#one

*! Which of the following is the MOST likely complication of acute appendicitis?

* acute phlegmonous appendicitis

* acute catarrhal appendicitis
* mesenteric thrombosis
* appendicular infiltrate +
* appendicular colic

#2
*! What clinical symptom is MOST typical for acute appendicitis?

* Murphy
* Razdolsky +
* Mondora
* Spijarny
* Elekera

#3
*! Which of the listed research methods is the MOST informative in making the diagnosis of
cholelithiasis?

* FGDS
* Ultrasound of the abdominal cavity +
* oral cholecystography
* biochemical blood test
* X-ray of the abdominal cavity

#four
*! WHAT ELEMENTS FORM THE KALO TRIANGLE?

* hepatoduodenal ligament, gallbladder, liver

* left hepatic artery, right hepatic artery, liver
* cystic artery, cystic duct, common hepatic duct +
* gallbladder, hepatoduodenal ligament, duodenum
* right hepatic artery, cystic artery, common hepatic artery

#five
*! What is the most common cause of acute pancreatitis?

* environmental factors
* alimentary factors +
* hereditary factor
* injury to the pancreas
* volumetric operations on the abdominal organs

#6
*! What is the basis of the pathogenesis of acute pancreatitis?
* autolysis +
*inflammation
*degeneration
* violation of the innervation of the gland
* violation of the blood supply to the gland

#7
*! What clinical sign is the MOST characteristic of gastroduodenal ulcerative bleeding?

* symptom of Spijarny
* plank belly
* vomiting of "coffee grounds" +
* "Dagger" pain
* Bailey's symptom

#eight
*! What clinical sign is the MOST characteristic of gastroduodenal ulcerative bleeding?

* melena +
* Kulenkampf's symptom
* vomiting not bringing relief
* "Night" pain
* symptom of Khvostek

#nine
*! What symptom is the MOST characteristic of a perforated ulcer?

* Kocher-Volkovich
* Sitkovsky
* Botkin
* Sklyarova
* Spijarny +

#10
*! What symptom is MOST typical for pyloroduodenal stenosis?

* Kocher-Volkovich
* Dielafoy
* Sklyarova
* Khvosteka +
* Voskresensky

#eleven
*! What symptom is MOST probable with pyloroduodenal stenosis?

* Sklyarova
* Voskresensky
* Spijarny
* Dielafoy
* Trousseau +
#12
*! What clinical sign is MOST typical for pyloroduodenal stenosis?
* splash noise in the epigastrium +
* disappearance of hepatic dullness with percussion
* plank belly
* dagger pain
* melena

#13
*! What sign is the MOST characteristic of an external hernia of the abdomen?

* symptom of a barking cough

* symptom of a falling drop
* a symptom of deathly silence
* symptom of a cough thrust +
* symptom of a geographic map

#fourteen
*! What anatomical structure is most likely to form the external opening of the inguinal canal?

* legs of the aponeurosis of the internal oblique muscle of the abdomen

* legs of the aponeurosis of the external oblique muscle of the abdomen
* legs of the aponeurosis of the transverse abdominal muscle +
* aponeurosis of the rectus abdominis muscle
* iliac crest

#fifteen
*! Which of the following research methods is the MOST informative in making the diagnosis of
esophageal diverticulum?

* X-ray contrast study +

* radionucleide research
*CT scan
* esophagoscopy
* Ultrasound

#sixteen
*! For which pathologies listed below are the MOST often used for pleural drainage according to Bulau?

* acute and chronic pleural empyema +

* acute and chronic lung abscess
* fibrocavernous tuberculosis
* common bronchiectasis
*lung cancer

# 17
*! What radiological signs are MOST characteristic of pyopneumothorax?

* intense darkening with multiple small cavities without clear outlines

* rounded cavity with fluid level and perfocal infiltration
* collapsed lung with fluid level in the pleural cavity +
* rounded shade, intense, homogeneous with a clear outline
* intense triangular shadow

#eighteen
*! Which of the following is the MOST correct definition of peritonitis?

* acute or chronic inflammation of the parietal and visceral peritoneum +

* presence of fluid in the abdominal cavity
* damage to the integrity of the peritoneum
* penetration into the abdominal cavity of infection without signs of inflammation
* adhesions in the abdominal cavity

#nineteen
*! Which way is the MOST typical for the spread of echinococcus in the human body?

* enteral route
* blood vessels +
* urinary tract
* biliary tract
* interfascial spaces

#twenty
*! For which of the following pathologies is the MOST often used drainage of the pleural cavity
according to Bulau?

* acute and chronic pleural empyema +

* acute and chronic lung abscess
* fibrocavernous tuberculosis
* common bronchiectasis
*lung cancer

# 21
*! A 25-year-old man H. was admitted to the admission department of the district hospital
with complaints of abdominal pain. On palpation, there is muscle tension and tenderness
in the right iliac region. Rovzing's symptom is positive.
Which of the following preliminary diagnoses is the MOST probable?

* thrombosis of mesenteric vessels

* acute intestinal obstruction
* acute appendicitis +
* acute pancreatitis
* acute cholecystitis

# 22
*! A 60-year-old man, was admitted with complaints of aching pain in the right side of the
abdomen He has been ill for 5-6 days, he has not consulted a doctor. On examination, the
body temperature is 37.6 ºС. Palpation in the right iliac region is determined by the
formation, oval, motionless, measuring 7.0x5.0 cm, moderately painful.
Which of the following preliminary diagnoses is the MOST probable?

* appendicular infiltrate +
* acute enterocolitis
*acute appendicitis
* tumor of the cecum
*peritonitis

# 23
*! Patient A., 52 years old, was hospitalized with an appendicular infiltrate. In dynamics,
there is an increase in body temperature up to 38.50C, an increase in pain in the right iliac
region. On palpation, a sharp soreness and softening of the infiltrate is determined.
What is the MOST likely complication?

* cecum cancer
* subhepatic abscess
* pyelephlebitis
* perforation of the cecum
* abscess formation of infiltrate +

# 24
*! Male K., 35 years old, was admitted to the clinic of appendicular infiltration.
Which of the following examination methods is MOST justified for making a
diagnosis?

* Ultrasound of the abdominal cavity +

* FGDS
* diaphanoscopy
* colonoscopy
* irrigoscopy

# 25
*! A 42-year-old woman was admitted to the clinic with complaints of pain in the right
hypochondrium, vomiting, fever up to 38 degrees. Earlier ultrasound revealed
cholelithiasis. On examination, the abdomen is tense and sharply painful in the right
hypochondrium. Ortner and Murphy's symptoms are positive. In a blood test, leukocytes
are 18x109 / l.
Which of the following preliminary diagnoses is the MOST probable?

*acute appendicitis
* acute duodenitis
* acute pancreatitis
* acute cholecystitis +
* perforated duodenal ulcer

# 26
*! On the 3rd day after cholecystectomy, the patient complained of pain in the right
hypochondrium, yellowness of the skin. Body temperature - 36.70C. In the blood test,
leukocytes are 7.8x109 / l, total bilirubin is 150.2 μmol / l, direct bilirubin is 120.5 μmol /
l.
Which of the following complications developed in the early postoperative period is the
MOST probable?

* Botkin's disease
* purulent cholangitis
* obstructive jaundice +
* subhepatic abscess
* parenchymal jaundice

# 27
*! A 58-year-old patient with a clinical picture of acute cholecystitis was admitted to the
clinic. On the background of the ongoing conservative treatment, intense abdominal pain
and cold sweat appeared. The abdomen is tense, painful and there is a positive Shchetkin-
Blumberg symptom in all departments.
What complication did this patient develop?

* acute cholangitis
* acute pancreatic necrosis
* empyema of the gallbladder
* perforation of the gallbladder +
* acute destructive cholecystitis

# 28
*! A 68-year-old man, hospitalized with suspected acute cholecystitis. Previously noted a
repeated attack of hepatic colic. I have never consulted a doctor. On examination, the
abdomen is tense and painful in the right hypochondrium. Ortner's symptom is doubtful.
What method of instrumental examination is advisable to appoint in this situation?

* Ultrasound +
* FGDS
*laparoscopy
* irrigoscopy
*endoscopic retrograde cholangiopancreatography

# 29
*! 3 years ago, a 67-year-old patient who was in the surgical department was operated on
for acute pancreatonecrosis. At the moment, on palpation, the abdomen is soft, painless. In
the analysis of blood: leukocytes - 8.5x109 / l. Ultrasound: in the parenchyma of the
pancreas, a hypoechoic formation with a diameter of up to 3.0 cm is determined without a
level of fluids.
What is the most likely postoperative complication?

* choledocholithiasis
*pancreas cancer
* abscess of the omental bursa
* pancreatic cyst +
* pancreatic abscess

#thirty
*! A 42-year-old man was admitted to the emergency department; he complains of
epigastric pain radiating to the lower back, frequent vomiting. He previously noted similar
pains. The present worsening of the condition is associated with the intake of fatty foods.
On examination, a patient with a dense physique, the symptoms of Gray-Turner and Kerte
are positive. On auscultation, sluggish intestinal motility is heard.
Your preliminary diagnosis:

*cirrhosis of the liver

* acute cholecystitis
* acute pancreatitis +
* acute intestinal obstruction
* perforation of stomach ulcers

# 31
*! A 37-year-old man with signs of acute pancreatitis was admitted. The disease is
associated with alcohol intake. In the analysis of blood: leukocytes - 9.4x109 / l, ESR-10
mm / h; Ultrasound: an increase in the volume of the pancreas.
What indicator level is determined in this case?

* coagulogram
* blood glucose
* amylase in the blood +
* blood urea
* total bilirubin in the blood

# 32
*! A 35-year-old patient was admitted to the hospital with complaints of pain in the
epigastric region, which radiates to the lumbar region and frequent vomiting. On
examination, cyanotic spots are observed on the anterior abdominal wall, palpation in the
epigastric region is determined by muscle resistance and sharp soreness.
Your preliminary diagnosis:
* acute cholecystitis
*acute appendicitis
* acute pancreatitis +
* acute intestinal obstruction
* acute thrombosis of mesenteric vessels

# 33
*! A 78-year-old patient was admitted to the hospital. A preliminary diagnosis was made:
acute pancreatitis. He has a history of arterial hypertension, 2 years ago he suffered a
myocardial infarction.
Taking into account the patient's age and history, what disease is it necessary to carry out
differential diagnosis of acute pancreatitis?

