Acute Pancreatitis

1.* Increased serum lipase activity (or amylase) in acute pancreatitis is:
A. 3 times higher than normal
B. 2 times higher than normal
C. in pancreatitis is not recorded increases in serum lipase
D. 4 times higher than normal
E. 1.5 times higher than normal

2. * Etiologic factor that causes 80% of cases of acute pancreatitis is represented by:
A. shock
B. heart failure
C. gallstones
D. surgery
E. ingestion of drugs

3.In acute pancreatitis is describing the following steps:

A. premature activation of trypsin
B. infectious response extrapancreatic
C. release of chemotactic factors
D. emphasizing microcirculation
E. Vascular thrombosis.

4.Anatomical and clinical forms of acute pancreatitis are:

A. acute catarrhal pancreatitis
B. acute edematous pancreatitis
C. acute necrotizing pancreatitis
D.Phlegmonous acute pancreatitis
E. Acute gangrenous pancreatitis

5.Complications of acute pancreatitis may be:

A. sepsis
B.shock
C. multi-organ dysfunction
D.colecistită acute lithiasic
E. anemia

6. * Infectious factors that may cause acute pancreatitis are excluding:

A. ascariasis
B. toxic
C.parazitosis
D. mycoplasma
E. HIV

7. * Leucocytosis in SIRS in acute pancreatitis is:

A. 10,000 / mm3
B> 18,000 / mm3
C.> 8000 / mm3
D.> 12,000 / mm3
E.> 15,000 / mm3

8. * Pseudocyst of the pancreas is:

A. Extrapancreatic collection
B. intrapancreatic collection
C. intraperitoneal collection
D. pancreatic cyst infection
E.due to the opening of a pancreas cyst

9. Encapsulated necrotic collection in acute pancreatitis is represented by:

A.pseudocyst associated with necrosis
B Pancreatic organized necrosis
C. "walled off necrosis"
D pancreatic sequesters
E. Acute necrotizing collection

10. On physical examination in acute pancreatitis can be highlighted:

A. sign Cullen
B. Grey Turner sign
C. sign Lanz
D. Romberg sign
E. sign wave

11. Ranson score at admission includes:

A. bilirubin value
B. value TGO
C TGP.value
D.LDH value
E. intracellular Calcium

12. Severe acute pancreatitis according to Ranson score corresponds to:

A.2
B.3
C.4.
D.6
E.7

13. Clinical forms of acute pancreatitis are:

A. mild acute pancreatitis
B. acute pancreatitis moderately severe form
C. subacute pancreatitis
D. superacute pancreatitis
E. severe pancreatitis
14. Clinical picture of acute pancreatitis typically comprises:
A. pain right hypochondrium
B. epigastric pain
C.pain irradiation in right shoulder
D. pain with radiation to the bar
E. pain lasting up to 30 minutes

15. In the acute pancreatitis is usually used the following investigations:

A. ERCP
B. upper gastrointestinal endoscopy
C.CT pelvis
D. abdominal CT
E abdominal ultrasound
I. Acute Appendicitis:

1. The main causes of acute appendicitis according to the theory enterogene are:
A. coprolith
B. foreign bodies
C. appendiceal artery thrombosis
D. Appendix bendings
E. intraluminal parasites

2.* Since typical clinical presentation of acute appendicitis can be part except:
A. Pain
B. anorexia
C. constipation
D. diarrhea
E. low grade fever

3. Triad symptom of Dieulafoy in acute appendicitis is represented by:

A. pain
B. vomiting
C. diarrhea
D. skin hypaesthesia
E. musculary defense in the right iliac fossa

4. *Leukocytosis in acute appendicitis have typical values:

A.14,000 / mm³
B. 20,000 / mm³
C.10,000 / mm³
D. 12,000 / mm³
E. leukocytosis is not present in acute appendicitis

5. Differential diagnosis of acute appendicitis can be done with:

A. left renal colic
B. biliary colic
C. mesenteric adenitis
D. gastric ulcer
E. salpingitis

II. Intestinal obstruction:

1. Ogilvie syndrome occurs:

A. in the elderly
B. in immunosuppressed
C. in postoperative cardiac surgery
D. in hypokalemia
E. In hypernatremia

2. Functional occlusion are:

A. paralytic ileus
B. neurogenic ileus
C. bowel inflammation
D. renal colic
E. biliary colic

3.*Mechanical occlusions are not due to:

A. anticholinergics
B. tumors
C.intestinal polyp
D. fecaloma
E. flanges

4. From an evolutionary standpoint occlusions are classified as:

A. Acute
B. supraacute
C. subacute
D. chronic
E. subchronic

5.*The causes of mechanical occlusions in the small intestine are except:

A. Ties
B. ileus bile
C. Crohn's Disease
D. Cystic Fibrosis
E. ulcerative colitis

6.* The high occlusions among the manifest clinical signs include;
A. anxiety
B. vomiting
C. Stop bowel gas
D. faecal intestinal transit stop
E. tachycardia

7. *Abdominal Radiography may reveal in typical occlusion:

A.pneumoperitoneum
B. sign Chilaiditi
C. levels air fluid
D. sign Lanz
E. distention of the rectum

8. Gravity signs in intestinal obstruction may include:

A. intestinal pneumatosis
B. over 5 cm dilation caecum
C. Gastric dilatation
D. air into the portal vein
E. pneumoperitoneum

9. Differential diagnosis of intestinal obstruction can be done with:

A. acute myocardial infarction
B. basal pneumonia
C. acute pancreatitis
D. tabes
E. acute cholecystitis

10. The sigmoid volvulus is characterized by:

A. increased frequency in women
B. occurs in children
C. favored by the presence of a short mezosigmoid
D. abdominal asymmetry
E. image air fluid levels in W

11. von Wahl sign includes:

A. tympanic sonority around the navel
B. left iliac fossa pain
C. flatulence intense around the navel
D. emphasis pain on palpation
E. remission pain on palpation

12. Intussusception can be:

A. ileo-ileal
B. ileocolica
C. ileocecocolica
D. colocolica frequently in children
E. ileocecal

13. Complications in mechanical occlusions are:

A. syndrome Mendelson
B. Munchausen syndrome
C. acute respiratory failure
D. COPD
E.ARF

14.In obstructions in the of the left colon the therapeutic conduct is classic:
A. subtotal colectomy
B. left hemicolectomy
C.operation Hartmann
D. colostomy clearance
E. operation Dixon

15. Untreated mechanical intestinal obstruction exhibit at:

A. diastatic perforations
B. shock toxicoseptic
C. secondary peritonitis
D. resume transit
E. hyperkalemia
III. Digestive bleeding
1. Digestive bleeding due to arteriovenous malformations are:
A. Mallory-Weiss syndrome
B. Lesion Dieulafoy
C. bleb nevus syndrome
D. Zollinger Ellison
E. Kaposi's sarcoma

2. *The cause of digestive bleeding are:

A. administration of ketones
B. Cytomegalovirus infection
C.Candida infection
D. Osler-Rendu syndrome
E. portal hypertension

3.*The clinical manifestations of upper digestive bleeding are:

A. rectoragia
B. chest pain
C. flushing
D. hematuria
E.Melena

4. *The primary diagnosis in upper digestive bleeding is represented by:

A. colonoscopy
B. upper gastrointestinal endoscopy
C. abdominal CT
D. Abdominal ultrasound
E.rectal examination

5.*The Forrest Ib classification in upper digestive bleeding mean:

A. bleeding jet
B. adherent clot
C. lesions without bleeding stigmata
D. bleeding canvas
E.blood vessel visible not bleeding

6.Indicators of a massive bleeding are:

A. bradycardia
B. tachycardia
C. alkalosis
D. acidosis
E.azotemia

7. Rockall score of severity depends on:

A. plus
B. temperature
C. TA
D. This comorbidities
E. Consciousness
8. Upper digestive bleeding treatment involves:
A. circulating volume recovery
B. applying the rule of "3-1"
C. correction tachycardia
D. correction of hypothermia
E. correction of coagulopathy

9.Upper digestive bleeding favorable prognostic criteria are:

A. aged under 80years
B. aged over 40 years
C. absence of ascites
D. presence of ascites
E. absence haematemesis 1 hour after presentation

