Хирургические болезни. Практикум = Surgical diseases. Practice book. Учебное пособие

e)deterministic conditionality of the main and lining cells of the gastric mucosa.

41.Features of the development of breast cancer are:

a)the same lesion of the right and left MG;

b)the most frequent localiza-

tion in the upper-outdoor quadrant; c) indicator of aggressive-

ness – the size of lesion;

d)size of lesion does not reflect the degree of aggression;

e)type of growth reflects the degree of malignancy.

42.By type of growth, breast cancer is divided into:

a)mastitis-like;

b)nodular;

c)infiltrative;

d)diffuse;

e)latent.

43.According to the histological type, breast cancer is divided into:

a)infiltrating;

b)noninfiltrating;

c)the armor;

d)separate species;

e)mixed type (Paget’s dis-

ease).

44.The nodular form of breast cancer is clinically manifested:

a)presence of palpable lesion of MG;

b)the presence of palpable dense axillary and supraclavicular lymph nodes;

c)the retraction of the skin or nipple;

d)erysipelas like skin changes;

e)edema of the hand on the side of the lesion.

45.The main mammographic signs of breast cancer are:

a)focal shadows with uneven contours and inhomogeneous density;

b)an increase in peripheral lymph nodes;

c)revealing of microcalcinates along the border of the ducts of the MG, going towards the nipple;

d)areas of darkening in the region of the foci of fibrosis;

e)shadows of connective tissue strands.

46.Possibilities of positron emission tomography in breast cancer allow us to identify:

a)the existing tumor more than 2 cm in diameter;

b)latent tumor up to 1 cm in diameter;

c)distant metastases;

d)tumor more than 5 cm in dia-

meter;

e)tissue destruction.

47.For the prognosis of breast cancer, the main immunohistochemical studies are:

a)the receptors of estrogen and progesterone;

b)a marker of the proliferation of Ki-67;

c)receptors of the human epidermal factor (HER 2);

d)MALT (mucosassociated lymphoid tissue);

e)there is no need for such a

study.

48.The diffuse forms of breast cancer include all except:

a)purulent-destructive;

b)edematous-infiltrative;

c)gangrenous;

d)latent;

e)mastitis-like.

49.Mastitis-like breast cancer is manifested by:

a)dense palpable tumor with clear contours;

b)infiltrate without signs of fluctuation and clear contours;

c)the presence of cancer lymphadenitis;

d)local increase in tempera-

ture;

e)itching and ulceration of the nipple.

50.Features of Paget’s cancer (breast nipple cancer) are:

a)age of 50–60 years;

b)age of 35–45 years;

c)itching and change in nipple sensitivity;

d)presence of eczematous changes or erosions of the nipple;

e)appearance of late infiltrate, not associated with the nipple and without signs of fluctuation.

51.A latent form of breast cancer manifests by all except:

a)dense palpable tumor;

b)diffuse skin tickening without the presence of a palpable tumor;

c)bloody discharge from the nipple;

d)mastitis-like infiltrate with the phenomena of cancer lymphangitis;

e)enlarge axillary lymph nodes.

52.Halstead Radical mastectomy in breast cancer is:

a)removal of MG with lymph nodes and fatty tissue (lymphadenectomy);

b)removal of both pectoral muscles;

c)removal of only the pectoralis minor muscle;

d)preservation of pectoral muscles;

e)removal of the adjacent skin 5 cm from the edge of the breast.

53.Radical mastectomy in the PA for breast cancer is:

a)extended sectoral breast resection;

b)removal of breast cancer with lymphandenectomy;

c)preservation of pectoral muscles;

d)removal of only the pectoralis minor muscle;

e)removal of both pectoral muscles.

54.Madden Radial mastectomy in breast cancer is:

a)extended sectoral resection of MG;

b)removal of the breast with lymphadenectomy;

c)removal of both pectoral muscles;

d)removal of the pectoralis minor muscle;

e)preservation of both pectoral muscles.

