MINISTRY OF HEALTH OF UKRAINE

O.O. BOGOMOLETS NATIONAL MEDICINE UNIVERSITY

STUDY GUIDE

for individual work of 6 course student

Full name___________________________________________________
of subject matter "Surgery", module 8
school "Medicine"
specialty "Medical practice"
Department of surgery No.2
 Content module 8. Systemic surgery pathology.
Theme: “Functional instrumental methods of research at ventricle and
intestinal tract diseases”.

Variant 1

Task #1.
What is classified as direct specific symptom of gastric ulcer, defined at
roentgen examination.
Direct symptoms of gastric ulcer at
roentgen examination Name of symptom, its characteristic

Niche (Haudek) symptom Additional shade or bulging of

ventricular boundary due to penetration
of contrast substance into ulcer crater

Inflammatory infiltration symptom

Gastric folds convergence symptom

Task 2.

Name the sequential methods of research that are performed for patients
with suspected case of colonopathy.
1. Digital (rectal) examination of straight intestine.
2. …
3. ...
4. ...
5. ...
Task 3.

Give the radiologic aspects of pyloroduodenal stenosis stages.

Stenosis stages. Radiologic aspect
1. Compensated Vernicle of normal size or slightly
extended. Mass ventricular movement.
Pyloroduodenal channel stenosed.
Evacuation suppression up to 6-12 hours

2. Subcompensated.
3. Decompensated.
Task 4.

Give the name to endoscopic criteria of hemostasis estimation in ulcer zone

by Forrest.
1. Stage IА – active spurting bleeding.
2. Stage IВ –
3. Stage IX –
4. Stage IIА –
5. Stage IIВ –
6. Stage IIС –
7. Stage III –

Task 5.

Specify names of sequential methods of instrumental examinationof patients

with suspected case of duodenum perforated ulcer.

1. Roentgenography examination of abdominal cavity organs.

2. ..
3. ..
4. ..
5. ..

Task 6.

Describe method of patient preparation to corresponding examination of large

intestine:
1. Digital examination of straight intestine – no preparation needed.
2. Rectoromanoscopy –
3. Irrigoradiography –
4. Colonofiberscopy –
5. Multispiral computerized tomography of abdominal cavity organs -
Test questions.
Choose one correct answer.
1. How many centimeters of straight intestine can be usually examined at
performance of rectoromanoscopy?
A. 10 cm;
B. 20 cm;
C. 30 cm;
D. 100 cm;
E. 80 cm.
2. Indicate what sign is not indirect at roentgenography diagnostics of gastric
ulcer:
А. "Index finger" sign.
В. Convergence of mucosa folds.
С. Duodenal-gastric reflux.
D. Segmentary hyperperistaltics.
Е. Suppression of ventricular
evacuation.
3. Patient D., age 37, duodenal ulcer for 5 years, complains of sudden strong,
insufferable pains in epigastrium. What methods of examination should be
applied first, in order of disease diagnostics?
A. Esophagofibrogastroduodenoscopy.
B. Ultrasonography of abdominal cavity organs.
C. Contrast roentgenography of ventricle.
D. Examination roengenography of abdominal cavity organs.
E. Examination pneumogastrography.
4. Patient K, age 56, continuously(approximately 5 years) suffering from
gastric ulcer, shows signs of gastric hemorrhage. Emergency fiberoptic
gastroduodenoscopy showed the gastric ulcer, up to 2.0 cm in diameter,
covered by blood clot, hemorrhage from bottom. Determine hemostasis
stage in zone of ulcer crater by Forrest:
A. F IIA;
B. F IA;
C. F IIB;
D. F IB;
E. F IX.
5. Indicate medicinal preparation that is not related, at oral administering, to
evacuation of bowels at patient preparation for performance of
colonofiberscopy:
A. Flit Phospho Soda;
B. Fortrans;
C. Motilium;
D. Endofalk;
E. Moviprep.
Content module 2
Theme. “Differential diagnosis, prevention and treatment of acute digestion
channel ulcer”
Variant 1
Task 1.
Fill table of variants of clinical progression of acute gastric ulcers.
Variants of clinical progression of acute Clinical signs
gastric ulcers
1. Acute gastric hemorrhage Signs of internal bleeding,
coffee-grounds vomiting,
melena
2. Gastric perforation
3. Pain form

