ACUTE APPENDICITIS (I)

1. Name the clinical signs which are similar to the acute catharrhal appendicitis:
A. Kocher – Volkovych’s Sign
B. Bartomie –Mikchelson’s Sign
C. Subfebrile fever
D. Rovzing’s Sign
E. Shchetkin- Blumberg’s Sign
2 . In the treatment of appendicular mass you shouldn’t apply :
A. Physiotherapy
B. Antibiotics
C. Enemas with chamomile
D. Opioids
E. Diet
3 . For the differential diagnosis of acute appendicitis with right sided renal colic you should
use:
A. Antispasmodics injection
B. Narcotic analgesics injection
C. Urgent urine test
D. Cystochromoscopy or excretory urography
E. Renal angiography
4 . Perforated appendicitis is characterized by:
A. The presence of free gas in the abdominal cavity
B. Decreasing of blood volume
C. Sudden abdominal pain increasing
D. Muscle guarding
E. Positive Shchetkin- Blumberg’s Sign
5 . Primary gangrenous appendicitis develops due to :
A. Lower mesenteric vein thrombosis
B. Stenosis of the iliocolic artery ostium
C. Nonspecific arteriitis of the abdominal aorta branches
D. Presence of bacteroid infection
E. Appendicular artery thrombosis
6. To acute phlegmonous appendicitis the next signs are similar:
A. Shchetkin- Blumberg’s Sign
B. Bartomie –Mikchelson’s Sign
C. Kocher – Volkovych’s Sign
D. Rovzing’s Sign
E. Murphey’s Sign
7. Which of the appendicular symptoms is rare in the elderly?
A. Mild pain in the right iliac area
B. High fever
C. Muscle guarding in the right iliac region
D. Constipation
E. Moderate leucocytosis
8. Which of the following methods is the least informative in the diagnosis of acute
appendicitis?
A. Laboratory research - especially white blood cell count
B. Paracentesis
C. Rectal finger research
D. Axillary and rectal thermometry
E. Clinical examination with the definition of painful zone during palpation and percussion, muscle
guarding.
9. Clinical features of acute appendicitis in elderly patients are :
A. The primary gangrenous form developing
B. Little pain syndrome intensivity
C. Multiple vomiting
D. Hectic fever
E. Doubtful signs of peritoneum irritation
10 . You should operate a patient with typical picture of acute appendicular abscess . What
surgical access it is expedient to choose?
A. Lower- median laparotomy
B. Volkovitch- Djyakonov’s access
C. Right side pararectal access
D. Right side transrectal access
E. Pfannenshtihl’s access
11. Surgical intervention in acute appendicitis is contraindicated in case of :
A. Appendicular mass formation
B. The 36th-38th weeks of pregnancy
C. Decompensated heart failure
D. Acute myocardial infarction
E. All mentioned above is not correct
12. What measures are necessary in acute appendicitis supposition?
A. Local hypothermia, painkillers and antispasmodics with dynamic observation
B. Surgical treatment
C. Appendectomy with the abdominal cavity drainaging
D. Appendectomy without the abdominal cavity drainaging
E. Dynamic observation for 4-6 hours, body temperature measuring and blood test analysis
13. The next sign is not typical for acute appendicitis:
A. Rovzing’s Sign
B. Voskresenski’s Sign
C. Murphey’s Sign
D. Obraztsov’s Sign
E. Bartomie –Mikchelson’s Sign
14. The most similar signs for acute appendicitis are :
A. Kocher – Volkovych’s Sign
B. Rovzing’s Sign
C. Sitkovski’sd Sign
D. All three signs
E. Neither of these signs
15. To peritoneal symptoms in acute appendicitis symptoms include :
A. Voskresenski’s Sign
B. Shchetkin- Blumberg’s Sign
C. Razdolski’s Sign
D. All these signs
E. Neither of these signs
16. Acute appendicitis should be differentiated from all of these diseases, except :
A. Glomerulonephritis
B. Acute pancreatitis
C. Ectopic pregnancy
D. Acute gastroenteritis
E. Right - sided renal colic
17. Acute appendicitis in children differs from that in adults by all, except :
A. Cramping pain, diarrhea, repeated vomiting
B. The rapid peritonitis developing
C. High temperature
D. Expressed intoxication
E. Sudden muscle tension in the right iliac area
18. Perforated appendicitis is characterized by:
A. Razdolski’s Sign
B. Increasing of peritonitis clinical manifestation
C. Sudden abdominal pain increasing
D. Abdominal muscles tension
E. All of the mentioned above
19. Decisive in the differential diagnosis of acute appendicitis with failed ectopic pregnancy is:
A. Kocher – Volkovych’s Sign
B. Promptov’s Sign
C. Rectal finger research
D. Bartomie –Mikchelson’s Sign
E. Posterior vaginal fornix puncture
20. Name the surgical operations stages in case of diffuse purulent appendicular peritonitis
presence:
A. Median laparotomy
B. Appendectomy
C. Lavage of the abdominal cavity
D. Abdominal drainaging
E. All of the mentioned above
21. For the diagnostics of acute appendicitis you should prescribe:
A. Laparoscopy
B. Complete blood test
C. Rectal finger research
D. Thermography
E. All of the mentioned above is true
22. In case of diffuse purulent appendicular peritonitis:
A. Appendectomy and lavage of the abdominal cavity
B. Correction of fluid and electrolyte disorders
C. Antibiotic therapy
D. Total parenteral nutrition for 1-2 days after surgery
E. All of the mentioned above is true
23. The most efficient method of appendicular stump closuring is :
A. Ligation with silk with subsequent stump inserting
B. Ligation with silk without subsequent stump inserting
C. Stump inserting without ligation
D. Ligation with catgut without stump inserting
E. Ligation with catgut with stump inserting
24. Development of the pathological process in acute appendicitis starts in :
A. Serous layer
B. Mucous layer
C. Muscular layer
D. Caecal mucosa
E. Limphatic vessels of the appendix mesentery
25. Meckel's diverticulum occurs :
A. In the jejunum
B. In the ileum
C. In the ascending colon
D. As a result of appendectomy
E. Because of embryologic disorders
26. To acute catharrhal appendicitis are similar:
A. Kocher – Volkovych’s Sign
B. Bartomie –Mikchelson’s Sign
C. Subfebrile fever
D. Rovzing’s Sign
E. Shchetkin- Blumberg’s Sign
27. What are the symptoms of the gangrenous appendicitis ?
A. Abdominal muscle guarding
B. Sudden abdominal pain increasing in the right iliac area
C. Decreasing of pain
D. Tachycardia
E. Shchetkin- Blumberg’s Sign in the right iliac region is positive
28. The main symptom of pelvic appendicitis :
A. Shchetkin- Blumberg’s Sign
B. Rovzing’s Sign
C. Presence of anterior wall painful protrusion during rectal finger research
D. Muscle tension in the right iliac area
E. Kocher – Volkovych’s Sign
29. Pylephlebitis usually is a complication of :
A. Perforated gastric ulcer
B. Volvulus of the small intestine
C. Small bowel infarction due to embolism of the superior mesenteric artery
D. Destructive appendicitis
E. Failed ectopic pregnancy
30. Appendicular mass usually develops :
A. During first two days after the onset of the disease
B. Up to the 3-4 days after the onset of the disease
C. Up to the 7-9 day after the onset of the disease
D. In the early period after appendectomy
E. In the late postoperative period
31. The patient of 23 years old, third trimester of pregnancy, being in the surgical ward for 18
hours. Acute appendicitis can not be completely excluded during dynamic monitoring. Your
medical tactics?
A. Urgent operative treatment
B. Monitoring of the patient condition
C. Abdominal ultrasonography
D. Together with the gynecologist you should cause artificial breaking of pregnancy with
subsequent appendectomy
E. Laparoscopy
32. Douglas’s space abscess after appendectomy is characterized by the following :
A. Hectic fever
B. Pains deep in the pelvis and tenesms
C. Limited excursion of the diaphragm
D. Overhanging walls of the vagina or anterior wall of the rectum
E. Muscle tension of the anterior abdominal wall
33. In patient of 18 years old on the 7th day after appendectomy pelvic abscess developed.
What should you do ?
A. Antibiotic therapy
B. Lower- median laparotomy, drainaging
C. Abscess drainaging through the right iliac area
D. Abscess drainaging through the anterior wall of the rectum
E. Abscess should be drainaged extraperitoneally
34. In patient of 40 years old on the 2nd day after appendectomy (gangrenous appendicitis)
intestinal paresis developed. The chill and pain began to disturb in the right half of the
abdomen, enlarged liver and jaundice also appeared. Symptoms of peritoneal irritation were
observed. What should you think about?
A. Peritonitis
B. Subdiaphragmatic abscess
C. Intraabdominal abscess
D. Pylephlebitis
E. Subhepatic abscess
35. Retroperitoneal phlegmon may develop in case of:
A. Anterior subhepatic location of appendix
B. Localized peritonitis presence in the right iliac area
C. Retroperitoneal location of the appendix
D. Medial location of the appendix
E. Location of the appendix laterally to the caecum
36. Subphrenic abscess should be drainaged through the following access :
A. Thoracoabdominal
B. Lumbotomic
C. Double- staged transpleural access
D. Laparotomy in the right upper quadrant according to Fedorov
E. Extrapleural extraperitoneal way
37. Typical complications of acute appendicitis are:
A. Appendicular mass
B. Omental bag abscess
C. Pylephlebitis
D. Douglas’s space abscess
E. Pyelonephritis
38. For the treatment of hard pelvic masses without signs of abscess formation:
A. Fowler position on the back
B. Antibiotic therapy
C. Apply warm chamomile enemas
D. Gentle, digestible nutritious diet
E. Detoxication
39. Signs of appendicular mass purulent sequestration:
A. Presence of hectic fever
B. Increasing of pain
C. Peritoneal irritation signs
D. Leukocytosis with a shift to the left, increasing of the ESR
E. Lack of tendency to decrease infiltration in sizes after 7-10 days of intensive therapy, especially
with antibiotics
40. Purulent sequestration should be treated by:
A. The operation under general anesthesia
B. The use of extraperitoneal access (by Pirogov)
C. Infiltrate carefully separated, avoiding damage of infiltrated loops of intestine
D. Removing of the destructive changed appendix
E. Thoroughly washed and drained the abscess cavity

ACUTE CHOLECYSTITIS (II)

1. Acute cholecystitis may develop as a result of :

A. Infection passing into the gallbladder bile
B. Stagnation of bile in the gallbladder
C. The presence of gallstones
D. Cystic artery thrombosis
E. Duodeno -gastric reflux
2 . The next symptoms are similar to acute catharrhal cholecystitis, except :
A. Nausea and vomiting
B. Kehr’s sign
C. Murphy’s sign
D. Muscle tension of the anterior abdominal wall in the right upper quadrant and
positive Shchetkin – Blumberg’s sign
E. Mussy- Georgievski’s sign
3 . In what cases in the patient with acute destructive cholecystitis the cholecystostomy is
indicated :
A. Concomitant acute pancreatitis
B. Concomitant obstructive jaundice
C. In severe general condition of the patient
D. Concomitant cholangitis
E. All answers are correct
4 . The patient was admitted to the hospital with acute phlegmonous cholecystitis. During the
next three days the chill , jaundice and febrile fever were detected. The symptoms of
peritonitis were absent. Name the complication of the acute cholecystitis?
A. Stenosis of the large duodenal papilla
B. Empyema of the gallbladder
C. Pylephlebitis
D. Obstructive jaundice
E. Purulent cholangitis
5 . To the urgent surgery indication in acute cholecystitis the most important is :
A. Pain intensity
B. The fever
C. The number of attacks in history
D. Peritonitis presence
E. The gallstones presence
6. Cholecystectomy is performed “from the bottom” in one of the following cases :
A. In the old-aged patients
B. In the presence of cholangitis symptoms
C. With wrinkled gallbladder
D. When the stone is impacted in the neck of the gallbladder
E. When the inflammatory mass is formed round the neck of the gallbladder
7. The patient of 81 years old was admitted to the hospital with acute phlegmonous
cholecystitis. During patient’s examination the empyema of the gallbladder was supposed.
What method of investigation should be prescribed primarily?
A. Ultrasound research of the abdomen
B. Injective cholecysto- cholangiography
C. Laparoscopy
D. ERCPG
E. Percutaneous transhepatic cholecystocholangiography
8. What surgery you should prescribe to the patient of 81 years old with acute phlegmonous
cholecystitis and severe general condition:
A. Cholecystectomy
B. Laparoscopic cholecystostomy under local anesthesia
C. Drainaging of the thoracic cavity
D. Laparoscopic drainaging of subhepatic space
E. Cholecystostomy
9. For the diagnosis of uncomplicated gallstone disease the preference should be given to:
A. Endoscopic retrograde cholangiopancreatography
B. Laparoscopy
C. Ultrasonography
D. Percutaneous transhepatic cholangiography
E Fractional duodenal intubation
10 . The main method of mechanical jaundice diagnostics is :
A. Radiography of the liver and subhepatic space
B. Injective cholecystocholangiography
C. Percutaneous transhepatic cholangiography
D. Endoscopic retrograde cholangiopancreatography
E. Ultrasonography
11. Acute cholecystitis may be complicated by all of the following except:
A. Obstructive jaundice
B. Portal hypertension
C. Suppurative cholangitis
D. Subhepatic abscess
E. The stone impaction in the large duodenal papilla
12. The examination of the patient of 67 years old revealed acute gangrenous cholecystitis and
local peritonitis . Your medical tactics ?
A. Conservative treatment according to the patient’s condition
B. Operation if the conservate treatment will be failed
C. Inspection of the patient in dynamics
D. Proper diet, discharging from the hospital
E. Emergency surgery
13. In the patient of 77 years old with severe heart
failure the examination revealed destructive cholecystitis with the symptoms of peritonitis in
the right upper quadrant. What method of treatment should be preferred ?
A. Laparoscopic cholecystostomy
B. Cholecystectomy
C. Laparotomic cholecystostomy
D. Percutaneous transhepatic cholangiostomy
E. Only conservative treatment
14. Cholecystectomy is performed “from the neck” in one of the following cases :
A. Conditions for bloodless removal of the gallbladder
B. Interrupted route of purulent bile in choledoch
C. It is possible to avoid migration of stones from the gallbladder into the choledoch
D. Allows you to refrain from choledochotomy
E. Eliminates the need for intraoperative cholangiography
15. What diseases should be differentiated from acute cholecystitis?
A. Perforated ulcer
B. Acute pancreatitis
C. Right-side pleuropneumonia
D. Acute appendicitis
E. Cancer of the stomach
16. Name three clinical symptoms of acute cholecystitis?
A. Mayo-Robson's
B. Murphy's
C. Rovzing's
D. Kehr's
E. Ortner's
17. Name the borders of Calot's triangle?
A. Common bile duct
B. Cystic duct
C. Portal vein
D. Cystic artery
E. Common hepatic artery
18. What should you prescribe to your patient with acute cholecystitis and severe concomitant
disease?
A. Cholecystostomy
B. Cholecystectomy
C. Choledochoduodenostomy
D. Cholangiostomy
19. The most informative methods in acute cholecystitis diagnostics:
A. CT
B. Plain radiography of the abdomen
C. Ultrasound research
D. Oral cholecystography
E. Plain radiography of the barium passage
20. Symptom Myussi-Georgievsky:
A. Acute pain tapping along the right costal arch
B. Pain during palpation between the cruses of right sternocleid muscle
C. Tenderness in the projection of the gallbladder
D. Pain when pressing near the navel
21. Surgical intervention in acute calculous cholecystitis should be performed in:
A. All patients in urgent cases
B. Patients with conservative therapy failure within 48-72 hours
C. Patients with peritonitis
D. Patients with subfebrile fever
22. Morphological forms of acute cholecystitis are:
A. Catharrhal
B. Abscess
C. Hemorrhagic
D. Gangrenous
E. Phlegmonous
23. In patient after fatty food abuse 3 days ago pain in the right subcostal area appeared.
After no-shpa administration pain syndrome decreased. Body temperature is 37,7 - 38,0 o.
The abdomen is soft. During palpation in the right subcostal area painful mass is present.
Leukocytosis 14.5 x 109 , neutrophil's shift to the left. Name the disease
A. Acute appendicitis
B. Acute pancreatitis
C. Perforated ulcer
D. Acute cholecystitis
E. Acute pyelonephritis
24. Name the mechanism of pain irradiation in acute cholecystitis?
A. Due to the vague nerve irritation
B. Due to the phrenic nerve irritation
C. Free oxygen radicals influence on the soft tissues
D. Bile acids influence on the soft tissues
25. Name complications wich are similar to acute cholecystitis:
A. Myocardial infarction.
B. Peritonitis
C. Renal colic from the right
D. Subdiaphragmatic abscess from the right
E. Pancreatitis
26. Surgical tactics in acute phlegmonous cholecystitis in the first turn is determined by the
following points :
A. Incidence of peritonitis
B . The presence of concomitant diseases
C. Age of the patient
D . Surgeon’s qalification
E . The presence of gallstones
27. Acute cholecystitis usually begins with :
A. Temperature rising
B. Vomiting
C. Pain in the right upper quadrant
D . Constipation
E . Heaviness in the epigastric region
28. In acute and chronic cholecystitis the application of the next drugs is contraindicated:
A. Omnopon
B. Morphine hydrochloride
C. Etamsylate
D. Atropine sulfate
E. Spazmalgon, baralgin and no-spa
29. Which of the following is not true for emphysematous cholecystitis?
A. Usually it is associated with acalculus cholecystitis.
B. Most common with diabetes mellitus
C. Air is seen in the lumen of the gallbladder
D. Clostridium perfringes and other clostridia are the comomn causative organisms.
30. Prophylactic cholecystectomy is not recommended for
A. Heart transplant receipients
B. Diabetes Mellitus
C. Incidental gallstones on laparotomy
D. Angina pectoris
31. Which of the following is not an ultrasonic finding in acute cholecystitis
A. Absence of gallstomes
B. Gallbladder wall thickness more than 6 mm
C. Pericholecystic fluid
D. Sonographic Murphy's sign
32. Which of the following statements about the diagnosis of acute calculous cholecystitis are
true?
A. Pain is so frequent that its absence almost precludes the diagnosis
B. Jaundice is present in a majority of patients
C. Ultrasonography is the definitive diagnostic test
D. Cholescintigraphy is the definitive diagnostic test
33. Which statements about acute acalculous cholecystitis are correct?
A. The disease is often accompanied by or associated with other conditions
B. The diagnosis is often difficult
C. The mortality rate is higher than that for acute calculous cholecystitis
D. The disease has been treated successfully by percutaneous cholecystostomy
34. True statements about the surgical management of patients with acute calculous
cholecystitis include:
A. Operation should be performed in all patients as soon as the diagnosis is made
B. Antibiotic therapy should be initiated as soon as the diagnosis is made
C. Dissection of the gallbladder is facilitated by decompression of the organ with the use of a trocar
D. An operative cholangiogram should be done in every patient
35. Which of the following are indications for cholecystectomy?
A. The presence of gallstones in a patient with intermittent episodes of right-side upper quadrant
pain
B. The presence of gallstones in an asymptomatic patient
C. The presence of symptomatic gallstones in a patient with angina pectoris
D. The presence of asymptomatic gallstones in a patient who has insulin-dependent diabetes
36. Which of the following statements about laparoscopic cholecystectomy are correct?
A. The procedure is associated with less postoperative pain and earlier return to normal activity
B. The incidence of bile duct injury is higher than for open cholecystectomy
C. Laparoscopic cholecystectomy should be used in asymptomatic patients because it is safer than
open cholecystectomy
D. Pregnancy is a contraindication
37. A 32-year-old woman with symptomatic gallstones wishes to discuss nonsurgical options
for her gallstones. Which of the following statement(s) are true?
A. The best commercially available oral dissolution agent, ursodeoxycholic acid, is associated with
a complete dissolution rate of less than 50%
B. If the gallstones dissolve, there is minimal risk of gallstone recurrence
C. Contact dissolution is applicable regardless of stone type
D. Extracorporial shock wave lithotripsy (ESWL) in combination with oral dissolution agents is an
appropriate technique for most patients and can result in complete stone fragment clearance in over
90% of patients by one year
38. With what diseases it is necessary to differentiate the acute cholecystitis?
A. Ischemic heart disease
B. Renal colic
C. Perforated ulcer
D. Acute pancreatitis
E. Inguinal hernia
39. Name the blockade wich may help to decrease the pain syndrome in the patient with acute
cholecystitis?
A. Round ligament of the liver blockade
B. Paranephral blockade
C. Vagosympathetic blockade
D. Solar plexus blockade
40. The empyema of the gallbladder- what does it mean?
A. Presence of the pus inside the gallbladder
B. Formation of the fistula between the gallbladder and the duodenum
C. Partial lysis of the gallbladder
D. Enlargement of the gallbladder because of the bile outflow disturbances

