Faculty surgery - Case study 1. A patient on day 5 after

Faculty surgery - Case study

1. A patient on day 5 after appendectomy occurred deterioration of general condition, hectic fever, high leukocytosis, pelvic pain were moderate, transient dysuria, tenesmus.

I. From what additional research method you start identifying the cause of the described picture:

A. cystochromoscopy

B. repeated blood and urine tests

V. digital examination of the rectum *

G. sigmoidoscopy

D. Control irrigoscopy

II.

Your preliminary diagnosis:

A. bleeding

B. subdiaphragmatic abscess

W. Douglas space abscess *

G. mezhkishechny abscess

D. pylephlebitis

2. The patient 24 years complains of nausea, vomiting, pain in the navel for 4 hours.

Over the last half-hour pain moves to the right lower abdomen, temp 37.8 C, leukocytes 13 thousand.

I. What is the diagnosis most faithful:

A. acute pyelitis

B. acute appendicitis *

B. renal colic

G. acute intestinal obstruction

D. inflammation of the uterus

II.

Your tactic:

A patient must operate *

B. must continue to monitor the patient

B. make ultroasonografiyu

G. perform laparoscopy

D. physiotherapy

3. The patient complains of abdominal pain and fever up to 37.5, a single vomiting and sick for days.

OBJECTIVE: pain and muscle tension right iliac region, increased pain on palpation, positive symptom

Shchetkina-Blumberg.

I. Your preliminary diagnosis:

A right-sided renal colic

B. ectopic pregnancy

B. acute appendicitis *

G. appendiceal infiltrate

D. acute cholecystitis

II.

Your treatment policy:

A. emergency surgery *




D. physiotherapy

4. The patient 23 years, pregnancy 32 weeks, located in the surgical department 18 hours in the follow completely rule out the presence of acute appendicitis is not possible.

I. Your medical tactic:

A patient must operate *



In conjunction with the gynecologist cause artificial termination of pregnancy, and then make a laparoscopy

D. physiotherapy

II.

When you operate:

A. for 1 hour *

B. 6 hours

B. 12 hours

G. for 24 hours

D. after childbirth

5. The patient operated on for appendicitis gangrenous condition does not improve, high fever, appeared bloating and yellowness of the skin.

I. The most likely diagnosis is:

A. pylephlebitis *

Infectious hepatitis B.

B. ileus

G. diffuse peritonitis

D. postoperative pneumonia

II.


A. relaparotomy

B. massive antibiotic therapy *

B. laparoscopy

G. CHCHHS

D. RPHG

6. After 12 hours after appendectomy at normal temperature in the patient appeared tachycardia, pallor, when you try to stand up - fainting.

I. What kind of complications can think of:

A. abdominal bleeding *

B. diffuse peritonitis

B. ileus

G. pylephlebitis

D. stroke

II.


A. relaparotomy *

B. massive antibiotic therapy

B. laparoscopy

G. CHCHHS

D. RPHG

7. The patient after appendectomy on the fifth day there were pains in the right hypochondrium, worse on inspiration, temp 38.7 C, the pulse speeded up.

Radiologically right dome of the diaphragm simplified limited mobility.

I. What complication occurred in a patient:

A. subdiaphragmatic abscess *

B. Douglas space abscess

B. mezhkishechny abscess

G. pylephlebitis

D. fester

II.


A. relaparotomy *


B. laparoscopy

G. CHCHHS

D. RPHG

8. The patient complains of pain in the right iliac region, raising t-ry body 2 to 37. Sick C. for 6 days.

Objectively: in the right iliac region is determined by the formation of a tight, painful, associated with the edge of the ilium.

I. Your diagnosis:

A tumor of the cecum

B. acute appendicitis

B. appendiceal infiltrate *

G. intussusception

D. appendiceal abscess

II.


A. surgery

B. laparoscopy

B. conservative treatment *

The observations

D. outpatient treatment

9. The patient has the right scrotum is enlarged, palpable, painless, stress formation in the abdominal cavity do not reduce a, the egg is not determined separately.

I. Your diagnosis:

A. oblique inguinal hernia

B. Direct inguinal hernia

B. orchiepididymitis

G. inguinal scrotal hernia,

D. hydrocele *

II.


A. recommend wearing a bandage

B. outpatient monitoring of patients

B. planned surgery *

The patients did not need to observe hipupga

D. surgical treatment only in the case of infringement

10. The patient has a left inguinal folds inwards from the femoral vessels is determined by the protrusion of 2 x 2 cm, in the stomach reduce a symptom cough shock is positive.

Protrusion below and outward from the pubic tubercle.

I. Your diagnosis:

A femoral hernia *

B. inguinal hernia on the left

B. wandering abscess on the left

G. inguinal lymphadenitis left

D. lipoma left groin

II.

What you have to differentiate between:

A. That's right *


B. hydrocele

G. orchiepididymitis

D. varicocele

11. In elderly patients spherical formation in the groin on both sides, soft kosistentsii not descend into the scrotum, vpravimye into the abdominal cavity.

I. Your diagnosis:

A. oblique hernia

B. Direct inguinal hernias *

B. hydrocele

G. cryptorchidism

D. varicocele

II.







12. The patient in the groin area is pear-shaped, soft-elastic education, descend into the scrotum, vpravimoe into the abdominal cavity.

I. Your diagnosis:

A. oblique inguinal hernia *


B. hydrocele

G. orchiepididymitis

D. varicocele

II.







13. The patient complains of cramping and bloating, neothozhdenie stool and gas, pain on the back surface of the right buttock, soreness at the exit point of the sciatic nerve.

I. Your diagnosis:

A posterior perineal hernia

B. strangulated hernia sciatic *

B. strangulated hernia obturator foramen

G. sciatica

D. acute intestinal obstruction

II.




B. planned surgery


D. urgent surgery *

14. The patient in the left groin swelling there, dense, mobile, painful.

Pubic - whitish stellate scar symptoms of intestinal obstruction is not, on the left leg abrasions, no pustules.


A strangulated inguinal hernia

B. venous thrombosis node groin

V. tumor metastasis in the groin

G. lipoma groin

D. inguinal lymphadenitis *

II.


A. surgery

B. laparoscopy


The observations


15. Patient 70 years, was admitted to ppavostoponney pahomoshonochnoy gpyzhey a history twice infringement with spontaneous razuschemleniem.

Condition concerning udovletvopitelnoe, BP 170/100, ECG gipeptpofiya left ventricle, moderate koponapnaya failure.




V. surgery after appropriate training *



II.

Possible complications, except for:

A. coprostasia

B. infringement

B. nepravimost

G. vospolenie

D. myocardial infarction *

16. 60-year-old obese woman complains of severe heartburn and chest pain who are more concerned when bending forward.


Zenker's diverticulum of the esophagus A.

B. chronic gastritis

B. reflux esophagitis *

G. esophageal cancer

D. Achalasia

II.


A. surgery

B. laparoscopy


The observations


17. The patient complains of pain throughout the abdomen, nausea, dry mouth, general weakness.

Acutely ill 25 hours ago.

Suddenly there were severe epigastric pain, nausea, blackout.

In the future, the growing pains acquired character, joined bloating, no longer depart gases.


A. abdominal form of myocardial infarction

B. lobar pneumonia

B. acute renal failure

G. acute peritonitis *

D. ulcerative colitis

II.




B. planned surgery


D. urgent surgery *

18. We examined patients with suspected "acute abdomen", with X-ray Review, was detected free gas under the dome of the diaphragm.

I. Your diagnosis:

A. acute pancreatitis

B. perforated stomach ulcer *

Leriche syndrome B.

G. Mallory-Weiss syndrome

D. acute appendicitis

II.


A diagnostic laparoscopy

B. monitoring of patients

B. planned surgery


D. urgent surgery *

19. In a patient with a suspected "acute abdomen", laparoscopy was found a large amount of effusion, cloudy nature with a touch of fibrin.

I. What complication arose:

A. acute intestinal obstruction

B. mezhpetlevoy abscess

B. bowel gangrene

G. acute peritonitis *

D. empyema

II.

Your prompt access:

A medium-midline laparotomy *

B. upper-middle laparotomy

B. Lower-middle laparotomy

The full laparotomy

D. Dyakonova cut-Volkovich

20. in patients undergoing laparotomy for peritonitis appendicular, on the sixth day after the operation, there were pains in the lower abdomen, tenesmus, dysuria.

Increased body temperature (39 C) with hectic scale, chills.

Tongue moist, abdomen soft, moderately painful over the pubis.

When rectal examination - in the pelvis is palpated sharply painful, of considerable size infiltration with softening.

I. Your diagnosis:

A. mezhpetlevoy abscess

B. Douglas abscess space *

B. periappendikulyarny abscess

G. sepsis

D. pylephlebitis

II.


A. relaparotomy *


B. laparoscopy

G. CHCHHS

D. RPHG

21. The patient 30 years after the death of a child there was a strong weakness, irritability, sweating, crying.

In a short time, she lost 15 pounds.

Objectively: the patient is restless, excited, a marked exophthalmos.

The thyroid gland is enlarged to the III degree, pulse 128 beats per minute, rhythmic, in the apex of the heart systolic murmur.

The liver is not increased, the main exchange increased (+ 55%).

I. Your diagnosis:

A. Graves' disease III, hypothyroidism.

B. thyroid cancer.

B. diffuse goiter III level, with symptoms of hyperthyroidism.

G. Graves' disease III.

*

D. diffuse euthyroid goiter III degree.

II.

That you will take:

A. will treat patients on an outpatient basis

B. direct the patient to the endocrinology department *

V. send a surgical clinic for surgery

G. radioactive iodine treatment

D. will observe the dynamics

22. The 24 year-old woman considers herself a patient for two years.

The patient observed manifestations of thyrotoxic goiter, but the thyroid gland is not increased.

On R-gram in the anterior mediastinum to the right of the ribs is determined II rounded education 5x5 cm, with clear margins.

The structure of the lung tissue is not changed.

I. On what disease in question:

A hydatid cyst of the mediastinum

B. mediastinal tumor

B. dermoid cyst of the mediastinum

G. thymoma

D. retrosternal goiter *

II.


A. surgery *

B. conservative treatment

B. dynamic observation


23. The patient 24 years, 24-25 weeks of pregnancy, harass severe weakness, irritability, sweating, crying.

Conservative therapy without effect.

Indicators: pulse 120 beats per minute, the basal metabolic rate increased (+ 65%).

The patient is against this background developed malignant ophthalmopathy dramatically disturbed sleep.

I. Your diagnosis:


B. thyroid cancer.



*


II.

That you will take:

A. active therapy for the Conservation of pregnancy

B. persistent thyrotoxicosis therapy under the supervision of an obstetrician-gynecologist

B. emergency surgery for goiter, and then treated by an endocrinologist

G. urgent abortion, then treatment in endocrinology department *

D. elective surgery, after removing the effects of hyperthyroidism

24 patients operated on six months ago, about toxic goiter came to the reception to complain: weakness, drowsiness, fatigue, progressive weight gain (30 kg).

On examination, draws attention pastoznost and puffiness of the face, dryness of the skin.

The thyroid gland is not increased.

Postoperative scar in good condition.

Basal metabolic rate dropped by 25%.

I. What complication developed in a patient:

A. developed myxedema *

B. relapse toxic goiter

B. malignant degeneration of the thyroid gland

G. failure of the parathyroid glands

D. none of these complications

II.


A. surgery




D. Replacement Therapy *

25. The patient 51 g 14 years ago was diagnosed with nodular euthyroid goiter (3x3 cm).

All these years, education did not cause the patient any anxiety.

Over the last 3 months education doubled.

The patient noted the deterioration of general condition, weakness, fatigue, lost weight 4 kg.

When viewed from the surface of the site is uneven, dense consistency, mobility is limited.

The observed increase in dense lymph nodes along the left sternocleidomastoid muscle.

I. What is the diagnosis can be assumed:

A mixed crop

B. malignancy node *

B. thyrotoxic goiter

G. developed goiter Riedel

D. goiter de Quervain

II.


A. surgery *




D. Replacement Therapy

26. The patient is marked hoarseness, diffusely enlarged, thick and nodular right lobe of the thyroid gland.

There is also an increase in regional lymph nodes.

Thyroid function is not changed.

I. Your diagnosis:

A nodular goiter

B. diffuse goiter

V. mixed crop

G. thyroid cancer *

D. goiter Riedel

II.


A. surgery *




D. Replacement Therapy

28. clinic patient appealed 18 years with complaints of swelling of the thyroid gland.

On examination, she had in the left lobe of the thyroid gland is determined by the node size 5x5 cm. Manifestations of hyperthyroidism not, have never been treated.

I. Your diagnosis:

A nodular goiter *

B. diffuse goiter

V. mixed crop

G. thyroid cancer

D. goiter Riedel

II.

