Monday 18 May 2009

Surgery Lugansk

Крок 2 Загальна лікарська підготовка_2004-2005

2 профиль

 

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1.  

40 year old patient presented to Emergency department with the cut injury on the right side of the chest wall. Profuse bleeding from the wound   but the patient is in conscious, B.P – 120/60 mm.Hg, pulse 100 beats per minute. Which one from below listed methods allows to define character of wound with the greatest accuracy? 

*Primary surgical cleaning and exploration of Wound. 

Chest X-ray 

Ultrasound of thoracic Cavity 

CT scan. 

Bronchoscopy 

2.  

The patient K. 42 years old, presented with the diagnosis of “ Acute iliofemoral vein thrombosis (1 rst. Day), Pulmonary artery thromboembolism ” and admitted in vascular department of the Hospital. What is your tactics? 

* Thrombolytic therapy plus implantation of Cava filter. 

Surgical treatment. 

Introduction of low-molecular wt. Heparin. 

Elastic Bandage of legs. 

Bronchoscopy. 

3.  

Patient K. 35 years old, after abortion   developed deep veins thrombosis of leg and on the 3-day cough and a retrosternal pain developed with hemoptysis. Which investigation is necessary at first   to make the correct diagnosis? 

*   Electrocardiogram, Chest X-Ray. 

Phlebography, Dopplerography. 

Ultrasonogram of Abdomen. 

Palpation of stomach. 

Auscultation of Lungs. 

4.  

73 years old patient hospitalized with the diagnosis of “ Tumour of Abdominal Cavity ”. On examination: On the right side of the abdomen a mass of 10х15 cm size is palpated. Patient is suffering of ischemic heart diseases, Hypertension ІІ-ІІІ   stages. It is suspected an aneurysm of an abdominal aorta. For the  verification of the diagnosis it is necessary to execute: 

* Aortoarteriography. 

X-ray of Abdomen. 

Diagnostic puncture. 

Laparosynthesis. 

Irrigoscopy. 

5.  

25 years old patient presented to emergency department after 40 minutes of stab injury of chest in a projection of heart in a critical condition.   Confused, cold sweating, Blood Pressure 60/20 mm.Hg, Pulse on peripheral arteries was absent. What is the most probable diagnosis? 

*Cardiac Injury.  

Lung Injury. 

Pneumohemothorax. 

Bleeding from soft tissues of   chest wall. 

Injury of intercostals vessels. 

6.  

53 years old patient, complains of a heartburn, regurgitation of air, vomiting. In esophagodudenoscopy: -   Marked prolapse of squamous mucous of stomach into the esophagus. In radiogram marked protrusion of 1/3 stomach into the posterior mediastinum. Provisional Diagnosis – A sliding hiatal hernia, ІІІ degree. What is the tactics of treatment? 

( Plastic of a diaphragm according to Belsey.  

Lewis's operation [Transhiatal resection of esophagus]. 

Vandal’s operation [plastic of lower third of esophagus.] 

Heller’s Operation.  

Esophagoectomy, Abdomino-cervical Method. 

7.  

Patient В, 64 years, complains of difficulty in swallowing solid food, vomiting, weakness, loss of weight.  In esophagodudenoscopy on a posterior-lateral wall, sub mucous layer tumour with the precise contours, easily movable is determined. The diagnosis: Benign tumour of lower third esophagus [Leiomyoma]. Your tactics? 

*Endoscopic   removal of a tumour. 

Heller’s Operation. 

Esophagoecotmy Экстирпация Esophagus Abdomino- cervical Method. 

Operation Vandal’s [plastic of the Lower third of esophagus]. 

Lewis's operation [Transhiatal resection of esophagus]. 

8.  

Patient [Female] 48 years old, chief complain of   dysphasia for solid and liquid food, nausea, and fatigue. In radiographic examination of esophagus- stricture of lower third esophagus and dilatation of upper third esophagus. Positive Symptom  [                    ]  Diagnosis-Cardiospasm III stage. What is the volume of necessary treatment needed?    

* Heller’s Operation. 

Conservative treatment: Cerucal, Rantac, No-spa, Intravenous infusion.   

Vandal’s Operation [Plastic surgery of lower third esophagus]. 

Esophagoectomy Экстирпация  Abdomino-cervical Method. абдомино-цервикальным access. 

Lewis Operation [Transhiatal resection of esophagus with gastroplasty]. 

9.  

Patient К, 65 years old, inpatient of surgical department of hospital after hernioplasty   on the 6 day suddenly lost consciousness; there was cyanosis of the upper part of a thorax and the face and dyspnea.    What is the diagnosis? 

* Pulmonary artery thromboembolism. 

Heart attack of a myocardium. 

Hypoglycemic Coma. 

Hyperglycemic Coma. 

Perforation of stomach Ulcer. 

10.     

