Dentistry – Surgery IV year

Which sign is not associated with peptic ulcer perforation: A 42-year-old male, with previous Sudden onset ulcer history and typical clinical picture of peptic ulcer perforation, on Cloiberg caps examination, in 4 hours after the Positive Blumberg sign beginning of the disease, discomfort in Free air below diaphragm on plain right upper quadrant, heart rate - abdominal film 74/min., mild abdominal wall muscles rigidity, negative Blumberg sign. Free Intolerable abdominal pain air below diaphragm on X-ray abdominal film. What is you diagnosis? Which ethiological factors causes Peptic ulcer recurrence peptic ulcer disease most oftenly? Acute cholecystitis Abdominal trauma, alimentary factor Chronic cholecystitis H. pylori, NSAID's Covered peptic ulcer perforation H. pylori, hyperlipidemia Acute appendicitis (subhepatic Drugs, toxins location) NSAID's, gastrinoma Most oftenly perforated peptic ulcers are located at: A 30-year-old male is operated on for peptic ulcer perforation, in 2,5 hours Posterior wall of antrum after the beginning of the disease. Fundus of stomach Which operation will be most efficient (radical operation for peptic ulcer)? Cardiac part of stomach Simple closure and highly selective Posterior wall of duodenal bulb vagotomy Anterior wall of duodenal bulb Simple closure Simple closure with a Graham patch Penetrated ulcer can cause such using omentum complications: 1). Abdominal abscess; Stomach resection 2). Portal pyelophlebitis; 3). Stomach- organ fistula; 4). Acute pancreatitis; 5). Antrumectomy Bleeding. 1, 2, 3; It has been abandoned as a method to treat ulcer disease 2, 3, 5;

1, 3, 5; A 42-year-old executive has refractory 3, 4, 5; chronic duodenal ulcer disease. His All physican has suggested several surgical options. The patient has chosen a parietal (highly selective) vagotomy A 45-year-old man complains of instead of a truncal vagotomy and burning epigastric pain that wakes him antrectomy because? up at night. The pain is relieved by eating or using over-thecounter It results in a lower incidence of ulcer antacids and H2 blockers. Diagnosis is recurrence best confirmed by which of the The complication rate is lower following? It reduces acid secretion to a greater Urea breath test extent Serum gastrin levels It benefits patients with antral ulcers Barium meal examination the most Upper endoscopy It includes removal of the ulcer Upper endoscopy and biopsy A 63-year-old woman is admitted to the hospital with severe abdominal pain A 44-year-old dentist complains of of 3-hour duration. Abdominal burning epigastric pain that wakes him examination reveals board-like rigidity, up at night caused by a recurrent guarding, and rebound tenderness. Her duodenal ulcer. He has shown blood pressure is 90/50 mm Hg, pluse considerable improvement following 110 bpm (beats per minute), and operative treatment by a truncal respiratory rate is 30 breaths per vagotomy and pyloroplasty, 10 years minute. After a thorough history and prior to this incident. Which is TRUE physical, and initiation of fluid of truncal vagotomy? resuscitation, what diagnostic study It is performed exclusively via the should be performed? thorax Supine abdominal x-rays It can be performed in the neck Upright chest x-ray If complete, it will result in increased Gastrograffin swallow acid secretion Computerized axial tomography (CAT) It requires a gastric drainage procedure scan of the abdomen Abdominal sonogram Cigarette smoking A frail elderly patient is found to have Rapid gastric emptying an anterior perforation of a duodenal High gastrin level ulcer. He has a recent history of nonsteroidal anti-inflammatory drug H2-blockers intake (NSAID) use and no previous history of peptic ulcer disease. A large amount of bilious fluid is found in the What we can find at abdominal abdomen. What should be the next examination of patient with perforated step? peptic ulcer: 1. abdominal wall muscles rigidity; 2. positive Blumberg sign; 3. Lavage and omental patch closure of guarding; 4. tenderness; 5. absence of the ulcer liver dullness. Choose the best Lavage of the peritoneal cavity alone combination. Total gastrectomy all are present Lavage, vagotomy, and 1,2,3 gastroenterostomy 1,2,4 Laser of the ulcer 1,3,5 2,3,4 Name 3 main signs of perforated peptic ulcer? Which statement, concerning Abdominal pain, multiple vomiting, perforated peptic ulcer, is NOT TRUE? distention of abdominal cavity Patient with a perforated peptic ulcer Increasing abdominal pain, meteorism, who has peritoneal signs should peritonitis undergo laparotomy Ulcer in past medical history, sudden Perforated peptic ulcers must be treated abdominal pain, board-like rigidity nonoperatively Ulcer in past medical history, pain in Patients with perforated peptic ulcer the epigastrium, which gradually usually present with a sudden onset of increases, peritonitis severe abdominal pain Abdominal pain, pale and cold skin, Free air under the diaphragm confirm low BPAbdominal pain, pale and cold the diagnosis of perforated peptic ulcer skin, low BP Perforation of posterior wall of stomach is seen very rarely What doesn't predispose to peptic ulcer disease? Steroid use Laboratory studies in patients with with Which ethiological factors causes perforated ulcer may include: 1. CBC; peptic ulcer disease most oftenly? 2. Serum gastrin level; 3. H. pylori Abdominal trauma, alimentary factor infection testing; 4. Urine analysis; 5. Serum human chorionic gonadotropin H. pylori, NSAID's levels. Coose correct answer. H. pylori, hyperlipidemia 1, 2, 3 Drugs, toxins 1, 3, 4 NSAID's, gastrinoma 1, 4, 5 2, 3, 5 A 30-year-old male is operated on for 2, 4, 5 peptic ulcer perforation, in 2,5 hours after the beginning of the disease.

Which operation will be most efficient Nonoperative treatment of selected (radical operation for peptic ulcer)? patients with a diagnosis of perforated Simple closure and highly selective ulcer includes all the following, vagotomy EXCEPT: Simple closure NSAIDs Simple closure with a Graham patch Broad-spectrum antibiotics using omentum Proton pump inhibitor Stomach resection Fluid resuscitation with replacement of Antrumectomy fluid and electrolytes

Nasogastric decompression A 42-year-old male, with previous

ulcer history and typical clinical picture Which sign is not associated with of peptic ulcer perforation, on peptic ulcer perforation: examination, in 4 hours after the beginning of the disease, discomfort in Sudden onset right upper quadrant, heart rate - Cloiberg caps 74/min., mild abdominal wall muscles Positive Blumberg sign rigidity, negative Blumberg sign. Free air below diaphragm on X-ray Free air below diaphragm on plain abdominal film. What is you diagnosis? abdominal film Peptic ulcer recurrence Intolerable abdominal pain Acute cholecystitis

Chronic cholecystitis Covered peptic ulcer perforation Acute appendicitis (subhepatic Upper endoscopy and biopsy location)

A 44-year-old dentist complains of Most oftenly perforated peptic ulcers burning epigastric pain that wakes him are located at: up at night caused by a recurrent duodenal ulcer. He has shown Posterior wall of antrum considerable improvement following Fundus of stomach operative treatment by a truncal Cardiac part of stomach vagotomy and pyloroplasty, 10 years prior to this incident. Which is TRUE Posterior wall of duodenal bulb of truncal vagotomy? Anterior wall of duodenal bulb It is performed exclusively via the thorax Penetrated ulcer can cause such It can be performed in the neck complications: 1). Abdominal abscess; If complete, it will result in increased 2). Portal pyelophlebitis; 3). Stomach- acid secretion organ fistula; 4). Acute pancreatitis; 5). Bleeding. It requires a gastric drainage procedure 1, 2, 3; It has been abandoned as a method to treat ulcer disease 2, 3, 5;

1, 3, 5; A 42-year-old executive has refractory 3, 4, 5; chronic duodenal ulcer disease. His All physican has suggested several surgical options. The patient has chosen a parietal (highly selective) vagotomy A 45-year-old man complains of instead of a truncal vagotomy and burning epigastric pain that wakes him antrectomy because? up at night. The pain is relieved by It results in a lower incidence of ulcer eating or using over-thecounter recurrence antacids and H2 blockers. Diagnosis is best confirmed by which of the The complication rate is lower following? It reduces acid secretion to a greater Urea breath test extent Serum gastrin levels It benefits patients with antral ulcers the most Barium meal examination It includes removal of the ulcer Upper endoscopy

