Surgery

100問 • 2年前

問題一覧

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

Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

Through the rectum

A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a significant relief. Which of the following mechanisms of action provided antishock effect of morphine in this patient?

Stimulation of opiate receptors

A 36-year-old woman applied to doctor with complaints of the enlargement of the right mammary gland. On physical exam: the right mammary gland is enlarged, hardened; nipple with areola is pasty and hydropic, looks like "lemon peel". There palpates a lymph node in the right axilla, 1,5 cm in diameter, dense consistence, not mobile. What is the most probable diagnosis?

Hydropic and infiltrative cancer of the mammary gland

A 40 year old woman has changes of mammary gland. What are the most often symtomps that precede the malignization?

Skin induration with inverted nipple

A 54-year-old female patient was admitted to the hospital with evident acrocyanosis, swollen cervical veins, enlarged liver, ascites. Cardiac borders are dilated. Heart sounds cannot be auscultated, apical beat is undetectable. AP is 100/50 mm Hg. X-ray picture of chest shows enlarged heart shadow in form of a trapezium. What pathology might have caused these symptoms?

Cardiac tamponade

During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

Developing of cardiac insufficiency

A 15 year old patient suffers from headache, nasal haemorrhages, sense of lower extremity coldness. Objectively: muscles of shoulder girdle are developed, lower extremities are hypotrophied. Pulsation on the pedal and femoral arteries is sharply dampened. AP is 150/90 mm Hg, 90/60 on the legs. Systolic murmur can be auscultated above carotid arteries. What is the most probable diagnosis?

Aorta coarctation

A week ago a 65-year-old patient suffered an acute myocardial infarction, his general condition deteriorated: he complains of dyspnea at rest, pronounced weakness. Objectively: edema of the lower extremities, ascites is present. Heart borders are extended, paradoxical pulse is 2 cm displaced from the apex beat to the left. What is the most likely diagnosis?

Acute cardiac aneurysm

A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:

Excision biopsy

A patient presented to a hospital with a carbuncle of the upper lip. The body temperature is $39^oC$. There is a pronounced edema of the upper lip and eyelids. What is the surgeon's tactics of choice?

Hospitalize in the surgical unit

4 weeks after myocardial infarction a 56-year-old patient developed acute heart pain, pronounced dyspnea. Objectively: the patient's condition is extremely grave, there is marked cyanosis of face, swelling and throbbing of neck veins, peripheral pulse is absent, the carotid artery pulse is rhythmic, 130 bpm, AP is 60/20 mm Hg. Auscultation of heart reveals extremely muffled sounds, percussion reveals heart border extension in both directions. What is the optimal treatment tactis for this patient?

Pericardiocentesis and immediate thoracotomy

A boy is 8 year old. His physical development is compliant with his age. The child has had cardiac murmur since birth. Objectively: skin and visible mucous membranes are of normal colour. AP- 100/70 mm Hg. Auscultation revealed systolo-diastolic murmur and diastolic shock above the pulmonary artery. ECG shows overload of the left heart. Roentgenoscopy shows coarsening of the lung pattern, heart shadow of normal form. What is the most likely diagnosis?

Atrioseptal defect

A prematurely born girl is now 8 months old. She has dyspnea, tachycardia, hepatosplenomegaly, physical developmental lag, limb cyanosis. There is also parasternal cardiac hump, auscultation revealed systolodiastolic murmur in the II intercostal space on the left. AP is 90/0 mm Hg. What disease should be suspected?

Patent ductus arteriosus

A 5-year-old boy has a history of repeated pneumonia, frequent acute respiratory viral diseases. Objectively: exertional dyspnea, minor fatigabilty. There is a systolic murmur having its epicenter in the IV intercostal space on the left. Left relative dullness is found along the midclavicular line. According to the findings of instrumental methods of examination (electrocardiography, echocardiography), the patient has been diagnosed with ventricular septal defect, subcompensation stage. What is the main method of treatment?

Operative therapy

A 30-year-old patient has been admitted to the intensive care unit for multiple bee stings. The skin is covered with cold sweat. The pulse is felt just on the carotid arteries, 110 bpm, respiration is 24/min, rhythmic, weakened. Which drug should be given in the first place?

Adrenalin hydrochloride intravenously

Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he felt acute pulsating pain at the end of the nail bone which was getting worse at pressing. Nail fold became hyperemic, body temperature rose up to 37,5oC, there was a change in nail plate colour. What is the most likely diagnosis?

