Chirurgie nr.

1
1. CS. Which of the following is characteristic for direct inguinal hernia:
a) It never descends to the scrotum
b) It is congenital
c) It is frequently unilateral
d) It strangulates frequently
e) It is an effort hernia
--------------------------------------------------------------------2. CS. Strangulation of the Meckel's diverticulum is called hernia of:
a) Rihter
b) Maydl
c) Littre
d) Hesselbach
e) Brok
--------------------------------------------------------------------3. The posterior wall of the inguinal canal is:
a) Fascia transversalis
b) Internal oblique muscle
c) Conjoint tendon
d) Crural arcade
e) External oblique muscle
--------------------------------------------------------------------4. The second in strangulated hernia incidence is:
a) Femoral hernia
b) Umbilical hernia
c) Direct inguinal hernia
d) Indirect inguinal hernia in male patients
e) Hernia of the linea alba in children
--------------------------------------------------------------------5. Parietal antimesenteric strangulation is called hernia of:
a) Brok
b) Hesselbach
c) Maydl
d) Rihter
e) Littre
--------------------------------------------------------------------6. Typical femoral hernia is found:
a) Anterior to the crural arcade
b) Medial to the femoral vessels
c) Lateral to the femoral vessels
d) Posterior to the femoral vessels
e) Medial to the Cooper ligament

--------------------------------------------------------------------7. In the ischemic stage of strangulated hernia the following signs can be found:
a) Cyanotic and distended intestinal loop
b) Mesenteric veins thrombosis
c) Thickened intestinal wall with fibrin deposits
d) Purulent, feculent peritoneal fluid
e) Pale efferent loop
--------------------------------------------------------------------8. Passage of intestinal content is preserved in the following types of strangulated hernia:
a) Littre hernia
b) Maydl hernia
c) Brok hernia
d) Hesselbach hernia
e) Rihter hernia
--------------------------------------------------------------------9. The hernial sac is missing in:
a) Congenital inguinal hernia
b) Umbilical hernia
c) Sliding inguinal hernia
d) Perineal hernia
e) Posttraumatic diaphragmatic hernia
--------------------------------------------------------------------10. Brock hernia or pseudostrangulation can appear in the following cases:
a) Acute cholecystitis
b) Pseudotumoral pancreatitis
c) Perforated gastroduodenal ulcer
d) Perforated acute appendicitis
e) Atypical perforation of gastric ulcer
--------------------------------------------------------------------11. When is conservative treatment (bandage) of hernia indicated:
a) In case of patient`s refusal
b) In any type of hernia
c) In elderly, when general state is severe; severe co-morbidities
d) In irreducible hernia
e) In congenital inguinal hernia
--------------------------------------------------------------------12. Choose the correct statements about indirect inguinal hernias:
a) Hernial sac consists of processus vaginalis
b) Hernial sac lies antero-medially to the spermatic cord
c) Hernial sac lies medially to the inferior epigastric vessels
d) Hernial sac lies laterally to the spermatic cord
e) Rarely it is bilateral compared to the direct hernia
---------------------------------------------------------------------

13. A dark red, distended, with a non-glossy serosa intestinal loop found in the hernial sac, with
subserosal bleeding on the strangulation ring is in the:
a) Congestion stage
b) Ischemic stage
c) Gangrene stage
d) Perforation stage
e) Viable loop
--------------------------------------------------------------------14. Choose the correct statements about strangulated hernia:
a) Passage of intestinal content is stopped in all cases
b) Femoral hernia strangulates more often compared to inguinal hernia
c) Strangulation is rare in children under 2 years of age
d) Ischemia is not characteristic for Brock hernia
e) In Maydl hernia the intermediate loop is the most affected
--------------------------------------------------------------------15. Choose the correct statements about left inguinal sliding hernia:
a) Hernia ring is big
b) It always contains only small bowel
c) Sigmoid colon is a part of the hernia sac
d) It never strangulates
e) Sometimes can it have big dimensions
--------------------------------------------------------------------16. The main purpose in indirect inguinal hernia repair is enforcing the anterior wall of the inguinal
canal. The most frequent used method is:
a) Bassini
b) Girard-Spasokukotki with Kimbarovski suture
c) Postempski
d) Kukudjanov
e) Martynov
--------------------------------------------------------------------17. The most frequently used method for femoral hernia repair is:
a) Rudji
b) Zatepin
c) Rudji-Parlaveccio
d) Lexer
e) Bassini
--------------------------------------------------------------------18. The preferred surgical procedure for umbilical hernias with the ring 3 is:
a) Mayo
b) Bassini
c) Sapejko
d) None of listed answers is correct
e) Lexer

--------------------------------------------------------------------19. Which of the listed below are complications of hernia?

a) Brock hernia
b) Prostatitis
c) Strangulation
d) Phlegmona of the hernia
e) Irreducibility
--------------------------------------------------------------------20. Parietal strangulation of the bowel (Richter hernia) exhibits the following clinical features:
a) Intestinal transit is present
b) Vomiting
c) Irreducible lump at the hernia site
d) Intestinal transit is arrested
e) Fever
--------------------------------------------------------------------21. Choose 3 signs of congenital inguinal hernia:
a) Painless onset
b) It is found only in children
c) Hernial ring is wide
d) It may evolve to inguino-scrotal hernia
e) Hernial sac contains the testis
--------------------------------------------------------------------22. The most frequent herniated organs are:
a) Bladder
b) Greater omentum
c) Ascending colon
d) Small bowel
e) Prostate
--------------------------------------------------------------------23. In noncomplicated hernia the pain is:
a) Dull, like discomfort
b) Violent
c) Colicky
d) Increasing upon physical effort
e) It may be absent
--------------------------------------------------------------------24. Inguino-scrotal hernia should be differentiated with:
a) Hydrocele
b) Varicocele
c) Perineal hernia
d) Testicular tumor
e) Obturator hernia
---------------------------------------------------------------------

25. Choose 3 signs of direct inguinal hernia:

a) It descends to the scrotum
b) Spherical shape
c) It never descends to the scrotum
d) It occurs more frequently in young persons
e) It is frequently bilateral
--------------------------------------------------------------------26. Physical examination of a patient with indirect inguinal hernia may reveal:
a) Indirect inguinal hernia descends to the scrotum
b) Pulsation of the inferior epigastric artery is medially to the hernia sac
c) Pulsation of the inferior epigastric artery is laterally to the hernia sac
d) Expansion upon coughing
e) Hernia trajectory is perpendicular to the abdominal wall
--------------------------------------------------------------------27. Which of the listed below are external hernias?
a) Femoral hernia
b) Umbilical hernia
c) Diaphragmatic hernia
d) Lumbar hernia
e) Inguino-scrotal hernia
--------------------------------------------------------------------28. Which of the following are the clinical features of strangulated umbilical hernia containing a
small bowel loop?
a) Hernial lump is tensioned and painful
b) Arrest of the intestinal transit
c) Sudden appeared irreducibility
d) Pain at the level of spermatic cord
e) Vomiting
--------------------------------------------------------------------29. Which of the listed below statements do not fit to Maydl hernia?
a) "W" retrograde strangulation
b) Hernia sac contains two loops of strangulated intestine
c) Herniation of the Meckel's diverticulum
d) Obturator hernia
e) Parietal bowel strangulation
--------------------------------------------------------------------30. Which of the following hernia types contain more than one bowel loop?
a) Littre hernia
b) Richter hernia
c) Brock hernia
d) Maydl hernia
e) Obturator hernia
---------------------------------------------------------------------

31. Brunner cells have a mucus rich secret with pH 8.2 - 9.3 and are predominantly situated in the:
a) Cardia
b) Duodenum (DI and DII)
c) Gastric fundus
d) Duodenum (DIII and DIV)
e) Gastric antrum
--------------------------------------------------------------------32. In gastric ulcer etiopathogenesis the determinant factor is:
a) Hyperacidity
b) Alimentary factor
c) Psychic factor
d) Defense factor
e) Hereditary factor
--------------------------------------------------------------------33. Which stage after ulcer perforation is characterized by the following signs: repeated vomiting,
tachycardia, superficial breathing, signs of hypovolemic shock, elevated body temperature,
distended tender abdomen, intestinal paresis:
a) False improvement
b) Shock
c) Diffuse peritonitis
d) Preperforation period
e) Onset of the disease
--------------------------------------------------------------------34. Perforated ulcer should be differentiated with:
a) Acute pancreatitis
b) Acute appendicitis
c) Right side pleuropneumonia
d) Pulmonary thromboembolism
e) Ruptured ectopic pregnancy
--------------------------------------------------------------------35. What surgical procedure should be done in a 40-60-year old patient with a gastric ulcer
perforation within 6 hours from the onset?
a) Simple suture of the ulcer
b) Partial gastrectomy (gastric resection)
c) Biopsy and Oppel procedure
d) Wedge resection of the stomach + vagotomy
e) Bilateral truncal vagotomy + simple suture
--------------------------------------------------------------------36. Gregersen-Adler test shows:
a) Pain decrease after the onset of bleeding
b) Occult bleeding
c) Presence of pancreatic gastrinoma
d) Rectal bleeding
e) Bleeding from esophageal varices

