Surgery 3
問題一覧
1
Name a statistical observation unit for determination of influence amount of bloodsugar on the healing of wound's surface in a postoperative period:
The patient in a postoperative period
2
Parents of a 2-year-old boy applied to clinic complaining of right testicle absence in the scrotum of a boy. While examining the boy, hypoplasia of the right half of the scrotum was revealed, absence of the testicle. Testicle is miniaturized, it palpitates along the inguinal canal but it could not be moved down to scrotum. What is the most probable diagnosis?
Right-sided cryptorchism, inguinal form
3
Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?
Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)
4
A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?
Right shin osteomielitis
5
While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of "umbilical sepsis". Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her child's condition had worsened for the last 24 hours what resulted in child's refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,80C. What is the most probable preliminary diagnosis?
Epiphysial osteomyelitis of the humerus
6
A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, there was also one-time vomiting. Objectively: the child's condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor's finger was stained with blood. What is the most probable diagnosis?
Ileocecal invagination
7
A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of "meat slops". Objectively: the patient's condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?
Lung gangrene
8
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?
Punction and drainage of pleural cavity
9
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?
Bronchography
10
A 28-year-old female patient has been admitted to a hospital. She states to be ill for 12 years. On examination she has been diagnosed with bronchiectasis with affection of the left lower lobe of lung. What is the optimal treatment tactics for this patient?
Left lower lobectomy
11
A 38-year-old patient has suddenly developed pain in the left side of his chest, suffocation. Objectively: moderately grave condition, Ps- 100/min, AP- 90/60 mm Hg, breath sounds on the left cannot be auscultated. Chest radiography shows the collapse of the left lung up to 1/2. What kind of treatment should be administered?
Passive thoracostomy
12
A 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the most trustworthy criterion of breath effectiveness?
РаСО2 and РаО2
13
A 42-year-old male patient has been delivered to a hospital in a grave condition with dyspnea, cough with expectoration of purulent sputum, fever up to 39,5oC. The first symptoms appeared 3 weeks ago. Two weeks ago, a local therapist diagnosed him with acute right-sided pneumonia. Over the last 3 days, the patient's condition deteriorated: there was a progress of dyspnea, weakness, lack of appetite. Chest radiography confirms a rounded shadow in the lower lobe of the right lung with a horizontal fluid level, the right sinus is not clearly visualized. What is the most likely diagnosis?
Abscess of the right lung
14
A 45-year-old male patient with acute abscess of the left lung has suddenly developed acute chest pain and dyspnea while coughing, tachycardia has increased. The control Ro-gram shows left lung collapse, the air in the left pleural cavity and a horizontal fluid level. What is the mechanism of this complication?
Abscess burst into the pleural cavity
15
A 21-year-old female patient has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest. Body temperature is 38,8oC. The condition developed three days ago. Respiratory rate is 42/min, auscultation reveals shallow breathing. There is percussive dullness on the right starting from the middle of the blade, breath sounds cannot be heard. The left border of heart is 3 cm displaced outwards. Embryocardia is present, HR is 110/min. The right hypochondrium is painful on palpation. What urgent therapeutic measures should be taken in this situation?
Emergency puncture of the pleural cavity
16
A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months. Objectively: t0 - 37,30С, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?
Lung cancer
17
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?
Acute pulmonary abscess
18
A 36-year-old injured has been taken to the emergency station with open tibial fractures. Examination reveals bleeding: pulsating blood spurts out of the wound. What medical manipulations are required at this stage of medical care?
Apply a tourniquet on the thigh proximal to the source of bleeding and transport the patient to the operating room
19
An infant is full-term. Delivery was pathological, with breech presentation. Examination of the infant revealed limited abduction of the right leg to 50o , positive "clicking" symptom on the right, asymmetric inguinal folds. What is the most probable diagnosis?
