Download Rector`s control test

"Rector’s control test"
Department of surgical diseases and post graduate education
Discipline: surgical diseases
for the VIth year students of medical faculty
2
Instructions: It is necessary to choose from each task one of the correct answer.
1. A 38-old-man was hospitalised to the thoracic surgery after road accident with
signs of thorax injury. What is injured most often in such trauma?
А. Primary bronchi
В. Esophagus
С. Diaphragm
+D. Lungs
Е. Heart
2. Patient А, 60–year-old was diagnosed to have a third stage of squamous cell
carcinoma of the upper third of the esophagus after esophagoscopy. What treatment
should be chosen?
А. Esophagectomy with single stage intrathoracic esophagic-gastric anastomosis
(Lewis procedure)
В. Dombromislov- Thorek’s operation
С. Extirpation of esophagus.
D. Gastrostomy
+Е. A gastrostomy and radical X -ray therapy \SGD -60-70Gr. \
3. A 40-years-old woman has pneumonia, complicated by pleuritis. Despite
treatment, condition of the patient has worsened – fever up to 39 – 40 o C, dyspnea;
blunt sound on percussion. Empyema of the pleura is suspected. What examination
is possible to confirm it?
А. Bronchoscopy
В. Bronchography
С. Radioisotope scanning of lungs.
+D. Pleurocentesis
Е. Tomography
4. A 40-year-old patient complains of weakness, presence of blood in sputum.
Endobronchial cancer of lungs is suspected. What from the following physical
signs can confirm this diagnosis?
А. Delayed movement of the chest wall during respiration
В. Signs of non specific arthropathy
С. Local emphysema
D. Pain in the arm on the side of tumour
+Е. Dislocation of trachea towards atelectasis
5. A patient, who had esophageal burn in the past, complaints of nausea, vomiting
and difficulty in food passage. What is the cause of these clinical symptoms?
А. Chronic inflammation of bronchi and lungs
В. Formation and development of hiatal hernia
С. Development of cancerous tumour in the area of stricture
+D. Obturation of esophagus by food mass
Е. Perforation of esophagus
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6. During operation for penetrating injury of the stomach, the surgeon finds injury
of the diaphragm. What suture material should not be used for suturing the
diaphragm?
А. Silk
В. Capron
С. Dedoron
+D. Catgut
Е. Acrylic
7. The active aspiration of pleural cavity is used after the listed operations, except
in:
А. Atypical pneumonectomy
В. Lobectomy
+С. Pneumonectomy
D. Segmentectomy
Е. Suturing of lung wounds
8. A 32-year-old patient has severe pneumonia, which has become complicated by
exudative pleuritis. Which of diagnostic signs will be absent in this case?
А. Blunt percussive sound in the lower lobe of the chest.
В. Shift of heart borders and mediastinum towards the healthy side
+С. Pleural murmur
D. Decreased lung compliance
Е. Absence of voice tremor
9. A 43-year-old patient has hiatal hernia. What below can not be the content of the
hernial bag?
А. Omentum
В. Transverse colon.
С. Stomach
D. Pancreas
+Е. The preperitoneal fatty tissue
10. For many years a 60-year-old patient has been suffering from hiatal hernia.
What clinical sign is not associated with this disease?
А. Thermalgias in the chest.
В. Concealed haemorrhage
С. Eructation
D. Hickups
+Е. Continuos vomiting
11. A 20-year-old patient was hospitalised at the surgical department after trauma.
At the review of the wound, it was noted that the wound on the right foot is deep,
contaminated with mud, with deformed edges. On what day is it possible to expect
the clinical signs of tetanus?
А. 12 - 24 hours.
В. 1-2 days
+С. 7-10 days
4
D. 5 Days
Е. 2 weeks
12. An 18-year-old patient is brought to the operating room with heart injury. What
suture material can be used to stitch the cardiac muscle?
А. Atraumatic catgut.
В. Nodular catgut sutures
С. Running catgut sutures
D. Any absorbable suture material
+Е. Any nonabsorbable suture material
13. A woman periodically complains of protruding inspissations at the vein
projections in different parts of the body. The diagnosis of migrating
thrombophlebitis is confirmed. What of the listed below can not be the cause?
А. In patients with malignant tumours
В. In cancer of pancreas
С. In hypernephroma
D. Hew’s symptoms
+Е. In thrombophlebitis of deep knee veins
14. On X -ray examination asbestosis and tumour of the lungs was revealed in a
patient. What complications of asbestosis are most probable?
А. Cancer of the thyroid gland
В. Lung cancer
+С. Mesothelioma
D. Cancer of the urinary bladder
Е. Hepatitis
15. A 28-year-old patient complains of yellowing of the mucosa, skin. What
diseases this sign is related to?
А. Cancer of the thyroid gland
В. Lung cancer
С. Mesothelioma
D. Cancer of the urinary bladder
+Е. Hepatitis
16. In the patient Н. of 16 years old the diagnosis of "Bronchoadenopathia" was
made. It is:
А. Absence of lymphatic nodules
В. Shrinking of lymphatic nodules
+С. Augmentation of lymphatic nodules
D. Metastasis in lymphatic nodules
Е. Inflammation of lymphatic vessels
17. In the patient К. aged 43 years the diagnosis of "Lymphangitis" was made. It is:
А. Absence of lymphatic nodules
В. Shrinking of lymphatic nodules
С. Augmentation of lymphatic nodules
D. Metastasis in lymphatic nodules
5
+Е. Inflammation of lymphatic vessels
18. Routine bronchography is prescribed to the patient for confirmation of the
diagnosis. What does it mean?
А. Examination of the lung vessels
В. Review of the trachea and bronchi
+С. Contrast research of the bronchi
D. Examination of the mediastinum
Е. Contrasting the colon
19. Irrigoscopy was prescribed to the patient in polyclinic. What does it mean?
А. Examination of the lung vessels
В. Review of the trachea and bronchi
С. Contrast research of bronchi
D. Examination of the mediastinum
+Е. Contrasting the colon
20. On ultrasonography of patient К. of 35 years old, who works at fur factory, the
coin-shaped lesion 8 cm in size in the liver containing liquid with thickened walls
is revealed. What can cause such condition?
А. Akinomycetes
В. Fungi
С. Pneumococci
+D. Echinococcus
Е. Hemangioma of the liver
21. The patient К. aged 58 is made the diagnosis " a Set of symptoms of minor
signs". It may mean the following:
А. Lung underdevelopment
В. Anomaly of the trachea development
С. Absence of cartillage and elastic tissue in the medial bronchi
D. Aneurysm of the pulmonary artery
+Е. Carcinoma of the stomach
22. The doctor has prescribed mediastinography to a patient. What diseases will be
informative of this investigation?
А. Retrosternal struma
В. Pancoast’s tumour
С. Lung gangrene
+D. Thymoma
Е. None
23. A surgeon had performed ideal echinococcectomy. What does it mean?
А. Echinococcectomy with evacuation of contents
В. Atypical pneumonectomy
С. Pneumonectomy
+D. Excision of the cyst without opening its lumen
Е. None
6
24. For diagnosis of the disease the doctor has prescribed the liver scan. For
diagnosis of what diseases is used this examination?
+А. Echinococcal cyst of the liver
В. Bile stone disease
С. Stricture of the choledochus
D. Cholangitis
Е. None
25. The surgeon has performed diagnostic laparocentesis. What diseases can this
procedure reveal ?
+А. Suspicion of the spleen rupture
В. Adhesive intestinal obstruction
С. Suspicion of acute appendicitis
D. Adenoma of the prostate gland
Е. None of the listed above
26. The patient М. of 32 years old complaints of purulent sputum. What disease can
be suspected?
А. Purulent lung abscess
В. Lung cancer
С. Bronchoectases
+D. Lung gangrene
Е. None
27. On X-ray inspection of a patient, the syndrome of " mouse tail " was revealed.
What disease is this sign characteristic of ?
А. Cancer of the esophagus
В. Combustion of the esophagus
С. Varicose phlebectasia of the esophagus
+D. Cardiospasm
Е. None
28. Patient Н. is hospitalised to the surgical department with the diagnosis of acute
cholecystitis. Which of the listed signs are indications for immediate operation?
А. Constant pain.
В. Hyperthermia.
С. Vomiting.
+D. Diffused peritonitis.
Е. Leukocytosis.
29. A patient Н. with jaundice and bilirubin level up to 86 g/l. What X-ray method
is necessary for diagnosis?
А. Peroral cholecystography.
В. Antegrade cholecystography.
С. Infusion cholecystography.
+D. Retrograde cholangiopancreatography
Е. None.
7
30. During the operation for phlegmonous cholecystitis an extended purulent
edenomatous infiltrate to the hepatoduodenal ligament was revealed. What
operation should be performed?
А. Cholecystostomy.
В. Cholecystectomy « from neck ».
+С. Cholecystectomy « from fundus ».
D. Choledochotomy.
Е. Choledochojejunoanastomosis.
31. A patient is prepared for intravenous cholecystography. What concentration of
Bilignost is used for this procedure?
А. 10 %
В. 25 %
С. 30 %
D. 40 %
+Е. 50 %
32. A patient with mechanical jaundice is hospitalised. Which of the following
parameters are elevated?
А. Blood protein.
В. Blood leucocytes.
+С. General blood bilirubin.
D. Urobilin of urine.
Е. Blood sedimentation rate.
33. Cholecystectomy, choledochlithotomy with drainage of the choledhochus was
performed on a patient with bile stone disease, jaundice and cholecystitis. What
examination is necessary before removal of the drain from the choledochus?
А. X-ray survey of the abdomen.
В. Percutaneous- transhepatic cholangiography.
С. Retrograde cholangiopancreatography
+D. Fistulography.
Е. Ultrasonography
34. A patient with acute cholecystitis is admitted to the surgical unit. What
medications are not recommended to this patient?
+А. Morphin.
В. Promedol.
С. Baralgin.
D. Maxigan.
Е. Platyphylline.
35. Which of the following complications are not associated with
choledocholithiasis?
+А. Jaundice.
В. Dynamic obstruction of the intestine.
С. Pancreatitis.
D. Cholangitis.
8
Е. Empyema of the gall bladder.
36. In the protocol of the operation the surgeon has noted, that the gall bladder
contains "white bile". In which of the following diseases white bile is found?
А. Purulent cholangitis.
В. Empyema of the gall bladder.
+С. Hydrops of the gall bladder.
