V.I.

Vernadsky Crimean Federal University

Medical Academy named after S.I. Georgievsky
Chair of Surgery №1
Objectives for Intermediate Certification 6 year

1. Patient M., 37 years old. He came to the clinic wounded after an hour. On the
abdominal skin there is pain around umbilicus due to prick and cut wound of about
0,5 x 1 cm with slight bleeding. What help would you provide to the patient
A) Laparotomy, survey organs of abdominal cavity. Primary surgical processing of the
wound
B) Drainage of the wound with rubber strip
C) Survey the wound with canal probe
D) Aseptic bandage
E) Suture the wound

2. The patient K. is 23 years old. He has wounded left arm due to the gunfire. The
bones of the arm are undamaged. What appropriate surgical help must be provided to
such a patient
A) Primary surgical Processing with a flowing suction
B) Suture wound
C) Suture wound and dry it
D) Dry wound with towel gauzes
E) Aseptic dressing of the wound

3. Patient K., 34 years old. A dog bit him 3 hours before. In the left arm there is wound
by the tooth of dog`s bite without bleeding . What surgical help would you provide to
such a patient
A) Wash wound with detergent water and apply anti-septic.
B) Aseptic bandage
C) Cream bandage
D) Complete suture of the wound
E) Incomplete suture of the wound

4. Patient K., 37 years old complains of pain in the right arm, which increases during
motion, increase body temperature up to 39° C. In the right cubital fossa there is a
place of injection, hyperemia and thickening along the vein. Your diagnosis
A) Phlebitis
B) Phlegmon
C) Abscess
D) Inflammation of lymph
E) Erizipeloid
5. What develops most often after accidental intake of Hydrochloric acid
A) Cardiac insufficiency
B) Cushing’s syndrome
С) Kutling’s syndrome
D) Deylads's syndrome
E) Acute pancreatitis

6. Purulent mediastinitis is diagnosed on a 63 year old patient. What of the below

listed diseases are not the cause of purulent mediastinitis
A) Cervical lymphadenitis
B) Deep neck phlegmon
C) Perforation of the cervical part of the esophagus
D) Perforation of the thoracic the esophagus
E) Iatrogenic injury of the trachea

7. The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What
method of treatment is indicated to the patient
A) Surgical treatment: Drainage of the pleural cavity
B) Antiinflammation therapy
C) Symptomatic therapy
D) Pleural puncture
E) Thoracotomy

8. The diagnosis – melanoma was made to a 16 year old patient after examination with
complaints of frequent pain in the abdomen, pigmentation of the mucosa and skin,
polyp in the stomach and large intestine was found. It is know that the mother of the
patient analogous pigmentation and was treated often for anemia What disease is
suspected
A) Peytz – Egers’s polyposis
B) Chron’s disease
C) Tuberculosis of the intestine
D) Adolescent polyposis
E) Hirschprung’s disease

9. What develops in cases with decompensated pyloric stenosis

A) Isotonic dehydration
B) Hypertonic dehydration
C) Hypotonic dehydration
D) Intoxication
E) Renal insufficiency
10. A 35 year old woman was admitted to thoracic surgery department with elevation
of body temperature up to 40 *C, onset of pain with deep breath in the side, cough
with big quantity of purulent sputum and blood with bad smell. What disease causes
these symptoms
A) Abscess of the lungs
B) Complication of liver echinococcosis
C) Bronchiectatic disease
D) Actinomycosis of lungs
E) Tuberculosis of lungs

11. A 38 year old woman was hospitalized to the surgical unit with acute abdominal
pain irradiating to the spine and vomiting. On laparocentesis hemorrhagic fluid is
obtained. What disease is suspected
A) Acute pancreatitis
B) Renal colic
C) Acute enterocolitis
D) Perforative gastric ulcer
E) Acute appendicitis

12. Which of the listed below operation are not done in cases of perforated duodenal
ulcers
A) Gastrostomy
B) Resection of 2/3 - 3/4 of the stomach
C) Vagotomy + Pyloroantrumectomy
D) Vagotomy + resection of the ulcer
E) Suturing of the ulcer

13. Contraindications for operation in acute pancreatitis are:

A) Hemodynamic unstability and pancreatogenic shock
B) Functional insufficiency of the parenchymatous organs
C) Purulent and septic complications
D) Peritonitis
E) Erosive bleeding

14. A 41 year old patient was admitted to the intensive care unit with hemorrhagic
shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years.
The source of bleeding are esophageal veins. What is the most effective method for
control of the bleeding?
A) Introduction of obturator nasogastric tube.
B) Intravenous administration of pituitrin
C) Haemostatic therapy
D) Operation
E) Administration of plasma

15. At the patient of 34 years of age you suspect an abscess of Douglas spaces. What
method of research is preferable to diagnostics
A) Digital research of rectum
B) Rectoromanoscopy
C) Laparoscopy
D) Percussion and auscultation of a stomach
E) R-scopy of abdominal cavity

16. What from the listed operations in treatment of ulcer of stomach and duodenum is
carried out only under emergency indications?
A) Sewing up perforated ulcer
B) Resection of stomach by Bilroth I
C) Resection of stomach by Bilroth II
D) Selective proximal vagotomy
T) Truncal vagotomy with pyloroplastic

17. With the restrained umbilateral hernia which has become complicated by
phlegmon of hernia sac, it is necessary to make for patient
A) Herniotomy by Meio-Sapegko
B) Herniotomy by Meio
C) Herniotomy by Sapegko
D) Herniotomy by Lekser
E) Herniotomy by Grenov

18. What treatment is shown for the patient of 63 years of age with an attack of bilious
colic, caused by gall-bladder stones
A) Conservative treatment
B) Emergency operation
C) Urgent operation after cupping an attack
D) E) Antienzyme therapy
E) Laparoscopic cholecystotomy

19. Choose correct tactics at the patient of 53 years of age at the initial stage of
obstructive intestinal obstruction
A) Operative treatment at an inefficiency of conservative actions
B) Only conservative treatment
C) Emergency operation
D) Scheduled operation
E) Nasogastric intubation
20. 52-year-old man have recurrent transient ischemic attacks. Auscultation of the
carotid arteries detected murmur. What diagnostic method is necessary to apply the
first
A) Ultrasound Doppler
B) CT of the brain
C) MRI of the brain
D) Cerebral angiography
E) Electroencephalography

21. On dispensary supervision at therapist are the patients with diabetes mellitus,
hypertonic disease, obesity. The cancer with what localizations in this group is
necessary to expect with a high degree of risk
A) Uterus body
B) Gulet
C) Liver
D) External sexual organs
E) Uterus neck

22. The patient with an acute middle purulent otitis complicated by mastoiditis has
been admitted to hospital. On roentgenogram of mastoid processes the shading of the
cellular system on the lesion, absence of bone septs have been marked. What are
medical actions in the second stage of mastoiditis
A) Mastoidotomy
B) Paracentesis of the drum
C) Radical operation on the middle ear
D) Tympanoplasty
E) Cateterization of the Eustachian tube

23. A woman, 35 years old, admitted to reanimation department in asthmatic state.

What is most trustworthy criterion of breath effectively
A) РаСО2 and РаО2
B) Respiratory volume
C) Respiratory volume
D) Minute respiratory volume
E) Determination of “dead” space

24. Increasing of central venous pressure is marked on the base of decreasing arterial
pressure during the dynamic investigation of it at victim with plural combined injuries.
What is this combination evidence of
A) Addition of cardiac insufficiency
B) Blood deposition in venous channel
C) Shunting
D) Hypervolemia
E) Growth of bleeding speed

25. What kind of injures is often happened while carthquakes

A) Crash syndrome
B) Cranio-facial trauma
C) Fracture of upper extremities
D) Fracture of lower extremities
E) Abdominal traumas

26. What kind of injures is often happened while explosions at mines

A) Poisoned of CO
B) Burns
C) Fractures
D) Cranio-facial trauma
E) Crash - syndrome

27. The most available and informative diagnostic methods for closed trauma of the
urinary bladder
A) Retrograde cystography
B) Pelvic arteriography
C) Cystography
D) Sonography of the urinary bladder
E) Palpation and percussion of abdomen

28. In order to differentiate diagnosis of anuria and ishuria you should accomplish:
A) Catheterization of the urinary bladder
B) Analysis of urine
C) Analysis of the blood
D) Excretory urography
E) None of the above

29. Female-patient K, of 45 years old, was admitted to the traumatological ward with
the closed fracture of the medial malleolus with its displacement up to 3 mm. In
which position the foot has to be fixed with a plaster cast
A) At right angle with varus positioning of the foot
B) In position of planter flexion of foot
C) In position of pronation
D) In position of supination
E) In position of dorsal flexion of foot

30. What wall of the inguinal canal is damaged in case of indirect inguinal hernia?
A) Anterior
B) Posterior
C) Inferior
D) Superior
E) Posterior-inferior

31. Triangle of Callot is orientation for exposure of

A) Cystic artery
B) Cystic duct
C) Common bill duct
D Common hepatic duct
E) Hepatic artery

32. A 19-year-old girl was admitted to Emergency Department: unconsciousness state,

cyanosis, myotic pupil, shallow breathing – 12/min. BP 90/60 mm Hg, 78 pulses/min.
Choose the action corresponding to this clinical situation
A) Controlled respiration
B) Gastric lavage
C) Oxygen inhalation
D) Caffeine injection
E) Cordiamine injection

33. A 47 year-old man with gastric cancer, complicated by profuse hemorrhage was
successfully treated by surgical intervention. After the operation the native blood
plasma transfusion was performed. Whereupon developed: acrocyanosis,
hypersalivation, hyperpnoea, BP 80/40 mm Hg, 120 pulses/min. The initial drug
therapy had to begin with injection of
A) Epinephrine
B) Prednisolon
C) Diphenylhidramin
D) Dopamine
E) Aminophilline

34. For the persons who are taking place in a zone of failure on nuclear object, the
greatest risk of development within the first decade is represented by cancer
A) Thyroid gland
B) Skin
C) Reproduction system organs
D) Breast
E) Lungs

35. 40 year old a patient is diagnosed: 1. Medular thyroid gland cancer. 2.

