Acute appendicitis

1.CS Select the most suggestive sign in the diagnosis of acute appendicitis:
A. The Dieulafoy triad
B. The Kocher sign
C. The Bartomier-Michelson sign
D. The Sitkovsky sign
E. The Blumberg sign
2. CS Which layer of appendiceal wall contains a large number of lymphatic follicles, the reason
why the appendix is called “abdominal tonsil”:
A. The mucosal layer
B. The submucosal layer
C. The muscular layer
D. The serous layer
E. All answers are correct.
3. CS Select the correct answer regarding the treatment of appendiceal mass (infiltrate) in the
stage of infiltration:
A. Conservative
B. Surgical
C. Medical-surgical
D. Physiotherapy
E. All answers are correct.
4. CS Select the preferred access path for the Douglas pouch abscess:
A. Rectotomy (transrectal)
B. Subumbilical laparotomy
C. Laparotomy in the right iliac fossa
D. Supra- and subumbilical laparotomy
E. Kocher laparotomy
5. CS The Blumberg maneuver in acute appendicitis is described as:
A. Pain caused by palpation in the right iliac fossa
B. Pain in the right iliac fossa at the extension of the body
C. Pain in the right iliac fossa during rectal exam
D. Pain at sudden decompression in the right iliac fossa (rebound tenderness)
E. Pain in the right iliac fossa at palpation with flexion of the right lower limb.
6. CS The Kocher sign for acute appendicitis describes the onset of pain in:
A. The right iliac fossa
B. The epigastrium
C. Over the whole abdominal area
D. The left iliac fossa
E. The hypogastrium
7. CS A tensed, dilated appendix with matte serosa and infiltrated mesentery is consistent with:
A. Catarrhal acute appendicitis
B. Phlegmonous acute appendicitis
C. Chronic appendicitis
D. Gangrenous acute appendicitis
E. Perforated acute appendicitis
8. CS Select the main functional sign in acute appendicitis:
 A. Abdominal pain
B. Loss of appetite
C. Nausea
D. Vomiting
E. Alteration of intestinal transit
9.CS The following statements about the incidence of acute appendicitis are true, EXCEPT:
A. It’s the most common abdominal emergency
B. The incidence is higher in the elderly
C. During puberty and adolescence women appear to be more affected
D. Incidence is lower in newborns and infants
E. The maximum incidence is seen in the first 3 decades of life
10.CS Select the correct statement about the treatment in the stage of infiltration of the
appendiceal mass:
A. Conservative treatment (ice pack, diet, antibiotics, physiotherapy)
B. Surgical treatment in young people
C. Surgical treatment in elderly
D. Surgical treatment when the process is located in the pelvis
E. Surgical treatment if caecum cancer cannot be excluded clinically
11. CM Select the optimal treatment options for the appendiceal mass with confirmed abscess:
A. Conservative therapy, including antibiotics and physiotherapy
B. Extraperitoneal drainage of the abscess (Pirogov incision)
C. Ultrasound/CT guided drainage of the abscess
D. Drainage of the abscess through inferior median laparotomy
E. Drainage of the abscess through McBurney’s oblique incision
12.CM Select the clinical and paraclinical parameters for monitoring of the appendiceal mass
evolution:
A. Thermometry
B. Leukocytosis evolution
C. Dynamic determination of alkaline phosphatase
D. Repeated abdominal ultrasound
E. The evolution of the inflammatory mass dimensions
13. CM Select the clinical features at the onset of acute appendicitis:
A. Fever and vomiting anticipate the abdominal pain
B. Vomiting occurring shortly after abdominal pain onset
C. Nausea appears after abdominal pain
D. Abdominal bloating
E. Diarrhea in some cases
14. CM Select the borders of the Iacobovici triangle:
A. Linia bispinalis
B. The median subumbilical line
C. The external edge of the rectus abdominis muscle
D. The right external third of the linia bispinalis
E. The right spino-umbilical line
15. CM Select the correct statements about acute appendicitis in an inguinal hernial sac:
A. The appendix is detected in the inguinal hernial sac
B. Simulates a strangulated hernia
 C. Is named Littre hernia
D. Can lead to the phlegmon of the hernial sac
E. Is named Amyand hernia
16. CM The appendiceal mass (infiltrate) can be manifested by the following signs:
A. Painless formation in the right iliac fossa
B. Alteration of the general condition accompanied by diarrhea
C. Pain on palpation in the right iliac fossa
D. The presence of fluctuation in the right iliac fossa
E. Painful mass with irregular margins located in the right iliac fossa
17.CM Select the symptoms which correspond to acute appendicitis?
A. Epigastric pain
B. Spontaneous pain and tenderness on palpation in the right iliac fossa
C. Nausea and vomiting
D. Diffuse spastic abdominal pain
E. Repeated diarrhea that ease the condition of the patient
18. CM In confirmed acute appendicitis the following manipulations are required:
A. Laxative medication
B. Enema
C. Broad spectrum antibiotics
D. Surgical intervention
E. Laparoscopic appendectomy
19. CM Generalized peritonitis of appendiceal origin is characterized by:
A. Alteration of the general condition
B. Altered bowel habits
C. Fever
D. Leukocytosis 15-20.000
E. Abdominal pain with posterior referral
20. CM Select the clinical signs of acute appendicitis in adults at the onset of the disease:
A. Pain in the right iliac fossa
B. Early inappetence
C. Fever > 39°C
D. Dry tongue with white deposits
E. Arrest of bowel transit
21. CM Choose the possible evolution variants of the appendiceal mass (infiltrate):
A. Double stage generalized peritonitis
B. Favorable after medical treatment
C. Abscess formation
D. Always regresses spontaneously
E. Fistulization
22. CM Select the morphopathological variants of acute appendicitis:
A. Catarrhal
B. Toxic
C. Gangrenous
D. Phlegmonous
E. Cystic
23. CM Acute appendicitis in children should be differentiated with:
 A. Acute gastroenteritis
B. Mesenteric lymhadenitis
C. Intestinal intussusception
D. Omphalocele
E. Urinary infection
24. CM Select the position variants of the vermiform appendix:
A. Retrocaecal
B. Mesoceliac
C. Retrogastric
D. Pelvic
E. Juxta pancreatic
25. CM Select the clinical signs of the appendiceal mass in the infiltration phase:
A. Leukocytosis
B. Painful mass with diffuse margins that appears 3-5 days after the onset of the
disease
C. Positive Blumberg sign in the right iliac fossa
D. Fluctuation in the right iliac fossa
E. Fever

Appendicitis (answers)
1. A 21. A,B,C,E
2. B 22. A,C,D
3. A 23. A,B,C,E
4. A 24. A,B,D
5. D 25. B,C,E
6. B
7. B
8. A
9. B
10. A
11. A,B,C
12. A,B,D,E
13. B,C,D,E
14. A,C,E
15. A,B,D,E
16. C,E
17. A,B,C
18. C,D,E
19. A,B,C,D
20. A,B,D
 Hernia

1. CS Which of following statements fits direct inguinal hernia:

A. It never descends to the scrotum

B. It is congenital

C. It's more often unilateral

D. It strangulates frequently

E. It is an effort hernia

2. CS The strangulation of Meckel`s diverticulum is named hernia:

A. Riсhter
B. Maydl
C. Littre
D. Hesselbach
E. Broсk
3. CS The posterior wall of the inguinal canal is represented by:
A. Transversalis fascia
B. Internal oblique muscle
C. Conjoint tendon
D. Arcada cruralis
E. External oblique muscle
4. CS Hernia with parietal antimesenteric strangulation is named:
A. Broсk
B. Hesselbach
C. Maydl
D. Riсhter
E. Littre

5. CS In case of typical femoral hernia, the neck of the hernial sac is situated
A. Anterior to the arcada cruralis
B. Medial to the femoral vessels
C. Lateral to the femoral vessels
D. Posterior to the femoral vessels
E. Medial to the Cooper ligament

6. CS Select the hernia in which the hernial sac is missing:

A. Congenital inguinal hernia
B. Umbilical hernia
C. Sliding inguinal hernia
D. Perineal hernia
E. Post-traumatic diaphragmal hernia
7. CS Which procedures of plasty provides for reinforcement of the posterior wall of the
 inguinal canal in case of femoral hernia?
A. Rudji
B. Postempsky
C. Rudji-Parlavecchio
D. Lexer
E. Bassini
8. CS The more preferable method of plasty in case of umbilical hernias in children with
herniar ring up to 3 cm is:
A. Mayo
B. Bassini
C. Sapejko
D. Lexer
E. Martynov

9. CS The famous words ` In every case of intestinal occlusion, the herniar gates must be
examined for strangulated hernias` are said by:
A. Iudin
B. Spasokukotsky
C. Kukudjanov
D. Mondor
E. Bassini

10. CS Which wall of the inguinal canal is consolidated by using the Lichtenstein alloplasty
in the treatement of inguinal hernia?:
A. Anterior
B. Posterior
C. Superior
D. Inferior
E. Lateral