Subungual panaritium

A 25-year-old patient works as a tractor driver. Four days ago, he got pain in the left axillary region, general weakness, fever up to 38oC. He hadn't sought medical helf until a painful solid lump appeared in this region. Objectively: in the left axilla there is a very painful cone-shaped mass sized 3x2,5 cm, with a destruction in the center of the pointed vertex. The surrounding skin is hyperemic, there are purulent discharges. What is the most likely diagnosis?

Hydradenitis

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 colour. Submandibular lymph nodes on the right are enlarged and painful. What is the most likely diagnosis?

Furuncle

A 33 y.o. 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 38,40C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through out. What disease should a doctor consider first of all?

Carbuncle

A 47-year-old male patient got a flame burn of trunk and upper extremities and was delivered to the hospital. The patient is in grave condition, confused mental state, with fever. AP- 80/50 mm Hg, Ps- 118 bpm. It was locally stated that the patient got III B degree burns with total area of 20%. What medical actions should be taken?

Injection of narcotic analgetics and powdered blood substitutes

A 30 y.o. 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?

Septicotoxemia

A 30 y.o. victim of fire has thermal burns of III-A and III-B degree that amount 20\% of total skin coverlet. AP is 110/70 mm Hg, HR- 120/min. What transfusion means shoul be used for blind infusion correction during transportation?

Salines

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:

Compression band

A 6-year-old girl drank some coloured fizzy drink which gave her a feeling of pressure in the throat. 30 minutes later the child's lips got swollen, then edema gradually spread over the whole face, laryngeal breathing became difficult. The child is excited. Ps- 120/min, breathing rate - 28/min, breathing is noisy, indrawing of intercostal spaces is observed. What basic aid is most appropriate for the restoration of laryngeal breathing?

Corticosteroids

A 56-year-old male patient has been delivered to the emergency department with frostbite on both feet. What aid should be rendered to the victim?

Apply a bandage, give an injection of vasodilators

A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?

To perform the Heimlich manoever

An unconscious victim in severe condition is brought to clinic. It is known that the patient touched the bare wire with his hand and during 5 minutes was under the influence of an alternating current with voltage of 220 V. Physical exam: skin is pale, cold by touch. Breath is weakened, BP - 90/50 mm Hg, Ps - 60 bpm, arrhythmical. There are fields of necrosis of the skin on the right hand and on the right foot. What is the preliminary diagnosis?

Electroburn of the right foot and right hand

A 55 year old patient felt suddenly sick in a hospital corridor, he was immediately examined by a doctor. Examination revealed that the patient's skin was pale, autonomous respiration was absent, pulse on carotid arteries couldn't be felt, pupils were mydriatic. What action should be taken at the beginning of cardiac resuscitation?

Precordial thump

An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, $t^o$- $35,0^oC$. AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient's mouth. What is the most likely diagnosis?

Hypothermia

A 69-year-old male patient has been hospitalized with hypothermia. Objectively: the patient is pale, has shallow breathing. AP is 100/60 mm Hg, Ps is 60/min. Palpation of the abdomen and chest reveals no pathological signs. The body temperature is of 34,8oC. The patient's breath smells of alcohol. Give treatment recommendations:

Warm bath + intravenous administration of warm solutions

A 33 year old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP - 60/30 mm Hg, Ps - 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb - 80 g/l, red blood cell count - 2,5*1012/l. The reduction of blood volume averages:

30-40%

A patient with frostbite of both feet was delivered to the admission ward. What actions should be taken?

To apply a bandage, to introduce vasodilating medications

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?

I degree

A 35-year-old victim of a road accident has got an injury of the right side of his chest. Objectively: respiration rate - 28-30/min, respiration is shallow, restricted respiratory excursion and acrocyanosis are present. Ps- 110 bpm, AP- 90/60 mm Hg. Respiratory sounds over the right lung cannot be auscultated. Chest radiograph shows fractures of the VI-VII ribs on the right, the right pleural cavity contains both air and fluid, with the fluid at about the level of the V rib, the shadow of the mediastinum is displaced to the left. What first aid should be provided to the victim?

Puncture of the pleural cavity

A 56-year-old patient was undergoing a surgery for suture repair of perforated ulcer. During the operation the cardiomonitor registered ventricular fibrillation. The first-priority measure should be:

Electrical defibrillation

Esophagus wall of a 72 year old patient with severe concomitant pathology was injured during urgent fibroesophagogastroscopy. This resulted in progressing of acute respiratory failure and collapse of the left lung. What aid should be rendered?

Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy

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?

Zinc

A 21-year-old male patient got a deep cut wound in his right thigh. In the emergency room a surgeon on duty performed primary debridement of the wound and primary wound closure with a suture. After 4 days, there appeared pain, redness, edema, purulent discharge from the wound gap, body temperature rose up to 39oC. What kind of wound complication can you think of and what actions should be taken?

Wound abscess, remove the sutures and drain the wound

A 25-year-old victim of a road accient complains of chest pain, dyspnea. Objectively: the patient is in a grave condition, Ps- 120/min, AP- 90/70 mm Hg.There is pathological mobility of fragments of III-V ribs on the right. Percussion reveals a box sound over the right lung, breathing sounds cannot be auscultated on the right. What examination should be administered in the first place?

X-ray of chest organs

A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

Operation on account of feochromocytoma

A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle, purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:

Hypertonic solution

A 40 year old patient was bitten by a stray dog for about an hour ago. The bite can be seen on the patient's left shin in form of a wound 4х2х0,5 cm large. What kind of aid would be recommended in this case?

Wound lavage with soapsuds, retension sutures

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?

Radical surgical treatment

A patient has a stab wound on his right foot. On the fourth day after injury the patient's body temperature rose up to $38^oC$, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?

Lymphadenitis

During dressing of a poorly-granulating wound Pseudomonas aeruginosa infection was revealed. What medication would be optimal for the wound d-bridement?

Boric acid solution

On the first day after a surgery for diffuse toxic goiter a patient developed difficulty breathing, cold sweats, weakness. Objectively: pale skin, body temperature - $38,5^oC$, RR - 25/min, Ps110/min, AP- 90/60 mm Hg. What early postoperative complication occurred in the patient?

Thyrotoxic crisis

A 39-year-old female patient complains of rapid fatigability, drowsiness, dry skin, hair loss, swelling of the face. A month ago, she underwent a surgery for thyrotoxicosis. The patient has the following gland dysfunction:

Thyroid (hypothyroidism), due to inadequate operative technique

A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes mellitus for 15 years, doesn't receive regular treatment. What complication of diabetes mellitus is it?

Gangrene of the IV toe on the right foot

A patient with autoimmune thyroiditis accompanied by multinodular goiter underwent the right lobe ectomy and subtotal resection of the left lobe. What drug should be administered to prevent postoperative hypothyroidism?

L-thyroxine

Thyrotoxic crisis

An emergency physician arrived to provide medical care for a hangman taken out of the loop by his relatives. The doctor revealed no pulse in the carotid arteries, lack of consciousness, spontaneous breathing and corneal reflexes; cadaver spots on the back and posterior parts of extremities. A person can be declared dead if the following sign is present:

Cadaver spots

Examination of a dead man who died from hanging revealed that cadaver spots disappeared when pressed upon and restored after 50 seconds, rigor mortis was moderately expressed only in the masticatory muscles and the muscles of neck and fingers. Body temperature was 31oC. Specify the time of death:

6-7 hours

Examination of a 26 year old female patient revealed a node in the right lobe of thyroid gland. The node appeared no earlier than 3 months ago. The patient associates this node with stress. She doesn't complain either about pain or enlargement of the node. Ultrasonic scanning revealed a 2x2,5 cm large node in the inferior part of the right lobe of thyroid gland. What treatment should be administered?

Surgical intervention

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?

Hashimoto's thyroiditis

On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old patient complains of heart pain. ECG shows prolonged $QT$ intervals. Chvostek's and Trousseau symptoms cannot be clearly defined. The patient is provisionally diagnosed with latent tetany. What study will allow to confirm the diagnosis?

Determination of blood calcium and phosphor

A 39-year-old patient complains of a tumour on the anterior surface of her neck. The tumour has been observed for 2 years. It is nonmobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional status of the thyroid gland is unchanged. What is the most likely diagnosis?

Thyroid gland cancer

A 40-year-old female patient complains of having a bulge on the anterior surface of neck for 5 years. Objectively: Ps- 72 bpm, arterial pressure - 110/70 mm Hg, in the right lobe of thyroid gland palpation reveals a mobile 4x2 cm node, the left lobe is not palpable, the basal metabolic rate is 6¥%. What is the most likely diagnosis?

