Chirurgie nr. 1

1. CS. Which of the following is characteristic for direct inguinal hernia:a) It never descends to the scrotumb) It is congenitalc) It is frequently unilaterald) It strangulates frequentlye) It is an effort hernia

--------------------------------------------------------------------- 2. CS. Strangulation of the Meckel's diverticulum is called hernia of:a) Riсhterb) Maydlc) Littred) Hesselbache) Broсk

--------------------------------------------------------------------- 3. The posterior wall of the inguinal canal is:a) Fascia transversalisb) Internal oblique musclec) Conjoint tendond) Crural arcadee) External oblique muscle

--------------------------------------------------------------------- 4. The second in strangulated hernia incidence is:a) Femoral herniab) Umbilical herniac) Direct inguinal herniad) Indirect inguinal hernia in male patientse) Hernia of the linea alba in children

--------------------------------------------------------------------- 5. Parietal antimesenteric strangulation is called hernia of:a) Broсkb) Hesselbachc) Maydld) Riсhtere) Littre

--------------------------------------------------------------------- 6. Typical femoral hernia is found:a) Anterior to the crural arcadeb) Medial to the femoral vesselsc) Lateral to the femoral vesselsd) Posterior to the femoral vesselse) Medial to the Cooper ligament

--------------------------------------------------------------------- 7. In the ischemic stage of strangulated hernia the following signs can be found:a) Cyanotic and distended intestinal loopb) Mesenteric veins thrombosisc) Thickened intestinal wall with fibrin depositsd) Purulent, feculent peritoneal fluide) Pale efferent loop

--------------------------------------------------------------------- 8. Passage of intestinal content is preserved in the following types of strangulated hernia:a) Littre herniab) Maydl herniac) Broсk herniad) Hesselbach herniae) Riсhter hernia

--------------------------------------------------------------------- 9. The hernial sac is missing in:a) Congenital inguinal herniab) Umbilical herniac) Sliding inguinal herniad) Perineal herniae) Posttraumatic diaphragmatic hernia

--------------------------------------------------------------------- 10. Brock hernia or pseudostrangulation can appear in the following cases:a) Acute cholecystitisb) Pseudotumoral pancreatitisc) Perforated gastroduodenal ulcerd) Perforated acute appendicitise) Atypical perforation of gastric ulcer

--------------------------------------------------------------------- 11. When is conservative treatment (bandage) of hernia indicated:a) In case of patient`s refusalb) In any type of herniac) In elderly, when general state is severe; severe co-morbiditiesd) In irreducible herniae) In congenital inguinal hernia

--------------------------------------------------------------------- 12. Choose the correct statements about indirect inguinal hernias:a) Hernial sac consists of processus vaginalisb) Hernial sac lies antero-medially to the spermatic cordc) Hernial sac lies medially to the inferior epigastric vesselsd) Hernial sac lies laterally to the spermatic corde) Rarely it is bilateral compared to the direct hernia

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13. A dark red, distended, with a non-glossy serosa intestinal loop found in the hernial sac, with subserosal bleeding on the strangulation ring is in the:a) Congestion stageb) Ischemic stagec) Gangrene staged) Perforation stagee) Viable loop

--------------------------------------------------------------------- 14. Choose the correct statements about strangulated hernia:a) Passage of intestinal content is stopped in all casesb) Femoral hernia strangulates more often compared to inguinal herniac) Strangulation is rare in children under 2 years of aged) Ischemia is not characteristic for Brock herniae) In Maydl hernia the intermediate loop is the most affected

--------------------------------------------------------------------- 15. Choose the correct statements about left inguinal sliding hernia:a) Hernia ring is bigb) It always contains only small bowelc) Sigmoid colon is a part of the hernia sacd) It never strangulatese) Sometimes can it have big dimensions

--------------------------------------------------------------------- 16. The main purpose in indirect inguinal hernia repair is enforcing the anterior wall of the inguinal canal. The most frequent used method is:a) Bassinib) Girard-Spasokukotki with Kimbarovski suturec) Postempskid) Kukudjanove) Martynov

--------------------------------------------------------------------- 17. The most frequently used method for femoral hernia repair is:a) Rudjib) Zatepinc) Rudji-Parlavecciod) Lexere) Bassini

--------------------------------------------------------------------- 18. The preferred surgical procedure for umbilical hernias with the ring ≤3 is:a) Mayob) Bassinic) Sapejkod) None of listed answers is correcte) Lexer

--------------------------------------------------------------------- 19. Which of the listed below are complications of hernia?a) Brock herniab) Prostatitisc) Strangulationd) Phlegmona of the herniae) Irreducibility

--------------------------------------------------------------------- 20. Parietal strangulation of the bowel (Richter hernia) exhibits the following clinical features:a) Intestinal transit is presentb) Vomitingc) Irreducible lump at the hernia sited) Intestinal transit is arrestede) Fever

--------------------------------------------------------------------- 21. Choose 3 signs of congenital inguinal hernia:a) Painless onsetb) It is found only in childrenc) Hernial ring is wided) It may evolve to inguino-scrotal herniae) Hernial sac contains the testis

--------------------------------------------------------------------- 22. The most frequent herniated organs are:a) Bladderb) Greater omentumc) Ascending colond) Small bowele) Prostate

--------------------------------------------------------------------- 23. In noncomplicated hernia the pain is:a) Dull, like discomfortb) Violentc) Colickyd) Increasing upon physical efforte) It may be absent

--------------------------------------------------------------------- 24. Inguino-scrotal hernia should be differentiated with:a) Hydroceleb) Varicocelec) Perineal herniad) Testicular tumore) Obturator hernia

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25. Choose 3 signs of direct inguinal hernia:a) It descends to the scrotumb) Spherical shapec) It never descends to the scrotumd) It occurs more frequently in young personse) It is frequently bilateral

--------------------------------------------------------------------- 26. Physical examination of a patient with indirect inguinal hernia may reveal:a) Indirect inguinal hernia descends to the scrotumb) Pulsation of the inferior epigastric artery is medially to the hernia sacc) Pulsation of the inferior epigastric artery is laterally to the hernia sacd) Expansion upon coughinge) Hernia trajectory is perpendicular to the abdominal wall

--------------------------------------------------------------------- 27. Which of the listed below are external hernias?a) Femoral herniab) Umbilical herniac) Diaphragmatic herniad) Lumbar herniae) Inguino-scrotal hernia

--------------------------------------------------------------------- 28. Which of the following are the clinical features of strangulated umbilical hernia containing a small bowel loop?a) Hernial lump is tensioned and painfulb) Arrest of the intestinal transitc) Sudden appeared irreducibilityd) Pain at the level of spermatic corde) Vomiting

--------------------------------------------------------------------- 29. Which of the listed below statements do not fit to Maydl hernia?a) "W" retrograde strangulationb) Hernia sac contains two loops of strangulated intestinec) Herniation of the Meckel's diverticulumd) Obturator herniae) Parietal bowel strangulation

--------------------------------------------------------------------- 30. Which of the following hernia types contain more than one bowel loop?a) Littre herniab) Richter herniac) Brock herniad) Maydl herniae) Obturator hernia

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31. Brunner cells have a mucus rich secret with pH 8.2 - 9.3 and are predominantly situated in the:a) Cardiab) Duodenum (DI and DII)c) Gastric fundusd) Duodenum (DIII and DIV)e) Gastric antrum

--------------------------------------------------------------------- 32. In gastric ulcer etiopathogenesis the determinant factor is:a) Hyperacidityb) Alimentary factorc) Psychic factord) Defense factore) Hereditary factor

--------------------------------------------------------------------- 33. Which stage after ulcer perforation is characterized by the following signs: repeated vomiting, tachycardia, superficial breathing, signs of hypovolemic shock, elevated body temperature, distended tender abdomen, intestinal paresis:a) False improvementb) Shockc) Diffuse peritonitisd) Preperforation periode) Onset of the disease

--------------------------------------------------------------------- 34. Perforated ulcer should be differentiated with:a) Acute pancreatitisb) Acute appendicitisc) Right side pleuropneumoniad) Pulmonary thromboembolisme) Ruptured ectopic pregnancy

--------------------------------------------------------------------- 35. What surgical procedure should be done in a 40-60-year old patient with a gastric ulcer perforation within 6 hours from the onset?a) Simple suture of the ulcerb) Partial gastrectomy (gastric resection)c) Biopsy and Oppel procedured) Wedge resection of the stomach + vagotomye) Bilateral truncal vagotomy + simple suture

--------------------------------------------------------------------- 36. Gregersen-Adler test shows:a) Pain decrease after the onset of bleedingb) Occult bleedingc) Presence of pancreatic gastrinomad) Rectal bleedinge) Bleeding from esophageal varices

