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STATE UNIVERSITY OF MEDECINE AND FARMACEUTICS

„NICOLAE TESTEMIŢANU”

«APPROVED»
Vice-Rector for quality assurance and educational integration,
Doctor Habilitatus in Medicine, Professor

__________________________ OLGA CERNEŢCHI


______” _______” 2018

THE SIMPLE AND MULTIPLE CHOICE TESTS

for the EXAM "SURGICAL DISEASES"

MEDICINE 2 FACULTY, 6TH YEAR of study, 2018-2019 ACADEMIC YEAR

(English version, 287 tests)

Head of Surgical Departament №2,


Doctor Habilitatus in Medicine,
Associate Professor ____________________ VLADIMIR CAZACOV

Chişinău, 2018

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1.DISEASES OF THE COLON

1.CM Which of the following statements about surgical anatomy of the colon
and rectum are correct?
A.The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.).
B.The rectosigmoid junction is situated at approximately 15 to 18 cm. from the anus.
C.The rectum is entirely an intraperitoneal organ.
D.The ileocolic, right colic, and middle colic arteries are branches from the inferior mesenteric
artery.
E.The arterial arcade created by communicating vessels at 1 to 2 cm from the mesenteric is
called the artery of Drummond.

2.CM Which of the following statements about surgical procedures on the colon and
rectum are correct?
A.Successful healing of colonic anastomoses depends on the adequacy of the blood supply.
B.In excising part of the colon containing cancer, the lymphatics should be avoided by dividing
the mesentery close to the wall of the colon.
C.Despite complete removal of the colon and rectum, transanal fecal flow can be preserved by
means of an ileal pouch–anal anastomosis.
D.When a colostomy is created it cannot be reversed.
E.Colostomy can be life saving in patients with colonic perforation or obstruction.

3.CM Which of the following statements about colon physiology are correct?
A.Colonic recycling of urea is accomplished by the splitting of urea by bacterial ureases.
B.Fermentation by colonic bacteria may rescue malabsorbed carbohydrates.
C.The preferred fuel of the colonic epithelium is glucose.
D.Absorption by the colonic mucosa is a passive process.
E.Insoluble fibers create bulk in the stool.

4.CM Which of the following statements about diagnostic studies for the colon and rectum
are true?
A.Acetylcholinesterase staining of rectal biopsies is unreliable for the diagnosis of
Hirschsprung's disease.
B.Cinedefecography is useful for detecting “hidden” prolapse or rectal intussusception.
C.A negative osmotic gap in stool is indicative of secretory diarrhea.
D.A colonic transit time study involves serial abdominal x-rays after ingestion of radiopaque
markers.
E.Carcinoembryonic antigen (CEA) is useful for monitoring patients after resection for colon
cancer.

5.CM Which of the following statements about the microbiology of the colon are true?
A.The colon contains no more bacteria than the stomach.
B.The predominant bacteria in the colon are aerobic.
C.Nearly one third of the dry weight of feces is bacteria.
D.Common bacteria in the colon are Bacteroides, Bifidobacterium, and Enterobacterium species.
E.The colonic microflora is relatively stable.

6.CM Which of the following statements about bowel preparation for colon surgery are
true?
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A.Bowel preparation is accomplished by a combination of mechanical cleansing and
nonabsorbable antibiotics.
B.Three days of clear liquids provides sufficient mechanical cleansing.
C.Commercial electrolyte-polyethylene glycol solutions provide mechanical cleansing without
inducing electrolyte imbalance.
D.Non-absorbable antibiotics such as neomycin and erythromycin base are administered the day
before the operation in three doses.
E.Intravenous antibiotics are also administered the day before surgery.

7.CS The test with the highest diagnostic yield for detecting a colovesical fistula is:
A.Barium enema.
B.Colonoscopy.
C.Computed tomography (CT).
D.Cystography.
E.Cystoscopy.

8.CS Which of the following about diverticular disease is not true:


A.It is more common in the United States and Western Europe than in Asia and Africa.
B.A low-fiber diet may predispose to development of diverticulosis.
C.It involves sigmoid colon in more than 90% of patients.
D.Eighty percent of general people develop diverticulitis sometime during their lifetime.
E.It is the most common cause of massive lower gastrointestinal hemorrhage.

9.CS The most common indication for surgery secondary to acute diverticulitis is:
A.Abscess.
B.Colonic obstruction.
C.Colovezical fistula.
D.Free perforation.
E.Hemorrhage.

10.CM Which of the following statements about colorectal polyps are true?
A.Familial juvenile polyposis is associated with an increased incidence of colon cancer.
B.Although the propensity for development of malignancy is related to the size of a neoplastic
polyp, those with mixed tubule-villous histologic appearance are most likely to develop
malignant changes.
C.The loss of a single tumor suppressor gene such as p53 is sufficient to lead to the development
of malignancy in colorectal neoplastic polyps.
D.Endoscopic polypectomy results in a decreased incidence of carcinomas of the colon and
rectum.

11.CS Which of the following statements about familial adenomatous polyposis (FAP) is
true?
A.Inherited in an autosomal-dominant manner, this genetic defect is of variable penetrance, some
patients having only a few polyps whereas others develop thousands.
B.The phenotypic expression of the disease depends mostly on the genotype.
C.Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis
and ileoanal pull-through with rectal mucosectomy.
D.Panproctocolectomy with ileostomy is not appropriate therapy for this disease.

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E.Pharmacologic management of this disease may be appropriate in some instances.

12.CM Which of the following statements about the etiology of chronic ulcerative colitis are
true?
A.Ulcerative colitis is 50% less frequent in nonwhite than in white populations.
B.Psychosomatic factors play a major causative role in the development of ulcerative colitis.
C.Cytokines are integrally involved in the pathogenesis of ulcerative colitis.
D.Ulcerative colitis has been identified with a greater frequency in family members of patients
with confirmed inflammatory bowel disease.
E.Ulcerative colitis is two to four times more common in Jewish than in non-Jewish populations.

13.CS Surgical alternatives for the treatment of ulcerative colitis include all of the
following, except:
A.Colectomy with ileal pouch–anal anastomosis.
B.Left colectomy with colorectal anastomosis.
C.Proctocolectomy with Brooke ileostomy or continent ileostomy.
D.Subtotal colectomy with ileostomy and Hartmann closure of the rectum.
E.Subtotal colectomy with ileorectal anasthomosis.

14.CM The initial management of toxic ulcerative colitis should include:


A.Broad-spectrum antibiotics.
B.6-Mercaptopurine.
C.Intravenous fluid and electrolyte resuscitation.
D.Opioid antidiarrheals.
E.Colonoscopic decompression.

15.CS Which finding suggest the diagnosis of chronic ulcerative colitis as opposed to
Crohn's colitis?
A.Endoscopic evidence of back-wash ileitis.
B.Granulomas on biopsy.
C.Anal fistula.
D.Rectal sparing.
E.Cobblestone appearance on barium enema.

KEY «Diseases of the large intestine»


1-BE,2-ACE,3-ABE,4-BCDE,5-CDE,6-ACD,7-E,8-D,9-A,10-AD,11-C,12-ACDE,13-B,14-
AC,15-A.

2.PLEUROPULMONARY PATHOLOGIES

1.CM Which of the following approaches are currently acceptable for the management of
spontaneous pneumothorax?
A.Chest tube replacement alone for the patient with a first episode.
B.Operation on presentation for any patient with a first episode.
C.Video-assisted thoracic surgery (VATS) bleb excision and pleurodesis for recurrent
pneumothorax on the same side.
D.Thoracotomy with bleb excision and pleurodesis for unilateral recurrent pneumothorax.
E.Operation after a first episode in an airline pilot.

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2.CM Which of the following statements about lung abscess are true?
A.Pyogenic lung abscess occurs most frequently in the lower lobe of the left lung.
B.Anaerobic bacteria are commonly present in pyogenic lung abscess.
C.Operation is usually required to eradicate a pyogenic lung abscess.
D.Penicillin is the treatment of choice for lung abscess.
E. Pyogenic lung abscess occurs only after blunt trauma of the chest.

3.CM Which of the following correctly describe a patient with spontaneous pneumothorax?
A.The patient is almost always elderly and debilitated.
B.An unsuspected primary or metastatic lung tumor may be present.
C.The administration of supplemental oxygen is of little benefit to the patient.
D.The patient should always be treated with an intercostal tube and closed pleural drainage.
E.Video-assisted thoracic surgery (VATS) should be considered for persistent air leak in patients
with secondary spontaneous pneumothorax.

4.CM Which of the following statements about spontaneous pneumothorax (PSP) are
correct?
A.The risk of recurrence after resolution of the first episode of PSP or secondary spontaneous
pneumothorax (SSP) is 35% to 45%.
B.Patients with PSP are typically tall, thin, young adult males with a history of smoking.
C.Secondary spontaneous pneumothorax is associated with family history in 10% of cases.
D.For bleb resection and pleurodesis thoracoscopic thoracotomy and open thoracotomy provide
similar cure rates for patients with primary spontaneous pneumothorax.
E.Causes of secondary pneumothorax include trauma and iatrogenic needle puncture.

5.CS Which of the following would be the least appropriate in the management of acute
suppurative mediastinitis?
A.Wide débridement.
B.Irrigation under pressure.
C.Topical antibacterials.
D.Long-term systemic antibacterials.
E.Closure with muscle flaps.

6.CS Each of the following is appropriate for managing acute suppurative mediastinitis
except:
A.Alloplastic material and skin flaps.
B.Rectus abdominis muscle flaps.
C.Omentum.
D.Pectoralis major muscle flaps.
E.Rigid internal fixation.

7.CS The principal etiologic factor in lung abcess and gangene is:
A.Bronchogenic.
B.Trauma.
C.Bronchiectatic disease.
D.Septic embolism.
E.Adjacent purulent focuses.

8.CM Emergency treatment of lung edema consists in:


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A.Secret aspiration.
B.Oxygenotherapy with positive expiratory pressure 10-15 cm H2O.
C.Intubation.
D.1/3 of dose of digoxyn for digitalisation (if not yet digitalisated and cardiac insufficiency is
present).
E.Vitaminotherapy.

9.CS Wich microflora more frequently provokes developing of pulmonary gangrene?


A.Protozoas.
B.Fungs.
C.Aerobic gram-positive microflora.
D.Aerobic gram-negative microflora.
E.Anaerobic nonclostridial microflora.

10.CS The most frequent localization of aspiration lung abcesses is:


A.Basal anterior segments of inferior lobes.
B.Lateral segments of inferior lobes.
C.Apical segments of superior lobes.
D.Anterior segments of superior lobes.
E.Posterior segments of lung /predominantly superior lobes/.

11.CM The causes of chronisation of acute empyema are:


A.Late treatment.
B.Inadequate draining of pleural cavity.
C.Agresive and resistant to antibiotics microflora.
D.Immune reactivity.
E.Hereditary factors.

12.CM Which affirmations regarding pulmonary anatomy are correct?


A.Left lung consists of 2 lobes.
B.Right lung consists of 3 lobes.
C.Lungs consists of 5 lobes.
D.Right lung consists of 2 lobes.
E.Right lung has the middle lobe.

13.CM Segments of the lobes of the lung are following:


A.Superior lobe of right lung consists of 3 segments /1,2,3/.
B.Middle lobe - 1 segment /4/.
C.Right inferior lobe - 5 segments /6,7,8,9,10/.
D.Left superior lobe - 5 segments /1,2,3,4,5/.
E.inferior left lobe - 4 segments /6,8,9,10/.