ACUTE PANCREATITIS (III)

1. Shock and collapse in acute pancreatitis are caused by :

A. Pancreatogenic peritonitis
B. Compression of the distal common bile duct and cholhaemia
C. Enzymatic toxemia
D. Biliaric hypertension
E. Dynamic ileus
2 . The most similar for hemorrhagic pancreatic necrosis are :
A. Collapse
B. Multiple vomiting
C. Positive Gray- Turner’s Sign
D. Positive Cullen’s Sign
E. Dynamic ileus
3 . What should you do to decrease the enzymatic toxemia in necrotizing pancreatitis:
A. Intravenous antiproteases injections
B. Cyclophosphamide or ftorafur prescriotion
C. Forced diuresis
D. Thoracic duct external drainaging
E. Novocaine blockade of the liver teres ligament
4 . To detect the pancreatic necrosis presence the most informative is:
A. Laparoscopy
B. Ultrasonography
C. Esophagogastroscopy
D. Urine amylase level
E. Blood analysis for the pancreatic enzymes presence
5 . In the patient of 26 years old the diagnosis of hemorrhagic necrotizing pancreatitis was
established after 2 days from the disease beginning. Your tactics?
A. Emergency laparotomy
B. Laparoscopic abdominal drainaging
C. Celiac trunc catheterization
D. Laparoscopic cholecystostomy in the presence of bile hypertension
E. Intensive I/V therapy
6. The postnecrotic complications of necrotic pancreatitis are:
A. Chronic pancreatitis
B. Calculus of Virzung duct
C. Omental bag abscess
D. Pancreatic pseudocyst
E. chronic cholecystitis
7. In the patient with an unclear diagnosis of "acute abdomen" laparoscopy was urgently
performed. In the abdomen serous exudate and multiple spots of fatty necrosis were detected.
Your diagnosis ?
A. Tuberculous peritonitis
B. Fatty pancreatic necrosis
C. Crohn's disease
D. Occlusive intestinal infarction
E. All the answers are wrong
8. In case of fatty pancreatic necrosis laparoscopically detection you should perform:
A. Laparotomy, abdominal sanitation and drainaging
B. Laparotomy, abdominal sanitation and small intestine mesentery novocainic blockade
C. Laparotomy, cholecystostomy and drainaging of subhepatic space
D. Abdominal drainaging of the abdomen and intensive concervative therapy
E. All the answers are wrong
9. Toxemia in necrotizing pancreatitis is caused by the action of:
A. Kallidin
B. Histamine
C. Bradykinin
D. Kallikrein
E. Products of tissues degeneration
10 . The main points of acute pancreatitis pathogenetic therapy :
A. Exocrine function of the pancreas suppression
B. Elimination of hypovolemia
C. Inactivation of pancreatic enzymes
D. Nasogastric decompression of the gastrointestinal tract
E. Analgesia
11. To the edematous form of acute pancreatitis is common:
A. Multiple vomiting
B. The abdominal muscles guarding
C. Presence of the fluid in the abdomen
D. Collapse
E. Hectic fever
12. In the acute pancreatitis diagnosis establishing the most informative are:
A. Plane abdominal radiography
B. Abdominal celiacography
C. MRI
D. Laparoscopy
E. Ultrasonography
13. In patients with pancreatic necrosis in anamnesis ( one month ago) in the upper
Part of the abdomen the mass is detected. It is moderately painful with fluctuation
in the center. The abdomen is soft without peritoneal irritation. Fever and blood test
- within normal limits. Your diagnosis?
A. Pancreatic tumor
B. Omental bag abscess
C Pancreatic mass in pseudocyst transformation
D. True pancreatic cyst
E. Pseudotumoral pancreatitis
14. Main complications of hemorrhagic pancreatic necrosis are:
A. Festering pancreatitis
B. Transformation to the chronic pancreatitis
C. Retroperitoneal abscess formation
D. External and internal pancreatic fistulas
E. Front left-side paranephritis
15. The clinical picture of pancreatic necrosis is characterized by all
listed except:
A. Severe abdominal pain
B. Multiple vomiting
C. Hypertension during the first hours of the disease
D. Collapse
E. Tachycardia
16. Main complications of acute pancreatitis are the listed, except :
A. Omental bag abscess
B. Hepato - renal failure
C. Pancreatic cyst formation
D. Peritonitis
E. Gorner’s triad
17. What drugs you should prescribe for acute pancreatitis treatment:
A. Gordox
B. Kontrikal
C. 5 - Fluorouracil
D. Atropine
E. Morphine
18. What methods of investigation you should prescribe to the patient with
hemorrhagic necrotizing pancreatitis ?
A. Abdominal X-ray survey
B. Laparoscopy
C. Ultrasound scan of the abdomen
D. X-ray of the stomach
E. Urine test for diastase
19. The complications of hemorrhagic pancreatic necrosis arethe following except:
A. Omental bag abscess
B. Hepato - renal failure
C. Portal hypertension
D. Pancreatic cyst formation
E. Retroperitoneal phlegmone
20. In the acute pancreatitis development the leading role belongs to:
A. Microbial flora
B. Arterial thrombosis
C. Microcirculatory disturbances
D. Autoenzymatic aggression
E. Venous stasis
21. Pancreatic fatty necrosis is caused by :
A. Proteolytic necrobiosis of pancreatic cells
B. Effects of elastase on the walls of venules and interlobular connective tissue
C. Lipolytic enzymes damaging effect on fatty and interstitial tissues
D. Spontaneous relief of autolytic processes and involution of small- sized pancreatic necrosis
E. Infection progressing on the background of edematous pancreatitis
22. Hemorrhagic pancreatic necrosis develops as a result of :
A. Infection progressing on the background of fatty pancreatic necrosis
B. Demarcation inflammatory foci formation in the place of pancreatic fatty necrosis
C. Spontaneous relief of autolytic process and involution of small- sized pancreatic necrosis
D. Pancreatic cells and vascular wall damage under the influence of proteolytic enzymes
E. Pancreatic cells and interstitial fatty tisue damaging effect of lipolytic enzymes
23. Transverse painful resistance during abdominal wall palpation in acute pancreatitis is
known as a symptom of:
A. Mayo-Robson’s
B. Kerte’s
C. Gray –Turner’s
D. Mondor’s
E. Voskresensky’s
24. Tenderness in the left costovertebral angle is a characteristic of :
A. Voskresensky’s Sign
B. Mayo-Robson’s Sign
C. Grunwald’s Sign
D. Mondor’s Sign
E. Gray –Turner’s Sign
25. The cyanotic spots presence along the lateral abdominal walls in acute pancreatitis:
A. Grunwald’s Sign
B. Mondor’s Sign
C. Gray –Turner’s Sign
D. Kehr’s Sign
E. Voskresensky’s Sign
26. Distension of the abdomen in patients with acute pancreatitis is usually observed because
of:
A. Compression of the duodenum with edematous head of the pancreas
B. Multiple vomiting
C. Enteroparesis
D. Pancreatic hormones deficiency
E. Pancreatic enzymes insufficiency
27. Decreasing or even vanishing of the abdominal aorta pulsation
in acute pancreatitis is known as :
A. Mayo-Robson’s Sign
B. Mondor’s Sign
C. Kehr’s Sign
D. Cullen’s Sign
E. Voskresensky’s Sign
28. Presence of serous exudate and spots of fatty necrosis during laparoscopy means:
A. Edematous pancreatitis
B. Fatty pancreatic necrosis
C. Hemorrhagic pancreatic necrosis
D. Purulent pancreatic necrosis
E. Such changes are not similar for pancreatic necrosis
29. In patient with combination of acute cholecystitis, pancreatic abscess and fatty
pancreatic necrosis the volume of surgical treatment should be :
A. Active conservative therapy
B. Laparoscopic abdominal drainaging with peritoneal dialysis
C. Conservative therapy, when it fails - surgery
D. Dynamic observation on the background of conservative therapy, in the case of peritonitis
development - surgical treatment
E. Emergency operation
30. With the aim of pain relief in acute pancreatitis you shouldn’t apply:
A. Vage and sympathetic blockades
B. Epidural anesthesia
C. Parinephral blockade
D. Teres ligament of the liver novocainic blockade
E. Morphine injections
31. The most common symptoms of acute pancreatitis are:
A. Nausea and vomiting
B. Hyperthermia
C. Jaundice
D. Vomiting
E. Pain in the upper part of the abdomen
32. In the pathogenesis of acute pancreatitis is not involved :
A. Enterokinase
B. Elastase
C. Phospholipase
D. Trypsin
E. Streptokinase
33. The most informative method of pancreatic cysts diagnostics is :
A. ERCPG
B. Barium meal passage investigation through the intestine
C. Biochemical test
D. USR
E. All the answers are wrong
34. Most characteristic of acute pancreatitis pain are :
A. Aching
B. “Belt- like”
C. Cramping
D. “Dagger like”
E. Dull
35. In patient of 30 years old with acute pancreatitis on the 14th day of the disease hectic fever,
chills, tachycardia, leukocytes shift to the left observed. During palpation of the abdomen in
the upper parts painful mass is present. These symptoms are similar for:
A. Cholangitis
B. Pneumonia
C. Pancreatic cysts
D. Retroperitoneal phlegmone
E. Omental bag abscess
36. Pancreatic pseudocysts inflammation is an indication to:
A. Antibacterial therapy
B. Detoxicative therapy
C. Operation
D. Observation
E. Continuation of previously prescribed therapy
37. The clinical picture of pancreatic necrosis is not characterized by :
A. Zoster abdominal pain
B. Multiple vomiting
C. Pneumoperitoneum
D. Collapse
E. Tachycardia
38. The main starting point in the acute pancreatitis development is:
A. Infection
B. Spasm of duodenum
C. Inflammation of the gallbladder and biliary tract
D. Reflux of bile and duodenal content into the pancreatic duct
39. In acute pancreatitis laparoscopy allows all listed except:
A. Confirming the diagnosis of acute pancreatitis, determining the nature of pathological process
B. Exudate aspiration from the peritoneal cavity, drainaging
C. Performing cholecystostomy for biliary decompression
D. Avoid large operative trauma, like laparotomy
E. Making papillotomy
40. Main features of vomiting in acute pancreatitis:
A. Single
B. Multiple, without relief
C. Single, bringing relief
D. Decreases after liquid taking
E. Vomitive masses are "coffee like" colour

GASTRODUODENAL ULCERS: ACUTE COMPLICATIONS (IV)