* with acute cholecystitis

* with acute appendicitis
* with acute thrombosis of mesenteric vessels +
* with chronic ulcerative colitis
* with acute strangulated intestinal obstruction

# 34
*! A 38-year-old man was hospitalized with a gastrointestinal clinic bleeding. On
examination, the skin is pale, covered with cold sweat. BP - 50/20 mm Hg, pulse - 120
beats / min. In the analysis of blood: erythrocytes - 1.6x1012 / l, hemoglobin - 60 g / l.
What complication is MOST likely for this patient?

* hypovolemic shock
*anaphylactic shock
* toxic shock
* septic shock
* hemorrhagic shock +

# 35
*! For a man, 52 years old, who was admitted to the admission department there is
repeated vomiting of little changed blood with clots, consciousness is impaired.
What is the nature of bleeding in this case?

* ongoing
* chronic
* recurrent
* massive +
* hidden
# 36
*! A patient with suspected perforated ulcer ("dagger" pain, ulcerative history, board-
shaped abdomen) has no pneumoperitoneum on a plain radiograph of the abdominal
cavity.
What additional research method is MOST justified in this case?

* endoscopic retrograde cholangiography

* pneumogastrography +
*CT scan
* duodenoscopy
* FGDS

# 37
*! A 22-year-old man who was admitted with a clinical picture of a perforated ulcer was
assigned a general X-ray of the abdominal cavity.
What X-ray sign is characteristic of a perforated ulcer?

* intestinal pneumatosis
* Kloyber bowl
* pneumoperitoneum +
*pneumothorax
* intestinal arch

# 38
*! A 45-year-old man has complained of weakness, dizziness, and multiple liquid black
stools. History of peptic ulcer for 5 years. On examination, the abdomen is soft.
What is the MOST research method for gastroduodenal ulcer bleeding?

* endoscopic retrograde cholangiography

* plain radiography of the abdominal cavity
* fibrogastroduodenoscopy +
*CT scan
* pneumogastrography

# 39
*! A man, 35 years old, was admitted with a clinical picture of gastrointestinal bleeding.
What research method is MOST justified to establish the source of bleeding?

* plain radiography of the abdominal cavity

* rectal examination
* fibrogastroduodenoscopy +
* Ultrasound of the abdominal cavity
* transillumination

# 40
*! A 28-year-old man was hospitalized for ulcerative bleeding. On examination, the skin is
pale, covered with cold sweat. BP - 50/20 mm Hg, pulse - 120 beats / min. In the analysis
of blood: erythrocytes - 1.8x1012 / l, hemoglobin - 62 g / l.
What complication is MOST likely for this patient?

* hypovolemic shock
*anaphylactic shock
* toxic shock
* hemorrhagic shock +
* septic shock

# 41
*! A 32-year-old man was admitted with suspected bleeding ulcers. EGD revealed a red
thrombus on the anterior wall of the duodenum without signs of ongoing bleeding.
Which tactic is MOST justified?

* hospitalization in the gastroenterology department

* hospitalization in the therapeutic department
* dispensary observation
*ambulatory treatment
* hospitalization in the surgical department +

# 42
*! A 50-year-old patient with a right-sided inguinal hernia was admitted to the surgery
department. On palpation of the hernial protrusion, the formation of a soft consistency of a
lobular structure is felt, with percussion, the dullness of the percussion sound is
determined.
Which of the following is the MOST likely content of the hernial sac?

* loops of the small intestine

*pancreas
*sigmoid colon
* big oil seal +
*cecum

# 43
*! A 28-year-old woman came to the surgeon with complaints of a protrusion in the navel.
On examination, the hernial protrusion was 4.0x3.5 cm, the color of the skin over the
formation was not changed. On palpation, the contents of the hernial sac have a soft elastic
consistency; with percussion, a tympanic sound is determined.
Which of the following is the MOST likely content of the hernial sac?
*pancreas
* large oil seal
*bladder
* intestines +
*liver

# 44
*! A 35-year-old man, taken for an operation 8 hours after an inguinal hernia infringement.
During the operation, viable two loops of the small intestine were found in the hernial sac.
After cutting the restraining ring, the intestinal loop connecting them is in the abdominal
cavity.
What kind of infringement is MOST likely?

* retrograde +
* parietal
* Richter's
* sliding
* feces

# 45
*! A 67-year-old man, presented with a right-sided inguinal hernia.
Which of the following is the MOST likely diagnostic test?

* shirts
* falling drops
* splash noise
* cough push +
* hepatic dullness

# 46
*! The patient, admitted to the clinic of acute intestinal obstruction, during the cleansing
enema could not enter no more than 500 ml of water.
In this case, the MOST likely symptom is?

* Obukhov hospital
* Tsege-Manteuffel +
* Shimana-Dansa
* Spasokukotsky
* Valya

# 47
*! In a patient admitted with acute intestinal obstruction, Kloyber's cups and Kerkring's
folds were found on a plain radiograph of the abdominal cavity. These radiological signs
are MOST probable at?

* small bowel obstruction +

* colonic obstruction
* volvulus of the sigmoid colon
* intussusception
* perforation of a hollow organ

# 48
*! A 56-year-old patient was admitted with complaints of abdominal distension, flatulence
and absence of stool. On examination, the symptoms of Tsege-Manteuffel and
Obukhovskaya hospital are positive.
Identify the MOST probable pathology leading to intestinal obstruction?

* tumor of the cecum

* phrenic hernia of the esophageal opening
* volvulus of the sigmoid colon +
* ileocecal intussusception
* volvulus of the small intestine

# 49
*! A 45-year-old patient has cramping pains all over the abdomen after physical exertion.
Over time, nausea, vomiting and abdominal distension appeared, and gases ceased to flow.
This symptom complex is MOST probable with?

* acute intestinal obstruction +

* perforated stomach ulcer
* acute pancreatitis
* acute appendicitis
* acute cholecystitis

#fifty
*! A 30-year-old woman complains of frequent, up to 6-8 times a day, loose stools mixed
with blood, mucus, pus; pain and flatulence throughout the abdomen. Considers herself
sick for 1 month, lost 5 kg. Notes general weakness, decreased performance. After a
cleansing enema, the rectum was examined with a finger, there was blood on the glove and
sigmoidoscopy up to 15 cm - the mucous membrane was loose, completely covered with
erosions and small ulcers up to 0.5 cm in diameter, bleeding.
Which of the following is the MOST likely tentative diagnosis?

* enterocolitis
* tumor of the cecum
* erosive proctosigmoiditis
* ulcerative colitis +
* irritable bowel syndrome

# 51
*! A 47-year-old man, was admitted with complaints of bleeding and severe pain in the
anus after a bowel movement. On examination, pronounced spasm of the sphincter.
Which of the following is the MOST likely tentative diagnosis?

* acute hemorrhoids
* acute paraproctitis
* sharp anal fissure +
* stricture of the anal canal
* thrombosis of hemorrhoids

# 52
*! A 37-year-old man, complains of recurrent itching in the anus, red blood flow after
defecation.
Which of the following preliminary diagnoses is the MOST probable?

* hemorrhoids +
* paraproctitis
* anal fissure
* rectal tumor
* syphilitic granuloma

# 53
*! A 50-year-old woman was admitted with complaints of severe throbbing pain in the
anus, an increase in body temperature up to 38 ° C for 2 days. When examining the anal
area, hyperemia, swelling and swelling of the skin to the left of the anus, palpation is
sharply painful.
Which of the following is the MOST likely tentative diagnosis?

* acute hemorrhoids
* acute paraproctitis +
* sharp anal fissure
* rectal prolapse
* stricture of the anal canal

# 54
*! Identify the most characteristic laboratory sign of Crohn's disease:
* leukocytosis, anemia, decreased ESR, hyperproteinemia
* thrombocytosis, left shift of the leukocyte formula
* decreased ESR, hyperproteinemia
* anemia, thrombocytosis, hypoproteinemia
* leukocytosis, anemia, increased ESR, hypoproteinemia +

# 55
*! Determine the most informative research method for Crohn's disease:

* X-ray examination, endoscopy +

* ultrasound examination, X-ray
* endoscopy, computed tomography
* magnetic resonance imaging, X-ray
* ultrasound examination, endoscopy

# 56
*! A patient operated on for perforated appendicitis, in dynamics, developed pains in the
right upper abdomen and chills. In the analysis of blood, leukocytosis is noted up to
18.0x109 / l, ESR is 28 mm / h. Ultrasound of the abdominal cavity in the subphrenic
space revealed a fluid formation.
Which of the following is the MOST probable complication in the postoperative period?

* pneumonia of the lower lobe of the right lung

* abscess +
* acute cholecystitis
* acute pancreatitis
* perforation of duodenal ulcer

# 57
*! Patient K., 19 years old, was admitted with complaints of diffuse pain in the abdomen,
vomiting, which does not bring burning. This aggravation of the condition within 18
hours. I took Ketonal and Spazmalgon on my own, which gave temporary relief. The
abdomen is moderately distended, tense, painful in all parts, intestinal motility is
weakened, the Shchetkin-Blumberg symptom is positive. Rectal examination reveals
overhanging, soreness of the anterior rectal wall.
Which of the following is the MOST likely cause of peritonitis?

* acute appendicitis +
* acute pancreatitis
* perforated stomach ulcer
* acute adnexitis
* acute intestinal obstruction
# 58
*! Patient A., 48 years old, is being treated in a hospital with a diagnosis of Acute
pancreatitis. In dynamics, the patient's condition worsened, the temperature rose, the pain
spread throughout the abdomen. On examination, the abdomen is swollen, tense, painful in
all parts. In sloping places, a dullness of the percussion sound is noted. Shchetkin-
Blumberg's symptom is positive. On ultrasound of the abdominal cavity, free fluid is
determined in all sections.
Which of the following is the MOST likely complication?

*Iduodenal ulcer complicated by perforation, diffuse peritonitis

*pancrenecrosis, peritonitis +
*stomach ulcer complicated by penetration into the head of the pancreas
* acute gangrenous-perforated appendicitis, diffuse peritonitis
* acute gangrenous-perforated cholecystitis, diffuse peritonitis

# 59
*! The patient, 24 years old, was admitted to the emergency department with a diagnosis
of Perforated duodenal ulcer. In the epigastric region, on palpation with deep pressure and
a sharp abduction of the hand, an increase in pain syndrome is noted.
Which of the following symptoms is the MOST characteristic?

