his calf and the left foot numb
- The patient felt severe pain in his left calf
- She clearly conscious, no breathing difficulties or vomiting

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3). What kind of examination should be done in the immediately? (6 Marks. Please
answer in less than 50 words)

The examination should be done in the immediately are X-ray examination, have
an important value of diagnosis and treatment, so routinely we take the X-ray
AP-Xray, LP-Xray that contain adjacent joints,
Compared with the contraletal limb if necessary
-inspection, gait-posture
-palpation
-special test
-neurological +vascular examinatio

4). Based on the main diagnosis, what is the next treatment strategy. (12 Marks.
Please answer in less than 100 words)

The next treatment strategi are

1.Reduction
2.Immobilization
- External fixation : splint, PLASTER CAST, bracket,brace, traction system
-internal fixation : plate, screw
3.Reabilitation
-active muscular contraction
-active exercises joints of adjacent fracture
-active resistance exercise
-physiology
4.Medication

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-traditional medication : forbid using nonsteroid anti-inflammatory drugs
(NSAIDS)