Крок 2 Загальна лікарська підготовка_2004-2005

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40 year old patient presented to Emergency *Primary surgical Chest X-ray Ultrasound of CT scan. Bronchoscopy
department with the cut injury on the right side cleaning and thoracic Cavity
of the chest wall. Profuse bleeding from the exploration of Wound.
wound but the patient is in conscious, B.P –
1.
120/60 mm.Hg, pulse 100 beats per minute.
Which one from below listed methods allows to
define character of wound with the greatest
accuracy?
The patient K. 42 years old, presented with the * Thrombolytic Surgical treatment. Introduction of low- Elastic Bandage of Bronchoscopy.
diagnosis of “ Acute iliofemoral vein thrombosis therapy plus molecular wt. legs.
2. (1 rst. Day), Pulmonary artery implantation of Cava Heparin.
thromboembolism ” and admitted in vascular filter.
department of the Hospital. What is your tactics?
Patient K. 35 years old, after abortion * Electrocardiogram, Phlebography, Ultrasonogram of Palpation of stomach. Auscultation of
developed deep veins thrombosis of leg and on Chest X-Ray. Dopplerography. Abdomen. Lungs.
the 3-day cough and a retrosternal pain
3.
developed with hemoptysis. Which investigation
is necessary at first to make the correct
diagnosis?
73 years old patient hospitalized with the * Aortoarteriography. X-ray of Abdomen. Diagnostic puncture. Laparosynthesis. Irrigoscopy.
diagnosis of “ Tumour of Abdominal Cavity ”.
On examination: On the right side of the
abdomen a mass of 10х15 cm size is
palpated. Patient is suffering of
4.
ischemic heart diseases, Hypertension
ІІ-ІІІ stages. It is suspected an
aneurysm of an abdominal aorta. For
the verification of the diagnosis it is
necessary to execute:
25 years old patient presented to emergency *Cardiac Injury. Lung Injury. Pneumohemothorax. Bleeding from soft Injury of intercostals
department after 40 minutes of stab injury of tissues of chest wall. vessels.
chest in a projection of heart in a critical
5. condition. Confused, cold sweating, Blood
Pressure 60/20 mm.Hg, Pulse on peripheral
arteries was absent. What is the most probable
diagnosis?
 53 years old patient, complains of a heartburn, ( Plastic of a Lewis's operation Vandal’s operation Heller’s Operation. Esophagoectomy,
regurgitation of air, vomiting. In diaphragm according [Transhiatal resection [plastic of lower third Abdomino-cervical
esophagodudenoscopy: - Marked prolapse of to Belsey. of esophagus]. of esophagus.] Method.
squamous mucous of stomach into the
6. esophagus. In radiogram marked protrusion of
1/3 stomach into the posterior mediastinum.
Provisional Diagnosis – A sliding hiatal
hernia, ІІІ degree. What is the tactics
of treatment?
Patient В, 64 years, complains of *Endoscopic Heller’s Operation. Esophagoecotmy Operation Vandal’s Lewis's operation
difficulty in swallowing solid food, removal of a tumour. Экстирпация [plastic of the Lower [Transhiatal resection
vomiting, weakness, loss of weight. In Esophagus third of esophagus]. of esophagus].
esophagodudenoscopy on a posterior- Abdomino- cervical
7. lateral wall, sub mucous layer tumour Method.
with the precise contours, easily movable is
determined. The diagnosis: Benign tumour of
lower third esophagus [Leiomyoma]. Your
tactics?
Patient [Female] 48 years old, chief complain of * Heller’s Operation. Conservative Vandal’s Operation Esophagoectomy Lewis Operation
dysphasia for solid and liquid food, nausea, and treatment: Cerucal, [Plastic surgery of Экстирпация [Transhiatal resection
fatigue. In radiographic examination of Rantac, No-spa, lower third Abdomino-cervical of esophagus with
esophagus- stricture of lower third esophagus Intravenous infusion. esophagus]. Method. gastroplasty].
8.
and dilatation of upper third esophagus. Positive абдомино-
Symptom [ ] Diagnosis- цервикальным
Cardiospasm III stage. What is the volume of access.
necessary treatment needed?
Patient К, 65 years old, inpatient of * Pulmonary artery Heart attack of a Hypoglycemic Coma. Hyperglycemic Coma. Perforation of
surgical department of hospital after thromboembolism. myocardium. stomach Ulcer.
hernioplasty on the 6 day suddenly
9.
lost consciousness; there was cyanosis
of the upper part of a thorax and the face
and dyspnea. What is the diagnosis?
Patient А., 44 Years old, presented to * Right sided Post- Right sided post- Отрыв Main Right-sided Hematoma
Emergency Department after 3 hours of trauma traumatic traumatic excudative Bronchus. Hemothorax. Mediastinium.
with chief complain of Right sided Chest pain, Pneumothorax. pleuritis.