Task 2.
Specify major mechanisms of acute gastric ulcers development:
1. Stress
2. ...
3. ...
4. …
Task 3.
Fill table of clinical and unbiased signs of acute gastric ulcers
Complains Unbiased signs
1. Epigastria pain 1. Peritoneal signs
2. 2.
3. 3.
Task 4.
Specify instrumental examinations of acute gastric ulcers.
1. Fiberoptic gastroduodenoscopy
2. ..
3. .
Task 5.
Specify diseases at which performance of differential diagnosis of acute gastric
ulcers is necessary
1. Mallory-Weiss syndrome
 2. ..
3. ..

Task 6.
Specify methods of prevention of acute gastric ulcers
1. Inhibitors of proton pump
2. ..
3. ..
Test questions.
Choose one correct answer.
І. Patient with burn disease shows signs of gastric colic. What is the reason?:
1. Hemorrhage of acute ulcer;
2. Hemorrhage of chronic ulcer;
3. Fibrinogen deficit;
4. Mallory-Weiss's syndrome
5. Hemorrhoid bolus hemorrhage
ІІ. On fifth day after gastric resection female patient shows signs of peritonitis in
lower abdomen. Most possible reason:
F. Perforation of acute ulcer
G. Failure of anastomose suture
H. Acute thrombosis of mesenteric vessels
I. Acute appendicitis
J. Acute salpingitis
ІІІ. Most effective method of acute ulcers prevention:
F. Proton-pump inhibitors
G. Cold compress on abdomen
H. Mucosa protectors
I. Meulengracht's diet
J. Antibiotic therapy
ІV. What can not cause acute gastric ulcer?
1. Early post-operative activity of patients
2. Endointoxication
3. Stress
4. Acid-peptic factor
5. Abnormality of digestion channel mucosa resistance
V. Most effective aid method at acute hemorrhage of acute gastric ulcers:
A. Endoscopic hemostasis
B. Gastric resection
C. Vagotomy
D. Cold compress on abdomen
E. Conservative hemostatic therapy
 Content module 8. Symptoms and syndromes in surgery.
Theme 3. “Functional, instrumental methods of examination at liver,
extrahepatic bile ducts, pancreas.”
Tasks for individual theme processing(write your answers)

Variant 1

Task 1.
Fill table about types of icterus
Icterus type Definition
1. Cythemolitic Icterus that is not associated with liver damage
(hemolytic) occurs at substantial hemolysis due to accelerated
erythrocytoschisis and increased formation of bilirubin

2. Hepatocellular

3. Obstructive
(mechanical)

Task 2.
Specify major indications for performance of endoscopic retrograde
cholangiopancreatography (ERCP):
1. Updating of mechanical icterus reason (presence of stones, tumors or strictures
of bile passages);
2.
3.
4.
5.
6.
 Task 3.

Statement of need of applying of radiological diagnosis method in

suspected case of chronic pancreatitis
Name of method Aim of examination
Roentgen examination of ventricle Detection of focuses of pancreas
and duodenum calcinosis
Ultrasonic examination
Computerized tomography, magnetic
resonance tomography
Endoscopic retrograde
cholangiopancreatography
Biopsy of local enlargement
of pancreas under US- and CT-
control
Curative cyst punctures that cause
blockade of pancreas and bile ducts

Task 4.
Specify major indication for use of endosonography:

1. Diagnosis of mass lesions of pancreas, major duodenal papilla, intraductal

tumors and also stage of their distribution.
2.
3.
4.
5.
6.