D. Hepatitis.
Е. Liver cirrhosis.
37. A-82-year old patient is hospitalised to the surgical unit with the diagnosis of
bile stone disease, choledocholithiasis, mechanical jaundice. In past history the
patient had myocardial infarction twice and renal failure. Which of the following
methods are recommended?
А. Cholecystectomy.
В. Cholecystectomy with drainage of choledochus.
С. Biliodigestive anastomosis.
+D. Endoscopic papillotomy.
Е. Transduodenal papilloshpincterotomy.
38. During the operation for bile stone disease, choledocholithiasis a stone was left
in the choledochus. What are your further actions?
А. Infusion therapy.
В. Sanatorium treatment.
+С. Endoscopic papillosphincterotomy.
D. Prescription of medicines which dissolve stones.
Е. Repeated operation.
39. Which of the listed below symptoms are for acute cholecystitis?
А. Promptov’s symptom.
В. Spizharnov’s symptom.
+С. Ortner’s symptom.
D. Meyo-Robson symptom.
Е. Bartome-Michelson’s symptom.
40. Up to 300,0 ml of bile was collected in the drain on the next day after
cholecystectomy and peritoneal signs. What are your actions?
А. Massive antibiotic therapy.
+В. Relaparotomy with exploration of the abdominal cavity.
С. Massive infusion therapy.
D. Fractional dialysis.
Е. Laparocentesis.
41. During cholecystectomy the stump of the cystic artery contracted and massive
bleeding began. What are your actions?
А. Diathermic coagulation.
+В. Compression of the hepatoduodenal ligament and suturing the stump.
С. Suturing the artery through all the layers of the ligament.
D. Introduction of absorbable gelatin sponge.
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Е. Hard tamponade of the source of bleeding.
42. A patient has bile stone disease complicated by jaundice. What operation is
indicated to this patient?
А. Cholecystectomy.
+В. Cholecystectomia with exploration of choledochus and drainage.
С. Cholecystostomy.
D. Transduodenal papillosphicterotomy.
Е. Cholecystojejunoanstomosis.
43. During the operation, acute cholecystitis complicated with pancreatitis is
revealed. Which of the below specified operations are indicated in such case?
А. Cholecystostomy.
В. Cholecystectomy.
С. Drainage of the omental sac.
+D. Cholecystectomy, choledochotomy, drainage of choledochus and omental sac.
Е. Cholecystojejunoanstomosis.
44. A patient of 87 years old was admitted to a hospital with the diagnosis of acute
cholecystitis, local peritonitis. What operation is necessary?
А. Cholecystectomy.
+В. Cholecystostomy, drainage of the abdominal cavity.
С. Cholecystectomy with choledochotomy.
D. Drainage of the abdominal cavity.
Е. Cholecystojejunoanstomosis.
45. During cholecystectomy, choledocholithiasis is found. Which of the listed
below examinations is obligatory during the operation on the patients with
choledocholithiasis?
А. Intraoperative ultrasonography.
В. Transhepatic cholangiography.
+С. Intraoperative cholangiography.
D. Intravenous cholangiography.
Е. Tomography.
46. After endoscopic papilloshpincterotomy, a patient developed acute pain and
vomiting. Which of the listed below complications is most probable?
А. Intestinal obstruction.
+В. Pancreatitis.
С. Thrombosis of the mesenteric vessels.
D. Jaundice.
Е. Cholangitis.
47. The surgeon is unable to locate the choledochus during the peration for
mechanical jaundice. What method is possible to determine the presence of
choledochus during the operation in cases with severe edema or cicatrical
transformation of the hepatoduodenal ligament?
А. Palpation.
+В. Puncture and getting bile.
10
С. Intraoperative ultrasonography.
D. Retrograde cholangiopancreatography.
E. Intravenous cholangiography.
48. A 26-year-old patient, , was hospitalised with complaints of weakness,
disorientation, pain in the right side of the lower abdomen. Onset of the symptoms
was 10 hours before. What examination is most informative?
А. Thoracocentesis.
+В. Puncture of the Douglas’s space.
С. Laparotomy.
D. Endoscopic gastroduodenoscopy.
Е. Ultrasonography of the abdomen.
49. A patient of 34 years old was hospitalised to the surgical department with the
diagnosis of acute pancreatitis. Which of the following signs is indication for
immediate operation?
А. Onset of disease 9 days before.
+В. Peritonitis.
С. Sharply elevated diastase of urine.
D. Leukocytosis.
Е. Constant pain in epigastric and subcostal regions.
50. A patient aged 33 was hospitalised with suspicion of perforation of the gastric
ulcer. Which of the methods listed below is most informative for diagnosis?
А. Laparocentesis.
В. Ultrasonography of the abdomen.
С. ECG.
+D. X-ray survey of the abdomen.
Е. Laparoscopy.
51. A patient aged 24 was hospitalised with the diagnosis of acute appendicitis,
peritonitis. Onset of the disease was 3 days back. What is right access for the
operation:
А. Pirogov’s.
В. Volkovih-Dyakonov’s.
+С. Medial laparotomy.
D. Pararectal laparotomy
Е. Phanenstillu’s.
52. During the operation for diffused peritonitis in a patient С of 63 years old,
perforation of the caecum tumour was revealed. What operation is optimal?
А. Right hemicolectomy.
В. Cecectomy, ileotransverse anastomosis.
С. Ileostomy.
+D. Suturing of the perforation, ileostomy.
Е. Drainage of the abdominal cavity.
11
53. A 38 year old patient М., was hospitalised with the diagnosis of
pelvioperitonitis. Onset of the disease was 7 days before, t- 38,5о C. Treatment
tactics:
А. Infusion detoxication therapy.
+В. Anti- inflammatory therapy.
С. Diagnostic currettage.
D. Ultrasonography of the pelvis.
Е. Laparotomy.
54. A patient L.of 29 years old, is admitted with strangulated inguinal hernia,
gangrene of the intestine, phlegmon of the anterior abdominal wall. Surgical
tactics:
А. Incision and drainage of the phlegmon.
В. Antibacterial and anti-inflammatory therapy.
С. Laparotomy, exploration of abdomen.
+D. Laparotomy, resection of the strangulated organ, drainage of the phlegmon of
the abdominal wall.
Е. Plasty of the anterior abdominal wall.
55. A 26 years old patient Н., complains of pain in the epigastric region, which is
gradually displaced to the right side of the abdomen, nausea, t-37,30 С. Onset of the
disease was 10 hours before. The patient had no illness in the past. The most
probable diagnosis:
А. Acute pancreatitis.
В. Acute cholecystitis.
С. Perforated ulcer.
+D. Acute appendicitis.
Е. Renal colic.
56. A patient aged 45 years was admitted with the diagnosis of acute appendicitis,
appendicicular infiltrate. Onset was 7 days back, t -390 С. Medical treatment is not
effective. What is your further tactics?
А. Continuation of antibacterial, anti-inflammatory therapy.
В. Laparoscopy.
С. Laparocentesis.
+D. Laparotomy, drainage of the appendicicular abscess by Volkovich’s method.
Е. Puncture of the Douglas’s space.
57. After cholecystectomy, in the postoperative period about 50,0 ml of bile was
collected by drains. Your tactics:
А. Immediate laparotomy.
+В. Active supervision of the patient + conservative treatment.
С. Laparocentesis.
D. Laparoscopy.
Е. Endoscopic papillosphincterotomy.
58. During the operation for peritonitis, on a patient of 56 years old, perforation of
the sigmoid tumour was found. Determine the scope of the operation.
12
+А. Hartmann’s operation.
В. Suturing of the perforation. Drainage of the abdominal cavity.
С. Left hemicolectomy. Ceacostomy.
D. Resection of the sigmoid colon with primary anastomosis.
Е. Double lumen tranversostomy.
59. On the 7th day a patient with appendicicular infiltrate complains of pain in the
lower abdomen and peritoneal signs appeared. Measures:
А. To continue antibacterial therapy with change of antibiotic.
В. Laparoscopy, drainage of the abdominal cavity.
С. Draining the appendicicular abscess by Pirogov’s access.
+D. Laparotomy, drainage of the abdominal cavity, appendicicular abscess.
Е. Laparotomy, cecostomy, drainage of the abdominal cavity.
60. A 21-year-old patient was operated on for perforation of acute duodenal ulcer
and local peritonitis. Scope of the operation:
А. Jadd’s operation and truncal vagotomy.
В. Antrumectomy, vagotomy.
+С. Excision of the ulcer, drainage of the abdominal cavity.
D. Opel- Polycarpov’s operation.
Е. Bilroth-II gastric resection.
61. In a patient of 38 years old, during the operation the following is found: right
pyosalpinx, secondary appendicitis. Scope of the operation?
+А. Resection of the right appendages, appendicectomy.
В. Resection of the right uterine tube and ovary, drainage of the abdominal cavity.
С. Appendicectomy, drainage of the abdominal cavity.
D. Sanation and drainage of the fallopian tube.
Е. Resection of uterine tube, appendicectomy, drainage of the abdominal cavity.
62. During the operation on a 34 years old patient, adhesive small bowl obstruction
and peritonitis was found. Scope of the operation:
А. Adhesiolysis, drainage of the abdominal cavity.
В. Small bowl resection at strangulation site.
С. Intubation of the small bowel, with resection of the small bowl at strangulated
siteand anastomosis.
+D. Adhesiolysis, intubation of the small bowel, drainage.
Е. Small bowel resection and anastomosis.
63. A 39 years old patient, is hospitalised with the diagnosis of acute pancreatitis.
Onset of the disease was 7 days back. The abdominal skin is pale, cyanotic, with
violet patches. Which of the listed below signs are typical of this case?
А. Meyo - Robson, Chukhriyenko, Spasokukotskova.
В. Gobe, Lyakhovitskova, Vigiatso.
+С. Kholsteda, Mondora, Quellen.
D. Grey - Turner, Gryunvald, Kylenkampfa.
Е. Krupa, Posner, Promptova.
13
64.A 23-year-old woman with pregnancy of 22 weeks was hospitalised with
complaints of pain in the right hypochondrium, nausea, vomiting, t-37,2 o C.
Peritoneal signs are slightly positive. Medical tactics:
А. Dynamic observation.
В. Infusion detoxication therapy.
+С. Operation.
D. Dynamic observation, spasmolytics.
Е. Antibacterial therapy.
65. A 33-year-old patient was hospitalised with acute destructive cholecystitis,
jaundice. Operation tactics:
А. Cholecystectomy, drainage of the abdominal cavity.