14.CM Hemoptysis may occure in following situations:


A.Bronchial sarcoma.
B.Bronchial asthma.
C.Bronchiectasis.
D.Pulmonary infarct.
E.Pulmonary tuberculosis.

15.CM Hemostasis in pulmonary gangrene with repeated lung hemorrhage is performed


by:
A.Bronchoscopy with lavage.
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B.Bronchoscopy with bronchus obstruction.
C.Administration of spasmolitics.
D.Thoracopneumotomy with vessels suturing.
E.Pulmonary resection.

16.CM The bronchial wall includes the following layers:


A.Mucosa and proper membrane
B.Muscular layer
C.Submucosal layer
D.Adipose-cellular layer
E.Fibrous-cartilagious and adventitious

17.CM Which of the following respiratory volumes are correct?


A.Inspiratory reserve volume 1500-2000 ml
B.Expiratory reserve volume - 500 ml
C.Residual volume - 1000-1300 ml
D.Respiratory volume - 400-500 ml
E.Minute respiratory volume - 5000-10000 ml

KEY «Pleuropulmonary Diseases»


1-ACDE,2-BD,3-BE,4-ABD,5-D,6-A,7-A,8-ABD,9-E,10-E,11-ABDE,12-ABCE,13-
ACDE,14-ACDE,15-ABDE,16-ABCE,17-ACDE.

3.PATHOLOGIES OF THE THYROID GLAND

1.CS Which of the following would be the least appropriate in the management of acute
suppurative mediastinitis?
A.Wide débridement.
B.Irrigation under pressure.
C.Topical antibacterials.
D.Long-term systemic antibacterials.
E.Closure with muscle flaps.

2.CS Each of the following is appropriate for managing acute suppurative mediastinitis,
except:
A.Alloplastic material and skin flaps.
B.Rectus abdominis muscle flaps.
C.Omentum.
D.Pectoralis major muscle flaps.
E.Rigid internal fixation.

3.CM Clinical features suggestive of myasthenia gravis include all of the following except:
A.Proximal muscle weakness.
B.Diplopia.
C.Sensory deficits of the extremities.
D.Dysphagia.
E.Intermitent claudication.

4.CS When progressive enlargement of a multinodular goiter causes symptomatic tracheal


compression, the preferred management in otherwise good-risk patients is:
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A.Iodine treatment.
B.Thyroid hormone treatment.
C.Surgical resection of the abnormal thyroid.
D.Radioactive iodine treatment.
E.Immunosupresive treatment.

5.CS The most precise diagnostic screening procedure for differentiating benign thyroid
nodules from malignant is:
A.Thyroid ultrasonography.
B.Thyroid scintiscan.
C.Fine-needle-aspiration biopsy (FNAB).
D.Thyroid hormone suppression.
E.Laringoscopy.

6.CS Which is the preferred operation for initial management of a thyroid nodule, that is
considered suspicious for malignancy by fine-needle-aspiration biopsy (FNAB):
A.Excision.
B.Partial lobectomy.
C.Total lobectomy and isthmusectomy.
D.Total thyroidectomy.
E.Enucleation of the nodule.

7.CS All of the following are components of the MEN type 2B syndrome, except:
A.Multiple neuromas on the lips, tongue, and oral mucosa.
B.Hyperparathyroidism.
C.Medullary carcinoma of thyroid.
D.Pheochromocytoma.
E.Gastrinoma.

8.CM Which of the following statements about hypoparathyroidism are true:


A.Is most commonly encountered as a postviral syndrome.
B.Can be associated with marked hypocalcemia after parathyroidectomy in patients with bone
disease.
C.Can cause anxiety, depression, or confusion.
D.Can cause physical signs such as Chvostek's and Trousseau's signs.
E.Is treatable acutely with intravenous calcium salts and chronically with oral calcium and
vitamin D.

9.CS Which steatment about Addisonian crisis, or acute adrenocortical insufficiency, is


true:
A.Occurs only in patients with known adrenal insufficiency or in those receiving long-term
supraphysiologic doses of exogenous steroids.
B.Can mimic an acute abdomen with fever, nausea and vomiting, abdominal pain, and
hypotension.
C.May cause electrolyte abnormalities, including hypernatremia, hypokalemia, hypoglycemia,
and hypercalcemia, as well as eosinophilia on peripheral blood smear.
D.Should be diagnosed with the rapid ACTH stimulation test before steroid replacement is
instituted.
E.May be effectively treated with intravenous “stress-dose” glucocorticoid and mineralocorticoid
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replacement.

10.CM Which of the following statements about the synthesis of thyroid hormone and its
physiology are true?
A.The iodine utilized in hormone synthesis is derived principally from dietary sources.
B.The role of thyroid-stimulating hormone (TSH) in thyroid physiology is limited to regulation
of the release of thyroid hormone in plasma.
C.Enough thyroxine (T4) is stored in the normal thyroid to provide a euthyroid state for 3 weeks
despite absence of iodine intake.
D.The regulation of thyroid function involves pituitary, but not hypothalamic, input.
E.Thyroid-stimulating hormone (TSH) is produced by suprarenal gland in stress situations.

11.CS Hyperthyroidism can be caused by all of the following pathologies, except:


A.Graves' disease.
B.Plummer's disease.
C.Struma ovarii.
D.Hashimoto's disease.
E.Medullary carcinoma of the thyroid.

12.CS The most common cause of goitrous hypothyroidism in adults is:


A.Graves' disease.
B.Riedel's thyroiditis.
C.Hashimoto's disease.
D.de Quervain's thyroiditis.
E. Plummer's disease.

13.CM Which of the following are surgical indications for thyroidectomy in Grave’s
disease?
A.Ocular involvement.
B.Symptomatic large goiter.
C.Women of childbearing age.
D.Concomitant thyroid nodule.
E.Cosmetic considerations.

14.CS Which of the following is the principal blood supply to the parathyroid glands?
A.Superior thyroid arteries.
B.Inferior thyroid arteries.
C.Thyroidea ima arteries.
D.Parathyroid arterial branches directly from the external carotid artery.
E.Highly variable.

15.CM Which of the following pharmacologic agents can be used in the treatment of
thyrotoxicosis to block the production of thyroid hormone?
A.Propylthiouracil.
B.Propranolol.
C.Methimazole.
D.Carbimazole.
E.Iodine.

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16.CM Which of the following statements regarding fine needle aspiration cytology of a
thyroid nodule are true?
A.It differentiates neoplastic and non-neoplastic nodules in most cases.
B.It does not allow differentiation of papillary, medullary and anaplastic carcinoma.
C.It cannot differentiate malignant and benign follicular or Hürthle cell neoplasms.
D.It is not recommended when a patient has a history of head and neck radiation.
E.It is high recommended in cysts of the neck.

17.CM Hyperthyroidism results from all of the conditions noted below. Which of the
following commonly require surgical management?
A.Graves’ disease.
B.Struma ovarii.
C.Functioning metastatic thyroid carcinoma.
D.Toxic diffuse goiter.
E.Single toxic thyroid nodule.

18.CM Which of the following statements regarding thyroid physiology are true?
A.Normally about 20% of T3 is secreted directly from the thyroid gland.
B.The thyroid gland is the only endogenous source of T4.
C.Excess thyroid hormone results in an increase in the number of ATP-dependent sodium pumps
on the cell membrane.
D.The majority of thyroid hormone in circulating plasma is bound to albumin, thus limiting the
availability of the metabolically active form.
E.Thyroid-stimulating hormone (TSH) decrease the levels of T3 and T4 in blood stream.

19.CS Which is the definitive treatment of choice for toxic multinodular goiter?
A.Total thyroidectomy.
B.Bilateral subtotal thyroidectomy.
C.Unilateral total lobectomy on the side of dominant disease.
D.131I treatment.
E. Thyroid hormone treatment

20.CM Which of the following are causes of Cushing syndrome?


A.Posterior pituitary adenoma.
B.Adrenal hyperplasia.
C.Small cell lung carcinoma.
D.Pheochromocytoma.
E.Adrenal carcinoma.

21.CS The goiter situated in mediastinum is considered as:


A.Normotopic.
B.Ectopic.
C.Aberrant.
D.Mediastinal.
E.Sublingual.

22.CS Exophtalmus at one’s patient with goiter is a result of the compression of:
A.Internal jugular vein.
B.Internal carotid artery.
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C.Recurrent nerve.
D.Cervical simpathecus.
E.None of above-mentioned.

23.CS Normal radioiodine uptake in 2 hours is:


A.10%.
B.20%.
C.30%.
D.50%.
E.70%.

24.CM Proteic iodine may be decreased in following situations:


A.Hypothyroid.
B.Hyperthyroid.
C.Liver cirrhosis.
D.Nephrotic syndrome.
E.Cardiac insufficiency.

25.CM Which of the following tests could be used for recording of peripheral consumption
of thyroid hormones:
A.Electrocardiogram
B.Basal metabolism
C.Serum cholesterol
D.Reactive C Protein (CRP)
E.Axillary reflexogram

26.CM Which of the following manifestations could be a result of overflow of thyroid


hormones in peripheral blood:
A. Cardiothyreosis
B. Thyreotoxic enteropathy
C. Diabetes mellitus
D. Renal insufficiency
E. Hepatosis

KEY «Disease of the Thyroid Gland»


1-D,2-A,3-CE,4-C,5-C,6-C,7-B,8-BCDE,9-B,10-AC,11-E,12-C,13-BCD,14-B,15-ACDE,16-
ACD,17-ADE,18-ABC,19-B,20-BCE,21-B,22-D,23-B,24-ACD,25-ABCE,26-ABCE.

4.GASTRORESECTIONAL SYNDROMES

1.CS All of the following are complications of peptic ulcer surgery, except:
A.Duodenal stump blowout.
B.Dumping.
C.Diarrhea.
D.Delayed gastric emptying.
E.Steatorrhea.

2.CS The presentation of Zollinger-Ellison syndrome includes all of the following, except:
A.Hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN 1) syndrome.
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B.Diarrhea.
C.Migratory rash.
D.Jejunal ulcers.
E.Duodenal ulcers.

3.CS All affirmations about the dumping syndrome are true, except:
A.Symptoms can be controlled with a somatostatin analog.
B.Diarrhea is always part of the dumping syndrome.
C.Flushing and tachycardia are common features of the syndrome.
D.Separating solids and liquids in the patient's oral intake alleviates some of the symptoms of the
syndrome.
E.Early postoperative dumping after vagotomy often resolves spontaneously.

4.CS Which is the endoscopic finding, associated with the highest incidence of rebleeding
in patients with bleeding duodenal ulcers:
A.Visible vessel.
B.Cherry-red spot.
C.Clean ulcer bed.
D.Duodenitis.
E.Shallow, 3-mm. ulcer.

5.CS All of the following measures have been recommended for control of acid secretion in
patients with Zollinger-Ellison syndrome, except:
A.Antrectomy.
B.Highly selective vagotomy.
C.Total gastrectomy.
D.Vagotomy and pyloroplasty.
E.Medical therapy with Prilosec (omeprazole).

6.CS All of the following contribute to peptic ulcer disease, except:


A.Cigarette smoking.
B.Nonsteroidal anti-inflammatory drugs.
C.Helicobacter pylori.
D.Gastrinoma.
E.Spicy foods.

7.CM Which are the major stimulants of acid secretion by the gastric parietal cells:
A.Histamine.
B.Prostaglandin E2.
C.Acetylcholine.
D.Gastrin.
E.Norepinephrine.

