General surgery Flashcards
(147 cards)
1
Q
A surgery is performed with diagnostic intent:
A) if the nature of the disease cannot be otherwise confirmed
B) if no further costly investigations can be carried out
C) if the patient refuses to undergo any other therapeutic intervention
D) in the majority of the surgical interventions
A
A) if the nature of the disease cannot be otherwise confirmed
2
Q
A surgery is considered curative:
A) in all the cases
B) if the cause of the disease can be completely eliminated with the surgery
C) if it is not aimed to prevent a disease
D) when peritoneal carcinomatosis is found
A
B) if the cause of the disease can be completely eliminated with the surgery
3
Q
All these methods are used to prevent thromboembolic complications in the perioperative period, except one:
A) Na-heparin
B) Colfarit (acidum acetylsalicylicum)
C) Ca-heparin
D) compression stockings
A
B) Colfarit (acidum acetylsalicylicum)
4
Q
All those means, methods and interventions with which we try to prevent the contamination of the pathogens are collectively called as:
A) disinfection
B) asepsis
C) antisepsis
D) sterilization
A
B) asepsis
5
Q
Principles of the modern antibiotic therapy:
A) broad-spectrum antibiotics are given in the proper dose
B) antibiotic treatment is always targeted
C) carefully selected antibiotics are given in the proper dose for the proper time
D) carefully selected antibiotics are given in the proper dose for the longest possible time
A
C) carefully selected antibiotics are given in the proper dose for the proper time
6
Q
Which of the following solutions CANNOT be used for disinfection of the skin around the wound?
A) iodine
B) petrol
C) alcohol
D) sublimate
A
B) petrol
7
Q
Instruments used before any invasive intervention have to be:
A) disinfected using H2O2 solution
B) disinfected using a solution containing alcohol and tensides or invert soap
C) sterilized (e.g. autoclave or gas sterilization, radiation sterilization)
D) sterilized (e.g. ultraviolet or infrared light)
A
C) sterilized (e.g. autoclave or gas sterilization, radiation sterilization)
8
Q
After any invasive intervention, the used instruments have to be:
A) rinsed under running water using soap and brush
B) soaked for disinfection and removal of blood residues
C) sterilized in a dry heat sterilizer
D) disassembled and sterilized
A
B) soaked for disinfection and removal of blood residues
9
Q
Clinical signs of bleeding, except:
A) tachycardia
B) drop of blood-pressure
C) dry mouth
D) polyuria
A
D) polyuria
10
Q
Which is the most probable cause of a gastrointestinal bleeding presenting in the form of hematemesis?
A) recto-sigmoid cancer
B) duodenal cancer
C) erosive gastritis
D) hemorrhagic enteritis
A
C) erosive gastritis
11
Q
Which is the most frequent cause of primary hyperparathyroidism?
A) parathyroid hyperplasia
B) parathyroid adenoma
C) parathyroid cancer
D) chronic renal failure
A
B) parathyroid adenoma
12
Q
From the following options which symptom is NOT characteristic of primary hyperparathyroidism?
A) hypercalcemia
B) oliguria
C) short QT interval
D) hypophosphatemia
A
B) oliguria
13
Q
The development of metastases in malignant diseases:
A) correlates with the size of the cancer
B) correlates with the time elapsed from the appearance of the cancer
C) depends on the biologic characteristics of the cancer and does not correlate with its volume
D) depends on the location of the primary cancer
A
C) depends on the biologic characteristics of the cancer and does not correlate with its volume
14
Q
Generally speaking, the aim of lymph node dissection in malignant diseases is:
A) to eliminate the pathways of further lymphatic
B) to remove the regional metastases as best as possible
C) to improve the lymphatic drainage of the involved tissues
D) to make the radical removal of the primary cancer possible
A
B) to remove the regional metastases as best as possible
15
Q
Select the correct (most appropriate) answer.
A) Fibroadenoma is the most common benign lesion of the breast in hormonally active women.
B) Fibroadenomas never turn malignant.
C) Fibroadenomas are never removed surgically, cytological examination is enough.
D) Fibrocystic breast lesion (mastopathy) is very common in non-lactating women.
A
A) Fibroadenoma is the most common benign lesion of the breast in hormonally active women.
16
Q
Select the correct (most appropriate) answer.
A) The TNM score has only a limited role in the staging of breast cancer; other classifications are becoming more important
B) About 80% of all breast cancers are invasive ductal carcinomas
C) About 70-80% of all breast cancers are invasive lobular carcinomas
D) The proportion of ductal and lobular breast carcinomas is roughly the same (45–45%)
A
B) About 80% of all breast cancers are invasive ductal carcinomas
17
Q
Which type of hernia is the most prone to incarceration?
A) femoral hernia with a wide orifice
B) complex ventral incisional hernia
C) inguinal hernia with a narrow orifice
D) non-reducible umbilical hernia
A
C) inguinal hernia with a narrow orifice
18
Q
The most frequent type of surgery of the repair of an inguinal hernia is:
A) Fabricius surgery
B) Kocher surgery
C) Nissen–Rosetti surgery
D) Lichtenstein surgery
E) Bassini-Kirschner surgery
A
D) Lichtenstein surgery
19
Q
During a laparoscopic surgical intervention
A) the abdominal cavity is inflated with oxygen
B) the increased intra-abdominal pressure has to be taken into account when considering the indication of surgery
C) any intraoperative bleeding complication necessitates a conversion to open procedure
D) antibiotic prophylaxis is compulsory before every surgery
A
B) the increased intra-abdominal pressure has to be taken into account when considering the indication of surgery
20
Q
During a laparoscopic hernia repair:
A) The defect of the abdominal wall is covered by a synthetic mesh
B) The defect of the abdominal wall is closed by plastic clips
C) The hernia contents are pushed back into the abdominal cavity from the outside
D) The defect of the abdominal wall is actually not closed
A
A) The defect of the abdominal wall is covered by a synthetic mesh
21
Q
Which one of the following statements is not true for abdominal abscesses?
A) often caused by perforation of some hollow viscera
B) treatment is primarily surgical exploration + drainage
C) drainage of the abscess can be done percutaneously with US, CT or MR guidance
D) interintestinal abscesses only develop on basis of Crohn’s disease
A
D) interintestinal abscesses only develop on basis of Crohn’s disease
22
Q
Which of the following statements is true?