11. CM In the ischemic stage of a strangulated hernia the following signs are found:
A. Cyanotic and dilated afferent loop
B. The thrombosis of the mezo veins
C. Thickened wall of the intestine with fake membranes on serous
D. There is a purulent, faecal fluid in the herniar sack
E. Pale efferent ansa

12. СМ The intestinal transit is kept in case of :

A. Littre Hernia
B. Maydl Hernia
C. Broсk Hernia
D. Gheselbah Hernia
E. Riсhter Hernia

13. CM Pseudostrangulation at a herniar carrier is manifested in the following situations:

A. Acute gangrenous cholecystitis with diffuse peritonitis
 B. Pseudotumoral pancreatitis
C. Perforated gastroduodenal ulcer
D. Acute appendicitis with perforation
E. Atypical perforation of duodenal ulcer

14. CM Conservative treatment of the hernia (bandage) is indicated in:

A. In case of categorically refuse of the pacient to surgery
B. In reponible hernia
C. When surgery is contraindicated
D. In irreducible hernia
E. In case of strangulated inguinal hernia in old pacient

15. CM Select the correct afirmations about obliquie inguinal hernia:

A. The herniar sac can extend to the scrotum
B. The sac can extend antero-medial to the spermatic cord
C. The sac is medial to the inferior epigastric vessels
D. The sac can extend lateral to the spermatic cord
E. Direct hernia is more often bilateral than obliquie

16. СМ If at the opening of the the herniar sac we find a loop with changes: dark red,
dilated, with a serous without gloss , with suffusions at the strangulation ditch, we
establish:
A. Congestion stage
B. Ischemic stage
C. Gangrenous stage
D. Perforation stage
E. Reversibility of morphopathological changes

17. СМ Select the correct statements about strangulated hernia

A. All the them stop the intestinal transit
B. The femoral hernia has a higher rate of strangulation than Spiegel hernia
C. The strangulation is absent at children
D. The ischemia is not characteristic for Brock hernia
E. Only the afferent loop is suffering in Maydl hernia

18. CM Select the correct affirmations about left inguinal hernia by cleavage:
A. Herniar gates are big
B. Contains only small bowel
C. The sigmoid colon is a wall of the herniar sac
D. It never strangulates
E. It is accompanied by disturbance of the micturition

19. CM: The main purpose in the surgery of the direct inguinal hernia is the plasty of the
posterior wall of the inguinal canal. More frequiently are used:
A. Bassini
B. Girard-Spasokukotsky
 C. Postempsky
D. Kimbarovsky
E. Martynov

20. CM Indicate the possible complications of the hernia:

A. Coprostase
B. Prostatitis
C. Strangulation
D. Phlegmon of the herniar sack
E. Irreductability

21. CM In strangulated Richter hernia, we establish:

A. Intestinal transit is present
B. Vomiting
C. An irreducible tumor at that level
D. The intestinal transit is stopped
E. Fever on debut

22. CM Which organs herniates more often:

A. Urinary bladder
B. Epiploon
C. The ascendent colon
D. Small bowel
E. Prostate

23. CM The pain in case of reducible hernia is:

A. Painful embarrassment
B. Violent
C. Colicative
D. Is increased by physical effort
E. Can be absent

24. CM Lichtenstein alloplasty is used in the treatment of following hernias:

A. Umbilical
B. Femoral
C. Inguinal
D. Linea alba hernia
E. Posttraumatic diaphragmal hernia

25. CM The internal orifice of the femoral canal is delimited by:

A. Femoral Vein
B. Cooper Ligament
C. Gimbernati Ligament
D. Poupart Ligament
E. Umbilical ligament is medial
Hernia (answers)
1. A 14. A,C
2. C 15. A,D,E
3. A 16. A,E
4. D 17. B,D
5. B 18. A,C
6. E 19. A,C
7. C 20. A,C,D,E
8. D 21. A,C
9. D 22. B,D
10. B 23. A,D,E
11. A,B,C,E 24. B,C
12. A,C,E 25. A,B,C,D
13. A,C,D
 Intestinal Obstrucrion

1. CS Pain in bowel obstruction by strangulation can be:

A. Continuous, strong, dramatic
B. Colicative
C. Just a feeling of weak diffuse pain
D. Intermittent
E. Is not specific

2. CS The Schlange sign in intestinal occlusion is characterize by:

A. The presence of the sloshing above the distended ansa
B. The noise of the drop falling
C. Pronounced timpanism above the asymmetry
D. The presence of the empty and enlarged rectal ampulla
E. The presence of the hyperperistaltism, which can be heared from the distance

3. CS On the debut of the intestinal occlusion, a radiological image with generalized

distension of the intestinal loops, without hydroaeric images is characteristic for :
A. Dynamic intestinal occlusion
B. Sigmoid volvulus
C. Strangulated inguinal hernia
D. Bouveret sindrom
E. The occlusion in caecum cancer

4. CS The Sklearov sign in intestinal occlusion is characterized by:

A. Pronounced timpanism above the asymmetry
B. Elastic resistance of the abdominal wall
C. Asymmetric bloating of the abdomen
F. The presence of the sloshing above the distended ansa
D. The noise of drop falling

5. CS The most common cause of the intestinal occlusion at a laparotomized pacient is:
A. Invagination
B. Bile ileus
C. Adherences
D. Postoperative foreign bodies
E. Postoperative intestinal stenosis

6. CS Which type of dynamic ileus is present in case of vertebral fractures, retroperitoneal

haematomas:
A. Toxic
B. Reflexogen
C. Metabolic
D. Neurogenic
E. Spastic
7. CS After devolvulation of the small intestine the necrosis of a segment of the ileum was
revealed. The limit of resection in cranial direction (afferent loop) will pass the visible mark
of necrosis with:
A. 10 - 15 cm
B. 20 - 30 cm
C. 5 - 10 cm
D. 30 - 40 cm
E. 15 - 20 cm

8. CS The normal intraintestinal pressure is:

A. 2-4 cm H2O
B. 6-8 cm H2O
C. 10-12 cmH2O
D. 14-16 cm H2O
E. 18-20 cmH2O

9. CS Which of the following is the most common cause of the intestinal occlusion in old
people:
A. Faecaloms
B. Left colon neoplasms
C. Invagination
D. Right colon neoplasms
E. Small bowel volvulus

10. CS. The Meckel diverticulum can cause the following type of intestinal occlusion:
A. Dynamic occlusion
B. Sigmoid volvulus
C. Bile ileus
D. Mechanic intestinal occlusion
E. Low intestinal occlusion
11. СМ Clinical signs of the extracellular dehydratation are:
A. Dry and pale skin
B. Dry and sable tongue
C. The thrilling thirst
D. Nausea and vomiting
E. Hypotonia, tachycardia

12. СМ The following events in intestinal occlusion contribute to the formation of the III-rd
pathological fluid sector:
A. Transudation of the fluid into the intestinal lumen above the obstacle
B. Gastric stasis
C. Transudation of fluid in the intestinal wall
D. Excessive absorption into intestinal lumen below the obstacle
E. Transudation of the liquid into the peritoneal cavity

13. СМ The most informative methods of diagnosis in mechanical occlusion of the small
 intestine are:
A. Schwartz test
B. Abdominal ultrasonography
C. Irrigoscopy
D. Laparoscopy
E. Overall abdominal radiography
14. СМ In which type of intestinal occlusion the vascularization of implicated portion is
affected on the debut?
A. Volvulus
B. Invagination
C. intralumenal foreign bodies
D. Strangulation
E. Parietal specific inflammatory lesions

15. CM Being a low intestinal occlusion, sigmoid volvulus:

A. Is frequently preceded by cramps or sub-occlusive crisis
B. Has a suddenly debut with pain in left iliac fose and abdominal distension
C. The intestinal transit is stopped on the debut
D. The radiological image presents an aerial image with a `bicycle tire` aspect
E. Cause frequent vomiting

16. CM Which of following can cause a paralytic ileus?

A. Fitobezoar
B. Nephritic colic
C. Peritonitis
D. Sigmoid volvulus
E. Retroperitoneal abscess

17. CM In the intestinal occlusion the gases accumulate in the intestinal lumen:
A. 70% of the swallowed air
B. 100% from fermentation processes of the microbial flora and biochemical reactions
of the digestive juices
C. 70% from fermentation processes of the microbial flora
D. 30% from biochemical reactions of the digestive juices
E. 30% from fermentation processes of the microbial flora and biochemical reactions of
the digestive juices

18. СМ The gastrointestinal aspiration realised in intestinal occlusion in case of small bowel
resection with termino-terminal anastomosis , pursues several objectives:
A. Improves intestinal microcirculation
B. Prevents anastomosis dehiscence
C. Prevents evisceration
D. Prevents paralytic occlusion
E. Prevents postoperative pancreatitis
19. CM In low intestinal occlusion caused by adenocarcinoma, the radiological image is
represented by:
A. "Niche" aspect
B. Filling defect
C. `Bite apple` aspect
D. The presence of hydroaeric images
E. Stenozation of intestinal lumen
20. CM The positive diagnostic in mechanical intestinal occlusion are based on:
A. Clinical signs
B. Radiological signs
C. Ultrasound signs
D. The pathological history of the patient
E. Mezenteric angiography

