Standards of answers

1 – c; 2 – d; 3 – c; 4 – a; 5 – b; 6 – c; 7 – d; 8 – a; 9 – a; 10 – c; 11 – b; 12 – d; 13 – c; 14 – a; 15 – c; 16 – a; 17 – c; 18 – c; 19 – d; 20 – a.

Chapter 4. Perforated peptic ulcer

Tests (one answer is correct)

1. Risk factors for perforated ulcer include:

1. H pylori infection;

2. hydrochloric acid;

3. NSAID events;

4. all answers are correct.

2. Mark incorrect answer about classification of perforated ulcer:

1. perforation of duodenal or gastric ulcer;

2. covered and atypical perforation;

3. perforation with peritonitis and perforation without peritonitis;

4. perforation has 3 stages.

3. Describe Ratner’s sign:

1. irradiation of pain to the right shoulder or scapula;

2. strengthening of pain at pressure on the region of stomach;

3. painfulness at the easy pattering on right costal arc by the edge of palm;

4. persisting moderate tenderness of abdominal wall in right epigastria region.

4. Describe Elicer’s sign:

1. irradiation of pain to the right shoulder or scapula;

2. strengthening of pain at pressure on the gallbladder region;

3. painfulness at the easy pattering on right costal arc by the edge of palm;

4. persisting moderate tenderness of abdominal wall in right epigastria region.

5. Ratner’s sign is a sign of:

1. stomach perforation;

2. covered perforation;

3. stage of illusions;

4. atypical perforation.

6. Initial method in diagnostic procedure is:

1. X-ray examination;

2. ultrasonic;

3. laboratory studies;

4. laparoscopy.

7. Tactic of treatment of perforated ulcer is:

1. conservative;

2. surgical;

3. initial treatment is conservative + surgery for some indications;

4. surgical in young patients, conservative in elderly patients.

8. Optimal term for operation in patients with perforated ulcer is:

1. 2 hours;

2. 12 hours;

3. 24–48 hours;

4. 72 hours.

9. Surgical procedures for perforated ulcer are:

1. simple closure;

2. ulcer exision;

3. partial gastrectomy;

4. all answers are correct.

10. Contraindication for laparoscopic surgery for perforated ulcer is:

1. total terminal peritonitis;

2. surgeon does not know how to perform a laparoscopic repair;

3. fatal cardiovascular events;

4. all answers are correct.

Standards of answers

1 – d; 2 – c; 3 – d; 4 – a; 5 – b; 6 – a; 7 – b; 8 – a; 9 – d; 10 – d.

Chapter 5. Peptic ulcer acute haemorrhage

Tests (one answer is correct)

1. Acute peptic ulcer haemorrhage is:

1. destruction of vessel in ulcer with flow of blood;

2. destruction of vessel in ulcer with flow of blood with haematomesis and melena;

3. destruction of vessel in ulcer with flow of blood with haematomesis, melena and multiorgan system disturbances;

4. all answers are correct.

2. Risk factors of peptic ulcer haemorrhage include:

1. H pylori infection;

2. hydrochloric acid;

3. NSAID events;

4. all answers are correct.

3. Mark incorrect answer about classification of peptic ulcer haemorrhage:

1. bleeding duodenal or gastric ulcer;

2. there are 3 stages of loss of blood;

3. Forrest classification correspondences with loss of blood;

4. Forrest classification correspondences with kind of hemostasis.

4. Сharacteristic of pain peptic ulcer haemorrhage:

1. intensive pain in the upper abdomen, has constant character;

2. pain has stopped after beginning of haemorrhage;

3. moderate pain in the upper abdomen, may radiate to the right shoulder or scapula;

4. colic pain.

5. Describe Bergmann’s sign:

1. pain has stopped after beginning of haemorrhage;

2. palpation pain in the left costovertebral angle;

3. abdominal distension in upper region;

4. absence of pulsation of abdominal aorta in epigastria region as a result of stomach dilatation.

6. Diagnostic procedure in peptic ulcer haemorrhage includes:

1. X-ray examination;

2. ultrasonic;

3. digital examination of rectum;

4. CT scan.

7. Diagnosis program includes:

1. anamnesis and physical examination;

2. B digital examination of rectum;

3. gastroduodenoscopy;

4. all answers are correct.

8. Treatment policy of peptic ulcer haemorrhage is:

1. only conservative;

2. only surgical;

3. gastroduodenoscopy haemostasis + conservative treatment + surgery for some indications;

4. initial treatment is conservative + surgery for some indications.

9. Absolute indications for surgical treatment are:

1. prolonged bleeding;

2. recurrent bleeding;

3. perforated bleeding ulcer;

4. all answers are correct.

10. Optimal term for operation in patients with absolute indications for surgical treatment:

1. 2 hours;

2. 12 hours;

3. 24–48 hours;

4. 72 hours.

11. Relative indication for surgical treatment is:

1. high risk of recurrent bleeding;

2. massive bleeding;

3. prolonged bleeding in older patients;

4. suspicion about stomach cancer.

12. Optimal term for operation in patients with relative indications for surgical treatment:

1. 2 hours;

2. 12 hours;

3. 24–48 hours;

4. 72 hours

13. Indication for angiographic embolization is:

1. bleeding ulcer of stomach;

2. high risk for surgical intervention;

3. recurrent bleeding;

4. bleeding recurrent ulcer after open surgery.

14. Contraindication for emergency gastroduodenoscopy is:

1. Zenker’s diverticulum;

2. upper abdominal open surgery;

3. severe cardiac and lung decompensation;

4. all answers are correct.

15. Treatment policy of perforated bleeding ulcer is:

1. conservative;

2. surgical;

3. initial treatment is conservative + surgery for some indications;

4. surgical in young patients, conservative in elderly patients.

16. Optimal term for operation in patients with perforated bleeding ulcer is:

1. 2 hours;

2. 12 hours;

3. 24–48 hours;

4. 72 hours.

17. Surgical procedure for perforated bleeding ulcer is:

1. simple closure;

2. laparoscopy repair;

3. ulcer excision;

4. all answers are correct.

18. Surgical procedure for bleeding duodenal ulcer is:

1. simple closure;

2. ulcer excision + pyloroduodenoplasty;

3. partial gastrectomy;

4. all answers are correct.

19. Surgical procedure for bleeding gastric ulcer is:

1. simple closure;

2. ulcer excision + truncal vagotomy;

3. partial gastrectomy;

4. all answers are correct.

20. Surgical procedure for bleeding gastric ulcer in elderly patients is:

1. simple closure;

2. ulcer excision;

3. partial gastrectomy;

4. all answers are correct.