A) Hernia repairs are categorized as clean-contaminated surgeries
B) The average suppuration rate after clean-contaminated surgeries is around 5-15%
C) The average suppuration rate after clean-contaminated surgeries is <8-22%.
D) The average suppuration rate after clean-contaminated surgeries is >2-8%.
A
D) The average suppuration rate after clean-contaminated surgeries is >2-8%.
23
Q
Which of the following signs is the least characteristic of a pancreatic cancer?
A) loss of appetite
B) asymptomatic jaundice
C) newly discovered diabetes
D) fever
A
D) fever
24
Q
Relatives of a 63-year-old male patient discover jaundice on him. All of the following presumed diagnoses are reasonable, except one:
A) infective hepatitis
B) pancreatic cancer
C) chronic pancreatitis
D) Crigler–Najjar syndrome
E) choledocholithiasis
A
D) Crigler–Najjar syndrome
25
The most common pathway of metastatic spreading in colonic cancer is:
A) via the inferior mesenteric vein
B) via the portal vein
C) lymphogenic spreading
D) intraluminar spreading
C) lymphogenic spreading
26
What do we call as neoadjuvant chemotherapy?
A) irradiation administered during the surgery
B) cytostatic treatment administered after the surgery
C) cytostatic treatment administered before the surgery
D) cytostatic treatment administered during the surgery
C) cytostatic treatment administered before the surgery
27
Proper treatment of a furuncle on the face:
A) incision, excochleation
B) expression of the pus
C) moist packing and antibiotics
D) excision
C) moist packing and antibiotics
28
Which histologic type of the thyroid cancer has generally the best prognosis?
A) medullary cancer
B) papillary cancer
C) follicular cancer
D) anaplastic cancer
B) papillary cancer
29
Primary varicosity:
A) develops always after deep vein thrombosis
B) is a result of superficial thrombophlebitis
C) is always treated surgically
D) is a hereditary, degenerative condition of the superficial veins
D) is a hereditary, degenerative condition of the superficial veins
30
The Perthes test:
A) assesses the condition of the valves in the greater saphenous vein
B) assesses the rate of blood flow towards the deep veins
C) is a sign of deep-vein thrombosis when dorsalflexion of the foot induces calf pain
D) if negative, phlebography has to be performed next
B) assesses the rate of blood flow towards the deep veins
31
In which disease is it most common to find an enlarged, palpable gallbladder?
A) Klatskin tumor
B) papilla of Vater carcinoma
C) cancer in the body of the pancreas
D) hepaticolithiasis
B) papilla of Vater carcinoma
32
All of these lesions can be drained by ultrasonic guidance, except one:
A) pancreas pseudocysts
B) retention cysts of the liver
C) meningeal cysts
D) retroperitoneal cysts
E) hydatid cysts
C) meningeal cysts
33
What is the definition of an in situ cancer?
A) if the tumor grows towards the lumen of an organ
B) if the tumor does not penetrate the serosal layer of the organ
C) if the tumor is confined to one tissue layer of the organ
D) if the tumor does not give regional metastases
C) if the tumor is confined to one tissue layer of the organ
34
Select the examples of an absolute indication of surgery:
1) an injury that is so severe that the life of the patient can only be saved with a surgical intervention
2) deepening jaundice
3) intestinal obstruction
4) certain cases of gallstone disease
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
35
A surgery is performed by vital indication in the case of:
1) incarcerated hernia with signs of intestinal obstruction
2) perforation of a hollow abdominal viscera
3) ruptured aortic aneurysm
4) bleeding from a superficial vein on the lower extremity
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
36
Possible causes of a complete postoperative abdominal wound disruption:
1) protein deficiency
2) improper surgical technique
3) postoperative abdominal distension
4) early mobilization
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
37
Anastomotic leakage is one of the most serious complications after a gastrointestinal surgery. The following factors play a role in the prevention of it:
1) antibiotics administered in therapeutic dose
2) the created anastomosis should be free of tension
3) at least two layers of suture should be made for the anastomosis
4) only tissues (e.g. bowel ends) with good blood supply should be approximated
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
38
We are speaking of radical (R0) resection if:
1) both the surgeon and the pathologist states that there is no residual tumor left behind
2) the tumor can be physically resected but histological assessment confirms microscopic residual tumor
3) the tumor can be physically resected but metastatic lymph nodes are left behind
4) there is a visible tumor mass left behind at the end of the surgery
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 1st answer is correct
E) all of the answers are correct
D) only 1st answer is correct
39
Clinical signs of an incarcerated hernia:
1) the hernia becomes swollen and rigid
2) the hernia becomes painful
3) signs of bowel obstruction
4) the hernia cannot be reduced to the abdominal cavity
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
40
Characteristics of the lateral/indirect inguinal hernia:
1) it is less prone to incarceration
2) can cause intermittent groin pain
3) it never extends into the scrotum
4) it is often congenital
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
41
Benefits of a laparoscopic surgery over an open procedure include:
1) less postoperative pain
2) shorter hospital stay
3) faster recovery
4) better exposure of the abdominal cavity
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
42
What are those areas where the laparoscopic surgical approach has the most obvious benefits?
1) gallstone disease
2) inguinal hernia
3) gastroesophageal reflux disease (GERD)
4) adrenal adenoma
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
43
Choose the correct (most appropriate) answer(s).
1) The average suppuration rate after a contaminated surgery does not exceed 20%.
2) An emergency subtotal gastric resection performed due to a bleeding ulcer is considered a contaminated surgery.
3) Biliary tract surgeries are considered contaminated only if the bile is confirmed to be bacterially infected.
4) No antibiotic prophylaxis is needed before a contaminated surgery since antibiotics should only be administered based on the culture reports.
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
44
Choose the correct (most appropriate) answer(s).
1) Staphylococcus species are often found in samples taken from purulent skin infections and abdominal abscesses.
2) Anaerobic bacteria can also cause septic skin lesions.
3) Furuncles most often develop from Staphylococcus infection.
4) Folliculitis is the purulent inflammation of the hair follicles.