Inborn dislocation of the right hip
20
A 20-year-old man complains about pain arising in the lower third of femoral bone under stress and at rest. He denies having a trauma. Objectively: the skin is of normal colour, deep palpation reveals pastosity and pain, knee joint motions are limited. X-ray picture of the meta-epyphisis of distal femur shows a destruction zone and spicules. In blood: immature cell forms, no signs of inflammation. What is the most likely diagnosis?
Osteogenic sarcoma
21
A 23-year-old male patient consulted a doctor about pain occurring in the lower third of the thigh with weight bearing activities and unloaded. The patient denies any injuries to the region. Objectively: the skin is of normal color, deep palpation reveals pastosity and tenderness, movements of the knee joint are limited. Radiograph of the distal femoral metaepiphyseal region shows a zone of degradation and spicules. In blood: immature cells are present, there are no signs of inflammation. What is the most likely diagnosis?
Osteosarcoma
22
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?
Acute pulmonary abscess
23
A patient undergoing treatment for the left-sided destructive pneumonia presents with deterioration of his general condition, progressing dyspnea, cyanosis. Objectively: the left side of chest is not involved in respiration, breathing sounds cannot be auscultated. Radiograph shows a shadow reaching the 5 rib with a horizontal fluid level and a radiolucency above it, the mediastinum is displaced to the right. What is the medical tactics?
Thoracostomy
24
A patient with suspicion of pelvic bones fraction is under examination conducted by the doctor who presses alae ilii in medial direction with his both hands. What causes painful syndrome of the patient?
Disorder of continuity of the pelvic ring
25
Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:
At right angle with varus positioning of the foot
26
A 2-year-old boy has been admitted to the casualty department for the pain and deformity of his right thigh. Radiograph shows a femoral fracture with longitudinal displacement. What method of treatment is indicated for the patient?
Schede-type vertical suspension
27
A 22 year old patient was admitted to trauma center with complaints of pain in the left ankle joint that was getting worse during moving and weight bearing. On the clinical examination it was found that the patient had the closed fracture of medial malleolus without displacement. In which position should the foot be fixed in plaster cast?
At right angle with varus positioning of the foot
28
A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the posterior surface of his left leg. The pain increases during changing body position and also in the upright position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?
Pathology of intercostal disks
29
A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position. positive stretching symptoms were revealed on examination. What is an initial diagnosis?
Intervertebral ligaments disorder
30
A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent mediastinitis?
Cervical lymphadenitis
31
Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?
Cervical lymphadenitis
32
Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?
Cervical lymphadenitis
33
A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient's condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?
Posttraumatic osteomyelitis
34
A patient was delivered to the admission ward 40 minutes after a minor trauma with complaints of pain in the thoracic spine. He has a history of pulmonary tuberculosis. Roentgenography results: suspected compression fracture of the VIII and IX thoracic vertebrae. What pathological process in spine might have stimulated pathological fracture of vertebral bodies?
Tuberculous spondylitis
35
A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patient's condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?
Contact-and-aspiration
36
Survey radiograph of chest of a 62 year old smoker who often suffers from "pneumonias" showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed deviation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?
Cenral cancer of lung
37
After the pneumatic dilatation of oesophageal stricture a patient developed acute retrosternal pain getting worse when throwing the head back and swallowing. Objectively: dilatation of the neck veins, dropped beat pulse, signs of purulent intoxication, oliguria, emphysema of the upper portion of chest. What disease can be suspected?
Suppurative mediastinitis
38
A 27-year-old male patient consulted a doctor about pain in the lower third of the thigh with weight bearing activities and unloaded. Two years ago, the patient underwent treatment in the casualty depatment for the open fracture of the lower third of femur. The fracture healed slowly, the healing process was accompanied by prulent inflammation. Objectively: edema of the lower third of the thigh, elevated local temperature. Radiograph shows signs of destruction and sequestration. What is the most likely diagnosis?
Chronic post-traumatic osteomyelitis
39
A boy is 1 year old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh, body temperature rose up to 39oC. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?
Acute haematogenic osteomyelitis
40
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:
In the 2nd intercostal space along the middle clavicular line
41
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 BP80/60 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?
