Acute appendicitis

1.Patient 20 years old, on the 7th day after an operation of appendectomy. After the rectal examination the
pelvic abscess was diagnosed. The signs of peritonitis are negative. What is the correct tactic for this
patient?
*The incision of the abscess throw rectum
Rectal cleansing with antibiotics
Active desintoxication and antiinflammation therapy
Laparatomy.Revision of the peritoneal cavity. Drainage of the abscess.
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2. On the 6th day after appendectomy for gangrenous-perforated appendicitis, the patient developed
intestinal paresis, fever, pain in the right side of the abdomen, an increase of the liver and jaundice. What
postoperative complication can be suspected?
*Pileflebitis
Abscess of the appendix stump
Acute liver failure
Purulent peritonitis
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3. The muscle tenderness could be negative in
*All of the cases
Children
Pregnant
Alcocholics
Elderly people
4. The patient complained of pains in the right ileal region, which appeared 16 hours ago. First, the pain
arose in the epigastrium, there was a single vomiting. After 3-4 hours moved to the right iliac region. The
patient is hospitalized with a diagnosis of acute appendicitis. Which of the symptoms of acute appendicitis
occurs in that case ?
*Kocher`s-Volkovitch`s
Rovsing`s
Bartomeiu-Michelson`s
Sitkovski`s
Spijarski`s
5. The patient complained of pains in the lower abdomen, fever, nausea. Feel himself ill for about 2 days.
Objectively: The state of moderate severity. Pulse-106u.Abdomen sharply painful in the right ileal region
and above the pubis. Positive symptom Shchetkin-Blumberg, leukocytosis-13.2 * 109, in the urine of
individual leukocytes. Ultrasound examination - fluid in the lower abdomen, small pelvis. The diagnosis at
admission is acute destructive appendicitis complicated by peritonitis. What operational access is more
rational to use?
*Lower-medium laparotomy
Mac`Burney-Mac-Adam`s
Medium laparotomy
Winkelman-Shprengel`s
Kocher`s
6. At the patient of 19 years 4 days ago there were pains in the right half of a stomach which at first grew,
and by the end of the second day began to decrease gradually, amplifying at sharp movements and tussis.
The state is satisfactory, pulse-84/min. The tongue is moist. In the right iliac region, there is a slight exertion
of muscles, palpable dense, painful tumor-like formation with an uneven contour and limited mobility.
What is the most likely diagnosis?
*Appendicular infiltrate
Tumor of the cecum
Appendicular abscess
Pileflebitis
Pyelonephritis
7. The patient complains of constant intense pain in the right ileal region, nausea. Sick for 2 days.
Objectively: body temperature 37.8, tachycardia. When palpating the abdomen in the right ileal region,
considerable soreness and muscle tension, positive symptoms of irritation of the peritoneum. Leukocytosis-
10,6 * 109, stab neutrophils-8%, urinalysis - without pathology. What is the most likely diagnosis?
*Acute appendicitis
Acute intestinal obstruction
Acute pancreatitis
Acute cholecystitis
Perforative ulcer of the gaster
8. The patient was taken to the emergency room in a serious condition with complaints of pain in all parts
of the abdomen, dry mouth, nausea, general weakness. From an anamnesis it is known that 3 days ago he
felt pain in the right ileal region, which gradually spread to all parts of the abdomen. When the pulse-
123aud is examined, a 90/70 mm AO, the abdomen is painful in all parts, positive symptoms of irritation of
the peritoneum, there is no intestinal peristalsis. What is the preliminary diagnosis for this patient?
*Acute destructive appendicitis, general peritonitis
Acute destructive ppendicitis, local peritonitis
Acute simple appendicitis, general peritonitis
Acute destructive appendicitis, appendicular infiltrate
Acute destructive appendicitis, appendicular abscess
9. The patient complains of pain in the right iliac and lumbar region to the right, frequent and painful
urination. Sick for 12:00, before such complaints were not. When viewed: the stomach takes part in the act
of breathing limitly, rigid and painful in the right iliac region, symptoms of irritation of the peritoneum are
negative. Notes the pain when tapping in the right lumbar region. What method of instrumental diagnostics
in this case is most expedient for applying to clarify the diagnosis?
*USD
Doplerograpy
ECG
Renthgenography of the ventricle
Radioisothopic scanning
10. The patient was hospitalized in a serious condition with complaints of pain in the upper abdomen, a
pronounced general weakness. In the anamnesis it is known that 3 days ago he felt pain in the right ileal
region, which gradually spread to all parts of the abdomen. When examined, the abdomen is swollen,
painful in all parts, the symptoms of irritation of the peritoneum are positive. Peristalsis is sharply
weakened. Diagnosis: Acute destructive appendicitis, generalperitonitis. What is the amount of surgical
intervention in this case?
*Laparatomy, appendectomy, sanation and drainage of the peritoneum cavity, nasointestinal intubation
Laparotomy, ceacostomy, sanation and drainage of the peritoneum cavity
Non-operative treatment
Laparascopic appendectomy, drainage of the peritoneal cavity
Appendectomy
11. Patient, 26 years old, was operated on for acute phlegmonous appendicitis. On the 5th day after the
operation, the condition deteriorated sharply. General weakness, loss of appetite, headache. There was
icterism of the skin. Body temperature has risen to 39 degrees, accompanied by chills. The pulse is 110 in 1
min. The abdomen is moderately inflated. Symptoms of irritation of peritoneum are negative. Increased
leukocytosis, shift the formula to the left. With ultrasound, small echopositive formations in the liver. What
complication of acute appendicitis should I think?
*Pileflebitis
The pyogenous pyelitis
Subdiaphragmal abscess
Viral hepatitis
General peritonitis
12. Pregnant M. (pregnancy 22 weeks), 26 years old, was delivered to the hospital urgently with complaints
of abdominal pain, fever up to 37.6, nausea. I got sick a day ago sharply, the pain initially arose in the
epigastric region, then in the right side of the abdomen, the vomiting once occured. The abdomen
corresponds to the period of pregnancy, painful above the right ileal region, strained. There are no dysuric
phenomens. Leukocytosis - 21 * 10 * 9 / liter. The most probable preliminary diagnosis:
*Acute appendicitis
Torsion of ovarian cysts
Threat of interruption of pregnancy
Toxicosys of pregnancy
Acute cholecystitis
13. In a 70-year-old patient who underwent appendectomy for acute gangrenous appendicitis with suturing
the operating wound of the abdominal cavity tightly, an abscess of the abdominal cavity with localization in
the right ileal region was diagnosed on the 5th day of the postoperative period. Indicate what action would
be effective in terms of prevention the occurrence of this complication in the patient?
*Drainage of the peritoneal cavity from contrapperture
Heamostatic therapy
Early activisation of the patient
Physiotherapy with physical exercises
Physiotherapy
14. A patient of 45 years complains of a dull constant pain in the right ileal region. Sick for 2 weeks.
Objectively: low-grade fever. Palpation in the right iliac region reveal a painful dense slow-moving, with
clear contours tumor. Diagnosed: appendicular infiltrate. What is the most rational medical tactic?
*Conservative therapy
Appendectomy from non-peritoneal incision
Typical appendectomy
Appendectomy from medial laparotomy
Retroversial appendectomy
15. A woman is 45 years old sick 2 days ago. The disease began with pain in the epigastric region, which
then moved down the abdomen, more into the right iliac region. Subfebrile temperature, nausea, vomiting
once. On third day the pain decreased, but a tumor-shaped formation appeared in the right ileal region,
subfebrile temperature was maintained. Palpation of the abdomen is soft, in the right iliac region painful
tumor-like formation, densely elastic consistency, peritoneal symptoms are absent. What disease arose in a
patient?
*Appendicular infiltrate
The pyogeneus inflammation of the right tube
Abscess of the Douglass` cavity
Appendicular carcenoid
Tumor of the ceacum
16. The patient 49 years old 14 days ago was operated on for perforated appendicitis, a general fibrinous-
purulent peritonitis. The postoperative period proceeded without complications. On day 9, the patient had
a low-grade fever, abdominal pain, diarrea. With ultrasound of the abdominal cavity in the left mesogastric
region, a liquid formation of 9 × 10 cm is determined. In blood tests, leukocytosis with a shift
leukocyte formula to the left. Formulate a preliminary diagnosis
*Interstitial abscess
Tumor of the peritoneal cavity
Cyst of the left kidney
Abscess of the liver
Abscess of the spleen
 Acute pancreatitis. Complications of the acute pancreatitis.
The diseases of the pancreas.
1. A 60 year old patient suffers from chronic calculous cholecystitis. 2 days ago after the use of fatty
food and alcohol surrogates has a pain in the epigastrium, nausea, multiple vomiting, which did not
bring relief, icterus sclera. When examined, the condition is heavy, breathless, the stomach is painful in
the epigastrium. Identified signs of delirium Peristalsis is much weakened. On the skin in the lumbar
region and on cystic spots appeared in the buttocks. With palpation in the epigastric region moderately
painful infiltration is determined. Pulse 120 per 1 minute, AT 80/40 Hg. At laparoscopy: in the abdominal
cavity hemorrhagic exudate, many foci of the steatoenecrosis. Daily diuresis up to 100 ml. The blood Ca
level is 1.75 mmol / l. Which is the most probable diagnosis?
*Acute aseptic necrotic pancreatitis
Acute infected necrotic pancreatits
Acute destructive cholecystitis
Toxic hepatitis
Poisoning with alcochol surrogates