* Kocher-Volkovich
* Sitkovsky
* Rovzinga
* Voskresensky
* Shchetkina-Blumberg +

# 60
*! The patient was operated on with a diagnosis of Acute appendicitis. During the revision
in the abdominal cavity there is a cloudy liquid with fibrin overlays with a smell.
Which of the following is the MOST probable type of peritonitis by the nature of the
effusion?

* serous fibrinous
* purulent fibrinous +
* fibrinous
*serous
*purulent

# 61
*! Patient J., 30 years old, underwent appendectomy for gangrenous appendicitis. On the
4th day after the operation, the condition worsened, pains in the lower abdomen, tenesmus
appeared, the temperature increased up to 39.00C in the evenings. When examining the
per.rectum, the overhang and soreness of the anterior rectal wall is determined.
Which of the following preliminary diagnoses is MOST probable?
* pelvic abscess +
* subphrenic abscess
* periappendicular abscess
* diffuse peritonitis
* subhepatic abscess

# 62
*! A 36-year-old man was admitted to the clinic with complaints of heaviness in the right
hypochondrium. There are episodes of itching, urticaria. Engaged in pasture animal
husbandry. In the projection of the left lobe of the liver, a tumor-like formation is palpated.
What is the MOST characteristic pathology that can be suspected in this patient?

*hepatitis
*cirrhosis of the liver
* echinococcosis of the liver +
*cholelithiasis
* allergic dermatitis

# 63
*! A 30-year-old man suffering from an echinococcal cyst of the liver developed pains all
over the abdomen, more in the right half. The deterioration of the condition is associated
with a fall with a horse. An ultrasound scan determines the free fluid in the abdominal
cavity.
Which of the following complications of liver echinococcosis is MOST probable in this
case?

* traumatic shock
* bleeding into the cyst cavity
* suppuration of an echinococcal cyst
* breakthrough of the cyst into the gallbladder
* breakthrough of the cyst into the free abdominal cavity +

# 64
*! In a 53-year-old woman, a tumor-like formation in the epigastric region is determined
when visiting a polyclinic surgeon. Latex agglutination reaction within 1:64. On CT scan
of the abdominal organs, there is a rounded mass in the left lobe of the liver with a
calcified wall.
Which of the following diagnoses is MOST likely?

* solitary liver cyst

* liver abscess
* pancreatic cyst
* echinococcal cyst of the liver +
*stomach cancer
# 65
*! A 48-year-old man, was admitted to the clinic with complaints of weakness, fatigue,
sharp weight loss. Has been ill for 6-7 months. On palpation in the epigastrium, a dense,
moderately painful formation is determined. In the analysis of blood eosinophilia, the
reaction of latex-agglutination at the level of 1:54.
Which of the following diagnoses is MOST likely?

*cirrhosis of the liver

* liver abscess
* alveococcosis of the liver +
* solitary liver cyst
* echinococcosis of the liver

# 66
*! A man suffering from echinococcosis of the liver developed jaundice, chills and high
body temperature.
Which of the following complications of liver echinococcosis is MOST typical in this
case?

* cholemic bleeding
* bleeding into the cyst cavity
* suppuration of an echinococcal cyst
* breakthrough of the cyst into the bile ducts +
* breakthrough of the cyst into the free abdominal cavity

# 67
*! A 46-year-old woman was hospitalized with clinical signs of bleeding. On EFGDS:
Completed bleeding.
What drugs are MOST justified in the etiopathogenetic treatment of gastroduodenal ulcer
bleeding?

* hemostatic drugs
* antisecretory drugs +
* antihistamines
* anticoagulants
* cytostatics

# 68
*! The patient, suffering from a lung abscess, had an increase in body temperature to
390C, increased weakness, and shortness of breath. On ultrasound of the pleural cavity, an
inhomogeneous fluid is determined.
Which of the following complications is the MOST probable in the patient?

* exudative pleurisy
* pulmonary bleeding
*pulmonary tuberculosis
* pleural empyema +
*pneumonia

# 69
*! A man, 45 years old, was admitted with complaints of pain in the left side of the chest
during breathing, general weakness, profuse purulent sputum. The patient notes an
improvement in his condition after a one-stage abundant discharge of fetid, purulent
sputum up to 300 ml. Auscultation in the left chest is auscultated amphoric breathing.
Which of the following changes is MOST likely on the radiograph:

* cavity with fluid level and perifocal infiltration +

* cavity with fluid level without perifocal infiltration
* area of infiltration of lung tissue without clear boundaries
* extensive darkening in the lung without clear boundaries
* cavity of destruction with foci of seeding

# 70
*! A man, 58 years old, was admitted to the clinic with complaints of pain in the left side
of the chest during breathing, general weakness, profuse purulent sputum. Chest x-ray
shows a cavity with fluid levels and perifocal infiltration
What is the MOST advisable tactics of patient management?

* treatment by an ENT doctor at the place of residence

* treatment by a therapist at the place of residence
* hospitalization in a hospital +
* treatment in the TB dispensary
* spa treatment

# 71
*! A 27-year-old man, an hour ago, amid full health, suddenly developed severe pains in
the left side of the chest, a feeling of shortness of breath. Lung disease in the past is
denied. Body temperature is normal. Breathing over the left lung is not heard, with
percussion - a boxed sound. Percussion mediastinum is displaced to the right.
Which of the following preliminary diagnoses is the MOST probable?

* restrained diaphragmatic hernia

* spontaneous pneumothorax +
* exudative pleurisy
* pulmonary tuberculosis
* myocardial infarction
# 72
*! Ischemia of the lower extremities IIA degree according to the classification of A.V.
Pokrovsky:

* hemorrhage, paresthesia
* limping after about 250-300 meters of walking +
* trophic disorders
* Limp after about 250 meters of walking
* feeling of pain in the legs in a calm state

# 73
*! The degree of IIB degree of chronic ischemia according to the classification of A.V.
Pokrovsky?

* hemorrhage, paresthesia
* limping after about 250-300 meters of walking
* trophic disorders
* Limping after about 250 meters of walking +
* feeling of pain in the legs in a calm state

# 74
*!The degree of III degree of chronic ischemia according to the classification of A.V.
Pokrovsky?

* hemorrhage, paresthesia
* limping after about 250-300 meters of walking
* trophic disorders
* Limp after about 250 meters of walking
* feeling of pain in the legs in a calm state +

# 75
*! Grade IV B degree of chronic ischemia according to the classification of A.V.
Pokrovsky?

* hemorrhage, paresthesia
* limping after about 250-300 meters of walking
* trophic disorders +
* Limp after about 250 meters of walking
* feeling of pain in the legs in a calm state

# 76
*! For what vascular pathology is it necessary to perform auscultation?

* Rhine disease
* arterial stenosis +
* Varicose veins
* after thrombophlebitis syndrome
* with acrocyanosis

# 77
*! Which of the following is MOST likely for acute thrombophlebitis of the saphenous
veins?

* painful induration, hyperemia along the saphenous veins +

* marbling, coldness and numbness
* crawling "goosebumps", cold snap
* severe pain and blackening of the toes.
* edema, cyanosis of the foot

# 78
*! A 28-year-old patient who consulted a surgeon in a polyclinic complaining of a sharp
swelling of the entire right upper limb after a sharp increase in weight, bursting pain.
Movement and sensitivity are preserved. The right upper limb is increased in volume
throughout, the edema spreads to the subclavian region and the anterolateral surface of the
chest.
Which of the following are the MOST probable diagnoses?

* acute thrombosis of superficial veins

* acute thrombosis of the subclavian vein +
* phlegmon of the right upper limb
* shoulder arthritis
* shoulder hematoma

# 79
*! With what diseases is it necessary to conduct differential diagnostics in case of varicose
veins?

* femoral hernia
* Leriche syndrome
* lymphangitis
* lymphostasis +
* diabetic angiopathy of the lower extremities

# 80
*! The patient underwent sclerotherapy.After 3 hours, the patient developed edema of the
left lower extremity, bursting pains in the extremities, cyanotic skin, cold to the touch.
MOST likely complication?
* deep vein thrombosis +
* thrombosis of the generational artery
*phlegmon
* lymphostasis
* thrombophlebitis

# 81
*!A 29-year-old patient, about 2 hours ago, suddenly felt severe pain in the left side of the
chest, shortness of breath. There was no injury, he denies pulmonary diseases. Body
temperature is normal. Breathing over the left lung is not heard. On the left is a boxed
sound. On the roentgenogram - total pneumothorax on the left, displacement of the
mediastinal organs to the right. Bronchoscopy was not performed. Your diagnosis:
*acute lung abscess complicated by pyopneumothorax
*spontaneous pneumothorax +
*closed chest trauma, traumatic hemopneumothorax, subcutaneous emphysema
*penetrating chest injury, traumatic pneumothorax
*empyema of the pleura

# 82
*! A 43-year-old patient after suffering acute right-sided lower lobe pneumonia noted a
worsening of his condition: increased weakness, malaise, and febrile fever appeared.
Later, pains in the chest, aggravated on inspiration, an unproductive cough, and
intoxication increased. Chest X-ray in 2 projections revealed a regular rounded
homogeneously darkened cavity with perifocal infiltration measuring 6 x 6 cm in the
lower lobe of the right lung. Your preliminary diagnosis
* cancer of the lower lobe of the right lung * right-sided hydrothorax

* abscess of the lower lobe of the right lung + * lower lobar pneumonia on the right,
pleurisy * pyothorax on the right

# 83
*! A 44-year-old patient, after hypothermia, had a rise in body temperature to 39.0 ° C,
pains appeared in the right half of the chest, aggravated by breathing, and a cough
appeared. The phlegm was hardly discharged. The temperature was maintained for 8 days
despite intensive antibacterial and anti-inflammatory treatment. Then, a large amount of
purulent sputum with an unpleasant odor in an amount of up to 200 ml began to separate
from the patient. The temperature dropped to normal. The patient began to feel better. The
general condition of the patient is satisfactory. A shortening of the percussion tone,
weakened breathing are determined under the right scapula behind. What additional
examinations should be carried out
* Ultrasound of the pleural cavity * bacterial culture of macrota * chest x-ray in two
projections + * bronchoscopy * bronchography

# 84
*! A 70-year-old man was admitted to the surgery department with complaints of
abdominal pain, stool retention. During diagnostic laparotomy, an infringement of a part
of the intestinal wall opposite to the line of mesentery attachment was found.
What is the MOST probable infringement of a hernia?

