TESTS FOR CONTROL

 

Chapter 1. Acute appendicitis

Tests (one answer is correct)

1.Acute appendicitis is:

inflammation of the appendix;

inflammation of the appendix with its perforation;

nonspecific inflammation of the inner lining of the vermiform appendix that spreads to its other parts;

purulent inflammation of the inner lining of the vermiform appendix that spreads to its other parts.

2. Kolesov’s classification of acute appendicitis:

oedematous stage, purulent stage, gangrenous stage;

appendicular colic, destructive appendicitis (phlegmonous, gangrenous, perforated), complicated;

no complicated and complicated;

phlegmonous, gangrenous, perforated.

3. Abdominal pain in patients with acute appendicitis:

sudden, intensive, localized in the right part of abdomen;

often begins gradually in the right lower quadrant of the abdomen;

usually begins as periumbilical or epigastric pain migrating to the right lower quadrant of the abdomen;

often begins as periumbilical or epigastric pain, accompanies with vomiting, nausea high temperature.

4. Describe Rovsign’s sign:

passive internal rotation of flexed right thigh with the patient in supine position causes pain;

light percussion on McBurney’s point will elicit pain;

pain in the right lower quadrant is complained of when palpation pressure is exerted in the left lower quadrant;

strengthening pain in the right lover square in the position of patient on the left side.

 

5. Describe Sitkoysky’s sign:

passive internal rotation of flexed right thigh with the patient in supine position causes pain;

light percussion on McBurney’s point elicits pain;

pain in the right lower quadrant is complained of when palpation pressure is exerted in the left lower quadrant;

strengthening pain in the right lover square in the position of patient on the left side.

6. Main method in diagnostic procedure is:

X-ray examination;

ultrasonic;

laboratory studies;

anamnestic and clinical examination.

7. Peculiarities of trends of acute appendicitis in elderly patients:

often retrocaecal position of appendix;

often pain accompanies with vomiting, nausea;

no evident clinical picture + rapid destructive changes in appendix;

often spontaneous regression of inflammation.

8. Patient 20 years old has pain in upper part of abdominal cavity with vomiting, nausea during last 2 hours. Optimal tactic is:

urgent operation;

antibiotics;

hospitalization and observation at surgical department;

observation at home by family doctor.

9. Optimal final method of differential diagnostic of acute appendicitis is:

laparoscopy;

ultrasonic;

laboratory studies;

anamnestic and clinical examination.

10. In preoperative preparation in patients with acute appendicitis we use:

analgetics;

spasmolitics;

antibiotics;

all answers are not correct.

11. In patients with acute appendicitis and clinical manifestation of local peritonitis surgeons use:

McBurney’s incision of abdominal wall;

Shprengel’s incision of abdominal wall;

Koher´s incision of abdominal wall;

middle line laparotomy.

12. In patients with acute appendicitis and clinical manifestation of general peritonitis surgeons use:

McBurney’s incision of abdominal wall;

pararectal incision of abdominal wall;

Koher’s incision of abdominal wall;

middle line laparotomy.

13. Differential diagnostic of appendicular mass:

colonic cancer;

appendicular abscess;

ovarium tumor;

all answers are correct.

14. Final method of differential diagnosis between colonic cancer and appendicular mass is:

laparoscopy;

ultrasonic;

colonoscopy + biopsy;

X-ray examination.

15. Final method of differential diagnostic between appendicular abscess and appendicular mass is:

laparoscopy;

ultrasonic;

colonoscopy + biopsy;

laboratory studies.

16. Clinical manifestation of appendicular abscess:

temperature of body rises to 38.0–39.0ºС;

increasing  of the size of the mass;

increasing  abdominal pain – suggesting spreading peritonitis;

all answers are correct.

17. Ultrasonic examination helps in differential diagnosis between colonic cancer and appendicular mass by:

detecting of adhesions between mass and bowels;

absence of adhesions between mass and bowels;

increasing  of mass during 2 weeks;

revealing of metastasis.

18. Treatment of the intra-abdominal bleeding from mesoappendix after appendectomy:

laparotomy and arrest of bleeding;

conservative;

surgical in young patients, conservative in elderly;

laparoscopy drainage.

19. Treatment of the appendicular mass:

surgical;

conservative;

surgical in young patients, conservative in elderly;

laparoscopy drainage.

20. Treatment of the pelvic abscess in man:

 laparotomy or laparoscopy drainage;

 conservative;

 surgical in young patients, conservative in elderly;

rectal drainage.

Standards of answers

1 – c; 2 – d; 3 – c; 4 – c; 5 – d; 6 – d; 7 – c; 8 – c; 9 – a; 10 – c; 11 – a; 12 – d; 13 – d; 14 – c; 15 – b; 16 – d;  17 – d; 18 – a;  19 – b; 20 – d.

