2 _2004-2005 2 ItemText 40 year old patient presented to Emergency department with the cut injury on the right side of the chest wall. Profuse bleeding from the wound but the patient is in conscious, B.P 120/60 mm.Hg, pulse 100 beats per minute. Which one from below listed methods allows to define character of wound with the greatest accuracy? The patient K. 42 years old, presented with the diagnosis of Acute iliofemoral vein thrombosis (1 rst. Day), Pulmonary artery thromboembolism and admitted in vascular department of the Hospital. What is your tactics? Patient K. 35 years old, after abortion developed deep veins thrombosis of leg and on the 3-day cough and a retrosternal pain developed with hemoptysis. Which investigation is necessary at first to make the correct diagnosis? 73 years old patient hospitalized with the diagnosis of Tumour of Abdominal Cavity . On examination: On the right side of the abdomen a mass of 1015 cm size is palpated. Patient is suffering of ischemic heart diseases, Hypertension - stages. It is suspected an aneurysm of an abdominal aorta. For the verification of the diagnosis it is necessary to execute: 25 years old patient presented to emergency department after 40 minutes of stab injury of chest in a projection of heart in a critical condition. Confused, cold sweating, Blood Pressure 60/20 mm.Hg, Pulse on peripheral arteries was absent. What is the most probable diagnosis? DistrA DistrB *Primary surgical Chest X-ray cleaning and exploration of Wound. DistrC Ultrasound of thoracic Cavity DistrD CT scan. DistrE Bronchoscopy

1.

2.

* Thrombolytic therapy plus implantation of Cava filter.

Surgical treatment.

Introduction of lowmolecular wt. Heparin. Ultrasonogram of Abdomen.

Elastic Bandage of legs.

Bronchoscopy.

* Electrocardiogram, Phlebography, Chest X-Ray. Dopplerography.

Palpation of stomach.

Auscultation of Lungs.

3.

* Aortoarteriography. X-ray of Abdomen.

Diagnostic puncture. Laparosynthesis.

Irrigoscopy.

4.

*Cardiac Injury.

Lung Injury.

Pneumohemothorax. Bleeding from soft Injury of intercostals tissues of chest wall. vessels.

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53 years old patient, complains of a heartburn, regurgitation of air, vomiting. In esophagodudenoscopy: - Marked prolapse of squamous mucous of stomach into the esophagus. In radiogram marked protrusion of 1/3 stomach into the posterior mediastinum. Provisional Diagnosis A sliding hiatal hernia, degree. What is the tactics of treatment? Patient , 64 years, complains of difficulty in swallowing solid food, vomiting, weakness, loss of weight. In esophagodudenoscopy on a posteriorlateral wall, sub mucous layer tumour with the precise contours, easily movable is determined. The diagnosis: Benign tumour of lower third esophagus [Leiomyoma]. Your tactics? Patient [Female] 48 years old, chief complain of dysphasia for solid and liquid food, nausea, and fatigue. In radiographic examination of esophagus- stricture of lower third esophagus and dilatation of upper third esophagus. Positive Symptom [ ] DiagnosisCardiospasm III stage. What is the volume of necessary treatment needed? Patient , 65 years old, inpatient of surgical department of hospital after hernioplasty on the 6 day suddenly lost consciousness; there was cyanosis of the upper part of a thorax and the face and dyspnea. What is the diagnosis? Patient ., 44 Years old, presented to Emergency Department after 3 hours of trauma with chief complain of Right sided Chest pain, Dyspnea, Fatigue, Dizziness. Cyanosis. Unstable Hemodynamic. On Chest X-ray-Fracture of Right four Posterior-Lateral ribs, Collapse of right lung 2\3 Volume. What is the possible diagnosis?

( Plastic of a diaphragm according to Belsey.

Lewis's operation [Transhiatal resection of esophagus].

Vandals operation Hellers Operation. [plastic of lower third of esophagus.]

Esophagoectomy, Abdomino-cervical Method.

*Endoscopic removal of a tumour.

Hellers Operation.

Esophagoecotmy Operation Vandals [plastic of the Lower third of esophagus]. Esophagus Abdomino- cervical Method.

Lewis's operation [Transhiatal resection of esophagus].

* Hellers Operation.

Conservative treatment: Cerucal, Rantac, No-spa, Intravenous infusion.

Vandals Operation [Plastic surgery of lower third esophagus].

Esophagoectomy Abdomino-cervical Method. access.

Lewis Operation [Transhiatal resection of esophagus with gastroplasty].