+В. Cholecystectomy with drainage of bile ducts.
С. Cholecystostomy with drainage of bile ducts.
D. Cholecystostomy with drainage of the abdominal cavity.
Е. Endoscopic retrograde drainage of choledochus.
66. A 49 years old patient, was hospitalised in 2 hours after trauma of the abdomen
with complaints of pain in the left half of the abdomen, weakness, disorientation.
Necessary examinations:
А. Diagnostic observation.
+В. Laparocentesis.
С. Laparostomy.
D. X-ray survey of the abdomen.
Е. Ultrasonography of the abdomen.
67. A patient aged 46 is hospitalised with complaints of acute pain in the epigastric
region, which appeared 3 hours before, muscles are tender in the upper abdomen.
Peritoneal signs are mildly positive. The necessary examination:
А. Endoscopic examination of the stomach and duodenum.
+В. X – ray survey of the abdomen.
С. Ultrasonography of the abdomen.
D. Explorative laparotomy.
Е. Dynamic observation, laparocentesis.
68. A young woman, after labours, complains of edema, cyanosis and pain in the
left lower extremity from the toe to inguinal region. The diagnosis is acute
ileofemoral thrombosis of the veins. What should the doctor suspect first of all?
А. Trauma of the urinary bladder.
В. Acute arterial thrombosis.
+С. Acute ileofemoral vein thrombosis.
D. Acute lymphostasis.
Е. Acute ankle deep vein thrombosis.
69. A young woman, after labours, complains of edema, cyanosis and pain in the
left lower extremity from the toe to inguinal region. The diagnosis is acute
ileofemoral thrombosis of the veins. What non-invasive methods of investigation
are most informative in such cases?
14
А. Ultrasonography of pelvis.
В. X- ray inspection.
С. Proctosigmoidoscopy.
+D. Doppler sonography of vessels.
Е. Prat’s test 1 and 2.
70. A young woman, after labors, complains of edema, cyanosis and pain in the left
lower extremity from the toe to inguinal region. The diagnosis is acute ileofemoral
thrombosis of the veins. Which investigations should the doctor administer in this
case?
А. Desagregants.
В. Anticoagulants of direct action.
С. Anticoagulants of indirect action.
+D. Fibrinolytic therapy.
Е. Antibiotic therapy.
71. A 60-year-old man complains of presence of varicose expansion of
subcutaneous veins in the ankle region, edema of the femur and ankle,
hyperpigmentation in the bottom third of the ankle. Which of the listed below
examinations is first of all necessary for establishment of the diagnosis?
А. X – ray of the abdominal cavity.
В. Ultrasound of the pelvis.
С. Urography.
+D. Doppler sonography of the pelvic veins.
E. Capillaroscopy.
72. A 60-year-old man complains of presence of varicose expansion of
subcutaneous veins in the ankle region, edema of the femur and ankle, hyper
pigmentation in the bottom third of the ankle. The doctor has suspected on
occlusion the of ileac veins, which is confirmed by doppler sonography. What is
necessary to carry out for more detailed inspection of the pelvic veins?
А. Arteriography.
В. Phlebography.
С. Computed tomography.
D. MRI.
+Е. Three-dimensional duplex scanning.
73. A 60-year-old man complains of presence of varicose expansion of
subcutaneous veins in the ankle region, edema of the femur and ankle, hyper
pigmentation in the bottom third of the ankle. The doctor, on the basis of ultrasonic
doppler sonography and phlebography has made the diagnosis of post thrombosis
syndrome of the pelvis and left lower extremity in the stage of occlusion of the
ileac veins. What operation is necessary to perform?
А. Trendelenburg’s operation.
В. Husni’s operation.
С. Torec’s operation.
+D. Palma’s operation.
15
E. Linton’s operation.
74. A 30-year-old young woman complains of presence of varicose expansion of
subcutaneous veins in the ankle region, edema of the femur and ankle, hyper
pigmentation in the bottom third of the ankle. What treatment is optimum?
А. Anticoagulants.
В. Elastic bandage of the lower extremity.
+С. Operative treatment.
D. Physical inability and easy work.
Е. Zinc – gelatinous high compression bandage.
75. A 30-year-old young woman complains of presence of varicose expansion of
subcutaneous veins in the ankle region, edema of the femur and ankle, hyper
pigmentation in the bottom third of the ankle. What operation is indicated in this
case?
А. Palma’s operation.
В. Jabuley’s operation.
+С. Linton’s operation.
D. Babcock’s operation.
E. Cockett’s operation.
76. After the automobile accident a young man complains of edema of both lower
extremities, cyanosis of the skin, pain on palpation in the region of the femur,
edema in the ankle region, pain in area of calf muscles. What diagnosis is most
probable?
А. Acute deep vein thrombosis of the ankle.
В. Acute thrombosis of the femoral veins.
+С. Ileofemoral veins thrombosis.
D. Lerish’s syndrome.
Е. Thromemboly of the the popliteal artery.
77. After the automobile accident a young man complains of edema of both lower
extremities, cyanosis of skin, pain on palpation in the region of the femur, edema in
the ankle region, pain in area of calf muscles. The patient had positive Homan’s
symptoms. What does it mean?
А. Pain on palpation of the femur.
+В. Pain on palpation of the ankle.
С. Pain while coughing in the upper third of the femur.
D. Pain in the inguinal region.
Е. Edema of the toe.
78. On examination, post thrombosis symptoms of the right lower extremity were
found in a young woman in the stage of the occlusion of the femoral vein. What
operation is proper in this case?
А. Ivanisevich operation.
В. Thorec operation.
С. Linton operation.
+D. Husni operation.
16
E. Babcock operation.
79. A man of advanced age comes to the outpatient clinic with complaints of
trophic ulcer 3х5 (cm) in the lower one third of the right leg, varicose expansion of
subcutaneous veins, edema of the right leg +3,5 cm in comparison with the left leg.
Concominant diseases: IInd stage of idiopathic hypertension, ischemic heart disease
of IIIrd functional stage. What treatment is optimum?
А. Bandage Unna + Troxevasin.
В. Heparinum + Troxevasin.
+С. Detralex +Elastic bandage.
D. Detralex + bandage, duoderm.
Е. Troxevasin + Esksuzan + elastic bandage.
80. A young woman, aged 35 with diagnosis of chronic venous insufficiency
varicose phlebectasia was admitted to a surgical department with complaints of
pain along the large saphenous vein of the left lower extremity, body temperature
37,3 о С, hyperemia, edema of the ankle. What complication is most probable in
this case?
А. Myocardial infarction.
В. Deep vein thrombosis of the ankle.
С. Intestine infarction.
+D. Thrombembolism of pulmonary artery branches.
Е. Gangrene of the lower extremity.
81. A young woman, aged 35 with diagnosis of chronic venous insufficiency,
varicose phlebectasia was admitted to surgical department with complaints of pain
on course of the large saphenous vein of the left lower extremity, body temperature
37,3 о С, hyperemia, edema of ankle. Some hours back she complained of pain in
the chest and pneumorrhagia. Which of the following diagnostic methods are
necessary for making the diagnosis?
А. ECG.
В. Doppler of vessels.
С. Phlebography.
D. Aorta-arteriography.
+Е. X-ray of the organs of the thorax.
82. Chronic venous insufficiency of the left lower extremity with insufficiency of
the valval device of communicating veins of the ankle was diagnosed in 25 yearold woman on examination in vascular surgery department. What operation is
indicated in this case?
А. Madelung operation.
В. Opell operation.
С. Spasokukotsky’s operation.
+D. Linton operation.
Е. Cockett operation.
83. A 47-year-old man who has been suffering from chronic venous insufficiency
of the lower extremities for 25 years, ischemic heart disease, had been diagnosed
17
three times thrombembolism of small branches of the pulmonary artery for last
year. What tactics is optimal in this case?
А. Thrombectomy from pulmonary vessels.
В. Linton operation.
С. Babcock venectomy.
+D. Installation of cavafilters.
Е. Conservative therapy.
84. A young man of 25 years old is admitted to a medical centre , after trauma of
calf muscles with the diagnosis of Acute deep vein thrombosis of calf region,
which is confirmed by clinical findings. The patient needs medical therapy with the
obligatory prescription of:
А. Heparin.
В. Pelentan.
С. Curantyl.
+D. Kabikinase.
Е. Trental.
85. A young man of 25 years old, with trophic ulcer of the ankle and chronic
venous insufficiency was operated on for inguinal hernia. He developed edema of
the femur and pain. What diagnosis is most correct?
А. Iatrogenic injury of the artery.
В. Iatrogenic injury of the spermatic cord.
С. Iatrogenic injury of the veins.
D. Iatrogenic injury of the lymphatic vessels.
+Е. Thrombosis of the pelvic veins.
86. The woman of 70 years old, complains of pain, edema and presence of varices
of the subcutaneous veins of the calf and presence of trophic ulcer in the lower
third of the ankle. The doctor has prescribed elastic constant bandage. What should
be the pressure of the bandage at the site of ulcer?
А. - 20 mm. of Hg.
В. - 10 mm. of Hg.
С. - 5 mm. of Hg.
+D. - 30 mm. of Hg.
Е. - superficial pressure.
87. The woman 70 years, complains of pain, edema and presence of varices of the
subcutaneous veins of the calf and presence of trophic ulcer in the lower third of
the ankle. The doctor has prescribed constant intake of anticoagulants. Which of
the listed below medicines are of this group?
А. Heparin.
В. Pelentan.
С. Phenilin.
+D. Curantyl.
E. Fibrinolysin.
18
88. A 63 years old patient, was treated in a traumatological department with the
diagnosis of pneumonia of lungs for 18 days. He was discharged in satisfactory
condition. In 2 weeks the symptoms of the disease recurred. What pathology is
necessary to think about first of all?
А. Bronchoectatic disease.
В. Chronic bronchitis.
+С. Obturative pneumonitis.
D. Bullous emphysema of the lungs.
Е. Pneumosclerosis after lung abscess.
89. A patient of 45 years old, complains to ENT specialist of hoarseness. On
examination paresis of the right vocal cord is revealed. What disease is most
probable?
А. Peripheral cancer of the lungs.
В. Lymphogranulomatosis.
+С. Mediastinal cancer of the lungs.
D. Phrenasthenia.
Е. Cancer of the esophagus.