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
45
When diabetes mellitus is diagnosed, the further investigations has to be carried out:
1) quantitative glucose assessment from collected urine
2) sugar profile assessment
3) glucose acetone assessment from fragmented urine using test strips
4) glucose tolerance test
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
46
If a patient develops jaundice, which of the following investigations would you perform first?
1) abdominal CT
2) MR cholangiography
3) HIDA scan
4) abdominal ultrasound
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
47
The following diseases can mimic the signs of acute abdomen:
1) diabetes mellitus
2) porphyrin metabolism disorders
3) lead poisoning
4) steroid administration
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
A) 1st, 2nd and 3rd answers are correct
48
After which surgeries do we have to administer drug replacement therapy?
1) partial thyroid resection
2) total pancreatectomy
3) subtotal gastric resection
4) total gastrectomy
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
49
Postoperative thyrotoxic crisis
1) it can develop after the surgery of hyperthyroidism
2) it can develop after the surgery of hypothyroidism
3) it is a life-threatening condition
4) recovery can occur spontaneously
5) rarely develops with adequate preoperative medication
A) 1, 2 and 3 answers are correct
B) 1, 3 and 4 answers are correct
C) 1, 4 and 5 answers are correct
D) 1, 3 and 5 answers are correct
E) 2, 3 and 4 answers are correct
D) 1, 3 and 5 answers are correct
50
Absolute indication of tracheostomy
1) prolonged intubation
2) bilateral paresis of the recurrent laryngeal nerve
3) polyp of the vocal cord
4) destructive trauma of the larynx
5) severe laryngeal edema
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
D) 1, 3 and 4 answers are correct
E) 2, 4 and 5 answers are correct
A) 1, 2, 4 and 5 answers are correct
51
Principle conditions of primary wound healing
1) tight wound suture
2) good blood supply
3) sterile wound dressing
4) intact innervation
5) viable wound edges
A) 1, 2 and 3 answers are correct
B) 1, 4 and 5 answers are correct
C) 2, 3 and 4 answers are correct
D) 2, 3 and 5 answers are correct
D) 2, 3 and 5 answers are correct
52
Sign of wound infection
1) wound is covered with dry slough
2) hyperemia of the wound edges
3) edema of the wound edges
4) suffusion around the wound
5) septic fever
A) 1, 2 and 3 answers are correct
B) 1, 4 and 5 answers are correct
C) 2, 3 and 4 answers are correct
D) 2, 3 and 5 answers are correct
D) 2, 3 and 5 answers are correct
53
Characteristics of steam sterilization
1) the process is done at above 1 Atm pressure and above 105 °C temperature
2) vacuum pumps suck out air before the chamber is filled with pressurized steam
3) to ensure sterility indicators should be taped on medical packaging
4) Surgical instruments should be placed in aluminum foil package
5) after the process the chamber should be cleaned with sodium hypochlorite (bleach)
A) 1, 2 and 3 answers are correct
B) 1, 3 and 4 answers are correct
C) 2, 3 and 5 answers are correct
D) 3, 4 and 5 answers are correct
A) 1, 2 and 3 answers are correct
54
In case of lacerated wound which involves the gluteal muscle
1) wound edges should be excised
2) prophylactic antibiotics (in this case Sulfaguanidine) should be administered
3) wound cavity should be rinsed with H2O2-solution
4) the wound should only be closed if a drain tube is left in the cavity
5) wound closure should be done with running intracutaneous suture
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
D) 1, 3 and 4 answers are correct
D) 1, 3 and 4 answers are correct
55
Tetanus prophylaxis is mandatory:
1) erysipelas
2) congelation
3) gunshot wound
4) bite wound
5) hydradenitis
A) 1, 2 and 3 answers are correct
B) 1, 3 and 4 answers are correct
C) 2, 3 and 4 answers are correct
D) 3, 4 and 5 answers are correct
C) 2, 3 and 4 answers are correct
56
Requirements of primary wound healing
1) debridement
2) good blood supply
3) intact innervation
4) Donati-type suturing
5) proper macrophage function
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
D) 1, 2 and 5 answers are correct
E) 2, 4 and 5 answers are correct
D) 1, 2 and 5 answers are correct
57
Steps of wound management
1) analgesia
2) tetanus prophylaxis
3) wound excision
4) wound cleaning
5) wound closure, dressing
A) 2–1–4–3–5
B) 3–1–4–5–2
C) 4–1–3–5–2
D) 2–4–3–1–5
C) 4–1–3–5–2
58
Local signs of wound infection
1) bulge
2) innervation problem
3) hyperemia
4) functional problems
5) local tetanic spasm
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 1, 3 and 4 answers are correct
D) 1, 2 and 5 answers are correct
E) 2, 4 and 5 answers are correct
C) 1, 3 and 4 answers are correct
59
Typical blood test parameters of a patient with crural phlegmon
1) eosinophilia
2) leukocytosis
3) elevated serum creatinine
4) increased erythrocyte sedimentation rate
5) severe anemia
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
D) 1, 2 and 5 answers are correct
E) 2, 4 and 5 answers are correct
C) 2 and 4 answers are correct
60
Choose the most appropriate answers
1) Most of breast cancers grow slowly
2) Most of breast cancers grow rapidly
3) Lymphatic drainage of the breast is three-level
4) Patient survival is most favorable in the case of papillary breast cancer
5) Hematogenous spreading is non-existent in breast cancer
A) 1, 3 and 4 answers are correct
B) 2, 3 and 5 answers are correct
C) 2, 4 and 5 answers are correct
D) 3, 4 and 5 answers are correct
A) 1, 3 and 4 answers are correct
61
Choose the most appropriate answers
1) Breast cancer do not develop in males
2) Considering the type of breast cancers patient survival is worst in case of inflammatory carcinoma
3) Hormone-receptor positive breast cancers progress faster
4) Hormone-receptor positive breast cancers progress slower
5) Hormone-receptors are not important in the progression of breast cancer so screening of these receptors are not necessary
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
C) 2 and 4 answers are correct
62
Post-thrombotic syndrome:
1) chronic venous circulatory insufficiency of the lower extremities
2) develops years after a deep vein thrombosis
3) totally unrelated to crural ulcers
4) leads to development of varicosity in the majority of cases
5) compression stockings are a major part of the conservative treatment
A) 1, 2, 4 and 5 answers are correct
B) all the answers are correct
C) 2 and 4 answers are correct
D) 1, 3 and 4 answers are correct
E) 2, 4 and 5 answers are correct
A) 1, 2, 4 and 5 answers are correct
63
Main symptoms in obstructive jaundice
1) pale stool
2) dark urine
3) yellowish sclera
4) flatulence
5) fatigue
A) 1, 2 and 3 answers are correct
B) 1, 3 and 4 answers are correct
C) 1, 4 and 5 answers are correct
D) 2, 3 and 4 answers are correct
A) 1, 2 and 3 answers are correct
64
The following parameters are elevated in obstructive jaundice
1) total bilirubin
2) conjugated bilirubin
3) CRP
4) alkaline phosphatase
5) GGT
A) 1, 2, 4 and 5 answers are correct
B) all of the answers are correct
C) 2 and 4 answers are correct
D) 1, 3 and 4 answers are correct
E) 2, 4 and 5 answers are correct
A) 1, 2, 4 and 5 answers are correct
65
What could be the main sources of bleeding in patients with liver cirrhosis except esophageal varices?