21. CM In case of intestinal occlusion, the simple abdominal radiography highlights:

A. Gazeous distension of intestinal loops
B. Hydroaeric images
C. Filling defect
D. Narrowing of the intestinal lumen
E. Semilunar folds

22. CM. Irrigoscopy can take a therapeutic role in case of:

A. Sigmoid cancer
B. Ileocaecal invagination in child
C. Voluminous strangulated inguinoscrotal hernia
D. Sigmoid volvulus
E. Rectal atresia in child
23. CM The clinical diagnostic of precocious high intestinal occlusion is based on:
A. The muscle contracture of the abdominal wall
B. Colicative abdominal pain
C. Nausea and vomiting
D. Positive Blumberg sign
E. Interruption of the intestinal transit from early hours of the disease

24. CM . Select the correct statements for intestinal occlusion caused by colon cancer:
A. The frequency of the right colon cancer is higher than left colon cancer frequency
B. Sudden onset with frequent vomiting
C. The `Gold standart` for the diagnostic is Endoscopic emergency examination.
D. Asymmetric abdominal distension
E. History of weight loss, cramps , diarrhea

25. CM Which of the following affirmations are able to describe the ethiopathogeny of the
intestinal occlusion?
A. Dynamic or functional occlusions have multiple causes that produce the sympathetic-
parasympathetic imbalances
B. Craniocerebral trauma can generate intestinal occlusions
 C. Professional poisoning can generate dynamic intestinal occlusions
D. Extrinsic compression cannot produce intestinal occlusion
E. Occlusions by strangulation also interest vascularization of the affected segment
Intestinal obstruction (answers)
1. A 14. A,B,D
2. E 15. B,C,D
3. A 16. B,C,E
4. D 17. A,E
5. C 18. A,B,D
6. B 19. B,C,D,E
7. D 20. A,B,C,D
8. A 21. A,B,E
9. B 22. B,D
10. D 23. B,C
11. A,B,D,E 24. D,E
12. A,B,C,E 25. A,B,C,E
13. A,E
 Cholelithiasis
1. CS Indicate the clinical sign characteristic for obstructive biliary lithiasis:
A. High fever
B. Vomiting
C. Constipation
D. Jaundice
E. Palpable painful tumor in the right hypochondrium

2. CS Choose the most common cause of jaundice in acute cholecystitis:

A. Viral hepatitis
B. The spasm of the sphincter of Oddi
C. Extendintion the inflammatory process to the main biliary duct
D. Pancreatic edema
E. Primary lithiasis of the common bile duct

3. CS The biliodigestive fistula is the affection characterized by formation of an abnormal

communication between the gallbladder and adjacent organs. The most frequent is affected:
A. The stomach
B. The duodenum
C. The ileum
D. The transverse colon
E. The jejunum

4. CS In acute perforated calculous cholecystitis, the positive symptom is:

A. Bereznigovsky
B. Bartomie-Mihelson
C. Korte
D. Mondor
E. Blumberg

5. CS Which of the complications of biliary lithiasis requires surgical intervention during the
first 2 hours after hospitalization?
A. Lithiasis of the common bile duct
B. Presenc eof fistula that involves the cystic duct and the common bile duct
C. Acute biliary pancreatitis
D. Destructive acute cholecystitis complicated with diffuse peritonitis
E. The mechanical jaundice

6. CS Primary lithiasis of the common bile duct is in consequence of:

A. Migration of stones from the gallbladder into the main biliary duct
B. Formation of a bilio-biliary fistula
C. Stones’ formation within the coledocus
D. Presence of a biliary-digestive fistula
E. Biliary colic (gallbladder attack)
7. CS A 44-year-old patient at the hospitalization presents colicative pain in the right
hypochondrium, fever, jaundice. Total bilirubin is 40 mmol / l. What investigations can guide the
diagnosis?
A. Intravenous colangiography
B. Oral colecistography
C. Abdominal X-ray
D. Liver scintigraphy
E. USG abdominal

8. CS The pathophysiological mechanism of haemolytic jaundice is:

A. Insufficient erythropoiesis
B. Excessive intra- and extravascular haemolysis
C. Temporar deficiency of liver transferase
D. Neonatal infections
E. Stricture of the intrahepatic bile ducts

9. CS One of the characteristicspresented below does not correspond to chronic sclero-atrophic

cholecystitis:
A. The gallbladder contains bile stasis
B. The stones may not be identified, if there was a passage through the main bile duct
C. There is pericholecystic inflammation
D. The walls contains sclerotic-lipomatous infiltration
E. It is an anatomopathological form

10. CS Select the mechanical complication of biliary lithiasis:

A. Acute cholecystitis
B. Gallbladder hydrops
C. Biliary pancreatitis
D. Stenosis of sphincter ofOdd
E. Cancer of the gallbladder

11. CM Which of the listed methods of investigation are more commonly used to confirm acute
cholecystitis?
A. Abdominal X-ray in vertical position
B. Ultrasound
C. CT scan
D. Scintigraphy of the gallbladder
E. Laparoscopy

12. CM Which are the indications for intraoperative cholangiography during the surgery for
acute cholecystitis:
A. Big stones inside the gallbladder
B. Lithiasis of the common bile duct
C. Dilatation of the bile ducts
D. Angina pectoris
E. Jaundice in anamnesis
13. CM Among the conditions listed below, choose those which increase the risk of
intraoperative lesions of the bile ducts:
A. Massive intraoperative haemorrhage
B. Variations and anomalies in the anatomical structure of the bile ducts
C. Maneuvers in pathologically modified tissues
D. Traction of the gllbladder while ligation of the cystic duct, instrumental investigation of the
bile ducts
E. Jaundice in anamnesis

14. CM What are the consequences of iatrogenic lesions of bile ducts, which are not observed
during the surgery?
A. Intra-abdominal septic process
B. External biliary fistulae
C. Impermeability of bile ducts
D. Supurative cholangitis
E. Internal hernias

15.CM The dyspeptic form of gallstones is characterized by:

A. Nausea
B. Flatulence after eating
C. Jaundice
D. Motility disorder
E. Colicative pain

16. CM Select clinical suggestive signs for identification of acute cholecystitis?

A. Pain in right hypochondrium
B. Fever
C. Contracture before biliary attack
D. Diarrhea
E. Jaundice

17. CM Which affirmations about the gallstone ileus are correct?

A. The clinical manifestation by high intestinal obstruction, the obstacle being more often
situated at the level of the terminal ileum
B. The gallstones with a minimum diameter of 3-4 cm, leaves the gallbladder passing into the
duodenum
C. By the abdominal x-ray , the presence of air in gallbladder or bile ducts is highlighted
D. By X-ray ansa santinelă is highlighted
E. It is accompanied by the contraction abdominal muscle

18. CM In the etiopathogenesis of gallstones, the following factors are involved:

A. Excess of cholesterol in the composition of the bile
B. Decreased concentration of bile acids and lecithin in the bile
C. The gallbladder incapacity to evacuate its content effectively
D. Presence of precipitation nuclei (epithelium, leukocytes, germs)
E. Involvement of testosterone

19. CM Biliary colic, or gallstone attack, has the following characteristics:

A. It is accompanied by violent pain with exacerbations with the background of a permanent
painful syndrome
B. The pain is located within the right hypochondrium with irradiation in epigastrium
C. Nausea and vomiting are excluded
D. The pain site is in the epigastrum with posterior irradiation
E. It is caused by tetaniform contraction of the smooth muscles of gallbladder

20.CM The clinical signs of acute cholecystitis in the elderly populations are characterized by
the following features:
A. Regression of the symptoms just by indication of drug treatment
B. Local non-significant pain with the prevalence of intoxication symptoms
C. Moderate fever in destructive forms
D. Unclear symptoms of peritoneal irritation in association with complications
E. Diarrhea

21. CM Intraoperative colangiography allows:

A. To assess the presence and to identify the position of the stones within the bile ducts
B. To identify the communication of the gall bladder with adjacent organs
C. To identify the communication of gallbladder with the main bile duct (the common hepatic
duct + common bile duct)
D. To evluate the permeability of the distal portion of the common bile duct
E. To solutionate the spasms of bile ducts

22. CM The Mirizzi syndrome is:

A. Communication of the gallbladder with the common hepatic duct
B. Communication of the gallbladder with the right hepatic duct
C. Communication of the gallbladder with the common bile duct
D. Communication the gallblader with the duodenum
E. Communication of the gallbldder with the transverse colon

23. CM Retrospective endoscopic colangiopancreatography is indicated in:

A. Acute calculous cholecystitis without jaundice
B. Dilatation of the common bile duct with transitionary jaundice
C. Jaundice in anamnesis
D. Suspect lithiasis of the common bile duct
E. Cholangitis

24. CM The decompression of the bile ducts in case of mechanical jaundice can be performed
by:
A. Endoscopic papillosphincterotomy
B. Cholecystectomy
C. Colecistectomy with drainage of the bile ducts
D. Percutaneous transhepatic drainage (PTD) drainage of the bile ducts
E. Endoscopic biliary drainage by nasobiliary drain