55.Certain types of organ-pre- serving operations in breast cancer are possible with:

a)the presence of regional metastases in the lymph nodes;

b)the size of the primary tumor up to 5 cm;

c)germination of large pectoralis and fascia;

d)the size of the primary tumor up to 1cm;

e)absence of regional metastases.

56.Preoperative chemotherapy for breast cancer is called:

a)adjuvant;

b)neoadjuvant;

c)preventive;

d)adical;

e)latent.

57. Neoadjuvant chemotherapy for breast cancer aims at:

a)elimination of an existing tumor;

b)regression of the primary tumor to increase its resectability;

c)prevention of possible metastasis;

d)destruction of existing regional micrometastases;

e)destruction of green metas-

tases.

58.The main indicators for the appointment of adjuvant chemotherapy for breast cancer are:

a)ostoperative effect on the undeveloped tumor;

b)evention of metastasis in the I–II stages of the disease;

c)revention of metastasis in the II–III stages of the disease;

d)alliative effect at stage I of the disease;

e)revention of infection of a postoperative wound.

59.The main indications for preoperative radiotherapy for breast cancer are all except:

a)decrease in the number of relapses after organ-preserving operations;

b)increase the ablasticity of the planned operation;

c)increasing the resectability of the tumor more than 5 cm in diameter;

d)increase the resectability of the tumor more than 2 cm in diameter;

e)blocking the function of the ovaries.

60.The main indications for postoperative radiotherapy for breast cancer are:

a)decrease in the number of relapses after organ-saving operations;

b)increased resectability of the tumor more than 5 cm in diameter;

c)increasing the ablastity of the operation;

d)treatment of identified regional metastases;

e)prevention of distant metas-

tases.

61.After surgical treatment of breast cancer in the period of premenopause, the following are used:

a)progestins;

b)aromatase inhibitors;

c)antiestrogens;

d)surgical or radial methods;

e)analogues of gonadotropinreleasing hormone.

1.To the acquired purulent-de- structive diseases of the bronchopulmonary system and the pleura belong all below except:

a)bronchoectatic disease;

b)acute and chronic lung abscess;

c)acute purulent pleuritis;

d)gangrene of the lungs;

e)Mounier-Kuhn’s syndrome (tracheobronchomegaly).

2.Bacterial lung destruction (BLD) includes the following processes, except:

a)acute and chronic pleural empyema;

b)gangrene of the lungs;

c)pulmonary sequestration;

d)acute and chronic lung ab-

scess;

e)Mounier-Kuhn’s syndrome (tracheobronchomegaly).

3.External manifestations of respiratory failure in purulent diseases of the lungs and pleura include:

a)sitting position with the upper shoulder girdle fixation;

b)acrocyanosis of the face;

c)thickening of the terminal phalanges of the fingers as “drumsticks”;

d)bulging of the cervical veins;

e)wideningoftheintercostalspaces.

4.The main indicators of the external respiration function in pa-

tients with purulent diseases of the lungs and pleura are:

a)vital capacity of the lungs;

b)minute volume of respiration;

c)maximum ventilation of the

lungs;

d)Tifno-votchal’s test;

e)increase in the volume of “deadspace”.

5.The main pathologies of the pulmonary function in purulent diseases of the lungs and pleura are:

a)general hypoventilation;

b)development of the “shunting” syndrome in the damaged parts of the lung);

c)imbalance between ventilation and perfusion;

d)Tifno-Votchal’s test;

e)impairment of alveolar and blood gases diffusion.

6.Radioisotope lung scintigraphy in case of purulent diseases of the lungs and pleura makes it possible for the doctors:

a)to estimate the amount of fluid in the pleural cavity;

b)to detect neoplasms of the tracheobronchial tree;

c)to assess the state of the lungs and mediastinum in relation to the surrounding tissues;

d)to assess the state of ventilation and perfusion of various parts of the lung;

e)to verify the structure of the bronchi or bronchiectasis.