Dyspnea, Fatigue, Dizziness. Cyanosis. Unstable
10.
Hemodynamic. On Chest X-ray-Fracture of
Right four Posterior-Lateral ribs, Collapse of
right lung 2\3 Volume. What is the possible
diagnosis?
 Patient 19 years old, Presented to Emergency ( Abruption of Left Left sided total Fracture of left Ribs, Left sided Post- Left sided post-
department in critical condition after Trauma of main bronchus. Hemothorax. left sided Pneumo- traumatic traumatic pleuritis.
Chest with chief complain of Left sided chest hemothorax. pnemothorax.
pain, Dyspnea, Fatigue, left sided massive
11.
subcutaneous emphysema of chest wall. On
chest X-ray Atelectasis of left lung, Shift of
mediastinal organs to left. Cardiac cavity not
enlarged. Your Diagnosis?
36 years old patient presented with complains of *Pneumothorax. Posttraumatic Empyema of pleura. Pleuritis. Posttraumatic
dyspnea, dizziness. History of Thoracic trauma 2 Hemothorax. pneumonia.
days back. On examination decrease movement
12. of the left side of the chest wall. On chest X-ray
– Collapse of the 1/3 of left lung. Fracture of left
4-6 ribs. What are the possible complication
patients has developed?
Patient К. 19 years old admitted with *Left sided Tension Fracture of Ribs. Injuries of a chest Cardiac Injury. Hemothorax.
the diagnosis “Chest Wall Trauma Pneumothorax. wall.
(Thoracic Trauma)” with Complain of
difficulty in expiration and inspiration. On
13. examination patient is pale. Blood Pressure
90/50 mm.Hg. On auscultation: Silent on left
side (no breathe Sound). On chest X-ray:- Shift
of mediastinal organs to right, atelectasis of left
lung, your diagnosis?
45 years old patient admitted in a clinic in a * Empyema of Bronchitis. Pleuritis. Pneumonia. Pneumothorax.
critical condition. Before admission patient was pleura.
suffering from pneumonia for 3 weeks. On
examination: - Skin and mucous membrane dark
14. - earthy color, a body temperature 38c, Dyspnea
on rest, decrease breathe on the left side.
Productive Cough with large amount of sputum.
On chest X-ray. What is the most probable
diagnosis?
32 years old patient presented in a hospital in a * Mediastinitis. Heart attack. Abscess of lung. Pneumothorax. Pneumonia.
critical condition with chief complain
of acute retrosternal chest pain with
radiation to back. On examination:-
skin and mucous are pale, t-38,8 С.
15.
Marked subcutaneous emphysema of
soft tissues of a neck, одутловатость
face. On the eve ate fish. On Chest X-
ray expansion of mediastinum is revealed. What
is the most probable diagnosis?
 48 years old patient, suffering from *Reconstructive Conservative therapy. Compression Phleboectomy. Phlebo-sclero-
postphlebetic syndrome of the left leg since 2 operation on deep treatment. obliteration.
years. On examination: Dilated superficial veins veins of the left thigh.
16. of left leg and thigh, and pubic region, a
significant swelling of the left leg. Light
physical exertion aggravates pain. What kind of
treatment should be recommended to patient?
52 years old patient admitted in vascular *Acute iliofemoral Erysipelas of the right Acute Lymphostatsis. Phlegmon of the right
department of the hospital with sever edema and vein thrombosis. leg. thrombophlebitis of Leg.
pain of holding apart character in the right leg superficial veins.
and thigh, aggravated by passive movements.
17.
On examination: On the right leg sever edema
starting from the foot till inguinal ligaments are
observed cyanotic skin. What is the most
probable diagnosis?
67 years old patient Hyperstenic features, *Ultrasonic duplex Functional tests to Phlebography. Dopplerography of Isotope Phlebography.
suffering from varicose veins of both legs since scanning. determine the deep veins.
18 years. During last 2 years three times had condition of Valve.
thrombophlebitis of superficial veins of the
18.
right leg. 4 months back on the lower third of
right leg trophic ulcer developed. What
method of investigation is informative for
specification of the diagnosis of the patient?
A 35 years old patient complains of a difficult *Corrosive Esophagitis Esophageal Cardia Achalasia Cardia insufficiency
swallowing, pain behind the breastbone. He can Esophagitis and diverticula
eat only liquid food. While swallowing strictura
sometimes he has attacks of cough and dyspnea.
19.
Above mentioned complaints is progressing. It
is known that the patient has had a chemical
burn of esophagus one month ago. What
complication does the patient have?