1. For a bleeding ulcer of duodenum is not typical :

A. Vomitive masses are "coffee like" colour
B. Increasing of abdominal pain
C. Haemoglobin level decreasing
D. Melena
E. Pulse rate decreasing
2 . In case of relapsing ulcerative gastroduodenal bleeding is indicated :
A. Endoscopic haemostasis, if fails - operation
B. Urgent surgery
C. Repeated endoscopic haemostatic therapy
D. Intensive conservative haemostatic therapy
3 . Atypical perforation means:
A. Perforation into the free peritoneal cavity
B . Penetration into the pancreas
C . Perforation into the omental bag
D . Perforation outside the abdomen
4 . Volume 2/3 of stomach resection in surgery for peptic ulcer is caused by :
A. The features of the blood supply of the stomach
B. The need to maintain sufficient volume of gastric stump for normal digestion
C. The need in removing of gastrin and acid- producing zones of the stomach
D. All answers are wrong
E. All answers are correct
5 . Some complications of peptic ulcer always are an indication for emergency surgery. Name
them?
A. Perforation
B. Penetration
C. Decompensated pyloric stenosis
D. Malignancy
E. Profuse gastrointestinal bleeding
6. Isolated selective proximal vagotomy is indicated for :
A. Ulcer of the antrum
B. Duodenal ulcer with subcompensated pyloric stenosis
C. Perforated ulcer of duodenum
D. Duodenal ulcer without signs of stenosis
E. Gastroduodenal bleeding
7. Unbareble pain syndrome, the abdominal muscles tension, tachycardia, profuse cold swet
are similar for:
A. Penetration into the pancreas
B. Covered perforation
C. Perforation into the free peritoneal cavity
D. Penetration into the hepato- duodenal ligament
E. Decompensated pyloric stenosis
8. The most common complication of the front wall duodenal ulcer is :
A. Perforation
B. Bleeding
C. Penetration into the head of the pancreas
D. Perforation and penetration into the head of the pancreas
E. All answers are correct
9. In patient of 56 years old, without ulcerative anamnesis, during operation perforated ulcer
of the stomach was detected. The onset of the disease was 4 hours earlier. Your tactics?
A. Simple suturing
B. Resection of 2/3 of the stomach
C. Resection of 3/4 of the stomach with large and small omentum
D. Suturing of the ulcer and truncal vagotomy
E. Antrumectomy
10 . Symptoms of perforated gastric ulcer are:
A. " Knife-like" pain
B. Abdominal muscles tension
C. Multiple vomiting
D. Liver dullness vanishing during percussion
E. Cramping pain in the upper abdomen
11. In patient of 65 years old (with 4 years ulcerative anamnesis) perforated duodenal ulcer
was diagnosed. He was admitted to the hospital after 12 hours from the onset of the disease.
Which operation should be performed in this case?
A. Simple suturing of perforation
B. Truncal vagotomy with Finney’s pyloroplasty
C. Gastrectomy
D. Gastrojejunostomy
E. Antrumectomy with duodenal ulcer
12. The patient of 32 years old, with perforated duodenal ulcer, was admitted to the hospital
through the night from the onset of the disease. What should be done in this case?
A. Emergency operation
B. Strictly conservative treatment
C. Operation in case of conservative treatment failure
D. Treatment by the method of Taylor
E. Laparoscopic abdominal drainaging
13. Duodenal bleeding ulcer is characterized by the following signs:
A. Severe abdominal pain
B. Vomitive masses are "coffee like" colour
C. Decreasing of pain
D. Bradycardia
E. Melena
14. How should be treated perforated ulcer in case of patient’s categorical refusal from the
surgery?
A. Gastric lavage with cold water
B. Treatment by the method of Taylor
C. Stimulation of intestinal peristalsis
D. Discharging from the hospital
E. Bed regimen with Trendelenburg’s position
15. Appearance of melena after usual epigastric pain vanishing - what complication of peptic
ulcer is described?
A. Pyloroduodenal stenosis
B. Ulcer perforation
C. Bleeding
D. Malignisation
E. Penetration into the pancreas
16. Name the indications for urgent surgery in case of perforated ulcer :
A. Peritonitis presence
B. Time from the moment of perforation
C. Surgeon’s qualification
D. The patient’s general condition and age
E. Ulcerative anamnesis
17. To the perforated ulcer is not similar :
A. “Knife stroke”- like pain in the abdomen
B. Abdominal muscles tension
C. Vomiting without pain relief
D. Positive Jober- Spizharny’s Sign
E. Positive Shchetkin – Blumberg’s Sign
18. Name from the listed drugs which you shouldn’t prescribe in case of bleeding ulcer
A. Vikasol
B. Cimetidine
C. ε- aminecaproic acid
D. Fibrinolizin
E. Frozen plasma
19. The patient of 38 years old was admitted to the hospital with gastrointestinal bleeding
symptoms. During urgent endoscopy the duodenal ulcer with diameter of 1.5 cm was detected.
Previous attempts for endoscopic haemostasis were failed.The tipe of bleeding according to
Forrest is F2a. Hemoglobin level is 80 g / l. Your tactics?
A. Emergency operation
B. Conservative treatment
C. Dynamic fibrogastroduodenoscopy
D. Embolization of gastric and gastroduodenal artery
E. Blackmore- Sangestacken’s nasogastric intubation
20. Name the optimal method to be applied in the differentiation of acute appendicitis and
perforated ulcer ?
A. Gastroduodenoscopy
B. Plain abdominal x-ray
C. Ultrasonography of the abdomen
D. Laparoscopy
E. X-ray of the stomach with barium meal
21. The patient of 32 years old complains on "dagger"- like abdominal pain. During
percussion Jober- Spizharny’s is positive. What disease is characterized by these symptoms?
A. Hemorrhagic pancreatic necrosis
B. Gangrenous cholecystitis
C. Perforated appendicitis
D. Infarcted bowel
E. All the answers are wrong
22. What is the cause of hepatic dullness vanishing in patients with perforated ulcer?
A. Flatulence
B. Intestinal paresis
C. Interposition of intestinal loops between the liver and the diaphragm
D. Presence of free gas in the abdominal cavity
E. The presence of fluid in the subdiaphragmatic space
23. The patient of 43 years old with a bleeding ulcer of stomach corpus is most justified
the following operation :
A. Gastrotomy, biopsy, suturing and gastrectomy
B. Excision of the ulcer with truncul vagotomy
C. Selective proximal vagotomy
D. Ligation of the left gastric artery branches
E. Gastrostomy
24. In patient with perforated stomach ulcer the basic methods of diagnostics are:
A. Gastroscopy
B. Plain x-ray of the abdomen
C. Emergency gastroduodenoscopy
D. USR of the abdomen
E. Laparoscopy
25. The clinical picture of perforated ulcer during the first 6 hours from the disease onset is
characterized by all of the following except :
A. Absence of vomiting
B. Abdominal muscles tension
C.”Dagger"- like abdominal pain
D. Liver dullness vanishing
E. Diarrhea
26. Patient was urgently admitted to the hospital with gastrointestinal bleeding. What should
you do first of all?
A. Nasogastric intubation
B. Gastroscopy with barium
C. Fibrogastroduodenoscopy
D. Laparoscopy
E.Hematocrite and hemoglobin levels evaluating
27. Surgical treatment of patients with duodenal ulcer is shown in next cases:
A. Frequent relapses occur
B. Disease is complicated with profuse bleeding
C. Pyloroduodenal stenosis presence
D. Perforation presence
E. The ulcer penetrates into the head of the pancreas
28. The patient of 40 years old with perforated stomach ulcer 5 hours ago needs to be
performed :
A. Classical resection of 2/3 of the stomach
B. Antrumectomy
C. Truncal vagotomy and suturing of the ulcer
D. Truncal vagotomy and pyloroplasty
E. Gastrectomy
29. What condition is not an indication for surgery in patients with duodenal ulcer:
A. Long-term disability and failure of conservative therapy
B . Profuse bleeding from the ulcer
C . Pyloric stenosis
D. Presence of multiple ulcers in the duodenal bulb
E . Penetration development
30. Operation of choice for perforated stomach ulcer with purulent peritonitis is :
A. Gastrectomy
B. Excision of the ulcer with vagotomy and pyloroplasty
C. Suturing of perforation
D. Gastrostomy
E. Antrumectomy
31. What operation should be performed in the patient with the bleeding ulcer of the stomach
body and a small degree of operational risk :
A. Excision of the ulcer with pyloroplasty and vagotomy
B. Gastrectomy
C. Gastrostomy
D. Truncul vagotomy and pyloroplasty
E. Excision of the ulcer
32. The most informative method of perforated ulcer diagnostics is :
A. Esophagogastroduodenoscopy
B. USR
C. Celiacography
D. Laparoscopy
E. X-ray of the stomach
33. The rarest complication of duodenal ulcer :
A. Perforation
B. Malignization
C. Bleeding
D. Penetration
E. Stenosis
34. Significant radiological sign of perforated ulcer is :
A. Elevation of diaphragm cupola
B. Presence of free gas in the abdominal cavity
C. Left- side pleuritis
D. Kloyberg’s cups presence
E. Increasing of Traube’s space sizes
35. It is not typical for perforated stomach ulcer during first 6 hours:
A. Positive Dielafoa’s Sign
B. Abdominal muscles tension
C. Positive Jober- Spizharny’s Sign
D. Absence of intestinal peristalsis
E. Free gas beneath the diaphragm
36. With the aim to decrease the acidity of the stomach you may perform:
A. Truncul vagotomy
B. Highly selective vagotomy
C. Hill- Barker procedure
D. Paracentesis
E. Paranephral novocaine blocade
37. To identify the source of gastrointestinal bleeding you should prescribe:
A. X-ray examination of the stomach
B. Laparoscopy
C. Fibrocolonoscopy
D. EGDS
E. Haemoglobin and hematocrite evaluation
38. Mallory -Weiss syndrome - is:
A. Bleeding varicose veins of the esophagus and cardia of the stomach
B. Meckel’s diverticulum bleeding ulcer
C. Bleeding from mucous hemorrhagic angiomatosis (illness of Randu - Ossler)
D. Bleeding cracks of mucous membrane in the cardia of the stomach
E. Hemorrhagic erosive gastroduodenitis
39. The aim of the Meylengraht’s diet is:
A. The mechanical sparing of the gastric mucous membrane
B. The inhibition of gastric juice secretion
C. The increasing of food callorage
D. All from the listed above is true
E. All from the listed above is wrong
40. Muscle tension in the right iliac region in case of perforated duodenal ulcer is explained
by:
A. Reflex connections through the spinal nerves
B. Presence of the air in the abdominal cavity
C. Passing of gastric content into the right abdominal flank
D. Development of peritonitis
E. Viscero - visceral connections with the vermiform appendix

ACUTE INTESTINAL OBSTRUCTION (V)

1. During operation, you determined small intestinal obstruction because of abdominal
adhesions. The discredited intestinal loop of cyanotic colour, peristalsis is weak. Your tactics?
A. Resection of the small intestine
B. Peridural anestesia
C. The mesentery root blockage with novocaine solution
D. Warming of discredited intestinal loop
E. Nasointestinal intubation
2 . Dehydration in acute intestinal obstruction develops due to :
A. Vomiting
B. Increased diuresis
C. Sequestration of the fluid into the intestinal lumen
D. Sequestration of the fluid retroperitoneally
E. Pain syndrome
3 . The patient of 70 years old was admitted to the surgical department because of sygmoid
volvulus. During operation partial necrotic changes of large intestine are present. What
optimal tactics should be:
A. Sygmoidostomy
B. Sygmoid colon resection with "end to end " anastomosis
C. Sigmoid colon resection with "side to side"anastomosis
D. Resection of the sigmoid colon with the formation of artifishial anus
E. All the answers are wrong
4 . The reasons for the development of paralytic ileus are:
A. Peritonitis
B. Poisoning
C. Pancreatonecrosis
D. Retroperitoneal haematoma
E. Mesenteric circulation disorders
5 . Dehydration develops most rapidly in case of :
A. The small intestine volvulus
B. Sigmoid volvulus
C. Ileocecal intussusception
D. Large intestine obstruction
E. Paresis of the small intestine
6. Positive "splash noise" symptom in acute intestinal obstruction is explained by:
A. The presence of exudate in the abdomen
B. Accumulation of fluid and gas in the proximal intestinal loop
C. Accumulation of fluid and gas in the distal intestinal loop
D. The presence of gas in the abdomen
E. All answers are wrong
7. Clinical signs of strangulative ileus are:
A. Persistent pain in the abdomen
B. Single vomiting
C. Multiple vomiting
D. Spastic abdominal pain
E. Positive "splash noise" symptom
8. For acute intestinal obstruction the next radiological signs are similar :
A. Kloyberg’s cups
B. Free gas under the cupola of the diaphragm
C. Kerkring’s folds
D. Vahl’s Sign
E. Tsege – Manteyffel’s Sign
9. Concervative measures in obstructive ileus are :
A. Injection of spasmolytics
B. Siphon enema
C. Correction of fluid and electrolyte disbalance
D. Administration of narcotic analgesics
E. Administration of prokinetics
10 . For ileo- caecal intussusception the next clinical signs are similar :
A. Bloody discharges from the rectum
B. " Sheep " type of feces
C. Presence of tumor formation in the right iliac area
D. Spastic abdominal pain
E. Atony of the anal sphincter
11. With the aim of the acute intestinal obstruction diagnostics first of all you should
prescribe to your patient :
A. Celiac artery angiography
B. Gastroduodenoscopy
C. Abdominal auscultation
D. Abdominal plain x-ray
E. A rectal finger research
12. Surgery is indicated to the patient with acute intestinal obstruction in case of :
A. Kloyberg’s cups presence after conservative treatment
B. Abdominal pain increasing
C. Positive signs of peritonitis
D . Severe hypovolemia
E . Severe hypokalemia
13. Patient’s preparation to the surgery because of mechanical intestinal obstruction includes
all from the listed except:
A. Nasogastric tube, aspiration
B. Fluid resuscitation
C. Spasmolytics therapy
D. Injection of laxatives and prokinetics
E. Siphon enema
14. In the patient with the cancer of the caecum complicated by acute intestinal
obstruction should be performed :
A. Right- sided hemicolectomy with ileotransverse anastomosis implementation
B. Right- sided hemicolectomy with temporary enterostoma formation
C. Ileotransverse bypass formation
D. Temporary transversostomy formation
E. Temporary ileostomy implementation
15. The next signs are similar for strangulation ileus:
A. Severe pain syndrome
B. Diarrhea
C. Blood pressure decreasing
D. Pleuritis
E. Constipation
16. Spastic abdominal pain is typical for:
A. Intestinal obstruction because of the transverse colon lumen occlusion
B. Paralysis of the small intestine
C. Volvulus of the small intestine
D. Fatty pancreatic necrosis
E. Intussusception of the small intestine into the caecum
17. For the volvulus of the small intestine is not typical :
A. Tsege – Manteuffel’s Sign
B. The asymmetry of the abdomen
C. " Splash "- sign
D. Multiple vomiting
E. Spastic abdominal pain
18. The low obstructive ileus defined by :
A. Early multiple vomiting
B. Constipation
C. Vahl’s Sign
D. Distension of the abdomen
E. Tsege – Manteuffel’s Sign
19. Method of acute intestinal obstruction diagnostics in the early stages is :
A. Plain x-ray of the abdomen
B. Laparoscopy
C. Irrigoscopy
D. Ultrasonography of the abdomen
E. Colonoscopy
20. The patient of 75 years old with acute sigmoid intestinal obstruction of tumoralm origin
was admitted to the department after 2 days from the onset of the disease. The tactics should
be the next:
A. Examination and surgery after 48-72 hours
B. Conservative therapy
C. Siphon enema
D. Conservative therapy for 2- 3 hours, with the subsequent Hartmann's operation
E. Emergency surgery with resection of the sigmoid colon with end -to-end anastomosis
21. Colon mechanical obstruction most often is caused by :
A. Foreign bodies (bezoars)
B. Gallstones
C. Malignant tumors
D. Abdominal adhesions
E. Helminths
22. Volvulus of the small intestine is one of the following types of intestinal obstruction :
A. Obstructive
B. Strangulative
C. Mixed (obstructive combined with strangulative)
D. Spastic
E. Paralytic
23. Acute intestinal obstruction is characterized by the following clinical signs :
A. Multiple vomiting
B. Severe constant abdominal pain
C. Spastic abdominal pain
D. " Splash "- sign is positive
E. Positive Jober- Spizharny’s Sign
24. During patient’s examination Tsege – Manteuffel’s and Grekov’s positive signs were
detected . To what kind of intestinal obstruction these symptoms are similar?
A. Ileocaecal intussusception
B. Ascending colon obturation
C. Volvulus of the small intestine
D. Strangulation of small intestine
E. Recto- sigmoid obstruction
25. What solutions you should prescribe to yor patient with intestinal obstruction
intravenously:
A. Hartmann’s solution
B. Ringer- Locc solution
C. Glucose solution
D. 0,9 % sodium chloride solution
E. 10 % sodium chloride solution
26. In what case necrotic changes may develop rapidly?
A. Senile contipation because of atony colitis
B. Volvulus of the small intestine
C . Obstruction of the jejunum lumen by a gallstone
D. Strangulation
E. Intestinal loop incarceration in hernial ring
27. The patient of 45 years old after physical overstraining felt spastic abdominal pain in the
area of postoperative scar, nausea, two times vomiting, and delay of gases. What disease is
characterized by these symptoms ?
A. Perforated gastric ulcer
B. Acute intestinal obstruction
C. Acute pancreatitis
D. Acute appendicitis
E. Acute cholecystitis
28. Typical obstructive ileus usually develops in case of tumor localization inside :
A. The caecum
B. The ascend colon
C. The descend colon
D. The transverse colon
E. The sigmoid colon
29. During the initial stages the large intestine obstruction shoul be treated as follows :
A. Emergency surgery
B. Operation in 48-72 hours after the determination of the cause of intestinal obstruction
C. Conservative therapy
D. Conservative therapy, if failed - emergency surgery
E. All answers are not correct
30. Factors contributing to the development of strangulative intestinal obstruction are:
A. Long narrow mesentery
B. Adhesions in the abdominal cavity
C. Abdominal surgery in anamnesis
D. Alcohol abuse
E. Smoking
31. In the early period of the acute intestinal obstruction the next changes are present :
A. Hyperglycemia
B. Dehydration
C. Decreasing of haematocrite
D. Increasing of haematocrite
E. Hypokaliemia
32. The obstructive ileus is caracterised bu the next features:
A. Constant pain in the abdomen
B. Spastic abdominal pain
C. Vomitive masses of "coffee like" colour
D. Constipation
E. Abdominal muscles tension
33. In acute intestinal obstruction diagnostics the less impotant are:
A. Survey abdominal radiography
B. The barium passage through the gastrointestinal tract
C. Esophagogastroduodenoscopy
D. Laparoscopy
E. Biochemical blood test
34. In what type of acute intestinal obstruction bleeding from the anus may be occured :
A. Paralytic
B. Spastic
C. Senile contipation because of atony colitis
D. Volvulus of the small intestine
E. Intussusception
35. In case of intestine necrosis developed what volume of resection should be performed:
A. Resection of the proximal part of intestine for 35 cm
B. Bowel resection within the boundaries of the visible necrosis
C. Overlay bypass
D. Concervative therapy, proper diet
E. Resection of the distal part of intestine for 15 cm
36. The less frequent cause of mechanical intestinal obstruction is:
A. Bezoars
B. Gallstones
C. Tumors
D. Abdominal adhesions
E. Helmints
37. The clinical picture of acute obstructive colon obstruction is characterized by:
A. Spastic abdominal pain
B. Distension of the abdomen
C. Singular vomiting
D. Constant abdominal pain
E. Delay of stool and gases
38. High small intestine obstruction is characterized by:
A. Spastic abdominal pain
B. " Splash "- sign is positive
C. Multiple vomiting
D. Tsege – Manteuffel’s Sign
E. Kloyberg’s cups presence on x-ray
39. Positive effects of acute intestinal obstruction conservative treatment are:
A. Lengthening of the interval between spasms
B. Normal passage of feces and gases
C. Decreasing od abdominal distension
D. Decreasing of peristalsis
E. The disappearance of pain
40. Patients with dynamic ileus should be treated:
A. Only conservatively
B. Only operatively
C. Operatively in the absence of conservative treatment effect
D. By laparoscopic ileostomy
E. By intubation of the colon with a colonoscope