7.Bronchography in patients with purulent diseases of the lungs and pleura cnobles the doctors:

a)to assess the condition of the lungs and mediastinum in relation to the surrounding tissues;

b)to assess the state of ventilation and perfusion of various lung parts;

c)to estimate the amount of fluid in the pleural cavity;

d)to verify the structure of the bronchi or bronchiectasis;

e)to assess the vital capacity of the lungs.

8.According to the form of enlargement bronchiectases are divided into:

a)serpentine;

b)cylindrical;

c)sac-like;

d)cyst-like;

e)mixed.

9.Bronchiectasic disease has the following stages, except:

a)latent;

b)reversible changes;

c)irreversible changes;

d)hemodynamic disorders;

e)deformation of the chest.

10.According to the development mechanism acute lung abscesses are divided into:

a)hematogenous-embolic;

b)aspiration;

c)post-traumatic;

d)lymphogenous;

e)post-pneumonic.

11.The predisposing factors of the acute lung abscess development include everything below, except:

a)chronic nonspecific lung diseases;

b)diseases accompanied by local and general immunoresistance decrease;

c)diseases accompanied by hemocoagulation disorders;

d)processes accompanied by cough and epiglottis reflexes pathology;

e)diseases, accompanied by the thyroid hormone synthesis disorder.

12.The main mechanisms of the acute lung abscess pathogenesis are all below, except:

a)translocation of microflora to the lower parts of the tracheobronchial tree;

b)hypoventilation and microatelectasation of the bronchial-al- veolar structures;

c)disorders of microcirculation with vascular thrombosis;

d)osteomalacia of the tracheal rings from the outside;

e)necrosis of bronchial-alveo- lar structures.

13.The most typical localizations of acute lung abscess are the following segments:

a)1st;

b)2nd;

c)3rd;

d)4th;

e)5th.

14.The following periods are distinguished during the acute lung abscess:

a)latent;

b)asymptomatic;

c)formation of the abscess;

d)breakthrough of the abscess into the bronchus;

e)restitution.

15.The period of acute lung abscess formation is characterized by all signs below, except:

a)hectic temperature;

b)pain in the chest during breathing;

c)dry cough;

d)abundant discharge of purulent sputum;

e)severe general condition.

16.The period of acute abscess rupture into the bronchi is characterized by:

a)deterioration of the general condition;

b)sudden onset of cough with abundant purulent sputum (“full mouth”);

c)improvement in general condition;

d)tendency of the body temperature to normalization;

e)disappearance of dyspnoea.

17.Acute lung abscess can be drained:

a)into pericardial cavity;

b)into pleural cavity;

c)into abdominal cavity;

d)into bronchus cavity;

e)hematogenously.

18.The period of acute lung abscess development is radiologically manifested by:

a)a “basket” symptom;

b)multiple foci of pulmonary destruction;

c)hydrothorax;

d)parietal pneumothorax;

e)a rounded homogeneous cavity surrounded by perifocal infiltration.

19.The radiological symptom of a “basket” (an abscess cavity containing a liquid layer with a gas bubble above it) is caused by:

a)fibro-inflammatory fusions around;

b)changes in the walls of the abscess;

c)perifocal infiltration;

d)inadequate bronchial drainage;

e)pneumohydrothorax.

20.Sputum, appearing after the drainage of an acute abscess into the bronchi:

a)forms 3 layers upon sedimen-

tation;

b)homogeneous in structure;

c)foam-purulent;

d)brown and homogeneous;

e)forms 2 layers upon sedimentation.

21.Treatment of acute lung abscess includes everything below, except for:

a)adequate drainage of the purulent focus into the tracheobronchial tree;

b)pleural adhesiolysis;

c)adequate antibiotic therapy;

d)increased immunoresistance;

f)disintoxication therapy.