That you will take:

A. will treat patients on an outpatient basis

B. direct the patient to the therapeutic or endocrinology department

V. send a surgical clinic for surgery *


D. will observe the dynamics

29. You turned 50 years old patient with nodular goiter 3x3 cm., Without the effects of hyperthyroidism.

I. What methods of study you recommend it:

A. ultrasonography *

B. ECG

B. EHOKS

G. scintigraphy

D. MRI

II.

What do you recommend it:

A. surgery *

B. iodine treatment for Plyummeru

B. Treatment pills on Plyummelyu-Sherishevskomu


D. micro dose iodine treatment

30. The patient who had undergone cholecystectomy for acute calculous cholecystitis, developed pain with signs of jaundice.

I. On what evidence is the manifestation of pathology postcholecystectomical syndrome:

A tumor of a biliary-pancreatic system

B. of a patient with chronic hepatitis transition to cirrhosis

B. the presence of common bile duct stones *

G. chronic pancreatitis

D. long stump of the cystic duct

II.

What methods of study you recommend it:

A. Ultrasound

B. RPHG *

B. CHCHHS

G. laparoscopy

D. X-ray

31. The patient 65 years old, suffering from bouts of illness zhelchakamennoy determined by palpation of considerable size plotnoelasticheskoy maloboleznennoe education with a smooth surface.

Symptoms of peritoneal irritation not.

I. As nazivaetsya symptom:

A symptom Ortner

B. Murphy symptom

B. De Musset's sign

G. symptom Courvoisier *

II.

Your diagnosis:

A. hydrocholecystis *

B. empiema gallbladder

B. acute destructive cholecystitis

G. chronic cholecystitis

32. B-term b.

32 years dealt with complaints and the presence of a rounded education under the right inguinal fold of severe pain in this region.

nevpravimost tensions and education, when viewed from the hernial ring is not determined by the negative symptom cough shock.

I. Your diagnosis:


B. strangulated femoral hernia *

B. nevpravimaya inguinal hernia

G. abscess inguinal hernia sac

D. inguinal lymphadenitis

II.


A. urgent surgery *

B. laparoscopy


The observations


33. A 17-year-old schoolboy during a football game there was a sharp pain in the right inguinal region. history pravostoronnyaya inguinal hernia with repeated infringements on. patient tried to straighten himself a hernia but failed.

I. Your diagnosis:

A strangulated inguinal hernia *

B. strangulated femoral hernia




II.

Determine the tactics of the patient:

A new attempt to reposition 2-3 hours

B. antispasmodics and warm bath

B. antibiotics and strict pastel mode

G. immediate gerniotomiya *

34. Sick. '42 Complaints of epigastric pain, nausea, vomiting, weight loss, weakness, and convulsions. 12 years suffers a stomach ulcer 12 items. Intestine. repeatedly received treatment, general satisfy-ing, flabby skin, dry tongue with a cataract bloom.

swollen belly a few painful on palpation in the epigastric positive symptom splashing. X-ray after 24 hours in the stomach about 50% contrast. Bulb 12 n. Colon dramatically deformed.

I. Your diagnosis:

A. stenosis *

B. bleeding

B. malignancy

G. penetration

D. perforation

II.

The volume of operations:

A. Gastrectomy *

B. vagotomy with drainage operations

B. gastroenteroanostomoz

G. SPV

D. selective vagotomy with pyloroplasty

35. The patient 24 years disturb severe weakness, irritability, sweating, crying. Conservative therapy without effect. Indicators: pulse 120 beats per minute, the basal metabolic rate increased (+ 65%). The patient is against this background developed malignant ophthalmopathy dramatically disturbed sleep.

I. Your diagnosis:


B. thyroid cancer.



*


II.

That you will take:

A. active therapy for the Conservation of pregnancy

B. persistent thyrotoxicosis therapy under the supervision of an obstetrician-gynecologist

B. emergency surgery for goiter, and then treated by an endocrinologist

G. treatment in endocrinology department *

D. elective surgery, after removing the effects of hyperthyroidism

36. The patient was 33 years old, to operate six months ago, about toxic goiter came to the reception to complain: weakness, drowsiness, fatigue, progressive weight gain). On examination, postoperative scar in good condition. Basal metabolic rate dropped by 25%.


A. myxedema *





II.


A. surgery




D. hormone therapy *

37. The patient has the right inguinal region has sharply painful formation of a dense consistency, not reduce a into the abdominal cavity, a symptom of "cough shock" - no, was vomiting.

I. Your diagnosis:

A hernia sac abscess

B. strangulated inguinal hernia *


G. inflammation of inguinal hernia

D. inguinal hernia

II.


A. urgent surgery *



The planned surgery

D. antibiotic therapy

38. In the left groin swelling there, descend into the scrotum and easily reduce a into the abdominal cavity. Inguinal ring extended symptom cough shock is positive.

I. Your diagnosis:

A hydrocele

B. cryptorchidism

B. pahomoshonochnaya hernia *

G. varicocele

D. orchiepididymitis

II.


A. urgent surgery



G. elective surgery *


39. Which complication of the presence of effusion around destructive gallbladder organizations adhesions, an adhesive bubble surrounding organs in a single conglomerate.

I. Your diagnosis:

A. cholangitis

B. obstructive abscess

B. localized peritonitis

G. subdiaphragmatic abscess

D. periholetsistit *

II.


A. surgery *



G. lparaskopiya


40. The patient has a history of duodenal ulcer five years there is a delay evacuation of chyme from the stomach to the 6-12chasov.

I. What can be assumed:

A. evacuation is not broken

B. pyloric stenosis of the stomach komsatornaya stage

B. pyloric stenosis of the stomach subkompensatornaya stage *

Pyloric stenosis G. part of the stomach dekompensatornaya stage

II.


A. Gastrectomy *

B. antrumectomy

B. vagotomy

G. piloraplastika

D. gastrectomy

41. In a patient with inguinal hernia hernia sometimes infringed, at this time there is pain in the bladder and frequent urination.

I. These features are typical for a hernia:

A direct inguinal hernia

B. oblique inguinal hernia

B. femoral hernia

G. sliding hernia *

II.


A. urgent surgery



G. elective surgery *


42. With the opening of the peritoneum by Dyakonov - Volkovich stood out hemorrhagic fluid.

I. What kind of doctor should think of pathology / select the wrong answer /:

A bowel obstruction

B. destructive cholecystitis *

B. pankreanekroz

G. thromboembolism mezenterialnh vessels

D. ectopic pregnancy with rupture of pipes

II.


A medium-midline laparotomy

B. upper-middle laparotomy *


The full laparotomy

D. extend the cut-Dyakonova Volkovich

43. The patient suddenly developed severe abdominal pain, collapse and developed epigastric auscultation systolic murmur.


A perforation of the ulcer


B. rupture of abdominal aortic aneurysm *

G. acute cholecystitis

D. peritonitis

II.


A. urgent surgery *



The planned surgery

D. transfusion

44. The patient girdle pain in the epigastric nausea, vomiting, elevated temperatures, lack of pulsation of the abdominal aorta.

I. Your diagnosis:

A perforated ulcer

B. acute cholecystitis

B. exacerbation of peptic ulcer disease

G. acute pancreatitis *

D. ileus

II.

What is the name simptom- absence of pulsation of the abdominal aorta:

A. with th Rovzinga

B. with th Resurrection *

B. with th Obraztsova

G. Murphy with th

D. c m Ortner

45. During grzhesechenie about accidentally damaged femoral hernia femoral vein.


A tie both ends of the veins

B. impose turnstiles above and below this area and impose a vascular seam *

B. press and hold your finger for 3-5 minutes

G. resect the damaged portion of vein

D. impose bypass using a large vein under the skin

II.

What is the wall of the femoral canal femoral vein:

A. Lateral *

B. Medial

V. top

Nizhny

D. rear

46. The patient with acute cholecystitis occurred deterioration appeared jaundice, enlarged liver, the temperature of

39-40 degrees with chills,. naros leukocytosis.

I. Your diagnosis:

Toxic hepatitis A.

B. peritonitis

B. purulent cholangitis *

G. hydrops of the gall puzrya

D. empyema gall puzrya

II.


A. urgent surgery



The planned surgery

D. massive antibiotic therapy *

47. During the surgery for inguinal hernia at the opening of the hernia sac was visible mucous membrane walls are thick, fleshy, not content. When tightening its walls appear urge to urinate.

I. Your diagnosis:

A direct inguinal hernia

B. oblique inguinal hernia

B. femoral hernia

G. sliding hernia *

II.

Your actions:

A wound closure of the bladder mucosa without capture and overlay epitsistostomy *

B. wound closure colon colostomy

V. wound closure of the bladder mucosa with the seizure.

G. wound closure of the bladder mucosa without capture

48. At the top of the cell atypia polyp without invasion of muscle plate mucosa.

I. What operation can be considered radical:

A wedge resection of the bowel wall in the area of the polyp *

B. the right or left hemicolectomy in the area of the polyp

B. resection of the sigmoid colon polyp in the area

Subtotal colectomy G. overlay iliorektalnogo anastomosis

D. subtotal koektomiya overlay ileosigmoidnogo anastomosis

II.

What complications can be expected:

A. stenosis

B. bleeding

B. malignancy *

G. penetration

D. perforation

49. Sick. '42 Complaints of epigastric pain, nausea, vomiting, weight loss, weakness, and convulsions. 12 years suffers a stomach ulcer 12 items. Intestine. repeatedly received treatment, general satisfy-ing, flabby skin, dry tongue with a cataract bloom.

swollen belly a few painful on palpation in the epigastric positive symptom splashing. X-ray after 24 hours in the stomach about 50% contrast. Bulb 12 n. Colon dramatically deformed.

I. Your diagnosis:

A. stenosis *

B. bleeding

B. malignancy

G. penetration

D. perforation

II.


A. Gastrectomy *



G. SPV

D. Selective vagotomy with pyloroplasty

50. The patient 30 years, 14-15 weeks of pregnancy, harass severe weakness, irritability, sweating, crying. Conservative therapy without effect. Indicators: pulse 120 beats per minute, the basal metabolic rate increased (+ 65%). The patient is against this background developed malignant ophthalmopathy dramatically disturbed sleep.

I. Your diagnosis:


B. thyroid cancer.



*


II.

What do you do about the pregnancy:

A save

B. interrupt *

51. The patient was 34 years old, to operate 4 a month ago, about toxic goiter came to the reception to complain: weakness, drowsiness, fatigue, progressive weight gain Seen, attention is drawn to pastoznost and puffiness of the face, dryness of the skin.


A. developed hypothyroidism *





II.


A. surgery




D. hormone replacement therapy *

52. The patient complains of pain in the right upper quadrant, fever up to 37.5, a single vomiting and sick for days. OBJECTIVE: pain and muscle tension, right upper quadrant, increased pain on palpation, positive symptom

Ortner.


A right-sided renal colic


B. acute cholecystitis *

G. appendiceal infiltrate


II.


A conservative therapy *




D. physiotherapy

53. The patient 22 years, with 15 weeks of pregnancy, located in the surgical department of 2:00, in the follow completely rule out the presence of acute appendicitis is not voznozhnym.


A patient must operate

B. must continue to monitor the patient *


In conjunction with the gynecologist cause artificial termination of pregnancy, and then make a laparoscopy

D. physiotherapy

II.

What tests should be repeated:

A complete blood count *

B. urinalysis

B. biochemical blood tests

G. coagulogram

54. The patient operated on for appendicitis gangrenous condition does not improve, high fever, appeared bloating and irritation of the peritoneum.

I. The most likely diagnosis is:

A. pylephlebitis

Infectious hepatitis B.

B. ileus

G. diffuse peritonitis *

D. postoperative pneumonia

II.


A. relaparotomy *


B. laparoscopy

G. CHCHHS

D. RPHG

55. After 6 hours after appendectomy at normal temperature in the patient appeared tachycardia, pallor, general weakness.

I. What kind of complications can think of:

A. abdominal bleeding *

B. diffuse peritonitis

B. ileus

G. pylephlebitis

D. stroke

II.

Additional Methods:

A. ultrasonography *

B. CT

B. laparoscopy

G. CHCHHS

D. RPHG

56 patients after cholecystectomy 3-Day appeared in the right upper quadrant pain, worse on inspiration, temp 38.7

C, the pulse speeded up. Radiologically right dome of the diaphragm simplified limited mobility.

I. What complication occurred in a patient:

A. subdiaphragmatic abscess *

B. Douglas space abscess


G. pylephlebitis

D. fester

II.


A. relaparotomy *


B. laparoscopy

G. CHCHHS

D. RPHG

57. The patient complains of epigastric pain opayasivayushego character, nausea, repeated vomiting, increased t-ry body 2 to 37. Sick C. for 1 day. Objectively: Kerte symptoms and Mayo-Robson positive.

I. Your diagnosis:

A tumor of the cecum

B. acute pancreatitis *

B. appendiceal infiltrate

G. intussusception

D. appendiceal abscess

II.


A. surgery

B. laparoscopy


The observations


58. The patient has the right scrotum is enlarged, palpable painful, tense formation in the abdominal cavity do not reduce a, the egg is not determined separately. The body temperature of 38 0

I. Your diagnosis:

A. oblique inguinal hernia


B. orchiepididymitis *

G. inguinal scrotal hernia,

D. hydrocele

II.




