1.
A.
B.
C.
D.
E.
2.
Classical X-ray examination of intestinal obstruction is (see Fig. 127):
Gas and horizontal levels *
Filling defect
High positioned diaphragm
Reactive pleuritis
Pneumatosis
A 50 -year-old woman complains of attacks of right subcostal pain after fatty
meal for 1 year. Last week the attacks have repeated every day and become more
painful. What diagnostic study would you recommend (see Fig. 122)
A. Ultrasound examination of the gallbladder *
B. Liver function tests
C. X-ray examination of the gastrointestinal tract
D. Ultrasound study of the pancreas
E. Blood cell count
3. A 39 -year-old woman complains of squeezed epigastric pain 1 hour after meal
and heartburn. She had been ill for 2 years. On palpation, there was moderate
tenderness in pyloroduodenal area. Antral gastritis was revealed on diagnostic
procedure (see Fig. 133). What study can establish genesis of the disease?
A. Revealing of Helicobacter infection in gastric mucosa *
B. Detection of autoantibodies in the serum
C. Gastrin level in blood
D. Examination of stomach secretion
E. Examination of stomach motor function
4. A patient, aged 58, complains of heaviness in the right hypochondrium, itching
of the skin. Repeatedly he had been treated in infectious diseases hospital due to
icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall
veins, spleen enlargement and Fig. 117. Diagnosis is:
A. Liver cirrhosis *
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
5. A patient, aged 60, complains of heaviness in the right hypochondrium, itching
of the skin. Repeatedly he had been treated in infectious diseases hospital due to
icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall
veins, spleen enlargement and Fig. 118. Diagnosis is:
A. Liver cirrhosis *
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
6. A patient, aged 55, complains of heaviness in the right hypochondrium, itching
of the skin. Repeatedly he had been treated in infectious diseases hospital due to
icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall
veins, spleen enlargement and Fig. 119. Diagnosis is:
A. Liver cirrhosis *
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
7. A woman, aged 60, mother of 6 children, has sudden onset of upper abdominal
pain radiating to the back, associated with nausea, vomitting, fever and chills.
Subsequently, she noticed yellow discoloration of her sclera and skin. On
physical examination the patient was found to be febrile with temp. of 38.9C,
along with right upper quadrant tenderness. US see Fig. 122. Most likely
diagnosis is
A. Gallstones *
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
8. A 40yr. woman has sudden onset of upper abdominal pain radiating to the back,
associated with nausea, vomitting, fever and chills. Subsequently, she noticed
yellow discoloration of her sclera and skin. On physical examination the patient
was found to be febrile with temp. of 38.0C, along with right upper quadrant
tenderness. X-ray examination see Fig. 123. Most likely diagnosis is
A. Gallstones *
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
9. A 40-year-old cigarette smoker complains of epigastric pain, well localized,
nonradiating, and described as burning. The pain is partially relieved by eating.
There is no weight loss. He has not used nonsteroidal anti-inflammatory agents.
The pain has gradually worsened over several months. The most sensitive way to
make a specific diagnosis is (Fig. 133)
A. Endoscopy *
B. Barium x-ray
C. Serologic test for Helicobacter pylori
D. Serum gastrin
E. Serum pepsin
10.A patient with a peptic ulcer was admitted to the hospital and a gastric biopsy
was performed Fig. 133. The tissue was cultured on chocolate agar incubated in
a microaerophilic environment at 37C for 5 to 7 days. At 5 days of incubation,
colonies appeared on the plate and were curved, Gramnegative rods, oxidasepositive. The most likely identity of this organism is
A. Helicobacter pylori *
B. Campylobacter jejuni
C. Vibrio parahaemolyticus
D. Haemophilus influenzae
E. Campylobacter fetus
11.A biopsy of the antrum of the stomach (Fig. 133) of an adult, who presents with
epigastric pain, reveals numerous lymphocytes and plasma cells within the
lamina propria, which is of normal thickness. There are also scattered
neutrophils within the glandular epithelial cells. A Steiner silver stain from this
specimen is positive for a small, curved organism, which is consistent with
A. Helicobacter pylori *
B. Enteroinvasive Escherichia coli
C. Enterotoxigenic E. coli
D. Salmonella typhi
E. Shigella species
12.A 35 year old man has a 3 week history of epigastric pain which is worse prior
to meals and at night. He has no other symptoms. You elicit a mildly tender
epigastrium on palpation; other examination is normal. You suspect peptic ulcer
disease. With regards to Peptic Ulcer Disease (PUD) (Fig. 131):
A. the most appropriate initial investigation is breath testing for Helicobacter pylori
*
B. duodenal ulcers are 10 times more common than gastric ulcers
C. this patient requires urgent endoscopy
D. smoking is not a risk factor for its development
E. duodenal ulcers are more common in patients with blood group A
13.A 40-year-old cigarette smoker complains of epigastric pain, well localized,
nonradiating, and described as burning. The pain is partially relieved by eating.
