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61

*!A man, 56 years old, was admitted with the bleeding from varicose dilated esophageal veins. One week before, he became bothered by pains in the right hypochondrium, jaundice developed. In anamnesis – viral hepatitis В. At examination, skin and sclera are icteric, telangiectasia, palmar erythema. Abdomen is bloated, enlarged due to ascites. Hepatosplenomegaly. Hemoglobin – 110 g/l.

Which plan of therapeutic measures is the MOST reasonable?

*vasopressin application

*performance of plasmapheresis

*balloon esophagus tamponade

*packed red cell transfusion

*+sclerosing with acrylate

62

*!A 39-years old woman with chronic viral hepatitis B has total bilirubin – 148 mmol/l, direct bilirubin – 102 mmol/l, AST – 64 units, ALT – 78 units, alkaline phosphatase – 210 units, cholesterol – 5.2 µmol/l.

Which of listed drugs is the MOST reasonable to prescribe?

*LIV-52

*silimarin

*ademethionin

*+ursodeoxycholic acid

*Essentiale

63

*!A man, 34 years old, complains of pains in epigastrium, appearing 1.5 – 2 hours after meal, as well as at nights; disposition towards constipations. Year ago, course of ulcerative disease was complicated by perforation.

Which of localizations of ulcer the MOST probable:

*on small curvature of the stomach

*in atrial part of stomach

*on large curvature of the stomach

*+on duodenal bulb

*in pyloric part of the stomach

64

*!A woman, 63 years old, is bothered by watery stool, sometimes accompanied by abdominal pains, which disappear after gases discharge. She is ill for a year after surgery due to benign tumor (intestinal anastomosis). Abdomen is bloated. Positive hydrogen breathing test (after loading with lactulose). Jejunum aspirate inoculation gives evidence of excessive bacterial growth.

What is the MOST probable syndrome developed in patient:

*afferent loop syndrome

*non-ulcerative dyspepsia syndrome

*irritated bowel syndrome

*disacharidase-deficient enteropathy

*+jejunum microbial contamination syndrome

65

*!A man, 53 years old, abusing alcohol, admitted with bleeding from varicose dilated esophageal veins. One week before, pains in right hypochondrium appeared, jaundice developed. Objectively: skin and sclera are icteric, teleangiectasias. Abdomen is bloated. The liver protrudes from the costal arch edge for 3 cm, thick, painful. Splenomegaly. In blood: anemia, thrombocytopenia, ESR – 36 mm/h. Total bilirubin 56 µmol/l, direct fraction – 12.2 µmol/l.

Which of listed diagnoses is the MOST probable?

*Cryptogenic liver cirrhosis

*Chronic alcohol hepatitis

*Chronic cryptogenic hepatitis

*Chronic medicinal hepatitis

*+Liver cirrhosis with alcoholic etiology

66

*!A woman, 22 years old, provides complaints about watery stool up to 20 times a day with admixture of blood, mucus, with stinking odor; colicky abdominal pains, aggravating after the meal, before the act of defecation and relieving after stool; weight loss, loss of appetite, arthralgias of ankle and knee joints, increased body temperature, general weakness. The examination revealed total affection of large intestine. Endoscopic picture becomes apparent by presence of micro abscesses in large intestine crypts, manifested purulent exudation, spontaneous bleedings. Which is the most probable diagnosis?

*Colon cancer

*Granulomatous colitis

*Ischemic colitis

*Amebiasis

*+Non-specific ulcerative colitis

67

*!A man, 50 years old, malicious smoker, provides complaints about asthma attacks, burning pains in the lower third of breastbone, sour belching. During theophylline group drugs, condition worsens. On ECG: ischemic changes are not registered. On peakflowmetry, insignificant decrease of peak expiration flow rate was detected. Which diagnosis is most probable?

*+Gastroesophageal reflux disease

*Chronic gastritis

*IHD. Angina

*Bronchial asthma

*Chronic obstructive pulmonary disease

68

*!A man, 30 years old, provides complaints about periodic hunger pains in epigastric region, heartburn, nausea, sour belching. Objectively: local painfulness in pyloroduodenal area. On FGDS, hyperemia and edema of antral section mucosa, hyperplasia of folds, antral spasm is detected. Which examination method will allow to establish pathological process etiology?