* feces
* elastic
* retrograde
* Richter's +
* combined

# 85
*! A 60-year-old patient was admitted to the hospital with a clinic of acute intestinal
obstruction. When irrigoscopy is determined by the filling defect of the ascending intestine
with clear contours in the form of a "two-prong".
Which of the following is the MOST likely diagnosis?

* obstructive intestinal obstruction against the background of a tumor of the cecum

* intussusception +
* volvulus of the cecum
* volvulus of the small intestine
* nodulation

# 86
*! A 45-year-old patient has cramping pains all over the abdomen after physical exertion.
Over time, nausea, vomiting and abdominal distension appeared, and gases ceased to flow.
This symptom complex is MOST probable with?

* acute intestinal obstruction +

* perforated stomach ulcer
* acute pancreatitis
* acute appendicitis
* acute cholecystitis

# 87
*! During surgery for a hernia of the white line of the abdomen, a hernial sac 8 by 6 cm, a
defect in the aponeurosis measuring 4 cm.Diagnosis after surgery
* Small size hernia of the white line of the abdomen
* Hernia of the white line of the abdomen of medium size +
* Large hernia of the white line of the abdomen
* Gigantic hernia of the white line of the abdomen
* Huge hernia of the white line of the abdomen

# 88
*! A 43-year-old patient was admitted with complaints of weakness, vomiting mixed with
blood and melena. When viewed on the anterior abdominal wall, pronounced venous
pattern, palmar erythema. What research method will determine the source of bleeding?
* liver scintigraphy
* superselective angiography
* FGDS
* colonoscopy
* Ultrasound of the abdominal organs +

# 89
*! The patient complains of pain in the anus, aggravated by the act of defecation, an
increase in body temperature up to 38 grams. When viewed in the perianal region, a
sharply painful infiltrate, with skin hyperemia. On digital examination, infiltration up to
the scallop line. What is your presumptive diagnosis?
* sciatic-rectal paraproctitis
* submucous paraproctitis
* subcutaneous paraproctitis +
* pelvic rectal paraproctitis
* retrorectal paraproctitis

# 90
*! After discharge from the hospital of a patient who was treated for acute paraproctitis,
after 2 months, a transition to a chronic form was established. What was the cause?
* the presence of an internal opening leading from the intestine to the abscess cavity +
* breakthrough of pus into adjacent cellular spaces
* breakthrough of pus outward
* breakthrough of pus into the intestine
* breakthrough of pus into the intestinal lumen and outwards

# 91
*! The examination revealed an enlarged painless gallbladder in the patient with jaundice
and acholia. What disease is this symptom typical for?
* Mirizzi syndrome type II
* Klatskin's tumors
* cancer of the head of the pancreas +
* Caroli disease
* strictures of the Vater nipple

# 92
*! A 47-year-old patient consulted a doctor complaining of a feeling of heaviness, fullness
in the legs, rapid fatigue during prolonged standing or walking. These phenomena
disappear rather quickly after the patient takes a horizontal position. Has been ill for
twelve years. The examination revealed a sharp expansion of the superficial veins of the
left leg of the thigh with pronounced pigmentation and trophic disorders of the skin in the
distal parts of the limb. There is also noted pastiness and slight edema. Your presumptive
diagnosis
* varicose veins +
* neurocompression syndrome
* piriformis syndrome
* neuromuscular syndrome of the lower extremities
* chronic arterial obstruction of the lower extremities

# 93
*!A 25-year-old patient complained of pain in the right lower quadrant of the abdomen,
diarrhea, weight loss and fever. An endoscopic examination was carried out: the mucous
membrane with deep longitudinal and transverse ulcers-cracks creates a picture of
"cobblestone pavement". Diagnose:
* Whipple's disease;
* Crohn's disease; +
* sprue disease;
*nonspecific ulcerative colitis;
*acute appendicitis

# 94
*! A patient abusing alcohol, after repeated vomiting without bleeding, began massive
bleeding from the upper gastrointestinal tract. There are no indications of a history of
peptic ulcer disease. What is most likely the cause of the bleeding?
*hernia
*stomach cancer
*duodenal ulcer
* Mallory-Weiss syndrome +
*gastritis

# 95
*! A 35-year-old man was admitted to the admission department of the hospital 2 hours
after the onset of the disease with complaints of severe pain in the epigastric region. When
examining the position of the patient on the right side with the legs brought to the
stomach. On palpation, the abdomen is tense, hepatic dullness is not detected. The positive
symptom of Elecker is determined.
Which of the following is the MOST probable diagnosis?
* perforated ulcer +
* acute intestinal obstruction
* acute pancreatitis
* acute cholecystitis
* myocardial infarction

# 96
*! A 50-year-old woman was admitted with complaints of severe throbbing pain in the
anus, an increase in body temperature up to 38 ° C for 2 days. When examining the anal
area, hyperemia, swelling and swelling of the skin to the left of the anus, palpation is
sharply painful.
Which of the following is the MOST likely tentative diagnosis?

* acute hemorrhoids
* acute paraproctitis +
* sharp anal fissure
* rectal prolapse
* stricture of the anal canal

# 97
*! Patient 57 years old, was admitted to the clinic of mechanical intestinal obstruction.
From the anamnesis: over the past 3 months, he has lost 8 kg. On palpation of the
abdomen in the right iliac region, an immobile tumor-like formation of a dense tuberous
consistency is determined.
To clarify the diagnosis, it is MOST expedient to prescribe?

* irrigoscopy +
* FGDS
* sigmoidoscopy
* plain radiography of the abdominal cavity
* Ultrasound of the abdominal cavity

# 98
*! Patient 57 years old, was admitted to the clinic of mechanical intestinal obstruction.
From the anamnesis: over the past 3 months, he has lost 8 kg. On palpation of the
abdomen in the right iliac region, an immobile tumor-like formation of a dense tuberous
consistency is determined.
To clarify the diagnosis, it is MOST expedient to prescribe?

* irrigoscopy +
* FGDS
* sigmoidoscopy
* plain radiography of the abdominal cavity
* Ultrasound of the abdominal cavity

# 99
*! A man, 35 years old, was admitted with a clinical picture of gastrointestinal bleeding.
On rectal examination, the feces on the glove are black.
What research method is MOST justified to establish the source of bleeding?

* plain radiography of the abdominal cavity

* sigmoidoscopy
* fibrogastroduodenoscopy +
* Ultrasound of the abdominal cavity
* colonoscopy

#100
*! A 56-year-old patient was admitted with complaints of bloating, flatulence and absence
of stool. On examination, the symptoms of Tsege-Manteuffel and Obukhovskaya hospital
are positive.
Identify the MOST probable pathology leading to intestinal obstruction?

* tumor of the cecum

* phrenic hernia of the esophageal opening
* volvulus of the sigmoid colon +
* ileocecal intussusception
* volvulus of the small intestine

# 101
*! Patient A., 52 years old, was hospitalized with an appendicular infiltrate. In dynamics,
there is an increase in body temperature up to 38.50C, an increase in pain in the right iliac
region. On palpation, a sharp soreness and softening of the infiltrate is determined.
What is the MOST likely complication?

* cecum cancer
* subhepatic abscess
* pyelephlebitis
* perforation of the cecum
* abscess formation of infiltrate +

# 102
*! A patient, 56 years old, two years ago, ultrasound revealed cholelithiasis. Upon
admission to the hospital, he complains of colicky pain in the right hypochondrium,
yellowness of the sclera and skin, itching, discoloration of feces and darkening of urine.
Body temperature is within normal limits. In the biochemical blood test, the bilirubin level
is 122.5 μmol / l.
Which of the following preliminary diagnoses is the MOST probable?
* cirrhosis of the liver, parenchymal jaundice
* cancer of the head of the pancreas, obstructive jaundice
* cholangitis, obstructive jaundice
* choledocholithiasis, obstructive jaundice +
* hepatitis, parenchymal jaundice

# 103
*! A 35-year-old man, taken for an operation 8 hours after an inguinal hernia infringement.
During the operation, viable two loops of the small intestine were found in the hernial sac.
After cutting the restraining ring, the intestinal loop connecting them is in the abdominal
cavity.
What kind of infringement is MOST likely?

* retrograde +
* parietal
* Richter's
* sliding
* feces

# 104
*! In the department of therapy, a patient with a diagnosis of "Lung abscess" developed
pyopneumothorax on the 7th day.
Which of the following is the MOST priority action for the patient?

* endobronchial administration of proteolytic enzymes

* drainage of the pleural cavity +
* antibacterial therapy
* introduction of cytostatics
* X-ray therapy

# 105
*! A 30-year-old woman, delivered by an ambulance 2 hours after accidentally taking 50
ml of acetic acid, complaining of chest pain when swallowing, weakness, nausea,
vomiting.
Which of the following preliminary diagnoses is the MOST probable?

* chemical burn of the esophagus +

* damage to the esophagus
* diverticula of the esophagus
* reflux esophagitis
* acute esophagitis

# 106
*! A 29-year-old woman complains of difficulty swallowing food, sensation of a lump in
the throat, regurgitation of recently eaten food, arising without any tension. According to
the words, gurgling noises are sometimes heard when the liquid is swallowed. During
examination of the neck, when the head was pulled back, a protrusion of a soft consistency
was revealed, which, when pressed, decreases in size.
Which of the following is the MOST probable pathology?

* obstruction of the esophagus

* foreign body of the esophagus
* Zenker's diverticulum +
* stricture of the esophagus
* esophageal ulcer

# 107
*! A 49-year-old man, suffering from duodenal ulcer for about 15 years, was admitted to
the surgical department with a diagnosis of Acute pancreatitis. Examined by a professor, a
stomach fluoroscopy is recommended.
What X-ray sign is MOST characteristic of a penetrating ulcer?

* flat ulcerative niche

* snail stomach
* cascading stomach
* deep ulcerative niche +
* pneumoperitoneum

# 108
*! Male, 70 years old, suffers from vomiting of food eaten, recently vomiting with the
smell of rotten eggs. History of peptic ulcer for 10 years. On the recommendation of the
surgeon, an X-ray of the stomach was performed.
What X-ray sign is MOST characteristic of the decompensated stage of pyloroduodenal
stenosis?