* Pulmonary artery thromboembolism.

Heart attack of a myocardium.

Hypoglycemic Coma. Hyperglycemic Coma. Perforation of stomach Ulcer.

* Right sided Posttraumatic Pneumothorax.

Right sided posttraumatic excudative pleuritis.

Main Bronchus.

Right-sided Hemothorax.

Hematoma Mediastinium.

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Patient 19 years old, Presented to Emergency department in critical condition after Trauma of Chest with chief complain of Left sided chest pain, Dyspnea, Fatigue, left sided massive subcutaneous emphysema of chest wall. On chest X-ray Atelectasis of left lung, Shift of mediastinal organs to left. Cardiac cavity not enlarged. Your Diagnosis? 36 years old patient presented with complains of dyspnea, dizziness. History of Thoracic trauma 2 days back. On examination decrease movement of the left side of the chest wall. On chest X-ray Collapse of the 1/3 of left lung. Fracture of left 4-6 ribs. What are the possible complication patients has developed? Patient . 19 years old admitted with the diagnosis Chest Wall Trauma (Thoracic Trauma) with Complain of difficulty in expiration and inspiration. On examination patient is pale. Blood Pressure 90/50 mm.Hg. On auscultation: Silent on left side (no breathe Sound). On chest X-ray:- Shift of mediastinal organs to right, atelectasis of left lung, your diagnosis? 45 years old patient admitted in a clinic in a critical condition. Before admission patient was suffering from pneumonia for 3 weeks. On examination: - Skin and mucous membrane dark - earthy color, a body temperature 38c, Dyspnea on rest, decrease breathe on the left side. Productive Cough with large amount of sputum. On chest X-ray. What is the most probable diagnosis? 32 years old patient presented in a hospital in a critical condition with chief complain of acute retrosternal chest pain with radiation to back. On examination:skin and mucous are pale, t-38,8 . Marked subcutaneous emphysema of soft tissues of a neck, face. On the eve ate fish. On Chest Xray expansion of mediastinum is revealed. What is the most probable diagnosis?

( Abruption of Left main bronchus.

Left sided total Hemothorax.

Fracture of left Ribs, Left sided Postleft sided Pneumotraumatic hemothorax. pnemothorax.

Left sided posttraumatic pleuritis.

*Pneumothorax.

Posttraumatic Hemothorax.

Empyema of pleura.

Pleuritis.

Posttraumatic pneumonia.

*Left sided Tension Pneumothorax.

Fracture of Ribs.

Injuries of a chest wall.

Cardiac Injury.

Hemothorax.

* Empyema of pleura.

Bronchitis.

Pleuritis.

Pneumonia.

Pneumothorax.

* Mediastinitis.

Heart attack.

Abscess of lung.

Pneumothorax.

Pneumonia.

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48 years old patient, suffering from postphlebetic syndrome of the left leg since 2 years. On examination: Dilated superficial veins of left leg and thigh, and pubic region, a significant swelling of the left leg. Light physical exertion aggravates pain. What kind of treatment should be recommended to patient? 52 years old patient admitted in vascular department of the hospital with sever edema and pain of holding apart character in the right leg and thigh, aggravated by passive movements. On examination: On the right leg sever edema starting from the foot till inguinal ligaments are observed cyanotic skin. What is the most probable diagnosis? 67 years old patient Hyperstenic features, suffering from varicose veins of both legs since 18 years. During last 2 years three times had thrombophlebitis of superficial veins of the right leg. 4 months back on the lower third of right leg trophic ulcer developed. What method of investigation is informative for specification of the diagnosis of the patient? A 35 years old patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints is progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have? A 42 years old man with long history of disease complains of a frequent heartburns, moderate pain in epigastrium and behind breastbone propagated in the back in point between shoulder blades. Pain appears with meals or just after meals and can be provoked by physical exertion. Also he has had a relapsed bronchopneumonia earlier and events of melena. The CBC reveals anemia. On X-Ray film there is a bubble of gas in the posterior mediastinum. ECG documents an arrhythmia. What is your diagnosis?

*Reconstructive Conservative therapy. operation on deep veins of the left thigh.

Compression treatment.

Phleboectomy.

Phlebo-scleroobliteration.

*Acute iliofemoral vein thrombosis.

Erysipelas of the right leg.

Acute thrombophlebitis of superficial veins.

Lymphostatsis.

Phlegmon of the right Leg.

*Ultrasonic duplex scanning.

Functional tests to determine the condition of Valve.