25. CM Small stones can cause the following medical conditions:

A. Acute biliary pancreatitis
B. Transitory mechanical jaundice
C. Biliary colic (gallstone attack)
D. Gallstone ileus
E. Acute colecystitis

Cholelithiasis (answers)
1. E 14. A,B,C,D
2. B 15. A,B,D
3. B 16. A,B
4. E 17. A,B,C
5. D 18. A,B,C,D
6. C 19. A,B,E
7. E 20. B,C,D
8. B 21. A,B,C,D
9. B 22. A,B,C
10. B 23. B,C,D,E
11. B,C,E 24. A,C,D,E
12. B,C,E 25. A,B,C,E
13. B,C,D
 Acute pancreatitis

1. CS Of those listed, the pancreatogenic shock is determined by:

A. Pancreatogenic peritonitis
B. Compression of the distal portion of the coledoc and the appearance of the
cholemy:
C. Fermentative toxemia
D. Biliary hypertension
E. Dynamic intestinal ileus

2. CS In the diagnosis of pancreonecrosis, the most informative instrumental diagnosis method

will be:
A. Termography
B. Superior digestive endoscopy
C. Urine Amylase
D. Blood Amylase
E. Diagnostic laparoscopy
3. CS Select the sign that is NOT characteristic of acute pancreatitis:
A. „Transversal” pain
B. Incoercible vomiting
C. Hypertension during the first few hours of the debut of the disease
D. Collapse
E. Tachycardia
4. CS List the complications of acute pancreatitis, except:
A. Abscess of the omental bursa
B. Hepatorenal failure
C. Pancreatic pseudocyst
D. Fermentative peritonitis
E. Colelitiasis
5. CS A patient with a history of pancreonecrosis (6 months ago), was clinically detected a
tumoral formation in the epigastric region and the left hypochondrium of 15x20cm; on
palpation- tought, a little painful, without feverish episodes. At the superior digestive
endoscopy determines the prolapsing of the posterior wall of the stomach, the duodenal
cadran is deformed. Set the diagnosis :
A. Tumor of the transverse colon
B. Tumor of the pancreas
C. Pancreatic pseudocyst
D. Renal polyhistosis
E. Abscess of the omental bursa
6. CS In the evolution of acute pancreatitis the decisive role belongs:
A. Microbial flora
B. Platelet infiltration
C. Fermentative aggression
D. Venous stasis
E. Mesenteric thrombosis
7. CS Cytosteatonecrosis stains are the result of:
 A. Proteolytic necrobiosis of the pacreatocites under the action of trypsin and
hemotrypsin
B. Effect of elastase on venous walls
C. The action of lipolytic ferments on pancreatocites and interstitial adipose tissue
D. Spontaneous reduction of autolithic processes with the involution of microfocal
pancreonecrosis
E. The association of infection with acute interstitial pancreatitis
8. CS FGDS performed in patients with acute pancreatitis reveals:
A. The condition of the Vater papilla
B. Confirmation of acute pancreatitis
C. Localization of the pathological process in the pancreas
D. Spreading the pathological process in the pancreas
E. The type of acute pancreatitis
9. CS The presence of pain on palpation in the region of the left costo-diaphragmatic angle
is the sign:
A. Mayo-Robson
B. Körte
C. Grey-Turner
D. Mondor
E. Voskresensky
10. CS The ecchymosis on the lateral abdominal flanks in acute pancreatitis is characteristic
of the sign:
A. Mayo-Robson
B. Körte
C. Grey-Turner
D. Mondor
E. Voskresensky
11. CS The most informative method of diagnosis in acute pancreatitis is:
A. Diagnostic pneumoperitoneum
B. The abdominal radiography
C. Diagnostic laparoscopy
D. FEGDS
E. Determination urine and blood amylase
12. CS To reduce pain in acute pancreatitis it ism ost effective:
A. Administration of spasmolytics
B. Peridural anesthesia
C. Antibiotic therapy
D. Blockage of the round ligament of the liver
E. Administration i/m or i/v of the sol.Morfini
13. CS In the pathogenesis of acute pancreatitis doesn’t participate the following ferment:
A. Enterokinase
B. Elastase
C. Phospholipase
D. Trypsin
E. Streptokinase
14. CS In the case of pancreatic pseudocyst suppuration it is indicated:
 A. Only antibiotic conservative treatment
B. Non-operative treatment
C. Emergency surgery
D. Dynamic surveillance
E. Physiotherapy
15. CS The most commonly used non-invasive method of diagnosing acute pancreatitis is:
A. Radiography of the abdomen
B. Abdominal USG
C. General blood analysis
D. Diagnostic laparoscopy
E. Abdominal CT
16. CM Select the clinical manifestations of acute pancreatitis:
A. Increase the blood pressure
B. Multiple vomiting
C. The symptom Mayo-Robson
D. The symptom Bonde
E. Reduction of intestinal peristalsis
17. CM Indicate curative measures to combat toxemia in pancreonecrosis:
A. Administration i/v of antifermentes
B. Intraaortal administration of cyclophosphine or fluorofur
C. Induction of forced diuresis
D. External draining of the lymphatic chest
E. Opioid administration
18. CM A 24-year-old patient who became ill 12 hours ago was diagnosed with
pancreonecrosis. Indicate the medical-surgical measures to be performed:
A. Emergency laparotomy
B. Diagnostic laparoscopy with peritoneal cavity drainage
C. Nasogastric decompression
D. Laparoscopic cholecystectomy at the presence of biliary lithiasis
E. Volumic replenishment
19. CM The following forms are included in the classification of acute pancreatitis
according to V.Filin:
A. Chronic pseudotumoral pancreatitis
B. Interstitial acute pancreatitis
C. Lipid pancreonecrosis
D. Acute infectious-necrotic pancreatitis
E. Acute haemorrhagic pancreatitis
20. CM The basic principles in the pathogenetic treatment of acute pancreatitis are:
A. Suppression of the pancreas excretory function
B. Volemic replenishment
C. Inactivation of pancreatic ferments
D. Decreased gastric secretion
E. Activation of intestinal peristalsis
21. CM In acute interstitial pancreatitis, the following clinical manifestations can be
determined:
A. Repeated vome
B. Abdominal muscular contract
C. Movable dullness on the sides of the abdomen
D. Colic pain located in the epigastrum
E. Hectic fever in the early hours
22. CM List the most informative positive diagnosis methods in acute pancreatitis:
A. Radiography of the abdomen
B. Celiacography
C. Abdominal CT
D. Diagnostic laparoscopy
E. Gastric pH measurement
23. CM Describe the curative procedures necessary to combat toxemia in
pancreonecrosis:
A. Administration of antifermentes
B. Laparoscopic drainage of the peritoneal cavity
C. Forced diuresis
D. Proton pump inhibitors
E. Laparoscopic cholecistotomy
24. CM In acute pancreatitis the following biochemical changes of blood are
determined:
A. Hypolipidemia
B. Hyperazotaemia
C. Hypocalcaemia
D. Hypercalcaemia
E. Hypoprothrombinemia
25. CM List the characteristics of pancreatic abscess:
A. Hectic fever
B. Infiltration in the epigastric region
C. Jaundice
D. Hyperamylasemia
E. Dilatation of the coledoc to the abdominal USG

26. CM Listthe complication characteristic of pancreonecrosis:

A. Pancreatic abscess
B. Pancreatic pseudocyst
C. Retroperitoneal phlegmon
D. Esophageal stenosis
E. Pancreatic fistula
27. CM List the indications for laparotomy in acute pancreatitis:
A. Fermentative peritonitis
B. Purulent peritonitis
C. Aseptic pancreonecrosis
D. Septic pancreonecrosis
E. Pancreatogenic shock
28. CM Retrospective endoscopic colangiopancreatography in a patient with acute
pancreatitis is indicated in the following cases:
A. Biliary pancreatitis
B. Dilatation of the coledoc on the ultrasonic examination
C. Growth of the liver cytolysis fermentations more than 3 times
D. Increase of alkaline phosphatase
E. It is obligatory in all cases
29. CM Describe the characteristics of algic syndrome in acute pancreatitis:
A. Localization of the pain in epigastrium
B. The pain is colicative
C. Iradiation of cranial pain
D. The presence of the pain „in the belt”
E. Iradiation of caudal pain
30. CM Which data can be found in abdominal USG in a patient with acute debut
pancreatitis:
A. Intrapancreatic necrosis zones
B. Retroperitoneal collections
C. Irrelevant examination duet o intestinal meteorism
D. Pancreas without modification
E. Free intraperitoneal fluid
31. CM List the indications to spiral CT in acute pancreatitis:
A.The appearance of complications
B.Absence of therapeutic response after 72 hours
C.Ranson score below 3
D.Clinical diagnostic uncertainty in the first 72 hours
E.Hyperamylasemia and signs of severe acute pancreatitis

32. CM Select the afirmations about postnecrotic pancreatic cyst:

A.Represent intra- or extrapancreatic fluid collection
B.Has its own walls with cylindrical epithelium
C.Represent a collection of pancreatic juice, necrotic squabs, blood and lymph
D.The most common localization is in the pancreas isthmus and body
E.The election localization is the omental bursa or retroperitoneal space