Feochromatcitoma. What operation should be made at first
A) Operation concerning feochromatcitoma
B) Operation on thyroid gland
C) Krail’s operation
D) Subtotal resection of thyroid gland and fascicular resection of lymphatic nodes
E) Vanach’s operation

36. To the doctor 28 years old a woman has addressed with the complaints to increase
of the size of pigment nevus which was available from birth, get wetting, itch. What
method of research should not be applied to diagnostics in this case
A) Incision biopsy
B) Yaks’s reaction
C) Radioisotope diagnostics
D) Thermography
E) Glass-print

37. A growth of the right side of the scrotum was found at the examination of a 3-
month-old child. This formation has elastic consistency, its size decreases in sleep and
increases when the child is crying. What investigation will be helpful for make a
correct diagnosis
A) palpation of the thickened cord, crossing the pubical tubercle - sign of the silk
glove
B) diaphanoscоpy
C) palpation of the external inguinal ring
D) puncture of the scrotum
E) examination of the formation in Trendelenburg’s position

38. A patient, male, 50 years old, has a black flat mole on the skin of the leg for 10
years. Since 4 months the shapes of the mole become irregular. What diagnostic
methods should be used
A) Excision biopsy
B) Fine needle biopsy
C) Smear for microscopic examination
D) Incision biopsy
E) Thermography

39. The method of treatment of the stenotic cancer of the rectum with local spread is
A) Colostomy
B) Chemotherapy
C) Phytotherapy
D) Hormonal therapy
E) Phytotherapy + chemotherapy

40. The method of treating the unresectable stenotic cancer of the pyloric area of the
stomach is
A) Sidetracking anastomoses
B) Chemotherapy
C) Radiotherapy
D) Phytotherapy
E) Phytotherapy + chemotherapy

41. In a patient with a stab injury to the femoral artery , the treatment of choice is:
A) End to end anastomosis
B) Interposition of autogenous vein graft
C) Ligation of both transected ends
D) Interposition of homologous arterial graft
E) Interposition of Dacron graft

42. A 28-year-old woman comes to the Emergency Room with a slightly reddened,
painful “knot”, 8 cm above the medial malleolus. Examination in the standing position
demonstrates a distended vein above and below the mass. There are no other
abnormalities on physical examination. The most likely diagnosis is
A) Superficial venous thrombosis
B) Early deep vein thrombosis
C) Insect bite
D) Cellulitis
E) Subcutaneous hematoma

43. The majority of arterial emboli originate from which one of the following sites
A) Left atrium
B) Left ventricle
C) Cardiac valves
D) Thoracic aorta
E) Abdominal aorta

44. A patient with a history of coronary artery disease and atrial fibrillation develops
sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity
with absent pulses below the groin and normal contrlateral leg. The most likely
diagnosis is
A) Arterial embolism
B) Arterial thrombosis
C) Acute thrombophlebitis
D) Cerebrovascular accident
E) Dissecting aortic aneurysm

45. Which of the following is the most common clinical manifestation of an abdominal
aortic aneurysm
A) Most are asymptomatic
B) Peripheral embolization
C) Acute rupture
D) Back pain
E) Chronic peripheral ischemia

46. Which of the following best summarizes indications for operation on an abdominal
aortic aneurysm
A) Any aneurysm greater than 5 cm in diameter
B) Any abdominal aortic aneurysm
C) Only symptomatic aneurysm
D) Only symptomatic aneurysm greater than 5 cm in diameter
E) Only ruptured aneurysm

47. Which one of these antibacterial drugs shows an ototoxic action

A) Gentamicine
B) Amoxycilline
C) Cefalexine
D) Оfloxacine
E) Ciprofloxacine

48. What is the most frequent cause of acute urinary retention in men over 60 years old
A) Benign prostatic hyperplasia
B) Prostate cancer
C) Urinary bladder cancer
D) Urethral stricture
E) Urethral stones

49. The method of treating a small cell of anaplastic lung cancer T2NxM1, with bone
methastases is
A) Chemotherapy
B) Pneumonectomy
C) Lobectomy
D) Radiotherapy
E) Immunotherapy

50. The male patient, 60-year-old, tobacco smoker for 30 years, alcoholic, has
dysphagia and weight loss since 4 months. Suggested diagnoses
A) Cancer of the esophagus
B) Esophageal achalasia
C) Hanter`s disease
D) Esophagitis
E) Esophageal diverticulum

51. A 50-year-old male patient was brought to Emergency Department with diffuse
abdominal pain and signs of cardiovascular collapse. Upon arrival he had BP 95/60
mm Hg, 120 pulses/min, diuresis 20 ml/h, HgB 100 g/l, red blood cells count
2.1·1012/l. The patient needs infusion of
A) Crystalloid and colloid
B) Crystalloid and red blood cells
C) Crystalloid and 5\% dextrose
D) 5\% dextrose and red blood cells
E) 5\% dextrose and colloid

52. A 33-year-old male patient was brought to Emergency Department with the signs
of cardiovascular collapse: BP 60/30 mm Hg, 140 pulses/min, the skin is pale and
moist, diuresis 20 ml/h, HgB 80 g/l, red blood cells count 2.5·1012/l. The reduction of
blood volume averages
A) 30-40%
B) 10-15%
C) 15-20%
D) 20-25%
E) 25-30%

53. A 45-year-old male patient was admitted to the intensive care unit because of
myocardial infarction. An hour later the ventricular facilitation occurred. What from
following should be administered
A) Defibrillation
B) External chest compression
C) Lidocaine injection
D) Adrenalin injection
E) Cardiac pacing

54. What is the most common histological type of malignant tumors of the prostate
A) Adenocarcinoma
B) Transitional cell carcinoma
C) Seminoma
D) Rhabdomyosarcoma
E) Squamous cell carcinoma

55. What is normal daily diuresis in adult

A) 1500-2000 ml
B) 200-500 ml
C) 500-1000 ml
D) 2000-2500 ml
E) 2500-3000 ml

56. What is the treatment choice for 60-year old male with renal cell carcinoma
T2N0M0 and normal contrlateral kidney
A) Radical nephrectomy
B) Resection of the kidney
C) Nephroureterectomy
D) Simple nephrectomy
E) Radiation therapy

57. Following bilateral femoral embolectomy, a patient with atrial fibrillation becomes
oliguric and passes red-colored urine. All the following measures may be appropriate
in this patient’s management EXCEPT
A) Cessation of heparin
B) Administration of sodium bicarbonate
C) Administration of mannitol
D) Determination of serum potassium
E) Aggressive hydration

58. A 45-year-old woman, mother of four children, comes to the emergency room
complaining of the sudden onset of the epigastric and right upper quadrant pain,
radiating to the back, associated with vomiting. On examination, tenderness is elicited
in the right upper quadrant, bowel sounds are decreased, and laboratory data shows
leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely
diagnosis is
A) Acute cholecystitis
B) Perforated peptic ulcer disease
C) Myocardial infarction
D) Sigmoid diverticulum
E) Acute pancreatitis

59. During an operation for presumed appendicitis, the appendix is found to be normal;
however, the terminal ileum is markedly thickened and feels rubbery to firm, its serosa
is covered with a gray-white exudate, and several loops of apparently normal small
intestine are adherent to it. The most likely diagnosis is
A) Crohn’s disease of the terminal ileum
B) Perforated Meckel’s diverticulum
C) Ulcerative colitis
D) Ileocecal tuberculosis
E) Acute ileitis

60. Which of the following are absolute indications for common bile duct exploration
without preliminary cholangiography
A) Toxic cholangitis
B) Pancreatitis
C) Bilirubinate stones in the gallbladder
D) Multiple small stones in the gallbladder
E) Dilated common bile duct

61. In patients who have sustained blunt trauma to the chest, which of the following
would most likely be the cause of acute cardiopulmonary collapse
A) Pneumothorax
B) Hemothorax
C) Pulmonary contusion
D) Rib fractures
E) Acute adult respiratory distress syndrome

62. A 50-year-old man comes to the emergency room with a history of vomiting of 3
days’ duration. His past history reveals that for approximately 20 years, he has been
getting epigastric pain, lasting for 2 to 3 weeks, during early spring and autumn. He
remembers getting relief from pain by taking milk and antacids. Physical examination
showed a fullness in the epigastric area with visible peristalsis, absence of tenderness,
and normal active bowel sounds. The most likely diagnosis is
A)Gastric outlet obstruction
B) Small bowel obstruction
C) Volvulus of the colon
D) Incarcerated umbilical hernia
E) Cholecystitis

63. A 50-year-old woman presents with a 2-year history of mild, diffuse, tender
thyroid enlargement with a 10-pound weight gain and fatigue. Of the following which
is the most likely diagnosis
A) Hashimoto’s thyroiditis
B) Riedel’s thyroiditis
C) Subacute thyroiditis
D) Suppurative thyroiditis
E) Papillary thyroid carcinoma

64. Which of the following is the most appropriate in the initial management of a
patient with confirmed esophageal corrosive injury
A) Steroids for 3 weeks
B) Prompt institution of serial esophageal dilatation
C) Parenteral hyperalimentation and prohibition of oral intake for 2 to 3 weeks
D) Esophagectomy with gastrostomy, cervical esophagostomy, and delayed
reconstruction
E) Esophagectomy with immediate reconstruction

65. A 24-year-old law student is brought into the emergency room complaining of
severe abdominal pain of 6-8 hours duration. He had been to a party the night before.
The pain is in the epigastrium radiating to the back and is associated with nausea. The
patient vomited twice prior to coming to the emergency room. Clinical examination
reveals an anxious, acutely ill youth with a regular pulse rate of 100/min, blood
pressure og 100/68 mm Hg, and a temperature of 38,1 C. The most likely diagnosis is
A) Acute pancreatitis
B) Acute cholecystitis
C) Acute appendicitis
D) Acute diverticulitis
E) Mesenteric adenitis

66. In which of the following disorders does the pathophysiology of portal

hypertension involve presinusoidal intrahepatic obstruction
A) Congenital hepatic fibrosis
B) Alcoholic cirrhosis
C) Hemochromatosis
D) Budd-Chiari syndrome
E) Cavernomatous transformation of the portal vein