A 63-year-old woman is admitted to Name 3 main signs of perforated peptic the hospital with severe abdominal pain ulcer? of 3-hour duration. Abdominal Abdominal pain, multiple vomiting, examination reveals board-like rigidity, distention of abdominal cavity guarding, and rebound tenderness. Her blood pressure is 90/50 mm Hg, pluse Increasing abdominal pain, meteorism, 110 bpm (beats per minute), and peritonitis respiratory rate is 30 breaths per Ulcer in past medical history, sudden minute. After a thorough history and abdominal pain, board-like rigidity physical, and initiation of fluid resuscitation, what diagnostic study Ulcer in past medical history, pain in should be performed? the epigastrium, which gradually increases, peritonitis Supine abdominal x-rays Abdominal pain, pale and cold skin, Upright chest x-ray low BPAbdominal pain, pale and cold Gastrograffin swallow skin, low BP Computerized axial tomography (CAT) scan of the abdomen What doesn't predispose to peptic ulcer Abdominal sonogram disease? Steroid use A frail elderly patient is found to have Cigarette smoking an anterior perforation of a duodenal Rapid gastric emptying ulcer. He has a recent history of nonsteroidal anti-inflammatory drug High gastrin level (NSAID) use and no previous history H2-blockers intake of peptic ulcer disease. A large amount of bilious fluid is found in the abdomen. What should be the next What we can find at abdominal step? examination of patient with perforated Lavage and omental patch closure of peptic ulcer: 1. abdominal wall muscles the ulcer rigidity; 2. positive Blumberg sign; 3. guarding; 4. tenderness; 5. absence of Lavage of the peritoneal cavity alone liver dullness. Choose the best Total gastrectomy combination. Lavage, vagotomy, and all are present gastroenterostomy 1,2,3 Laser of the ulcer 1,2,4 1,3,5 2,3,4 Proton pump inhibitor Fluid resuscitation with replacement of fluid and electrolytes Which statement, concerning perforated peptic ulcer, is NOT TRUE? Nasogastric decompression Patient with a perforated peptic ulcer who has peritoneal signs should The most efficient noninvasive undergo laparotomy diagnostic method for small bowel Perforated peptic ulcers must be treated obstruction is: nonoperatively Ultrasound examination. Patients with perforated peptic ulcer Irrigography usually present with a sudden onset of severe abdominal pain Colonoscopy Free air under the diaphragm confirm Laparoscopy the diagnosis of perforated peptic ulcer Plain abdominal film Perforation of posterior wall of stomach is seen very rarely Medical therapy will be effective in cases of bowel obstruction caused by: Laboratory studies in patients with with 1.Volvulus; 2.Cancer of colon; perforated ulcer may include: 1. CBC; 3.Paralytic ileus; 4.Spastic bowel 2. Serum gastrin level; 3. H. pylori obstruction; 5.Coprostasis. infection testing; 4. Urine analysis; 5. 1, 2, 4 Serum human chorionic gonadotropin levels. Coose correct answer. 1, 2, 5 1, 2, 3 3, 4, 5 1, 3, 4 2, 3, 4 1, 4, 5 1, 2, 3 2, 3, 5 2, 4, 5 The signs of strangulation are: 1.Acute onset of disease; 2.Severe abdominal pain; 3.Slow beginning; 4.Dull pain; 5. Nonoperative treatment of selected Dilated small intestine loops with patients with a diagnosis of perforated air/fluid levels on plain abdominal film. ulcer includes all the following, 2, 3, 5 EXCEPT: 1, 2, 5 NSAIDs 1, 3, 4 Broad-spectrum antibiotics 3, 4, 5 Surgical treatment in case of acute bowel obstruction is indicated in cases: 4, 5 1. Electrolyte disbalance. 2. Abdominal cramps. 3. Strangulation. 4. The signs of obturation are: 1.Acute Obstruction has not resolved within 24- onset of disease; 2.Severe abdominal 48 hours of concervative treatment 5. pain; 3.Slow beginning; 4.Dull pain; 5. Multiple air-fluid level on plain Dilated air-filled colon on plain abdominal film. abdominal film. 2, 3 3, 4, 5 4, 5 1, 4, 5 3, 4 2, 3, 5 3, 5 1, 2 1, 2 1, 2, 3 A 42-year-old woman is admitted to Patient with bowel obstruction is the emergency department with severe complaining for blood in the stool. colicky pain, vomiting, and abdominal What is you diagnosis? distention. She has not passed stools or flatus for 48 hours. X-rays of the Intussusception abdomen confirm the presence of Paralytic ileus smallbowel obstruction. What is the most likely cause of small-bowel Hernia incarceration obstruction in the patients? Spastic bowel obstruction Tumors, groin hernia Volvulus Gallstones, tumors Groin hernia incarceration, adhesions For low large bowel obstruction are Helminths, tumors characteristic all signs except: Adhesions, inflammatory diseases Acute dehydration

Absence of stool Most oftenly small bowel obstruction is Cloiberg caps on plain abdominal film caused by: Abdominal distension Adhesions, inflammatory diseases Slow beginning; Helmints, tumors Groin hernia incarceration, adhesions Gallstones, tumors Tumors, groin hernia. starts 2 hours before admission, after consumption of large amout of food.

Patient anxious, pale skin, Surgical treatment in case of acute acrocyanosis, pulse 120 bpm, BP 90/60 bowel obstruction is indicated in cases: mmHg. Abdomen moderately 1. Electrolyte disbalance. 2. Abdominal distended in the epigastric region, in cramps. 3. Strangulation. 4. the lower parts - sink in. On palpation: Obstruction has not resolved within 24- tenderness in the epigastrium. On 48 hours of concervative treatment 5. percussion: tympanic sound in the Multiple air-fluid level on plain epigastic region, increased peristalsis. abdominal film. On plain abdominal film dillated small 2, 3 intestinal loops. Make diagnosis? 4, 5 Bowel obstruction caused by the tumor of large intestineBowel obstruction 1, 5 caused by the tumor of large intestine 3, 4 Small intestine volvulus 1, 2 Acute pancreatitis Groin hernia incarceration An elderly nursing home patient is Peptic ulcer perforation brought to the hospital with recent onset of colicky abdominal pain, distension and obstipation on The small intestine receives blood examination, the abdomen is markedly supply from different sources. They distended and tympanitic. There is no are: marked tenderness. Plain abdominal x- 1)Superior mesenteric artery (SMA) ray shows a markedly distended loop located mainly in the right upper 2)Inferior mesenteric artery (IMA) quadrant. The likely diagnosis is: 3)Arteries iliaca externae Mesenteric vascular occlusion 4)Arteries iliaca internae Sigmoid volvulus 5)Celiac axis Gallstone ileus Choose correct combination. Chron's disease 2, 3 Small-bowel obstruction 4, 5

1, 5 56-year-old patient admitted to the 3, 4 surgical department with complaints of abdominal pain, repeated vomiting, 1, 2 which does not bring relief. The pain It left the nerve supply to pylorus intact (nerves of Latarjet). The small bowel wall consists of all of the followinglayers, EXCEPT: It includes removal of the ulcer. Subserosa Mucosa A frail elderly patient is found to have an anterior perforation of a duodenal Submucosa ulcer. He has a recent history of Muscularis nonsteroidal anti-inflammatory drug Serosa (NSAID) use and no previous history of peptic ulcer disease. A large amount of bilious fluid is found in the A 45-year-old man complains of abdomen. What should be the next burning epigastric pain that wakes him step? up at night. The pain is relieved by Lavage and omental patch closure of eating or using over-the-counter the ulcer antacids and H2 blockers. Diagnosis is best confirmed by which of the Lavage of the peritoneal cavity alone following? Total gastrectomy Urea breath test Laser of the ulcer Serum gastrin levels Lavage, vagotomy, and Ultrasound gastroenterostomy Barium meal examination Upper endoscopy and biopsy A 37-year-old man has had recurrent symptoms suggestive of peptic ulcer disease for 4 years. Endoscopy reveals A44-year-old patient has refractory an ulcer located on duodenum buld. A chronic duodenal ulcer disease. His mucosal biopsy reveals Helicobacter. physican has suggested several surgical pylori. What is TRUE about H. pylori? options. The patient has chosen a Active organisms can be discerned by parietal (highly selective) vagotomy serology. instead of a truncal vagotomy and antrectomy because? It is protective against gastric carcinoma. It results in a lower incidence of ulcer recurrence. It is associated with chronic gastritis. It benefits patients with antral ulcers It cannot be detected by the urea breath the most. test. It includes stomach resection. It causes gastric ulcer but not duodenal ulcer. Pyloric obstruction due to cicatricial stenosis of the lumen of the duodenum A 68-year-old woman has been diagnosed with a benign ulcer on the Carcinoma of the fundus greater curvature of her stomach, 5 cm proximal to the antrum. After 3 months of standard medical therapy, she A 2-cm ulcer on the greater curvature continues to have guaiac positive stool, of the stomach is diagnosed in a 70- anemia, and abdominal pain with year-old woman by a barium study. failure of the ulcer to heal. Biopsies of Gastric analysis to maximal acid the gastric ulcer have not identified a stimulation shows achlorhydria. What malignancy. The next step in is the next step in management? management is which of the following? Antacids, H2 blockers, and repeat Surgical intervention, including total barium study in 6 to 8 weeks gastrectomy Proton pump inhibitor (e.g., Surgical intervention, including partial omeprazole) gastric resection Prostoglandin E (misoprostol) and Admission of the patient for total repeat barium study in 6 to 8 weeks parenteral nutrition (TPN), treatment of Immediate elective surgery anemia, and endoscopic therapy Upper endoscopy with multiple Endoscopy and bipolar electrocautery biopsies (at least 8 or 9) for the ulcer or laser photocoagulation of the gastric ulcer Treatment of the anemia and repeat all Which condition does not cause gastric studies in 6 weeks outlet obstruction? pancreatic pseudocyst Over the past 6 months, a 60-year-old bezoar woman with long standing duodenal sliding esophageal hernia ulcer disease has been complaining of anorexia, nausea, weight loss and ingestion of caustics repeated vomiting. She recognizes gastric polyps undigested food in the vomitus. Examination and workup reveal dehydration, hypokalemia, and Which tumors may cause gastric outlet hypochloremic alkalosis. What is the obstruction? (1) papilla Vateri cancer, most likely diagnosis? (2) duodenal cancer, (3) hepatocellular Anorexia nervosa carcinomas, (4) pancreatic cancer, (5) uterine cancer ZES (Zollinger Ellison Syndrome) All Penetrating ulcer 1, 3, 5 Continuous vomiting may lead to dehydration and electrolyte 3, 4, 5 abnormalities 2, 3, 5 Barium upper GI tests may 1, 2, 4 demonstrate the obstruction Plain radiographs can demonstrate the Which steps are indicated for treatment presence of gastric dilatation of gastric outlet obstruction? (1) IV The major benign cause of gastric rehydration; (2) Immediate blood outlet obstruction (GOO) is transfusion; (3) Correction of malnutrition electrolyte disbalance; (4) Nasogastric tube placement; (5) Endoscopic gastrostomy. Clinical presentation of patient with gastric outlet obstruction may include 1, 2, 4 all listed below, EXCEPT: 2, 3, 5 Nausea and vomiting are the cardinal 3, 4, 5 symptoms of gastric outlet obstruction 1, 3, 4 Vomiting usually is rich for bile 1, 2, 5 Vomitus contains undigested food particles Which procedure usually is NOT Patients may develop significant and performed for gastric outlet obstruction progressive gastric dilatation related to peptic ulcer disease? Patients may develop significant vagotomy and antrectomy weight loss vagotomy and pyloroplasty truncal vagotomy and A 48-year-old man undergoes surgery gastrojejunostomy for a chronic duodenal ucler. The procedure is a truncal vagotomy and pyloroplasty alone which of the following? proximal gastric resection Gastroenterostomy Removal of the duodenum Which statement concerning gastric Closure of the esophageal hiatus outlet obstruction is WRONG? Incidental appendectomy Peptic ulcer disease or carcinoma can cause gastric outlet obstruction No further procedure

