中南大学湘雅医院外科学(普外科)2013年考博真题试卷

去年在小木虫、百度文库、丁香园、爱爱医收集的博士入学考试外科学简答题，是好几个学校在一块的，北医、上交、协和、山大,301，华科的，受益颇大，当时下载也花了不少心血，总结费了不少时间，分享给大家，一份耕耘，一份收获，但愿好运常相随！！！考博问答题整理无菌术1.什么是无菌术？无菌术的内容包括那些？无菌术是针对微生物及感染途径所采取的一系列预防措施。

无菌术的内容包括灭菌、消毒法、操作规则及管理制度。

2.无菌术、灭菌？所谓灭菌就是杀灭一切活的微生物。

而消毒是指杀灭病原微生物和其他活动有害微生物，但不要求奢靡额和清除所有微生物3.常用的灭菌消毒法有：(1)高压蒸汽法。

(2)煮沸法。

(3)火烧法。

(4)药液浸泡法。

(5)甲醛蒸汽熏蒸法。

4.手术过程中的无菌原则(1)手术人员穿无菌手术衣和戴无菌手套之后，手不能接触背部、腰部以下和肩部以上部位，这些区域属于有菌地带；同样，也不要接触手术台边缘以下的布单。

(2)不可在手术人员的背后传递手术器械及用品。

坠落到无菌巾或手术台边以外的器械物品，不准拾回再用。

(3)手术中如手套破损或接触到有菌地方，应更换无菌手套。

如前臂或肘部触碰有菌地方，应更换无菌手术衣或加套无菌袖套。

如无菌巾、布单等物已被湿透，其无菌隔离作用不再完整，应加盖干的无菌布单。

(4)在手术过程中，同侧手术人员如需调换位置，一人应先退后一步，背对背地转身到达另一位置，以防触及对方背部不洁区。

(5)手术开始前要清点器械、敷料，手术结束时，检查胸、腹等体腔，待核对器械、敷料数无误后，才能关闭切口，以免异物遗留腔内产生严重后果。

(6)切口边缘应以无菌大纱布垫或手术巾遮盖，并用巾钳或缝线固定，仅显露手术切口。

术前手术区粘贴无菌塑料薄膜可达到相同目的。

(7)做皮肤切口以及缝合皮肤之前，需再消毒皮肤一次。

(8)切开空腔脏器前，要先用纱布垫保护周围组织，以防止或减少污染。

(9)参观手术的人员不可太靠近手术人员或站得太高，也不可经常在室内走动，以减少污染的机会。

考博外科学试题及答案一、选择题（每题2分，共20分）1. 以下哪项不是外科手术的基本原则？A. 无菌操作B. 无创原则C. 快速切除D. 保护组织2. 外科手术中，以下哪项不是常用的止血方法？A. 压迫止血B. 电凝止血C. 药物止血D. 物理止血3. 以下哪种情况不适合进行手术治疗？A. 急性阑尾炎B. 慢性胆囊炎C. 严重营养不良D. 早期乳腺癌4. 外科手术中，以下哪项不是术后并发症？A. 感染B. 出血C. 疼痛D. 血栓形成5. 以下哪项是腹腔镜手术的优点？A. 切口大B. 恢复快C. 视野差D. 并发症多6. 以下哪项是外科手术前的常规准备？A. 禁食禁水B. 立即手术C. 无需体检D. 无需心理辅导7. 以下哪种麻醉方式适用于短小手术？A. 全身麻醉B. 局部麻醉C. 椎管内麻醉D. 神经阻滞麻醉8. 以下哪项是外科手术中常见的感染类型？A. 细菌性感染B. 真菌性感染C. 病毒性感染D. 寄生虫感染9. 以下哪项是外科手术中常见的并发症？A. 心律失常B. 肾功能衰竭C. 肺栓塞D. 以上都是10. 以下哪项是外科手术中的无菌操作原则？A. 无菌区域与非无菌区域分离B. 手术器械随意摆放C. 手术人员可以随意进出手术室D. 手术人员可以不戴口罩答案：1-5 C, D, C, D, B；6-10 A, B, A, D, A二、简答题（每题10分，共30分）1. 简述外科手术前的基本准备流程。

答：外科手术前的基本准备流程包括：患者体检、病情评估、术前讨论、手术方案制定、患者及家属的知情同意、禁食禁水、皮肤准备、术前用药等。

2. 请列举三种常见的外科手术并发症，并简要说明其预防措施。

答：常见的外科手术并发症包括感染、出血和血栓形成。

预防措施分别为：严格遵守无菌操作原则、术中控制出血、术后使用抗凝药物和鼓励患者早期活动。

3. 描述腹腔镜手术与传统开腹手术的主要区别。

答：腹腔镜手术与传统开腹手术的主要区别在于：腹腔镜手术切口小、创伤小、恢复快、疼痛轻、住院时间短；而传统开腹手术切口大、创伤大、恢复慢、疼痛重、住院时间较长。

2013年外科学真题回忆版(外科学+普通外科+骨外科+心胸外科+整形外科+泌尿外科)2013年外科主治医师考试相关专业知识真题2013年外科主治医师考试相关专业知识真题，考生回忆版，试题供各位考生参考。

1、距骨颈骨折手术入口：2、甲状腺手术后出现切口内出血：及时剪开缝线，迅速去除血肿。

3、17岁女生甲状腺二度肿大治疗方案：碘剂后手术。

4、硬膜外血肿：脑膜中动脉。

5、青年女生，洗澡时发现右乳外上象限一肿物，无痛：乳房纤维腺瘤。

6、乳腺癌患者乳房表面皮肤凹陷：累能Cooper韧带。

7、纵隔上、下两部：以胸骨角与第4胸椎下缘水平线为界。

8、脾切除后并发症除了：胰瘘。

9、十二指肠破裂最常见于：降部和水平部。

10、急性血源性骨髓炎最常见细菌：溶血性金葡菌。

11、胃十二指肠溃疡穿孔最常发生部位：胃小弯和十二指肠球部前壁。

12、病例：毕二式胃切除术后出现腹痛、发热、腹膜刺激征，腹穿秀胆汁样液体：十二指肠残端破裂。

13、成人肠套叠病因多见于：病理因素（肿瘤、肠息肉）。

14、阑尾炎保守治疗：化脓性阑尾炎。

15、直肠癌距肛门10cm，手术方案：经腹会阴联合直肠癌根治术。

16、下肢静脉曲张潘氏试验：深静脉是否通畅17、上消化道大出血最常见的原因：胃十二指肠溃疡。

18、可诱发急性胰腺炎：ERCP19、直径2cm的胆囊结石治疗方法：胆囊切除术。

20、有胆道回虫病史30年，近日出现发热、黄疸、腹痛，血象高，考虑诊断：急性化脓性胆管炎。

21、内分泌肿瘤中最常见的是：甲状腺。

22、壶腹癌与胰头癌的鉴别最可能是壶腹癌的是：肝内外胆管均扩张。

23、胃溃疡病人上消化道大出血，血压：80/60mmHg，选择止血方案是：三腔二囊管压迫止血。

24、急性胰腺炎出血坏死型，增强CT不仅可以明确诊断，而且可以发现坏死的胰腺组织。

25、膀胱憩室结石治疗方案：耻骨上膀胱切开取石。

26、耻骨支、坐骨支骨折后尿道滴血，属于哪种骨折？开放性骨折。

27、骨折后血肿吸收热一般不超过：38度。

2013MD全国医学博士外语统一考试英语试卷答题须知1．请考生首先将自己的姓名、所在考点、准考证号在试卷一答题纸和试卷二标准答题卡上认真填写清楚，并按“考场指令”要求，将准考证号在标准答题卡上划好。