10. Gastric aspiration is practiced in upper gastrointestinal bleeding in order to:

A. monitoring bleeding
B. diagnosis
C. preparation for colonoscopy
D. hemostasis
E. administrating corrosive substances

11.The surgical therapy of upper digestive bleeding has absolute indications if:
A. endoscopic treatment failure
B. hemodynamic instability
C. recurrent bleeding
D. history of gastric ulcer
E. refusing transfusion

12. Therapeutic options in bleeding esophageal varices are:

A. sclerotherapy
B. transjungular postosistemic intrahepatic shunt
C. transjungular postosistemic extrahepatic shunt
D. Pharmacotherapy
E. plugging probe Linton-Nachlas

13. Risk factors for stress ulcers are:

A. shock
B. sepsis
C. administration of aspirin
D. multiple trauma
E. 10% body surface area burns

14. Heraldry hemoragia includes:

A. the occurrence of bleeding after medical treatment
B. associating a aortointestinal fistula
C. the association of esophageal varices
D. massive hemorrhage
E. reduced bleeding
15. Injury digestive bleeding include:
A. watermelon stomach
B. intestinal angiodisplaziile
C. hemobilia
D. hemosuccus pancreaticus
E. appendicitis

16. The lower gastrointestinal bleeding can occur with:

A. Melena
B. Haematemesis
C. haematochezia
D. rectal
E. hemoptysis
1.* On what place is situated worldwide colo-rectal cancer?
A. First place
B. Second place
C. Third place
D. Fourth place
E. Fifth place

2. Write the corect statements about colo-rectal cacer:

A. In the last two decades the incidence of colo-rectal cancer has decreased in Europe
especially in the East countries
B. In the last two decades the incidence of colo-rectal cancer has increased in Europe
especially in the East countries
C. Occasionally appears with a frequency of 75-80%
D. Occasionally appears with a frequency of 90-95%
E. Occasionally appears with a frequency of 60-70%

3. Contributing factors of colo-rectal cancer are:

A. A history of gastrectomy
B. A history of radioterapy
C. Low fat diet
D. A history of colecistectomy
E. Use of hormon preparation

4. The most common symptoms of colo-rectal cancer are:

A. Tenesmus
B. Rectal bleeding
C. Inapetence
D. Abdominal pain
E. Low grade fever

5.* Intestinal transit disorders manifested with false diarrhea appear in:
A. Rectal tumors
B. Recto-sigmoidian lesions
C. Locally advaced cancer
D. Left colon tumors
E. Right colon tumors

6. Stomach invasion of a colotransversal tumor manifests with:

A. Abdominal pain
B. Pneumaturie.
C. Fetor oris
D. Uncontrolable diarrhea
E. Loss of weight
7.* Synchronous colorectal tumors appear in a percentage of:
A. 3-5%
B. 60-70%
C. 1-3%
D. 5-10%
E. 15-20%

8. Negative prognosis factors for second stage of colorectal cancer are:

A. The answer at adjuvant treatment
B. The stage of tumor differentiation
C. Lymphatic and venous invasion
D. Neural invasion
E. The answer at neoadjuvant teatment

9.* Oclussion frequecy as a method of diagnossis in colo-rectal cancer is about:

A. 5-10%
B. 10-15%
C. 15-25%
D. 25-35%
E. 35-45%

10. Write the correct answers about retroperitoneal method of surgery in colo-rectal cancer:
A. Palpation reveals a tumor with fluctuence zone
B. Symptoms are dominated by the sepsis
C. Shows parietal cellulite phenomena
D. Had abdominal pain
E. Has subcutaneos ephysema

11. Safety radical rezection borders in colo-rectal cancer are:

A. 10 cm above tumor
B. 5 cm above tumor
C. 5 cm under the tumor
D. 3 cm under the tumor
E. 1 cm under the tumor

12. Left segmentary high colectomy assumes:

A. Right colic artery ligature
B. Medium colic artery ligature
C. Left colic artery ligature
D. Inferior mezenteric artery ligature
E. Medium colic artery left branch ligature

13. Local reccurence rate in colo-rectal cancer it was reduced at 8%, because of:
A. Anatomo-pathological resection piece evaluation
B. Preoperathory chimiotherapy eficiency
C. Preoperathory radiotheraphy eficiency
D. Mesorectal total excision
E. Postoperathory chimiotheraphy eficiency