8.CM Which are the methods of examination, used for determining the cause of
postoperative peptic ulcer?
A.Esophagogastroduodenoscopy.
B.Biopsy.
C.Serum gastrin.
D.Irigografia.
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E.Tests to evaluate the gastric secretion.

9.CM Which of the following approaches are included in the treatment of postoperative
peptic ulcer:
A.H2 –blockators.
B.Excluding the remedies with toxic effect to gastrointestinal mucosa.
C.Endoscopic methods.
D.Antiviral drugs.
E.Reoperation.

10.CS Which of following clinical situations after stomach surgery sometimes need near
total gastrectomy?
A.Early dumping syndrome.
B.Late dumping syndrome.
C.Postsurgical gastroparesis.
D.Alcaline reflux gastritis.
E.Postvagotomic diarrhoea.

11.CM Which of the following surgical interventions are most effective in treatment of
dumping syndrome:
A.Reduodenisation.
B.Vagotomy.
C.Inversion of small intestine segment.
D.Reduodenisation with reduction of evacuation throu gastric stump.
E.Gastrectomy.

12.CS Which is the operation of choice in gastro-jejuno-colic fistulas:


A.Double resection.
B.Triple resection with gastrojejunal and colo-colonic anasthomosis.
C.Double-stage operation.
D.Triple-stage operation.
E.Total gastrectomy.

13.CS First of all the frequency of postoperative peptic ulcer is determined by:
A.Age of the patient.
B.Anamnesis of the disease.
C.Ulcer’s localization and size.
D.Ulcer’s complications at the time of operation.
E.Type of primary operation.

14.CS After what type of operation for duodenal ulcer the appearance of postoperative
peptic ulcer is less possible?
A.Gastroenteroanasthomosis.
B.Partial gastrectomy.
C.Trunkular vagotomy with draining operation.
D.Trunkular vagotomy with antrumectomy.
E.High selective vagotomy.

KEY «Gastroresectional Syndromes»


1-E,2-C,3-B,4-A,5-A,6-E,7-ACD,8-ABCE,9-ABCE,10-C,11-ACD,12-B,13-E,14-D.

5. PORTAL HYPERTENSION (SC)


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1.SC. Fibroscopy reveals the third grade esophageal varices which bleed, the gastric
mucosa without ulceration. Name the first method of hemostasis:
A.Esophageal varices ligation.
B.The resection of inferior esophagus with gastroesophageal anasthomosis.
C.Plugging with Blackmore probe, intravenous pituitrine.
D.Azygo-portal deconnection.
E.Spleno-renal anasthomosis.

2.SC. What is the most safest and objective method of diagnosing upper digestive
haemorrhage?
A.Fibroesophagogastroduodenoscopy.
B.Barium radiography.
C.Scintigraphy.
D.Angiography.
E.Diagnostic laparoscopy.

3.SC. What is the most useful method in the treatment of cirrhous portal hypertension,?
A.Drainage of Wirsung.
B.Truncal vagotomy.
C.Lien transplantation.
D.Azygo-portal deconection.
E.Left spleno-pancreatectomy.

4.SC. What is the most common cause of portal hypertension?


A.Congestive pericarditis.
B.The Budd-Chiari syndrome.
C.Liver cirrhosis with intrahepatic dam.
D.Quadrifurcation of the portal vein.
E.The lienal vein thrombosis.

5.SC.Which gradation is used to assess the liver function in cirrhotic patients with portal
hypertension:
A.Ranson score.
B.Algover index.
C.Apgar score.
D.Child-Pugh cryterion.
E.Glasgow score.

6.SC. That is the indication for Tanner surgery in patients with portal hupertension:
A.Encefalopathy.
B.Refractory ascites to medical treatment.
C.Haemorrhagy through rupture of esophageal varices.
D.Haemorrhagy through rupture of colonic varices.
E.Haemorrhagy through rupture of rectal varices.

7.SC.What is the wrong affirmation about the prehepatic form of portal hypertension?
A.Occurs more frequently in children.
B.Causes intermittent claudication.
C.Distal spleno-renal anastomosis reduces portal pressure.
D.Is caused by the development of congenital anomalies of the portal vein.
E.Causes the onset of digestive haemorrhage.

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PORTAL HYPERTENSION (MC)

8.MC. Cirrhogenic portal hypertension has the following complications, with the
exception of:
A.Jaundice.
B.Haemorrhage of esophageal varices.
C.Lower digestive haemorrhage.
D.Exophthalmia.
E.Encephalopathy.

9.MC. List the causes of digestive bleeding in the context of portal hypertension:
A.Rupture of esophageal varices.
B.Portal-hypertensive gastropathy.
C.Barrett’s esophageal epithelial dysplasia.
D.Breaking of the secondary hemorrhoids.
E.Breaking gastric varicose veins.

10.MC. List the major risks of using the Blackmore probe:


A.Tracheal aspiration (Mendelson’s syndrome).
B.Rupture of the esophageal wall.
C.Paradoxical breathing.
D.Rupture of large intrathecal vessels.
E.Heart rhytm disorders, angina pain.

11.MC Which of the following surgeries does rarely lead to hepatic encephalopathy?
A.The endo-lateral porto-cava anasthomosis.
B.The lateral-lateral porto-cava anasthomosis.
C.The proximal spleno-renal anasthomosis.
D.Distal spleno-renal anasthomosis (Warren).
E.Mesenterico-caval anasthomosis.

12.MC. Which of the following therapeutic modalities can be used to stop bleeding from
esophageal varices?
A.Endoscopic sclerotherapy.
B.Thoracic esophagus resection with esophagoplasty.
C.Sengstaken-Blackmore probe.
D.Vagotomy with pyloroplasty.
E.Elasting ring ligature.

13.MC. What are the goals of surgical treatment in portal hypertension?


A.Reducing gastric secretion.
B.Volumatic and hematic rebalancing.
C.Reducing portal hypertension.
D.Control of acute gastroesophagial variceal hemorrhage.
E.Reducing the risk of relapse of variceal bleeding.

14.MC. The Child classification criteria for the assessment of liver function include:
A.Bilirubin and serum albumin.
B.Ascites, neurological disorders.
C.Transaminases, urea, prothrombin.
D.Glucose, transferase
E.The state of nutrition.
15
15.MC. Which of the following statements about the porto-caval shunt in emergency cases
are
true?
A.A prompt haemostasis is obtained.
B.Should be followed by liver transplantation.
C.A selective type shunt is preffered.
D.Has no contraindications.
E.Postoperative mortality is low.

16.MC. The spleen response to portal hypertension, regardless of the obstacle site, is:
A.Splenomegaly.
B.Hypervascularization with increased portal pressure through hiperaflux.
C.Immunological hypersplenism.
D.Splattering of the spleen.
E.The occurrence of arterio-venous lienal fistulas

17.MC.Which of the following conditions can cause a pre-hepatic portal obstruction?


A.Atresia of venous portal shaft.
B.Phlegm of the shaft of portal vein.
C.Thrombosis of the spleno-portal venous spindle.
D.Banti syndrome.
E.Hepatic fibrosis.

18.MC.Which of the conditions below may cause intraheptatic portal obstruction?


A. Pancreatic disorders.
B. Primitive splenomegaly.
C. Liver tumour.
D. Liver cirrhosis.
E. Budd-Chiari syndrome.

19.MC. The main causes of the suprahepatic portal obstruction are?


A.Budd-Chiari syndrome.
B.Constrictive pericarditis.
C.Thrombosis of the lienal vein.
D.Hepatic fibrosis.
E.Liver cirrhosis.

KEY« Portal Hypertension »


1C; 2A; 3D; 4C; 5D; 6C; 7B; 8AD; 9ABDE;10ABE; 11DE; 12ACE; 13CDE; 14
ABE;15AC; 16ABC;17ABC;18CD;19AB.

6.SURGICAL DISEASES OF THE LIVER (SC)

1.CS. Intermediate host for Echinococcus granulosus may be any of the one’s listed,
except:
A.Sheep.
B.Pig.
C.Human.
D.Dog.
E.Horse.

16
2.CS.Complications of the Hydatid disease of the liver are the following, except:
A.The rift in the pleura, bronchi.
B.The rupture in the abdominal cavity.
C.The rupture in the biliary pathways.
D.Pileflebitis.
E.Suppuration.

3.CS.What statement concerning the liver hydatid cyst is incorrect:


A.Usually it’s unique.
B.It is most commonly located in the left lobe of the liver.
C.Serology is often positive for hydatidosis.
D.It may erupt in biliary ways, pleura, abdominal cavity.
E.Surgery is necessary.

4.CS.The most common benign tumor of the liver is represented by:


A.Liver lipoma.
B.Liver hemangioma.
C.Liver cystadenoma.
D.Liver leiomyoma.
E.Liver fibroma.

5.CS.What statement concerning the hepatic alveolar echinococcosis is true:


A.Ultrasound shows a single cystic image.
B.It is transmitted primarily through foxes.
C.It is often met especially in Moldova and southern Ukraine.
D.It is caused by Echinococcus granulosus.
E.Surgical treatment consists in the cysts liner.

6.CS. What statement, related to non parasitic liver cyst, is incorrect:


A.It has acute onset.
B.It can appear after trauma.
C.It is often without symptoms.
D.Ecoguided punction is the optimal treatment solution.
E.Some complications may appear in evolution.

7.CS. The treatment of choice in hydatid cyst of liver is:


A.Chemotherapy.
B.Surgery.
C.Actinic therapy.
D.Hormone therapy.
E.Antibiotic therapy.

8.CS.When is indicated marginal hepatic resection in liver hydatidosis:


A.In all kinds of hydatid cysts what ever their evolutionary stage.
B.In suppurated hydatid cyst with liver piosclerosis.
C.In hepatic hydatid cyst complicated with biliary fistula.
D.Eruption in the abdominal cavity.
E.In hepatic hydatid cyst located marginally.

SURGICAL DISEASES OF THE LIVER (MC)

17
9.MC. Which of the following statements, referring to the alveolar echinococcosis of the
liver, are false:
A.It has a slow evolution.
B.The diagnosis is experiencing difficulties.
C.It’s a malignant tumor.
D.It has an invasive growth and a gloomy prognosis.
E.Optimal treatment solution is peritoneal lavage-puncture.

10.MC. Which kind of surgeries can be practiced in the case of giant subcapsular
hematoma without liver’s rupture:
A.Hematoma puncture and evacuation.
B.Capsule incision and hematoma evacuation.
C.Hematoma evacuation and diathermocoagulation to the respective liver zone.
D.Drainage of peritoneal cavity.
E.Abstention from any maneuvers, and closing abdominal cavity.

11.MC.Which of the statements, relating to the haemobilia, are false:


A.Liver colic.
B.Jaundice.
C.Bleeding in digestive tract.
D.Hepatomegaly.
E.Hematochezia.

12.MC. Which are the surgical modalities in the treatment of non parasitic liver cysts:
A.Cyst fenestration.
B.Liver resection.
C.Cysto-dygestive anasthomosis.
D.Azygo-portal devascularization.
E.Porto-systemic transjugular shunt.

13.MC. Which of the following can be causes of the haemobilia?


A.Liver trauma.
B.Liver tumor in decomposition.
C.Gallstones.
D.Budd-Chiari syndrome.
E.Mirizzi syndrome.

14.MC.Which of the following symptoms are characteristic for the hemobilia:


A.Liver colic.
B.Jaundice.
C.Bleeding in the digestive tract.
D.Hepatomegaly.
E.Hematochezia.