--------------------------------------------------------------------37. Bergman sign means:

a) Pain decrease after the onset of bleeding
b) Occult bleeding
c) Presence of pancreatic gastrinoma
d) Rectal bleeding
e) Bleeding from esophageal varices
--------------------------------------------------------------------38(su2al(63)). The following clinical features epigastric distension, episodic vomiting with
increasing volume and amelioration after it, correspond to:
a) Subcompensated stenosis
b) Compensated stenosis
c) Decompensated stenosis
d) Penetration of gastric ulcer to the pancreas
e) Penetration of duodenal ulcer to the pancreas
--------------------------------------------------------------------39. Which ulcer exhibit malignancy more frequently:
a) In the distal third of the stomach
b) In the duodenum
c) In the cardia
d) In the gastric fundus
e) On the lesser curvature of the stomach
--------------------------------------------------------------------40. Which of the listed below are acute complications of peptic ulcer:
a) Perforation
b) Stenosis
c) Malignancy
d) Penetration
e) Bleeding
--------------------------------------------------------------------41. Biopsy of perforated ulcer is mandatory in:
a) Acute gastric ulcer
b) Chronic duodenal ulcer greater than 2 cm
c) Gastric ulcer in a patient over 40 years
d) Johnson II gastric ulcer with perforation in the stomach
e) Chronic duodenal ulcer penetrating in the pancreas, complicated with bleeding
--------------------------------------------------------------------42. According to Johnson classification mediogastric ulcer is:
a) Not classified by Johnson
b) Is classified only in case of malignancy
c) Type I
d) Type II
e) Type III

--------------------------------------------------------------------43. Kussmaul sign is:

a) Phlebitis of the left lower limb in gastric cancer
b) Metabolic disturbances in decompensated pyloric stenosis
c) Muscle rigidity in duodenal ulcer perforation
d) Presence of peristaltic waves of the stomach in pyloric stenosis
e) Left supraclavicular lymphadenopathy
--------------------------------------------------------------------44. Which of the listed below surgical procedures for gastroduodenal ulcer has a lower rate of
postoperative diarrheea?
a) Proximal vagotomy
b) Truncal vagotomy
c) Partial gastrectomy with Balfour anastomosis
d) Partial gastrectomy with Billroth-I anastomosis
e) Truncal vagotomy with Heineke-Miculicz operation
--------------------------------------------------------------------45. Atypical ulcer perforation is:
a) Sealed
b) Blind
c) That of the posterior duodenal wall
d) That of the gastric cardia
e) In the free peritoneal cavity
--------------------------------------------------------------------46. What surgical procedure includes omental patching of ulcer perforation?
a) Oppel
b) Judd
c) Braun
d) Heineke-Miculicz
e) Holle
--------------------------------------------------------------------47. Partial gastrectomy is not indicated in ulcer perforation in case of:
a) Duodenal ulcer in a patient over 60 years
b) Duodenal "mute" ulcer (without ulcer history)
c) In association with bleeding
d) In case of malignancy suspicion
e) In young patients under 30 years
--------------------------------------------------------------------48. What hemostatic measures would you choose in case of Blakemore's probe failure to stop
esophageal variceal bleeding?
a) Beta-blockers
b) Gastric refrigeration
c) Hepatoprotectors
d) Endoscopic band ligation/Sclerotherapy of esophageal varices

e) Blood transfusion
--------------------------------------------------------------------49. Ulcerogenic adenoma produces large amounts of:
a) Histamine
b) Trypsin
c) Kallicrein
d) Gastrin
e) Kinins
--------------------------------------------------------------------50. Which gastric drainage procedure is associated with truncal vagotomy more frequently in
emergency surgery of peptic ulcer:
a) Judd pyloroplasty
b) Finney pyloroplasty
c) Jaboulay gastroduodenostomy
d) Gastrojejunostomy
e) Heineke-Miculicz pyloroplasty
--------------------------------------------------------------------51. Duodenal ulcer can have the following complications, except:
a) Malignancy
b) Stenosis
c) Bleeding
d) Penetration
e) Perforation
--------------------------------------------------------------------52. The most characteristic laboratory parameter for perforated ulcer is:
a) Leukopenia with shift to the left
b) Hypochloremia
c) Moderate anemia
d) Moderate leukocytosis (12.000 - 14.000), increasing gradually
e) Increased hematocrit
--------------------------------------------------------------------53. In duodenal ulcer the pain:
a) Is permanent
b) Is colicky
c) Depends on food intake
d) Decreases after gastric lavage
e) Decreases during the night
--------------------------------------------------------------------54. Conservative treatment in Mallory-Weiss syndrome includes:
a) Diet, antacids, hemocoagulants
b) Hormones (corticosteroids)
c) Pituitrin i/v
d) Sengstaken-Blakemore probe

e) Endoscopic hemostasis
--------------------------------------------------------------------55. Depending on the site of ulcer there are the following types of stenosis, except:
a) Stenosis of the cardia
b) Stenosis of the duodenal bulb
c) Pyloric stenosis
d) Postbulbar stenosis
e) Stenosis of the gastric fundus
--------------------------------------------------------------------56. What is the earliest sign of ulcer malignancy:
a) Fetid vomiting
b) Hematemesis
c) Disappearance of pain periodicity and decrease of its intensity
d) Weight loss
e) Melena
--------------------------------------------------------------------57. Gastrinoma resembles a cystic or lobulated node with a 50% of potential of malignancy and
metastasis and may be found in the following organs:
a) Pancreas
b) Duodenum
c) Spleen
d) Gallbladder
e) Stomach
--------------------------------------------------------------------58. Which of the listed complications may be present in duodenal ulcer:
a) Malignancy
b) Stenosis
c) Bleeding
d) Penetration
e) Perforation
--------------------------------------------------------------------59. The most accurate method to determine gastric secretion is:
a) Hollender test
b) pH-measuring
c) Kay test
d) X-ray
e) Upper GI endoscopy
--------------------------------------------------------------------60. Which of the listed below fits the Johnson I type gastric ulcer:
a) Prepyloric ulcers
b) Body ulcers on the greater curvature
c) Ulcers on lesser curvature and duodenal ulcer
d) Lesser curvature ulcers with normal antrum and pylorus and decreased acidity

e) Lesser curvature ulcers with prepyloric ulcers and increased secretion

--------------------------------------------------------------------61. Which of the listed below statements about upper GI bleeing are true:
a) Bleeding stops easier in the elderly
b) The most important is to differentiate ulcer bleeding from esophageal varices bleeding
c) You should wait 48 hours performing medical hemostasis
d) Surgery is indicated after 48 hours in order to reduce mortality
e) The bleeding source is located proximal to the duodenojejunal junction
--------------------------------------------------------------------62. Mallory-Weiss syndrome may be caused by:
a) Alcohol and food abuse
b) Sudden increase of intraabdominal pressure
c) Repeated violent vomiting
d) Violent coughing
e) Use of aspirin, steroids, anticoagulants
--------------------------------------------------------------------63. Vomiting is more frequent in:
a) Compensated stenosis
b) Decompensated stenosis
c) Duodenal ulcer penetrating to the pancreas
d) Perforated duodenal ulcer associated with bleeding
e) Subcompensated stenosis
--------------------------------------------------------------------64. The most efficient method to find ulcer malignancy is:
a) Double contrast gastric X-ray
b) History and physical examination
c) Upper GI endoscopy
d) Gregersen-Adler test
e) Computed tomography
--------------------------------------------------------------------65. Which of the following is the most indicated surgical procedure In a 45 years old patient with
long history of intractable duodenal ulcer with Kay test prevalence:
a) Highly selective vagotomy
b) Truncal vagotomy with ulcer excision and gastric drainage procedure
c) Selective vagotomy with Jaboulay gastroduodenostomy
d) Truncal vagotomy with gastrojejunostomy
e) 2/3 gastric resection
--------------------------------------------------------------------66. Which of the listed below procedures cannot be used in case of esophageal varices bleeding in a
patient with liver cirrhosis?
a) Highly selective vagotomy
b) Endoscopic hemostasis
c) Ligation of the celiac trunk