Task 5.
Specify imnunotechniques used for diagnosis of chronic pancreatitis:
1. Definition of containment on normal and changed antigens of tissue, separate
components of pancreas in blood and biologic fluids.
2.
3.
Task 6.
Specify methods of examination of exocrinous function of pancreas:
1) examination of pancreatic juice for containment of pancreatic enzymes and
bicarbonates;
2)
3)
4)
5)

Test questions.
Choose one correct answer.
1. Which method of differential diagnosis of icterus is the most informative:
1. – endoscopic retrograde cholangiopancreatography;
2. – laparocentesis;
3. – fiberoptic esophagogastroduodenoscopy;
4. – selective angiography;
Е – intravenous cholangiography.

2. Name characteristic sign of mechanical icterus at instrumental examination:

A – presence of concrements in gall bladder at USE;
B – abnormality of bile diversion at quantitative hepatobiliary
scintigraphy;
C – reduction of vascular pattern at selective angiography;
D – increase of portal pressure at umbilical vein catheterization;
Е – extension of bile ducts at roentgen contrast examination.
3. Indicate normal diameter of common bile duct (choledoch):
A – up to 3 mm;
B – 3-5 mm;
C – 5-7 mm;
D – 8-10 mm;
E – more than 10 mm.

3. Patient age 43, 6 years ago underwent cholecystectomy regarding chronic

calculous cholecystitis. For last half of year began to recognize periodical
occurrence of pains in right hypochondrium and periodical occurrence of
icterus signs. For last two weeks icterus persists. At examination was detected
 constrictive papillitis with extension up to 0.5 cm. Choose the best variant of
patient treatment:
А. Perform endoscopic papillosphincterotomy;
В. Administer conservative treatment: spasmolytic,
antibiotics, anti-inflammatory drugs;
С. Perform external drainage of common bile duct;
D. Perform transduodenal papillosphincterotomy;
Perform choledochoduodenostomy.

5. Patient, age 47, hospitalized with permanent pains in right hypochondrium,

subicteral skin color. Conservative therapy for 24 hours did not resulted in
amelioration, ochrodermia increased, t - 37,6˚ С. White blood cell count - 12,5
х 10*9/l. Regarding acute calculous cholecystitis, surgical measure started.
What intraoperative examination should be performed obligatory?
A. Choledochomanometry;
B. Punction and urgent histologic examination of pancreas;
C. Intraoperational cholangiography;
D. Punction of gall bladder with bile culture;
E. Definition of bile viscosity.
Content module 2
Theme. “Differential diagnosis at gastrointestinal hemorrhage”

Tasks for individual theme processing (write your answers)

Variant 1.

Task 1.
Specify Major clinical signs of GIH:
1.Melena.
2.
3.
4.

Task 2.
Specify major methods of GIT examination:
1. Fibrogastroduodenoscopy
2.
3.

Task 3.
Fill table of clinical and unbiased signs of GIH:
Major complains Clinical signs
-weakness -skin pallor.
- -
- -
- -

Task 4.
Specify major reasons of GIH from upper GIT:
1. Gastric and duodenal ulcer.
2.
3.
4.
Task 5.Specify diseases at which is necessary to perform differential diagnosis of
 GIH:
1. Myocardial infarct.
2.
3.
Task 6.
Specify sequence of diagnosis algorithm in differential diagnosis of intestinal
hemorrhage.
1.Digital examination of straight intestine
2.
3.
Test questions.
Choose one correct answer.
1. Patient's GIH showed as blood vomiting and melena. What is the most
possible reason?
1 Hemorrhage of esophagus varicose veins.
2 Nonspecific ulcerative colitis.
3 Chronic hemorrhoid.
4 Anal fissure.
5 Chron's disease.
2.Patien's hemorrhage first showed as gastric contents vomiting that later
transferred to blood vomiting. What is the most possible reason of GIH?