14.* On the moment of diagnossis what is the rate of inoperable rectal tumors?
A. 5-10%
B. 10-20%
C. 20-30%
D. 30-35%
E. 35-45%

15. Preoperahory radiotheraphy indications in rectal cancer are:

A. Stage T3 tumors
B. Stage T4 tumors
C. Subperitoneal rectal neoplasma
D. Rectosigmoidian neoplasma
E. Rectal ampoule neoplasma

16. Neoadjuvant treatment benefits in advanced local rectal cancer are:

A. Secundary lessions eradication
B. Functional result improvement
C. Local reduction of the recurrence
D. Operability conversion maximization
E. The descent of low situated rectal cancer resection border

17.* Distal border of rezection in rectal cancer is:

A. 1 cm
B. 3 cm
C. 5 cm
D. 8 cm
E. 10 cm

18. Minimum invasive way of surgery in rectal cancer (robothic assisted laparoscopy) has the
following advantages:
A. Improves the survival
B. Allows a very low dissection
C. Allows the view of venous plexus
D. Local recurrence reduction
E. Anal sfincter presentation

19. Right colon tumors is characterized by:

A. Clots blood elimination
B. Fresh red blood bleeding
C. Chronic iron deficienty anemia
D. Elimination of red blood mixed with faeces
E. Repeted bleeadings with small amounts of blood

20. Write the correct answers about colorectal cancer:

A. Ranks second place as frequency
B. Ranks third place as frequency
C. Ranks second place in men
D. Ranks third place in women
E. Ranks second place in women
GASTRIC CANCER

1. From an epidemiological point of view, gastric cancer is characterized by:

A. The frequency of the disease is highest among 30-40 years
B. Regarding gender, male / female ratio is 4/1
C. Risk areas are the counties of eastern Transylvania (Covasna, Harghita)
D. In the world it ranks second in the standings after breast cancer malignancy
E. The frequency is significantly higher in developing countries

2. In gastric cancer, which of the following conditions may be considered precancerous states:
A. Gastric ulcer
B. Chronic atrophic gastritis
C. Hypertrophic gastritis
D. Gastric polyps
E. Duodeno-gastric bile reflux

3. Advanced stage gastric cancer may have the following semiologic signs:
A. Palpation of a tumor in the mesogastric region
B. On digital rectal examination, palpation of lymph nodes at the level of prerectal fascia(
Strauss sign)
C. Palpation of a "superficial cancer”
D. Virchoff-Troiserlynmphnode palpation
E. Anemia - low proteins

4. Niche of malignant gastric cancer may have the following:

A. Wide communicating pedicule
B. Narrow communicating pedicule
C. It falls in the interior of the outline of the side-view of the stomach
D. It is the most important radiological sign for ulcerated neoplasms
 E. It occurs most frequently in infiltrating neoplasms

5. The macroscopic view in endoscopy of early gastric cancer is:

A. Type I or protrusion - appears as a polypoid or papillary excrescence
B. Type III or excavating
C. Type II or vegetant
D. Type IV or infiltrative
E. Type II or plastic linitis

6. * Determination of carcinoembryonic antigen (CEA) in gastric cancer may reveal:

A. The presence of early cancer
B. Elevated levels in serum of CEA is found in more than 70-85% of cases
C. It is a specific tumor marker for gastric cancer
D. Increased plasma levels in the postoperative period is of diagnostic significance for
local recurrences
E. Elevated CEA can highlight a monocytic anemia

7. Carcinoembryonic antigen (CEA) in gastric cancer:

A. Has increased specificity
B. Elevated values above 5-10 ng / ml are found only in 25-40% of cases
C. The usefulness of this test increases in postoperative follow-up
D. Decreased plasma levels of CEA in the postoperative period has diagnostic
significance for local recurrence
E. Increased plasma levels of CEA in the postoperative period is useful in deciding
reintervention( "second look").