--------------------------------------------------------------------- 37. Bergman sign means:a) Pain decrease after the onset of bleedingb) Occult bleedingc) Presence of pancreatic gastrinomad) Rectal bleedinge) Bleeding from esophageal varices

--------------------------------------------------------------------- 38(su2al(63)). The following clinical features epigastric distension, episodic vomiting with increasing volume and amelioration after it, correspond to:a) Subcompensated stenosisb) Compensated stenosisc) Decompensated stenosisd) Penetration of gastric ulcer to the pancrease) Penetration of duodenal ulcer to the pancreas

--------------------------------------------------------------------- 39. Which ulcer exhibit malignancy more frequently:a) In the distal third of the stomachb) In the duodenumc) In the cardiad) In the gastric funduse) On the lesser curvature of the stomach

--------------------------------------------------------------------- 40. Which of the listed below are acute complications of peptic ulcer:a) Perforationb) Stenosisc) Malignancyd) Penetratione) Bleeding

--------------------------------------------------------------------- 41. Biopsy of perforated ulcer is mandatory in:a) Acute gastric ulcerb) Chronic duodenal ulcer greater than 2 cmc) Gastric ulcer in a patient over 40 yearsd) Johnson II gastric ulcer with perforation in the stomache) Chronic duodenal ulcer penetrating in the pancreas, complicated with bleeding

--------------------------------------------------------------------- 42. According to Johnson classification mediogastric ulcer is:a) Not classified by Johnsonb) Is classified only in case of malignancyc) Type Id) Type IIe) Type III

--------------------------------------------------------------------- 43. Kussmaul sign is:a) Phlebitis of the left lower limb in gastric cancerb) Metabolic disturbances in decompensated pyloric stenosisc) Muscle rigidity in duodenal ulcer perforationd) Presence of peristaltic waves of the stomach in pyloric stenosise) Left supraclavicular lymphadenopathy

--------------------------------------------------------------------- 44. Which of the listed below surgical procedures for gastroduodenal ulcer has a lower rate of postoperative diarrheea?a) Proximal vagotomyb) Truncal vagotomyc) Partial gastrectomy with Balfour anastomosisd) Partial gastrectomy with Billroth-I anastomosise) Truncal vagotomy with Heineke-Miculicz operation

--------------------------------------------------------------------- 45. Atypical ulcer perforation is:a) Sealedb) Blindc) That of the posterior duodenal walld) That of the gastric cardiae) In the free peritoneal cavity

--------------------------------------------------------------------- 46. What surgical procedure includes omental patching of ulcer perforation?a) Oppelb) Juddc) Braund) Heineke-Miculicze) Holle

--------------------------------------------------------------------- 47. Partial gastrectomy is not indicated in ulcer perforation in case of:a) Duodenal ulcer in a patient over 60 yearsb) Duodenal "mute" ulcer (without ulcer history)c) In association with bleedingd) In case of malignancy suspicione) In young patients under 30 years

--------------------------------------------------------------------- 48. What hemostatic measures would you choose in case of Blakemore's probe failure to stop esophageal variceal bleeding?a) Beta-blockersb) Gastric refrigerationc) Hepatoprotectorsd) Endoscopic band ligation/Sclerotherapy of esophageal varices

e) Blood transfusion

--------------------------------------------------------------------- 49. Ulcerogenic adenoma produces large amounts of:a) Histamineb) Trypsinc) Kallicreind) Gastrine) Kinins

--------------------------------------------------------------------- 50. Which gastric drainage procedure is associated with truncal vagotomy more frequently in emergency surgery of peptic ulcer:a) Judd pyloroplastyb) Finney pyloroplastyc) Jaboulay gastroduodenostomyd) Gastrojejunostomye) Heineke-Miculicz pyloroplasty

--------------------------------------------------------------------- 51. Duodenal ulcer can have the following complications, except:a) Malignancyb) Stenosisc) Bleedingd) Penetratione) Perforation

--------------------------------------------------------------------- 52. The most characteristic laboratory parameter for perforated ulcer is:a) Leukopenia with shift to the leftb) Hypochloremiac) Moderate anemiad) Moderate leukocytosis (12.000 - 14.000), increasing graduallye) Increased hematocrit

--------------------------------------------------------------------- 53. In duodenal ulcer the pain:a) Is permanentb) Is colickyc) Depends on food intaked) Decreases after gastric lavagee) Decreases during the night

--------------------------------------------------------------------- 54. Conservative treatment in Mallory-Weiss syndrome includes:a) Diet, antacids, hemocoagulantsb) Hormones (corticosteroids)c) Pituitrin i/vd) Sengstaken-Blakemore probe

e) Endoscopic hemostasis

--------------------------------------------------------------------- 55. Depending on the site of ulcer there are the following types of stenosis, except:a) Stenosis of the cardiab) Stenosis of the duodenal bulbc) Pyloric stenosisd) Postbulbar stenosise) Stenosis of the gastric fundus

--------------------------------------------------------------------- 56. What is the earliest sign of ulcer malignancy:a) Fetid vomitingb) Hematemesisc) Disappearance of pain periodicity and decrease of its intensityd) Weight losse) Melena

--------------------------------------------------------------------- 57. Gastrinoma resembles a cystic or lobulated node with a 50% of potential of malignancy and metastasis and may be found in the following organs:a) Pancreasb) Duodenumc) Spleend) Gallbladdere) Stomach

--------------------------------------------------------------------- 58. Which of the listed complications may be present in duodenal ulcer:a) Malignancyb) Stenosisc) Bleedingd) Penetratione) Perforation

--------------------------------------------------------------------- 59. The most accurate method to determine gastric secretion is:a) Hollender testb) pH-measuringc) Kay testd) X-raye) Upper GI endoscopy

--------------------------------------------------------------------- 60. Which of the listed below fits the Johnson I type gastric ulcer:a) Prepyloric ulcersb) Body ulcers on the greater curvaturec) Ulcers on lesser curvature and duodenal ulcerd) Lesser curvature ulcers with normal antrum and pylorus and decreased acidity

e) Lesser curvature ulcers with prepyloric ulcers and increased secretion

--------------------------------------------------------------------- 61. Which of the listed below statements about upper GI bleeing are true:a) Bleeding stops easier in the elderlyb) The most important is to differentiate ulcer bleeding from esophageal varices bleedingc) You should wait 48 hours performing medical hemostasisd) Surgery is indicated after 48 hours in order to reduce mortalitye) The bleeding source is located proximal to the duodenojejunal junction

--------------------------------------------------------------------- 62. Mallory-Weiss syndrome may be caused by:a) Alcohol and food abuseb) Sudden increase of intraabdominal pressurec) Repeated violent vomitingd) Violent coughinge) Use of aspirin, steroids, anticoagulants

--------------------------------------------------------------------- 63. Vomiting is more frequent in:a) Compensated stenosisb) Decompensated stenosisc) Duodenal ulcer penetrating to the pancreasd) Perforated duodenal ulcer associated with bleedinge) Subcompensated stenosis

--------------------------------------------------------------------- 64. The most efficient method to find ulcer malignancy is:a) Double contrast gastric X-rayb) History and physical examinationc) Upper GI endoscopyd) Gregersen-Adler teste) Computed tomography

--------------------------------------------------------------------- 65. Which of the following is the most indicated surgical procedure In a 45 years old patient with long history of intractable duodenal ulcer with Kay test prevalence:a) Highly selective vagotomyb) Truncal vagotomy with ulcer excision and gastric drainage procedurec) Selective vagotomy with Jaboulay gastroduodenostomyd) Truncal vagotomy with gastrojejunostomye) 2/3 gastric resection

--------------------------------------------------------------------- 66. Which of the listed below procedures cannot be used in case of esophageal varices bleeding in a patient with liver cirrhosis?a) Highly selective vagotomyb) Endoscopic hemostasisc) Ligation of the celiac trunk

d) Sengstaken-Blackmore probee) Pituitrin i/v

--------------------------------------------------------------------- 67. Which stage after ulcer perforation is characterized by the following signs: violent epigastric pain, anxiety, mydriasis, cold sweat, superficial breathing, Eleker sign, forced position:a) 12 hours after perforation with bleedingb) First 6 hours after retroperitoneal perforation of duodenal ulcerc) First (first 4-6 hours) staged) Second (next 4-6 hours) stagee) Third (after 12 hours from onset ) stage

--------------------------------------------------------------------- 68. Conservative treatment of perforated ulcer (nasogastric aspiration, wide spectrum antibiotics, correction of hydroelectrolytic imbalancies) is used when there are no conditions to perform surgery or the patient does not agree with the surgery. This treatment method was proposed by:a) Billroth (1881)b) Pierandozzi (1960)c) Dragstedt (1960)d) Taylor (1946)e) Braun (1892)