There is no weight loss. He has not used nonsteroidal anti-inflammatory agents.
The pain has gradually worsened over several months. The most sensitive way to
make a specific diagnosis is (Fig. 133)
A. Endoscopy *
B. Barium x-ray
C. Serologic test for Helicobacter pylori
D. Serum gastrin
E. Serum pepsin
14.An overweight 41-year-old woman with a body mass index of 32 presents with a
5-day history of severe right upper quadrant pain. Initially the pain was
intermittent, lasting for 2 hours then subsiding, but for the past 12 hours it has
been constant. On examination she is pyrexial (38.5°C) and there is tenderness
and rigidity in the right upper quadrant. Liver function tests and amylase are
within the normal range. US see Fig. 122. Which of the following diagnoses is
most likely?
A. Biliary colic *
B. Acute pancreatitis
C. Acute cholecystitis
D. Choledocholithiasis
E. Perforated peptic ulcer disease
15.An overweight 48-year-old woman with a body mass index of 32 presents with a
5-day history of severe right upper quadrant pain. Initially the pain was
intermittent, lasting for 2 hours then subsiding, but for the past 12 hours it has
been constant. On examination she is pyrexial (38.5°C) and there is tenderness
and rigidity in the right upper quadrant. Liver function tests (LFTs) and amylase
are within the normal range. X-ray examination Fig.123. Which of the following
diagnoses is most likely?
A. Biliary colic *
B. Acute pancreatitis
C. Acute cholecystitis
D. Choledocholithiasis
E. Perforated peptic ulcer disease
16.A 54-year-old male presents with a high fever, jaundice and colicky abdominal
pain in the right upper quadrant. The gallbladder cannot be palpated on physical
examination. Workup reveals hemoglobin level of 15.3 g/dL, unconjugated
bilirubin level of 0.9 mg/dL, conjugated bilirubin level of 1.1 mg/dL, and
alkaline phosphatase level of 180 IU/L. US see Fig. 122. What is the correct
diagnosis?
A. Bile duct obstruction by a stone *
B. Acute cholecystitis
C. Chronic cholecystitis
D. Carcinoma of the gallbladder
E. Carcinoma of the head of the pancreas
17. Epigastric area is number (see Fig 132) :
A. 2 *
B. 1
C. 3
D. 4
E. 5
18.Diagnostic procedure on Fig. 131 names:
A. Breath test for determination of Helicobacter pylori *
B. Serologic test for Helicobacter pylori
C. Irrigographia
D. EHDS
E. U.S.
19.Ultrasonography on Fig. 122. What is diagnosis?
A. Calculous cholecystitis *
B. Cirrhosis
C. Chronic gastro
D. Chronic hepatitis
E. Chronic pancreatitis
20.Increased abdomen is at (see Fig. 88)
A. Obesity *
B. Ascites
C. Diabetes
D. Hypothyroidism
E. Hernia
21.Palmar erythema, see Fig. 118, is the characteristic of:
A. Cirrhosis *
B. Chronic duodenitis
C. Chronic hepatitis
D. Calculous cholecystitis
E. Chronic pancreatitis
22.Liver cirrhosis is characterized by a symptom (Fig. 118)
A. Palmar erythema*
B. Eczema
C. Neurodermatitis
D. Drum Sticks
E. Bran eruption
23.What is the symptom of liver cirrhosis (Fig. 118)
A. Palmar erythema*
B. Eczema
C. Neurodermatitis
D. Urticaria
E. Spider angioma
24. What is the symptom of liver cirrhosis (Fig. 117)
A. Spider angioma *
B. Erythema
C. Eczema
D. Neurodermatitis
E. Urticaria
25.Spider angioma is characteristic of (Fig. 117)
A. Cirrhosis *
B. Hypertension
C. Chronic hepatitis
D. Ulcerative Colitis
E. Chronic pancreatitis
26.Gynecomastia is a symptom of (Fig.119)
A. Cirrhosis *
B. Fatty hepatose
C. Hepatitis
D. Nutritional obesity
E. Hypothyroidism
27.Which of the symptoms of cirrhosis is shown on Fig. 119?