8. Mallory-Weiss's syndrome.
9. Hemorrhage of esophagus varicose veins.
10. Ulcerous hemorrhage.
11. Erosive-hemorrhagic gastritis.
12. Gastric cancer.
3. Patient associates beginning of hemorrhage with taking large amount of
nonspecific anti-inflammatory drugs regarding arthritis deformans. Which
disease is the most possible reason of GIH?
6. Acute gastric ulcers and erosions.
7. Chronic duodenal ulcer.
8. Mallory-Weiss's syndrome.
9. Chronic hemorrhoid.
10. Gastric cancer.

4. Patient with acute GIH previously had hepatitis of B and C type.Varicosity of

subcutaneous veins is visible on anterior abdomen wall. For differential diagnosis
expect to find:
3. Varicosity of esophagus veins.
4. Mallory-Weiss's syndrome.
5. Acute erosive ulcerous gastric damage.
6. Barett esophagus.
7. Nonspecific ulcerative colitis.

5. Beginning of GIH was warned by epigastric burning, hunger pains, ulcer

anamnesis. Expect from results of fiberoptic gastroduodenoscopy:
1. Duodenal ulcer.
2. Gastric ulcer.
3. Mallory-Weiss's syndrome.
4. Gastric cancer.
5. Dieulafoy syndrome.
 Theme 12. “Transplantology principles. Transplantation of heart, pancreas, liver,
nephros "
Tasks for individual theme processing (write your answers)

Variant 1
Task 1.
Types of transplantates (organ or issue portion used for transplantation):
1. Autologous transplantate (transplantation type -autotransplantation)–tissue or part of
organ is taken from one part of body and transplanted into other part of same patient body;
2.
3.
4.
5.

Task 2.
Indicate drugs for performance of immunosuppressive therapy:
Pharmaceutical
No. Drug Name group Mechanism of action
1 Cyclosporine Cyclosporine was It inhibits immune response of T-lymphocytes
separated from fungi of due to inhibition of interleukine-2 (IL-2)
Cylindrocarpum lucidum production.
and Tolypocladium Consequence of this is decrease of
inflatum genus. It is a antigens of І and II classes response in cascade
cycling decapeptide with reaction of rejection.
potential Cyclosporine also inhibits gene transcription
immunosuppressive IL-2 (a-interferon, IL-3, IL-4
activity and other regulators of process of differentiation
and proliferation of T- and B- lymphocytes)
2 Basiliximab and
Daclizumab
3 Mycophenolate
mofetil (Cell-
Cept)
4 Prednisolone

Task 3.
Indications for nephros transplantation–terminal stage of chronic kidney
disease, reason of which is:
1. Chronic glomerulonephritis.
2.
3.
4.
5.
6.
7.
 Task 4.
Grounding of indications to pancreas transplantation:
1. Unlike transplantation of liver and heart, transplantation of pancreas is performed
not for saving life of patient, but for prevention of chronic diabetic complications
development (angyopathy and neuropathy):
2.

3.

Task 5.
Choice of donor for heart transplantation:
1. Optimal donors for heart transplantation are:

2. In course of selection of donor and recipient is taken into account match by system:

8. Time limit for allowable cold ischemia for heart does not exceed:

Task 6.
Absolute counterindications for liver transplantation:
1. Presence of HIV infection;
2.
3.
4.
5.
6.
7.

Test questions.
Choose one correct answer.

5. Indicate the most perspective solution for liver conservation:

А. Ringer's.
B. Euro-Collins.
C. Sacks'.
D. Wisconsin university solution.
E. Ross-Marshall's.

6. Cyclosporine А is:
А. Immunosuppressant.
5. Corticosteroid.
6. Antibiotic.
7. Immunomodulator.
8. Cytostatic.
 1. Indicate the most important criteria of donor selection for kidney transplantation:
А. Sex match.
B. Match by rhesus factor.
C. Presence of matching НLA-antigens of І class.
D. Presence of matching НLA-antigens of ІІ class.
E. Match by АВО system.