B. antibiotic therapy *



59. The patient 35 years, under the left inguinal fold medially from the femoral vessels is determined by the protrusion of 3 x 2 cm, in the stomach reduce a symptom cough shock is positive. Protrusion below and outward from the pubic tubercle.

I. Your diagnosis:

A femoral hernia *

B. inguinal hernia on the left

B. wandering abscess on the left

G. inguinal lymphadenitis left


II.

What you should otdiferentsirovat:

A. That's right *

B. inguinal hernia

B. wandering abscess

G. inguinal lymphadenitis


60. The patient has the right inguinal region has swollen, firm, mobile and in the center there is a symptom fluctuation painful. Symptom cough shock is negative. Pubic - whitish stellate scar symptoms of intestinal obstruction is not, on the right foot are pustules.



B. venous thrombosis node groin

V. tumor metastasis in the groin

G. lipoma groin

D. inguinal lymphadenitis *

II.


A. surgery *

B. laparoscopy


The observations


61. Patient 65 years, was admitted with a direct inguinal hernia, a history of double-infringement with spontaneous razuschemleniem. Condition concerning udovletvopitelnoe, BP 170/100, ECG gipeptpofiya left ventricle, moderate koponapnaya failure.




V. surgery after appropriate training *



II.

Methods of plastic:

A. Postemsky *

B. Girard

V. Bassini

Mr. Martin

D. Kukudzhanov

62. The 40-year-old obese woman complains of severe heartburn and chest pain who are more concerned about when bending forward.


Zenker's diverticulum of the esophagus A.

B. chronic gastritis

B. hiatal hernia *

G. esophageal cancer

D. Achalasia

II.


A. surgery *

B. laparoscopy


The observations


63. The patient complains of pain throughout the abdomen, nausea, dry mouth, general weakness. Acutely ill 5:00 back. Suddenly there were severe epigastric pain, nausea, blackout. In the future, the growing pains acquired character, joined bloating, no longer depart gases.


A. abdominal form of myocardial infarction

B. lobar pneumonia

B. acute renal failure

G. acute intestinal obstruction *

D. ulcerative colitis

II.




B. planned surgery


D. urgent surgery *

64. We examined patients with suspected "acute abdomen", with X-ray Review, was detected free gas under the dome of the diaphragm.

I. Your diagnosis:

A. acute pancreatitis

B. perforated stomach ulcer or 12. n. A. *

Leriche syndrome B.

G. Mallory-Weiss syndrome

D. acute appendicitis

II.

As a symptom called "free gas under the dome of the diaphragm":

A symptom Spizharskogo *

B. Murphy symptom

B. Ortner symptom

G. symptom Rovzinga

65. In a patient with a suspected "acute abdomen", laparoscopy was found a large amount of effusion, hemorrhagic and reddened loops of the small intestine.

I. What complication arose:

A. acute intestinal obstruction


B. bowel gangrene

G. Crohn's disease *

D. empyema

II.

Your tactic:

A conservative treatment *

B. surgery


The full laparotomy

D. Dyakonova cut-Volkovich

66. The patient who had undergone cholecystectomy for chronic calculous cholecystitis, developed pain with signs of jaundice.

I. On what evidence is the manifestation of pathology postcholecystectomical syndrome:

A tumor of a biliary-pancreatic system

B. of a patient with chronic hepatitis transition to cirrhosis

B. holedoholitaze *

G. chronic pancreatitis

D. long stump of the cystic duct

II.

What methods of study you recommend it:

A. Ultrasound

B. RPHG *

B. CHCHHS

G. laparoscopy

D. X-ray

67. The patient 45 years old suffering from the disease zhelchikamennoy determined by palpation of considerable size plotnoelasticheskoy maloboleznennoe education with a smooth surface. Symptoms of peritoneal irritation not.

I. As nazivaetsya symptom:

A symptom Ortner

B. Murphy symptom

B. De Musset's sign

G. symptom Courvoisier *

II.

Your tactic:

A. LCE urgently

B. LCE routinely *

B. open cholecystectomy

G. overlay cholecystostomy

68. B-term b. 42 years dealt with complaints and the presence of a rounded education under the right inguinal fold of severe pain in this region. nevpravimost tensions and education, when viewed from the hernial ring is not determined by the negative symptom cough shock.

I. Your diagnosis:


B. strangulated femoral hernia *




II.


A. urgent surgery *

B. laparoscopy


The observations


69. 15-year-old schoolboy during physical education there was a sharp pain in the navel. history -pupochnaya hernia with repeated infringements on. patient tried to straighten himself a hernia but failed.

I. Your diagnosis:

A strangulated umbilical hernia *

B. strangulated femoral hernia

B. nvpravimaya inguinal hernia



II.

Determine the tactics of the patient:

A new attempt to reposition 2-3 hours

B. antispasmodics and warm bath

B. antibiotics and strict pastel mode

G. emergency surgery *

70. Sick. '32 Complaints of epigastric pain, nausea, vomiting, weight loss, weakness, and convulsions. 6 years suffering a stomach ulcer 12 n. Colon, repeatedly received treatment, general satisfy-ing, flabby skin, dry tongue with a cataract bloom.

swollen belly a few painful on palpation in the epigastrium, positive symptom splashing, X-ray after 24 hours in the stomach about 50% contrast. I. Your diagnosis:

A. decompensated pyloric stenosis *

B. subcompensated pyloric stenosis

B. malignancy

G. penetration

D. perforation

II.


A. Gastrectomy *



G. SPV

D. selective vagotomy with pyloroplasty

71. The patient observed in the clinic over the appendicular infiltrate in the right iliac region, on the 6th day, there are signs of his festering.

I. Your diagnosis:

A. appendiceal abscess *

B. pylephlebitis

B. peritonitis

G. sepsis

II.

How access is necessary to open the abscess:

A. through the anterior wall of the rectum

B. produce lower-median laparotomy

B. Access to Lenanderu

G. Dyakonov-cut Volkovich with the opening of the abdominal cavity

D. extraperitoneal access to Pirogov *

72. Patient M was admitted with complaints of pain in the right upper quadrant, nausea, vomiting. From history 1 minute ago after error diet appeared pain in the right upper quadrant.

I. Your diagnosis:

A. acute cholecystitis *


B. acute pancreatitis

G. acute adnexitis

II.

The appearance of pain with pressure on the phrenic nerve above the collarbone on the right in the legs sternoclavicular muscles - it's a symptom of acute cholecystitis:

A. Musso (frenikus - symptom) *

B. Courvoisier

B. Murphy

Voskresensk

J. Ortner

73. The patient is marked hoarseness, diffusely enlarged, thick and nodular right lobe of the thyroid gland. There is also an increase in regional lymph nodes. Thyroid function is not changed.

I. Your diagnosis:

A nodular goiter

B. diffuse goiter

V. mixed crop

G. thyroid cancer *

D. goiter Riedel

II.


A. surgery *



G. Treatment with antibiotics

D. surgery on an emergency basis

74. In a patient with a suspected "acute intestinal obstruction" when rectal examination showed a large amount of effusion, hemorrhagic turbid nature.

I. Your diagnosis:

A. intussusception *


B. bowel gangrene

G. acute peritonitis

D. empyema

II.


A. surgery




D. surgery on an emergency basis *

75. in patients undergoing laparotomy for perforated ulcers 12. n. To, on the sixth day after the operation, there were pains in the lower abdomen, tenesmus, dysuria. Increased body temperature (39 C) with hectic scale, chills.

When rectal examination - in the pelvis is palpated sharply painful, of considerable size infiltration with softening.

I. Your diagnosis:

A. mezhpetlevoy abscess

B. Douglas abscess space *


G. sepsis

D. pylephlebitis

II.


A. relaparotomy *




76. The patient 35 years after the death of a child there was a strong weakness, irritability, sweating, crying. In a short time, she lost 10 pounds. Objectively: the patient is restless, excited, a marked exophthalmos. The thyroid gland is enlarged to the III degree, pulse 100 beats per minute, rhythmic, in the apex of the heart systolic murmur. The liver is not increased, the main exchange increased (+ 30%).

I. Your diagnosis:

A. Graves' disease II *

B. thyroid cancer.




II.


A. surgery



G. radioactive iodine therapy *

77. The 45 year-old woman considers herself a patient for two years. The patient observed manifestations of thyrotoxic goiter, but the thyroid gland is not increased. On Re-gram in the anterior mediastinum to the right of II ribs rounded education is determined by the size of 5x5 cm, with clear margins. The structure of the lung tissue is not changed.

I. On what disease in question:

A hydatid cyst of the mediastinum

B. mediastinal tumor

B. dermoid cyst of the mediastinum

G. thymoma

D. retrosternal goiter *

II.


A. surgery *




78. If a patient operated on for goiter revealed hoarseness.

I. What research needs to be done to confirm the diagnosis:

A special audit of the surgical wound

B. urgent laryngoscopy *

B. urgently determine the level of calcium in the blood

The definition in the dynamics of blood pressure and heart rate

D. determine the level of Hb, Ht, and the number of red blood cells

II.

What kind of complications in question:

A recurrent nerve damage *

B. bleeding

B. tracheomalacia

G. thyrotoxicosis

79. The patient was 16 years old was admitted with complaints of pain in the right iliac region, bloating, general weakness. On examination, the abdomen is soft, moderately painful in the right iliac region, symptoms Rovzinga,

Razdolsky, Sitkovskiy, Bartome-Mehelsona questionable. In analyzes: Leukocytes-6400; FRI-1.7.


A. acute appendicitis? *

B. spastic colitis

B. ileus

G. chronic adnexitis

D. renal colic

II.

Your tactic:

A. hospitalization and monitoring *

B. outpatient

B. emergency surgery

G. apply again in the amplification of pain

D. scheduled examination

80. The patient 27 years with the classical clinic of acute appendicitis during surgery incision Dyukonova-

Volkovich, at the opening of the peritoneum stood out blood clots.


A. ectopic pregnancy *

B. rupture of ovarian cysts *

B. mesenteric thrombosis

G. pancreatitis

D. mechanical intestinal obstruction

II.

Your tactic:

A revision of the ovaries and tubes *

B. appendectomy and abdominal drainage

B. Operating suturing wounds and haemostatic therapy

G. closure of the surgical wound, and hormone therapy

81. The patient's 35-week normal pregnancy had pains in the right iliac fossa, vomiting, fever up to 37.8

0

C. In the right half of the abdomen, more in the lower marked a sharp pain, positive symptom Shchetkina-

Blumberg. Symptom effleurage negative on both sides. White blood cell count 16,000 in the urine traces of protein,

5-6 leukocytes in sight.

I. Your diagnosis:

A. acute appendicitis *

B. threatening preterm labor

B. rupture of ovarian cysts

G. renal colic

D. intestinal colic

II.

Your tactic:

A. emergency appendectomy *

B. conservative therapy

B. extra labor, then appendectomy

The observations in gynecology

D. expectant management

82. The patient 55 years old, was admitted with complaints of severe pain in the right iliac region and in the abdomen, dry mouth. On examination: the abdomen is soft, there is a sharp pain in the right iliac region and in the lower abdomen, there has muscle tension anterior wall, positive symptom Shchetkina-Blumberg.

I. Your diagnosis:

A. acute appendicitis, peritonitis *

B. complicated peptic ulcer perforation

B. renal colic

G. intestinal colic

D. acute cystitis

II.

Your tactic:

A lower-midline laparotomy *

B. incision Dyakonov-Volkovich

B. incision Mac Burneya

G. adrectal incision

D. laparoscopy

83. The patient 23 years old, ailing 4 hours, dealt with complaints of abdominal pain, low-grade temperature, dry mouth. On examination, the abdomen is soft, painful in the right iliac region, there is palpated dense formation of hard-elastic consistency, fixed, painful. Symptoms of peritoneal irritation negative. In analyzes: Leukocytes

10500; FRI-2.8.

I. Your diagnosis:

A. periappendikulyarny infiltration *


V. tumor of the cecum

G. intussusception

D. volvulus of the small intestine

II.

Your tactic:

A. Active-expectant *


B. delayed operation

G. emergency surgery

D. elective surgery

84. obese patients 43 years of ill 5 days, was admitted with complaints of pain in the right iliac region, subfebrile temperature. On examination, the abdomen is soft, painful in the right iliac region. Positive symptoms Sitkovskiy,

Rovzinga, Bartome-Michelson. During operation, with the diagnosis of acute appendicitis, found on the right iliac fossa conglomerate from omentum, loops of the small intestine and colon.

I. Your diagnosis:

A. periappendikulyarny infiltration *



G. intussusception

D. volvulus

II.