15.MC.Which are the methods of diagnosis of haemobilia:


A.Fibrogastroduodenoscopy.
B.Echography.
C.Scintigraphy.
D.Computed tomography.
E.Selective angiography.

16.MC.Which organs are more commonly affected by Echinococcus granulosus?


18
A.Lungs.
B.Retina.
C.Pancreas.
D.Osteo-articular system.
E.Liver.

17.MC. Choose the drugs solutions used to process residual cavity of a hepatic hydatid
cyst:
A.Formaldehyde, peroxide.
B.Clorurat hipertonic serum of 20% concentation.
C.5 – Fluoruracil.
D.Octreotide.
E.Brilliant green.

18.MC.The clinical manifestations of suppurated hepatic Hydatid cyst are:


A.Dyspnea, cyanosis.
B.Fever, pain, shivers.
C.Impaired pulmonary ventilation.
D.Septic condition.
C.Haemobilia.

19.MC.Which statements about hepatic hydatid cyst, complicated with biliary fistula,
are true:
A.Parasite migration throught gallbladder main path.
B.The appearance of hepatic secretions in the remaining cavity.
C.The presence of clear fluid in the remaining cavity.
D.The presence of the turbid, viscous liquid.
E.Paradoxical breathing.

KEY« Liver Diseases»


1D; 2D; 3B; 4B; 5B; 6A; 7B; 8E; 9CE; 10ABC; 11ABD; 12ABC; 13AB; 14CE; 15AE;
16AE; 17AB; 18BD; 19AB

7. SURGICAL PATHOLOGY OF THE MEDIASTINUM (SC)

1.SC. The following radiological methods are used to diagnose the mediastinal tumors and
cysts, excepting:
A.Radioscopy and radiography in two projections.
B.Computed tomography.
C.Pneumomediastinography.
D.Angiography.
E.Cystoscopicurography.

2.SC.Which of the listed investigations confirms the histogenesis of the mediastinal tumors?
A.Magnetic resonance imaging (MRI).
B.Computed tomography.
C.Mediastinography.
D.Morphological test.
E.Pneumomediastinography.

3.SC.Mediastinal tumors of embryonic origin are, excepting:


A.Dermoid cysts and teratomas.
19
B.Primitive seminomas.
C.Benign and malignant mesenchimal tumors.
D.Primitive chorioepithelioma.
E.Chordoma.

4.SC.Mediastinal cysts of embryonic origin are, except:


A.Pleuropericardial mesothelial cysts.
B.Bronchogenic cysts.
C.Gastroenterogencysts.
D.Parasophageal cysts.
E.Meningocele.

5. SC. The most frequent complication of mediastinal primitive cysts is:


A.Malignant degeneration.
B.Compression of adjacent organs.
C.Haemorrhage.
D.Perforation.
E.Inflammation and suppuration.

6. SC. Which affirmation regarding the treatment of benign tumors and mediastinal cysts
is correct?
A.Observation in dynamics.
B.Surgical treatment.
C.Radiotherapy.
D.Chemotherapy.
E.Combined treatment.

7. SC. The most effective method of treatment in mediastinal malignant tumors is:
A.Surgical treatment.
B.Radiotherapy.
C.Chemotherapy.
D.Radiotherapy and chemotherapy.
E.Combined surgical and chemotherapeutic treatment.

8.SC.The main method in the treatment of primitive malignant lymphomas of the


mediastinum is:
A.Surgical treatment.
B.Radiotherapy.
C.Chemotherapy.
D.Surgical and chemotherapeutic treatment.
E.Combined chemoradiotherapeutic treatment.

SURGICAL PATHOLOGY OF THE MEDIASTINUM(MC)


9.MC. Which of the following statements about the anatomy of the mediastinum are
correct:
A. The posterior mediastinum includes: trachea, esophagus, vagal nerves, azygos and
hemiazygos veins, lymph nodes
B. In the superior mediastinum are included: proximal segments of the trachea, esophagus and
thymus, aortic arch and and its branches, the thoracic lymphatic channel.

20
C. In the posterior mediastinum are located: the esophagus, the thoracic segment of the
descendent aorta; the thoracic lymphatic channel, sympathetic and parasympathetic nerves,
lymph nodes.
D. In the middle mediastinum are located: pericardium, heart, trachea bifurcation and main
bronchus, pulmonary arteries and veins, lymph nodes of the trachea bifurcation.
E. In the anterior mediastinum between pericardium and sternum are located: thymus, vagus
nerves, thoracic lymphatic channel, esophagus.

10.MC Which of the listed investigations are used to determine the location of tumors and
cysts
in the mediastinum?
A.Radiological methods.
B.Ultrasonic biolocation.
C.Magnetic resonance imaging (MRI).
D.Instrumental methods of diagnosis.
E.Morphological investigations.

11.CS. Which statement is true of posterior mediastinal masses?


A. They are commoner in children than adults
B. They are more likely to be malignant in adults
C. They commonly present with spinal cord compression
D. They usually secrete catecholamines
E. They cause narrowing of the paravertebral stripe on a chest X‐ray

12.MC.Primary mediastinal tumors and cysts are, excepting:


A.Thymic tumors.
B.Meningocele.
C.Hydatid cyst.
D.Metastatic tumors.
E.Hodgkin's disease.

13.MC.Which are the absolute contraindications for surgical intervention in malignant


mediastinal tumors:
A.Remote metastase.
B.Superior vena cava syndrome.
C.Laryngeal paralysis (persistent).
D.Dysphagia.
E.Algic syndrome.

14. MC.Which are the possible causes of emphysema of the mediastinum:


A.Tracheal rupture.
B.Esophagus rupture.
C.Bronchial rupture.
D.Stomach rupture.
E.Pericardial rupture.

15.MC.Which forms of non-specific acute mediastinitis are primitive?


A.Mediastinitis caused by the mediastinal trauma without harming the mediastinal organs.
B.Mediastinitis caused by the mediastinal trauma with harming the mediastinal organs.
C.Mediastinitis caused by mediastinal trauma with pleural and lung damage.
D.Mediastinitis succeeding a source in the neighborhood.
E.Metastatic mediastinitis (succeeding generalized infections).
21
16.MC.Which syndromes and symptoms are characteristic for acute mediastinal disease?
A.Retrosternal pain.
B.Diarrhoea with blood and mucous membranes.
C.Dysphagia.
D.Breathlessness.
E.The instability of hemodynamics.

KEY «Pathologies of the Mediastinum»


1E; 2D; 3C; 4E; 5E; 6B; 7E; 8E; 9BCD; 11A; 12BCD; 13ABC; 14ABC; 15ABC; 16ACDE.

8.CONGENITAL AND AQUIERED CARDIOPATIES (SC)

1.SC.The following statements regarding the risk factors in the development of


cardiovascular pathology are true, except:
A.Hypertension.
B.The high level of HDL cholesterol (high density cholesterol fraction).
C.Age.
D.Male gender.
E.Diabetes mellitus.

2.SC.At which level is localized the most rare atherosclerotic conditions:


A.The abdominal aorta.
B. Intramural coronary arteries.
C.Leg arteries.
D.Brain arteries.
E.External coronary arteries.

3.SC.For radionuclear angiography, the following statements are true, except:


A.The procedure performed for the first time allows the left and right ventricle to be studied.
B.The term - ejection fraction, is not based on geometric parameters.
C.Due to the high resolution properties, the first-time procedure allows the morphological
valvular study.
D.Radionuclear angiography may be useful in detecting coronary heart disease caused by effort.
E.This investigation may be useful for the prognosis of patients who have had infarction

4.SC.Which of the following congenital heart diseases is at risk of septic endocarditis:


A.Persistent arterial duct.
B.Tetralogy of Fallot.
C.Subvalvular aortic stenosis.
D.Interatrial septal defect.
E.Interventricular septal defect.

5.SC.One of the most important clinical investigations for the differential diagnosis
between the foramen ovale (ostium secundum) of the interatrial septum and ostium
primum is:
A.Diffusion of the II sound.
B.Prominence of the left sternal wall at palpation.
C.Mezodiastolic sound in the lower left sternum.
D.Incomplete block of the left branch of Hiss bundle.
E.Deviation of the heart axis to the left.
22
6.CS Which of following affirmation is not characteristic for aortic coarctation:
A.More commonly occurs in men.
B.Frequently is associated with Turner syndrome.
C.Frequently associated with the aneurysm in the circle of Willis.
D.Frequently associated with the biluminal aortic valve.
E.Increases the risk of aortic rupture in the first trimester of pregnancy.

7.SC. Which affirmation about persistent arterial duct is false:


A.It is more common in women.
B.More frequently occurs in newborns with mothers who have had rubella in the first trimester
of pregnancy.
C.More frequently occurs in newborns with mothers who underwent toxoplasmosis in the first
trimester of pregnancy.
D.More often occurs in premature births.
E.More often in newborns at high altitude conditions.

CONGENITAL AND AQUIERED CARDIOPATIES (MC)

8.MC. Patent Ductus Arteriosus (PDA), select the correct answers:


A.PDA connects the aorta with the pulmonary artery.
B.PDA connects the ascending aorta with the pulmonary artery.
C.In the initial PDA period, oxygenation of the blood in the small circuit is increased.
D.Initially in pulmonary hypertension the arteriolar miofibers hypertrophy.
E.In the IV phase of pulmonary hypertension the bloodstream changes its direction through the
PDA.

9.MC. Patent Ductus Arteriosus (PDA), select the correct answers:


A.In the case of PDA, after birth, the blood pressure in the pulmonary artery is higher than in the
aorta.
B.For the onset of PDA, is characterized by the systolo-diastolic murmur in the presence of the
unidirectional blood flow.
C.The PDA defect can pass from pale to cyanotic.
D.In patients with the onset of PDA, pulmonary hypervolemia occurs.
E.In the PDA, in the absence of surgical treatment, the most severe changes first occur in the
small bloodstream.

10.MC. Patent Ductus Arteriosus (PDA), select the correct answers:


A.The PDA occlusion can be performed without thoracotomy.
B.The PDA operation is performed by thoracotomy with channel ligation.
C.The PDA operation can consist of sectioning and suturing the aortic and pulmonary ends.
D.In the ligation of the PDA, the vagus nerve can be affected more frequently.
E.In the ligation of the PDA, the recurrent nerve can be affected more frequently.

11.MC. Ventricular Septal Defect (VSD), select the correct answers:


A.In the VSD, systolic murmur spreads across the whole chest.
B.Pale defect can be turned into cyanotic.
C.Palliative surgery can only be performed after the age of one year.
D.Palliative surgery can be performed within the first three months of life.
E.The operation performed in the cyanogenic phase is ineffective.

12.MC.Atrial Septal Defect (ASD), select the correct answers:


23
A.In the septum defect plasty, the surge is applied continuously.
B.In ASD plasty dotted sutures are applied.
C.Electrocardiography detects signs of overloading only in the right chambers of the heart.
D.The left ventricle remains under solicited.
E.Morphological changes in the small bloodstream occur gradually.

13.MC.Constrictive pericarditis, select the correct answers:


A.The small bloodstream is trained in the process by compressing the pulmonary veins.
B.The liver relatively soon increases due to strangulation of the inferior cave vein and right
atrium.
C.The operation consists of total pericardectomy.
D.The operation consists of subtotal pericardectomy.
E.After the pericardectomy, the heart is denuded.

14.MC.Tricuspid insufficiency, select the correct answers:


A.Excessively jugular veins pulsation.
B.Excessively carotid arteries pulsation.
C.In the liver, as a result of venous stasis, cirrhosis develops.
D.Peripheral edema occurs.
E.Viciousness can be corrected by valve plasty, narrowing of the fibrous ring, application of
valvular prosthesis.