90. A woman aged 56, working at a restaurant was revealed to have during routine
X –ray prophylactic examination, a shadow in the upper lobe of the right lung of
diameter up to 2 cm. She has no complaints. Your diagnosis:
А. Echinococcosis of the lung.
В. Lung sarcoidosis .
С. Bronchial cancer of lung.
D. Pulmonary tuberculosis.
+Е. Peripheral lung cancer.
91. A 68 year old patient, was hospitalised to the thoracic surgery department with
the diagnosis of bronchial cancer of left lung. What scope of operation is indicated
in this case?
А. Atypical pneumonectomy.
В. Lobectomy.
С. Laser pleurodesis.
+D. Pneumonectomy.
Е. Thoracoplasty.
92. A patient of 56 years old, has been treated by a neuropathologist for 5 months
for a shoulder plexitis without success. Last month the condition of the patient has
worsened: weight loss, liver enlargement, unbearable shoulder pain. What disease
is it necessary to think about?
А. Bek’s sarcoidosis.
В. Lymphogranulomatosis.
С. Cancer of the liver.
+D. Pancost’s disease.
Е. Inherent dislocation of shoulder.
19
93. A patient of 53 years old, complains to a doctor of constant pain in the left
subscapular region, not related the act of respiration, with irradiation to other half
of the thorax. What examination is necessary to specify the cause of pain?
А. Electrocardiography.
В. Echocardioscopy.
С. Spirography.
D. Computed tomography.
+Е. Plain chest X – ray examination
94. A patient aged 58 years old, complains of intensive coughing during 6 months.
Sometimes with blood in sputum. In the past the patient did not refer to doctor.
Some days back he developed dyspnea, edema of face and neck and cyanotic skin.
About which disease you should think?
А. Periphery lung cancer.
В. Aneurysm of heart.
+С. Bronchial lung cancer.
D. Thrombembolism of the pulmonary artery.
Е. Myocardial infarction.
95. Atelectasis of the remained lobe is revealed in the patient after lobectomy,
during chest radiography on the second day after operation. What is the most
possible cause of atelectasis?
А. Absence of active aspiration.
В. Presssure on the lobe by the exudate.
+С. Bronchial obstruction by mucous or blood.
D. Thrombembolism of the pulmonary artery.
Е. Acute myocardial infarction.
96. A patient of 50 years old, is transferred to the ICU from the operation theatre
after left pneumonectomy. In some minutes the patients condition dramatically
worsened: arrhythmia, blood pressure decreased up to 60/40 mm. of Hg, dyspnea,
cyanotic skin. What is the cause of serious condition of the patient?
А. Acute intrapleural bleeding.
В. Thromembolism of the pulmonary artery.
С. Bronchospasm.
+D. Extreme shift of the mediastinum as a result of active aspiration.
Е. Acute myocardial infarction.
97. A patient aged 6, has developed dysphagia in one year after extended
pneumonectomy of the right lung cancer. What is the cause of dysphagia?
А. Cicatrical stenosis of the esophagus.
В. Achalasia of the esophagus.
+С. Metatstases in the mediastinum.
D. Foreign body in the esophagus.
Е. Diverticulum of the esophagus.
20
98. A patient with complaints of pain in the thorax has a high temperature and
cough. On chest radiography, an oval shadow near the thoracic wall with precise
internal contour is revealed. What procedure helps to specify the diagnosis?
А. Tomography.
В. Bronchoscopy.
С. Ultrasonography.
D. Bronchography.
+Е. A diagnostic pleurocentesis.
99. Tuberculoma of the lung was diagnosed in a patient of 32 years old, during
thoracotomy for peripheral lung tumour,. An atypical pneumonectomy is
performed. What medical tactics is necessary for the patient after discharge from
the hospital?
А. Check-up in 3 months.
+В. An obligatory antituberculosis therapy.
С. Sanatorium treatment.
D. Chest radiographs every 6 months.
Е. The patient is subjected to physical inability.
100. A patient aged 37, who underwent surgery 1,5 months back - lobectomy for
complicated echinococcosis of the lung, complains of rise of the body temperature
up to 39 о С, Cough and a lot of purulent sputum. On chest radiography there was
revealed emptiness in the lower hemithorax with horizontal level of liquid. What
complication is most probable?
А. Recurrent echinococcosis.
В. Lung abscess.
С. Lung hematoma.
D. Residual pleural cavity.
+Е. Empyema of the residual cavity with bronchopleural fistula.
101. What is the basic criterion for pneumonectomy in patients with lung cancer?
А. Age of the patient.
В. Size of the tumour.
С. Presence of enlarged lymphatic nodes in the lung root.
+D. External respiration function.
Е. Weight of the patient.
102. A 69 year old patient, with undifferentiated carcinoma of the lower lobe in the
bronchi of the right lung has hydrothorax. During pleurocentesis, 200 ml. of
hemorrhagic fluid was evacuated. What is the scope of operation?
А. Atypical resection.
В. Lobectomy.
С. Bilobectomy.
D. Pulmonectomy.
+Е. The operation is contraindicated.
103. A patient of 57 years old, complains of insignificant elevation of the body
temperature, cough with mucous and purulent sputum with blood without smell. On
21
chest radiogaraphy, a circular shadow with fenestrated internal contours in the
lower lobe of the left lung is revealed. Your diagnosis?
А. Complicated echinococcosis of the lung.
В. Chronic lung abscess.
С. Bronchoectatic disease.
+D. Cavity lung cancer.
Е. Tuberculosis of the lung.
104. On the 3rd day after left pneumonectomy on the left while turning the patient
on the right side, he developed severe coughing with discharge of a large amount of
pinkish sputum and dyspnea. Which of the following complications he developed
in the postoperative period?
А. Acute empyema of the pleura.
В. Intrapleural bleeding.
+С. Broncho-pleural fistula.
D. Contralateral pneumonia.
Е. Infarct - pneumonia of the lung.
105. A patient with minor cell cancer of the lungs, complains of headaches. What
disease is suspected?
А. Brain Abscess.
В. Encephalopathy.
С. Idiopathic hypertension.
+D. Metastases in the brain.
Е. Osteochondrosis of the cervix.
106. In a 47 years old patient, was revealed to have a lung tumour of 1 cm in
diameter in the left upper lobe, during a routine prophylactic chest radiography 2
years back. He was under observation. In the last month negative chest radiograph
changes were obtained. The diagnosis is :
А. Lung tuberculoma.
В. Gamartoma of the lung.
С. Localised pneumosclerosis.
+D. Lung cancer.
Е. Arteriovenous aneurysm.
107. The lesion of 1х 2 cm was found in a 47 years old patient during thoracotomy
for peripheral tumour of lung. What should be the scope of the operation?
А. Pneumonectomy.
В. Lobectomy.
+С. Scope of the operation will be determined after identification of the tumour.
D. Bilobectomy.
Е. Atypical pneumonectomy.
108. On the 4th day after appendicectomy (phlegmonous appendicitis), acute
abdominal pain (as colic), vomiting, abdominal distention, delay of stool and
passage of gases have developed in a patient of 16 years old. What complication
has occurred?
22
А. Perforation of caecum.
В. Thrombosis of mesenteric vessels.
+С. Adhesive bowel obstruction.
D. Abscess of Douglas’s space.
Е. Bleeding from the appendicular artery.
109. On the 5-th day after appendicectomy (gangrenous appendicitis) acute
abdominal pain (as colic), vomiting, abdominal distention, delay of passage of
gases developed in a child aged 10. If adhesive bowel obstruction is suspected,
which additional diagnostic methods are necessary?
А. Laparoscopy.
В. Irrigoscopy.
+С. Abdomen radiograph.
D. Proctosigmoidoscope.
Е. Neymark’s test
110. If complication occurrs (adhesive bowel obstruction) on the fourth day after
appendicectomy, what should be the tactics of the surgeon?
А. Bowel stimulation, hypertonic odema, desintoxication therapy.
+В. Relaparotomy, adhesiolysis, intubation of the small bowel for decompression,
drainage of the abdominal cavity.
С. Paranephral blockade, deintoxication therapy.
D. Relaparotomy, adhesiolysis.
Е. Siphon enema, gastric lavage.
111. The woman of 66 years old, complains of colic like pain in the abdomen,
disorientation, vomiting, abdominal distention, delay of stool and passage of gases.
Abdominal radiograph shows Clouberg’s cups and intestinal pneumatosis. For a
year the patient has lost 15 kg of weight. Irrigoscopy is performed in the emergency
department. Barium fills the rectum and lower 1/3 of the sigmoid colon and does
not pass further. The most probable diagnosis?
А. Spastic colitis.
В. Sigmoid vulvulous.
С. Crohn’s disease.
+D. Sigmoid cancer.
Е. Invagination of the intestine.
112. To determine the scope of the operation for sigmoid cancer complicated by
acute bowl obstruction, which of the following additional diagnostic methods are
necessary:
А. Laparoscopy.
+В. Liver ultrasonography.
С. Pneumogastrography.
D. Gastroscopy.
Е. Selective angiography.
113. During the operation on a woman aged 66, for bowel obstruction, a circular
tumour in the lower 1/3 of the sigmoid colon was revealed. The large and small
23
bowels are distened by gases, contain liquid faeces. The abdominal cavity has
muddy exudate. No signs of metastases. What should be the scope of the operation?
А. Sigmoid resection with the tumour and primary anastomosis.
+В. Hartmann’s operation.
С. Double lumen colostomy.
D. Left hemicolectomy, transversostomy.
Е. Sigmoidostomy.
114. A young man was operated on for bowel necrosis due to vulvulus. About a
metre of the small bowel was resected with side-to-side enteroenteroanastomosis.
List out the basic elements of conservative therapy in the postoperative period:
+А. Gastrointestinald decompression drainage, intestinal stimulation, antibacterial
therapy, anesthesia, infusion therapy.
В. Respiratory gymnastics.
С. Hemotransfusion, paranephral blockade.
D. Ensymostatic and hepatoprotective therapy.
Е. Cardiotonic and anticoagulatory drugs.
115. A patient of 40 years old, with strangulated inguinal hernia, in 6 hours after
strangulation, felt independent reduction of the hernial contents. After 4 hours of
observation in the hospital the patient was operated. Herniotomy and plasty of the
inguinal canal was performed. But the surgeon did not perform adequate
exploration of the abdominal cavity. On the next day the patient developed signs of
peritonitis. What is the cause of peritonitis?