Phlebography.

Dopplerography of deep veins.

Isotope Phlebography.

*Corrosive Esophagitis and strictura

Esophagitis

Esophageal diverticula

Cardia Achalasia

Cardia insufficiency

* Hiatus hernia of esophagus

Chronic pancreatitis

Ischemic heart disease

Gastric ulcer

Mediastenitis

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A 70 years old woman had had a planned laparoscopic cholecystectomy done according biliary calculi. Six months later the patient again has attacks of severe pains in the right hypochondrium accompanied by jaundice and dark urine and stool discoloration. The total serum bilirubin is increased up to 60 mcmol/l, direct 40 mcmol/l. What disease does the patient have? A 60 years old woman has been ill with chronic calculous cholecystitis for 10 years. During the treatment in sanatorium the patient had had a hepatic colic with jaundice. Ultra sound investigation revealed a lot of calculi sized 5-6 mm in the gallbladder. Choledochus is widened to 15 mm and contains concrements up to 6 mm in diameter in the distal part. What method of treatment is the most adequate and current? A 58 years old woman with overweight right before has had an attack of right hypochondrium pain and jaundice with dark urine and stool discoloration appeared. On clinical examination the abdomen is distended and painful on palpation in the right hypochondrium, The mild liver enlargement there is. In blood the total bilirubin is 90 mkmol/l, direct (conjugated) 60 mkmol/l . What investigation is the most informative to clarify the diagnosis? A 62 years old woman complains of severe constant pain in the right hypochondrium, jaundice, discoloration of stool and dark urine, mild fever up to 37,5. Above mentioned complaints were appeared after an attack of severe abdomen pain connected with fatty food intake. On clinical examination the abdomen is soft. A painful enlarged gall bladder is palpated. The Orthner, Kerrs symptoms are positive. What is the probable diagnosis?

*residual choledocholithiasis

Papillostenosis

tumour of the pancreas head

tumour of the large duodenal papilla

choledochus stricture

* endoscopic papillosphincterotomy , laporoscopic cholecystectomy

cholecystectomy, choledocholithotomy, external choledochus drainage according to Kerr

cholecystectomy, cholecystectomy, cholecystectomy, transduodenal choledochoduodenosto choledochojejunostom papillosphincterotom my y y

* retrograde intravenous cholangiopancreatogra cholegraphy phy

infusional cholegraphy

intracutaneous intrahepatic cholegraphy

ultra sound investigation of the hepatopancreatobiliar y zone

* Acute cholecystitis, Infectious hepatitis choledochus calculi and obstructive jaundice

Liver cancer

Liver abscess

Liver cirrhosis

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A 22 years old woman was admitted to the reception department. She complains of severe cramping lower abdomen pain occurred unexpectedly, general weakness, sleeplessness, appetite loss and fever up to 39,90 C. At first the pain was appeared in point between umbilical region and epigastrium and then it was localized in the in the right iliac region. The patient recall the last menses 8 weeks ago. On clinical examination the abdomen is soft, painful in the right iliac. The Schyotkin Blumbergs symptom is slightly positive, Michelsons symptom is clear positive. On bimanual gynecological examination the soft uterus is enlarged according pregnancy onset. Near the uterus there is a soft swelling identified as a separated ovary. In CBC the WBCs (leucocytes) are 15x109 /l. Their formula shows bandemia. There is high ESR up to 65 mm/h. What is the most probable cause provoked above written condition? A pregnant woman with 24 weeks gestation term has felt a cramping pain in low abdomen. Nausea and vomitting are absent. She looks for a medical aid in the gynecologic out-patient office. On clinical examination the abdomen is soft and tender on the right. The Schyotkin Blumberg, Rovzing, Koaps symptoms are slightly positive and Brendo, Michelsons signs are strongly positive. What is the most adequate tactics of the doctor in the situation? A 45 years old woman was operated because of biliary calculi and obstructive jaundice. A two months later after operation there is continuing bile discharge up to 500,0-600,0 ml per day through the Kerr`s external choledochus drainage. On fistulography using the drainage in the distal part of the choledochus a forgotten stount up to 8 mm in diameter was identified. The choledochus is dilated up to 16 mm. The most correct surgeon treatment in this case is:

* Acute appendicitis and ectopic pregnancy.