ACUTE PERITONITIS (VI)

1. Normally in adult the amount of abdominal serous fluid is :

A. 20ml
B. 80 ml
C. 120ml
D. 200 ml
E. 220 ml
2 . Hemorrhagic exudate in the abdominal cavity is absent in :
A. Acute pancreatitis
B. Acute cholecystitis
C. Mesenteric thrombosis
D. Myocardial infarction
E. Acute intestinal obstruction (without strangulation)
3 . Acute peritonitis usually is accompanied with abdominal pain in the next % of cases :
A. 50 %
B. 50-75 %
C. 75-90 %
D. 100 %
4 . Acute peritonitis usually is accompanied with abdominal muscles tension in the next % of
cases :
A. 15-25%
B. 35-50 %
C. 85-90 %
D. 100 %
5 . In what type of acute peritonitis intestinal peristalsis is preserved:
A. E. coli’ s type
B. Typhoid’s type
C. Pneumococci’s type
D. The mixed infection’s type
6. In the patient of 46 years old the appendicectomy because of acute gangrenous appendicitis
was performed. On the 5th day after operation he complained on the dull abdominal pain,
tenesms, pain during defecation, problems with urination, fever (37.8 - 38.5o C). Put the
preliminary diagnosis?
A. Acute paraproctitis
B. Acute hemorrhoids
C. Diffuse peritonitis
D. Douglas’s space abscess
E. Acute cystitis
7. The most frequent cause of peritonitis is :
A. Acute appendicitis
B. Perforated ulcer
C. Salpingitis
D. Strangulation of the small intestine
E. Gastric cancer
8. The lenth of the second fase of acute peritonitis is about:
A. 4- 6 hours
B. 24 hours
C. 48 hours
D. 72 hours
E. more than 72 hours
9. Name the way of primary peritonitis development :
A. Perforation of gastric ulcer
B. Perforation of the appendix
C. Due to adnexitis
D. Hemato-, lymphogenously
E. Gun- shot wound of the abdomen
10 . For acute peritonitis is not typical :
A. Muscle tension of the abdominal wall
B. Courvoisier’s Sign
C. Tachicardia
D. Tachipnoe
E. Pain in the abdomen
11. For acute peritonitis is not typical :
A. Tachycardia
B. Dryness in the mouth
C. Muscle tension of the abdominal wall
D. Decreasing of peristalsis
E. Diarrhea
12. The main symptom of peritonitis is :
A. Vomiting
B. Abdominal pain
C . Haematochesia
D . Gases and feces delay
E . Muscle tension of the abdominal wall
13. The peritonitis development may be as a result of the next deseases origin :
A. Meckel’s diverticulum perforation
B. Crohn's disease
C. Stenosis of the major duodenal papilla
D. Richter’s incarceration
E. Acute intestinal obstruction
14. In subdiaphragmatic abscess all listed may be observed except :
A. Lung respiratory excursion decreasing
B. High level of phrenic cupola
C. The same- sided to the abscess pleuritis
D. Pain irradiation to the supraclavicular area
E. Diarrhea
15. The best treatment of subphrenic abscess is :
A. Conservative treatment
B. Extraperitoneal drainaging
C. Laparotomy and drainaging
D. USR controlled abscess puncture
E. All of the listed is correct
16. The best access to the subphrenic abscess drainaging :
A. Thoracolaparotomy
B. Lumbotomy
C. Double-staged transpleural access
D. Laparotomy according to Fedorov
E. Extrapleural extraperitoneal access
17. Douglas’s space abscess should be treated :
A. By puncturing through the abdominal wall
B. With therapeutic enemas
C. By drainaging through laparotomy
D. By puncturing, incision and drainaging through the rectum
E. Conservatively
18. Median laparotomy should be performed in next case:
A. Diffuse peritonitis
B. Local peritonitis
C. Douglas space abscess
D. Appendicular mass
E. Acute appendicitis
19. Fibrinous deposits on the peritoneum are absent in next type of peritonitis :
A. Serous
B. Fibrinous
C. Fecal
D. Purulent
E. Putrid
20. The terminal stages of peritonitis are characterized by all except :
A. Abdominal distention
B. Hypovolemia
C. Vanishing of peristalsis
D. Hypoproteinemia
E. Severe pain syndrome presence
21. Name the optimal way of antibiotics injection during the postoperative period in patients
with diffused peritonitis?
A. Subcutaneous
B. Intramuscular
C. Intravenous
D. Intraarterial
E. Intraabdominal
22. What should be done during the operation because of purulent peritonitis :
A. Elimination or delimitation the source of peritonitis origin
B. Irrigation of the abdomen with antiseptics solutions
C. Nasointestinal intubation, decompression
D. Abdominal drainaging
E. All the answers are correct
23. What is the purpose of nasointestinal intubation in the treatment of widespread purulent
peritonitis ?
A. Accounting of fluid leakage through the gastrointestinal tract
B. Intestinal lavage performing
C. Enteral tube feeding
D. Injection of medicines
E. Prevention of the early adhesive intestinal obstruction development
24. The abdominal hollow organ perforation into the free abdominal cavity is characterized
by all listed except :
A. Acute pain onset
B. Abdominal muscles tension
C. Collapse
D. Polyuria
E. Tachycardia
25. What are the symptoms related to the initial phase of peritonitis :
A. Painful protrusion during rectal finger research
B. Tachycardia
C . Water- electrolyte disbalance
D. Abdominal muscles tension
E. Leukocytosis
26. Pathognomonic symptom of the abdominal hollow organ perforation into the free
abdominal cavity is :
A. High leukocytosis
B. Absence of peristalsis
C. Pneumoperitoneum
D. Positive peritoneal signs
E. Dullness in the sloping areas of the abdomen
27. For Douglas’s space abscess diagnostics you should prescribe all methods listed below,
except :
A. Rectal finger research
B. Sigmoidoscopy
C. Ultrasonography
D. CT
E. Vaginal research
28. Name the agents causing peritonitis:
A. Urine inside the abdominal cavity
B. Gastric content in perforated ulcer
C. Blood inside the abdominal cavity
D. Bile inside the abdominal cavity
E. The air abdominal cavity after laparoscopy procedure
29. Complications of peritonitis are:
A. Subdiaphragmatic abscess
B. Subhepatic abscess
C. Sepsis
D. Pelvic abscess
E. Ishiorectal paraproctitis
30. Name three classical phases of peritonitis clinical course :
A. Early
B. Late
C. Reactive
D. Toxic
E. Terminal
31. Comprehensive treatment of purulent peritonitis include:
A. Surgery
B. Detoxication
C. Correction of metabolic disorders
D. Adequate antibiotic therapy
E. Intestinal paresis decreasing
32. Long-termed drainage tube presence in the abdomen can cause :
A. Intestinal loops bedsores
B. Bleeding
C. Infected complications
D. Adhesions
E. Renal colic
33. For prevention and treatment of postoperative intestinal paresis in
peritonitis you should perform:
A. Novocaine blockade of the mesentery
B. Intubation of the small intestine
C. Enterosorbtion
D. Transcutaneous electrical peristalsis stimulation
E. Enteral tube feeding
34. The toxic phase of acute peritonitis is characterized by:
A. Moderate abdominal pain
B. Positive Shchetkin- Blumberg’s Sign
C. Toxic encephalopathy
D. Tachycardia
E. Disappearance of intestinal peristalsis
35. Detoxicative methods for peritonitis treatment are:
A. Hyperbaric oxygenotherapy
B. Peritoneal dialysis
C. Enterosorbtion
D. Plasmapheresis
E. Local hypothermia
36. Relaparotomy and laparostomy in diffuse peritonitis are nesessary to perform:
A. Repeated abdominal sanations
B. Replacement of drainage tubes
C. Removing of pus and fibrinous deposits
D. Correlations of revealed pathological changes in abdominal cavity
E. Imposition of stomas if it is necessary
37. Signs of peritonitis are:
A. Distension of the abdomen
B. Absence of peristaltic sounds
C. Pain during abdomen palpation
D. Abdominal muscles tension
E. Shchetkin- Blumberg’s Sign
38. Symptoms of peritoneal irritation are:
A. Shchetkin- Blumberg’s Sign
B. Voskresensky’s Sign
C. Razdolsky’s Sign
D. Kushnirenko’s Sign
E. Sharko’s triad
39. "The rule of 4 catheters " includes :
A. Urethral catheter
B. Nasogastric tube
C. Central venous catheter
D. Rectal probe
E. Paracenthesis catheter
40. Peritonitis is characterized by:
A. LIRS
B. SIRS
C. CARS
D. MOFS
E. ERCPG

ABDOMINAL HERNIAS AND THEIR COMPLICATIONS (VII)

1. The inferior wall of the inguinal channel is:

A. Transverse fascia
B. The inferior merge of external oblique abdominal muscle
C. Gimbernati’s ligament
D. Inguinal ligament
E. Iliac bone merge
2. Hiatal hernia may be diagnosed due to:
A. Plain x- ray of the abdomen
B. Plain x- ray of the chest
C. X-ray of the stomach with barium meal
D. USR
E. ECG
3. Testis presence incide the hernia sac is similar for:
A. “Sliding” hernia
B. Incarcerated hernia
C. Femoral hernia
D. Inguinal indirect hernia
E. Inguinal direct hernia
4. Irreducible hernia is a result of:
A. Adhesions between the hernial content and hernial sac
B. Adhesions between the intestinal loops inside the hernial sac
C. Fibrous changes between the hernial sac and neighbouring tissues
D. Incompatibility of the hernial content sizes to the hernial ring
E. All mentioned above
5. For the postoperative ventral hernia the next features are similar:
A. Frequent irreducibility
B. Wide hernial ring
C. Dense borders of the hernial ring
D. Tendency to the incarceration
E. No tendency to hernial ring enlargement
6. What is the hernial sac in oblique inguinal hernia ?
A. Parietal peritoneum
B. Intestinal mesentery
C. Peritoneal vaginal process
D. Visceral peritoneum
E. Transverse fascia
7. The main feature of the “sliding” hernia is:
A. Easy reducibility
B. Hereditary predisposition
C. One of the hernial sac walls is the organ, located mesoperitoneally
D. Passing between the muscles and aponeurosis
E. All listed is correct
8. You should operate the patient with the umbilical hernia according to the method of:
A. Sapezhko;s
B. Lexner’s
C. Mayo’s
D. Martynov’s
E. Girard’s
9. What types of hernias doesn’t have the hernial sac:
A. Indirect inguinal
B. Femoral
C. Umbilical
D. “Sliding”
E. False posttraumatic
10. In what hernia the hernial sac is located between the elements of spermatic cord?
A. Direct inguinal
B. Hereditary and congenital oblique and relapsing inguinal
C. Postoperative
D. Spigeli’s line
E. Inguinal hernia in female
11. What is the posterior wall of the inguinal channel?:
A. Poupart’s ligament
B. Inguinal falx
C. Couper’s ligament
D. Transverse fascia
E. Rectal abdominal muscle
12. The weekness of what wall of the inguinal channel is similar to the indirect inguinal
hernia?
A. Posterior
B. Anterior
C. Superior
D. Inferior
E. All walls
13. The main features of the oblique inguinal hernia are:
A. The hernial sac is located between the elements of spermatic cord
B. The hernial sac is located medially to the spermatic cord
C. Frequently it may be bilateral
D. It freely passes into the scrotum
E. It may be hereditary
14. You should operate the patient with the femoral hernia according to the method of:
A. Mayo’s
B. Ruji- Parlaveccio’s
C. Bassini’s
D. Martynov’s
E. Postempski’s
15. What does the “sliding” hernia mean:
A. Hernial content passes through the lacunar ligament
B. When the hernial content is Meckel’s diverticulum
C. When one of the hernial sac wall the urinary bladder is
D. When the hernial content is appendix
E. All mentioned is incorrect
16. In case of direct inguinal hernia the optimal method of hernioplasty is:
A. Martynov’s
B. Girard- Spasokukotski’s
C. Kimbarovski’s
D. Roux- Oppel
E. Bassini- Postempski’s
17. In case of oblique inguinal hernia the optimal methods of hernioplasty are:
A. Sapezhko’s
B. Mayo’s
C. Bassini- Postempski’s
D. Girard- Spasokukotski’s
E. Ruji- Parlaveccio’s
18. These are the borders of internal ring of the femoral hernia, except:
A. Periosteum of the iliac bone
B. Femoral artery
C. Gimbernati’s ligament
D. Poupart’s ligament
E. Femoral vein
19. Name the main features of the direct inguinal hernia:
A. It passes through the medial inguinal fossa
B. It passes through the medial inguinal fossa
C. The hernial sac is located inside the spermatic cord
D. The hernial sac is located medially to the spermatic cord
E. It may be hereditary
20. For the postoperative ventral hernia the next features are similar:
A. Frequent irreducibility
B. Wide hernial ring
C. Dense borders of the hernial ring
D. Painful hernial protrusion
E. Absence of the hernial sac
21. What does Richter’s incarceration mean?
A. Intestine incarceration near the Treitz’s ligament
B. Strangulated sigmoid colon incarceration
C. The stomach incarceration inside the diaphragmatic hernia
D. Partial incarceration of the wall of intestine
E. Meckel’s diverticulum incarceration
22. Name the signs of hernia incarceration:
A. You may check the hernial ring sizes
B. Acute pain in the area of hernial protrusion
C. You can’t reduce the hernia
D. Dense and painful hernial protrusion
E. Positive “cough- sign”
23. In the patient with incarceration during transferring to the hospital the hernial content
reduced to the abdominal cavity. Your tactics?
A. Emergency surgery
B. Plan surgery
C. Emergency laparoscopy
D. Urgent admition to the hospital, inspection in dynamics
E. All listed is incorrect
24. Main stages of operation because of incarcerated hernia are:
A. General anesthesia
B. The line of incision is along and 2 cm above the Poupart’s ligament
C. First step is hernial ring dissection, the second- hernial sac
D. First step is hernial sac dissection, the second- hernial ring
E. First of all median laparotomy should be performed
25. Выберите основной признак скользящей грыжи:
A. It is located in the lumbar area
B. It passes through the diaphragm into the thoracic cavity
C. One of the hernial sac walls is the organ, located mesoperitoneally
D. It passes through the femoral channel
E. There is no hernial sac
26. Before the incarcerated intestine resection you should check the next moments:
A. The colour of it
B. Presence of peristalsis
C. Mesentery vessels pulsation
D. Presence of exudate in abdominal cavity
E. Presence of strangulation lines
27. In case of umbilical hernia incarceration and hernial phlegmone developing you should
performe:
A. Lexner’s method
B. Mayo’s method
C. Incision and drainaging
D. Grekov’s method
E. Sapezhko’s method
28. What method you should prescribe to your patient with postoperative ventral hernia?
A. Mayo’s
B. Lichtenstein’s
C. Stopp’s
D. Martynov’s
E. Mc Vay’s
29. During operation because of incarcerated hernia after hernial sac dissection two normal
intestinal loops were detected. What type of incarceration is described??
A. Retrograde
B. Partial
C. Volvulus inside the hernial sac
D. Incarceration of these two loops
E . Nothing from mentioned above
30. In case of incarcerated hernia what should you do?
A. Spasmolytics and warm bath
B. Observation
C. Antibiotic therapy and strict bed regimen
D. Plain X- ray of the abdomen
E. Urgent surgery
31. In case of incarcerated hernia with concomitant myocardial infarction what should you
do?:
A. Observation, local hypothermy
B. Hernia reducing
C. Spasmolytics injection
D. Trendelenburg’s position
E. Urgent surgery
32. For the incarceration is not typical:
A. Acute pane in the area of protrusion
B. Sudden onset
C. Positiv “cough- sign”
D. Quick progressing of peritonitis
E. Irreducibility
33. To the patient with incarcerated hernia before the operation should be done the next:
A. Paranephral blockade
B. Cleansinic enema
C. The spermatic cord blockade
D. Operative area shaving
E. Gastric lavage
34. The tympanic sound above the incarcerated protrusion means the incarceration of the :
A. Greater omentum
B. Bladder
C. Spermatic cord
D. Loop of intestine
E. Appendix
35. In case of intestine resection proximally you should resect:
A. 30-40 sm
B. 20-25 sm
C. 10-20 sm
D. 5-10 sm
E. 2-3 sm
36. What organs from the listed may be the wall of the hernia sac in “sliding” inguinal hernia
from the right?
A. Small intestine
B. Right kidney
C. Bladder
D. Caecum
E. Left ovary with uteral tube
37. What signs from the listed are similar to the incarceration?
A. Free gas in the abdomen
B. Aqute onset of pain in the area of protrusion
C. Irreducibility
D. Hernial sac phlegmone
E. Positive “ cough- signs”
38. What are the symptoms of bladder incarceration:
A. Pain in the area of protrusion
B. Tenesmuses
C. Constipation
D. Disuric ahd hematuria
E. Dispepsy
39. What should you do first of all in case of incarceration:
A. Spasmolytics injection before reducing
B. Antibiotic injection before hernia reducing
C. Urgent surgery
D. Warm bath
E. Reducing under general anesthesia
40. In case of incarceration:
A. Pain in the area of protrusion
B. Irreducibility
C. No itching and feces delay
D. Hernial sac tension
E. All listed is correct