A 35-year-old man underwent an Iron deficiency anemia Billroth II resection. Although usually careful with his diet, he ate a large meal during a business lunch. Within 1 Choose all signs typical for early hour, he felt lightheaded and developed dumping syndrome: 1. Occurs within abdominal cramping and diarrhea. His 10-30 minutes after meals; 2. Occurs 1- symptoms may be attributed to: 3 hours after a meal; 3. Nausea, bloating, abdominal cramps; 4. Anemia Explosive diarrhea; 5. Flushing, Jejunogastric intussusceptions dizziness, palpitations; 6. An intense desire to lie down Dumping syndrome 1, 3, 4 Afferent loop syndrome 2, 3, 4 Alkaline reflux gastritis 2, 4, 5

2, 4, 6 A 63-year-old man underwent gastric resection for severe peptic ulcer 1, 5, 6 disease. He had complete relief of his symptoms but developed "dumping syndrome." This patient is most likely Choose all signs typical for late to complain of which of the following? dumping syndrome: 1. Occurs within 10-30 minutes after meals; 2. Occurs 1- Severe vasomotor symptoms after 3 hours after a meal; 3. Nausea, eating bloating, abdominal cramps; 4. Repeated vomiting Explosive diarrhea; 5. Flushing, dizziness, palpitations; 6. An intense Anemia desire to lie down Gastric intussusception 1, 3, 4 Intestinal obstruction 2, 3, 4

2, 4, 5 A 64-year-old man was evaluated for 2, 5, 6 moderate protein deficiency. He underwent a gastrectomy 20 years 1, 5, 6 earlier. He is more likely to show which of the following? The following are pathogenetic links of Porphyria dumping syndrome except: Hemosiderosis Immediate dumping of gastric contents Aplastic anemia into the jejunum Hemolytic anemia Relative intravascular volume Acarbose contraction and hemoconcentration Octreotide occur as a consequence of osmotic shift of fluids from the intravascular Tolbutamide compartment i Propranolol Release of vasoactive GI hormones Verapamil responsible for peripheral and splanchnic vasodilatation and vasomotor symptoms such as flushing, The following statements about tachycardia and di surgical treatment of patients with In response to rapid delivery of a meal dumping syndrome are true except: to the small intestine, high The goal of surgical treatment is to concentration of carbohydrates is seen slow down gastric emptying in the proximal small bowel followed by ra Surgery is suggested after one year of medical measures (diet, behavioral, Hyperglicemia develops due to insulin drug therapy) deficiency in patients with dumping syndrome Surgery is highly effective method of dumping syndrome treatment

In patients with Billroth II gastrectomy, The following are diet a conversion to Billroth I anatomy recommendations for a patient with allows restoration of the gastric content dumping syndrome except: delivery into the duodenum Avoid liquids for at least 30 minutes Excellent results with an interposed after a solid meal jejunal segment has been reported Daily food intake should be divided into at least six meals What hormone produces beta-cells of Carbohydrate intake should be reduced, pancreatic gland: with preference for complex, rather than simple carbohydrates Somatostatin Increased intake of milk and diary is Somatotropin recommended Insulin Supplementation of dietary fibers Glucagon (bran, citrucel) has been shown to be beneficial in the treatment of late Pancreozymin hypoglycemia Which ethiological factors causes acute The most effective drug for dumping pancreatitis most oftenly? syndrome treatment is: Abdominal trauma, alimentary factor 500-1000 ml Gallstones, alcohol 700 ml Hypercalcemia, hyperlipidemia 2500 ml Drugs, toxins ERCP, sphincter of Oddi disfunction What instrumental examination should be performed to diagnose necrotizing

pancreatitis? Which thesis is correct according to US pathogenesis of acute pancreatitis? ERCP Intrapancreatic enzyme's activation Plain abdominal film Pancreatic gland autolisys Blood gases Neutrophils chemoactivation, infiltration and inflamation CT SIRS All are correct A 60-year-old alcoholic is admitted to the hospital with a diagnosis of acute

pancreatitis. Upon admission, his white A 52-year-old male, without alcohol blood cell (WBC) count is 21x109/l. history, admitted to hospital with acute His lipase, lactate dehydrogenase and pain in epigastrium, radiating to the aspartate aminotransferase are elevated, back. Amylase level elevated. Which blood glucose is 10 mmol/L. Which of radiological findings will help the following is TRUE? diagnosing acute pancreatitis? A serum calcium level of 1.7 mmol/L Changes in liver on CT scans on the second hospital day is a bad Choledocholithiasis on US prognostic sign Stomach shifted anteriorly on contrast This patient is expected to have a examination of GIT mortality rate of less than 5% Cloiber cups on plain abdominal film The patient's lipase level is not important indication of prognosis Air below diaphragm on plain abdominal film This patient requires immediate surgery A venous blood gas would be helpful in assessing the severity of illness in What is the volume of pancreatic juice this patient produced in 24 hours?

200-500 ml A 40-year-old alcoholic male is 100-200 ml admitted with severe epigastric pain radiating to the back. Serum amylase It is usually an isolated single-organ level is reported as normal injury (fluoroscopic method), but serum It often requires a total pancreatectomy lipase is elevated. The serum is noted to be milky in appearance. A diagnosis It may easily diagnosed at operation of pancreatitis is made. The serum It is proved by the mildly elevated amylase is normal because: amylase level The patient has chronic renal failure The patient has hyperlipidemia The severity of pancreatitis can be The patient has alcoholic cirrhosis estimated with: The patient has alcoholic hepatitis Ranson Criteria The diagnosis of pancreatitis is Alvarado scale incorrect US examination results SOFA scale A 57-year-old woman is admitted to CXR the hospital with abdominal pain. She reports that she drinks alcohol only at social occasions. The amylase is Clinical staging (Atlanta consensus) of elevated to 120 mmol/l. Which acute pancreatitis consists of the following x-ray finding would support following forms of the disease: 1. a diagnosis of acute pancreatitis? Pseudotumorous pancreatitis. 2. Mild Hepatic lesion on CT scan acute pancreatitis. 3. Sterile pancreonecrosis. 4. Infected Gas in abdominal cavity pancronecrosis. 5. Pseudocyst of the Dilated colon transversum pancreas. Select the correct combination of answers: Large loop of colon in the RUQ 2,3,4 Irregular cutoff of the CBD on cholangiogram 1,2,3,5 3,4 Following a motor vehicle accident a 2,3,4,5 truck driver complains of severe All correct abdominal pain. Serum amylase level is markedly increased to 400 mmol/l. Grey Turner's sign is seen in the flanks. Enzyme toxemia in case of Pancreatic trauma is suspected. Which pancronecrosis is caused by: 1. statement is true of pancreatic trauma? Trypsin. 2. Phospholipase A2. 3. It is oftenly caused by blunt injuries Chymotrypsin. 4. Elastase. 5. Enterokinase. Select the correct From all sides combination of answers: From anterior and posterior sides 1,4 From anterior and inferior sid 2,3,5 Covers only anterior surface of the 1,2,3,4 gland 1,3,4,5 Covers anterior and posterior sides only of the head of the gland All correct

For clinical picture of acute pancreatitis A 45-year-old male addmitted to the are typical all signs except: surgical department with severe pain in epigastrium with irradiation to the Continuous severe pain located in the back, which develops after alcohol epigastrium and/or left upper quadrant consumption. Acute pancreatitis was The pain irradiates to the back diagnosed. The patient was performed CT scan: pancreatic enlargement. What Multiple vomiting is the stage of acute pancreatitis Paralytic ileus according to CT picture? Absence of liver dullness Grade A

Grade B In differential diagnosis of acute Grade C pancreatitis and acute bowel Grade D obstruction will be usefull: 1. CBC; 2. Liver enzymes serum levels; 3. Serum Grade E amylase and lipase levels; 4. Plain abdominal film; 5. Serum electrolytes. Choose best combination. Acute pancreatitis is most rearly seen in: 1, 2 > 60 years old women 2, 3 21-45 years old men 3, 4 45-60 years old women 1, 5 45-60 years old men 2, 5 Children Choose changes in biochemical test typical for patients with acute How peritoneum covers pancreatic pancreatitis: 1. Hypertriglyceridemia; gland? 2. Hyperglycemia; 3. Hypercalcemia; 4. Hypotriglyceridemia; 5. A 45-year-old male treated in surgical Hypocalcemia. department for acute pancreatitis during 28 days. He started to complain 1, 2, 5 for the temperature elevation to 39°C, 1, 3, 4 weakness, fatigue. CBC: RBC - 2, 3, 4 3,51012/l, WBC - 21109/l. CT: 11 cm in diameter fluid collected near the 3, 4, 5 head of the pancreatic gland. What 1, 2, 4 complication of acute pancreatitis developed in this case?