Pericardium tamponade
42
A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is indicated to the patient?
Drainage of the pleural cavity
43
A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?
Surgical treatment: drainage of the pleural cavity
44
The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of treatment is indicated to the patient?
Drainage of the pleural cavity
45
A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?
Pleural cavity drainage
46
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 roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
Valvular pneumothorax
47
On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?
The second intercostal space along the medioclavicular line
48
A 29-year-old unconscious patient has been delivered to a hospital. Objectively: skin and mucous membranes are pale, cyanotic, breath sounds are dramatically diminished on the right and cannot be auscultated in the lower parts, at the level of the 6 rib along the anterior axillary line there is a wound hole with moderate bleeding and passage of air during inspiration. Radiography reveals a bullet in the pleural cavity. What is the medical tactics of choice?
Emergency thoracotomy
49
A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps- 120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:
With ambulance vehicle in the 1st turn
50
A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps- 132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the first-aid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?
Dressing ward
51
As a result of a road accident a 45-year-old male patient got multiple injuries, namely closed fractures of the right humerus and the left antebrachial bones with a displacement of bone fragments, a closed blunt abdominal injury. The patient was delivered to the emergency department 30 minutes after the injury. Objectively: the skin is pale. AP- 90/20 mm Hg, there is pain and deformation at the fracture sites. Abdomen is tense, palpation causes severe pain, there is rebound tenderness (positive Blumberg's sign). What is the treatment tactics of choice?
Urgent diagostic laparotomy
52
A 19 year old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:
Controlled respiration
53
What developes most often after accidental intake of Hydrochloric acid?
Cardiac insufficiency
54
A 24-year-old patient had been delivered to the thoracic department with a chest injury, a fracture of the IV, V, VI ribs on the right. Plan radiography shows the fluid level in the pleural cavity reaching the III rib on the right. Puncture blood contained clots. What is the optimal treatment tactics?
Emergency thoracotomy
55
Surgical department admitted a 37-year-old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?
Removal of necrotic tissues and timely surgical processing of the wound
56
An emergency team deliverd a 83-year-old patient complaining of inability of her right leg to support the body after falling on her right side. Objectively: the patient lies on a gurney, her right leg is rotated outwards, the outside edge of foot touches the bed. There is positive straight leg raising sign. What is your provisional diagnosis?
Femoral neck fracture
57
The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that developed a few days after blunt abdominal injury is:
Nasogastric decompression and parenteral alimentation
58
A 54-year-old patient applied with complaints of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?
Dislocation of the clavicle
59
A 27-year-old patient with a knife stomach wound has been delivered to a hospital 4 hours after injury. Objectively: the patient is in grave condition. Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid blood in the abdominal cavity. The patient has been found to have bleeding from the mesenteric vessels of the small intestine. Damage to hollow organs has not been revealed. What is the best way to restore the blood loss?
Autoblood reinfusiont
60
After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:
Digital occlusion of the femoral artery
61
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?
Conduct an artificial ventilation of lungs and closed-chest cardiac massage after having released from the belt
62
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 roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
Valvular pneumothorax
63
A 23 y.o. patient has a gunshot wound of his left arm.The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?
Primary surgical processing with a flowing suction
64
Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the patient is pale, AP80/40 mm Hg, Ps- 138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic rupture is present. What treatment tactics should be chosen?
Drainage of the left pleural cavity and laparotomy
65
A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog's bite. What surgical care would you provide to the patient?
Wound bathing with detergent water and antiseptic application
66
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?
Kidney's contusion
67
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:
Pressure bandage and limb strapping
68
A 20-year-old patient was delivered to the hospital in summer from the street with haemorrage 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?
120 minutes
69
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?
Arteriosclerosis obliterans
70
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 ausculation: systolic murmur. What is the most probable diagnosis?
Abdominal aortic aneurism
71
Which of the following best summarizes indications for operation on an abdominal aortic aneurysm?