1) gastritis
2) duodenal ulcer
3) gastric ulcer
4) Mallory–Weiss-syndrome
5) Barret's esophagus
A) 1, 2 and 3 answers are correct
B) 1, 3 and 4 answers are correct
C) 1, 4 and 5 answers are correct
D) 1, 3 and 5 answers are correct
E) 2, 3 and 4 answers are correct
A) 1, 2 and 3 answers are correct
66
Clinical significance of basal cell cancer
1) its histological structure is not malignant
2) recurrence is frequent
3) metastases are uncommon
4) frequently develops in elderly patients
5) its only therapy is surgical
A) 1, 3 and 4 answers are correct
B) 2, 3 and 4 answers are correct
C) 1, 3 and 5 answers are correct
D) 3 and 4 answers are correct
E) all of the answers are correct
D) 3 and 4 answers are correct
67
Match the followings.
A) absolute indication of surgery
B) relative indication of surgery
C) absolute contraindication of surgery
D) preventive (prophylactic) indication of surgery
SUR - 1.71 - abdominal wall hernia causing many symptoms
SUR - 1.72 - significant but asymptomatic stenosis of internal carotid artery
SUR - 1.73 - severe damage of central nerve system
SUR - 1.74 - perforated acute appendicitis
71- B
72- D
73- C
74- A
68
Choose the appropriate therapies to the following postoperative complications
A) reoperation
B) wound opening
C) puncture
D) anticoagulant therapy
SUR - 1.75 - serous fluid collection in the wound
SUR - 1.76 - wound infection
SUR - 1.77 - pulmonary embolism
SUR - 1.78 - total wound dehiscence
75- C
76- B
77- D
78- A
69
Match the followings.
A) blood culture
B) wound excretion
C) urinary sample
D) sputum sample
SUR - 1.79 - suggested in fever conditions caused by catheter implacement
SUR - 1.80 - taken by the suspicion of tuberculosis
SUR - 1.81 - taken for verifying pathogens in recurrent fever conditions
SUR - 1.82 - suggested sample of postoperative wound infections
79- C
80- D
81- A
82- B
70
Match the followings.
A) often occurs due to wound infection
B) immediate surgery is required
C) hernia protrudes due to provoking
D) diagnosis is made commonly during surgery
SUR - 1.83 - internal hernia
SUR - 1.84 - incarcerated hernia
SUR - 1.85 - postoperative abdominal wall hernia
SUR - 1.86 - opened hernia ring
83- D
84- B
85- A
86- C
71
Match the followings! During laparoscopic surgery
A) two-dimensional view
B) detailed explored area
C) fast recovery
D) low postoperative pain
SUR - 1.87 - minimal invasive surgery
SUR - 1.88 - provides detailed intraoperative technique
SUR - 1.89 - requires specific surgical training
SUR - 1.90 - preservation of the integrity of abdominal wall
87- D
88- B
89- A
90- C
72
Match the followings!
A) active immunization against tetanus infection
B) antibiotics prophylaxis before colon surgery
C) gas gangrene
D) severe third-degree burns
SUR - 1.91 - main symptom is pain caused by significantly increased interstitial pressure
SUR - 1.92 - response reaction develops within 30 days
SUR - 1.93 - excision of necrotized tissues to vital layers is the prevention of infections
SUR - 1.94 - it assures the expected effect with the help of mechanical bowel cleansing
91- C
92- A
93- D
94- B
73
Match the followings!