Patient А., 44 Years old, presented to Emergency Department after 3 hours of trauma with chief complain of Right sided Chest pain, Dyspnea, Fatigue, Dizziness. Cyanosis. Unstable Hemodynamic. On Chest X-ray-Fracture of Right four Posterior-Lateral ribs, Collapse of right lung 2\3 Volume. What is the possible diagnosis?    

* Right sided Post-traumatic Pneumothorax. 

Right sided post-traumatic excudative pleuritis. 

Отрыв Main Bronchus. 

Right-sided Hemothorax. 

Hematoma Mediastinium.  

11.     

Patient 19 years old, Presented to Emergency department in critical condition after Trauma of Chest with chief complain of Left sided chest pain, Dyspnea, Fatigue, left sided massive subcutaneous emphysema of chest wall. On chest X-ray Atelectasis of left lung, Shift of mediastinal organs to left. Cardiac cavity not enlarged. Your Diagnosis?   

( Abruption of Left main bronchus.  

Left sided total Hemothorax.   

Fracture of left Ribs, left sided Pneumo-hemothorax.   

Left sided Post-traumatic pnemothorax.   

Left sided post-traumatic pleuritis.   

12.     

36 years old patient presented with complains of dyspnea, dizziness. History of Thoracic trauma 2 days back. On examination decrease movement of the left side of the chest wall. On chest X-ray – Collapse of the 1/3 of left lung. Fracture of left 4-6 ribs. What are the possible complication patients has developed? 

*Pneumothorax.  

Posttraumatic Hemothorax. 

Empyema of pleura. 

Pleuritis. 

Posttraumatic pneumonia. 

13.     

Patient К. 19 years old admitted with the diagnosis “Chest Wall Trauma (Thoracic Trauma)” with Complain of difficulty in expiration and inspiration. On examination patient is pale. Blood Pressure 90/50 mm.Hg. On auscultation: Silent on left side (no breathe Sound). On chest X-ray:- Shift of mediastinal organs to right, atelectasis of left lung, your diagnosis? 

*Left sided Tension Pneumothorax. 

Fracture of Ribs. 

Injuries of a chest wall. 

Cardiac Injury. 

Hemothorax. 

14.     

45 years old patient admitted in a clinic in a critical condition. Before admission patient was suffering from pneumonia for 3 weeks. On examination: - Skin and mucous membrane dark - earthy color, a body temperature 38c, Dyspnea on rest,   decrease breathe on the left side. Productive Cough with large amount of sputum. On chest X-ray. What is the most probable diagnosis? 

* Empyema  of pleura.  

Bronchitis. 

Pleuritis. 

Pneumonia. 

Pneumothorax. 

15.     

32 years old patient presented in a hospital in a critical condition with chief complain of acute retrosternal chest pain with radiation to back.  On examination:-  skin  and mucous  are pale, t-38,8  С. Marked subcutaneous emphysema of  soft tissues of a neck, одутловатость face. On the eve ate   fish. On Chest X-ray expansion of mediastinum is revealed. What is the  most probable diagnosis? 

* Mediastinitis. 

Heart attack. 

Abscess of lung. 

Pneumothorax. 

Pneumonia. 

16.     

48 years old patient, suffering from postphlebetic syndrome of the left leg since 2 years. On examination: Dilated superficial veins of left leg and thigh, and pubic region, a significant swelling of the left leg. Light physical exertion aggravates pain. What kind of treatment should be recommended to patient? 

*Reconstructive operation on deep veins of the left thigh. 

Conservative therapy. 

Compression treatment. 

Phleboectomy. 

Phlebo-sclero-obliteration. 

17.     

52 years old patient admitted in vascular department of the hospital with sever edema and pain of holding apart character in the right   leg and thigh, aggravated by passive movements. On examination: On the right leg sever edema starting from the foot till inguinal ligaments are observed cyanotic skin. What is the most probable diagnosis? 

*Acute iliofemoral vein thrombosis.   

Erysipelas of the right leg. 

Acute thrombophlebitis of superficial veins. 

Lymphostatsis. 

Phlegmon of the right Leg. 

18.     

67 years old patient   Hyperstenic features, suffering from varicose veins of both legs since 18 years. During last 2 years   three   times had thrombophlebitis of superficial    veins of the right leg. 4 months back on the lower third of right leg   trophic ulcer developed.  What method of investigation is informative for specification of the diagnosis of the patient? 

*Ultrasonic duplex scanning. 

Functional tests to determine the condition of Valve.  

Phlebography. 

Dopplerography of deep veins. 

Isotope Phlebography. 

19.     

A 35 years old patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he  has attacks of cough and dyspnea. Above mentioned complaints is progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does  the patient have? 

*Corrosive Esophagitis and  strictura 

Esophagitis 

Esophageal  diverticula 

Cardia Achalasia 

Cardia insufficiency 

20.     