15.MC. Coarctation of the aorta, select the correct answers:


A.Narrowing of the aorta occurs after the beginning of the brachiocephalic artery.
B.Narrowing occurs distal to the left subclavian artery.
C.Blood passes to the lower part of the body through the dilated subclavian artery.
D.The tension in the femoral arteries is diminished.
E.Plasty in the coarctation of the aorta consists in the excision of the narrowed segment with
end-to-end suture or the application of the vascular prosthesis.

16.MC. Isolated pulmonary artery stenosis (IPAS), select the correct answers:
A.In IPAS, narrowing can be valvular or subvalvular.
B.In IPAS, the trunk of the pulmonary artery is dilated.
C.In IPAS, the tension in the small blood stream reflectory increases.
D.In IPAS the second sound on the pulmonary artery is diminished.
E.Operation in IPAS consists of open comisurotomy, excision of muscle surplus, application of
plastic patch.

17.MC.Tetralogy of Fallot, select the correct answers:


A.Is characterized by excessive cyanosis.
B.There are forms that periodically (especially at rest) become acyanotic.
C.Frequently associated with lipothymy.
D.Minute circulating volume in the small blood stream is diminished.
E The left atrium is overstretched.

18.MC. Coronary bypass procedures have been demonstrated to:


A. Reduce the incidence of myocardial infarction.
B. Significantly relieves angina symptoms.
C. Statistically improve the life span.
D. Improve the ejection fraction of the left ventricle in many patients in whom it is significantly
depressed preoperatively.

24
E. To reduce the manifestations of overhepatic portal hypertension.

19.MC. Which of the following signs are characterized the cardiac tamponade:
A.Increased venous pressure.
B.Shock.
C.Low minute cardiac volume.
D.Increased diastolic filling.
E.Low blood pressure.

20.CS. Which of the following anomalies is not associated with tetralogy of Fallot?
A. Absence of the left pulmonary artery.
B. A right aortic arch.
C. A retroesophageal subclavian artery.
D. Anomalous origin of the left anterior descending coronary artery from the right coronary
artery.
E. Primary pulmonary hypertension.

21.MC.Which are the tipic clinical simptoms of the mitral stenosis:


A.Decreased heart flow (debit).
B.Atrial fibrillation.
C.Systemic embolism.
D.Increase of peripheral resistance.
E.Pulmonary edema.

KEY «Congenital and Aquired Heart Diseases»


1B; 2B; 3C; 4D; 5E; 6E; 7C; 8ACDE; 9ACDE; 10ABCE; 11ABDE; 12ABDE; 13ABCE;
14ACDE; 15ABDE; 16ABDE; 17ABCD; 18ABCD; 19ACDE; 20 E; 21 ABCE.

9.CHRONIC PANCREATITIS
1.CS.Which of the following is the fundamental anatomo-pathological lesion of chronic
pancreatitis?
A.Wirsungian lithiasis.
B.Necrhosis.
C.Fibrosclerosis.
D.Suppuration.
E.Pseudocysts.

2.CS. Which of the following radiological signs (abdominal radiographs) is most specific to
chronic pancreatitis?
A.The sentinel loop.
B.Calcifications in the pancreas area.
C.Colonic pneumatosis.
D.Hydro-aeric images.
E.Wirsungian stenosis

3.CS. Which of the following dietary measures have more importance in the treatment of
chronic pancreatitis?
A.Increased intake of vitamins.
B.Increased protein intake.
C.Reduction of carbohydrate rations.
D.Refuse of alcohol.

25
E.Increased of plant intake.

4.CS. Which of the following medical treatments can improve the symptoms of chronic
pancreatitis?
A.Drugs with vasodilatation effects.
B.Vitamins.
C.Pancreatic substitution enzymes.
D.Choleretics drugs.
E.Propanolol.

5.CS. Which of the following is the main indication of surgical treatment in chronic
pancreatitis?
A.Weight loss.
B.Portal hypertension.
C.Pseudocysts.
D.Pain.
E.Pancreatic calcifications.

6.CS. Which of the following situations is indication for Puestow operation (wirsungo-
jejunostomy)?
A.Multiple pseudochists.
B.Infected pseudocysts.
C.Wirsung dilatation.
D.Normal Wirsung.
E.None of them.

7.CM. Which of the following factors are incriminate in the etiology of chronic
pancreatitis:
A.Channel obstruction.
B.Alcoholism.
C.Portal hypertension.
D.Malnutrition.
E.Biliary lithiasis.

8.CM.Which of the following clinical signs can occur in chronic pancreatitis:


A.Pain.
B.Jaundice.
C.Steatorrhea.
D.Anemia.
E.Weight loss.

9.CM.Which of the following signs of chronic pancreatitis can be viewed at the computer
tomography?
А.Pseudocysts.
B.Narrowing of the terminal part of choledocus.
C.Dilatation of the Wirsung channel.
D.Spasm of Oddian sphincter.
E.Microlithiasis of the distal part of choledocus.

10.CM.Which of the following may be the complications of pancreatic pseudocysts?


A.Rupture in the peritoneal cavity.
B.Intracystic haemorrhage.
26
C.Erosion of the aorta.
D.Digestive stenosis.
E.Abcess.

11.CM.Which of the following can be methods of treatment of a pancreas pseudocyst?


A.Alcoholization.
B.Excision.
C.Internal drainage.
D.Laser destruction.
E.External drainage.

12.CM.Which of the following methods can be used in the treatment of pancreatic ascytes?
A.Parenteral nutrition.
B.Paracentesis.
C.Diuretic drugs.
D.Propranolol.
E.Surgical treatment.

13.CM. Which of the following complications of chronic pancreatitis may require surgical
treatment?
A.Biliary obstruction.
B.Wirsungian lithiasis with Wirsung duct dilation and pronounced algic syndrome.
C.Digestive stenosis.
D.Repeated acute pancreatitis.
E.Portal hypertension.

14.CS.Which is the preferate method of treatment of pancreatic postnecrotic pseudocyst


aging up to 3 months:
A.External drainage.
B.Cysto-digestive derivatives.
C.Drainage of Wirsung.
D.The left splenopancreatectomy.
E.Total pancreatectomy.

15.CS. Cancer of the pancreas are translated by the following phenomenon, except:
A.Progressive jaundice.
B.Enlarged palpable gallbladder.
C.Pruritus.
D.Colangitis.
E.Atrophic liver.

16.CM. Which are the clinical manifestations of the non-suppurative pancreatic


pseudocyst:
A.Algic syndrome.
B.Fever.
C.Local symptoms.
D.Intoxication.
E.Palpable abdominal tumour.

17.CS.Which is the method of choice in surgical treatment of pancreatic pseudocyst?


A.Enucleation.
B.Marsupialization.
27
C.Transparietal drainage.
D.Internal derivation (cysto-jejunostomia).
E.None of them.

18.CM. From the following statments, choose the possible causes of steatorea:
A.Insufficient lipase activity in current doses
B.Inactivating lipase in the stomach
C.Bacterial contamination
D.Using of cimetidine
E.Using omeprazole

19.CM.Choose the correct afirmations about congenital cysts of the pancreas:


A.They are pseudocysts by the presence of the epithelial layer.
B.If they are solitary, they are presented as abdominal tumors.
C.Multiple cysts rarely associate with other congenital disorders.
D.The elective exam is abdominal ultrasound.
E.The elective exam is transhepatic percutaneous colangiography.

20.CM. Best studies for detecting complications of acute and chronic pancreatitis are:
A. CT
B. MRI
C. Selective catheterization of hepatic, splenic, and gastroduodenal arteries
D. Doppler ultrasound
E. Laprotomy

21. CM. With regard to the control of pancreatic exocrine function, which of the following
statements are correct?
A. Cholecystokinin, a hormone released from the duodenal mucosa, is the predominant stimulus
for pancreatic enzyme secretion
B. Gastrin is a major stimulant for pancreatic bicarbonate secretion
C. Secretin is released from the duodenum upon mucosal acidification and stimulates pancreatic
bicarbonate secretion
D. Acetylcholine, released from pancreatic nerves, stimulates enzyme secretion
E. Hystamine, released from the duodenal mucosa, stimulates the passage of non-active
enzymatic complexes of the pancreas into active enzymes in the lumen of the duodenum.

22.CM.Which of the following statements about algic syndrome in chronic pancreatitis are
correct:
A.The development of algic syndrome is associated with the development of exocrine
insufficiency of the pancreas.
B.Reduction of intraductal pressure through decompressive surgery can reduce pain.
C.Peripancreatic nerve alteration at histological examination is demonstrated in chronic
pancreatitis.
D.Celiac plexus blockade results in limited improvement in most patients.
E.The development of algic syndrome is associated with the development of endocrine
insufficiency of the pancreas.

23.CM.Which of the following statements about pancreatic abscesses are correct:


A.They are associated with the development of respiratory distress at the adults.
B.They can be prevent by administration of broad spectrum antibiotics.
C.They determine urgent surgical treatment with necrotic tissue debridement.

28
D.Diagnosis can be confirm by percutaneous puncture with fine needle aspiration of
peripancreatic fluid.
E.Surgical treatment consists in the application of internal anasthomoses.

24.CM. Which of the following statements about the pancreatic pseudocyst are true:
A.In the absence of complications, drainage of the pseudocyst should be limited to cases, where
the pseudocyst has a size greater than 6 cm and persists for more than 6 weeks.
B.The pseudocyst associated with normal pancreatic duct can also be treated by percutaneous
drainage.
C.The pseudocyst, located proximal to stricture of the pancreatic duct, must be treated by
percutaneous drainage.
D.The pseudocyst, located in the pancreatic head, can be drained endoscopically through the
major or minor duodenal papilla.
E.In the cases of the pseudocyst's supurative complications, external drainage must be
performed.

25.CM.Which are the correct afirmations about the role of alcohol in development of
chronic pancreatitis:
A.Increase the protein enzymes in pancreatic juice.
B.Increase the pancreatic blood flow.
C.Increase the permeability of pancreatic ducts.
D.Precipitate the calcium in pancreatic ducts.
E.conduct to spazm of the Oddi sphincter.

KEY «Chronic pancreatitis»


1C; 2B; 3E;4C; 5D; 6C; 7ABDE; 8ABCE; 9AC; 10ABDE; 11BCD; 12ABE; 13ABCE; 14A;
15E; 16BD; 17D; 18ABC; 19 ABD; 20 ABC; 21 ACD; 22 ACD; 23 ABD; 24 ACDE; 25
ACDE.

10.POSTCOLECYSTECTOMY SYNDROME

1.CM. Which information may suggest upper digestive radiography with barium milk and
hypotonic duodenography in postcholecystectomic syndrome:
A.Tumors of the ampulla.
B.Indirect signs of pancreatic tumor.
C.Gastric tumors with invasion in the hepatic ligament.
D.Duodenal disorders.
E.Condition of intra-and extrahepatic biliary pathways.

2.CM. Retrograde endoscopic colangiopancreatography in postcolecystectomic syndrome


reveals:
A.Stenosis of papilla duodenalis major.
B.Acute or chronic cholecystitis.
C.Benign and malignant stenosis of main biliary duct.
D.Sclerosing angiocolitis.
E.Jejunal and ileal diverticulas.