--------------------------------------------------------------------- 69. Upper GI bleeding activity determines the surgical management and is assessed:a) Clinicallyb) By laboratory valuesc) By X-rayd) By endoscopye) By laparoscopy

--------------------------------------------------------------------- 70. Upper GI endoscopy reveals bleeding grade III esophageal varices (gastric mucosa normal). What hemostatic method would you choose initially?a) Endoscopic band ligationb) Resection of the distal esophagus with esophagogastrostomy (Tanner procedure)c) Sengstaken-Blakemore probe + pituitrin i/vd) Azygoportal disconnectione) Splenorenal anastomosis

--------------------------------------------------------------------- 71. Zollinger-Ellison syndrome has the following features:a) Increase of night basal secretionb) Constipationc) Intense, frequent, acid vomitingd) Frequent upper GI bleedinge) Intense, continuous epigastric pain with night exacerbations

--------------------------------------------------------------------- 72. Which of the following is Pean-Billroth-I anastomosis in gastric resection:

a) Gastroduodenal end-to-end anastomosis with narrowing of the stomach from the lesser curvatureb) Gastrojejunal end-to-side anastomosisc) Gastrojejunal "Y" anastomosisd) Gastroduodenal side-to-side anastomosise) Gastroduodenal end-to-side anastomosis

--------------------------------------------------------------------- 73. The most important sign of gastroduodenal anastomotic leak is:a) Intense epigastric painb) Nausea and vomitingc) Fever with chillsd) Discharge of metilen blue through the drains after it was introduced to the stomache) Epigatsric muscle rigidity

--------------------------------------------------------------------- 74. Postoperative bleeding (after surgery for ulcer) is either in the GI tract lumen (2% of gastric resections) or in the peritoneal cavity. Conservative treatment is more frequently indicated in:a) None of themb) Both of themc) That in the GI tract lumend) Intraperitoneal bleedinge) Bleeding from acute ulcer

--------------------------------------------------------------------- 75. The most frequent cause of mechanical evacuation disturbances is:a) Wrong position of the anastomotic loopb) Transmesocolic herniac) Anastomotic healingd) Anastomositise) Gastroplegia

--------------------------------------------------------------------- 76. Anastomisitis occurs usually in the early postoperative period after Billroth I gastric resection and is caused by microbial factor, tissue trauma, reaction to sutures, allergy etc. Its major signs - epigastric pain and abundant vomiting will appear on PO day:a) 1-2b) 2-3c) 4-5d) 6-7e) 7-10

--------------------------------------------------------------------- 77. Cephalic phase of gastric secretion is stimulated by:a) Gastric fundus and antrum distensionb) Sight, smell and touching the foodc) Mastication and salivationd) Deglutitione) Insulin

--------------------------------------------------------------------- 78. Disappearance of liver dullness is present in the majority of perforated ulcers and may be confused with one of the following signs:a) Mandel-Razdolskiib) Celoditic) Kulencampfd) Vighiatoe) Iudin

--------------------------------------------------------------------- 79. The most informative diagnostic procedure for perforated ulcer is:a) Contrasted orthostatic gastrographyb) Pneumogastrographyc) Plain abdominal filmd) Laparoscopye) Contrasted gastrography (patient lying on the side)

--------------------------------------------------------------------- 80. Which of the listed below procedures are used in case of gastric ulcer depending on the morphology:a) Partial gastrectomyb) Suture of the ulcerc) Truncal vagotomy and suture of the ulcerd) Selective vagotomy and suture of the ulcere) Wedge resection of the stomach

--------------------------------------------------------------------- 81. What surgical procedures can be used to treat Mallory-Weiss syndrome:a) Mucosa and submucosa sutureb) Ligation of artera gastrica sinistrac) Distal gastric resectiond) Mucosa and submucosa suture + ligation of artera gastrica sinistrae) Proximal gastric resection

--------------------------------------------------------------------- 82. Surgical treatment is indicated for gastric ulcer:a) Immediately upon revealing ulcerb) After the first bleedingc) At first signs of malignancyd) If medical treatment is ineffective for 1-2 monthse) Only in case of perforation

--------------------------------------------------------------------- 83. Which phase of secretion does Hollender test (2 units of insulin/10 kg body weight i/m with sampling of 8 portions of gastric juice every 15 minutes) assess:a) Nocturnalb) Basalc) Intestinal

d) Cephalice) Hormonal (gastric)

--------------------------------------------------------------------- 84. The following signs: paresthesia, hallucinations, tetania, in blood - metabolic alcalosis , hypochloremia, hyponatremia, hypopotassemia, extrarenal azotemia, in a cachectic patient with rare, abundant vomiting, suggests:a) Late intestinal obstructionb) Zollinger-Ellison syndromec) Hemorrhagic shockd) Chronic renal failuree) Decompensated pyloric stenosis

--------------------------------------------------------------------- 85. The most frequent complication after Billroth II gastric resection is:a) Thrombophlebitisb) Duodenal stump fistulac) Sepsisd) Retroanastomotic herniae) Bleeding

--------------------------------------------------------------------- 86. Kulencampf sign is characteristic for the II stage after ulcer perforation and means:a) Acute pain in all abdominal areasb) Shiftable dullness in right iliac fossac) "Board-like abdomen"d) Painful prolabation of the Douglas pouche) "knife sharp" pain

--------------------------------------------------------------------- 87. Loss of 1000-1500 ml of blood (30% of circulating blood volume) corresponds to:a) Occult digestive bleedingb) Minor upper GI bleedingc) Moderate upper GI bleedingd) Massive upper GI bleedinge) Cataclysmic upper GI bleeding

--------------------------------------------------------------------- 88. The main pathogenetic factors in peptic ulcer disease are:a) Hyperacidityb) Decrease of gastroduodenal mucosa resistancec) Psychic factor (stress)d) Gastroduodenal hypermotilitye) Helicobacter pylori

--------------------------------------------------------------------- 89. On X-ray pneumoperitoneum may be found in:a) Appendiceal perforationb) Gastroduodenal perforation

c) Colon perforationd) Gallbladder perforatione) Bladder perforation

--------------------------------------------------------------------- 90. Physical examination in uncomplicated gastroduodenal ulcer reveals:a) Epigastric splashb) Epigastric tumorac) Epigastric pain on palpationd) Muscle guardinge) During remission the physical examination is negative

--------------------------------------------------------------------- 91. Ulcer may perforate:a) Into the free peritoneumb) In limited peritoneal spacesc) In an adjacent organd) To the skine) In retroperitoneal space

--------------------------------------------------------------------- 92. The pain in strangulated intestinal obstruction is:a) Continuous, intense, dramaticb) Continuous and intermittentc) Vague, diffuse paind) Intermittent, colickye) Violent pain at the onset followed by improvement

--------------------------------------------------------------------- 93. Schlange sign is:a) Splash over the distended loopb) Sound of falling dropc) Tympanic sound over the asymmetric sited) Enlarged, empty rectal ampulae) Loud hyperperistaltic sounds

--------------------------------------------------------------------- 94. Diffuse distention of the bowel loops on X-ray will suggest:a) Dynamic obstructionb) Sigmoid colon volvulusc) Strangulated inguinal herniad) Bouveret syndromee) Obstructive caecum cancer

--------------------------------------------------------------------- 95. Criteria of treatment efficiency of dynamic ileus are:a) Absence of feverb) Skin conditionc) Diuresis

d) Restoration of the peristalsise) Normalization of the WBC

--------------------------------------------------------------------- 96. Choose the X-ray sign of small bowel obstruction:a) Haustrab) Multiple air-fluid levelsc) Peripheral air-fluid levelsd) "Bycicle tyre"e) Pneumoperitoneum

--------------------------------------------------------------------- 97. The major differentiation criterion between intracellular and extracellular dehydration is:a) Arterial hypotensionb) Excessive thirstc) Tachycardiad) Meteorisme) Oliguria

--------------------------------------------------------------------- 98. Sklearov sign is:a) Tympanic sound over the asymmetric siteb) Elastic resistance of the abdominal wallc) Asymmetric abdominal distentiond) Splash over the distended loope) Sound of the falling drop

--------------------------------------------------------------------- 99. The main purposes of mechanical intestinal obstruction treatment are:a) Remove the cause of obstructionb) Antibiotic therapyc) Restoration of peristalsisd) Decrease of intestinal distentione) Correction of hydroelectrolytic disturbances