SURGERY OF THE STOMACH AND DUODENUM (VIII)

1. The signs indicating the malignisation of gastric ulcers are:
A. Constant abdominal pain
B. The appearance of pain in the epigastrium in 40 minutes after eating
C. Heartburn
D. Anemia
E. Low gastric acidity
2 . Compensated stage of pyloroduodenal stenosis is not characterized by :
A. " Splash "- sign is positive
B. Vomiting in the morning
C. Barium delay in the stomach longer than 12 hours
D. Hypovolemia
E. Muscles tetany
3 . The optimal treatment for the patient of 28 years old with subcompensated
pyloroduodenal stenosis of ulcerative origin is :
A. Subtotal gastrectomy
B. Selective proximal vagotomy
C. Selective proximal vagotomy combined with drainage operation
D. Truncul vagotomy
E. Posterior gastrojejunostomy
4 . The decompensated pyloroduodenal stenosis is characterized by:
A. Vomiting of food eaten on the evening
B. Abdominal muscles tension
C. Reduced diuresis
D. Positive "splash"- sign in epigastrium on an empty stomach
E. Barium delay in the stomach for more than 24 hours
5 . Patient was admitted to the hospital with decompensated pyloroduodenal stenosis of
ulcerative origin, severe water and electrolyte disbalance and muscles tetany. Your tactics?
A. Emergency gastrectomy
B. Emergency gastrostomy
C. Gastroduodenostomy after 4-hours preparation of the patient
D. Plan surgery after resuscitation and hypoproteinemia correction
E. All the answers are wrong
6. Name the probable results of duodenal ulcer penetration?
A. Pyloroduodenal stenosis
B. Perforation
C. Malignization
D. Peritonitis
E. Acute pancreatitis
7. In the patient with malignant ulcer of the antral part of the stomach you should performe:
A. Vagotomy with pyloroplasty
B. Resection of the stomach according to Hoffmeister – Finsterer’s method
C. Subtotal gastrectomy with greater and small omentum
D. Antrumectomy
E. Circular resection of the antral part
8. Criteria of adequate preoperative preparation of the patient with decompensated ulcerative
pyloric stenosis are:
A. Diuresis
B. Circulating blood volume
C. Hematocrite
D. Acid-base and electrolytes status
E. Indicators blood electrolytes
9. The volume of duodenal ulcer surgical treatment with subcompensated pyloric stenosis is:
A. Anterior gastroenterostomy
B. Gastroduodenostomy
C. Selective proximal vagotomy
D. Highly selective vagotomy combined with Finney’s pyloroplasty
E. Resection of the stomach according to Hoffmeister – Finsterer’s method
10 . Name the rarest complication of duodenal ulcer ?
A. Perforation
B. Malignization
C. Bleeding
D. Stenosis
E. Penetration
11. In the patient of 27 years old with long- termed ulcerative anamnesis during
fibrogastroscopy the scarring ulcer of 3 mm in diameter in the bulb was revealed. Your
tactics?
A. Conservative treatment
B. Spa treatment
C. Clinical observation
D. Psychotherapy
E. Surgical treatment
12. Specify the wrong cause of anastomosis peptic ulcer origin after gastric resection
according to Billroth -II.
A. Expressed dumping syndrome
B. Ellison- Zollinger’s Syndrome
C. Hyperacidity
D. “Sparing resection of one third of the stomach”
E. Hyperparathyroidism
13. Patient of 10 years old complained on the heartburn, pain in the epigastrium. One week
earlier was abundant womiting with the food eaten in the evening. During gastroscopy
barium meal is complitely present inside the stomach. Name diagnosis?
A. Cardiospasm
B. Gastroduodenitis
C. Compensated pyloric stenosis
D. Decompensated pyloric stenosis
E. Duodenal ulcer penetrated into the pancreas
14. In the complex treatment of patients with decompensated pyloric stenosis you should
prescribe :
A. Transfusion of glucose- potassium solutions
B. Injection of sodium bicarbonate
C. Injection of diuretics
D. Haemotransfusion
E. Daily gastric lavage
15. Specify the clinical situations in which the resection of the stomach is most justified:
A. Acute duodenal ulcer
B. Compensated pyloric stenosis
C. Decompensated pyloric stenosis
D. Perforated gastric ulcer
E. Chronic ulcer of the lesser curvature of the stomach
16. Among the factors that contributes the severity of the patient with ulcerative
pyloric stenosis are:
A. Hypokaliemia
B. Hyponatriemia
C. Hypovolemia
D. Hypocalcemia
E. Hypoglycemia
17. How should be operated on the patient with pyloroduodenal stenosis of ulcerative origin :
A. Highly selective vagotomy with pyloroplasty
B. Antrumectomy with selective vagotomy
C. Subtotal gastrectomy
D. Classical Gastrectomy
E. Selective proximal vagotomy
18. In callous gastric ulcer what surgery should be performed :
A. Gastrectomy
B. Truncul vagotomy with excision of the ulcer
C. Selective vagotomy and pyloroplasty on Finney
D. Gastrostomy
E. Selective proximal vagotomy
19. Specify the clinical situations when the selective proximal vagotomy execution is justified :
A. Perforated ulcer of the stomach
B. Acute ulcer of the cardia
C. Compensated pyloric stenosis
D. Profuse bleeding from duodenal ulcer .
E. Chronic duodenal ulcer with frequent exacerbations
20. Patients with decompensated pyloric stenosis should be prepared with :
A. Blood transfusion
B. Injection of concentrated glucose solutions
C. Injection of Ringer- Locc’s solution
D. Injection of Hartmann’s solution
E. Osmotic diuretics
21. Name the main pathophysiological changes which are similar to decompensated pyloric
stenosis :
A. Hypervolaemia
B. Anemia
C. Metabolic alkalosis
D. Hypovolaemia
E. Respiratory acidosis
22. Name the absolute indications for surgery ?
A. Compensated stenosis
B. Sub-and decompensated stenosis
C. Profuse bleeding
D. Malignization
E. Perforated ulcer
23. What type of vagotomy should be combined with pyloroplasty?
A. Truncal vagotomy
B. Selective vagotomy
C. Selective proximal vagotomy
24. What is the difference between highly selective and selective vagotomy ?
A. Latarjet’s nerves are dissected
B. Latarjet’s nerves are preserved
C. Grassi’s nerves are preserved
D. No differences
25. Name the diseases of operated stomach :
A. Postresectable anemia
B. Peptic ulcer of the anastomosis
C. Dumping syndrome
D. Afferent loop syndrome
E. Zollinger – Ellisson’s syndrome
26. Main features of Billroth- 2 stomach resection :
A. The passage through the duodenum is saved
B. Meal passes from the stomach into the jejunum
C. Antrum is absent
D. Pylorus is preserved
E. The stump of duodenum is formed
27. The dumping- syndrome is characterized by:
A. Sudden weakness for10 - 15 minutes after meal intake
B. Occurs after eating of sweety and dairy dishes
C. Abdominal pain, hyperperistalsis, profuse diarrhea
D. Usually occurs during sleeping
E. By dizziness, sweating
28. The "afferent loop syndrome" is characterized by:
A. The vomiting with eaten food and bile in 30 - 40 minutes after eating
B. Bursting epigastric pain, worse after eating
C. Water and electrolyte disbalance
D. Observed after Billroth -1 resection of the stomach
E. Anuria
29. The hypoglycemic syndrome is characterized by:
A. Weakness, dizziness, sudden hunger
B. Moderate epigastric pain
C. State of hypoglycemia
D. Does not occur after gastrectomy
E. Febrile fever presence
30. In the diagnosis of “afferent loop syndrome” the leading role belongs to :
A. Fibrogastroscopy
B. Fluoroscopy with barium
C. Fibrocolonoscopy
D. ECG
E. pH- metry
31. Prevention of the “afferent loop syndrome” is :
A. Posterior gastroenterostomy on the short loop
B. Formation of latero- lateral entero- enterostomy by Brown
C. Entero- enterostomy by Roux
D. Truncal vagotomy
32. Main features of Billroth- 1 stomach resection :
A. Passage of the food through the duodenal horseshoe is not broken
B . The Brown’s anastomosis is absent
C . In this case " afferent loop syndrome " may develop
D . Resection of the proximal part of the stomach
33. The modifications of Billroth -2 include:
A. Modification of Hoffmeister - Finsterer
B . Roux’s operation
C. Balfour’s modification
D. Modification Reichel -Polya
E . Operation of Kenyu - Miles
34. The most informative method for diagnosis of peptic ulcer of anastomosis is?
A. FEGDS
B . CT
C . ECG
D . Sigmoidoscopy
E . Plain abdominal radiography
35. Afferent loop syndrome can occur after :
A. Billroth -1
B. Billroth -2
C. Gastroduodenostomy on Jaboulay
D. Operation of Judd- Horsley
E. Truncul vagotomy
36. Which operation should be performed in malignant ulcer of the stomach body?
A. Gastrectomy
B . Billroth -1
C . Billroth -2
D . Segmental resection of the stomach
E . Anterior gastroenterostomy with Brown’s anastomosis
37. Types of pyloroplasty :
A. by Finney
B. by Geyneke - Mikulicz
C. by Jaboulay
D. by Nakayama
E . by Hill - Barker
38. Selective vagotomy :
A. Is performed with preservation of the Latarjet’s nerves
B . Does not require a pyloroplasty
C . Innervation of the pylorus is preserved
D. Requires pyloroplasty performing
E. Is performed without preservation of the Latarjet’s nerves
39. To exclude the possibility of malignancy of gastric ulcer what should be performed :
A. FEGDS with polytopic biopsy
B.UZI abdominal
C . Irrigoscopy
D . Abdominal CT
E . ERCP
40. What characterizes gastrectomy
A. Total stomach removing
B. Entero- esophageal anastomosis implementation
C . Splenectomy
D . Hernioplasty

EXTRAHEPATIC BILE DUCTS DESEASES (IX)