A. Gynecomastia *
B. Spider angioma
C. Palmar erythema
D. Ascites
E. Caput medusae
28.Which of the symptoms of cirrhosis is shown on Fig. 117?
A. Spider angioma *
B. Ascites
C. Gynecomastia
D. Palmar erythema
E. Caput medusae
29.Which of the symptoms of cirrhosis is shown on Fig.118?
A. Palmar erythema*
B. Spider angioma
C. Ascites
D. Gynecomastia
E. Caput medusae
30. Patient complains of acute abdominal pain. Changes have been revealed on Xray examination (see Fig. 127). Diagnosis?
A. Intestinal obstruction *
B. Perforation of duodenal ulcer
C. Calculous cholecystitis
D. Renal colic
E. Acute appendicitis
31.Patient complains of acute abdominal pain. Changes have been revealed on Xray examination (see Fig. 123).. Diagnosis?
A. Calculous cholecystitis *
B. Intussusception
C. Perforation of duodenal ulcer
D. Renal colic
E. Acute appendicitis
32.Patient complains of acute abdominal pain. Changes have been revealed on Xray examination (see Fig. 126). Diagnosis?
A. Perforation of duodenal ulcer *
B. Calculous cholecystitis
C. Intussusception
D. Renal colic
E. Acute appendiciti
33.Patient complains of acute abdominal pain. Ultrasonography revealed changes
(Fig. 122). Diagnosis?
A. Biliary colic *
B. Intussusception
C. Perforation of duodenal ulcer
D. Renal colic
E. Acute appendicitis
34.Patient complains of acute abdominal pain. Proctoscopy revealed changes (Fig.
121). Diagnosis?
A. Colon Cancer *
B. Hemorrhoids
C. Anal fissures
D. Ulcerative colitis
E. Crohn's disease
35.Patient complains of acute abdominal pain. X-ray examination of
gastrointestinal tract with barium revealed changes (Fig. 130). Diagnosis?
A. Peptic ulcer disease small curvature of the stomach *
B. Calculous cholecystitis
C. Duodenal ulcer
D. Peptic ulcer disease of the curvature of the stomach
E. Pyloric ulcer of stomach
36.Examining of a patient with acute abdominal pain identified the changes
presented on Fig.122. Your actions:
A. Hospitalization in the surgical department of a hospital *
B. Observations. Do not prescribe treatment
C. Hospitalization in Therapy Unit
D. Referral to gastroenterologist for consultation
E. Outpatient treatment
37.Examining of a patient with acute abdominal pain identified the changes
presented on Fig.127. Your actions:
A. Hospitalization in the surgical department of a hospital *
B. Observations. Do not prescribe treatment
C. Hospitalization in Therapy Unit
D. Referral to gastroenterologist for consultation
E. Outpatient treatment
38.X-ray examination revealed changes (Fig. 123). Diagnosis?
A. Calculous cholecystitis *
B. Intussusception
C. Perforation of duodenal ulcer
D. Renal colic
E. Acute appendicitis
39.What is the diagnosis (Fig. 130)?
A. Ulcers small curvature of the stomach *
B. Esophageal achalasia
C. Acute gastritis
D. Outlet obstruction
E. Duodenal ulcer
40. Markers of Hypersplenism syndrome in liver disease with sign shown in the Fig.
120 are all except
A.
thrombocytopenia
B.
C.
D.
E.*
41.
A.
B.
C.
D.
E.*
42.
A.
B.
C.
D.
E.*
43.
A.
B.
C.
D.
E.*
44.
A.
B.
C.
D.
E.*
45.
A.
B.
C.
D.
E.*
anemia+ thrombocytopenia
anemia+ thrombocytopenia +leukocytopenia
anemia
Increase of ESR
Choose markers of Hypersplenism syndrome in liver disease with sign shown in
the Fig. 120
Increase of ALT
Increase of GGT
Increase of Bilirubin
Increase of AST
anemia, thrombocytopenia, leukocytopenia
The endoscopic changes in the Fig 121 characterize
Peptic ulcer
Gastric cancer
Barrett’s oesophagus
Oesophageal adenocarcinoma
Oeophageal varices
The sign shown in the Fig. 121 is observed in
Gastro-oesophageal reflux disease
Peptic ulcer
Irritable bowel syndrome
None of above
Liver cirrhosis
Which sign do you see in Fig 117
Hematoma
Erythema nodosum
Pyoderma gangrenosum
Contracture
Spider naevus
The sign shown in the Fig. 117 may be observed in
Gastro-oesophageal reflux disease
Peptic ulcer
Irritable bowel syndrome
Gynecomastia
Liver cirrhosis