Standards of answers

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

Situational problem tasks

Young man, 22 years old, has moderate pain in suprapubic region, dysuria. He sufferes from abdominal pain for 2 days. Pain started as diffuse lower part abdominal pain and after 12 hours localized in suprapubic region. Temperature of body is 37.8 ºС. Signs of peritonitis are negative.

1. Provisional diagnosis is:

1. acute cystitis;

2. acute prostatitis;

3. acute appendicitis;

4. renal colic.

2. The most informative laboratory study is:

1. white blood cell count;

2. urinalysis;

3. C – reactive protein;

4. all studies are not specific.

3. The most informative investigation is:

1. excretory urography;

2. CT scan of abdominal cavity;

3. abdominal plain film;

4. cystoscopy.

4. Treatment policy includes:

1. emergency surgery;

2. analgetic + antibiotics;

3. analgetic + uroseptics;

4. surgery, if conservative treatment is not successful.

5. The cause of misdiagnosis is:

1. patient’s age;

2. patient’s sex;

3. late hospitalization;

4. unusual pelvic position of appendix.

Standards of answers

1 – c; 2 – d; 3 – b; 4 – a; 5 – d.

Woman, 62 years old, has pain in right subcostal region, vomiting with bile. Pain started as a colic pain after fatty food intake, after 2 hours became constant. Temperature of body is 37.4 ºС. During palpation painfulness and muscle resistance are observed in right subcostal region. Blumberg’s sign is negative.

1. Provisional diagnosis is:

1. acute cholecystitis;

2. acute gastritis;

3. acute appendicitis;

4. renal colic.

2. The most informative laboratory study is:

1. white blood cell count;

2. urinalysis;

3. C – reactive protein;

4. all studies are not specific.

3. The most informative investigation is:

1. excretory urography;

2. Ultrasonic scan of abdominal cavity;

3. abdominal plain film;

4. chest film.

4. Treatment policy includes:

1. emergency surgery;

2. conservative treatment;

3. gallstones – emergency surgery;

4. surgery, if conservative treatment is not successful.

5. If conservative treatment of acute calculous cholecystitis is successful:

1. surgery is indicated after next pain attack;

2. surgery is not indicated;

3. surgery is perfomed after 1 month;

4. surgery is perfomed after 6 months.

Standards of answers

1 – a; 2 – d; 3 – b; 4 – d; 5 – c.

Woman, 59 years old, has intensive upper abdominal pain, vomiting. Pain started after fatty meat intake 12 hours ago. Scleras are icteric. During palpation painfulness and muscle resistance are observed in upper abdomen. Blumberg’s sign is negative. Last 2 years patient noted periodical colic pain in wright subcostal region.

1. Provisional diagnosis is:

1. acute cholecystitis;

2. acute hepatitis;

3. acute pancreatitis;

4. food toxicoinfection.

2. The most informative laboratory study is:

1. white blood cell count;

2. level of serum amylase;

3. C – reactive protein;

4. all studies are not specific.

3. What the most indicated investigation is:

1. endoscopic retrograde cholangiopancreatography;

2. Ultrasonic scan of abdominal cavity;

3. abdominal plain film;

4. CT scan of abdominal cavity.

4. The most probable aetiological factor:

1. peptic ulcer;

2. hepatitis;

3. gallstones;

4. toxic factor.

5. Treatment policy includes:

1. emergency surgery;

2. conservative treatment;

3. surgery if conservative treatment is not successful after 12–24 hours;

4. surgery, if conservative treatment is not successful after 24–48 hours.