Postnecrotic pseudocyst Most common cause of death in early acute pancreatitis is? Retroperitoneal phlegmone Renal failure Enzyme peritonitis Cardiac failure Pancreatic abscess Respiratory failure Cancer of the head of the pancreas Uncontrolled coagulopathy Sepsis The early complications of acute pancreatitis are all, except:

Pancreatic shock A 60-year-old female treated in surgical department for acute Acute respiratory distress syndrome pancreatitis. On 30 day of treatment in Enzyme peritonitis epigastrium appeared mass 10 cm in diameter. CBC: RBC - 3,71012/l, WBC Renal failure - 10109/l. US examination: fluid Pancreatic fistula collected near the head of the pancreatic gland. What complication of acute pancreatitis developed in this When infection complications of acute case? pancreatitis develops most oftenly? Postnecrotic pseudocyst On 7-th day of disease Retroperitoneal phlegmone After 2 weeks Enzyme peritonitis On 4-th day of disease Pancreatic abscess After 6 months Cancer of the head of the pancreas On 2-nd day of disease

Treatment of acute pancreatitis To start on a low-fat diet at home includes all EXCEPT: To increase the fat content of her diet Diurhetics To undergo immediate Antibiotics cholecystectomy Intravenous hydration To undergo cholecystectomy during the same hospital stay as well as an Analgesics assessment of her bile ducts Nothing per os That she will be discharged and should undergo elective cholecystectomy after A 24-year-old college student recovers 3 months from a bout of severe pancreatitis. He has mild epigastric discomfort, A 26-year-old woman with a known sensation of bloating, and loss of history of chronic alcoholism is appetite. Examination reveals an admitted to the hospital with severe epigastric fullness that on ultrasound is abdominal pain due to acute confirmed to be a pseudocyst. The pancreatitis. The serum and urinary swelling increases in size over a 3- amylase levels are elevated. On the day week period of observation to 15 cm in following admission to the hospital, diameter. What should be the next step there is no improvement, and she has a in management? mild cough and slight dyspnea. What is Percutaneous drainage of the cyst the most likely complication? Laparotomy and internal drainage of Pulmonary atelectasis the cyst Bronchitis Excision of pseudocyst Pulmonary embolus Total pancreatectomy Afferent loop syndrome Administration of pancreatic enzymes Pneumonia

A 42-year-old woman with a history of The most often cause of death in case chronic alcoholism is admitted to the of destructive pancreatitis is: hospital because of acute pancreatitis. The bilirubin and amylase levels are in Pulmonary embolism the normal range. An ultrasound Mechanical jaundice reveals cholelithiasis (stones in the gallbladder, CBD 6 mm in diameter). Peritonitis The symptoms decreased on the fifth Septic complications day after admission. What should she be advised? Renal failure Which drug is used to suppress the secretion of the pancreas? 30-year-old man hospitalized with a severe epigastric pain. During Aprotinin examination: hypoxemia, dehydration. Octreotide Laboratory tests: increased levels of amylase and lipase in the blood. CT Papaverine confirmed severe acute pancreatitis. Imipenem/cilastatin Which antibiotic will reduce the risk of infection? Acetaminophen Ampicillin Erythromicin Which drug is used to inhibite proteases? Gentamicin Aprotinin Ceftriaxon Octreotide Imipenem/cilastatin Papaverine

Imipenem/cilastatin 45-year-old man who abused alcohol, admitted to the hospital complaining of Acetaminophen abdominal pain, nausea, vomiting. Body temperature 36,8°C. At palpation: defined tumor in the Which statement concerning medical epigastrium. Laboratory tests: treatment of patient with acute pancreatic amylase normal. On the pancreatitis on early phase (first 3-5 second day in the hospital CT was days) is WRONG? held: 9 cm pseudocyst of pancreas was Patients are kept "nothing per os" found. Which statement regarding this patient is correct? Aggressive fluid resuscitation is critically important Pseudocyst can cause compression of stomach and biliary ducts Antibiotics should be used in any case of acute pancreatitis Spontaneous resorption never met Imipenem/cilastatin is indicated to Pseudocyst can be seen only in case of prevent infication in patients with acute pancreatitis pancreatic necrosis In this case pseudocyst doesn't need Early initiation of enteral nutrition is any treatment important in treatment and infection Malignant degeneration occurs in 25% prevention of cases, if untreated

Name the source of infection in Retroperitoneal bleeding patients with necrotizing pancreatitis? Pancreatic duct disruption Pulmonary infection Retroperitoneal phlegmon Bacterial translocation from gut Pancreatic abscess Skin infection

Urinary infection Choose the WRONG statement Nosocomial infection concerning pseudocyst definition: Peripancreatic fluid collection persisting for more than 4 weeks A 44-year-old woman is admitted to the hospital because of acute Pseudocyst lack an epithelial layer pancreatitis. Biochemical test: bilirubin Most of them are filled with necrotic - 45 mcmol/l. An ultrasound reveals debris stones in gallbladder and CBD 14 mm in diameter. MRCP: 8 mm stone in the Intervention (minimally invasive or distal part of CBD, which is dilated to conventional) should be performed in 14 mm. What should she be the first case of pseudocyst complications step in the treatment of patient? development Whipple procedure In all cases pseudocysts should be treated with conventional surgery Distal resection of the pancreas

Sphincterotomy and stone extraction Which sign is characterized by rebound Only medical treatment tenderness over the site of abnormality Urgent cholecystectomy in patients with peritonitis? Kocher's sign A 47-year-old man with a known Blumberg's sign history of chronic alcoholism is Murphy's sign admitted to the hospital with severe abdominal pain due to acute Pasternatski's sign pancreatitis. His general condition Cullen's sign worsens in first 48 hours. CBC: RBC - 4,41012/l, WBC - 11,2109/l. On second series of CT scans rapid What is the leading etiological factor increase in retroperitoneal fluid causing spontaneous bacterial accumulation was found. Which peritonitis? complication of necrotizing pancreatitis develops in this case? Candida albicans Enzyme peritonitis Streptococcus pyogenes; Staphylococcus aureus Which statement is WRONG concerning primary microbial Escherichia Coli peritonitis? Pseudomonas aeruginosa Occurs without perforation of a hollow viscus Name the scoring system which helps Occurs with perforation of a hollow surgeon to make the prognosis in case viscus of peritonitis? Caused by direct seeding of Manheim index microorganisms APACHE II Seeding of microorganisms via ONTARIO Score bacterial translocation from the gut EuroSCORE Seeding of microorganisms via hematogenous dissemination SOFA

Which statement is wrong concerning A 68-year-old woman is admitted with secondary microbial peritonitis? an acute surgical abdomen. After resuscitation with IV crystalloids fluids Occurs subsequent to perforation of a and administration of antibiotics, she is hollow viscus taken for an immediate laparotomy. Endogenous microbes spill out into the Perforated diverticulitis of the sigmoid peritoneal cavity colon is found. The sigmoid colon is Even after timely surgical intervention inflamed but mobile and the mesentery and preemptive antibiotic therapy, contains a perforated abscess. The best about 15-30% of patients demonstrate operation for this patient would be: ongoing infection consisting of rec Insertion of a drain in the abscess Perforation of the colon is associated Sigmoid resection including the with lower infection rates abscess and primary colon-to-colon Patients who develop secondary anastomosis microbial peritonitis should undergo Sigmoid loop colostomy surgery to alleviate the source of Left hemicolectomy ongoing peritoneal soilage Sigmoid resection and end sigmoid colostomy and oversew the rectum Which examination would be most (Hartmann procedure) efficient in finding the cause for secondary bacterial peritonitis? Laparoscopy Plain abdominal film Ultrasound cavity of patients with purulent peritonitis: CT scan Monomicrobial Level of CRP Gram-positive microorganisms

domination One of the listed below diseases didn't Gram-negative microorganisms cause secondary peritonitis domination Acute cholecystitis Staphylococcus Destructive appendicitis Streptococcus Acute cholangitis

Bowel obstruction Choose a reason for the use of Intestinal infarction metronidazole as a component of antibacterial therapy of patients with diffuse peritonitis? Choose the clinical sign, not typical for acute peritonitis: Elimination of anaerobic bacteria Tachycardia Elimination of gram-positive flora Positive Blumberg sign Elimination of gram-negative flora Muscles rigidity Elimination of fungal infections Paralytic ileus Antiprotozoal antibiotoc Positive Ortner sign For the clinical course of acute peritonitis three stages are typical. Select the method of instrumental Choose the corect combination: 1. examination, which is not suitable for Subclinical; 2. Reactive; 3. Toxic; 4. localization of intra-abdominal Septic; 5. Terminal: abscesses: 1, 2, 3 US 2, 3, 4 Colonoscopy 1, 2, 5 CT 3, 4, 5 MRI 2, 3, 5 Laparoscopy

Specify the main microorganisms, which are identified in the abdominal For clinical picture of throughout the abdomen, vomiting. The subdiaphragmatic abscess is typical patient's condition is severe. On everything except: examination: confused consciousness, pale skin, swelling of both legs, Reduction of pulmonary respiratory breathing - 26 per minute, heart rate - excursions 120 bpm, BP - 90/60 mmHg, dry Elevation of diaphragm dome tongue, anterior abdominal wall in the Reactive pleural effusion act of breathing is not involved, abdominal cavity is painful in all Leukocytosis departments, positive Blumberg sign, Hematemesis absence of bowel sounds on auscultation, daily urine output - 800 ml/24 hours, CBC - WBC - 15 x 10 A 40-year-old patient, operated at 36 ⁹ / l, HMG - 131 g/l, hours after onset of the disease, patient serum amylase - 200 U/l (N=60-180 was perfromed median laparotomy. On U/l). Plain abdominal film revealed visual inspection of abdominal cavity free gas under the diaphragm. Make the during operation: redness and swelling diagnosis: of the peritoneum in the lower parts of Peptic ulcer perforation, peritonitis, abdominal cavity, peritoneum coverd reactive stage with fibrin, purulent exudate in the peritoneal cavity of the pelvis. Peptic ulcer perforation, peritonitis, Appendix is thickened, tense, dark toxic stage purple color with perforations that Peptic ulcer perforation, peritonitis, exudes pus. Choose the best method of terminal stage treatment: Acute pancreatitis Appendectomy, sanitation and drainage of the abdominal cavity by installing Acute appendicitis, peritonitis, toxic drains stage Appendectomy Appendectomy and sanitation of the A 60-year-old patient with coronary abdominal cavity heart disease, was hospitalized after 48 hours of onset of acute severe Appendectomy and sanitation of the epigastric pain, which extended abdominal cavity, ileostomy throughout the abdomen, vomiting. The Appendectomy and laparostomy patient's condition is severe. On examination: confused consciousness, pale skin, swelling of both legs, A 60-year-old patient with coronary breathing - 26 per minute, heart rate - heart disease, was hospitalized after 48 120 bpm, BP - 90/60 mmHg, dry hours of onset of acute severe tongue, anterior abdominal wall in the epigastric pain, which extended act of breathing is not involved, abdominal cavity is painful in all departments, positive Blumberg sign, The main factors determining the absence of bowel sounds on outcome in patients with peritonitis are: auscultation, daily urine output - 800 1). The prevalence of abdominal ml/24 hours, CBC: WBC - 21 x 10 contamination. 2). Virulence of ⁹ / l, HMG - 131 g/l, pathogens. 3). Source of peritonitis. 4). serum amylase - 200 U/l (N=60-180 Disease duration. 5). The age of the U/l). Plain abdominal film revealed patient. Choose the best combination of free gas under the diaphragm. Choose answers: optimal strategy of patient's management: 1,2,3 Laparoscopy to make the diagnosis 1,4,5 Infusion and cardiac therapy for 1-2 1,2,3,5 hours followed by surgery 2,3,4,5 Emergency surgery without preparation All are true Ultrasound examination of the abdominal cavity in order to confirm the diagnosis and choose surgical The severity of endogenous approach intoxication in patients with peritonitis is caused by: 1). Metabolic disorders; Infusion and cardiac therapy for 1-2 2). Hypovolemia; 3). Impaired hours followed by upper GI endoscopy microcirculation; 4). Paresis of the intestine; 5). Condition of cellular immunity. Choose the best In differential diagnosis between combination of answers: intraperitoneal bleeding and peritonitis, choose the right combination of the 1,4,5 following clinical symptoms 1,2,3 pathognomonic for peritonitis: 1). RBC - 2,0 x 10 9 /l, hemoglobin - 70 g/l; 2). 1,2,3,5 Arterial hypotension; 3). Blumberg 2,3,4,5 sign; 4). Paralitic ileus; 5). Severe persistent abdominal pain. Choose All are true correct combination: 1,2,5 The most efficient noninvasive 1,2,3 diagnostic method for small bowel obstruction is: 1,2,4 Ultrasound examination. 2,3,4 Irrigography 3,4,5 Colonoscopy Laparoscopy 1, 2 Plain abdominal film 1, 2, 3