d) Sengstaken-Blackmore probe
e) Pituitrin i/v
--------------------------------------------------------------------67. Which stage after ulcer perforation is characterized by the following signs: violent epigastric
pain, anxiety, mydriasis, cold sweat, superficial breathing, Eleker sign, forced position:
a) 12 hours after perforation with bleeding
b) First 6 hours after retroperitoneal perforation of duodenal ulcer
c) First (first 4-6 hours) stage
d) Second (next 4-6 hours) stage
e) Third (after 12 hours from onset ) stage
--------------------------------------------------------------------68. Conservative treatment of perforated ulcer (nasogastric aspiration, wide spectrum antibiotics,
correction of hydroelectrolytic imbalancies) is used when there are no conditions to perform surgery
or the patient does not agree with the surgery. This treatment method was proposed by:
a) Billroth (1881)
b) Pierandozzi (1960)
c) Dragstedt (1960)
d) Taylor (1946)
e) Braun (1892)
--------------------------------------------------------------------69. Upper GI bleeding activity determines the surgical management and is assessed:
a) Clinically
b) By laboratory values
c) By X-ray
d) By endoscopy
e) By laparoscopy
--------------------------------------------------------------------70. Upper GI endoscopy reveals bleeding grade III esophageal varices (gastric mucosa normal).
What hemostatic method would you choose initially?
a) Endoscopic band ligation
b) Resection of the distal esophagus with esophagogastrostomy (Tanner procedure)
c) Sengstaken-Blakemore probe + pituitrin i/v
d) Azygoportal disconnection
e) Splenorenal anastomosis
--------------------------------------------------------------------71. Zollinger-Ellison syndrome has the following features:
a) Increase of night basal secretion
b) Constipation
c) Intense, frequent, acid vomiting
d) Frequent upper GI bleeding
e) Intense, continuous epigastric pain with night exacerbations
--------------------------------------------------------------------72. Which of the following is Pean-Billroth-I anastomosis in gastric resection:

a) Gastroduodenal end-to-end anastomosis with narrowing of the stomach from the lesser
curvature
b) Gastrojejunal end-to-side anastomosis
c) Gastrojejunal "Y" anastomosis
d) Gastroduodenal side-to-side anastomosis
e) Gastroduodenal end-to-side anastomosis
--------------------------------------------------------------------73. The most important sign of gastroduodenal anastomotic leak is:
a) Intense epigastric pain
b) Nausea and vomiting
c) Fever with chills
d) Discharge of metilen blue through the drains after it was introduced to the stomach
e) Epigatsric muscle rigidity
--------------------------------------------------------------------74. Postoperative bleeding (after surgery for ulcer) is either in the GI tract lumen (2% of gastric
resections) or in the peritoneal cavity. Conservative treatment is more frequently indicated in:
a) None of them
b) Both of them
c) That in the GI tract lumen
d) Intraperitoneal bleeding
e) Bleeding from acute ulcer
--------------------------------------------------------------------75. The most frequent cause of mechanical evacuation disturbances is:
a) Wrong position of the anastomotic loop
b) Transmesocolic hernia
c) Anastomotic healing
d) Anastomositis
e) Gastroplegia
--------------------------------------------------------------------76. Anastomisitis occurs usually in the early postoperative period after Billroth I gastric resection
and is caused by microbial factor, tissue trauma, reaction to sutures, allergy etc. Its major signs epigastric pain and abundant vomiting will appear on PO day:
a) 1-2
b) 2-3
c) 4-5
d) 6-7
e) 7-10
--------------------------------------------------------------------77. Cephalic phase of gastric secretion is stimulated by:
a) Gastric fundus and antrum distension
b) Sight, smell and touching the food
c) Mastication and salivation
d) Deglutition
e) Insulin

--------------------------------------------------------------------78. Disappearance of liver dullness is present in the majority of perforated ulcers and may be
confused with one of the following signs:
a) Mandel-Razdolskii
b) Celoditi
c) Kulencampf
d) Vighiato
e) Iudin
--------------------------------------------------------------------79. The most informative diagnostic procedure for perforated ulcer is:
a) Contrasted orthostatic gastrography
b) Pneumogastrography
c) Plain abdominal film
d) Laparoscopy
e) Contrasted gastrography (patient lying on the side)
--------------------------------------------------------------------80. Which of the listed below procedures are used in case of gastric ulcer depending on the
morphology:
a) Partial gastrectomy
b) Suture of the ulcer
c) Truncal vagotomy and suture of the ulcer
d) Selective vagotomy and suture of the ulcer
e) Wedge resection of the stomach
--------------------------------------------------------------------81. What surgical procedures can be used to treat Mallory-Weiss syndrome:
a) Mucosa and submucosa suture
b) Ligation of artera gastrica sinistra
c) Distal gastric resection
d) Mucosa and submucosa suture + ligation of artera gastrica sinistra
e) Proximal gastric resection
--------------------------------------------------------------------82. Surgical treatment is indicated for gastric ulcer:
a) Immediately upon revealing ulcer
b) After the first bleeding
c) At first signs of malignancy
d) If medical treatment is ineffective for 1-2 months
e) Only in case of perforation
--------------------------------------------------------------------83. Which phase of secretion does Hollender test (2 units of insulin/10 kg body weight i/m with
sampling of 8 portions of gastric juice every 15 minutes) assess:
a) Nocturnal
b) Basal
c) Intestinal

d) Cephalic
e) Hormonal (gastric)
--------------------------------------------------------------------84. The following signs: paresthesia, hallucinations, tetania, in blood - metabolic alcalosis ,
hypochloremia, hyponatremia, hypopotassemia, extrarenal azotemia, in a cachectic patient with rare,
abundant vomiting, suggests:
a) Late intestinal obstruction
b) Zollinger-Ellison syndrome
c) Hemorrhagic shock
d) Chronic renal failure
e) Decompensated pyloric stenosis
--------------------------------------------------------------------85. The most frequent complication after Billroth II gastric resection is:
a) Thrombophlebitis
b) Duodenal stump fistula
c) Sepsis
d) Retroanastomotic hernia
e) Bleeding
--------------------------------------------------------------------86. Kulencampf sign is characteristic for the II stage after ulcer perforation and means:
a) Acute pain in all abdominal areas
b) Shiftable dullness in right iliac fossa
c) "Board-like abdomen"
d) Painful prolabation of the Douglas pouch
e) "knife sharp" pain
--------------------------------------------------------------------87. Loss of 1000-1500 ml of blood (30% of circulating blood volume) corresponds to:
a) Occult digestive bleeding
b) Minor upper GI bleeding
c) Moderate upper GI bleeding
d) Massive upper GI bleeding
e) Cataclysmic upper GI bleeding
--------------------------------------------------------------------88. The main pathogenetic factors in peptic ulcer disease are:
a) Hyperacidity
b) Decrease of gastroduodenal mucosa resistance
c) Psychic factor (stress)
d) Gastroduodenal hypermotility
e) Helicobacter pylori
--------------------------------------------------------------------89. On X-ray pneumoperitoneum may be found in:
a) Appendiceal perforation
b) Gastroduodenal perforation

c) Colon perforation
d) Gallbladder perforation
e) Bladder perforation
--------------------------------------------------------------------90. Physical examination in uncomplicated gastroduodenal ulcer reveals:
a) Epigastric splash
b) Epigastric tumora
c) Epigastric pain on palpation
d) Muscle guarding
e) During remission the physical examination is negative
--------------------------------------------------------------------91. Ulcer may perforate:
a) Into the free peritoneum
b) In limited peritoneal spaces
c) In an adjacent organ
d) To the skin
e) In retroperitoneal space
--------------------------------------------------------------------92. The pain in strangulated intestinal obstruction is:
a) Continuous, intense, dramatic
b) Continuous and intermittent
c) Vague, diffuse pain
d) Intermittent, colicky
e) Violent pain at the onset followed by improvement
--------------------------------------------------------------------93. Schlange sign is:
a) Splash over the distended loop
b) Sound of falling drop
c) Tympanic sound over the asymmetric site
d) Enlarged, empty rectal ampula
e) Loud hyperperistaltic sounds
--------------------------------------------------------------------94. Diffuse distention of the bowel loops on X-ray will suggest:
a) Dynamic obstruction
b) Sigmoid colon volvulus
c) Strangulated inguinal hernia
d) Bouveret syndrome
e) Obstructive caecum cancer
--------------------------------------------------------------------95. Criteria of treatment efficiency of dynamic ileus are:
a) Absence of fever
b) Skin condition
c) Diuresis

d) Restoration of the peristalsis

e) Normalization of the WBC
--------------------------------------------------------------------96. Choose the X-ray sign of small bowel obstruction:
a) Haustra
b) Multiple air-fluid levels
c) Peripheral air-fluid levels
d) "Bycicle tyre"
e) Pneumoperitoneum
--------------------------------------------------------------------97. The major differentiation criterion between intracellular and extracellular dehydration is:
a) Arterial hypotension
b) Excessive thirst
c) Tachycardia
d) Meteorism
e) Oliguria
--------------------------------------------------------------------98. Sklearov sign is:
a) Tympanic sound over the asymmetric site
b) Elastic resistance of the abdominal wall
c) Asymmetric abdominal distention
d) Splash over the distended loop
e) Sound of the falling drop
--------------------------------------------------------------------99. The main purposes of mechanical intestinal obstruction treatment are:
a) Remove the cause of obstruction
b) Antibiotic therapy
c) Restoration of peristalsis
d) Decrease of intestinal distention
e) Correction of hydroelectrolytic disturbances
--------------------------------------------------------------------100. Spasmodic abdominal pain, vomiting, periumbilical fusiform palpable mass and bloody rectal
discharge in a child will suggest:
a) Acute pelvic appendicitis
b) Acute enterocolitis
c) Dysenteria
d) Intestinal intussusception
e) Small bowel volvulus
--------------------------------------------------------------------101. The most frequent cause of intestinal obstruction in a patient with previous laparotomy is:
a) Intussusception
b) Gallstone ileus
c) Bands, adhesions