Your tactic:

A. abdominal drainage and wound closure *

B. resection conglomerate

B. selection process of the conglomerate and appendectomy

G. median laparotomy, appendectomy

D. Conclusions and fix the conglomerate to the skin

85. The patient has been treated for periappendikulyarnogo infiltration on day 8 were heightened abdominal pain, temperature up to 38.7

0

C. An ultrasound revealed accumulation of fluid in the center of the infiltrate.

I. Your diagnosis:

A secondary periappendikulyarny abscess *

B. periappendikulyarny primary abscess

B. peritonitis

G. mezhpetlevoy abscess

D. pylephlebitis

II.

Your tactic:

A. extraperitoneal autopsy and drainage of abscess *

B. Enhancement of antibacterial therapy

B. resection konglamerata

G. selection process of konglamerata and appendectomy

D. laparotomy incision and drainage of abscess

86. Patient 18 received, on day 3 with the onset of the disease, complaining of pain in the right iliac region, the temperature up to 39

0

C, a dry mouth. On examination, the abdomen is soft, there is muscle tension and pain in the right iliac region. On ultrasound in the right iliac region has infiltrative education liquid content in the center. Blood leukocytes 16,700. FRI-4.6.

I.

I. Your diagnosis:

A. periappendikulyarny abscess *

B. pylephlebitis


G. intussusception

D. peritonitis

II.

Your tactic:

A. extraperitoneal autopsy and drainage of abscess *

B. Enhancement of antibacterial therapy

B. resection konglamerata

G. selection process of konglamerata and appendectomy

D. laparotomy incision and drainage of abscess

87. The patient complaints of low emission of red blood and pain after defecation, constipation, weakness. When viewed from above stool painted crimson blood.

I. Your diagnosis:

A. hemorrhoids *

B. rectal cancer

B. crack rectum

G. acute subcutaneous paraproctitis

D. Anal fistula

II.

What research be carried out to confirm the diagnosis:

A digital examination of the rectum *

B. sigmoidoscopy

B. fibrocolonoscopy

G. ergography

D. Ultrasound

88. A young woman complained of severe pain during and after defecation, irradiation of pain in the sacrum, scant bleeding after defecation, constipation.

I. Your diagnosis:

A crack rectum *

B. hemorrhoids

B. Anal fistula

G. rectal cancer

D. acute subcutaneous paraproctitis

II.


A visual inspection of the anal region *

B. digital examination of the rectum

B. sigmoidoscopy

G. fibrocolonoscopy

D. ergography

89. The patient had undergone 5 days ago hemorrhoidectomy surgery after defecation noted profuse bleeding from the anus, general weakness, blackout, tachycardia.

I. Your diagnosis:

A. bleeding feet hemorrhoids *

B. hemorrhagic proctosigmoiditis

B. ulcerative colitis

G. Crohn's disease

D. megacolon

II.

Your tactic:

A sewing area stump legs hemorrhoids *

B. rectectomy

B. hemostasis pad cigar

G. pouring into the rectum aminocaproic acid

D. ice water enema

90. A woman of 23 years was admitted with complaints of low-grade temperature, weight loss, cramping pain in the left iliac region, bloody diarrhea, tenesmus. Colonoscopy revealed hyperemia, granularity ulcers and bleeding mucosa in contact with the device.

I. Your diagnosis:

A. ulcerative colitis *

B. Crohn's disease

B. anal fissure

G. acute paraproctitis

D. hemorrhoids

II.

Your tactic:



B. planned colectomy

G. imposition iliestomy, then conservative therapy

91. The patient was 15 years presented with complaints of persistent constipation, bloating, weight loss, nausea, lack of appetite. On examination, the abdomen increased in the left iliac fossa palpable tumor formation, which disappears after a bowel movement, positive symptom Gerzuni.

I. Your diagnosis:

A. Hirschsprung's disease *

B. Crohn's disease


G. ulcerative colitis

D. Addison's disease

II.


A. ergography *

B. plain radiography of the abdominal cavity

B. CT scan

G. ultrasound

D. tseliakografiya

92. The patient received 40 years with complaints of loose stools mixed with blood, fever, pain in the joints, and weakness. On examination, pale skin, belly swollen, painful along the colon, education palpated in the left half of the abdomen. Colonoscopy: ulcers with no tendency to merge, terrain type cobblestones.

I. Your diagnosis:

A. Crohn's disease *

B. ulcerative colitis

B. typhoid

G. brucellosis

D. dysentery

II.

Your tactic:



B. planned colectomy

G. imposition iliestomy, then conservative therapy

93. The patient 34 years comes from the frequent complaints of foul-smelling stools, weight loss, low-grade fever, weakness. When viewed from pale pasty skin, tachycardia, belly moderately swollen, painful along the colon. On irrigogramme: colon without gaustr, smartness of the cecum to the hepatic corner pseudopolyps.

I. Your diagnosis:


B. Crohn's disease

B. Hirschsprung's disease

G. polyposis colon

D. salmonellosis

II.

Your tactic:

A planned colectomy *


B. imposition iliestomy, then conservative therapy

G. dnamicheskoe observation

94. The patient was 28 years moved from the Infectious Diseases Hospital in the surgical hospital with complaints of hectic temperature, loose stools with mucus and blood, cramping abdominal pain, tenesmus, thirst, weakness. On examination: the skin is dry, pale with ikterichnost shade, belly swollen, painful along the large intestine. Chair offensive, in the form of bloody irritating liquid. Oliguria.

I. Your diagnosis:


B. Crohn's disease

B. Hirschsprung's disease

G. dizentiriya

D. typhoid

II.


A. ergography *

B. fibrocolonoscopy *


G. transit barium gastrointestinal tract

D. computed tomography

95. In the surgical ward patient is delivered 42 years. Ill three days ago, when there were epigastric pain, vomiting was single. Self-hosted Nospanum, analginum locally - a warm heating pad. Then gradually the pain localized in the right iliac region, there was loose stools. When viewed from a state of moderate severity, pulse 92 beats. 1 min. , Tongue dry, coated with white bloom, belly swollen, there is muscle tension, more on the right. Symptom

Shchetkina-positive Blumberg.

I. Your diagnosis:

A. acute appendicitis, peritonitis *

B. peptic ulcer complicated by perforation

B. pelvioperitonit


D. acute intestinal infection

II.

Your tactic:

A medium-emergency midline laparotomy, appendectomy, sanitation, drainage of the abdominal cavity *

B. preoperative antibiotic therapy, then surgery through access Dyakonov-Volkovich

B. emergency surgery through an incision Mc Burneya, appendectomy, sanitation, drainage through the main incision

G. intensive therapy, antibiotics, immunostimulants, then surgery routinely

D. antibiotic therapy, laparoscopic abdominal drainage

96. The patient was 43 years in the last 5 months have trouble tearfulness, fatigue, progressive weight loss. The thyroid gland is enlarged, densely-elastic consistency, contains pockets of sharp seals. When scanning gland is enlarged and contains areas of increased drug accumulation.

I. Your diagnosis:

A mixed toxic goiter *

B. Graves' disease

B. nodular toxic goiter

G. hypothyroidism

II.

Your tactic:

A. elective surgery after removal of hyperthyroidism *

B. only medication

B. elective surgery


97. Patient A., 42 years old suffering from gastric ulcer for 10 years. After treatment in a hospital in remission lasting 2-3 years. Three months ago, the patient developed pain in the lumbar region, sometimes wearing shingles character. X-ray examination is determined by a deep niche, located on the back wall near the lesser curvature of the antrum.

I. What complication developed:

A. penetration *

B. malignancy

B. stenosis

G. bleeding

D. perforation

II.

Your tactic:

A. Gastrectomy *

B. gastrectomy

B. pancreatectomy

G. gastroenteroanastomosis

D. pancreatoduodenal resection

98. Patient N., 30 years, EFGDS found callous ulcer gastric body dimensions 2x2.5 cm. However, a history of abdominal pain associated with food intake were observed. Due to the lack of any abdominal pain the patient is examined and not treated. The patient's condition is satisfactory. Pulse 80 A / D-120/80. Tongue moist, overlaid. Belly of the usual form, is involved in the act of breathing, palpable soft, b / w. Chair prone to constipation.

I. What is the ulcer in a patient:

A silent ulcer *

B. silent ulcer 12 n / a

B. acute gastric ulcer

G. acute ulcer 12 n / a

D. chronic ulcer 12 n / a

II.

Your tactic:

A. Gastrectomy *

B. gastrostomy

B. pancreatectomy



99. The patient 40 years long suffering PUD, the last 2 days the pain he has become less intense, but at the same time there was increasing weakness, dizziness. This morning, after rising from bed, a few seconds he was unconscious. The patient was pale. Epigastric pain a little. Symptoms of peritoneal irritation not.

I. Your diagnosis:

A PUD, bleeding complications *

B. GU bleeding complications

B. PUD, complicated penetration

G. PUD, complicated by perforation

D. GU complicated by malignancy

II.

What instrumental study be carried out to confirm the diagnosis:

A. EFGDS *


B. gastrointestinal transit of barium

G. ultrasound

D. CT

100. Patient G., 30, turned to the clinic complaining of sharp "stabbing" pain in the abdomen, which started 6 hours before going to the clinic. Earlier pain associated with food intake were observed. A serious condition, the position of the forced - feet are given to the stomach, lying motionless. Pulse-90, A / D-110/70. Language dryish. Stomach in, does not participate in the act of breathing. Hepatic dullness saved. Symptom Shchetkina-positive

Blumberg. Leukocytes, 9.8 thousand.

I. Your diagnosis:

A. GU and duodenum complicated by perforation *

B. GU and duodenum, complicated by penetration

B. GU and duodenum complicated by malignancy

G. GU and duodenum complicated by stenosis

D. GU and duodenum complicated by bleeding

II.

What instrument studies be carried out to confirm the diagnosis:

A. EFGDS *

B. Review abdominal radiography *

B. gastrointestinal transit of barium

G. ultrasound

D. CT

101. The patient 42 years appealed to the clinic complaining of pain in the right half of the abdomen, nausea, vomiting, bloating, and increased body temperature. In the history of the patient noted hungry and night pain, pain seasonality. 10 hours before treatment there was a sharp "knife-like pain" in the epigastric region. At the end of 6-8 hours of abdominal pain decreased and shifted to the right iliac region. The patient's condition of moderate severity. Ps-100 bpm. min, A / D-110/70. Tongue dry. Abdomen slightly swollen, painful on palpation is defined in the epigastric and right iliac region. Symptoms Shchetkina-Blumberg, Razdolsky positive.Leukocytes, 14.2 thousand.

I. Your diagnosis:

A PUD, complicated by perforation *

B. GU complicated by perforation


G. acute appendicitis, peritonitis

D. appendicular colic

II.

Your tactic:

A. Emergency laparotomy closure of perforated ulcer, debridement and drainage of the abdominal cavity *

B. antibiotics, painkillers, symptomatic therapy

B. preparation of the patient, elective surgery

G. appendectomy incision on Dyakonov-Volkovich

D. dynamic observation

102. A patient of 70 years complained of pain in the epigastric region, general weakness, palpitations and feeling short of breath. The patient suffers from PUD for 30 years. 2 hours prior to treatment was a sharp "knife-like pain" in the epigastric region. The patient's condition serious, the forced position. 90 pulse per minute aritmichen, A / D-

150/90. Tongue moist, overlaid. Stomach in, does not participate in the act of breathing. On palpation, tenderness in the epigastric region and muscle tension anterior abdominal wall. Symptoms of peritoneal irritation positive. Leukocytes, 9.8 thousand. Review abdominal X-ray has a free gas under the dome of the diaphragm. After the patient ECG and examination kardioreanimatologa diagnosed as IBS. Acute myocardial infarction.

I. Your diagnosis:

A PUD, complicated by perforation. Acute myocardial infarction *

B. GU complicated by perforation. Acute myocardial infarction

B. abdominal form of myocardial infarction

D. All of the answers are correct

II.

Your tactic:


B. Emergency laparotomy, pyloroplasty, vagotomy trunkulyarnaya

B. Emergency laparotomy, gastric resection Billroth-I

G. conservative therapy


103. The patient 30 years admitted to the hospital with complaints of abdominal pain, nausea, vomiting, bloating, and increased body temperature. Sick for 13 years suffers PUD. "Stabbing pain" in his stomach is noted for 14 hours before treatment. A serious condition. Ps-110, A / D-100/60. Tongue dry, lined with gray patina. Abdomen swollen, painful sharply in all departments. Symptoms of peritoneal irritation positive. Leukocytes, 18.3 thousand.

Overview fluoroscopy free gas in the abdominal cavity is detected.

I. Your diagnosis:

A PUD, complicated veiled perforation, peritonitis *

B. PUD, state predperforativnoe

B. GU complicated by perforation, peritonitis

G. PUD, complicated by penetration

D. GU complicated by penetration

II.

Your tactic:


B. Emergency laparotomy, pyloroplasty, vagotomy trunkulyarnaya

B. Emergency laparotomy, gastric resection Billroth-I



104. The patient is a long time in the gastroenterological department. GU suffering for 12 years. Currently, the diagnosis of peptic ulcer confirmed by EFGDS. However, in spite of treatment, the patient is stored persistent sharp epigastric pain radiating to the back, pain pass only after taking painkillers and soda.

