Gastroenterology

2 Уровень

1

!*A woman, 42 years old, complaints of retrosternal pains, appearing after the meal, increasing at physical stress, heartburn, gaseous eructation, in the morning – voice hoarseness. This symptomatology bothers her for many years. EGDS was performed:

What treatment MOST probably?

*omeprasol and domperidon

*rabeprasol and prosulpid

*cimetidinum and itoprid

*ranitidinum and metronidasol

*omeprasol and tinidasol

2

!*In a 61-year old woman, pains and a feeling of heaviness in the right hypochondrium after fatty meal are noted. In the examination: no icterus, positive Kehr's symptom, subfebrile temperature, ESR — 30 mm/h. Doctor recommended choleretics – sylimarin.

Give the evaluation for this recommendation:

* correct, but also need addition of metronidasol

* correct, but also need addition of amoxicilline

* correct, but also need addition of ursodesoxyholic acid

*incorrect, must be replaced by ursodesoxyholic acid

*incorrect, using of choleretics will worsen pain

3

!* Woman 35 years old, complaint on heaviness in epigastric area, eructation. On FGDS:

Which examination will allow to confirm diagnosis?

*for antibodies for parietal cells of stomach

*biopsy of stomach mucus

*ELISA for H.pylory antibodies

*pH-metry of gullet and stomach

*ureas breathing test

4

!* The woman of 47 years, complaints to pains in the epigastrium and the right hypochondrium arising 1-1,5 hours later after a meal, a bitter taste in a mouth, especially in the mornings, weight and a discomfort in right hypochondrium, constipation. At EGDS: a hyperemia mucous in an antral part of a stomach, simple erosion, in a stomach gleam – mucilage and bile are revealed. The Ureas test – negative.

What preparation from following most possibly useable?

*Ursodesoxicholic acid

*Metronidazolum

*Silymarinum

*Ranitidine

*Omeprazol

5

!*The woman of 35 years complains of hungry and night pains to the epigastriums stopped meal; heartburn and vomiting to sour gastric contents at pain height. At a palpation the morbidity in epigastric area is defined.

What of following preparation she has to use before going to bed?

*Ursodesoxycholic acid

*Metronidazolum

*Silymarinum

*Ranitidine

*Omeprazol

6

!* To the woman of 40 years treatment for rheumathoid arthritis of high activity is begun. Within a month notes emergence of unpleasant feelings in epigastrium after meal. At FEGD – a photo.

What treatment tactic most required?

* famotidine before each reception of Prednisolonum

* accept antacid before each reception of Prednisolonum

*canceling of NSAID

*canceling of prednisolonum

* lansoprazol 2 times a day

7

!*A woman, 35 years old, complains of heartburn, gaseous eructation, bitter taste in mouth, increasing at physical stress or when leaning forward, voice hoarseness in the morning, periodically cough. Half a year earlier, patient undergone FGDS (oesophagus), see picture.

Which of listed diagnoses is MOST probable?

*GERD

*esophageal carcinoma

*esophageal achalasia

*peptic ulcer of esophagus

*Barrett's syndrome

8

!* A man, 62 year old, complaints against dysphagia, heartburn, eructation, hoarseness of voice. These complaints bother him for several years. Bad habits: he smokes for 20 years, 1 package a day. Objectively: malnutrition, pale coverlets. FGDS (oesophagus) see photo.

Which complication MOST probably has developed in this patient?

*esophageal peptic ulcer

*esophageal carcinoma

*Barrett's esophagus

*esophageal achalasia

*esophageal strictures

9

!*Female patient, 28 years old, complains of gaseous eructation, heartburn after meal. On performed gullet and stomach рН-metry:

Which of listed diagnoses is MOST probable?

*GERD

*gullet cardia insufficiency

*esophageal achalasia

*esophagitis at scleroderma

*Barrett's esophagus

10

!* Woman 24 years old with complaints against pains in epigastric area, occurring 2.5 – 3 hours after meal, periodic heartburn during the year. On EGDS: hyperemia, edema of gastric mucosa. Respiratory urease test positive.

Your treatment tactic?

*Clarytromicine plus metronodasol

*Clindamycin plus metronidasol

*De-nol plus metronidasol

*Cyprofloxacin plus ranitidine

*Pefloxacin plus omeprasol

11

!*Woman, 81 years old, suffering from chronic gastritis, complains of weight loss for 5 kg last 2 months, decreased appetite, appearing meat aversion. At the examination, patient with malnutrition, dry pale coverlets, thick fur on tongue. In the blood analysis Hb – 82 g/l, CI – 0,76, ESR – 52 mm/h.

Which complication most probably has developed in this patient?

*stomach ulcer, complicated by malignant transformation

*stomach ulcer, complicated by hemorrhage

*stomach ulcer, complicated by perforation

*stomach ulcer, complicated by penetration

*stomach ulcer, complicated by stenosis

12

!*A man, 62 years old, came to doctor with complaints against pains in epigastrium, appearing 30 min after meal, constipations, decreased appetite. In anamnesis, he has earlier no stomach ulcer, gastritis. Bad habits: he smokes for 15 years 10 cigarettes a day. Objectively: normal coverlets, sufficient nutrition, tongue covered with white fur. On EGDS: atrophy of glands in mucous coat of stomach. In blood: Hb 89 g/l, CI 1.5.