d) Postoperative foreign bodies

e) Postoperative intestinal stenosis
--------------------------------------------------------------------102. The most characteristic sign of mechanic obstruction of the ascending colon is:
a) Bayer sign
b) Abundant vomiting
c) Complete arrest of intestinal transit
d) Konig sign
e) Bouveret sign
--------------------------------------------------------------------103. Few, big, lateral air fluid levels and WBC count up to15.000 are more characteristic of:
a) Sigmoid volvulus
b) Colon obstruction
c) Small bowel obstruction
d) Strangulated inguinal hernia
e) Mesenteric ischemia
--------------------------------------------------------------------104. The pain in simple mechanic intestinal obstruction is:
a) Vague
b) Continuous
c) Colicky (paroxysmal)
d) Transitory
e) Burning
--------------------------------------------------------------------105. Clinical signs of extracellular dehydration are:
a) Dry and pale skin
b) Dry tongue with deposits
c) Excessive thirst
d) Nausea and vomiting
e) Arterial hypotension, tachycardia
--------------------------------------------------------------------106. In pleuritis, vertebral fractures, retroperitoneal hematoma the dynamic ileus is:
a) Toxic
b) Reflex
c) Metabolic
d) Neurogenic
e) Spastic
--------------------------------------------------------------------107. How much is the small bowel resected distally from the necrosis limit:
a) 30 - 40 cm
b) 10 - 15 cm
c) 15 - 20 cm
d) 5 - 10 cm

e) 40 -50 cm
--------------------------------------------------------------------108. What type of obstruction is gallstone ileus:
a) Intussusception
b) Volvulus
c) Due to compression
d) Due to intraluminal obstruction
e) Spasm of the bowel muscle
--------------------------------------------------------------------109. The III (pathologic) fluid sector in intestinal obstruction is formed due to:
a) Transudation of the fluid in the lumen of the proximal bowel
b) Gastric stasis
c) Transudation of the fluid in the bowel wall
d) Excessive absorption in the distal bowel
e) Transudation of the fluid in the peritoneal cavity
--------------------------------------------------------------------110. How much of the small bowel would you resect proximally from the necrosis limit:
a) 10 - 15 cm
b) 20 - 30 cm
c) 5 - 10 cm
d) 30 - 40 cm
e) 15 - 20 cm
--------------------------------------------------------------------111. Konig sign appears in the early stage of intestinal obstruction and means:
a) Sound of falling drop
b) Asymmetric distention
c) Visible peristalsis
d) Distended caecum
e) Evident meteorism over the distended site
--------------------------------------------------------------------112. Many, small, central air fluid levels are characteristic of:
a) Bouveret syndrome
b) Obstructive sigmoid cancer
c) Small bowel obstruction
d) Acute pancreatitis
e) Pyloric stenosis
--------------------------------------------------------------------113. The most informative diagnostic methods for small bowel obstruction are:
a) Schwartz procedure
b) Abdominal ultrasonography
c) Barium enema
d) Laparoscopy
e) Plain film of the abdomen

--------------------------------------------------------------------114. Increase of blood urea nitrogen in intestinal obstruction is due to:

a) Loss of extracellular protein
b) Loss of inracellular protein
c) Loss of extracellular fluid
d) Loss of potassium
e) Hypochloremia
--------------------------------------------------------------------115. In colon obstruction the most appropriate diagnostic method is:
a) Schwartz procedure
b) Barium enema
c) Plain abdominal X-ray
d) Computed tomography
e) Laparoscopy
--------------------------------------------------------------------116. Bayer sign is:
a) Symmetric distention of the abdomen
b) Right side asymmetric distention
c) Peristaltic sounds on the right flank
d) Asymmetric distention from the left iliac fossa to the right hypochondrium
e) Bloody rectal discharge
--------------------------------------------------------------------117. Bouveret syndrome is found in:
a) Mesenteric ischemia
b) Caecum cancer
c) Gallstone ileus
d) Postoperative ileus
e) Strangulated hernia
--------------------------------------------------------------------118. Treatment of mechanical intestinal obstruction is complex. Choose two components which are
performed pre-, intra- and postoperatively:
a) Elimination of the cause of obstruction
b) Restoration of the bowel function
c) Intestinal decompression (reducing the distention)
d) Correction of hydroelectrolytic disturbances
e) Prevention of septic complications
--------------------------------------------------------------------119. In what types of obstruction blood supply of the involved segment is affected from the onset?
a) Volvulus
b) Intussusception
c) Intraluminal foreign bodies
d) Strangulation
e) Specific inflammatory parietal lesions

--------------------------------------------------------------------120. Which of the listed below belongs to strangulated obstruction:

a) Obstruction caused by intraperitoneal foreign bodies
b) Volvulus
c) Gallstone ileus
d) Strangulated hernia
e) Obstruction caused by trichobezoars
--------------------------------------------------------------------121. Choose the correct statements about sigmoid colon volvulus:
a) It is frequently preceded by coliSC or subocclusive episodes
b) Sudden onset with pain in the left lower quadrant and asymmetric abdominal distension
c) Intestinal transit is arrested from the onset
d) X-ray exhibits specific "bicycle tyre" image
e) Frequent vomiting
--------------------------------------------------------------------122. Which of the listed below can lead to a paralytic ileus?
a) Phytobezoars
b) Renal colic
c) Peritonitis
d) Sigmoid volvulus
e) Retroperitoneal abscess
--------------------------------------------------------------------123. The main postoperative care measures of a patient with intestinal obstruction are:
a) Correction of hydroelectrolytic disturbances and maintaining the normal levels of the biologic
constants
b) Antibiotic therapy
c) Early mobilization of patients is forbidden
d) Forbid enteral feeding for a week
e) Stimulation of intestinal peristalsis
--------------------------------------------------------------------124. In proximal intestinal obstruction gas accumulation in the intestinal lumen consists of:
a) 70% of swallowed air
b) 100% of gas as a result of microflora fermentation processes and biochemical reactions of
digestive juices
c) 70% of gas as a result of microflora fermentation processes
d) 30% of gas as a result of biochemical reactions of digestive juices
e) 30% of gas as a result of microflora fermentation processes and biochemical reactions of
digestive juices
--------------------------------------------------------------------125. Decompression of distended bowel in intestinal obstruction is useful because:
a) It reduces ischemia of the bowel
b) It removes intraluminal toxins
c) It prevents Mendelson syndrome

d) It alters chlorine ion loss

e) It reduces water loss
--------------------------------------------------------------------126. What radiologic signs are characteristic of early proximal mechanical obstruction:
a) Kloiber air-fluid levels
b) Pneumoperitoneum
c) Presence of arcades and organ tubes
d) Presence of semilunar folds
e) Presence of Chercring folds
--------------------------------------------------------------------127. What signs are characteristic of sigmoid colon torsion:
a) Complete arrest of the intestinal transit
b) Fever
c) Blood on rectal examination
d) Positive Hochwag-Grecov sign
e) Abdominal asymmetry
--------------------------------------------------------------------128. Chauffard-Villard-Charcot triad is found in CBD stones with major choledochal syndrome and
consists of:
a) Right upper abdominal quadrant pain
b) Distended gallbladder
c) Fever
d) Jaundice
e) Significant weight loss
--------------------------------------------------------------------129. The most frequent cause of obstructive jaundice is:
a) Tumor of the pancreatic head
b) CBD stones
c) Biliary duct stricture
d) Biliary duct tumors
e) Stenotic papillitis
--------------------------------------------------------------------130. Liver scintigraphy found out a normal absorption of isotopes was found, but the isotopes were
absent in the gallbladder, bile ducts and bowel. This suggests:
a) Hepatic jaundice
b) Posthepatic jaundice
c) Hemolytic jaundice
d) Liver cirrhosis
e) None of the above listed
--------------------------------------------------------------------131. CBD gallstone found preoperatively can be removed by:
a) Supraduodenal CBD incision
b) Transduodenal intraoperative papillosphincterotomy

c) Postoperative endoscopic papillosphincterotomy

d) Preoperative endoscopic papillosphincterotomy
e) It is dissolved with drugs
--------------------------------------------------------------------132. Which of the listed below methods provide the most complete information about
morphological type of cholecystitis, adjacent organs' and perioneum's changes:
a) Ultrasonography
b) Computed tomography
c) Transparietal cholecystocholangiography
d) Laparoscopy
e) ERCP
--------------------------------------------------------------------133. The optimal and less aggressive diagnostic method in a patient with obstructive jaundice is:
a) Oral cholecystography
b) Intravenous cholecystography
c) Ultrasonography
d) ERCP
e) Transparietohepatic cholangiography
--------------------------------------------------------------------134. Air in the bile ducts suggests:
a) CBD stones
b) Acute cholecystitis
c) Biliary-digestive fistula
d) Biliary-biliary fistula
e) Salmonella infection of the gallbladder
--------------------------------------------------------------------135. The following signs: moderate pain in the right hypochondrium, moderate fever, marked
jaundice with reddish nuance, slight liver enlargement, moderate splenomegaly without anemia are
specific for:
a) Acute cholecystitis
b) Cholangitis
c) CBD stones
d) Hepatic jaundice
e) Cancer of the pancreatic head
--------------------------------------------------------------------136. What kind of bile is formed in hepatocytes and contains cholesterol, biliary acids and
phospholipids?
a) Primary bile
b) Secondary bile
c) Final bile
d) None of the listed
e) All three of them
---------------------------------------------------------------------

