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

b)gradual increase of intra-ab- dominal pressure with accompanying coprostasis;

c)gradual compression of the afferent loop of the intestine and secondary compression of the efferent portion;

d)accompanying secondary reflex spasm of mechanically expanded hernial orifice;

e)absence of elastic component upon strangulation.

38.The features of parietal (lateral) strangulation include:

a)compression of a separate portion of the intestine opposite the mesentery portion;

b)strangulation of the intermediate intestinal loop located in the abdominal cavity;

c)strangulation of the entire intestinal loop including the mesenteric and antimesentric margins;

d)strangulation involving the Meckel’s diverticulum;

e)narrow or elongated hernia orifice.

39.Specific features of retrograde (W-shaped) strangulation are:

a)strangulation of a separate portion of the intestine opposite the mesenteric portion;

b)strangulation of the entire intestinal loop including mesenteric and antimesentric margins;

c)strangulation involving the Meckel’s diverticulum;

d)strangulation of the intermediate intestinal loop located in the abdominal cavity;

e)inflammation of the organs in the hernial sac associated with “false” strangulation.

40.Pathogenic features of the strangulated hernia are all except:

a)initially developed venous stasis and stasis in the mesentery of the strangulated intestine;

b)“sweating” of plasma and blood elements into the tissue of the intestinal wall and the cavity of the hernial sac;

c)increase in pressure of more than 50 mm Hg. in the venous system with subsequent disruption of the microcirculation of the intestinal wall;

d)desquamation of mucosal epithelium and subsequent bacterial intestinal translocation;

e)initial impairment of arterial blood flow in the strangulated intestinal loop accompanied by primary ischemic necrosis of the wall.

41.Characteristic features of disorders in the afferent loop in case of strangulated hernia include the following ones:

a)overfilling with contents is accompanied by an increase in intraluminal pressure;

b)intraluminal pressure prevails over the venous contributing to the disruption of intra-wall microcirculation;

c)intraluminal pressure becomes lower than the venous pressure contributing to arterial necrosis;

d)strangulation of the nerve plexuses is accompanied by the development of pain shock;

e)absence of pain syndrome and reflex vomiting due to the arising primary water-electrolyte disorders.

42.Microcirculatory disorders in the afferent loop of the strangulated intestine extend from the “strangulation mark” to:

a)10–20 cm;

b)30–40 cm;

c)5–7 cm;

d)more than 70–80 cm;

e)20–30 cm.

43.Characteristic clinical features of strangulated hernia include all ones except:

a)the onset of severe pain after physical exertion;

b)localization of pain syndrome in the place of primary strangulation;

c)irreducibility of herniated contents;

d)presence of positive “cough push” symptom;

e)absence of tension and tenderness of the hernial protrusion on examination.

44.The signs of accompanying phlegmon of the hernial membranes in case of strangulated hernias are:

a)hyperemia of the skin with purple-cyanotic coloring;

b)paling and hypothermia of the skin in the area of protrusion;

c)swelling and local hyperthermia of the skin;

d)the onset of symptoms of softening and fluctuation in the area of hernial protrusion;

e)absence of inflammatory syndrome and intoxication.

45.Specific surgical techniques in case of strangulated hernia include all ones except:

a)dissection of the external hernial membranes and hernial sac;

b)fixation of the strangulated organ in the wound before dissection of the strangulation ring;

c)absence of necessity to fix the strangulated organ before dissection of the strangulation ring;

d)assessment of the viability of the injured organ;

e)hernioplasty after excision of the hernial sac.

46.Signs of the viability of the strangulated intestinal loop after the repair of the strangulation include:

a)appearance of pink-red

color;

b)presence of peristalsis;

c)glossy surface of the visceral peritoneum;

d)absence of pulsation of mesenteric vessels;

e)absence of peristalsis.

47.Characteristic features of a nonviable strangulated intestinal loop include all ones except:

a)dark gray or black color;

b)reversible color changes from cyanotic-purple to pink-red;

c)the appearance of active peristalsis;

d)a dull appearance without the gloss of the visceral peritoneum;

e)absence of pulsation of mesenteric vessels.

48.In case of a nonviable strangulated intestinal loop, resection is performed, the resected portion being not less than:

a)15–20 cm of the afferent segment;

b)30–40 cm of the efferent segment;

c)30–40 cm of the afferent segment;

d)15–20 cm of the efferent segment;

e)15–25 cm of the afferent segment and 5–15 cm of the efferent segment.

49.In case of the strangulated hernia with accompanying phlegmon of the sac and external hernial membranes, the operation is completed by means of:

a)primary hernioplasty;

b)external drainage of the wound with hernioplasty;

c)external drainage of the wound without hernioplasty;

d)external drainage of the wound with hernioplasty delayed for 3–5 days;

e)necrectomy without hernioplasty with mandatory layer-by-layer suturing of the postoperative wound.

50.Scheduled hernia repair with primary hernioplasty is performed after curing the phlegmon of the hernial membranes in:

a)5–7 days;

b)3–4 weeks;

c)2–5 days;

d)3–4 months;

e)simultaneously with the main stage.

51.Variants of “false” repositioning in case of strangulated hernia are all ones except:

a)complete repositioning of the hernia with the preserved strangulation ring;

b)detachment of the strangulation ring from the hernial sac and subsequent repositioning of organs into the abdominal cavity;

c)displacement of the strangulated organs from one chamber to another, the strangulation preserved;

d)rupture of the strangulated intestinal loop in the sac or abdominal cavity;

e)full repositioning of contents into the abdominal cavity without preserving the strangulation ring.

52.If “false” reposition is confirmed the following procedures are indicated:

a)dynamic observation in a surgical in-patient department;

b)diagnostic videolaparoscopy with possible conversion to laparotomy;

c)laparocentesis;

d)diagnostic puncture under ultrasound control;

e)X-ray with dynamic evaluation of the passage of contrast agent.

1.The definition of acute intestinal obstruction includes:

a)disorder of the passage through the intestine;

b)severe disorders of homeo-

stasis;

c)disorders of all types of metabolism;

d)complications after various surgical diseases;

e)evident water-electrolyte changes without any disorders of the intestinal passage.

2.Which form of acute intestinal obstruction is considered as an independent disease:

a)dynamic;

b)obturative;

c)extraorganic;

d)adhesive;

e)intramural.

3.The following types of acute intestinal obstruction are distinguished according to the mechanism of its onset:

a)small intestinal;

b)dynamic;

c)mechanical;

d)with disorders of intestinal microcirculation;

e)mixed.

4.Dynamic (functional) forms of intestinal obstruction include:

a)invaginational;

b)paralytic;

c)spastic;

d)obturative;

e)intramural.

5.The mechanical forms of intestinal obstruction include:

a)strangulational;

b)paralytic;

c)obturative;

d)colonic;

e)mixed.

6.The strangulation forms of intestinal obstruction include all except:

a)small intestine;

b)volvulus;

c)nodulus;

d)hernial strangulation;

e)extraorganic.

7.Obturational forms of intestinal obstruction are:

a)colonic;

b)spastic;

c)intraorganic;

d)extraorganic;

e)intramural.

8.The intraorganic form of obturation includes all except:

a)foreign bodies;

b)concretions (coprolites);

c)tumors;

d)nodulus;

e)helminths.

9.Extraorganic forms of obturation include:

a)retroperitoneal tumors;

b)retroperitoneal infiltrates;

c)adhesions;

d)nodulus;

e)arteriomesenteric obstruction.

10.Intramural forms of obturation include all except:

a)retroperitoneal infiltrates;

b)polyps;

c)corrosive strictures;

d)tumors;

e)Crohn’s disease.

11.Mixed forms of intestinal obstruction include:

a)polyps;

b)spastic;

c)intussusception;

d)volvulus;

e)adhesive.

12.By anatomical localization the following types of intestinal obstruction are distinguished:

a)spastic;

b)intramural;

c)small intestinal;

d)colonic;

e)arterio-mesenteric.

13.There are the following stages of the development of acute intestinal obstruction except:

a)acute;

b)acute disorder of the intestinal passage (“ileus cry”);

c)acute disorders of intestinal microcirculation;

d)recurrent;

e)peritonitis (late).

14.By the type of disturbances of the intestinal passage, the following types of intestinal obstruction are distinguished:

a)acquired;

b)complete;

c)congenital;

d)incomplete;

e)recurrent.

15.The main etiological factors in the development of the spastic form of intestinal obstruction are all except:

a)excessive stimulation with proserin (eserin);

b)lesions of the brain or spinal

cord;

c)chronic lead or cadmium poisoning;

d)ulcerative dystrophic disorders of the small intestine;

e)inflammation of the intestine from the visceral peritoneum.

16.The main factors in the development of the paralytic form of intestinal obstruction are:

a)chronic lead or cadmium poisoning;

b)inflammation of the intestine from the visceral peritoneum;

c)neurogenic diseases;

d)early postoperative period;

e)long-term use of antidepressant drugs or opiates.

17.The main mechanisms of the pathogenesis of the dynamic intestinal obstruction are all except:

a)hypertension of the sympathetic part of the gastrointestinal tract regulation;

b)reduction of synthesis of somatostatin, neurotensin and motilin;

c)dysfunction of vegetative and endocrine mechanisms of the gastrointestinal tract;

d)blockade of cholinergic (cholinesterase) transmission in the intestinal synapses;

e)hypertonia of parasympathetic part of the gastrointestinal tract regulation.

18.The main clinical manifestations of acute intestinal obstruction are:

a)absence of pain syndrome;

b)severe pain syndrome (of varying intensity);

c)absence of gases and stools;

d)frequent unformed stool;

e)nausea and vomiting.

19.Conservative treatment of dynamic intestinal obstruction includes everything except:

a)prolonged epidural anesthe-

sia;

b)administration of anticholinesterase drugs;

c)permanent gastric aspiration;

d)use of fibrinolysis activators;

e)siphon enema.

20.Congenital (predisposing) factors of mechanical intestinal obstruction development include:

a)tumors of the abdominal cavity;

b)Ledd’s syndrome;

c)dolichosigmoid;

d)presence of additional ligaments, pockets, folds of the peritoneum;

e)adhesive process of the abdominal cavity.

21.Acquired (predisposing) factors of the mechanical intestinal obstruction development include all except:

a)dolichosigmoids;

b)inflammatory infiltrates or tumors of the abdominal cavity;

c)adhesive process of the abdominal cavity;

d)hernia of the anterior abdominal wall with the large hernial orifice;

e)coprostasia.

22.The initiating factors of the development of the mechanical form of intestinal obstruction include:

a)increased food load on the background of prolonged starvation;

b)eating rough food;

c)excess of raw plant fiber;

d)inflammatory infiltrates or tumors of the abdominal cavity;

e)prolonged drug stimulation.

23.The main pathogenetic manifestations of the initial stage of obturative intestinal obstruction are all except:

a)gradual over-filling of the afferent segment of the intestinal wall;

b)increased intra-intestinal pressure compared with the venous one in the afferent segment;

c)development of ischemic damage to the intestinal wall 24 hours after the onset;

d)the presence of a collapsed part of the efferent segment of the intestine;

e)increased venous pressure compared with the intestinal one in the afferent segment, which then contributes to the disorders of intestinal microcirculation.

24.The stage of acute disorders of intestinal microcirculation in the development of the mechanical form of intestinal obstruction is characterized by all except:

a)improved resorptive and digestive functions of the small intestine;

b)uncontrolled growth of pathogenic microflora in the intestine lumen;

c)accumulation in the lumen of water, electrolytes, products of incomplete protein transformation, lipids, carbohydrates;

d)development of the syndrome of “bacterial intestinal translocation”;

e)activation of total immunoreactivity.

25.Among the clinical symptoms of mechanical intestinal obstruction all of the following are significant except:

a)high tympanitis over the detected elastic conglomerate on the background of an asymmetric abdomen;

b)“falling drop” noise determined by auscultation;

c)determination of “splash noise” by superficial palpation of the abdomen;

d)visible “asymmetry” of the anterior abdominal wall;

e)filled rectal ampulla during rectal examination.

26.Instrumental methods of mechanical intestinal obstruction diagnosis include all except:

a)plain radiography of the abdominal cavity;

b)dynamic radiography with passage control (with barium sulphate suspension);

c)thermography of the anterior abdominal wall;

d)double contrast barium enema (irrigoscopy);

e)ultrasonography of the abdominal cavity.

27.The treatment-diagnostic examination in case of acute intestinal obstruction includes all except:

a)the probe for permanent gastric aspiration;

b)bilateral novocaine paranephric block;

c)administration of antispasmodic drugs of myotropic action and anticholinesterase drugs;

d)administration of laxative osmotic drugs;

e)siphon enema.

28.The positive effect of the treat- ment-diagnostic examination in AIO is assessed by:

a)intensification of pain syndrome;

b)activation of vomiting and stagnant discharge along the gastric probe;

c)restoration of rhythmic peristalsis;

d)restoration of the passage of flatus and natural defecation;

e)positive x-ray and ultrasound clinical picture of the process.

29.The tasks of surgical treatment of nontumorous forms of intestinal obstruction are all except:

a)elimination of the cause or underlying (main) disease;

b)restoration of the natural intestinal passage;

c)elimination of endogenous intoxication sources;

d)carrying out a complex of antiblastic measures;

e)prevention of recurrent adhesions.

30.The main features of surgical treatment of acute nontumorous intestinal obstruction are:

a)general anesthesia with neuromuscular blocking agents;

b)midline laparotomy with thorough operative exploration of the abdominal cavity;

c)reintervention to eliminate the underlying (main) cause only after the final stabilization of the condition;

d)elimination of the detected cause and, if it is impossible to eliminate it, the formation of “bypass” anastomosis or stoma exteriorization;

e)carrying out decompression of the small intestine.

31.Most often the development of acute obstructive colonic obstruction is due to:

a)nonspecific ulcerative colitis;

b)tumors of the right flank of the colon;

c)tumors of the left flank of the colon;

d)diverticular disease;

e)familial polyposis.

32.The main features of the clinical course of colonic obturative obstruction are:

a)slow progression of the pro-

cess;

b)in early stages – the presence of a local generalized process;

c)with sub-decompensation – occuring paralytic small intestine obstruction;

d)absence of multicentric or metachronous growth of the tumor;

e)in the late stages – local and general complications.

33.At the late stage local complications of colonic obstruction are all except:

a)infiltrates and abscesses of the abdominal cavity;

b)development of diffuse peritonitis;

c)intestinal bleedings;

d)development of enterocolitis;

e)proliferation into adjacent organs.

34.In the surgical treatment of obturative colonic obstruction it is necessary to take into account:

a)the volume and prevalence of the process;

b)the stage of intestinal obstruction;

c)the presence of local and general complications;

d)wishes of the patient;

e)the severity of the condition and age of the patient.

35.Emergency intervention in patients with obturative colonic obstruction and extremely severe condition should be carried out to the following extent:

a)obstructive resection of the tumor and sugery with proximal end colostomy;

b)bowel decompression by forming a proximal loop colostomy;

c)right-sided (left-sided) hemicolectomy with primary anastomosis;

d)should be performed only after patient’s condition stabilization;

e)should not be performed at all.

36.In the left-sided localization of the process and compensated state

of the patient with obturative colonic obstruction, urgent surgical treatment is performed to the following extent:

a)decompression of the intestine by forming a proximal loop colostomy;

b)obstructive resection of the intestine with a tumor and sugery with proximal end colostomy;

c)left-sided hemicolectomy with the formation of primary anastomosis;

d)obstructive resection of the tumor with the formation of primary anastomosis and sugery with proximal protective loop enterostomy;

e)transanal decompression with subsequent planned intervention should only be performed.

37.In the right-sided localization of the process and a compensated state of the patient with obturative colonic obstruction, urgent surgical treatment should be performed to the following extent:

a)the right-sided hemicolectomy with intraoperative decompression and formation of the primary transverse enteroanastomosis;

b)obstructive resection of the tumor with the formation of proximal enterostomy;

c)decompression of the intestine by forming a proximal loop enterostomy or cystostomy;

d)subtotal colectomy;

e)transanal decompression alone with subsequent planned intervention should only be performed.

38.Ethiopathogenetic factors of sigmoid colon volvulus are all except:

a)congenital increase in length and diameter;

b)excessive length of the mesosigmoid;

c)coprostasis and hypokinetic dysfunctional disorders;

d)abrupt increase in the intraabdominal pressure;

e)diarrhea with water-electro- lyte disorders.

39.The following symptoms are characteristic of clinical manifestations of sigmoid colon volvulus except:

a)cramp-like intense pain in the left ileal region;

b)forced patient’s position to reduce pain;

c)complete retention of gases and stools against a relatively satisfactory condition;

d)palpable elastic tumor in the sigma projection against the background of the lack of muscular defense;

e)asymmetric bloating with the retraction of the left iliac region.

40.After the elimination of the sigmoid colon volvulus the surgical intervention is most often completed by:

a)mesosigmoplication;

b)primary resection of sigma with the formation of anastomosis;

c)resection of the necrotic area with the proximal descendostomy;

d)surgery of the necrotic area in the form of the loop sigmostoma;

e)formation of a protective loop enterostomy or cystostomy.

41.The producing factors of the development of a small bowel volvulus are:

a)vertical line of attachment of the mesosigmoid to the posterior wall of the abdominal cavity;

b)nutritional disorder;

c)consumption of large quantities of rough food on an empty stomach;

d)the presence of adhesions due to previous interventions;

e)hypercathartic diseases on the background of overfilling of the proximal parts of the gastrointestinal tract.

42.Typical features of intussusception of intestines are all except:

a)different mixed forms of intestinal obstruction;

b)the development mainly in young children due to anatomical conditions;

c)the substrate of the process is represented by a cylinder of superimposed intestinal walls;

d)compression of the mesosigmoid with vessels passing through it, venous stasis and microcirculatory disturbances;

e)the absence of chronic or subacute disease progression.

43.Typical features of adhesive intestinal obstruction are:

a)the fold of the intestinal lumen similar to the type of obtura-