* evacuation from the stomach is delayed by more than 24 hours +

* slowdown of evacuation from the stomach is 12-20 hours
* slowdown of evacuation from the stomach is 20-36 hours
* slowdown of evacuation from the stomach is 3-6 hours
* evacuation from the stomach is slowed down by 6-12 hours

# 109
*! A 65-year-old patient has been suffering from intermittent claudication for 2 years. On
angiography: stenosis of the abdominal aorta at the bifurcation level, atherosclerotic
changes on the walls of the aorta.
Which of the following is the MOST probable diagnosis?
* thrombosis of the iliac vein
* iliac embolism
* syndrome of abdominal ischemia
* Takayasu syndrome
* Leriche syndrome +

# 110
*! Patient J., 30 years old, underwent appendectomy for gangrenous appendicitis. On the
4th day after the operation, the condition worsened, pains in the lower abdomen, tenesmus
appeared, the temperature increased up to 39.00C in the evenings. When examining the
per.rectum, the overhang and soreness of the anterior rectal wall is determined.
Which of the following preliminary diagnoses is MOST probable?

* pelvic abscess ++
* subphrenic abscess
* periappendicular abscess
* diffuse peritonitis
* subhepatic abscess

# 111
*! An 18-year-old patient with a preliminary diagnosis of acute appendicitis was admitted to the
emergency room of the district hospital.
What is the MOST advisable tactics of patient management?

* emergency operation +
* routine appendectomy
* conservative therapy
*ambulatory treatment
* observation in the surgical department

# 112
*! Patient P., 28 years old, underwent appendectomy for gangrenous-perforated appendicitis.
Which of the following is the MOST appropriate drug to be prescribed?

* vitamins
* antibiotics (cephalosporins, aminoglycosides) +
* absorbable preparations (aloe)
* proton pump blockers (pantoprozole, controllers)
* hemostatics (etamsylate, vicasol)

# 113
*! Patient R., 57 years old, who was in the hospital with appendicular infiltration, developed pulsating
pain in the right iliac region and an increase in body temperature up to 39.00C. On ultrasound of the
abdominal cavity, a cavity with a fluid level is determined.
What further treatment tactics is MOST advisable?
* urgent surgical treatment +
* conservative treatment * routine surgical treatment * delayed surgical treatment * outpatient treatment

# 114
*! Patient D., 25 years old, was discharged from the hospital after conservative treatment for appendicular
infiltration. At the time of discharge, the patient has no complaints, the condition is satisfactory, the
abdomen is soft, the infiltration is significantly reduced in size.
What further treatment tactics is MOST advisable?

* appendectomy 6 months after chemotherapy

* appendectomy 1 year after radiation therapy * appendectomy 2 months after conservative therapy + *
surgical treatment after 10 days on a delayed basis

* conservative treatment without surgery

# 115
*! Male 62 years old, was admitted to the clinic of acute cholecystitis. In the analysis of blood,
leukocytosis is noted up to 25.4x109 / l. On ultrasound, the wall of the gallbladder is layered, there is a
fixed calculus at the neck.
What is the MOST acceptable patient management tactics?

* referral for outpatient treatment

*conservative treatment
* emergency cholecystectomy +
* surgical treatment in a planned manner
* observation in the surgical department

# 116
*! In a 47-year-old patient, six months after cholecystectomy performed for chronic calculous
cholecystitis, pains in the right hypochondrium began to appear again, periodically accompanied by
yellowing of the sclera. Ultrasound examination of the abdominal cavity did not reveal any obvious
pathology of the extrahepatic biliary tract.
Which of the listed diagnostic methods in this case is the MOST informative?

* infusion cholangiography
* percutaneous transhepatic cholangiography
* endoscopic retrograde cholangiopancreatography +
* liver scan
*CT scan

# 117
*! A 56-year-old patient two years ago, an ultrasound scan revealed cholelithiasis. Upon admission to the
hospital, he complains of colicky pain in the right hypochondrium, yellowness of the sclera and skin,
itching, discoloration of feces and darkening of urine. Body temperature is within normal limits. In the
biochemical blood test, the bilirubin level is 122.5 μmol / l.
Which of the following preliminary diagnoses is the MOST probable?

* cirrhosis of the liver, parenchymal jaundice

* cancer of the head of the pancreas, obstructive jaundice
* cholangitis, obstructive jaundice
* choledocholithiasis, obstructive jaundice +
* hepatitis, parenchymal jaundice

# 118
*! In the surgical department conservative treatment is carried out to a 57-year-old patient with a
diagnosis of acute pancreatitis.
Indicate from the following groups of drugs, the action of which is to suppress the excretory function of
the pancreas:

* analgesics
* cytostatics +
* antispasmodics
* protease inhibitors
* proteolytic enzymes

# 119
*! 51 year old patient P., hospitalized in the surgical department with a diagnosis of "Acute pancreatitis".
Indicate from the following groups of drugs, the action of which is to reduce the activity of pancreatic
enzymes:

* analgesics
* cytostatics
* antispasmodics
* protease inhibitors +
* proteolytic enzymes

# 120
*! Patient 54 years old, operated on for acute fatty pancreatic necrosis.
What medications will you prescribe in the postoperative period in order to prevent purulent
complications?

* immune therapy
* vitamin therapy
* hepatoprotectors
* antibacterial therapy +
* antihistamine therapy

# 121
*! A 31-year-old man, presents with a sudden attack of severe pain in the upper abdomen. On palpation of
the abdomen, there is a pronounced tension in the muscles of the anterior abdominal wall. An abdominal
x-ray revealed free gas.
Which treatment tactic is the most ADVANCED in this case?

* emergency operation +
*conservative treatment
* urgent operation
* planned operation
* dynamic observation

# 122
*! A 58-year-old man was admitted on an emergency basis to the clinic of ulcerative bleeding. He denies
a history of ulcers, 2 years ago he had a myocardial infarction, about which he has been receiving
cardiomagnyl for a long time. EGDS revealed acute gastric ulcers, no ongoing bleeding.
Which treatment strategy is MOST justified?

* conservative treatment in the therapeutic department

* conservative treatment in a surgical hospital +
* outpatient treatment at the place of residence
* emergency operation
* planned operation

# 123
*! A 35-year-old man was admitted to the admission department of the hospital with complaints of severe
pain in the epigastric region. When examining the position of the patient on the right side with the legs
brought to the stomach. On palpation, the abdomen is tense, hepatic dullness is not detected.
Which of the following is the MOST probable diagnosis?

* perforated ulcer +
* acute intestinal obstruction
* acute pancreatitis
* acute cholecystitis
* myocardial infarction

# 124
*! A 45-year-old woman was admitted to the emergency department with complaints of general
weakness, dizziness, black stools. From the anamnesis: suffers from duodenal ulcer for 10 years. On
examination: conscious, flaccid, pale skin. HELL 70/30 mm Hg, Pulse - 110 beats. in min. On EFGDS:
Duodenal ulcer complicated by bleeding. Forrest Ia.
What surgical tactics are used in this patient with duodenal ulcer complicated by profuse bleeding?

* emergency operation +
* urgent operation
*conservative treatment
* delayed operation
* planned operation

# 125
*! A 55-year-old man was admitted to the emergency department with complaints of severe pain in the
epigastric region. Suffers from peptic ulcer disease. Suddenly I felt a sharp intense pain in the upper
abdomen. When viewed, lies on the right side with legs brought to the abdomen. On palpation, the
abdomen is sharply tense and painful in the epigastrium. Hepatic dullness is not defined.
What research method allows you to make a diagnosis?

* MRI of the abdominal cavity

* CT scan of the abdomen
* plain X-ray of the abdominal cavity +
* ERCP
* FGDS

# 126
*! A man with gastric ulcer notes that in the last year he began to be bothered by constant and difficult to
stop pain in the epigastric region, while exacerbations of the disease "lost" their specific frequency and
seasonality, appetite is reduced.
What complication of peptic ulcer disease do these signs indicate?

* hidden bleeding from an ulcer

* covered perforation of the ulcer
* development of cicatricial stenosis
* disease regression
* malignancy of the ulcer +

# 127
*! X-ray examination of the stomach revealed a deep ulcerative "niche" with uneven edges protruding
above the mucous membrane, while the stomach itself acquired a cascade shape.
What is the MOST probable complication of peptic ulcer disease?

* these signs have no diagnostic value

* about the penetration of the ulcer into the left lobe of the liver +
* about the development of hypertrophic gastritis
* about exacerbation of peptic ulcer
* about the malignancy of the ulcer

# 128
*! A 52-year-old man, went to the clinic with complaints of a feeling of heaviness in the epigastrium,
rapid saturation of rotten belching, profuse vomiting of food eaten the day before, significant weight loss.
From the anamnesis: for 7 years suffers from peptic ulcer disease, has repeatedly received outpatient
treatment. Objectively: emaciated, dry skin, reduced turgor, symptom of Khvostek, Trousseau is
determined. The abdomen is soft, defined by a splash noise.
What complication of peptic ulcer disease can you think of?

* pyloroduodenal stenosis +
*bleeding
* malignancy
*perforation
* penetration

# 129
*! A 40-year-old man was delivered to the PPC with complaints of severe pain in the epigastrium and on
the right, radiating to the back, nausea. From the anamnesis: periodically disturbed by night "hungry"
pains, the man relieves them by taking a solution of baking soda, notes the seasonal nature. On
examination, the skin is of normal color, the abdomen is of normal shape, soft, painful in the epigastrium
and right hypochondrium. Ultrasound of the abdominal cavity: there is no free fluid, the gallbladder is
normal, the pancreas is not enlarged, the contours are clear. Diastasis is normal.
What is the MOST probable diagnosis?

* perforated duodenal ulcer

* acute pancreatitis
* malignant ulcer
* penetration of the ulcer +
*gastritis

# 130
*! A 70-year-old woman was admitted with complaints of a painful hernial protrusion in the navel, which
cannot be adjusted on its own. On examination, cyanosis of the skin over the protrusion is noted. History
of diabetes mellitus, ischemic heart disease.
What tactics of patient management is the MOST expedient?

* supervision in the department of surgery

* emergency operation +
* operation as planned
* urgent operation
* outpatient follow-up

# 131
*! A 68-year-old patient was admitted to the emergency department with complaints of the presence of an
inguinal hernia on the left, difficulty urinating. Preliminary diagnosis: Sliding hernia on the left.
Which of the following examination methods is MOST justified for making a diagnosis?