137. What diagnostic methods are not useful, thus are not indicated in a patient with obstructive
jaundice:
a) Ultrasonography
b) Intravenous cholecystography
c) Transparietohepatic cholangiography
d) ERCP
e) Oral cholecystography
--------------------------------------------------------------------138. In acute obstructive lithiasic cholecystitis the stone is impacted:
a) In the intrahepatic bile ducts
b) In the body of the gallbladder
c) In the CBD
d) In the hepatic duct
e) In the gallbladder infundibulum or cystic duct
--------------------------------------------------------------------139. Choose the "gold standard" diagnostic method in obstructive jaundice:
a) Oral cholecystography
b) Intravenous cholecystography
c) Ultrasonography
d) ERCP
e) Laparoscopy
--------------------------------------------------------------------140. The simple T-shaped drain of the CBD is called:
a) Lane drain
b) Kehr drain
c) Cattele-Champeau drain
d) Voelker drain
e) Duval drain
--------------------------------------------------------------------141. The major differentiation sign of the stone-induced obstructive jaundice from malignant
jaundice is:
a) Marked jaundice accompanied by pain
b) Acholic stool and dark urine
c) Jaundice preceded by painful colic
d) Pruritus
e) Intermittent fever
--------------------------------------------------------------------142. The most informative noninvasive method of obstructive and hepatic jaundice differentiation
is:
a) ERCP
b) Scintigraphy
c) Oral cholecystography
d) Intravenous cholecystocholangiography
e) Transparietohepatic cholecystography

--------------------------------------------------------------------143. Choose the clinical signs characteristic of acute cholecystitis with local peritonitis:
a) Murphy sign
b) Korte sign
c) Mandel-Razdolschi sign
d) Blumberg sign
e) Ortner sign
--------------------------------------------------------------------144. Pancreas produces the following ferments:
a) Alpha-amylase
b) Lipase, phospholipase A and B
c) Pepsin
d) Trypsine, chymotrypsine
e) Elastase, collagenase
--------------------------------------------------------------------145. Infected pancreatic necrosis is characteristic of the following phase of evolution of
pathological process in the pancreas:
a) Edema
b) Fat necrosis
c) Hemorrhagic necrosis
d) Lysis and sequestration
e) Pancreatic pseudocyst
--------------------------------------------------------------------146. In the evolution of the acute pancreatitis One of the mentioned substances is formed in
ischemic pancreas and induces pancreatic shock:
a) Kinine
b) Heparin
c) Serotonin
d) Kallikrein
e) Histamine
--------------------------------------------------------------------147. In the management of acute pancreatitis in the early phase the most important is:
a) Pain management, spasmolytics, circulation improvement
b) Shock and homeostasis management
c) Reduction of pancreatic secretion and inactivation of pancreatic enzymes
d) Reduction of toxemia
e) Prevention of complications
--------------------------------------------------------------------148. In the management of acute hemorrhagic pancreatitis before surgery the main aim is:
a) Pain management
b) Detoxification
c) Spasmolytics and circulation improvement
d) Circulating plasma volume increase

e) Reduction of pancreatic secretion

--------------------------------------------------------------------149. Non-invasive diagnostic procedures for acute pancreatitis are:
a) Plain film of the abdomen
b) Abdominal CT scan
c) Abdominal ultrasound
d) ERCP
e) Thermography
--------------------------------------------------------------------150. The most optimal surgical procedure for infected pancreatic necrosis is:
a) Peripancreatic infiltration with novocaine and antiferments
b) Lesser sack debridement
c) Pancreas resection
d) Abdominisation of the pancreas
e) Pancreatic decapsulation and lesser sack drainage
--------------------------------------------------------------------151. The Courvoisier-Terrier sign is characteristic of:
a) CBD stones
b) Cancer of the body of the pancreas
c) Klatskin tumor
d) Cancer of the head of the pancreas
e) Gallbladder carcinoma
--------------------------------------------------------------------152. What is the type of surgery in case of pancreatic pseudocyst?
a) Pseudocyst external drainage
b) Pancreatectomy
c) Gastrocystostomy
d) Jejunocystostomy
e) Cholecystocystostomy
--------------------------------------------------------------------153. Which of the following is a poor prognostic sign of acute pancreatitis:
a) Elevated blood amylase
b) Hypocalcemia
c) Elevated blood glucose
d) Elevated urine amylase
e) Elevated WBC
--------------------------------------------------------------------154. In acute pancreatitis Korte sing means:
a) Absence of pulsation on the abdominal aorta
b) Absence of intestinal peristalsis
c) Pain in the scapula-humerus area on the left
d) Tympanic sound located on the projection of the transverse colon
e) Muscular guarding and pain in the projection of the pancreas

--------------------------------------------------------------------155. Optimal management of infected pancreatic pseudocyst is:

a) Cystogastrostomy
b) Pancreatectomy
c) Cystojejunostomy
d) Antibiotics
e) External drainage
--------------------------------------------------------------------156. What x-ray signs are characteristic of acute pancreatitis?
a) Pneumoperitoneum
b) "Sentinel" jejunal loop
c) Distended transverse colon
d) Diffuse distension of the intestinal loops
e) Multiple air-fluid levels on the small bowel
--------------------------------------------------------------------157. The endocrine part of the pancreas is in form of islets located in:
a) Parenchymatous tissue
b) Interlobular spaces
c) Pancreatic fat tissue
d) Fibrous septa of the gland
e) Retroperitoneal at the level of the pancreatic tail
--------------------------------------------------------------------158. The most accepted theory of the onset of acute pancreatitis is:
a) Common channel theory
b) Allergic theory
c) Fermentative theory
d) Vascular theory
e) Infectious theory
--------------------------------------------------------------------159. In acute pancreatitis Gobief sign means:
a) Muscular guarding in the pancreas projection
b) Periumbilical cyanosis
c) Lack of abdominal aortic pulsation
d) Tympanic sound on the projection of the transverse colon
e) Pain on percussion in the area of the upper left abdominal quadrant
--------------------------------------------------------------------160. Which of the following clinical signs are the most important in the diagnosis of chronic
pancreatitis?
a) Elevated blood and/or urine amylase
b) Weight loss
c) Vomiting
d) Pain
e) Palpable epigastric tumor

--------------------------------------------------------------------161. The most accurate diagnostic procedure in acute pancreatitis with fermentative peritonitis is:
a) Contrasted abdominal x-ray
b) Abdominal ultrasonography
c) Scintigraphy
d) Laparoscopy
e) ERCP
--------------------------------------------------------------------162. In case of acute pancreatitis the most efficient method for inactivation of proteolytic ferments
is:
a) Stimulated dieresis
b) Antienzymes in high doses
c) Laparoscopic lavage and drainage of the peritoneal cavity
d) Hemofiltration
e) Blood transfusion
--------------------------------------------------------------------163. In case of a mature pancreatic pseudocyst located in the head of the gland the following
surgical procedures are indicated:
a) Cystogastrostomy
b) Cystoduodenostomy
c) Cystojejunostomy
d) Cystectomy
e) Whipple pancreaticoduodenctomy
--------------------------------------------------------------------164. In case when chronic pancreatitis is induced by stenosis of the big duodenal papilla, the most
indicated surgical procedure is:
a) Resection of the pancreatic head (Duval procedure)
b) Pancreatojejunostomy (Puestow procedure)
c) Pancreatojejunostomy (Duval procedure)
d) Papillosphincterotomy and endoscopic wirsungotomy
e) Papillectomy
--------------------------------------------------------------------165. Which of the following signs are relevant in the early diagnosis of acute pancreatitis?
a) Periumbilical cyanosis
b) Episodes of elevated arterial pressure
c) Dyspnea and polypnea
d) Fever
e) Severe general clinical signs and objective state of the patient
--------------------------------------------------------------------166. In acute pancreatitis the Grey-Turner sign means:
a) Pale skin
b) Ecchymosis and cyanosis on the lateral edges of the abdomen
c) Pain in the point of junction of the ribs to the vertebrae on the left side