Medical therapy will be effective in Patient with bowel obstruction is cases of bowel obstruction caused by: complaining for blood in the stool. 1.Volvulus; 2.Cancer of colon; What is you diagnosis? 3.Paralytic ileus; 4.Spastic bowel Intussusception obstruction; 5.Coprostasis. Paralytic ileus 1, 2, 4 Hernia incarceration 1, 2, 5 Spastic bowel obstruction 3, 4, 5 Volvulus 2, 3, 4

1, 2, 3 For low large bowel obstruction are

characteristic all signs except: The signs of strangulation are: 1.Acute Acute dehydration onset of disease; 2.Severe abdominal pain; 3.Slow beginning; 4.Dull pain; 5. Absence of stool Dilated small intestine loops with Cloiberg caps on plain abdominal film air/fluid levels on plain abdominal film. Abdominal distension 2, 3, 5 Slow beginning; 1, 2, 5

1, 3, 4 Surgical treatment in case of acute 3, 4, 5 bowel obstruction is indicated in cases: 4, 5 1. Electrolyte disbalance. 2. Abdominal cramps. 3. Strangulation. 4.

Obstruction has not resolved within 24- The signs of obturation are: 1.Acute 48 hours of concervative treatment 5. onset of disease; 2.Severe abdominal Multiple air-fluid level on plain pain; 3.Slow beginning; 4.Dull pain; 5. abdominal film. Dilated air-filled colon on plain 2, 3 abdominal film. 4, 5 3, 4, 5 3, 4 1, 4, 5 3, 5 2, 3, 5 1, 2 3, 4 A 42-year-old woman is admitted to 1, 2 the emergency department with severe colicky pain, vomiting, and abdominal distention. She has not passed stools or An elderly nursing home patient is flatus for 48 hours. X-rays of the brought to the hospital with recent abdomen confirm the presence of onset of colicky abdominal pain, smallbowel obstruction. What is the distension and obstipation on most likely cause of small-bowel examination, the abdomen is markedly obstruction in the patients? distended and tympanitic. There is no marked tenderness. Plain abdominal x- Tumors, groin hernia ray shows a markedly distended loop Gallstones, tumors located mainly in the right upper quadrant. The likely diagnosis is: Groin hernia incarceration, adhesions Mesenteric vascular occlusion Helminths, tumors Sigmoid volvulus Adhesions, inflammatory diseases Gallstone ileus

Chron's disease Most oftenly small bowel obstruction is caused by: Small-bowel obstruction Adhesions, inflammatory diseases Helmints, tumors 56-year-old patient admitted to the surgical department with complaints of Groin hernia incarceration, adhesions abdominal pain, repeated vomiting, Gallstones, tumors which does not bring relief. The pain Tumors, groin hernia. starts 2 hours before admission, after consumption of large amout of food. Patient anxious, pale skin, Surgical treatment in case of acute acrocyanosis, pulse 120 bpm, BP 90/60 bowel obstruction is indicated in cases: mmHg. Abdomen moderately 1. Electrolyte disbalance. 2. Abdominal distended in the epigastric region, in cramps. 3. Strangulation. 4. the lower parts - sink in. On palpation: Obstruction has not resolved within 24- tenderness in the epigastrium. On 48 hours of concervative treatment 5. percussion: tympanic sound in the Multiple air-fluid level on plain epigastic region, increased peristalsis. abdominal film. On plain abdominal film dillated small intestinal loops. Make diagnosis? 2, 3 Bowel obstruction caused by the tumor 4, 5 of large intestineBowel obstruction 1, 5 caused by the tumor of large intestine Small intestine volvulus Associated with a specific systemic disease Acute pancreatitis Associated with specific infection Groin hernia incarceration disease Peptic ulcer perforation Cryptoglandular in origin

Associated with hemorrhoids The small intestine receives blood Etiology is not known supply from different sources. They are: 1)Superior mesenteric artery (SMA) According to their location perirectal abscesses are classified to (one answer 2)Inferior mesenteric artery (IMA) is not correct): 3)Arteries iliaca externae Perianal 4)Arteries iliaca internae Superficial 5)Celiac axis Supralevator Choose correct combination. Ischiorectal 2, 3 Intersphincteric 4, 5

1, 5 The typical complications of perirectal 3, 4 abcess are all, except: 1, 2 Hemorrhoids Sphincter injury The small bowel wall consists of all of Perineal sepsis the followinglayers, EXCEPT: Chronic fistula Subserosa Internal fistula Mucosa

Submucosa What imaging study is necessary to Muscularis make diagnosis uncomplicated Serosa perirectal abscess fistula disease? Sinogram Perirectal abscess fistulous disease is Transrectal US most oftenly: CT No imagine study MRI III-IV grade hemorrhoids Severe bleeding The most effective treatment, which is Thrombosis successful in healing 90% of anal I-II grade hemorrhoids fisures, includes: 1. Stul softeners; 2. Lexatives; 3. Antibiotics; 4. NSAIDs; Necrosis 5. Sitz bath. 1, 2, 3 Why during hemorrhoidal bleeding the 1, 4, 5 blood is bright-red? 2, 3, 4 Hemorrhoidal vein have lots of shunts with rectal arteries 3, 4, 5 Hemorrhoids never bleed 1, 2, 5 Hemorrhoids develops from arteries

Bleeding is associsted with Uncomplicated interanal hemorrhoids coagulopathy typicaly are acossiated with: Most oftenly upper parts of colon are Anorectal pain bleeding, which are richy vascularized Pain after defecation

Thrombosis A 44-year-old man has recurrent Perirectal abscesses hemorrhoids. What treatment modality is not indicated in case of recurency? Bright-red bleeding per rectum Decreasing time spent on the toilet

Increasing dietary fiber Interanal and external hemorrhoids can develop all complications except: Decreasing constipating foods Incarceration Minimaly invasive treatment Necrosis Conventional surgery Perianal condylomas Thrombosis It is suspected that a 34 year old patient has an abscess of Douglas pouches. Bleeding What diagnostic method is to be chosen? Proctoscopy reveals nonbleeding grade Digital examination of rectum I hemorrhoids. Indications for surgical Rectoromanoscopy treatment are all except: Laparoscopy R-scopy of abdominal cavity Percussion and auscultation of stomach The typical complications of Chron's disease are all, except:

Sclerosing cholangitis A patient complains about evaginations in the region of anus that appear during Hemorrhage defecation and need to be replaced. Intestinal obstruction caused by Examination with anoscope revealed strictures 1x1 cm large evaginations of mucosa above the pectineal line. What is the Internal fistula most probable diagnosis? Abdominal abscesses Acute paraproctitis Anal fissure A 26-year-old man is present with mild External hemorrhoids clinical signs of Chron's colitis. What primary treatment this patient should Internal hemorrhoids be recommended:

Medical treatment with All statements concerning Chron's aminosalicylates disease are true, except? Total coloproctectomy Nonspecific inflamation Treatment of anemia Etiology is not known Left hemicolectomy Ileocolic region affected most oftenly Right hemicolectomy Affects all parts of GI (from the oropharynx to the anus) A 43-year-old woman undergoes Superficial (mucosal) inflamation investigation for colitis. In her history, it is noted that 20 years earlier she underwent a surgical procedure on the All statements concerning Ulcerative large intestine. Is the diagnosis more colitis (UC) are true, except? likely to be ulcerative colitis rather than Smokers are in the risk group for UC Crohn's disease because at the previous Etiology is not known operation? 20-30% of patients with UC have The serosa appeared normal on another family member with the inspection, but the colon mucosa was disease extensively involved Transmural inflamation There was evidence of fistula formation Affects colon and rectum All layers of the bowel wall were Has an excellent prognosis because of involved physician awareness. Skip lesions were noted Has a synchronous carcinoma in 4-5% of cases. The preoperative GI series showed a narrowing string like stricture in the Occurs equally in the right and left ileum (string sign) side. Occurs more frequently than in the rest of the population. A 35-year-old man has known ulcerative colitis. Which of the Is more likely to occur when the following is an indication for total ulcerative disease is confined to the left proctocolectomy? colon. Occasional bouts of colic and diarrhea Sclerosing cholangitis A 40-year-old man with a long history of bloody diarrhea presents with Toxic megacolon increased abdominal pain, vomiting, Arthritides and fever. On examination, he is found Iron deficiency anemia to be dehydrated and shows tachycardia and hypotension. The abdomen is markedly tender with A 54-year-old man with diarrhea is guarding and rigidity. What is the most found to have ulcerative colitis. likely cause? Colectomy should be advised in Acute perforated diverticulitis patients with ulcerative colitis who have symptoms that persist for more Volvulus of the sigmoid colon than which of the following? Perforated carcinoma of the sigmoid 10-20 years colon More than 25 years Toxic megacolon in ulcerative colitis 1 month Small-bowel perforation from regional enteritis 6 months

