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Методички онкология / 5 курс / Студентам / 4 колоректальный рак.doc
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Teaching Problem


Task 1.

Patient A., 68 years old, admitted with complaints of unstable stools (diarrhea alternating with constipation), blood and mucus in the stool, recurrent abdominal pain, bloating, general weakness. Sick 5 months. OBJECTIVE: low power, anemic, peripheral l / v is increased. Liver on the edge of the arc. The abdomen is inflated during palpation soft, painful in the left iliac area where palpable - the formation of up to 6 cm in diameter, dense, partially movable.

What is the most likely diagnosis in this case?

A. Sigmoid colon cancer.

B. Retroperitoneal tumor.

C. Inflammatory tumor (infiltration).

D. Cancer of the small intestine.

E. Actinomycosis sigmoid colon.


Task 2.

Patient D, 57 years old, appealed with complaints of general weakness, loss of weight up to 10 kg in 7 months, periodic increase t body, diffuse abdominal pain, and constipation. OBJECTIVE: low power, on the left collarbone tightly-elastic l / v to 2 cm in diameter. Abdomen increased in volume due to the presence of free fluid. Liver 5 cm thick, hilly. In the right iliac area palpable infiltration fixed to 8 cm in diameter.

. Which diagnosis is most likely?

A. Appendicular infiltrate.

B. Actinomycosis cecum.

C. Cancer of the cecum.

D. Retroperitoneal tumor.

E. Tuberculosis of the cecum.


Problem 3.

Patient A., '50, who works as a teacher, conducted surgery for cancer of the sigmoid colon. How to evaluate the performance of the patient?

A. Not broken

B. Temporarily lost

C. Steadily lost

D. It can not work with children

E. Requires the reduction of working time


Problem 4.

Patient D, aged 59, complained of pain in the left abdomen, flatulence, constipation, increased body t to 38 ° C. He considers himself a patient for 1 year, with prophylactic examinations revealed the formation of the descending colon that narrows its lumen within 8 cm. Blood - anemia, leukocytosis. What diagnostic methods are needed to clarify the nature of the prevalence of the process?

A. Radiography of the lungs.

B. CT of the abdomen, retroperitoneum.

C. The liver ultrasound.

D. Scanning the liver.

E. Excretory urography.


Problem 5.

Patient A., 70, complained of intermittent color stool in dark color, sometimes mixed with blood, general weakness. OBJECTIVE: Peripheral l / v is increased. Abdomen symmetrical, painful epigastric. Segments of colon pnevmotyzovani. In contrast enema comes to the hepatic flexure of the colon. What is the possible diagnosis?

A. Cancer of the stomach.

V. Cancer of the transverse colon.

C. Cancer hepatic flexure of the colon.

D. Retroperitoneal tumor.

E. Cancer of the right kidney.


Problem 6.

Patient 49 years. Complaints about the growing presence of formation in the left half of the abdominal cavity, the presence of blood, mucus in stool, general weakness. In history - chronic colitis. OBJECTIVE: general condition is satisfactory. There hiperperystaltyka colon. What methods are needed to clarify the diagnosis?

A. Plain radiographs of the abdomen.

V. fibrokolonoskopiyu with biopsy.

C. The liver ultrasound.

D. Enema.

E. Excretory urography.


Problem 7

Patient A., 35 complaints of abdominal pain, constipation, episodes cr at vomazannya from the rectum, nausea, weakness. Palpation of the rectum and manifested in the dense, hilly formation that stenozuye hole rectum, the p in kavychtsi - traces of blood. Exhibited alleged diagnosis - rectal ki ki w. What are the symptoms most pathognomonic for this disease?

A. Disease duration and episodes of spotting.

B. Constipation, weakness.

C. Abdominal pain, nausea.

D. The blood on the glove during rectal palpation.

E. Dense, hilly formation that stenozuye hole palpation of the rectum.


Task 8

Patient M., 70 years obstezhyvsya the clinic: when sigmoidoscopy in the rectum polyps found 3 to 1.5 cm in diameter on a broad basis. What further tactics?

A. Dynamic observation.

B. Enema.

C. Fibrokolonoskopiyu with biopsy.

D. Coagulation polyps.

E. Assign treatment celandine in enemas.


Problem 9

Patient M., 65, was treated in the surgical department of the district l and punishable about hemorrhoids without effect. When afterexamination rektoskopichno ment in tumor county serednoampulyarnoho rectum. Palpation of the rectum revealed exophytic tumor, relatively mobile. When fibrokol at noskopiyi diagnosis is confirmed, taken biopsy - adenocarcinoma. Another stalemate at nology were found. What is the treatment strategy?

A. Surgical treatment after the biopsy results.

B. Operative treatment without waiting for biopsy results.

C. Radiotherapy.

D. Preoperative radiotherapy and surgery.

E. Chemotherapy.


Problem 10

Patient S., 67 years old, entered the hospital for cancer rektosyhmoyidn at first colon with complaints shvatkopodibni pain in the abdomen, bloating, constipation, piles are in yutsya taking laxatives or cleansing enemas. What complication of the underlying disease has developed in a patient?

A. Complete intestinal obstruction.

B. Parakolichnyy abscess.

C. Partial intestinal obstruction.

D. Perforation of the tumor.

E. Complications arose.


Standards of answers: 1 - A, 2 - C, 3 - B, 4 - B, 5 - B 6 - C, 7 - E, 8 - C, 9 - D, 10 - C.


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