I. Your diagnosis:

A. GU complicated by penetration *

B. GU complicated by stenosis

B. GU complicated by malignancy

G. GU complicated by hemorrhage

D. GU complicated by perforation

II.

Your tactic:

A. Gastrectomy *

B. gastrostomy

B. pancreatectomy



105. The patient 38 years old, admitted to the hospital with symptoms of gastrointestinal bleeding when emergency gastroduodenoscopy detected ulcer 12 duodenal ulcer diameter of 1.5 cm. In the center there is a large ulcer thrombosed vessel. Hemoglobin - 45 g / l.

I. Your diagnosis:

A PUD, complicated to stop the bleeding. Hemorrhagic anemia grade IV *

B. GU complicated to stop the bleeding. Hemorrhagic anemia grade IV

B. PUD, complicated by penetration into the pancreas

G. PUD, complicated by bleeding. Hemorrhagic anemia grade IV

II.

Your tactic:

A. Active-expectant management *

B. only conservative therapy



D. elective surgery

106. Male 58 years old taken to the emergency department with abundant vomiting "coffee grounds" and re melena that followed the collapse of the 3:00 back. Within two weeks, this was preceded by general weakness, multiple black unformed stool. The last few years there has been a pain in the epigastric region, which recently began to radiate to the back. Never before had been treated and was not surveyed. The patient's condition of moderate severity, pulse 96 per minute. , Blood pressure 105/75 mm Hg.

Art.

I. Your a prior diagnosis:

A peptic ulcer complicated by bleeding *

B. peptic ulcer disease, complicated by penetration

B. peptic ulcer complicated by perforation

D. All of the answers are correct

II.


A. EFGDS *

B. Review X-ray abdomen

B. radiopaque study GIT

G. ultrasound

D. fibrocolonoscopy

107. The patient 44 years old, admitted to the hospital within 6 hours from the start of gastrointestinal bleeding, manifested by vomiting bright red blood and collapse, made EFGDS. Set the source of bleeding - duodenal ulcer and endoscopic coagulation of the vessel at the bottom of the ulcer, then the bleeding stopped. In the course of intensive therapy in the intensive care unit after 8 hours EFGDS came rebleeding.

I. Your diagnosis:

A PUD, complicated by bleeding *

B. PUD, complicated by bleeding stopped

B. PUD, complicated by penetration into the pancreas

G. GU complicated by hemorrhage

D. GU complicated by bleeding stopped

II.

Your treatment strategy:


B. elective surgery

B. Repeat conservative treatment

G. repeat EFGDS coagulation

D. all of the answers are correct

108. The examination in the clinic surgeon identified in a patient with gastric ulcer progressive weight loss, loss of appetite and anemia. In the left supraclavicular area detected dense sedentary lymph node.

I. Your diagnosis:

A. GU malignancies complicated *

B. GU complicated by stenosis

B. GU complicated by occult blood

G. GU complicated by penetration

II.


A. EFGDS with biopsy *


B. fibrocolonoscopy

G. chest x-ray

D. Ultrasound

109 patients after endoscopic papillosphincterotomy expressed pain in the epigastric region radiating to the back, repeated vomiting, muscle tension anterior abdominal wall. Pronounced leukocytosis and increased levels of serum amylase.

I. Your diagnosis:

A. Acute pancreatitis *

B. gastrointestinal bleeding

B. acute cholangitis

G. ileus

D. perforation of the duodenum

II.

Your tactic:

A conservative therapy with protease inhibitors and cytotoxic drugs *

B. emergency surgery, abdominizatsiya omental

B. emergency surgery, resection of the pancreas

G. elective surgery, cholecystectomy with external drainage of common bile duct

D. diagnostic laparoscopy

110. The patient 27 years ago last month received blunt trauma of the right half of the abdomen, the doctors did not apply. Pain syndrome verse a week, and then began to grow fever yes 38-40

0

C, showed signs of intoxication. On the US - in the right lobe of the liver revealed the formation of three-dimensional diameter of 8 cm, preferably liquid density of the capsule thickness of 4 mm.

I. Your diagnosis:

A post-traumatic liver abscess *

B. festering cyst of the liver

B. holangiogenny liver abscess

G. pyogenic liver abscess

D. amebic liver abscess

II.


A. intensive conservative treatment, further examination

B. laparotomy, drainage of Education

B. dynamic monitoring, control ultrasound after 10 days

G. percutaneous drainage under ultrasound education *

D. needle biopsy under ultrasound

111 in patients undergoing REPST and common bile duct stone extraction of about jaundice after 8 days on the background of deterioration and signs of purulent intoxication on ultrasound revealed two rounded education fluid in the right lobe of the liver and a diameter of 5 to 6 cm.

I. Your diagnosis:

A. hydatid disease of the liver

B. non-parasitic liver cysts

B. holangiogennye liver abscesses *

G. liver metastases

D. makronodulyarny cirrhosis

II.


A percutaneous transhepatic puncture and drainage of liquid formation under ultrasound *

B. monitoring of patients with antibiotic therapy

B. Emergency laparotomy with resection of the right lobe of the liver

The planned operation - echinococcectomy liver

D. intensive care in the ICU

112. The patient complains of nausea, vomiting, yellowness of the skin and sclera, pain in the right upper quadrant and epigastric zoster character. In history a year ago with the US was discovered small stones in the gallbladder. The above complaints appeared after errors in diet.

I. Your diagnosis:

A. exacerbation of DU

B. perforation GU

B. biliary pancreatitis, jaundice *

G. acute destructive appendicitis

D. ileus

II.


A. ultrasound biliary tract *

B. EFGDS


G. barium gastrointestinal transit

D. fibrocolonoscopy

113. The patient as a result of ushemleniya stone BDS bother severe pain in the upper abdomen, herpes nature, uncontrollable vomiting, dry mouth, weakness. Positive symptoms Kёrte, Mayo-Robson, Grey-Turner.

I. Your diagnosis:

A. acute biliary pancreatitis *

B. acute cholangitis

B. acute obstructive cholecystitis

G. acute gastritis

II.


A. RPHG, EPST, lithoextraction, conservative treatment of pancreatitis *

B. cholecystectomy, holedoholitoekstraktsiya, conservative treatment of pancreatitis

B. cholecystectomy, TDPSP, conservative treatment of pancreatitis

G. RPHG, conservative treatment of pancreatitis

D. resection BDS, conservative treatment of pancreatitis

114 patients within 5-6 years of suffering with chronic pancreatitis and repeatedly treated. In recent years, the patient worried about weakness, poor appetite, weight loss, diarrhea 5-6 times a fetid odor. Infectious disease is excluded.

I. Your diagnosis:

A. exacerbation of chronic gastritis, gastric insufficiency

B. chronic cholecystitis, lack of function of the gallbladder

B. chronic hepatitis, liver function failure

G. chronic pancreatitis insufficiency PZHZH *

II.


A. scatological study *

B. EFGDS

B. US

G. radiopaque examination of the stomach

D. biochemical blood

115. The patient clinical picture insufficiency of exocrine pancreatic function.

I. What method of research is needed to confirm the diagnosis:

A. scatological study *

B. ultrasound of the pancreas

B. bihimichesskoe blood analysis

G. EFGDS

D. CT

II.

Select the correct treatment:

A. Antibiotic

Vitamin B.

B. Replacement Therapy *

G. restorative therapy

D. protease inhibitors

116. suspected acute surgical pathology patient made laparoscopy and found: stearic plaques on the peritoneum, redness and swelling of the greater omentum, a small amount of serous-hemorrhagic effusion.

I. Your diagnosis:

A perforation PUD


B. acute pancreatitis *

G. ileus

D. inflammation of diverticula Mikkel

II.

Your tactic:

A. Active-expectant *

B. Emergency laparotomy, resection of the prostate podzheledochnoy

B. Emergency laparotomy cholecystectomy

G. emergency laparotomy, sanitation and drainage of abdominal polposti

D. elective surgery after training

117. Complaints patient weakness, loss of appetite, fever (up to 38-39

0

), and pain in the right upper quadrant. Palpation, tenderness in the right upper quadrant, the liver is increased by 2 cm.. From anamnesis 2 - weeks ago the patient was blunt trauma to the right side of the chest in the projection of the liver.

I. Your diagnosis:

A hematoma of the liver

B. liver abscess *

B. pneumonia

G. cholecystitis

D. soft tissue injury of the chest

II.


A. EFGDS

B. ultrasonography *


G. fibrocolonoscopy

118. Complaints patient weakness, loss of appetite, pain in the right upper quadrant. Palpation, tenderness in the right upper quadrant, the liver is increased by 4 cm. An ultrasound revealed a homogenous liquid obrozovanie with a clear outline and shell.

I. Your diagnosis:

A. echinococcus liver *

B. alveokokk liver

V. liver abscess

G. festering echinococcus liver

II.

Your tactic:

A. Emergency laparotomy, debridement and drainage of the liver

B. elective surgery - echinococcectomy liver *

B. Percutaneous transhepatic puncture and drainage of the liver

G. emergency laparotomy, resection of liver

119. During routine inspection revealed three patient OBROZOVANIE homogeneous liquid with unclear contours and dimensions of 3 to 4 cm. The same formation observed in the kidneys and pancreas.

I. Your diagnosis:

A. echinococcus liver

B. alveokokk liver

V. liver abscess

G. simple cyst of the liver *

II.

Your tactic:

A clinical examination *

B. elective surgery and distance education

B. Emergency laparotomy and abdominal revision

G. percutaneous puncture under ultrasound formations

120. The complaints of the patient to weight loss, weakness, lack of appetite, otvrashenie food, yellowness of the skin and sclera. On examination, the patient noted cachexia. Ultrasound detected in the liver with the formation of inhomogeneous indistinct contours.

I. Your diagnosis:

A. alveokokk liver

B. liver cancer *

B. Echinococcus liver

G. liver abscess

II.

Your tactic:

A. Emergency laparotomy, sanitation and drainage of abscess cavity

B. planned laparotomy, echinococcectomy


G. refer patients to the oncologist *

121. The complaints of the patient on the yellowness of the skin and sclera, weakness, fever. Ultrasound detected liquid education of the same size with the total size of 5-6 cm. (As a honeycomb).

I. Your diagnosis:

A liver cancer

B. cyst of the liver

B. Echinococcus liver

G. alveococcus liver *

II.


A planned laparotomy, resection of the liver *

B. planned echinococcectomy

B. percutaneous puncture and drainage under ultrasound education

G. emergency laparotomy, removal of education

122. The patient is 86 years old with multiple comorbid chronic diseases, clinical acute cholecystitis with increasing intoxication and progressive deterioration. Palpable tense, increased sharply painful gall bladder. In the right hypochondrium positive symptom Shchetkina-Blumberg.

I. What is the instrumental study be carried out to confirm the diagnosis:

A. EFGDS

B. ultrasonography *

B. CT

G. MRI

II.


A. cholecystostomy *

B. cholecystectomy

B. holetsistoduodenoanastamoz

G. RPHG

D. REPST

123. Patient 20 years, appealed to the clinic for pain and the presence of tumor formation in the right upper quadrant, weight loss, weakness. On PSM - ehinokokkokovaya tense cyst V-IV segment of the right lobe of the liver size 15h19 see.

I. Your tactics:


B. Percutaneous puncture of the cyst


G. active-expectant management

II.

What are the possible complications:

A breakthrough cyst into the abdominal cavity, anaphylactic shock and colonization *

B. breakthrough cyst in the bile ducts, jaundice and cholangitis

B. festering cysts, sepsis

G. calcification of the cyst

D. breakthrough cysts in the pleural cavity

124. During the operation for acute appendicitis was found out that process immured in the spikes for the dome of the cecum. Print the process and the cecum into the wound fails, barely managed to get into the wound only part of the cecum to the base process.

I. What type of arrangement process in this case:

A. retrotsekalny *

B. pelvic

B. obstructive

G. lateral

D. medial

II.

What kind of reception operative technique can be applied:

A retrograde appendectomy *

B. antegrade appendectomy

B. appendectomy method kuskovaniya

125. The patient 2 months after suffering an attack of pancreatitis epigastric appeared densely - elastic consistency moderately painful still education.

I. Your diagnosis:

A. pancreatic cysts *

B. pancreatic tumor

B. stomach tumor

II.

Your tactic:

A conservative therapy

B. tsistogastroanastomoz *

B. Gastrectomy

G. pancreatoduodenal resection

126. During the operation, iatrogenic crossed choledoch ends stitched on the "lost" drainage. A year later appeared jaundice.

I. Your diagnosis:

A stricture hepaticocholedochus *

B. faterova stenosis of the papilla

B. choledocholithiasis

II.

