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Äìèòðèé Ñàâðàöêèé

Krok2 – 2014 Base(Surgery)

‘Foundation Course’ for FMGE Preparation

    Question 21 of 209
    21. Question

    A 36-year-old male patient complains of having headache, obstructed nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had his right maxillary premolar filled. Radiolography revealed an intense opacity of the right maxillary sinus. Diagnostic puncture revealed a large amount of thick malodorous crumbly pus. What is the most likely diagnosis?
       --- 1. Chronic suppurative odontogenic sinusitis
        2. Chronic purulent sinusitis
        3. Tumor of the maxillary sinus
        4. Chronic atrophic sinusitis
        5. Acute purulent sinusitis
 22. Question

A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of “meat slops”. Objectively: the patients condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?

    --1. Lung gangrene
    2. Pleura empyema
    3. Multiple bronchiectasis
    4. Lung abscess
    5. Chronic pneumonia
 23. Question

A 78-year-old patient complains of severe pain in the lower abdomen, perineum and rectum; intense urge to urinate and inability to urinate without assistance. Abdomen palpation reveals a moderately painful globular formation above the pubis, there is percussion dullness over the formation. What is the most likely diagnosis?

    1. Chronic incomplete urinary retention
    ---2. Acute urinary retention
    3. Chronic urinary retention
    4. Paradoxical ischuria
    5. Cystitis
 Question 24 of 209
24. Question

A 20-year-old patient complains of pain in the left lumbar region, arterial pressure rise up to 160/110 mm Hg. USI revealed that the structure and size of the right kidney were within age norms, there were signs of 3 degree hydronephrotic transformation of the left kidney. Doppler examination revealed an additional artery running to the lower pole of the kidney. Excretory urogram shows a narrowing in the region of ureteropelvic junction. Specify the therapeutic tactics:

    1. Administration of beta-blockers
    2. Kidney catheterization
    3. Administration of ACE inhibitors
    --4. Surgical intervention
    5. Administration of spasmolytics
 Question 25 of 209
25. Question

Esophagus wall of a 72 year old patient with severe concomitant pathology was injured during urgent fibroesophagogastroscopy. This resulted in progressing of acute respiratory failure and collapse of the left lung. What aid should be rendered?

    1. Left-sided thoracotomy, closure of esophagus and mediastinum wound
    2. Endoscopic closure of esophagus wound, drainage
    3. Left-sided thoracotomy, closure of esophagus wound
    ---4. Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy
    5. Buelaus drainage of pleural cavity, antibacterial therapy
 Question 26 of 209
26. Question

In a 65 y.o. female patient a tumor 13;8 cm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On ausculation: systolic murmur. What is the most probable diagnosis?

    1. Tricuspid valve insufficiency
    --2. Abdominal aortic aneurism
    3. Stomach tumor
    4. Arterio-venous aneurism
    5. Mitral insufficiency
 27. Question

An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused, anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?

    1. Predict the psychological state of the patient
    ---2. Start the surgery after correction of blood pressure
    3. Organize monitoring of the patient by medical personnel and mental health counselor
    4. Organize monitoring of the patient by his family members
    5. Isolate the patient
 Question 28 of 209
28. Question

A 43 year old patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenosing papillitis 0.5 cm long has been revealed. What is the best way of treatment?

    1. To perform choledochoduodenostomy
    2. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
    3. To perform external choledoch drainage
    --4. To perform endocsopic papillosphincterotomy
    5. To perform transduodenal papillosphincterotomy

 29. Question

A 24-year-old patient had been delivered to the thoracic department with a chest injury, a fracture of the IV, V, VI ribs on the right. Plan radiography shows the fluid level in the pleural cavity reaching the III rib on the right. Puncture blood contained clots. What is the optimal treatment tactics?

    --1. Emergency thoracotomy
    2. Thoracentesis and thoracostomy
    3. Pleural puncture
    4. Medical thoracoscopy
    5. Hemostatic therapy

 30. Question

A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patients blood group and rhesus compatibility?

    1. An anaesthesilogist
    2. A laboratory physician
    ---3. A doctor of any speciality
    4. A surgeon
    5. A traumatologist