Any aneurysm greater than 5 cm in diameter
72
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 wasaccompanied 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:
Rupture of abdominal aortic aneurism
73
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?
Clean wound with detergent water and apply anti-septic
74
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?
Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the wound
75
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?
Ultrasound dopplerography
76
For a patient with a stab injury to the femoral artery, the treatment of choice is:
End- to-end anastomosis
77
A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave Р is not changed, superimposes QRST, natural conformity between Р and QRS is not present. What kind of arrhythmia is present?
Paroxismal ventricular tachycardia
78
A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?
Acute thrombophlebitis
79
A 49-year-old male patient who had been scheduled for a surgery for gastric cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was introduced into the right cubital vein. The following day, he felt a dragging pain in the right shoulder. Objectively: on the inner surface of the shoulder there is a longitudinal hyperemic zone, edema of skin, a tender cord. What complication occurred in the patient?
Acute thrombophlebitis
80
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?
Acute thrombophlebitis of subcutaneous veins
81
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:
Superficial venous thrombosis
82
A 47-year-old female patient complains of leg heaviness, fatigue when standing and walking. This feeling disappears when she takes a horizontal position. Objectively: dilatation of the superficial veins of the left shin and thigh with pigmentation and trophic skin disorders. What functional test should the examination be started with?
Trendelenburg's test
83
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:
Shin muscles
84
A 62-year-old male patient complains of intense pain in the left leg that suddenly arose three hours before, leg numbness and coldness. During the year there has been pain in the leg while walking, hypersensitivity to cooling. Objectively: the left foot and shin have marbled skin, subcutaneous veins are collapsed. The foot is cold, active movements of the foot and toes are preserved. Pulse is present only on the femoral artery. There is rough systolic murmur above the artery. Make a provisional diagnosis:
Acute occlusion of the left femoral artery
85
Two hours ago a 38-year-old patient got pain in his right shin. He was diagnosed with popliteal artery embolism, acute arterial insufficiency of grade I. What is the most appropriate therapeutic tactics?
Embolectomy
86
A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?
Thromboembolia of pulmonary artery
87
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?
Postthrombophlebitic syndrome
88
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?
Postthrombophlebitic syndrome, varicose form
89
A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?
Occlusion of the left subclavicular artery, steal syndrome
90
A 48-year-old male patient complains of pain in the lower extremities, especially when walking, intermittent claudication, numbness in the fingers, cold extremities, inability to walk more than 100 meters. Sleeps with his leg lowered. The patient has been a smoker since he was 16, abuses alcohol, has a history of CHD. The left lower extremity is colder than the right one, the skin of extremities is dry, pedal pulse cannot be palpated, femoral pulse is preserved. What is the most likely diagnosis?
Obliterating endarteritis
Surgery
Surgery
Reshma Shaji · 100問 · 2年前Surgery
Surgery
100問 • 2年前Surgery 2
Surgery 2
Reshma Shaji · 100問 · 2年前Surgery 2
Surgery 2
100問 • 2年前Medicine
Medicine
Reshma Shaji · 99問 · 2年前Medicine
Medicine
99問 • 2年前Pediatrics 3
Pediatrics 3
Reshma Shaji · 87問 · 2年前Pediatrics 3
Pediatrics 3
87問 • 2年前Hygiene 1
Hygiene 1
Reshma Shaji · 100問 · 2年前Hygiene 1
Hygiene 1
100問 • 2年前Medicine 2
Medicine 2
Reshma Shaji · 100問 · 2年前Medicine 2
Medicine 2
100問 • 2年前Medicine 3
Medicine 3
Reshma Shaji · 81問 · 2年前Medicine 3
Medicine 3
81問 • 2年前Gynecology 1
Gynecology 1
Reshma Shaji · 92問 · 2年前Gynecology 1
Gynecology 1
92問 • 2年前Hygiene 2
Hygiene 2
Reshma Shaji · 94問 · 2年前Hygiene 2
Hygiene 2
94問 • 2年前Gynecology 2
Gynecology 2
Reshma Shaji · 100問 · 2年前Gynecology 2
Gynecology 2
100問 • 2年前Pediatrics 1
Pediatrics 1
Reshma Shaji · 100問 · 2年前Pediatrics 1
Pediatrics 1
100問 • 2年前Pediatrics 2
Pediatrics 2
Reshma Shaji · 51問 · 2年前Pediatrics 2
Pediatrics 2
51問 • 2年前問題一覧
1
Name a statistical observation unit for determination of influence amount of bloodsugar on the healing of wound's surface in a postoperative period:
The patient in a postoperative period
2
Parents of a 2-year-old boy applied to clinic complaining of right testicle absence in the scrotum of a boy. While examining the boy, hypoplasia of the right half of the scrotum was revealed, absence of the testicle. Testicle is miniaturized, it palpitates along the inguinal canal but it could not be moved down to scrotum. What is the most probable diagnosis?