 

Chapter 2. Acute cholecystitis

Tests (one answer is correct)

1. Acute cholecystitis is:

inflammation of gallbladder;

inflammation of gallbladder with its perforation;

nonspecific inflammation of gallbladder;

purulent inflammation of gallbladder.

2. Risk factors for cholecystitis include:

gallstones;

pregnancy;

cardiovascular events;

all answers are correct.

3. Mark incorrect answer about classification of acute cholecystitis:

oedematous stage, purulent stage, gangrenous stage;

calculous and non-calculous;

catarrhal, phlegmonous, gangrenous;

incomplicated and complicated.

4. Сharacteristic of pain in acute cholecystitis:

sudden pain in the upper abdomen, has moderate intensity, constant character and not irradiate;

colic pain;

constant pain, may radiate to the right shoulder or scapula;

“knife-like” pain.

5. Describe Murphy’s sign:

delay of breathing during palpation of gallbladder on inhalation because of pain increasing;

strengthening of pain at pressure on the  gallbladder region;

painfulness at the easy pattering on right costal arc by the edge of palm;

increasing  of pain after palpation between the legs of right nodding muscle.

6. Describe Kehr’s sign:

delay of breathing during palpation of gallbladder on inhalation because of pain increasing;

strengthening of pain at pressure on the gallbladder region;

painfulness at the easy pattering on right costal arc by the edge of palm;

increasing  of pain after palpation between the legs of right nodding muscle.

7. Describe Ortner’s sign:

delay of breathing during palpation of gallbladder on inhalation because of pain increasing;

strengthening of pain at pressure on the gallbladder region;

painfulness at the easy pattering on the right costal arc by the edge of palm;

increasing  of pain after palpation between the legs of right nodding muscle.

8. Describe Mussy’s sign:

delay of breathing during palpation of gallbladder on inhalation because of increasing  of pain;

strengthening of pain at pressure on the gallbladder region;

painfulness at the easy pattering on right costal arc by the edge of palm;

increasing  of pain after palpation between the legs of right nodding muscle.

9. Peculiarities of acute appendicitis manifistation in elderly patients:

often pain is accompanied by vomiting, nausea;

not evident clinical picture + rapid destructive changes in gallbladder;

often spontaneous regression of gallbladder;

all answers are correct.

10. The main method in diagnostic procedure is:

X-ray examination;

ultrasonic;

laboratory studies;

anamnestic and clinical examination.

11. Ultrasonographic findings of acute cholecystitis include:

gallstones;

free liquid in abdominal cavity;

gallbladder wall thickening greater than 4 mm;

all answers are correct.

12. Treatment policy of acute cholecystitis is:

only conservative;

only surgical;

initial treatment is conservative + surgery for some indications;

individual.

13. Indications for surgical treatment are:

peritonitis;

retention of abdominal pain and muscles resistance;

increasing  of body temperature and leukocytosis;

all answers are correct.

14. Optimal term for operation in patients with inefficacy of conservative treatment is:

2 hours;

12 hours;

24–48 hours;

72 hours.

15. If acute calculous cholecystitis resolves, optimal policy is:

following conservative management may be the mainstay of treatment;

laparoscopic cholecystectomy can be carried out 2 weeks later;

laparoscopic cholecystectomy can be carried out 4–6 weeks later;

open cholecystectomy can be carried out 4–6 weeks later.

16. Indications for open cholecystectomy in acute cholecystitis:

total terminal peritonitis;

surgeon does not know how to perform a laparoscopic cholecystectomy;

complications have developed or the patient has had prior surgery to the region;

all answers are correct.

17. In cases of severe inflammation, shock, or if the patient has higher risk of operation the surgeon has to:

perform only conservative treatment;

perform immediately laparoscopic cholecystectomy;

perform immediately open cholecystectomy;

perform percutaneous cholecystostomy tube under ultrasonic or CT scan control.

18. The most dangerous complication of laparoscopic cholecystectomy in patient with acute cholecystitis is:

bile duct injury;

cystic duct injury;

liver injury;

all answers are correct.

19. Treatment of the gallbladder mass:

surgical;

conservative;

surgical in young patients, conservative in elderly;

laparoscopy drainage.

20. Treatment of the intra-abdominal bleeding from cystic artery after cholecystectomy:

laparotomy and arrest of bleeding;

conservative;

surgical in young patients, conservative in elderly;

laparoscopy drainage.

 

Standards of answers

1 – c; 2 – d; 3 – a; 4 – c; 5 – a; 6 – b; 7 – c; 8 – d; 9 – b; 10 – b; 11 – c; 12 – c; 13 – d; 14 – c; 15 – c; 16 – d; 17 – d; 18 – a; 19 – b; 20 – a.