67. A nonalcoholic 45-year-old woman presents with an asymptomatic, septated 10-

cm cystic mass in the body of the pancreas. She should be advised that
A) Complete excision of the lesion is indicated
B) Drainage by Roux-en-Y jejunostomy is indicated
C) The lesion is probably benign and requires observation only
D) It is cancerous and she will likely die from it in 12 months
E) Total pancreatectomy is the preferred surgical management

68.The patient with aquired heart failure has diastolic pressure 0 mm Hg. What heart
failure does the patient have
A) Aortal stenosis
B) Mitral stenosis
C) Aortal insufficiency
D) Mitral insufficiency
E) Rheumatism

69. Child [15 years old] has the ulcer disease of stomach. What is the etiology of this
disease
A) Intestinal bacillus
B) Salmonella
C) Lambliosis
D) Influenza
E) Helicobacter pylory
70. A 20 yr old woman with a 3-4 month history of bloody diarrhea; stool examination
negative for ova and parasites; stool cultures negative for clostridium, campylobacter
and Yesinia; normal small bowel series; edema, hyperemia and ulceration of the
rectum and sigmoid colon seen on sigmoidoscopic examination. Select the most likely
Diagnosis
A) Ulcerative colitis
B) Gastroenteritis
C) Carcinoid syndrome
D) Zollinger-Ellison syndrome
E) Granulomatous colitis

71. A 75yr. old man who had developed diabetes within the last six months was found
to be jaundiced. He was asymptomatic except for weight loss of 10 pounds in 6
months. On physical examination he is found to have a nontender, globular, right
upper quadrant mass that moves with respiration. A CT scan shows enlargement of the
head of the pancreas, with no filling defects in the liver. Most likely diagnosis
A) Carcinoma of the head of the pancreas
B) Infectious hepatitis
C) Haemolytic jaundice
D) Malignant biliary stricture
E) Metastatic disease of liver

72. A 47 year old man presents to his physician with progressive abdominal swelling.
On examination he is found to have ascites and a tender, enlarged liver. If the patient
describes a chronic course associated with wasting and low grade fever, the differential
diagnosis should include everything EXCEPT
A) Chronic Pancreatitis
B) Tuberculosis
C) Cirrhosis with hepatocellular carcinoma
D) Hepatitis
E) Alcoholic liver disease with cirrhosis

73. A 60 yr. old man with unstable angina pectoris fails to respond to heparin,
nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best
management includes
A) Coronary artery bypass grafting
B) Intravenous streptokinase
C) Exercise testing
D) Oral aspirin
E) Antihypertensive therapy

74. A 42yr. old patient suffering from alcoholism has advanced liver disease with
ascites. He is hospitalized for agitation and bizarre behavior. Examination reveals
apteryxes on the hands, ankle clonus, and spider angiomas on the face and chest.
Blood ammonia level is twice its baseline. Precipitating factors to look for include all
of the following EXCEPT
A) Insufficient protein ingestion
B) Bleeding esophageal
C) Excessive diuretic therapy
D) Non compliance with lactulose therapy
E) Spontaneous bacterial peritonitis

75. A 45 yr. old man is admitted with his 3rd episode of upper gastrointestinal
haemorrhage. He had 2 prior ulcer operation. Zollinger-Ellison syndrome is suspected.
All the following would support your suspicions EXCEPT
A) Suppression of hypergastrinaemia by secretin given IV
B) A fasting gastrin level of 450pg/ml
C) Post operative notes detailling ulcers in the duodenum and jejunum
D) Liver metastasis on CT scan
E) A history of diarrhea

76. A 60 yr. Old woman, mother of 6 children, developed sudden onset of upper
abdominal pain radiating to the back, associated with nausea, vomiting, fever and
chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On
physical examination the patient was found to be febrile with temp. of 38.9C, along
with right upper quadrant tenderness. Most likely Diagnosis
A) Choledocholithiasis
B) Benign biliary stricture
C) Malibnant biliary stricture
D) Carcinoma of the head of the pancreas
E) Choledochal cyst

77. A 30 yr. old man presents with a history of recurrent pneumonias and a chronic
cough production of foul smelling, purulent sputum, occasionally good tinged, which
is worse in the morning and on lying down on physical examination, the patient
appears chronically ill with clubbing of fingers, wet inspiratory rails at the base of
lungs posteriorly. Most likely diagnosis
A) Bronchiectasia
B) Chronic bronchitis
C) Disseminated pulmonary tuberculosis
D) Pulmonary neoplasm
E) Chronic obstructive emphysema

78. Woman age 40,ill on rheumatic disease with composite mitral disease with
prevalence of the stenosis of left venous foramen. Complains on the palpitation,
fatigability progressing dyspnea, attacks of a dyspnea and hemoptysis. Now she can
not execute even the mild activities. What tactics is the most expedient
A) Mitral comissurotomia
B) Conduction of current bicilino-prophilaxis
C) Assigning of anticoagulants
D) Assigning of venous vasodilatators

79. A patient 40 year old is diagnosed: 1. Medular thyroid gland cancer. 2.

Feochromatcitoma. What operation should be made at first
A) Operation concerning feochromatcitoma
B) Operation on thyroid gland
C) Krail’s operation
D) Subtotal resection of thyroid gland and fascicular resection of lymphatic nodes
E) Vanach’s operation

80. Classical X-ray image of intestinal obstruction is

A) Gas and horizontal levels
B) Filling defect
C) High positioned diaphragm
D) Reactive pleuritis
E) Pneumatosis

81. A patient 40 year old presented to Emergency department with the cut injury on
the right side of the chest wall. Profuse bleeding from the wound but the patient is in
conscious, B.P - 120/60 mm.Hg, pulse 100 beats per minute. Which one from below
listed methods allows to define character of wound with the greatest accuracy
A) Primary surgical cleaning and exploration of Wound
B) Chest X-ray
C) Ultrasound of thoracic Cavity
D) CT scan
E) Bronchoscopy

82. The patient K. 42 years old, presented with the diagnosis of “Acute iliofemoral
vein thrombosis(1 rst. Day), Pulmonary artery thromboembolism” and admitted in
vascular department of the Hospital. What is your tactics
A) Surgical treatment
B) Thrombolytic therapy plus implantation of Cava filter
C) Introduction of low-molecular wt. Heparin
D) Elastic Bandage of legs
E) Bronchoscopy

83. Patient K. 35 years old, after abortion developed deep veins thrombosis of leg and
on the 3-day cough and a retrosternal pain developed with hemoptysis. Which
investigation is necessary at first to make the correct diagnosis
A) Phlebography, Dopplerography
B) Ultrasonography of Abdomen
C) Electrocardiogram, Chest X-Ray
D) Palpation of stomach
E) Auscultation of Lungs

84. A 73 years old patient hospitalized with the diagnosis of “Tumour of Abdominal
Cavity”. On examination: On the right side of the abdomen a mass of 10х15 cm size is
palpated. Patient is suffering of ischemic heart diseases, Hypertension ІІ-ІІІ stages. It
is suspected an aneurysm of an abdominal aorta. For the verification of the diagnosis it
is necessary to execute
A) X-ray of Abdomen
B) Diagnostic puncture
C) Laparocenthesys
D) Aortoarteriography
E) Irrigoscopy

85. A patient 25 years old presented to emergency department after 40 minutes of stab
injury of chest in a projection of heart in a critical condition. Confused, cold
sweating, Blood Pressure 60/20 mm.Hg, Pulse on peripheral arteries was absent. What
is the most probable diagnosis
A Lung Injury
B) Pneumohemothorax
C) Bleeding from soft tissues of chest wall
D) Injury of intercostals vessels
E) Cardiac Injury

86. 53 years old patient, complains of a heartburn, regurgitation of air, vomiting. In

esophagodudenoscopy: Marked prolapse of squamous mucous of stomach into the
esophagus. In radiogram marked protrusion of 1/3 stomach into the posterior
mediastinum. Provisional Diagnosis A sliding hiatal hernia, ІІІ degree. What is the
tactics of treatment
A) Plastic of a diaphragm according to Belsey
B) Lewis's operation
C) Vandal's operation
D) Heller's Operation
E) Esophagectomy, Abdomino-cervical Method

87. Patient В, 64 years, complains of difficulty in swallowing solid food, vomiting,

weakness, loss of weight. In esophagodudenoscopy on a posterior-lateral wall, sub
mucous layer tumour with the precise contours, easily movable is determined. The
diagnosis: Benign tumour of lower third esophagus. Your tactics
A) Heller's Operation
B) Endoscopic removal of a tumour
C) Esophagectomy
D) Operation Vandal's -lastic of the Lower third of esophagus
E) Lewis's operation - Transhiatal resection of esophagus

88. Patient 48 years old, chief complain of dysphasia for solid and liquid food, nausea,
and fatigue. In radiographic examination of esophagus- stricture of lower third
esophagus and dilatation of upper third esophagus. Diagnosis-Cardiospasm III stage.
What is the volume of necessary treatment needed
A) Conservative treatment: Cerucal, Rantac, No-spa, Intravenous infusion
B) Vandal's Operation [Plastic surgery of lower third esophagus]
C) Heller's Operation
D) Esophagectomy Abdomino-cervical Method
E) Lewis Operation -Transhiatal resection of esophagus with gastroplasty

89. Patient К, 65 years old, inpatient of surgical department of hospital after

hernioplasty on the 6 day suddenly lost consciousness; there was cyanosis of the
upper part of a thorax and the face and dyspnea. What is the diagnosis
A) Heart attack of a myocardium
B) Hypoglycemic Coma
C) Hyperglycemic Coma
D) Pulmonary artery thromboembolism
E) Perforation of stomach Ulcer

90. Patient А., 44 Years old, presented to Emergency Department after 3 hours of
trauma with chief complain of Right sided Chest pain, Dyspnea, Fatigue, Dizziness.
Cyanosis. Unstable Hemodynamic. On Chest X-ray-Fracture of Right four Posterior-
Lateral ribs, Collapse of right lung 2\3 Volume. What is the possible diagnosis.
A) Right sided post-traumatic exudative pleuritis
B) Detachment of Main Bronchus
C) Right-sided Hemothorax
D) Hematoma Mediastinum
E) Right sided Post-traumatic Pneumothorax