Right-sided cryptorchism, inguinal form
3
Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?
Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)
4
A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?
Right shin osteomielitis
5
While making a round, a doctor had noticed the edema of the right shoulder of a 26-day-old child with diagnosis of "umbilical sepsis". Active movements in the shoulder joint were absent, right hand was hanging down. Mother stated that her child's condition had worsened for the last 24 hours what resulted in child's refusal to be breast-fed, restlessness, weeping while swaddling, rise in body temperature up to 38,80C. What is the most probable preliminary diagnosis?
Epiphysial osteomyelitis of the humerus
6
A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, there was also one-time vomiting. Objectively: the child's condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor's finger was stained with blood. What is the most probable diagnosis?
Ileocecal invagination
7
A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of "meat slops". Objectively: the patient's condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?
Lung gangrene
8
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?
Punction and drainage of pleural cavity
9
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?
Bronchography
10
A 28-year-old female patient has been admitted to a hospital. She states to be ill for 12 years. On examination she has been diagnosed with bronchiectasis with affection of the left lower lobe of lung. What is the optimal treatment tactics for this patient?
Left lower lobectomy
11
A 38-year-old patient has suddenly developed pain in the left side of his chest, suffocation. Objectively: moderately grave condition, Ps- 100/min, AP- 90/60 mm Hg, breath sounds on the left cannot be auscultated. Chest radiography shows the collapse of the left lung up to 1/2. What kind of treatment should be administered?
Passive thoracostomy
12
A 35-year-old woman was admitted to resuscitation department in asthmatic status. What is the most trustworthy criterion of breath effectiveness?
РаСО2 and РаО2
13
A 42-year-old male patient has been delivered to a hospital in a grave condition with dyspnea, cough with expectoration of purulent sputum, fever up to 39,5oC. The first symptoms appeared 3 weeks ago. Two weeks ago, a local therapist diagnosed him with acute right-sided pneumonia. Over the last 3 days, the patient's condition deteriorated: there was a progress of dyspnea, weakness, lack of appetite. Chest radiography confirms a rounded shadow in the lower lobe of the right lung with a horizontal fluid level, the right sinus is not clearly visualized. What is the most likely diagnosis?
Abscess of the right lung
14
A 45-year-old male patient with acute abscess of the left lung has suddenly developed acute chest pain and dyspnea while coughing, tachycardia has increased. The control Ro-gram shows left lung collapse, the air in the left pleural cavity and a horizontal fluid level. What is the mechanism of this complication?
Abscess burst into the pleural cavity
15
A 21-year-old female patient has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest. Body temperature is 38,8oC. The condition developed three days ago. Respiratory rate is 42/min, auscultation reveals shallow breathing. There is percussive dullness on the right starting from the middle of the blade, breath sounds cannot be heard. The left border of heart is 3 cm displaced outwards. Embryocardia is present, HR is 110/min. The right hypochondrium is painful on palpation. What urgent therapeutic measures should be taken in this situation?