2. In case of transplantations of organ or tissue to recipient from donor of different biological

species, the following type of transplantation is used:
А. Xenotransplantation
B. Autotransplantation.
C. Implantation.
D. Allotransplantation.
Е. Transmissing
5. Chronic rejection of transplantate most often occur in period
А. From 6 to 24 hours after transplantation
В. Immediately after inserting of transplantate into blood flow of recipient and till 72
hours after transplantation
С. After several months or years after operation
D. From 1 week to 12 weeks after operation
Е. No correct answer
 Content module 4.Vascular surgery.
Theme 6. “Endoscopic coronary artery bypass surgery”
Tasks for individual theme processing (write your answers)

Variant 1

Task 1.
Fill table of CHD classification (order No. 54 MoH of Ukraine).
Clinical form Characteristics
1. Sudden cardiac arrest Sudden cardiac arrest with successful
reanimation;
Fatal case.
2.
3.
4.
5.

Task 2.
Specify major etiological factors of CHD:
1. Increase of total blood cholesterol due to LDL.
2. ...
3. ...
4. ...
5. ...
Task 3.
Fill table by indicating signs of functional classes of stable stenocardia:
Functional class Unbiased signs
1. 1FC 1. Stenocardia occur at increased
physical exertion
2. 2.
3. 3.
4. 4.
5. 5.
Task 4.
Specify instrumental examinations of CHD.
1. Electrocardiography.
 2. ..
3. ..
4. ..
5. ..
Task 5.

Specify diseases at which is necessary to perform differential diagnosis of

CHD.
1. Cardialgia.
2. ..
3. ..
4. ..
5. ..

Task 6.
Specify methods of CHD prevention.
1. Dietary intervention.
2. ..
3. ..
4. ..
5. ..

Test questions.
Choose one correct answer.
1. Is collateral ties between coronary heart arteries normal?

А. No.
В. Yes.
С. Rarely.
7. Disappear after birth
8. Yes, between right and left coronary arteries

2. How often at acute myocardial infarct occur interventricular septal

rupture?
A. 2–4% of patients
B. 8–10% of patients
C. 20% of cases
D. Half of patients
E. 70% of patients
3. Which of specified below clinical variants of myocardial infarct occur
most frequently:
A. Algesic.
 B. Asthmatic.
C. Abdominal.
D. Arrhythmic.
E. Cerebrovascular.
4. Which tactic of cardiac surgeon should be for patients with unstable stenocardia,
resistant to performed adequate antianginal treatment?
А. Recommend urgent surgery ofcoronary artery bypass surgery or
coronary angioplasty for patient.
В. Recommend to increase administration of antianginal drugs for patient.
С. Recommend to continue conservative treatment for patient.
3. Recommend to increase administering of antiplatelet drugs for patient.
4. Recommend to increase administering of anticoagulation drugs for patient.

5. At which localization of myocardial infarct the abdominal syndrome

occur most frequently?
A. Posterodiaphragmatic myocardial infarct.
B. Anterial myocardial infarct.
C. Lateral myocardial infarct.
D. Posterobasal myocardial infarct.
E. Basal infarct.
Content module 4.Vascular surgery.
Theme 6. “Differential diagnosis and treatment of acute thrombosis of
mesenteric vessels.”
Tasks for individual theme processing (write your answers)

Variant 1
Task 1.
Specify major reasons of acute mesenteric vessels thrombosis development:
1. Hypercoagulable syndrome.
2.
3.

Task 2.
Quote classification of acute mesenteric vessels thrombosis by clinical
progression:
1. Compensations of mesenteric blood circulation.
2.
3.

Task 3.
Specify instrumental examinations at acute mesenteric vessels thrombosis:
1. Doppler solography of aorta branches.
2.
3.
4.

Task 4.
For morphological verification of acute mesenteric vessels thrombosis are used the
following instrumental methods of examination:
1. Enteroscopy or colonoscopy with biopsy.
2.
3.