Acute appendicitis

Acute salpingoophoritis

Pyosalpinx

Tubo-ovarian abscess

*To send the patient to the in-patient department at once to solve the problem of urgent surgical operation

To observe the patient Medication therapy for the next 24 hours at home to clarify the condition

Emergent diagnostic abdominal cavity puncture through the posterior vaginal fornix in this female dispensary office

Urgent interruption of pregnancy

* Endoscopic Choledocholithotomy papillosphincterotomy with close seam on and removing a choledochus; concrement from choledochus;

Choledocholethotom Choledocholithotomy Choledocholithotomy y choledochojejunostom and drainage of the choledochoduodenost y; choledochus. omy;

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A 19 years old man was admitted to the reception department in 20 minutes after a knife wound of the left chest. The patient is confused. The heart rate is 96 beats per minute and blood pressure 80/60 mm Hg, The dilated neck veins, sharply diminished apical beat and evident heart enlargement there are. What penetrative chest wound complication is described? Classical X-ray image of intestinal obstrustion is: 54 years old patient, presented with dizziness, an episode of decreased brain blood circulation, complains of a pain over the umbilicus after meal ,sometimes very sharp, is accompanied by vomiting, a episode of diarrhea. History of Blood in stool sometimes. Cardiac activity arrhythmic, extra systole. Moderate tenderness around umbilicus. What is the most probable diagnosis? 45 years old man presented with chief complains of rise in temperature up to 38c, pain and swelling in lumbar region and painful mass 56 sm. in size, crimson color of skin over the mass, in the center purulent necrotic fistulas which is secreting pus. What is the most probable diagnosis? Patient , 43 years old hospitalized in surgical department of the hospital with the diagnosis of Mechanical jaundice, cholangitis. During echographic researches found out Huge hydatid cyst of liver (echinoccocus of liver), dilatation of CBD(Common Bile duct) and intrahepatic ducts. What is the mechanism of jaundice in echinoccocus of liver? Patient K, 54 years old operated for hydatid cyst of liver, during operation found two cysts instead of three, as it has been diagnosed in the preoperative period. Which methods of investigation will be accurate to locate the third cysts?

*Pericardium tamponade

Massive hemothorax

Open pneumothorax

Closed pneumothorax Valve-likes pneumothorax

*Gas and horizontal levels *Non- specific ulcerative colitis.

Filling defect Crohns Diseases.

High positioned diaphragm Acute intestinal ischemia.

Reactive pleuritis Chronic cholecystitis.

Pneumatosis Duodenal Ulcer with penetration.

*Carbuncle of lumbar Abscess of lumbar region. region.

Erysipelaous inflammation.

Para nephritis.

Renal Colic.

*Rupture of contents of cysts into hepatic ducts.

Compression of portal Occurrence of a viral vein with occurrence hepatitis. of portal hypertension with jaundice.

Intoxicytic hepatitis due to absorption of ecchinococcus fluid (Hydatid cyst fluid).

Suppuration of cyst with occurrence purulent cholangitis.

*Intraoperative echography.

Intraoperative Cholangiography.

Intraoperative Choledochoscopy.

Intraoperative X-ray Abdomen and Retrograde Pelvis. Cholangiopancreatogra phy.

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65 years old patient complains of a pain in the right iliac fossa, loss of weight, decrease appetite, weakness, and history of constipation more than 6 months. Objectively: dry, muddy colored skin, On palpation On the right iliac fossa infiltration (mass) 810 sm. Size. Which is almost not displacing (Immovable), on percussion dull sound above the mass. On auscultation peristalsis is increased. blood - 86 g/l. What is the most probable pathology that might have causes such clinical picture? Patient K, 42 years old, is hospitalized in surgical department with complaints of acute sharp pain in the stomach, vomiting. Suffering from a duodenal ulcer for last 8 years. Suspected as a Duodenal Perforation, however free fundus gas in abdominal cavity is not revealed. The ulcer is suspected as covered perforation. What method of diagnosis should be applied for correct diagnosis? Patient B. 74 years old is hospitalized in surgical department with the diagnosis of perforated stomach ulcer. In the anamnesis heart attack of a myocardium, diabetes, Hypertension. The patient was advised for Operation, which patient categorically refused. How to treat the patient? A 32 years old patient presented with sudden rise in temperature, High grade fever, headache, pain in stomach and lumbar region, yellowish discoloration of skin. Urine out put of the patient is 100 ml dark muddy colored. Later with theses symptoms Muscles pain is added. One week ago the patient went for fishing. What is the probable diagnosis? 28 years old patient presented with history of 14 hours constant pain in right iliac fossa.In last 2 hours the pain has decreased. Objectively: Local guarding of abdominal muscles. Diagnosed as acute appendicitis. What histological form of acute appendicitis could result in reduction of intensity of a pain of a stomach?