Emergency puncture of the pleural cavity
16
A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months. Objectively: t0 - 37,30С, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?
Lung cancer
17
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?
Acute pulmonary abscess
18
A 36-year-old injured has been taken to the emergency station with open tibial fractures. Examination reveals bleeding: pulsating blood spurts out of the wound. What medical manipulations are required at this stage of medical care?
Apply a tourniquet on the thigh proximal to the source of bleeding and transport the patient to the operating room
19
An infant is full-term. Delivery was pathological, with breech presentation. Examination of the infant revealed limited abduction of the right leg to 50o , positive "clicking" symptom on the right, asymmetric inguinal folds. What is the most probable diagnosis?
Inborn dislocation of the right hip
20
A 20-year-old man complains about pain arising in the lower third of femoral bone under stress and at rest. He denies having a trauma. Objectively: the skin is of normal colour, deep palpation reveals pastosity and pain, knee joint motions are limited. X-ray picture of the meta-epyphisis of distal femur shows a destruction zone and spicules. In blood: immature cell forms, no signs of inflammation. What is the most likely diagnosis?
Osteogenic sarcoma
21
A 23-year-old male patient consulted a doctor about pain occurring in the lower third of the thigh with weight bearing activities and unloaded. The patient denies any injuries to the region. Objectively: the skin is of normal color, deep palpation reveals pastosity and tenderness, movements of the knee joint are limited. Radiograph of the distal femoral metaepiphyseal region shows a zone of degradation and spicules. In blood: immature cells are present, there are no signs of inflammation. What is the most likely diagnosis?
Osteosarcoma
22
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?
Acute pulmonary abscess
23
A patient undergoing treatment for the left-sided destructive pneumonia presents with deterioration of his general condition, progressing dyspnea, cyanosis. Objectively: the left side of chest is not involved in respiration, breathing sounds cannot be auscultated. Radiograph shows a shadow reaching the 5 rib with a horizontal fluid level and a radiolucency above it, the mediastinum is displaced to the right. What is the medical tactics?
Thoracostomy
24
A patient with suspicion of pelvic bones fraction is under examination conducted by the doctor who presses alae ilii in medial direction with his both hands. What causes painful syndrome of the patient?
Disorder of continuity of the pelvic ring
25
Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:
At right angle with varus positioning of the foot
26
A 2-year-old boy has been admitted to the casualty department for the pain and deformity of his right thigh. Radiograph shows a femoral fracture with longitudinal displacement. What method of treatment is indicated for the patient?
Schede-type vertical suspension
27
A 22 year old patient was admitted to trauma center with complaints of pain in the left ankle joint that was getting worse during moving and weight bearing. On the clinical examination it was found that the patient had the closed fracture of medial malleolus without displacement. In which position should the foot be fixed in plaster cast?
At right angle with varus positioning of the foot
28
A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the posterior surface of his left leg. The pain increases during changing body position and also in the upright position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?
Pathology of intercostal disks
29
A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position. positive stretching symptoms were revealed on examination. What is an initial diagnosis?
Intervertebral ligaments disorder
30
A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent mediastinitis?
Cervical lymphadenitis
31
Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?
Cervical lymphadenitis
32
Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?
Cervical lymphadenitis
33
A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient's condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?
Posttraumatic osteomyelitis
34
A patient was delivered to the admission ward 40 minutes after a minor trauma with complaints of pain in the thoracic spine. He has a history of pulmonary tuberculosis. Roentgenography results: suspected compression fracture of the VIII and IX thoracic vertebrae. What pathological process in spine might have stimulated pathological fracture of vertebral bodies?
Tuberculous spondylitis
35
A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patient's condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?
Contact-and-aspiration
36
Survey radiograph of chest of a 62 year old smoker who often suffers from "pneumonias" showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed deviation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?
Cenral cancer of lung
37
After the pneumatic dilatation of oesophageal stricture a patient developed acute retrosternal pain getting worse when throwing the head back and swallowing. Objectively: dilatation of the neck veins, dropped beat pulse, signs of purulent intoxication, oliguria, emphysema of the upper portion of chest. What disease can be suspected?