Chapter 3. Acute pancreatitis

Tests (one answer is correct)

1. Acute pancreatitis is:

inflammation of pancreas;

inflammation of gallbladder and pancreas;

autodigestion of tissues by pancreatic enzymes, and econdary infection and multiorgan system failure may be associated with autodigestion process;

purulent inflammation of pancreas.

2. Risk factors for cholecystitis include:

gallstones;

pregnancy;

fatty foods;

all answers are correct.

3. Mark incorrect answer about classification of acute pancreatitis:

oedematous pancreatitis and pancreonecrosis;

fatty and haemorrhagic pancreonecrosis;

catarrhal, phlegmonous, gangrenous;

incomplicated and complicated.

4. Сharacteristic of pain in acute pancreatitis:

intensive pain in the upper abdomen, has constant character;

colic pain;

moderate pain in the upper abdomen, may radiate to the right shoulder or scapula;

“knife-like” pain.

5. Describe Mayo-Robson’s sign:

regional tension of anterior abdominal wall in epigastria region, along the projection of pancreas;

palpation pain in the left costovertebral angle;

abdominal distension in upper region;

absence of pulsation of abdominal aorta in epigastria region.

6. Describe Gobye’s sign:

regional tension of anterior abdominal wall in epigastria region, along the projection of pancreas;

palpation pain in the left costovertebral angle;

abdominal distension in upper region;

absence of pulsation of abdominal aorta in epigastria region.

7. Describe Voskresensky’s sign:

regional tension of anterior abdominal wall in epigastria region, along the projection of pancreas;

palpation pain in the left costovertebral angle;

abdominal distension in upper region;

absence of pulsation of abdominal aorta in epigastria region.

8. Describe Korte’s sign:

regional tension of anterior abdominal wall in epigastria region, along the projection of pancreas;

palpation pain in the left costal-vertebral angle;

abdominal distension in upper region;

absence of pulsation of abdominal aorta in epigastria region.

9. Describe Cullen’s sign:

bluish discolouration around the umbilicus;

reddish-brown discolouration along the flanks resulting from retroperitoneal blood dissecting;

violet sports on the body and face;

cyanosis of skin of abdominal wall.

10. Describe Mondor’s sign:

bluish discolouration around the umbilicus;

reddish-brown discolouration along the flanks resulting from retroperitoneal blood dissecting along tissue plaines;

violet sports on the body and face;

cyanosis of skin of abdominal wall.

11. Describe Grey-Turner’s sign:

bluish discolouration around the umbilicus;

reddish-brown discolouration along the flanks resulting from retroperitoneal blood dissecting;

violet sports on the body and face;

cyanosis of skin of abdominal wall.

12. Describe Holsted’s sign:

bluish discolouration around the umbilicus;

reddish-brown discolouration along the flanks resulting from retroperitoneal blood dissecting;

violet sports on the body and face;

cyanosis of skin of abdominal wall.

13. The main method in diagnostic procedure is:

X-ray examination;

Ultrasonic;

laboratory studies;

anamnestic and clinical examination.

14. Specifical ultrasonographic findings of acute pancreatitis include:

changing in size and structure of pancreas;

free liquid in abdominal cavity;

gallstones;

all answers are correct.

15. Treatment policy of acute pancreatitis is:

only conservative;

only surgical;

initial treatment is conservative + surgery for some indications;

individual.

16. Indications for surgical treatment are:

peritonitis;

retention of abdominal pain and muscles resistance;

increasing  of body temperature and leukocytosis;

formation of mass.

17. Optimal term for operation in patients with gallstones pancreatitis:

2 hours;

12 hours;

24–48 hours;

72 hours.

18. If acute gallstones pancreatitis resolves, optimal policy is:

following conservative management may be the mainstay of treatment;

laparoscopic cholecystectomy can be carried out 2 weeks later;

laparoscopic cholecystectomy can be carried out 4–6 weeks later;

open cholecystectomy can be carried out 4–6 weeks later.

19. Indication for peritoneal lavage is:

formation of mass;

retroperitoneal phlegmone;

increasing  of body’s temperature and leukocytosis;

peritonitis.

20. Treatment of the pancreatic mass:

surgical;

conservative;

surgical in young patients, conservative in elderly;

laparoscopy drainage.

Standards of answers

1 – c; 2 – d; 3 – c; 4 – a; 5 – b; 6 – c; 7 – d; 8 – a; 9 – a; 10 – c; 11 – b; 12 – d; 13 – c; 14 – a; 15 – c; 16 – a; 17 – c; 18 – c; 19 – d; 20 – a.

Chapter 4. Perforated peptic ulcer

Tests (one answer is correct)

1. Risk factors for perforated ulcer include:

H pylori infection;

hydrochloric acid;

NSAID events;

all answers are correct.