--------------------------------------------------------------------- 100. Spasmodic abdominal pain, vomiting, periumbilical fusiform palpable mass and bloody rectal discharge in a child will suggest:a) Acute pelvic appendicitisb) Acute enterocolitisc) Dysenteriad) Intestinal intussusceptione) Small bowel volvulus

--------------------------------------------------------------------- 101. The most frequent cause of intestinal obstruction in a patient with previous laparotomy is:a) Intussusceptionb) Gallstone ileusc) Bands, adhesions

d) Postoperative foreign bodiese) Postoperative intestinal stenosis

--------------------------------------------------------------------- 102. The most characteristic sign of mechanic obstruction of the ascending colon is:a) Bayer signb) Abundant vomitingc) Complete arrest of intestinal transitd) Konig signe) Bouveret sign

--------------------------------------------------------------------- 103. Few, big, lateral air fluid levels and WBC count up to15.000 are more characteristic of:a) Sigmoid volvulusb) Colon obstructionc) Small bowel obstructiond) Strangulated inguinal herniae) Mesenteric ischemia

--------------------------------------------------------------------- 104. The pain in simple mechanic intestinal obstruction is:a) Vagueb) Continuousc) Colicky (paroxysmal)d) Transitorye) Burning

--------------------------------------------------------------------- 105. Clinical signs of extracellular dehydration are:a) Dry and pale skinb) Dry tongue with depositsc) Excessive thirstd) Nausea and vomitinge) Arterial hypotension, tachycardia

--------------------------------------------------------------------- 106. In pleuritis, vertebral fractures, retroperitoneal hematoma the dynamic ileus is:a) Toxicb) Reflexc) Metabolicd) Neurogenice) Spastic

--------------------------------------------------------------------- 107. How much is the small bowel resected distally from the necrosis limit:a) 30 - 40 cmb) 10 - 15 cmc) 15 - 20 cmd) 5 - 10 cm

e) 40 -50 cm

--------------------------------------------------------------------- 108. What type of obstruction is gallstone ileus:a) Intussusceptionb) Volvulusc) Due to compressiond) Due to intraluminal obstructione) Spasm of the bowel muscle

--------------------------------------------------------------------- 109. The III (pathologic) fluid sector in intestinal obstruction is formed due to:a) Transudation of the fluid in the lumen of the proximal bowelb) Gastric stasisc) Transudation of the fluid in the bowel walld) Excessive absorption in the distal bowele) Transudation of the fluid in the peritoneal cavity

--------------------------------------------------------------------- 110. How much of the small bowel would you resect proximally from the necrosis limit:a) 10 - 15 cmb) 20 - 30 cmc) 5 - 10 cmd) 30 - 40 cme) 15 - 20 cm

--------------------------------------------------------------------- 111. Konig sign appears in the early stage of intestinal obstruction and means:a) Sound of falling dropb) Asymmetric distentionc) Visible peristalsisd) Distended caecume) Evident meteorism over the distended site

--------------------------------------------------------------------- 112. Many, small, central air fluid levels are characteristic of:a) Bouveret syndromeb) Obstructive sigmoid cancerc) Small bowel obstructiond) Acute pancreatitise) Pyloric stenosis

--------------------------------------------------------------------- 113. The most informative diagnostic methods for small bowel obstruction are:a) Schwartz procedureb) Abdominal ultrasonographyc) Barium enemad) Laparoscopye) Plain film of the abdomen

--------------------------------------------------------------------- 114. Increase of blood urea nitrogen in intestinal obstruction is due to:a) Loss of extracellular proteinb) Loss of inracellular proteinc) Loss of extracellular fluidd) Loss of potassiume) Hypochloremia

--------------------------------------------------------------------- 115. In colon obstruction the most appropriate diagnostic method is:a) Schwartz procedureb) Barium enemac) Plain abdominal X-rayd) Computed tomographye) Laparoscopy

--------------------------------------------------------------------- 116. Bayer sign is:a) Symmetric distention of the abdomenb) Right side asymmetric distentionc) Peristaltic sounds on the right flankd) Asymmetric distention from the left iliac fossa to the right hypochondriume) Bloody rectal discharge

--------------------------------------------------------------------- 117. Bouveret syndrome is found in:a) Mesenteric ischemiab) Caecum cancerc) Gallstone ileusd) Postoperative ileuse) Strangulated hernia

--------------------------------------------------------------------- 118. Treatment of mechanical intestinal obstruction is complex. Choose two components which are performed pre-, intra- and postoperatively:a) Elimination of the cause of obstructionb) Restoration of the bowel functionc) Intestinal decompression (reducing the distention)d) Correction of hydroelectrolytic disturbancese) Prevention of septic complications

--------------------------------------------------------------------- 119. In what types of obstruction blood supply of the involved segment is affected from the onset?a) Volvulusb) Intussusceptionc) Intraluminal foreign bodiesd) Strangulatione) Specific inflammatory parietal lesions

--------------------------------------------------------------------- 120. Which of the listed below belongs to strangulated obstruction:a) Obstruction caused by intraperitoneal foreign bodiesb) Volvulusc) Gallstone ileusd) Strangulated herniae) Obstruction caused by trichobezoars

--------------------------------------------------------------------- 121. Choose the correct statements about sigmoid colon volvulus:a) It is frequently preceded by coliSC or subocclusive episodesb) Sudden onset with pain in the left lower quadrant and asymmetric abdominal distensionc) Intestinal transit is arrested from the onsetd) X-ray exhibits specific "bicycle tyre" imagee) Frequent vomiting

--------------------------------------------------------------------- 122. Which of the listed below can lead to a paralytic ileus?a) Phytobezoarsb) Renal colicc) Peritonitisd) Sigmoid volvuluse) Retroperitoneal abscess

--------------------------------------------------------------------- 123. The main postoperative care measures of a patient with intestinal obstruction are:a) Correction of hydroelectrolytic disturbances and maintaining the normal levels of the biologic constantsb) Antibiotic therapyc) Early mobilization of patients is forbiddend) Forbid enteral feeding for a weeke) Stimulation of intestinal peristalsis

--------------------------------------------------------------------- 124. In proximal intestinal obstruction gas accumulation in the intestinal lumen consists of:a) 70% of swallowed airb) 100% of gas as a result of microflora fermentation processes and biochemical reactions of digestive juicesc) 70% of gas as a result of microflora fermentation processesd) 30% of gas as a result of biochemical reactions of digestive juicese) 30% of gas as a result of microflora fermentation processes and biochemical reactions of digestive juices

--------------------------------------------------------------------- 125. Decompression of distended bowel in intestinal obstruction is useful because:a) It reduces ischemia of the bowelb) It removes intraluminal toxinsc) It prevents Mendelson syndrome

d) It alters chlorine ion losse) It reduces water loss

--------------------------------------------------------------------- 126. What radiologic signs are characteristic of early proximal mechanical obstruction:a) Kloiber air-fluid levelsb) Pneumoperitoneumc) Presence of arcades and organ tubesd) Presence of semilunar foldse) Presence of Chercring folds

--------------------------------------------------------------------- 127. What signs are characteristic of sigmoid colon torsion:a) Complete arrest of the intestinal transitb) Feverc) Blood on rectal examinationd) Positive Hochwag-Grecov signe) Abdominal asymmetry

--------------------------------------------------------------------- 128. Chauffard-Villard-Charcot triad is found in CBD stones with major choledochal syndrome and consists of:a) Right upper abdominal quadrant painb) Distended gallbladderc) Feverd) Jaundicee) Significant weight loss

--------------------------------------------------------------------- 129. The most frequent cause of obstructive jaundice is:a) Tumor of the pancreatic headb) CBD stonesc) Biliary duct strictured) Biliary duct tumorse) Stenotic papillitis

--------------------------------------------------------------------- 130. Liver scintigraphy found out a normal absorption of isotopes was found, but the isotopes were absent in the gallbladder, bile ducts and bowel. This suggests:a) Hepatic jaundiceb) Posthepatic jaundicec) Hemolytic jaundiced) Liver cirrhosise) None of the above listed

--------------------------------------------------------------------- 131. CBD gallstone found preoperatively can be removed by:a) Supraduodenal CBD incisionb) Transduodenal intraoperative papillosphincterotomy

c) Postoperative endoscopic papillosphincterotomyd) Preoperative endoscopic papillosphincterotomye) It is dissolved with drugs

--------------------------------------------------------------------- 132. Which of the listed below methods provide the most complete information about morphological type of cholecystitis, adjacent organs' and perioneum's changes:a) Ultrasonographyb) Computed tomographyc) Transparietal cholecystocholangiographyd) Laparoscopye) ERCP