*Carcinoma of Caecum.

Cancer of the right kidney.

Appendicular Infiltrate.

Crohns Diseases.

Retroperitoneal Tumour.

*Pneumogastrography Pneumoperitoneum. .

Laparosynthesis.

Contrast (dye) investigation of stomach and duodenum.

Fibrogastroscopy.

*Taylors Method.

Infusion therapy.

Antibacterial therapy. Start Ulcer Therapy

Discharge the patient.

* Leptospirosis.

Viral hepatitis A

Viral hepatitis E

Acute pyelonephritis

Food poisoning

* Gangrenous.

Cataral.

Phlegmonic.

Perforated

Empyema of the appendix

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A 35 year old woman was admitted to thoracic surgery department with elevation of body temperature upto 40 0 C, onset of pain with deep breath in the side, cough with big quantity of purulent sputum and blood with bad smell. What disease causes these symptoms? Which of the listed below opertion are not done in cases of perforative duodenal ulcers ? What preparations are used for prevention of fungal infection?

* Abcsess of the lungs Complication of liver echinococcosis

Bronchectatic disease Actinomycosis of lungs

Tuberculosis of lungs

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Resection of 2/3 - 3/4 of the stomach *Fluconozol, Orungol, Rubomycin, Nisoral. Bleomycin, Mytomycin C. Patient , 44 years old, is hospitalized *Intraoperative X-ray of Abdomen. cholagiogrpahy. in surgical department with the diagnosis of postcholecystectomic syndrome, residual choledocholithiasis, cholangitis, and mechanical jaundice. Operated 8 months back, done cholecystectomy, Choledocholithotomy, drainage of abdomen according to Keru. What from of belowmentioned procedure would be appropriate to avoid occurrence of postcholecystectomic syndrome? 30 years old woman, 15 days ago had mild *Bony. Hypodermic trauma of 5th finger of the left hand. Treated her self at home independently, Due deterioration of a condition she visited hospital for medical advice with rise in temperature up to 36 0c. Objectively: Hypermia and swelling on the ventarl surface of finger. Restricted Movements of the finger. X-ray of the left hand: It is impossible to exclude an early stage of development steomyolitis of the fifth finger. The diagnosis: Panarchy of 5th finger of the left hand. What form of Panarchy has occurred in the patient? Contraindications for operation in acute * Hemodynamic Functional pancreatitis are: unstability and insufficiency of the pancreatogenic shock parenchymatous organs

*Gastrostomy

Vagotomy + Vagotomy + resection Suturing of the ulcer Pyloroantrumectomy of the ulcer Cytosar, Cormyctin, Captopril, Enalapril. Isoniazid, Ftibazid, Lomycitin Pyrazinamid. Intravenous Per oral Cholecystocholangio Cholecystography. graphy. Echography.

Paronychia

Tendon Type.

Joints Type.

Purulent and septic complications

Peritonitis

Erosive bleeding

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The patient, 43 years old is hospitalized with complaints of repeated vomiting, spasmodic pain in the abdomen, delay in passes of gases and stool. History of the patient - appendectomy. Objectively: Position of the patient -lying, pale skin. Pulse 90/ minutes. Blood Pressure - 110/80 mm. Hg, t - 37, 2 oc Moderately distended abdomen, asymmetric, rigidity on the lower part of the abdomen. Increased peristalsis. Rebound tenderness- negative (Shetkina- Blumberg). Manual per rectum analysis of rectum- empty ampoule. Your diagnosis? A 41 year old patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding? What developes in cases with decompensated pyloric stenosis: The diagnosis melanoma was made to a 16 year old patient after examination with complaints of frequent pain in the abdomen, pigmentation of the mucosa and skin, polyp in the stomach and large intestine was found. It is know that the mother of the patient analogous pigmentation and was treated often for anemia What disease is suspected? What developes most often after accidental intake of Hydrochloric acid: Patient , On chest X-ray found collapse of the right lung, dislocation of the mediastinum on the left. During puncture of the pleural cavity 2.5 L. of air is allocated. What is your diagnosis? Patient of 23 years old suffering from acute glomerulonephritis with nephrotic syndrome, Initial Phase with normal renal function. What is the baseline treatment?

* Acute intestinal obstruction.

Food poisoning

Hepatic Colic.

Acute pancreatitis

Hepatic Colic.

* Introduction of obturator nasogastric tube.