1. For the jaundice because of the choledocholithiasis is similar:
A. Urobilinuria
B. Alcaline phosphatase increasing
C. Hypoproteinemia
D. Hyperbilirubinemia
E. Increasing of the transferases (ALT, AST) levels
2. During the calculi passing from the gallbladder to the choledoch does not develop:
A. Bile colic
B. Jaundice
C. Purulent cholangitis
D. Choledocholithiasis
E. Budd- Khiari’s Syndrome
3. The patient with the jaundice of calculous origin needs:
A. Urgent surgery
B. Conservative treatment
C. Urgent surgery after preoperative preparation
D. Celiac trunk catheterization
E. Plasmapheresis
4. Courvoisier’s syndrome is not similar for the:
A. Acute calculous cholecystitis
B. Cancer of the head of the pancreas
C. Indurative pancreatitis
D. Large duodenal papilla tumor
E. Tumor of choledoch
5. In jaundice and its probable cause diagnostics is not used:
A. CT
B. Intravenous cholecystocholangiography
C. Percutaneous transhepatic cholangiography
D. ERCPG
E. USR
6. Intermittant jaundice is caused by:
A. The impacted calculus of the distal part of choledoch
B. The tumor of choledoch
C. Cystic duct calculus
D. Calculus which temporary impacts the choledoch- “ball- valve” calculus
E. Choledocheal stricture
7. What does the Courvoisier’s syndrome consist of:
A. Enlarged painless gall- bladder combined with the jaundice
B. Liver enlargement, ascitis, anterior abdominal wall phlebectasia
C. Jaundice, constipation, spastic abdominal pain
D. Jaundice, enlarged liver, progressive weight loss
8. To the cholangitis the next combination is similar:
A. Jaundice
B. Fever
C. Cophing
D. Leucocytosis
E. Ascitis
9. During ERCPG in the patient with mechanical jaundice the stricture of choledoch of
significant lenth was detected. What surgical intervention should be performed?
A. Transduodenal papillosphincteroplasty
B. Supraduodenal choledochoduodenostomy
C. Endoscopic papilisphincterotomy
D. Hepaticojejunostomy
E. Miculiz’s procedure
10. In the patient with acute pain in the right subcostal area, vomiting and jaundice during
urgent endoscopy the impacted in major papilla calculus was detected. What should you do in
this case?
A. Endoscopic papillosphincterotomy
B. Laparotomy, duodenotomy, calculi extraction
C. Cholecystostoma implementation
D. Laparotomy, Kehr,s drainaging of the choledoch
E. D. Hepaticojejunostomy
11. What research sould be prescribed before the drainage tube extraction:
A. Intravenous cholangiography
B. Gastroduodenoscopy
C. ERCPG
D. Transdrainage fistulography
E. Laparoscopy
12. The most informative method of mechanical jaundice diagnostics is:
A. Intravenous cholecystocholangiography
B. pH- metry
C. Gastroduodenoscopy
D. ERCPG
E. Laparoscopy
13. For the mechanical jaundice reason diagnostics the next method is not useful:
A. ECG
B. USR
C. ERCPG
D. CT
E. Percutaneous transhepatic cholangiography
14. The most probable reason of the mechanical jaundice origin immediately after acute pain
in the right subcostal area is:
A. Tumor of the pancreas
B. Viral hepatitis
C. Vater’s papilla stricture
D. Choledocholithiasis
15. To what disease the Courvoisier’s syndrome is not similar:
A. Chronic calculous cholecystitis
B. Vater’s papilla cancer
C. The pancreatic head cancer
D. Liver cancer
16. The choledocholithiasis may leads to the next complications development:
A. Empyema of the gallbladder
B. Gangrene of the gallbladder
C. Budd- Khiari’s Syndrome
D. Cholangitis, mechanical jaundice
E. Blood loss
17. Mechanicall jaundice in case of the gallstone disease may be as a result of:
A. Choledoch impaction
B. Cystic duct impaction
C. Common hepatic ducts enlargement
D. All listed
18. Aerocholia may be as a result of:
A. Viral hepatitis
B. Choledocholithiasis
C. Bile peritonitis
D. Acute pancreatitis
19. To the complication of choledocholithiasis the next doesn’t belong:
A. Cholangitis
B. Jaundice
C. Hydrops of the gall bladder
20. The gallstone disease is not a cause of:
A. Mechanical jaundice
B. Purulent cholangitis
C. Acute cholecystitis
D. Liver cirrhosis
21. In the patient of 50 years old with the gallstone disease on the 2 day after the acute pain in
the right subcostal area jaundice and febrile fever with chill appeared. Tachicardia (110 beats
per minute) is present. During palpation the abdomen is soft, moderately painful in the right
subcostal area, enlarged liver is detected. Your diagnosis:
A. Destructive cholecystitis
B. Viral hepatitis
C. Purulent cholangitis
D. The tumor of the pancreatic head
22. In the patient with choledocholithiasis the symptoms of purulent cholangitis were
detected. The patient should be prescribed:
A. Urgent surgery
B. Conservative treatment
C. Plasmapheresis
D. Celiac trunk catheterisation
E. Plan surgery after antibiotic therapy
23. Which of the following statements about choledocholithiasis are correct?
A. Common duct stones can originate in the gallbladder and migrate to the common duct, and
stones can form de novo in the duct system.
B. Calcium bilirubinate stones are associated with the presence of bacteria in the duct system.
C. Common duct stones discovered at laparoscopic cholecystectomy should be treated by
postoperative endoscopic extraction.
D. The serum bilirubin value is usually greater than 15 mg. per dl. in the patient with a symptomatic
common duct stone.
24. Which of the following statements about cholangitis are correct?
A. Charcot's triad is always present.
B. Associated biliary tract disease is always present.
C. Chills and fever are due to the presence of bacteria in the bile duct system.
D. The most common cause of cholangitis is choledocholithiasis.
25. Recurrent episodes of cholangitis:
A. Suggest the presence of undetected or overlooked bile duct pathology.
B. Occur frequently in patients who have indwelling biliary tubes or stents.
C. May be ameliorated by long-term administration of antibiotics.
D. May be associated with the development of secondary biliary cirrhosis.
26. The initial goal of therapy for acute toxic cholangitis is to:
A. Prevent cholangiovenous reflux by decompressing the duct system.
B. Remove the obstructing stone, if one is present.
C. Alleviate jaundice and prevent permanent liver damage.
D. Prevent the development of gallstone pancreatitis.
27. The clinical picture of gallstone ileus includes which of the following?
A. Air in the biliary tree.
B. Small bowel obstruction.
C. A stone at the site of obstruction.
D. Acholic stools.
E. Associated bouts of cholangitis.
28. Which of the following statement(s) about gallstone ileus is/are not true?
A. The condition is seen most frequently in women older than 70.
B. Concomitant with the bowel obstruction, air is seen in the biliary tree.
C. The usual fistula underlying the problem is between the gallbladder and the ileum.
D. When possible, relief of small bowel obstruction should be accompanied by definitive repair of
the fistula since there is a significant incidence of recurrence if the fistula is left in place.
E. Ultrasound studies may be of help in identifying a gallstone as the obstructing agent.
29. Which of the following statement(s) is/are true concerning gallstone ileus?
A. The diagnosis may be suggested by plain abdominal radiography
B. Primary surgical management consists of relief of obstruction and cholecystectomy
C. Gallstone ileus accounts for less than 5% of all causes of intestinal obstruction
D. Typical patients are elderly with long-standing gallstone disease
30. Appropriate options for management of common bile duct stones identified at
laparoscopic cholecystectomy include:
A. Conversion to open cholecystectomy and common duct exploration
B. Transcystic duct dilatation and exploration
C. Laparoscopic choledochotomy
D. Complete the laparoscopic cholecystectomy with postoperative ERCP and stone removal
31. The gold standard for evaluation of patients with bile duct strictures is cholangiography.
The two routes for cholangiography are percutaneous transhepatic cholangiography (PTC) or
endoscopic retrograde cholangiography (ERC). Which of the following statement(s) is/are
true?
A. PTC is generally more valuable than ERC in defining the proximal biliary tree to be used in
reconstruction
B. ERC is technically easier in patients with bile leaks because the biliary tree is usually not dilated
C. Parenteral antibiotics should be administered prior to either procedure to prevent cholangitis
D. Biliary stents can be placed via either technique to control biliary leaks
32. Main features of the liver (bile) colic:
A. Acute onset
B. After prodromal period
C. Gradual onset
D. After fatigue
E. Usually combines with constipation
33. Normal level of serum bilirubin:
A. 0,10-0,68 мкмоль/л
B. 8,55-20,52 мкмоль/л
C. 2,50-8,33 мкмоль/л
D. 3,64-6,76 мкмоль/л
E. 7,62-12,88 мкмоль/л
34. What method from the listed below is not used for choledoch drainaging:
A. Kehr’s
B. Vishnevski’s
C. Spasokukotski’s
D. Holsted’s
E. All answers are wrong
35. To the purulent cholangitis all symptoms from the listed below are similar except:
A. Chill
B. Hectic fever
C. Paresis of the intestine
D. Moderate pain syndrome in the right subcostal area
E. Jaundice
36. The Mirizzi’s syndrome means:
A. Intestinal obstruction with the gallstone
B. The fistula formation between the gallbladder and the choledoch
C. Leucopenia on the background of the jaundice
D. Intermittant jaundice of tumoral origin
37. Name the main signs of cholangitis:
A. Sharko’s triad
B. Dizzyness
C. Low blood pressure
D. Skin covers rash
E. Hyperglycemia
38. The listed below methods are used for choledoch external drainaging:
A. Pickovski’s
B. Holsted’s
C. Kehr’s
D. Kerte’s
E. Doliotti's
39. What are the differences between the tumoral and calculous jaundice?
A. The first one is “quiet”, painless
B. The second one is develop usually after pain in the right subcostal area
C. The hyperbilirubinemia is similar for both of them
D. Cholangitis is similar for both of them
40. The patient of 56 years old was admitted to the hospital with mechanical jaundice of
tumoral origin and general bilirubin level of 250 mkmol/l. What should you prescribe to your
patient?
A. Urgent surgery
B. Decompression of the biliar hypertension with US- controlled drainaging
C. Conservative therapy
D. Surgery after “B” and “C”
E. Discharging from the hospital

LIVER DISEASES (X)

1. The liver abscesses were detected during ultrasound research. There are
signs of severe intoxication. What is the most rational way of antibiotics injection :
A. In the inferior vena cava
B . Intraductal way
C. Into the celiac trunk
D . In the subclavian vein
E . Intraabdominal way
2 . What method you should prescribe to your patient in case of suspicious diagnosis of liquid
formation of the liver :
A. Laparoscopy
B . Cavography
C . Liver scintigraphy
D. Diagnostic ultrasound puncturing
E . Aortography
3 . The patient of 40 years old complains on pain in the right subcostal area. Skin covers of
yellowish color. Patient’s condition of moderate severity . At the age of 20 years old the
patient felt ill with viral hepatitis. For a long time alcohol abuse was present. During the
inspection the signs of portal hupertension, during palpation- splenomegaly were detected.
Put the diagnosis:
A. Suprahepatic block
B. Intrahepatic block
C . Subhepatic block
D . The mixed block
E . Hypersplenism
4 . Choose the symptom from the listed which is not common for portal hypertension:
A. Collateral vessels opening
B. Splenomegaly
C. Hemorrhagic manifestations
D. Ascitis
E. Jaundice
5 . Name the most informative method for determining the level of the block in portal
hypertension :
A. Endoscopy
B . Laparoscopy
C . Liver ultrasound research
D. Celiacography
E. ERCPG
6. For the liver cirrhosis and portal hypertension is not typical :
A. Varicose veins of the esophagus and stomach
B. Varicose veins of the anterior abdominal wall
C. Expanding of the superficial veins of the right lower extremity
D. Hemorrhoids
E. Ascitis
7. The liver abscess is not characterized by :
A. Fever
B. Pain in the right subcostal area
C. Leukocytosis
D. The liver enlargement
E. Courvoisier’s sign
8. Which of the following statements about the segmental anatomy of the liver are not true?
A. Segments are subdivisions in both the French and American systems.
B. Segments are determined primarily by the hepatic venous drainage.
C. The French anatomic system is more applicable than the American system to clinical hepatic
resection.
D. Segments are important to the understanding of the topographic anatomy of the liver.
9. Bile formation is:
A. An active secretory process.
B. Determined at two sites principally.
C. Regulated physiologically by hormones.
D. Largely determined by the intactness of the enterohepatic circulation (EHC).
10. Generally, the two most important hepatic functions to consider after hepatic resection
are:
A. Hepatic synthetic function.
B. Glucose metabolism.
C. The liver's role in lipid metabolism.
D. The liver's role in vitamin metabolism.
11. Which of the following statements about pyogenic abscess of the liver are true?
A. The right lobe is more commonly involved than the left lobe.
B. Appendicitis with perforation and abscess is the most common underlying cause of hepatic
abscess.
C. Mortality is largely determined by the underlying disease.
D. Mortality from hepatic abscess is currently greater than 40%.
12. Which of the following statements most accurately describes the current therapy for
pyogenic hepatic abscess?
A. Antibiotics alone are adequate for the treatment of most cases.
B. All patients require open surgical drainage for optimal management.
C. Optimal treatment involves treatment of not only the abscess but the underlying source as well.
D. Percutaneous drainage is more successful for multiple lesions than for solitary ones.
13. Which of the following statements characterize amebic abscess?
A. Mortality is higher than that for similarly located pyogenic abscesses.
B. The diagnosis of amebic abscess may be based on serologic tests and resolution of symptoms.
C. In contrast to pyogenic abscess, the treatment of amebic abscess is primarily medical.
D. Patients with amebic abscess tend to be older than those with pyogenic abscess..
14. Echinococcosis liver disease caused by Echinococcus granulosus:
A. Is not a neoplasm.
B. Is endemic to parts of Europe, but not the United States.
C. Is usually curable by resection.
D. Is more deadly than in its Echinococcus multilocularis form.
15. Which of the following is the most common acid-base disturbance in patients with
cirrhosis and portal hypertension?
A. Metabolic acidosis.
B. Respiratory alkalosis.
C. Metabolic alkalosis.
D. Respiratory acidosis.
16. Which of the following veins is preserved in performing the extensive esophagogastric
devascularization procedure described by Sugiura?
A. Left gastric (coronary) vein.
B. Short gastric vein.
C. Splenic vein.
D. Left gastroepiploic vein.
17. Which of the following complications of portal hypertension often require surgical
intervention (for more than 25% of patients)?
A. Hypersplenism.
B. Variceal hemorrhage.
C. Ascites.
D. Encephalopathy.
18. The following statement(s) is/are true concerning the differential diagnosis between an
amoebic and a pyogenic liver abscess.
A. The clinical presentation is often clearly distinguishable
B. A history of travel or origin from a high risk area might suggest an amebic liver abscess
C. Routine liver chemistries frequently can distinguish pyogenic from amoebic liver abscess
D. Serologic testing for the presence of antibody to entamoeba histolyctica is the only specific and
sensitive way to confirm the diagnosis of amoebic liver abscess
E. Distinguishing pyogenic from hepatic abscesses preoperatively is not important since surgical
drainage is imperative for both
19. The following statement(s) is/are true concerning the diagnosis and treatment of hydatid
cysts.
A. Percutaneous aspiration is an important aspect of diagnosis and treatment of a hydatid cyst
B. CT scan will oftentimes show the classic findings of a cystic liver lesion with a calcific rim
C. At operation, care must be taken to protect the operative field from spillage of the cyst fluid
D. The use of a scoleocide has become obsolete with current surgical techniques
20. Which of the following statement(s) is/are true concerning treatment of pyogenic liver
abscess?
A. Antibiotic therapy alone may be advisable in patients with multiple small abscesses
B. Percutaneous drainage provides comparable results to surgical drainage in patients with
unilocular large abscesses
C. Sufficient antibiotic coverage for most hepatic abscesses includes coverage for gram-positive
aerobic bacteria only
D. In patients with a primary biliary origin for the hepatic abscess, treatment must also be addressed
at underlying biliary pathology such as choledocholithiasis or biliary ductal obstruction
21. Important spontaneous portosystemic collaterals which develop in the face of portal
hypertension include:
A. The hemorrhoidal veins
B. Left renal vein
C. The paraumbilical venous plexus
D. The coronary, short gastric, and paraesophageal veins
22. The following statement(s) is/are true concerning the management of ascites associated
with chronic liver disease.
A. Spontaneous bacterial peritonitis is an insignificant complication
B. Large volume paracentesis is unsafe due to excessive volume loss from the intervascular space
C. Peritoneovenous shunting is a trivial surgical procedure with minimal perioperative morbidity
and mortality
D. Transjugular intrahepatic portosystemic shunts (TIPS) can effectively treat ascites in patients
refractory to conventional medical therapy
23. Which of these statement(s) is/are true concerning the etiologic factors in the development
of cirrhosis?
A. Viral hepatitis of any type (A, B, or non-A, non-B) can all progress to cirrhosis
B. Acetaminophen can cause acute liver failure and necrosis but will not lead to cirrhosis
C. Alcohol exerts toxic effects on the liver via reactive intermediates such as acetaldehyde
D. Long-standing congestive heart failure can lead to cirrhosis secondary to centrilobular
congestion, hemorrhage, and necrosis
24. Which of the following statement(s) is/are true concerning the pathophysiology of variceal
hemorrhage?
A. All patients with portal hypertension will develop esophageal varices
B. All patients with esophageal varices eventually bleed
C. Variceal size can predict the incidence of variceal hemorrhage d. Control of acid secretion by H2
blockade can decrease the incidence of rebleeding after esophageal hemorrhage
D. None of the above
25. Hepatic encephalopathy is a common systemic manifestation of chronic liver disease.
Which of the following statement(s) is/are true concerning this condition?
A. Blood ammonia levels correlate well with the stage of hepatic encephalopathy
B. Alterations in central nervous system neurotransmitters such as the neurotransmitter g-
aminobutyric acid (GABA) have been proposed in the pathogenesis of hepatic encephalopathy
C. Lactulose can be used to decrease intestinal ammonia absorption
D. Patients can be expected to have an increased sensitivity to benzodiazepines
26. Which of the following statement(s) is/are true concerning the management of
gastroesophageal variceal hemorrhage?
A. Vasopressin decreases portal pressure through the process of splanchnic vasoconstriction
B. Somatostatin is as effective as vasopressin but without the cardiac side effects
C. Balloon tamponade provides good long-term control of bleeding esophageal varices
D. Endoscopic sclerotherapy is more effective than conservative medical therapy in the treatment of
bleeding esophageal varices
E. Sclerotherapy, although excellent for the control of bleeding short-term, does not prolong overall
survival
27. Which of the following statement(s) is/are true concerning the surgical management of
bleeding esophageal varices.
A. A side-to-side portacaval shunt may be associated with the development of hepatofugal blood
flow
B. Selective shunts preserve prograde (hepatopedal) blood flow while decompressing esophageal
varices or reducing portal pressure
C. The presence of intractable ascites is a contraindication to the Warren shunt
D. If the patient is considered a liver transplant patient, an interposition mesocaval shunt is a
suitable alternative
28. Name the first steps to stop the bleeding from the esophageal variceal plexuses?
A. Nasogastric intubation with the Blackmore tube
B. Urgent surgery
C. Hemostatics injection
D. Proper diet
E. Syphonic enema
29. What methods you should prescribe to your patient to confirm liver rupture?
A. X-ray of the abdomen
B. USR
C. Paracentesis
D. Laparoscopy
E. Chest CT- scanning
30. The volume of the operative treatment with the giant benign cyst of the liver left lobe is:
A. Left- sided hemyhepatectomy
B. Fenestration of the cyst
C. External drainaging
D. Only biopsy taking
E. Atypical resection
31. What are the main complications of the liver cirrhosis?
A. Ascitis
B. Parenchimatous jaundice
C. Liver failure
D. Portal hypertension
E. Cirrhotic foci malignisation
32. Name three membranes of the hydatid cyst?
A. Fibrose capsule
B. Chitinic membrane
C. Endothelium
D. Herminative membrane
E. Serose layer
33. What drug you should prescribe to your patient with the hydatid cyst in postoperative
period with the aim of relapse prophilaxy?
A. Cephalosporines of the third generation
B. NSAD
C. Albendazolum
D.Vitamine B12
E. Amine caproic acid
34. These are the CT- signs of the liver hydatid cyst, exept
A. Round- shaped formation of low density and precise borders
B. Round cystic formation with calcified walls
C. Round- shaped formation with the level of fluid
D. Round- shaped formation with the contrast presence inside it
E. Multiple nodes of high density with the contrast inside
35. Yor tactics concerning the patient with ascitis?
A. MRI of the abdomen
B. USR
C. Paracentesis with the laboratory of the abdominal content
D. FEGDS
E. ERCPG
36. What you should check first of all in your patient with colorectal cancer before the
operation?
A. Lungs functioning
B. Renal excretion
C. Ascitis presence
D. Abdominal lymph nodes condition
E. Metastatic liver damage presence
37. Name the optimal method of the liver cirrhosis surgical treatment?
A. Liver resection
B. Cholangiostomy
C. Catheterization of the hepatic artery
D. Portal vein catheterization
E. Liver transplantation
38. The liver capsule is innervated by the:
A. Vague nerve
B. Phrenic nerve
C. Trigeminal nerve
D. Solar plexus
E. Spinal nerves
39. Your tactics concerning the liver residual cavity after hydatidectomy:
A. Simple suturing
B. Tamponade with omental patch
C. Drainaging with suturing
D. Using of special surgical resorbable sponge
E. Lobe resection
40. Enterohepatic Le Breton’s cycle of circulation- what does it mean?
A. Venose circulation
B. Arterial circulation
C. Lymph circulation
D. Bile acids circulation
E. Toxins circulation
THE SPLEEN AN THE PANCREAS DISEASES (XI)
1. As the functional anatomy of the spleen is divided into red pulp, white pulp, and marginal
zone, what function is incorporated into the anatomy of the cortical zone that relates to
infection control?
A. Filtration of red cells, encapsulated bacteria, and other foreign material.
B. Red pulp for formation of red cells.
C. White pulp for its role in formation of granulocytes.
D. Gray areas, so formed because of the production of platelets.
E. Fibrous trabeculae.
2. During the evolution of the understanding of hematologic diseases, the indications for
splenectomy have changed. The most common indications for splenectomy are, in descending
order of frequency:
A. Traumatic injury, immune thrombocytopenia, hypersplenism.
B. Immune thrombocytopenic purpura, traumatic injury, hypersplenism.
C. Hypersplenism, traumatic injury, immune thrombocytopenia.
D. Immune thrombocytopenia, hypersplenism, traumatic injury.
E. None of the above.
3. Useful methods for detection of splenic injury, in descending order of sensitivity, are:
A. Paracentesis.
B. CT.
C. Ultrasonography.
D. Isotope scan.
E. Magnetic resonance imaging (MRI).
4. The following statements about splenosis are correct:
A. Autotransplantation of splenic tissue is an etiology.
B. May protect against OPSS.
C. May over time be “born again” and regain some immune function.
D. May produce tuftsin and properdin.
E. All of the above.
5. The following comments about immune thrombocytopenic purpura (ITP) are accurate:
A. Platelet count is low.
B. Circulating antiplatelet factor is present.
C. Antiplatelet factor is immunoglobulin G (IgG) antibody.
D. Purpura is directed against a platelet-associated antigen.
E. May be fatal.
F. All of the above.
6. Idiopathic thrombopenic purpura (ITP):
A. Is most common in men in their 20s.
B. Is frequently cured in adults by corticosteroid administration.
C. Usually requires splenectomy in children.
D. Is most common in the sixth decade of life.
E. Is in remission in more than 80% of patients with splenectomy.
7. Splenectomy and perioperative therapy for ITP:
A. Follow successful steroid therapy.
B. Respond permanently to high-dose intravenous gamma globulin.
C. Are best preceded by polyvalent vaccines for Pneumococcus, Haemophilus influenzae, and
Neisseria meningitidis.
D. Cannot be done laparoscopically.
E. Are associated with splenomegaly.
8. Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by all of the
following except:
A. Thrombocytopenia.
B. Microangiopathic hemolytic anemia.
C. Deposition of platelet microthrombi.
D. Fluctuating neurologic abnormalities.
E. Renal failure.
F. Afebrile.
9. Which of the following comments does not describe hypersplenism?
A. It may occur without underlying disease identification.
B. It may be secondary to many hematologic illnesses.
C. It is associated with work hypertrophy from immune response.
D. It requires evaluation of the myeloproliferation.
E. It is associated with antibodies against platelets.
10. Hyposplenism is a potentially lethal syndrome. Which of the following statements is
incorrect?
A. It is confirmed by isotope scan.
B. It is always associated with an atrophic spleen.
C. It may be associated with overwhelming post-splenectomy sepsis syndrome (OPSS).
D. It is associated with thyrotoxicosis, corticosteroid administration, and some contrast agents.
E. It may be associated with ulcerative colitis or sickle cell anemia.
11. Which of the following statements regarding post splenectomy sepsis are true?
A. The incidence in children is generally reported as less than 5%
B. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis are the most
common causative organisms
C. Autotransplantation techniques eliminate this risk
D. The mortality rate is now approximately 50%
E. The incidence in adults in approximately 1%
12. Hypersplenism is associated with which of the following diseases?
A. Portal hypertension
B. Lymphoma
C. Mononucleosis
D. Systemic lupus erythematosus
E. Gaucher disease
13. Which of the following statements regarding splenic function in humans are true?
A. The specific immune function of the spleen is principally related to its antigen processing role
B. The spleen is the major site of synthesis of complement pathway proteins
C. The spleen is more efficient than the liver at removing bacteria with a high density of surface
opsonins
D. The spleen serves as a principal source of nonspecific opsonins
14. The pancreas occupies a retroperitoneal position in the upper abdomen. Which
statement(s) is/are correct?
A. The superior mesenteric vein and the splenic vein join to form the portal vein posterior to the
neck of the pancreas.
B. The uncinate process of the pancreas extends posterior to the inferior vena cava.
C. The tail of the pancreas extends to the left of the aorta, toward the splenic hilum.
D. The head of the pancreas is jointly supplied by arterial blood from the celiac axis and the
superior mesenteric artery.
15. Both endocrine and exocrine tissue comprise the pancreas. Which statement(s) is/are true?
A. The islets of Langerhans total 1 million per gland and drain their secretions via intercalated duct
cells through the ampulla of Vater.
B. Islet alpha cells produce glucagon.
C. Islet sigma cells produce somatostatin.
D. The acini and ductal systems constitute the exocrine portion of the pancreas.
16. Pancreatic exocrine secretory products include a bicarbonate-rich electrolyte solution as
well as digestive enzymes. Which of the following statement(s) is/are true?
A. Cholecystokinin (CCK) is the most potent endogenous stimulant of pancreatic enzyme secretion.
B. The chloride and bicarbonate concentrations of pancreatic juice vary and depend on the secretory
flow rate.
C. Secretin is the most potent endogenous stimulant of pancreatic water and electrolyte secretion.
D. The peptidases synthesized by acinar cells are released into the pancreatic duct system in active
form.
17. Which of the following statements about chronic pancreatitis is/are correct?
A. Chronic pancreatitis is the inevitable result after repeated episodes of acute pancreatitis.
B. Patients with chronic pancreatitis commonly present with jaundice, pruritus, and fever.
C. Mesenteric angiography is useful in the evaluation of many patients with chronic pancreatitis.
D. Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis.
E. For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated
stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate
surgical option.
18. In the performance of a pancreaticoduodenectomy (Whipple procedure), the superior
mesenteric vein is an important landmark. Which of the following statements is/are true with
regard to the superior mesenteric vein?
A. Small venous branches enter the superior mesenteric vein anteriorly as it courses beneath the
neck of the pancreas
B. The superior mesenteric vein joins the splenic vein at the superior border of the pancreas to form
the portal vein
C. Small venous branches enter the superior mesenteric vein laterally as it courses beneath the neck
of the pancreas
D. The superior mesenteric vein courses anterior to the neck of the pancreas
19. Which of the following statements is/are correct with regard to the blood supply of the
pancreas?
A. The inferior pancreaticoduodenal artery, a branch of the celiac artery, divides into anterior and
posterior branches to supply the pancreatic head
B. The body and tail of the pancreas are supplied by branches of the splenic artery
C. The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery
D. The body and tail of the pancreas are supplied by branches derived from the left renal artery
20. The islets of Langerhans contain four major endocrine cell types that secrete which of the
following hormones?
A. Insulin, somatostatin, glucagon, secretin
B. Insulin, somatostatin, cholecystokinin, pancreatic polypeptide
C. Insulin, somatostatin, glucagon, pancreatic polypeptide
D. Insulin, secretin, glucagon, cholecystokinin
21. Which of the following statement(s) relating to chronic pancreatitis is/are correct?
A. In the United States, the most common cause of chronic pancreatitis is alcohol abuse
B. Approximately 50% of chronic alcoholics develop chronic pancreatitis
C. Clinically significant chronic pancreatitis develops on average after five years of alcohol abuse
in men
D. The risk of alcohol-induced chronic pancreatitis can be decreased by consumption of a high-
protein diet
22. The most appropriate test to confirm a clinical diagnosis of early chronic pancreatitis is
which of the following?
A. Serum amylase determination
B. Calculation of urinary amylase clearance
C. Measurement of para-aminobenzoic acid absorption
D. Endoscopic retrograde cholangiopancreatography
23. Which of the following is the most common cause of obstructive jaundice in patients with
chronic pancreatitis?
A. Adenocarcinoma of the head of the pancreas
B. Choledocholithiasis
C. Fibrotic stricture of the common bile duct
D Pancreatic pseudocyst formation
24. Alcohol-induced and hereditary chronic pancreatitis are the two most common etiologies
observed in North American patients. Most of the remaining patients fall into which of the
following categories?
A. Chronic pancreatitis secondary to hyperparathyroidism
B. Chronic pancreatitis caused by protein-calorie malnutrition
C. Chronic pancreatitis secondary to congenital pancreatic ductal obstruction
D. Idiopathic chronic pancreatitis
25. Which of the following is the most common clinical manifestation of chronic pancreatitis?
A. Epigastric pain with radiation to the hypogastrium
B. Diabetes mellitus
C. Steatorrhea
D. Epigastric pain with radiation to the upper lumbar vertebrae
26. The most common cause of death in the postoperative period following
pancreaticoduodenectomy is which of the following?
A. Myocardial infarction
B. Intraperitoneal hemorrhage
C. Pulmonary embolism
D. Pneumonia
27. Your tactics concerning the patient with the varified spleen rupture:
A. Simple suturing
B. Splenic artery embolization
C. Splenectomy
D. Laparoscopic clipping
28. Name the main organ- preserving surgical procedures in chronic pancreatitis:
A. Frey’s procedure
B. Beger’s procedure
C. Hartmann’s procedure
D. Bilroth 1 procedure
29. Name the main resectable surgical procedures in chronic pancreatitis:
A. Whipple’s procedure
B. Distal pancreatectomy
C. Puestow’s 1 procedure
D. Nakayama’s procedure
30. Name the main drainaging surgical procedures in chronic pancreatitis:
A. Heinecke- Mikulich’s procedure
B. Judd’s procedure
C. Partington- Rochelle’s procedure
D. Puestow’s 2 procedure
31. What complications of chronic pancreatitis do you know?
A. Mechanical jaundice
B. Duodenal obstruction
C. Malignization
D.Portal hypertension
32.The reasons of pain origin in chronic pancreatitis are:
A. Cytokins influence on nervous fibers
B. Distension of pancreatic ducts system because of ductul hypertension
C. Nervose fibers and pancreatic parenchime fibrosis
D. Hyperglicemia
33. What clinical manifistations of chronic pancreatitis do you know?
A. Chronic pain
B. Maldigestion
C. Steatorrhea, diarrhea
D. Hyperglicemia
34. What drugs may help you to decrease the pain on the initial stages of chronic pancreatitis?
A. H2- blockers
B. Enzymes
C. Opioids
D. Spasmolitics
35. What should you do to differentiate chronic indurative pancreatitis from the carcinoma?
A. PET
B. Fine- needle biopsy
C. CA 19-9, CA 50 and CEA levels
D. FEGDS