22.To ensure adequate drainage of acute lung abscess, everything below is applied, except:

a)postural drainage;

b)endotracheal sanation;

c)Mohnaldi’s percutaneous microdrainage;

d)pleurodesis and decortication of the lung;

e)videothoracoabsessoscopy.

23.Indications for surgical treatment of acute lung abscess are:

a)inefficiency of drainage with the help of minimally invasive techniques;

b)complications;

c)chronic abscess;

d)gangrene of the lung;

e)lack of dynamics in the puru-

lent cavity healing during 4 weeks.

24.The operation of choice in case of acute lung abscess is:

a)pneumonectomy;

b)pleural adhesiolysis;

c)decortication of the lung;

d)lobe, bilobectomy with the removal of the pyogenic capsule and the destruction cavity;

e)thoracomioplasty of the purulent cavity.

25.Optimal routes of antibiotics administration in case of acute lung abscess are as follows:

a)intramuscular;

b)intravenous;

c)oral;

d)selective intra-arterial;

e)selective intralesional (performed by means of Mohnaldi’s percutaneous drainage or sanation bronchoscopy).

26.Pyopneumothorax with acute lung abscess develops due to:

a)drainage into the large bron-

chus;

b)communication between the second purulent cavity, connected with the bronchus;

c)development of a dense con- nective-tissue pyogenic shell;

d)drainage into the pleural cavity;

e)inadequate blood transfusion therapy.

27.The optimal outcome of acute abscess is:

a)chronic abscess;

b)pneumothorax;

c)localized pneumosclerosis;

d)chronic pleural empyema;

e)amyloidosis.

28.Postural drainage in the treatment of acute lung abscess includes:

a)percutaneous microdrainage of the abscess cavity;

b)creation of a specific system for vacuum-drainage of the purulent cavity;

c)placing the patient in a position for natural adequate drainage from the mild destruction cavity;

d)creating a system for flowwashing drainage;

e)varieties of sanative bronchoscopy.

29.The operation of choice for the lung gangrene is:

a)bilobectomy;

b)pleural adhesiolysis;

c)lung decortication;

d)pneumonectomy;

e)thoracoabsessocopy.

30.Acute empyema of the pleura is called:

a)limited purulent destructive process of the lung tissue;

b)acute inflammation of the pleura layers with purulent exudates;

c)widespread destruction of the lung tissue;

d)limited purulent-destructive disease of the lung tissue;

e)transsudate in the pleural cavity.

31.The main microflora causing the development of acute pleural empyema is:

a)clostridial anaerobes;

b)adenovirus;

c)nonclostridial anaerobes;

d)gram-positive and gramnegative aerobes;

e)fungal flora.

32.Primary acute pleural empyema is a complication of:

a)pus-destructive diseases of the pleural cavity;

b)chest injuries;

c)thoracic interventions;

d)acute lung abscess;

e)transsudate suppuration.

33.The main routs of pleural cavity infection are:

a)aspiration;

b)contact;

c)perforating;

d)hematogenous-metastatic;

e)obturating.

34.The main types of the pleural cavity contact infection are:

a)perforating diseases;

b)parapneumonic foci;

c)metapneumonic diseases;

d)secondary piometastatic foci;

e)suppuration of a thoracic wound.

35.In terms of prevalence, acute pleural empyema is divided into:

a)bilateral;

b)putrefactive;

c)total;

d)polysegmentary;

e)limited.

36.Among the localizations of limited pleural empyema are all below, except:

a)apical;

b)parietal;

c)paramediastinal;

d)metapneumonic;

e)interlobal.

37.By the nature of the exudate, acute pleural empyema is divided into:

a)purulent;

b)putrefactive;

c)serous;

d)hemorrhagic;

e)fungal.

38.By the type of complications, acute empyema is divided into processes that occur:

a)without lung destruction;

b)with lung destruction;

c)with pyopneumothorax;

d)with the diaphragm involve-

ment;

e)with pneumonia.