2. "A 42-year-old complains about a sharp burning sore pain in the epigastric area. On the background of
persistent pain there are attacks of its amplification that accompanied by heartburn, repeated vomiting
with bile and blood. The disease is associated with the adoption on the eve of a significant amount of
greasy food. The patient is restless. General condition of moderate severity. The pulse rate is 94 per 1 a
minute AT 150/90 mm Hg. On the review X-ray of the abdominal cavity there is pneumatosis of the
transverse colon. Blood leukocytes - 10.8 x 109 / l. Blood Sugar - 4.3 mmol / L. Urine diastase 512 units.
What is the most likely diagnosis?"
*Acute simple pancreatitis
Recidive ulcer of the duodenum
Perforative ulcer
Acute cholecystitis
Recidive of the urolithic disease

3. The patient complains of pain in the epigastric area, nausea, multiple vomiting, abdominal distension,
and growing weakness. The condition of the patient is severe, pronounced pallor of the skin. Pulse - 100
/ min. AO - 110/50 mm Hg. Art. The language is dry, overlaid. The abdomen is swollen, but soft when
palpated. Symptoms of irritation of the peritoneum are weakly positive. Leukocytosis $ 26 * 10 ^ 9 / l $.
Blood amylase 44 g / (hl). What is the diagnosis?
*Acute pancreatitis
Perforative ulcer
Acute cholecystitis
Acute appendicitis
Thrombosis of the mesenterial vessels

4. "A 48-year-old patient has been operated urgently for acute destructive cholecystitis. After
laparotomy, the presence of hemorrhagic exudate, many foci of epiploid steatorecrosis. What is the
most probable diagnosis?"
*Acute aseptic necrotic pancreatitis
Bile peritonitis
Perforative ulcer of the duodenum
Pericholedochal limphadenitis
Choledocholithiasis

5. "At the patient of 49 years after reception of meat, fat and spicy food suddenly appeared intensive
pain in the epigastric region, multiple vomiting, body temperature remained normal. With palpation of
the epigastric region - unexpressed boiliness. Diastasis level of urine 1024od. Conducted conservative
treatment within a day led to an improvement in the condition: the pain significantly decreased,
disappeared vomiting. The abdomen became mild, an easy pain in the epigastrium and the area still
remained. Diastasis of urine 256iod. What form of acute pancreatitis most corresponds to the clinic?
*Simple
Heamorragic
Lipomatic
Mixed
Purulent

6. "The patient complains of severe pain in the upper half of the belly of the shingles character,
repeated vomiting. The condition is heavy, the patient is nervous. Sclerosis are icteric. Pulse 120 /
minute, blood pressure - 70/40 mm Hg. The tongue is dry. The abdomen is swollen, with palpation
marked sharp soreness in the upper abdomen. Peristalsis of the intestine is not determined. Positive
symptoms Resurrection and Mayo-Robson. The diastase of urine is 512 units. What is the most likely
diagnosis?"
*Acute pancreatitis
Perforative ulcer of the ventricle
Acute mesenterial thrombosis
Acute appendicitis
Acute cholecystitis

7. In the patient, 35 years old, after the use of alcohol there was an intense pain, nausea, multiple
vomiting. In laparoscopy is found in the abdomen cavity of hemorrhagic exudate and foci of
steatoenecrosis. After conservative treatment condition has improved. However, for 21 days
moderately painful infiltrate has appeared in epigastric region, motionless. Pulse 88 per minute, AT
100/60 Hg. Body temperature 36,4 S. Daily diuresis up to 1000 ml. Ultrasonography defined hollow
formation in the area of the head of the pancreas in diameter up to 6 cm. What is the most probable
diagnosis?
*Postnecrotic cyst of the pancreas
Abscess of the pancreas
Abscess of the peritoneal cavity
Cyst of the liver
Cancer of the pancreas
8. "A patient 60 years old for 6 weeks develops painless jaundice, skin itching, weight loss up to 8 kg,
achiloids. There is a positive symptom of Courvoisier. Choose a preliminary diagnosis:"
*Cancer of the pancreas
Malaria
Viral hepatitis
Cancer of the liver
Tumor of the gallbladder

9. What causes morphological changes in the pancreas and parapancreatic fibroids in acute
pancreatitis? What causes morphological changes in the pancreas and parapancreatic fibroids in acute
pancreatitis?
*Occurrence of acidosis
Paresis of the intestine
Hypercoagulation
Hypocoagulation

10. Early localized complications of acute destructive pancreatitis are:

*Acute fluid formation of the pancreas and extraocular space
Abscesses of the pancreas
Sterile pancreatic necrosis
Infected pancreatic necrosis
Cyst of the pancreas

11. Late localized complications of acute destructive pancreatitis are:

*Pseudocyst pancreas and abscess
Infected pancreatic necrosis
Acute fluid retention in the pancreas
Intraperitoneal bleeding
Peritonitis

12. The most common signs of acute pancreatitis in the review chest x-ray are:
*Тhe presence of atelectasis in the basal parts of the lungs and effusion in the left aberrant-
diaphragmatic sinus
The presence of pneumothorax
Dislocation of mediastinum
Pneumosclerosis
Emphysema of the lungs

13. What is the purpose of surgical intervention in infected pancreatic necrosis?

*Removal of necrotic tissues and wide disclosure of the affected retroperitoneal cellular media
Panning of the pancreas
Abdominization of the pancreas
Drainage of the abdominal cavity
Embolization of pancreatic vessels
14. What violations of homeostasis results from the pathogenetic factors of acute pancreatitis?
*Systemic lesions in the form of hypercoagulation, activation of kinins, enzymes, microcirculation
disorder, catabolism
Hypocoagulation
Hyperosmolarity of plasma blood
Reduced oncotic blood pressure
Metabolic alkalosis