3.CM.Which of the following moments are important in the profilaxis of


postcolecystectomic syndrome:
A.Complete pre- and intraoperative diagnosis.
B.Correct surgical technique.
C.A surgical tactics as appropriate as clinical situation.
29
D.Using intraoperative colangiography.
E.The full refusal from the laparoscopic cholecystectomy in favor of cholecystectomy by the
open method.

4.CS. Mechanical jaundice is caused by the following pathological situations, except:


A.Choledocholithiasis.
B.Cancer of the pancreas and papilla duodenalis mayor.
C.Liver and gallbladder cancer.
D.Primary and secondary malignant tumors of the liver.
E.Duodenal malrotation.

5.CS.Which of the following surgical methods to restorate the bile passage into the
digestive tract is not applicable in case of tumors of the hepato-pancreato-duodenal area:
A.Tumor removal with bilio-digestive anasthomoses.
B.Bilio-digestive by-pass anasthomoses.
C.Transtumoral stanting.
D.External drainage of the main biliary way and microjejunostomy type Delany.
E.Pancreatojejunostomy.

6.CS.Which of the next afirmations is not characteristic for acute colangitis:


A.Fever with hectic thermal curve.
B.Fever with chills.
C.Sweating and thirsting.
D.Hepatomegaly.
E.Enlarged painless gallbladder.

7.CS. Which of the following clinical situations do not require intraoperative verification of
assumed permeability of the main biliary duct:
A.Obstructive jaundice.
B.Pseudotumorous chronic pancreatitis with jaundice.
C.Dilatation of hepatocholedocus.
D.Choledocholithiasis.
E.Duodenal diverticulum.

8.CS. Which of the following clinical signs is not a characteristic for malignant obstructive
jaundice:
A.Fever with chills.
B.Jaundice.
C.Weight loss.
D.Skin pruritus.
E.Dyspeptic signs.

9.CS.That anatomical structure requires a rigorous intraoperative exploration in case of


mechanic jaundice:
A.Liver.
B.Spleen.
C.Duodenum.
D.Bile duct.
E.Right colon.

10.CS. What is the main way of penetration of infectious germs in biliary tree:
A.The arterial way.
30
B.The venous way.
C.The lymphatic pathway.
D.From the duodenum.
E.Through artero-venous shifts.

11.CM. Which of the following clinical signs represent the pentad of Raynold, in the case of
acute cholangitis:
A. The Vilard-Charcot triad.
B. Hypotonia.
C. Encephalopathy.
D. Ascytes.
E. Gastrointestinal bleeding.

12.CM.Which of the following statements about uremigen jaundice in acute cholangitis are
true:
A.It is characterized by progressive hepato-renal insufficiency.
B.Exclude the main bile duct lithiasis.
C.Requires prolonged preoperative training.
D.Requires decompression of the bile tree with strong antibiotic therapy.
E.In serious cases are indicated the bilio-digestive derivations.

13.CM. Which of the following conditions may contribute to the diagnosis of


postcolecystectomy syndrome?
A.Confused diagnosis.
B.Cardio-vascular disorders.
C.Disorders of the hepato-pancreatic area as complications of cholelithiasis.
D.Incomplete or inadequate operation on biliary ways.
E.Injury due to incorrect surgical gesture (iatrogenic lesions).

14.CM. Which of the following clinical signs characterize the postcolecystectomic


syndrome?
A.Dysphagia.
B.Biliary colic.
C.Transitory jaundice.
D.Pirosis.
E.Low back pain.

15.CM. Which of the following diseases may lead to the postcolecystectomic syndrome?
A.Disorders of the main biliary duct and papilla duodenalis major.
B.Disorders of the liver and pancreas.
C.Disorders of the duodenum.
D.Diseases of other organs of the digestive system.
E.Esophageal diverticulas.

16.CM. Which of the following radiological investigations can indicate the possible causes
of the postcolecystectomy syndrome?
A.Retrograde endoscopic colangiography.
B.Duodenography with barium milk.
C.IMR-colangiography.
D.Per oral colangiography.
E.Transparietohepatic colangiography.

31
17.CM.Which are the main factors contributing to appearance of the long cystic or cysto-
vesicular duct after cholecystectomy?
A.Subhepatic inflammatory infiltrate.
B.Difficult anatomic variations in subhepatic space and hepato-duodenal ligament.
C.Surgeon incompetence or negligence.
D.Liver cirrhosis.
E.Duodenostasis.

18.CM. Which are the most common causes of postcolecystectomy syndrome?


A.Obstructive biliary tract disorders.
B.Diseases of papilla duodenalis mayor.
C.Duodenal disorders.
D.Diseases of the pancreas.
E.Diseases of the right colon.

19.CM. Which are the most common complications of retrograde


colangiopancreatography?
A.Acute pancreatitis.
B.Intramural trauma.
C.Acute cholangitis.
D.Bleeding.
E.Acute cholecystitis.

20.CM. Which of the following pathologies can be traced to the sonografic exam, conducted
in a patient with postcolecistectomic syndrome?
A.Dilatation of the bile ducts.
B.Choledocholithiasis.
C.Duodenostasis.
D.Diseases of the pancreas.
E.Congenital malformations of the liver.

21.CM. What are the most common causes of obstructive jaundice?


A. Choledocholithiasis.
B. Congenital maladies of the gallbladder.
C. Cancer of the head of the pancreas.
D. Traumatic and inflammatory strictures of the bile ducts.
E. Parasitic diseases of the liver.

22.CM. Which of the following features are characteristic for obstructive jaundice, caused
by cancer of the head of pancreas?
A.Yellow-greenish skin.
B.Intensive dark brown color of the urine.
C.Aholic fecal masses.
D.Pronounced pruritus.
E.The emergence of jaundice is preceded by crampy pains in the right subhepatic space.

23.CM. In which of the following cases Courvoisier-Terrier sign is missing in clinical


picture of cancer of the head of pancreas?
A.In cholecystectomized patients.
B.In patients with choledocolithiasis.
C.In patients with sclerosing-atrophic cholecystitis.
D.In patients with liver cirrhosis.
32
E.In fatty patients with hepatomegaly.

24.CM. In which of the following circumstances of ampular and pancreatic cancer is


possible to use gallbladder for internal bilio-digestive derivatives?
A.Absence of pains.
B.Existence of a sufficient distance between the cystico-choledocian junction and the tumor.
C.Cystic duct is permiable
D.Absence of tumoral invasion in the stomach.
E.Absence of tumoral peripancreatic adenopathies.

25.CM.Which of the following signs are characteristic of benign mechanical jaundice?


A.Progressive jaundice.
B.Fluctuant jaundice.
C.The emergence of jaundice is preceded by hectic fever during three days.
D.The emergence of jaundice is preceded by crampy pains in the right subhepatic space.
E.The presence of the Courvoisier-Terrier sign

KEY «Postcholecystectomy Syndromes»


1ABCD; 2ABCD; 3ABCD; 4E; 5E; 6E; 7E; 8A; 9D; 10B; 11ABC; 12AD; 13ACDE; 14BC;
15 ABC; 16ACE; 17ABC; 18AB; 19ACE; 20ABDE; 21AC; 22ABCD; 23ACE; 24BC;
25BD.

11.ENDOCRINE TESTS

1.CS. What is the scintigraphic image of the toxic adenoma of thyroid gland?
A.Diffuse and homogeneous capture of the radioactive tracer.
B.Diffuse but non-homogeneous capture of radioactive tracer.
C.Catch in "chessboard".
D."Hot Node".
E."Cold node".

2. CS. Which is the indication for radioactive treatment with iodine in thyrotoxicosis?
A.Basedow disease.
B.The toxic adenoma.
C.Association of hyperthyreoidism with thyroid cancer.
D.Thyroid hormone which induced the thyreoxicosis.
E.Secondary hyperthyroidism of secondary thyroid tumors.

3.CS. Which of the following drugs should be used in the treatment of thyreotoxicosis?
A.Mebendazole.
B.Biseptol.
C.Mercazolil.
D.Omeprazole.
E.Ampicillin.

4.CS. After 24 hours from subtotal thyreoidectomy for thyreotoxicosis, it occurs: hustle the
patient, tachycardia - 180 /min, arhythmia, hyperthermia. Which kind of postoperative
complication occurred?
A.Paralysis of recurrent nervs.
B.Hiperthyreosis.
C.Hipoparathyreosis.
D.Thyreotoxic crisis.
33
E.Embolic complications.

5. CS. Which of the following is not a complication of operations on thyroid gland?


A.Paresis of recurrent nervs.
B.Mexedem.
C.Tetanus crisis.
D.Tyreotoxic crisis.
E. Exophthalmia.

6. CS. Which of the following changes, produced by compression of thyroid hypertrophy


on cervical sympathetic nerves, is correct exposed?
A.Turgery, face cyanosis.
B.Cardio-respiratory and gastric disorders.
C.Bitonal voice, aphonia.
D.Miosis, enophthalmia, bradycardia, palpebral ptosis.
E.Brain disorders, lipothimia.

7.CS. Which of the following statements about thyroid pathologies is not correct?
A. In chronic thyroiditis Hashimoto, we detect anti-thrombolytic and antimicrosomal antibodies.
B. Basedov's disease reveals tireostimulatory immunoglobulins (LATS-P).
C. Thyroid benign tumors are adenomas.
D. In chronic thyroiditis Ridel takes place induration of thyroid gland.
E. Basedov's disease affects only women of childbearing age.

8.CS. What is the exact name of the tireotoxic adenoma?


A.Disease Graves-Basedov.
B.Chronic thyroiditis Hashimoto.
C.Plummer's disease.
D.Chronic thyroiditis Ridel.
E.Subacute thyroiditis de Quervain.

9.MC.Which are the possible causes of thyreotoxic crisis after surgical intervences on
thyroid gland?
A.Suspension of medicinal treatment.
B.Infectious or neuro-psychological aggression.
C.Limited surgical interventions.
D.Bleeding in postoperative period.
E.Spicy foods.

10.CS.Which is the most sensitive and specific method to identify the patients with
Zollinger-Ellison syndrome?
A.Serum titration of anti-thyroid antibodies.
B.Dosage of serum gastrinemia.
C.Appreciation of kateholamines.
D.pH-metria of gastric juice.
E. Dosage of serum bilirubinemia.

11.CM. Which of the following statements about sporadic goiter are true?
A.Increased size of the thyroid gland.
B.Normal function of the thyroid gland.
C.It occurs about 20% of the population of some area.
D.It occurs more frequently in women.
34
E.Is is transmitted autosomal recessive.

12.CM. Which kind of complications may appear in the evolution of a sporadic goiter?
A.Compression of adjacent anatomical structures.
B.Interstitial bleeding.
C.Acute thyroiditis.
D.Hiperparathyreosis.
E.Malignant degeneration.

13.CM.Which are the indications for surgical treatment in one’s goiter?


A.Failure of the medical treatment.
B.Diffuse parenchymatous goiter at onset.
C.Goiter with hyperthyreoisis.
D.Nodular goiter.
E.Goiter with malignancy.

14.CM.Depending on the situation, which of the following types of surgery may be used in
the treatment of goiter?
A.Subtotal thyreoidectomy.
B.Total lobectomy.
C.Total thyreoidectomy.
D.Subtotal lobectomy.
E.Radical neck dissection.

15.CM.Which of the following statements about tyreotoxicosis are true?


A.Cardiovascular, digestive and neuropsychial syndrome.
B.It has neuro-psychological features, related to etiology, age, morbid association.
C.The amount of clinical and visceral manifestations is a consequence of an excess of thyroid
hormone
D.The amount of clinical manifestations is not the consequence of excess thyroid hormone
E.Severity of clinical manifestations is join only with the age of patient.