1 year A 25-year-old man has recurrent, indolent fistula in ano. He also A 48-year-old woman develops colon complains of weight loss, recurrent cancer. She is known to have a long attacks of diarrhea with blood mixed in history of ulcerative colitis. In the stool, and tenesmus. Proctoscopy ulcerative colitis, which of the revealed a healthy, normal-appearing following is a characteristic of colon rectum. What is the most likely cancer? diagnosis? Crohn's colitis Fever Ischemic colitis Amoebic colitis Patient, who suffered on Crohn's disease, is admitted to the hospital. Ulcerative colitis Physical examination can evaluate Colitis associated with acquired FOLLOWING features: (1) nutritional immunodeficiency syndrome (AIDS) status, (2) presence of abdominal tenderness or a mass, (3) perianal and rectal disorders, (4) intestinal Risk factors for Crohn's disease may fistulisation, (5) colon ulceration. include all, EXCEPT: 1,4,5 Nonsteroidal anti-inflammatory drugs (NSAIDs) 2,3,5 Family history 1,2,5 Ethnicity 2,3,4 Age of 20 and 30 1,2,3 Cigarette smoking Laboratory study findings in the evaluation of Crohn's disease may The characteristic presentation of indicate all disorders, EXCEPT: Crohn disease may be all(EXCLUDE wrong point): Anemia Abdominal pain Leukocytosis Diarrhea Hypoalbuminemia Tenesmus Increased erythrocyte sedimentation rate (ESR) Obstruction Thrombocytopenia Intestinal fistulization

Patient with Crohn's disease is going to People with severe Crohn's disease as undergo X ray procedure. Barium usual experience following symptoms, contrast studies can evaluate features EXCEPT: such as (1) adhesions, Skin disorders (2)pseudodiverticula, (3) fistulization, (4) submucosal edema, (5) RDS syndrom malnutrition. Arthritis 2,3,5 Fatigue 1,4,5 1,2,5 1,3,5 2,3,4 1,2,3 Which statement, concerning Crohn's disease, is NOT true?

The primary treatment of Crohn's Computed tomography (CT) scanning, disease is medical. Surgery is indicated in case of Crohn's disease, is helpful in for complications of the disease the assessment of: process. Abscesses Severe hemorrhage is usual in patients Adhesions with Crohn disease. Enteral insuffitiency Patients with Crohn disease most Extraintestinal complications commonly present with symptoms related to a chronic inflammatory All are correct process involving the ileocolic region Perianal fissures or fistulae are For patients with moderate or severe common in case of Crohn disease. Crohn's disease therapy may include: Transmural involvement on Aminosalicylats(1), Antibiotic(2), histological examination is a feature of Vitamin B14(3), Steroids(4), Crohn disease Octreotide(5). 1,2,4 Etiologic factors contributing to 2,3,4 ulcerative colitis are the following, EXCEPT: 1,2,5 Low-fiber diet 1,3,5 Nonsteroidal anti-inflammatory drug 2,3,5 (NSAID) use Consumption of milk products The three classic indications for Immune system reactions surgery, in patients with Crohn's disease, are: (1)stricture, (2)weight Genetic factors loss, (3)bleeding, (4)fistulisation, (5)perforation. Toxic megacolon is a condition, which 2,3,5 may result in: (1) colonic dysmotility, 1,2,4 (2) intestinal fistulisation, (3) colonic dilation, (4) infarction and perforation, 2,3,4 (5) multiple perianal fissures. 1,2,5 3,4,5 The inflammation is uniform, without intervening areas of normal mucosa 2,4,5 Contact bleeding may also be observed 1,2,5 Abnormal erythematous mucosa, with 1,2,3 or without ulceration 1,3,4 Extending from the rectum to part or all of the colon Ulcerative colitis is associated with various extracolonic manifestations. In case of Ulcerative colitis, findings These include which of the following? on CBC count may include which of (1) pyoderma gangrenosum, (2) the following: erythema nodosum, (3) ankylosing gastritis, (4) chronic pyelonephritis, (5) (1)Hyperhemoglobinenemia (ie, uveitis. hemoglobin > 16 g/dL in males and > 14 g/dL in females) 2,4,5 (2)Anemia (ie, hemoglobin < 14 g/dL 3,4,5 in males and < 12 g/dL in females) 1,2,5 (3)Thrombocytosis (ie, platelet count 1,3,4 >350,000/µL) 1,2,3 (4)Thrombocytopenia (ie, platelet count <160,000/µL) Patients with severe case of ulcerative (5)Leucocytosis (ie, total count colitis can have signs of volume >10,000/µL) depletion and toxicity. Which of the (6)Leucocytopenia (ie, total count following is true? <4,000/µL) All are correct 2,4,5 Weight loss 1,3,6 Fever 2,4,6 Tachycardia 2,3,5 Significant abdominal tenderness 1,3,5

Endoscopically, ulcerative colitis is The extent of Ulcerative colitis is characterized by: defined by the following: All are correct (1)Right-sided disease - Ulcerative Ulcerative colitis is an idiopathic colitis present in the ascending colon chronic inflammatory disorder limited up to, but not distal to, the splenic to the colon (2)Extensive disease - Evidence of ulcerative colitis proximal to the Which diagnostic procedure should be splenic flexure performed at first in a (3)Left-sided disease - Ulcerative hemodynamically unstable patient with colitis present in the descending colon blunt abdominal trauma? up to, but not proximal to, the splenic Ultrasound (Focused abdominal flexure sonography for trauma) (4)Proctosigmoiditis - Disease limited Triple contrast CT to the rectum with or without sigmoid involvement Diagnostic peritoneal lavage (5)Terminal ileitis - Disease limited to Laparoscopy the ileum without colonic involvement Plain abdominal film 1,2,3 2,3,4 Which diagnostic procedure should be 1,2,5 performed at secondly in a hemodynamically unstable patient with 1,4,5 blunt abdominal trauma? 3,4,5 Ultrasound (Focused abdominal sonography for trauma) Which statement, concerning Triple contrast CT Ulcerative colitis, is NOT true? Diagnostic peritoneal lavage The surgical treatment of ulcerative Laparoscopy colitis involves removing the colon and, in most cases, the rectum. Plain abdominal film Histologically, most of the pathology is limited to the mucosa and submucosa The indications for laparotomy in Ulcerative colitis extends proximally patient with penetrating abdominal from the anal verge in an uninterrupted trauma are: 1). Hemodynamic pattern to involve part or the entire instability; 2). Positive peritoneal signs; colon 3). Evisceration; 4). Grade IV liver injury; 5). Grade V spleen injury. Double-contrast barium enema Choose the best combination. examination is a useless technique for diagnosing ulcerative colitis 1, 2, 3 1, 3, 4 1, 4, 5 3, 4 2, 3, 5 5, 6 All conditions are indications for 1, 6 laparotomy

A 7-year-old boy was involved in a Which diagnostic procedure should be motorcycle crash while seated in the performed at first in a back of a minivan without restraints. hemodynamically stable patient with His vital signs in the emergency room penetrating abdominal trauma? are stable but he is complaining of left upper quadrant abdominal pain. The Ultrasound (Focused abdominal FAST scan shows scanty fluid around sonography for trauma) in the left colic gutter. An abdominal СТ and pelvic CT scan with iv and po Laparoscopy contrast is performed and the radiologist suggests a "blush" (arterial Local wound exploration extravasation) in the splenic Diagnostic peritoneal lavage parenchyma. The spleen itself sustained a deep parenchymal tear and is classified as a grade III injury. The Which diagnostic procedure should be child remains hemodynamically stable. performed secondly in a What is recommended next? hemodynamically stable patient with Continuous hemodynamic monitoring, penetrating abdominal trauma? celiac angiogram, and angio Ultrasound (Focused abdominal embolisation of splenic artery. sonography for trauma) Immediate exploration in the operation СТ room Laparoscopy If hemodynamic instability develops, aggressive fluid resuscitation including Local wound exploration a repeated bolus of 20 mL/kg lactated Diagnostic peritoneal lavage Ringer's solution followed by a li Monitoring only Which organs are injured most oftenly Pneumovax and elective splenectomy in patients with blunt abdominal in 6 weeks trauma: 1). Stomach; 2). Duodenum; 3). Liver; 4). Spleen; 5). Small intestine; 6). Large intestine. Laparoscopy in abdominal trauma may be indicated in which of the following? 1, 2 To exclude diaphragmatic injury 2, 5 In patients with multiple previous Octreotide abdominal operations

If there is limited cardiovascular In a patient who had a motor-cycle reserve crash, a CT of the abdomen revealed a If severe diffuse peritonitis exists peripancreatic hematoma and indistinct pancreatic border. The most definitive In hemodynamically unstable patients test for a pancreatic injury requiring operative intervention is: A 30-year-old restrained driver was ERCP involved in a motor-vehicle crash. He Ultrasonography is hemodynamically stable and has a large seat belt sign on the abdomen. CT scanning His abdomen is tender to palpation. In Operative exploration this patient one should be most concerned about: Amylase test of lavage fluid Liver and spleen injury Transection of the head of the pancreas A 25-year-old man fell down from his bicycle and hit a concrete wall on his Renal pedicle avulsion left side. An ultrasound examination Hollow-viscus injuries showed free fluid in the abdomen. A CT scan confirmed a grade III splenic Pelvic fracture injury. The most important contraindication for a nonoperative A 20-year-old unrestrained driver was management of the splenic injury is: involved in a motor-vehicle crash. A Hemodynamic instability computed tomography (CT) of the Active bleeding on CT scan abdomen revealed a large hematoma in the second portion of duodenum. The Adult patient rest of the abdomen is normal. The Lack of availability of blood for initial management of this duodenal transfusion hematoma should be: Extensive associated injuries Operative evacuation