15. What factors lead to the growth of pancreatic toxemia in patients with acute destructive
pancreatitis?
*Absence in the human organism of protective mechanisms of cytokine, enzyme, calicreatin-kinin, nitric
oxide oxidation
Growth of leukocytosis and increase in body temperature
Hypercoagulation
Tachypnea
Metabolic alkalosis

16. What determines the severity of the clinical course of acute pancreatitis?
*Severity of systemic disorders
Increase in the pancreas
Severity of destructive changes in the pancreas
The amount of effusion in the abdominal cavity
The presence of paresis of the intestine

17. Specify the main pathways for toxin resorption in acute pancreatitis:
*Through the system of the chest lymphatic duct
Through the abdominal aortic system
Due to varicose veins of the esophagus
Through the digestive canal
Through the pelvic venous plexus

18. Therapeutic tactic for acute uncomplicated pancreatitis involves:

*Application of integrated conservative therapy
Execution of urgent surgical interventions
Laparoscopic resection of the pancreas
Application of extracorporeal methods of detoxification
Using cryosurgical techniques

Gallstone disease, acute cholecystitis, cholangitis

1. During the operation for acute phlegmonous-gangrenous cholecystitis, the surgeon noted the
presence of a concrement in the choledoch with the phenomena of cholangitis. What should be the
most effective type of drainage in this case?
*T-type throw choledoch
Descending throw choledoch
Throw the cystical stump
Ascending throw choledoch
Throw Oddi`s sphincter

2. What are the anatomical components of the triangle of Calais, which in the bile duct surgery called
the "key" for operations on the bile system?
*Common bile duct, cystical duct, cystic artery
Cystic artery, v.portae, common bile duct
Cystic artery, v.portae, common hepatic artery
Cystic artery, right hepatic duct, common bile duct
Cystic artery, cystic duct, v.portae

3.Which of the clinical symptoms is characteristic for perforative cholecystitis?

*Expressed pain in the right lumbar region with irradiation in the right shoulder, deafness of the
abdominal muscles, positive symptom of Schotkin-Blumberg in all parts of the abdomen.
Very sharp pain in the right lumbar region with irradiation in the right pubic region, hematuria.
Sudden, severe pain in the epigastrium, flatulent abdomen, lack of liver dullness.
"Sharp circular pain in the epigastrium, collapse, positive symptom of Mondor, leukocytosis more than
20 thousand, glucosuria, hypercalcemia"
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4. Which laboratory analises are more common for destructive cholecystitis?

Leukocytosis, shift of leukocyte formula to the left
Eosinophilia
Basophilia
Anemia
Leukopenia, shifting the formula to the right

5. The patient complains of pain in the epigastric region, the right hypochondrium with irradiation in the
right shoulder blade. Body temperature 37.8; Stomach is tight and painful in the right hypochondrium.
In sonography concrements in the gallbladder are absent, the wall of the bubble is 1.5 cm, the contour is
double. Holedoch-0.6 cm in diameter. A preliminary diagnosis is:"
*Acute cholecystitis
Choledocholithiasys, cholangitis
Hepatic colic"
Lobar pneumonia of the right lung
Chronic cholecystitits

6. A patient of 70 years complains of jaundice of the skin, sclera, discolored feces, darkening of urine, an
increase in body temperature from 37.8. Jaundice appeared a day after the attack of pain in the right
hypochondrium, the abdomen painful in the right upper quadrant where the enlarged, painful
gallbladder is palpable. Formulate a preliminary diagnosis"
*Acute cholecystitis, obstructive jaundice
Residual choledocholithiasis
Choledocholithiasis
Cancer of the head of the pancreas
Cholestatic hepatitis

7. "A the patient after eating of fat food 3 days has felt a strong pain in right hypochondrium which has
decreased after taking the drothaverinum. Body temperature is 37.7-38.0. The abdomen is soft. In the
right hypochondrium palpable painful infiltration. Leukocytosis 14.5 * 109, stab neutrophils-18%. What
disease should you think about? """
Acute cholecystitis
Acute appendicitis
Perforative ulcer of the duodenum
Acute pyelonephritis
Acute pancreatitis

8. The patient complains of pain in the epigastric region, in the right hypochondrium with irradiation in
the right scapula. There was vomiting, which is not brought relief. Body temperature is 37.6. The
abdomen is moderately inflated, tense and painful in epigastrium and in the right hypochondrium,
where a dense, painful formation is palpable. Ortner's symptom is positive. Formulate a preliminary
diagnosis of "
*Acute cholecystitis
Acute appendicitis
Acute pancreatitis
Renal colic"
Acute cystitits

9. The patient of 50 years, is in a hospital in occasion of the acute calculous cholecystitis. On the 2nd day
after the onset of the disease jaundice appeared. Laboratory: leukocytes-12.5 * 10 9st, bacillus-7%,
segmented neutrophils 64%, total bilirubin-80 μmol / l, direct-68 μmol / l, indirect-12 μmol / l, feces
discolored, urine dark. AlAt, AcAt is within the norm. What kind of jaundice probably developed in a
patient?
*Mechanical jaundice
Parenchymal jaundice
Hemolytic jaundice"
Jaundice caused by leptospirosis"
Toxic jaundice"

10. Patient of 53 years complains of acute pain in the right upper quadrant, which arose after dinner
after 2 hours, nausea, vomiting with bile. Sick for 18 hours. The patient is restless, fussing about in bed.
Pulse -98 / min., The tongue is coated with white coating, moist. Body temperature is 38,2 ° C. During
the examination: the right half lags behind in the act of breathing, palpation in the right upper quadrant
determines the muscle tension, soreness. Positive frenicus-symptom and symptom of Grekov-Ortner.
Symptoms of irritation of the peritoneum are negative. Make the diagnosis:
*Acute cholecystitits
Acute pancreatitits
Acute peritonitis
Acute appendicitis
Obstruction of the intestine

11. "The patient felt severe pain in the right hypochondrium with irradiation in the right shoulder. Twice
had vomiting with bile. Earlier hasn`t expected illness like this. Body temperature 37,8 C, sclera sub-
chronic, liver not enlarged, Murphy's positive symptoms, Georgievsky-Mussi, Kera. What is the most
likely diagnosis in this patient?"
*Acute cholecystitits
Acute pancreatitits
Acute peritonitis
Acute appendicitis
Obstruction of the intestine

12. A patient 48 years old, after taking a fatty meal, there was a severe pain in the right hypochondrium
with irradiation in the right shoulder . The temperature rises to 37.8 C. Palpation of the right
hypochondrium area is defined by severe pain and tension of muscles Symptoms of peritoneal irritation
are low-positive. Blood leukocytes 14.8x109. What is your previous diagnosis?
*Acute destructive cholecystittis
Perforative ulcer of the ventricle
Hepatic colic
Edema of the gallbladder
Acute pancreatitis

13. "Patient S., 42 years old, is hospitalized for acute calculous cholecystitis, jaundice appeared on the
sixth day after the onset of conservative therapy. Laboratory data, attention is drawn to the level of
total blood bilirubin -80 μmol / liter; direct bilirubin - 68 μmol / l, indirect - 12 μmol / l. feces discolored,
urine dark. What kind of jaundice has developed in a patient?"
Obstructive
Heamolitic
Infectious
Multiple-case
Toxic

14. "Patient of 49 years old had a planned cholecystectomy for chronic calculous cholecystitis with
frequent attacks of hepatic colic., 3 months later resumed painful attacks in the right hypochondrium as
a type of hepatic colic. twice there were episodes of short-term mechanical jaundice (up to 5-7 days).
On ultrasound and RCFG, the presence of expanded hepatoccholodynia up to 12 mm with the presence
in it a stone with a diameter of 0.6 cm. Which of the methods of surgical treatment for residual
choledocholithiasis is most appropriate in this case?"
*Choledocholithiasis, acute cholangitis
Viral hepatitits
Acute pancreatitis
Empyema of the gallbladder
Cirrhosis of the liver

15. "A woman, 72 years old, suffering from chronic calculous cholecystitis for 20 years, confirmed by
ultrasound. She refused surgery. Came from constant pain in the right hypochondrium, jaundice, body
temperature is 40 degrees. Symptoms of peritoneal irritation are negative. Liver + 4 cm Leukocytes
18x10 G / L, blood bilirubin 80 mkmol / L, preferably straight. The clinic of that illness in the patient.?"
*Choledocholithiasis, acute cholangitis
Viral hepatitits
Acute pancreatitis
Edema of the gallbladder
Cirrhosis of the liver

16. The patient complains of pain in the right upper quadrant, jaundice of the skin and sclera, light feces,
dark urine, body temperature in the evening to 38 C, chills. Sick for 5 days. The onset of the disease is
associated with physical activity. The abdomen is soft. Painful in the right hypochondrium, there is
palpable inflammatory infiltrate. What is the preliminary diagnosis?
*Acute cholecystitis, obstructive jaundice, cholangitis
Cancer of the gallbladder, jaundice, cholangitis
Malignant neoplasm of the liver, jaundice
Abscess of the liver, jaundice, cholangitis
Acute pancreatitis, jaundice, cholangitis

17. The patient complains of pain in the right upper quadrant, jaundice of the skin, sclera, discolored
feces, darkening of urine, increase in body temperature to 37 ^ 0С Jaundice appeared 2 days after an
attack of severe pain in the right upper quadrant. The abdomen is soft, painful in the right upper
quadrant, the liver protrudes below the edge of the costal arch by 4 cm. The symptom of Ortner is
positive. Palpable enlarged gallbladder. What is the most likely diagnosis?
*Acute cholecystitis, obstructive jaundice
Botkin's disease, jaundice
Hemolitic icterus
Abscess of the liver, jaundice
Cirrhosis, jaundice

18. In a patient 56 years after receiving fatty food, 3 days ago, a strong pain appeared in the right
subcostal area, which diminished after receiving barralgin, no-spa. The temperature of the body is closer
to evening 38 ^ C. Abdomen issoft, in the right side of the of it is palpable painful infiltrate. Leuk. -12.5 *
10 ^ 9 / l, n - 18 \%. What disease should you think first of all?
Acute cholecystitis
Acute pancreatitis
Perforated ulcer of the duodenum
Acute appendicitis
Acute pyelonephritis

19. The patient 36 years of age, during surgery for acute catarrhal calculous cholecystitis, the outer
diameter of the choledoch was 14 mm and after choledochotomy under pressure began to stand out
muddy with flakes of bile. What is the complication of cholecystitis?
*Cholangitis
Empyema of the gallbladder
Pancreatitis
Abscess of the gallbladder
Hydrocholecystis

Gastic ulcer and duodenal ulcer. Complications of peptic

ulcer. Surgery of the gaster and duodenum.
1. Indicate the etiological factors of the occurrence of perforative ulcer:
*Exacerbation of ulcers, use of anti-inflammatory nonsteroidal drugs, atrial fibrillation, chronic
cholecystitis
Dysfunction of the diet, increased blood pressure, exacerbation of the ulcer
Deepening of degenerative destructive changes in the area of ulcers, constipation, duodenogatral reflux,
chronic pancreatitis
Deepening of degenerative-destructive changes in the area of ulcers, exacerbation of ulcers, alcohol
consumption, violation of diet
-

2. Which perforated ulcers should be considered atypical?

*Covered perforated ulcer of the back wall of the stomach and duodenum, multiple perforated ulcers
Covered perforated ulcer, ulcer of great curvature of the stomach, ulcer in the pyloric region
Ulcer of the back wall of the stomach and duodenum, multiple perforated ulcers, penetration of the
ulcer
An ulcer of great curvature of the stomach, an ulcer in the region of the pyloric, perforation in the
omentum bag and retroperitoneal tissue
-

2. What is the clinical picture of a typical perforated ulcer conditioned by ?

*Localization of the ulcer, peculiarities of the distribution of the contents of the stomach and duodenum
in the abdominal cavity
The size of the ulcer infiltrate
Localization of ulcers and congenital diseases
Available pyloroduodenal stenosis
-

3. What methods of instrumental research should be used to diagnose a perforated ulcer?

*Radiographic examination of chest and abdominal organs, FGD, ultrasound, laparocentesis, PH-metry
of the stomach
FGDS, ultrasound, laparocentesis, laparoscopy, gastroscopy
FGDS, ultrasound, laparocentesis, PH-metry of the stomach
Radiographic examination of chest and abdominal organs, FGDS, ultrasound, laparocentesis,
laparoscopy
-

4. Name the operations for perforative ulcer:

*Suturing a perforated ulcer, removing a perforated ulcer with duodenal or pyloric plastic, vagotomy
with removal of perforated ulcer with duodenal pyloric plastic, gastrectomy
Suturing a perforated ulcer, removing a perforated ulcer, vagotomy with removing of perforative ulcer,
duodenal or pyloric plastic, gastro-duodenal anastomosis
Suturing a perforative ulcer, vagotomy with removing of perforative ulcer, duodenal or pyloric plastic
Suturing a perforative ulcer, vagotomy with removing of perforative ulcer, duodenal or pyloric plastic,
removing of perforative ulcer
-

5. Indicate the most likely risk factors for ulcer bleeding

*Localization of the ulcer on the anterior wall of the bulb of duodenum, prolonged ulcerative
anamnesis, ulcer penetration, large ulcer
Localization of the ulcer on the posterior wall of the bulb of Duodenum or small curvature of the
stomach, prolonged ulcer history, ulcer penetration, ulcer of considerable size, multifocal
atherosclerosis, hypertension
Prolonged ulcerative anamnesis, ulcer penetration, large ulcer, multifocal atherosclerosis, hypertonic
bolzen, chronic pancreatitis
Ulcer of great curvature of the stomach, ulcer of the posterior wall of the DPC, a violation of diet,
hypovitaminosis, chronic hepatitis
-

6. Indicate the most appropriate surgical intervention for bleeding from a stomach ulcer
*Gastrotomy, suturing of the ulcer
Stem vagotomy, removing of the ulcer, pyloroplastic
Resection of the gaster
Gastrectomy
-

7. List the indications for emergency surgery with ulcer bleeding

*Continuous profuse bleeding, ineffectiveness of conservative therapy and endoscopic methods of
hemostasis, blood loss more than 10% BCC
Continuous profuse bleeding, ineffective conservative therapy and endoscopic methods of hemostasis,
relapse of bleeding in the hospital, localization of ulcers in the antrum stomach
Continuous profuse bleeding, ineffective conservative therapy and endoscopic methods of hemostasis,
relapse of bleeding in the hospital
Continuous profuse bleeding, ineffective conservative therapy and endoscopic methods of hemostasis,
blood loss to 20% BCC
-

8. A 27-year-old patient was hospitalized in hospital with complaints of severe pain along the right
flank, most pronounced in the right ileal region. The pain arose abruptly suddenly in the epigastrium 2
hours ago, eventually passed into the right ileal region. With the diagnosis of acute appendicitis is taken
for surgery. During laparatomy, access to Volkovich-Dyakonov revealed that the abdominal cavity
contains a liquid colored with bile. What disease is most likely in a patient?
*Perforative ulcer of the duodenum
Perforation of the Mekkel`s diverticule
Rupture of the gallbladder
Rupture of the colon
Acute pancreatitis

9. At the patient of 36 years, the driver on a specialty, an hour ago there was a sharp pain in an
epigastrium. There was no dyspeptic phenomena . Pulse-56 per min. The tongue is dry. There is pallor,
sweating. The situation is compulsory. The abdomen is retracted with muscle tension. Hepatic dullness
is not determined. Positive symptoms of irritation of the peritoneum. What is the most likely diagnosis?
*Perforative gastroduodenal ulcer
Acute gastroduodenitis
Acute cholecystitis
Acute colon obstruction
Acute pancreatitis

10. The patient complains of a constant feeling of heaviness in the epigastric region.
Ulceratic anamnesis is 18 years old. Deterioration of the state within a year and a half. Periodic
discomfort in the epigastrium has become permanent. Self-induced vomiting facilitates the patient's
condition. She is exhausted. The abdomen is soft, painful in epigastrium. The "splash noise" in the
mesogaster is determined. Symptoms of irritation of the peritoneum are absent. Pasternatsky's
symptom is negative on both sides. Rectal study did not reveal anything. Your diagnosis?
*"Pyloroduodenal stenosis
Penetration of the ulcer into the head of the pancreas
Perforative gastric ulcer
Acute pancreatitis
Malignancy of the ulcer

11. A 47-year-old patient complains of severe weakness, dizziness, tremor, a feeling of heat, palpitation,
headache, a feeling of heaviness in the epigastrium, which appear 10-15 minutes after eating, has lost
weight. In the anamnesis, peptic ulcer for 20 years. Half a year ago, subtotal resection of the stomach by
Billroth II. Your diagnosis?
*Dumping syndrome
Syndrome of a leading loop
"Diabetes
Chronic post-resection pancreatitis
Chronic gastritis of stump of stomach

12. The patient, 42 years old, suffers from peptic ulcer disease for 10 years. Two months ago the pains
became permanent, radiating into the lower back, sometimes surrounding the character. With
endoscopic examination, a deep niche located on the posterior wall is closer to the small curvature of
the antral part of the stomach. which complications of peptic ulcer arose in the patient?
*Penetration
Stenosis
Malignancy of the ulcer
Perforation
Bleeding

13. A patient, 40 years old, suffering from peptic ulcer disease for a long time, noted that
the last 2 days of pain he became less intense, but at the same time there was growing weakness,
dizziness. This morning, rising from the bed, he fainted for a few seconds. The patient is pale. In the
epigastric region, a little soreness. Symptoms of irritation of the peritoneum are absent. What
complication of peptic ulcer would you suspect?
*Ulcerous bleeding
Perforation of the ulcer
Penetration of the ulcer
Ulcerous stenosis
Malignancy of the ulcer

14. Patient 58 years old, many years suffer from peptic ulcer disease, against the background
of severe weight loss and periodic vomiting for 6 months, suddenly arose convulsions and confused
consciousness. What complication of peptic ulcer can lead to such symptoms?
*Ulcerous stenosis, comlicated with hypochloraemic tremor
Perforation
Malignancy of the ulcer
Bleeding
Penetration

15. Pation N., 30 years old, acted with complaints of acute pain in the abdomen. At examination: the
patient lies on the right side with the knees brought to the stomach. When he try to turn on the back-
pain in the abdomen sharply increases. Has ulcer of the duodenum for 12 years. With a review X-ray, the
free gas is determined under the right diaphragm dome. What complication did the patient experience?
*Perforation
Duoudeno-jejunal fistula
Bleeding from ulcer
Penetration
Pyloric stenosis

16. Patient N., 48 years old, complained of constant vomiting, general weakness. Objectively: the patient
is sluggish. The tongue is dry, the skin turgor is sharply reduced. Pulse = 104 per minute, arrhythmic,
weak filling. Blood pressure 100/70 mm Hg. Art. One year ago at EGDFS at the patient the peptic ulcer is
revealed in duodenum. What complication of peptic ulcer occurred in the patient?
*Pylorostenosis
Bleeding
Perforation
Penetration
Flegom of the ventricle

17. In the patient K., 35 years old, with contrasting radiography of the stomach installed: the stomach is
sharply increased in size, the lower edge reaches the hypogastric. The initial department of the stomach
is sharply narrowed. The barium suspension is determined in the initial parts of the small intestine one
day after the start of the study. Is your diagnosis possible?
*Pyloric stenosis 3 gr.
Gastroparesis
Gastroptosis
Pyloric stenosis 2 gr.
Pyloric stenosis 1 gr.

18. In a patient operated after 12 hours from the moment of the disease, during the operation it was
revealed that on the front wall of the bulb of DPC is a perforating hole up to 0.4 cm in diameter. In all
areas of the abdominal cavity, serous-purulent exudate is determined, the intestinal loops are swollen.
What operation should I perform?
*Suturing of the perforative ulcer
Resection of the ventricle
Stem vagotomy + plastic of the pylorus
Stem vagotomy + suturing of the foramen
Sel;ective vagotomy + plastic of the pylorus

19. Patient 51 years old was operated a year ago for a perforated ulcer of the duodenum. A bilateral
stem vagotomy with excision of the ulcer is made. Complains of the periodic appearance of frequent
loose stool, which occurs suddenly (2-3 times a day for a week), after which it independently normalizes.
Define the diagnosis?
*Post-vagotomy syndrom
Chronic pancreatitis with exocrinic disfunction
Irritable bowel syndrome
Chronic colitis
Dumping syndrome

20. Patient C. 35 years old delivered to the PCB with complaints of general weakness, temporary loss of
consciousness. From the data of the anamnesis it became known that periodically for three years
disturbed pain in the epigastric region, especially at night, heartburn to reduce the use of soda. No
medical assistance addressed, was surveyed. It notes for two weeks before admission pain
intensification, self-paced two days ago. On the day of admission, there was severe weakness, nausea,
dizziness, twice a black, greyish stool. According to the companions, he lost consciousness twice.
General blood test: hemoglobin 96 g / l. leukocytes 16 * 109 / l. The most probable preliminary
diagnosis
*Acute duodenal ulcerous bleeding
Cancer of the stomach
Actue pancreatitis
Myocardial infarct
Bleeding from esophageal veins

21. A 35-year-old patient has been diagnosed with gastrointestinal bleeding, accompanied by a melena
and vomiting type of "coffee" thicket, a decrease in hemoglobin level to 90 g / l and an amount of
erythrocytes up to 2.7 (1012 / l.) The general condition of the patient is satisfactory.What additional
testing methods do you need?
*FGDS
Laparoscopy
Gregersen's test
Holland`s test
Rentgenography of the gaster

22. The 36-year-old male, who is treated for an ulcer output of the stomach appeared a feeling of
heaviness after eating, vomiting 1 every 2-3 days accepted food. Has lost 10 kg. What complication of
peptic ulcer need to think?
*Stenosis of stomach
Penetration of ulcers in the liver
Achalasia of the esophagus
Duodenstasis
Chronic mezenteric obstruction

23. A builder of 35 years during the last 6 months marks the severity of the epigastric region. Not
surveyed. The night before, has drunk a lot of alcochol. In the morning there was vomiting, and after
physical stress in 30 minutes there was a dizziness, hematomezis a large amount. What pathology
should be considered in the first place?
*Melorie-Weiss syndrome
Disease Menetiere
Stomach ulcer
Erosive gastritis
Zollinger-Ellison syndrome
KROK 2

24. "A woman is 45 years old, suffering from hypertension for 20 years in time of increase in blood
pressure to 240/160 mm Hg. there was multiple bloody vomiting. Delivered to a surgical hospital. On
examination, a clinic of acute anemia. Urgent FGD was performed - mucosal ruptures in the cardial part
stomach, where the blood comes from, another pathology is not revealed. Your diagnosis."
*Melori-Weiss Syndrome
Acute gastritis
Rundu-Osler disease
Zollinger-Ellison Syndrome
Acute pancreatitis

Hernias. Complication of hernias. Operations with hernias of

the anterior abdominal wall. Internal hernias of the
abdominal cavity.
1. In the urgent clinic, a patient of 50 years was delivered with a preliminary diagnosis of the
incarcerated hernia of the white abdominal line. The patient's condition is severe, due to intoxication
and hypovolemia. The abdomen is swollen, limitedly involved in breathing. Herniated protrusion is
sharply painful, around him positive symptoms of irritation of the peritoneum. The surgeon agreed with
diagnosis and performed herniotomy. When revising a hernial sac, the latter does not contain any
injured organs, but a turbid liquid flows from the abdominal cavity fibrin. How should I evaluate this
pathology?
*Pseudoincarceration Broch`s, peritonitis
Elastic incarceration, peritonitis
Maydl`s hernia
Richter`s hernia
Ascetic Syndrome

2. The patient of 70 years recently bothered tumor formation in the inguinal area to the right and
dysuria. 5 hours ago protrusion somewhat increased in size, it became sharply painful, dysuria
intensified. When viewed from the inguinal area on the right, bulging in the form of a ball is determined,
painful, does not enter the abdominal cavity, the symptom (coughing shock) is negative. What is the
diagnosis?
*Incarcarated sliding hernia
Incarcarated inguinal hernia
Incarcarated femoral hernia
Cancer of the urinal bladder
Fibroma of anterior abdominal wall

3. "The patient complains of the presence of a hernia in the inguinal region, and argues that she is often
incarcarate. Incarcaration are accompanied by cramping pains in the pubis, frequent urge to urinate.
Most likely the patient has :"
*Sliding hernia
Obturatorial hernia
Direct inguinal hernia
Femoral hernia
Indirect inguinal hernia

4. "A patient of 64 years complains of pain, the appearance of a tumor-like formation in the right
inguinal region, which increases when walks, falls into the scrotum, and when it is in the horizontal
position - disappears. External ring of the right inguinal canal is deviated. What diagnosis is for this
patient?"
*Right-sided indirect inguinal hernia
Right-sided incarcarated indirect inguinal hernia
Dropsy of the right testicle
Right-sided inguinal lymphadenitis

Right-sided direct inguinal hernia

5. "In the reception department of the surgical clinic, a 56-year-old patient with an incarcarated
hernia. He was ill for 3 years. The incarcarationt arose 2 hours before admission. The patient was
hospitalized in the surgical department for surgical treatment. In the ward, the hernia self-corrected.
Tactics of the surgeon?"
*Observation. In the presence of signs of peritonitis - laparotomy. If no complaints show - planned
hernia repair after 3 days
Urgent operation - hernoplastic
Urgent laparotomy
Consevative treatment
Band usage

6. "The patient is 56 years old, complains of pain and the presence of a tumor-like formation in the right
subinguinal region.The pain is worse when walking and exercising. Objectively: a tumor-like formation of
6 × 4 cm, densely-elastic, moderately painful, is not palpable below the right puert ligament, abdominal
cavity. Percussion over nim-blunt sound, auscultatory noise is not heard. Femoral hernia is diagnosed.
Are surgical interventions performed in this pathology?"
*Bassini, Rudgi, Parlaveccio, Lichtenstein
Sapezshko, Spasokukotski, Kimbarovski
Sapezshko, Meyo
Martynov, Macvey, Shoulday`s
-

7. "The patient is 44 years old, complains of pain and bulging in the navel, pains are exacerbated by
physical exertion.The protrusion arose 3 years ago.In recent months, the patient began to worry about
pain during physical exertion, sometimes at rest.Objectively: the stomach is symmetrical, the abdominal
wall in the act breathing takes place evenly, palpation determines pain in the navel region, auscultatory
gypsum peristalsis normal in the navel region, tumor-shaped up to 3.5 cm in diameter, round, soft-
elastic, not in the abdominal cavity. What is the likely diagnosis?"
*Irreducibilic umbillical hernia
Reducibic umbillical hernia
Omphalitis
Paraumbilical lipoma
Endometriosis

8. The patient complains of pain, the appearance of a tumor-like formation in the right inguinal region,
which when walking increases, descends into the scrotum, and in the horizontal position, disappears.
Palpation is determined by the expansion of the outer ring of the right inguinal canal. What disease
should be diagnosed?
*Right-sided indirect inguinal hernia
Incarcarated inguinal hernia
Right-sided inguinal limphadenitis
Right-sided femoral hernia
Dropsy of the right testicle
9. During hernioplasty in a patient of 20 years, it was found that the contents of the hernial sac is the
testicle. What kind of hernia does the patient have?
*Congenital indirect inguinal hernia
Direct inguinal hernia
Obtained indirect inguinal hernia
Femoral hernia
Hernia of obturatorious canal

10. Patient previously had laparoscopic cholecystectomy. Patient with obesity degree III. After the
operation she gained another 15 kg. In paraumbillical area nearr surgical scar appeared painful
protrusion, 6x11 cm, soft-elastic consistency, increasing with straining and coughing. In the prone
position, formation disappears. Formulate a preliminary diagnosis.
*Postoperative ventral hernia
Abdominal cavity tumor
Diastase of rectus abdominal muscles
The preperitoneal lipoma
Cirrhosis of the liver, ascites

11. The patient complains of the presence of a tumor-like formation in the navel, periodic pain in it
under stress. In the navel region there is a tumor-shaped formation up to 4 cm in diameter, of an elastic
consistency, painless at the time of examination. In the abdominal wall in the projection of the navel, a
rounded defect of annular shape up to 3 cm in diameter. When coughing, the formation of the
abdominal wall increases in size. What is the preliminary diagnosis?
*Repaired umbilical hernia
Lipoma of anterior abdominal wall
Paraumbilical Repetitive Hernia
Hernia of the white line of the abdomen
Preperitoneal lipoma

12. The patient complains of a sudden pain in the area of hernial protrusion in the right inguinal and
scrotal area. The appearance of pain is associated with the lifting of the weight. In the right inguinal
area, a hernial protrusion is defined up to 8 cm in diameter, the lower pole of which lies in the scrotum.
At palpation: the formation is sharply painful, strained, the skin over it is not changed, the symptom of
coughing is negative. What is the preliminary diagnosis?
*Strangulated inguinal hernia on the right
Irreachable inguinal and scrotal hernia
Slipping hernia of the bladder
Dropsy of testicles
Acute orchoepididymitis to the right

Intestinal obstruction. Diseases of the small and large

intestine. Surgery in coloproctology.
1. A patient, 70 years old, complains of a delay in feces, discharge with feces of blood, weight loss.
Periodically observed withdrawal of liquid feces, gas retention, flatulence. These symptoms pass after
the siphon enema. Sick for 10 months. Which the most likely diagnosis?
*Cancer of the large intestine. Chronic intestinal obstruction
Chronic pancreatitis
Idiopathic colostasis
Chronic colitis
Chronic hemorrhoids

2. Patient , 40 L., Complains of cramping abdominal pain, nausea, vomiting, bloating, difficulty in
removing gases, lack of feces. Earlier, she was operated on for destructive appendicitis, an ectopic
pregnancy. Palpable abdomen is painful in all departments, tense. The noise of splashing is determined,
indistinct symptoms of irritation of the peritoneum. What is the diagnosis?
*Adhesive intestinal obstruction
General peritonitis
Diverticular colitis
Cancer of the large intestine
Stomach ulcer

3. A patient of 38 L., Complains of a frequent feces (up to 4 times), with impurities of blood and mucus,
cramping pain in the course of the colon. Objectively: reduced nutrition, severe palpable tenderness in
the sigmoid colon. Er-3,2х1012 / l, HB-100 g / L, ESR-28 mm / h, total protein - 65 g / l, colonoscopy -
diffuse hyperemia of the mucous membrane, erosion, individual superficial ulcers. What is the most
probable?
*Nonspecific ulcerative colitis
Crohn's disease
Dysentery
Chronic dyskinetic colitis
Intestinal Tumor

4. The patient is 60 years old. For 10 years has chronic gastroduodenitis. In the last 1.5 years, blood
stains on feces and toilet paper periodically appeared. What instrumental research needs to be done
regularly for a patient to diagnose cancer early?
*Colonoscopy of the large intestine
Recto-manoscopy, colonophibroscopy
CT of abdominal cavity organs
Response to screened blood in feces
Biopsy of the mucosa

5. The patient is 56 y.o. Complains of paroxysmal pain in the abdomen, unrestrained vomiting. Sick for
12 hours. for no apparent reason. In an anamnesis 3 years ago, surgery for perforated gastric ulcer. The
tongue is dry. The abdomen is asymmetric, defined visible peristalsis of the gut. Palpatory abdomen is
soft, painful in the upper half. Symptoms of irritation of the peritoneum are negative. with auscultation
of peristalsis reinforced, dzvinka. What is the most likely diagnosis?
*Acute gastrointestinal obstruction
Disease of the operated stomach
Aggravated peptic ulcer disease
Acute pancreatitis
Repeated perforation of the ulcer
KROK 2

6. The patient is 67 years old with complaints of cramping pain in the left side of the abdomen, nausea,
stool and gas retention. Sick for 6 months, the condition worsened for the last 3 days. There were no
operations. Over the past 2 years, constipation, an admixture of mucus and blood in the feces, has lost
10 kg. Pulse 84 in 1 min. The tongue is moderately moist. The abdomen is sharply inflated with
asymmetry due to an increase in the left half. The noise of the splinters is determined. Peristaltic noise is
periodically amplified. On a survey radiograph of the abdominal organs of the Bowlboy Bowl in the left
side of the abdomen with a swollen loop of the colon above them. Rectal is a symptom of the Obukhov
hospital. The most likely diagnosis?
*Obturative intestinal obstruction
Sigmoidal curvature
Thrombosis of mesenteric vessels
Nonspecific ulcerative colitis
Adhesive obstruction of the intestine

7. A 37 year old patient for 5 years is concerned with abdominal pain, frequent [up to 10-12 times a day]
a stool with mucus and blood components, general weakness, weight loss. 4 hours ago there was a
sharp abdominal pain that in a half an hour somewhat decreased and concentrated in the left half of the
abdomen. The skin is pale. Temperature 37.7оС, РС 110 avd. per minute. AT 110/60 mm Hg. Art. The
tongue is dry. The lower part of the abdomen lags in the act of breathing. Palpation of the abdomen
shows pain and tension of the muscles in the left abdomen, where the positive symptom of Blumberg-
Shchetkin is determined. What is the previous diagnosis?
*Perforation of the large intestine
Perforated ulcer of the stomach
Thromboembolism of the mesenterial vessels
Acute pancreatitis
Sigmoidal curvature

8. Patient 47 years old, hospitalized in the surgical department with complaints of pain in the abdomen
of a spastic nature, nausea, repeated vomiting, dry mouth. Sick for 16 hours. In the history -
cholecystectomy 2 years ago. Similar complaints appeared after consuming legumes. Objectively: the
abdomen is moderately swollen, painful. Auscultatory: intestinal noises are strengthened. Symptom
Shchetkin-Blumberg negative. Gases retreat, stool retention. With the radiography of the abdominal
cavity, "arches" and "cups of Klauber" were found. Which diagnosis is most likely in a patient?

*"Acute adhesive small bowel obstruction"

Obstructive colonic obstruction
Acute pancreatitis
Food poisoning
Renal colic

9. The patient, 71 years old, suffers from constipation for many years." 3 days ago, after reception of
laxative medicines there were growing pains in a stomach, a nausea, no feces was. At survey of
integuments pale, gray. Pulse 104 beats. / Min., Arrhythmic, AD-90/60 mmHg, tongue dry. The abdomen
is swollen, painful when palpated over the entire surface. In the left ileal region, a still, dense infiltrate is
palpated. The ampulla of the rectum is empty, the anal sphincter is atonic. On the survey radiography of
the abdomen, multiple levels of fluid in the small and large intestine. Most likely, the patient has:
*Tumor of the large intestine
Hypomotoric dyskinesia of the intestine with coprostasis
Complications of chronic ulcerative colitis
Sigmoidal curvature
Injury of the intestine in the inguinal canal

10. A 33-year-old patient complains of dull pains in the rectum, which are amplified by the act of
defecation. Sick for 4 days. The body temperature is $ 37.8 ^ 0С $. When finger examination of the
rectum, at a depth of 6-7 cm, a painful seal is palpable along the right lateral wall, 3x4 cm in size, in the
center of which fluctuation is determined. Lake. blood 11.4x109 / l, stab neutrophils 8 \%. What is the
most likely diagnosis?
*Acute submucosal paraproctitis
Acute subcutaneous paraproctitis
Chronic transsynchronous fistula
Acute internal hemorrhoids
Rectum polyp

11. The patient, hospitalized with a diagnosis of intestinal obstruction, indicates a weight loss (12 kg in 2
months), weakness, periodic blood in the stool. What cause of obstruction should the surgeon think?
*Intestinal Tumor
Cluster invasion
Adhesive disease of the intestine
Nonspecific ulcerative colitis
Coprolits

12. The patient complains of the presence of protrusions in the anus that appear with minimal physical
exertion and require correction. When the anoscope is viewed above the comb line at 3, 7, 11 h, bluish
protrusions are visualized, measuring 1 to 2 cm. What is the diagnosis?
*Internal hemorrhoids
Acute paraproctitis
External hemorrhoids
Acute thrombosis of hemorrhoidal veins

Anal fissure

13. The 43-year-old was hospitalized with complaints of repeated vomiting, abdominal pain, gas and
stool retention. In the anamnesis: apentectomy. State of moderate severity. Skin has usual color. Pulse-
106 / min, BP-115/85 mmHg. The tongue is dry. The abdomen is moderately inflated, asymmetric.
Peristalsis reinforced. Percutaneous: high tympanitis above the swollen abdomen. Symptoms of
irritation of the peritoneum are absent. What is the most likely diagnosis?
*Acute intestinal obstruction
Hepatic colic
Acute pancreatitis
Renal colic
Food poisoning
14. The patient, 45 years and, for the past 5 months has delayed feces (constipation, diarrhea), mucus
discharge from the feces mixed with blood, lost weight at 20 kg. There are no nausea and vomiting.
What research should be performed first and foremost to diagnose?
*Finger rectal examination
Fibrocolonoscopy
R-scopy of the gastrointestinal tract
Irrigoscopy
Sigmoidoscopy

15. The 39-year-old patient complained of constipation after a hemorrhoidectomy surgery for Milligan-
Morgan on the 25th day. What is the cause of constipation?
*Postoperative stricture of the anal canal
Recurrence of hemorrhoids
Spasm of anal sphincter
Proctogenic colostasis
Paraproctitis

16. The proctologic department received a 28-year-old patient with complaints of pain in the anus area,
which increases during and after the bowel movement, and admixture of blood in the feces for 15 days.
During rectal examination, a defect was detected with depth to the submucosal layer at 6 o'clock on the
dial, covered with gray layers, painful with palpation. Set up a preliminary diagnosis:
*Anal fissure
Rectal prolapse
Acute hemorrhoids
Adenocarcinoma
Procititis
Surgery # 2

17. Patient 28 years diagnosed: non-specific ulcerative colitis, total lesion, activity of the III degree,
severe course. The duration of the disease is more than 15 years. What is the next therapeutic tactic?

Operative treatment
Continuation of medication therapy
Connection of hormone therapy
The use of immunosuppressors
X-ray therapy

18. A patient R. 52 years old was hospitalized in a clinic in a bad condition with complaints of pain in the
abdominal cavity, weakness, dizziness. One hour ago he was hit by a horse hoof in the left half of the
abdomen, he did not lose consciousness. Pallor of the skin and mucous membranes is noted. Pulse 120
az. per min., at. 80 mm by 40 mm Hg Belly palpation is tense, painful to the left of the navel. The
symptom of Shchotkin-Blumberg is positive. Urine without changes. Total blood count: er-2,8x1012 / l,
Nb-90 g / l. What damage should be considered in the first place?
*Rupture of the spleen. Internal bleeding
Subcapsular spleen rupture
Rupture of the large intestine. fecal peritonitis
Kidney damage
Closed injury of abdominal cavity without damage to internal organs

19. The patient, 42 years old, suffered a polytrauma as a result of an accident: closed fractures of the
right humerus and bones of the left forearm with the displacement of the chips, closed blunt abdominal
trauma. Delivered to the office 30 minutes after the injury. Leather covers are pale. Arterial pressure
90/20 mm Hg. Art., in places of fracture deformation, pain. The abdomen is tense, with palpation a
sharp pain, a positive symptom of Shchotkin-Blumberg. What treatment should be the first?
*Urgent laparotomy
Infusion therapy to stabilize blood pressure
Imposition of immobilization on fractures, anesthesia
Blockade of fractures by local anesthetic
Additional examination to determine the exact diagnosis

20. Patient M., 47 years old, complains about pain in the left half of the chest, difficulty breathing,
nausea, cramping abdominal pains, vomiting and difficulty getting left gases Complaints arose a few
hours ago after falling from a height of 6 meters. What should the patient have to be screened?
*Observation radiography of the chest and abdomen
Laparoscopy
Toracoscopy
Roentgenoscopy of the gastrointestinal tract
Irishoscopy

21. The patient 32 years at work received a slaughter of the anterior abdominal wall, falling from
increase. After 4 days, lifting the load, he felt a sharp pain in the left hypochondrium, dizziness.
Objectively: the skin is pale; pulse 110 / min .; AT - 90/50 mm Hg; tongue dry, clean; stomach bloated,
palpated soft, resistant to the left hypochondria percussion on the intestine of tympanitis, in the
projection of both flanks - dull sound; auscultatory - weakening of the peristalsis; signs of peritoneal
irritation - slightly positive. What damage is most likely in this case?
*Two-stage rupture of the spleen
Liver rupture
Breaking the left kidney
Breaking the tail of the pancreas
Rupture of the colon

22. During the surgery for acute intestinal obstruction, it was revealed that at a distance of 1 m from the
Treytic ligament the intestine is over-stretched with a cord-like spike. After disconnection of the latter, a
strangulation furrow of black-cyan color, up to 5 mm in width, was found. After the introduction of
mesocarcinum novocaine with heparin, the furrow color did not change. Oral sections of the intestine
are swollen up to 5 cm in diameter, the aboral department is not changed. In the abdominal cavity 100-
150 ml of transparent liquid without odor. Choose the most correct amount of operation
*Bowel resection by the rule of Kocher
Bowel resection with ostomy excretion
Repeated administration of Novocaine and a probe into the intestine
Imposing of bypass anastomosis
Resection of the altered bowel site

23. The patient complains of severe pain in the upper abdomen, repeated vomiting. Sick for 24 hours.
The disease is associated with the use of fatty foods. 7 months ago, he underwent surgery for a stomach
resection for a peptic ulcer. Objectively: pulse 120ud / min, tongue dry. The abdomen is taken up in the
upper parts, painful near the navel. At auscultation the peristalsis is strengthened. When survey
radiography of the abdominal cavity revealed: swollen loops of the small intestine, separate bowl of
Kloyber, poststenotic collapse of the bowel (the absence of gas in the large and small intestine). What is
the most likely diagnosis?
*Acute intestinal obstruction
Acute pancreatitis
Acute pancreatitis
Perforated ulcer
Peptic ulcer gastroenteroanastomosis

24. The patient complains of severe pain in the left abdominal dust, gas stasis and stomach cramps. Ill 12
hours. Objectively: the stomach is asymmetric by protrusion in the upper half, palpation is mild,
moderately painful in the left half. Intestinal perestalia is enhanced. When you try to clean the enema,
the water returns quickly in the opposite direction. What is the most likely diagnosis?
*Inversion of the sigmoid colon
Mild congestion
Tumor of the rectum, complicated by intestinal obstruction
Acute pancreatitis
Fill the small intestine

25. A patient with acute transmural myocardial infarction is concerned about abdominal pain, gas
retention. Objectively: the tongue is dry, the stomach is swollen. With palpation moderately painful in
all departments. Symptoms of irritation of the peritoneum are negative. Percutally revealed tympanitis,
hepatic deafness preserved. Peristalsis of the intestine is not bugged. What complication developed in
the patient?
*Paralytic intestinal obstruction
Perforation of acute "medicamentous" ulcers
Acute pancreatitis
Mechanical intestinal obstruction
Acute cholecystitis

26. "The patient complains of severe abdominal pain, vomiting. Objective: tongue dry, stomach blown,
palpation resistant, painful. Peristalsis of the intestine is intensified, a call. What kind of surveys should
be used in the first place?"
*X-ray of the abdominal cavity, biochemical blood test, coagulogram
Ultrasound, general tests of blood, urine, coagulogram
Irioscopy, general biochemical analysis of blood, urine, coagulogram
Colonoscopy, general biochemical analysis of blood, urine, coagulogram
X-ray of the stomach, general biochemical analysis of blood, urine, coagulogram

27. The patient complains of swollen abdominal pain, vomiting, gas retention and stomach cramps. Ill 3
days. Objective: tongue dry, stomach blown, palpation resistant, painful. Positive symptoms of
peritoneal irritation. Peristalsis of the intestine is not obeyed. In the review radiography of the stomach,
a bowl of Cloyber was found. Lecocytes 15,8 * 109, rod-core neutrophils-11%, urea-10,5 mmol / liter.
Choose the best curative tactics
Emergency operation
Operation in the absence of the effect of conservative therapy
Dynamic observation, the choice of the method of treatment according to its results
Conservative treatment
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