d) "Sentinel" intestinal loop on a plain film of the abdomen

e) Pain on palpation of the left upper abdominal quadrant
--------------------------------------------------------------------167. In order to reduce pancreatic secretion several treatment options are available, the least
indicated one due to adverse effects is:
a) Nasogastric intubation
b) Local extra- and intragastric hypothermia
c) No enteral feeding
d) 1.0 ml of 0.1% atropine solution 3 times a day
e) 5-Fluorouracil
--------------------------------------------------------------------168. In acute pancreatitis the Cullen sign means:
a) Pale skin
b) Ecchymosis and periumbilical cyanosis
c) Pain in the point of junction of the ribs to the vertebrae on the left side
d) "Sentinel" intestinal loop on a plain film of the abdomen
e) Pain on palpation of the left upper abdominal quadrant
--------------------------------------------------------------------169. In a patient with acute pancreatitis plain film of the abdomen can reveal the following:
a) Transverse colon enlargement
b) Liquid in the left pleural cavity
c) Left lung atelectasis
d) Pneumoperitoneum
e) Reduced movement of the left part of the diaphragm
--------------------------------------------------------------------170. In the first phase (edema) of evolution of acute pancreatitis the optimal management is:
a) Conservative management and if necessary laparoscopy with drainage of the abdomen and
lesser peritoneal sac
b) Laparotomy with the drainage of the CBD
c) Laparatomy and pancreatic capsula removal
d) Laparatomy, peripancreatic blockage
e) Laparatomy, lesser peritoneal sac debridement
--------------------------------------------------------------------171. The mean secretion volume of a healthy pancreas within 24 hours is:
a) 1500 - 2500 ml
b) 600 - 700 ml
c) 300 - 400 ml
d) 1000 - 1500 ml
e) 400 - 500 ml
--------------------------------------------------------------------172. A simple wound with a penetrating orifice and an exit one is called:
a) Penetrating wound
b) Penetrating but nonperforating wound

c) Perforating wound
d) Through-wall injury
e) Blind wound
--------------------------------------------------------------------173. In case of multiple jejunal injuries within the first 6 hours after the onset the optimal surgical
procedure is:
a) Simple suture
b) Resection with primary end-to-end anastomosis
c) Resection with primary end-to-side anastomosis
d) Jejunostomy
e) Primary anastomosis and protective stoma
--------------------------------------------------------------------174. The majority (90%) of the abdominal traumas are multiple injuries, the main etiology being:
a) Gunshot wounds
b) Knife wounds
c) Catatrauma (falls)
d) Traffic accidents
e) Sport trauma
--------------------------------------------------------------------175. The rate of isolated abdominal trauma is minimal (10%), because nowadays the main
etiological factor is:
a) Traffic accidents
b) Gunshot wounds
c) Knife wounds
d) Catatrauma (falls)
e) Sport trauma
--------------------------------------------------------------------176. The delayed diagnosis of retroperitoneal duodenal injuries is due to the following factors:
a) Leakage of the duodenal content into the retroperitoneal space
b) Low aggressivity of the duodenal content
c) Initial onset of retroperitoneal phlegmon
d) Lack of diffuse peritonitis within the first hours after the onset
e) Reduced bacterial contamination of the duodenal content
--------------------------------------------------------------------177. A patient with a gunshot wound is diagnosed with liver, small bowel and mesentery injuries.
The correct determination of the trauma is:
a) Complex multiple injuries (multivisceral injuries)
b) Simple trauma
c) Through-wall injury
d) Combined trauma
e) Penetrating but non-perforating wound
--------------------------------------------------------------------178. A patient was diagnosed with the following injuries: pelvic fracture, urethral and splenic

injuries. The correct term for above mentioned trauma is:

a) Blunt non-penetrating injury
b) Polytrauma
c) Associated trauma
d) Simple trauma
e) Combined trauma
--------------------------------------------------------------------179. The diagnosis of retroperitoneal injury of the duodenum is difficult. One of the most important
clinical signs is:
a) Blumberg sign
b) Mandel-Razdolski sign
c) Grassman-Kulenkampf sign
d) Bernstein sign
e) Vighiato sign
--------------------------------------------------------------------180. The most useful diagnostic procedures of pancreatic injuries are:
a) USG
b) Peritoneal lavage
c) Plain film of the abdomen
d) Laparoscopy
e) CT scan
--------------------------------------------------------------------181. In case of total pancreatic injury the optimal surgical procedure is:
a) Parenchyma suture with Wirsung duct suture
b) Distal pancreatic resection
c) Drainage of the both ends of the Wirsung duct as well as the lesser sac
d) Parenchyma suture with Wirsung duct drainage
e) Pancreatectomy
--------------------------------------------------------------------182. In splenic injuries the Kehr sign is:
a) Pain and rebound tenderness on palpation of the left upper abdominal quadrant
b) Pain in the left upper abdominal quadrant irradiating into the left shoulder
c) Dull sound on percussion of the left upper abdominal quadrant
d) Dull sound on percussion of the abdominal flanks
e) Hypotension
--------------------------------------------------------------------183. Intraoperative signs of retroperitoneal duodenal injury are:
a) Fat necrosis on the peritoneal wall
b) Green colored posterior peritoneal layer
c) Fibrin and pus in the peritoneal cavity
d) Retroperitoneal emphysema
e) Retroperitoneal hematoma
---------------------------------------------------------------------

184. Gastric injuries are more often observed in case of penetrating wounds (6-12%) compared to
blunt trauma (2-3%). The most useful diagnostic procedures are:
a) Laparoscopy
b) Plain film of the abdomen
c) USG
d) Diagnostic peritoneal lavage
e) CT scan
--------------------------------------------------------------------185. In case of blunt abdominal trauma the most frequent injuries of solid organs are:
a) Pancreas
b) Spleen
c) Liver
d) Kidney
e) Suprarenal glands
--------------------------------------------------------------------186. In case of hollow organ injury the least invasive and the most informative is the following
procedure:
a) USG
b) Laparoscopy
c) Plain film of the abdomen
d) Diagnostic peritoneal lavage
e) CT scan
--------------------------------------------------------------------187. The following symptoms are characteristic of the toxic phase of peritonitis:
a) Tachycardia
b) Elevated WBC
c) Distended, painful abdomen
d) Prevalence of local signs but not general signs
e) Frequent vomiting
--------------------------------------------------------------------188. There are different procedures used for the diagnosis of localized peritonitis. Tick 2 the most
informative ones:
a) Rectal and vaginal examination
b) Abdominal USG
c) Laparoscopy
d) Diagnostic peritoneal lavage
e) Plain film of the abdomen in upright position
--------------------------------------------------------------------189. In acute appendicitis Blumberg sign is:
a) Pain during sudden decompression of the right iliac fossa
b) Pain on right iliac fossa palpation
c) Pain in the right iliac fossa on chest extension
d) Pain on the right iliac fossa palpation irradiating in the epigastric area
e) Pain in the right iliac fossa during air insufflation into the rectum

--------------------------------------------------------------------190. There are the following pain characteristics of peritonitis:

a) It is reduced by opioid analgesics
b) It always has an acute onset
c) It can be associated with thirst
d) It can spread upon the entire abdomen
e) It is always located in the projection of the affected organ
--------------------------------------------------------------------191. A patient with clinical signs of acute appendicitis presents peritoneal signs in the right iliac
fossa and suprapubic area. What type of peritonitis is suspected?
a) Limited localized
b) Localized unlimited
c) Diffuse generalized
d) Total generalized
e) Douglas pouch abscess
--------------------------------------------------------------------192. The early signs of acute generalized peritonitis are:
a) Abdominal pain
b) Muscle guarding
c) Board-like abdomen
d) Vomiting
e) Fever
--------------------------------------------------------------------193. In case of acute peritonitis protein and fluid loss can reach 300 g and 9-10 l respectively. The
main factor of these losses is:
a) Circulatory disturbances
b) Intestinal paresis
c) Multiple vomiting
d) Alkalosis
e) Renal impairment
--------------------------------------------------------------------194. After peritoneal lavage in a patient with diffuse purulent peritonitis, the peritoneal cavity is
drainaged according to the following rules:
a) Through the laparotomy incision
b) Drains should be placed through separate incisions of the abdominal wall
c) In the postoperative period washout of the drainaged spaces is indicated
d) Antibiotics should be administrated in the peritoneal cavity
e) Antibiotics must be administrated every 4-6 hours
--------------------------------------------------------------------195. In case of appendiceal abscess the optimal surgical approach is:
a) Extraperitoneal, according to Pirogov's procedure
b) Through McBurney approach
c) Through middle inferior laparotomy

d) Through medial laparotomy

e) Through lumbar approach
--------------------------------------------------------------------196. In case of the onset of diffuse peritonitis physical examination reveals the following clinical
sign:
a) Distended abdomen
b) Periombilical ecchymosis
c) Board-like abdomen
d) The abdomen not participating in respiratory movements
e) Kussmaul's sign
--------------------------------------------------------------------197. Among the general goals in the management of peritonitis one of the most important is
management of dynamical intestinal obstruction. In order to achieve this goal the following
procedures are indicated:
a) Epidural analgesia
b) I/V infusion of glucose, potassium and insulin
c) Intestinal decompression
d) Sympathetic stimulation
e) Intestinal peristalsis stimulation
--------------------------------------------------------------------198. Circulatory disturbances are more evident in the II and III phases of peritonitis evolution and
are determined by the following factors:
a) Hypokalemia
b) Decreased hematocrit
c) Metabolic acidosis
d) Protein catabolism
e) Natrium imbalances
--------------------------------------------------------------------199. A patient with perforated peptic ulcer is admitted in 10 hours after the onset, with the
following signs: xerostomia, Ps - 96 b/min., BP - 120/70 mmHg, dyspnea, severe abdominal pain,
board-like abdomen, WBC - 16.000. Tick the phase of peritonitis:
a) Reactive phase
b) Toxic phase
c) Terminal phase
d) Infectious complication phase
e) Multiple organ failure phase
--------------------------------------------------------------------200. In a patient with perforated duodenal ulcer in 48 hour after the onset, the most appropriate
surgical techniques are:
a) Gastric resection Bilroth I
b) Simple suture of the perforate ulcer
c) Oppel-Policarpov's procedure
d) Ulcer excision and pyloroplasty
e) Gastric resection Bilroth II