91. Patient 19 years old, Presented to Emergency department in critical condition after
Trauma of Chest with chief complain of Left sided chest pain, Dyspnea, Fatigue, left
sided massive subcutaneous emphysema of chest wall. On chest X-ray Atelectasis of
left lung, Shift of mediastinal organs to left. Cardiac cavity not enlarged. Your
Diagnosis
A) Detachment of Left main bronchus
B) Left sided total Hemothorax
C) Fracture of left Ribs, left sided Pneumo-hemothorax
D) Left sided Post-traumatic pneumothorax
E) Left sided post-traumatic pleuritis

92. 36 years old patient presented with complains of dyspnea, dizziness. History of
Thoracic trauma 2 days back. On examination decrease movement of the left side of
the chest wall. On chest X-ray – Collapse of the 1/3 of left lung. Fracture of left 4-6
ribs. What are the possible complication patients has developed
A) Posttraumatic Hemothorax
B) Pneumothorax
C) Empyema of pleura
D) Pleuritis
E) Posttraumatic pneumonia

93. Patient К. 19 years old admitted with the diagnosis “Chest Wall Trauma (Thoracic
Trauma)” with Complain of difficulty in expiration and inspiration. On examination
patient is pale. Blood Pressure 90/50 mm.Hg. On auscultation: Silent on left side (no
breathe Sound). On chest X-ray:- Shift of mediastinal organs to right, atelectasis of left
lung, your diagnosis
A) Fracture of Ribs
B) Injuries of a chest wall
C) Left sided Tension Pneumothorax
D) Cardiac Injury
E) Hemothorax

94. 45 years old patient admitted in a clinic in a critical condition. Before admission
patient was suffering from pneumonia for 3 weeks. On examination: - Skin and
mucous membrane dark - earthy color, a body temperature 38c, Dyspnea on rest,
decrease breathe on the left side. Productive Cough with large amount of sputum. On
chest X-ray. What is the most probable diagnosis
A) Bronchitis
B) Pleuritis
C) Pneumonia
D) Empyema of pleura
E) Pneumothorax

95. A patient 32 years old presented in a hospital in a critical condition with chief
complain of acute retrosternal chest pain with radiation to back. On examination:-
skin and mucous are pale, t-38,8 С. Marked subcutaneous emphysema of soft tissues
of a neck, одутловатость face. On the eve ate fish. On Chest X-ray expansion of
mediastinum is revealed. What is the most probable diagnosis
A) Heart attack
B) Abscess of lung
C) Pneumothorax
D) Pneumonia
E) Mediastinitis

96. 48 years old patient, suffering from posttrombotic syndrome of the left leg since 2
years. On examination: Dilated superficial veins of left leg and thigh, and pubic
region, a significant swelling of the left leg. Light physical exertion aggravates pain.
What kind of treatment should be recommended to patient
A) Reconstructive operation on deep veins of the left thigh
B) Conservative therapy
C) Compression treatment
D) Phlebectomy
E) Phlebo-sclero-obliteration

97. A patient 52 years old admitted in vascular department of the hospital with sever
edema and pain of holding apart character in the right leg and thigh, aggravated by
passive movements. On examination: On the right leg sever edema starting from the
foot till inguinal ligaments are observed cyanotic skin. What is the most probable
diagnosis
A) Erysipelas of the right leg
B) Acute iliofemoral vein thrombosis
C) Acute thrombophlebitis of superficial veins
D) Lymphostatsis
E) Phlegmon of the right Leg

98. A patient 67 years old Hyperstenic features, suffering from varicose veins of both
legs since 18 years. During last 2 years three times had thrombophlebitis of
superficial veins of the right leg. 4 months back on the lower third of right leg
trophic ulcer developed. What method of investigation is informative for
specification of the diagnosis of the patient
A) Functional tests to determine the condition of Valve
B) Phlebography
C) Ultrasonic duplex scanning
D) Dopplerography of deep veins
E) Isotope Phlebography

99. A patient 35 years old complains of a difficult swallowing, pain behind the
breastbone. He can eat only liquid food. While swallowing sometimes he has attacks
of cough and dyspnea. Above mentioned complaints is progressing. It is known that
the patient has had a chemical burn of esophagus one month ago. What complication
does the patient have
A) Esophagitis
B) Esophageal diverticulum
C) Cardia Achalasia
D) Corrosive Esophagitis and stricture
E) Cardia insufficiency

100. A man 42 years old with long history of disease complains of a frequent
heartburns, moderate pain in epigastrium and behind breastbone propagated in the
back in point between shoulder blades. Pain appears with meals or just after meals
and can be provoked by physical exertion. Also he has had a relapsed
bronchopneumonia earlier and events of melena. The CBC reveals anemia. On X-Ray
film there is a bubble of gas in the posterior mediastinum. ECG documents an
arrhythmia. What is your diagnosis
A) Chronic pancreatitis
B) Ischemic heart disease Gastric ulcer
C) Mediastinitis
D) Hiatus hernia of esophagus

101. A woman 70 years old had had a planned laparoscopic cholecystectomy done
according biliary calculi. Six months later the patient again has attacks of severe pains
in the right hypochondrium accompanied by jaundice and dark urine and stool
discoloration. The total serum bilirubin is increased up to 60 mcmol/l, direct 40
mcmol/l. What disease does the patient have
A) residual choledocholithiasis
B) Papillostenosis
C) tumour of the pancreas head
D) tumour of the large duodenal papilla
E) choledochus stricture

102.A 70 years old woman had had a planned laparoscopic cholecystectomy done
according biliary
calculi. Six months later the patient again has attacks of severe pains in the right
hypochondrium
accompanied by jaundice and dark urine and stool discoloration. The total serum
bilirubin is
increased up to 60 mcmol/l, direct 40 mcmol/l. What disease does the patient have
A) residual choledocholithiasis
B) Papillostenosis
C) tumour of the pancreas head
D) tumour of the large duodenal papilla
E) choledochus stricture

103.A 60 years old woman has been ill with chronic calculous cholecystitis for 10
years. During the treatment in sanatorium the patient had had a hepatic colic with
jaundice. Ultra sound investigation revealed a lot of calculi sized 5-6 mm in the
gallbladder. Choledochus is widened to 15 mm and contains concrements up to 6 mm
in diameter in the distal part. What method of treatment is the most adequate and
current
A) cholecystectomy, choledocholithotomy, external choledochus drainage according to
Kerr
B) endoscopic papillosphincterotomy, laparoscopic cholecystectomy
C) cholecystectomy, transduodenal papillosphincterotomy
D) cholecystectomy, choledochoduodenostomy
E) cholecystectomy, choledochojejunostomy

104.A 58 years old woman with overweight right before has had an attack of right
hypochondrium pain and jaundice with dark urine and stool discoloration appeared.
On clinical examination the abdomen is distended and painful on palpation in the right
hypochondrium, The mild liver enlargement there is. In blood the total bilirubin is 90
mkmol/l, direct (conjugated) 60 mkmol/l. What investigation is the most informative
to clarify the diagnosis
A) intravenous cholegraphy
B) infusional cholegraphy
C) retrograde cholangiopancreatography
D) intracutaneous intrahepatic cholegraphy
E) ultra sound investigation of the hepatopancreatobiliary zone

105.A 62 years old woman complains of severe constant pain in the right
hypochondrium, jaundice, discoloration of stool and dark urine, mild fever up to
37,5оС. Above mentioned complaints were appeared after an attack of severe abdomen
pain connected with fatty food intake. On clinical examination the abdomen is soft. A
painful enlarged gall bladder is palpated. The Orthner, Kerr's symptoms are positive.
What is the probable diagnosis
A) Infectious hepatitis
B) Liver cancer
C) Liver abscess
D) Acute cholecystitis, choledochus calculi and obstructive jaundice
E) Liver cirrhosis

106. A 22 years old woman was admitted to the reception department. She complains
of severe cramping lower abdomen pain occurred unexpectedly, general weakness,
sleeplessness, appetite loss and fever up to 39,90 C. At first the pain was appeared in
point between umbilical region and epigastrium and then it was localized in the in the
right iliac region. The patient recall the last menses 8 weeks ago. On clinical
examination the abdomen is soft, painful in the right iliac. The Schyotkin -
Blumberg's symptom is slightly positive, Michelson's symptom is clear positive. On
bimanual gynecological examination the soft uterus is enlarged according pregnancy
onset. Near the uterus there is a soft swelling identified as a separated ovary. In CBC
the WBCs (leucocytes) are 15x109 /l. There is high ESR up to 65 mm/h. What is the
most probable cause provoked above written condition
A) Acute appendicitis
B) Acute salpingoophoritis
C) Pyosalpinx
D) Tubo-ovarian abscess
E) Acute appendicitis and ectopic pregnancy

107. A pregnant woman with 24 weeks gestation term has felt a cramping pain in low
abdomen. Nausea and vomiting are absent. She looks for a medical aid in the
gynecologic out-patient office. On clinical examination the abdomen is soft and tender
on the right. The Schyotkin - Blumberg, Rovzing, Koap's symptoms are slightly
positive and Brendo, Michelson's signs are strongly positive. What is the most
adequate tactics of the doctor in the situation
A) To send the patient to the in-patient department at once to solve the problem of
urgent surgical operation
B) To observe the patient for the next 24 hours at home to clarify the condition
C) Medication therapy
D) Emergent diagnostic abdominal cavity puncture through the posterior vaginal
fornix in this female dispensary office
E) Urgent interruption of pregnancy

108. A 45 years old woman was operated because of biliary calculi and obstructive
jaundice. A two months later after operation there is continuing bile discharge up to
500,0-600,0 ml per day through the Kerr`s external choledochus drainage. On
fistulography using the drainage in the distal part of the choledochus “a forgotten
stount” up to 8 mm in diameter was identified. The choledochus is dilated up to 16
mm. The most correct surgeon treatment in this case is
A) Choledocholithotomy with close seam on choledochus
B) Endoscopic papillosphincterotomy and removing a concrement from choledochus
C) Choledocholethotomy choledochoduodenostomy
D) Choledocholithotomy choledochojejunostomy
E) Choledocholithotomy and drainage of the choledochus

109. The first treatment of rupture of varicose vein at the ankle should be
A) direct pressure and elevation
B) rest in prone position of patient
C) application of tourniquet proximally
D) application of tourniquet distally

