###TITLE### ТЕРАПИЯ ###THEMES### ТЕМА ГАСТРОЭНТЕРОЛОГИЯ ТЕМА ГЕМАТОЛОГИЯ ТЕМА ПУЛЬМОНОЛОГИЯ ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 27-year old man complained of aching epigastric pain just after meal, heartburn, and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Establish the diagnosis. +Chronic type A gastritis Chronic type B gastritis Peptic ulcer of the stomach Chronic type C gastritis Menetrier’s desease ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 60-year-old woman, mother of 6children, developed sudden onset of upper abdominal pain radiating to the back, associated with nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temperature of 38,9oC, along with right upper quadrant tenderness. Most likely diagnosis; Benign biliary structure +Choledocholithiasis Malibnant biliary stricture Carcinoma of the head of the pancreas Choledochal cyst ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Pateint, aged 47 years old, complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrarum. The liver is +6sm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol\l per hour, AST-2,1 mmol\l, ALT-1,8 mmol\l, alkaline phosphotase 4,6 mmol\l per hour, cholesterol -9,2 mmol\l, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis? Alcoholic liver cirrhosis Primary liver cancer Chronic viral hepatitis B Acute viral hepatitis B + Primary biliary liver cirrhosis ##theme 1 ##score 1 ##type 1
##time 00:01:00 The man of 25 years old colmplains of periodic epigastralgia. At inspection the chronic gastritis with the increased acidity is revealed. Treatment is lead. What preparation is expedient for using for primary preventive maintenance of a stomach ulcer? Vicalinum Cerucal +Famotidin Maalox Gastrophan ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A sick man who is 43, started to complain to his therapeutist about the heaving in the stomach after a meal, bad beleh, vomiting with food, he had eaten the day before. He has suffered from ulcer of duodenum for 10years. He has applied to the doctor 2 times but he started to feel worse last month. What pathology must it be? Ahalaziya of the gullet Gullet cancer Stomach cancer +Ulcerous stenosis of the exit part of the gullet Reactive pancreatitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A patient 33 years old was admitted to a hospital. Patient is pale, at an attempt to stand up complains about strong dizziness. There was approximately hour ago vomiting like coffe- grounds. BP-90\60 mm hg, pulse -120b\min. It is known from anamnesis that patient during 4 year suffers with ulcerous illness of the stomach, painless form. An ulcer was exposed at fybrogastroscopie. Your diagnosis? +Ulcerous illness of duodenum, complicated with bleeding. Erosive gastritis Acute pleurisy Acute myocardial infarction, abdominal form ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Patient, 48 years. Complaints about the decline of appetite, heaviness in an epigastria, region after a meal, pains in right hypohondria, aching character, increasing after meal, especially fat. Disturbs nausea, flatulence, disorders of stool. Loss of weight. At examination – jaundice of skin, vascular spiders, gynecomastia, ascities, “caput medusea” . A liver at palpation is painless, dense, an edge is sharp, a spleen is enlarged. Your preliminary diagnosis. +Acute hepatitis A Chronic active hepatitis Liver cirrhosis Acute cholecystitis Acute pancreatitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00
Patient, 38 years old, complaints about dull, aching pains in area of right hypohondria, permanent arising up in 1-2 hours after the reception of abundant and especially fat food and fried dishes. Pain radiates upwards, in the region of right shoulder and neck. In addition, often disturbing feeling of bitter taste and metal taste , belch with air. At palpation of abdomen tenderness in area projection of gall bladder. Your preliminary diagnosis/ Cirrhosis of liver +Chronic cholecystitis Acute hepatitis Chronic hepatitis Acute cholecystitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 5 years old teacher consulted a department therapist about a corresponding diet. Complains: frequent constipations( defecation once in 2-3 days), flatulence and unpleasant aftertaste; blunt pain in the lower half of abdomen after intake of ice cream or soda drinks. At 17-20 she was treated for duodenal ulcer. Objectively height 164sm, weight 62 kg. abdomen is oval, palpation doesn’t detect pathological changes. What diet is necessary into acute priod? Table 9 by Pevzner Table 4a by Pevzner General Table Table 2 by Pevzner +Table 4 by Pevzner ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Patient, 45 years old, was delivered by an ambulance with complains of pain in the epigastrium, vomit at the height of pain with impurity of blood; heartburn, weakness, dizziness, “black stool” in the morning. He has been ill for 10 years, nutrition is irregular. What complication has developed in the patient? Thrombocytopenia Intestinal bleeding Bleeding from esophageal veins Bleeding from hemorrhoidal veins +Gastric bleeding ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 39y.o. woman complains of squeezed epigastric pain 1 hour after meal and heartburn. She had been ill for 2 years. On palpation, there was moderate tenderness in pyloroduodenal area. Antral gastritis was revealed on gastroscopy. What study can establish genesis of the disease? Examination of stomach motor function Examination of stomach secretion +Revealing of Helicobacter infection in gastric mucosa Gastirn level in Blood Detection of autoantibodies in the serum ##theme 1 ##score 1 ##type 1 ##time 00:01:00