A 42 years old man with long history of disease complains of a frequent heartburns, moderate pain in  epigastrium and behind  breastbone propagated in the back in point  between  shoulder blades. Pain appears with meals or just after meals and can be provoked by physical exertion. Also he has had a relapsed  bronchopneumonia earlier and events of melena. The CBC reveals anemia. On X-Ray film there is a bubble of gas in the posterior mediastinum. ECG                          documents  an arrhythmia. What is your diagnosis? 

* Hiatus  hernia of  esophagus   

Chronic pancreatitis 

Ischemic heart disease 

Gastric ulcer 

Mediastenitis 

21.     

A 70 years old woman had had  a planned laparoscopic cholecystectomy done according biliary calculi. Six months later the patient again has attacks of severe pains in the right hypochondrium accompanied by jaundice and dark urine and stool discoloration. The total  serum bilirubin is increased up to 60 mcmol/l, direct  40 mcmol/l. What disease does the patient have? 

*residual choledocholithiasis 

Papillostenosis 

tumour of the pancreas head 

tumour of the large duodenal papilla 

choledochus stricture 

22.     

A 60 years old woman has been ill with chronic calculous cholecystitis for 10 years. During the  treatment in  sanatorium the patient had had a hepatic colic with jaundice. Ultra sound investigation revealed a lot of calculi  sized 5-6 mm in the gallbladder.  Choledochus is widened to 15 mm and contains concrements up to 6 mm in diameter in the distal part. What method of treatment is the most adequate and current? 

* endoscopic papillosphincterotomy, laporoscopic cholecystectomy 

cholecystectomy, choledocholithotomy, external choledochus drainage according to Kerr 

cholecystectomy, transduodenal papillosphincterotomy 

cholecystectomy, choledochoduodenostomy 

cholecystectomy, choledochojejunostomy 

23.     

A 58 years old  woman with overweight right before has had  an attack of right hypochondrium pain and jaundice with dark urine and stool discoloration appeared. On clinical examination the abdomen is distended and painful on palpation in the right hypochondrium,  The mild liver enlargement there is.  In blood the total  bilirubin is 90 mkmol/l,  direct (conjugated)  60 mkmol/l . What investigation  is the most informative to clarify the diagnosis? 

* retrograde cholangiopancreatography 

intravenous cholegraphy 

infusional cholegraphy 

intracutaneous intrahepatic cholegraphy 

ultra sound investigation of the hepatopancreatobiliary zone 

24.     

A 62 years old woman complains of  severe  constant pain in the right hypochondrium, jaundice, discoloration of stool and dark urine, mild fever  up to 37,5оС. Above mentioned complaints were appeared after an attack of severe abdomen pain connected with fatty food intake. On clinical examination the abdomen is soft. A painful enlarged gall bladder is palpated. The Orthner, Kerr’s symptoms are positive. What is the probable diagnosis? 

* Acute cholecystitis, choledochus calculi  and obstructive jaundice 

Infectious  hepatitis  

Liver cancer 

Liver abscess 

Liver cirrhosis 

25.     

A 22 years old woman was admitted to the reception department. She complains of  severe cramping lower abdomen  pain  occurred unexpectedly, general weakness, sleeplessness, appetite loss and fever  up to 39,90 C. At first the pain was appeared in point between  umbilical region and epigastrium and then it was localized in the  in the right iliac region. The patient recall the last menses 8 weeks ago. On clinical examination the abdomen is soft,  painful in the right iliac.  The Schyotkin – Blumberg’s symptom is slightly positive, Michelson’s symptom is clear positive. On bimanual gynecological examination the soft uterus is  enlarged according pregnancy onset. Near the uterus there is a soft  swelling identified as a separated ovary. In CBC the WBCs (leucocytes) are 15x109 /l. Their  formula shows bandemia. There is  high ESR up to 65 mm/h. What is the most probable cause  provoked above written condition? 

* Acute appendicitis and ectopic  pregnancy.  

Acute appendicitis  

Acute salpingoophoritis  

Pyosalpinx  

Tubo-ovarian abscess 

26.     

A pregnant woman with 24 weeks gestation term has felt a cramping  pain in low abdomen. Nausea and vomitting are  absent. She looks for  a medical aid in the gynecologic out-patient office. On clinical examination the  abdomen is soft and tender on the  right. The Schyotkin – Blumberg, Rovzing, Koap’s symptoms are  slightly positive and Brendo, Michelson’s signs are strongly positive. What is the most adequate tactics of the doctor in the situation? 

*To send the patient to the in-patient department at once to solve the problem of urgent surgical operation 

To observe the patient for the next 24 hours at home to clarify the condition  

Medication  therapy 

Emergent diagnostic abdominal cavity puncture through the posterior vaginal fornix  in this female dispensary office 

Urgent interruption of  pregnancy 

27.     