А. Thrombosis of mesenteric vessels;
В. Bleeding from spermatic cord vessels;
+С. The loop of intestine, which was in hernial sac, necrosed
D. Early adhesive obstruction;
E. Pylephlebitis.
116. During laparotomy for acute adhesive bowel obstruction in a 55 year old
patient, , a loop of the intestine of 20 cm long of dark colour and hemorrhagic fluid
in the abdominal cavity were revealed. Tactics of the surgeon?
А. Inject Novocain with Heparin into the mesentry of the intestine, drain the
abdominal cavity, close the laparotomy wound.
В. To replace the necrotic loop of the intestine to the anterior abdominal wall and
close the wound.
С. Perform resection of the necrotic loop of the intestine proximally 60 cm from the
border of necrosis and 40 cm distally.
D. Perform resection of the necrotic loop of the intestine proximally 20 cm from
the border of necrosis and 30 cm distally, bowel intubation through the nose, drain
abdominal cavity.
+Е. Perform resection proximally 15 cm from the border of necrosis and 40 cm
distally, bowel intubation through the nose, drain abdominal cavity.
117. During the operation for high small bowel obstruction, which developed
during 2 days, in a 62 year old woman, , the surgeon finds a gallstone in the small
24
bowel 20 cm from Treitz’s ligament, which caused obturation of the bowel lumen
and gall bladder-duodenal fistula was also revealed. What kind of the operation is
optimum?
А. Bowel resection with stone and side-to-side anastomosis.
В. Enterotomy at the site of stone, exraction, suturing the bowel in transverse
direction.
С. Enterotomy higher to the stone, extraction, suturing the bowel in transverse
direction.
+D. Enterotomy lower to the stone, extraction, suturing the bowel in transverse
direction.
Е. Enterotomy lower to the stone, extraction, suturing the bowel in transverse
direction, cholecystectomy, suturing of fistula of the duodenum.
118. A 3-years-old child, complains of occasional abdominal pain, giddiness
vomiting, which appeared unexpectedly 3 hours before. The skin is cyanotic, tired
expressions on the face, the abdomen is slightly distended, a tumour like formation
is revealed on palpation of the right ileac region. Shotkin-Blumberg’s sign is
doubtful. He had semi- liquid stool with traces of blood. The most probable
diagnosis?
А. Acute appendicitis.
В. Terminal ilitis.
С. Dysentry.
+D. Invagination of the intestine.
E. Helminths invagination.
119. A one-year-old child is restless, cries, keeps his hand on the stomach. He had
vomiting, stool with lumps of mucous and traces of blood. The abdomen is
distended but not rigid, on auscultation - loud peristalsis, an invagination,
moderately painful is palpated in the right ileac area. The onset of the disease was
an hour before. What kind of treatment is optimal in this case?
А. Enema;
В. Laparotomic desinvagination;
С. Stimulation of bowel peristalsis by neostigmine methylsulfate, hypertonic
enema;
+D. Controllable insufflation of air through the rectum;
Е. Spasmolytics, peridural blockade.
120. On the 4-th day after appendicectomy for phlegmonous appendicitis acute
abdominal pain, nausea, vomiting, abdominal distention, delay of stool and passage
of gases have developed in a child of 14 years old,. A loud peristalsis is heard at the
distance. What complication has developed?
А. Bleeding from the appendicicular artery.
В. Incompetence of the appendicicular stump.
С. Abscess of the Douglas’s space.
+D. Early adhesive bowel obstruction.
25
Е. Vulvulous of the stomach.
121. During the operation for acute adhesive bowel obstruction in a 62 years old
woman, (in the past she had appendicectomy, cholecystectomy, tubectomy for
ectopic pregnancy ) the surgeon find that the loops of the small bowel are distended
and deformed at the mesentry of the terminal part by adhesions. All loops of the
small bowel, caecum, ascending, transverse are extremely extended, are overfilled
with liquid contents and gases. Descending and sigmoid colon are collapsed,
without intestinal contents. Please indicate the localisation of the pathological
process, which has caused the obturation of the intestine?
А. Caecum.
В. Terminal part of the small bowel.
С. Transverse colon.
+D. Splenic flexure of the colon.
Е. Hepatic flexure of the colon.
122. A the woman aged 66 with II nd stage of obesity complains of acute episodic
abdominal pain, which is accompanied by loud peristalsis of the intestine,
vomiting, delay of stool and passage of gases, abdominal distention. These
symptoms developed 2 days ago. Many years back she was operated on for
salpingooforitis. The condition of the patient is serious. Pulse 115. The abdomen is
extremely distended, moderately painful. There is an old postoperative scar from
the umbilicus to pubis. Peritoneal signs are doubtful. Multiple Clouberg’s cups are
seen on plain abdomen radiogram. An urgent operation is indicated.
What are basic components of short-term preoperative preparation?
А. Hemotransfusion, cardiac medications, antibiotics, gastric lavage.
+В. Saline infusion, intubation of the stomach.
С. Paranephral blockade, glucose infusion, cardiac medications, siphon enema.
D. Cardiac-vascular medications, diuretic, siphon enema.
Е. Wide spectrum antibiotics, hemotransfusion, analgesics, cardiovascular
medications, cleansing enema.
123. A woman of 70 years old, with the II nd stage of obesity, has developed
gigantic umbilical hernia in 3 hours. Her condition is serious. Dyspnea, cyanotic
skin, tachycardia 120 bpm. Edema of the calf. The bulging is of large size
(25х25х25 cm), of dense – elastic consistency, painful, cough signs - negative. The
other parts of the abdomen are soft and painless. Herniotomy is performed. Hernial
fluid is evacuated. A loop of the small bowel of bluish colour is attached to the
hernial sac. After excision of the strangulating ring, the intestine stored normal
colour and peristalsis appeared. The length of the loop is about 1 meter. After
adhesiolysis the loop is placed back into the abdominal cavity. Meuyo’s
hernioplasty is performed. Anesthesia was without complications. In conscious
condition the patient was transferred to the ward. In 4 hours after the operation the
patient died. What is the most probable cause of death?
А. Thromembolism of the pulmonary artery.
В. Myocardial infarction.
26
+С. Extreme elevation of the intra-abdominal pressure.
D. Intra-abdominal bleeding.
E. Brain hemorrhage.
124. During the operation for a day-long adhesive bowel obstruction, , adhesions
are found in a 58-year-old woman as she had hysterectomy in the past for
fibromyoma. The small bowel is deformed, as double lumen, distended by gases,
hyperinflated by intestinal contents. Some loops of the intestine were deserosed.
The distal part of the small bowel is deflated, the proximal part - hyperinflated,
distended, of cyanotic colour. Due to compression by adhesions, some parts of the
small intestine were of dark brownish colour. Scary changes were in the mesentery.
Name the convincing signs of attributes of frailty of an intestine:
А. Deserosed intestine of brownish- dark blue colour.
В. Paresis of the intestine.
С. Deformed as “double lumen” intestine with cyanotic shade.
D. Distended proximal part of the intestine.
+Е. Deflated distal part of the intestine.
125. A woman of 67 years old, with the IIIrd stage of obesity complains of acute
pain in the region of hernia, repeated vomiting, delay of stool and passage of gases.
She has postoperative ventral hernia for many years (after cesarean delivery). For
the last 5 years the hernia has become gigantic and irreducible: 6 hours before it
was strangulated.
Condition of the patient is serious, dyspnea at rest, the skin is cyanotic.
Pulse rate is 120 bpm, arrhythmic and of satisfactory qualities. The abdomen is
distended, along the course of old postoperative scar, the hernial bulging is of large
size (25х25х25 cm), of dense – elastic consistency, painful, cough signs – negative,
irreducible to the abdominal cavity. After a short (30 min.) preoperative
preparation, herniotomy is performed. In the hernial sac “hernial water” is found.
The length of the strangulated loop is one metre in length. After dissection of the
strangulating ring, peristalsis in the loop was stored. Which of the following is the
correct tactics of the surgeon?
А. To inject Novocaine in the mesentry of the strangulated loop, replace the loop
into the abdominal cavity and perform hernioplasty by Sapezhko’s technique.
В. A bowel resection in the hernial sac and anastomosis «side -to-side»,
hernioplasty by mesh.
С. To replace the intestine into the abdominal cavity, resection of a hernial sac and
wound closure in usual manner.
+D. After dissection of the strangulating ring and management of obstruction,
wound closure.
Е. Manage strangulation, replace the loop into the abdominal cavity, intubate the
intestine for decompression and wound closure.
126. A 35 year old man, complains of episodic abdominal pain, nausea, vomiting
with bile intestinal contents, abdominal distention, delay of stool and passage of
27
gases. Onset of the disease was 8 hours before. Last year, he was operated on for
multiple knife injuries of the abdomen penetrating into the small bowel. For 20
years, the patient has been suffering from peptic duodenal ulcer, constantly on
medication (Ranitidine, Almagel) and alkaline water. The abdomen is moderately
distended, painful at the midline postoperative scar. Percussion reveals high
tympanic sound in all parts of the abdomen. Peritoneal signs (Shotkin-Blumberg’
sign) are mildly positive. Which of the following examinations are contraindicated
to the patient?
А. X-ray of the abdomen.
В. Gastroscopy.
С. Proctosigmoidoscopy.
+D. Laparoscopy.
E. Pneumogastrography.
127. A woman aged 56 years, complains of acute episodic abdominal pains,
nausea, repeated vomiting, abdominal distention, delay of stool and passage of
gases. The onset of the disease was acute 6 hours before. 3 years ago the patient
had cholecystectomy and a year back – hysterectomy for fibromyoma. The
abdomen is distended, very painful in the region of old postoperative scar.
Peristalsis is audible at the distance. Peritoneum signs are doubtful. Leukocytosis
15 G/l; Alkaline phosphatase - 10 g/hr; urine diastase - 256.
Which of the following examinations can help to make the diagnosis?
А. Laparoscopy.
В. Proctosigmoidoscopy.
+С. X-ray of the abdomen.
D. ERCP.
E. Pneumogastrography.
128. A man of 36 years old, came to the outpatient clinic. he has a painful lesion of
spherical form on the upper lip. The skin above the lesion is red. The diagnosis is:
furuncle of the upper lip. Correct tactics.
А. Physiotherapy.
В. Antibiotic therapy.
С. Operation in the out-patient clinic.
+D. Urgent hospitalisation.
E. Dressing with ointment.
129. A carbuncle is:
А. Acute purulently - necrotic inflammation of the hair sac and sebaceous glands.