A patient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of hepatic cirrhosis is meant? +Hepatocellular insufficiency Hemorrhage from varicosely dilatated veins of esophagus Acute stomach ulcer Thrombosis of mesenteric vessels Portal hypertension ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively : temperature 36,5oC, RR- 16\min, Ps- 70 bpm, AP-120\80 mm hg. On palation local painfulness in the right epigastric region. What parameters of intragastric PH-meter in the region of stomach body are the most typical for this patient’s disease? pH = 6,0-7,0 pH = 5,0-6,0 pH = 3,0 -4,0 pH = 4,0 -5,0 +pH = 1,0 – 2,0 ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 50 y.o. woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnosis study would you recommend? X-ray examination of the gastrointestinal tract +Ultrasound examination of the gallbladder Ultrasound study of the pancreas Blood cell count Liver function tests ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A patient is 65 y.o. He has been a smoker for 40 years. Now he has lost 10kg during the last 3 months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogene reaction. Where is the initial process that caused these changes? In gallbladder +In pancreas In duodenum In common bile duct In liver ##theme 1 ##score 1 ##type 1 ##time 00:01:00
A 40 y.o. patient was admitted to the gastroenterology with the skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of stratches, liver is +5sm, splin is 6x8cm. In blood: alkaline phosphatase -2,0mmol\l, general bilirubin – 60 mkmol\l, cholesterol -8,0 mmol\l. What is leading syndrome in the patient? Mesenchymal inflammatory Cystolic Asthenic Liver-cells insufficiency +Cholestatic ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3 times a dsy has appeared for the last 2 years, loss of weight for 8kg for 2 years. On examination: abdomen is soft, painless. Blood amylase – 12g\l. Feces examination – neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage? Contrykal +Pankreatin Imodium Levomicytine Aminocapron acid ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP – 90/60 mm hg, pulse 120 bpm. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberscopy. Your diagnosis? Acute myocardial infarction, abdominal form Acute pleurisy Erosive gastritis Ulcer of duodenum, complicated with bleeding +Ulcer of stomach, complicated with bleeding ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 27 y.o. patient complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter pylory. What can be diagnosed in this case? Reflux-gastritis Rigid antral gastritis Gastritis of A type Menetrier’s disease +Gastritis type B ##theme 1 ##score 1 ##type 1 ##time 00:01:00
A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome? Malabsorption syndrome Syndrome of decayed dyspepsia Dyskinesia of fermentative dyspepsia +Syndrome of fermentative dyspepsia Syndrome of fatty dyspepsia ##theme 1 ##score 1 ##type 1 ##time 00:01:00 47y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma, palpebrae. The liver is +6sm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160mkmol\l, direct-110mkmol\l, AST – 2,1 mmol\l per hour, ALT – 1,8 mmol\l, alkaline phosphotase – 4,6mmol\l per hour, cholesterol – 9,2 mmol\l, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis? Primary liver cancer Acute viral hepatitis B Alcoholic liver cirrhosis Chronic viral hepatitis B +Primary biliary liver cirrhosis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 27 y.o.man complain of aching epigastric pain right after meal , heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a differential diagnosis. Chronic gastritis of type B Chronic gastritis of type C +Peptic ulcer of stomach Menetrier’s disease ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage? +10-14% 15-20% 25-30% 6-9% 35-50%
##theme 1 ##score 1