Intravenous administration of pituitrin

Hemostatic therapy

Operation

Administration of plasma

* Isotonic dehydration. * Peytz Egerss polyposis.

Hypertonic dehydration (eksikosis). Chrons disease.

Hypotonic dehydration. Tuberculosis of the intestine.

Intoxication.

Renal insufficiency.

Adolescent polyposis. Hirschprungs disease.

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49.

* Cardiac insufficiency. *Right sided Pneumothorax.

Cushings syndrome. Left-sided Pneumothorax.

Kutlings syndrome. Empyema Pleura.

Deylads's syndrome. Mediastinitis.

Acute pancreatitis. Pneumomediastinium.

50.

*Antibiotics

Saluretics.

Kurantil

Heparin

Prednisolone.

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65 years old patient had been on observation for 5 years concerning an ulcer of antral part of a stomach. Patient refused operation. Since last 6 months patient is having constant pain in the epigastric region. Disgust to meat products has appeared. Working capacity has decreased. The patient has become thin. In contrast examination of the stomach circular form of defect of a mucous membrane up to 5 sm. in diameter and aperistaltic zone is revealed. What is an effective method of verification of the diagnosis 38 years old man suffering form duodenal ulcer for long time, patient start feeling constant heaviness in a stomach after meal, regurgitation, vomiting food contains which he had in the evening of the previous day, weight loss. Objectively: Relatively satisfactory condition of the patient, appetite not changed, Turgor of skin is reduced. On palpation the stomach is soft, symptoms of irritation of abdomen is not present, noise of splash in epigastria region. Urinations normal. Stool once in 3 days. What complication has occurred in the patient? A 60 year old patient complains of the weakness, loss of appetite, periodic fever up to 38-40 o C , loss of body weight, cough with a purulent sputum in a small amount on daytime and large up to 300-400ml sputum discharge with stinking smell on morning. He is chronic patient suffering from chronic lung emphysema within 10 years. At the past he had had an acute left sided pneumonia of the lower lobe 8-10 weeks ago. After that he noticed a mild mainly on evening fever and night sweats. The above mentioned complaints was appeared 4 days ago. On physical examination the patient looks toxic. There are severe underweight, grey skin, unpleasant small from the mouth, finger clubbing, asymmetric chest secondary to the air entry limitation on the left. On auscultation the breathing sounds are diminished in the lower chest on the left and pleural rub phenomenon is defined here. Over other chest surface a moist rales are heard. The chest X-Ray reveals a pneumosclerosis and lung cavity with liquid level and thick walls sized 10x7cm in diameter in the upper lobe on the left. What is the diagnosis of the patient?

*Fibrogastroduedenos Ultra sonogram. copy with biopsy.

Pneumoperitoneum.

Roentgenoscopy of Stomach.

ERCP

* An ulcerative stenosis of pyloric canal.

Acute pancreatitis.

Achalasia, esophagitis.

Cancer of a stomach.

The covered perforation of an ulcer.

*Chronic lung abscess Acute abscess of the with in bronchus left lung drainage

Left sided destructive Left sided chest TB pneumonia

Bronchiectasis

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The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What method of treatment is indicated to the patient? A 33 years old patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38,4oC and general weakness. It is known that the patient suffers from diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounded skin. The tissues affected by swelling are tens and blue reddish discolored in central area. There are also several purulent necrotic pustules which are connected with each other and formed a large skin necrosis. A thinned necrotic skin of this swelling has a holes look like sieve and a pus is discharging through out. What disease should a doctor consider first of all? Patient B, 63 years old is hospitalized in thoracic surgery department with complaints of nausea, vomiting after taking food, weakness, loss of weight. After radiological investigation the diagnosis is as follows: - Achalasia Cardia. What from below-mentioned is the reason of this disease? A 38 year old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected? Purulent medisatinitis is diagnosed on a 63 year old patient. What of the below listed diseases are not the cause of purulent mediasdtinitis? A woman born in 1952 consulting by a doctor in the out-patient office complains of a reddish bordered swelling in the low back skin appeared 3 days after branch tree prick. The fever is mild up to 37,9 C. Other complains are the general weakness, headache, malaise and appetite loss. On physical examination on the loin skin a swelling and hyperemia are revealed. On palpation there is a positive fluctuation symptom. What is the most probable diagnosis?