В. Acute purulently - necrotic inflammation of several hair sacs.
+С. Acute purulently - necrotic inflammation of several hair sacs and sebaceous
glands with development of necrosis of the skin and subcutaneous fat.
D. Necrosis of skin and subcutaneous fat.
Е. Purulent cavity of subcutaneous fat.
28
130. A 40 year old man, has several infiltrates of ball-shaped form in the axillary
region with debrediment in the centre and pus oozing through. The patient has
fever. The probable diagnosis is:
А. Axillary lymphadenitis.
+В. Hydradenitis.
С. Tuberculosis of the skin.
D. Infected lipoma.
Е. Metastases.
131. Treatment of purulent lymphadenitis:
А. Antibiotic therapy.
В. Physiotherapy.
+С. Operative treatment.
D. Dressing with ointment.
Е. Treatment of the cause.
132. Edema of the forearm as longitudinal strips, directed to the axillary fossa
developed in a woman after microtrauma of the 1st finger of the right arm. The
most probable diagnosis is:
А. Phlegmon of the wrist and forearm.
В. Erypsipelas of the forearm.
+С. Lymphangitis.
D. Erisipeloid.
Е. Lymphostasis.
133. Name the isolated cavity in pyogenic capsule filled with pus.
А. Phlegmon.
+В. Abscess.
С. Hydradenitis.
D. Lymphadenitis.
Е. Furuncle.
134. On the 5th day, after intra-muscular injection of analgin a patient, developed
edema and painful lesion on the right hip. The skin is red with fluctuation above the
lesion. The optimum treatment is:
А. Antibiotic therapy.
+В. Operative treatment.
С. Physiotherapy.
D. Dressing with ointment.
Е. Aseptic bandage
135. A patient had a tumour of the skin and region of bright - red colour on the
right ankle, which rather quickly has grown in size, had rough serrate contours. The
patient has acute pain and fever up to 39 o C. The diagnosis is:
+А. An erythematic erypsipelas.
В. Lymphangitis.
С. Phlegmon of the ankle.
D. Bullous erypsipelas.
29
Е. Lymphostasis.
136. A patient has “erythematic erypsipelas”. What treatment will you prescribe?
А. Semialcoholic bandage + antibiotics.
В. Antibiotics + immobilisation.
+С. Ultra-violet irradiation + antibiotics.
D. Immobilisation + dressings with ointment.
E. Humid dressings and a bath.
137. During examination of a patient, the diagnosis “phlegmon of the femur” is
made Phlegmon is:
А. Aseptic necrosis of tissues.
В. Isolated cavity
С. Generalised purulent process.
D. Diffusion of inflammation to all layers of the skin.
+Е. An acute purulent inflammation of fatty tissue.
138. A patient who had adenophlegmon of the left axillary fossa in the past
developed spontaneous pain in the thoracic muscles, acute pain on palpation. The
abduction of the shoulder causes acute pain. The probable diagnosis is:
А. Erypsipelas.
В. Myositis of the thoracic muscles.
+С. Subpectoral phlegmon.
D. Mastitis.
Е. Tuberculosis of the skin.
139. A patient has paraproctitis. It is:
+А. Pelviorectal tissue phlegmon.
В. Inflammation of the rectum.
С. Pelvic abscess.
D. External intestinal fistula.
Е. Thrombosis of hemorrhoidal veins.
140. A woman complains of constantly growing pulsating and throbbing pain in the
1st finger of the right wrist. Objectively: tissues of the finger are dense,
interphalangic plica are smoothened, fever is up to 38,5 o C. Movements of the
finger are painful. Palpation shows the region of intensive pain. The diagnosis is:
А. Erisepeloid.
В. Erysipilatous inflammation.
+С. Hypodermic panaritium.
D. Lymphangitis.
Е. Paronychea.
141. Two-dimensional phlegmon of the wrist is:
А. Supra-aponeurotic phlegmon of the wrist.
В. Sub-aponeurotic phlegmon of the wrist.
С. Interdigital phlegmon of the wrist.
+D. Infection of the ulnar and radial synovial spaces.
Е. Phlegmon of the hypothenar.
30
142. A patient has acute mastitis. (infiltration phase). What treatment is necessary?
А. Operative treatment.
В. Dressings with ointment.
С. Immobilisation.
+D. Prevent milk and venous stasis
Е. Physiotherapy.
143. A patient has epithelial coccygeal fistula. It is:
А. Dermoid cyst.
В. Fistula of the coccygeal area.
С. Abscess of the coccygeal area.
+D. Anomaly of development of the coccygeal area skin.
Е. Inflammation of the colorectal fat.
144. A patient has pandactylitis. It is:
А. Inflammation of all phalanxes of a finger.
В. Inflammation of several fingers.
С. Inflammation of all layers of the finger skin.
+D. A purulent inflammation of all tissues of a finger.
Е. Purulent inflammation of the tendon.
145. A patient has hanging of nail wall of the 2nd finger of the right wrist.
Palpation of the edematous tissues is extremely painful. Purulent exudate oozes
from under the nail. The diagnosis is:
А. Hypodermic panaritium.
В. Hyponychial panaritium.
+С. Paronichy.
D. Erisepeloid.
Е. Pandactylitis.
146. A patient developed edema of the wrist, of bluish-red colour, palpation is
painful, fingers are bent, straightening of the fingers is also very painful. On
palpation the maximum pain is in the area of tendons of flexors of 1st and 2nd
fingers and in the proximal part of the wrist. The diagnosis is:
А. Supra-aponeurotic phlegmon of the wrist.
В. Sub-aponeurotic phlegmon of the wrist.
С. Phlegmon of the posterior subcutaneous space.
D. Phlegmon of hypothenar.
+Е. Crossed (U type) phlegmon of the wrist.
147. A patient feels an appreciable edema at the posterior surface of the wrist, the
fingers are moved apart. The swelling of the interdigital folds is symmetrically
distributed to the basic phalanxes of the next fingers. The skin of interdigital
interspace is intense, temperature of the body is up to 38o C. The diagnosis is:
+А. Interdigital phlegmon.
В. Phlegmon of the posterior subcutaneous space.
С. Supra-aponeurotic phlegmon of the wrist.
D. Sub-aponeurotic phlegmon of the wrist.
31
Е. Crossed (U type) phlegmon.
148. A young man of 16 years old, is examined for medical fitness for army. He
had no complaints. Pulse rate - 70 bpm, respiration rate - 14 bpm, BP - 120/70 mm.
Hg. On auscultation – systolic hum, accent of the 2nd murmer and bifurcation of
2nd murmer above the pulmonary artery. ECG shows hypertrophy of the right
ventricle, blockade of right fascicle of His’ bundle are revealed. What disease is it
necessary to think about first?
А. Fallo’s Tetrade
В. Interventricular defect
С. Mitral stenosis
+D. Failure of the mitral valve
Е. Aortal stenosis
149. A patient of 62 years old, complains of a tumor in the left inguinal region,
which has gradually enlarged. Objectively: in the left inguinal region, a tumor of
size 5-6 cm of dense-elastic, mildly painful, irreducible to the abdominal cavity is
palpable. The skin above it is unchanged. The external inguinal ring allows to pass
the tip of the finger. What is the most probable diagnosis?
А. Irreducible left inguinal hernia
В. Reducible left inguinal hernia
С. Tumor
D. Left-sided strangulated inguinal hernia
+Е. Inguinal lymphadenitis
150. A 4 year old boy, complains of dyspnea, early fatigue. He has a history of
frequent respiratory diseases. Objectively: the borders of the heart are extended to
the left and upwards. Auscultation: intensified 2nd sound above the pulmonary
artery, in 2nd-3rd intercostal space to the left of the sternum, systolic “mechanical”
murmurs which are heard at all parts of the chest and back. BP - 100/20 mm. of Hg.
What is the most probable diagnosis?
А. Valve stenosis of the artery
+В. Defect of the interatrial septum
С. Defect of the interventricular septum
D. Open arterial duct
Е. Isolated stenosis of the aperture of the pulmonary artery
151. A woman aged 22, is hospitalised in the gynecological department with
complains of pain in the lower abdomen, rise of the body temperature up to 39,5 O
C. Objectively: pulse rate-108 bpm, BP - 120/80 mm. of Hg, the abdomen is
moderately distended, acute pain in hypogastric area. Peritoneal signs (Shotkin’s)
are positive in hypogastric area. Vaginal examination: the uterus and the ovaries are
not palpable due to tenderness of the anterior abdominal wall, the back vault of the
vagina hangs, very painful. What is the most probable diagnosis?
А. Acute adnexitis
В. Ectopic pregnancy
С. Apoplexy of an ovary
32
D. Acute endometritis
+Е. Pelviperitonitis
152. A 18 years old patient, has rheumatic disease for 3 years. Auscultation reveals
weakening of the 1 st sound at the apex, accent of the 2 nd sound at the pulmonary
artery and systolic murmurs at the apex and in the left axillary area. What defect of
the heart is most probable?
А. Defect of interventricular membrane
В. Tricuspid failure
С. Aortal failure
D. Mitral failure
+Е. Mitral stenosis
153. Bronchial cancer of the lung is suspected in a patient. What examination is
most informative for verification and localisation of the primary tumour for the
given pathology?
+А. Bronchoscopy with biopsy
В. Plain chest X-ray examination.
С. Computed tomography
D. Bronchography
Е. Polypositioned X-ray examination
154. A patient of 49 years old, after intake of meat, greasy and spicy food
complaints of sudden intensive girdle pain in the epigastric area, repeated vomiting,
there is no change in body temperature. Palpation of the epigastric area is mildly
painful. Urine diastase - 1024 units. After conservative treatment for the day, the
condition of the patient has improved: the pain became less and the vomiting has
disappeared. The abdomen became soft, but mild pain in the epigastric area still
remained. Urine diastase- 256 units. What type of acute pancreatitis does the
patient have?
+А. Edematous
В. Haemorrhagic
С. Fatty
D. Purulent
Е. Mixed
155. The onset of the disease, in a 1.5 year old child, was acute with abdominal
pain with vomiting and frequent liquid stool. His condition is moderately serious.
Flaccid. Body temperature is 38O C. Blood analyses: Leukocytes - 18 х 109/l.
Palpation of the abdomen during sleep shows tenderness of the muscles of
abdominal wall in the right ileac area. While immersing the arm deep in this area,
the child wakes up and cries. What is the most probable diagnosis?