* Ultrasound
* cystography +
* irrigoscopy
* colonoscopy
* retrogenography

# 132
*! An ambulance delivered a man with a strangulated inguinal hernia. During transportation, the hernia
spontaneously opened.
What further tactics of the surgeon is MOST expedient?

* to carry out diagnostic laparoscopy

* to carry out diagnostic laparotomy
* observation in hospital conditions +
* put a cleansing enema
* outpatient follow-up

# 133
*! A 42-year-old woman was admitted for planned surgical treatment for an umbilical hernia.
Which of the following plastic methods is the MOST acceptable?

* by Bassini
* by Sapezhko +
* in Liechtenstein
* according to Kukudzhanov
* across Spasokukotsky

# 134
*! During surgery for acute intestinal obstruction, a dark-colored loop of the small intestine and
hemorrhagic fluid in the abdominal cavity were found.
What is the MOST acceptable surgical approach?

* resection of necrotic colon +

* imposition of a bypass anastomosis
* vagotomy
* withdraw colostomy
* external drainage of the abdominal cavity

# 135
*! Patient 72 years old, was admitted with symptoms of coprostasis. History of chronic colitis.
No stool for 7 days. During rectal examination, feces are determined. Which of the following is the
MOST priority for the patient?

* drugs that enhance intestinal motility

* antispasmodics
* laxatives
* dietary table No. 10
* devulsion of the anus followed by a siphon enema +

# 136
*! A 33-year-old woman presented with complaints of abdominal pain, nausea and vomiting that started
this morning. On examination, the abdomen is swollen. From the anamnesis: underwent cholecystectomy
operations, two cesarean sections. Given the clinical picture, which of the following diagnoses is the
MOST probable?

* Colon tumor
* Mesenteric ischemia
* Intussusception
* Acute adhesive intestinal obstruction +
* Acute pancreatitis

# 137
*! A 57-year-old patient was admitted to the clinic for mechanical intestinal obstruction. From the
anamnesis, over the past 2 months, he has lost 8 kg. On palpation of the abdomen in the right iliac region,
an immobile tumor-like formation of a dense tuberous consistency is determined.
To clarify the diagnosis, it is MOST expedient to prescribe?

* irrigoscopy +
* FGDS
* CT
* plain radiography of the abdominal cavity
* Ultrasound of the abdominal cavity

# 138
*! What research method is the MOST acceptable for rectal diseases?

* anoscopy +
* irrigoscopy
*CT scan
*ultrasound procedure
*Magnetic resonance imaging
# 139
*! A 30-year-old woman was admitted with complaints of pain and bleeding after a bowel movement. On
examination of the anal area, sphincter spasm is noted.
Which of the following is the MOST priority research method for a patient?

* sigmoidoscopy
* fistulography
* irrigoscopy
* colonoscopy
* anoscopy +

# 140
*! A 47-year-old man was diagnosed with Acute subcutaneous paraproctitis.
Which of the following is the MOST first choice of treatment?

* physiotherapy
* immunostimulants
* surgical treatment +
* antibacterial therapy
* detoxification therapy

# 141
*! A 54-year-old woman complained of itching, sensation of a foreign body in the anus, red blood flow
during bowel movements.
Which of the following is the MOST priority action for the patient?

* anoscopy
* irrigoscopy
* sigmoidoscopy
* digital examination of the rectum
* external examination of the perianal area +

# 142
*! Patient A., 45 years old, was admitted with complaints of pain throughout the abdomen, tenesmus,
vomiting, high fever, repeated diarrhea mixed with blood (up to 20 times a day). On examination, it was
revealed: bloating, pain on palpation along the colon. KLA - increased ESR, decreased hemoglobin level,
hematocrit, erythrocyte count, leukocytosis with a shift of the leukocyte formula to the left.
Which of the listed diagnostic methods in this case is the MOST informative?

* colonoscopy +
*biopsy
* anoscopy
*angiography
* ultrasound dopplerography

# 143
*!A 38-year-old patient was admitted to the clinic with complaints of weakness, fatigue, dizziness,
diarrhea up to 5-6 times a day, sometimes mixed with blood, abdominal pain, more in the right iliac
region. Ill for 8 years. Objectively: pallor and dryness of the skin. On palpation of the abdomen, soreness
and muscle tension in the right lower quadrant. Colonoscopy: narrowing of the terminal segment of the
ileum and the initial segment is blind, the passage of barium is sharply slowed down. Continuing
colonoscopy is difficult.
What disease can be diagnosed on the basis of the clinic?

*hemorrhoids
* Crohn's disease +
*nonspecific ulcerative colitis
* Mallory-Weiss syndrome
* Gardner's syndrome

# 144
*! A patient at the age of 20, against the background of prolonged stress, developed bloody diarrhea with
a frequency of up to 20 times a day. In endoscopic examination (colonoscopy), the mucous membrane in
the form of a "sponge" is pink, thick, porous, the pores are filled with blood, profuse bleeding.
What disease can be diagnosed on the basis of the clinic and blood tests?

* ulcerative colitis +
*Crohn's disease
* acute intestinal obstruction
* anal fissure
* aganglionic megacolon

# 145
*!A 38-year-old patient complains of loose stools with mucus and blood up to 6-8 times a day, abdominal
pain, more on the left in the iliac region, low-grade fever, weight loss, weakness. Objectively: pallor of
the skin, pain on palpation of the abdomen along the descending colon. In the analysis of blood:
hemoglobin 90 g / l, leukocytes 10, ESR 30 mm / hour. With irrigoscopy - smoothness of the relief of the
mucous membrane of the descending colon, the absence of haustration.
What is the most appropriate surgical indication for complications?

* diverticulum abscesses, adhesions

* arrosion of an arterial vessel
* fistulas between the colon and other organs
* bowel perforation, toxic dilatation in NUC +
* rectovaginal atresia

# 146
*! During the operation, the diagnosis "Spilled purulent peritonitis" was made.
Which medicinal product is most appropriate for the prevention of purulent-septic complications?

* Antispasmodics
*antiseptics
* antibiotics +
* analgesics
* detoxification therapy

# 147
*! Patient K., 25 years old, was operated on for acute gangrenous appendicitis. In the postoperative
period, pains in the lower abdomen, false desires appeared, the temperature increased up to 38.50C.
Blood testsmarked leukocytosis up to 16.0x109 / l, ESR - 32 mm / h, moderate anemia.
Which of the following examination methods is the MOST expedient to prescribe?

* plain radiography of the abdominal cavity

* CT scan of the abdomen +
* passage of barium along the gastrointestinal tract
* irrigoscopy
* colonoscopy

# 148
*! Patient A., 43 years old, was admitted to the surgical department. The patient was examined, diagnosed
with peritonitis.
Which of the following treatment tactics is the MOST appropriate?

* outpatient treatment at the place of residence

* make additional examinations
*conservative treatment
* emergency operation +
* planned operation

# 149
*! At the operation in patient M., 53 years old, an abscess of the pelvic cavity was revealed.
What is the MOST appropriate treatment strategy?

* drainage of the abdominal cavity according to Shalimov

* opening and drainage of the abscess cavity +
* massive antibacterial therapy
* guided laparostomy
* overlay lavage system

# 150
*! A 48-year-old man was diagnosed with echinococcosis of the right lobe of the liver.
What kind of treatment tactics are appropriate in this case?

*chemotherapy
*radiation therapy
* puncture drainage of the echinococcal cavity
* UFO blood
* echinococcectomy +

# 151
*! A 52-year-old woman is suspected of having an echinococcal cyst of the liver.
What is the MOST informative laboratory test that should be prescribed to clarify the diagnosis?

* Katsoni test +
* leukocyte level
* Mantoux test
* test of a cough push
* level of erythrocytes

# 152
*! A 43-year-old man, was admitted on an emergency basis with complaints of general weakness, fever
up to 39.0 C, chills, heaviness in the right hypochondrium. On MRI: festering echinococcal cyst of the
right lobe of the liver.
Which treatment tactic is MOST acceptable in this case?

* conservative therapy
* puncture of an echinococcal cyst
* urgent surgical treatment +
* surgical treatment in a planned manner
* percutaneous cholecystostomy under ultrasound control

# 153
*! A patient suffering from a lung abscess has an increase in body temperature up to 390C, increased
weakness, and shortness of breath. On ultrasound of the left pleural cavity, an inhomogeneous fluid is
determined. A preliminary diagnosis was made "Pyothorax on the left".
Which of the following methods is the MOST informative for confirming the diagnosis?

* puncture of the pleural cavity +

*blood chemistry
*CT scan
* bronchoscopy
*biopsy

# 154
*! In the department of therapy, a patient with a diagnosis of "Lung abscess" developed
pyopneumothorax on the 7th day.
Which of the following is the MOST priority action for the patient?

* endobronchial administration of proteolytic enzymes

* drainage of the pleural cavity +
* antibacterial therapy
* introduction of cytostatics
* X-ray therapy

# 155
*! A 16-year-old boy, was admitted with complaints of pain in the right side of the chest, shortness of
breath, general weakness. A survey chest X-ray was performed, where the collapse of the right lung was
determined. Diagnosed with Spontaneous pneumothorax.
What is the MOST appropriate treatment method?

* drainage of the pleural cavity with active air aspiration +

* pleural puncture with air aspiration
* conservative therapy
* thoracotomy
* observation

# 156
*! A 68-year-old man, suffering from habitual constipation for a long time, complains of their
intensification, the lack of effect from previously helped laxatives, the appearance of blood impurities in
the feces, rumbling, and heaviness in the abdomen. On examination: satisfactory nutrition, the abdomen is
somewhat swollen, gas rumbling in the intestines on palpation.
With which diagnostic method from the listed below is the MOST expedient to start the examination?

* with sigmoidoscopy with targeted biopsy

* from digital examination of the rectum +
* with computed tomography
* with irrigoscopy and -graphic
* with ultrasound

# 157
*!A 44-year-old patient has grade III ischemia of the right lower extremity, cannot walk more than 30
meters. The pulsation is expressed at all levels of the artery of the left lower limb, and on the right - the
pulse is expressed only in the femoral artery. On angiography - occlusion of the right popliteal artery, its
branches are characterizedsaturation of collaterals.
Which of the following operations is MOST expedient in this case?

*amputation
* arterialization of the great saphenous vein
* auto- (allo) plastic of the popliteal artery +
* lumbar sympathectomy
* stelectomy

# 158
*!A 63-year-old patient was operated on with a diagnosis of atherosclerosis of the iliac artery, with
stenosis and occlusion of the inferior femoral artery. During the operation, calcification of the femoral
artery was found.
In this case, which surgical tactic is the MOST acceptable?