8. In gastric cancer, blood work modifications may be:

A. Microcytic hypochromic anemia
B. Macrocytic anemia due to acute bleeding
C. Leukocytosis 20.000-25.000 / mmc
D. The increase of IgG and haptoglobin
 E. Erythrocyte sedimentation rate can be accelerated in advanced cancer

9. * The TNM staging of gastric cancer, T3 is:

A. Cancer limited to muscle
B. Cancer limited to the submucosa
C. Cancer invades serous membrane
D. Cancer invading neighboring organs
E. Cancer limited to muscle, but lymph-node in the neighborhood

10. * In TNM staging of gastric cancer, T2 is represented by:

A. Cancer invades serous membrane
B. Cancer limited to the mucosa
C. Cancer limited to the submucosa
D. Cancer limited to muscle
E. Early cancer with regional lymph-node

11. The surgical indications in gastric cancer may include:

A. Emergency (bleeding)
B. Elective surgery with a possibility of a radical approach
C. Absolute in all cases
D. Elective with palliative means
E. Emergency (perforation)

12. In gastric cancer by gastric radical subtotal resection we understand:

A. Subtotal resection which removes the gastric tumor fully
B. Removing the small omentum
C. Removing the perigastric lymph-nodes
D. Removing the great omentum
E. Removal of regional lymph nodes and spleen
13. In gastric cancer, radical proximal gastrectomy resection includes:
A. Gastro-colic ligament
B. Gastro-splenic ligament without splenectomy
C. Small omentum
D. The distal 1/3 of the thoracic esophagus
E. Gastro-splenic ligament with spleen

14. Total radical gastrectomy in gastric cancer resection includes:

A. Great omentum.
B. All of the 16 lymph node stations
C. Small omentum
D. Spleen
E. Transverse mesocolon

15. Radical complex surgeries in gastric cancer may include:

A. Gastro-pancreatectomy
B. Gastrectomy associated with oophorectomy
C. Total gastrectomy associated with hysterectomy
D. Gastrectomy and right nephrectomy
E. Gastrectomy associated with the excision of the left hepatic lobe

16. Palliative resection of gastric cancer has the following benefits:

A. Allows completely removing the tumor along with all regional lymph node groups
B. 5-year survival reaches 40-50%
C. Provides secondary prophylaxis of bleeding from the tumor
D. It reduces the degree of intoxication and tumor cachexia
E. Slows the growth of metastases by improving immunological defense reaction of the
body

17. By-pass gastric cancer surgery is indicated:

 A. In limited tumor forms, with small, uncomplicated forms
B. In the event of extensive tumors, placed near the cardia
C. In obstruction of the alimentary transit
D. In non-obstructive cancers, but with metastasis in the liver or lungs
E. In extensive cancers placed near the pylorus

18. Immunotherapy in gastric cancer:

A. It is indicated in stage II
B. It is effective in advanced forms
C. The duration of treatment is up to 3 months
D. Applied alone is less effective
E. It is indicated only in stage IV

19. Chemotherapy in gastric cancer:

A. It is indicated only in the early stages
B. It is currently considered less effective
C. Allows the reduction of the tumor relapse in 5 year prognosis, in 80% of the cases
with stage III
D. Use mitomycin-C or 5-fluorouracil
E. 5-year survival increases to 55-65%

20. After total radical gastrectomy ingastric cancer, restoration of the digestive continuity can
be achieved by:
A. Eso-duodenal anastomosis
B. Eso-jejunal end-to-end anastomosis
C. Interposition of ileal segment
D. Expandable prosthesis fitting
E. Eso-jejunal anastomosis end-to-side
1. Primary bile duct lithiasishas the following causes:
A. High CBD postoperative stenosis
B. Inflammatory strictures of common bile duct
C. Compressive cephalicpancreatitis
D. Dilatation of the cystic duct
E. Duodenal diverticulum

2. Common bile duct colic is characterized by:

A. Pain located in the epigastric area
B. Pain located in the left upperquadrant
C. Atrocious pain iradiating to the lumber spine
D. Pain located in the umbilical area
E. Left upper quadrant pain, with radiation to the left shoulder

3. Billiary retention sydrome includes:

A. Hyperbilirubinemia with predominance of conjugated bilirubin
B. Hyperbilirubinemia with predominance of unconjugated bilirubin
C. Alkaline phosphatase over 70 IU
D. Decresed transaminas is below 200-300 IU
E. Gamma-GT raised over 100 IU