Nodular euthyroid goiter

Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:

Live birth

Examination of the corpse of a man who died from hanging reveals: death spots disappear when pressed upon and restore after 50 seconds, rigor mortis is moderately expressed only in the masticatory muscles as well as neck and finger muscles, body temperature is of $31^oC$. The time of death:

6-7 hours ago

A patient suddenly felt an acute chest pain irradiating to the left arm. Objectively: the patient is excited, with pale skin. Breathing rate - 38/min, AP - 180/110 mm Hg. Later the patient lost consciousness and fell down. Pulse on the great vessels was absent, the pupils were equally dilated. What is the most likely diagnosis?

Clinical death

A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal periproctitis. On the 12th day of treatment the patient's condition deteriorated: there was an increase in the rate of intoxication and hepatic failure, the body temperature became hectic, AP was 100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs - $19,6¥cdot10^9$/l, RBCs.- $3,0¥cdot10^{12}$/l, Hb- 98 g/l. What complication was developed?

Liver abscess

A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be suspected?

Acute pancreatitis

A 20 y.o. patient suddely felt ill 12 hours ago. There was pain in epigactric 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?

Acute appendicitis

A patient complains about evaginations in the region of anus that appear during defecation and need to be replaced. Examination with anoscope revealed 1x1 cm large evaginations of mucosa above the pectineal line. What is the most probable diagnosis?

Internal hemorrhoids

3 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?

Acute periproctitis

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?

In 2 hours

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:

Acute cholecystitis

A 57-year-old female patient complains of intense pain in the right hypochondrium irradiating to the right supraclavicular region. Skin and sclerae are icteric. There is tension and tenderness in the right hypochondrium on palpation. Body temperature is 38,8oC. Blood test results: WBC- 11,2*109 /l, total bilirubin - 112 mmol/l (conjugated - 86 mmol/l, unconjugated - 26 mmol/l). What is the most likely diagnosis?

Cholangitis

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?

To perform endocsopic papillosphincterotomy

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:

Crohn's disease of the terminal ileum

A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and weight loss since 4 months. Suggested diagnosis?

Cancer of the esophagus

A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?

Cancer of esophagus

A 47-year-old female patient complains of having pain on swallowing and difficult passing of solid food for two months. The patient has taken to the liquid and semi-liquid food. During the last week the liquid food has barely passed through. General condition is satisfactory, the patient is undernourished, the appetite is preserved, there is a fear of eating. What is the provisional diagnosis?

Esophageal carcinoma

A 49-year-old male patient consulted a doctor about difficult swallowing, voice hoarseness, weight loss. These symptoms have been gradually progressing for the last 3 months. Objectively: the patient is exhausted, supraclavicular lymph nodes are enlarged. Esophagoscopy revealed no esophageal pathology. Which of the following studies is most appropriate in this case?

Computed tomography of chest and mediastinum

A 35 year old female patient suffering from cholelithiasis has broken her diet, and this caused an acute pain attack in the right subcostal are. The pain eased off on the third day, but the patient got progressing jaundice. What non-invasive diagnostic method should be applied?

Endoscopic retrograde cholangiopancreatography

A 41 year old patient was admitted to the intensive care unit with haemorrhagic 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?

Introduction of obturator nasogastric tube

A 50-year-old man comes to the emergency room with a history of vomiting of 3 days' duration. His past history examination reveals that for about 20 years he has been suffering from epigasric 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:

Gastric outlet obstruction

On the next day after esophagoscopy and biopsy a 44-year-old female patient developed emphysema of both supraclavicular regions, deglutition pain and pain behind the breastbone, cyanosis. Body temperature - 39oC. In blood: WBCs – 16*109 /l, left shift in the neutrophils. X-ray picture shows a limited shadow of the posterior mediastinum at a level with trachea bifurcation. The patient was diagnosed with esophagus rupture. What treatment tactics would be the most rational?

Surgical: mediastinum drainage, gastric fistula establishment

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?

Corrosive esophagitis and stricture

A 62-year-old patient complains of the pain behind the sternum, bad passing of solid and liquid food, bad breath, increased salivation weight, loss of 15 kg during the period of 2 months. Appetite is retained. On physical exam: face features are sharpened. The skin is pale, with sallow tint, its turgor is decreased. The liver is not enlarged. Blood Hb - 86g/L. Gregersen reaction is positive. What kind of pathology caused the given clinical situation?