2．试卷一(Paper One)答案和试卷二(Paper Two)答案都作答在标准答题卡上，不要做在试卷上。

3．试卷一答题时必须使用2B铅笔，将所选答案按要求在相应位置涂黑；如要更正，先用橡皮擦干净。

书面表达一定要用黑色签字笔或钢笔写在标准答题卡上指定区域。

4．标准答题卡不可折叠，同时答题卡须保持平整干净，以利评分。

5．听力考试只放一遍录音，每道题后有15秒左右的答题时间。

国家医学考试中心PAPER ONEPart 1 ：Listening comprehension（30%）Section ADirections:In this section you will hear fifteen short conversations between two speakers, At the end of each conversation, you will hear a questionabout what is said, The question will be read only once, After you hearthe question, read the four possible answers marked A, B, C, and D.Choose the best answers and mark the letter of your choice on theANSWER SHEET.Listen to the following exampleYou will hearWoman: I feel faint.Man: No wonder. You haven’t had a bite all day.Question: What’s the matter with the woman?You will read:A. She is sick.B. She was bitten by an ant.C. She is hungry.D. She spilled her paint.Here C is the right answer.Sample AnswerA B C DNow let’s begin with question Number 1.1. A. A cough B. Diarrhea C. A fever D. V omiting2. A. Tuberculosis B. Rhinitis C. Laryngitis D. Flu3. A. In his bag. B. By the lamp.C. In his house.D. No idea about where he left it.4. A. He’s nearly finished his work.B. He has to work for some more time.C. He wants to leave now.D. He has trouble finishing his work.5. A. A patient B. A doctor C. A teacher D. A student6. A. 2.6 B. 3.5 C. 3.9 D. 1367. A. He is the head of the hospital. B. He is in charge of Pediatrics.C. He went out looking for Dan.D. He went to Michigan on business.8. A. He has got a fever. B. He is a talented skier.C. He is very rich.D. He is a real ski enthusiast.9. A. To ask local people for help.B. To do as Romans do only when in Rome.C. Try to act like the people from that culture.D. Stay with your country fellows.10.A. She married because of loneliness.B. She married a millionaire.C. She married for money.D. She married for love.11.A. Aspirant B. Courageous C. Cautious D. Amiable12.A. He was unhappy. B. He was feeling a bit unwell.C. He went to see the doctor.D. The weather was nasty.13.A. You may find many of them on the bookseller’ shelves.B. You can buy it from almost every bookstore.C. It’s a very popular magazine.D. It doesn’t sell very well.14.A. A general practitioner. B. A gynecologist.B. An orthopedist D. A surgeon.15.A. Chemotherapy B. Radiation C. Injections D. Surgery Section BDirection:In this section you will hear one conversation and two passages, after each of which, you will hear five questions. After each question, readthe four possible answers marked A, B, C and D, Choose the bestanswer and mark the letter of your choice on the ANSWER SHEET. Dialogue16.A. It is a genetic disorder.B. It is a respiratory condition in pigs.C. It is an illness from birds to humans.D. It is a gastric ailment.17.A. Eating pork.B. Raising pigs.C. Eating chicken.D. Breeding birds.18.A. Running nose.B. Inappetence.C. Pains all over.D. Diarrhea.19.A. To stay from crowds. B. To see the doctor immediately.C. To avoid medications.D. To go to the nearby clinic.20.A. It is a debate.B. It is a TV program.C. It is a consultation.D. It is a workshop.Passage One21.A. About 10,000,000.B. About 1,000,000.C. About 100,000.D. About 10,000.22.A. A cocktail of vitamins.B. A cocktail of vitamins plus magnesium.C. The combination of vitamins A, C and E.D. The combination of minerals.23.A. The delicate structures of the inner ear. B. The inner ear cells.C. The eardrums.D. The inner ear ossicles.24.A. General Motors. B. The United Auto Workers.C. NIH.D. All of above.25.A. An industrial trial in Spain.B. Military trials in Spain and Sweden.C. Industrial trials in Spain and Sweden.D. A trial involving students at the University of Florida.Passage Two26.A. The link between obesity and birth defects.B. The link between obesity and diabetes.C. The risk of birth abnormalities.D. The harmful effects of obesity.27.A. Neural tube defects. B. Heart problems.C. Cleft lip and palate.D. Diabetes.28.A. 20 million. B. 200 million.C. 400 million.D. 40 million.29.A. A weight-loss surgery. B. A balanced diet.C. A change of life style.D. More exercise.30.A. Why obesity can cause birth defects.B. How obesity may cause birth defects.C. Why obesity can cause diabetes.D. How obesity may cause diabetes.Part II Vocabulary (10%)Section ADirection:In this section, all the sentences are incomplete. Four words or phrases, marked A B C and D .are given beneath each of them. You are tochoose the word or phrase that best completes the sentence. Then markyour answer on the ANSWER SHEET.31. Having a bird’s eye view from the helicopter, the vast pasture was __________ with beautiful houses.A. overlappedB. segregatedC. intersectedD. interspersed32. As usual, Singapore Airlines will reduce trans-pacific capacity in _________ seasons this year.A. sternB. slackC. sumptuousD. glamorous33. As to the living environment, bacteria’s needs vary, but most of them grow best ina slightly acid ___________.A. mechanismB. miniatureC. mediumD. means34. Under an unstable economic environment, employers in the construction industry place great value on ___________ in hiring and laying off workers as their volumes of work wax and wane.A. flexibilityB. moralityC. capacityD. productivity35. In a stark _________ of fortunes, the Philippines – once Asia’s second richest country – recently had to beg Vietnam to sell its rice for its hungry millions.A. denialB. reversalC. intervalD. withdrawal36. Web portal Sohu has gone a step further and called for netizens to join in an all-out boycott of __________ content.A. wholesomeB. contagiousC. vulgarD. stagnant37. Experts urge a reforesting of cleared areas, promotion of reduced-impact logging, and _____________ agriculture, to maintain the rain forest.A. sustainableB. renewableC. revivableD. merchandisable38. In the U.S., the Republican’s doctrines were slightly liberal, whereas the Democrats’ were hardly _____________.A. rationalB. radicalC. conservativeD. progressive39. Officials from the Department of Agriculture confirmed that the __________ floods and drought this summer did not affect the country’s grain output.A. ripplingB. waningC. fluctuatingD. devastating40. It is believed that the Black Death, rampant in the Medieval Europe __________, killed 1/3 of its population.A. at largeB. at randomC. on endD. on averageSection BDirections:Each of the following sentences has a word or phase underlined. There are four words or phases beneath each sentence, Choose the word orphase which can best keep the meaning of the original sentence if it issubstituted for the underlined part, Mark your answer on theANSWER SHEET.41. Christmas shoppers should be aware of the possible defects of the products sold ata discount.A. deficitsB. deviationsC. drawbacksD. discrepancies42. The goal of this training program is to raise children with a sense of responsibility and necessary courage to be willing to take on challenges in life.A. despiseB. evadeC. demandD. undertake43. After “9.11”, the Olympic Games severely taxed the security services of the host country.A. improvedB. burdenedC. inspectedD. tariffed44. The clown’s performance was so funny that the audience, adults and children alike, were all thrown into convulsions.A. a fit of enthusiasmB. a scream of frightC. a burst of laughterD. a cry of anguish45. We raised a mortgage from Bank of China and were informed to pay it off by the end of this year.A. loanB. paymentC. withdrawalD. retrieval46. The advocates highly value the “sport spirit”, while the opponent devalue it, asserting that it’s a sheer hypocrisy and self-deception.A. fineB. suddenC. finiteD. absolute47. Whenever a rattlesnake is agitated, it begins to move its tail and make a rattling noise.A. irritatedB. tamedC. stampedD. probed48. The detective had an unusual insight into criminal’s tricks and knew clearly how to track them.A. inductionB. perceptionC. interpretationD. penetration49. My little brother practices the speech repeatedly until his delivery and timing were perfect.A. presentationB. gestureC. rhythmD. pronunciation50. In recent weeks both housing and stock prices have started to retreat from their irrationally amazing highs.A. untimelyB. unexpectedlyC. unreasonablyD. unconventionallyPart III Cloze (10%)Directions: In this section there is a passage with ten numbered blanks. For each blank, there are four choices marked A, B, C, and D on the right side.Choose the best answer and mark the letter of your choice on theANSWER SHEET.Video game players may get an unexpected benefitfrom blowing away bad guys—better vision. Playing “action” video games improves a visual ability __51__ tasks like reading and driving at night, a new study says. The ability, called contrast sensitivity