Compilation of Past Final Exam Questions (Original questions often appear, recommended to review all)
Class of 2018
Discussion: Clinical manifestations and main prescriptions of the five Syndrome Types of Stockfish in Traditional Chinese Medicine
Case Studies
Class of 2017
Fill in the blanks: Three Western medicine diseases of gangrene, Western medicine name of myoma, internal and external lacteal abscesses,
Definitions: sinus tract, acne-form breast abscess, intermittent claudication, anal fistula,
Short answers: incision and drainage of breast abscess, differential diagnosis of diseases with bloody stools
Discussion: differential diagnosis of head carbuncle and lipoma poisoning
Case study: semen turbidity
Class of 2016
Short answer: compression symptoms of giant goiter, advantages and mechanism of the hang-string method
Q&A: syndrome differentiation and treatment of male infertility, case study, prolapse
Fill in the blanks: Western medicine name of breast secretion, bloody stools also called blood discharge, near blood and far blood, definition of rectal prolapse
Definitions: nipple leakage, hematospermia, loss of vitality, intermittent claudication
Class of 2015
Case study: Stockfish swelling. Discussion of syndrome differentiation and treatment of male infertility. Short answers: etiology and pathogenesis of breast mass, advantages and mechanism of the hang-string method for treating anal fistula. Definitions: urolithiasis, anal fistula, intermittent claudication, indication, loss of vitality
Fill in the blanks: Surgery is divided into internal and external treatment, four surgeries of anal fistula, cellulitis — cause, thyroid gland compression, four blanks
Key Summary from Class of 2018 Group
General Theory
Briefly describe the three methods of surgical drainage:
Incision at ulcer, medicinal threads, catheter @Wang Yuquan
Breast Diseases
Dimple sign, orange peel sign concepts
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@Tong Yao March 30, 2022 18:30
Concept of “breast rock peeling”
Breast rock refers to malignant tumors occurring in the breast area; in late stages, ulceration with projections resembling lotus leaves or cauliflower may be seen, termed breast rock peeling @Wang Yuquan
Rectal and Anal Diseases
Hemorrhoids
Inside and outside the anus, fleshy protrusions, symptoms include pain, itching, discharge, bleeding @Wang Yuquan
Rectal ampulla
Narrowing at both ends of the rectum with a middle dilation, the dilated area is the rectal ampulla @Wang Yuquan
(If the anatomical terminology is hard to understand, refer to the diagram for easier comprehension)
Anal angle:
The angle formed between the rectum and anal canal, approximately 90° @Wang Yuquan
Rectal valves:
Semilunar mucosal folds on the rectal mucosa (horizontally long, prevent fecal backflow) @Wang Yuquan
Anal canal
About 3 cm long, connected to the rectum above, ends at the anal verge below @Wang Yuquan
Rectal columns / Anal columns
Narrowing at the lower end of the rectum; longitudinal mucosal folds inside the intestinal lumen @Wang Yuquan
Anal valves / Anal valves:
Semilunar mucosal folds between adjacent lower ends of rectal columns @Wang Yuquan
Anal crypts:
Pocket-like spaces opening upward formed between anal valves and rectal columns mucosa @Wang Yuquan
Anal papillae:
Triangular papillary projections at the base of rectal columns, located on the dentate line @Wang Yuquan
Dentate line:
Junction line at the anal canal formed by the bases of the anal valves and rectal columns (above is rectum, below is anal canal) @Wang Yuquan
Internal hemorrhoids, external hemorrhoids, mixed hemorrhoids
Internal hemorrhoids: hemorrhoids above the dentate line, caused by dilation and varicosity of the superior rectal venous plexus
External hemorrhoids: hemorrhoids below the dentate line, caused by dilation and varicosity of the inferior rectal venous plexus
Mixed hemorrhoids: connected dilation of both internal and external hemorrhoidal venous plexuses, forming a whole @Wang Yuquan
Anal fissure concept
Full-thickness skin fissure of the anal canal forming ischemic ulcers @Tong Yao
Anal cryptitis - Perianal abscess - Anal fistula concept
Anal cryptitis, also called anal sinusitis, is an acute or chronic inflammation occurring in the anal sinuses and anal valves, presenting symptoms such as incomplete defecation, heaviness, pain, anal itching, etc.