Esophagus cancer

A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

Strict following of feeding regimen

During a surgery on a 30-year-old patient a dark ileo-ileal conglomerate was discovered, the intussusceptum intestine was considered to be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full of intestinal contents and gases. What pathology led to the surgery?

Invagination (combined) obstruction

A 22-year-old female patient has been delivered by an ambulance team to a surgical clinic with symptoms of acute intestinal obstruction. It is known from the past history that 2 years ago she was operated for acute destructive appendicitis. For two years, she has repeatedly complained of bloating and abdominal pain. Which of the following etiological factors has led to the intestinal obstruction in the patient?

Abdominal adhesions

A patient complains about pyrosis and permanent pain behind his breastbone. When he bends forward after eating there appears regurgitation. Roentgenological examination revealed extrasaccular cardiofunctional hernia of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux-esophagitis. What is the necessary tretment tactics?

Operation in a surgical department

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 37,6oC. 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?

Alveolar echinococcus of liver

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?

Perforation of esophagus with mediastinitis

A 40-year-old male patient has had heaviness in the epigastric region for the last 6 months. He has not undergone any examinations. The night before, he abused vodka. In the morning there was vomiting, and 30 minutes after physical activity the patient experienced dizziness and profuse hematemesis. What pathology should be suspected in the first place?

Mallory-Weis's syndrome

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 - $18¥cdot10^9$/l. What is the required tactics of the patient's treatment?

Surgical treatment

A 44-year-old male patient complains of severe non-localized abdominal pain, pain in the right shoulder girdle, repeated vomiting, red urine. The onset of the disease is associated with alcohol consumption. The face is hyperemic. AP- 70/40 mm Hg. Abdominal radiography reveals no pathological shadows. Hemodiastase is 54 mg/h/l. Prothrombin is 46%. What is the provisional diagnosis?

Acute pancreatitis

A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient's blood from the abdominal cavity be used for autotransfusion?

Stomach rupture

A 65-year-old patient complains of dull pain in the rectum during and after defecation, 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?

Cancer of the medium-ampullar section of the rectum

In which of the following disorders does the pathophysiology of portal hypertension involve presinusoidal intrahepatic obstruction?

Congenital hepatic fibrosis

A 16 year old patient with complaints of frequent pain in the abdomen was diagnosed with melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach and large intestine. It is know that the patient's mother has an analogous pigmentation and has been often treated for anemia. What disease is suspected?

Peytz-Egers's polyposis

1,5 hour after start of gullet bougienage a 48 year old patient suffering from corrosive stricture felt acute abdominal pain. Previously he had been suffering from duodenal ulcer. Examination revealed that abdomen was very tense and painful; Ps- 110 bpm, painful sialophagia, skin pallor. What is the most probable diagnosis?

Perforation of abdominal part of esophagus

A 24-year-old law student is brought to 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 accompanied by nausea. The patient had vomited twice prior to coming to the emergency room. Clinical examination revealed that the young man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of 100/68 mm Hg, and body temperature of 38,1oC. The most likely diagnosis is:

Acute pancreatitis

A 30-year-old man was injured in a fire and got thermic 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?

Saline solutions

A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patient's state?

Malignisation

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?

Urgent surgery

100

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?