--------------------------------------------------------------------- 133. The optimal and less aggressive diagnostic method in a patient with obstructive jaundice is:a) Oral cholecystographyb) Intravenous cholecystographyc) Ultrasonographyd) ERCPe) Transparietohepatic cholangiography

--------------------------------------------------------------------- 134. Air in the bile ducts suggests:a) CBD stonesb) Acute cholecystitisc) Biliary-digestive fistulad) Biliary-biliary fistulae) Salmonella infection of the gallbladder

--------------------------------------------------------------------- 135. The following signs: moderate pain in the right hypochondrium, moderate fever, marked jaundice with reddish nuance, slight liver enlargement, moderate splenomegaly without anemia are specific for:a) Acute cholecystitisb) Cholangitisc) CBD stonesd) Hepatic jaundicee) Cancer of the pancreatic head

--------------------------------------------------------------------- 136. What kind of bile is formed in hepatocytes and contains cholesterol, biliary acids and phospholipids?a) Primary bileb) Secondary bilec) Final biled) None of the listede) All three of them

---------------------------------------------------------------------

137. What diagnostic methods are not useful, thus are not indicated in a patient with obstructive jaundice:a) Ultrasonographyb) Intravenous cholecystographyc) Transparietohepatic cholangiographyd) ERCPe) Oral cholecystography

--------------------------------------------------------------------- 138. In acute obstructive lithiasic cholecystitis the stone is impacted:a) In the intrahepatic bile ductsb) In the body of the gallbladderc) In the CBDd) In the hepatic ducte) In the gallbladder infundibulum or cystic duct

--------------------------------------------------------------------- 139. Choose the "gold standard" diagnostic method in obstructive jaundice:a) Oral cholecystographyb) Intravenous cholecystographyc) Ultrasonographyd) ERCPe) Laparoscopy

--------------------------------------------------------------------- 140. The simple T-shaped drain of the CBD is called:a) Lane drainb) Kehr drainc) Cattele-Champeau draind) Voelker draine) Duval drain

--------------------------------------------------------------------- 141. The major differentiation sign of the stone-induced obstructive jaundice from malignant jaundice is:a) Marked jaundice accompanied by painb) Acholic stool and dark urinec) Jaundice preceded by painful colicd) Prurituse) Intermittent fever

--------------------------------------------------------------------- 142. The most informative noninvasive method of obstructive and hepatic jaundice differentiation is:a) ERCPb) Scintigraphyc) Oral cholecystographyd) Intravenous cholecystocholangiographye) Transparietohepatic cholecystography

--------------------------------------------------------------------- 143. Choose the clinical signs characteristic of acute cholecystitis with local peritonitis:a) Murphy signb) Korte signc) Mandel-Razdolschi signd) Blumberg signe) Ortner sign

--------------------------------------------------------------------- 144. Pancreas produces the following ferments:a) Alpha-amylaseb) Lipase, phospholipase A and Bc) Pepsind) Trypsine, chymotrypsinee) Elastase, collagenase

--------------------------------------------------------------------- 145. Infected pancreatic necrosis is characteristic of the following phase of evolution of pathological process in the pancreas:a) Edemab) Fat necrosisc) Hemorrhagic necrosisd) Lysis and sequestratione) Pancreatic pseudocyst

--------------------------------------------------------------------- 146. In the evolution of the acute pancreatitis One of the mentioned substances is formed in ischemic pancreas and induces pancreatic shock:a) Kinineb) Heparinc) Serotonind) Kallikreine) Histamine

--------------------------------------------------------------------- 147. In the management of acute pancreatitis in the early phase the most important is:a) Pain management, spasmolytics, circulation improvementb) Shock and homeostasis managementc) Reduction of pancreatic secretion and inactivation of pancreatic enzymesd) Reduction of toxemiae) Prevention of complications

--------------------------------------------------------------------- 148. In the management of acute hemorrhagic pancreatitis before surgery the main aim is:a) Pain managementb) Detoxificationc) Spasmolytics and circulation improvementd) Circulating plasma volume increase

e) Reduction of pancreatic secretion

--------------------------------------------------------------------- 149. Non-invasive diagnostic procedures for acute pancreatitis are:a) Plain film of the abdomenb) Abdominal CT scanc) Abdominal ultrasoundd) ERCPe) Thermography

--------------------------------------------------------------------- 150. The most optimal surgical procedure for infected pancreatic necrosis is:a) Peripancreatic infiltration with novocaine and antifermentsb) Lesser sack debridementc) Pancreas resectiond) Abdominisation of the pancrease) Pancreatic decapsulation and lesser sack drainage

--------------------------------------------------------------------- 151. The Courvoisier-Terrier sign is characteristic of:a) CBD stonesb) Cancer of the body of the pancreasc) Klatskin tumord) Cancer of the head of the pancrease) Gallbladder carcinoma

--------------------------------------------------------------------- 152. What is the type of surgery in case of pancreatic pseudocyst?a) Pseudocyst external drainageb) Pancreatectomyc) Gastrocystostomyd) Jejunocystostomye) Cholecystocystostomy

--------------------------------------------------------------------- 153. Which of the following is a poor prognostic sign of acute pancreatitis:a) Elevated blood amylaseb) Hypocalcemiac) Elevated blood glucosed) Elevated urine amylasee) Elevated WBC

--------------------------------------------------------------------- 154. In acute pancreatitis Korte sing means:a) Absence of pulsation on the abdominal aortab) Absence of intestinal peristalsisc) Pain in the scapula-humerus area on the leftd) Tympanic sound located on the projection of the transverse colone) Muscular guarding and pain in the projection of the pancreas

--------------------------------------------------------------------- 155. Optimal management of infected pancreatic pseudocyst is:a) Cystogastrostomyb) Pancreatectomyc) Cystojejunostomyd) Antibioticse) External drainage

--------------------------------------------------------------------- 156. What x-ray signs are characteristic of acute pancreatitis?a) Pneumoperitoneumb) "Sentinel" jejunal loopc) Distended transverse colond) Diffuse distension of the intestinal loopse) Multiple air-fluid levels on the small bowel

--------------------------------------------------------------------- 157. The endocrine part of the pancreas is in form of islets located in:a) Parenchymatous tissueb) Interlobular spacesc) Pancreatic fat tissued) Fibrous septa of the glande) Retroperitoneal at the level of the pancreatic tail

--------------------------------------------------------------------- 158. The most accepted theory of the onset of acute pancreatitis is:a) Common channel theoryb) Allergic theoryc) Fermentative theoryd) Vascular theorye) Infectious theory

--------------------------------------------------------------------- 159. In acute pancreatitis Gobief sign means:a) Muscular guarding in the pancreas projectionb) Periumbilical cyanosisc) Lack of abdominal aortic pulsationd) Tympanic sound on the projection of the transverse colone) Pain on percussion in the area of the upper left abdominal quadrant

--------------------------------------------------------------------- 160. Which of the following clinical signs are the most important in the diagnosis of chronic pancreatitis?a) Elevated blood and/or urine amylaseb) Weight lossc) Vomitingd) Paine) Palpable epigastric tumor

--------------------------------------------------------------------- 161. The most accurate diagnostic procedure in acute pancreatitis with fermentative peritonitis is:a) Contrasted abdominal x-rayb) Abdominal ultrasonographyc) Scintigraphyd) Laparoscopye) ERCP

--------------------------------------------------------------------- 162. In case of acute pancreatitis the most efficient method for inactivation of proteolytic ferments is:a) Stimulated dieresisb) Antienzymes in high dosesc) Laparoscopic lavage and drainage of the peritoneal cavityd) Hemofiltratione) Blood transfusion

--------------------------------------------------------------------- 163. In case of a mature pancreatic pseudocyst located in the head of the gland the following surgical procedures are indicated:a) Cystogastrostomyb) Cystoduodenostomyc) Cystojejunostomyd) Cystectomye) Whipple pancreaticoduodenctomy

--------------------------------------------------------------------- 164. In case when chronic pancreatitis is induced by stenosis of the big duodenal papilla, the most indicated surgical procedure is:a) Resection of the pancreatic head (Duval procedure)b) Pancreatojejunostomy (Puestow procedure)c) Pancreatojejunostomy (Duval procedure)d) Papillosphincterotomy and endoscopic wirsungotomye) Papillectomy

--------------------------------------------------------------------- 165. Which of the following signs are relevant in the early diagnosis of acute pancreatitis?a) Periumbilical cyanosisb) Episodes of elevated arterial pressurec) Dyspnea and polypnead) Fevere) Severe general clinical signs and objective state of the patient