110. Classical X-ray image of intestinal obstruction is

A) Filling defect
B) High positioned diaphragm
C) Reactive pleuritis
D) Gas and horizontal levels
E) Pneumatosis

111. 54 years old patient, presented with dizziness, an episode of decreased brain
blood circulation, complains of a pain over the umbilicus after meal ,sometimes very
sharp, is accompanied by vomiting, a episode of diarrhea. History of Blood in stool
sometimes. Cardiac activity arrhythmic, extra systole. Moderate tenderness around
umbilicus. What is the most probable diagnosis
A) Crohn's Diseases
B) Acute intestinal ischemia
C) Chronic cholecystitis
D)Duodenal Ulcer with penetration
E) Non- specific ulcerative colitis

112. 45 years old man presented with chief complains of rise in temperature up to 38c,
pain and swelling in lumbar region and painful mass 5х6 sm. in size, crimson color of
skin over the mass, in the center purulent - necrotic fistulas which is secreting pus.
What is the most probable diagnosis
A) Carbuncle of lumbar region
B) Abscess of lumbar region
C) Erysipelas inflammation
D) Para nephritis
E) Renal Colic

113. Patient К, 43 years old hospitalized in surgical department of the hospital with the
diagnosis of Mechanical jaundice, cholangitis. During echographic researches found
out Huge hydatid cyst of liver (echinoccocus of liver), dilatation of CBD(Common
Bile duct) and intrahepatic ducts. What is the mechanism of jaundice in echinoccocus
of liver
A) Compression of portal vein with occurrence of portal hypertension with jaundice
B) Rupture of contents of cysts into hepatic ducts
C) Occurrence of a viral hepatitis
D) Toxic hepatitis due to absorption of echinococcus fluid (Hydatid cyst fluid)
E) Suppuration of cyst with occurrence purulent cholangitis

114. Patient K, 54 years old operated for hydatid cyst of liver, during operation found
two cysts instead of three, as it has been diagnosed in the preoperative period. Which
methods of investigation will be accurate to locate the third cysts
A) Intraoperative Cholangiography
B) Intraoperative Choledochoscopy
C) Intraoperative echography
D) Intraoperative Retrograde Cholangiopancreatography
E) X-ray Abdomen and Pelvis
115. 65 years old patient complains of a pain in the right iliac fossa, loss of weight,
decrease appetite, weakness, and history of constipation more than 6 months.
Objectively: dry, muddy colored skin, On palpation On the right iliac fossa -
infiltration (mass) 8х10 sm. Size. Which is almost not displacing (Immovable), on
percussion dull sound above the mass. On auscultation peristalsis is increased. Нв
blood - 86 g/l. What is the most probable pathology that might have causes such
clinical picture
A) Cancer of the right kidney
B) Appendicular Infiltrate
C) Crohn's Diseases
D)Carcinoma of Caecum
E)Retroperitoneal Tumour

116. Patient K, 42 years old, is hospitalized in surgical department with complaints of

acute sharp pain in the stomach, vomiting. Suffering from a duodenal ulcer for last 8
years. Suspected as a Duodenal Perforation, however free fundus gas in abdominal
cavity is not revealed. The ulcer is suspected as covered perforation. What method of
diagnosis should be applied for correct diagnosis
A) Pneumoperitoneum
B) Laparocentesis
C) Contrast (dye) investigation of stomach and duodenum
D) Fibrogastroscopy
E) Pneumogastrography

117.Patient B. 74 years old is hospitalized in surgical department with the diagnosis of

perforated stomach ulcer. In the anamnesis heart attack of a myocardium, diabetes,
Hypertension. The patient was advised for Operation, which patient categorically
refused. How to treat the patient
A) Taylor's Method
B) Infusion therapy
C) Antibacterial therapy
D) Start Ulcer Therapy
E) Discharge the patient

118.A 32 years old patient presented with sudden rise in temperature, High grade
fever, headache, pain in stomach and lumbar region, yellowish discoloration of skin.
Urine output of the patient is 100 ml dark muddy colored. Later with these symptoms
Muscles pain is added. One week ago the patient went for fishing. What is the
probable diagnosis
A) Viral hepatitis A
B) Leptospirosis
C) Viral hepatitis E
D) Acute pyelonephritis
E) Food poisoning

119.28 years old patient presented with history of 14 hours constant pain in right
iliac fossa. In last 2 hours the pain has decreased. Objectively: Local guarding of
abdominal muscles. Diagnosed as acute appendicitis. What histological form of acute
appendicitis could result in reduction of intensity of a pain of a stomach
A) Cataral
B) Phlegmonic
C) Gangrenous
D) Perforated
E) Empyema of the appendix

120.A 35 year old woman was admitted to thoracic surgery department with elevation
of body temperature up to 40 0 C, onset of pain with deep breath in the side, cough
with big quantity of purulent sputum and blood with bad smell. What disease causes
these symptoms
A) Complication of liver echinococcosis
B) Bronchiectasis disease
C) Actinomycosis of lungs
D) Abscess of the lungs
E) Tuberculosis of lungs

121.Which of the listed below operation are not done in cases of perforated duodenal
ulcers
A) Resection of 2/3 - 3/4 of the stomach
B) Vagotomy + Pyloroantrumectomy
C) Vagotomy + resection of the ulcer
D) Suturing of the ulcer
E) Gastrostomy

122.What preparations are used for prevention of fungal infection

A) Fluconozol, Orungol, Nisoral
B) Rubomycin, Bleomycin, Mytomycin C
C) Cytosar, Cormyctin, Lomycitin
D) Captopril, Enalapril
E) Isoniazid, Ftibazid, Pyrazinamid

123. Patient Н, 44 years old, is hospitalized in surgical department with the diagnosis -
of postcholecystectomic syndrome, residual choledocholithiasis, cholangitis, and
mechanical jaundice. Operated 8 months back, done cholecystectomy,
Choledocholithotomy, drainage of abdomen according to Kerr. What from of below-
mentioned procedure would be appropriate to avoid occurrence of
postcholecystectomic syndrome
A) X-ray of Abdomen
B) Intraoperative cholangiography
C) Intravenous Cholecystocholangiography
D) Per oral Cholecystography
E) Echography

124. A 30 years old woman, 15 days ago had mild trauma of 5th finger of the left
hand. Treated her self at home independently, Due deterioration of a condition she
visited hospital for medical advice with rise in temperature up to 36 0c. Objectively:
Hypermia and swelling on the ventral surface of finger. Restricted Movements of the
finger. X-ray of the left hand: It is impossible to exclude an early stage of development
оsteomyelitis of the fifth finger. The diagnosis: felon of 5th finger of the left hand.
What form of felon has occurred in the patient
A) Hypodermic
B) Paronychia
C) Bony
D) Tendon Type
E) Joints Type

125.Contraindications for operation in acute pancreatitis are

A) Functional insufficiency of the parenchymatous organs
B) Purulent and septic complications
C) Peritonitis
D) Hemodynamic instability and pancreatogenic shock
E) Erosive bleeding

126. The patient, 43 years old is hospitalized with complaints of repeated vomiting,
spasmodic pain in the abdomen, delay in passes of gases and stool. History of the
patient - appendectomy. Objectively: Position of the patient -lying, pale skin. Pulse 90/
minutes. Blood Pressure - 110/80 mm. Hg, t - 37, 2 oc Moderately distended abdomen,
asymmetric, rigidity on the lower part of the abdomen. Increased peristalsis. Rebound
tenderness- negative (Shetkina- Blumberg). Manual per rectum analysis of rectum-
empty ampoule. Your diagnosis
A) Food poisoning
B) Hepatic Colic
C) Acute pancreatitis
D) Hepatic Colic
E) Acute intestinal obstruction

127. A 41 year old patient was admitted to the intensive care unit with hemorrhagic
shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years.
The source of bleeding are esophageal veins. What is the most effective method for
control of the bleeding
A) Introduction of obturator nasogastric tube
B) Intravenous administration of pituitrin
C) Haemostatic therapy
D) Operation
E) Administration of plasma

128.What develops in cases with decompensated pyloric stenosis

A) Hypertonic dehydration
B) Isotonic dehydration
C) Hypotonic dehydration
D) Intoxication
E) Renal insufficiency

129.The diagnosis - melanoma was made to a 16 year old patient after examination
with complaints of frequent pain in the abdomen, pigmentation of the mucosa and
skin, polyp in the stomach and large intestine was found. It is know that the mother of
the patient analogous pigmentation and was treated often for anemia What disease is
suspected
A) Chron's disease
B) Tuberculosis of the intestine
C) Peytz - Egers's polyposis
D) Adolescent polyposis
E) Hirschprung's disease

130.What develops most often after accidental intake of Hydrochloric acid

A) Cushing's syndrome
B) Kutling's syndrome
C) Deylads's syndrome
D) Cardiac insufficiency
E) Acute pancreatitis

131.Patient С, On chest X-ray found collapse of the right lung, dislocation of the
mediastinum on the left. During puncture of the pleural cavity 2.5 L. of air is
allocated. What is your diagnosis
A) Left-sided Pneumothorax
B) Empyema Pleura
D) Mediastinitis
C)Pneumomediastinum
E) Right sided Pneumothorax

132.Patient of 23 years old suffering from acute glomerulonephritis with nephrotic

syndrome, Initial Phase with normal renal function. What is the baseline treatment
A) Antibiotics
B) Saluretics
C) Kurantil
D) Heparin
E) Prednisolone

133.65 years old patient had been on observation for 5 years concerning an ulcer of
antral part of a stomach. Patient refused operation. Since last 6 months patient is
having constant pain in the epigastric region. Disgust to meat products has appeared.
Working capacity has decreased. The patient has become thin. In contrast examination
of the stomach circular form of defect of a mucous membrane up to 5 sm. in diameter
and aperistaltic zone is revealed. What is an effective method of verification of the
diagnosis
A) Ultra sonogram
B) Fibrogastroduedenoscopy with biopsy
C) Pneumoperitoneum
D) Roentgenoscopy of Stomach
E) ERCP