*Intragastric рН-metry

*Common blood analysis

*+Urease test

*Stomach roentgenography

*Duodenal intubation

69

*!In a man, 53 years old, suffering from liver cirrhosis, increased pains in hypochondrium, growing jaundice, manifested edemas on lower extremities appeared. He lost 12 kg in last 4 months. Liver at palpation very knobby, stone thick. In blood: erythr. – 2.6 mln., Nv – 72 g/l, thrombocytes – 156 thousand, total protein – 45 g/l, γ-glutamil transpeptidase – 237 units/l, α-fetoprotein – 90 µg/l. US found space-occupying lesion in projection of quadrate lobe of liver.

Which of listed pathologies the MOST probably developed in a patient?

*Visceral tumor deposit

*+Hepatocellular carcinoma

*Hemochromatosis

*Echinococcosis

*Hemangioma

70

*!An elderly man complains of abdominal pains, blood admixture in feces, quick loss of weight. Dull pains in right half of abdomen bother him about 2 years, in last time they became more intense. At irrigoscopic examination: in projection of upper part of ascending intestine, contour unevenness with extrusion into cavity is noted; limited intestine stricture; wall rigidity; absence of haustration; below the stricture the intestine is dilated, after emptying, contrast delay is noted.

For which of listed pathologies, this radiological picture is the MOST typical?

*Chronic spastic colitis

*Non-specific ulcerative colitis

*+Colorectal cancer

*Crohn's disease

*Megacolon

71

*! 78 years old man complains of a feeling of heaviness and overflow after meals, belching; general weakness, dizziness. From history: hypothyroidism, diabetes insulin-required form. On examination - pale skin, mild tenderness in epigastric. The general blood test: HB - 98 g / l, Erithrocytes- 2.8x10¹²/l, color index-1.4. EFGDS: gastric mucosa is atrophic.

Which of the following factors is the most likely led to the development of anemia in the patient? * Violation of iron absorption from food in the intestines * Reducing the food consumption containing iron *+ Lack of Castle's factor * The low acidity of gastric juice * Low concentration of transferrin

72

*! Female 45 years old woman complains of dull aching pain in the epigastric region, not related to food intake, nausea. On examination: abdomen is soft, sensitive in the epigastric region. EFGDS - multiple were polyps found in the lower third of the body and antrum on the greater curvature of 0.5 to 1.0 cm round shape.

Which of the following methods of inspection is the MOST appropriate to appoint? * The daily pH-meter * Gastrin level detection * Fractional research of gastric juice *+ Cytological research of biopsy material * Detection of lactic acid in gastric juice

73

*! Male 43, complained of abdominal pain in the epigastric the right of the midline, which appear in 2-2.5 hours after a meal, sometimes at night, as well as a feeling of "sucking in his stomach," which relieves after meal intake - that is why He is often snacking, including before going to bed at night. He was also worried about heartburn, acid regurgitation.

Which picture is the most likely during EFGDS?

* Hyperemia and inflammation of the gastric mucosa in the antrum * Ulcer located in the cardia of the stomach * Ulcer located on the greater curvature of the stomach *+ Ulcer located in the antral part of the stomach * Ulcer located on the lesser curvature of the stomach

74

*! Male 47 years old man complains of pain in the epigastric and left upper quadrant, which is worsening on lying or bending position. The pain appears after 1 hour after meals, especially after the fried food, has a dull persistent character. Also worried about heartburn, belching, bloating, unstable chair. On examination: the patient is overweight, his skin is dry, "ruby droplets", pain at Mayo-Robson points.

What laboratory tests should be carried out to a patient?

* Lipid profile * The level of GGT and alkaline phosphatase * The level of transaminases *+ Amylase and lipase level * Level of alcogoldehydrogenase

75

*! 48 years old woman complains of a dull pain in the epigastric and left upper quadrant, radiating to the back, flatulence, unstable stool, weakness, loss of appetite, thirst. Recently had treated the vaginal candidiasis. OBJECTIVE: low feeding, the skin is dry, "ruby droplets", palmar erythema, pain in the epigastric and left upper quadrant. US: increasing size of the pancreas, the uneven increase of density.

Which of the following laboratory tests is necessary?

* Determination of TSH, T3, T4 * Determination of the lipid profile *+ Determination of glycemia * Determining the calcium level

* Definition SA19-9, CEA