4. The following statements about imagistic investigations in CBD lithiasis are false:
A. Transparietal abdominal ultrasound is the elective method
B. Endoscopic retrograde cholangiopancreatography is an imprecise method of diagnosis,
showing a morbidity of almost 6%
C. Echoendoscopyis a highly reliable method
D. CT scan can not highlightlow-calciumstones
E. Cholangio-MRIhas no accuracy in revealinglesions at this level

5. *The differential diagnosis of jaundice caused by common bile duct stones is made
with:
A. Vaterianampuloma
B. Acute hepatitis
C. Jaundiceduetocephalic pancreatic cancer
D. Hepatic hydatidcyst
E. All of theabove

6. Reynoldspentad of acute cholangitis is characterized by:

A. Colicative pain
B. Fever 39-40 °C and shivers
C. Jaundice
D. Hypertension
E. Liver and kidney insufficiency
R: A, B, C, E (page 184)
 7.
A. Represents germcolonization of bile
B. Infection hematogenic spread
C. Infection occurs on the up ward path from the small intestine
D. The most serious form is uremigenic-angiocholitis
E. Periportalhepatocyte necrosisfoci never appear

8. Minimally invasive techniques in resolving common bile duct stones are:

A. Therapeutic Endoscopy
B. Interventional Radiology
C. Laparoscopic surgery
D. Ultrasound extracorporeallithotripsy
E. Chemical dissolution of gallstones

9. * Desobstruction of the common bile duct by open surgery is done as follows:

A. Transcystic
B. Classic sphincterotomy
C. Incision of the common bile duct
D. A and C are correct answers
E. Correct answers are a, b and c

10. * The complexity of a common bile duct lithiasisischolangiographic is certified by:

A. Gallstones smaller than 2 cm diameter
B. The absence of lithiasic relapses
C. Atonic dilated common bile duct(diameter less than 2 cm)
D. Panlitiasis
E. No right answer
1. Charcot triadis suggestive for an obstructive complication, and it is represented by:
A. Epigastric pain irradiated in the right upper quadrant
B. Vomitting
C. Fever
D. Shivers
E. Jaundice

2. Abdominal ultrasound in biliary lithiasis is a method:

A. Very accurate
B. Accesible
C. Invasive
D. Expensive
E. Can be done regardless of the patient’s condition

3. *Abdominal ultrasound in biliary lithiasis can not always show:

A. Liver’s echogenicity
B. The thickness of the gallbladder’swall
C. Number of gallstones
D. The size of the gallbladder
E. The gallstone’sposition

4. Clinical manifestations of thebiliary lithiasis may take the following forms:

A. Asymptomatic form
B. Oligosymptomatic form
C. Painful form
D. Ulcerative form
E. All of the above

5. *Which of the following is true about the simple abdominal radiography in biliary
lithiasis:
A. High lighthy perechoicimages with posterior shadow cone
B. Has absolute indication
C. It can not identify only radiolucent gallstones
D. Can identify only radiopaque gallstones
E. Brings informations about common bile duct

6. Acute cholecystitis is characterized by:

A. Pain increased in intensity and duration
B. Leucocytosis with values 18.000-20.000/mm3
C. Decreasing transaminases
D. Muscular defense
E. Fever 37-38 °C

7. *Treatment of biliary lithiasis:

A. Has emergency surgery indication be cause of the evolution
B. Antibiotics are mandatory in the acute version
C. Golden standard isrepresentedbyclassiccholecystectomy
D. Laparoscopiccholecystectomyhas an increased rate of postoperativemortality
E. Cholecistendesis is practiced by routine
 PERITONITIS

1. Which of the following is true regarding peritonitis?

A. It may be caused by chemical agents or radiation
B. It is the most frequent pathology in emergency surgery
C. The most frequent form of peritonitis is the primitive form
D. In the past century, deaths related to peritonitis have grown considerably
E. Secondary peritonitis is about 95% of the total cases of peritonitis

2. Which of the following statements regarding the primary peritonitis are not true?
A. The source of contamination is not from the peritoneal cavity
B. In the initial phase it is polymicrobial
C. Germs that are frequently incriminated are: pneumococcus, meningococcus and
staphylococcus
D. Gastrointestinal integrity is preserved
E. Genital upward propagation path is incriminated in staphylococcal primitive
peritonitis