Suppurative mediastinitis
38
A 27-year-old male patient consulted a doctor about pain in the lower third of the thigh with weight bearing activities and unloaded. Two years ago, the patient underwent treatment in the casualty depatment for the open fracture of the lower third of femur. The fracture healed slowly, the healing process was accompanied by prulent inflammation. Objectively: edema of the lower third of the thigh, elevated local temperature. Radiograph shows signs of destruction and sequestration. What is the most likely diagnosis?
Chronic post-traumatic osteomyelitis
39
A boy is 1 year old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh, body temperature rose up to 39oC. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?
Acute haematogenic osteomyelitis
40
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:
In the 2nd intercostal space along the middle clavicular line
41
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 BP80/60 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?
Pericardium tamponade
42
A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is indicated to the patient?
Drainage of the pleural cavity
43
A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?
Surgical treatment: drainage of the pleural cavity
44
The diagnosis of a right-sided pneumothorax is made to a 36- year-old patient. What method of treatment is indicated to the patient?
Drainage of the pleural cavity
45
A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?
Pleural cavity drainage
46
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 roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
Valvular pneumothorax
47
On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?
The second intercostal space along the medioclavicular line
48
A 29-year-old unconscious patient has been delivered to a hospital. Objectively: skin and mucous membranes are pale, cyanotic, breath sounds are dramatically diminished on the right and cannot be auscultated in the lower parts, at the level of the 6 rib along the anterior axillary line there is a wound hole with moderate bleeding and passage of air during inspiration. Radiography reveals a bullet in the pleural cavity. What is the medical tactics of choice?
Emergency thoracotomy
49
A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps- 120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:
With ambulance vehicle in the 1st turn
50
A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps- 132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the first-aid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?
Dressing ward
51
As a result of a road accident a 45-year-old male patient got multiple injuries, namely closed fractures of the right humerus and the left antebrachial bones with a displacement of bone fragments, a closed blunt abdominal injury. The patient was delivered to the emergency department 30 minutes after the injury. Objectively: the skin is pale. AP- 90/20 mm Hg, there is pain and deformation at the fracture sites. Abdomen is tense, palpation causes severe pain, there is rebound tenderness (positive Blumberg's sign). What is the treatment tactics of choice?
Urgent diagostic laparotomy
52
A 19 year old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:
Controlled respiration
53
What developes most often after accidental intake of Hydrochloric acid?
Cardiac insufficiency
54
A 24-year-old patient had been delivered to the thoracic department with a chest injury, a fracture of the IV, V, VI ribs on the right. Plan radiography shows the fluid level in the pleural cavity reaching the III rib on the right. Puncture blood contained clots. What is the optimal treatment tactics?
Emergency thoracotomy
55
Surgical department admitted a 37-year-old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?
Removal of necrotic tissues and timely surgical processing of the wound
56
An emergency team deliverd a 83-year-old patient complaining of inability of her right leg to support the body after falling on her right side. Objectively: the patient lies on a gurney, her right leg is rotated outwards, the outside edge of foot touches the bed. There is positive straight leg raising sign. What is your provisional diagnosis?
Femoral neck fracture
57
The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that developed a few days after blunt abdominal injury is:
Nasogastric decompression and parenteral alimentation
58
A 54-year-old patient applied with complaints of acute pain in the shoulder-joint. 10 minutes earlier he fell in the street with his arms stretched. Doctor of the traumatological unit noticed an acute deformation of the right shoulder-joint, the impossibilty of active movement in the right extremity. Roentgenologically: uncoincidence of articulating surfaces. What is the most probable diagnosis?
Dislocation of the clavicle
59
A 27-year-old patient with a knife stomach wound has been delivered to a hospital 4 hours after injury. Objectively: the patient is in grave condition. Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid blood in the abdominal cavity. The patient has been found to have bleeding from the mesenteric vessels of the small intestine. Damage to hollow organs has not been revealed. What is the best way to restore the blood loss?