16.CM.The manifestations of the thyroid crisis include?


A.Hyperthermia, tachycardia, hypertension.
B.Thermophobia, sweating, paresthesia.
C.Agitation, confusional state, vomiting.
D.Exophthalmia, insomnia, muscle atrophy.
E.Endophthalmia, hypothermia, hypotension.

17.CM.What statements about benign tumors of the thyroid gland are correct?
A.They are represented by adenomas, are asymptomatic, develop slowly.
B.They have a acute debut with early onset.
C.Metastasis is frequent and early.
D.In 70% of cases, they appear as "cold" nodules on the scintigram.
E.In 70% of cases they appear as "hot" nodules on the scintigram.

18.CM. Which of the following examinations are useful for the preoperative diagnosis of
malignancies goiter?
A.Thyroid scintigraphy.
B.Serum antibody titration.
C.Basic metabolism.
D.Iodine indices.
35
E.Biopsy through aspiration puncture (FNA).

19.CM. Which of the following statements about Multiple Endocrine Neoplasia Type I
(MEN1) are true?
A.It is composed of tumors or hyperplasias of parathyroids, pancreatic islets and hypophysis.
B.It is composed of tumors or hyperplasias of the adrenals, pancreas and hypophysis.
C.In MEN 1, hyperparathyroidism is the most common manifestation (90-100%).
D.The hypophysis adenoma appears in almost all patients with MEN 1.
E.MEN 1 is an autosomal dominant genetic abnormality.

20.CM. Which of the following describtions of Zollinger-Ellison syndrome are true?


A.Multiple ulcers or multiple recurrent ulcers, atypical, with grave and rapid evolution.
B.Quantitative and qualitative gastric hypoaesthesia.
C.Gastric chemistry indicates abundant basal hypersecretion.
D.Gastric-secretory tumor (gastrinoma).
E.Serum gastrin values are very low.

21.CM. What statements about Hashimoto lymphocytic thyroiditis are true?


A. It is autoimmune disease.
B. It occurs predominantly the women.
C. High titers of anti-thyroid antibodies are highlighted in the serum.
D. Disease is often familial with other autoimmune conditions.
E. Clinic appears as a rough, woody, compressing goiter.

22.CM.What statements about Quervain's subacute thyroiditis are false?


A.It is more common at the men.
B.Appears after an episode of upper respiratory tract infection.
C.Begging with fever / frison.
D.Thyroid increases rapidly in volume, painful on palpation.
E.It is a serious form of thyrotoxicosis.

23.CM.What statements about multiple endocrine neoplasias are incorrect?


A.There are syndromes where tumors are present in the same individual with interest two or
more endocrine glands.
B.Both forms MEN I and MEN II have a thyroid component.
C.In the MEN I and MEN II forms the thyroid component is missing.
D.MEN II syndrome presents three varieties: type A, B and family type.
E.Feocromocytoma is a component of MEN I syndrome.

24.CM.What statements about Hashimoto lymphocytic thyroiditis are true?


A.It is autoimmune disease.
B.It occurs predominantly the women.
C.High titers of anti-thyroid antibodies are highlighted in the serum.
D.Disease is often familial with other autoimmune conditions.
E.Clinic appears as a rough, woody, compressing goiter.

KEY «Endocrine pathologies»


1D; 2D; 3C; 4D; 5E; 6D; 7E; 8C; 9ABC; 10B; 11ABDE; 12ABCE; 13ACDE; 14ABCD;
15ABC; 16AC; 17AC; 18AE; 19ACDE; 20ACD; 21ABCD; 22AE; 23CE; 24ABCD.

12.DIGESTIVE HEMORRHAGE

36
1.CS.The source of hemorrhage in digestive tract is localized more frequently in:
A.Esophagus
B.Stomach
C.Duodenum
D.Small bowel
E.Colon

2.CS.Where is the demarcation line, starting from where we can talk about upper and
lower digestive tract haemorrhages:
A.At the level of papilla of Vater
B.At the level of inferior duodenal flexion
C.At the duodenol-jejunal angle
D.With 30-50 cm distally from ligament Treitz
E.At the level of Bauhin valve

3.CS. From the clinical signs of haemorrhage the less relevant as the criteria of severity of
blood loss is:
A.Hematemesis
B.Characteristics of pulse and arterial blood pressure level
C.Respiratory rate
D.Signs of peripheral vasoconstriction
E.Melena

4.CS.The folowing system does not participate in the blood loss compensation:
A.Nervous vegetative system
B.Cardiovascular system
C.Endocrine system
D.Hematopoietic system
E.Immune system

5.CS.About the influence of poor microcirculation on internal organs in conditions of


hypovolemia, caused by blood loss, it is more easier to estimate the functional disorders of:
A.Brain
B.Cord
C.Lngs
D.Large and small bowel
E.Kidneys

6.CS.From the methods of diagnosis of upper digestive haemorrhage the priority has:
A.Endoscopy
B.X-ray with barium.
C.Scintigraphy
D.Angiography
E.Diagnostical laparotomy

7.CM.The risk of persistence or recurrence of haemorrhage is particularly high when:


A.The patient is in shock
B.Hemoglobin <70 g / l
C.Endoscopy reveals the gastric ulcer with active bleeding
D.Patient's age > 50 years
E. Patient's age < 20 years

37
8.CM Endoscopical signs of active bleeding from the ulcer are:
A.Arterial blood in the jet
B.Visible vessel
C.Oozing of the blood alongside the thrombus
D.Blood clots in the stomach
E.„Coffe-ground” in the stomach

9.CM.The selection of surgical tactics in bleeding from ulcer is determined by:


A.Patient’s station
B.Level of Ht and Hb
C.Endoscopical findings
D.Results of intensive care
E.Radiological findings

10. CM. The absolute indications for surgery in haemorrhage from ulcer are:
A.Sock or not stable hemodynamics
B.Reccurence of haemorrhage in first hours or days after stabilisation
C. Haemorrhage associated with ulcer perforation
D.Insignificant prolongation of the endoscopically detected blood in a patient with stable
hemodynamic
E. Stopped bleeding

11.CM.In election of surgical method of treatment of haemorrhagic ulcer are taken into
account:
A.Ulcer localization
B.Type of secretion
C.Patient's condition
D.Haemorrhagic episodes in anamnesis
E.Type of patients professional conditions

12.CM.Stress ulcers differ from duodenal and gastric ulcers by:


A.Etiopathogenesis
B.Morphopathological characteristics
C.Clinical evolution
D.Complications
E.Clinical manifestations

13.CM.Patient with spontaneous stopping of haemorrhage from esophageal varices has


serum bilirubin within 35-50 mcmol/l, serum albumin - 30-35 g/l, transient ascites,
neurological oligosimptomatology, good nutritional status. Which treatments are
acceptable in this case:
A.Sclerotherapy
B. Porto-systemic shunt
C.Transparietohepatic embolization of the gastric veins
D.Sugiura operation
E.Liver transplantation

14.CM.For intraoperative diagnosis of the causes of low digestive haemorrhage are


acceptable:
A.Exploration of the intestine
B.Videopanendoscopy
C.Selective mesenteric angiography
38
D.Enterotomy and colotomy
E.Gastrotomy

15.CM.Among intraoperative methods in Mallory-Weiss syndrome surgery is used:


A.Wide gastrotomy
B.Exploring of the integral stomach
C.Suturing of the fissure by catching the submucosal and muscular layers
D.Eploring the adjacent organs
E.Pyloroplasty

KEY «Digestive Hemorrhage»


1B; 2C; 3E; 4E; 5E; 6A; 7ABC; 8ABC; 9ABCD; 10ABC; 11ABC; 12ABC; 13BD;
14ABC; 15ABCD

13.ENTERO-MEZENTERIC INFARCTION

1.CS. One of the most common causes of entero-mezenteric infarction is:


A. Obstruction of the arteries through embolism or thrombosis
B .Mesenteric venous thrombosis
C.Outside compression of the mesenteric vessels
D.Heart failure, arrhythmias, hypovolemia
E.Ttraumatic injuries of mesenteric vessels

2.CS. The main source of arterial embolism is:


A.Deep veins thrombosis of of lower limbs
B.Pathological processes in the left cord
C.Cord and artery operations
D.Aortic ulcer ateromatosis
E.Aortic aneurysm

3.CS. Spontaneous detachment and primitive thrombus fragmentation may be favored by


the following factors, except:
A.Changes in strength and rhythm of cardiac contractions
B.Variations of arterial pressure
C. Physical and mental overexertion
D. Autolysis of thrombotic masses
E. Administration of synthetic anticoagulants

4.CS. The relatively higher frequency of upper mesenteric artery embolism than the
inferior artery is not related to:
A.Topography of the vessels
B.Caliber of the vessel
C.Angle of derivation from of the aorta
D.Atherosclerotic vessel changes
E.There is nothing of the above

5.CS. Ischemia of the entire small bowel and ceco-ascendent segment occurs in case of
obstruction of:
A.Superior mesenteric artery in segment I
B.Superior mesenteric artery in segment II
C.Ileocolic artery
D.Left colic artery
39
E.Inferior mesenteric artery

6.CS. Organic changes caused by various pathological processes are the main premise of
thrombosis of the superior mesenteric artery. More often in this role is presented:
A.Obliterative thrombangeitis
B.Atherosclerosis
C.Periarteritis nodosa
D.Non-specific aorto-arteritis
E.Fibromuscular hyperplasia

7.CS. In which aortic pathology the obstruction of superior and inferior mesenteric
arteries may be simultaneous:
A.Atherosclerosis
B.Nonspecific arteritis
C.Dissecting aneurysm
D.Thrombosis
E.Embolism of bifurcation of aorta

8.CS. All factors, listed below, may contribute to the appearance of non-occlusive
mesenteric circulation disorders, except:
A.Heart failure
B.Arithmia
C.Hypovolemia
D.Adrenomimetics
E.Cardiac glycosides

9.CM. Which of the following factors, listed below, may contribute to the appearance of
non-occlusive mesenteric circulation disorders:
A.Heart failure
B.Arithmia
C.Hypovolemia
D.Adrenomimetics
E.Cardiac glycosides

10.CM. Which statements about upper mesenteric artery obstruction by embolism or


thrombosis are correct:
A.Mmainly people in age > 50 years are affected
B.Is mainly found in women with overweight
C.Occurs more frequently in the presence of signs of generalized atherosclerosis
D.May occur due to chronic intestinal ischemia
E.The main source of embolism is left heart

11.CM. What are the most common causes of entero-mezenteric infarction:


A.Acute obstruction of the celiac trunk
B.Embolisation and thrombosis of upper mesenteric artery
C.Superior mesenteric vein thrombosis
D.Obstruction of inferior mesenteric artery
E.Low cardiac output and long circulatory depression

12.CM. Entero-mesenteric infarction starts with:


A Periombilical violent pain
B.Vomiting
40
C.Peristaltic active noises
D.Signs of peritoneal irritation
E.Hypovolemic shock

13.CM. Chronic intestinal ischemia are manifested through:


A.Anorexia
B.Postprandial pain
C.Occult digestive haemorrhage
D.Diarrhea
E.Weigh loss

14.CM. For preoperative preparation in entero-mesenteric infarction, it is necessary to


administrate:
A.Solutions of electrolytes, colloids and proteins
B.Antibiotics
C.Anticoagulants.
D.Sodium bicarbonate solutions
E.Beta-adrenomimetics

15.CM. Entero-mesenteric venous infarction demonstrates some features including:


A.Prodromos
B.Insidious onset
C.More frequent bloody diarrhea
D.Marked leukocytosis and increased HCT
E.Slow evolution

16.CM. Which factors can provoke thrombosis of mesenteric veins with intestinal
infarction:
A.Acute appendicitis
B.Antithrombin deficiency III
C.Liver cirrhosis
D.Abdominal trauma
E.Duodenal peptic ulcer

17.CM. Which statements about upper mesenteric artery obstruction by embolism or


thrombosis are correct:
A.Mainly people in age > 50 years are affected
B.Is mainly found in women with overweight
C.Occurs more frequently in the presence of signs of generalized atherosclerosis
D.May occur due to chronic intestinal ischemia
E.The main source of embolism is left heart

18.SM. Which methods of surgery are possible in acute obstruction of the superior
mesenteric artery:
A.Embol- and thromboembolectomy, thrombendarterectomy
B.By-pass operation
C.Dezobliteration with resection of the intestine
D.Intestinal resection
E.Gastroenteroanastomosis

KEY «Entero-mezenteric Infarction»


1 A; 2B; 3E; 4D; 5A; 6B; 7C; 8D; 9ABCE; 10ACDE; 11BCE; 12ABC; 13BE; 14ABCDE;
41
15ABCD; 16ABCD; 17ACDE; 18 ABCD

14. PERIPHERAL ARTERIAL OCCLUSIVE DISEASES


(syndromeof chronic ischemia, obliterating atherosclerosis, obliterating endartritis)

1.CS.In atherosclerotic stenosis of the internal carotid artery, the method of choice of
treatment consists in:
A.Thrombendarterectomy
B.Resection with end-to-end anastomosis
C.By-pass
D.Ligation of the internal carotid artery
E.Administration of anti-thrombotic agents

2.CS.Treatment of arteriovenous fistula consists in:


A.Excision of fistula with restoration of vessels continuity
B.Ligation of the artery distally from the fistula
C.Amputation of the member of extremity
D.Ligation of the vein distally from fistula
E.Only medical treatment

3.CS. Intermittent claudication due to advanced atherosclerosis of external iliac arteries is


more effectively treated by:
A.Lumbar sympathectomy
B.Gymnastics performed daily
C.By-pass
D.Vasodilators
E.Resection of the affected segment with anastomosis

4.CS.Arterial emboli fixes more often to:


A.Aortic bifurcation
B.Common iliac artery
C.Common femoral artery
D.Cerebral vessels
E.Popliteal artery

5.CS.Restoring blood circulation in the acute arterial insufficiency of the limb is absolutely
contraindicated in:
A.Ischemia gr.Ia slow progressive
B.Ischemia gr. Ilb patient with myocardial infarction
C.Ischemia gr. IIIa in the patient with stroke
D.Ischemia gr. IIIc
E.Patient age > 85 years

6.CS.Which statement about the particularities of Burger disease is incorrect:


A.More frequent incountered in men
B.Is observed between 20 and 40 years
C.Is accompanied by intermittent claudication
D.Is closely related to smoking
E.Represents a particular form of atherosclerosis

7.CM.Regarding segmental femoro-popliteal occlusion, the following statements are true:


A.Usually involved superficial femoral artery in the adductor channel
42
B.Are common ulcers and gangrene
C.Is characterized by intermittent claudication
D.Disease progression is rapid
E.The method of choice of treatment is endarterectomy

8.CM.Principles of treatment of femoro-popliteal occlusion include:


A.Program of energetic movements
B.Sympathectomy in case of pronounced intermittent claudication
C.By-pass with autovenous graft
D.Endarterectomy
E.Diet

9.CM.Clinical manifestations of the arterio-venouse fistula of the extremity include:


A.Dilated varicose veins
B.Tachycardia in compressing of fistula with finger
C.Constant murmors
D.Distally from fistula develops arterial insufficiency
E.Low digestive bleeding

10.CM.Trophic changes caused by chronic ischemia include the following:


A.Hair loss
B.Nail changes
C.Skin atrophy
D.Atrophy of muscles
E.Osteoporosis

11. CM.The features of aortic-iliac vascular disease include:


A.Lack of clinical manifestations until lumen obliteration fails to reach 90%
B.Frequent formation of an aneurysm
C.Coronary or cerebral vascular disease is observed in 30-50% of cases
D.Often total occlusion of the aorta takes place in the 7th and 8th decades
E.Leads to acute pancreatitis

12.CM. Which of the phenomena listed below is seen in arterio-verous fistulae:


A.Increased blood volume
B.Increased pulse pressure
C.Development of collateral circulation
D.Reduced cardiac minute – volume
E.Hepatomegaly

13.CM.Congenital arterio-venous fistulae:


A.Usually located on the extremities
B.Often are multiple
C.Lead to loco-regional gigantism
D.Lead to heart failure
E.Lead to portal hypertension

14.CS.Thrombolytic effect is obtained by administering:


A.Complamin
B.Streptaza
C.Aspirin
D.Heparin
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E.TPA (tissue plasminogen activator)

15.CM.For acute thrombosis of the major artery of the low extremity is characteristicthe
following signs:
A.Paleness
B.Pain
C.Edem
D.Paresthesia
E.The pulse disappearance

16.CM.Embolism of the brachial artery may be caused by following :


A.Mitral stenosis
B.Acute myocardial infarction
C.Hheart aneurysm
D.Abdominal aorta aneurysm
E.Compression of the subclavian artery with an additional cervical rib

17.CS.In the femoral artery embolism with grade III ischemia (leg contraction) the method
of choice is:
A.Urgent embolectomy
B.Thrombolytic therapy
C.Therapy with anticoagulants
D.Symptomatic therapy
E.Primary leg amputationn

18.CS. Amputation as an elective operation in acute limb arterial insufficiency is indicated:


A.In advanced atherosclerosis of magistral limb vessels with early begining manifestations of
acute thrombosis
B.In aged patients
C.Grade IIIb ischemia
D.Only in Grade IIIc of ischemia
E.In late patient hospitalization

KEY «Peripheral arterial occlusive diseases»


1A; 2A; 3C; 4C; 5D; 6E; 7AC; 8AC; 9AC; 10ABCD; 11ABC; 12ABC; 13ABC;
14BE; 15ABDE; 16ABCE; 17E; 18.D

15.ESOPHAGUS
1.CS.In gastro-esophageal reflux, the following statements are true, except:
A.Alcohol consumption and smoking are important aggravating factors
B.Is often associated with disordered esophageal motility
C.A hiatus hernia is invariably present
D.Barrett’s esophagus may develop
E.Iron deficiency anemia may occur as a result of chronic blood loss

2.CS.Which is more frequent complication of Zenker diverticula:


A.Hemorrhage
B.Perforation
C.Malignancy
D.Pulmonary complications

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E.Peridiverticula phlegmon

3.CS.Which affirmation regarding to Zenker diverticula is fals?


A.Is a pulsative diverticula
B.Is situated in ½ superior of esophagus
C.The rupture could appear in time of endoscopy
D.Diverticula walls consists only from mucosa
E.Operation is indicated in only symptomathic diverticula

4.CS.Which complication is more frequent in esophageal ulcer:


A.Hemorrhage
B.Perforation
C.Stenosis
D.Malignancy
E.Pulmonary complications

5.CS.Which of the following statements about epiphrenic diverticula of the esophagus is


correct:
A.They are traction diverticula that arise close to the tracheobronchial tree.
B.They characteristically arise proximal to an esophageal reflux stricture.
C.The degree of dysphagia correlates with the size of the pouch.
D.They are best approached surgically through a right thoracotomy.
E.The operation of choice is a stapled diverticulectomy, long esophagomyotomy, and
partial fundoplication.

6.CS. The best management for a 48-hour-old distal esophageal perforation is:
A.Antibiotics and drainage.
B.Division of the esophagus and exclusion of the perforation.
C.Primary repair with buttressing.
D.Resection with cervical esophagostomy, gastrostomy, and jejunostomy.
E.T-tube fistula and drainage.

7.CM.Esophageal syndrome includs following signs:


A.Regurgitation
B.Syalorrhea
C.Hiccup
D.Dysphagia
E.Retrosternal pain

8.CM.Spontaneous rupture of esophagus is manifested by following signs:


A.Retrosternal pain on swallowing
B.Nazal voice
C.Subcutaneous cervical emphysema
D.Paradoxal disphagia
E.Hydropneumothorax

9.CM.Which affirmations regarding to epiphrenic diverticula are correct:


A.Is associated with gastro-esophageal reflux
B.Is a tractive diverticula
C.Could be associated with hiatal hernia
D.Could has more large size than parabronchical diverticula
E.Could be associated with other esophageal pathology
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10. CM.Which affirmations about the anatomy of mediastinum are correct:
A.Posterior mediastinum contain: trachea, esophagus, vagus nerves, azygos and hemiazygos
veins, lymphatic ganglions.
B.In superior mediastinum are situated: proximal segments of trachea, esophagus and
thymus:aortic arch with branches, lymphatic thoracic canal.
C.In posterior mediastinum are situated: esophagus, thoracic descendent segment of aorta;
lymphatic thoracic canal, sympathic and parasympathic nerves, lymphatic ganglions.
D.In middle mediastinum are situated: pericardium, heart, bifurcation of trachea and main
bronchus, pulmonary artery and vein, lymphatic nodes of trachea bifurcation.
E.In anterior mediastinum between pericardium and sternum are localized: thymus, vagal nerves,
lymphatic thoracic canal, esophagus.

11.CM.Which of the following statements are true concerning esophageal diverticula:


A.A Zenker’s diverticulum characteristically occurs in older patients
B.Mediastinal granulomatous disease usually results in a mid-esophageal traction
diverticulum which is usually asymptomatic
C.An epiphrenic diverticulum that presents to the right of the esophagus should be managed
via left thoracotomy
D.Minimally symptomatic epiphrenic diverticula should not be operated upon
E.Epiphrenic diverticula is associated with achalasia of cardia

12.CM.Which of the following statements are true concerning caustic injury to the
esophagus:
A.Alkaline injury is more destructive than acid injury
B.Acid ingestion is not injurious to the stomach due to its normal acidic pH
C.Ingested caustic agents rapidly pass through the esophagus and stomach into the small
intestine
D.Unless perforation occurs, clinical manifestations resolve quickly with initial
clinicalimprovement noted
E.Children are less likely to form a late esophageal stricture than adults

13.CM.Spontaneous perforation of the oesophagus:


A.Occurs after a heavy meal
B.Usually occurs in a previously abnormal oesophagus
C.Diagnosis is aided by the presence of mediastinal gas
D.Diagnosis is confirmed by oesophagoscopy
E.Is preferably treated conservatively

14.CM.The diagnosis and staging of a carcinoma of the oesophagus should ideally include:
A.Upper gastrointestinal endoscopy and biopsy
B.Carcinoembryonic antigen (CEA) level
C.Oesophagealmanometry
D.Laparoscopy
E.Transoesophageal ultrasound and lymph node biopsy

15.CM Achalasia of the cardia:


A.Is associated with hyperplasia of the lower oesophageal sphincter
B.Has an absence of ganglion cells in Auerbach's plexus
C.Presents in children with dysphagia
D.Diagnosis is confirmed by oesophageal function tests
E.Cardiomyotomy may relieve symptoms
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KEY «Esofagus»
1C; 2D; 3D; 4A; 5E; 6C; 7ABDE; 8ABCE; 9-ACDE; 10BCD; 11BCD; 12ADE; 13AC;
14ADE; 15BCDE.

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