A) GEA
B) EST
C) EST + biliary stent implantation
D) modified pancreas head resection
SUR - 1.95 - stenosing papillitis
SUR - 1.96 - chronic pancreatitis complicated by long distal part stenosis of the common bile duct
SUR - 1.97 - duodenum obstruction caused by irresectable pancreas head cancer
SUR - 1.98 - cholestasis complicated by liver abscess
95- B
96- D
97- A
98- C
74
Some of the tumors are unresectable, so the same number of cases is inoperable
.A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
75
If a surgery is curative, then the tumor is resectable, but if it is palliative then it is not radical.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
76
Because of a coecum tumor right hemicolectomy was performed with ileotransversostomy. In order to avoid anastomosis insufficiency, we have to suture the anastomosis in as many layers as possible.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
77
Bite wounds should not be stitched because they are always considered infected.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
78
During laparoscopic surgical interventions, a detailed exploration of the abdominal cavity is usually not possible, therefore the importance of the preoperative examination is greatly increased.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
79
The start of antibiotic prophylaxis is the time before surgery because it serves to prevent contamination during surgery.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
80
Non-reducible hernias represent a vital surgical indication because of the impaired blood flow and the consequent gangrene of the incarcerated abdominal organ.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
81
Repeated hernia incarceration in elderly patients should be an alarming sign for the presence of colonic cancer, because a malignant process may be the in background of elevated abdominal pressure leading to herniation.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
82
With the introduction of laparoscopic surgeries, the indication of cholecystectomy was expanded because the surgical load decreased significantly.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
83
Before a laparoscopic surgery very careful preoperative preparation of the patient is needed because the surgical exploration of the abdominal cavity may be limited.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
84
Surgical infections also include primary and secondary septic conditions because surgical procedures requiring surgical interventions or surgical procedures related complications are called surgical infections.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
85
The furuncle is a purulent inflammation of the skin, because the most common pathogen is Streptococcus.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
86
A mass in the pancreatic head may be histologically inflammatory or neoplastic condition, so the ultrasonography of the pancreas head must be double-checked with a CT scan.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
87
In the diagnosis of jaundice caused by occlusion, ultrasonography is not the first choice of imaging technique because therapeutic intervention also can be performed with ERCP.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
88
Infections on the leg of a diabetic patient are difficult to treat and sometimes amputation may be necessary because these limbs are always arteriosclerotic.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
89
Ascites due to hepatic failure cannot be treated surgically because after an abdominocentesis the ascites is re-produced.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
90
The incision when opening the abdominal cavity should always be closed, because later herniation may develop at the site of the injury.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
91
Blood samples should be taken from the patient for blood group determination prior to administration of plasma expanders in hemorrhagic shock, because dextran products interfere with the assessment of blood typing.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
92
The sharp instruments can only be sterilized in ethylene oxide gas, because other sterilization methods result in rusting.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
93
In the case of fresh - within 2 hours – facial injury the skin does not have to be excised, because this time is too short for the bacteria for reproduction.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
94
A gastric lymphoma develops in the lymphatic tissue nearby the mucosa, so it responds better to medication than the nodal lymphomas.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
95
At the initial stage of gastrointestinal bleeding, the patient's blood tension may be even higher because the circulatory redistribution initially compensates the lack of volume.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
96
The high hematocrit value measured in a bleeding patient is not an accurate indicator of blood volume loss because circulation is also compensated with extracellular fluid uptake into the vessels.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
97
In the case of an anaplastic carcinoma of the thyroid gland, the surgical treatment of the patient is irrelevant, since the anaplastic carcinoma of the thyroid gland should be treated with iodine.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
98
In situ carcinomas should only be treated by local excision because they never give distant metastases.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
99
Primary liver cancer is always centrally located so it often gives lung metastases.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
100
The hormone receptor assessment plays an important role in the oncologic treatment of breast cancer, because this is fundamental for the establishment of the surgical plan.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
101
In the treatment of breast cancer, the collaboration of a surgeon, an oncologist, and a pathologist is important, so surgery is recommended only in a department where such cooperation is possible.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
102
In Graves' disease resection is never an option as surgical treatment, because patients can always be kept in a permanent euthyroid status with combined drug-radioiodine treatment.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
103
Following bilateral thyroid resection serum Ca levels may be reduced because thyroxin affects the Ca-metabolism.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
C) the first is correct in itself, but the second is incorrect
104
Secondary varices are always a consequence of primary varices, so it can never be operated.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
105
The occurrence of superficial thrombophlebitis is more frequent on the basis of existing varices, so it is important to exclude deep vein thrombosis.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
B) both are correct, but there is no causal relationship between the two parts
106
Endoscopic stone extraction is contraindicated in case of choledocholithiasis because of the increased risk of bleeding after EST due to disturbance of vitamin K absorption.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
D) the first is incorrect, the second is correct in itself
107
Intraoperative ultrasound imaging plays a prominent role in the treatment of pancreatic insulinomas, since finding this disorder during surgery is often possible only with this method.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
A) both are correct, with a causal relationship between the two parts
108
Tumor markers can only be used before removal of the tumor, because more sensitive methods are needed to monitor the recurrence of the tumor process.
A) both are correct, with a causal relationship between the two parts
B) both are correct, but there is no causal relationship between the two parts
C) the first is correct in itself, but the second is incorrect
D) the first is incorrect, the second is correct in itself
E) both are incorrect
E) both are incorrect
109
A physical examination by the family doctor on the right side reveals basal bruises, the patient should immediately be sent to the following tests:
A heavy smoker and known alcoholic patient arrives to the family doctor visibly having lost weight and in a weakened state, saying he has severe cough attacks, especially after drinking. After eating solid food, he vomits frequently.
1) Chest X-ray
2) abdominal ultrasound examination
3) Swallowing X-ray
4) Laboratory test
A) Answers 1, 2 and 4 are correct
B) Answers 2, 3 and 4 are correct
C) Answers 1 and 3 are correct
D) All of the answers are correct
E) None of the answers are correct
C) Answers 1 and 3 are correct
110
In the patient, chest X-ray confirmed right sided pneumonia, swallowing could not be performed due to patient dysphagia, so the most important thing to do is:
A heavy smoker and known alcoholic patient arrives to the family doctor visibly having lost weight and in a weakened state, saying he has severe cough attacks, especially after drinking. After eating solid food, he vomits frequently.
1) Antibiotic and mucolytic treatment should be applied for pneumonia
2) The patient should be treated with some minor neuroleptic agent to deal with the consequences of alcoholism
3) Because of respiratory and swallowing complaints the patient is to be hospitalized
4) The patient should be instructed to apply a feeding tube
A) Answers 1, 2 and 4 are correct
B) Answers 2, 3 and 4 are correct
C) Answer 1 is correct
D) Answer 3 is correct
E) All of the answers are correct
D) Answer 3 is correct
111
Repeated chest X-ray examination in the inpatient clinic confirmed constriction in the upper third of the esophagus. The most necessary test is:
A heavy smoker and known alcoholic patient arrives to the family doctor visibly having lost weight and in a weakened state, saying he has severe cough attacks, especially after drinking. After eating solid food, he vomits frequently. 1) chest, mediastinal CT scan
2) bronchoscopy
3) abdominal ultrasound examination
4) endoscopic examination
5) biopsy of the lesion
6) bacteriological sampling from sputum
A) Answers 1, 2 and 3 are correct
B) Answers 2 and 4 are correct
C) Answers 4 and 5 are correct
D) All of the answers are correct
C) Answers 4 and 5 are correct
112
The swallowing test confirmed the existence of an oesophagobronchial fistula, for which the following options should be considered:
A heavy smoker and known alcoholic patient arrives to the family doctor visibly having lost weight and in a weakened state, saying he has severe cough attacks, especially after drinking. After eating solid food, he vomits frequently.