Task 5.
Goal of operative intervention at mesenteric thrombosis is:

1. Restoring of mesenteric blood circulation.

2.
3.
Test questions:
Choose one correct answer.

1. Patient, age 66, complains about abdominal pain, vomiting with addition of
blood, abdominal swelling, increased vessel pressure 170/90 mm of mercury.
Survey roentgenogram of abdomen shows Kloiber's cups. What disease can you
think about?
A. Mesenteric vessels thrombosis.
B. Hemorrhage of duodenal ulcer.
C. Hepatic cirrhosis.
D. Acute pancreatitis.
E. Chrone's disease.

2. Patient D., age 58, complains about pain and tumor in abdomen, general weakness.
weight loss, numbness of lower limbs. Considers himself sick for 4-5 months. Pulse
regular, 98 per minute, AP 150/70 mm of mercury. Palpable tumor in epigastrium,
12.0x10 cm, hard consistency, fixed to surrounding tissue, pulsation over tumor feels
palpably. Your provisional diagnosis?
A. Abdominal aortic aneurism.
B. Acute pancreatitis
C. Gastric tumor.
D. Mesenteric vessels thrombosis.
E. Pancreatic cyst

3. Patient P., age 57, in course of surgery diagnosed segmentary thrombosis of small
intestine of length 1 m. What amount of surgery should be performed?
A. Limited resection of small intestine.
B. Subtotal resection of small intestine.
C. Total resection of small intestine.
D. Explorative laparotomy.

4. Female patient, age 76, suffering hypertensive disease, arrhythmia, complains

about abdominal pain, vomit with blood addition, swell of abdomen. Intestine
peristaltic is not heard auscultatory. Survey roentgenogram of abdomen shows
Kloiber's cups. What diagnostics measures should be taken?
 A. Laparoscopy.
B. Coagulogram.
C. EFGDS.
D. General blood analysis.
E. Laparocentesis.

5. Female patient, age 82, underwent resection of small intestine of length 1.5 m in
course of surgery due to mesenteric vessel thrombosis. Which group of drugs should
not be administered?
A. Protamine sulfate.
B. Colloid infusions.
C. Crystalloid infusions.
D. Painkiller drugs.
E. Heparin therapy under control of blood coagulation system condition.
F. Antibacterial therapy.
Content module 4. Symptoms and syndromes in surgery, contemporary
state of transplantology.
Theme 8. “Cell therapy in treatment of chronical obliterating
diseases of pelvis limbs arteries”
Tasks for individual theme processing (write your answers)

Variant 1

Task 1.
Fill table.
Stage of PLCI by Fontaine – Symptomatology
Pokrovsky
І Pains in leg occur after rather
long-lasting walk (more than 1 km)
ІІ a

ІІ b

ІІІ

ІV

Task 2.
Specify major directions of therapeutic angiogenesis:
9. introduction of recombinant proteins – inductors of angiogenesis
(growth factors).
2. ..
3. ..
4. ..
Task 3.

Specify major properties of SC:

1. Autoreconstitution
2. ..
Task 4.

Specify types of SC.

1. Postnatal
2. ..
3. ..

Task 5.
Specify types of postnatal SC.
1. Hemopoetic
2. ..
3. ..
4. ..

Task 6.
Specify major methods of fat tissue sampling
1. Liposuction
2. ..

Test questions. (Choose one correct answer).

1) The most frequent reason of PLACOD development is:
A. vascular aneurism
B. obliterating thromboangiitis (endarteritis)
C. aortoarteritis
D. coagulopathy
E. artery atherosclerosis.
2) Major stimulating factor of angiogenesis is:
growth of рО2 in tissues
worsening of blood rheological properties, hypoxia of tissues
reducing of tissue glucose level
tissue swell

3) What antigens express on their surface SC derived from fat tissue?

