Exam Questions: Hospital and Operative Surgery (PDF)

Memorization 1. A 38-year-old female patient consulted the family doctor at the FMC with complaints of pain and edema of the right leg, increased pain when walking. Sick for three days. After a complete examination, the diagnosis was made of vascular thrombosis of the right leg. Wha...

Memorization 1. A 38-year-old female patient consulted the family doctor at the FMC with complaints of pain and edema of the right leg, increased pain when walking. Sick for three days. After a complete examination, the diagnosis was made of vascular thrombosis of the right leg. What are the favorable conditions for the occurrence of a blood clot and subsequent inflammation? 2. A 25-year-old patient in a surgical hospital for pleural empyema is planned to undergo a puncture of the pleural cavity. In what intercostal space is the puncture of the pleural cavity performed? 3. Throbbing pain behind the sternum, increased pain when tapping on the sternum, increased pain when tilting the head back, with mediasthenitis. What is the symptom? 4. The main method to determine the presence of an intestinal fistula, its location and size, intestinal motor disorders, the presence of complications. 5. A 42-year-old female patient consulted a surgeon at the family medicine center with complaints of pain in the legs during prolonged walking, leg cramps and numbness in the legs. The patient has a history of the above complaints for one week. Objectively, the patient's condition is satisfactory. The local status of the lower limbs: normal color, on palpation- pain along the vessels is noted, the nails are brittle. What is your preliminary diagnosis? 6. A 45-year-old patient in a private clinic underwent sclerotherapy for varicose veins of the lower leg, after which the next day bursting pain in the calf muscles of the left leg, swelling of the foot, body temperature increased to 38.5 ° C. Positive Moses symptom. What complication did this patient develop? 7. A 25-year-old patient consulted a doctor at the family medicine center with complaints of chest pain, fever up to 38C, chills, dry cough, general weakness, sweating. On the survey radiograph of the chest organs, an infiltrate with clear  boundaries, a homogeneous structure, without bronchial lumens in it is determined. What is your preliminary diagnosis? 8. A 20-year-old patient has consulted a surgeon with complaints of chest pain, tremendous chills, pain in the neck. From the anamnesis, the patient has been ill for 1 week. After a complete examination and computed tomography of the chest organs, an increase in the retrocervical space, the presence of edema in this area, and a posterior displacement of the trachea were revealed. What complication did this patient develop? 9. Patient 30 years old. An additional education was found in the mediastinum with an annual fluorographic examination. The patient was sent to the hospital. The patient underwent a complete examination. On the survey radiograph of the chest organs in frontal and lateral projections, in the middle floor of the anterior mediastinum, an oval-shaped formation was found, its outer contours are clear, smooth. The adjacent parts of the lung are not changed. What is your presumptive diagnosis? 10.. A 35-year-old patient has turned to a family medicine center with complaints of heartburn for 5 years. Three months ago, the condition worsened, at night food from the stomach began to flow into the oral cavity, from which the patient was forced to sleep half-sitting. Spitting up in the slope appeared. What is your preliminary diagnosis? 11. Patient 44 years old, turned to the surgeon with complaints of various pains behind the breastbone during a meal, impaired swallowing. Sometimes pain occurs outside of meals. She has a history of sickness for 1 year. After a complete examination, X-ray examination of the esophagus revealed its deformation in the form of beads and pseudodiverticula. The diameter of the esophagus above and below the narrowing is not changed. What is your preliminary diagnosis? 12. A 30-year-old patient was admitted to a surgical hospital with complaints of diarrhea mixed with blood and mucus up to more than five times a day, general  weakness, weight loss, pain in the knee and ankle joints. She has a history of illness for more than two weeks when the above complaints appeared. Objectively: the state of moderate severity, the skin and visible mucous membranes of the usual color, the tongue is moist, coated with white; percussion borders of the lungs within normal limits, clear pulmonary sound; during auscultation, vesicular breathing, no wheezing. Your provisional diagnosis. 13. A 45-year-old patient complained of pain in the right iliac region, nausea, body temperature 37.4˚C. On palpation of the abdomen - pain and tension in the right iliac region. There are no symptoms of peritoneal irritation. What is your preliminary diagnosis? 14. A 42-year-old patient was admitted to a surgical hospital with pain in the left side of the abdomen, dry mouth, weakness. The patient has a history of constipation for 1 year. Objectively, the patient's condition is relatively satisfactory. Locally, the tongue is moist. The abdomen is of a normal shape, it participates evenly in the act of breathing. On palpation, the abdomen is painful in the left abdomen. There are no free gas and liquid levels on plain abdominal fluoroscopy. What is your preliminary diagnosis? 15.. Patient, 64 years old, on the 7th day is hospitalized after surgery for adhesive intestinal obstruction. In the postoperative period, the patient has a postoperative wound on the anterior abdominal wall suppurating, the bottom of the wound is the loops of the small intestine. The food taken by the patient after 20-30 minutes is excreted through the wound, and there is also an abundant discharge from the wound of intestinal juice, stained with bile. What postoperative complication did the patient develop? 16. A 40-year-old patient, on the 2nd day after the operation of appendectomy for gangrenous appendicitis, developed intestinal paresis, chills, pains in the right abdomen began to disturb, the liver increased and jaundice appeared. There were  no symptoms of peritoneal irritation. What complication of acute appendicitis can be considered in the first place? 17. A 42-year-old patient is worried about moderate pain in the right hypochondrium, aggravated in an upright position. She has noted similar symptoms for several years. The patient independently revealed a tumor-like formation in the right half of the abdomen. What pathology should be considered first of all? 18. A 52-year-old patient in a surgical department received conservative therapy for acute pancreatitis. 3 weeks after discharge, fever, chills, icterus of the sclera and skin appeared. In the projection of the head of the pancreas, a volumetric painful formation is palpable. What is the most likely diagnosis? 19. A patient who suffered fatty pancreatic necrosis six months ago developed a tumor-like formation in the epigastrium and left hypochondrium, dense, slightly painful, measuring 15x20 cm. The body temperature did not rise. X-ray examination of the stomach revealed that the stomach was pushed forward, the loop of the duodenum was unrolled. What is your diagnosis? 20. A 32-year-old patient has a clinic of diffuse purulent peritonitis. He was admitted to the hospital 3 hours after the onset of the disease. Hemodynamic indicatorsupon admission satisfactory. Your tactics? 21. A 24-year-old patient was admitted to the emergency department 2 days after the onset of the disease, with complaints of pain in the lower abdomen, which then spread to the right iliac region. : 22. For what vascular diseases is the Schwarz palpation-percussion test used: 23. For embolectomy from the aortic bifurcation, the most commonly used surgical approach 24. A typical place for drainage of the pleural cavity in order to evacuate blood in hemothorax is? 25. What is purulent mediastinitis? 26.. In a patient, 32 years old, with X-ray examination of the chest in the anterior superior mediastinum revealed a tumor-like formation measuring 8 x 7 cm. What disease should you think about? 27.. A paraesophageal hernia is called if a part of which organ enters the chest cavity? 28. Xyphoidal hernia. What type of hernias are referred to? 29. What stage of achalasia of the cardia correspond - cicatricial changes (stenosis) of the muscle layers of the lower esophageal sphincter with a pronounced expansion of the esophagus 30. What severity of dumping syndrome correspond to - long-term attacks that appear after each meal. They are accompanied by: fainting, collapse, cachexia, dull consciousness, involuntary urination. 31. Dysphagia after vagotomy is associated with: 32. Indication for surgical treatment of Crohn's disease: 33. Which of the following methods can be used in the study of intestinal fistulas? 34. True postcholecystectomy syndrome can be caused only by: 35.. What pathology refers to overhepatic blockade of the portal circulation: 36. What method is applicable in the diagnosis of liver abscess? 37. A complication typical of acute pancreatitis is: 38.. Which of the microorganisms is most often found in the exudate with diffuse purulent peritonitis? 39. In what period of diffuse purulent peritonitis is potassium deficiency in the blood typical? 40. If the spleen is damaged, accompanied by intra-abdominal bleeding, there will be a positive symptom: 41. What method of surgical prevention of pulmonary embolism is indicated in the presence of a floating thrombus in the infrarenal portion of the inferior vena cava?  42. For what complications of ulcerative colitis do patients undergo emergency surgical treatment? 43. What type of peritonitis is common in women? Application 44. A 60-year-old patient was taken by ambulance to the hospital with complaints of blackening and fetid odor of the right foot and shin, coldness of the limb. Diagnosed with obliterating endarteritis, complicated by wet gangrene of the right lower extremity. What is your surgical treatment strategy? 45. A 78-year-old female patient came to a surgical hospital with complaints of pain and a feeling of heaviness in the calf muscles during prolonged standing in one place, on enlarged veins in the lower extremities. From the anamnesis, he has been sick for one month. On physical examination, there is an increase in the venous pattern and edema of the lower extremities. In some places there are enlarged dilated veins of the lower extremities. On palpation of the lower extremities, a cordlike - painful compaction along the veins is noted. The patient was diagnosed with varicose veins of the lower extremities, complicated by thrombophlebitis. What functional test should be used to determine venous insufficiency? 46. Patient 67 years old, was admitted to the hospital of the Angiology department with complaints of a dense painful formation in the middle and upper third of the left thigh. From the anamnesis the patient has been suffering from varicose veins of the lower extremities for 7 years. About a week ago, she noted the appearance of a seal in the middle third of the thigh, then pain appeared and the seal spread to the upper third of the thigh. The general condition of the patient is of moderate severity. Body temperature 38.1C. On the medial surface of the thigh, there is skin hyperemia, painful seals in the projection of the trunk of the great saphenous vein. Your tactics for surgical treatment: 47. Patient 28 years old, taken to a surgical hospital in an ambulance. Complaints upon admission to chest pain, cough with difficult sputum, nausea, dry mouth, fever up  to 38C. According to the patient, the above complaints are disturbed for 4 days. After a complete examination, she was diagnosed with multiple abscesses of the lower lobe of the right lung. What is your treatment strategy? 48. A 48-year-old patient consulted a surgeon with complaints of the chest, cough with difficult sputum, fever up to 38C, nausea, dry mouth, general weakness. She has a history of 3 days of illness. After a complete examination and an X-ray examination, an abscess of the right lung with a diameter of up to 10 cm was revealed, which is located in the costo-diaphragmatic angle. What is your surgical treatment strategy? 49. Patient, 32 years old, was admitted to a surgical hospital by her parents. With complaints of throbbing chest pain radiating to the interscapular region, increased pain when pressing on the spinous processes of the thoracic vertebrae, increased pain when swallowing and inhaling, pasty in the thoracic vertebrae, swelling over the collarbone, the appearance of crepitus, rigidity of the long muscles of the back. The patient is planned to undergo surgery for acute anterior purulent mediastinitis. What kind of operative access should you use for this patient? 50. A 55-year-old patient, after a complete examination in a surgical hospital, was diagnosed with a diaphragmatic hernia of the abdominal esophagus and cardiac stomach. Your surgical treatment tactics: 51. An ambulance delivered a patient on duty for years. who fell while skiing from the mountains. After the examination, a blunt abdominal trauma was diagnosed, the patient was taken for surgery. During an emergency laparotomy, an infringement of the loop of the small intestine was established in a slit defect in the region of the left lumbar-costal diaphragm. Your surgical treatment tactics. 52. A 45-year-old patient, at a surgeon's appointment, complained of sore throat, dry cough, sensation of a foreign body in the throat and perspiration. In anamnesis, the patient has been sick for several years. After a contrast study of the esophagus,  a Zenker diverticulum of the esophagus was found. What is your surgical treatment strategy? 53. A 70-year-old patient was admitted to a surgical hospital with complaints of pain in the upper abdomen, nausea, vomiting mixed with bile, heartburn, regurgitation of food, weight loss. The anamnesis established that the patient underwent gastric resection three years ago. After the instrumental examination, the diagnosis was made of the adductor loop syndrome, severe. Your surgical treatment tactics: 54. A 65-year-old patient was admitted to a surgical hospital with complaints of epiggastric pain, nausea, vomiting at the height of pain and weight loss. In anamnesis, the patient underwent surgery for a perforated gastric ulcer 5 years ago. After a complete examination, a diagnosis of peptic ulcer of the anastomosis was made. What is your surgical treatment strategy? 55. A 30-year-old patient, at a surgeon's appointment, complained of general weakness, loose stools mixed with blood, general weakness, dizziness. A state of moderate severity. Tongue dryish, coated. The abdomen is painful in the lower regions. There are no symptoms of peritoneal irritation. Which of the additional research methods should be prescribed to establish a clinical diagnosis? 56. Patient 74 years old, taken by ambulance to the hospital with complaints of nausea, vomiting, stool and flatulence, general weakness, dry mouth. Objectively, the patient's condition is serious. Locally, the tongue is dry, coated. The abdomen is painful on palpation in all parts. Symptoms of peritoneal irritation. After a complete examination, the diagnosis was made - a tumor of the sigmoid colon, acute obstructive intestinal obstruction. What is your surgical tactics? 57. A 55-year-old patient was admitted to a surgical hospital with complaints of reddening of the skin and pain in the area of the external small intestinal fistula. From the anamnesis the patient was discharged from the hospital after treatment of intestinal obstruction a month ago. The patient's condition is relatively satisfactory. Locally, on the anterior abdominal wall there is an external labial  fistula, the skin around the fistula is hyperemic, there is maceration. What remedy should be used in this patient for the treatment of maceration? 58. During the prophylactic medical examination in a 50-year-old patient, ultrasound examination for the first time revealed the formation of increased echogenicity in the right lobe of the liver with uneven contours in the 7th segment,dimensions 4.0 x 5.0 cm. No complaints. What should be the management of such a patient? 59. 10 days after appendectomy for gangrenous appendicitis, the patient developed a hectic temperature, pain in the right hypochondrium. An increase in the liver was noted. Ultrasound in the right lobe of the liver revealed a hypoechoic formation - an abscess. Determine the optimal surgical tactics: 60. The patient, 69 years old, was admitted to the surgical department with complaints of recurrent pain in the left hypochondrium with an increase in body temperature to subfebrile numbers in the evenings. History 2 months ago, injury to the left half of the body. On physical examination, there is a significant increase in the spleen. Ultrasound reveals a fluid formation of 15x10 cm with an inhomogeneous structure in the projection of the spleen. Diagnosed with spleen abscess. What is your surgical tactics? 61. A 48-year-old patient was admitted to the hospital with complaints of dull pain in the epigastrium, nausea, dry mouth, weakness. After a complete examination, computed tomography revealed a pancreatic pseudocyst. What is your surgical tactics? 62. A patient has diffuse purulent peritonitis caused by a perforated duodenal ulcer. You should make: 63. The patient is 21 years old. Operated for phlegmonous appendicitis - performed appendectomy and drainage of the right lateral canal of the abdominal cavity due to the presence of turbid effusion. After 3 days, he noted an increase in pain throughout the abdomen, an increase in temperature to 38.4 ° C. On  examination, the state of moderate severity, the pulse rate of 94 beats / min rhythmic. The tongue is dry. The abdomen is painful in all parts, more on the right, tense. Shchetkin's symptom is positive. Peristalsis is sluggish. When examining the rectum, overhang and soreness of the anterior wall is noted. Plain X-ray shows fluid levels in the loops of the small intestine. In the blood leukocytosis. What is your diagnosis? 64. A 38-year-old patient notes that 2 days ago the left limb suddenly became cold, numb, the pain was growing. From the anamnesis: suffers from rheumatism. Objectively: there are no movements in the toes. Locally, the left lower limb is in the toes, the ankle joint, there is no movement, there is no deep sensitivity. The lower leg is increased in volume. The skin is cold, marbled in color. There is no ripple at all levels. Determine the treatment tactics. 65. A 44-year-old patient was admitted urgently with complaints of acute pain in the left lower limb, numbness, cold snap in it. He fell ill acutely, suddenly. Suffers from rheumatism, is registered with a cardiologist. Analgesics do not relieve pain. Delivered after 16 hours from the onset of the disease, there were no previous complaints from the lower extremities. Preliminary diagnosis: 66. A 42-year-old patient has III degree ischemia on the left lower extremity; he fell ill suddenly 3 years ago, walking no more than 30 meters. Previously suffered a myocardial infarction. The right lower limb does not bother. No noise symptoms on the lower limb. The pulsation on the right lower limb is preserved at all levels, on the left - only on the femoral artery. Angiography shows occlusion of the left popliteal artery with filling of its branches through collaterals. What operation is indicated for this patient? 67. In a 52-year-old patient suffering from thromboangiitis obliterans, both lower extremities were previously amputated, suffering from osteochondrosis of the cervical spine, high blood pressure, ischemic heart disease, suffered a heart attack 2 years ago, on the upper limbs 4 months ago appeared in the area of the nail  phalanges on the left on the remaining 4, on the right on all 5 fingers, in stages on one, then on the other, at first, a sharp pallor, pain, cold snap, then cyanosis, edema. The pain is severe, the patient does not sleep. There is no pulsation on the left radial artery. Saved on the right. Surgeon's tactics? 68. A 58-year-old female patient consulted a surgeon with complaints of enlargement of the saphenous veins of the lower extremities for 20 years, feeling heaviness and swelling in the feet and legs in the evening for 7-8 years, works as a salesman. Discoloration of the skin on the inner surface of both legs within 3 years, a trophic ulcer opened. Objectively: the lower limbs are pale pink, on the inner surface in the lower third of the lower leg, skin hyperpigmentation, the skin is thinned, like "Parchment paper". There is a scar, dilated saphenous veins on the lower leg and thighs due to v. saphena magna. In the course of the main trunk and its lateral branches, the volume of the lower leg is increased by 2 cm. What operation is indicated? 69. A 48-year-old patient came to an appointment with complaints of an ulcer in the lower third of the right leg, pain in the right leg and leg of a breaking character, arising towards the end of the day, edema of the foot and leg, periodic cramps in the lower extremities. When examining the right lower leg in n / 3 above the inner ankle, there is an ulcer 4 cm in diameter with uneven edges, 0.5 cm deep, the bottom and walls are covered with necrotic plaque, the discharge is moderate purulent, fetid. Expansion of the great saphenous vein is noted: on the thigh - in the form of a soft cord, and in n / 3 thighs and throughout the ankle varicose veins. On palpation of the vein and its nodes, pain and seals were not found. The pulsation of the arteries is well defined. What is your diagnosis? 70. A 64-year-old female patient consulted a surgeon in a polyclinic with complaints of pain along the veins of the left leg, swelling in the feet, more often at night. From the anamnesis it became clear that the patient suffers from varicose veins of the lower extremities for 3 years. Locally: there are varicose veins on the thighs  and lower legs. On the inner surface of the left thigh in the lower third, hyperemia is determined along the v. saphena magna, palpation marked a sharp soreness in the lower third of the left leg and infiltration. What is your preliminary diagnosis? 71. A 58-year-old patient suffering from rheumatic mitral stenosis and atrial fibrillation suddenly developed pain in the right lower extremity. On examination, marked swelling of the right leg is noted. The skin of the limb is cyanotic with an increase in the subcutaneous venous pattern. Palpation of the zones of the vascular bundle on the thigh is painful. The pulsation on the arteries of the foot is clearly defined. Indicate the diagnosis: 72. Patient 78 years old, was admitted to the surgical department with complaints of a dense painful formation in the middle and upper third of the left thigh along its inner surface. Varicose veins for over 30 years. About a week ago, she noted the appearance of a seal in the middle third of the thigh, then pain appeared and the seal spread to the upper third of the thigh. The general condition of the patient is satisfactory. Body temperature 37.4C. On the medial surface of the thigh, there is skin hyperemia, painful seals in the projection of the trunk of the great saphenous vein. Select the method of surgery: 73. A patient was admitted to a surgical hospital with complaints of pain in the calf muscles and the popliteal region of the left lower extremity. Ill for the third day. On examination, there is swelling of the left leg, the perimeter of the circumference of the middle third of the leg. On palpation, pain in the popliteal fossa is determined. Your provisional diagnosis. 74. A patient of 80 years old, turned to the family doctor with complaints of pain in the right leg, swelling of the leg, an increase in body temperature up to 37C. creeping feeling. In anamnesis, the patient suffers from varicose veins of the lower extremities. The patient's condition is moderate. Locally, on palpation of the right lower leg, swollen, hyperemic, local hyperthermia of the skin and sharp soreness are noted. What complication did this patient develop? 75. A 48-year-old female patient consulted a surgeon complaining of pain in the lower extremities when walking, swelling of the extremities, general weakness. From the anamnesis she has been ill for more than a month. She did not seek medical help anywhere. The patient's condition is relatively satisfactory. There are edemas locally on both feet. Painless on palpation. What instrumental research method prescribe to confirm the diagnosis? 76. Patient R., 28 years old, is being treated in the therapeutic department with a diagnosis of acute abscess of the upper lobe of the right lung. Against the background of general well-being, acute sharp pains appeared in the right half of the chest clerk, chills, severe shortness of breath, pallor with a bluish tinge of the skin. Pulse - 130 beats per minute. On auscultation of the lungs on the right, breathing is amphoric. On the chest X-ray in the right pleural cavity, the horizontal level of fluid up to the III rib is determined, the lung is compressed, the mediastinum is displaced to the left. What is your diagnosis and treatment strategy? 77. Patient N., 61 years old, was hospitalized with complaints of weakness, shortness of breath, fever up to 39 ° C, cough with mucopurulent sputum, chest pain on the left. Considers himself ill within two months after the operation, deterioration of health during the last week. From anamnesis 2 months ago, an extended left pulmonectomy was performed for central lung cancer. Radiographically: on the left, the volume of the pleural cavity is significantly reduced, the mediastinum is displaced to the left, the fluid level up to the II rib is determined. A purulent exudate was obtained by puncture. What is your diagnosis? Treatment tactics. 78. A 45-year-old patient is diagnosed with acute total pleural empyema. What treatment is indicated for the patient? 79. A 70-year-old patient with an acute lung abscess up to 10 cm in diameter, located near the chest wall, has pronounced signs of severe intoxication. What is the preferred treatment method? 80. A 22-year-old patient was admitted to a surgical hospital with complaints of chest pain, fever, chills. From the anamnesis, he has been sick for a week, and has not sought medical help anywhere. After a complete examination, pleural empyema was diagnosed. Your treatment tactics. 81. Patient 38 years old, builder. I went to the hospital with complaints of pain in the chest on the right, chills, fever up to 37C, weakness. Sick for 1 month. Locally, the rib cage is cylindrical; in the act of breathing it lags behind on the right. Vocal tremor is weakened in the lower parts of the right. Percussion on the right is dullness of the pulmonary sound. What study do you prescribe to establish a diagnosis? 82. The patient came to the family medicine center with complaints of cough with difficult sputum, nausea, dry mouth. The patient has a history of a cold a week ago while resting in the mountains. After a complete examination, the diagnosis was made of an abscess of the right lung. The patient underwent a chest puncture and drainage of the abscess. The next day after the procedure, the patient's condition worsened, there was shortness of breath, a feeling of lack of air. The patient developed pneumothorax. What is your treatment strategy? 83. A 20-year-old patient was admitted to the hospital by his parents. Complaints upon admission to chest pain, cough with difficult sputum, nausea, dry mouth, fever. After a complete examination, she was diagnosed with multiple abscesses of the lower lobe of the right lung. What is your treatment strategy? 84. A 6-year-old female patient consulted a surgeon complaining of chest pain, fever, nausea, weakness. From the anamnesis, the patient has been ill for 1 month. Locally, the rib cage is cylindrical; in the act of breathing it lags behind on the left. Vocal tremor is weakened in the lower regions on the left. Percussion on the left is dullness of the pulmonary sound. In the general analysis of blood, leukocytosis. Is there a rounded fluid formation on a plain chest x-ray? What research should be used in this patient to clarify the diagnosis? 85. A 36-year-old patient, while eating fried fish, suddenly felt sharp pains behind the breastbone. Over the next 2 hours, the patient's condition progressively worsened: the body temperature rose to 39 ° C. With an objective examination of the patient, the pain behind the sternum increases when the head is thrown back, as well as when tapping on the sternum. What is your presumptive diagnosis? 86. A 50-year-old patient, who had previously been diagnosed with Zenker's diverticulum, was admitted to the clinic with complaints of severe pain behind the sternum and between the shoulder blades, which arose at the time of intense vomiting. The patient is in a state of shock, temperature - 39.5C. Leukocytosis - 20,000. X-ray - the accumulation of air and fluid in the left pleural cavity and mediastinum. Your provisional diagnosis. 87. A 68-year-old patient was admitted to the hospital with complaints of chest pain, fever, shortness of breath. The patient's condition is moderate. In the general analysis of blood, leukocytosis. To exclude the pathology of the chest organs, an X-ray was taken, preliminary data for an acute purulent mediastinum. What instrumental research method would you prescribe to confirm the diagnosis? 88. A 48-year-old patient was admitted to inpatient treatment at a surgical hospital. With complaints of pulsating chest pain radiating to the interscapular region, increased pain when pressing on the spinous processes of the thoracic vertebrae, increased pain when swallowing and inhaling, pasty in the thoracic vertebrae, swelling above the collarbone, the appearance of crepitus, rigidity of the long muscles of the back. The patient is planned to undergo surgery for acute anterior purulent mediastitis. What kind of operative access should you use for this patient? 