33. CM List the criteria under which the diagnosis of acute pancreatitis is established:
A.Amylasemia is the definite diagnostic criterion
B.Abdominal pain with acute, severe and persistent debut with epigastric localization
C.Characteristic appearacnce of acute pancreatitis at the CT with contrast, MRI or
abdominal ultrasound
D.Activity of serum lipase (or amylase) greater than three times the maximum normal
value
E.Slow, progressive, severe and persistent slow debut of abdominal pain with epigastric
localization

34. CM List possible variants of pancreatic plastron evolution:

A. Forming a pancreatic pseudocyst
B. Eruption of the plastron into the peritoneal cavity
C. Gradual reabsorption of infiltration for 1-3 months
D. Malignancy of plastron
E. Suppuration of plastron with the development of purulent pancreatitis and
parapancreatitis

35.CM List the characteristics of fermentative peritonitis in acute pancreatitis:

A. Peritoneal fluid contains high levels of pancreatic enzymes
B. Peritonitis is aseptic
C. Requires laparotomy with the repair of the peritoneal cavity
D. It develops in the late stages of the disease
E. Requires laparoscopic peritoneal lavage

Acute pancreatitis (answers)

1. C 19. B,D
2. E 20. A,B,C,D
3. C 21. A,B,C
4. E 22. C,D
5. C 23. A,B,C
6. C 24. B,C
7. C 25. A,B
8. A 26. A,B,C,E
9. A 27. B,D
10. C 28. A,B
11. C 29. A,D
12. B 30. C,D,E
13. E 31. A,B,D,E
14. C 32. A,C,D,E,
15. B 33. B,C,D
16. B,C,D,E 34. A,B,C,E
17. A,B,C,D 35. A,B,E
18. C,D,E
 Peptic ulcer
1. CS. Select the area where Brunner secreting mucus cells are located:

A. Gastric cardia
B. The duodenal bulb with descending side of the duodenum
C. The fundus of the stomach
D. The horizontal and ascending part of the duodenum
E. The antral part of the stomach

2. CS Alegeţi factorul patogenetic, dezechilibrul căruia determină apariţia ulcerului gastric

Select the pathogenetic factor, which imbalance will determine the occurrence of gastric
ulcer:

A. Secretory factor
B. Alimentary factor
C. Neuro-psyhiatric factori
D. Protective factor
E. Hereditary factor
3. CS Select the useful diagnostic test in monitoring of anti-Helicobacter pylori therapy:

A. Detection of urease
B. Biopsy
C. Histology
D. Bacteriology
E. Serology
4. CS Indicate the diagnostic method used to detect the source of upper digestive
haemorrhage:

A. Radioisotop scanning
B. Ultrasound
C. The barium examination of the gastrointestinal tract
D. Fibroesophagogastroduodenoscopy
E. Selective angiography
5. CS Select the period of perforated ulcer characterized by the following clinical
signs: vomiting, accelerated pulse, superficial breathing, hypotension and lack of
intestinal transit:
A. False improvement
B. Shock
C. Diffuse peritonitis
D. Preperforation period
E. Period of onset of perforation

6. CS Select surgical procedure indicated for perforation of chronic gastric ulcer in 40-60
years old patient admitted within 6 hours from onset:
A. Simple suture of the ulcer
B. Gastric resection (primary partial gastrectomy)
C. Biopsy with ulcer suture Oppel procedure
D. Wedge gastric resection and vagotomy (Cuneiform excision of ulcer and vagotomy)
E. Bilateral truncal vagotomy and simple suture of the ulcer

7. CS Select the dominant clinical sign of the chronic duodenal ulcer:

A. Haematemesis
B. Nausea
C. Vomiting
D. Pain
E. Tenesmus

8. CS Define the Bergman's sign, determined in bleeding peptic ulcer:

A. Decrease of epigastric pain at the beginning of bleeding

B. Microscopic upper bleeding
C. The presence of ulcerogenic adenoma in the pancreas
D. Rectal bleeding
E. Esophageal varices bleeding

9. CS Malignancy of gastroduodenal ulcer more often occurs when it is localized in:

A. The greater curvature of the stomach

B. The duodenal bulb
C. Gastric cardia region
D. The gastric fundus region
E. The lesser curvature of the stomach

10. CS Select the gastric secretion phase appreciated by Hollender test:

A. At night
B. Basal phase
C. Intestinal phase
D. Cephalic phase
E. Hormonal phase

11. CS Select the grade of upper digestive bleeding at loss of 1000-1500 ml of blood (30%
of circulating volume):
A. IV
B. I
C. II
D. III
E. V

12. CS According to Johnson classification the lesser curvature ulcer is classied as:
A. Type IV
B. Type V
C. Type I
D. Type II
E. Type III

13. СS Indicate the most common gastric drainage surgerical procedure associated with
truncal vagotomy in peptic ulcer disease:

A. Judd Pyloroplasty
B. Finney Pyloroplasty
C. Jaboulay Gastroduodenostomy
D. Gastrojejunostomy
E. Heineke-Miculicz Pyloroplasty

14. CS Select the rare complication that occurs in the duodenal ulcer:

A. Malignancy
B. Gastric outlet obstruction
C. Bleeding
D. Penetration
E. Perforation

15. CS Pacient C., 45 year old, with a long history of duodenal ulcer refractory to drug
therapy, and the prevalence of hyperacidity after the Kay test, the specifed operation is:
A. Highly selective vagotomy
B. Truncal vagotomy with ulcer excision and gastric drainage
C. Selective vagotomy with Jaboulay gastroduodenostomy
D. Truncal vagotomy with gastrojejunal anastomosis
E. 2/3 partial gastrectomy ( Gastric resection 2/3)

16. CM Select treatment guidelines for Mallory-Weis's syndrome:

A. Antacid and hemostasis drugs

B. Hormonal therapy (Corticosteroids)
C. Pituitrin
D. Blakemore tube insertion
E. Endoscopic haemostasis

17. CM Select the types of gastric outlet obstruction as result of peptic ulcer disease:

A. Cardiac
B. Mediogastric
C. Pylobulbar
D. Postbulbar
 E. Stenosis in the fundus region

18. CM Select the most common complications in duodenal ulcer:

A. Malignancy
B. Gastric outlet obstruction
C. Bleeding
D. Penetration
E. Perforation

19. CM Select the right statements about upper gastrointestinal bleeding:

A. In the elderly, upper gastrointestinal bleeding stops more easily than in young people
B. It is important to differentiate bleeding from ulcer from bleeding caused by esophageal
varices
C. Waiting for 48 hours to perform medical hemostasis
D. It is operated after 48 hours to reduce mortality
E. The hemorrhage source is located up to Treitz

20. CM Select the features of Zollinger-Ellison Syndrome:

A. Increase of basal nocturnal secretion

B. Constipation
C. Frequent and acid vomiting
D. Frequent upper gastrointestinal bleeding
E. Intensive, continuous epigastric pain with nocturnal crisis

21. CM Select types of atypical ulcer perforation:

A. Sealed (Covered)
B. Blind perforation
C. Perforation of the posterior duodenal wall
D. Perforation of the cardiac part of the stomach
E. In the free peritoneum

22. MC Select clinical conditions that are radiologically manifested by

pneumoperitoneum:

A. Perforation of the abdominal part of esophagus

B. Perforated gastroduodenal ulcer
C. Intestinal perforation
D. Perforation of the gallbladder
E. Perforation of the urinary bladder

23. MC The clinical features (signs) of the perforated duodenal ulcer in the third phase of
evolution is dominated by:
A. „board like” abdomen
B. Abdominal distension
C. Upper digestive haemorrhage
D. Septic shock
E. Pain in the right hypochondrium

24. MC Specify the diseases that can cause the appearance of stress ulcer:

A. Extensive burns
B. Pulmonary fibrosis
C. Severe polytrauma
D. Chronic ingestion of aspirin
E. Sepsis

25. MC Select the components of Darrow's syndrome, characteristic for gastric outlet
obstruction:

A. Hypochloraemia
B. Hypokalemia
C. Hyperkalaemia
D. Hyperazotaemia
E. Metabolic Alkalosis

26. MC Select the components of the Mondor's triad, characteristic of the perforated ulcer:

A. Violent epigastric pain

B. Tenderness of the abdominal wall
C. Hyperesthesia of skin
D. Pneumoperitoneum
E. History of peptic ulcer disease

27. MC Specify the signs that can be detected in the perforated ulcer during percussion of
the abdomen:

A. disappearance of hepatic dullness

B. Celaditi's sing
C. appearance of dullness in the right parietal-colic space
D. Mandel's sing
E. Blooping in the epigastric region

28. MC The presence of subdiaphragmatic free air on an abdominal radiography is

characteristic of:
 A. Perforated gastric ulcer
B. Biliary ileus
C. Intestinal obstruction caused by adherent
D. Acute cholecystitis with perforation
E. Perforated duodenal ulcer

29. MC Select methods of endoscopic hemostasis used in upper digestive bleeding:

A. Electro-, thermo- or photocoagulation of hemorrhagic ulcers

B. Local injection of alcohol and thrombin
C. Sclerotization
D. Elastic bands ligation
E. Applying hemostatic clips

30. MC Specify the correct statements about the treatment of peptic ulcer disease
with proton pump inhibitors:
A. It acts by inhibiting ATPase H + / K +
B. Аppointed daily at 18.00
C. The standard dose of lansoprazole is 30 mg / day for 4-8 weeks
D. The serum level of gastrin normalized 2 months after cessation of treatment
E. Hyperplasia of enterocromofon cells of the gastric mucosa in humans after the
introduction of lansoprazole was not observed.