##type 1 ##time 00:01:00 Classical X-ray image of intestinal obstrustion is: +Gas and horizontal levels Filling defect High positioned diaphragm Reactive pleuritis Pneumatosis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 45-year-old man for 1 month has complained of epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever, and significant weight loss. On exam: jaundice, presence of Curvuasier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis? +Cancer of the pancreas head Gallbladder stones Chronic pancreatitis Chronic cholangitis Chronic hepatitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 50 -year-old woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend? +Ultrasound examination of the gallbladder Liver function tests X-ray examination of the gastrointestinal tract Ultrasound study of the pancreas Blood cell count ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 27 -year-old man complained of aching epigastric pain just after meal, heartburn, and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Establish the diagnosis. +Chronic type A gastritis Chronic type B gastritis Peptic ulcer of the stomach Chronic type C gastritis Menetrier’s disease ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 62 years old woman complains of severe constant pain in the right hypochondrium, jaundice, discoloration of stool and dark urine, mild fever up to 37,5оС. Above mentioned complaints were appeared after an attack of severe
abdomen pain connected with fatty food intake. On clinical examination the abdomen is soft. A painful enlarged gall bladder is palpated. The Orthner, Kerr’s symptoms are positive. What is the probable diagnosis? +Acute cholecystitis, choledochus calculi and obstructive jaundice Infectious hepatitis Liver cancer Liver abscess Liver cirrhosis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 56y.o. teacher consulted a department therapist about a corresponding diet. Complaints: frequent constipations [defecation once in 2-3 days], flatulence and unpleasant aftertaste; blunt pain in the lower half of abdomen after intake of ice cream or soda drinks. At 17-20 she was treated for duodenal ulcer. Objectively: height – 164cm, weight – 62kg. Abdomen is oval, palpation doesn’t detect pathological changes. What diet is necessary for prevention of transition of chronic disease into acute? +Table #4 by Pevzner Table #4a by Pevzner General table Table #2 by Pevzner Table #9 by Pevzner ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 60 year old woman mother of 6 children developed sudden onset of upper abdominal pain radiating to back,associtated with nausea,vomiting ,fever and chills.She noticed yellow discoloration of her sclera and skin.On physical examination the patient was found to be febril with temperature of 38.9C, along with right upper quadrant tenderness +Choledocholithiasis Infectious hepatitis Hemoytic jaundice Choledochal cyst Ascariasis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 75 year old man who had developed diabetes within last 6 months was found to be jaundiced.He has remained asymptomatic,expect for weight loss about10 pounds in 6 months.On physical examination he is found to have a non- tender ,globular ,right upper quadrant mass that moves with respiration.A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver +Carcinoma of the head of the pancreas Metastatic disease of the liver Pancreatitis Choledocholithiasis Hemolytic jaundice ##theme 1 ##score 1 ##type 1 ##time 00:01:00
The patient has peptic ulcer of stomach with frequent recurrences. Courses of anti-recurrent therapy must be: +Once in 3 months Twice a year Each year Each month After each recurrence ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 34y.o. patient has been admitted to clinic with complaints of heaviness in the right subrib, nausea and emesis after intake of fried pork; dark urine and light feces. He was ill with viral hepatitis half a year ago, but wasn’t on a diet. Objectively: Scleras are subicteric. Abdomen is with continent inflation. Liver is +2cm of costal arc margin on lin. medioclavicularis dextra. Its surface is smooth and it has an elastic consistence. What disease would you think about? +Chronic hepatitis Cirrhosis of liver Active hepatitis Chronic cholecystitis Chronic pancreatitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 60 year old woman was admitted in ths hospital with abdominal cramps,watery diarrhea and flushing with episodes of wheezing.Select the appropriate diagnosis +Carcinoid syndrome Gastroenteritis Uclerative colitis Lactose intolerance Short gut syndrome ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 20- year old woman with 3-4 months history of bloody diarrhea ,stool examination negative for a ova and parasites,stool culutre negative for Clostridium,Campylobacter and Yersinia,normal bowel series edema,hypermia and ulceration of rectum and sigmoid colon seen on sigmoidoscopic examination +Ulcerative colitis Gastroenteritis Carcinoid syndrome Granulomatous colitis Lactose intolerance ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Which of the diseases doesn’t trigger cancer of the rectum: +amebiasis diffusive family polyposis Crohn's disease
