Standards of answers

1 – c; 2 – b; 3 – b; 4 – c; 5 – d.

Young man, 28 years old, has intensive diffuse abdominal pain. Pain started 2 hours ago after physical training. Temperature of body is 36.9 ºС. Recent year patient noted periodical pain in stomach. Tenderness of abdominal wall and Blumberg’s sine are present.

1. Provisional diagnosis is:

1. acute cholecystitis;

2. acute pancreatitis;

3. perforated ulcer;

4. acute gastritis.

2. What the most informative laboratory study for differential diagnostic is:

1. white blood cell count;

2. C – reactive protein;

3. level of serum amylase;

4. all studies are not informative.

3. The most informative investigation is:

1. gastroscopy;

2. Ultrasonic scan of abdominal cavity;

3. abdominal plain film;

4. laparoscopy.

4. Treatment policy includes:

1. emergency surgery;

2. conservative treatment (Taylor method);

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

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

5. The best method for perforated duodenal ulcer is:

1. ulcer excision;

2. ulcer excision + vagotomy;

3. ulcer excision + adequate antiulcer treatment;

4. partial gastrectomy.

Standards of answers

1 – c; 2 – c; 3 – d; 4 – a; 5 – c.

Young man, 34 years old, has coffee ground vomiting and melena during 20 hours. Pulse rate is 100 per min., decreasing of arterial blood pressure is 90/60 mm Hg. Abdominal pain, tenderness of abdominal wall and Blumberg’s sine are absent.

1. Provisional loss of blood is:

1. “microbleeding”;

2. I – II stage;

3. III stage;

4. profuse bleeding.

2. The most informative investigation is:

1. gastroduodenoscopy;

2. ultrasonic scan of abdominal cavity;

3. abdominal plain film;

4. laparoscopy.

3. Treatment policy includes:

1. emergency surgery;

2. medicamentous haemostasis;

3. endoscopic haemostasis;

4. endoscopic haemostasis + medicamentous hemostasis.

4. The best method for haemostasis control is:

1. pulse rate;

2. blood pressure;

3. clinical observation;

4. endoscopic observation.

5. The best procedure for bleeding duodenal ulcer is:

1. ulcer excision;

2. ulcer excision + vagotomy;

3. ulcer excision + adequate antiulcer treatment;

4. partial gastrectomy.

Standards of answers

1 – b; 2 – a; 3 – d; 4 – d; 5 – c.

Woman, 70 years old, has moderate crampy abdominal pain, constipation, abdominal distension during 4 days. 2 hours became constant. Body temperature is 37.4 ºС. During palpation diffuse painfulness without muscle resistance is observed. Digital rectal examination – empty rectum.

1. Provisional diagnosis is:

1. acute colitis;

2. small bowel obstruction;

3. large bowel obstruction;

4. coprostasis.

2. What the most informative laboratory study for differential diagnostics is:

1. white blood cell count;

2. C – reactive protein;

3. packed cell volume level;

4. all studies are not informative.

3. The most informative investigation is:

1. CT scan of abdominal cavity;

2. ultrasonic scan of abdominal cavity;

3. abdominal plain film;

4. laparoscopy.

4. Treatment policy includes:

1. emergency surgery;

2. conservative treatment;

3. surgery if conservative treatment is not successful;

4. colonoscopic procedures.

5. The best method for control of conservative treatment efficiency:

1. pulse rate;

2. X-ray observation;

3. clinical observation;

4. clinical + X-ray observation.