--------------------------------------------------------------------- 166. In acute pancreatitis the Grey-Turner sign means:a) Pale skinb) Ecchymosis and cyanosis on the lateral edges of the abdomenc) Pain in the point of junction of the ribs to the vertebrae on the left side

d) "Sentinel" intestinal loop on a plain film of the abdomene) Pain on palpation of the left upper abdominal quadrant

--------------------------------------------------------------------- 167. In order to reduce pancreatic secretion several treatment options are available, the least indicated one due to adverse effects is:a) Nasogastric intubationb) Local extra- and intragastric hypothermiac) No enteral feedingd) 1.0 ml of 0.1% atropine solution 3 times a daye) 5-Fluorouracil

--------------------------------------------------------------------- 168. In acute pancreatitis the Cullen sign means:a) Pale skinb) Ecchymosis and periumbilical cyanosisc) Pain in the point of junction of the ribs to the vertebrae on the left sided) "Sentinel" intestinal loop on a plain film of the abdomene) Pain on palpation of the left upper abdominal quadrant

--------------------------------------------------------------------- 169. In a patient with acute pancreatitis plain film of the abdomen can reveal the following:a) Transverse colon enlargementb) Liquid in the left pleural cavityc) Left lung atelectasisd) Pneumoperitoneume) Reduced movement of the left part of the diaphragm

--------------------------------------------------------------------- 170. In the first phase (edema) of evolution of acute pancreatitis the optimal management is:a) Conservative management and if necessary laparoscopy with drainage of the abdomen and lesser peritoneal sacb) Laparotomy with the drainage of the CBDc) Laparatomy and pancreatic capsula removald) Laparatomy, peripancreatic blockagee) Laparatomy, lesser peritoneal sac debridement

--------------------------------------------------------------------- 171. The mean secretion volume of a healthy pancreas within 24 hours is:a) 1500 - 2500 mlb) 600 - 700 mlc) 300 - 400 mld) 1000 - 1500 mle) 400 - 500 ml

--------------------------------------------------------------------- 172. A simple wound with a penetrating orifice and an exit one is called:a) Penetrating woundb) Penetrating but nonperforating wound

c) Perforating woundd) Through-wall injurye) Blind wound

--------------------------------------------------------------------- 173. In case of multiple jejunal injuries within the first 6 hours after the onset the optimal surgical procedure is:a) Simple sutureb) Resection with primary end-to-end anastomosisc) Resection with primary end-to-side anastomosisd) Jejunostomye) Primary anastomosis and protective stoma

--------------------------------------------------------------------- 174. The majority (90%) of the abdominal traumas are multiple injuries, the main etiology being:a) Gunshot woundsb) Knife woundsc) Catatrauma (falls)d) Traffic accidentse) Sport trauma

--------------------------------------------------------------------- 175. The rate of isolated abdominal trauma is minimal (10%), because nowadays the main etiological factor is:a) Traffic accidentsb) Gunshot woundsc) Knife woundsd) Catatrauma (falls)e) Sport trauma

--------------------------------------------------------------------- 176. The delayed diagnosis of retroperitoneal duodenal injuries is due to the following factors:a) Leakage of the duodenal content into the retroperitoneal spaceb) Low aggressivity of the duodenal contentc) Initial onset of retroperitoneal phlegmond) Lack of diffuse peritonitis within the first hours after the onsete) Reduced bacterial contamination of the duodenal content

--------------------------------------------------------------------- 177. A patient with a gunshot wound is diagnosed with liver, small bowel and mesentery injuries. The correct determination of the trauma is:a) Complex multiple injuries (multivisceral injuries)b) Simple traumac) Through-wall injuryd) Combined traumae) Penetrating but non-perforating wound

--------------------------------------------------------------------- 178. A patient was diagnosed with the following injuries: pelvic fracture, urethral and splenic

injuries. The correct term for above mentioned trauma is:a) Blunt non-penetrating injuryb) Polytraumac) Associated traumad) Simple traumae) Combined trauma

--------------------------------------------------------------------- 179. The diagnosis of retroperitoneal injury of the duodenum is difficult. One of the most important clinical signs is:a) Blumberg signb) Mandel-Razdolski signc) Grassman-Kulenkampf signd) Bernstein signe) Vighiato sign

--------------------------------------------------------------------- 180. The most useful diagnostic procedures of pancreatic injuries are:a) USGb) Peritoneal lavagec) Plain film of the abdomend) Laparoscopye) CT scan

--------------------------------------------------------------------- 181. In case of total pancreatic injury the optimal surgical procedure is:a) Parenchyma suture with Wirsung duct sutureb) Distal pancreatic resectionc) Drainage of the both ends of the Wirsung duct as well as the lesser sacd) Parenchyma suture with Wirsung duct drainagee) Pancreatectomy

--------------------------------------------------------------------- 182. In splenic injuries the Kehr sign is:a) Pain and rebound tenderness on palpation of the left upper abdominal quadrantb) Pain in the left upper abdominal quadrant irradiating into the left shoulderc) Dull sound on percussion of the left upper abdominal quadrantd) Dull sound on percussion of the abdominal flankse) Hypotension

--------------------------------------------------------------------- 183. Intraoperative signs of retroperitoneal duodenal injury are:a) Fat necrosis on the peritoneal wallb) Green colored posterior peritoneal layerc) Fibrin and pus in the peritoneal cavityd) Retroperitoneal emphysemae) Retroperitoneal hematoma

---------------------------------------------------------------------

184. Gastric injuries are more often observed in case of penetrating wounds (6-12%) compared to blunt trauma (2-3%). The most useful diagnostic procedures are:a) Laparoscopyb) Plain film of the abdomenc) USGd) Diagnostic peritoneal lavagee) CT scan

--------------------------------------------------------------------- 185. In case of blunt abdominal trauma the most frequent injuries of solid organs are:a) Pancreasb) Spleenc) Liverd) Kidneye) Suprarenal glands

--------------------------------------------------------------------- 186. In case of hollow organ injury the least invasive and the most informative is the following procedure:a) USGb) Laparoscopyc) Plain film of the abdomend) Diagnostic peritoneal lavagee) CT scan

--------------------------------------------------------------------- 187. The following symptoms are characteristic of the toxic phase of peritonitis:a) Tachycardiab) Elevated WBCc) Distended, painful abdomend) Prevalence of local signs but not general signse) Frequent vomiting

--------------------------------------------------------------------- 188. There are different procedures used for the diagnosis of localized peritonitis. Tick 2 the most informative ones:a) Rectal and vaginal examinationb) Abdominal USGc) Laparoscopyd) Diagnostic peritoneal lavagee) Plain film of the abdomen in upright position

--------------------------------------------------------------------- 189. In acute appendicitis Blumberg sign is:a) Pain during sudden decompression of the right iliac fossab) Pain on right iliac fossa palpationc) Pain in the right iliac fossa on chest extensiond) Pain on the right iliac fossa palpation irradiating in the epigastric areae) Pain in the right iliac fossa during air insufflation into the rectum

--------------------------------------------------------------------- 190. There are the following pain characteristics of peritonitis:a) It is reduced by opioid analgesicsb) It always has an acute onsetc) It can be associated with thirstd) It can spread upon the entire abdomene) It is always located in the projection of the affected organ

--------------------------------------------------------------------- 191. A patient with clinical signs of acute appendicitis presents peritoneal signs in the right iliac fossa and suprapubic area. What type of peritonitis is suspected?a) Limited localizedb) Localized unlimitedc) Diffuse generalizedd) Total generalizede) Douglas pouch abscess

--------------------------------------------------------------------- 192. The early signs of acute generalized peritonitis are:a) Abdominal painb) Muscle guardingc) Board-like abdomend) Vomitinge) Fever

--------------------------------------------------------------------- 193. In case of acute peritonitis protein and fluid loss can reach 300 g and 9-10 l respectively. The main factor of these losses is:a) Circulatory disturbancesb) Intestinal paresisc) Multiple vomitingd) Alkalosise) Renal impairment

--------------------------------------------------------------------- 194. After peritoneal lavage in a patient with diffuse purulent peritonitis, the peritoneal cavity is drainaged according to the following rules:a) Through the laparotomy incisionb) Drains should be placed through separate incisions of the abdominal wallc) In the postoperative period washout of the drainaged spaces is indicatedd) Antibiotics should be administrated in the peritoneal cavitye) Antibiotics must be administrated every 4-6 hours

--------------------------------------------------------------------- 195. In case of appendiceal abscess the optimal surgical approach is:a) Extraperitoneal, according to Pirogov's procedureb) Through McBurney approachc) Through middle inferior laparotomy

d) Through medial laparotomye) Through lumbar approach

--------------------------------------------------------------------- 196. In case of the onset of diffuse peritonitis physical examination reveals the following clinical sign:a) Distended abdomenb) Periombilical ecchymosisc) Board-like abdomend) The abdomen not participating in respiratory movementse) Kussmaul's sign