*Surgical treatment: Drainage of the pleural cavity. *Carbuncle

Antiinflammation therapy. Furuncle

Symptomatic therapy. Pleural puncture. Acute skin cellulitis Carbuncle associated with anthrax

Thoracotomy. Skin abscess

*Insufficient development of Auerbachs plexus.

Cicatricial stenosis of esophagus.

Hiatal Hernia.

Varicose of Tumour of lower third Esophageal vein of esophagus. (Esophageal Varices).

* Acute pancreatitis

Renal colic

Acute enterocolitis

Perforative gastric ulcer

Acute appendicitis

* Cervical lymfadinitis.

Perforation of the cervical part of the easophagus. * Acute abscess of the Acute cellulitis of the Hematoma loin skin loin skin

Deep nech phlegmon.

Perforation of the thoracic the easophagus. Carbuncle

Iatrogenic injury of the trachea. Furuncle

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A 42 years old patient consults by a surgeon with complains of the painful, severely itching and hyperemic thumb of the right hand. It is known that the patient has pricked his finger with a fish bone one week ago. On examination the affected thumb is rosy red and painful on touch. There is a red bordered and elevated above the surrounding skin spot. The chest and heart are symptomatic free. The heart rate is 80 per min. Blood pressure is 130/90 mm Hg, Body temperature is 36,70 C. Whats the diagnosis? Patient , 51 year old is hospitalized in gastroenterology department with complaints of jaundice, loss of weight, weakness, dark color urine, and light colored stool. Diagnosis: Mechanical jaundice, Cholangitis. Disease began gradually. Suspected as Cancer of ampullaes of vater. What diagnostic method should be applied for confirmation of the diagnosis? A 15 years old teen complains of high fever up to 39,5 40 0 C and a local metaepiphesal localized in low one third of hip pain. There are local skin hyperemia, soft tissues swelling and knee movements restriction secondary to the pain. The patient denies the trauma. Blood WBC (leucocytes) are 15x10E9. X-ray reveals hip bone destruction and sequestration. The 67 years old patient within 5 years had had 5 recurrent fractures of the lower extremities without considerable cause. O-shaped deformity of the legs in the knee joints was appeared. The skull, pelvis and lower extremities X-Ray films shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis. The blood tests does not reveal any inflammation activity. Serum calcium is normal. What disease do you consider in this case? 45 years old woman complaints of pain and movement restriction in the right hip joint. The disease is in progress. The history of trauma is negative. The X-Ray does not reveal malignancy or inflammatory disease but only shows an angled disproportions and ostephytes. What is the diagnosis?

*episipeloid

Erysipelas

acute lymphangitis

acute panaritium

Paronychia

*Fibroduedenoscopy with biopsy of ampulla of Vater.

Echography.

X-ray Abdomen.

Pneumogastrography.

Computer tomography.

*Haematogenic osteomyelitis

Bone TB (tuberculosis) Pagets disease

Osteosarcoma

Myeloma

*Pagets disease

hyperparathyoid dystrophy

chronic osteomyelitis myeloma

mottled disease (marble disease)

* The deforming arthrosis of the right hip joint

Non-specific arthritis

Specific arthritis

Polyarthritis

Radiculitis

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The 45 years old man locksmith complains of poor fourth and fifth fingers straitening in the right hand. He is ill whithin 6-7 years. Every year the disease worsens. On examination the fourth and the fifth fingers are flexed and can not be even passively extended. The X-Ray does not reveal any bone damage. What kind of contracture do you consider in this case? The 35 years old patient has severely restricted movement ability in the vertebral column. Within 3 years the patient has had a persistent pain and progressive stiffness in the low back later spread out into the thorax and cervix. The patient did not look for medical help before. The history of back trauma or acute disease is negative. The laboratory tests are normal. What disease do you consider in this case? The patient man-welder (profession related with long standing on knee position) was consulted by a doctor because of development knee joint swelling and knee pain at working time. On examination there has been found a soft bordered swelling localized lowly from patella with normal color and callous skin. There is not local hyperthermia. The X-Ray does not reveal any destructive impairment of the bones. What is the treatment?. The sick woman complains of fever up to to 38,20C, severe earache reflected into the left temple and persistent headache. Also there is hearing depletion. She fall in illness 3 days ago after common cold. Otoscopy shows normal auricle and external auditory meatus without pathological features. Palpation of trugus and papillae - like spout is painless. Tympanic membrane looks red and bulged with indistinct landmarks. Whisper is perceived by the patient from 0,8m of distance and colloquial speech only from 3 m. Whats a probable diagnosis?