A 45 years old  woman was operated because of biliary calculi and obstructive jaundice.  A two months  later after operation there is continuing bile discharge up to 500,0-600,0 ml per day through   the  Kerr`s  external  choledochus drainage. On fistulography using the  drainage in the  distal part of the  choledochus “a forgotten stount” up to 8 mm in diameter was identified.   The choledochus is  dilated up to 16 mm. The most correct surgeon treatment in this case is: 

* Endoscopic papillosphincterotomy and removing a concrement  from  choledochus; 

Choledocholithotomy with close seam  on  choledochus; 

Choledocholethotomy choledochoduodenostomy; 

Choledocholithotomy choledochojejunostomy; 

Choledocholithotomy and drainage of the choledochus. 

28.     

A 19 years old man was admitted to the reception department in 20 minutes after a knife wound of the left  chest. The patient is confused. The heart rate is 96 beats per minute and blood pressure 80/60 mm Hg, The dilated neck veins, sharply diminished apical beat and  evident  heart enlargement there are. What penetrative chest wound complication is described? 

*Pericardium  tamponade  

Massive hemothorax 

Open pneumothorax 

Closed pneumothorax 

Valve-likes  pneumothorax 

29.     

Classical X-ray image of intestinal obstrustion is: 

*Gas and horizontal levels 

Filling defect 

High positioned diaphragm 

Reactive pleuritis 

Pneumatosis 

30.     

54 years old patient,  presented with dizziness, an episode  of decreased brain blood circulation, complains of a pain  over  the umbilicus after meal ,sometimes very sharp, is accompanied by vomiting, a episode of diarrhea.  History of Blood in stool sometimes. Cardiac activity arrhythmic, extra systole. Moderate tenderness around umbilicus. What is the most probable diagnosis? 

*Non- specific ulcerative colitis. 

Crohn’s Diseases. 

Acute intestinal ischemia. 

Chronic cholecystitis. 

Duodenal Ulcer with penetration. 

31.     

45 years old man presented with chief complains of rise in temperature up to 38c,   pain and swelling in lumbar region and painful mass 5х6 sm. in size, crimson color of skin over the mass, in the center   purulent - necrotic fistulas which is secreting pus. What is the most probable diagnosis? 

*Carbuncle of lumbar region. 

Abscess of lumbar region. 

Erysipelaous inflammation. 

Para nephritis. 

Renal Colic. 

32.     

Patient К, 43 year’s old hospitalized in surgical department of the hospital with the diagnosis of Mechanical jaundice, cholangitis. During echographic researches   found out Huge hydatid cyst of liver (echinoccocus of liver), dilatation of CBD(Common Bile duct) and intrahepatic ducts. What  is the mechanism of jaundice in echinoccocus of liver? 

*Rupture of contents of cysts into  hepatic ducts. 

Compression of portal vein with occurrence of portal hypertension with jaundice. 

Occurrence of a viral hepatitis. 

Intoxicytic hepatitis due to absorption of ecchinococcus fluid (Hydatid cyst fluid). 

Suppuration of cyst with occurrence purulent cholangitis. 

33.     

Patient K, 54 years old operated for hydatid cyst of liver, during operation found two cysts instead of three, as it has been diagnosed in the preoperative period. Which methods of investigation will be accurate to locate the third cysts? 

*Intraoperative echography. 

Intraoperative Cholangiography. 

Intraoperative Choledochoscopy. 

Intraoperative Retrograde Cholangiopancreatography.  

X-ray Abdomen and Pelvis. 

34.     

65 years old patient complains of a pain in the right iliac fossa, loss of weight, decrease appetite, weakness, and history of constipation more than 6 months. Objectively: dry, muddy colored skin, On palpation On the right iliac fossa – infiltration (mass) 8х10 sm. Size.  Which is almost   not displacing (Immovable), on percussion dull sound above the mass. On auscultation peristalsis is increased. Нв blood - 86 g/l. What is the most probable pathology that might have causes such clinical picture? 

*Carcinoma of Caecum. 

Cancer of the right kidney. 

Appendicular Infiltrate. 

Crohn’s Diseases. 

Retroperitoneal Tumour. 

35.     

Patient K, 42 years old, is hospitalized in surgical department with complaints of acute sharp pain in the stomach, vomiting. Suffering from a duodenal ulcer for last 8 years. Suspected as a Duodenal Perforation, however free fundus gas in abdominal cavity is not revealed. The ulcer is suspected as covered perforation. What method of diagnosis should be applied for correct diagnosis? 

*Pneumogastrography. 

Pneumoperitoneum. 

Laparosynthesis. 

Contrast (dye) investigation of stomach and duodenum. 

Fibrogastroscopy. 

36.     

Patient B. 74 years old is hospitalized in surgical department with the diagnosis of perforated stomach ulcer. In the anamnesis   heart attack of a myocardium,   diabetes, Hypertension. The patient was advised for Operation, which patient   categorically refused. How to treat the patient?  

*Taylor’s Method. 

Infusion therapy. 

Antibacterial therapy. 

Start Ulcer Therapy 

Discharge the patient. 

37.     