A 42 years old man with long history of disease * Hiatus hernia of Chronic pancreatitis Ischemic heart Gastric ulcer Mediastenitis
complains of a frequent heartburns, moderate esophagus disease
pain in epigastrium and behind breastbone
propagated in the back in point between
shoulder blades. Pain appears with meals or just
after meals and can be provoked by physical
20.
exertion. Also he has had a relapsed
bronchopneumonia earlier and events of melena.
The CBC reveals anemia. On X-Ray film there
is a bubble of gas in the posterior mediastinum.
ECG documents an arrhythmia.
What is your diagnosis?
 A 70 years old woman had had a planned *residual Papillostenosis tumour of the tumour of the large choledochus stricture
laparoscopic cholecystectomy done according choledocholithiasis pancreas head duodenal papilla
biliary calculi. Six months later the patient again
has attacks of severe pains in the right
21. hypochondrium accompanied by jaundice and
dark urine and stool discoloration. The total
serum bilirubin is increased up to 60 mcmol/l,
direct 40 mcmol/l. What disease does the
patient have?
A 60 years old woman has been ill with chronic * endoscopic cholecystectomy, cholecystectomy, cholecystectomy, cholecystectomy,
calculous cholecystitis for 10 years. During the papillosphincterotomy choledocholithotomy, transduodenal choledochoduodenosto choledochojejunostom
treatment in sanatorium the patient had had a , laporoscopic external choledochus papillosphincterotom my y
hepatic colic with jaundice. Ultra sound cholecystectomy drainage according to y
22. investigation revealed a lot of calculi sized 5-6 Kerr
mm in the gallbladder. Choledochus is widened
to 15 mm and contains concrements up to 6 mm
in diameter in the distal part. What method of
treatment is the most adequate and current?
A 58 years old woman with overweight right * retrograde intravenous infusional intracutaneous ultra sound
before has had an attack of right cholangiopancreatogra cholegraphy cholegraphy intrahepatic investigation of the
hypochondrium pain and jaundice with dark phy cholegraphy hepatopancreatobiliar
urine and stool discoloration appeared. On y zone
clinical examination the abdomen is distended
23. and painful on palpation in the right
hypochondrium, The mild liver enlargement
there is. In blood the total bilirubin is 90
mkmol/l, direct (conjugated) 60 mkmol/l .
What investigation is the most informative to
clarify the diagnosis?
A 62 years old woman complains of * Acute cholecystitis, Infectious hepatitis Liver cancer Liver abscess Liver cirrhosis
severe constant pain in the right choledochus calculi
hypochondrium, jaundice, and obstructive
discoloration of stool and dark urine, jaundice
mild fever up to 37,5оС. Above
mentioned complaints were appeared
24.
after an attack of severe abdomen pain
connected with fatty food intake. On clinical
examination the abdomen is soft. A painful
enlarged gall bladder is palpated. The Orthner,
Kerr’s symptoms are positive. What is the
probable diagnosis?
 A 22 years old woman was admitted to the * Acute appendicitis Acute appendicitis Acute Pyosalpinx Tubo-ovarian abscess
reception department. She complains of severe and ectopic salpingoophoritis
cramping lower abdomen pain occurred pregnancy.
unexpectedly, general weakness, sleeplessness,
appetite loss and fever up to 39,90 C. At first
the pain was appeared in point between
umbilical region and epigastrium and then it was
localized in the in the right iliac region. The
patient recall the last menses 8 weeks ago. On
clinical examination the abdomen is soft,
25. painful in the right iliac. The Schyotkin –
Blumberg’s symptom is slightly positive,
Michelson’s symptom is clear positive. On
bimanual gynecological examination the soft
uterus is enlarged according pregnancy onset.
Near the uterus there is a soft swelling
identified as a separated ovary. In CBC the
WBCs (leucocytes) are 15x109 /l. Their
formula shows bandemia. There is high ESR up
to 65 mm/h. What is the most probable cause
provoked above written condition?
A pregnant woman with 24 weeks gestation *To send the patient To observe the patient Medication therapy Emergent diagnostic Urgent interruption of
term has felt a cramping pain in low abdomen. to the in-patient for the next 24 hours at abdominal cavity pregnancy
Nausea and vomitting are absent. She looks for department at once to home to clarify the puncture through the
a medical aid in the gynecologic out-patient solve the problem of condition posterior vaginal
office. On clinical examination the abdomen is urgent surgical fornix in this female
26.
soft and tender on the right. The Schyotkin – operation dispensary office
Blumberg, Rovzing, Koap’s symptoms are
slightly positive and Brendo, Michelson’s signs
are strongly positive. What is the most adequate
tactics of the doctor in the situation?
A 45 years old woman was operated because of * Endoscopic Choledocholithotomy Choledocholethotom Choledocholithotomy Choledocholithotomy
biliary calculi and obstructive jaundice. A two papillosphincterotomy with close seam on y choledochojejunostom and drainage of the
months later after operation there is continuing and removing a choledochus; choledochoduodenost y; choledochus.
bile discharge up to 500,0-600,0 ml per day concrement from omy;
through the Kerr`s external choledochus choledochus;
27.
drainage. On fistulography using the drainage in
the distal part of the choledochus “a forgotten
stount” up to 8 mm in diameter was identified.