--------------------------------------------------------------------- 197. Among the general goals in the management of peritonitis one of the most important is management of dynamical intestinal obstruction. In order to achieve this goal the following procedures are indicated:a) Epidural analgesiab) I/V infusion of glucose, potassium and insulinc) Intestinal decompressiond) Sympathetic stimulatione) Intestinal peristalsis stimulation

--------------------------------------------------------------------- 198. Circulatory disturbances are more evident in the II and III phases of peritonitis evolution and are determined by the following factors:a) Hypokalemiab) Decreased hematocritc) Metabolic acidosisd) Protein catabolisme) Natrium imbalances

--------------------------------------------------------------------- 199. A patient with perforated peptic ulcer is admitted in 10 hours after the onset, with the following signs: xerostomia, Ps - 96 b/min., BP - 120/70 mmHg, dyspnea, severe abdominal pain, board-like abdomen, WBC - 16.000. Tick the phase of peritonitis:a) Reactive phaseb) Toxic phasec) Terminal phased) Infectious complication phasee) Multiple organ failure phase

--------------------------------------------------------------------- 200. In a patient with perforated duodenal ulcer in 48 hour after the onset, the most appropriate surgical techniques are:a) Gastric resection Bilroth Ib) Simple suture of the perforate ulcerc) Oppel-Policarpov's procedured) Ulcer excision and pyloroplastye) Gastric resection Bilroth II

--------------------------------------------------------------------- 201. The most frequent cause of infection of the peritoneal cavity is:a) Hollow organ perforationb) Through the blood streamc) Intraperitoneal rupture of hydronephrosisd) Lymphatic waye) None of the above

--------------------------------------------------------------------- 202. The following clinical signs are characteristic of diffuse generalized peritonitis:a) Blumberg signb) Mandel-Razdolskii signc) Presence of the liver dullness signd) Cough signe) Grassman-Kulencampf sign

--------------------------------------------------------------------- 203. A patient with perforated peptic ulcer is admitted in 32 hours after the onset with the following signs: xerostomia, Ps - 120 b/min., BP - 90/40 mm Hg, tachypnea 32 pe min., "Hippocratic facies", distended and painful abdomen, no intestinal peristalsis, WBC - 25.000. Tick the phase of peritonitis:a) Reactive phaseb) Toxic phasec) Terminal phased) Infectious complications phasee) Multiple organ failure phase

--------------------------------------------------------------------- 204. Which of the following signs are characteristic of diffuse peritonitis:a) History of gallstone diseaseb) Reduced level of urine amylasec) Pneumoperitoneumd) "Cough sign"e) Fecaloid vomiting

--------------------------------------------------------------------- 205. Muscular guarding is a major sign of peritonitis, but it could be absent in the following cases:a) In the elderlyb) In childrenc) In case of antibiotics treatmentd) In cachectic patientse) In opioid analgesics

--------------------------------------------------------------------- 206. The most important purpose of the management of acute generalized peritonitis is:a) Surgical debridementb) Antibiotic treatmentc) I/V infusions

d) Recovery of intestinal functione) Prophylaxis of complications

--------------------------------------------------------------------- 207. The surface of the peritoneum is about 2 m2, the functions of the peritoneum are:a) Spread of infectionb) Internal organs fixationc) Antibacterial protectiond) Absorptione) Secretion

--------------------------------------------------------------------- 208. There are acute and chronic peritonitis. The possible etiologies of chronic peritonitis are:a) TBb) Malignancyc) Parasitesd) Biliarye) Urinary

--------------------------------------------------------------------- 209. The following signs are characteristic of perforated duodenal ulcer with generalized peritonitis:a) Epigastric painb) Muscle guardingc) Liver dullnessd) Pneumoperitoneume) Pain on rectal examination

--------------------------------------------------------------------- 210. In the diagnosis of acute appendicitis the most important sign is:a) Dieulafoy triadeb) Kocher signc) Bartomie-Mihelson signd) Sitcowschi signe) Blumberg sign

--------------------------------------------------------------------- 211. Which of the following are true for acute appendicitis:a) Characteristic pain in the right iliac fossab) Fever is the most common in the elderlyc) Elevated WBC is always presentd) Tachycardiae) It can evolve into gangrene

--------------------------------------------------------------------- 212. In the first phase of evolution appendiceal infiltrate is characterized by the following signs:a) Constant elevation of WBCb) Palpable mass after 3-5 days of disease onsetc) Dull pain in the right iliac fossa

d) Fluctuation in the right iliac fossae) Fever

--------------------------------------------------------------------- 213. In acute appendicitis Blumberg sign means:a) Pain during decompression of the right iliac fossab) Pain during palpation of the right iliac fossac) Pain in the right iliac fossa on lower limb liftingd) Pain radiating to the epigastric region during right iliac fossa palpatione) Pain in the right iliac fossa during rectal air insufflation

--------------------------------------------------------------------- 214. Pain in the paraumbilical area and the symptoms of Kummel, Krasnobaev are characteristic of the following location of inflammed appendix:a) Subhepaticb) In the elderlyc) Retrocecald) Mediale) Pelvic

--------------------------------------------------------------------- 215. Acute appendicitis with diffuse peritonitis must be differentiated from the following nosologies:a) Intestinal obstructionb) Renal lithiasisc) Gut ischemiad) Acute pancreatitise) Peritonitis

--------------------------------------------------------------------- 216. The most efficient method to secure an appendiceal stump is:a) Simple ligationb) Purse-string suture using non-absorbable stitchesc) Purse-string suture without ligationd) Purse-string suture using absorbable stitchese) Simple ligation and separate sutures

--------------------------------------------------------------------- 217. Subhepatic appendicitis is characterized by the following clinical signs:a) High feverb) It is diagnosed more frequently in childrenc) It can be accompanied with jaundiced) Peritoneal signs are positive in the right upper abdominal quadrante) It simulates acute cholecystitis

--------------------------------------------------------------------- 218. Acute appendicitis must be differnciated from:a) Perforated peptic ulcerb) Mallory-Weiss syndrome

c) Intoxicationd) Acute pancreatitise) Renal colic

--------------------------------------------------------------------- 219. Acute appendicitis in the elderly is characterized by the following signs:a) Sudden onsetb) Poor muscle guardingc) Pain on the right iliac fossa palpationd) Higher incidence of destructive forms with poor clinical signse) Moderate WBC, slight fever

--------------------------------------------------------------------- 220. The following conditions could simulate subhepatic appendicitis:a) Acute cholecystitisb) Subhepatic abscessc) Meckel's diverticulumd) Right-sided hydronephrosise) Pyelitis

--------------------------------------------------------------------- 221. The management of appendiceal infiltrate in the first phase of evolution is:a) Non-operative management (local hypothermia, antibiotics)b) Surgery is indicated in young patientsc) Surgery is indicated in the elderlyd) Surgery is indicated in case of pelvic localizatione) Surgery is indicated in case of suspected cecal carcinoma

--------------------------------------------------------------------- 222. Tick two the most important etiologic factors of acute appendicitis:a) Allergic factorb) Vascular factorc) Infectious factord) Chemical factore) Obstructive factor

--------------------------------------------------------------------- 223. The major and constant sign of acute appendicitis is:a) Anorexiab) Vomitingc) Feverd) Diarrheae) Pain in the right iliac fossa

--------------------------------------------------------------------- 224. In children differential diagnosis of acute appendicitis must be made with:a) Perforated peptic ulcerb) Acute cholecystitisc) Intoxication

d) Renal colice) Acute pancreatitis

--------------------------------------------------------------------- 225. Which of the following are not true for appendiceal infiltrate in the phase of abscess formation:a) Appendectomy is mandatoryb) Emergency surgery is indicatedc) Only autoamputated appendix is removedd) Surgery is not indicatede) Non-operative management is indicated

--------------------------------------------------------------------- 226. The most frequent position of the appendix is:a) Lateralb) Descendingc) Retrocecald) Ascendinge) Medial

--------------------------------------------------------------------- 227. Clinical features of acute appendicitis during pregnancy are:a) Atypical painb) It is more frequent in the third trimester of gestationc) Severe forms are more frequentd) Pain and vomiting can simulate gestatione) The Sitkovschi, Bartomie-Mihelson and Cope's signs are positive

--------------------------------------------------------------------- 228. The following nosologies could simulate pelvic appendicitis:a) Pyonephrosisb) Inflammation of the Meckel's diverticulumc) Crohn diseased) Acute prostatitise) Psoas abscess