* continuation and implementation of reconstructive surgery +

* only profundoplasty
* periarterial sympathectomy
* lumbar sympathectomy
* completion of the operation with the execution of the revision

# 159
*! A 70-year-old patient suffers from obliterating atherosclerosis of the artery of the lower extremities.
During the examination, grade IV ischemia was revealed.
What is the MOST expedient treatment tactic in this case?

* start dilating blood vessels

* amputation +
* make thromboembolectomy
* lumbar sympathectomy
* revascularization osteotrepanation

# 160
*! I entered the emergency room A 72-year-old patient with a preliminary diagnosis of III degree
ischemia of the right lower limb. Angiography shows segmental stenosis of the right femoral artery.
Which of the following is the MOST effective in this case?
* symptomatic treatment
* femoral-popliteal bypass
* aorto-femoral bypass surgery +
* One-time reconstruction, which restores the patency of the disturbed areas of the aorta and its branches
* reconstruction of the popliteal arteries

# 161.
*! A 26-year-old patient was diagnosed with a lung abscess complicated by profuse pulmonary
hemorrhage. Your tactics
* bronchoscopy, stopping bleeding * torocotomy, pulmonectomy + * torocoscopy, ligation of a bleeding
vessel * hemostatic therapy * hemostatic therapy, hematransfusion

# 162.
*! A 37-year-old patient was undergoing outpatient treatment 3 months ago with a diagnosis of right-
sided lower lobe pneumonia. He did not receive adequate antibiotic therapy. I went to the polyclinic again
due to persisting low-grade fever and unproductive cough. X-ray examination in the lower lobe of the
right lung - 2 thick-walled intrapulmonary cavities with uneven contours, the presence of a horizontal
fluid level, surrounded by a zone of pneumosclerosis. Your diagnosis
* lung abscess +
*lung cancer
* pleural empyema
* pyothorax
* hydrothorax

# 163.
*! A 30-year-old patient was admitted with complaints of "dagger" pain throughout the abdomen, nausea,
weakness. Objectively: the general condition is serious. Tongue dry, abdomen tense. Does not participate
in the act of breathing. On palpation, the abdomen is tense, sharply painful throughout the abdomen.
Hepatic dullness is not defined. Symptom Shchetkin-Blumberg sharply positive in all parts of the
abdomen. What is your presumptive diagnosis?
* gastric ulcer complicated by perforation. Peritonitis +
* acute adhesive intestinal obstruction. Peritonitis
* acute pancreatitis. Pancreatic necrosis. Peritonitis
*acute appendicitis
* acute cholecystitis

# 164.
*!During an operation for a right-sided strangulated inguinal hernia in the hernial sac, the surgeon
discovered a Meckel diverticulum without signs of destruction. How are these hernias called by the
author, is diverticulum resection indicated?
* Richter's hernia, diverticulum resection not indicated
* Lexner's hernia, diverticulum resection not indicated
* Ru-Oppel hernia, diverticulum resection is indicated
* Littre's hernia, diverticulum resection is indicated +
* hernia Bassini, diverticulum resection not indicated
# 165
*! A 44-year-old man was admitted to the surgery department with complaints of sharp pains and painful
induration in the right groin region on the right. When viewed in the right groin above the inguinal
ligament, there is a tumor-like formation of a dense consistency, does not fit into the abdominal cavity,
sharply painful on palpation. The symptom of a cough impulse is negative. Your preliminary diagnosis
and treatment tactics:
* Hernia of the white line of the abdomen, planned surgical treatment
* Postoperative ventral hernia, emergency surgical treatment
* Umbilical hernia, planned surgical treatment
* Diastasis of the rectus abdominis muscles, emergency surgical treatment +
* Inguinal hernia, urgent surgical treatment?

# 166.
*! During an operation for an inguinal hernia, it was found: the hernial sac passes through the elements of
the spermatic cord, goes into the scrotum, visually laterally from the elements, there is an omentum in the
hernial sac, a moderate amount of light hernial water, a testicle. Postoperative diagnosis:
* Oblique inguinal hernia
* Direct inguinal hernia
* Inguinal-scrotal hernia
* Congenital inguinal hernia +
* Oblique inguinal hernia with a straightened canal

# 167.
*! Patient D., 48 years old, was operated on in the clinic for calculous cholecystitis in a planned manner.
The postoperative course was unremarkable, after 9 days in a satisfactory condition, she was discharged
for outpatient treatment. 2 months after the operation, the patient notes an attack of pain in the right
hypochondrium with a rise in temperature to 39 degrees with chills. A day after the attack, jaundice
appeared. The patient was admitted to the surgical department. Preliminary diagnosis
* Acute pancreatitis. Obstructive jaundice
* Acute cholecystopancreatitis. Obstructive jaundice
*Hepatitis. Parenchymal jaundice
* Cancer of the pancreatoduodenal zone. Obstructive jaundice
* Residual stone of common bile duct. Obstructive jaundice +

# 168
*! A 58-year-old patient has fever, paroxysmal pain in the right hypochondrium, icterus of the sclera,
bilirubinemia due to direct fraction, increased alkaline phosphatase, leukocytosis with a shift to the left.
What research method allows you to diagnose the disease?
* laparoscopy, FGDS
* selective angiography, PCR
* MRI of the abdominal cavity (hepatobiliary zone) +
* Liver biopsy, splenoportography
* Radioisotope liver scan

# 169
*! Patient M., 57 years old, complains of acute colicky pain in the right hypochondrium with irradiation
to the scapula, darkening of the color of urine. The sclera are icteric. Three years ago she underwent
cholecystectomy. What is the most likely illness in the patient?
*pancreas cancer
* echinococcosis of the liver
* Mirizi syndrome
* alveococcosis of the liver
* choledoch stone +
# 170
*! Patient N., 75 years old, after undergoing cholecystectomy 3 years ago, developed jaundice after
several bouts of pain. MRI revealed a calculus up to 9 mm in the terminal section of the common bile
duct. What treatment is indicated?
* laparotomy, choledocholithotomy, drainage of the choledochus according to Ker
* percutaneous transhepatic cholangiostomy
* ERCP with EPST +
* laparotomy, choledocholithotomy, choledochoduodenostomy
* laparotomy, ideal choledocholithotomy

# 171
*! Patient A, 45 years old. Complaints about: bleeding that occurs during bowel movements, itching of
the perianal region, pain in the anus, painful "bumps" in the anal canal. Anamnesis morbi: Suffers from
chronic hemorrhoids for 2 years. The last 6 months are worried about bleeding and prolapse of
hemorrhoids. I went to the polyclinic at my place of residence. He was sent for planned surgical treatment
at the Medical Center of the State Medical University in Semey. Examined by a surgeon and hospitalized
in the farm for surgical treatment. Anamnesis vitae: B-Botkina, tuberculosis, venous disease denies.
Allergies to food and drugs are not noted. Status localis: In the supine position of the patient at 3,7,11
hours, there are external hemorrhoidal nodes measuring 1.5x1.0x2.5 cm Per.rectum: Internal hemorrhagic
nodes at 3,7.11 hours measuring 2.5x2.0x2, 5 cm freely fall out of the anus. Prospective operation
* Hemoroidectomy according to Milligon-Morgan +
* Hemoroidectomy according to Mikulich
* Hemoroidectomy according to Monor
* Hemoroidectomy according to Miller
* Hemoroidectomy according to Milliter

# 172
*! Patient A, 45 years old. Complaints about: bleeding that occurs during bowel movements, itching of
the perianal region, pain in the anus, painful "bumps" in the anal canal. Status localis: In the supine
position of the patient at 3,7,11 hours, there are external hemorrhoidal nodes measuring 1.5x1.0x2.5 cm
Per.rectum: Internal hemorrhagic nodes at 3,7.11 hours measuring 2.5x2.0x2, 5 cm freely fall out of the
anus. What complications can be
* thrombosis, infringement of hemorrhoids +
* Abscess, phlegmon
* Submucosal abscess, pelviorectal abscess
* pelviorectal abscess
* Purulent fusion of the urethra, the transition of a purulent process to the scrotum, followed by gangrene

# 173
*! The patient complains of bleeding from the rectum, diarrhea, cramping abdominal pain, fever up to 38
degrees, tenesmus, recurrent vomiting, as well as deterioration in general condition and weight loss. What
is your presumptive diagnosis?
*Dysentery
* Enterocolitis
* Nonspecific ulcerative colitis +
* Colon cancer
* Complicated hemorrhoids

# 174
*! A 36-year-old patient underwent surgery 12 hours after the hernia was infringed. The hernial sac
contains two loops of the small intestine. After dissection of the restraining ring, the color of the intestinal
loops became normal, peristalsis appeared, the pulsation of the mesenteric vessels was restored. Both
loops are immersed in the abdominal cavity, plastic surgery of the back wall of the inguinal canal was
performed. Type of infringement?
* retrograde +
* parietal
* sliding
* Richter's
* feces

# 175
*! A 27-year-old patient underwent surgery for a strangulated hernia 10 hours after the disease, two loops
of the small intestine appeared in the hernial sac. After dissection of the restraining ring, the color of the
intestinal loops, peristalsis recovered, the pulsation of the mesenteric vessels was good. Both loops are
immersed in the abdominal cavity, plastic surgery of the back wall of the inguinal canal was performed. A
day after the operation, the patient was re-operated on for diffuse purulent peritonitis. During the
operation, a perforation of the necrotic loop of the small intestine was found. What was the mistake that
led to the onset of peritonitis?
* the wrong method of plastic surgery of the inguinal canal
* the third intermediate loop has not been inspected +
* no solution of 0.25% novocaine was introduced into the mesentery of the small intestine
* dynamic surveillance not established
* not performed gastric intubation

# 176
*! A 62-year-old patient suffering from chronic calculous cholecystitis, after an error in the diet,
developed sharp pains in the right hypochondrium and epigastrium with irradiation to the lumbar region,
repeated vomiting. After 4 hours, sclera icterus appeared, noted darkening of urine. The level of blood
amylase activity was 280 U / L.
What is the MOST probable complication of gallstone disease in the patient?