31. MC Specify in what cases the perforated ulcer suturing is prescribed:

A. Perforated ulcer in young people

B. Chronic gastric ulcer
C. Аcute ulcer with severe co-morbidity in the elderly
D. Chronic ulcer with peritonitis 24 hours (chronic perforating ulcer complicated by
peritonitis over 24 hours)
E. "Kissing" duodenal ulcers

32. MC A stomach ulcer such as Johnson III has the following characteristics:

A. Hypersecretion
B. It is located in the prepiloric antral region.
C. Giant ulcer located in the cardia
D. Аppeared as a result of the use of nonsteroidal anti-inflammatory drugs.
E. Usually accompanied by gastritis

33. MC Indicate the radiological features suggesting benign gastric ulcer («niche»
sign or Haudek's niche sign):
 A. The mucosal folds are symmetrical converge, visible along the edges of the “niche”
B. The presence of a regular radiotransparent area surrounding the ulcerative crater due to
edema
C. The "niche" projection does not extend beyond the gastric lumen
D. Absence of peristalsis in the in the area around the ulcer
E. Spastic incision located on the opposite wall of the "niche"

34. MC Which of the endoscopic estimates are indications for emergency

surgical treatment in hemorrhagic gastroduodenal ulcer?
A. I a (Spurting hemorrhage)
B. I b (Oozing hemorrhage)
C. II a (Non bleeding Visible vessel) > 2 mm
D. II b (Adherent clot)
E. III (Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)

35. MC Select discirculatory hypoxic ulcers that occur as a result of deficit gastrointestinal
protective factors
A. Atherosclerotic ulcer
B. Curling's ulcer
C. Cushing's ulcer
D. Hypovolemic shoc ulcer
E. Ulcer of Zollinger-Ellison Syndrom

Peptic ulcer (answers)

1.B 19.BE
2.D 20.ACDE
3.A 21.BCD
4.D 22.ABC
5.C 23.BD
6.B 24.ACE
7.D 25.ABDE
8.A 26.ABE
9.A 27.ACD
10.D 28.AE
11.C 29.ABE
12.C 30.ACE
13.A 31.ACD
14.A 32.AB
15.E 33.ABE
16.ADE 34.AC
17.BCD 35.ABCD
18.BCDE

Chest trauma
  
1. CS In thoracic trauma, thoracotomy is indicated in the following clinical situation:
A. In the simple costal fracture, to stabilize the fracture and prevent the worsening of
the lesions
B. If on the thoracostomy tube is exposed hemorrhage with a flow rate over than
300ml / h in more than 3 hours
C. If on the toracostomy tube there is initially a volume of 1000 ml of blood
D. If after 2 hours the toracostomy tube is placed there is still air flow on the drain
E. If initialy on the toracostomy tube a large amount of air originally appears
2. CS For the pulmonary contusions, the following statement is correct:
A. The gravity of the contusion is assessed by pulmonary radiography, CT being
unnecessary in these cases
B. Often the exploratory thoracotomy it is required
C. They can take serious forms, even by developing of the shock lung (post-traumatic
ARDS)
D. There are always minor and superficial injuries that require only medical treatment
E. They are produced exclusively by closed trauma
3. CS Select the false statement for the traumatic lesions of the esophagus:
A. They may be spontaneous
B. Frequently associates with pleural lesions
C. Currently the most frequent are iatrogenic lesions
D. Surgery is recommended within the first 24 hours
E. The FEGDS is a mandatory diagnostic test that confirms the presence of the lesion
4. CS Select the most feasible sign for traumatic aortic lesion in simple chest X-ray:
A. Obliteration of the aortic-pulmonary window
B. Compression of the main bronchus on the left
C. Displacement of the trachea
D. Enlargement of the mediastinum
E. Abnormal contour of the aorta
5. CS Aortic lesions are more commonly caused by:
A. Wounds caused by a white weapon
B. Wounds caused by a firearm
C. Crushing the chest
D. Closed trauma by deceleration
E. Closed trauma by a hit from back
6. CM Select the false statement for haemothorax:
A. There is a build-up of blood in the pleural cavity
B. The most common source are intercostal vessels
C. Severe obstructive respiratory insufficiency occurs
D. It may be the cause of restrictive respiratory disorders
E. Always requires thoracotomy
7. CM In thoracic traumas thoracocentesis is:
A. A complex maneuver, with a risk of bleeding and other major complications, which
will only be performed by the chest surgeon in the operating room
B. It dramatically ameliorates the condition of the patient with massive pneumothorax
C. It's a purely curative manoeuvre, not diagnostic
 D. It can be therapeutic
E. It can be diagnostic
8. CM Thoracocentesis is performed taking into account the following correct statements:
A. It has many risks and is not indicated in the absence of a definite diagnosis
B. It is indicated in haemothorax
C. It is indicated in all cases of pneumothorax
D. It can be therapeutic
E. It's purely diagnostic
9. CM The volume of surgical intervention in cardiac tamponade in trauma consists of:
A. The blood from the pericardium is evacuated
B. Allows direct cardiac massage
C. Antero-lateral thoracotomy is the most useful approach
D. Median sternotomy allows a quick and wide access
E. The pericardium is sutured hermetically to protect the heart
10. CM Sternal fractures are characterized by:
A. Fractures without displacement are not excluding the presence of intrathoracic
lesions
B. The uncoupled safety belt presents a risk factor
C. It is usually associated with coastal fractures
D. Appear frequently in car accidents
E. The coupled safety belt presents a risk factor
11. CM Flail chest causes:
A. Decreased cardiac output by mediastinal balancing
B. Decreased ventilation due to paradoxical breathing
C. Paradoxical breathing with moving the flail chest inside during expiration
D. Decreased effective ventilation due to oscillatory respiration
E. Paradoxical breathing with moving the flail chest outside during inspiration
12. CM Cardiac lesions from thoracic trauma can be characterized by the
following correct statements :
A. Wounds are more common than concussions
B. The presence of pericardial blood requires emergency surgery
C. Pericardic murmur is a constant sign
D. The Beck triad is constantly present
E. Contusions are more common than wounds
13. CM Chose the indications for thoracotomy in thoracic trauma:
A. There is initially 1000 ml of blood on the drainage tube
B. Bleeding at a rate of more than 250 ml / hr for 2 hours
C. Haemothorax with coagulated blood
D. Bleeding at a rate of over 50 ml / hr for 5 hours
E. Bleeding at a rate of more than 100 ml / hr for 2 hours
14. CM Emergency treatment of traumatized with flail chest consists of:
A. Treatment of respiratory insufficiency
B. Immobilization with bandages attached with adhesive tapes
C. Immobilization with circular bands of the chest
D. Permanent immobilisation of the chest by external restriction
E. Treatment of acute cardio-circulatory insufficiency
15. CM Specify clinical changes in a patient with suffocating pneumothorax:
A. Cyanosis
B. Dyspnoea
C. Filiform pulse, tachycardia
D. Bradypnea
E. Agitation
 
Chest trauma (answers)
1. B 8. B,D
2. C 9. A,B,C
3. E 10. A,B,C
4. D 11. B,D
5. D 12. B,E
6. C,E 13. B,C
7. B,D,E 14. A,B,E
15. A,B,C,E
 