Nasogastric decompression, intravenous fluids, and gradual A 17-year-old girl presents to the resumption of oral diet emergency department with a stab wound to the abdomen and a blow to Endoscopic retrograde the head that left her groggy. Her blood cholangiopancreatogram (ERCP) pressure is 80/0 mm Hg, pulse is 120 Laparotomy, pyloric exclusion, and bpm, and respiration rate is 28 breaths gastrojejunostomy per minute. Her abdomen has a stab wound in the anterior axillary line at Which of the following techniques the right costal margin. Two large-bore should be used immediately? intravenous lines, a nasogastric tube, Pringle's maneuver and a Foley catheter are inserted. The blood pressure rises to 85 mm Hg after Packing the liver 2 L of Ringer's lactate. The appropriate Suture ligation management is which of the following? Ligation of the right hepatic artery Peritoneal lavage Ligation of the proper hepatic artery Ultrasound of the abdomen

Laparoscopic assessment of the peritoneal cavity A 23-year-old man is shot with a handgun and found to have a through- Exploratory laparotomy and-through injury to the right CT of the head transverse colon. There is little fecal contamination and no bowel

devascularization. At operation, what A 22-year-old woman presents to the does he require? emergency department with a chief Right hemicolectomy with complaint of severe left upper quadrant ileotransverse colon anastomosis (LUQ) pain after being punched by her husband. Her blood pressure is 110/70 Right hemicolectomy with ileostomy mm Hg, pulse is 100 bpm, and and mucous fistula respiration rate is 24 breaths per Debridement and closure of wounds minute. The best means to establish a with exteriorization of colon diagnosis is which of the following? Debridement and closure of wounds FAST Segmental resection with primary Physical examination anastomosis CT of the abdomen Peritoneal lavage A 20-year-old woman presents to the Upper gastrointestinal (GI) series emergency department with a stab wound to the abdomen. There is

minimal abdominal tenderness. Local A 60-year-old man is attacked with a wound exploration indicates that the baseball bat and sustains multiple knife penetrated the peritoneum. What blows to the abdomen. He presents to is the ideal use of antibiotic the emergency department in shock and administration? is brought to the operating room (OR), Preoperatively where a laparotomy reveals massive hemoperitoneum and a stellate fracture Intraoperatively, if a colon injury is of the right and left lobes of the liver. found Postoperatively, if the patient develops column with severance of the fever pancreatic duct. What is the next step in management? Postoperatively, based on culture and sensitivity of fecal contamination found Intraoperative cholangiogram at the time of surgery Debridement and drainage of defect Intraoperatively, if any hollow viscus is Distal pancreatectomy found to be injured Closure of abdomen with J-P drains

Vagotom A 70-year-old woman is hit by a car and injures her midabdomen. The best way to rule out a rupture of the second In case of abdomenal trauma, we can part of the duodenum is by which divide abdomen into few parts. They mode? are all, EXCEPT: Repeated physical examinations intrathoracic abdomen Ultrasound pelvic abdomen Repeated amylase levels retroperitoneal abdomen CT with oral and intravenous contrast true abdomen Peritoneal lavage lateral abdomen

A 15-year-old girl had an injury to the Blunt force injuries to the abdomen can right retroperitoneum with duodenal generally be explained by a few contusion. What is the test required to mechanisms. They are 1) deceleration; exclude a rupture of the duodenum? 2) penetration; 3) crushing; 4) Serum amylase compression; 5) acceleration. Choose the correct combination. Dimethyliminodiacetic acid (HIDA) scan 1, 2, 3 Gastrografin study 1, 3, 4 Upper GI with barium 1, 4, 5 ERCP 2, 4, 5 2, 3, 5 A 33-year-old man presents to the emergency department with a gunshot What is the most common reason of injury to the abdomen. At laparotomy, blunt abdominal trauma in the civilian a deep laceration is found in the population? pancreas just to the left of the vertebral Vehicular trauma Recreational accidents Which, laboratory evaluation of abdominal trauma patients is useless in Industrial accidents consideration of management? Trauma during cardiopulmonary complete blood count (CBC) resuscitation serum electrolytes Heimlich maneuver serum amylase

urinalysis The most reliable signs and symptoms in patients after blunt abdominal coagulation studies trauma are all of the following, blood typing and cross-matching EXCEPT: arterial blood gases (ABGs) Pain

External hemorrhage In case of blunt abdominal trauma, you Hypervolemia should perform all listed bellow, Peritoneal irritation EXCEPT: Internal hemorrhage Nasogastric tube should be placed routinely

Foley catheter should be placed Blunt abdominal trauma may lead to intra abdominal bleeding. Concerning All patients should undergo tetanus this condition, which statement is NOT immunization true? The most important initial concern is Large amounts of blood can an assessment of hemodynamic accumulate in the peritoneal and pelvic stability cavities Obtain pregnancy test on all females of Lap belt marks have been correlated childbearing age with an increased incidence of other intra-abdominal injuries The FAST examination protocol in Intraperitoneal bleeding never causes trauma patient, consists of 4 acoustic hypovolemia windows (known as the 4 P's) with the Bradycardia may indicate the presence patient supine. These windows are all, of free intraperitoneal blood EXCEPT: Ecchymosis involving the flanks (Grey Pericardiac Turner sign) or the umbilicus (Cullen Perihepatic sign) indicates retroperitoneal hemorrhage Perisplenic Pelvic Stab wound; 3. Height falls; 4. Airplane crashe; 5. Bullet wound: Peritoneal 1, 3, 4

2, 3, 5 Contraindications to DPL(diagnostic peritoneal lavage) are all the following, 3, 4, 5 EXCEPT: 2, 3, 4 need for laparotomy 1, 2, 3 morbid obesity history of multiple abdominal surgeries Name the most common thoracic injury pregnancy in blunt trauma? evidence of thoracic injury Pericardial tamponade Sternal fracture Complications of DPL(diagnostic Rib fracture peritoneal lavage) may include: Flail chest Bleeding from catheter insertion Hemothorax Wound or peritoneal infection

Injury to intra-abdominal structures A 45-year-old man skidded from the All are wrong road at high speed and hit a tree. Examples of deceleration injuries in All are correct this patient include:

Rib fracture Indications for laparotomy in a patient Hemothorax with blunt abdominal injury include the following: Posterior dislocation of shoulder Signs of peritonitis Aortic arch rupture Shock within admission Aortic valve rupture Suspicion on hepatic laceration Negative FAST(focused assessment Choose life-threatening injuries, which with sonography for trauma) should be identified immediately: 1. Esophageal rupture; 2. Tension All are correct pneumothorax; 3. Massive hemothorax; 4. Cardiac tamponade; 5. Pulmonary Blunt chest trauma can be caused most contusion. oftenly by: 1. Motor vehicle crashe; 2. 2, 3, 5 1, 4, 5 Insertion of a nasogastric tube 1, 3, 5 Tracheostomy 1, 2, 3 Tube thoracostomy 2, 3, 4 An 18-year-old man is brought to the emergency department with a stab A 70-year-old man is brought into the wound just to the right of the sternum emergency department following his in the sixth intercostal space. His blood injury as a passenger in a car crash. He pressure is 80 mm Hg. Faint heart complains of right side chest pain. sounds and pulsus paradoxus are noted. Physical examination reveals a Auscultation of the right chest reveals respiratory rate of 42 breaths per markedly decreased breath sounds. The minute and multiple broken ribs of a initial management of this patient segment of the chest wall that moves should be which of the following? paradoxically with respiration. At thoracentesis signs of tension Insertion of central venous access line pneumothorax absent. Make the Pericardial window diagnosis? Echocardiogram Aorta rupture Analgesics Esophageal injury Aspiration of the right chest cavity Flail chest

Sternal fracture An 18-year-old man presents to the Hemothorax emergency department with a gunshot wound to the left chest in the anterior axillary line in the sixth intercostal A 70-year-old man is brought into the space. His blood pressure is 120/70 emergency department following his mm Hg, pulse - 78 bpm. A sucking injury as a passenger in a car crash. He sound is audible during inspiration. complains of right side chest pain. Immediate management is which of the Physical examination reveals a following? respiratory rate of 42 breaths per minute and multiple broken ribs of a Insertion of central venous access line segment of the chest wall that moves Closure of the hole with sterile dressing paradoxically with respiration. At thoracentesis signs of tension Pleurocentesis pneumothorax absent. What should the Exploratory thoracotomy next step be? Exploratory laparotomy Intercostal nerve blocks

Endotracheal intubation While landing at the end of flight a Massive hemothorax young man develops shortness of Tension pneumothorax breath and rightsided pressure chest pain. He is tall and thin. He has not Pneumothorax previously consulted a doctor. A chest film is likely to show? A 31-year-old man is shot in the back Cardiomegaly of the left chest, and the bullet exits the Hemothorax left anterior chest. The patient's blood pressure is 130/90 mm Hg, respiration Dilated stomach rate is 28 breaths per minute, and pulse Spontaneous pneumothorax is 110 bpm. A chest x-ray reveals hemothorax. A chest tube is inserted Left pleural effusion and yields 800 mL of blood; the first and second hour drainage is 200 mL/h While landing at the end of flight a and 240 mL/h, respectively. What is young man develops shortness of the next step in management? breath and rightsided pressure chest Perform a left thoracotomy pain. He is tall and thin. He has not Insert a Swan-Ganz catheter previously consulted a doctor. The treatment is: Transfuse and observe drainage for another hour Thoracoscopy Collect the blood for autotransfusion Insertion of a nasogastric tube Place a second chest tube Thoracocentesis

Immediate cardiology consult A 31-year-old man is shot in the back Insertion of a chest tube of the left chest, and the bullet exits the left anterior chest. The patient's blood A 26-year-old man is stabbed in the pressure is 130/90 mm Hg, respiration right intercostal space in the rate is 28 breaths per minute, and pulse midclavicular line and presents to the is 110 bpm. A chest x-ray reveals emergency department. On hemothorax. A chest tube is inserted examination, subcutaneous emphysema and yields 800 mL of blood; the first of the right chest wall, absent breath and second hour drainage is 200 mL/h sounds, and a trachea shifted to the left and 240 mL/h, respectively. are noted. What is the most likely In the patient described above the most serious diagnosis? likely cause of the bleeding in the Chest wall laceration patient is injury to which of the following? Hemopneumothorax Left atrium Pulmonary vein 1, 2, 3 Internal thoracic or intercostals arteries Lung parenchyma Which statement is wrong concerning sternal fracture? Pulmonary artery Is associated with high rate of

myocardial contusion and cardiac Which statement concerning 1st and tamponade 2nd ribs fractures is wrong? Is caused by direct blow to front of the Causes pulsus paradoxicus chest May injure subclavian artery/vein Needs large traumatic force Frequently have injury to bronchi Is very uncommon injury Frequently have injury to aorta Is seen in 60% of patients with blunt Require high force trauma

Most oftenly fracture of 11th or 12th A 25-year-old man is shot in the left ribs are associated with: lateral chest. In the emergency department, his blood pressure is Pneumothorax 120/90 mm Hg, pulse rate is 104 beats Injury to bronchi per minute (bpm), and respiration rate is 36 breaths per minute. Chest x-ray Injury to aorta shows air and fluid in the left pleural Damage to underlying abdominal solid cavity. Nasogastric aspiration reveals organs (liver, spleen, kidney) blood-stained fluid. What is the best step to rule out esophageal injury? Flail chest Peritoneal lavage

Esophagoscopy In what cases patients with rib fractures should be treated immediately or Esophagogram with gastrografin monitored carefully: 1. Elderly Insertion of nasogastric tube patients; 2. Patients with concomitant heart diseases; 3. Patients with COPD; Insertion of chest tube 4. Patients with multiple rib fractures; 5. Patients with flail chest. Because of his involvement in a motor 1, 4, 5 vehicle accident, a 23-year-old football 1, 2, 4 player has a chest wall injury. The only abnormal findings on clinical and 3, 4, 5 radiologic examination are a fracture of 2, 4, 5 the left fifth to seventh ribs and a small hemothorax. What should treatment Massive hemothorax include? Flail chest Administration of cortisone to prevent Open pneumothorax callus formation Tension pneumothorax Administration of analgesic medication Cardiac tamponade Insertion of a metal plate to fix the fracture Thoracotomy to treat a small A 40-year-old woman is brought to the hemothorax in the left base emergency department following a car crash in which she was the driver. In Insertion of an intercostal drain to the emergency department, her blood avoid pneumothorax pressure is 80/60 mm Hg, pulse is 128 bpm, and respiratory rate is 36 breaths per minute. She complains of right A 25-year-old woman was stabbed by lower chest wall and severe right upper her boyfriend in the left chest. On quadrant (RUQ) tenderness. Her breath examination, she has a 1-cm stab sounds are questionably diminished. wound just inferior to her left breast in The immediate priority is to perform the mid-clavicular line. There is jugular which of the following? venous distension and breath sounds are completely absent on the left side. Endotracheal intubation She is becoming extremely dyspneic Thoracentesis with an 18-gauge needle and hypoxic. Make the diagnosis. CT scan of chest and abdomen Rupture diaphram Chest x-ray Flail chest Peritoneal lavage Massive hemothorax

Tension pneumothorax In the case of isolated pneumothorax Cardiac tamponade the tube should be placed in the:

Fifth intercostal space, mid axillary line A 45-year-old man was a passenger in Fifth intercostal space, midclavicular a car when he was T-boned by a truck line at a high speed. He is short in breath, complains of severe pain in the chest, Second intercostal space, mid axillary and is hypoxic on the pulse oximeter. line The breath sounds are diminished on Second intercostal space, midclavicular the left and the percussion note is line completely dull. He rapidly becomes tachycardic and hypotensive. Second intercostal space, anterior axillary line and chest is unstable. Treatment for this is: In the case of hemothorax the tube should be placed in the: Temporary extracorporeal circulation to allow fractures to heal. Fifth intercostal space, mid axillary line Avoid intubation, control pain, and Fifth intercostal space, midclavicular perform aggressive bronchial toilette. line Fracture stabiliztion, with towel clips Second intercostal space, mid axillary on ribs and attached to weights line (external fixation). Second intercostal space, midclavicular Once the patient is stable, open rib line fracture reduction and stabilization Second intercostal space, anterior with plates. axillary line Prolonged intubation and ventilatory support until rib fractures heal along A 55-year-old man involved in an with aggressive bronchial toilette. automobile accident is unresponsive and is intubated at the scene. On arrival A 31-year-old man is brought to the in the emergency department, he emergency room following an responds to painful stimulation. His automobile accident in which his chest systolic BP is 60 mm Hg, his HR is struck the steering wheel. Examination 140 bpm, his neck veins are distended, reveals stable vital signs, but the and his breath sounds are absent on the patient exhibits palpable 7 rib fractures left side. Immediate management from the right side and paradoxical should involve which of the following? movement of the right side of the chest. CT scan of head Chest x-ray shows no evidence of Peritoneal lavage pneumothorax or hemothorax, but a large pulmonary contusion is Pericardiocentesis developing. Proper treatment would Insertion of an 18-gauge needle in the consist of which of the following? left second intercostal space No treatment unless signs of Insertion of a central venous line on the respiratory distress develop right side Immediate operative stabilization Stabilization with towel clips During a car crash a young man suffers Stabilization of the chest wall with bilateral multiple fracture ribs. He is sandbags alert and presents shortness of breath. His blood pressure is 100/60 mm Hg Tracheostomy, mechanical ventilation, and positive end-expiratory pressure Subxiphoid window Select the proper intervention for a life- Tube thoracostomy threatening injury of the chest: Cricothyroidotomy LARYNGEAL OBSTRUCTION Endotracheal intubation Occlusive dressing

Tube thoracostomy Select the proper intervention for a life- Subxiphoid window threatening injury of the chest: Cricothyroidotomy PERICARDIAL TAMPONADE Endotracheal intubation Occlusive dressing Tube thoracostomy Select the proper intervention for a life- Subxiphoid window threatening injury of the chest: OPEN Cricothyroidotomy PNEUMOTHORAX Endotracheal intubation Occlusive dressing

Tube thoracostomy Name please indications for immediate Subxiphoid window surgery in patients with chest trauma: Cricothyroidotomy 1. Traumatic disruption with loss of chest wall integrity; 2. A chronic Endotracheal intubation clotted hemothorax; 3. Athelectasis associated with ribs fracture; 4. A Select the proper intervention for a life- massive air leak following chest tube threatening injury of the chest: FLAIL insertion; 5. High rate of blood loss via CHEST the chest tube (>200 ml/h). Tube thoracostomy 2,3,4 Occlusive dressing 2,4,5 Subxiphoid window 1,4,5 Cricothyroidotomy 1,3,5 Endotracheal intubation 1,2,3

Select the proper intervention for a life- Name indications for immediate threatening injury of the chest: surgery in patients after chest trauma: TENSION PNEUMOTHORAX 1. Traumatic disruption with loss of chest wall integrity; 2. Cardiac Occlusive dressing tamponade; 3. Tracheoesophageal fistula; 4. A persistent thoracic duct Mediastinum dislocation to the fistula/chylothorax; 5. Large vessel contralateral side injury. Distended shade of the mediastinum 2, 3, 4 Absence of complete expansion of the 2, 4, 5 lung 1, 3, 5 Abdominal visceral herniation into the chest 1, 2, 5

1, 3, 4 Which statement IS NOT true

сoncerning thoracic trauma? What is the cornerstone in management Large, clotted hemothoraces may of patients with rib fractures? require an operation Diagnostic thoracotomy Tension pneumothoraces are always Ipsilateral chest tube placement life-threatening states Endotracheal intubation Treatment for an open pneumothorax Immediate surgery consists of placing a 3-way occlusive dressing over the wound Pain control Open pneumothorax is caused by lung tissue defect that is larger than the Concerning thoracic trauma which cross-sectional area of the larynx statement IS NOT true? All patients with pneumothorax due to Isolated first and second rib fractures trauma need a tube thoracostomy require surgical therapy First and second rib fractures are What are the primary therapies for caused by excessive energy force pulmonary contusions? 1. Surgical Cardiac tamponade is an indications for debridement; 2. Pain control, iv fluid immediate surgery restriction; 3. Immobilization with a figure-of-eight dressing; 4. Pulmonary Flail chest is associated with toilet; 5. supplemental oxygen. paradoxical motion of the flail segment 2,3,4 Rib fractures do not require surgery 2,4,5

1,2,5 What is the obvious sign of diaphragmatic disruption on chest 1,3,5 radiographs? 1,3,4 Evidence of ipsilateral pneumothorax All conditions belong to blunt cardiac Lung contusion injuries, except:

Atrioventricular stenosis Measurement of serum creatine kinase Cardiac tamponade isoenzyme (creatine kinase-MB) levels is frequently performed in patients with Cardiac chamber rupture possible: Rupture of interventricular septum Tension pneumothorax Rupture of the valves, Flail chest developing

Traumatic asphyxia Which condition CAN NOT occur in Multiple ribs fracture patients with chest trauma? Blunt myocardial injury Main bronchial disruption

Heart contusion What is the initial study of choice in Esophageal ahalasia patients with thoracic blunt trauma, Esophageal rupture suspicious on pneumothorax? Pericardial tamponade Ventilation test CT scaning Trauma is the leading cause of death, Echocardiography morbidity, hospitalization, and 12-lead ECG disability in Americans in the age: The chest radiogram More than 65y

45 - 65y Ultrasound examinations of thoracic 10 - 45y cavities can be performed to confirm 1 - 10y the diagnosis: 0 - 1y Multiple athelectasis Main bronchi disruption What injury DOES NOT compromise Multiple ribs fracture ventilation? Open pneumothorax Acute cardiac tamponade Acute cardiac tamponade Flail chest Painfull ribs fracture Open pneumothorax