Perianal abscess, also known as perirectal or perianal soft tissue abscess, is an acute purulent infection occurring in the soft tissue or surrounding spaces around the anal canal and rectum; pus accumulates, forming an abscess usually caused by obstruction and infection of anal glands, mainly presenting as swelling and pain around the anus.
Anal fistula is a chronic infectious tract connecting the anal canal or rectum with the skin of the perineum, a sequela of rupture or incision drainage of perianal abscess; repeated spontaneous pus discharge and swelling pain around the anus are main symptoms.
@Tong Yao
Strangulated hemorrhoids concept
Initially manifests as bloody stools and discharge; gradually, stools deform, defecation difficulty increases, frequency rises, tenesmus and incomplete evacuation occur; a hard mass appears in the anus discharging pus and foul blood, commonly occurring in anal-rectal cancers, equivalent to anal canal or rectal cancer in Western medicine. @Tong Yao @Wang Yuquan
Most important examination method for strangulated hemorrhoids
Digital rectal examination @Wang Yuquan
Full length of rectum?
About 12 cm @Wang Yuquan
Full length of anal canal?
About 3 cm
Five anal-rectal spaces?
Two pelvic-rectal spaces, two ischiorectal spaces, one retrorectal space
Describe the 12-segment marking method for anal-rectal diseases
In the bladder lithotomy position, divide the anus into 12 parts according to a clock face marking method: the midpoint of the perineum is 12 o’clock, the midpoint of the sacrococcygeal region is 6 o’clock, left midpoint is 3 o’clock, right midpoint is 9 o’clock, and so on.
Describe the location and function of important anal sphincters
The anal sphincter is divided into internal and external sphincters.
The internal sphincter is the thickened distal part of the circular muscle of the rectum, surrounding the upper 2/3 of the anal canal, controlling anal function.
The external sphincter consists of subcutaneous, superficial, and deep parts.
The subcutaneous part is beneath the skin at the anal verge, surrounding the lower part of the anal canal, located external and inferior to the internal sphincter.
Briefly describe the four stages of internal hemorrhoids
Stage I: hemorrhoids are small, do not prolapse, mainly bleeding during defecation
Stage II: hemorrhoids enlarge, may prolapse externally during defecation but reduce spontaneously afterward; variable bleeding
Stage III: hemorrhoids prolapse on defecation or during walking, coughing, sneezing, or standing, unable to reduce spontaneously; manual reduction or lying down and warm compress is needed; bleeding is minimal or absent
Stage IV: incarcerated internal hemorrhoids; prolapsed hemorrhoids cannot be reduced timely and become incarcerated externally; congestion, edema, and thrombosis cause swelling, erosion, and necrosis.
Briefly describe the treatment principle and indications of sclerotherapy with atrophy injection
Principle: inject sclerosing agent into internal hemorrhoids to induce a aseptic inflammatory response in hemorrhoidal tissue, leading gradually to fibrosis.
Indications: Stage I, II, III internal hemorrhoids; internal hemorrhoids complicated with anemia; internal portion of mixed hemorrhoids.