A 32 years old patient presented with sudden rise in temperature, High grade fever,   headache, pain in   stomach and lumbar region, yellowish discoloration of skin.  Urine out put of the patient is 100 ml dark muddy colored. Later with theses symptoms Muscles pain is added. One week ago the patient went for fishing. What is the probable diagnosis? 

* Leptospirosis. 

Viral hepatitis A 

Viral hepatitis E 

Acute pyelonephritis 

Food poisoning 

38.     

28 years old patient presented with history of   14 hours   constant pain in right iliac fossa.In last 2 hours the pain has decreased. Objectively: Local guarding of abdominal muscles. Diagnosed as acute appendicitis. What histological form of acute appendicitis     could result in reduction of intensity of a pain of a stomach? 

* Gangrenous. 

Cataral. 

Phlegmonic. 

Perforated 

Empyema of the appendix 

39.     

A 35 year old woman was admitted to thoracic surgery department with elevation of body temperature upto 40 0 C, onset of pain with deep breath in the side, cough with big quantity of purulent sputum and blood with bad smell. What disease causes these symptoms? 

* Abcsess of the lungs 

Complication of liver echinococcosis 

Bronchectatic disease 

Actinomycosis of lungs 

Tuberculosis of lungs 

40.     

Which of the listed below opertion are not done in cases of perforative duodenal ulcers ? 

*Gastrostomy 

Resection of 2/3 - 3/4 of the stomach 

Vagotomy + Pyloroantrumectomy 

Vagotomy + resection of the ulcer 

Suturing of the ulcer 

41.     

What preparations are used for prevention of fungal infection? 

*Fluconozol, Orungol, Nisoral. 

Rubomycin, Bleomycin, Mytomycin C. 

Cytosar, Cormyctin, Lomycitin 

Captopril, Enalapril. 

Isoniazid, Ftibazid, Pyrazinamid. 

42.     

Patient Н, 44 years old, is hospitalized in surgical department with the diagnosis – of postcholecystectomic syndrome, residual choledocholithiasis, cholangitis, and mechanical jaundice. Operated 8 months back, done cholecystectomy, Choledocholithotomy, drainage of abdomen according to Keru. What from of below-mentioned procedure would be appropriate to avoid occurrence of postcholecystectomic syndrome? 

*Intraoperative cholagiogrpahy. 

X-ray of Abdomen. 

Intravenous Cholecystocholangiography. 

Per oral Cholecystography. 

Echography. 

43.     

30 years old woman, 15 days ago had mild trauma of 5th finger of the left hand. Treated her self at home independently, Due deterioration of a condition she visited hospital for medical advice with rise in temperature up to 36 0c. Objectively: Hypermia and swelling on the ventarl surface of finger. Restricted Movements of the finger. X-ray of the left hand: It is impossible to exclude an early stage of development оsteomyolitis of the fifth finger. The diagnosis: Panarchy of 5th finger of the left hand. What form of Panarchy has occurred in the patient? 

*Bony. 

Hypodermic 

Paronychia 

Tendon Type. 

Joints Type. 

44.     

Contraindications for operation in acute pancreatitis are: 

* Hemodynamic unstability and pancreatogenic shock 

Functional insufficiency of the parenchymatous organs 

Purulent and septic complications 

Peritonitis 

Erosive bleeding 

45.     

The patient, 43 years old is hospitalized with complaints of repeated vomiting, spasmodic pain in the abdomen, delay in passes of gases and stool. History of the patient - appendectomy. Objectively: Position of the patient -lying, pale skin. Pulse 90/ minutes. Blood Pressure - 110/80 mm. Hg, t - 37, 2 oc Moderately distended abdomen, asymmetric, rigidity on the lower part of the abdomen. Increased peristalsis. Rebound tenderness- negative (Shetkina- Blumberg). Manual per rectum analysis of rectum-   empty ampoule. Your diagnosis? 

* Acute intestinal obstruction. 

Food poisoning 

Hepatic Colic. 

Acute pancreatitis 

Hepatic Colic. 

46.     

A 41 year old patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of  hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding? 

* Introduction of obturator nasogastric tube. 

Intravenous administration of pituitrin 

Hemostatic therapy 

Operation 

Administration of plasma 

47.     

What developes in cases with decompensated pyloric stenosis: 

* Isotonic dehydration. 

Hypertonic dehydration (eksikosis). 

Hypotonic dehydration. 

Intoxication. 

Renal insufficiency. 

48.     

The diagnosis – melanoma was made to a 16 year old patient after examination with complaints of frequent pain in the abdomen, pigmentation of the mucosa and skin, polyp in the stomach and  large intestine was found. It is know that the  mother of the patient analogous pigmentation and was treated often for anemia What disease is suspected?   

* Peytz – Egers’s polyposis. 

Chron’s disease. 

Tuberculosis of the intestine. 

Adolescent polyposis. 

Hirschprung’s disease. 

49.     

What developes most often after accidental intake of Hydrochloric acid:    

* Cardiac insufficiency. 