1) esophageal resection by removal of the tumor
2) Endoscopic tube implantation to close the fistula and ensure nutrition
3) apply a feeding tube
4) antibiotic, mucolytic and analgesic treatment
A) Answers 1, 2 and 3 are correct
B) Answers 2 and 3 are correct
C) Answer 2 is correct
D) Answer 1 is correct
E) Answer 4 is correct
C) Answer 2 is correct
113
One correct answer is possible based on the key.
After two years of uneventful period in the central operating room of the well-known surgical unit, the operations of nosocomial category A and B are facing infections. The cause was discovered by the surgeon and the hygienist and then reported. As a result of the report, the air ducts of the air conditioning unit were disinfected, and the bacterial filters were replaced. After the final disinfection, surgeries restarted, and the rate of wound infections reduced to an acceptable level.
1) For nosocomial category A, after sterile or clean surgery, no pathogen is expected in the surgical area.
2) For nosocomial category A, the prevalence of wound healing is 4–8%.
3) In the case of nosocomial category A, antibiotic prophylaxis is not required from a surgical aspect.
4) In the case of a blocked bacterial filter, the over pressure in the operating room is eliminated.
5) The condensation fluid of the air ducts in the air conditioner may become colonized by bacteria.
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 2, 3 and 5 are correct
D) Answers 2, 3 and 4 are correct
E) All of the answers are correct
B) Answers 1, 3, 4 and 5 are correct
114
Choose the right answer!
After two years of uneventful period in the central operating room of the well-known surgical unit, the operations of nosocomial category A and B are facing infections. The cause was discovered by the surgeon and the hygienist and then reported. As a result of the report, the air ducts of the air conditioning unit were disinfected, and the bacterial filters were replaced. After the final disinfection, surgeries restarted, and the rate of wound infections reduced to an acceptable level.
A) Closing disinfection should be performed daily after the final surgery.
B) Closing disinfection can be performed with a 12.5% hypochlorite solution.
C) The final disinfection can only be supervised by the head of the department.
D) Closing disinfection should be performed after each nosocomial infection and the result should be checked by bacteriological examination.
E) Final disinfection can only be ordered by the ÁNTSZ.
D) Closing disinfection should be performed after each nosocomial infection and the result should be checked by bacteriological examination.
115
Choose the right answer!After two years of uneventful period in the central operating room of the well-known surgical unit, the operations of nosocomial category A and B are facing infections. The cause was discovered by the surgeon and the hygienist and then reported. As a result of the report, the air ducts of the air conditioning unit were disinfected, and the bacterial filters were replaced. After the final disinfection, surgeries restarted, and the rate of wound infections reduced to an acceptable level.
A) A bacteriologically positive wound fluid is considered a wound infection if the secretion lasts longer than 4 days.
B) In the case of wound infection, remove the pus twice a day through the incision with a syringe.
C) In the case of wound infection, bacteriological examination of the discharged pus is unnecessary.
D) The surgeon is always responsible for the wound infection.
E) Wound infection is part of the surgical risk.
E) Wound infection is part of the surgical risk.
116
Choose the right answer!
After two years of uneventful period in the central operating room of the well-known surgical unit, the operations of nosocomial category A and B are facing infections. The cause was discovered by the surgeon and the hygienist and then reported. As a result of the report, the air ducts of the air conditioning unit were disinfected, and the bacterial filters were replaced. After the final disinfection, surgeries restarted, and the rate of wound infections reduced to an acceptable level.
A) A surgical isolation film has no role in avoiding wound infection.
B) The frequency of wound infection is a quality indicator.
C) Wound infection does not affect surgical mortality and the average cost of patient care.
D) The treatment of wound infection requires only a qualified nurse.
E) Wound infection cannot be the subject of scientific publication.
B) The frequency of wound infection is a quality indicator.
117
Diseases in differential diagnosis except:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) infective hepatitis
B) pancreatic cancer
C) chronic pancreatitis
D) Crigler-Najjar syndrome
E) choledocholithiasis
D) Crigler-Najjar syndrome
118
Knowing the laboratory results, the family doctor referred the patient to the hospital:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) diagnosis: acute septic cholangitis - internal medicine
B) diagnosis: infective hepatitis - infectology
C) diagnosis: obstructive icterus, chronic pancreatitis - internal medicine
D) diagnosis: obstructive icterus, pancreatic tumor? - internal medicine
E) diagnosis: obstructive icterus, choledocholithiasis - internal medicine
D) diagnosis: obstructive icterus, pancreatic tumor? - internal medicine
119
Based on the medical history and laboratory results the following additional laboratory tests should be carried out for differential diagnosis in the ward:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
1) pancreatic function tests (Lundh test, secretion test, starch load, etc.)
2) virus-serological tests (anti-HAV IgM, HbsAG, anti-HBs, anti-HBc, etc.)
3) serum iron, iron binding capacity, stool benzidine tests
4) tumor marker tests (CEA, CA19-9, etc.)