134. A 38 years old man suffering from duodenal ulcer for long time, patient start
feeling constant heaviness in a stomach after meal, regurgitation, vomiting food
contains which he had in the evening of the previous day, weight loss. Objectively:
Relatively satisfactory condition of the patient, appetite not changed, Turgor of skin is
reduced. On palpation the stomach is soft, symptoms of irritation of abdomen is not
present, “noise of splash “in epigastria region. Urinations normal. Stool once in 3 days.
What complication has occurred in the patient
A) Acute pancreatitis
B) Achalasia, esophagitis
C) An ulcerative stenosis of pyloric canal
D) Cancer of a stomach
E) The covered perforation of an ulcer

135. A 60 year old patient complains of the weakness, loss of appetite, periodic fever
up to 38-40 *C, loss of body weight, cough with a purulent sputum in a small amount
on daytime and large up to 300-400ml sputum discharge with stinking smell on
morning. He is chronic patient suffering from chronic lung emphysema within 10
years. At the past he had had an acute left sided pneumonia of the lower lobe 8-10
weeks ago. After that he noticed a mild mainly on evening fever and night sweats.
The above mentioned complaints was appeared 4 days ago. On physical examination
the patient looks toxic. There are severe underweight, grey skin, unpleasant small
from the mouth, finger clubbing, asymmetric chest secondary to the air entry
limitation on the left. On auscultation the breathing sounds are diminished in the
lower chest on the left and pleural rub phenomenon is defined here. Over other chest
surface a moist rales are heard. The chest X-Ray reveals a pneumosclerosis and lung
cavity with liquid level and thick walls sized 10x7cm in diameter in the upper lobe
on the left. What is the diagnosis of the patient
A) Acute abscess of the left lung
B) Left sided destructive pneumonia
C) Left sided chest TB
D) Chronic lung abscess with in bronchus drainage
E) Bronchiectasis

136.The diagnosis of Right sided pneumothorax is made to a 36 year old patient. What
method of treatment is indicated to the patient
A) Antiinflammation therapy
B) Symptomatic therapy
C) Pleural puncture
D) Thoracotomy
E) Surgical treatment: Drainage of the pleural cavity

137.A 33 years old patient was admitted to the reception room of the Central District
Hospital. He complains of a severely painful swelling localized on posterior neck,
fever up to 38,4oC and general weakness. It is known that the patient suffers from
diabetes mellitus within 5 years. On physical examination on the posterior neck
surface there is an infiltrate elevated above surrounded skin. The tissues affected by
swelling are tens and blue reddish discolored in central area. There are also several
purulent necrotic pustules which are connected with each other and formed a large
skin necrosis. A thinned necrotic skin of this swelling has a holes look like sieve and a
pus is discharging throughout. What disease should a doctor consider first of all
A) Carbuncle
B) Furuncle
C) Acute skin cellulites
D) Carbuncle associated with anthrax
E) Skin abscess

138. Patient B, 63 years old is hospitalized in thoracic surgery department with

complaints of nausea, vomiting after taking food, weakness, loss of weight. After
radiological investigation the diagnosis is as follows: - “Achalasia Cardia”. What from
below-mentioned is the reason of this disease
A) Cicatricial stenosis of esophagus
B) Insufficient development of Auerbach's plexus
C) Hiatal Hernia
D) Varicose of Esophageal vein (Esophageal Varices)
E) Tumour of lower third of esophagus

139. A 38 year old woman was hospitalized to the surgical unit with acute abdominal
pain irradiating to the spine and vomiting. On laparocentesis hemorrhagic fluid is
obtained. What disease is suspected
A) Renal colic
B) Acute enterocolitis
C) Acute pancreatitis
D) Perforated gastric ulcer
E) Acute appendicitis

140. Purulent mediastinitis is diagnosed on a 63 year old patient. What of the below
listed diseases are not the cause of purulent mediastinitis
A) Deep neck phlegmon
B) Perforation of the cervical part of the easophagus
C) Perforation of the thoracic the esophagus
D) Cervical lymphadenitis
E) Iatrogenic injury of the trachea

141.A woman born in 1952 consulting by a doctor in the out-patient office complains
of a reddish bordered swelling in the low back skin appeared 3 days after branch tree
prick. The fever is mild up to 37,9 C. Other complains are the general weakness,
headache, malaise and appetite loss. On physical examination on the loin skin a
swelling and hyperemia are revealed. On palpation there is a positive fluctuation
symptom. What is the most probable diagnosis
A) Acute cellulites of the loin skin
B) Hematoma
C) Carbuncle
D) Furuncle
E) Acute abscess of the loin skin

142.A 42 years old patient consults by a surgeon with complains of the painful,
severely itching and hyperemic thumb of the right hand. It is known that the patient
has pricked his finger with a fish bone one week ago. On examination the affected
thumb is rosy red and painful on touch. There is a red bordered and elevated above the
surrounding skin spot. The chest and heart are symptomatic free. The heart rate is 80
per min. Blood pressure is 130/90 mm Hg, Body temperature is 36,7*C. What's the
diagnosis
A) erysipelas
B) Erysipelas
C) acute lymphangitis
D) acute panaritium
E) Paronychia

143.Patient Е, 51 year old is hospitalized in gastroenterology department with

complaints of jaundice, loss of weight, weakness, dark color urine, and light colored
stool. Diagnosis: Mechanical jaundice, Cholangitis. Disease began gradually.
Suspected as Cancer of ampullae's of Vater. What diagnostic method should be
applied for confirmation of the diagnosis
A) Echography
B) Fibroduedenoscopy with biopsy of ampulla of Vater
C) X-ray Abdomen
D) Pneumogastrography
E) Computer tomography

144.The 67 years old patient within 5 years had had 5 recurrent fractures of the lower
extremities without considerable cause. O-shaped deformity of the legs in the knee
joints was appeared. The skull, pelvis and lower extremities X-Ray films shows the
thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.
The blood tests does not reveal any inflammation activity. Serum calcium is normal.
What disease do you consider in this case
A) Hyperparathyoid dystrophy
B) Chronic оsteomyelitis
C) Myeloma
D) Paget's disease
E) Mottled disease (marble disease)

145. A 34 years old patient, during tooth filling accidentally inhaled a dental pine.
Referred to emergency department of Hospital. Complain of moderate dyspnea, dry
cough, dizziness, and disturbed. On Chest X-ray on the hilar region of right lung
identified radio opaque subject. What volume of the help is necessary in this case
A) Urgent Fibrobronchoscopic removal of the foreign body
B) Urgent Diagnostic Fibrobronchoscopy
C) Urgent Rigid Bronchoscopic removal of the foreign body
D) Thoractomy, Bronchotomy, removal of foreign body
E) Antibacterial therapy, Cough expectorants, Control Chest X-ray

146. Diarrhea is not typical but still often symptom of acute appendicitis in children.
In what case diarrhea is exact sign of appendix inflammation
A) in case of peritonitis
B) in infants and early aged children
C) in case of retrocecal appendicitis
D) when acute appendicitis is secondary to acute enterocolitis
E) in case of pelvic appendices location

147.The symptoms and signs of acute appendicitis depends on the anatomical location
of appendix. What kind of location promotes signs of urine tract irritation and the
diarrhea
A) Medial
B) Retrocaecal
C) typical
D) descending
E) left- hand side location

148. A patient was delivered to a surgical department after a road accident with a
closed trauma of chest and right-sided rib fracture. The patient was diagnosed with
right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural
puncture should be made in:
A) In the 2nd intercostal space along the middle clavicular line
B) In the 6th intercostal space along the posterior axillary line
C) In the 7th intercostal space along the scapular line
D) In the projection of pleural sinus
E) In the point of the greatest dullness on percussion

149. Name a statistical observation unit for determination of influence amount of

bloodsugar on the healing of wound's surface in a postoperative period
A) The patient in a postoperative period
B) An amount of bloodsugar
C) Blood analysis
D) The patient who has a wound surface
E) The patient who was discharged on an after-care

150. A 20-year-old patient was delivered to the hospital in summer from the street with
hemorrhage from the brachial artery. First medical aid involved application of a
tourniquet for provisional arrest of bleeding. What is the maximal exposure of the
tourniquet
A) 120 minutes
B) 15 minutes
C) 30 minutes
D) 60 minutes
E) 180 minutes

150. During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic
man is found to have multiple areas of narrowing alternating with dilatation ("chain of
lakes" appearance) of the main pancreatic duct. The operation of choice is
A) Lateral pancreaticojejunostomy
B) Distal pancreaticojejunostomy
C) Sphincterotomy
D) Distal pancreatectomy
E) Total pancreatectomy
151. The treatment of choice for duodenal obstruction caused by secondary duodenal
hematoma that developed a few days after blunt abdominal injury is
A Nasogastric decompression and parenteral alimentation
B Retrocolic gastrojejunostomy
C Duodenojejunostomy
D Immediate exploration
E Tube duodenostomy

152. A 37-year-old patient has come to clinic being wounded in the area of umbilicus
an hour ago. On physical exam, there is a prick and cut painful wound of about 0,5x1
cm around umbilicus on the abdominal skin with slight bleeding. How would you help
this patient
A Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the
wound
B Drainage of the wound with rubber strip
C Inspection of the wound with canal probe
D Aseptic bandage
E Suture on the wound

153. A 34-year-old patient was bitten by a dog 3 hours ago. There is a wound by dog
teeth without bleeding in the left arm. What surgical help would you provide to this
patient
A Clean wound with detergent water and apply anti-septic
B Aseptic bandage
C Cream bandage
D Complete suture of the wound
E Incomplete suture of the wound

154. The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient.

What method of treatment is indicated to the patient
A Drainage of the pleural cavity
B Antiinflammation therapy
C Symptomatic therapy
D Pleural puncture
E Thoracotomy

155. It is suspected that a 34 year old patient has an abscess of Douglas pouches. What
diagnostic method is to be chosen
A Digital examination of rectum
B Rectoromanoscopy
C Laparoscopy
D Percussion and auscultation of stomach
E R-scopy of abdominal cavity
156. A patient has restrained umbilical hernia complicated by phlegmon of hernia sac,
it is necessary to take following actions
A Herniotomy by Mayo-Sapezhko
B Herniotomy by Mayo
C Herniotomy by Sapezhko
D Herniotomy by Lekser
E Herniotomy by Grenov

157. A 52 year old man has recurrent transient ischemic attacks. Auscultation of the
carotid arteries detected murmur. What diagnostic method is to be applied in the first
place
A Ultrasound Doppler
B CT of the brain
C MRI of the brain
D Cerebral angiography
E Electroencephalography