ulcerative colitis immunodeficiency ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A sick man, who is 43, started to complain to his therapeutist about the heaviness in the stomach after a meal, bad belch, vomiting with food, he had eaten the day before. He has suffered from ulcer of duodenum for 10 years. He has applied to the doctor (therapeutist) two times but he started to feel worse last month. What pathology must it be? +Ulcerous stenosis of the exit part of the gullet Gullet cancer Stomach cancer Ahalaziya of the gullet Reactive pancreatitis. ##theme 1 ##score 1 ##type 1 ##time 00:01:00 The man os 25 years complains of periodic epigastralgia. At inspection the chronic gastritis with the increased acidity is revealed. Treatment is lead. What preparation is expedient for using for primary preventive maintenance of a stomach ulcer? +Famotidin Cerucal Vicalinum Maalox Gastropharm ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Rectoromanoscopy showed a 1 cm polyp in the patient. On histological examination there was found an adenomatous polyp. The further reasonable step in treating this patient can be? +irrigoscopy rectum resection endoscopy polypectomy repeated analysis of the occult blood in feces repeated rectoromanoscopy ##theme 1 ##score 1 ##type 1 ##time 00:01:00 The complications of acute cholecystitis which require surgical intervention are as follows except: +Jaundice Empyema of the gall-bladder Emphysematous gall-bladder Gall-bladder perforation Cholangitis conditioned by the presence of stones in the bile tract ##theme 1 ##score 1
##type 1 ##time 00:01:00 The serologic profile of the patient having been inoculated with recombinant vaccine against hepatitis B (HBV includes the positive result of the test for: +anti-НВс HBsAg anti-HBe anti--HBs anti - HBc and anti -HBs ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Which of the following substances (drugs) can cause granulomatous hepatitis? +allopurinolum alchohol paracetamol methyldopha cordaron ##theme 1 ##score 1 ##type 1 ##time 00:01:00 The patient is 36. For a few years he has complained of heaviness and a dull ache in the abdomen. The liver is enlarged, hard and has an uneven surface. CT (computer tomography) has shown multiple pathological changes in the organs of abdominal cavity. The correct diagnosis is: +polycystosis of the liver; cirrhosis of the liver; multiple metastases of liver cancer; echinococcosis of the liver; acute hepatitis. ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Splenomegaly, the low RBC (red blood cells) count, the high content of urobilinogen in feces of the patient with jaundice are the symptoms of: +hemolytic jaundice extrahepatic cholestasia intrahepatic cholestasia sepsis mechanical jaundise ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A boy aged 15 yr periodically has been complaining of the epigastric pains, nausea and heartburn. Gastroduodenoscopy revealed the sings of gastroduodenitis and ulcer impairment of the duodenal mucous membrane. What drug will be the most effective in the treatment of this patient? +De-nol
Nos-pa Papaverin Atropin Almagel ##theme 1 ##score 1 ##type 1 ##time 00:01:00 The 52 years old patient has been admitted to the hospital. He complains of vomiting, soft black repeated stools (melena) during the day. Such cases have never been before. The pulse rate is 96 beats per minute, the blood pressure 100/70 mm Hg. On finger examination of the rectum there was found black feces. The appropriate examining is: +esophagogastroduodenoscopy rectoromanoscopy irrigoscopy roentgenoscopy of the stomach laparoscopy ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A patient T. 33 years was admitted to a hospital. A patient is pale, at an attempt to stand up complains about strong dizziness. There was approximately hour ago vomiting like coffee-grounds. BP - 90/60 mm Hg., pulse - 120 b/min. It is known from anamnesis, that a patient during 4 years suffers with ulcerous illness of the stomach, painless form. An ulcer was exposed at gastrofiberoscopy. Your diagnosis: +Ulcerous illness of stomach, complicated with bleeding Ulcerous illness of duodenum, complicated with bleeding Erosive gastritis Acute pleurisy Acute myocardial infarction, abdominal form ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Patient T., 48 years. Complaints about the decline of appetite, heaviness in an epigastria region after a meal, pains in right hypochondria, aching character, increasing after a meal, especially fat. Disturbs nausea, flatulence, disorders of stool, loss of weight. At examination – jaundice of skin, vascular spiders, gynecomastia, ascites, “caput medusae”. A liver at palpation is painless, dense, an edge is sharp, a spleen is enlarged. Your preliminary diagnosis: +Liver cirrhosis Chronic active hepatitis Acute hepatitis A Acute cholecystitis Acute pancreatitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Patient L., 38 years. Complaints about dull, aching pains in area of right hypochondria, permanent or arising up in 13 hours after the reception of abundant and especially fat food and fried dishes. Pain radiates upwards, in the region of right shoulder and neck. In addition, often disturbs feeling of bitter taste and metallic taste into the mouth, belch with air, flatulence. At palpation of abdomen tenderness in area of projection of gall bladder. A liver is not enlarged,