A. CD4+, CD45+, CD15+
B. CD34+, CD31, CD105+, CD73+
C. CD8+, CD45+, CD3+
D. CD105+, CD45+, CD3+, CD4+
E. CD105+ CD45+, CD61+

4. To what SC type belong impregnated ovum at morula stage?

A. Totipotent
B. Pluripotent
C. Multipotent
 D. Unipotent
E. Polypotent

5. Patient, age 65, that suffers PLOVA for length of time, multifocal leg artery
disease that corresponds to IV stage of PLCI. Foot phlegmon is present. To patient
are administered broad-spectrum antibiotics. Is this condition a counterindication
for administration of stem cells PLCrI therapy.
A. SC therapy is indicated on the top of already administered intensive
antibiotic therapy
B. Introduction of SC is prohibited on top of antibiotics already administered to
patient.
C. Given condition of patient is absolute counterindicator for SC therapy
D. SC therapy should be administered with increased dose of SC
E. At suppurative diseases administering of SC is allowed.
Module 4 Theme 9 . “Clinic, diagnosis and treatment of intestinal fistulas.”
Tasks for individual theme processing (write your answers)

Task 1.
Fill table of variants of clinical progression of intestinal fistulas.

Variants of clinical progression of Clinical signs

intestinal fistulas:
Uncomplicated intestinal fistula Uncomplicated – functioning intestinal
fistula without signs of abscess of
fistulous passage, phlegmon of
abdomen wall and other complications.
Duodenal fistula

High small intestine fistula

Low small intestine fistula

Large intestine fistula

Cholecystoduodenal fistula

Incomplete fistula that opens into pus

pocket

Intestine fistula complicated by abscess

of fistulous passage site

Intestine fistula complicated by

phlegmon of soft tissues in fistulous
passage site
Special aspects of clinical progression
of intestine fistula at Chrone's disease

Variants of clinical progression of

straight intestine fistula
Task 2.
Specify major methods of intestinal fistula diagnosis:
1. Fistulography,
2. ...
3. ...
4. ...
5. ...

Task 3.
Indicate signs of intestine-bladder fistula presence.
Complains Unbiased signs

1.Pain of bladder site and urethra, mostly 1.Increase of pain in bladder

at urinating
2. Elimination of gas with urine at
urination
3. Elimination of admixtures of
excrements with urine at urination
projection at palpation, presence of
cystitis, urethritis, increase of body
temperature, leukocytosis with deflection
of white blood cell count to the left.
2.
3.

Task 4.

Indicate instrumental methods of examination at straight intestine fistula

1. Fistula intubation.
2. ..
3. ..
4. ..
5. ..

Task 5.
Indicate diseases in presence of which can occur external intestine fistulas
1. Chrone's disease of small or large intestine,
2. ..
3. ..
4. ..
5. ..
 Task 6. Indicatediseases in presence of which can occur internal intestine
fistulas
1. Chrone's disease of small or large intestine,
2. ..
3. ..
Task 7. Indicate specific aspects of clinical progression of duodenal fistula
1. Loss of substantial amount of liquid, electrolytes, enzymes
2.
3.

Task 8. Indicate specific aspects of clinical progression of complicated high

small intestine fistula that opens into pus pocket
1. Loss of liquid, electrolytes, pain in fistula site, external elimination of
chymus with admixture of pus, presence of intoxication syndrome
2.
3.

Task 9.Indicate special aspects if treatment tactics at complicated unformed

fistulas that open into pus pocket.
1. Drainage of pus pocket in order to transform unformed fistula into
formed.
2.
3.

Task 10. Define indications for conservative treatment of intestinal fistula

1. Formed tubulous fistula
2.
3.
Test questions:
Choose one correct answer.

1. Patient who had gallstone disease for more than 15 years, suffered from
acute obstructive obstruction of small intestine.What is the most possible
reason of its occurrence?:
a. Concrement of bile bladder that migrated into lumen of small intestine and
caused its obstruction;
b. adhesion process;
c. dolichomegacolon;
d. coprostasia;
e. intestine dysmotility.