The choledochus is dilated up to 16 mm. The
most correct surgeon treatment in this case is:
 A 19 years old man was admitted to the *Pericardium Massive hemothorax Open pneumothorax Closed pneumothorax Valve-likes
reception department in 20 minutes after a knife tamponade pneumothorax
wound of the left chest. The patient is confused.
The heart rate is 96 beats per minute and blood
28.
pressure 80/60 mm Hg, The dilated neck veins,
sharply diminished apical beat and evident
heart enlargement there are. What penetrative
chest wound complication is described?
Classical X-ray image of intestinal obstrustion *Gas and horizontal Filling defect High positioned Reactive pleuritis Pneumatosis
29.
is: levels diaphragm
54 years old patient, presented with dizziness, *Non- specific Crohn’s Diseases. Acute intestinal Chronic cholecystitis. Duodenal Ulcer with
an episode of decreased brain blood circulation, ulcerative colitis. ischemia. penetration.
complains of a pain over the umbilicus after
meal ,sometimes very sharp, is accompanied by
30. vomiting, a episode of diarrhea. History of
Blood in stool sometimes. Cardiac activity
arrhythmic, extra systole. Moderate tenderness
around umbilicus. What is the most probable
diagnosis?
45 years old man presented with chief *Carbuncle of lumbar Abscess of lumbar Erysipelaous Para nephritis. Renal Colic.
complains of rise in temperature up to region. region. inflammation.
38c, pain and swelling in lumbar
region and painful mass 5х6 sm. in
31.
size, crimson color of skin over the
mass, in the center purulent -
necrotic fistulas which is secreting pus.
What is the most probable diagnosis?
Patient К, 43 year’s old hospitalized in *Rupture of contents Compression of portal Occurrence of a viral Intoxicytic hepatitis Suppuration of cyst
surgical department of the hospital of cysts into hepatic vein with occurrence hepatitis. due to absorption of with occurrence
with the diagnosis of Mechanical jaundice, ducts. of portal hypertension ecchinococcus fluid purulent cholangitis.
cholangitis. During echographic researches with jaundice. (Hydatid cyst fluid).
32. found out Huge hydatid cyst of liver
(echinoccocus of liver), dilatation of
CBD(Common Bile duct) and intrahepatic ducts.
What is the mechanism of jaundice in
echinoccocus of liver?
Patient K, 54 years old operated for hydatid cyst *Intraoperative Intraoperative Intraoperative Intraoperative X-ray Abdomen and
of liver, during operation found two cysts echography. Cholangiography. Choledochoscopy. Retrograde Pelvis.
instead of three, as it has been diagnosed in the Cholangiopancreatogra
33.
preoperative period. Which methods of phy.
investigation will be accurate to locate the third
cysts?
 65 years old patient complains of a pain in the *Carcinoma of Cancer of the right Appendicular Crohn’s Diseases. Retroperitoneal
right iliac fossa, loss of weight, decrease Caecum. kidney. Infiltrate. Tumour.
appetite, weakness, and history of constipation
more than 6 months. Objectively: dry, muddy
colored skin, On palpation On the right iliac
fossa – infiltration (mass) 8х10 sm. Size.
34. Which is almost not displacing
(Immovable), on percussion dull sound
above the mass. On auscultation
peristalsis is increased. Нв blood - 86
g/l. What is the most probable
pathology that might have causes
such clinical picture?
Patient K, 42 years old, is hospitalized in *Pneumogastrography Pneumoperitoneum. Laparosynthesis. Contrast (dye) Fibrogastroscopy.
surgical department with complaints of acute . investigation of
sharp pain in the stomach, vomiting. Suffering stomach and
from a duodenal ulcer for last 8 years. Suspected duodenum.
35. as a Duodenal Perforation, however free fundus
gas in abdominal cavity is not revealed. The
ulcer is suspected as covered perforation. What
method of diagnosis should be applied for
correct diagnosis?
Patient B. 74 years old is hospitalized in surgical *Taylor’s Method. Infusion therapy. Antibacterial therapy. Start Ulcer Therapy Discharge the patient.
department with the diagnosis of perforated
stomach ulcer. In the anamnesis heart attack of
36.
a myocardium, diabetes, Hypertension. The
patient was advised for Operation, which patient
categorically refused. How to treat the patient?
A 32 years old patient presented with sudden * Leptospirosis. Viral hepatitis A Viral hepatitis E Acute pyelonephritis Food poisoning
rise in temperature, High grade fever,
headache, pain in stomach and lumbar region,
yellowish discoloration of skin. Urine out put of
37.
the patient is 100 ml dark muddy colored. Later
with theses symptoms Muscles pain is added.