* perforation of the gallbladder with the development of peritonitis

* obturation of the cystic duct stone
* acute papillitis
* cholangitis
* restrained stone of the large duodenal papilla +

# 177
*! A 48-year-old patient underwent elective cholecystectomy for chronic calculous cholecystitis with
frequent bouts of hepatic colic. After 3 months, painful attacks in the right hypochondrium, like hepatic
colic, resumed. There were two episodes of short-term obstructive jaundice (up to 5-7 days). Ultrasound
and ERCP showed the presence of an enlarged hepaticoholedochus up to 13 mm with a calculus with a
diameter of 0.6 cm.
What is the MOST expedient method of surgical treatment of residual choledocholithiasis in this case?

* endoscopic papillotomy +
* choledochoduodenostomy
* choledocholithotomy
* transduodenal papillosphincterotomy
* choledochoenterostomy

# 178
*! A 67-year-old patient underwent cholecystectomy about 5 years ago. After the operation, moderate
pain in the epigastrium and recurrent stool disorders were troubling. Alcohol abuse. On admission
obstructive jaundice, in the biochemical blood test, the bilirubin level is 122.5 μmol / l. With ultrasound -
chronic pancreatitis, an increase in the size of the head of the pancreas. With ERCP, the distal part of the
common bile duct is narrowed over 2.5 cm, discharge into the duodenum is sharply difficult, the common
bile duct is enlarged to 2 cm.
What is the MOST appropriate treatment method in this case?

* percutaneous drainage of the bile duct

* laparotomy, transduodenal papillosphincteroplasty
* conservative therapy using extracorporeal detoxification methods
* laparotomy, choledochotomy with drainage of the choledoch according to Keru
* laparotomy, choledochoduodenostomy +

# 179
*! A 27-year-old woman complains of difficulty swallowing food, sensation of a lump in the throat and
regurgitation of recently eaten food, occurring without any tension. According to the patient, gurgling
noises are sometimes heard when the liquid is swallowed.
Which of the following examination methods is MOST justified for making a diagnosis?

* contrast X-ray examination +

* radionucleide research
* esophagoscopy
* mediastinoscopy
* torocoscopy

# 180
*! Young woman 29 years old, delivered after accidentally ingesting 50 ml of acetic acid. On admission,
she complains of chest pain when swallowing, weakness, nausea, and vomiting.
What is the MOST appropriate treatment?

* parenteral nutrition, antibiotics, detoxification +

* resection of the esophagus
* cardiodilation
* gastric resection
* bougie

# 181
*! A 40-year-old man was delivered to the PPC with complaints of severe pain in the epigastrium and on
the right, radiating to the back, nausea. From the anamnesis: periodically disturbed by night "hungry"
pains, the man relieves them by taking a solution of baking soda, notes the seasonal nature. On
examination, the skin is of normal color, the abdomen is of normal shape, soft, painful in the epigastrium
and right hypochondrium. Ultrasound of the abdominal cavity: there is no free fluid, the gallbladder is
normal, the pancreas is not enlarged, the contours are clear. Diastasis is normal.
What is the MOST probable diagnosis?

* perforated duodenal ulcer

* acute pancreatitis
* malignant ulcer
* penetration of the ulcer +
*gastritis

# 182
*! A 55-year-old man is admitted to the hospital with complaints of vomiting food for a week. Skin and
mucous membranes are dry, hematocrit is 55%. In the anamnesis, there was a constant pain syndrome,
which has recently been replaced by a feeling of heaviness in the epigastric region. Not previously
examined. X-ray examination of the stomach revealed a significantly enlarged stomach.
For which pathological condition is the presence of these symptoms most characteristic?

* electrolyte disturbances +
* impaired liver function
* hyperglycemia
* hypertension
*fever

# 183
*! The surgeon was summoned for a consultation in the therapeutic department to a 65-year-old patient
with a clinic of gastrointestinal bleeding, who was completing the course of treatment for myocardial
infarction.
What's your tactic?

* dynamic observation in the therapy department

* transfer to the gastroenterology department
* transfer to the surgical department +
*ambulatory treatment
* day hospital

# 184
*! The patient, 42 years old, is in the clinic with a diagnosis of abscess of the right lung in the stage of
formation, without a breakthrough in the bronchus.
The MOST informative laboratory research method for differential diagnosis with a tuberculous cavity?

* sputum analysis for mycobacterium tuberculosis +

*blood chemistry
* serological blood test
*general blood analysis
* coagulonram

# 185
*! A 52-year-old man who is in the surgical department, on the 6th day after the operation, pain appeared
in the area after the surgical wound, the body temperature increased to 38.50C. When viewed in the area
of the postoperative wound, hyperemia is noted, painful on palpation. Which of the following
complications is the MOST probable in this case?

* pylephlebitis
* purulent cholangitis
* under hepatic abscess
* parenchymal jaundice
* suppuration after an operating wound +

# 186
*! A 48-year-old woman complains of pain in the right hypochondrium, which appeared after eating fatty
and fried foods. On palpation: the abdomen is moderately painful in the epigastrium and right
hypochondrium. Ultrasound of the abdominal organs: gallbladder 8.0x4.0 cm, wall 0.3 cm. There are
many stones up to 0.3 cm in the cavity. The choledoch is expanded to 2.1 cm. it defines a calculus up to
0.5 cm.
Which of the following treatment tactics is MOST appropriate in this case?

* percutaneous drainage of the gallbladder under ultrasound control

* ERCP with EPST, followed by laparoscopic cholecystectomy +
* emergency cholecystectomy after preoperative preparation
* elective ERCP with EPST followed by laparoscopic cholecystectomy
* only conservative treatment, including antibacterial drugs

# 187
*! A 70-year-old woman was admitted with complaints of a painful hernial protrusion in the navel, which
cannot be adjusted on its own. On examination, cyanosis of the skin over the protrusion is noted. History
of diabetes mellitus, ischemic heart disease.
What tactics of patient management is the MOST expedient?

* supervision in the department of surgery

* emergency operation +
* operation as planned
* urgent operation
* outpatient follow-up

# 188
*! A 50-year-old woman was admitted to the department of surgery with a femoral hernia for planned
surgical treatment.
Which of the following plastic methods is the MOST acceptable?

* according to Mayo
* by Ruji +
* according to Sapezhko
* according to Kukudzhanov
* across Spasokukotsky

# 189
*! A 60-year-old man was admitted to the surgery department for planned surgical treatment for an
inguinal hernia. The surgeon is planning a plastic surgery of the inguinal canal according to Girard-
Spasokukotsky.
Which operational technique is MOST justified in this case?

* strengthening the posterior wall of the inguinal canal

* strengthening the lower wall of the inguinal canal
* strengthening the upper wall of the inguinal canal
* narrowing of the external opening of the inguinal canal
* strengthening the anterior wall of the inguinal canal +

# 190
*! A 50-year-old man, was admitted with complaints of bleeding at the time of bowel movement, general
weakness, dizziness. On examination, the patient was adynamic, and continued hemorrhoidal bleeding
was revealed.
What is the MOST advisable tactics of patient management?

* observation in the dynamics of the house

* hospitalization and observation in a hospital
* surgical treatment in a hospital +
* conservative treatment in a hospital setting
* outpatient treatment using hemostatics

# 191
*! Patient 57 years old, was admitted to the clinic of mechanical intestinal obstruction. From the
anamnesis, over the past 2 months, he has lost 8 kg. On palpation of the abdomen in the right iliac region,
an immobile tumor-like formation of a dense tuberous consistency is determined.
To clarify the diagnosis, it is MOST expedient to prescribe?

* irrigoscopy +
* FGDS
* CT
* plain radiography of the abdominal cavity
* Ultrasound of the abdominal cavity

# 192
*! Patient 51 years old, was admitted to the clinic of paralytic intestinal obstruction. According to the
words, he has been working at a lead plant for about 10 years. On a plain x-ray of the abdominal cavity,
swollen loops of the small intestine are determined, there are no fluid levels.
What is the MOST appropriate treatment tactic in this case?

* emergency operation
* Conservative treatment +
* operation as planned
*ambulatory treatment
* planned operation

# 193
*! Which of the listed surgical interventions is MOST advisable in case of failure of the perforating veins
of the lower extremities?

* Bebcocca
* Narata
* Madelunga
* Troyanov-Trendelenburg
* Linton +

# 195
*! A patient in the intensive care unit developed epistaxis and bleeding from the injection site against the
background of heparin therapy. Blood clotting more than 15 minutes. The patient receives treatment for
pulmonary embolism.
Which of the following drugs is MOST effective in this case?

* cancel heparin
* introduce SZP
* prescribe hemostatics - vicosol, dicinon
* introduce sodium thiosulfate
* introduce sodium protamine sulfate +

# 196
*! A 33-year-old patient was admitted to the trauma department with complaints of pain, numbness in the
right lower extremity, the pain increases in intensity. From the anamnesis: fell from a height of 2 meters,
dislocation in the knee joint on the right. After the examination, the diagnosis was made of "Thrombosis
of the popliteal artery on the right".
Which of the following operations is the MOST expedient?

* Linton operation
* Troyanov's operation
* revision of the knee joint
* thromboembolectomy +
* Oppel's operation

# 197
*! A 54-year-old patient undergoing hospital treatment for acute pancreatitis underwent surgery due to
ineffectiveness of conservative treatment. When the omental bursa was opened, hemorrhagic fluid was
released, the pancreas was dark brown throughout with fatty blotches.
What operational tactics are MOST advisable?

* resection of the body of the gland

* subtotal resection
* pancreatoduodenal resection
* resection of the tail of the gland
* drainage of the stuffing box +

# 198
*! A 23-year-old man, hospitalized with a diagnosis of acute appendicitis. There are no clinical signs of
peritonitis. Emergency appendectomy is planned.
What kind of operational access is the MOST advisable?

* lower median laparotomy

* Volkovich-Dyakonov +
* Fedorova
* Lenander
* Kochera
# 199
*! A 55-year-old patient was admitted to a surgical hospital with complaints of abdominal pain, nausea,
vomiting, dry mouth. On an ultrasound examination of the abdominal cavity, free fluid is determined in
the lateral pockets and half of the small pelvis.
Which of the listed examination methods is the MOST expedient to produce to clarify peritonitis?

* CT
* MRI
* FGDS
* colonoscopy
* laparoscopy +

# 200
*! How can histological verification of the state of the esophageal mucosa be obtained?

* bronchoscopy
* Ultrasound of the esophagus
* radiometry of the esophagus
* fluoroscopy of the esophagus
* esophagoscopy and biopsy +