a spleen not palpate. Your preliminary diagnosis: +Chronic cholecystitis Cirrhosis of liver Acute hepatitis Chronic hepatitis Acute cholecystitis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Pateint, aged 47 years old, complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrarum. The liver is +6sm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmolM per hour, AST-2,1 mmol\l, ALT-1,8 mmol\l, alkaline phosphotase 4,6 mmolM per hour, cholesterol -9,2 mmolM, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis? Alcoholic liver cirrhosis Primary liver cancer Chronic viral hepatitis B Acute viral hepatitis B +Primary biliary liver cirrhosis ##theme 1 ##score 1 ##type 1 ##time 00:01:00 Patient, 45 years old, was delivered by an ambulance with complains of pain in the epigastrium, vomit at the height of pain with impurity of blood; heartburn, weakness, dizziness, "black stool" in the morning. He has been ill for 10 years, nutrition is irregular. What complication has developed in the patient? Thrombocytopenia Intestinal bleeding Bleeding from esophageal veins Bleeding from hemorrhoidal veins +Gastric bleeding ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 39y.o. woman complains of squeezed epigastric pain 1 hour after meal and heartburn. She had been ill for 2 years. On palpation, there was moderate tenderness in pyloroduodenal area. Antral gastritis was revealed on gastroscopy. What study can establish genesis of the disease? Examination of stomach motor function Examination of stomach secretion +Revealing of Helicobacter infection in gastric mucosa FGastirn level in Blood Detection of autoantibodies in the serum ##theme 1 ##score 1 ##type 1 ##time 00:01:00
A patient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of hepatic cirrhosis is meant? +Hepatocellular insufficiency Hemorrhage from varicosely dilatated veins of esophagus Acute stomach ulcer Thrombosis of mesenteric vessels Portal hypertension ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively : temperature 36,5oC, RR- 16\min, Ps- 70 bpm, AP-120\80 mm hg. On palation local painfulness in the right epigastric region. What parameters of intragastric PH-meter in the region of stomach body are the most typical for this patient's disease? pH = 6,0-7,0 pH = 5,0-6,0 pH = 3,0 -4,0 pH =4,0-5,0 +pH = 1,0-2,0 ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A patient is 65 y.o. He has been a smoker for 40 years. Now he has lost 10kg during the last 3 months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogene reaction. Where is the initial process that caused these changes? In gallbladder +In pancreas In duodenum In common bile duct In liver ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 40 y.o. patient was admitted to the gastroenterology with the skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of stratches, liver is +5sm, splin is 6x8cm. In blood: alkaline phosphatase -2,0mmol\l, general bilirubin - 60 mkmolM, cholesterol -8,0 mmol\l. What is leading syndrome in the patient? Mesenchymal inflammatory Cystolic Asthenic Liver-cells insufficiency +Cholestatic ##theme 1
##score 1 ##type 1 ##time 00:01:00 A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3 times a dsy has appeared for the last 2 years, loss of weight for 8kg for 2 years. On examination: abdomen is soft, painless. Blood amylase - 12g\l. Feces examination - neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage? Contrykal +Pankreatin Imodium Levomicytine Aminocapron acid ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 27 y.o. patient complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter pylory. What can be diagnosed in this case? Reflux-gastritis Rigid antral gastritis Gastritis of A type Menetrier's disease +Gastritis type B ##theme 1 ##score 1 ##type 1 ##time 00:01:00 A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome? Malabsorption syndrome Syndrome of decayed dyspepsia Dyskinesia of fermentative dyspepsia +Syndrome of fermentative dyspepsia Syndrome of fatty dyspepsia ##theme 1 ##score 1 ##type 1 ##time 00:01:00 47y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma, palpebrae. The liver is +6sm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160mkmol\l, direct-1 lOmkmolM, AST - 2,1 mmol\l per hour, ALT - 1,8 mmol\l, alkaline phosphotase - 4,6mmol\l per hour, cholesterol - 9,2 mmol\l, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis? Primary liver cancer Acute viral hepatitis B Alcoholic liver cirrhosis Chronic viral hepatitis B +Primary biliary liver cirrhosis
##theme 1 ##score 1 ##type 1 ##time 00:01:00 A man. 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage? +10-14% 15-20% 25-30% 6-9% 35-50%