*Dupuytrens contracture

Myogenic contracture

neurogenic contracture

Ischemic contracture

tendinous contracture

*ankylosing spondylarthritis

osteochondrosis

tuberculous spondylitis

polyarthritis

radiculitis

*operative bursectomy

ultrahighfrequency (UHF)

tight bandage

puncture

magnetotherapy

*Acute otitis media

Furuncle of the external auditory meatus

Acute mastoiditis

Acute external otitis

Exacerbation of chronic otitis media

70.

71.

72.

73.

74.

75.

A 38 years old woman complains of a purulent discharge from the left nostril. The body temperature is 37,50C. The patient is ill during a week and associates her illness with common cold. pain on The palpation of her left cheek reveals tenderness.. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudates is seen in the middle meatus in maxillary. What is the most probable diagnosis? 34 years old patient, during tooth filling accidentally inhaled a dental pine. Referred to emergency department of Hospital. Complain of moderate dyspnea, dry cough, dizziness, and disturbed. On Chest X-ray on the hilar region of right lung identified radio opaque subject. What volume of the help is necessary in this case? A patient complains of a general weakness, fever, muscle and joint pains and sore throat. The pain is increasing on swallowing. Throat examination reveals pink mucous membranes of the pharynx. The tonsils are congested and swelled. There is membranous exudate in crypts. This membranes arent spreading out of the tonsils border and can be removed easily. What is the previous diagnosis? The patient factory worker has been brought in the department emergency by ambulance. The admission diagnosis is the penetrating cornea injury of the right eye. On the slit lamp examination the low intraocular pressure, corneal swelling and adgesion of injured corneal margins in paraoptical zone have been detected. The depth of anterior chamber is 2,5 mm. What method of the following investigations mast be carried out first? The patient complains of eyelids redness and swelling, troublesome itching of the eyelids margin and eyelashes loss. He is being consulted by an ophthalmologist in the local public health center. The doctor prescribes various eye drops preparations with relapsed effect. What kind of investigation should be carried out? Diarrhea is not typical but still often symptom of acute appendicitis in children. In what case diarrhea is exact sign of appendix inflammation:

*Acute purulent maxillary sinusitis

Acute purulent frontitis Acute purulent ethmoiditis

Acute purulent sphenoiditis

Purulent rhinitis

* Urgent Urgent Diagnostic Fibrobronchoscopic Fibrobronchoscopy. removal of the foreign body.

Urgent Rigid Bronchoscopic removal of the foreign body.

Thoractomy, Antibacterial therapy, Bronchotomy, removal Cough expectorants, of foreign body. Control Chest X-ray.

* Membranous (lacunar) streptococcal tonsillitis

Follicular streptococcal Acute viral tonsillitis pharyngitis

Diphtheria

Hypertrophic pharyngitis

*Roentgenography of Roentgenography of the orbital cavity by f the orbital cavity in Komberg Baltin two projections

boneless roentgenography by A.Vogt

eye eye ultrasonography electroplatismagraphy

*investigation for demodicidosis

conjunctival sac bacteriological smear

checking up the refraction

consulting by an allergologist

testing blood glucose

* in case of pelvic appendices location

in case of peritonitis

in infants and early aged children

in case of retrocecal appendicitis

when acute appendicitis is secondary to acute enterocolitis

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The child with the symptoms of acute appendicitis has been brought to the in-patient department by ambulance. Examination is impossible because of his negative contact faulted behaviour. What are you to do? On the second day after birth the newborn has multiple duodenal content vomiting. Meconium didnt pass away. The abdomen is soft and distended in the upper region but retracted in the lower one. The correct diagnosis is: The 5 month old child has become uneasy after first time carrot puree feeding. There is multiple vomiting. The general condition is moderate. The abdomen is not distended and soft. By rectal examination there has been found that the feces contain much mucus with bright blood admixture and looks like red currant jelly. What disease does the child have? The symptoms and signs of acute appendicitis depends on the anatomical location of appendix. What kind of location promotes signs of urine tract irritation and the diarrhea?

*to examine the child to examine the child in to have laparoscopy under general spite of his temper taken anesthesia * development of congenital ileus; resolution of congenital ileus; pylorostenosis;

to wait for child`s to admit the child to a physiological sleeping hospital for observation by childrens doctor and the surgeon Ledds syndrome; congenital diaphragm hernia.

* intussusception

intestinal infection;

dyspepsia;

gastrointestinal hemorrhage (bleeding);

acute ileus.

*descending

Medial

Retrocaecalis

typical

left- hand side location