 
 Abdominal Trauma
 
1. CS Indicate the statement that characterizes the traumatic lesions of the viscera:
A. Colonic lesions require resection and anastomosis indifferently of extension due to
contamination with faeces
B. Intestinal lesions that interest less than ½ of the intestinal circumference can often
be sutured
C. Antibiotic prophylaxis for 24 hours is sufficient
D. The gastric wounds are not sutured but drained through temporary gastrostomy
E. Abdominal visceral lesions are most often the result of closed trauma
2. CS Choose the most common clinical sign in retroperitoneal hematomas:
A. Pollakiuria
B. Spasm of lumbar muscles
C. Dysuria
D. Renno-ureteral colic
E. Haematuria
3. CS Indicate postoperative post-splenectomy specific complication:
A. Pancreas lesion
B. Haemoperitoneum
C. Systemic infections with encapsulated germs
D. Postoperative eventration
E. Postoperative wound suppuration
4. CS Pringle maneuver for the temporary control of haemorrhage in exploratory laparotomy
is:
A. Application of local haemostatics
B. Digital clamping of bleeding sources
C. Median xifo-pubic incision
D. Hepatic pedicle clamping in bleeding from hepatic rupture
E. Clapming of the splenic hillum in delayed splenic rupture
5. CS Select the correct treatment method for penetrating perforating wounds:
A. Administration of analgesics and wound monitoring
B. Wound dressing associated with antibiotic therapy
C. Vaccination against pneumococcal infections
D. Laparotomy, exploration of the entire digestive tract and lesions treatment
E. Stimulation of intestinal transit
6. CS Indicate the most common complication that may occur as a result of pancreatic
trauma:
A. Generalized septic peritonitis
B. Massive haemoperitoneum
C. Subphrenic abscess on the right
D. Acute pancreatitis
E. Chronic pancreatitis
7. CS Select the surgical management in case of spenic injuries with haemodynamic stability:
A. Splenectomy
B. Antibiotic therapy
C. Vaccination against pneumococcal infections
 D. Coastal fractures immobilization
E. Non-operative treatment
8. CS Select the mandatory measure in all cases of abdominal wounds:
A. Exploratory laparotomy
B. Tetanus prophylaxis and antibiotic prophylaxis
C. Non-penetrating wounds - exploring of the entire digestive tract
D. Diagnostic laparoscopy
E. Computed tomography
9. CS The cause of patient agitation in the onset of hemorrhagic shock is determined by:
A. Vasoconstriction
B. Anxiety
C. Decrease in circulating blood volume
D. Insufficient brain oxygenation
E. Tachycardia
10. CS Intraabdominal haemorrhage is defined as:
A. Haematemesis
B. Haemobilia
C. Epistaxis
D. Haemoptysis
E. Haemoperitoneum
11. CM Select the statements that characterize closed abdominal trauma:
A. In case of impact on lateral areas of the abdomen, the hollow organs are mainly
affected
B. Intestinal lesions are more rare and can be omitted at the initial clinical examination
C. The deceleration lesions are predominantly encountered in traffic collisions
D. The supramezocolic floor lesions are constantly accompanied by fractures of the
pelvic bones
E. Central abdominal contusions are involving in particular parenchymal organs
12. CM Abdominal wounds may have the following characteristics:
A. Those produced by blunt objects associate with the destructive effect of contusion
B. Those produced by firearms are usually serious
C. Tetanus prophylaxis is mandatory
D. Those produced by white weapons are usually multiple and associate vascular
lesions
E. They are classified as penetrating and non-penetrating
13. CM Specify the correct elements of exploratory laparotomy in abdominal trauma:
A. Intestinal lesions prevent abdominal contamination
B. The incision is median, xifo-pubic
C. Pringle maneuver is performed in case of hepatic bleeding
D. In important contamination, the skin is sutured
E. It is only indicated after identification of the traumatized organ
14. CM Non-operative management of liver and splenic lesions in abdominal contusions is
characterized by:
A. The presence of extra-abdominal related lesions it is a contraindication for non-
operative treatment
B. In case of failure for non-operative treatment, surgery is mandatory
 C. CT examination is mandatory in identifying lesions and initiating the treatment
D. Most splenic trauma actively bleeds and can not be treated non-operatively
E. It is contraindicated in patients with hemoperitoneum
15. CM Select the statements that characterize surgical tactics in splenic lesions:
A. Prevention of serious infections is by vaccination in the first 41 days
B. Non-operative treatment is considered as the first intention
C. Hemostasis is obtained exclusively by electrocoagulation and suture
D. Surgery is attempted as often as possible
E. If surgical intervention occurs, the total or partial preservation of the spleen is
attempted
16. CM The clinical signs of hypovolemic shock are the following:
A. Decreased TA (systolic <90 mmHg and mean TA <50-60 mmHg)
B. Tachycardia
C. Tachypnoea
D. As result, increased of urinary flow with polyuria ocurs
E. Alteration of consciousness
17. CM Choose the contraindicated diagnostic methods in patients with unstable
haemodynamics:
A. Computerized tomography
B. Laparoscopy
C. Thoracentesis
D. FAST
E. Laparocentesis
18. CM Indicate the elements of the "Lethal Triad" in polythematized patients:
A. Hypothermia
B. Acidosis
C. Anuria
D. Coagulopathy
E. Adult Respiratory Distress Syndrome
19. CM Select diagnostic methods for assessing abdominal muscle lesions:
A. Diagnostic peritoneal lavage
B. Laparoscopy
C. Computerized tomography
D. Thoracoscopy
E. Abdominal ultrasound
20. CM Specify hemostasis methods used to solve hepatic lesions:
A. Widening of the liver lesion by suturing or ligating the source of hemorrhage
B. Tamponade of transfixant liver wound
C. Injection of local hemostatics into superficial liver lesions
D. Diathermocoagulation of superficial liver lesions
E. Perihepatical meshing (packing)
21. CM Lesions of what organs will manifest clinically by peritonitis:
A. Gallbladder
B. Ileum
C. Kidneys
D. Spleen
 E. Colon
22. CM Select the evolutionary phases in the post-traumatic period in patients with diaphragm
lesions:
A. Infiltration
B. Abcedation
C. Delayed rupture
D. False amelioration
E. Herniation and strangulation
23. CM Select the features of the supraaponeurotic haematoma:
A. Detachment of the skin and subcutaneous cellular layer from aponeurosis
B. Appreciation of fluctuating collection on palpation
C. The cold and cyanotic teguments
D. It may be accompanied by false peritoneal syndrome
E. Puncture is the indicated surgical management
24. CM Abdominal radiography in the diaphragm rupture consists in:
A. Hypertransparency of the organs that migrated into the thoracic cavity
B. Ascending the affected hemidiaphragme
C. Hydroaeric levels
D. Pulmonary atelectasis
E. Movement of the mediastinum to the affected part
25. CM Indicate criteria for non-operative treatment in liver and splenic lesions:
A. Stable hemodynamics
B. Absence of peritoneal signs
C. Unconsciousness
D. The presence of associated lesions
E. Computed tomography is mandatory in assessing the severity and evolution of
lesions
Abdominal trauma (answers)
1. B 19.C,E
2. E 20. A,B,D,E
3. C 21. A,B,E
4. D 22. D,E
5. D 23. A,B,C,E
6. D 24. A,B,C,D
7. E 25. A,B,E
8. B
9. D
10. E
11. B,C
12. A,B,C,E
13. B,C
14. B,C
15. B,E
16. A,B,C,E
17. A,B
18. A,B,D
 Peritonitis
1. CS Indicate the form of peritonitis that evolves without the presence of pathogenic germs:
A. Primary
B. Secondary
C. Tertiary
D. Specific
E. Postoperative

2. CS In a 46-year-old patient who underwent appendectomy for acute gangrenous appendicitis,

on the 5th postoperative day there have appeared obtuse pains in the suprapubic region, tenesmus,
severe pain in defecation and dysuria, fever 37,8- 38,5°C. What is the presumptive diagnosis?
A. Acute paraproctitis
B. Acute anorectal thrombosis
C. Diffuse peritonitis
D. Abscess of Douglas space
E. Acute pyelonephritis

3. CS Indicate the most common causes of peritonitis:

A. Acute intestinal obstruction
B. Perforated gastroduodenal ulcer
C. Acute salpingitis
D. Acute appendicitis
E. Gastric cancer

4. CS For acute peritonitis is NOT characteristic:

A. Muscular abdominal contraction
B. Courvoisier symptom
C. Tachicardia
D. Retention of gas and faecal excretion
E. Vomiting

5. CS Indicate the main clinical sign in acute peritonitis:

A. Vomiting
B. Abdominal pain
C. Bloody stool
D. Retention of gas and faecal excretion
E. Fever

6. CS Acute peritonitis may be secondary to the following conditions, EXCEPTION being:

A. Perforation of Meckel’s diverticulum
B. Crohn illness
C. Stenosis of Vater papillae
D. Richter strangulation
E. Acute intestinal obstruction

7. CS Indicate the surgical gesture in Douglas abscess:

A. Ecoguided puncture of the abscess through peritoneal cavity:
B. Evacuator enema
C. Opening and draining the abscess by lower median laparotomy
D. Puncture, transrectal opening and draining of the abscess
E. Only conservative treatment

8. CS Indicate the most suggestive sign for establishing the diagnosis of acute postoperative
peritonitis:
A. Fever
B. Pain
C. Pneumoperitoneum
D. Persistent intestinal ileus
E. Diuresis

9. CS A 70 years old pacient with a history of heart attack prezents the clinical picture of
generalized peritonitis with a 5-day onset. Indicate the medical-surgical tactics:
A. Emergency surgery after 24 hours of preoperatory preparation
B. Immediate surgery after administration of cardiotonic drugs
C. Immediate surgery after hydro-electrolytic repletion
D. No need for preoperatory preparation
E. Emergency surgery after the establishment of diagnosis with correction of the heart failure

10. CS In a patient with acute diffuse fecalide peritonitis during the laparotomy there has been
detected a resected neoplasm of the ascendant peritonitis with perforation of the proximal tumor
intestine.Indicate the volume of the operation:
A. Suturing of the perforation with the application of ileotransversoanastomosis
B. Right hemicolectomy with terminal ileostomy
C. Suturing of perforation with application of terminal ileostomy
D. Suturing of perforation perforației with drainage of peritoneal cavity
E. Appling cecostomy with perforation suturing