One week ago the patient went for fishing. What
is the probable diagnosis?
28 years old patient presented with history of * Gangrenous. Cataral. Phlegmonic. Perforated Empyema of the
14 hours constant pain in right iliac fossa.In appendix
last 2 hours the pain has decreased. Objectively:
Local guarding of abdominal muscles.
38.
Diagnosed as acute appendicitis. What
histological form of acute appendicitis could
result in reduction of intensity of a pain of a
stomach?
 A 35 year old woman was admitted to thoracic * Abcsess of the lungs Complication of liver Bronchectatic disease Actinomycosis of Tuberculosis of lungs
surgery department with elevation of body echinococcosis lungs
temperature upto 40 0 C, onset of pain with deep
39.
breath in the side, cough with big quantity of
purulent sputum and blood with bad smell. What
disease causes these symptoms?
Which of the listed below opertion are not done *Gastrostomy Resection of 2/3 - 3/4 Vagotomy + Vagotomy + resection Suturing of the ulcer
40.
in cases of perforative duodenal ulcers ? of the stomach Pyloroantrumectomy of the ulcer
What preparations are used for prevention of *Fluconozol, Orungol, Rubomycin, Cytosar, Cormyctin, Captopril, Enalapril. Isoniazid, Ftibazid,
41. fungal infection? Nisoral. Bleomycin, Lomycitin Pyrazinamid.
Mytomycin C.
Patient Н, 44 years old, is hospitalized *Intraoperative X-ray of Abdomen. Intravenous Per oral Echography.
in surgical department with the cholagiogrpahy. Cholecystocholangio Cholecystography.
diagnosis – of postcholecystectomic graphy.
syndrome, residual choledocholithiasis,
cholangitis, and mechanical jaundice. Operated
42. 8 months back, done cholecystectomy,
Choledocholithotomy, drainage of abdomen
according to Keru. What from of below-
mentioned procedure would be appropriate to
avoid occurrence of postcholecystectomic
syndrome?
30 years old woman, 15 days ago had mild *Bony. Hypodermic Paronychia Tendon Type. Joints Type.
trauma of 5th finger of the left hand. Treated her
self at home independently, Due deterioration of
a condition she visited hospital for medical
advice with rise in temperature up to 36 0c.
Objectively: Hypermia and swelling on the
ventarl surface of finger. Restricted
43.
Movements of the finger. X-ray of the
left hand: It is impossible to exclude
an early stage of development
оsteomyolitis of the fifth finger. The
diagnosis: Panarchy of 5th finger of
the left hand. What form of Panarchy
has occurred in the patient?
Contraindications for operation in acute * Hemodynamic Functional Purulent and septic Peritonitis Erosive bleeding
pancreatitis are: unstability and insufficiency of the complications
44.
pancreatogenic shock parenchymatous
organs
 The patient, 43 years old is hospitalized with * Acute intestinal Food poisoning Hepatic Colic. Acute pancreatitis Hepatic Colic.
complaints of repeated vomiting, spasmodic obstruction.
pain in the abdomen, delay in passes of gases
and stool. History of the patient - appendectomy.
Objectively: Position of the patient -lying, pale
skin. Pulse 90/ minutes. Blood Pressure - 110/80
45.
mm. Hg, t - 37, 2 oc Moderately distended
abdomen, asymmetric, rigidity on the lower part
of the abdomen. Increased peristalsis. Rebound
tenderness- negative (Shetkina- Blumberg).
Manual per rectum analysis of rectum- empty
ampoule. Your diagnosis?
A 41 year old patient was admitted to the * Introduction of Intravenous Hemostatic therapy Operation Administration of
intensive care unit with hemorrhagic shock due obturator nasogastric administration of plasma
to gastric bleeding. He has a history of hepatitis tube. pituitrin
46.
B during the last 5 years. The source of bleeding
are esophageal veins. What is the most effective
method for control of the bleeding?
What developes in cases with decompensated * Isotonic Hypertonic Hypotonic Intoxication. Renal insufficiency.
47. pyloric stenosis: dehydration. dehydration dehydration.
(eksikosis).
The diagnosis – melanoma was made to a 16 * Peytz – Egers’s Chron’s disease. Tuberculosis of the Adolescent polyposis. Hirschprung’s
year old patient after examination with polyposis. intestine. disease.
complaints of frequent pain in the abdomen,
pigmentation of the mucosa and skin, polyp in
48.
the stomach and large intestine was found. It is
know that the mother of the patient analogous
pigmentation and was treated often for anemia
What disease is suspected?
What developes most often after accidental * Cardiac Cushing’s syndrome. Kutling’s syndrome. Deylads's syndrome. Acute pancreatitis.