--------------------------------------------------------------------201. The most frequent cause of infection of the peritoneal cavity is:
a) Hollow organ perforation
b) Through the blood stream
c) Intraperitoneal rupture of hydronephrosis
d) Lymphatic way
e) None of the above
--------------------------------------------------------------------202. The following clinical signs are characteristic of diffuse generalized peritonitis:
a) Blumberg sign
b) Mandel-Razdolskii sign
c) Presence of the liver dullness sign
d) Cough sign
e) Grassman-Kulencampf sign
--------------------------------------------------------------------203. A patient with perforated peptic ulcer is admitted in 32 hours after the onset with the following
signs: xerostomia, Ps - 120 b/min., BP - 90/40 mm Hg, tachypnea 32 pe min., "Hippocratic facies",
distended and painful abdomen, no intestinal peristalsis, WBC - 25.000. Tick the phase of
peritonitis:
a) Reactive phase
b) Toxic phase
c) Terminal phase
d) Infectious complications phase
e) Multiple organ failure phase
--------------------------------------------------------------------204. Which of the following signs are characteristic of diffuse peritonitis:
a) History of gallstone disease
b) Reduced level of urine amylase
c) Pneumoperitoneum
d) "Cough sign"
e) Fecaloid vomiting
--------------------------------------------------------------------205. Muscular guarding is a major sign of peritonitis, but it could be absent in the following cases:
a) In the elderly
b) In children
c) In case of antibiotics treatment
d) In cachectic patients
e) In opioid analgesics
--------------------------------------------------------------------206. The most important purpose of the management of acute generalized peritonitis is:
a) Surgical debridement
b) Antibiotic treatment
c) I/V infusions

d) Recovery of intestinal function

e) Prophylaxis of complications
--------------------------------------------------------------------207. The surface of the peritoneum is about 2 m2, the functions of the peritoneum are:
a) Spread of infection
b) Internal organs fixation
c) Antibacterial protection
d) Absorption
e) Secretion
--------------------------------------------------------------------208. There are acute and chronic peritonitis. The possible etiologies of chronic peritonitis are:
a) TB
b) Malignancy
c) Parasites
d) Biliary
e) Urinary
--------------------------------------------------------------------209. The following signs are characteristic of perforated duodenal ulcer with generalized
peritonitis:
a) Epigastric pain
b) Muscle guarding
c) Liver dullness
d) Pneumoperitoneum
e) Pain on rectal examination
--------------------------------------------------------------------210. In the diagnosis of acute appendicitis the most important sign is:
a) Dieulafoy triade
b) Kocher sign
c) Bartomie-Mihelson sign
d) Sitcowschi sign
e) Blumberg sign
--------------------------------------------------------------------211. Which of the following are true for acute appendicitis:
a) Characteristic pain in the right iliac fossa
b) Fever is the most common in the elderly
c) Elevated WBC is always present
d) Tachycardia
e) It can evolve into gangrene
--------------------------------------------------------------------212. In the first phase of evolution appendiceal infiltrate is characterized by the following signs:
a) Constant elevation of WBC
b) Palpable mass after 3-5 days of disease onset
c) Dull pain in the right iliac fossa

d) Fluctuation in the right iliac fossa

e) Fever
--------------------------------------------------------------------213. In acute appendicitis Blumberg sign means:
a) Pain during decompression of the right iliac fossa
b) Pain during palpation of the right iliac fossa
c) Pain in the right iliac fossa on lower limb lifting
d) Pain radiating to the epigastric region during right iliac fossa palpation
e) Pain in the right iliac fossa during rectal air insufflation
--------------------------------------------------------------------214. Pain in the paraumbilical area and the symptoms of Kummel, Krasnobaev are characteristic of
the following location of inflammed appendix:
a) Subhepatic
b) In the elderly
c) Retrocecal
d) Medial
e) Pelvic
--------------------------------------------------------------------215. Acute appendicitis with diffuse peritonitis must be differentiated from the following
nosologies:
a) Intestinal obstruction
b) Renal lithiasis
c) Gut ischemia
d) Acute pancreatitis
e) Peritonitis
--------------------------------------------------------------------216. The most efficient method to secure an appendiceal stump is:
a) Simple ligation
b) Purse-string suture using non-absorbable stitches
c) Purse-string suture without ligation
d) Purse-string suture using absorbable stitches
e) Simple ligation and separate sutures
--------------------------------------------------------------------217. Subhepatic appendicitis is characterized by the following clinical signs:
a) High fever
b) It is diagnosed more frequently in children
c) It can be accompanied with jaundice
d) Peritoneal signs are positive in the right upper abdominal quadrant
e) It simulates acute cholecystitis
--------------------------------------------------------------------218. Acute appendicitis must be differnciated from:
a) Perforated peptic ulcer
b) Mallory-Weiss syndrome

c) Intoxication
d) Acute pancreatitis
e) Renal colic
--------------------------------------------------------------------219. Acute appendicitis in the elderly is characterized by the following signs:
a) Sudden onset
b) Poor muscle guarding
c) Pain on the right iliac fossa palpation
d) Higher incidence of destructive forms with poor clinical signs
e) Moderate WBC, slight fever
--------------------------------------------------------------------220. The following conditions could simulate subhepatic appendicitis:
a) Acute cholecystitis
b) Subhepatic abscess
c) Meckel's diverticulum
d) Right-sided hydronephrosis
e) Pyelitis
--------------------------------------------------------------------221. The management of appendiceal infiltrate in the first phase of evolution is:
a) Non-operative management (local hypothermia, antibiotics)
b) Surgery is indicated in young patients
c) Surgery is indicated in the elderly
d) Surgery is indicated in case of pelvic localization
e) Surgery is indicated in case of suspected cecal carcinoma
--------------------------------------------------------------------222. Tick two the most important etiologic factors of acute appendicitis:
a) Allergic factor
b) Vascular factor
c) Infectious factor
d) Chemical factor
e) Obstructive factor
--------------------------------------------------------------------223. The major and constant sign of acute appendicitis is:
a) Anorexia
b) Vomiting
c) Fever
d) Diarrhea
e) Pain in the right iliac fossa
--------------------------------------------------------------------224. In children differential diagnosis of acute appendicitis must be made with:
a) Perforated peptic ulcer
b) Acute cholecystitis
c) Intoxication

d) Renal colic
e) Acute pancreatitis
--------------------------------------------------------------------225. Which of the following are not true for appendiceal infiltrate in the phase of abscess
formation:
a) Appendectomy is mandatory
b) Emergency surgery is indicated
c) Only autoamputated appendix is removed
d) Surgery is not indicated
e) Non-operative management is indicated
--------------------------------------------------------------------226. The most frequent position of the appendix is:
a) Lateral
b) Descending
c) Retrocecal
d) Ascending
e) Medial
--------------------------------------------------------------------227. Clinical features of acute appendicitis during pregnancy are:
a) Atypical pain
b) It is more frequent in the third trimester of gestation
c) Severe forms are more frequent
d) Pain and vomiting can simulate gestation
e) The Sitkovschi, Bartomie-Mihelson and Cope's signs are positive
--------------------------------------------------------------------228. The following nosologies could simulate pelvic appendicitis:
a) Pyonephrosis
b) Inflammation of the Meckel's diverticulum
c) Crohn disease
d) Acute prostatitis
e) Psoas abscess
--------------------------------------------------------------------229. What is the most appropriate surgical approach in case of suspected acute appendicitis?
a) Lenander incision
b) McBurney incision
c) Sprengel incision
d) Midline laparotomy
e) Inferior midline laparotomy
--------------------------------------------------------------------230. The management of acute appendicitis in the elderly is:
a) Non-operative
b) Emergency surgery
c) Colonic examination in order to rule out colon carcinoma