function, allows people to discern even subtle changes __52__ gray against a uniformly colored backdrop. It’s also one of the first visual aptitudes to fade with age. __53__ a regular regimen of action video game training can provide long-lasting visual power, according to work led by Daphne Bavelier of the University of Rochester.Previous research shows that gaming improves other visual skills, such as the ability to track several objects at the same time and __54__ attention to a series of fast-moving events. Bavelier said, “A lot of different aspects of the visual system are being enhanced, __55__.”The new work suggests that playing video games could someday become part of vision-correction treatments, which currently rely mainly on surgery or corrective lenses. “__56__ you’ve had eye surgery or get corrective lenses, exposing yourself to these games should help the optical system to recover faster and better, you need to retrain the brain to make use of the better, crisper information that’s coming in __57__ your improved eyesight,” Bavelier said.Expert action gamers in the study played first-person shooters Unreal Tournament 2004 and Call of Duty 2. A group of experienced nonaction gamers played The Sims 2, a “life simulation” video game. The players of nonaction video games didn’t see the same vision __58__, the study says. Bavelier and others are now trying to figure out exactly why action games __59__ seem to sharpen visual skill. It may be that locating enemies and aiming accurately is a strenuous, strength-building workout for the eyes, she said. Another possible __60__ is that the unpredictable, fast-changing environment of the typical action game requires players to constantly monitor entire landscapes and analyze optical data quickly.51. A. crucial forB. available inC. resulting fromD. ascribed to52. A. in disguise ofB. in shades ofC. in search ofD. in place of53. A. This is howB. That’s whyC. It is not thatD. There exists54. A. paidB. paysC. payD. paying55. A. thoughB. not to sayC. not just oneD. as well56. A. UntilB. WhileC. UnlessD. Once57. A. as opposed toB. in addition toC. as a result ofD. in spite of58. A. benefitsB. defectsC. approachesD. risks59. A. in caseB. in advanceC. in returnD. in particular60. A. effectB. reasonC. outcomeD. conclusionPart IV Reading Comprehension (30%)Directions:In this part there are six passages, each of which is followed by 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 onthe ANSWER SHEET.Passage oneThere is plenty we don’t know about criminal behavior. Most crime goes unreported so it is hard to pick out trends from the data, and even reliable sets of statistics can be difficult to compare. But here is one thing we do know: those with a biological predisposition to violent behavior who are brought up in abusive homes are very likely to become lifelong criminals.Antisocial and criminal behavior tends to run in families, but no one was sure whether this was due mostly to social-environmental factors or biological ones. It turns out both are important, but the effect is most dramatic when they act together. This has been illustrated in several studies over the past six years which found that male victims of child abuse are several times as likely to become criminals and abusers themselves if they were born with a less-active version of a gene for the enzyme monoamine oxidase A (MAO-A), which breaks down neurotransmitters crucial to the regulation of aggression.Researchers recently made another key observation: kids with this “double whammy” of predisposition and an unfortunate upbringing are likely to show signs of what’s to come at a very early age. The risk factors for long-term criminality – attention deficit hyperactivity disorder, low IQ, language difficulties – can be spotted in kindergarten. So given what we now know, shouldn’t we be doing everything to protect the children most at risk?No one is suggesting testing all boys to see which variant of the MAO-A gene they have, but what the science is telling us is that we should redouble efforts to tackle abusive upbringings, and even simple neglect. This will help any child, but especially those whose biology makes them vulnerable. Thankfully there is already considerable enthusiasm in both the US and the UK for converting the latest in behavioral science into parenting and social skills: both governments have schemes in place to improve parenting in families where children are at risk of receiving poor care.Some people are uncomfortable with the idea of early intervention because it implies our behavior becomes “set” as we grow up, compromising the idea of free will. That view is understandable, but it would be negligent to ignore what the studies are telling us. Indeed, the cost to society of failing to intervene －in terms of criminal damage, dealing with offenders and helping victims of crime －is bound to be greater than the cost of improving parenting. The value to the children is immeasurable.61. Researchers have come to a consensus: to explain violent behavior ________.A. in terms of physical environmentB. form a biological perspectiveC. based on the empirical dataD. in a statistical way62. When we say that antisocial and criminal behavior tends to run in families, asindicated by the recent findings, we can probably mean that ___________.A. a particular gene is passed on in familiesB. child abuse will lead to domestic violenceC. the male victims of child abuse will pass on the tendencyD. the violent predisposition is exclusively born of child abuse63. The recent observation implicated that to check the development of antisocialand criminal behavior ___________.A. boys are to be screened for the biological predispositionB. high-risk kids should be brought up in kindergartenC. it is important to spot the genes for the risk factorsD. active measures ought to be taken at an early age64. To defend the argument against the unfavorable idea, the author makes it apoint to consider ___________.A. the immeasurable value of the genetic research on behaviorB. the consequences of compromising democracyC. the huge cost of improving parenting skillsD. the greater cost of failing to intervene65. Which of the following can be the best title for the passage?A. Parenting Strategies for KidsB. The Making of a CriminalC. Parental EducationD. Abusive ParentingPassage twoAfter 25 years battling the mother of all viruses, have we finally got the measure of HIV? Three developments featured in this issue collectively give grounds for optimism that would have been scarcely believable a year ago in the wake of another failed vaccine and continuing problems supplying drugs to all who need them.Perhaps the most compelling hope lies in the apparent “cure” of a man with HIV who had also developed leukemia. Doctors treated his leukemia with a bone marrow transplant that also vanquished the virus. Now US Company Sangamo Biosciences is hoping to emulate the effect patients being cured with a single shot of gene therapy, instead of taking antiretroviral drugs for life.Antiretroviral therapy (ART) is itself another reason for optimism. Researchers at the World Health Organization have calculated that HIV could be effectively eradicated in Africa and other hard-hit places using existing drugs. The trick is to test everyone often, and give those who test positive ART as soon as possible. Because the drugs rapidly reduce circulating levels of the virus to almost zero, it would stop people passing it on through sex. By blocking the cycle of infection in this way, the virus could be virtually eradicated by 2050.Bankrolling such a long-term program would cost serious money – initially around $3.5 billion a year in South Africa alone, ring to $85 billion in total. Huge as it sounds, however, it is peanuts compared with the estimated $1.9 trillion cost of the Iraq war, or the $700 billion spent in one go propping up the US banking sector. It also look small beer compared with the costs of carrying on as usual, which the WHO says can only lead to spiraling cases and costs.The final bit of good news is that the cost of ART could keep on falling. Last Friday, GlaxoSmithKline chairman Andrew Witty said that his company would offer all its medicines to the poorest countries for at least 25 per cent less than the typical price in rich countries. GSK has already been doing this for ART, but the hope is that the company may now offer it cheaper still and that other firms will follow their lead.No one doubt the devastation caused by AIDS. In 2007, 2 million people died and 2.7 million more contracted the virus. Those dismal numbers are not going to turn around soon – and they won’t turn around at all without