Autoblood reinfusiont
60
After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:
Digital occlusion of the femoral artery
61
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?
Conduct an artificial ventilation of lungs and closed-chest cardiac massage after having released from the belt
62
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 roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
Valvular pneumothorax
63
A 23 y.o. patient has a gunshot wound of his left arm.The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?
Primary surgical processing with a flowing suction
64
Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the patient is pale, AP80/40 mm Hg, Ps- 138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic rupture is present. What treatment tactics should be chosen?
Drainage of the left pleural cavity and laparotomy
65
A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog's bite. What surgical care would you provide to the patient?
Wound bathing with detergent water and antiseptic application
66
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?
Kidney's contusion
67
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:
Pressure bandage and limb strapping
68
A 20-year-old patient was delivered to the hospital in summer from the street with haemorrage 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?
120 minutes
69
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?
Arteriosclerosis obliterans
70
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 ausculation: systolic murmur. What is the most probable diagnosis?
Abdominal aortic aneurism
71
Which of the following best summarizes indications for operation on an abdominal aortic aneurysm?
Any aneurysm greater than 5 cm in diameter
72
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 wasaccompanied 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:
Rupture of abdominal aortic aneurism
73
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?
Clean wound with detergent water and apply anti-septic
74
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?
Laparotomy, abdominal cavity organs inspection. Primary surgical processing of the wound
75
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?
Ultrasound dopplerography
76
For a patient with a stab injury to the femoral artery, the treatment of choice is:
End- to-end anastomosis
77
A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave Р is not changed, superimposes QRST, natural conformity between Р and QRS is not present. What kind of arrhythmia is present?
Paroxismal ventricular tachycardia
78
A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?
Acute thrombophlebitis
79
A 49-year-old male patient who had been scheduled for a surgery for gastric cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was introduced into the right cubital vein. The following day, he felt a dragging pain in the right shoulder. Objectively: on the inner surface of the shoulder there is a longitudinal hyperemic zone, edema of skin, a tender cord. What complication occurred in the patient?
Acute thrombophlebitis
80
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?
Acute thrombophlebitis of subcutaneous veins
81
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:
Superficial venous thrombosis
82
A 47-year-old female patient complains of leg heaviness, fatigue when standing and walking. This feeling disappears when she takes a horizontal position. Objectively: dilatation of the superficial veins of the left shin and thigh with pigmentation and trophic skin disorders. What functional test should the examination be started with?
Trendelenburg's test
83
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:
Shin muscles
84
A 62-year-old male patient complains of intense pain in the left leg that suddenly arose three hours before, leg numbness and coldness. During the year there has been pain in the leg while walking, hypersensitivity to cooling. Objectively: the left foot and shin have marbled skin, subcutaneous veins are collapsed. The foot is cold, active movements of the foot and toes are preserved. Pulse is present only on the femoral artery. There is rough systolic murmur above the artery. Make a provisional diagnosis:
Acute occlusion of the left femoral artery
85
Two hours ago a 38-year-old patient got pain in his right shin. He was diagnosed with popliteal artery embolism, acute arterial insufficiency of grade I. What is the most appropriate therapeutic tactics?
Embolectomy
86
A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?
Thromboembolia of pulmonary artery
87
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?
Postthrombophlebitic syndrome
88
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?
Postthrombophlebitic syndrome, varicose form
89
A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?
Occlusion of the left subclavicular artery, steal syndrome
90
A 48-year-old male patient complains of pain in the lower extremities, especially when walking, intermittent claudication, numbness in the fingers, cold extremities, inability to walk more than 100 meters. Sleeps with his leg lowered. The patient has been a smoker since he was 16, abuses alcohol, has a history of CHD. The left lower extremity is colder than the right one, the skin of extremities is dry, pedal pulse cannot be palpated, femoral pulse is preserved. What is the most likely diagnosis?
Obliterating endarteritis