2. Mark incorrect answer about classification of perforated ulcer:

perforation of duodenal or gastric ulcer;

covered and atypical perforation;

perforation with peritonitis and perforation without peritonitis;

perforation has 3 stages.

3. Describe Ratner’s sign:

irradiation of pain to the right shoulder or scapula;

strengthening of pain at pressure on the region of stomach;

painfulness at the easy pattering on right costal arc by the edge of palm;

persisting moderate tenderness of abdominal wall in right epigastria region.

4. Describe Elicer’s sign:

irradiation of pain to the right shoulder or scapula;

strengthening of pain at pressure on the gallbladder region;

painfulness at the easy pattering on right costal arc by the edge of palm;

persisting moderate tenderness of abdominal wall in right epigastria region.

5. Ratner’s sign is a sign of:

stomach perforation;

covered perforation;

stage of illusions;

atypical perforation.

6. Initial method in diagnostic procedure is:

X-ray examination;

ultrasonic;

laboratory studies;

laparoscopy.

7. Tactic of treatment of perforated ulcer is:

conservative;

surgical;

initial treatment is conservative + surgery for some indications;

surgical in young patients, conservative in elderly patients.

8. Optimal term for operation in patients with perforated ulcer is:

2 hours;

12 hours;

24–48 hours;

72 hours.

9. Surgical procedures for perforated ulcer are:

simple closure;

ulcer exision;

partial gastrectomy;

all answers are correct.

10. Contraindication for laparoscopic surgery for perforated ulcer is:

total terminal peritonitis;

surgeon does not know how to perform a laparoscopic repair;

fatal cardiovascular events;

all answers are correct.

Standards of answers

1 – d; 2 – c; 3 – d; 4 – a; 5 – b; 6 – a; 7 – b; 8 – a; 9 – d; 10 – d.

 

 

Chapter 5. Peptic ulcer acute haemorrhage

Tests (one answer is correct)

1. Acute peptic ulcer haemorrhage is:

destruction of vessel in ulcer with flow of blood;

destruction of vessel in ulcer with flow of blood with haematomesis and melena;

destruction of vessel in ulcer with flow of blood with haematomesis, melena and multiorgan system disturbances;

all answers are correct.

2. Risk factors of peptic ulcer haemorrhage include:

H pylori infection;

hydrochloric acid;

NSAID events;

all answers are correct.

3. Mark incorrect answer about classification of peptic ulcer haemorrhage:

bleeding duodenal or gastric ulcer;

there are 3 stages of loss of blood;

Forrest classification correspondences with loss of blood;

Forrest classification correspondences with kind of hemostasis.

4. Сharacteristic of pain peptic ulcer haemorrhage:

intensive pain in the upper abdomen, has constant character;

pain has stopped after beginning of haemorrhage;

moderate pain in the upper abdomen, may radiate to the right shoulder or scapula;

colic pain.

5. Describe Bergmann’s sign:

pain has stopped after beginning of haemorrhage;

palpation pain in the left costovertebral angle;

abdominal distension in upper region;

absence of pulsation of abdominal aorta in epigastria region as a result of stomach dilatation.

6. Diagnostic procedure in peptic ulcer haemorrhage includes:

X-ray examination;

ultrasonic;

digital examination of rectum;

CT scan.

7. Diagnosis program includes:

anamnesis and physical examination;

B digital examination of rectum;

gastroduodenoscopy;

all answers are correct.

8. Treatment policy of peptic ulcer haemorrhage is:

only conservative;

only surgical;

gastroduodenoscopy haemostasis + conservative treatment + surgery for some indications;

initial treatment is conservative + surgery for some indications.

9. Absolute indications for surgical treatment are:

prolonged bleeding;

recurrent bleeding;

perforated bleeding ulcer;

all answers are correct.

10. Optimal term for operation in patients with absolute indications for surgical treatment:

2 hours;

12 hours;

24–48 hours;

72 hours.

11. Relative indication for surgical treatment is:

high risk of recurrent bleeding;

massive bleeding;

prolonged bleeding in older patients;

suspicion about stomach cancer.

12. Optimal term for operation in patients with relative indications for surgical treatment:

2 hours;

12 hours;

24–48 hours;

72 hours

13. Indication for angiographic embolization is:

bleeding ulcer of stomach;

high risk for surgical intervention;

recurrent bleeding;

bleeding recurrent ulcer after open surgery.

14. Contraindication for emergency gastroduodenoscopy is:

Zenker’s diverticulum;

upper abdominal open surgery;

severe cardiac and lung decompensation;

all answers are correct.

15. Treatment policy of perforated bleeding ulcer is:

conservative;

surgical;

initial treatment is conservative + surgery for some indications;

surgical in young patients, conservative in elderly patients.

16. Optimal term for operation in patients with perforated bleeding ulcer is:

2 hours;

12 hours;

24–48 hours;

72 hours.