39.In the development of acute pleural empyema there are the following stages:

a)the stage of fibrous pleurisy;

b)the latent stage;

c)the stage of fibrin organization into connective tissue structures (moorings);

d)the reparative stage;

e)the pleurobronchothoracic complications.

40.The stage of fibrin and adhesions formation in acute pleural empyema is characterized by all below symptoms, except:

a)purulent exudate;

b)adhesion of both pleural layers with the fibrosis development;

c)hyperemia and pleura leukocyte infiltration;

d)separation of purulent exudate from the unchanged pleural cavity with spikes;

e)formation of scar tissue.

41.The main complications of acute pleural empyema are all below except:

a)chest soft tissue phlegmons;

b)pyopneumothorax;

c)syndrome of healthy lung tissue bypass;

d)compartment syndrome of the abdominal cavity;

e)dislocation of the mediastinum to a healthy side.

42.Clinical stage of acute pleural empyema is characterized by:

a)strong stitching pain in the chest, worse when inhaled;

b)frequent, shallow breathing;

c)reflex cough;

d)decrease in body temperature against the background of skin pallor;

e)febrile fever with chills and increased sweating.

43.The main methods of acute pleural empyema instrumental diagnosis are:

a)MRI;

b)polypositional radiography;

c)pleural puncture with bacteriological examination;

d)fine needle aspiration biopsy with cytological examination;

e)videothoracopy.

44.The basis of acute pleural empyema treatment is all below, except:

a)drainage of the pleural cavity with active aspiration;

b)postural drainage;

c)rational antibiotic therapy;

d)Mounaldi’s microdrainage;

e)pleurectomy.

45.Indications for acute pleural empyema surgical treatment are:

a)amyloidosis of internal organs;

b)active pleural fistula;

c)large sequestration in the empyema cavity;

d)multi-chamber empyema;

e)inadequate postural drainage.

46.In case of pleural empyema surgical treatment preference is given to:

a)wide lateral thoracotomy;

b)videothoracoscopic sanation;

c)mini-thoracotomy;

d)puncture draining interventions under ultrasound and radiographic control;

e)robot-assisted interventions.

47.The aims of videothorascopic sanation of the pleural cavity in case of acute pleural empyema are all below, except:

a)removal of fibrous overlays, moorings and adhesions;

b)removal of sequestrants and blood clots;

c)extrapleural thoracoplasty;

d)rooting of the affected lung;

e)open thoracostomy formation.

48.The manifestation of the clinical pyopneumothorax in acute pleural empyema depends on:

a)pulmonary edema;

b)the size of the lung purulent cavity;

c)the valve mechanism;

d)the diameter of the involved bronchus;

e)the character of empyema (limited or common).

49.The clinically acute form of pyopneumothorax with acute pleural empyema is manifested by all below symptoms, except:

a)sudden severe chest pain with the signs of shock;

b)dyspnea at rest;

c)forced position of the patient with support on the upper shoulder girdle;

d)absence of pain syndrome;

e)increase in the body temperature up to 39 °C accompanied with chills.

50.Valve pyopneurmothorax is accompanied by the following disorders, except:

a)flotation of the mediastinum;

b)development of the healthy lung areas bypass syndrome;

c)Kurnan’s syndrome (increased pressure in the pulmonary vessels caused by general hypoxemia);

d)compartment syndrome in the abdominal cavity;

e)paradox breathing.

51.The main diagnostic methods to reveal pyopneumothorax are:

a)celiacography;

b)diagnostic puncture;

c)fistulopleurobronchography;

d)videothoracoscopy;

e)MRI.

52.In complex treatment of pyopneumothorax, all below methods are used, except:

a)sanitation of the empyema cavity;

b)drainage of the pleural cavity;

c)restoration of airway patency;

d)elimination of respiratory hypoxemia;

e)lobectomy with circular resection of the adjacent bronchi.

53.Causes contributing to the transition of acute pleural empyema to its chronic form are all below, except: