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

e)chronic inflammation due to recurrent suppurative external fistulas.

7.For the diagnosis of pilonidal cyst, the following instrumental methods are used, except:

a)irrigoscopy with double contrasting;

b)fistulography;

c)radiography of the sacrococcygeal part;

d)MRI of the sacrococcygeal region;

e)ultrasound examination of soft tissues.

8.In acute abscessing of the pilonidal cyst, surgical intervention is performed by:

a)one-stage radical operation;

b)lancing and sanation of the abscess with the follow-up radical surgery delayed for 2–3 months;

c)the introduction of anti-in- flammatory drugs and antibiotics into the abscess cavity;

d)lancing and sanitation of the abscess with the follow-up radical surgery in 5–6 days at a specialized hospital;

e)performing the operation immediately after the end of the conservative treatment of abscessing.

9.Acute paraproctitis is characterized by:

a)acute inflammation of the paraproctium;

b)acute inflammation of the nonobstructed subcutaneous passage in the intergluteal fold;

c)the spread of infection from anal crypts and anal glands;

d)spread of the infection from the formed pylonidal cyst;

e)spread of infection from in- flammatory-destructive foci in the abdominal cavity.

10.The main microbial pathogens of acute paraproctitis are:

a)pathogenic cocci;

b)proteus;

c)colibacillus;

d)nonclostridial anaerobes;

e)clostridium tetani.

11.The main mechanisms for the formation of acute paraproctitis are:

a)penetration of infection from the lumen of the rectum in the anal glands and anal crypts;

b)penetration of infection from endogenous foci into the paraproctium;

c)occurrence of microabscesses in the anal crypts in case of obstruction of its excretory ducts;

d)microabscess emptying through the crypt and into the lumen of the rectum;

e)infection of perianal cellular space in the absence of microabscess emptying from the crypt into the lumen of the rectum.

12.Burrowing pus, spreading from the affected anal crypt to the external sphincter of the rectum, is subdivided by localization into:

a)extraperitoneal;

b)extrasphincter;

c)transsphincter;

d)intrasphincter;

e)pelviorectal.

13.According to the localization the following types of acute paraproctitis are distinguished, except:

a)subcutaneous and submu-

cosal;

b)retrorectal;

c)pelviorectal;

d)isheorectal;

e)transsphincter.

14.Acute paraproctitis with the pelviorectal localization is manifested by everything except:

a)slight pain in the rectum;

b)bursting severe pain in the pelvis or lower parts of the abdomen;

c)short-term slight increase of body temperature;

d)hectic fever with chills;

e)tenesmus and dysuriac phenomena.

15.The outcomes of acute paraproctitis are:

a)chronization of the process with the development of purulent external fistulas;

b)spontaneous opening into the vagina or rectum with the formation of internal fistulas;

c)formation of retroperitoneal phlegmon;

d)burst into the peritoneal cavity with the development of widespread peritonitis;

e)formation of dysplastic coxarthrosis.

16.In case of acute forms of acute paraproctitis complicated by intra-

sphincter fistula, the surgical intervention is performed by:

a)external lancing of abscess with evacuation of pus and formation of a single cavity at the first stage;

b)fistulectomy into the lumen of the rectum with its internal opening and crypt at the second stage;

c)transanal opening of the fistula and excision of the affected crypt simultaneously;

d)single-step external removal of abscess and altered tissues without transanal removal of crypt;

e)external removal of the abscess, then transanal removal of crypt with the putting in primary subcutaneous-cutaneous sutures.

17.The method of Hippocrates (step-by-step dosing of the ligature through the internal fistula and sphincter fiber) is used in the treatment of:

a)intranssphincter fistula;

b)transsphincter fistula;

c)extrasphincter fistula;

d)extraperitoneal swelling;

e)retrorectal swelling.

18.Chronic paraproctitis is characterized by:

a)inflammation of the paraproctium in the period from 1 to 3 weeks;

b)inflammation of the paraproctium in the period from 3 months;

c)transsphincter sinus tract connected from the inside with the anal crypt and outside – with the skin of the perineum;

d)intrasphincter sinus tract not connected from the inside with the anal crypt;

e)impossibility of spontaneous healing.

19.The most difficult for surgical treatment are (peri)anal fistulas, located:

a)in the deep cellular spaces of the pelvis outside the sphincter (extrasphincter);

b)in paraproctium and partially passing through the sphincter (transsphincter);

c)inside of the sphincter (intrasphincter);

d)under the mucous membrane or in the hypoderm;

e)in retrectectal tissue.

20.The clinical manifestations of chronic paraproctitis are all except:

a)purulent discharge from the external sinus tracts on the perineal skin;

b)pains in the anus region, increasing with defecation or in sedentary position;

c)appearance of a general inflammatory reaction in case of exacerbation of the process;

d)the presence of a dense infiltrate with a sinus tract, located strictly on the intercluneal fold;

e)pains and swelling in the region of the fallen out hemorrhoids.

21.For additional diagnosis of chronic paraproctitis everything is applied except:

a)fistula probing and anoscopy;

b)fistulography;

c)sphincterometry;

d)endorectal ultrasonography;

e)survey radiography of the abdominal cavity organs.

22.Surgical treatment of chronic paraproctitis should include everything except:

a)localization of the fistula in relation to the tissues of the sphincter;

b)severity of burning swelling;

c)severity of incontinence of the sphincter;

d)stage of the process;

e)composition of the microflora of the colon.

23.The peculiarities of surgical treatment of chronic transsphincter fistulas are:

a)wedge-shaped excision of the fistula and crypts into the lumen of the rectum;

b)excision of the fistula with levatoroplasty and drainage of the purulent cavity;

c)excision of fistula with plastic cover of its internal opening with displaced musculomucosal graft;

d)application of the ligature method (Hippocrates);

e)only external fistula opening and drainage of the purulent cavity.

24.Features of surgical treatment of chronic extrasphincter fistulas are:

a)application of the ligature method (Hippocrates);

b)external drainage of the purulent cavity;

c)excision of the fistula with levatoroplasty and external drainage of the purulent cavity;

d)excision of fistula with plastic cover of its internal opening with displaced musculomucosal graft;

e)external opening of the purulent cavity with excision of the fistula without removal of the inner crypt.

25.Predisposing factors of hemorrhoids development include:

a)dystrophic and involutional disorders in the submucosal layer of the rectum;

b)involution of the retaining (ligamentous) apparatus of the rectum;

c)hypotonia of the venous walls of cavernous bodies due to the past diseases;

d)diseases of peripheral nerves or vegetative ganglia of the perianal region;

e)constant increase of intraabdominal pressure.

26.The producing factors of the development of hemorrhoids include everything except:

a)dysfunction of venous veins of cavernous bodies, leading to their overfilling;

b)involution of the retaining (ligamentous) apparatus of the rectum;

c)increase of intra-abdominal pressure due to severe physical exertion or cough;

d)sedentary life-style or long stаying on legs;

e)abuse of spices or alcohol.

27.Variants of the clinical course of acute hemorrhoids are all except:

a)periodic prolapse of hemorrhoidal nodes on physical exertion;

b)episodes of rectal bleeding without prolapse of hemorrhoids;

c)thrombosis of hemorrhoids;

d)inflammation of the hemorrhoids;

e)“false incarceration” of hemorrhoids.

28.The first stage of chronic hemorrhoids is clinically manifested by:

a)inflammation of the hemorrhoids;

b)thrombosis of external and internal hemorrhoids;

c)rectal bleeding without prolapse of hemorrhoids;

d)prolapse of hemorrhoids and spontaneous correction;

e)prolapse of hemorrhoids on the slightest physical exertion with the need for subsequent manual reduction.

29.Clinically, the second stage of chronic hemorrhoids is manifested by:

a)prolapse of hemorrhoids and spontaneous correction;

b)rectal bleeding without prolapse of hemorrhoids;

c)thrombosis of hemorrhoids;

d)inflammation of the hemorrhoids;

e)prolapse of hemorrhoids on the slightest physical exertion with the need for subsequent manual reduction.

30.For instrumental diagnosis of hemorrhoids they apply everything except:

a)anoscopy;

b)digital transrectal investiga-

tion;

c)procto(sigmoido)scopy;

d)endo-rectal ultrasonography (doplerography);

e)selective angiography.

31.Digital transrectal examination, used for the diagnosis of hemorrhoids, allows:

a)to clarify the localization and condition of hemorrhoids, based on their timing to the conditioned clock dial;

b)degree of prolapse of nodes on straining;

c)blood velocity and type of blood flow in the region of the pedicles of the hemorrhoids;

d)localization of the internal fistula in relation to the tissues of the sphincter;

e)condition of the sphincter tone on straining.

32.Minimally invasive methods for the treatment of chronic hemorrhoids include everything except:

a)infrared or laser photocoagulation;

b)sclerotherapy of hemorrhoids;

c)ligation of the pedicles of internal hemorrhoids with latex rings;

d)hemorrhoidectomy by Milli- gan-Morgan method;

e)transanal “desarterization” of hemorrhoids under Doppler control.

33.In order to reduce the periods of postoperative rehabilitation during hemorrhoidectomy everything is applied except:

a)ultrasound scalpel;

b)laser scalpel;

c)radio-wave equipment (“Surgitron”);

d)high-frequency apparatus for tissue coagulation (“Lida Sure”);

e)the introduction of sclerosants in the nodes for their subsequent cryodestruction.

34.For the treatment of chronic hemorrhoids with the prolapse of the rectal mucosa they use:

a)traditional hemorrhoidectomy according to Milligan-Morgan;

b)transanal circular apparatus resection of the excess mucosasubmucous layer of the rectum (Longo’s operation);

c)the application of latex pedicles on internal hemorrhoids;

d)transanal “desarterization” of hemorrhoids under Doppler control;

e)radio-wave equipment (“Surgitron”).

35.The main producing factors of the appearance of anal fissure are:

a)sexual characteristics of the anatomical structure of the posterior wall of the anal canal;

b)chronic constipation;

c)constant hypertension of the muscular sphincter of the rectum;

d)acquired diseases accompanied by a change in the perianal epithelium;

e)infectious nonspecific processes localized in the anal canal and accompanied by acute ulceration.

36.The main predisposing factors for the appearance of anal fissure are:

a)sexual characteristics of the anatomical structure of the anal canal;

b)anatomical features of the localization of distal crypts and anal glands leading to their fibrosis;

c)constant hypertension of the muscular sphincter of the rectum;

d)presence of multiple points of attachment of the anal sphincter muscles;

e)uniform structure of the anal canal in women associated with the fibrous center of the perineum.

37.The most common types of localization of a chronic fissure in the anal canal are:

a)the anterior wall;

b)side walls;

c)skin of the peranal region;

d)the posterior wall;

e)projections of both levators.

38.The clinical picture of a chronic anal fissure is characterized by everything except:

a)intense pain in the anus with irradiation to the sacrum after defecation;

b)prolapse of hemorrhoids with their thrombosis;

c)spastic contraction of the muscular sphincter increasing the pain;

d)poor anorectal bleeding associated with defecation;

e)intensive pulsating jet of anorectal bleeding.

39.For local treatment of acute anal fissure everything is applied except:

a)hydrophilic colloids;

b)nitroglycerin ointment;

c)combined rectal suppositories after the act of defecation;

d)injections of the preparation of botulinum toxin (disporta) into the posterior semicircle of the sphincter;

e)alcohol-novocainic presacral blocks.

40.The optimal type of surgery for a chronic anal fissure is:

a)transverse deep excision with the bottom and site of a sphincter;

b)longitudinal flat excision without the edges and bottom;

c)longitudinal excision with the edges and bottom and subsequent lateral dosing sphincterotomy;

d)only dosing sphincterotomy without excision of the fissure;

e)laser vaporization of abnormal tissues and the sphincter site.

41.Polyp of the colon (rectum) is characterized by everything except:

a)benign growth of glandular epithelium;

b)benign growth of connective

tissue;

c)formation above the level of the mucous membrane;

d)formation retracted into the muco-submucous layer;

e)fungiform structure located on the stalk or a wide base.

42.Multiple polyps (polyposis) of the colon are divided into:

a)congenital;

b)primary;

c)secondary;

d)tertiary;

e)neoplastic.

43.Family congenital polyposis of the colon is characterized by:

a)inheritance by recessive

type;

b)inheritance according to autosomal dominant type;

c)mutation of 5g – 21 chromosome of adenomatous polyposis intestinal gene;

d)mutation of carcinoid cells;

e)process, considered as an optional precancer.

44.According to multiplicity polyps of the colon are divided into:

a)single;

b)group;

c)scattered;

d)hyperplastic;

e)diffuse family polyposis.

45.The surgical methods of treatment of colon polyps include everything except:

a)endoscopic polypectomy with electrocoagulation of the bed;

b)transanal removal;

c)transabdominal colectomy with resection of the site if the intestine containing a malignant polyp;

d)subtotal colectomy with the formation of ascendorectal anastomosis in case of diffuse family polyposis;

e)endoscopic multiple polypectomy in case of diffuse family polyposis.