huge effort and investment. But at least there is renewed belief that, given the time and money, we can finally start riddling the world of this most fearsome of viruses.66. Which is the following can be most probably perceived beyond the first paragraph?A. The end of the world.B. A candle of hope.C. A Nobel prize.D. A Quick Fix.67. According to the passage, the apparent “cure” of the HIV patient who had alsodeveloped leukemia would ___________.A. make a promising transition from antiretroviral medication to gene therapyB. facilitate the development of effective vaccines for the infectionC. compel people to draw an analogy between AIDS and leukemiaD. would change the way we look at those with AIDS68. As another bit of good news, ___________.A. HIV will be virtually wiped out first in AfricaB. the cycle of HIV infection can be broken with ARTC. the circulating levels of HIV have been limited to almost zeroD. the existing HIV drugs will be enhanced to be more effective in 25 years69. The last reason for optimism is that ___________.A. governments will invest more in improving ARTB. the cost of antiretroviral therapy is on the declineC. everybody can afford antiretroviral therapy in the worldD. the financial support of ART is coming to be no problem70. The whole passage carries a tone of ___________.A. idealismB. activismC. criticismD. optimismPassage ThreeArchaeology can tell us plenty about how humans looked and the way they lived tens of thousands of years ago. But what about the deeper questions? Could early humans speak, were they capable of self-conscious reflection, did they believe in anything?Such questions might seem to be beyond the scope of science. Not so. Answering them is the focus of a burgeoning field that brings together archaeology and neuroscience. It aims to chart the development of human cognitive powers. This is not easy to do. A skull gives no indication of whether its owner was capable of speech, for example. The task then is to find proxies (替代物)for key traits and behaviors that have stayed intact over millennia.Perhaps the most intriguing aspect of this endeavor is teasing out the role of culture as a force in the evolution of our mental skills. For decades, development of the brain has been seen as exclusively biological. But increasingly, that is being challenged.Take what the Cambridge archaeologist Colin Renfrew calls “the sapient (智人的) paradox (矛盾)”. Evidence suggests that the human genome, and hence the brain, has changed little in the past 60,000 years. Yet it wasn’t until about 10,000 years ago that profound changes took place in human behavior: people settled in villages and built shrines. Renfrew’s paradox is why, if the hardware was in place, did it take so long for humans to start changing the world?His answer is that the software – the culture – took a long time to develop. In particular, the intervening time saw humans vest (赋予) meaning in objects and symbols. Those meanings were developed by social interaction over successive generations,passed on through teaching, and stored in the neuronal connections of children.Culture also changes biology by modifying natural selection, sometimes in surprising ways. How is it, for example, that a human gene for making essential vitamin C became blocked by junk DNA? One answer is that our ancestors started eating fruit, so the pressure to make vitamin C “relaxed” and the gene became unnecessary. By this reasoning, early humans then became addicted to fruit, and any gene that helped them to find it was selected for.Evidence suggests that the brain is so plastic that, like genes, it can be changed by relaxing selection pressure. Our understanding of human cognitive development is still fragmented and confused, however. We have lots of proposed causes and effects, and hypotheses to explain them. Yet the potential pay-off makes answers worth searching for. If we know where the human mind came from and what changed it, perhaps we can gauge where it is going. Finding those answers will take all the ingenuity the modern human mind can muster.71. The questions presented in the first paragraph ___________.A. seem to have no answers whateverB. are intended to dig for ancient human mindsC. are not scientific enough to be answered hereD. are raised to explore the evolution of human appearance72. The scientists find the proxy to be ___________.A. the role of cultureB. the passage of timeC. the structure of a skullD. the biological makeup of the brain73. According to Renfrew’s paradox, the transition from 60,000 to 10,000 years agosuggests that ___________.A. human civilization came too lateB. the hardware retained biologically staticC. it took so long for the software to evolveD. there existed an interaction between gene and environment74. From the example illustrating the relation between culture and biology, wemight conclude that ___________.A. the mental development has not been exclusively biologicalB. the brain and culture have not developed at the same paceC. the theory of natural selection applies to human evolutionD. vitamin C contributes to the development of the brain75. Speaking of the human mind, the author would say that ___________.A. its cognitive development is extremely slowB. to know its past is to understand its futureC. its biological evolution is hard to predictD. as the brain develops, so as the mindPassage FourDespite the numerous warnings about extreme weather, rising sea levels and mass extinctions, one message seems to have got lost in the debate about the impact of climate change. A warmer world won’t just be inconvenient. Huge swathes (片) of it, including most of Europe, the US and Australia as well as all of Africa and China will actually be uninhabitable--- too hot, dry or stormy to sustain a human population.This is no mirage. It could materialize if the world warms by an average of just 4°C, which some models predict could happen as soon as 2050. This is the world our children and grandchildren are going to have to live in. So what are we going to do about it?One option is to start planning to move the at-risk human population to parts of the world where it will still be cool and wet. It might seem like a drastic move, but this thought experiment is not about scaremongering (危言耸听). Every scenario is extrapolated from predictions of the latest climate models, and some say that 4°C may actually turn out to be a conservative estimate.Clearly this glacier-free, desertified world---with its human population packed into high-rise cities closer to the poles---would be a last resort. Aside from anything else, it is far from being the most practical option: any attempt at mass migration is likely to fuel wars, political power struggles and infighting.So what are the alternatives? The most obvious answer is to radically reduce carbon dioxide levels now, by fast-tracking green technologies and urgently implementing energy-efficient measures. But the changes aren’t coming nearly quickly enough and global emissions are still rising. As a result, many scientists are now turning to “Earth’s plan B”.Plan B involves making sure we have large scale geoengineering technologies ready and waiting to either suck CO2 out of the atmosphere or deflect the sun’s heat. Most climate scientists were once firmly against fiddling with the Earth’s thermostat, fearing that it may make a bad situation even worse, or provide politicians with an excuse to sit on their hands and do nothing.Now they reluctantly acknowledge the sad truth that we haven’t managed to reorder the world fast enough to reduce CO2 emissions and that perhaps, given enough funding research and political muscle, we can indeed design, test and regulate geoengineering projects in time to avert the more horrifying consequences of climate change.Whatever we do, now is the time to act. The alternative is to plan for a hothouse world that none of us would recognize as home.76. To begin with, the author is trying to remind us of ____________.A. the likelihood of climate change making life inconvenientB. the warning against worsening climate changeC. the inevitable consequence of global warmingD. the misconception of a warmer world77. As the thought experiment shows, those at risk from global warming will ____________.A. live with the temperature raised by an average of 4°CB. have nowhere to go but live in the desertC. become victims as soon as 2050D. move closer to the poles78. It is clear from the passage that a practical approach to global warming is _________.A. to reduce massively CO2 emissionsB. to take protective measures by 2025C. to prepare a blueprint for mass migrationsD. to launch habitual constructions closer to the poles。

全国医学博士外语统一考试英语真题2013年(总分：100.00，做题时间：180分钟)一、Part 1 ：Listening comprehension（30%） (总题数：15，分数：15.00)A.A coughB.Diarrhea √C.A feverD.Vomiting解析：A.TuberculosisB.RhinitisryngitisD.Flu √解析：A.In his bag.B.By the lamp.C.In his house. √D.No idea about where he left it.解析：A.He’s nearly finished his work.B.He has to work for some more time. √C.He wants to leave now.D.He has trouble finishing his work.解析：A.A patientB.A doctorC.A teacherD.A student √解析：A.2.6B.3.5C.3.9D.136 √解析：A.He is the head of the hospital.B.He is in charge of Pediatrics.C.He went out looking for Dan.D.He went to Michigan on business. √解析：A.He has got a fever.B.He is a talented skier.C.He is very rich.D.He is a real ski enthusiast. √解析：A.To ask local people for help.B.To do as Romans do only when in Rome.C.Try to act like the people from that culture. √D.Stay with your country fellows.解析：A.She married because of loneliness.B.She married a millionaire.C.She married for money. √D.She married for love.解析：A.AspirantB.Courageous √C.CautiousD.Amiable解析：A.He was unhappy.B.He was feeling a bit unwell. √C.He went to see the doctor.D.The weather was nasty.解析：A.You may find many of them on the bookseller’ shelves.B.You can buy it from almost every bookstore.C.It’s a very popular magazine.√D.It doesn’t sell very well.解析：A.A general practitioner.B.A gynecologist. √C.An orthopedistD.A surgeon.解析：A.ChemotherapyB.RadiationC.Injections √D.Surgery解析：二、Section B (总题数：3，分数：15.00)A.It is a genetic disorder.B.It is a respiratory condition in pigs. √C.It is an illness from birds to humans.D.It is a gastric ailment.解析：A.Eating pork.B.Raising pigs. √C.Eating chicken.D.Breeding birds.解析：A.Running noseB.Inappetence √C.Pains all overD.Diarrhea解析：A.To stay from crowds. √B.To see the doctor immediately.C.To avoid medications.D.To go to the nearby clinic.解析：A.It is a debate.B.It is a TV program. √C.It is a consultation.D.It is a workshop.解析：A.About 10,000,000. √B.About 1,000,000.C.About 100,000.D.About 10,000.解析：A.A cocktail of vitamins.B.A cocktail of vitamins plus magnesium. √C.The combination of vitamins A, C and E.D.The combination of minerals.解析：A.The delicate structures of the inner ear. √B.The inner ear cells.C.The eardrums.D.The inner ear ossicles.解析：A.General Motors.B.The United Auto Workers.C.NIH √D.All of above.解析：A.An industrial trial in Spain.itary trials in Spain and Sweden.C.Industrial trials in Spain and Sweden. √D.A trial involving students at the University of Florida. 解析：A.The link between obesity and birth defects. √B.The link between obesity and diabetes.C.The risk of birth abnormalities.D.The harmful effects of obesity.解析：A.Neural tube defects.B.Heart problems.C.Cleft lip and palateD.Diabetes √解析：A.20 million.B.200 million.C.400 million. √D.40 million.解析：A.A weight-loss surgery. √B.A balanced diet.C.A change of life style.D.More exercise.解析：A.Why obesity can cause birth defects.B.How obesity may cause birth defects. √C.Why obesity can cause diabetes.D.How obesity may cause diabetes.解析：三、Part II Vocabulary (10%) (总题数：10，分数：5.00)16.Having a bird’s eye view from the helicopter, the vast pasture was __________ with beautiful houses.（分数：0.50）A.overlappedB.segregatedC.intersectedD.interspersed √解析：17.As usual, Singapore Airlines will reduce trans-pacific capacity in _________ seasons this year. （分数：0.50）A.sternB.slack √C.sumptuousD.glamorous解析：18.As to the living environment, bacteria’s needs vary, but most of them grow best in a slightly acid ___________.（分数：0.50）A.mechanismB.miniatureC.medium √D.means解析：19.Under an unstable economic environment, employers in the construction industry place great value on ___________ in hiring and laying off workers as their volumes of work wax and wane. （分数：0.50）A.flexibility √B.moralityC.capacityD.productivity解析：20.In a stark _________ of fortunes, the Philippines –once Asia’s second richest country –recently had to beg Vietnam to sell its rice for its hungry millions.（分数：0.50）A.denialB.reversal √C.intervalD.withdrawal解析：21.Web portal Sohu has gone a step further and called for netizens to join in an all-out boycott of __________ content.（分数：0.50）A.wholesomeB.contagiousC.vulgar √D.stagnant解析：22.Experts urge a reforesting of cleared areas, promotion of reduced-impact logging, and_____________ agriculture, to maintain the rain forest.（分数：0.50）A.sustainable √B.renewableC.revivableD.merchandisable解析：23.In the U.S., the Republican’s doctrines were slightly liberal, whereas the Democrats’ were hardly _____________.（分数：0.50）A.rationalB.radicalC.conservative √D.progressive解析：24.Officials from the Department of Agriculture confirmed that the __________ floods and drought this summer did not affect the country’s grain output.（分数：0.50）A.ripplingB.waningC.fluctuatingD.devastating √解析：25.It is believed that the Black Death, rampant in the Medieval Europe __________, killed 1/3 of its population.（分数：0.50）A.at large √B.at randomC.on endD.on average解析：四、Section B (总题数：10，分数：5.00)26.Christmas shoppers should be aware of the possible defects of the products sold at a discount. （分数：0.50）A.deficitsB.deviationsC.drawbacks √D.discrepancies解析：27.The goal of this training program is to raise children with a sense of responsibility and necessary courage to be willing to take on challenges in life.（分数：0.50）A.despiseB.evadeC.demandD.undertake √解析：28.After “9.11”, the Olympic Games severely taxed the security services of the host country. （分数：0.50）A.improvedB.burdened √C.inspectedD.tariffed解析：29.The clown’s performance was so funny that the audience, adults and children alike, were all thrown into convulsions.（分数：0.50）A.a fit of enthusiasmB.a scream of frightC.a burst of laughter √D.a cry of anguish解析：30.We raised a mortgage from Bank of China and were informed to pay it off by the end of this year.（分数：0.50）A.loan √B.paymentC.withdrawalD.retrieval解析：31.The advocates highly value the “sport spirit”, while the opponent devalue it, asserting that it’s a sheer hypocrisy and self-deception.（分数：0.50）A.fineB.suddenC.finiteD.absolute √解析：32.Whenever a rattlesnake is agitated, it begins to move its tail and make a rattling noise. （分数：0.50）A.irritated √B.tamedC.stampedD.probed解析：33.The detective had an unusual insight into criminal’s tricks and knew clearly how to track them.（分数：0.50）A.inductionB.perception √C.interpretationD.penetration解析：34.My little brother practices the speech repeatedly until his delivery and timing were perfect. （分数：0.50）A.presentation √B.gestureC.rhythmD.pronunciation解析：35.In recent weeks both housing and stock prices have started to retreat from their irrationally amazing highs.（分数：0.50）A.untimelyB.unexpectedlyC.unreasonably √D.unconventionally解析：五、Part III Cloze (10%) (总题数：1，分数：10.00)Video game players may get an unexpected benefit from blowing away bad guys—better vision. Playing “action” video games improves a visual ability __51__ tasks like reading and driving at night, a new study says. The ability, called contrast sensitivity function, allows people to discern even subtle changes __52__ gray against a uniformly colored backdrop. It’s also one of the first visual aptitudes to fade with age. __53__ a regular regimen of action video game training can provide long-lasting visual power, according to work led by Daphne Bavelier of the University of Rochester. Previous research shows that gaming improves other visual skills, such as the ability to track several objects at the same time and __54__ attention to a series of fast-moving events. Bavelier said, “A lot of different aspects of the visual system are being enhanced, __55__.” The new work suggests that playing video games could someday become part of vision-correction treatments, which currently rely mainly on surgery or corrective lenses. “__56__ you’ve had eye surgery or get corrective lenses, exposing yourself to these games should help the optical system to recover faster and better, you need to retrain the brain to make use of the better, crisper information that’s coming in __57__ your improved eyesight,” Bavelier said. Expert action gamers in the study played first-person shooters Unreal Tournament 2004 and Call of Duty 2. A group of experienced nonaction gamers played The Sims 2, a “life simulation” video game. The players of nonaction video games didn’t see the same vision __58__, the study says. Bavelier and others are now trying to figure out exactly why action games __59__ seem to sharpen visual skill. It may be that locating enemies and aiming accurately is a strenuous, strength-building workout for the eyes, she said. Another possible __60__ is that the unpredictable, fast-changing environment of the typical action game requires players to constantly monitor entire landscapes and analyze optical data quickly. （分数：10.00）A.crucial for √B.available inC.resulting fromD.ascribed to解析：A.in disguise ofB.in shades of √C.in search ofD.in place of解析：A.This is howB.That’s why√C.It is not thatD.There exists解析：A.paidB.paysC.payD.paying √解析：A.thoughB.not to sayC.not just one √D.as well解析：A.UntilB.WhileC.UnlessD.Once √解析：A.as opposed toB.in addition toC.as a result of √D.in spite of解析：A.benefits √B.defectsC.approachesD.risks解析：A.in caseB.in advanceC.in returnD.in particular √解析：A.effectB.reason √C.outcomeD.conclusion解析：六、Part IV Reading Comprehension (30%) (总题数：6，分数：30.00)Passage one There is plenty we don’t know about criminal behavior. Most crime goes unrepor ted so it is hard to pick out trends from the data, and even reliable sets of statistics can be difficult to compare. But here is one thing we do know: those with a biological predisposition to violent behavior who are brought up in abusive homes are very likely to become lifelong criminals.Antisocial and criminal behavior tends to run in families, but no one was sure whether this was due mostly to social-environmental factors or biological ones. It turns out both are important, but the effect is most dramatic when they act together. This has been illustrated in several studies over the past six years which found that male victims of child abuse are several times as likely to become criminals and abusers themselves if they were born with a less-active version of a gene for the enzyme monoamine oxidase A (MAO-A), which breaks down neurotransmitters crucial to the regulation of aggression. Researchers recently made another key observation: kids with this “double whammy” of predisposition and an unfortunate upb ringing are likely to show signs of what’s to come at a very early age. The risk factors for long-term criminality –attention deficit hyperactivity disorder, low IQ, language difficulties –can be spotted in kindergarten. So given what we now know, should n’t we be doing everything to protect the children most at risk? No one is suggesting testing all boys to see which variant of the MAO-A gene they have, but what the science is telling us is that we should redouble efforts to tackle abusive upbringings, and even simple neglect. This will help any child, but especially those whose biology makes them vulnerable. Thankfully there is already considerable enthusiasm in both the US and the UK for converting the latest in behavioral science into parenting and social skills: both governments have schemes in place to improve parenting in families where children are at risk of receiving poor care. Some people are uncomfortable with the idea of early intervention because it implies our behavior becomes “set” as we grow up, compromising the idea of free will. That view is understandable, but it would be negligent to ignore what the studies are telling us. Indeed, the cost to society of failing to intervene －in terms of criminal damage, dealing with offenders and helping victims of crime －is bound to be greater than the cost of improving parenting. The value to the children is immeasurable. （分数：5.00）(1).Researchers have come to a consensus: to explain violent behavior ________. （分数：1.00）A.in terms of physical environmentB.form a biological perspective √C.based on the empirical dataD.in a statistical way解析：(2).When we say that antisocial and criminal behavior tends to run in families, as indicated by the recent findings, we can probably mean that ___________. （分数：1.00）A.a particular gene is passed on in familiesB.child abuse will lead to domestic violenceC.the male victims of child abuse will pass on the tendency √D.the violent predisposition is exclusively born of child abuse解析：(3).The recent observation implicated that to check the development of antisocial and criminal behavior ___________. （分数：1.00）A.boys are to be screened for the biological predispositionB.high-risk kids should be brought up in kindergartenC.it is important to spot the genes for the risk factorsD.active measures ought to be taken at an early age √解析：(4).To defend the argument against the unfavorable idea, the author makes it a point to consider ___________. （分数：1.00）A.the immeasurable value of the genetic research on behaviorB.the consequences of compromising democracyC.the huge cost of improving parenting skillsD.the greater cost of failing to intervene √解析：(5).Which of the following can be the best title for the passage? （分数：1.00）A.Parenting Strategies for KidsB.The Making of a Criminal √C.Parental EducationD.Abusive Parenting解析：Passage two After 25 years battling the mother of all viruses, have we finally got the measure of HIV? Three developments featured in this issue collectively give grounds for optimism that would have been scarcely believable a year ago in the wake of another failed vaccine and continuing problems supplying drugs to all who need them. Perhaps the most compelling hope lies in the apparent “cure” of a man wit h HIV who had also developed leukemia. Doctors treated his leukemia with a bone marrow transplant that also vanquished the virus. Now US Company Sangamo Biosciences is hoping to emulate the effect patients being cured with a single shot of gene therapy, instead of taking antiretroviral drugs for life. Antiretroviral therapy (ART) is itself another reason for optimism. Researchers at the World Health Organization have calculated that HIV could be effectively eradicated in Africa and other hard-hit places using existing drugs. The trick is to test everyone often, and give those who test positive ART as soon as possible. Because the drugs rapidly reduce circulating levels of the virus to almost zero, it would stop people passing it on through sex. By blocking the cycle of infection in this way, the virus could be virtually eradicated by 2050. Bankrolling such a long-term program would cost serious money – initially around $3.5 billion a year in South Africa alone, ring to $85 billion in total. Huge as it sounds, however, it is peanuts compared with the estimated $1.9 trillion cost of the Iraq war, or the $700 billion spent in one go propping up the US banking sector. It also look small beer compared with the costs of carrying on as usual, which the WHO says can only lead to spiraling cases and costs. The final bit of good news is that the cost of ART could keep on falling. Last Friday, GlaxoSmithKline chairman Andrew Witty said that his company would offer all its medicines to the poorest countries for at least 25 per cent less than the typical price in rich countries. GSK has already been doing this for ART, but the hope is that the company may now offer it cheaper still and that other firms will follow their lead. No one doubt the devastation caused by AIDS. In 2007, 2 million people died and 2.7 million more contracted the virus. Those dismal numbers are not going to turn around soon –and they won’t turn around at all without huge effort and investment. But at least there is renewed belief that, given the time and money, we can finally start riddling the world of this most fearsome of viruses. （分数：5.00）(1).Which is the following can be most probably perceived beyond the first paragraph? （分数：1.00）A.The end of the world.B.A candle of hope. √C.A Nobel prize.D.A Quick Fix.解析：(2).According to the passage, the apparent “cure” of the HIV patient who had also developed leukemia would ___________. （分数：1.00）A.make a promising transition from antiretroviral medication to gene therapy √B.facilitate the development of effective vaccines for the infectionpel people to draw an analogy between AIDS and leukemiaD.would change the way we look at those with AIDS解析：(3).As another bit of good news, ___________. （分数：1.00）A.HIV will be virtually wiped out first in AfricaB.the cycle of HIV infection can be broken with ART √C.the circulating levels of HIV have been limited to almost zeroD.the existing HIV drugs will be enhanced to be more effective in 25 years解析：(4).The last reason for optimism is that ___________. （分数：1.00）ernments will invest more in improving ARTB.the cost of antiretroviral therapy is on the decline √C.everybody can afford antiretroviral therapy in the worldD.the financial support of ART is coming to be no problem解析：(5).The whole passage carries a tone of ___________. （分数：1.00）A.idealismB.activismC.criticismD.optimism √解析：Passage Three Archaeology can tell us plenty about how humans looked and the way they lived tens of thousands of years ago. But what about the deeper questions? Could early humans speak, were they capable of self-conscious reflection, did they believe in anything? Such questions might seem to be beyond the scope of science. Not so. Answering them is the focus of a burgeoning field that brings together archaeology and neuroscience. It aims to chart the development of human cognitive powers. This is not easy to do. A skull gives no indication of whether its owner was capable of speech, for example. The task then is to find proxies (替代物) for key traits and behaviors that have stayed intact over millennia. Perhaps the most intriguing aspect of this endeavor is teasing out the role of culture as a force in the evolution of our mental skills. For decades, development of the brain has been seen as exclusively biological. But increasingly, that is being challenged. Take what the Cambridge archaeologist Colin Renfrew calls “the sapient (智人的) paradox (矛盾)”. Evidence suggests that the human genome, and hence the brain, has changed little in the past 60,000 years. Yet it wasn’t until about 10,000 years ago that profound changes took place in human behavior: people settled in villages and built shrines. Renfrew’s paradox is why, if the hardware was in place, did it take so long for humans to start changing the world? His answer is that the software – the culture – took a long time to develop. In particular, the intervening time saw humans vest (赋予) meaning in objects and symbols. Those meanings were developed by social interaction over successive generations, passed on through teaching, and stored in the neuronal connections of children. Culture also changes biology by modifying natural selection, sometimes in surprising ways. How is it, for example, that a human gene for making essential vitamin C became blocked by junk DNA? One answer is that our ancestors started eating fruit, so the pressure to make vitamin C “relaxed” and the gene became unnecessary. By this reasoning, early humans then became addicted to fruit, and any gene that helped them to find it was selected for. Evidence suggests that the brain is so plastic that, like genes, it can be changed by relaxing selection pressure. Our understanding of human cognitive development is still fragmented and confused, however. We have lots of proposed causes and effects, and hypotheses to explain them. Yet the potential pay-off makes answers worth searching for. If we know where the human mind came from and what changed it, perhaps we can gauge where it is going. Finding those answers will take all the ingenuity the modern human mind can muster. （分数：5.00）(1).The questions presented in the first paragraph ___________. （分数：1.00）A.seem to have no answers whateverB.are intended to dig for ancient human minds √C.are not scientific enough to be answered hereD.are raised to explore the evolution of human appearance解析：(2).The scientists find the proxy to be ___________. （分数：1.00）A.the role of culture √B.the passage of timeC.the structure of a skullD.the biological makeup of the brain解析：(3).According to Renfrew’s paradox, the transition from 60,000 to 10,000 years ago suggests that ___________. （分数：1.00）A.human civilization came too lateB.the hardware retained biologically staticC.it took so long for the software to evolve √D.there existed an interaction between gene and environment解析：(4).From the example illustrating the relation between culture and biology, we might conclude that ___________. （分数：1.00）A.the mental development has not been exclusively biologicalB.the brain and culture have not developed at the same paceC.the theory of natural selection applies to human evolution √D.vitamin C contributes to the development of the brain解析：(5).Speaking of the human mind, the author would say that ___________. （分数：1.00）A.its cognitive development is extremely slowB.to know its past is to understand its future √C.its biological evolution is hard to predictD.as the brain develops, so as the mind解析：Passage Four Despite the numerous warnings about extreme weather, rising sea levels and mass extinctions, one message seems to have got lost in the debate about the impact of climate change.A warmer world won’t just be inconvenient. Huge swathes (片) of it, including most of Europe, the US and Australia as well as all of Africa and China will actually be uninhabitable--- too hot, dry or stormy to sustain a human population. This is no mirage. It could materialize if the world warms by an average of just 4°C, which some models predict could happen as soon as 2050. This is the world our children and grandchildren are going to have to live in. So what are we going to do about it? One option is to start planning to move the at-risk human population to parts of the world where it will still be cool and wet. It might seem like a drastic move, but this thought experiment is not about scaremongering (危言耸听). Every scenario is extrapolated from predictions of the latest climate models, and some say that 4°C may actually turn out to be a conservative estimate. Clearly this glacier-free, desertified world---with its human population packed into high-rise cities closer to the poles---would be a last resort. Aside from anything else, it is far from being the most practical option: any attempt at mass migration is likely to fuel wars, political power struggles and infighting. So what are the alternatives? The most obvious answer is to radically reduce carbon dioxide levels now, by fast-tracking green technologies and urgently implementing energy-efficient measures. But the changes aren’t coming nearly quickly enough and global emissions are still rising. As a result, many scientists are now turning to “Earth’s plan B”. PlanB involves making sure we have large scale geoengineeringtechnolo gies ready and waiting to either suck CO2 out of the atmosphere or deflect the sun’s heat. Most climate scientists were once firmly against fiddling with the Earth’s thermostat, fearing that it may make a bad situation even worse, or provide politicians with an excuse to sit on their hands and do nothing. Now they reluctantly acknowledge the sad truth that we haven’t managed to reorder the world fast enough to reduce CO2 emissions and that perhaps, given enough funding research and political muscle, we can indeed design, test and regulate geoengineering projects in time to avert the more horrifying consequences of climate change. Whatever we do, now is the time to act. The alternative is to plan for a hothouse world that none of us would recognize as home.（分数：5.00）(1).To begin with, the author is trying to remind us of ____________. （分数：1.00）A.the likelihood of climate change making life inconvenient √B.the warning against worsening climate changeC.the inevitable consequence of global warmingD.the misconception of a warmer world解析：(2).As the thought experiment shows, those at risk from global warming will ____________. （分数：1.00）A.live with the temperature raised by an average of 4°CB.have nowhere to go but live in the desertC.become victims as soon as 2050D.move closer to the poles √解析：(3).It is clear from the passage that a practical approach to global warming is _________. （分数：1.00）A.to reduce massively CO2 emissions √B.to take protective measures by 2025C.to prepare a blueprint for mass migrationsD.to launch habitual constructions closer to the poles解析：(4).Earth’s plan B is ambitious enough ___________. （分数：1.00）A.to stop climate scientists making a bad situation even worseB.to remove the sources of CO2 emissions altogetherC.to regulate geoengineering projects for efficiencyD.to manage the Earth’s thermostat√解析：(5).Which of the following statements are the supporters of “Earth’s plan B” for? （分数：1.00）A.It’s Time to Go GreenB.Energy-efficient measures must be taken √C.Mass migration to the poles is inevitableD.For the Planet’s Geoengineer or Catatrophe解析：Passage Five Brittany Donovan was born 13 years ago in Pennsylvania. Her biological father was sperm donor G738. Unbeknownst to Brittany’s m other, G738 carried a genetic defect known as fragile X-a mutation that all female children born from his sperm will inherit, and which causes mental impairment, behavioral problems and atypical social development. Last week, Brittany was given the green l ight to sue the sperm bank, Idant Laboratories of New York, under the state’s product liability laws. These laws were designed to allow consumers to seek compensation from companies whose products are defective and cause harm. Nobody expected them to be applied to donor sperm.Thousands of people in the US have purchased sperm from sperm banks on the promise that the donor’s history has been carefully scrutinized and his sample rigorously tested, only for some of them to discover that they have been sold a batch of bad seed. Some parents learn about genetic anomalies after their disabled child is born and they press the sperm bank for more information. Others realize it when they contact biological half-siblings who have the same disorder. So will Donovan vs Idant laboratories open the floodgates? It seems unlikely. New York’s product liability laws are highly unusual in that they consider donor sperm to be a product just like any other. Most other US states grant special status to blood products and body parts, including sperm. In these states, donor sperm is not considered a “product” in the usual sense, despite the fact that it is tested, processed, packaged, catalogued, marketed and sold. Similarly, European Union product liability law could not be used in this way. Even if this lawsuit is an isolated case, it still raises some difficult questions. First, to what lengths should sperm banks go to ensure they are supplying defect-free sperm? As we learn more and more about human genetics, there is growing list of tests that could be performed. Nobody would deny that donor sperm carrying the fragile X mutation should be screened out--- and there is a test that can do so ---but what about more subtle defects, such as language impairment or susceptibility to earl y Alzheimer’s? Donovan vs Idant Laboratories also serves as a reminder of the nature of the trade in human gametes. Sperm bank catalogues can give the impression that babies are as guaranteed as dishwashers. The Donovans are entitled to their day in court, but in allowing the product liability laws to be used in this way, the legal system is not doing much to dispel that notion. （分数：5.00）(1).Donovan sued Idant Laboratories for ______________. （分数：1.00）A.a cheat in boasting its biological productsB.donor sperm as a productC.problematic donor sperm √D.a breach of confidentiality解析：(2).It can be inferred from the passage that thousands of people in the US purchase sperm_____________. （分数：1.00）A.without knowing its potential dangers √B.regardless of repeated warningsC.for the reason of quality supplyD.for their desperate needs解析：(3).The question from the case is whether ___________. （分数：1.00）A.people are entitled to donor spermB.donated sperm should be just a product √C.Donovan is allowed to sue the sperm bankD.Donovan’s health problems have been clinically certified解析：(4).It seems that sperm banks are in no position to _______________. （分数：1.00）A.treat donor sperm as a productB.screen out the fragile X mutationC.manage their business as others do in NYD.guarantee sperm absolutely free of any defect √解析：(5).The statement Sperm bank catalogues can give the impression that babies are as guaranteed as dishwashers implies that _____________. （分数：1.00）A.Donovan will surely win the case in courtB.any product could have a defect in one way or another。

外科学考博试题及答案一、选择题（每题2分，共20分）1. 外科感染中最常见的致病菌是：A. 金黄色葡萄球菌B. 大肠杆菌C. 肺炎链球菌D. 真菌答案：A2. 以下哪项不是外科手术的基本原则？A. 无菌原则B. 无创原则C. 快速原则D. 安全原则答案：C3. 以下哪项是开放性骨折的特点？A. 骨折端不与外界相通B. 骨折端与外界相通C. 骨折线完全在皮肤下D. 骨折线完全在骨髓内答案：B4. 急性阑尾炎最典型的临床表现是：A. 腹痛B. 恶心呕吐C. 右下腹固定压痛D. 发热答案：C5. 以下哪项是乳腺癌的高危因素？A. 长期吸烟B. 长期饮酒C. 家族遗传史D. 长期素食答案：C二、简答题（每题10分，共30分）1. 简述外科手术切口的分类及其特点。

答案：外科手术切口根据其感染风险分为三类：清洁切口、可能污染切口和污染切口。

清洁切口是指手术区域无炎症，无感染，且手术过程中未进入呼吸道、消化道、泌尿生殖道及口咽部。

可能污染切口是指手术区域可能存在细菌，但无明显感染，如胃肠道手术。

污染切口是指手术区域有明显感染或手术过程中进入有菌环境，如脓肿切开引流。

2. 描述急性胆囊炎的诊断要点。

答案：急性胆囊炎的诊断要点包括：右上腹疼痛，尤其是Murphy征阳性；发热和白细胞计数升高；腹部超声检查发现胆囊壁增厚、胆囊内结石或胆囊周围积液；有时可伴有黄疸。

3. 解释何为“无菌技术”及其在外科手术中的重要性。

答案：无菌技术是指在手术过程中采取的一系列措施，以防止手术区域受到微生物污染。

这包括使用无菌器械、穿戴无菌手术衣和手套、保持手术区域清洁等。

无菌技术在外科手术中至关重要，因为它可以显著降低术后感染的风险，提高手术成功率。

三、论述题（每题25分，共50分）1. 论述外科手术前的准备要点。

答案：外科手术前的准备要点包括：详细的病史采集和体格检查，以评估患者的整体健康状况和手术风险；必要的辅助检查，如血常规、凝血功能、心电图、肝肾功能等；术前禁食和禁水，以减少术中呕吐和误吸的风险；术前抗生素的使用，以预防感染；心理支持和教育，以减轻患者的焦虑和恐惧。

外科学总试题库一 .A 型选择题1． ARF时最需紧急处理的情况是( )A、酸中毒 B 、水中毒 C 、高钾血症 D 、感染 E 、低钠血症参考答案： C2．不用造影剂而显示尿路梗阻部位及程度的检查是( ) A、 CT B、 KUB+IVP C、 KUB D、肾图 E 、磁共振水成像参考答案： E3．患者腰部绞痛后突然无尿常提示( )A、肾前性ARFB、肾后性ARFC、肾性 ARFD、 MODE、ARDS参考答案： B4． MODS一期速发型的发生往往由于( )A、原发急症甚轻 B 、原发急症甚为严重C、肾功能障碍D、肺功能障碍 E 、胃肠功能障碍参考答案： B5．发生 MODS时，要待病变进展到相当程度方有明显临床表现的系统或器官是( )A、心血管 B 、肺 C 、肝、胃肠和血液凝固系统 D 、脑 E 、肾参考答案： C6．关于 MODS以下哪个是正确的？（A、凡有两个或两个以上的重要器官功能衰竭即是MODSB、肝脏损害往往是首发器官C、全身性炎症反应（SIRS）只表现在感染而与损伤无关D、肠道细菌 / 内毒素移位可触发（SIRS），但不会导致MODSE、以上都是错的参考答案： E 7．关于 MODS以下叙述哪个是不正确的？（）A、当病人出现创伤、休克、严重脓毒症时，应警惕有可能并发 MODSB、对病人的救治必须有整体观念C、急性创伤时，只要出现呼吸困难，就可以诊断为ARDSD、病因治疗是防治MODS的首要措施E、防治感染是预防MODS极为重要的措施参考答案： C8．关于多器管功能不全综合症（MODS）以下哪个是错误的？（）A、MODS常指急性疾病过程中发生的两个或两个以上主要器官功能不全B、其特点之一是急性C、死亡率高D、凡是两个或两个以上的主要器官功能不全就是MODSE、 MODS最好的治疗是预防参考答案： D9．现在认识MSOF属于全身性病理连锁反应，受累的器官处于变化中，病变有轻有重，所以改称为( )A、 ARDSB、 MODSC、 ARFD、 AOSCE、 DIC参考答案： B10． MODS二期迟发型的形成往往由于( )A、原发急症甚为严重 B 、心衰 C、肾衰D、继发感染特续存在毒素或抗原 E 、肝衰参考答案： D11． ARF时，若尿素氮升高较肌酐明显，其比例>20 时，提示 ( )A、肾前性ARFB、肾后性ARFC、高分解代谢存在D、低分解代谢存在 E 、肾性 ARF参考答案： C12． ARF当有高钾血症时必然有：( )A、高钠血症 B 、高钙血症 C 、高氯血症疗，防止 MODSD、高镁血症 E 、低磷血症参考答案： B参考答案： D18．治疗 ARF以下哪项是不正确的？（）13． ARF时，导致低血钠的主要原因是：( )A、有效的治疗基于正确的诊断。