DISEASES OF RECTUM AND PERINEAL SOFT TISSUES (XII- XIII)

1. To the chronic paraproctitis the most similar is:
A. Blood mixtures in urine
B. Fistula external opening on the perineal skin covers
C. Presence of unchanged blood in feces after defecation
D. Pain in the lower parts of the abdomen
E. Diarrhea
2. For the fistulas research you should use:
A. External inspection and palpation
B. Rectal finger research
C. Fistulography
D. Fistula probing
E.. All answers are correct
3. Epithelial coccygeal fistula:
A. Is connected with the sacrum
B. Is connected with the coccyx
C. Ends blindly in the subcutaneous tissue of intergluteal area
D. Is located between the posterior surface of the rectum and the anterior surface of the sacrum
E. Is connected with the rectum lumen
4. The most effective treatment of the rectal fistula is:
A. Conservative
B. Sclerosants injection
C. Surgical
D. Filling with special foam
5. The surgical treatment of the intrasphincteric rectal fistula includes all methods, except:
A. Fistula dissection inside the rectum lumen
B. Fistula excision inside the rectum lumen (Habriel’s procedure)
C. Fistula excision with the purulent cavities drainaging
D. Fistula excision with the purulent cavities drainaging and subsequent suturing
6. The surgical treatment of the transsphincteric rectal fistula includes all methods, except:
A. Fistula excision inside the rectum lumen with the wound bottom suturing
B. Fistula excision inside the rectum lumen with the wound bottom partial suturing, purulent
cavities drainaging
C. Fistula excision inside the rectum lumen with the purulent cavities drainaging
D. Fistula excision with the ligature inserting
7. The method of choice in surgical treatment of the extrasphincteric fistula of the 1 degree of
severity is :
A. Fistula excision with sphincter suturing
B. Fistula excision with rectal mucous flap dislocation
C. Fistula excision without sphincter suturing
D. Partial sphincterotomy on the depth of 0,6-0.8 cm with fistula excision
8. The method of choice in surgical treatment of the extrasphincteric fistula of the 2 degree of
severity is:
A. Fistula excision with sphincter suturing
B. Fistula excision with rectal mucous flap dislocation
C. Fistula excision with the ligature inserting
D. Partial sphincterotomy on the depth of 0,6-0.8 cm with fistula excision
9. The method of choice in surgical treatment of the extrasphincteric fistula of the 3 degree of
severity is:
A. Fistula excision with sphincter suturing
B. Fistula excision with rectal mucous flap dislocation or fistula excision with the ligature inserting
C. Fistula excision (without sphincterotomy) with the ligature inserting
D. Partial sphincterotomy on the depth of 0,6-0.8 cm with fistula excision
10. The method of choice in surgical treatment of the extrasphincteric fistula of the 4 degree
of severity is:
A. Fistula excision with sphincter suturing
B. Fistula excision with rectal mucous flap dislocation
C. Partial sphincterotomy on the depth of 0,6-0.8 cm with fistula excision
D. Fistula excision (without sphincterotomy) with the ligature inserting
11. In extrasphincteric fistula, complicated with the purulent cavity, the most radical
operation is:
A. Fistula excision inside the rectum lumen
B. Purulent cavity drainaging
C. Plastic surgery with mucous membrain dislocation according to Blinnitchev
D. Fistula excision with sphincter suturing
E. The ligature inserting with the purulent cavity drainaging
12. Name the clinical picture of the complite pararectal fistula:
A. The gases discharging from the fistula
B. The pus discharging from the fistula
C. The liquid feces discharging from the fistula
D. Pain syndrome exacerbation with the fever
E. All answers are correct
13. What methods should be used for the acute paraproctitis treatment?
A. Antibiotic treatment
B. Physiotherapy methods
C. Urgent surgery
D. Elective surgery
14. In the acute paraproctitis treatment the next points should be kept up:
A. Early surgery
B. Drainaging of the purulent cavity
C. Fistula internal opening excision
D. Adequate drainaging
15. The most frequent type of the acute parproctitis?
A. Subdermal paraproctitis
B. Submucous paraproctitis
C. Ishiorectal paraproctitis
D. Pelviorectal paraproctitis
E. Retrorectal paraproctitis
16. The patients with the acute ishiorectal paraproctitis should be operated on under the:
A. Intravenous anaestesia
B. Local anaestesia
C. Sacral anaestesia
D. Peridural anaestesia
E. All types of anaestesia except local
17. In case of acute hemorrhoids conservative treatment the most optimal will be:
A. Laxatives prescription, NSAD, proper diet
B. Novocainic blockade
C, Analgesics, bed regimen, heparinic ointment locally, proper diet
D. Hemorrhoidectomy
E. Sclerosants injection
18. The main reasons of the anal crack origin are:
A. Acute paraproctitis
B. Hemorrhoids
C. Constipation
D. Trauma of the rectum and anal channel
19. The most frequently the anal crack is located on:
A. The posterior semicircle of the anal channel
B. The anterior semicircle of the anal channel
C. The right semicircle of the anal channel
D. The left semicircle of the anal channel
E. The posterior and anterior semicircles of the anal channel
20. For the anal crack diagnosis establishment is enough to performe:
A. Rectal finger research
B. Irrigoscopy
C. Rectoromanoscopy
D. Colonoscopy
E Anoscopy
21. Clinical picture of the chronic anal crack is characterized by:
A. Pain during defecation
B. Profuse bleeding during defecation
C. Pain after defecation
D. Small bleeding during after defecation
E. Correct “A” and “B”
22. Clinical picture of the acute anal crack is characterized by:
A.Pain during defecation
B. Constipation
C. Pain after defecation
D. Profuse bleeding
23. The treatment of the acute anal crack is consist of:
A. Pain and spasm relief
B. Defecation normalization
C. Anal crack excision
D. Anal crack excision with sphincterotomy
24. The most effective treatment of the cronic callous anal crack is:
A. Novocain- spirituous injection under the crack
B. Presacral blockade with novocain solution
C. Excision of the crack
D. Digital distension of the sphincter by Rekamje
E. Excision of the crack with sphinkterotomy
25. For the hemorrhoids diagnostics will be enough:
A. Rectal finger research and anal region inspection
B. Rectoromanoscopy
C. Anoscopy
D. Irrhigoscopy
E. Colonoscopy
26. Haemorrhoidectomy is indicated:
A. Anal itching
B. 1 stage of haemorrhoids
C. Pain during defecation
D. 3 stage of haemorrhoids
E. Haemorrhoids exacerbation
27. The most effective haemorrhoids treatment is:
A. Conservative
B. Injective
C. Operative
D. Constipation eliminaiton
E. Sclerosants injection
28. Haemorrhoidectomy according to Millighan- Morgan means:
A. Anal chanal mucous membrane circular excision
B. Excision of piles according to 2,5,8 hours of the dial
C. Excision of piles according to 3,7,11 hours of the dial
D. Excision of piles according to 3,7,11 hours of the dial with anal chanal mucous membrane
restoration
E. Excision of piles
29. To the patient after acute piles inflammation recovering the next procedure is indicated:
A.Sclerotherapy
B. Piles ligation
C. Haemorrhoidectomy
D. Presacral novocainic blockade
30. Haemorrhoidectomy complications are:
A. Anal stenosis
B. Sphincter incompetancy
C. Uncomplite internal fistulas
D. Problems with micturition
31. Acute paraproctitis- is:
A. Inflammation of perirectal soft tissue
B. Inflammation of perirectal soft tissue with rectal mucose membraine prolapse
C. Inflammation of perirectal soft tissue with inflammation and thrombosis of piles
D. Inflammation of perirectal soft tissue in connection with purulent processbin the wall of rectum
32. According to the localization there are some types of acute paraproctitis. Name them?
A. Subdermal
B. Summucouse
C. Ishiorectal
D. Anococcygeal
33. Typical clinical course of the ishiorectal paaraproctitis is characterized by all except:
A. Mucous discharging from the anus
B. Severe fever
C. Deep pelvic pain
D. Absence of skin changes
34. According to the rectal sphincter there are:
A. Intrasphincteric fistula
B. Uncomplete fistula
C. Transsphincteric fistula
D. Extrasphincteric fistula
E. Complete fistula
35. Main principles of the operation because of the acute paraproctitis include all from the
listed except:
A. Incision
B. Drainaging of the abscess cavity
C. Fistula internal opening excision
D. Wound suturing
36. Radical treatment of acute subdermal paraproctitis means:
A. General antibiotic therapy
B. Systemic abscess cavity punctions and sanations with antibiotics
C. Simple incision and drainaging
+ Purulent cavity opening with inflammatory zone crypt and fistula excision
37. In acute ishiorectal paraproctitis you should do:
A. Abscess punction and antibiotic injection
B. To open the abscess into the rectum lumen
C. To open the abscess through the perineum with anococcygeal ligament dissection
D. Abscess punction and irrigator inserting
E. Opening, drainaging and the anal crypt excision
38. How many stages of rectum prolapse do you know?
A. 2
B. 3
C. 4
D. 5
E. 6
39. Rectum prolapse diagnostics is based on the data of:
A. USR
B. Irrhygography
C. Inspection and complaints
D. Colonoscopy
E. Anoscopy
40. In case of rectum prolapse of the III - IV stages the most effective surgical intervention is:
A. Tirsh’s
B. Kummel- Zerenin’s
C. Cadjan- Bruhn’s
D. Svyatukhin’s
E. Zhirard- Marshan’s