Cushing’s syndrome. 

Kutling’s syndrome. 

Deylads's syndrome. 

Acute pancreatitis. 

50.     

Patient С, On chest X-ray found collapse of the right lung, dislocation of the mediastinum on the left. During   puncture of the pleural cavity 2.5 L. of air is allocated. What is your diagnosis? 

*Right sided Pneumothorax. 

Left-sided Pneumothorax. 

Empyema Pleura. 

Mediastinitis. 

Pneumomediastinium. 

51.     

Patient of 23 years old suffering from acute glomerulonephritis with nephrotic syndrome, Initial Phase with normal renal function. What is the baseline treatment? 

*Antibiotics 

Saluretics. 

Kurantil 

Heparin 

Prednisolone. 

52.     

65 years old patient    had been on observation for 5 years concerning an ulcer of antral part of a stomach.  Patient refused operation. Since last 6 months patient is having constant pain in the epigastric region. Disgust to meat products has appeared. Working capacity has decreased. The patient has become thin. In contrast examination of the stomach circular form of defect of a mucous membrane up to 5 sm. in diameter and aperistaltic zone is revealed. What is an effective method of verification of the diagnosis  

*Fibrogastroduedenoscopy with biopsy. 

Ultra sonogram. 

Pneumoperitoneum. 

Roentgenoscopy of Stomach. 

ERCP 

53.     

38 years old man suffering form duodenal ulcer for long time, patient start feeling constant heaviness in a stomach after meal, regurgitation, vomiting food contains which he had in the evening of the previous day, weight loss. Objectively:  Relatively satisfactory condition of the patient, appetite not changed, Turgor of skin is reduced. On palpation the stomach is soft, symptoms of irritation of abdomen is not present, “noise of splash “in epigastria region. Urinations normal. Stool once in 3 days. What   complication has occurred in the patient? 

* An ulcerative stenosis of pyloric canal. 

Acute pancreatitis. 

Achalasia, esophagitis. 

Cancer of a stomach. 

The covered perforation of an ulcer. 

54.     

A 60 year old patient complains of the weakness, loss of appetite, periodic fever  up to 38-40 o C , loss of body weight, cough with a purulent sputum in a small amount on daytime  and large up to 300-400ml sputum  discharge with stinking smell on morning. He is chronic patient suffering from chronic lung emphysema within 10 years. At the past he had had an acute left sided pneumonia of the lower lobe  8-10 weeks ago. After  that he noticed  a mild mainly on evening fever and night sweats. The  above mentioned complaints was appeared 4 days ago. On physical examination the patient looks toxic. There are severe underweight, grey skin, unpleasant small  from the mouth, finger clubbing, asymmetric chest  secondary to the air entry limitation  on the left. On auscultation the breathing sounds are diminished in the lower chest on the left and pleural rub phenomenon   is defined here. Over other chest surface a moist rales are heard. The chest X-Ray reveals  a  pneumosclerosis and  lung cavity with  liquid level and thick walls sized  10x7cm in diameter  in the upper lobe on the left. What is the diagnosis of the patient? 

*Chronic lung abscess  with in bronchus drainage  

Acute abscess of the left lung  

Left sided destructive pneumonia  

Left sided chest TB  

Bronchiectasis  

55.     

The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What method of treatment is indicated to the patient? 

*Surgical treatment: Drainage of the pleural cavity. 

Antiinflammation therapy. 

Symptomatic therapy. 

Pleural puncture. 

Thoracotomy. 

56.     

A 33 years old patient was admitted to the reception room  of the Central District Hospital. He complains of a  severely painful swelling localized  on  posterior  neck, fever up to 38,4oC and general weakness. It is known that the patient suffers from  diabetes mellitus within  5  years. On physical examination on the posterior neck surface there is an infiltrate elevated above  surrounded skin. The tissues  affected by swelling  are  tens and  blue reddish discolored   in  central area. There are also several purulent necrotic pustules which are connected with each other and formed a large skin necrosis. A thinned necrotic skin of this swelling has a holes look like sieve and a pus is discharging through out.   What disease should a doctor consider  first of all? 

*Carbuncle 

Furuncle 

Acute skin cellulitis  

Carbuncle associated with anthrax  

Skin abscess 

57.     

Patient B, 63 years old is hospitalized in thoracic surgery department with complaints of nausea, vomiting after taking food, weakness, loss of weight. After radiological investigation the diagnosis is as follows: - “Achalasia Cardia”. What from below-mentioned is the reason of this disease? 

*Insufficient development of Auerbach’s plexus. 

Cicatricial stenosis of  esophagus. 

Hiatal Hernia. 

Varicose of Esophageal vein (Esophageal Varices). 

Tumour of lower third of esophagus. 

58.     

A 38 year old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected? 

* Acute pancreatitis 

Renal colic 

Acute enterocolitis 

Perforative  gastric ulcer 

Acute appendicitis 

59.     

Purulent medisatinitis is diagnosed on a  63 year old patient. What of the below listed diseases are not the cause of purulent mediasdtinitis?     

* Cervical lymfadinitis. 

Deep nech phlegmon. 

Perforation of the cervical part of the easophagus. 

Perforation of the thoracic the easophagus. 

Iatrogenic injury of the trachea. 

60.     

A woman born in 1952 consulting by a doctor in  the out-patient office  complains of a reddish bordered  swelling in the low back skin appeared 3 days after branch tree prick. The fever is mild up to  37,9 C. Other complains are the general weakness, headache, malaise and appetite loss. On physical examination on the loin skin  a swelling and  hyperemia are revealed. On palpation there is a positive fluctuation symptom. What is the most probable diagnosis? 

* Acute abscess of the loin skin 

Acute cellulitis  of the loin skin  

Hematoma 

Carbuncle 

Furuncle 

61.     

A 42 years old patient consults by a surgeon with complains  of the painful, severely itching and hyperemic thumb  of the  right hand. It is known  that the patient  has pricked his finger with a fish bone one week ago. On examination  the affected thumb is rosy red and  painful on touch. There is a red bordered and elevated above the surrounding skin spot.  The chest and heart are symptomatic free. The heart rate is 80 per min. Blood pressure is 130/90 mm Hg, Body temperature  is 36,70 C. What’s the diagnosis? 

*episipeloid 

Erysipelas 

acute lymphangitis 

acute panaritium 

Paronychia 

62.     

Patient Е, 51 year old is hospitalized in gastroenterology department with complaints of jaundice, loss of weight, weakness, dark color urine, and light colored stool. Diagnosis:  Mechanical jaundice, Cholangitis. Disease began gradually. Suspected as Cancer of ampullae’s of vater. What diagnostic method should be applied     for confirmation of the diagnosis?  

*Fibroduedenoscopy with biopsy of ampulla of Vater. 

Echography. 

X-ray Abdomen. 

Pneumogastrography. 

Computer tomography. 

63.     

A 15 years old teen  complains of high fever up to  39,5 – 40 0 C  and a local metaepiphesal localized in low one third of hip pain. There are local skin hyperemia, soft tissues swelling and knee movements restriction secondary to the pain. The patient  denies the trauma. Blood WBC (leucocytes) are 15x10E9.  X-ray reveals hip bone destruction  and sequestration.  

*Haematogenic osteomyelitis  

Bone TB (tuberculosis) 

Paget’s disease 

Osteosarcoma  

Myeloma  

64.     

The 67 years old patient within 5 years  had had 5  recurrent  fractures of the lower extremities without considerable cause.  O-shaped deformity of the legs in the knee joints was appeared.  The  skull, pelvis and  lower extremities X-Ray films  shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis. The blood tests does not reveal any inflammation activity. Serum calcium is normal. What disease  do you consider in this case?   

*Paget’s disease 

hyperparathyoid dystrophy 

chronic osteomyelitis 

myeloma 

mottled disease (marble disease) 

65.     

45 years old woman complaints of pain and movement restriction in the right hip joint.  The disease is  in progress. The history of trauma is negative. The X-Ray does not reveal malignancy or inflammatory disease but only  shows an angled disproportions and ostephytes. What is the diagnosis?  

* The deforming arthrosis of the right hip joint 

Non-specific arthritis  

Specific arthritis 

Polyarthritis 

Radiculitis 

66.     

The 45 years old man locksmith complains of poor fourth and  fifth fingers straitening in the right hand. He is ill whithin 6-7 years. Every year the disease worsens. On examination the fourth and the fifth fingers are flexed and can not be even passively extended.   The X-Ray does not reveal any  bone damage. What kind of contracture do you consider in this case?    

*Dupuytren’s contracture 

Myogenic contracture 

neurogenic contracture 

Ischemic contracture 

tendinous contracture 

67.     

The 35 years old patient has severely restricted movement ability in the vertebral column. Within 3 years the patient has had a persistent  pain and progressive stiffness  in the low back  later spread out   into the thorax and cervix. The patient did not look for medical help before. The history of back trauma or acute disease is negative. The laboratory tests  are normal. What disease  do you consider in this case?   

*ankylosing spondylarthritis 

osteochondrosis 

tuberculous spondylitis 

polyarthritis 

radiculitis 

68.     

The patient man-welder (profession related  with long standing  on knee position)  was consulted by a doctor because of  development  knee joint swelling and knee pain  at  working time. On examination there has been found a soft bordered swelling localized lowly from patella with  normal color and callous skin. There is not local hyperthermia. The X-Ray does not reveal  any destructive impairment of the bones. What is the  treatment?. 

*operative bursectomy 

ultrahighfrequency (UHF) 

tight bandage 

puncture 

magnetotherapy 

69.     