A) Answer 1, 2 and 3 are correct
B) Answer 2 and 3 are correct
C) Answer 2 and 4 are correct
D) Only the 4th answer is correct
E) all 4 answers are correct
D) Only the 4th answer is correct
120
For diabetes mellitus, the following tests are required:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
1) blood glucose test
2) hemoglobin A1C test
3) urine sugar depletion test
4) glucose tolerance test
A) Answer 1, 2 and 3 are correct
B) Answer 2 and 3 are correct
C) Answer 2 and 4 are correct
D) Only the 4th answer is correct
E) all 4 answers are correct
A) Answer 1, 2 and 3 are correct
121
The following imaging procedures are used as first orientation examinations in the ward:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
1) intravenous cholecystography
2) HIDA scan
3) oral cholecystography
4) abdominal ultrasound examination
A) Answer 1, 2 and 3 are correct
B) Answer 2 and 3 are correct
C) Answer 2 and 4 are correct
D) Only the 4th answer is correct
E) all 4 answers are correct
D) Only the 4th answer is correct
122
Additional imaging studies needed for diagnosis:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
1) pancreas scintigraphy
2) CT
3) ERCP
4) intravenous cholecystography
A) Answer 1, 2 and 3 are correct
B) Answer 2 and 3 are correct
C) Answer 2 and 4 are correct
D) Only the 4th answer is correct
E) all 4 answers are correct
B) Answer 2 and 3 are correct
123
If the HIDA scan shows generally dilated biliary tract until the level of the papilla of Vater, with good bile excretion but slow drainage, the correct diagnosis is:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) distal tumor of the common bile duct
B) choledocholithiasis
C) stone in the papilla of Vater
D) pancreas cancer
E) chronic calcifying pancreatitis
D) pancreas cancer
124
If the patient presents with an solid, inhomogeneous pancreatic mass on the ultrasound and/or CT scan, the most probable diagnosis:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) calcifying chronic pancreatitis
B) acute exacerbation of chronic pancreatitis
C) pancreatic tumor
D) tumor of the papilla of Vater
E) none of the above
C) pancreatic tumor
125
If the ECP shows stone-free, dilated bile ducts and the Wirsungian-duct fills up only for a short segment and then abruptly aborted ("terminated Wirsungian"), the correct diagnosis is:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) pancreas tumor
B) tumor of the papilla of Vater
C) stenosing papillitis
D) each of the above
E) none of the above
A) pancreas tumor
126
The preoperative diagnosis can be safely established in the following case:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) FNAB with positive result for cancer
B) FNAB with negative result for cancer
C) FNAB yielding chronic pancreatitis
D) FNAB yielding no result
E) each of the above
A) FNAB with positive result for cancer
127
If the patient's cytological examination cannot confirm malignancy, the following should be done:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) consider surgical exploration due to a suspected cancer
B) observe of the patient until healing of chronic pancreatitis
C) consider endoscopic sampling
D) antibiotic treatment 'ex juvantibus'
A) consider surgical exploration due to a suspected cancer
128
If the cytology test is positive for malignancy, do the following:
There is no significant illness in the 63-year-old male patient. His relatives noticed the yellow color of his scleras, so he attended his family doctor who carried out a laboratory test. The family doctor received the following laboratory results: accelerated erythrocyte sedimentation rate, moderate anemia, significant serum bilirubin elevation, which was mainly direct, elevated AST and ALT, significantly elevated ALP, slightly elevated serum creatinine, elevated blood glucose, normal amylase and lipase, bilirubinuria, glucosuria.
A) radiation and cytostatic treatment, followed by surgery depending on their effectiveness
B) starting cytostatic treatment
C) surgical exploration and the evaluation of tumor resectability
D) percutaneous transhepatic drainage for palliative purposes
C) surgical exploration and the evaluation of tumor resectability
129
Radiological studies that play a key role in breast cancer diagnosis (3 responses possible)
1) breast ultrasound examination
2) mammography
3) PET
4) MR
5) CT
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 2, 3 and 5 are correct
D) Answers 2, 3 and 4 are correct
E) All of the answers are correct
A) Answers 1, 2 and 4 are correct
130
The breast cyst (one answer wrong)
A) the most common benign breast lesion
B) often gets superinfected
C) rarely needs surgical treatment
D) pneumocystography is the best diagnostic and therapeutic method
B) often gets superinfected
131
Breast Cancer Screening Program (one response is false)
A) reduces the mortality of breast cancer
B) increases the recognition rate of early stage tumors
C) is a primary tumor prevention method
D) is a secondary tumor prevention method
C) is a primary tumor prevention method
132
Recommended surgical treatment for a non-palpable invasive breast cancer (one answer is correct)
A) excision with guide-wire localization + axillary block dissection
B) excision with isotope localization + sentinel lymph node biopsy
C) mastectomy
D) quadrant resection + axillary block dissection
B) excision with isotope localization + sentinel lymph node biopsy
133
What tests would you carry out?
A 48-year-old female patient was presented at the clinic with an enlarged goiter. Despite having good appetite, she complained of weight loss, being tense and nervous. Occasionally there was a feeling of palpitation, drowsiness and difficulty in swallowing.
1) neck US
2) basic metabolic tests
3) thyroid scintigraphy
4) thyroid hormone levels assessment
5) swallowing X-Ray, native trachea X-Ray
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 2, 3 and 5 are correct
D) Answers 2, 3 and 4 are correct
E) All of the answers are correct
B) Answers 1, 3, 4 and 5 are correct
134
The scintigraphy shows a hot nodule. Which treatment would you use from the following options?
A 48-year-old female patient was presented at the clinic with an enlarged goiter. Despite having good appetite, she complained of weight loss, being tense and nervous. Occasionally there was a feeling of palpitation, drowsiness and difficulty in swallowing.
A) thyreostatics
B) iodine treatment
C) surgery
D) thyreostatics and surgery
E) hormone substitution
D) thyreostatics and surgery
135
What kind of surgical treatment should be performed?
A 48-year-old female patient was presented at the clinic with an enlarged goiter. Despite having good appetite, she complained of weight loss, being tense and nervous. Occasionally there was a feeling of palpitation, drowsiness and difficulty in swallowing.
A) total thyroidectomy
B) lobectomy on the affected side
C) removing the nodule
D) bilateral subtotal thyroid resection
E) total thyroidectomy, cervical lymph node block dissection
B) lobectomy on the affected side
136
After the surgery, the patient's voice becomes hoarse. What is the main reason?
A 48-year-old female patient was presented at the clinic with an enlarged goiter. Despite having good appetite, she complained of weight loss, being tense and nervous. Occasionally there was a feeling of palpitation, drowsiness and difficulty in swallowing.
A) vocal cords have been damaged during intubation
B) recurrent nerve lesion.
C) temporary laryngitis developed due to surgery
D) the trachea was damaged during surgery
E) parathyroid injury occurred during surgery
B) recurrent nerve lesion.
137
What conservative treatment had been probably used to treat the limb disorders 5 years ago?
A 45-year-old woman was admitted with a history of large bowel resection 5 years ago due to colonic cancer. At that time on postoperative day 4 the left lower limb got swollen, the skin tightened, shiny, warm, slightly cyanotic and pain occurred. The symptoms disappeared for conservative treatment. Three years ago, repeated left lower limb complaints began. Currently the limb is swollen again, with visible varices and ulcers on the lower extremity.