17. Surgical procedure for perforated bleeding ulcer is:

simple closure;

laparoscopy repair;

ulcer excision;

all answers are correct.

18. Surgical procedure for bleeding duodenal ulcer is:

simple closure;

ulcer excision + pyloroduodenoplasty;

partial gastrectomy;

all answers are correct.

19. Surgical procedure for bleeding gastric ulcer is:

simple closure;

ulcer excision + truncal vagotomy;

partial gastrectomy;

all answers are correct.

20. Surgical procedure for bleeding gastric ulcer in elderly patients is:

simple closure;

ulcer excision;

partial gastrectomy;

all answers are correct.

Standards of answers

1 – c; 2 – d; 3 – c; 4 – b; 5 – a; 6 – c; 7 – d; 8 – c; 9 – d; 10 – a; 11 – a; 12 – c; 13 – b; 14 – c; 15 – b; 16 – a; 17 – c; 18 – b; 19 – c; 20 – b.

 

Chapter 6. Bowel obstruction

Tests (one answer is correct)

1. Small bowel blood supply is (arteries):

a. mesenteric superior;

a. mesenteric inferior;

truncus celiacus;

a. gastric dextra.

2. Large bowel blood supply is (arteries):

a. mesenteric superior;

a. mesenteric inferior;

Riolany ark;

all answers are correct.

3. Venous bowel outflow is:

v. cava superior;

v. cava inferior;

portal vein;

all answers are correct.

4. Mark incorrect answer about clinical classification of bowel obstruction:

acute;

subacute;

chronic;

mechanical.

5. Classification of ileus:

according abdominal injury;

paralytic or spastic;

according central nerve system injury;

all answers are correct.

6. Classification of large-bowel obstruction:

obstructive;

strangulated;

acute and chronic;

all answers are correct.

7. The main sign of bowel obstruction:

constant pain;

cramp-like pain;

hyperthermia;

weakness.

8. The main sign of small-bowel obstruction:

hyperthermia;

vomiting;

absence of gas and stool;

weakness.

9. The main sign of large-bowel obstruction:

hyperthermia;

vomiting;

absence of gas and stool;

weakness.

10. Intensive pain is observed in patients with:

obstructive bowel obstruction;

strangulated bowel obstruction;

acute bowel obstruction;

paralytic bowel obstruction.

11. Paralytic bowel obstruction usually occurs after:

abdominal injury;

laparoscopy;

laparotomy;

all answers are correct.

12. Obstructive bowel obstruction may be caused by:

tumors;

gallstones;

coproliths;

all answers are correct.

13. In elderly patients the most frequent cause of obstructive bowel obstruction is:

tumors;

gallstones;

coproliths;

all answers are correct.

14. The most frequent localisation of tumors which are complicated by obstructive bowel obstruction is:

cecum;

ascendant colon;

transversal colon;

descendant and sigmoid colon.

15. In diagnostic program for bowel obstruction we use:

plain radiography;

enteroclisis;

ultrasonography;

all answers are correct.

16. Treatment policy of bowel obstruction is:

conservative;

surgical;

initial treatment is conservative + surgery for some indications;

surgical in young patients, conservative in elderly patients.

17. The main sign of nonviability of bowel:

changing of colour;

absents of pulsation of mesenteric arteries;

decreasing  of motor activity;

all answers are correct.

18. The limits of resection of small bowel are:

nonviability part + 40 cm before + 20 cm after;

nonviability part + 20 cm before + 10 cm after;

only nonviability part;

surgeon has to detect individually.

19. Optimal surgical procedure in patients with tumor of ascendant colon and bowel obstruction:

tumor + 40 cm before + 20 cm after;

right haemicolectomy + enterostomy;

right haemicolectomy + ileotransversostomy;

surgeon has to detect individually.

20. Optimal surgical procedure in patients with tumor of descendant colon and bowel obstruction:

tumor + 40 cm before + 20 cm after;

left haemicolectomy + colostomy;

left haemicolectomy + transversosigmosostomy;

surgeon has to detect individually.

Standards of answers

1 – a; 2 – d; 3 – c; 4 – d; 5 – b; 6 – d; 7 – b; 8 – b; 9 – c; 10 – b; 11 – c; 12 – d; 13 – a; 14 – d; 15 – d; 16 – d; 17 – b; 18 – a; 19 – c; 20 – b.

 

Chapter 7. Acute peritonitis

Tests (one answer is correct)

1. Mark incorrect answer. The organs are divided into:

intraperitoneal;

mesoperitoneal;

extraperitoneal;

mixed posission.

2. Normally, the amount of peritoneal fluid present is less than:

10 ml;

50 ml;

100 ml;

150 ml.

3. Classification of peritonitis according to origin includes:

perforated;

serose;

primary;

reactive phase.

4. Classification of peritonitis according to cause includes:

perforated;

serose;

primary;

reactive phase.

5. Classification of peritonitis according to character of exudate includes:

perforated;

serose;

primary;

reactive phase.

6. Classification of phases of peritonitis includes:

perforated;

serose;

primary;

reactive phase.

7. Classification of phases of peritonitis doesn’t include:

initial;

reactive;

toxic;

terminal.

8. Pathophysiology of the reactive phase includes:

respiratory distress syndrome;

appearance of exudate into abdominal cavity;

adynamic ileus when distended bowel wall loses barrier function;

all answers are correct.

9. Pathophysiology of the toxic phase includes:

respiratory distress syndrome;

appearance of exudate into abdominal cavity;

adynamic ileus when distended bowel wall loses barrier function;

all answers are correct.

10. Pathophysiology of the terminal phase includes:

respiratory distress syndrome;

appearance of exudate into abdominal cavity;

adynamic ileus when distended bowel wall loses barrier function;

all answers are correct.

11. General treatment policy of acute peritonitis is:

conservative;

surgical;

initial treatment is conservative + surgery for some indications;

surgical in young patients, conservative in elderly patients.

12. Treatment policy of tuberculous peritonitis is:

specific therapy;

surgical;

initial treatment is conservative + surgery for some indications;

surgical in young patients, conservative in elderly patients.

13. Preoperative preparation in acute peritonitis:

is prescribed individually;

isn’t indicated;

is necessary for all patients with acute peritonitis;

is necessary in the terminal phase.

14. Antibacterial therapy in acute peritonitis:

isn’t indicated;

is starting before the operation;

is starting at the operation;

is starting after the operation.

15. Contraindication for Ultrasonic- and CT-guided percutaneous drainage of abdominal abscess is:

subphrenic abscess;

multiple or multiloculated abscesses;

subhepatic abscess;

parapancreatic abscess.

16. Laparoscopic sanation of the abdominal cavity isn’t effective in:

perforated peritonitis;

pancreatogenic peritonitis;

elderly patients;

terminal phase with multiloculated abscesses.

17. In patients with general peritonitis surgeons use:

McBurney’s incision of abdominal wall;

pararectal incision of abdominal wall;

local incisions of abdominal wall;

middle line laparotomy.

18. The main reasons of surgical treatment in acute peritonitis are:

adequate sanation of abdominal cavity;

source control;

gastrointestinal decompression;

all answers are correct.

19. Required quantity of solutions for adequate sanation of abdominal cavity in patients with total perinonitis is:

5 liters;

10 liters;

15 liters;

20 liters.

20. The inspection method after operation is:

open-abdomen technique;

scheduled relaparotomy;

scheduled relaparoscopy;

all answers are correct.

Standards of answers

1 – d; 2 – b; 3 – c; 4 – a; 5 – b; 6 – d; 7 – a; 8 – b; 9 – c; 10 – a; 11 – b; 12 – a; 13 – c; 14 – b; 15 – b; 16 – d; 17 – d; 18 – D; 19 – c; 20 – d.

 

Chapter 8. Hernias of abdominal wall

Tests (one answer is correct)

1. The predisposing factor of hernias is:

hard physical activity;

weight loss;

chronic cough;

chronic constipation.

2. The causative factor of hernias is:

congenital weakness of the abdominal wall;

weight loss;

chronic cough;

pregnancy.

3. The sliding hernia occurs when:

patient has congenital weakness of the abdominal wall;

the hernia’s sac is absent;

the hernia’s sac is formed by the strangulated bowel;

the hernia’s sac is partially formed by the wall of an organ without peritoneal covering.

4. Classification of hernias of the abdominal wall according to localization doesn’t include:

diaphragmatic hernia;

midline hernia;

femoral hernia;

umbilical hernia.

5. Classification of hernias complications doesn’t include:

incarceration;

strangulation;

sliding hernia;

inflammation.

6. The main method in diagnostic procedure is:

X-ray examination;

ultrasonic;

laboratory studies;

anamnestic and clinical examination.

7. Clinical manifestations of strangulated hernia:

acute pain;

incarceration;

vomiting;

all answers are correct.

 8. Differential sign between incarcerated and strangulated hernias is:

“cough push” sign;

Blumberg sign;

cramp-like abdominal pain;

all answers are correct.

9. Final method of differential diagnostic between incarcerated and strangulated hernias is:

laparocentesis;

ultrasonic;

herniotomy;

X-ray examination.

10. Treatment of the patients with strangulated hernias is:

conservative;

surgical;

surgical in young patients, conservative in elderly;

symptomatic treatment.

11.Optimal term for operation in patients with strangulated hernia is:

2 hours;

12 hours;

24–48 hours;

72 hours.

12. The limits of resection of small bowel in patients with strangulated hernia are:

nonviability part + 40 cm before + 20 cm after;

nonviability part + 20 cm before + 10 cm after;

only nonviability part;

surgeon has to detect individually.