158. The main symptom of gastric diverticulum is:

A Epigastric pain
B hematemesis
C vomiting
D pain relieved by food

159. A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of
treatment is indicated to the patient
A Surgical drainage of the pleural cavity
B Antiinflammation therapy
C Symptomatic therapy
D Pleural puncture
E Thoracotomy

160. A 28 year old woman was admitted to the emergency room with a slightly
reddened, painful "knot" 8 cm above the medial malleolus. Examination in the
standing position demonstrates a distended vein above and below the mass. There are
no other abnormalities on physical examination. The most likely diagnosis is
A Superficial venous thrombosis
B Early deep vein thrombosis
C Insect bite
D Cellulitis
E Subcutaneous hematoma

161. A patient is staying in the hospital with the diagnosis of abdominal typhus.
During the 3-d week from the beginning of the disease the patient stopped keeping diet
and confinement to bed. As a result the body temperature and rapid pulse decreased
and melena appeared. What kind of complications should we think about first of all
A Intestinal haemorrhage
B Thrombophlebitis
C Meningitis
D Nephroso-nephritis
E Hepatitis

162. A 45-year-old woman, mother of four children, comes to the emergency room
complaining of a sudden onset of the epigastric and right upper quadrant pain,
radiating to the back, accompanied by vomiting. On examination, tenderness is elicited
in the right upper quadrant, bowel sounds are decreased, and laboratory data shows
leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely
diagnosis is
A Acute cholecystitis
B Perforated peptic ulcer disease
C Myocardial infarction
D Sigmoid diverticulitis
E Acute pancreatitis

163. During an operation for presumed appendicitis the appendix was found to be
normal; however, the terminal ileum is evidently thickened and feels rubbery, its
serosa is covered with grayish-white exudate, and several loops of apparently normal
small intestine are adherent to it. The most likely diagnosis is
A Crohn's disease of the terminal ileum
B Perforated Meckel's diverticulum
C Ulcerative colitis
D Ileocecal tuberculosis
E Acute ileitis

164. A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid
enlargement complains of 10 pound weight gain and fatigue. What is the most
probable diagnosis
A Hashimoto's thyroiditis
B Riedel's thyroiditis
C Subacute thyroiditis
D Suppurative thyroiditis
E Papillary thyroid carcinoma

165. A severely traumatized patient who has been receiving prolonged parenteral
alimentation develops diarrhea, mental depression, alopecia and perioral and
periorbital dermatitis. Administration of which of the following trace elements is most
likely to reverse these complications
A Zinc
B Iodine
C Selenium
D Silicon
E Copper

166. A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute
abdominal pain irradiating to the spine. On laparocentesis hemorrhagic fluid is
obtained. What disease should be suspected
A Acute pancreatitis
B Renal colic
C Acute enterocolitis
D Perforated gastric ulcer
E Acute appendicitis

167. A 19 y.o. man was admitted to the reception department in 20 minutes after being
wounded with the knife to the left chest. The patient is confused. The heart rate is 96
bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished
apical beat and evident heart enlargement What kind of penetrative chest wound
complications has developed in patient
A Pericardium tamponade
B Massive hemothorax
C Open pneumothorax
D Closed pneumothorax
E Valve-likes pneumothorax

168. A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone.
He can eat only liquid food. While swallowing sometimes he has attacks of cough and
dyspnea. Above mentioned complaints are progressing. It is known that the patient has
had a chemical burn of esophagus one month ago. What complication does the patient
have
A Corrosive esophagitis and stricture
B Esophagitis
C Esophageal diverticulum
D Cardiac achalasia
E Cardiac insufficiency

169. A patient operated for acute paraproctitis undergoes antibacterial and

detoxification therapy, the local course of the disease has the positive dynamics. Since
the operation the patient has had chills, pyrexia, tachycardia, euphoria for five days.
The doctor suspected sepsis. What study will confirm the diagnosis
A Blood culture for a pathogen
B X-ray of lungs
C Liver ultrasound
D Determining the rate of microbial contamination of wound
E Determining the rate of average-weight molecules

170. A 44-year-old patient has been admitted to a hospital with complaints of dull,
aching pain in the left lumbar region, the admixture of pus in the urine. Examination
revealed a grade II staghorn calculus on the left. What method of treatment is indicated
for this patient
A Surgery
B Contact lithotripsy
C Distance lithotripsy
D Conservative therapy
E Ascending litholysis

171. A 48-year-old patient got a job-related injury of a hypodermic varicose vein on

his shin that was accompanied by the intensive phleborrhagia. Choose the optimal
variant of first aid
A Pressure bandage and limb strapping
B Application of Esmarch's tourniquet above the injury
C Application of Esmarch's tourniquet beneath the injury
D Occlusion of femoral artery in a typical place
E Maximal limb flexion in knee joint

172. A 24-year-old patient got a puncture injury below the Poupart's ligament
accompanied by intense arterial bleeding. The best method to temporarily stop the
bleeding in the patient would be
A Compression band
B Esmarch's tourniquet
C Maximum limb bending
D Compressing a blood vessel with a clamp
E Wound suturing

173. Late complication of gastrojejunostomy is

A Malabsorption
B Stomal edema
C Fistula
D Volvulus

174.A 65-year-old patient complains of dull pain in the rectum during and after
defecation, discharge of mucus and small amount of blood mixed up with mucus and
faeces. The discharged blood is of dark red color, sometimes with small amount of
clots. The patient is sick for 8 months, has lost some weight. On digital examination,
there is a round constriction of the rectum with infiltrate at a height of 4-5 cm from the
anus. What is the most probable diagnosis
A Cancer of the medium-ampullar section of the rectum
B Cicatricial stenosis of the rectum
C Chronic paraproctitis
D Crohn's disease
E Non-specific ulcer colitis

175. A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar
area. He complains of pain in this area. There is microhematuria in the urea. Excretory
urography revealed that kidney's functioning is satisfactory. What is the most probable
diagnosis?
A Kidney's contusion
B Subcapsular kidney's rupture
C Multiple kidney's ruptures
D Paranephric hematoma
E Kidney's abruption

176. A female patient has been suffering from pain in the right subcostal area, bitter
taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg.
Body temperature in the evening is 37,6*C. Sonography revealed that bile bladder was
5,5х2,7 cm large, its wall - 0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver
segment contains a roundish hypoechoic formation up to 5 cm in diameter and another
two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the
most likely diagnosis
A Alveolar echinococcus of liver
B Liver cancer
C Liver abscess
D Cystous liver cancer
E Paravesical liver abscesses

177. A 43 year old patient had cholecystectomy 6 years ago because of chronic
calculous cholecystitis. Lately he has been suffering from pain in the right subcostal
area and recurrent jaundice. Jaundice hasn't gone for the last 2 weeks. Stenosing
papillitis 0,5 cm long has been revealed. What is the best way of treatment
A To perform endocsopic papillosphincterotomy
B To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
C To perform external choledocheal drainage
D To perform transduodenal papillosphincterotomy
E To perform choledochoduodenostomy

178. A 62-year-old patient has been delivered to the surgical department with
complaints of sudden pain in the umbilical region irradiating to the back and groin,
which was accompanied by a syncope. Objectively: the patient is in grave condition,
umbilical region is tender on palpation, bowel sounds are diminished. AP drop is
present. USI reveals: free fluid in the abdomen, thickening of the wall of the
abdominal aorta. The most likely diagnosis is
A Rupture of abdominal aortic aneurism
B Stomach ulcer perforation
C Acute pancreatitis
D Peritonitis
E Acute appendicitis

178. A patient suffers from suddenly arising crampy pain in the right loin area. 2
hours after the pain had started, hematuria took place. Loin X-ray: no pathological
shadows. Ultrasound: pyelocaliectasis on the right, the left part is normal. What is the
most probable diagnosis
A Stone of the right kidney, renal colic
B Acute appendicitis
C Intestine invagination
D Twist of the right ovary cyst
E Tumor of the right kidney pelvis

179. A patient complains of an extremely intense pain in epigastrium. He has peptic

ulcer disease of duodenum for 10 years. The patient is in the forced position being on
the right side with legs abducted to stomach. Abdomen has acute tenderness in the
epigastrium. Guarding contraction of the abdominal wall muscles is observed. What is
the preliminary diagnosis
A Perforation of ulcer
B Acute pancreatitis
C Acute condition of peptic ulcer disease
D Penetration of ulcer into pancreas
E Thrombosis of mesenteric vessels

180. A 30-year-old patient complains of pain, hyperemia along subcutaneous veins,

rise in body temperature. While examining the large shin subcutaneous vein, there is
hyperemia, pain by pressing. Homanss and Luses's symptoms are negative. What is
the preliminary diagnosis
A Acute thrombophlebitis of subcutaneous veins
B Acute ileophemoral phlebothrombosis
C Lymphostasis
D Embolism of aorta
E Thrombosis of aorta

181. A 30-year-old man has suffered from traffic accident. Consciousness is absent.
Pulse on the carotid artery is undeterminable, no respiration. There is a wide leather
belt on man's waist. What measures are to be taken
A Conduct an artificial ventilation of lungs and closed-chest cardiac massage after
having released from the belt
B Start immediate artificial ventilation of lungs and closed-chest cardiac massage
C Turn the victim to the right side
D Do not touch the victim until the arrival of the police
E Put the victim with his back on the shield

182. A 50-year-old patient complains of bursting pain in the left lower limb that is
getting worse on exertion, swelling in the region of shin and foot. Objectively: left shin
and foot are doughy, skin of the lower shin is indurated and has a bronze tint,
subcutaneous veins are dilated, there is an ulcer with necrotic masses. What is the most
likely diagnosis
A Postthrombophlebitic syndrome
B Chronic arterial insufficiency
C Acute arterial thrombosis
D Deep vein thrombosis of the lower limbs
E Gangrene of the lower extremity

183. Three days ago a 29-year-old patient presented with pulsating pain in the region
of rectum, fever, general weakness. Objectively: local tenderness in the anal region in
the 6 o'clock position. Digital investigation of rectum revealed a painful infiltration
reaching the pectinate line. What is the most likely diagnosis
A Acute periproctitis
B Acute anal fissure
C Acute haemorrhoids
D Rectum tumour
E Acute prostatitis

184. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area
following occasional swallowing of a fish bone. On esophagoscopy the foreign body
wasn't revealed. The pain increased and localized between scapulas. In a day
temperature elevated, condition became worse, dysphagia intensified. What
complication has developed?
A Perforation of esophagus with mediastinitis
B Esophageal hemorrhage
C Obstruction of esophagus
D Pulmonary atelectasis
E Aspirative pneumonia

185. A 19 year old patient was admitted to a hospital with acute destructive
appendicitis. He suffers from hemophilia of B type. What antihemophilic medications
should be included in pre- and post-operative treatment plan
A Fresh frozen plasma
B Cryoprecipitate
C Fresh frozen blood
D Native plasma
E Dried plasma

186. On the 4th day after recovering from a cold a patient was hospitalized with
complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single
discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the
patient's condition is moderately severe. Respiratory rate - 28-30/min, Ps- 96 bpm, AP-
110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung.
There are moist rales of different types above the lower lobe and amphoric breath near
the angle of scapula. What is the most likely diagnosis
A Acute pulmonary abscess
B Exudative pleuritis
C Acute focal pneumonia
D Pleural empyema
E Pyopneumothorax

187. A 24 y.o. male patient was transferred to the chest surgery department from
general surgical department with acute post-traumatic empyema of pleura. On the X-
ray: wide level horizontal of fluid on the right. What method of treatment should be
prescribed
A Puncture and drainage of pleural cavity
B Decortication of pleura
C Pneumonectomy
D Thoracoplasty
E Lobectomy

188. In a 65 y.o. female patient a tumor 13х8 сm in size in the umbilical area and
above is palpated, mild tenderness on palpation, unmovable, pulsates. On auscultation:
systolic murmur. What is the most probable diagnosis
A Abdominal aortic aneurism
B Stomach tumor
C Arterio-venous aneurism
D Tricuspid valve insufficiency
E Mitral insufficiency

189. A 30-year-old man was injured in a fire and got thermal burns of III-A and III-B
degree that affected 20% of the total skin. AP - 110/70 mm Hg, heart rate -120/min.
What transfusion means should be used for blind infusion before transportation
A Saline solutions
B Polyglycine
C 10% glucose solution
D Fresh frozen plasma
E Albumin

190. Development of chronic venous insufficiency of lower extremities depends on the

functional condition of so-called musculovenous pump. This term refers to the
following group of muscles
A Shin muscles
B Abdominal wall muscles
C Buttock region muscles
D Thigh muscles
E Foot muscles

191. A 27-year-old patient was brought to clinic with a crashed wound of the posterior
surface of the right shin in 2 hours after the accident happened. During surgical
treatment pieces of dirty clothes and gravel were removed. What actions from the
given below are the decisive ones to prevent an anaerobic infection
A Radical surgical treatment
B Introduction of the preventive dose of an anti-gangrene serum
C Introduction of the medical dose of the anti-gangrene serum
D Rational antibiotic therapy
E Hyperbaric oxygenation

192. A 32-year-old patient lives in an area endemic for echinococcosis. In the last 6
months he reports of pain in the right subcostal area, fever. He is suspected to have
liver echinococcosis. What study would be the most informative in this case
A Sonography
B Survey radiography of abdominal cavity
C Biochemical laboratory examination
D Angiography
E Liver scanning

193. Ideal treatment for duodenal ulcer is

A High selective proximal vagotomy
B gastrojejunostomy
C gastrectomy
D truncal vagotomy

194. The patient complains of a painful swelling in the chin region, malaise, headache.
Examination reveals an acutely inflamed cone-shaped dense node. The skin over it is
tense, red. In the center of the node there is an ulcer with overhanging edges and a
necrotic core of a dirty-green color. Submandibular lymph nodes on the right are
enlarged and painful. What is the most likely diagnosis
A Furuncle
B Tuberculosis
C Carbuncle
D Tertiary syphilis (gummatous form)
E Parasitic sycosis

195. On the 5th day after a surgery for colon injury a patient complains of bursting
pain in the postoperative wound, weakness, drowsiness, headache, fever up to 400C.
Objectively: the skin around the wound is swollen, there is gas crepitation. The wound
discharges are scarce foul-smelling, of dark-gray color. What is the most likely
diagnosis
A Anaerobic clostridial wound infection
B Abscess
C Postoperative wound infection
D Erysipelas
E Phlegmon

196. A 54-year-old female patient has been admitted to a hospital 12 days after the
beginning of acute pancreatitis. Objectively: the patient is in grave condition. The
body temperature is hectic. Ps - 112 bpm. The abdomen is swollen. Epigastrium
palpation reveals a very painful infiltration falling in the localization of pancreas.
Abdominal cavity contains fluid. There is an edema of the left lumbar region. In blood:
WBCs – 18*109/l. What is the required tactics of the patient's treatment
A Surgical treatment
B Further conservative treatment
C Peritoneal dialysis
D Increase in antienzymes
E Massive antibacterial therapy

197. To replace the blood loss replacement 1000 ml of the same group of Rhesus-
compatible donated blood was transfused to the patient. The blood was conserved by
sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin,
tachycardia, muscles cramps in the patient. What complication should be suspected
A Citrate intoxication
B Citrate shock
C Allergic reaction
D Anaphylactic shock
E Pyrogenous reaction

198. A 20 y.o. patient suddenly felt ill 12 hours ago. There was pain in epigastric area,
nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain
localized in the right iliac area. On examination: positive rebound tenderness
symptoms. WBC- 12,2*109/L. What is the most probable diagnosis
A Acute appendicitis
B Acute pancreatitis
C Perforated ulcer
D Right side kidney colic
E Acute cholecystitis

199. A patient, aged 58, was fishing in the winter. On return home after some time felt
some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then
after rewarming became red, warm to the touch. Edema is not significant, limited to
the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is
observed
A I degree
B II degree
C III degree
D IV degree
E V degree

200. A 43 year old patient had right-sided deep vein thrombosis of iliofemoral segment
3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right
extremity. Objectively: moderate edema of shin, brown induration of skin in the lower
third of shin, varix dilatation of superficial shin veins are present. What is the most
probable diagnosis
A Postthrombophlebitic syndrome, varicose form
B Acute thrombosis of right veins
C Lymphedema of lower right extremity
D Parkes-Weber syndrome
E Acute thrombophlebitis of superficial veins

201. A child undergoes in-patient treatment for acute staphylococcal destruction of the
right lung. Unexpectedly he developed acute chest pain on the right, dyspnea,
cyanosis. The right side of chest lags behind in the respiratory act. Percussion reveals
dullness in the lower parts on the right, bandbox resonance in the upper parts. Borders
of the relative cardiac dullness are shifted to the left. What complication has most
likely developed
A Right-sided pyopneumothorax
B Pleural empyema
C Spontaneous pneumothorax
D Exudative pleuritis
E Right lung abscess

202. A 98 y.o. male patient complains of pain in the left lower limb which intensifies
on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On
examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the
left shin. "Furrow symptom " is positive on the left. Pulse on foot arteries and popliteal
artery isn't palpated, on the femoral artery it's weak. On the right limb the artery
pulsation is reserved. What is the most probable diagnosis
A Arteriosclerosis obliterans
B Obliterating endarteritis
C Hemoral artery thrombosis
D Raynauld's disease
E Buerger's disease (thromboangiitis obliterans)

203. A 26-year-old patient complains of experiencing pain in the right hand for 4 days.
The pain arose at the site of corns on the palmar surface at the base of the II and III
fingers. Some time later the dorsum of hand became edematic. I and III fingers are
half-bent in the interphalangeal joints, the hand looks like "rake". What is the most
likely diagnosis
A Phlegmon of the second interdigital space of the right hand
B Adenophlegmon of the right hand
C Corn abscess of the right hand
D U-shaped phlegmon of the right hand
E Tendovaginitis

204. A 30-year-old patient had deep burn covering 30\% of body 30 days ago. Now he
presents with continued fever, loss of appetite, night sweats. Burned surface weakly
granulates. What is the stage of burn disease
A Septicotoxemia
B Primary burn shock
C Secondary burn shock
D Acute burn toxemia
E Convalescence

205. A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric
area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing
is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg's
symptom. What is the maximal term to make a diagnosis
A In 2 hours
B In 0,5 hours
C In 1 hour
D In 3 hours
E In 6 hours

206. A surgeon examined a 42-year-old patient and diagnosed him with right forearm
furuncle at the purulo-necrotic stage. The furuncle was lanced. At the hydration stage
the wound dressing should enclose the following medication
A Hypertonic solution
B Vishnevsky ointment
C Ichthyol ointment
D Chloramine
E Dimexide

207. A 19 year old boy was admitted to a hospital with closed abdominal trauma. In
course of operation multiple ruptures of spleen and small intestine were revealed. AP
is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the
patient's blood group and rhesus compatibility
A A doctor of any specialty
B A laboratory physician
C A surgeon
D A traumatologist
E An anaesthesilogist

208. A 36-year-old man was delivered to the surgical department an hour after a road
accident. His condition is getting worse: respiratory insufficiency is progressing, there
are cardiac abnormalities. Clinical and roentgenologic investigations revealed
mediastinal displacement. What process has caused this complication
A Valvular pneumothorax
B Open pneumothorax
C Closed pneumothorax
D Subcutaneous emphysema
E Mediastinitis

209. A 35 y.o. female patient was admitted to the surgical department with symptoms
of ulcerative gastric hemorrhage. It's been the third hemorrhage for the last 2 years.
After conservative treatment vomiting with blood stopped, hemoglobin elevated from
60 till 108 g/L. General condition became better. But profuse vomiting with blood
reoccured in 2-3- hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is
the tactics of treatment
A Urgent surgery
B Deferred surgery
C Conservative treatment
D Conservative treatment with following surgery
E Taylor's treatment

210. A 47-year-old patient complains about cough with purulent sputum, pain in the
lower part of the left chest, periodical body temperature rise. She has been suffering
from these presentations for about 10 years. Objectively: "drumstick" distal phalanges.
What examination would be the most informative for making a diagnosis
A Bronchography
B Bronchoscopy
C Survey radiograph of lungs
D Pleural puncture
E Bacteriological analysis of sputum