What of the listed factors MOST possibly led to development in the patient of anemia?

* Violation of iron absorption from food in intestines

* Decrease in consumption of the food containing iron

* Lack of an internal Castle factor

* Low gastric acidity

* Low concentration of a transferrin

13

!*A patient, 48 years old, complains of feeling of heaviness and discomfort in epigastrium, periodically occurring heartburn, bloating. In anamnesis, stomach ulcer for a year. When performing diurnal pH-metry, in stomach body the hyperacidity of more than 3.0 was found. On EGDS: duodenal cap ulcer in the stage of cicatrization, bile admixture in gastric juice.

Which treatment tactic most probable?

*de-nol

*domparodon

*drotaverine

*lansoprasol

*ranitidine

14

!*I n development of kind of tumor now the crucial role is associated with H.Pylory infection?

* Adenocarcinoma of gullet

* cancer

* Carcinoid of stomach

* Pancreatic cancer

* The MALT associated stomach lymphoma

15

!* A patient, 73 years old, applied to doctor with complaints against epigastric pains, appearing one hour after meal, general weakness, constipation. On EGDS: atrophy of glands in mucous of stomach.

Which laboratory changes will confirm your diagnosis:

*antibodies to parietal cells of stomach

*antibodies to Helicobacter Pylory

*increased amylase levels

*increasing of CEA and CA19-9

*hypochromic anemia

16

!* Into admission room came a patient with complaints on terrible weakness, dyspnea. In anamnesis, he suffers from duodenal ulcer for many years. Several days before he applied acetylsalicylic acid 4 g. Objectively: conscious, inhibited, pale coverlets, covered with cold sweat. HR 100 bpm, BP 85/60 mmHg. In blood: Hb – 67 g/l.

Your presumable diagnosis:

*duodenal ulcer, complicated by malignant transformation

*duodenal ulcer, complicated by hemorrhage

*duodenal ulcer, complicated by perforation

*duodenal ulcer, complicated by penetration

*duodenal ulcer, complicated by stenosis

17

!* The patient of 78 years receives treatment concerning unstable stenocardia. Within several days he is disturbed by pains in epigastriums and an eructation sour. The unstable state on cardiological pathology does not allow to carry out EGD. OAK: level of a hemoglobin decreased from 122 to 85 g/l in 5 days. The weakness, dizziness increase. What pathology should be assumed at the patient?

*Relapse of the peptic ulcer of a stomach

*Gastrointestinal bleeding

*Development of a stressful ulcer

*Hemolytic anemia

*Stomach ulcer penetration

18

!*A woman, 30 years old, for the last 3 years is observed in polyclinic because of suddenly occurring colicky pains attacks in the right hypochondrium, having short-term nature. Attack is accompanied by nausea, hyperhydrosis. She relates attack occurrence with psychoemotional factors. Pains are relieved by drotavertin injection. In the observation period, no body temperature rise, icterus were noted.

What examination could verify the diagnosis ?

*FEGDS

*sonography of gall bladder and pancreas

*CT of abdominal cavity

*MRT of abdomen

*pH-metry of stomach and duodenum

19

!*Woman М., 34 years old, was delivered to hospital with complaints against pains in the right hypochondrium, bitter taste in mouth, belching, nausea, body temperature increase to 37.5C, constipations. In anamnesis: skin itch, heaviness in the right hypochondrium, bothering the last 5 years. Objectively: cutaneous covering of usual color with urticaria rash. Subicteritiousness of sclera. Abdomen at palpation is soft, painful in the right hypochondrium, positive Murphy's sign. Kurlov's liver dimensions – 10 × 9 × 8 cm. Spleen is not enlarged.

Which treatment tactic most probable?

*ceftriaxon

*gentamycine

*sylimarine

*amoxiclline

*ranitidine

20

!*Man W, 50 years old, complains of girdle pains in epigastric area immediately after food intake, rumbling, abdominal distension, frequent watery stool episodes. In 6 months he lost 8 kg. The present exacerbation lasts for 6 days. In anamnesis – chronic cholecystitis, chronic gastritis. Objectively: height 188 cm, weight 68 kg. Tongue is covered with white fur. Abdomen is bloated, tenderness at epigastric area palpation. Blood analysis: Hb 110 g/l, erythrocytes 3.8 × 10¹²/l, CP 0.94, leukocytes 8.4 × 10⁹/l, ESR 17 mm/h. Blood biochemistry: total protein 75 g/l, albumins 35 g/l. Blood amylase 236 IU/l.

Which treatment tactic most probable?

*gordox

*drotaverin

*sylimarine

*cimetidine

*prosulpin

21

!*A man, 50 years old, abusing alcohol, complains of pains in the upper part of abdomen, increasing after meal, nausea, abdominal distension, watery stool, weight loss.

Which diagnostic methods allows to evaluate condition of damaged organ exocrine function?

*рН-metry

*coprology

*colonoscopy

*amylase level

*FEGDS