49.
intake of Hydrochloric acid: insufficiency.
Patient С, On chest X-ray found *Right sided Left-sided Empyema Pleura. Mediastinitis. Pneumomediastinium.
collapse of the right lung, dislocation Pneumothorax. Pneumothorax.
of the mediastinum on the left. During
50.
puncture of the pleural cavity 2.5 L. of
air is allocated. What is your
diagnosis?
Patient of 23 years old suffering from acute *Antibiotics Saluretics. Kurantil Heparin Prednisolone.
glomerulonephritis with nephrotic syndrome,
51.
Initial Phase with normal renal function. What is
the baseline treatment?
 65 years old patient had been on observation *Fibrogastroduedenos Ultra sonogram. Pneumoperitoneum. Roentgenoscopy of ERCP
for 5 years concerning an ulcer of antral part of a copy with biopsy. Stomach.
stomach. Patient refused operation. Since last 6
months patient is having constant pain in the
epigastric region. Disgust to meat products has
52. appeared. Working capacity has decreased. The
patient has become thin. In contrast examination
of the stomach circular form of defect of a
mucous membrane up to 5 sm. in diameter and
aperistaltic zone is revealed. What is an effective
method of verification of the diagnosis
38 years old man suffering form duodenal ulcer * An ulcerative Acute pancreatitis. Achalasia, Cancer of a stomach. The covered
for long time, patient start feeling constant stenosis of pyloric esophagitis. perforation of an
heaviness in a stomach after meal, regurgitation, canal. ulcer.
vomiting food contains which he had in the
evening of the previous day, weight loss.
Objectively: Relatively satisfactory condition of
53.
the patient, appetite not changed, Turgor of skin
is reduced. On palpation the stomach is soft,
symptoms of irritation of abdomen is not
present, “noise of splash “in epigastria region.
Urinations normal. Stool once in 3 days. What
complication has occurred in the patient?
A 60 year old patient complains of the *Chronic lung abscess Acute abscess of the Left sided destructive Left sided chest TB Bronchiectasis
weakness, loss of appetite, periodic fever up to with in bronchus left lung pneumonia
38-40 o C , loss of body weight, cough with a drainage
purulent sputum in a small amount on daytime
and large up to 300-400ml sputum discharge
with stinking smell on morning. He is chronic
patient suffering from chronic lung emphysema
within 10 years. At the past he had had an acute
left sided pneumonia of the lower lobe 8-10
weeks ago. After that he noticed a mild mainly
on evening fever and night sweats. The above
mentioned complaints was appeared 4 days ago.
54. On physical examination the patient looks toxic.
There are severe underweight, grey skin,
unpleasant small from the mouth, finger
clubbing, asymmetric chest secondary to the air
entry limitation on the left. On auscultation the
breathing sounds are diminished in the lower
chest on the left and pleural rub phenomenon is
defined here. Over other chest surface a moist
rales are heard. The chest X-Ray reveals a
pneumosclerosis and lung cavity with liquid
level and thick walls sized 10x7cm in diameter
in the upper lobe on the left. What is the
diagnosis of the patient?
 The diagnosis of Right sided pnuemothorax is *Surgical treatment: Antiinflammation Symptomatic therapy. Pleural puncture. Thoracotomy.
55. made to a 36 year old patient. What method of Drainage of the therapy.
treatment is indicated to the patient? pleural cavity.
A 33 years old patient was admitted to the *Carbuncle Furuncle Acute skin cellulitis Carbuncle associated Skin abscess
reception room of the Central District Hospital. with anthrax
He complains of a severely painful swelling
localized on posterior neck, fever up to 38,4oC
and general weakness. It is known that the
patient suffers from diabetes mellitus within 5
years. On physical examination on the posterior
neck surface there is an infiltrate elevated above
56. surrounded skin. The tissues affected by
swelling are tens and blue reddish discolored
in central area. There are also several purulent
necrotic pustules which are connected with each
other and formed a large skin necrosis. A
thinned necrotic skin of this swelling has a holes
look like sieve and a pus is discharging through
out. What disease should a doctor consider
first of all?
Patient B, 63 years old is hospitalized in thoracic *Insufficient Cicatricial stenosis of Hiatal Hernia. Varicose of Tumour of lower third
surgery department with complaints of nausea, development of esophagus. Esophageal vein of esophagus.
vomiting after taking food, weakness, loss of Auerbach’s plexus. (Esophageal Varices).
57. weight. After radiological investigation the
diagnosis is as follows: - “Achalasia Cardia”.
What from below-mentioned is the reason of
this disease?
A 38 year old woman was hospitalized to the * Acute pancreatitis Renal colic Acute enterocolitis Perforative gastric Acute appendicitis
surgical unit with acute abdominal pain ulcer
58. irradiating to the spine and vomiting. On
laparocentesis hemmorhagic fluid is obtained.