The sick woman complains of fever up to to 38,20C, severe earache  reflected into the left temple and persistent headache. Also there is hearing depletion.  She fall in illness 3 days ago after common cold. Otoscopy shows  normal auricle and external auditory meatus  without pathological features. Palpation of trugus and papillae - like spout is painless. Tympanic membrane looks red and bulged  with indistinct  landmarks. Whisper is perceived by the patient from 0,8m of distance and colloquial  speech only from  3 m. What’s a probable diagnosis?  

*Acute otitis media  

Furuncle of the external auditory meatus 

Acute mastoiditis 

Acute external  otitis 

Exacerbation  of chronic otitis media  

70.     

A 38 years old woman complains of a purulent discharge from the left nostril. The body temperature is 37,50C. The patient  is ill during a week and associates her illness with common cold.  pain on The palpation  of her  left cheek reveals tenderness.. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudates is seen in the middle meatus in maxillary. What is the most probable diagnosis? 

*Acute purulent maxillary sinusitis 

Acute purulent frontitis 

Acute purulent ethmoiditis 

Acute purulent sphenoiditis 

Purulent rhinitis 

71.     

34 years old patient, during tooth filling accidentally inhaled a dental pine. Referred to emergency department of Hospital. Complain of moderate dyspnea, dry cough, dizziness, and disturbed. On Chest X-ray on the hilar region of right lung identified radio opaque subject. What volume of the help is necessary in this case? 

* Urgent Fibrobronchoscopic removal of the foreign body. 

Urgent Diagnostic Fibrobronchoscopy. 

Urgent Rigid Bronchoscopic removal of the foreign body. 

Thoractomy, Bronchotomy, removal of foreign body. 

Antibacterial therapy, Cough expectorants, Control Chest X-ray. 

72.     

A patient complains of a general weakness, fever, muscle and joint pains and sore throat. The pain is increasing on swallowing. Throat  examination reveals pink mucous membranes of the pharynx. The  tonsils  are congested and swelled. There is membranous exudate in crypts. This membranes aren’t spreading out of  the tonsils border  and  can be removed  easily. What is the previous diagnosis? 

* Membranous (lacunar) streptococcal  tonsillitis 

Follicular streptococcal  tonsillitis  

Acute viral pharyngitis 

Diphtheria 

Hypertrophic pharyngitis 

73.     

The patient factory worker has been brought in the department emergency by ambulance. The admission diagnosis is the penetrating cornea injury of the right eye. On the slit lamp examination  the low intraocular pressure, corneal swelling and adgesion  of injured corneal margins in paraoptical zone have been detected. The depth of anterior chamber is 2,5 mm. What method of the following  investigations  mast  be carried out first? 

*Roentgenography of the orbital cavity by f Komberg – Baltin 

Roentgenography of the orbital cavity in two projections 

boneless roentgenography by  A.Vogt 

eye electroplatismagraphy 

eye ultrasonography  

74.     

The patient complains of eyelids redness and swelling, troublesome itching of the eyelids margin and eyelashes loss. He is being consulted  by an ophthalmologist in the local public health center. The doctor prescribes various eye drops  preparations with relapsed  effect. What kind of investigation should be carried out? 

*investigation for demodicidosis 

conjunctival sac bacteriological smear   

checking up the refraction 

consulting by an allergologist 

testing blood glucose  

75.     

Diarrhea   is not typical but still often symptom of acute appendicitis in children. In what case diarrhea is exact sign of appendix inflammation: 

* in case of pelvic appendices location  

in case of peritonitis 

in infants and early aged children  

in case of retrocecal appendicitis 

when acute appendicitis is secondary to acute enterocolitis   

76.     

The child with the symptoms of acute appendicitis has been brought to the in-patient department  by ambulance. Examination is impossible because of his negative contact faulted    behaviour. What are you to do? 

*to examine the child under general anesthesia 

to examine the child in spite of his temper 

to have laparoscopy taken 

to wait for child`s  physiological sleeping 

to admit  the child to a hospital for  observation by children’s doctor and the surgeon 

77.     

On the second day after birth the newborn has  multiple duodenal content vomiting. Meconium didn’t pass away. The abdomen is soft and distended in the upper region but retracted in the lower one. The correct diagnosis is: 

* development of  congenital ileus;  

resolution  of congenital ileus; 

pylorostenosis; 

Ledd’s syndrome; 

congenital diaphragm hernia. 

78.     

The 5 month old child has become uneasy after first time carrot puree feeding.  There is multiple vomiting. The general condition is moderate. The abdomen is not distended and soft. By rectal examination there has been found that the feces contain much mucus with bright blood admixture and looks like red currant jelly. What disease does the child have? 

* intussusception 

intestinal infection; 

dyspepsia; 

gastrointestinal hemorrhage (bleeding); 

acute ileus. 

79.     

The symptoms and signs of acute appendicitis depends on the anatomical location of appendix. What kind of location promotes signs of urine tract irritation and  the diarrhea? 

*descending 

Medial 

Retrocaecalis   

typical 

left- hand side location 

 

1 comment:

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