Your tactic:

A percutaneous transhepatic cholangiography with cholangiostomy *

Retrograde cholangiopancreatography with B. papillosphincterotomy


G. emergency surgery, gepatikoduodenoanastomoz

127. The patient, 54 years old, was admitted with severe pain in the epigastrium, nausea and repeated vomiting that began after a fatty meal. Pain radiating to the spine and are herpes character. Yellow skin and sclera.The abdomen was soft, painful epigastric. Intravenous cholangiography significantly expanded the common bile duct. Amylase urine 256 units. Bilirubin blood 32 ml / l.

I. Your diagnosis:

A stone wedged BDS *

B. Zollinger-Ellison syndrome

B. pancreatic tumor

II.

Your tactic:

A retrograde cholangiopancreatography with extra papillosphincterotomy *

B. conservative symptomatic therapy

B. planned laparotomy cholecystectomy

The planned laparotomy, resection of the pancreas

D. Emergency laparotomy, resection of the stomach

128. The patient, 80 years old, 5 years after cholecystectomy were pain, jaundice. An ultrasound found a stone in the distal common bile duct.

I. Your diagnosis:

A GSD. Choledocholithiasis. Jaundice.

*

B. papillary stenosis. Obstructive jaundice

V. extended terminal part of the common bile duct stricture. Obstructive jaundice

G. tumor of the pancreatic head. obstructive jaundice

II.

What is the optimal strategy:

A. RPHG with REPST *

B. TDPSP

B. HDA

D. pancreatectomy

129. The patient was 32 years, two weeks ago, underwent surgery appendectomy. Postoperatively, the patient was observed low-grade fever. 10 days after surgery were observed pain in the surgical wound, the formation of infiltration, the presence of pus and fecal discharge from the wound.

I. Your diagnosis:

A postoperative fistula cecum *

B. postoperative fistula of the anterior abdominal wall

B. postoperative fistula of the small intestine

II.

Your tactic:


B. Emergency laparotomy, the elimination of fistula

B. postoperative scar excision with fistula

130. In 16 years the patient during surgery for inguinal hernia was found: the hernial sac size of 6x8 cm; at the opening of its contents is a strand of the gland and testis.

I. What is a hernia in a patient:

A congenital inguinal hernia, scrotal *

B. acquired inguinal hernia, scrotal

B. sliding inguinal hernia, scrotal

II.

As you finish the operation:

A hernia repair with plastic surgery and Winckelmann *

B. hernia repair with plastic, gemikastratsiya

B. isolation and dive into the scrotum testicle hernia repair with plastic

131. The patient 35 years old at the time of surgery for strangulated hernia inguinal-scrotal hernia sac at autopsy found that disadvantaged body are 3 loops of the small intestine.

I. What type of infringement:

A retrograde *

B. antegrade

B. parietal

G. fecal

II.

Your tactic:

A dive loops intestine into the abdominal cavity, plastic inguinal canal

B. removal of bowel loops intermediate regions and evaluation of the viability *

B. resection loop intestine, plastic inguinal canal

132. The patient 30 years old, complains of pain and the presence of tumor formation in the right upper quadrant, weight loss, weakness. On PSM - tense cyst of the right lobe of the liver size 14h16 see. During the inspection there was a sudden pain, the patient's condition deteriorated sharply, cold sweat, pulse thready, A / D 80/50 mm.

Hg.

Art.

About-but: abdomen tense, positive symptom Shchetkina-Blumberg.

I. What complication observed:

A cyst rupture into the peritoneal cavity *

B. gap cyst in the biliary tract

B. cyst rupture into the pleural cavity

G. internal bleeding

II.

Your tactic:

A fight with anaphylactic shock, emergency laparotomy *

B. intensive therapy in the intensive care unit

B. elective surgery after stabilization

G. symptomatic therapy

133. The patient 58 years old, 5 years suffering from hepatic echinococcosis confirmed PSM in the last 15 days sharply deteriorated: weight loss, pallor, ikterichnost sclera, pain in the right upper quadrant, chills, temperature -

38-39 0 C, pulse - 120 AD - 100/50, Lake. - 20000, bilirubin - 110 mmol / l. The liver is a large and coarsely nodular. When re-PSM - expansion of the common bile duct.

I. What complication observed:

A cyst rupture in the biliary tract *

B. cyst rupture into the peritoneal cavity

B. cyst rupture into the pleural cavity

G. liver tumor with invasion into the biliary tract

II.


A. RPHG with REPST *

B. Emergency laparotomy, revision of the abdominal cavity

B. planned echinococcectomy

G. conservative therapy, further examination of the patient

134. The patient was 45 years old, complains of pain in the right upper quadrant, weakness, temperature up to

39 0 C. From history: ill within 1 month, when the background of overall health appeared low-grade fever. 2 months ago, the patient was bruised abdomen. On the US - in the right lobe of the liver with the formation of heterogeneous liquid inclusions irregularly shaped 5x8 cm.

I. Your diagnosis:

A festering hematoma of the liver *

B. decaying liver tumor

B. festering cyst of the liver

G. alveakokkoz

II.


A percutaneous transhepatic puncture and drainage under ultrasound education *

B. Emergency laparotomy, resection of liver

B. planned laparotomy, echinococcectomy


135. At the reception in the clinic to address to you a woman of 60 years. For 10 years, suffering from gastric ulcer with low acidity. In recent years, began to mark weakness, malaise, aversion to meat diet, weight loss.

I. On what disease you can think of in this patient:

A. gastritis

B. pancreatitis

B. cirrhosis

G. malignant gastric ulcer *

D. polyp of the stomach

II.

What is the best study to confirm the diagnosis in a patient:

A. gastrofibroskopiya with biopsy *

B. contrast radiography of the stomach


G. ultrasound of the abdomen

D. study stimulated gastric secretion

136. The clinic patient appealed to you 58 years with complaints of epigastric pain, ameliorated after vomiting, weight loss, vomiting eve eaten food, belching, weakness. For 20 years, suffering from duodenal ulcer. On examination: The patient rapidly depleted, reduced skin turgor. Pulse 88 beats per 1 min weak filling. Determined by "splashing" in the epigastric region. The border of the stomach is greatly increased. Marked delay chair.


A. stomach cancer

B. ulcerative gastric pyloric stenosis *

B. ileus

G. gastric polyposis

D. chronic gastritis

II.

What instrumental methods of diagnosis is required to set a definitive diagnosis of the patient:

A. EFGDS *

B. contrast X-ray examination of the stomach *

B. ultrasound of the abdomen

G. computed tomography

D. laparoscopy

137. The patient 30 years brought to the emergency department with complaints of vomiting such as "coffee grounds". Eve was in a state of intoxication, accompanied by uncontrollable vomiting. Diseases of the stomach in the history denies. Pale, BP-110/60 mm Hg.

Art.

, 86 min pulse, hemoglobin - 110 g / l, 35% hematocrit, stomach painless stool was not.

I. Your tactics:

A. gastric lavage with cold water through a tube *

B. Emergency laparotomy

V. introduction probe Blackmore

G. urgent esophagogastroscopy *

D. conducting hemostatic therapy *

E. performance of X-ray examination of the stomach

II.

In this patient vomiting as a "coffee grounds" may be due to the following reasons:

A. Mallory-Weiss syndrome *

B. erosive gastritis hemorrhagic *

B. iyazvennoy ulcer and duodenal ulcer *


D. acute toxic hepatitis and liver failure

III.

What instrumental method of diagnosis allows to pinpoint the source of bleeding in this patient:

A. gastroduodenofibroskopiya *

B. laparoscopy

V. contrast radiography of the stomach


D. ultrasound of the abdomen

138. In the emergency room hospital patient is delivered male 35 years with complaints of severe pain in the epigastric region. For several years, notes epigastric pain, heartburn. During a trip to the subway suddenly felt a sharp pain in the upper abdomen; the pain was so strong that for a while lost consciousness. Position of the patient on the couch: lying on his right side, bringing your knees to the stomach, afraid to move. Tongue dry, stomach tense. Hepatic dullness is not defined.

I. Your diagnosis:

A. stomach cancer


B. perforated ulcer of the stomach or duodenum *

G. splenic rupture


II.

What instrumental method of diagnosis is necessary to confirm your diagnosis:

A. EFGDS

B. Review X-ray abdomen *



D. colonoscopy

III.

Your tactic of treatment of this patient:


B. active-expectant management


G. elective surgery

139. At night on "emergency" brought to the clinic patient 30 years with complaints of severe general weakness, dizziness, feeling of "tinnitus" and "flickering flies" in front of his eyes. The patient was pale, listless, apathetic. Previously, these phenomena were not. But lately, the patient noted some stomach discomfort - sometimes heartburn, stomach pain on an empty stomach. These postprandial effects disappear. Chair was black.


A. bleeding duodenal ulcer *

B. myocardial infarction

B. acute leukemia

G. rectal bleeding

D. cirrhosis

II.

What method of research you can confirm your preliminary diagnosis:

A. EFGDS *

B. ECG

B. colonoscopy

G. rectoscopy

D. laparoscopy

E. liver ultrasound

J. hemogram

140. The patient, long-suffering stomach ulcer with localization in the duodenal bulb, recently changed the clinical picture: there were pain and a feeling of heaviness in the epigastric region after eating, nausea, profuse vomiting of food in the afternoon, bad breath, loss of weight.

I. We can assume the following:

A. pyloroduodenal stenosis zone *

B. bleeding ulcer

B. stomach cancer

G. penetration ulcers

D. ulcer perforation

II.

What method of research you can confirm your preliminary diagnosis:

A. EFGDS *

B. X-ray contrast examination of the stomach *

B. colonoscopy


D. laparoscopy

E. liver ultrasound

J. Review X-ray abdomen

141. A patient of 70 years for 5 years was observed for an ulcer of the antrum. Surgical treatment refused. Over the last 3 months epigastric pain took a permanent nature, there was an aversion to meat products, decreased performance, thin.

I. What kind of complications of the disease can be thought of:

A malignancy of gastric ulcer *

B. penetration ulcers

B. stenosis output of the stomach

G. ulcer perforation

D. bleeding from stomach ulcers

II.

What method of research is needed to confirm the diagnosis:

A. EFGDS with biopsy

B. X-ray of the stomach


The study of gastric juice

D. fecal occult bleeding

142. In serious condition in the emergency department delivered a man of 68 years. Patient nablyudaetsyachastaya vomiting "coffee grounds" and liquid dёgteobraznқy chair. During the last week there was a general weakness. The last few years the patient noted a seasonal exacerbation of the disease. Never before has the patient does not obroўalsya. Pulse 106 per minute, blood pressure 90/60 mm Hg.


A stomach ulcer, bleeding complications *

B. colonic bleeding

B. dysentery

G. hemorrhoidal bleeding

D. bleeding from colon polyps

II.

Carrying out any medical diagnostic measures most appropriate for the patient:

A. gastric lavage with cold water *

B. conducting EFGDS *

B. Conduct of hemostatic therapy *

G. anticoagulant and fibrinolytic

D. the contrast X-ray examination of the stomach

E. gastric lavage with warm soda solution

143. In urgent gastroscopy in the angle of the stomach is found deep ulcer crater 3.0 x 3,0sm with active bleeding from large vessels in the bottom of the ulcer.

I. What is the source of the blood vessel bleeding:

A. pancreatic-duodenal artery 12

B. the right gastric artery

B. left gastric artery *

G. gastroepiploic artery

D. short gastric artery

II.

What tactics are most appropriate in this situation:

A massive blood transfusion

B. endoscopic hemostasis

B. embolization bleeding vessel

G. active hemostatic therapy

D. gastrotomy, flashing bleeding vessel *

144. Male 30 years old taken to the emergency room complaining of severe abdominal pain, weakness. An hour ago, felt a sharp pain in the epigastrium. OBJECTIVE: belly in the act of breathing is not involved, retracted. Palpable tension felt doskoobraznoe anterior abdominal wall, the symptoms of peritoneal irritation sharply positive. For percussion noted the disappearance of hepatic dullness.


A. acute appendicitis



G. perforated ulcer of the stomach or duodenum *

D. renal colic

E. sided pleuropneumonia

II.

What research should be taken in the first place:

A. gastroduodenoscopy

B. Review abdominal radiography *

B. laparoscopy

G. laparocentesis using the procedure "groping catheter"

D. X-ray of the stomach

III.

Performing any operation on the stomach would be best given to the patient in case of perforated ulcer KDP:

A radical operation (TV AE, AJ) *

B. Palliative surgery

B. imposition gastroenteroanastamoza

G. gastrostomy

D. laying holetsistoduodenoanastamoz

145. Man '31 comes with a sudden attack of severe pain in the upper abdomen. Previously been sick. The situation forced. Pulse - 78 per minute. On palpation of the abdomen -vyrazhennoe tension anterior abdominal wall and positive symptom Shchetkina-Blumberg. When survey abdominal radiography in the standing position identified

"free gas".


A perforated duodenal ulcer *

B. penetrating duodenal ulcer



D. acute gastritis

II.