What disease is suspected?
Purulent medisatinitis is diagnosed on a 63 year * Cervical Deep nech phlegmon. Perforation of the Perforation of the Iatrogenic injury of
59. old patient. What of the below listed diseases are lymfadinitis. cervical part of the thoracic the the trachea.
not the cause of purulent mediasdtinitis? easophagus. easophagus.
A woman born in 1952 consulting by a doctor in * Acute abscess of the Acute cellulitis of the Hematoma Carbuncle Furuncle
the out-patient office complains of a reddish loin skin loin skin
bordered swelling in the low back skin appeared
3 days after branch tree prick. The fever is mild
up to 37,9 C. Other complains are the general
60.
weakness, headache, malaise and appetite loss.
On physical examination on the loin skin a
swelling and hyperemia are revealed. On
palpation there is a positive fluctuation
symptom. What is the most probable diagnosis?
 A 42 years old patient consults by a surgeon *episipeloid Erysipelas acute lymphangitis acute panaritium Paronychia
with complains of the painful, severely itching
and hyperemic thumb of the right hand. It is
known that the patient has pricked his finger
with a fish bone one week ago. On examination
61. the affected thumb is rosy red and painful on
touch. There is a red bordered and elevated
above the surrounding skin spot. The chest and
heart are symptomatic free. The heart rate is 80
per min. Blood pressure is 130/90 mm Hg, Body
temperature is 36,70 C. What’s the diagnosis?
Patient Е, 51 year old is hospitalized in *Fibroduedenoscopy Echography. X-ray Abdomen. Pneumogastrography. Computer
gastroenterology department with with biopsy of tomography.
complaints of jaundice, loss of weight, ampulla of Vater.
weakness, dark color urine, and light
62. colored stool. Diagnosis: Mechanical
jaundice, Cholangitis. Disease began gradually.
Suspected as Cancer of ampullae’s of vater.
What diagnostic method should be applied for
confirmation of the diagnosis?
A 15 years old teen complains of high fever up *Haematogenic Bone TB (tuberculosis) Paget’s disease Osteosarcoma Myeloma
to 39,5 – 40 0 C and a local metaepiphesal osteomyelitis
localized in low one third of hip pain. There are
local skin hyperemia, soft tissues swelling and
63.
knee movements restriction secondary to the
pain. The patient denies the trauma. Blood
WBC (leucocytes) are 15x10E9. X-ray reveals
hip bone destruction and sequestration.
The 67 years old patient within 5 years had had *Paget’s disease hyperparathyoid chronic osteomyelitis myeloma mottled disease
5 recurrent fractures of the lower extremities dystrophy (marble disease)
without considerable cause. O-shaped deformity
of the legs in the knee joints was appeared. The
skull, pelvis and lower extremities X-Ray films
64.
shows the thickening of flat bones. In the long
bones there is a hyperostosis along the bone
axis. The blood tests does not reveal any
inflammation activity. Serum calcium is normal.
What disease do you consider in this case?
45 years old woman complaints of pain and * The deforming Non-specific arthritis Specific arthritis Polyarthritis Radiculitis
movement restriction in the right hip joint. The arthrosis of the right
disease is in progress. The history of trauma is hip joint
65. negative. The X-Ray does not reveal malignancy
or inflammatory disease but only shows an
angled disproportions and ostephytes. What is
the diagnosis?
 The 45 years old man locksmith complains of *Dupuytren’s Myogenic contracture neurogenic Ischemic contracture tendinous contracture
poor fourth and fifth fingers straitening in the contracture contracture
right hand. He is ill whithin 6-7 years. Every
year the disease worsens. On examination the
66.
fourth and the fifth fingers are flexed and can
not be even passively extended. The X-Ray
does not reveal any bone damage. What kind of
contracture do you consider in this case?
The 35 years old patient has severely restricted *ankylosing osteochondrosis tuberculous polyarthritis radiculitis
movement ability in the vertebral column. spondylarthritis spondylitis
Within 3 years the patient has had a persistent
pain and progressive stiffness in the low back
67. later spread out into the thorax and cervix. The
patient did not look for medical help before. The
history of back trauma or acute disease is
negative. The laboratory tests are normal. What
disease do you consider in this case?
The patient man-welder (profession related with *operative ultrahighfrequency tight bandage puncture magnetotherapy
long standing on knee position) was consulted bursectomy (UHF)
by a doctor because of development knee joint
swelling and knee pain at working time. On
examination there has been found a soft
68.
bordered swelling localized lowly from patella
with normal color and callous skin. There is not
local hyperthermia. The X-Ray does not reveal
any destructive impairment of the bones. What
is the treatment?.