А. Acute mesadenitis
В. Intestinal infection
С. Renal colic
+D. Acute appendicitis
Е. Acute enteroviral infection
33
156. A patient aged 46, complains of acute pain in the upper abdomen, more to the
left side, nausea, vomiting which does not relax the condition. He had similar
condition after overeatings. Objectively: body temperature-37O С, skin is cyanotic,
wet. Pulse rate is 88 bpm, rhythmical, the abdomen is moderately distended, very
painful at the projection of pancreas. Urine diastase- 256 units. Leucocytes of blood
18 х 109/l. Whst is the most appropriate tactics of the physician?
А. Scheduled hospitalisation in the therapeutic department
В. Hospital domiciliary
+С. Urgent hospitalisation in the surgical department
D. Consultation of as gastroenterologist
Е. Ambulatory treatment
157. A patient of 32 years old, with the diagnosis: of polytrauma. Blunt skull
injury. Blunt trauma of the thorax. Closed fracture of the right femur. BP - 100/60
mm.of Hg, Pulse rate is 124 bpm, respiration rate is 28 pm. In 2 hours after skeletal
extension under local anesthesia by lidocaine, the condition of the patient suddenly
worsened; hi developed cyanosis of the face and neck, BP - 60/40 mm. of Hg,
Pulse rate was 160 bpm, respiration rate was 44 pm. What complication has most
probably aggravate polytrauma?
+А. Fatty embolism of the pulmonary artery
В. Pain shock
С. Myocardial infarction, cardiogenic shock
D. Thrombembolism of the pulmonary artery
Е. Acute anemia
158. A 5-month-old child has suddenly developed episodic abdominal pain,
repeated multiple vomiting, delay of stool and passage of gases. Examination: the
abdomen is soft, a tumorous formation, in the right hypochondrium mobile, slightly
painful on palpation. Rectal examination shows traces of blood. What is the most
probable diagnosis?
+А. An invagination
В. Polyposes
С. Tumour of the abdominal cavity
D. Peritonitis
Е. Tumour of the intestine
159. An ambulance brings a 23-year-old woman to the hospital with complaints of
pain in the lower abdomen, weakness and giddiness. Last menses were 2 months
back. Objectively: skin cyanotic, BP - 60/40 mm. of Hg, pulse rate - 120 bpm. The
abdomen is intense, extremely painful in the lower abdomen, positive peritoneal
signs (Shotkin-Blumberg’s). What is the most probable diagnosis?
А. Exacerbation of cholecystitis
+В. Ectopic pregnancy
С. Chronic adnexitis
D. Apoplexy of the ovary
Е. Acute appendicitis
34
160. A patient of 47 years old, with carcinoma of the stomach has Virkhov’s
metastasis. In what organ or system should the metastasis spread in this patient?
+А. Metastasis in the upper clavicular lymph nodules
В. Metastatic lesion in the pelvis
С. Metastasis in the umbilicus
D. Metastasis in the ovary
Е. Metastasis in the spleen
161. A 43-years-old patient, smoking for 30 years, complains of dyspnea, which
has increased a day before. Earlier he had cough with small quantity of sputum, and
dyspnea on physical exertion. Auscutation - weakened respiration and dry whistling
rhonchuses. Pulse rate- 90 bpm, BP - 160/80 mm. of Hg. In this case most probable
cause of an acute dyspnea can be:
+А. Increased viscosity of the sputum
В. Acute emphysema of the lungs
С. Acute left ventricular failure after hypertonic crisis
D. Thromboemboly of the small branches of pulmonary artery
Е. Development of spontaneous pheumothorax
162. After cold and flu a patient was hospitalised for 4 days with complaints of
cough with single spittles of mucous sputum. In 2 days he had an episode of cough
with 250 ml of purulent sputum with traces of blood. His condition is moderately
serious. Respiration rate - 28-30 pm, pulse rate - 96 bpm, BP - 110/70 mm. of Hg.
Respiration above left lung is vesicular, above right - weakened, wet variegrated
rhonchuses above the lower lobe and amphoric respiration near the angle of
scapula. What is the most probable diagnosis?
А. Exudative pleuritis
В. Acute focal pneumonia
+С. Acute abscess of lung
D. Pyopneumothorax
Е. Empyema of pleura
163. A patient aged 24 years, is transferred to the thoracic surgical department from
a general surgical hospital with an acute posttraumatic empyema of the pleura.
Horizontal wide level of liquid on the right is visible on a general chest X-ray
examination. What method of treatment is it necessary to prescribe?
+А. Puncture and drainage of the pleural cavity
В. Pneumonectomy
С. Thoracoplasty
D. Lobectomy
Е. Decortication of the pleura
164. A 33 years old patient, was examined routinely. On plain chest X-ray film of
the right lung a tumour up to 4cm in diameter, of weak intensity, with indistinct,
equal contours, not homogeneous, with an enlightenment in centre is revealed in
the 2nd segment. What disease is most probable in this patient?
35
+А. Tuberculosis
В. Abscessive pneumonia
С. Lung cancer
D. Cyst
Е. Abscess
165. You have to treat a woman of 58 years old, who has excessive bleeding from
the rupture of the varicose vein on the left ankle. What should be the first aid?
А. Z – figure suture on the ruptured varicose vein
В. Troyanov- Trendelenburg’s operation
+С. Upraised position of the lower extremity. Compression with sterile bandage
D. Application of tourniquet proximal to the bleeding point
Е. Application of tourniquet distal to the bleeding point
166. A young man aged 17 years old, had frequent respiratory diseases in
childhood: in the period between respiratory diseases he had cough with sputum.
Rarely he noticed traces of blood in sputum and was examined by a phthisiologist observation is recommended. Above the lungs, especially over the right, one
variegrated bronch are auscultated. Sputum is muco-purulent up to 50 ml per day.
X-ray shows mild intensity and cellular drawing above the right lower lobe. What
is the most probable diagnosis?
А. Chronic abscess of the lungs
В. Chronic bronchitis
С. Pneumosclerosis metarheumatic
+D. Bronchoectatic disease
Е. Metatuberculous pneumosclerosis
167. A woman of 22 years old, felt an increasing pain in the right leg, heaviness on
the second day after labours. Objectively: the condition of the patient is moderately
serious. Pulse rate is 100 bpm, body temperature is 37,30 C, cardiac sounds are
muffled, sinus rhythm, respiration murmurs are normal, 18 – 20 per min. The right
leg is edematous, cyanotic in comparison with the left leg, local temperature is
below normal. The pulsation of arteries of the right leg at all points is palpable, but
weakened. What is the most probable diagnosis?
А. Pospartum sepsis
В. Thromemboly of the pulmonary artery
С. Thromemboly of the femoral artery
D. Acute ileofemoral phlebothrombosis
Е. Acute thrombophlebitis
168. In emergency department, a 68-year-old patient, complains of acute pain in
both legs, numbness and decrease of sensitivity in the fingers, absence of pulsation
in both femoral arteries. The disease started suddenly 2 hours back. The diagnosis
“acute thrombosis of aortal bifurcation” is made. Which of the following is most
appropriate in this case:
А. Aorta - arteriography
+В. Thrombectomy
36
С. Thrombolytic therapy
D. Aorta – bifemoral bypass
Е. Aorta - femoral prosthetic repair
169. A patient aged 20 had microtrauma 4 days back in the area of nail phalanx of
the 3-rd finger while preparing pork meat. He complains of skin itching, bright
reddening of the skin and oedema of the finger, temperature is normal. what disease
is it necessary to think about first of all?
+А. Erysipilatous inflammation
В. Phlegmon
С. Erisopeloid
D. Panaritium
Е. Paronichy
170. A patient 35-year-old, complains of pain in the epigastric region, nausea,
vomiting for the last one day. The pain appears after meals. At the time of
examination the pain migrated to the umbilicus and then to the right lower
abdomen. There were intestinal gases depart, he had a semi-liquid stool. The
general condition is satisfactory. Body temperature was 370 С. Pulse rate was 80
bpm. BP - 130/80 mm. Hg. Tongue is wet. The abdomen is not deformed. On
palpation the abdomen was soft, a little tense and painful in the right ileac area,
Shotkin - Blumberg’s sign is doubtful. What is the most probable diagnosis?
А. Acute cholecystitis
В. Acute pancreatitis
С. Gastritis
+D. Acute appendicitis
Е. Coloenteritis
171. A patient of 45 years old, is on treatment for rheumatic disease, in active
phase combined with defect of the mitral valve. During morning toilet hi suddenly
felt pain in the left arm with subsequent numbness. The pain and numbness are
increasing increases. Objectively: the skin of the left arm is cyanotic, rather cold.
The pulsation of the artery of the arm is absent. What is the most appropriate tactics
of treatment of this patient?
А. Fibrinolytics and anticoagulants
В. Antibiotics and antiinflammatory drugs
С. Urgent thrombintimectomy
D. Cardiac catheterization
+Е. Urgent embolectomy
172. A patient aged 30 years old, complains of pain in the calf of both legs, which
intensifices in walking. The patient is compelled to stop every 150-200 m.
Alternate lameness has appeared a year back, the distance between stoppages has
reduced. Both ankles are cyanotic and cold. The pulsation in the dorsal arteries of
the ankles is absent. The skin is dry hyperkeratosis on the soles, nails are dwarfed
and easily crack, of dim colour. Patches of allopecia are on the ankles . What stage
of obliterative endoarteritis dos the patient have?
37
А. I stage - stage of functional compensation
В. V stage
+С. II stages - stage of subcompensation
D. II stages - stage of decompensation
Е. 1V stage - stage of destructive changes
173. While examining the abdomen of a patient with blunt trauma of the abdomen,
the surgeon revealed profuse bleeding from liver. Choose the most appropriate way
of temporary control of bleeding.
А. Tamponade of the liver wound
В. Cryo application to the region of injury
+С. Quick compression of the hepato-duodenal ligament
D. Suture of the bleeding vessel
Е. Treatment of the wound by H2 O 2
174. A patient of 28 years old, is operated on for thyrocardiac struma. In 12 hours
after the operation the body temperature has elevated up to 39 0 C, tachycardia up
to 160 bpm developed and BP was elevated up to 180/110 mm of Hg. What
complication is most probable in this patient?
А. Incompetency of the parathyroid glands
В. Hypertonic crisis
+С. A thyrocardiac crisis
D. Damage of recurrence nerve
Е. Pneumonia
175. A 29-years-old patient, complaints of pulsating pain in the rectum, elevation
of the body temoerature, general weakness for the last three days. Palpationrevealed local pain in anal region on 6 hours. By finger examination, there found a
painful area which doesn’t extend above the pectinal plica. What is the most
probable diagnosis?