This patient is shown:

A. antibiotic therapy

B. X-ray of the stomach with barium

B. Emergency laparotomy

The observations

D. pain therapy, including drugs

146. The patient 40 years long suffering from duodenal ulcer, for the last 2 days the pain he has become less intense, but at the same time there was increasing weakness, dizziness. This morning, after rising from bed, for a few seconds he lost consciousness. The patient was pale. Epigastric pain nebolno. Symptoms of peritoneal irritation not.

I. What complication of peptic ulcer you suspect:

A. bleeding *

B. pyloroduodenal stenosis

Q. penetration

G. malignancy

D. perforation

II.

What urgent additional research apply to confirm your assumptions:

A. gastroduodenofibroskopiya *


B. X-ray of the stomach with barium sulfate

G. abdominal ultrasound

D. computed tomography

147. The patient 42 years suffers from duodenal ulcer for 10 years. After treatment in the hospital into remission, lasting 1-2-3 year. January of this year, the patient developed epigastric pain became constant, intense and intensified after a meal. And also appeared irradiation of pain in the lumbar region. X-ray examination is determined by a deep niche, located on the rear wall of the duodenum.

I. What is the reason the changing nature of abdominal pain:

A. with penetration ulcers pancreas *

B. malignancy ulcers

B. with exacerbation of peptic ulcer

G. with concomitant gastritis

D. bleeding from the ulcer

E. perforated ulcer

II.

Carrying out any medical activities of the following is acceptable to the patient:

A. gastric lavage *

B. pain therapy *

B. operation routinely

G. surgery on an emergency basis

D. Endoscopic diathermocoagulation

E. antiulcer therapy *

148. For a general practitioner in a clinic patient appealed 18 years, and found her unit 5x5 cm in the left lobe of the thyroid gland. Phenomenon thyrotoxicosis not. Had never been treated.

I. What is the preliminary diagnosis can be assumed:

A. Graves' disease

B. Graves' disease

B. nodular goiter *

G. thyroid tumor

D. Hashimoto thyroiditis

II.

To what professionals need to refer patients:

A. endocrinologist *

B. therapist

B. surgeon *

G. neurologist

D. dermatologist

III.

What instrumental examination should be held:

A thyroid ultrasound *

B. EFGDS

B. Doppler

G. rheovasography

D. puncture thyroid

149. The patient, 27 years old, operated under local anesthesia on the diffuse goiter III century. with symptoms of hyperthyroidism moderate through the day appeared cramps, stiffness, muscle twitching, "hand obstetrician" and

muscle pain. Subtotal strumectomy. Voice saved. Pulse - 90 beats per minute, blood pressure - 110/80 mm Hg, the temperature of 37,5 °.

I. What kind of complication in question:

A. parathyroid tetany *

B. thyrotoxic crisis

B. bleeding

G. anaphylactic shock

D. damage to the larynx

II.

What can cause this complication:

A remission of the parathyroid glands

B. removal of the parathyroid glands *

B. total removal of the thyroid gland

G. gemirezektsiya thyroid

D. damage laryngeal nerves

III.

In the treatment of this complication which measures are leading:

A. plasmapheresis

B. replenishing calcium deficiency *

B. blood transfusion

G. hemodialysis

D. use of micro-doses of iodine

150. The patient, 37 years old, complains of irritability, tearfulness, insomnia, sweating, weight loss and heart. Ill

1.5 years. A year ago, saw the formation of a tumor on the left side of the neck. On examination, the thyroid gland is somewhat increased markedly during swallowing, palpation painless. Basal metabolic rate 30, heart rate - 120 beats per minute, blood pressure - 140/70 mm Hg, respiratory rate - 32.

I. What is the magnification of goiter:

A. I degree

B. Grade II *

B. Grade III

G. grade IV

D. degree V

II.

Your detailed diagnosis:

A. Graves' disease, thyrotoxicosis of average weight *

B. euthyroid goiter

B. Hashimoto

Mr. Riedel's struma

D. mixed goiter II degree, mild hyperthyroidism

III.

What specific research methods to perform:

A study of thyroid hormones *

B. abdominal ultrasound

B. rheovasography

G. Doppler

D. Fine-needle aspiration biopsy

151. The patient, 43 years old, complains of fatigue, irritability, tearfulness, resentment, palpitations. Ill 2 years. Eighteen months ago, noticed tumor formation in the neck. Over the past year she lost 6 kg. Recently notes of disability in the afternoon. On examination, the thyroid gland is enlarged, altered the contours of the neck ("bull neck"), notably when swallowing, palpation painless. Basal metabolic rate 25, heart rate - 90 beats per minute.

I. What is the magnification of goiter:

A. I degree

B. Grade II

B. Grade III *

G. grade IV

D. degree V

II.

Your detailed diagnosis.

A. Graves' disease, a mild form of hyperthyroidism *

B. euthyroid goiter

B. Hashimoto

Mr. Riedel's struma

D. degree V mixed goiter, thyrotoxicosis moderate severity

III.

What method of treatment is preferred:

A conservative

B. Surgical *

B. puncture

G. combined

D. radiotherapy

152. A patient of 60 years suffering from ischemic heart disease, hospitalized after 2 days of onset of the disease, when the epigastric pain, then spread throughout the abdomen. Twice was vomiting. The patient's condition serious. RR - 26 per minute. Heart rate - 120 beats per minute. BP - 90/60 mm Hg. Tongue dry, coated. Belly in the act of breathing is not involved, tense, painful in all departments, symptom-Shchetkina Blumberg positive. Bowel sounds are not listened. White blood cells - 15,000 hemoglobin - 131 g / l.


A. acute pneumonia

B. exacerbation of peptic ulcer disease

B. peritonitis of unknown etiology *

G. abdominal form of myocardial infarction

D. acute enterocolitis

II.

What instrumental method is set to make a diagnosis:

A. Overview abdominal radiography *

B. complete blood count

B. sigmoidoscopy

G. selective angiography

D. Doppler

III.

Select the optimum treatment policy:

A laparoscopy in order to clarify the diagnosis and choice of surgical approach

B. preoperative infusion and cardiac therapy for 1-2 hours, followed by laparotomy *

B. emergency surgery without preoperative infusion therapy

G. abdominal ultrasound to clarify the diagnosis and choice of surgical approach

D. preoperative infusion and cardiac therapy for 1-2 hours, followed by EFGDS

153. The patient 35 years old, hospitalized in 24 hours from the onset of the disease, when there were severe epigastric pain, then spread throughout the abdomen. Of history for many years suffered a stomach ulcer 12 duodenal ulcer. The patient's condition serious. RR - 24 per minute. Heart rate - 100-110 beats per minute.

Blood pressure - 110/70 mm Hg.

Tongue dry, coated. Belly in the act of breathing is not involved, tense, painful in all departments, symptom-Shchetkina Blumberg positive.


A peptic ulcer 12 duodenal ulcer complicated by perforation and peritonitis *

B. exacerbation of peptic ulcer 12 duodenal ulcer

B. pelvioperitonit

G. peritonitis of unknown etiology

D. peritonizm

II.

What are the combination of the most informative diagnostic methods for diagnosis:

A. EFGDS + Review fluoroscopy abdomen *

B. US + chest x-ray

V. complete blood count + EFGDS

The study of blood sugar + irrigoscopy

D. selective angiography + laparocentesis

154. The patient 33 years complained of pain in the lower abdomen, nausea, vomiting. Sick for 2 days, when the pain in the upper abdomen, after 6 hours of pain moved to the right iliac region, was single vomiting. State of moderate severity. Pulse 90 beats per minute, blood pressure of 120/80 mm Hg.

Art.

Tongue dry, lined coating. Belly several swollen, painful on the right, the left iliac and suprapubic areas where muscle tension is determined and positive symptom Shchetkina-Blumberg. Bowel sounds are weakened. White blood cells - 15000

ESR - 16 mm / hour.


A terminal ileitis (Crohn's disease), diffuse peritonitis

B. destructive cholecystitis, diffuse peritonitis

B. destructive appendicitis, peritonitis diffuse *

G. pancreatic necrosis, peritonitis

D. perforated stomach ulcer, peritonitis

II.

What treatment should be applied in this situation:

A. Antibiotic

B. surgery *

B. laser

G. UFOK

D. barotherapy

III.

Select the optimal surgical approach for the operation:

A. incision Dyakonov-Volkovich

B. midline laparotomy *

B. adrectal

G. infracostal

D. transanal

155. The patient 37 years old who underwent appendectomy from 5 th day there was deterioration of general condition: fever hectic nature, increasing leukocytosis, transient dysuria, tenesmus.

I. What kind of complications can be assumed:

A. Douglas abscess space *


B. pylephlebitis

G. postoperative peritonitis

D. intra-abdominal bleeding

II.

With some additional research method you will begin to clarify arising complications:

A sigmoidoscopy

B. irrigoscopy

V. digital examination of the rectum *

G. cystochromoscopy

D. repeated blood and urine tests

III.

Surgical tactics in Douglas abscess space:

A puncture through the abdominal wall

B. puncture incision and drainage through the rectum *

V. therapeutic enema

G. opening through the abdominal wall

D. Conservative treatment

156. In elderly patients during defecation or exercise in the anus notes foreign body dimensions 3 x 5 cm, sticky, somewhat painful, which spontaneously disappears after exercise.

I. Your diagnosis:

A prolapse of the rectum *

B. hemorrhoids

B. crack rectum

G. Anal fistula

D. rectal cancer

II.

What instrumental examination must always be performed before the operation:

A. sphincterometry *

B. colonoscopy

B. ergography

G. biopsy of the rectum

1. In the first hours when begun stomach bleeding may occur:

A. melena

B. symptom of muscle protection

B. vomiting gastric contents color "coffee grounds" *

G. bradycardia

D. collapse

2. intraoperative methods of investigation of extrahepatic biliary tract include everything except:

A. palpation choledoch

B. holedohoskopii

B. intraoperative cholangiography

G. sensing choledoch

D. intravenous cholangiography *

3. Symptom Courvoisier not characteristic:

A cancer of the pancreatic head

B. acute calculous cholecystitis *

B. indurativnyy pancreatitis

G. tumors of the major duodenal papilla

D. tumor choledoch

4. To clarify the nature of jaundice and causes of not being used:

A computed tomography

B. intravenous cholecystocholangiography *

B. percutaneous cholangiography chrezpechenochnaya

G. ERPHG

D. Ultrasound

5. For acute obstructive cholangitis not typical:

A. jaundice

B. increase in temperature

B. decrease in liver size *

G. leukocytosis with a left shift

D. increase in liver

6. Intraoperative cholangiography is not shown:

A. for a single large stones in the bladder and common bile duct narrow *

B. cancer of the pancreatic head

B. if there is a history of jaundice

G. the expansion of common bile duct

D. jaundice at the time of surgery

7. colic caused by cholelithiasis, is not typical:

A. intense pain in the right upper quadrant

B. nausea

B. Blumberg symptom-Shchetkina in the right upper quadrant *

G. symptom Ortner

D. Murphy symptom

8. clinic acute cholangitis is not typical:

A high temperature

B. pain in the right upper quadrant

B. jaundice

G. leukocytosis

D. intermittent loose stools *

9. Intermittent jaundice caused by:

A break-terminal part of the common bile duct stone

B. tumor choledoch

V. cystic duct stone

G. brushless choledochal stone *

D. stricture of common bile duct

10. Gallstone disease is dangerous all the above except:

A. cirrhosis *

B. cancerous degeneration gallbladder

B. secondary pancreatitis

The development of destructive cholecystitis

D. jaundice

11. Symptom Courvoisier is not observed in cancer:

A head of the pancreas

B. supraduodenal of the common bile duct

B. retroduodenalnogo of the common bile duct

G. major duodenal papilla

D. gallbladder *

12. complication of choledocholithiasis is:

A. hydrocholecystis

B. gallbladder empyema

B. jaundice, cholangitis *

G. chronic active hepatitis

D. ruptured cholecystitis, peritonitis

13. What is the most common cause of jaundice:

A scar strictures of the extrahepatic biliary tract

B. choledocholithiasis *

V. cancer of the pancreatic head

G. echinococcus liver

D. liver metastases of tumors

14. Which combination of clinical symptoms of the syndrome corresponds Courvoisier:

A painless enlarged gall bladder in conjunction with jaundice *

B. enlargement of the liver, ascites, varicose veins of the anterior abdominal wall

B. jaundice, painful palpable gallbladder, peritoneal local events

The absence of the chair, cramping, the emergence of palpable abdominal education

D. severe jaundice, enlarged liver nodular, cachexia

15. What methods of preoperative examination is the most informative in assessing the biliary tract pathology:

A. intravenous infusion cholangiography

B. endoscopic retrograde cholangiopancreatography *

B. percutaneous cholangiography chrezpechenochnaya

G. ultrasound

D. oral cholecystocholangiography

16. The patient was 55 years old, had undergone cholecystectomy 2 years ago, was admitted with a clinical picture of obstructive jaundice. In retrograde cholangiopancreatography revealed choledocholithiasis. What is the preferred method of treatment:

A. Endoscopic papillosphincterotomy *

B. comprehensive conservative therapy

B. cholecystostomy

G. choledochotomy with external drainage of the common bile duct

D. extracorporeal lithotripsy

17. The patient was 55 years old, had undergone cholecystectomy 2 years ago, was admitted with a clinical picture of obstructive jaundice. In retrograde cholangiopancreatography revealed choledocholithiasis. What is the preferred method of treatment:

A. Endoscopic papillosphincterotomy *

B. comprehensive conservative therapy

B. drainage choledoch

G. choledochotomy with external drainage of the common bile duct

D. extracorporeal lithotripsy

18. The patient 76 years admitted to the hospital with a picture of obstructive jaundice, sick for a month. Examination revealed cancer of the pancreatic head. Suffers from diabetes and hypertension. What kind of treatment is preferable:

A. cholecystostomy

B. operation Mikulic (holetsistoeyunoanastomoz with Brownian fistula) *

B. pancreatoduodenal resection

G. endoscopic papillosphincterotomy

D. abandon operations, a conservative therapy

19. On the 7th day after holedoholitotomii and drainage to drainage Keru dropped. No signs of peritonitis. What you should do:

A. emergency surgery, the reintroduction of drainage

B. laparoscopy for diagnostic and therapeutic purposes

B. monitoring of patients, including ultrasound subhepatic space *

G. attempts to introduce the fistula drainage on the go

D. fistulography

20. The cause of jaundice in a patient may be all of the above except:

A concretion in the neck of the gallbladder *

B. increase the head of the pancreas

B. concretion in the proximal common bile duct

G. papillita

D. stenosis duodenal papilla

21.U patient during surgery for cholelithiasis occurred profuse bleeding from the elements hepatoduodenal ligament. What are the actions of a surgeon:

A dab site bleeding hemostatic sponge

B. Pringle sample *

B. zatamponirovat bleeding site for 5-10 minutes

G. used to stop bleeding drug zhelplastin

D. apply laser coagulation

22. Select one of the symptoms that are not typical for hydrocholecystis:

A. increase in gallbladder

B. pain in the right upper quadrant

B. jaundice *

G. radiologically-disabled gall bladder

D. absence of peritoneal signs

23. In operation set the cause of jaundice - metastasis of gastric cancer in the liver gate. Tactics:

A. gepatikoenterostomiya

B. restrict laparotomy

B. probing the narrowed area and drainage ducts

G. transhepatic drainage of the hepatic tract *

D. outdoor gepatikostoma

24. The patient PHES, 2 years ago cholecystectomy. Pain resumed after 5-6 months after surgery. When you receive a state of moderate ikterichnost skin and sclera. The most reliable method of diagnosing the disease:

A study of bilirubin blood, urine, feces

B. Study blood enzymes

B. laparoscopy with a liver biopsy

G. ERCP *

D. fistulography

25. The mechanism of therapeutic action of cytostatic drugs in acute pancreatitis:

A blockade of the vagus nerve

B. reducing inflammation in the gland

B. reducing pain

The blockade of protein synthesis in iron *

D. Inactivation of pancreatic enzymes

26. The most common symptom of acute pancreatitis with gastroduodenoscopy:

A. acute gastric ulcer

B. acute ulcer 12 duodenal ulcer

B. edema and hyperemia of the posterior wall of the stomach *

G. hemorrhage on the front wall of the stomach

D. thickening of the folds of the stomach and duodenum 12

27. Within 12 days after cholecystectomy and choledochotomy on drainage Kera continues to flow to 1 liter of bile per day. When fistulography detected choledochal calculus mouth. What should be done:

A re-laparotomy to extract the calculus

B. conducting litholytic therapy through drainage

V. remote wave lithotripsy

G. endoscopic papillosphincterotomy *

D. percutaneous intervention chrezpechenochnoe endobiliary

28. Contraindications for the purpose of cytostatics in acute pancreatitis:

A destructive forms of pancreatitis

B. respiratory failure

B. purulent complications of pancreatitis with renal hepatic insufficiency *

G. collapse

D. jaundice

29. The most common cause of death in destructive pancreatitis:

A. purulent complications *

B. jaundice

B. peritonitis

G. bleeding

D. pulmonary embolism

30. On the 15th day in a patient with pancreatitis saved significant signs of intoxication, the body temperature of 39

° C, chills, sweating, leukocytosis, flushing of the skin in the lumbar region. Diagnosis:

A. edematous pancreatitis

B. abscess of the pancreas

B. omental abscess

G. pyoperitonitis

D. retroperitoneal abscess *

31. Indications for surgery in destructive pancreatitis:

A. parapancreatic infiltration

B. purulent complications, bleeding *

B. swelling retroperitoneal fat

G. pancreatogenic peritonitis

D. severe intoxication

32. The patient was hospitalized in the clinic with complaints of epigastric pain, nausea, vomiting. Within 6 months lost 15 lbs. X-ray examination of the stomach revealed a pushing his front. Diagnosis:

A. pyloric stenosis

B. pancreatic tumor *

B. peptic ulcer

G. stomach cancer

D. colon tumor

33. Signs of endocrine pancreatic insufficiency in chronic pancreatitis:

A. jaundice

B. frequent loss of consciousness

B. high sugar content in the blood and urine *

G. enlargement of the liver, gall bladder palpable

D. kreatoreya, steatorrhea

34. Specify the symptoms of the violation of exocrine pancreatic activity:

A dry skin

B. diabetes

B. weight loss, and steatorrhea kreato- *

G. veins of the anterior abdominal wall

D. renal hepatic failure

35. After 6 months after myocardial pankreatonekroza patient 45 years revealed a cyst on ultrasound of the pancreas. Option transaction:

A. external drainage

B. tsistoenteroanastomoz *

B. pancreatoduodenal resection with Sealing duct in the distal part of the pancreas

G. marsupilizatsiya

D. tsistogastroduodenostomiya

36. The external drainage of pancreatic cyst shown:

A. with malignancy

B. with festering cysts *

B. obstructive jaundice

G. for bleeding into the lumen of the cyst

D. no indications for this operation

37. In patients with chronic pancreatitis with RPHG detected stenosis faterova nipple over 0.8 cm. What do you prefer:

A. holedohoduodenoanastomoz

B. endoscopic papillotomy *

B. holetsistoenteroanastomoz

G. transduodenalnym papillosfinkteroplastiku

D. external drainage of the common bile duct

38. In the operation revealed the formation in the pancreas 3x4 cm. The patient for a long time suffered from diabetes. Histological examination revealed that the tumor starts from alpha cells. Specify the type of the tumor:

A. gastrinoma

B. glucagonoma *

B. acinar cancer

G. squamous cell carcinoma

D. insulinoma

39. Specify the benign epithelial tumors of the pancreas:

A. adenoma, cystadenoma *

B. lipoma

B. neuroma, gastrinoma

G. papilloma

D. insulinoma

40. At surgery for obstructive jaundice a tumor of the pancreatic head, isolated liver metastases. Your tactic:

A. pancreatoduodenal resection

B. holetsistoenteroanastomoz *

V. Cholecystectomy

G. holedohoduodenoanastomoz

D. external drainage of the common bile duct

41. The main pathogenetic treatment of acute pancreatitis is:

A suppression of the secretory function of pancreas *

B. elimination of hypovolemia

B. Inactivation of pancreatic enzymes

G. nasogastric decompression of the gastrointestinal tract

D. introduction of cytostatics

42. Perforation any hollow organ in the abdomen is characterized by all of these symptoms, except for:

A. occurrence of severe pain

B. tension in the muscles of the anterior abdominal wall

B. bradycardia

G. frenikus-symptom

D. symptom Mayo - Robson *

43. When fat pancreonecrosis shown:

A laparotomy, abdominal drainage

B. laparotomy with excision of the prostate capsule

V. infusion therapy, and cytotoxic drugs antifermental *

G. distal pancreatectomy

D. all right

44. subdiaphragmatic abscess can occur all except:

A decrease in lung respiratory excursions

B. high standing dome of the diaphragm

V. friendly pleural effusion

G. pain radiating to the supraclavicular region

D. diarrhea *

45. The best treatment option is subphrenic abscess:

A conservative treatment

B. extraperitoneal autopsy and drainage

B. laparotomy, autopsy and plugging cavity

G. abscess thick needle puncture under ultrasound and drainage *

D. all of the above is true

46. The best way of opening subphrenic abscess is:

A. torakolaparotomiya

B. lumbotomy

B. dvuhmomentny chrezplevralny access

G. laparotomy for Fedorov

D. Vneplevralnaya extraperitoneal method *

47. Painted bile fluid in the abdominal cavity is observed in all cases, except for:

A perforation of the gallbladder

B. gap festering cyst of the liver *

B. prolonged jaundice

G. perforation of ulcer 12 duodenal ulcer

D. spontaneous bile peritonitis

48. Hernia Larrea diagnostsiruetsya at:

A. Overview fluoroscopy abdomen

B. Overview abdominal radiography

B. X-ray contrast examination of the stomach *

G. ultrasound

D. contrast study of the esophagus

49. Manifestation sliding hiatal hernia is:

A. dysphagia

B. frequent vomiting

V. frequent heartburn *

G. weight loss

D. none of the named

50. paraesophageal hernia is dangerous:

A. infringement stomach *

B. malignancy

B. precordial pain

G. anything from title

All named G.

51. hiatal hernia often occur:

A heavy bleeding

B. light bleeding

B. hypersecretion

G. pain after eating *

D. asymptomatic

52. The most common sliding hernia formation involved:

A lean and ileum

B. sigmoid and descending colon

B. cecum and the bladder *

G. gland

D. Suspension fat colon

53. The patient was admitted to the hospital with complaints of pain in the left chest, shortness of breath worse after eating and physical activity, as well as in the supine position, nausea and occasionally vomiting, bringing relief. In the history of avtotravma 10 days ago. Chest radiography diaphragm over the gas bubble to the liquid level. Your diagnosis:

A left-sided abscessed pneumonia

B. angina

B. sliding hiatal hernia

G. left hemothorax

D. traumatic hernia of the diaphragm *

54. Complication any of these diseases is erosive and ulcerative esophagitis:

A. gastric cancer

B. peptic ulcer 12 duodenal ulcer

B. cardiospasm

G. sliding hiatal hernia *

D. chronic gastritis

55. Under what conditions are detected R-logically sliding hiatal hernia:

A standing

B. a semi-sitting position

B. in the Trendelenburg position *

G. under artificial hypotension 12 duodenal ulcer

D. a lateral position

56. The patient 50 years of a sudden there was an acute dysphagia, accompanied by a sharp pain behind the breastbone. What are the possible causes of the following diseases:

A. intercostal neuralgia

B. angina

B. incarcerated paraesophageal hernia *

G. reflux esophagitis

D. hernia Lorreya

57. Specify the early clinical manifestations of prejudice to the small intestine for internal hernias:

A. diarrhea

B. collapse

B. cramping abdominal pain, delay flatus *

G. symptoms of peritoneal irritation

D. Dehydration

58. The operation of choice for peptic ulcer disease in violation of duodenal patency is:

A. gastrectomy (antrumectomy) from vagotomy Billroth-1

B. gastrectomy Roux *

B. gastrectomy (antrumectomy) from vagotomy on Hofmeister-Finsterer

G. SPV with duodenoeyunoanastomozom

D. SPV without special correction of impaired duodenal patency

59. The most physiologic method of resection is considered:

A. Billroth-2 modification Hofmeister-Finsterer

B. resection in the modification Roux

B. Billroth-1 *

G. Balfour modification

D. resected by Reichel - Polya

60. The highest figures are observed in gastric acidity:

A fundus

B. antrum

B. pyloric channel *

G. body

D. gastric cardia

61. Endoscopic examination is not to diagnose:

A type of gastritis

B. syndrome Mallory - Weiss

B. early gastric cancer

G. Zollinger - Ellison *

D. degree of pyloric stenosis

62. The theoretical justification based diet Meylengrafta:

A. on the mechanical sparing the gastric mucosa

B. on inhibition of gastric juice secretion

B. on providing high-calorie food

D. all of the above is true *

D. all not true

63. In step one hour after the perforation callous ulcer shows:

A true antrumectomy

B. classic 2/3 resection of the stomach *

B. suturing perforated ulcer

G. stem vagotomy with pyloroplasty

D. Any of these operations

64. Meckel's diverticulum is the anatomical elements:

A. ileum *

B. jejunum

B. It is a protrusion of the bile ducts

G. often occurs after appendectomy

D. all of the above is true

65. Meckel diverticulum may be the cause:

A. intussusception

B. intestinal obstruction

B. perforation

G. bleeding

D. all of the above is true *

66. Meckel diverticulum is most often seen:

A bloody vomiting

B. intestinal bleeding *

V. small bowel obstruction

G. constipation

D. diverticulitis

67. lymph from Sigma through lymph nodes:

A. upper mesenteric

B. lower mesenteric *

V. para-aortic

G. through any of the groups listed

D. all of these through the lymph nodes

Faculty surgery - Case study 1. A patient on day 5 after

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