1) bed rest for 5-7 days
2) elevation of the limb
3) wearing elastic bandage or compression stockings
4) anticoagulation for 5 to 7 days with heparin followed by long-term treatment with Warfarin
5) fibrinolysis (depending on indication)
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 2, 3 and 5 are correct
D) Answers 1, 2, 3 and 4 are correct
E) All of the answers are correct
E) All of the answers are correct
138
What could be the postoperative complication of the patient 5 years earlier?A 45-year-old woman was admitted with a history of large bowel resection 5 years ago due to colonic cancer. At that time on postoperative day 4 the left lower limb got swollen, the skin tightened, shiny, warm, slightly cyanotic and pain occurred. The symptoms disappeared for conservative treatment. Three years ago, repeated left lower limb complaints began. Currently the limb is swollen again, with visible varices and ulcers on the lower extremity.
A) acute arterial thrombosis
B) lower limb arterial embolization
C) acute deep vein thrombosis
D) erysipelas
E) Postoperative hypoproteinemia
C) acute deep vein thrombosis
139
What was the reason for her current admission?
A 45-year-old woman was admitted with a history of large bowel resection 5 years ago due to colonic cancer. At that time on postoperative day 4 the left lower limb got swollen, the skin tightened, shiny, warm, slightly cyanotic and pain occurred. The symptoms disappeared for conservative treatment. Three years ago, repeated left lower limb complaints began. Currently the limb is swollen again, with visible varices and ulcers on the lower extremity.
A) acute arterial thrombosis
B) lower limb embolization
C) acute deep vein thrombosis
D) post-thrombotic Syndrome
E) chronic obliterate arterial disease
D) post-thrombotic Syndrome
140
What kind of surgery would you choose in this case?
A 45-year-old woman was admitted with a history of large bowel resection 5 years ago due to colonic cancer. At that time on postoperative day 4 the left lower limb got swollen, the skin tightened, shiny, warm, slightly cyanotic and pain occurred. The symptoms disappeared for conservative treatment. Three years ago, repeated left lower limb complaints began. Currently the limb is swollen again, with visible varices and ulcers on the lower extremity.
A) arterial thrombectomy
B) arterial embolectomy
C) venous thrombectomy
D) crossectomy, stripping, subfascial ligature of perforator veins
E) reconstructive arterial surgery
D) crossectomy, stripping, subfascial ligature of perforator veins
141
What would be the first tests that could help establishing the diagnosis?
A 78-year-old diabetic woman is admitted to the hospital due to right subcostal cramping pain, nausea, vomiting. Two days later she developed jaundice.
1) laboratory tests
2) abdominal UH
3) abdominal CT
4) ERCP
5) abdominal MR
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 2, 3 and 5 are correct
D) Answers 2, 3 and 4 are correct
E) All of the answers are correct
A) Answers 1, 2 and 4 are correct
142
What is the most likely diagnosis?
A 78-year-old diabetic woman is admitted to the hospital due to right subcostal cramping pain, nausea, vomiting. Two days later she developed jaundice.
A) hepatitis
B) Crigler-Najjar syndrome
C) cholecystitis
D) cholelithiasis and choledocholithiasis
E) pancreatic carcinoma
D) cholelithiasis and choledocholithiasis
143
What treatment plan would you choose based on the previous diagnosis?A 78-year-old diabetic woman is admitted to the hospital due to right subcostal cramping pain, nausea, vomiting. Two days later she developed jaundice.
A) open surgery after the inflammation was gone
B) laparoscopic surgery after the inflammation was gone
C) pancreatic head resection
D) referring the patient to an Infectology Ward
E) ERCP, stone extraction and laparoscopic cholecystectomy performed next day
E) ERCP, stone extraction and laparoscopic cholecystectomy performed next day
144
What is the most urgent test?
An elderly female patient is referred to an inpatient ward due to repeated episodes of melena. The patient's laboratory examination shows anemia (Ht: 25). The patient is known to have confirmed liver cirrhosis and previous upper gastrointestinal bleeding episodes, treated conservatively (endoscopy, sclerotherapy).
A) radiological examination of the upper gastrointestinal tract
B) search for the source of the bleeding in the lower gastrointestinal tract
C) angiography
D) urgent gastroscopy
E) urgent colonoscopy
D) urgent gastroscopy
145
If no source of bleeding was found with gastroscopy, what shall be the next diagnostic option?
An elderly female patient is referred to an inpatient ward due to repeated episodes of melena. The patient's laboratory examination shows anemia (Ht: 25). The patient is known to have confirmed liver cirrhosis and previous upper gastrointestinal bleeding episodes, treated conservatively (endoscopy, sclerotherapy).
A) rectoscopy or colonoscopy
B) angiography
C) ultrasound examination
D) CT
E) none of the above
A) rectoscopy or colonoscopy
146
Gastroscopy revealed an acutely bleeding ulcer. What is the proper endoscopic treatment approach?
An elderly female patient is referred to an inpatient ward due to repeated episodes of melena. The patient's laboratory examination shows anemia (Ht: 25). The patient is known to have confirmed liver cirrhosis and previous upper gastrointestinal bleeding episodes, treated conservatively (endoscopy, sclerotherapy).
1) notify the surgeon
2) order for blood transfusions
3) perform endoscopic sclerotherapy
4) hemostasis with endoscopic electrocoagulation
5) start steroid treatment
A) Answers 1, 2 and 4 are correct
B) Answers 1, 3, 4 and 5 are correct
C) Answers 1 and 3 are correct
D) Answers 2, 3 and 4 are correct
E) All of the answers are correct
C) Answers 1 and 3 are correct
147
36 hours after the successful endoscopic hemostasis, the patient vomited blood again at night. Next step to do:
An elderly female patient is referred to an inpatient ward due to repeated episodes of melena. The patient's laboratory examination shows anemia (Ht: 25). The patient is known to have confirmed liver cirrhosis and previous upper gastrointestinal bleeding episodes, treated conservatively (endoscopy, sclerotherapy).
A) urgent gastroscopy
B) urgent gastroscopy and repeated endoscopic hemostasis
C) urgent colonoscopy
D) urgent surgery
E) maintaining the patient's circulation by repeated transfusions until morning
D) urgent surgery