--------------------------------------------------------------------- 229. What is the most appropriate surgical approach in case of suspected acute appendicitis?a) Lenander incisionb) McBurney incisionc) Sprengel incisiond) Midline laparotomye) Inferior midline laparotomy

--------------------------------------------------------------------- 230. The management of acute appendicitis in the elderly is:a) Non-operativeb) Emergency surgeryc) Colonic examination in order to rule out colon carcinoma

d) Initial management of concomitant diseasese) Antibiotics

--------------------------------------------------------------------- 231. In case of gangrenous appendicitis with localized peritonitis the optimal drainage is:a) Drainage of the Douglas pouch through a separate incisionb) Drainage of the Douglas pouch through McBurney incisionc) Drainage through the left iliac fossad) Drainage of the iliac fossa on the both sidese) Drainage is not indicated

--------------------------------------------------------------------- 232. In acute appendicitis Dieulafoy's tiad includes:a) Epigastric pain shifting to the right iliac fossa within 4-6 hours, hypersensitivity of the skin, tenderness and muscular contraction at McBurney's pointb) Hypersensitivity of the skin, tenderness and muscular contraction at McBurney's pointc) Anorexia, hypersensitivity of the skin, tenderness and muscular contraction at McBurney's pointd) Tenderness and muscular contraction at McBurney's point, hypersensitivity of the skin, fevere) Tenderness and muscular contraction at McBurney's point, Hypersensitivity of the skin, pain radiating into the right testicle

--------------------------------------------------------------------- 233. The optimal management of appendiceal infiltrate in the phase of abscess formation is:a) Non-operative managementb) Extraperitoneal drainage (Pirogov)c) USG-guided abscess drainaged) Laparotomy and abscess drainagee) Abscess drainage through McBurney apporach

--------------------------------------------------------------------- 234. The most accepted etiological theory of acute appendicitis is:a) Infectious theoryb) Polyethiologic theoryc) Mechanical theoryd) Corticovisceral theorye) Chemical theory

--------------------------------------------------------------------- 235. The following signs are used for the differential diagnosis of acute appendicitis and gynecological pathology:a) Promptov's signb) Metrorrhagiac) Jendrinschi signd) Kulencampf's signe) Bartomie-Mihelson's sign

--------------------------------------------------------------------- 236. Chronic appendicitis must be differentiated from:a) Nephrolithiasis, pyelonephritis

b) Crohn's diseasec) Zollinger-Ellison's syndromed) Colon carcinomae) Fallopian tube inflammation

--------------------------------------------------------------------- 237. In case of acute appendicitis, pain on abdominal palpation is localized in:a) Sonnenburg pointb) Wenglovschi trianglec) McBurney's pointd) Iacubovici trianglee) Lanz point

--------------------------------------------------------------------- 238. Flail chest is:a) Multiple rib fracturesb) When multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independentlyc) Formation of a flap intimately adhered to the rib caged) Chest trauma complicated by acute respiratory failuree) It is a severe form of pneumothorax

--------------------------------------------------------------------- 239. What is the cause of paradoxical respiration?a) Inhibition of the superior respiratory centersb) Respiratory muscle paralysisc) Flail chestd) Dilution of atmospheric aire) Decrease of cardiac contractions

--------------------------------------------------------------------- 240. In case of open pneumothorax emergency measures are:a) Urgent transportation of a patient to a hospitalb) Tamponade of the wound and occlusive bandage applicationc) Oxygen therapyd) Assisted respiratione) Aspiration from the pleural cavity

--------------------------------------------------------------------- 241. Choose the characteristic features of massive hemothorax:a) Pale tegumentsb) Marked dyspnea, cyanosisc) Tympanic sound on percussion, pleural friction rubd) Dull sound on percussion, absence of respiratory soundse) Bradycardia

--------------------------------------------------------------------- 242. Massive hemothorax treatment includes:a) Massive packed red blood cells transfusion

b) Pleurotomy with active aspiration from the pleural cavityc) Assisted respiration and circulating blood volume restorationd) Thoracotomy, surgical hemostasise) Clinical monitoring

--------------------------------------------------------------------- 243. Choose the appropriate management of thoracic wounds with suspicion of peritoneal cavity organ injury :a) Clinical monitoringb) Analgesics, opioid and nonopioidc) Diagnostic laparotomyd) Aspiration of gastric contente) Paracentesis, laparoscopy

--------------------------------------------------------------------- 244. Hemothorax:a) Is seen on X-ray, if the volume exceeds 500 mlb) Is characterized by pleuropulmonary compression syndromec) Tympanic sound on percussiond) Treatment consists of urgent thoracotomy if the volume is under 100 mle) Is accumulation of blood in the pleural cavity

--------------------------------------------------------------------- 245. Choose the indications for emergency thoracotomy:a) Posttraumatic cardiac arrhythmiab) Posttraumatic arteriovenous fistulac) Massive hemothoraxd) Diaphragm injurye) Closed pneumothorax

--------------------------------------------------------------------- 246. Features of traumatic injuries of the diaphragm are:a) They do not affect general state of the patientb) They may be penetratingc) Their symptoms vary depending on the body's positiond) Their surgical treatment is mandatorye) They manifest with obstructive, hemorrhagic and respiratory syndromes

--------------------------------------------------------------------- 247. Which of the listed below features does not fit pneumothorax:a) Dyspneab) Cyanosisc) Tympanic sound on percussiond) Dull sound on percussione) Absence of respiratory sounds

--------------------------------------------------------------------- 248. Pneumothorax consequences are:a) Intrapleural compression syndrome

b) Mediastinum deviationc) Increase of the affected thoracic side volumed) Healthy lung aeration disturbancee) Intestinal peristalsis impairment

--------------------------------------------------------------------- 249. Traumatic injuries of the diaphragm:a) Appear after penetrating thoracic woundsb) Is 0.5 -2% of all polytraumac) Do not affect heart activityd) Can be often complicated by prolapse of the abdominal organs to the pleural cavitye) Needs only conservative treatment

--------------------------------------------------------------------- 250. Which of the following can be attributed to the „ecchymotic mask":a) Inferior vena cava syndromeb) It appears as a result of elevated pressure in the superior vena cavac) Sclera hemorrhage is presentd) It is characteristic of thorax woundse) It is a result of thoracic compression

---------------------------------------------------------------------

Chirurgie nr.1

1. A2. C3. A4. D5. D6. B7. ABCE8. ACE9. E10. ACD11. AC12. ACDE13. AE14. BDE15. ACE16. B17. E18. E19. CDE20. AC21. CDE22. BD23. ADE

24. ABD25. BCE26. ABD27. ABDE28. ABCE29. CDE30. CD31. B32. D33. C34. ABCE35. B36. B37. A38. B39. A40. AE41. CD42. C43. D44. D45. CD46. A

47. BE48. DE49. D50. A51. A52. D53. C54. ADE55. AE56. C57. ABDE58. BCDE59. B60. D61. BE62. ABCD63. E64. C65. E66. AC67. C68. D69. D

70. C71. ACDE72. A73. D74. CE75. D76. E77. BCDE78. B79. D80. ABE81. ABD82. D83. D84. E85. B86. D87. C88. AB89. BC90. CE91. ABE92. A93. E94. A95. CD96. B97. B98. D99. ACDE100. D101. C102. E103. B104. C105. ABDE106. B107. C108. D109. ABCE110. D111. C112. C113. AE114. B115. B116. D117. C118. CD

119. ABD120. BD121. BCD122. BCE123. ABE124. AE125. ABCE126. ACE127. ADE128. ACD129. B130. B131. CD132. D133. C134. C135. D136. A137. BE138. E139. D140. B141. C142. B143. ACDE144. ABDE145. D146. D147. B148. D149. ABCE150. B151. D152. ACD153. B154. E155. DE156. BCD157. B158. C159. D160. BD161. D162. B163. ABCD164. D165. BCE166. B167. D

168. B169. ABCE170. A171. D172. D173. B174. D175. A176. ABDE177. A178. C179. E180. DE181. C182. B183. BDE184. ABE185. BC186. C187. ABC188. BE189. A190. ACD191. B192. ABCE193. B194. BCDE195. A196. D197. ABCE198. ACDE199. A200. BC201. A202. ABDE203. B204. CD205. ACDE206. A207. BCDE208. ABC209. ABDE210. A211. AE212. ABCE213. A214. D215. ACDE216. B

217. ACDE218. ACDE219. BCDE220. ABDE221. A222. CE223. E224. C225. ABDE226. B227. ACDE228. BCDE229. D230. B231. A232. B233. B234. B235. ABCE236. ABDE237. D238. B239. C240. B241. ABD242. ABD243. E244. ABE245. CD246. BCDE247. D248. ABC249. ABD250. BCE