Perforation of ulcer

Surgery 2

Reshma Shaji · 100問 · 2年前

Surgery 2

100問 • 2年前

Reshma Shaji

Surgery 3

Reshma Shaji · 90問 · 2年前

Surgery 3

90問 • 2年前

Reshma Shaji

Medicine

Reshma Shaji · 99問 · 2年前

Medicine

99問 • 2年前

Reshma Shaji

Pediatrics 3

Reshma Shaji · 87問 · 2年前

Pediatrics 3

87問 • 2年前

Reshma Shaji

Hygiene 1

Reshma Shaji · 100問 · 2年前

Hygiene 1

100問 • 2年前

Reshma Shaji

Medicine 2

Reshma Shaji · 100問 · 2年前

Medicine 2

100問 • 2年前

Reshma Shaji

Medicine 3

Reshma Shaji · 81問 · 2年前

Medicine 3

81問 • 2年前

Reshma Shaji

Gynecology 1

Reshma Shaji · 92問 · 2年前

Gynecology 1

92問 • 2年前

Reshma Shaji

Hygiene 2

Reshma Shaji · 94問 · 2年前

Hygiene 2

94問 • 2年前

Reshma Shaji

Gynecology 2

Reshma Shaji · 100問 · 2年前

Gynecology 2

100問 • 2年前

Reshma Shaji

Pediatrics 1

Reshma Shaji · 100問 · 2年前

Pediatrics 1

100問 • 2年前

Reshma Shaji

Pediatrics 2

Reshma Shaji · 51問 · 2年前

Pediatrics 2

51問 • 2年前

Reshma Shaji

問題一覧

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

Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

Through the rectum

Stimulation of opiate receptors

Hydropic and infiltrative cancer of the mammary gland

A 40 year old woman has changes of mammary gland. What are the most often symtomps that precede the malignization?

Skin induration with inverted nipple

Cardiac tamponade

During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

Developing of cardiac insufficiency

Aorta coarctation

Acute cardiac aneurysm

A 40 year old woman has a self-detected hard breast mass. The procedure of choice for confirming the diagnosis is:

Excision biopsy

Hospitalize in the surgical unit

Pericardiocentesis and immediate thoracotomy

Atrioseptal defect

Patent ductus arteriosus

Operative therapy

Adrenalin hydrochloride intravenously

Subungual panaritium

Hydradenitis

Furuncle

Carbuncle

Injection of narcotic analgetics and powdered blood substitutes

Septicotoxemia

Salines

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:

Compression band

Corticosteroids

A 56-year-old male patient has been delivered to the emergency department with frostbite on both feet. What aid should be rendered to the victim?

Apply a bandage, give an injection of vasodilators

To perform the Heimlich manoever

Electroburn of the right foot and right hand

Precordial thump

Hypothermia

Warm bath + intravenous administration of warm solutions

30-40%

A patient with frostbite of both feet was delivered to the admission ward. What actions should be taken?

To apply a bandage, to introduce vasodilating medications

I degree

Puncture of the pleural cavity

A 56-year-old patient was undergoing a surgery for suture repair of perforated ulcer. During the operation the cardiomonitor registered ventricular fibrillation. The first-priority measure should be:

Electrical defibrillation

Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy

Zinc

Wound abscess, remove the sutures and drain the wound

X-ray of chest organs

A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

Operation on account of feochromocytoma

Hypertonic solution

Wound lavage with soapsuds, retension sutures

Radical surgical treatment

Lymphadenitis

During dressing of a poorly-granulating wound Pseudomonas aeruginosa infection was revealed. What medication would be optimal for the wound d-bridement?

Boric acid solution

Thyrotoxic crisis

Thyroid (hypothyroidism), due to inadequate operative technique

Gangrene of the IV toe on the right foot

L-thyroxine

Thyrotoxic crisis

Cadaver spots

6-7 hours

Surgical intervention

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?

Hashimoto's thyroiditis

Determination of blood calcium and phosphor

Thyroid gland cancer

Nodular euthyroid goiter

Live birth

6-7 hours ago

Clinical death

Liver abscess

Acute pancreatitis

Acute appendicitis

Internal hemorrhoids

Acute periproctitis

In 2 hours

Acute cholecystitis

Cholangitis

To perform endocsopic papillosphincterotomy

Crohn's disease of the terminal ileum

A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and weight loss since 4 months. Suggested diagnosis?

Cancer of the esophagus

Cancer of esophagus

Esophageal carcinoma

Computed tomography of chest and mediastinum

Endoscopic retrograde cholangiopancreatography

Introduction of obturator nasogastric tube

Gastric outlet obstruction

Surgical: mediastinum drainage, gastric fistula establishment

Corrosive esophagitis and stricture

Esophagus cancer

A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

Strict following of feeding regimen

Invagination (combined) obstruction

Abdominal adhesions

Operation in a surgical department

Alveolar echinococcus of liver

Perforation of esophagus with mediastinitis

Mallory-Weis's syndrome

Surgical treatment

Acute pancreatitis

A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient's blood from the abdominal cavity be used for autotransfusion?

Stomach rupture

Cancer of the medium-ampullar section of the rectum

In which of the following disorders does the pathophysiology of portal hypertension involve presinusoidal intrahepatic obstruction?

Congenital hepatic fibrosis

Peytz-Egers's polyposis

Perforation of abdominal part of esophagus

Acute pancreatitis

Saline solutions

Malignisation

Urgent surgery

100

Perforation of ulcer