3. * Which of the following statements related to secondary peritonitis is false:

A. They may have pelvic origin: ovarian abscess, Fallopian tube abscess
B. Always polymicrobial
C. May have iatrogenic origins: enema, gastro-intestinal instrumental dilatations
D. Posttraumatic or postoperative
E. Anaerobic agent most commonly discovered is Escherichia Coli

4. In peritonitis, abdominal pain can have the following characters:

A. Can be non-localised in primitive peritonitis
B. Can be mild in elderly patients with comorbidities
C. Maximum intensity is situated in the centro-abdominal area
D. May irradiate along the legs
 E. May irradiate to the shoulder as an expression of peritoneal irritation of the diaphragm

5. * In peritonitis, which of the following statements is false:

A. Maximum intensity of pain is usually felt in the affected organ
B. Pain may irradiate,interscapulovertebral or in the shoulder, as an expression of
irritation of the vagus nerve
C. Vomiting with food content is a common initial symptom
D. Hiccups occur late in phrenic irritation
E. Anorexia occurs early by central reflex mechanism

6. Which of the following statements regarding the objective signs of peritonitis are true?
A. The abdomen is immobile, retracted
B. Hypoesthesia of the skin is frequently present
C. Auscultation reveals the absence of intestinal noises in advanced stages (Silentium
"sepulchral")
D. Contracture can be generalized or unilateral
E. Bell, Mendel signs are negative

7. Which of the following electrolyte imbalances are common in peritonitis?

A. Hyponatremia
B. Hiperpoatesemie
C. Hypercalcemia - due to vomiting
D. Hypochloraemia
E. Hypocalcemia - due to low parathyroid hormone levels in the serum

8. Which of the following imagistic investigations are indicated in peritonitis?

A. Abdominal ultrasound
B. Peritoneal puncture, with or without lavage
C. Computed tomography (CT)
D. Chest-X-ray
 E. Barium swallow, to highlight headquarters perforation

9. * Which of the following is not an appropriate imagistic investigation in the diagnosis of

peritonitis:
A. Chest-X-ray.
B. MRI.
C. Laparoscopy/Coelioscopy.
D. Barium swallow, to highlight headquarters perforation.
E. Plain abdominal radiography

10. Spontaneous peritonitis in adults is characterized by:

A. Can occur in patients with decompensated cirrhosis
A. It is favored by immunosuppression
B. The peritoneal liquid is alkaline
C. The peritoneal fluid has less than 150 bcm, polymorphonuclearelements
D. It is a monomicrobial infection

11. Which of the following statements are true regarding tuberculosis peritonitis?
A. Acute debut, night sweats, weight loss
B. Surgery is urgent
C. Abdominal contracture is always present, even after onset
D. Surgical treatment is necessary in the stages with perforation or occlusion
E. Patients presenting multiple disseminated nodules on the surface of the peritoneum
and omentum

12. Biliary peritonitis may be caused by the following:

A. Liver puncture
B. Liver trauma
C. Chronic cholecystitis
D. CBP trauma
 E. Chronic pancreatitis

13.* Which of the following is false regarding peritonitis through colonic perforation?

A. It can evolve as an asthenic peritonitis in elderly patients

B. It has a supra-acute evolution
C. It may be the result of a perforation with a foreign body
D. It can occur through a diverticular perforation or an inflammatory colitits
E. Diastatic perforation is mostly found in the sigmoid

14.* Differential diagnosis of peritonisis can comprise the following acute surgical abdomen
pathology except:
A. Acute pancreatitis
B. Visceral torsions
C. Non-traumatic hemoperitoneum
D. Saturnine crisis
E. Occlusion.