The sick woman complains of fever up to to *Acute otitis media Furuncle of the Acute mastoiditis Acute external otitis Exacerbation of
38,20C, severe earache reflected into the left external auditory chronic otitis media
temple and persistent headache. Also there is meatus
hearing depletion. She fall in illness 3 days ago
after common cold. Otoscopy shows normal
auricle and external auditory meatus without
69.
pathological features. Palpation of trugus and
papillae - like spout is painless. Tympanic
membrane looks red and bulged with indistinct
landmarks. Whisper is perceived by the patient
from 0,8m of distance and colloquial speech
only from 3 m. What’s a probable diagnosis?
 A 38 years old woman complains of a purulent *Acute purulent Acute purulent frontitis Acute purulent Acute purulent Purulent rhinitis
discharge from the left nostril. The body maxillary sinusitis ethmoiditis sphenoiditis
temperature is 37,50C. The patient is ill during
a week and associates her illness with common
cold. pain on The palpation of her left cheek
70.
reveals tenderness.. The mucous membrane in
the left nasal cavity is red and turgescent. The
purulent exudates is seen in the middle meatus
in maxillary. What is the most probable
diagnosis?
34 years old patient, during tooth filling * Urgent Urgent Diagnostic Urgent Rigid Thoractomy, Antibacterial therapy,
accidentally inhaled a dental pine. Referred to Fibrobronchoscopic Fibrobronchoscopy. Bronchoscopic Bronchotomy, removal Cough expectorants,
emergency department of Hospital. Complain of removal of the foreign removal of the of foreign body. Control Chest X-ray.
71. moderate dyspnea, dry cough, dizziness, and body. foreign body.
disturbed. On Chest X-ray on the hilar region of
right lung identified radio opaque subject. What
volume of the help is necessary in this case?
A patient complains of a general weakness, * Membranous Follicular streptococcal Acute viral Diphtheria Hypertrophic
fever, muscle and joint pains and sore throat. (lacunar) tonsillitis pharyngitis pharyngitis
The pain is increasing on swallowing. Throat streptococcal
examination reveals pink mucous membranes of tonsillitis
72. the pharynx. The tonsils are congested and
swelled. There is membranous exudate in crypts.
This membranes aren’t spreading out of the
tonsils border and can be removed easily.
What is the previous diagnosis?
The patient factory worker has been brought in *Roentgenography of Roentgenography of boneless eye eye ultrasonography
the department emergency by ambulance. The the orbital cavity by f the orbital cavity in roentgenography by electroplatismagraphy
admission diagnosis is the penetrating cornea Komberg – Baltin two projections A.Vogt
injury of the right eye. On the slit lamp
examination the low intraocular pressure,
73.
corneal swelling and adgesion of injured
corneal margins in paraoptical zone have been
detected. The depth of anterior chamber is 2,5
mm. What method of the following
investigations mast be carried out first?
The patient complains of eyelids redness and *investigation for conjunctival sac checking up the consulting by an testing blood glucose
swelling, troublesome itching of the eyelids demodicidosis bacteriological smear refraction allergologist
margin and eyelashes loss. He is being consulted
74. by an ophthalmologist in the local public health
center. The doctor prescribes various eye drops
preparations with relapsed effect. What kind of
investigation should be carried out?
Diarrhea is not typical but still often symptom * in case of pelvic in case of peritonitis in infants and early in case of retrocecal when acute
of acute appendicitis in children. In what case appendices location aged children appendicitis appendicitis is
75.
diarrhea is exact sign of appendix inflammation: secondary to acute
enterocolitis
 The child with the symptoms of acute *to examine the child to examine the child in to have laparoscopy to wait for child`s to admit the child to a
appendicitis has been brought to the in-patient under general spite of his temper taken physiological sleeping hospital for
76. department by ambulance. Examination is anesthesia observation by
impossible because of his negative contact children’s doctor and
faulted behaviour. What are you to do? the surgeon
On the second day after birth the newborn has * development of resolution of pylorostenosis; Ledd’s syndrome; congenital diaphragm
multiple duodenal content vomiting. Meconium congenital ileus; congenital ileus; hernia.
77. didn’t pass away. The abdomen is soft and
distended in the upper region but retracted in the
lower one. The correct diagnosis is:
The 5 month old child has become uneasy after * intussusception intestinal infection; dyspepsia; gastrointestinal acute ileus.
first time carrot puree feeding. There is multiple hemorrhage
vomiting. The general condition is moderate. (bleeding);
The abdomen is not distended and soft. By rectal
78.
examination there has been found that the feces
contain much mucus with bright blood
admixture and looks like red currant jelly. What
disease does the child have?
The symptoms and signs of acute appendicitis *descending Medial Retrocaecalis typical left- hand side
depends on the anatomical location of appendix. location
79.
What kind of location promotes signs of urine
tract irritation and the diarrhea?