А. Acute anal crack
В. Acute hemorrhoids
+С. Acute paraproctitis
D. Tumour of the rectum
Е. Acute prostatitis
176. The shadow of average intensity without clear contours is found in the patient,
of 16 years old, on plain chest X-ray examination in the posterior segment of the
right lung which is connected with the roots of the lung. A tomogram shows
enlargement of the tracheobronchial lymphatic nodes. The blood analysis shows
ESR - 30 mm / hour, lymphopenia, monocytosis. What diagnosis is most probable?
А. Eosinophilic infiltrate
В. Peripheric lung cancer
С. Focal pneumonia
D. Sarcoidosis
+Е. A primary tubercular complex
38
177. A patient aged 58, complains of inflation of the intestine, constipations, acute
weakness, weight loss. Within last month he has stool only after intake of
purgatives. Palpation revealed a dense formation in the left ileac area. What is the
most probable diagnosis?
А. Tumour of the mesentery of the colon
В. Cancer of the descending colon
С. Cancer of the left ureter
D. Tumour of left retroperitoneal space
+Е. Sigmoid cancer
178. A 26-years-old woman, complaints of sudden pain in the lower abdomen,
weakness, loss of consciousness at home. She didn’t have menses last month. Hb 106 g/l, pulse rate is 120 bpm, BP is 80/50 mm of Hg. Pain and peritoneal signs are
positive in the right lower abdomen. What diagnosis is most probable?
А. Apoplexy of the ovary
В. Twisting of the ovary ligament
С. Acute appendicitis
D. Right acute adnexitis
+Е. Ruptured ectopic pregnancy
179. A man of 73 years old, complains of delay of stool, discharge of dark blood
mixed with faeces, loss of weight. The delay of stool and meteorism is periodically
observed. He has been ill for 9 months. What is the most probable diagnosis?
А. Tumour of the retroperitoneal space
В. Acute pancreatitis
+С. Colon cancer
D. Urolithiasis
Е. Proctosigmoiditis
180. A patient is brought to hospital by ambulance with complaints of sudden acute
abdominal pain. In the past he suffered from peptic ulcer. Examination shows
positive peritoneal signs. Perforation of the ulcer was suspected. What examination
will allow to confirm the preliminary diagnosis?
А. Radiopaque examination of the stomach and duodenum
В. Ultrasonography of the abdomen
+С. X-ray examination of the abdomen in the vertical position of the patient
D. X-ray examination of the abdomen in the horizontal position of the patient
Е. Thermography of the abdomen
181. A 69 years old woman, is in a serious condition. She complaints of frequent
vomit of black colour and with fresh blood mixed with parts of tissues, dramatic
weakness, thirst, dryness in the mouth, giddiness. After complex hemostatic
treatment with repeated hemotransfusions the bleeding has stopped. The condition
of the patient gradually improved. The faeces became of normal colour. Hb from
68 g/l has raised up to 90 g/l. The X-ray examination shows cup-like cancer of 6.5
39
cm in diameter in the antral part of the stomach. What treatment is indicated to the
patient?
А. Radial therapy
В. Patient care
+С. Surgical treatment
D. Chemotherapy
Е. Symptomatic therapy
182. A patient aged 31, complains of rise of the body temperature up to 38 0 C, pain
in the lumbar area, tumescence. On examination of the right lumbar area the painful
infiltrate of 5х6 cm in size is found, the skin above it is reddish colour, in the centre
a purulent - necrotic fistulas, from which pus is oozing. What is the most probable
diagnosis?
А. Erypsipelas
В. Abscess of the lumbar area
С. Renal colic
D. Paranephritis
+Е. Erysipelas of the lumbar area
183. A boy of 10 years old, complains of recurrence of peptic ulcer of the
duodenum associated with H. pylori. Which of the following preparations used for
treatment of peptic ulcer, has anti-helicobacter effect?
А. Omeprazole
+В. Amoxycilline
С. Gastrosepin
D. Maalox
Е. Famotidine
184. A patient of 35 years old, has been suffering from rheumatic disease since the
age of 12. For the last 2 years he has been complaining of dyspnea, attacks of
dyspnea at night, with pneumorrhagia. Objectively: the outlines of the heart are a
little extended due to the left auricle, the diastolic murmur with presystolic
intensification is heard at apex of the heart, bifurcation of the 2 nd sound and
pulmonary murmur are revealed. ECG shows hypertrophy of the right ventricle.
Mitral stenosis of II stage without decompensation is diagnosed. What should be
the scope of the operation?
А. Mitral commisurotomy in conditions of artificial circulation
В. Mitral commisurotomy as closed technique
С. Antirheumatic treatment
D. Dressing of the ileac veins
Е. Prosthetic repair of the mitral valve
185. A builder of 35 years old, for last 6 months feels heaviness in the epigastric
area. He has no check-ups. Last night hi had extra intake of vodka. He had
vomiting in the morning and after physical exertion, he felt giddiness and had big
quantity of hematemesis in 30 minutes. What pathology is it necessary to think first
about?
40
А. Menestrey’s disease
В. Peptic ulcer of the stomach
С. Erosive gastritis
D. Zollinger-Ellisons’s syndrome
Е. Meylori- Weis’s syndrome
186. A patient with peptic ulcer of the duodenum in history has developed new
signs: the pain occurs after meals, irradiated to the back, hardly controlled by
Atropin. Loss in weight up to 6 kg for last 6 months was noted. Endoscopy reveals
ulcer of the duodenal bulb with dense edges is revealed; deformation of the bulb is
revealed. What of the following is possible to explain a change of the symptoms?
А. Duodenostasis combined with duodenitis
В. Perforation
+С. Penetration
D. Malignancy
Е. Pyloric stenosis
187. A patient is in the condition of traumatic shock, BP - 50\0 mm of Hg. Pulse
rate is 160 bpm. Define the shock index.
А. 1
В. 0,3
С. 0,5
D. 2
+Е. 3.
188. A restless man of 37 years old, complaints of sharp constant pain in the upper
pert of the abdomen of surrounding character, irradiating to the back, left scapula
and the left arm and repeated vomiting. The disease onset was 1,5 day after
celebrations. The eyes are yellowish. The abdomen is distended at the projection of
the transverse colon, the muscles of the epigastric area are tense. Voskresenskogo’s
and Meyo-Robsons’s signs are positive. The intestinal peristalsis is weakened.
Leukocytosis is 18х109/l. Urine diastase -512 units. The diagnosis is acute
pancratitis. What is the most probable etiological factor?
А. Stress
В. Vascular
С. Allergic
D. Disease of the biliary system
+Е. Alcohol
189. A 63-years-old patient, has developed hoarseness, sometimes cough during
meals. ENT examination shows immovability of the left half of larynx. Which of
the listed diseases most probably has resulted in paresis of the left recurrence
nerve?
+А. A clump of lymphatic nodes in the mediastinum.
В. Petrificates of apexes of both lungs.
С. Aortic aneurysm.
D. Nodal struma.
41
Е. Diverticulum of the right wall of the esophagus.
190. In a patient with complaints of rising of the body temperature up to 38 0 C,
cough with mucous sputum, a spherical shadow up to 4 cm in diameter, of low
intensity, with indistinct equal contours, non homogeneous, with enlightenment in
the centre is revealed in the 2nd segment on plain chest X-ray. Objectively: no
pathology is revealed. Blood analysis: ESR is 30mm/hour. TB is positive in the
sputum. In what observation group should the patient be followed-up and treated?
+А. I B
В. III
С. II
D. 1А
Е. VII
191. A patient of 30 years old, notice of the appearance of “mole” on the skin of the
right femur some months ago. The “mole” rapidly enlarged in size and the patient
was referred to an oncologist. What method of diagnosis is indicated in this case?
+А. Thermography
В. Immunological method
С. Tracer technique
D. Puncture biopsy
Е. Excission biopsy.
192. A 46-year-old patient, complaints of elevation of the body temperature up to –
38O C, cough with plenty of purulent sputum, dyspnea. What diagnosis is most
probable?
А. Pneumonia.
В. Bronchoectatic disease.
+С. Acute abscess of the lung.
D. Bronchitis.
Е. Thromembolism of the pulmonary artery.
193 X-ray shows a shadow with clear contours and horizontal level in the lower
lobe of the right lung in a patient aged 28. What disease can be suspected?
+А. Drained abscess of the lower lobe of the right lung.
В. Bronchial cancer of the lower lobe.
С. Peripheric cancer.
D. Tumour.
Е. Pleuritis.
194. A plain chest X-ray examination is performed to a patient with
pyopneumothorax. Which of the X-ray signs are most frequently found in this
disease?
А. Basket sign
В. Blackout hemithorax.
+С. A wide level with air above it
D. Atelectasis of a lobe.
Е. Lung collapse.
42
195. Pus and air are received on thoracocentesis. What diagnosis is most probable?
А. Pleuritis.
В. Hemothorax.
С. Pheumothorax.
+D. Pyopeumothorax.
Е. Mesothelyoma of the pleura.
196. A patient has chronic abscess of the lungs. What is the most radical method of
treatment?
А. Infusion therapy.
В. Conservative.
С. Puncture methods.
D. Sanatorium therapy.
+Е. Operative treatment.
197. The diagnosis of hemipneumothorax is made in a patient, who had trauma of
the thorax in past. What does it means?
А. Clot of blood in the pleural cavity.
В. Clot of air in the pleural cavity.
С. Clot of pus in the pleural cavity.
+D. Clot of blood and air in the pleural cavity.
Е. Clot of pus and air in the pleural cavity.
198. A patient of 33 years old, with the diagnosis of tension pneumothorax is
admitted to hospital. What treatment should be given?
+А. Drainage pleural cavity.
В. Intubation of the trachea.
С. Infusion therapy.
D. Thoracotomy.
E. Laparotomy.
199. Thoracoscopy is scheduled to a patient for diagnostic purpose. This procedure
examines!
А. Trachea.
+В. Pleural cavity.
С. Heart.
D. Mediastinum.
E. Bronchi.
200. After examination of a patient, the diagnosis is made of Hylothorax. It is:
А. Clot of blood.
В. Clot of pus.
С. Clot of air.
+D. Clot of lymph in the pleural cavity.
E. Tumoral disease.