2. Patient with present external fistula of small intestine periodically suffers pain
and induration at fistula site, increasing of body temperature. What caused stated
complains?
a) Abscess of fistulous passage site;
b) enteritis;
c) retention of contains movement in small intestine;
d) malfunction of suction;
e) hernia in site of present fistula .
3. Patient with present external small intestine fistula is suspected in formation of
fistula passage site abscess. What additional examination methods are necessary to
perform for assessment of diagnosis?

A. Ultrasonic examination of abdomen organs, computerized tomography or

magnetic resonance tomography of abdomen organs;
B. pyelography, irigography;
C. control of contents transition in small intestine;
D. irigography;
E. gastroduodenoscopy.

4. What treatment method is reasonable to use for patient with formed tubular
external fistula of large intestine that occurred due to failure of colon and rectum
anastomosis sutures?
A. conservative treatment;
B. suturing of fistula;
C. resection of fistula;
D. formation of bypass anastomosis;
5. What major treatment method is reasonable for patient with unformed small
intestine fistula that opens into pus pocket of abdomen?

A. Surgery intervention;
B. ablution of fistula;
C. Physiotherapeutic methods;
D. Radiotherapy;

6.Indicate factors that prevent healing of tubular formed intestinal fistula

А. Distortion of intestine contents transition in intestine parts placed
distally from fistula
В. increase of abdomen pressure
С. short fistulous passage
D.sulcated fistulous passage
Content module 8 Theme No.10. Obesity and metabolic syndrome. Clinic,
diagnosis, treatment.
Tasks for individual theme processing (write your answers)

Variant 1

Task 1.
Fill table of variants of body weight types dependently on body weight index
Variants of body weight types Definition
2
1. ˂ 18,5 kg/m Body weight deficit
2 2
2. 18,5 kg/m – 24,9 kg/m
2
3. 25 kg/m – 29,9 kg/m2
2
4. 30 kg/m – 34,9 kg/m2
2
5. 35 kg/m – 39,9 kg/m2
2
6. ˃ 40kg/m
2
7. ˃ 50kg/m

Task 2.
Specify criteria of metabolic syndrome
1. Disorder of glucose tolerance
2. ...
3. ...
4. ...
5. ...
9. …
10. …
11. …

Task 3.
Specify method of surgical treatment of obesity.
1. Malabsorbtive – anticipate reduction of suction surface are of small intestine
due to exclusion of its part from digestion process (jejunoileostomy,
biliopancreatic bypass)
2. …
3….
Test questions.
Choose one correct answer.
2
1. 1. Overweight patient with BWI 40 kg/m is delivered in reception department
of hospital with brain concussion. Patient stated that he was involved in road
accident due to falling asleep behind the wheel at traffic light. At examination
no alcohol found in blood. What is the most possible reason of losing attention
by driver?
A. Pickwick's syndrome;
B. myocardial infarct;
C. acute malfunction of brain blood circulation;
D. hemorrhagic insult;
2. Wife of patient with morbid obesity, age 45, addressed to family
doctor with complains that her husband suffers complete
respiratory standstill while sleeping, for 20-40 seconds, in course
of which the face skin become bluish, which makes her wake
him up. Relief occur is case when husband sleeps in armchair, in
semi-sitting position. What is the reason of respiration standstill?
A. sleep (night) apnea;
B. thrombosis of small branches of lung artery;
C. defatigation;
D. ingestion of foreign object in respiratorypassages;

3. Patient, age 40, suffering from obesity, addressed with complains

about progressing increase of body weight, increase appetite,
necessity to take food even in the middle of the night. Suffers from
diabetes of type II that requires insertion of up to 120 it. of insulinper
24 hours. At examination was determined diagnosis of morbid
obesity (BWI – 48 kg/m2), dyslipidemia, pancreatic diabetes of II
type, night apnea, Pickwick's syndrome.
Which type of treatment, you think, should be administered to patient?
А. surgical treatment
В. diet therapy
С. stationary treatment by gastroenterologist and psychotherapist
D. hunger treatment