13. Optimal surgical procedure in patients with strangulated hernia and nonviability of sigmoid colon is:

nonviability part + 40 cm before + 20 cm after;

resection of  sigmoid colon + colostomy;

resection of sigmoid colon + primary anastomosis;

surgeon has to detect individually.

14.  Differential sign of the sliding inguinal hernia is:

cramp-like abdominal pain;

incarceration;

dysuria;

all answers are correct.

15. Optimal surgical procedure in femoral hernia:

Bassini’s repair;

Lichtenstein’s repair;

Postempsky’s repair;

MacVay’s repair.

16. Optimal surgical procedure in umbilical hernia:

Bassini’s repair;

Lichtenstein’s repair;

Postempsky’s repair;

Mayo’s repair.

17. Optimal surgical procedure in postoperative hernia:

simple nonprosthetic repair;

“onlay” repair;

“sublay” repair;

all answers are correct.

18. More frequent postoperative complication in patients with “gigantic” hernias is:

pulmonary embolism;

abdominal compartment syndrome;

wound infection;

systemic fat embolism.

19. More frequent postoperative complication after simple nonprosthetic repair is:

seroma;

wound infection;

recurrence of the hernia;

systemic fat embolism.

20. More frequent postoperative complication after prosthetic “onlay” repair is:

seroma;

wound infection;

recurrence of the hernia;

lymphorrhea.

Standards of answers

1 – b; 2 – c; 3 – d; 4 – a; 5 – c; 6 – d; 7 – d; 8 – a; 9 – c; 10 – b; 11 – a; 12 – a; 13 – b; 14 – c; 15 – a; 16 – d; 17 – c; 18 – b; 19 – c; 20 – d.

 

 

SITUATIONAL PROBLEM TASKS

Young man, 22 years old, has moderate pain in suprapubic region, dysuria. He sufferes from abdominal pain for 2 days. Pain started as diffuse lower part abdominal pain and after 12 hours localized in suprapubic region. Temperature of body is 37.8 ºС. Signs of peritonitis are negative.

1. Provisional diagnosis is:

acute cystitis;

acute prostatitis;

acute appendicitis;

renal colic.

2. The most informative laboratory study is:

white blood cell count;

urinalysis;

C – reactive protein;

all studies are not specific.

3. The most informative investigation is:

excretory urography;

CT scan of abdominal cavity;

abdominal plain film;

cystoscopy.

4. Treatment policy includes:

emergency surgery;

analgetic + antibiotics;

analgetic + uroseptics;

surgery, if conservative treatment is not successful.

5. The cause of misdiagnosis is:

patient’s age;

patient’s sex;

late hospitalization;

unusual pelvic position of appendix.

Standards of answers

1 – c; 2 – d; 3 – b; 4 – a; 5 – d.

 

Woman, 62 years old, has pain in right subcostal region, vomiting with bile. Pain started as a colic pain after fatty food intake, after 2 hours became constant. Temperature of body is 37.4 ºС. During palpation painfulness and muscle resistance are observed in right subcostal region. Blumberg’s sign is negative.

1. Provisional diagnosis is:

acute cholecystitis;

acute gastritis;

acute appendicitis;

renal colic.

2. The most informative laboratory study is:

white blood cell count;

urinalysis;

C – reactive protein;

all studies are not specific.

3. The most informative investigation is:

excretory urography;

Ultrasonic scan of abdominal cavity;

abdominal plain film;

chest film.

4. Treatment policy includes:

emergency surgery;

conservative treatment;

gallstones – emergency surgery;

surgery, if conservative treatment is not successful.

5. If conservative treatment of acute calculous cholecystitis is successful:

surgery is indicated after next pain attack;

surgery is not indicated;

surgery is perfomed after 1 month;

surgery is perfomed after 6 months.

Standards of answers

1 – a; 2 – d; 3 – b; 4 – d; 5 – c.

Woman, 59 years old, has intensive upper abdominal pain, vomiting. Pain started after fatty meat intake 12 hours ago. Scleras are icteric. During palpation painfulness and muscle resistance are observed in upper abdomen. Blumberg’s sign is negative. Last 2 years patient noted periodical colic pain in wright subcostal region.

1. Provisional diagnosis is:

acute cholecystitis;

acute hepatitis;

acute pancreatitis;

food toxicoinfection.

2. The most informative laboratory study is:

white blood cell count;

level of serum amylase;

C – reactive protein;

all studies are not specific.

3. What the most indicated investigation is:

endoscopic retrograde cholangiopancreatography;

Ultrasonic scan of abdominal cavity;

abdominal plain film;

CT scan of abdominal cavity.

4. The most probable aetiological factor:

peptic ulcer;

hepatitis;

gallstones;

toxic factor.