Briefly describe the significance of different examination positions in anal-rectal examination
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@Wang Yuquan
Briefly describe the triad of anal fissure
Hypertrophic anal papilla, sentinel pile, subcutaneous fistula @Wang Yuquan
Names and indications of four anal fissure surgeries
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@Tong Yao March 30, 2022 18:30
Briefly describe Solomon’s law
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@Tong Yao March 30, 2022 18:30
Briefly describe the hang-string method for anal fistula
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@Tong Yao March 30, 2022 18:30
Briefly describe precautions for anal fistula incision method
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@Tong Yao March 30, 2022 18:30
Briefly describe grading of rectal prolapse
Grade I Prolapse Grade II Prolapse Grade III Prolapse Rectal mucosa prolapses; protrusion is light red, 3–5 cm length, not easy to bleed Full thickness rectal prolapse; protrusion 5–10 cm, conical shape, light red Rectum and part of sigmoid colon prolapse; length more than 10 cm, cylindrical shape Soft on palpation, no elasticity Surface is annular and layered Thicker on palpation, elastic Can spontaneously reduce after defecation Relaxed; sometimes requires manual reduction after defecation Relaxed and weak
@Wang Yuquan
Chinese medicine treatment of rectal prolapse (focus on composition of Bu Zhong Yi Qi Tang)
Qi deficiency with prolapse Bu Zhong Yi Qi Tang Damp heat downward Bi Xie Shen Shi Tang
@Wang Yuquan
Indications for mucosal subcutaneous injection and perirectal injection for rectal prolapse
Male Diseases
Concept of testicular abscess
Testicular abscess: purulent disease of the testis and epididymis
Concept of epididymal tuberculosis
Epididymal tuberculosis: ulcerative disease occurring in the epididymis
Concept of ovum plague
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@Fan Hongyou March 30, 2022 18:30
Normal sperm concentration
20,000/ml+ @Wang Yuquan
Urinary System Diseases
Three ureteral narrow points
Union of renal pelvis and ureter, crossing the pelvic brim (intersecting the iliac artery), and the bladder opening
@Wang Yuquan
Rocky Swelling (Tumor Sores)
Concept of loss of vitality:
Occurs in neck and area before and behind ears; in late stages, qi and blood deficiency with stasis occurs, leading to a wasted, haggard face and emaciated body; the appearance resembles branches and leaves of a withered tree losing its vitality, hence the name loss of vitality (Shi Rong) @Wang Yuquan
Concept of kidney rock peeling:
Rock swelling occurring on the penis, named kidney rock; with time, ulceration and skin cracking occur, called kidney rock peeling @Wang Yuquan
Peripheral Vascular Diseases — Common Major Topics
Concepts of intermittent pain/intermittent claudication/claudication distance:
Intermittent pain: mainly exercise-induced pain, referring to discomfort with movement including dull pain, tightness, pressure, cramping, or sharp pain in ischemic areas.
Intermittent claudication: exercise-induced pain occurring in the lower limbs.
Claudication distance: distance walked before pain appears; indicates disease severity—the shorter the distance, the more severe the condition.
@Wu Ziyu
Skin capillary refill test
Use fingers to press fingertips or toenails, observe capillary refill time to assess arterial blood supply to the extremities.
@Wu Ziyu
Limb position test
For lower limbs: expose feet, ankles, knees; elevate lower limbs; flex hip joint 70°-80° and maintain for 60 seconds; for upper limbs: sitting or standing position, raise both upper limbs above the head. Paleness or waxy white color on toes, soles, palms indicates arterial blood supply impairment.
@Wu Ziyu
Allen test
Examiner simultaneously compresses the patient’s radial and ulnar arteries; instructs patient to repeatedly clench fist and open fingers until palm color turns pale; examiner then releases pressure on ulnar artery while maintaining compression on radial artery; observes color changes of the palm. If color recovers within 10 seconds, ulnar and radial collateral circulation is good (positive Allen test), indicating radial artery can safely be punctured without causing ischemia even if radial artery occludes. If palm remains pale after 10 seconds, test is negative, indicating poor collateral circulation, radial artery puncture should be avoided to prevent severe ischemia.
@Wu Ziyu
Great saphenous vein valve function test
Patient lies supine; raise affected limb to empty varicose veins; place rubber tourniquet at upper third of thigh to prevent reflux in great saphenous vein. Patient stands for 30 seconds; release tourniquet; observe venous filling of great saphenous vein.
- Before releasing tourniquet, great saphenous vein collapses; upon release, immediate distal-to-proximal filling indicates valve insufficiency in great saphenous vein but normal inter-communication valves with deep veins.
- Vein partially filled before release, filling worsens after release, suggesting valve insufficiency both in great saphenous and inter-communicating valves.
- Vein filled before release and no increased filling after release indicates insufficient inter-communicating valves but normal great saphenous vein valves. Alternatively, venous filling starting from proximal to distal within 10 seconds after release indicates valve insufficiency in the great saphenous vein.
@Wu Ziyu
Deep vein patency test
- Examiner applies tourniquet at thigh root to compress main great saphenous vein trunk.
- After obvious filling of great saphenous vein, patient performs repeated squatting and standing 10 times.
- If varicose vein filling significantly decreases after exercise, it indicates superficial veins can return blood via deep veins, showing deep veins are patent.
@Wu Ziyu