11. CM Indicate the purpose of gastrointestinal intubation in the treatment of diffuse purulent
peritonitis:
A. Evidence of fluid losses in the digestive tract
B. Decompression of the intestine
C. Feeding the patient through the probe
D. Introduction of drugs through probe
E. Profylaxis of paralytic intestinal occlusion

12. CM Indicate clinical manifestations attributed to the reactive phase of acute peritonitis:
A. Pain in the suprapubic region when performing
B. Tachicardia
C. Irreversible hydroelectrolytic disruptions
D. Muscular defencity of anterior abdominal wall
E. Leukosytosis
 13. CM Indicate the most commonly used routes of antibiotic administration in the postoperative
period in patients with diffuse peritonitis:
A. Subcutaneous
B. Intramuscular
C. Intravenous
D. Intraarterial
E. Intraabdominal

14. CM Indicate the correct assertions on argumenting the performance of the laparotomy
incision in acute diffuse peritonitis:
A. Appropriate revision of the peritoneal cavity
B. Optimal sanitation of the peritoneal cavity
C. Minor trauma of the peritoneal cavity organs
D. Minor losses of blood
E. Minimal wound suppuration risk

15. CM Indicate the forms of acute peritonitis in which fibrin deposition on parietal and visceral
sheets is determined:
A. Serous
B. Purulent
C. Fecaeloid
D. Fermentative
E. Fibrinous

16. CM Indicate maladies that can cause fake surgical abdomen syndrome:
A. Aortic dissection aneurysm
B. Retroperitoneal hematoma
C. Multiple rib fractures
D. Reily syndrome
E. Strangulated femoral hernia

17. CM Acute diffuse peritonitis may occur in the following forms of acute peritonitis:
A. Appendicular colic
B. Acute catarrhal appendicitis
C. Acute phlegmonous appendicitis
D. Acute gangrenous appendicitis
E. Acute perforative appendicitis

18. CM For the terminal phase of the acute peritonitis are characteristic:
A. Adinamy
B. Hipertermy
C. Tachicardia
D. Arterial hypotony
E. Arterial hypertony

19. CM List the therapeutic measures in the complex treatment of the acute diffuse peritonitis:
A. Non-operative treatment
B. Intoxication reduction
C. Correction of metabolic disorders
D. Antibiotherapy

20. CM Indicate the diagnostic criteria of the anaerobic peritonitis:

A. Fulminant evolution
B. Mrked intoxication
C. Bacteriological confirmation
D. Enormous amount of exudate in the peritoneal cavity with a greenish-brown hue
E. Absence of exudate in the peritoneal cavity

21.CM Indicate the etiologic treatment of the acute peritonitis:

A. Antibioticotherapy
B. Pleurostomy
C. Lavage of peritoneal cavity
D. Surgical treatment
E. Corticotherapy
22.CM List the consequences of acute peritonitis at systemic level:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Liver failure
E. Kidney failure

23.CM Specify the symptoms that facilitate the diagnosis of postoperatory peritonitis:
A. Persistent fever
B. Presence of hyperperistaltism
C. Acute kidney failure, acute respiratory failure
D. Purulent secretions through the wound/on drainage tubes
E. Presence of pneumoperitoneum

24.CM Specify the clinical signs present at abdomen palpation in secondary diffuse
peritonitis:
A. Presence of liver dullness
B. Muscle defense
C. Shielded dullness on the flanks
D. Fluctuation in the right iliac beam
E. Epigastric depression

25.CM Indicate the microflora present in tertiary peritonitis:

A. Fungi
B. Bacteria with low pathogenesis
C. Enterococci
D. Clostridia
E. Staphylococci
 Peritonitis (answers)
1. C 14. A,B
2. D 15. B,C,E
3. D 16. A,B,C,D
4. B 17. C,D,E
5. B 18. A,C,D
6. C 19. B,C,D,E
7. D 20. A,B,C,D
8. D 21.A,C,D
9. C 22. B,D,E
10. B 23. A,C,D
11. A,B,C,D 24. B,C
12. B,D 25. A,B
13. B,C
 Varicose veins
1. CS Choose the false statement, which does not characterize the deep venous system of the
inferior limbs:
A. The deep venous system drains about 90% of the total inferior limbs’ blood flow
B. The venous circulation within the foot region is bidirectional
C. The gravitational force is the most important factor which determines the venous return
D. Deep veins are located below the aponeurosis (subaponeurotic)
E. Doppler examination is the method of choice in evaluation of the vessels’ permeability

2.CS Indicate the signs characteristic for trophic disturbances in varicose disease:
A. Decrease of local temperature, decrease of the hair follicle
B. Brown skin coloration, inductive cellulitis, eczema, presence of trophic ulcers
C. Hypertrophy and elongation of the affected limb, presence of angiomas, congenital varicose
veins
D. Pigmentation of the lower limb, cutaneous atrophy, arteriovenous fistulae
E. Bone hypertrophy, hyperpigmentation, circular trophic ulcers, angiomas

3.CS In case of ascending thrombophlebitis of the magna saphenous vein with the spread of the
process to the upper third of the thigh, it is indicated:
A. The elastic bandage of the limb
B. Administration of platelet antiaggregant (antiaggregant)
C. Local application of the ointments with heparin
D. Emergency surgery
E. Administration of the drugs that improve blood rheological qualities

4. CS Indicate the optimal pathogenetic procedure in varicose vein complicated with trophic
ulcer of the leg:
A. Troianov-Trendelenburg
B. Babcock
C. Linton
D. Madelung
E. Narath
5. CS According to CEAP classification (2004), the C5 stage of varicose disease is characterized
by:
A. Ache in the leg, fatigue predominantly in orthostatism
B. Heavy feeling in the legs
C. Eczema, pigmentary dermatitis, Lipodermatosclerosis, healed ulcer
D. Feeling tension in the muscle of the posterior leg region
E. Eczema, pigmentary dermatitis, lipodermo-sclerosis, active ulcer

6. CM Which of the factors listed below determine the appearance of trophic cutaneous disorders
in varicose disease:
A. Occlusion of the tibial artery
B. Insufficiency of the valves of perforator veins
C. Thrombosis of the deep veins of the leg
D. Insufficiency of the valve of the magna saphenous vein
E. Lymphostasis

7. CM Functional tests performed for the diagnosis of varicose disease can provide the following
data:
A. The evaluation of the insufficiency of the valves of the superficial veins
B. Diagnosis of superficial vein thrombophlebitis
C. Assessment of the location of the insufficient perforated veins
D. Highlighting arteriovenous fistulae
E. Assessment of the permeability of deep veins

8. CM The physiological flow of the venous blood within the lower limbs is characterized by:
A. Flow from the periphery to the right atrium
B. Flow from the superficial veins into the deep ones
C. Flow from deep veins into superficial veins
D. Two-way (bidirectional) flow
E. Flow from the heart to the periphery

9. CM List the complications that may occur as a result of varicose vein sclerotherapy:
A. Infiltrations
B. Acute thrombophlebitis of the superficial and deep veins
C. Thromboembolism of the pulmonary artery
D. Regional skin necrosis
E. Arteriovenous fistula

10. CM List the methods that can be used to prevent massive pulmonary thromboembolism in
the case of a floating inferior vena cava thrombus:
A. Thrombectomy
B. Plication of inferior cava vein
C. Resection of the inferior cava vein
D. Appling cava-filters
E. Creation of the aortocaval fistula

11. CM Indicate the specific methods in diagnosis of lung embolism:

A. X-ray of the thorax
B. Electrocardiography (ECG)
C. Cardiac ultrasound
D. Angiopulmonography
E. Pulmonary scan perfusion

12. CM Indicate the factors involved in the thrombi formation:

A. Lesion to the venous wall
B. Presence of the congenital arteriovenous fistulae (șunturi)
C. Hypercoagulation
D. Disturbance of the heart rate
E. Slow blood flow in the veins
13. CM Select the characteristics of post-thrombotic (post-phlebitic) syndrome:
A. Elongation of lower limbs
B. Pain in the lower limb
C. Increased limb volume
D. Deformation of leg joints
E. Trophic ulcers

14. CM The aims of the surgery for varicose veins are, EXCEPT:
A. To stop the venous reflux through the valve of the magna saphenous vein
B. Modeling of the incompetent valves
C. Suspension of reflux through the collaterals of the magna saphenous vein
D. Insertion of cava-filters
E. To stop the reflux through communicating and collateral veins

15. CM Indicate the factors that influence positively the venous blood circulation:
A. Residual systolic force
B. Diastolic aspiration of atria
C. Thoracic aspiration
D. Intraabdominal pressure
E. Musculovenous pump

Varicose veins (answers)

1. C 9. A,B,C,D
2. B 10. B,D
3. D 11. D,E
4. C 12. A,C,E
5. C 13. B,C,E
6. B,D 14. B,D
7. A,C,E 15. A,B,C,E
8. A,B