DISEASES OF THE NTESTINE (XIV)

1. All of the following statements about the embryology of Meckel's diverticulum are true
except:
A. Meckel's diverticulum usually arises from the ileum within 90 cm. of the ileocecal valve.
B. Meckel's diverticulum results from the failure of the vitelline duct to obliterate.
C. The incidence of Meckel's diverticulum in the general population is 5%.
D. Meckel's diverticulum is a true diverticulum possessing all layers of the intestinal wall.
E. Gastric mucosa is the most common ectopic tissue found within a Meckel's diverticulum.
2. Meckel's diverticulum most commonly presents as:
A. Gastrointestinal bleeding.
B. Obstruction.
C. Diverticulitis.
D. Intermittent abdominal pain.
3. What is the conservative therapy of the nonspecific ulcerative colitis:
A. Dietotherapy (to avoid milk and milk products)
B. Vitaminotherapy
C. Sulphanilamides administration
D. Desensebilitive therapy
E. All listed above
4. Name the reason of the colonic toxic dilatation in ulcerative colitis?
A. Muscle fibers dystrophy
B. Intestinal neural plexuses damage
C. Electrolytes disbalance
D. Nothing from the listed above
E. All from the listed above
5. In Hirshprung’s disease diagnostics the next method is not useful:
A. Sigmoidoscopy
B. Barium passage investigation along the large intestine
C. Internal rectal sphincter tonus measuring
D. Swenson’s biopsy
E. Colonoscopy
6. In case of intestinal perforation because of the ulcerative colitis you should perform:
A. Perforation suturing and ileostomy
B. Proximal colostomy
C. Total colectomy and ileostomy
D. Segmental intestinal resection (with perforation)
E. The stoma formation from the perforated intestinal loop
7. In what complication of the nonspecific ulcerative colitis you shouldn’t operate your
patient:
A. Bleeding
B. Toxic colonic dilatation
C. Water- electrolytes disbalance
D. Malignization
E. Perforation
8. The most common indication for surgery secondary to acute diverticulitis is:
A. Abscess.
B. Colonic obstruction.
C. Colovesical fistula.
D. Free perforation.
E. Hemorrhage.
9. The enterohepatic circulation refers to the circular flow of bile through the small intestine
and liver. Which of the following statement(s) concerning the absorption of bile salts is/are
correct?
A. The enterohepatic circulation is highly efficient with 80% to 90% of secreted bile salts
reabsorbed and returned to the liver through the portal circulation
B. The reabsorption of bile is entirely an active process
C. The small amount of bile escaping in the colon is deconjugated by bacteria, promoting lipid
solubility and passive colonic absorption
D. Ileal resection results in presenting high concentrations of bile salts to the colon which promotes
diarrhea by bacterial overgrowth
10. In the ulcerative colitis this part of intestine is usually damaged most of all:
A . Ascend
B. Transverse
C. Descend
D. Caecum
E. Rectum
11. A common manifestation of Crohn’s disease is perianal disease, including anal fistulas
with extension to adjacent organs and soft tissue regions, fissures, and perirectal abscesses.
Which of the following statement(s) is/are true concerning perianal disease with Crohn’s
disease?
A. Perianal disease is the initial mode of presentation in the majority of patients
B. The prevalence of perianal disease is increased in patients with either ileocolitis or isolated
colonic involvement
C. Metronidazole has been shown to be effective in the treatment of perianal disease secondary to
Crohn’s
D. An aggressive surgical approach is appropriate in most cases due to the frequent rapid
progression of perianal disease
12. Nongastrointestinal complications of Crohn’s disease include:
A. Renal calculi
B. Cholelithiasis
C. Arthritis
D. Anemia
13. Which of the following points is/are true concerning the diagnosis of Crohn’s disease?
A. Recurrent disease on contrast radiographs frequently lags behind the development of clinical
signs and symptoms
B. In 10% of cases, Crohn’s disease cannot be distinguished from chronic ulcerative colitis based
on clinical, radiologic, and pathologic criteria
C. Although no specific laboratory tests exist for Crohn’s disease, the erythrocyte sedimentation
rate has evolved as a useful measure of disease activity
D. Specific endoscopic features encountered in Crohn’s disease which allow differentiation from
ulcerative colitis include aphthous ulcers, cobblestoning, and skip areas
14. The following statement(s) is/are true concerning the surgical management of Crohn’s
disease.
A. Strictureplasty, although offering short-term benefits, is associated with a higher rate of
recurrence when compared to resection
B. Frozen section examination of the margin of resection is essential to prevent both recurrent
disease and early anastomotic complications
C. Conservative margins of resection are appropriate, resecting only grossly involved segments of
bowel
D. Patients with Crohn’s disease confined to the colon may be treated with total proctocolectomy
with construction of an ileal-anal pouch anastomosis
15. The etiology of Crohn’s disease is unknown, although two major hypotheses have evolved:
an infectious and an immunologic theory. The following statement(s) is/are true concerning
the possible etiology of Crohn’s disease.
A. The leading infectious agent thus far suggested is infection with a Mycobacterium species
B. Strong evidence linking viral pathogens to Crohn’s disease has been developed
C. Although many alterations in cellular and immune functions in patients with Crohn’s disease
have been observed, no primary defect in the immune system has yet been identified
D. The identification of antibodies to enterocytes provides strong support for the theory that
Crohn’s disease is an autoimmune process
16. Which of the following statement(s) is/are true concerning drug therapy for Crohn’s
disease?
A. Corticosteroids have been demonstrated to effectively treat acute exacerbations and to prolong
remission in patients with Crohn’s disease
B. Sulfasalazine is indicated primarily for the treatment of patients with acute exacerbations of
Crohn’s disease involving the small bowel
C. Azathioprine, an immunosuppressant, has been shown to be effective in maintaining remission of
Crohn’s disease
D. Low dose cyclosporine has significant therapeutic benefit for patients with both low and high
disease activity
17. Which of the following are predominant histologic features of Crohn’s disease?
A. The presence of granulomas involving the bowel wall and mesenteric lymph nodes
B. Transmural inflammation
C. Fissures and ulceration extending into the muscularis propria
D. Chronic fibrotic changes
18. The following statement(s) is/are true concerning the epidemiology of Crohn’s disease.
A. Crohn’s disease has an age distribution with peaks between the ages of 15 and 30 years and 65
and 75 years
B. There is a definite female predilection for Crohn’s disease
C. The disease is equally prevalent in industrialized versus underdeveloped countries
D. First and second generation relatives with Crohn’s disease have an increased prevalence when
compared to the general population
19. Which answers are true? In contrast to ulcerative colitis, Crohn's disease of the colon:
A. Is not associated with increased risk of colon cancer.
B. Seldom presents with daily hematochezia.
C. Is usually segmental rather than continuous.
D. Has a lower incidence of perianal fistulas.
E. Never develops toxic megacolon.
20. Which answers are true? Options to consider when operating for Crohn's disease of the
large intestine include:
A. Colectomy and ileorectostomy.
B. Colectomy, closure of the rectal stump, and ileostomy.
C. Colectomy and continent ileostomy (Kock pouch).
D. Proctocolectomy and ileostomy.
E. Proctocolectomy and ileal pouch–anal canal anastomosis.
21. Crohn's disease:
A. Is caused by Mycobacterium paratuberculosis.
B. Is more common in Asians than in Jews.
C. Tends to occur in families.
D. Is less frequent in temperate climates than in tropical ones.
E. Is improved by smoking.
22. Recurrence after operation for Crohn's disease:
A. Occurs after operations for ileal Crohn's but not colonic Crohn's.
B. Is usually found just proximal to an enteric anastomosis.
C. Rarely requires reoperation.
D. Occurs in 1% of patients at risk per year during the first 10 years after the operation.
E. Is prevented by maintenance therapy with corticosteroids.
23. Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn's
because:
A. Excision is safer.
B. Bypass does not relieve symptoms.
C. Excision cures the patient of Crohn's disease but bypass does not.
D. Fewer early complications appear with excision.
E. The risk of small intestine cancer is reduced.
24. Which statements about anorectal Crohn's disease are true?
A. It may be the only overt manifestation of Crohn's disease.
B. It accompanies large intestine Crohn's more often than small-intestine Crohn's.
C. It subsides when associated small intestinal Crohn's is excised.
D. It should not be treated operatively.
E. It may subside in response to metronidazole, 250 mg. q.i.d.
25. The most common indication for operation in Crohn's disease of the colon is:
A. Obstruction.
B. Chronic debility.
C. Bleeding.
D. Perforation.
E. Carcinoma.
26. Surgical treatment in nonspecific ulcerative colitis is indicated in case of:
A . Profuse bleeding
B. Intestinal perforation
C. Toxic dilatation
D. Concervative treatment failure
E. All mentioned above
27. Which of the following statements about surgical procedures on the colon and rectum
is/are correct?
A. Successful healing of colonic anastomoses depends on the adequacy of the blood supply.
B. In excising part of the colon containing cancer, the lymphatics should be avoided by dividing the
mesentery close to the wall of the colon.
C. Despite complete removal of the colon and rectum, transanal fecal flow can be preserved by
means of an ileal pouch–anal anastomosis.
D. When a colostomy is created it cannot be reversed.
E. Colostomy can be life saving in patients with colonic perforation or obstruction.
28. Which of the following statements about colon physiology is/are correct?
A. Colonic recycling of urea is accomplished by the splitting of urea by bacterial ureases.
B. Fermentation by colonic bacteria may rescue malabsorbed carbohydrates.
C. The preferred fuel of the colonic epithelium is glucose.
D. Absorption by the colonic mucosa is a passive process.
E. Insoluble fibers create bulk in the stool.
29. Which of the following statements about colonic motility is/are true?
A. Mass contractions involve only the rectum.
B. “Antiperistaltic” contractions occur in the descending colon.
C. The rectum can accommodate stool by receptive relaxation.
D. Stool in the colon is propelled by tonic contractions.
E. Defecation involves both sensory and motor pathways.
30. Conservative treatment of the nonspecific ulcerative colitis usually includes:
A. Total parenteral feeding
B. Total colectomy with ileostomy
C. Subtotal colectomy with ileostomy
D. All mentioned above
E. Nothing from the listed
31. Which of the following statements about bowel preparation for colon surgery is/are true?
A. Bowel preparation is accomplished by a combination of mechanical cleansing and
nonabsorbable antibiotics.
B. Three days of clear liquids provides sufficient mechanical cleansing.
C. Commercial electrolyte-polyethylene glycol solutions provide mechanical cleansing without
inducing electrolyte imbalance.
D. Nonabsorbable antibiotics such as neomycin and erythromycin base are administered the day
before the operation in three doses.
E. Intravenous antibiotics are also administered the day before surgery.
32. The test with the highest diagnostic yield for detecting a colovesical fistula is:
A. Barium enema.
B. Colonoscopy.
C. Computed tomography (CT).
D. Cystography.
E. Cystoscopy.
33. Which of the following is not true of diverticular disease:
A. It is more common in the United States and Western Europe than in Asia and Africa.
B. A low-fiber diet may predispose to development of diverticulosis.
C. It involves sigmoid colon in more than 90% of patients.
D. Sixty per cent develop diverticulitis sometime during their lifetime.
E. It is the most common cause of massive lower gastrointestinal hemorrhage.
34. Which of the following statements about the etiology of chronic ulcerative colitis are true?
A. Ulcerative colitis is 50% less frequent in nonwhite than in white populations.
B. Psychosomatic factors play a major causative role in the development of ulcerative colitis.
C. Cytokines are integrally involved in the pathogenesis of ulcerative colitis.
D. Ulcerative colitis has been identified with a greater frequency in family members of patients with
confirmed inflammatory bowel disease.
E. Ulcerative colitis is two to four times more common in Jewish than in non-Jewish populations.
35. Surgical alternatives for the treatment of ulcerative colitis include all of the following
except:
A. Colectomy with ileal pouch–anal anastomosis.
B. Left colectomy with colorectal anastomosis.
C. Proctocolectomy with Brooke ileostomy or continent ileostomy.
D. Subtotal colectomy with ileostomy and Hartmann closure of the rectum.
36. The initial management of toxic ulcerative colitis should include:
A. Broad-spectrum antibiotics.
B. 6-Mercaptopurine.
C. Intravenous fluid and electrolyte resuscitation.
D. Opioid antidiarrheals.
E. Colonoscopic decompression.
37. Which finding(s) suggest(s) the diagnosis of chronic ulcerative colitis as opposed to
Crohn's colitis?
A. Endoscopic evidence of backwash ileitis.
B. Granulomas on biopsy.
C. Anal fistula.
D. Rectal sparing.
E. Cobblestone appearance on barium enema.
38. Which of the following features would be more consistent with Crohn’s disease than with
ulcerative colitis?
A. Transmural inflammation
B. Microscopic evidence of granulomas within mucosal biopsies
C. Microscopic evidence of submucosal thickening and fibrosis
D. Microscopic evidence of submucosal inflammation
39. The most common place of the large intestinal diverticulas origin is:
A. Caecum
B. Ascend colon
C. Transverse colon
D. Descend colon
E. Sygmoid colon
F. Rectum
40. Of what disease the toxic megacolon complication is?
A. Crohn’s disease
B. Hirshprung’s disease
C. Gardner’s syndrome
D. Peitz-Egers’s syndrome
E. Nonspecific ulcerative colitis