d) Initial management of concomitant diseases

e) Antibiotics
--------------------------------------------------------------------231. In case of gangrenous appendicitis with localized peritonitis the optimal drainage is:
a) Drainage of the Douglas pouch through a separate incision
b) Drainage of the Douglas pouch through McBurney incision
c) Drainage through the left iliac fossa
d) Drainage of the iliac fossa on the both sides
e) Drainage is not indicated
--------------------------------------------------------------------232. In acute appendicitis Dieulafoy's tiad includes:
a) Epigastric pain shifting to the right iliac fossa within 4-6 hours, hypersensitivity of the skin,
tenderness and muscular contraction at McBurney's point
b) Hypersensitivity of the skin, tenderness and muscular contraction at McBurney's point
c) Anorexia, hypersensitivity of the skin, tenderness and muscular contraction at McBurney's point
d) Tenderness and muscular contraction at McBurney's point, hypersensitivity of the skin, fever
e) Tenderness and muscular contraction at McBurney's point, Hypersensitivity of the skin, pain
radiating into the right testicle
--------------------------------------------------------------------233. The optimal management of appendiceal infiltrate in the phase of abscess formation is:
a) Non-operative management
b) Extraperitoneal drainage (Pirogov)
c) USG-guided abscess drainage
d) Laparotomy and abscess drainage
e) Abscess drainage through McBurney apporach
--------------------------------------------------------------------234. The most accepted etiological theory of acute appendicitis is:
a) Infectious theory
b) Polyethiologic theory
c) Mechanical theory
d) Corticovisceral theory
e) Chemical theory
--------------------------------------------------------------------235. The following signs are used for the differential diagnosis of acute appendicitis and
gynecological pathology:
a) Promptov's sign
b) Metrorrhagia
c) Jendrinschi sign
d) Kulencampf's sign
e) Bartomie-Mihelson's sign
--------------------------------------------------------------------236. Chronic appendicitis must be differentiated from:
a) Nephrolithiasis, pyelonephritis

b) Crohn's disease
c) Zollinger-Ellison's syndrome
d) Colon carcinoma
e) Fallopian tube inflammation
--------------------------------------------------------------------237. In case of acute appendicitis, pain on abdominal palpation is localized in:
a) Sonnenburg point
b) Wenglovschi triangle
c) McBurney's point
d) Iacubovici triangle
e) Lanz point
--------------------------------------------------------------------238. Flail chest is:
a) Multiple rib fractures
b) When multiple adjacent ribs are broken in multiple places, separating a segment, so a part
of the chest wall moves independently
c) Formation of a flap intimately adhered to the rib cage
d) Chest trauma complicated by acute respiratory failure
e) It is a severe form of pneumothorax
--------------------------------------------------------------------239. What is the cause of paradoxical respiration?
a) Inhibition of the superior respiratory centers
b) Respiratory muscle paralysis
c) Flail chest
d) Dilution of atmospheric air
e) Decrease of cardiac contractions
--------------------------------------------------------------------240. In case of open pneumothorax emergency measures are:
a) Urgent transportation of a patient to a hospital
b) Tamponade of the wound and occlusive bandage application
c) Oxygen therapy
d) Assisted respiration
e) Aspiration from the pleural cavity
--------------------------------------------------------------------241. Choose the characteristic features of massive hemothorax:
a) Pale teguments
b) Marked dyspnea, cyanosis
c) Tympanic sound on percussion, pleural friction rub
d) Dull sound on percussion, absence of respiratory sounds
e) Bradycardia
--------------------------------------------------------------------242. Massive hemothorax treatment includes:
a) Massive packed red blood cells transfusion

b) Pleurotomy with active aspiration from the pleural cavity

c) Assisted respiration and circulating blood volume restoration
d) Thoracotomy, surgical hemostasis
e) Clinical monitoring
--------------------------------------------------------------------243. Choose the appropriate management of thoracic wounds with suspicion of peritoneal cavity
organ injury :
a) Clinical monitoring
b) Analgesics, opioid and nonopioid
c) Diagnostic laparotomy
d) Aspiration of gastric content
e) Paracentesis, laparoscopy
--------------------------------------------------------------------244. Hemothorax:
a) Is seen on X-ray, if the volume exceeds 500 ml
b) Is characterized by pleuropulmonary compression syndrome
c) Tympanic sound on percussion
d) Treatment consists of urgent thoracotomy if the volume is under 100 ml
e) Is accumulation of blood in the pleural cavity
--------------------------------------------------------------------245. Choose the indications for emergency thoracotomy:
a) Posttraumatic cardiac arrhythmia
b) Posttraumatic arteriovenous fistula
c) Massive hemothorax
d) Diaphragm injury
e) Closed pneumothorax
--------------------------------------------------------------------246. Features of traumatic injuries of the diaphragm are:
a) They do not affect general state of the patient
b) They may be penetrating
c) Their symptoms vary depending on the body's position
d) Their surgical treatment is mandatory
e) They manifest with obstructive, hemorrhagic and respiratory syndromes
--------------------------------------------------------------------247. Which of the listed below features does not fit pneumothorax:
a) Dyspnea
b) Cyanosis
c) Tympanic sound on percussion
d) Dull sound on percussion
e) Absence of respiratory sounds
--------------------------------------------------------------------248. Pneumothorax consequences are:
a) Intrapleural compression syndrome

b) Mediastinum deviation
c) Increase of the affected thoracic side volume
d) Healthy lung aeration disturbance
e) Intestinal peristalsis impairment
--------------------------------------------------------------------249. Traumatic injuries of the diaphragm:
a) Appear after penetrating thoracic wounds
b) Is 0.5 -2% of all polytrauma
c) Do not affect heart activity
d) Can be often complicated by prolapse of the abdominal organs to the pleural cavity
e) Needs only conservative treatment
--------------------------------------------------------------------250. Which of the following can be attributed to the ecchymotic mask":
a) Inferior vena cava syndrome
b) It appears as a result of elevated pressure in the superior vena cava
c) Sclera hemorrhage is present
d) It is characteristic of thorax wounds
e) It is a result of thoracic compression
--------------------------------------------------------------------Chirurgie nr.1
1. A
2. C
3. A
4. D
5. D
6. B
7. ABCE
8. ACE
9. E
10. ACD
11. AC
12. ACDE
13. AE
14. BDE
15. ACE
16. B
17. E
18. E
19. CDE
20. AC
21. CDE
22. BD
23. ADE

24. ABD
25. BCE
26. ABD
27. ABDE
28. ABCE
29. CDE
30. CD
31. B
32. D
33. C
34. ABCE
35. B
36. B
37. A
38. B
39. A
40. AE
41. CD
42. C
43. D
44. D
45. CD
46. A

47. BE
48. DE
49. D
50. A
51. A
52. D
53. C
54. ADE
55. AE
56. C
57. ABDE
58. BCDE
59. B
60. D
61. BE
62. ABCD
63. E
64. C
65. E
66. AC
67. C
68. D
69. D

70. C
71. ACDE
72. A
73. D
74. CE
75. D
76. E
77. BCDE
78. B
79. D
80. ABE
81. ABD
82. D
83. D
84. E
85. B
86. D
87. C
88. AB
89. BC
90. CE
91. ABE
92. A
93. E
94. A
95. CD
96. B
97. B
98. D
99. ACDE
100.D
101. C
102. E
103. B
104. C
105. ABDE
106. B
107. C
108. D
109. ABCE
110. D
111. C
112. C
113. AE
114. B
115. B
116. D
117. C
118. CD

119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.

ABD
BD
BCD
BCE
ABE
AE
ABCE
ACE
ADE
ACD
B
B
CD
D
C
C
D
A
BE
E
D
B
C
B
ACDE
ABDE
D
D
B
D
ABCE
B
D
ACD
B
E
DE
BCD
B
C
D
BD
D
B
ABCD
D
BCE
B
D

168.
169.
170.
171.
172.
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.
197.
198.
199.
200.
201.
202.
203.
204.
205.
206.
207.
208.
209.
210.
211.
212.
213.
214.
215.
216.

B
ABCE
A
D
D
B
D
A
ABDE
A
C
E
DE
C
B
BDE
ABE
BC
C
ABC
BE
A
ACD
B
ABCE
B
BCDE
A
D
ABCE
ACDE
A
BC
A
ABDE
B
CD
ACDE
A
BCDE
ABC
ABDE
A
AE
ABCE
A
D
ACDE
B

217.
218.
219.
220.
221.
222.
223.
224.
225.
226.
227.
228.

ACDE
ACDE
BCDE
ABDE
A
CE
E
C
ABDE
B
ACDE
BCDE

229.
230.
231.
232.
233.
234.
235.
236.
237.
238.
239.
240.

D
B
A
B
B
B
ABCE
ABDE
D
B
C
B

241.
242.
243.
244.
245.
246.
247.
248.
249.

ABD
ABD
E
ABE
CD
BCDE
D
ABC
ABD
250. BCE