15. Laparoscopic approach in peritonitis has the following advantages:

A. Small chances of residual abscesses post-surgery
B. Pain with lower intensity post-surgery
C. It does not impose antimicrobial chemotherapy
D. Less parietal complications
E. Shorter hospitalisation
 CHOICE TEST - THORACIC AND ABDOMINAL TRAUMA

1 . *At polytrauma - heart failure or absent pulse threadlike veins and dilated cervix is
due to the following except:
A. Cardiac tamponade
B. Coronary embolism gas
C. The massive haemotorax
D. Cardiac contusion with heart cardiac
E. Suffocating pneumothorax

2. *The following information about posttraumatic empyema are true except:

A. It is a complication that occurs in half of patients
B. The diagnosis is confirmed by CT with IV contrast.
C. The septic patient can be done VATS drainage of fluid collections
D. Could occur secondary to pneumonia with pleurisy parapneumonica
E. Could occur secondary to lung abscess broken

3. *The following information about the indications for surgical treatment in thoracic
trauma are true except:

A. thoracotomy is indicated in the initial hemorrhage > 1500 ml or bleeding in rhythm

> 300 ml / hour for 3 hours
B. Thoracotomy is always indicated in patients with coagulopathy or anticoagulant
therapy
C. This heralded the need for surgery gastric contents
D. Establish among patients without bleeding is performed laboratory examinations
necessary for the specification of vascular lesion
E. Failure to achieve normal current volumes can announce serious injuries.

4. * The thoracic flail may occur following except:

A. Paradoxical breathing
B. Swinging Breath
C. Balance mediastinal
D. Mechanical ventilation increases the mobility of abnormal wall
E. Accumulation of bronchial secretions with possible obstructive insufficient

5. * The common solution solving a stomach wounds:

A. Simple suture
B. Partial gastrectomy
C. Gastroenteoanastomosy
D. None of the above
E. All of the above
6. In massive haemotorax appear following:

A. Percussion dullness
B. Absent vesicular Murmur
C. Collapsed of cervical veins
D. Trachea dislodged toward healthy
E. Distended neck veins.

7. In abdominal trauma - visceral lesions is primarily delivered through the following

syndromes intricate
A. Internal bleeding
B. Peritoneal irritation syndrome
S. Subocclusiv syndrome
D. Pancreatitis syndrome
E. Traumatic shock

8. The organs most commonly affected in abdominal contusions:

A. Spleen
B. Kidneys
C. Pancreas
D. Bowl
E. Liver

9. In the postoperative period following a liver trauma surgery may encounter the
following as the most common complications:
A. Jaundice
B. Acute cholecystitis
C. Hepatic necrosis
D. Biliary fistulas and bile collections
E. None of the above

10. Plagues of bile can be solved by:

A. Kehr tube drainage
B. Implantation of the common bile duct into a jejunal loop
C. Ligation temporary choledoc
D. Externalizing the common bile duct D.
E. None of the above.

11. The following statements are true about thoracic duct injury:
A. No surgical treatment in this situation
B. Treatment may consist of thoracic duct ligation above and below the lesion
C. The accumulation of lymph mediastinum and pleura is fast then
D. Conservative treatment consisted of diet poor in long-chain triglycerides or total
parenteral nutrition
E. It is always necessary thoracotomy

12. Wounds of atrial or ventricular heart are as follows:

A. Penetrating cardiac wall when partial interests
B Non-penetrative you interested partially cardiac wall
C. Penetrating cardiac wall when the lesion is complete
D Transfixiante when total wall cardiac care
E. Transfixiante when the agent fully crossing the vulnerable heart

13. The clinical picture is dominated by cardiac lesions:

A. Flushing
B. Cyanosis
C. Cervical vein collapse
D. Hepatomegaly
E. Signs of acute cardio-respiratory failure

14. The following statements about the trauma diaphragmatic ruptures are true:
A. interested commonly outskirts muscle
B. In 90-95% of cases are located in the right hemidiaphragm
C. diaphragmatic rupture is followed by intrathoracic herniation of abdominal viscera
D. In selected cases indicated laparoscopic approach
E. The existence of concomitant injuries exploratory thoracotomy and intrathoracic
imposes tarapeutică

15. Among threatening conditions to be treated during the initial assessment and first
aid are:
A. Pneumothorax voltage
B. Open pneumothorax
C. Minimum-moderate haemothorax
D. Thorax soft
E. Cardiac tamponade

16. Hemodynamically stable patients with abdominal trauma unstable closed are:
A. Exam emergency CT
B. FAST ultrasound exam
C. Puncture Diagnostic peritoneal
D. Diagnostic Laparoscopy
E. All of the above