5. Treatment policy includes:

emergency surgery;

conservative treatment;

surgery if conservative treatment is not successful after 12–24 hours;

surgery, if conservative treatment is not successful after 24–48 hours.

Standards of answers

1 – c; 2 – b; 3 – b; 4 – c; 5 – d.

Young man, 28 years old, has intensive diffuse abdominal pain. Pain started 2 hours ago after physical training. Temperature of body is 36.9 ºС. Recent year patient noted periodical pain in stomach. Tenderness of abdominal wall and Blumberg’s sine are present.

1. Provisional diagnosis is:

acute cholecystitis;

acute pancreatitis;

perforated ulcer;

acute gastritis.

2. What the most informative laboratory study for differential diagnostic is:

white blood cell count;

C – reactive protein;

level of serum amylase;

all studies are not informative.

3. The most informative investigation is:

gastroscopy;

Ultrasonic scan of abdominal cavity;

abdominal plain film;

laparoscopy.

4. Treatment policy includes:

emergency surgery;

conservative treatment (Taylor method);

surgery, if conservative treatment is not successful after 12 hours;

surgery, if conservative treatment is not successful after 24 hours.

5. The best method for perforated duodenal ulcer is:

ulcer excision;

ulcer excision + vagotomy;

ulcer excision + adequate antiulcer treatment;

partial gastrectomy.

Standards of answers

1 – c; 2 – c; 3 – d; 4 – a; 5 – c.

 

Young man, 34 years old, has coffee ground vomiting and melena during 20 hours. Pulse rate is 100 per min., decreasing  of arterial blood pressure is 90/60 mm Hg. Abdominal pain, tenderness of abdominal wall and Blumberg’s sine are absent.

1. Provisional loss of blood is:

“microbleeding”;

I – II stage;

III stage;

profuse bleeding.

2. The most informative investigation is:

gastroduodenoscopy;

ultrasonic scan of abdominal cavity;

abdominal plain film;

laparoscopy.

3. Treatment policy includes:

emergency surgery;

medicamentous haemostasis;

endoscopic haemostasis;

endoscopic haemostasis + medicamentous hemostasis.

4. The best method for haemostasis control is:

pulse rate;

blood pressure;

clinical observation;

endoscopic observation.

5. The best procedure for bleeding duodenal ulcer is:

ulcer excision;

ulcer excision + vagotomy;

ulcer excision + adequate antiulcer treatment;

partial gastrectomy.

Standards of answers

1 – b; 2 – a; 3 – d; 4 – d; 5 – c.

 

Woman, 70 years old, has moderate crampy abdominal pain, constipation, abdominal distension during 4 days. 2 hours became constant. Body temperature is 37.4 ºС. During palpation diffuse painfulness without muscle resistance is observed. Digital rectal examination – empty rectum.

1. Provisional diagnosis is:

acute colitis;

small bowel obstruction;

large bowel obstruction;

coprostasis.

2. What the most informative laboratory study for differential diagnostics is:

white blood cell count;

C – reactive protein;

packed cell volume level;

all studies are not informative.

3. The most informative investigation is:

CT scan of abdominal cavity;

ultrasonic scan of abdominal cavity;

abdominal plain film;

laparoscopy.

4. Treatment policy includes:

emergency surgery;

conservative treatment;

surgery if conservative treatment is not successful;

colonoscopic procedures.

5. The best method for control of conservative treatment efficiency:

pulse rate;

X-ray observation;

clinical observation;

clinical + X-ray observation.

Standards of answers

1 – c; 2 – d; 3 – c; 4 – c; 5 – d.

 

Young man, 25 years old, has diffuse abdominal pain, vomiting. He suffers from abdominal pain for 4 days. Pain started as diffuse lower part abdominal pain, after some hours localized in right lower quadrant, became general again on the 3 day. Body temperature is 38.5 ºС. Tenderness of abdominal wall and Blumberg’s sine are present.

1. What is the most probable cause of peritonitis:

acute cholecystitis;

acute pancreatitis;

acute appendicitis;

perforated ulcer.

2. The most important laboratory study for patient is:

CBC with differential, serum electrolytes with renal function;

urinalysis;

C – reactive protein;

liver tests.

3. The most informative investigation is:

Ultrasonic scan of abdominal cavity;

CT scan of abdominal cavity;

abdominal plain film;

that is necessary for preoperative preparation.

4. Treatment policy includes:

emergency surgery;

conservative treatment (Taylor method);

surgery if conservative treatment is not successful;

emergency surgery after preoperative preparation.

5. Optimal surgical incision for patient isik:

McBurney incision;

middle line laparotomy;

right side pararectal laparotomy;

right side transrectal laparotomy.

Standards of answers

1 – с; 2 – a; 3 – d; 4 – d; 5 – b.