89. The patient is 20 years old. Operated in a surgical hospital for a gunshot wound to the chest. On the sixth day after the operation, the patient began to worry about chest pain, shortness of breath, chills, fever up to 38C. On the plain chest X-ray, acute upper anterior purulent mediastitis was diagnosed. What is your surgical treatment strategy? 90. A 48-year-old patient, in the family medicine center, after a complete examination, was diagnosed with acute purulent mediastitis. What is your outpatient treatment strategy? 91. Patient 16 years old. Complaints of dull pain in the chest and back. Anamnesis: for the first time, she noted discomfort in the chest six months ago. Gradually, pain in the chest and back joined. Objectively: the condition is satisfactory. The organs were unremarkable. X-ray examination of the chest organs in the costo-vertebral angle on the right at the Th IV-V level showed an intense oval-shaped formation of a homogeneous structure, with clear contours, measuring 4.0x4.0 cm. A presumptive diagnosis of thymoma was made. What instrumental research method prescribe to confirm the diagnosis? 92. Patient 26 years old. She underwent an annual scheduled examination. After a complete examination, the patient was found to have a mediastinal cyst. What are your actions, as a family doctor, to which specialist do you refer the patient? 93. A 57-year-old patient has been suffering from severe reflux esophagitis due to diaphragmatic hernia over the past 7 years. Conservative treatment is ineffective. Duodenoscopy revealed a duodenal ulcer. Tactics. 94. A 55-year-old female patient, X-ray examination revealed a displacement of the abdominal esophagus and cardiac stomach into the mediastinum and smoothing of the esophageal-gastric fold. Your treatment tactics: 95. Patient 28 years old. She was admitted to the hospital with complaints of chest pain, aggravated after eating, heartburn, belching, weight loss. From the anamnesis, he has been sick for four months. After a complete examination, the patient was diagnosed with a sliding hiatal hernia. What kind of operative access should you use for this patient? 96. A 48-year-old patient consulted a family doctor with complaints of dull pain behind the sternum, at the level of the xiphoid process, in the epigastric region, in the hypochondrium, radiating to the left shoulder. She has had a history of illness  for more than a year. According to the patient, the pain intensifies in the horizontal position of the patient and during physical exertion, as well as when the body is tilted forward. On a plain radiograph with barium contrast, the cardial part of the stomach is located above the diaphragm. What additional research method should you prescribe to clarify the diagnosis? 97. A 28-year-old patient with an acute abdomen clinic was delivered to the emergency hospital after a car accident. During an emergency laparotomy, an infringement of the loop of the small intestine was established in a slit defect in the region of the left lumbar-costal diaphragm. The same defect is found in the area of the right lumbar-costal diaphragm. Your diagnosis and treatment tactics. 98. The patient came to the family doctor with complaints of heartburn, pain behind the breastbone of a burning character, belching with an admixture of gastric contents. The patient has a history of suffering for one year. After the examination, the patient was diagnosed with a hiatal hernia. What is your treatment strategy? 99. A 36-year-old patient complains of sore throat, dry cough, foreign body sensation in the throat, perspiration. After contrast examination of the esophagus, a Tsenker diverticulum of the esophagus was found. What treatment should a surgeon prescribe for a patient with Zenker's diverticulum? 100. A 60-year-old patient was admitted to the hospital by ambulance with complaints of abnormalities in swallowing food, regurgitation of food, chest pain. The patient has a history of cardiac achalasia for three years. What is your treatment strategy? 101. Patient 42 years old. I went to the family medicine center with complaints of dysphagia, regurgitation, pain in the epigastrium and in the xiphoid process. The patient's condition is relatively satisfactory. Locally, the abdomen of the usual form, participates evenly in the act of breathing. There are no symptoms of peritoneal irritation. In the right iliac region, there is an old postoperative scar measuring 6.0x1.0 cm, without signs of inflammation. What instrumental method do you prescribe to clarify the diagnosis? 102. A 36-year-old female patient consulted a surgeon complaining of pain in the epigastric region, aggravated by eating, difficulty passing food through the esophagus, dysphagia. The patient has a history of cardia achalasia for more than a year. Conservative therapy is not effective. What surgical method of treatment will you use for this patient? 103. A 30-year-old patient was admitted to a surgical hospital with complaints of pain behind the breastbone during the passage of food through the esophagus, impaired swallowing. Sometimes pain occurs outside of meals. X-ray examination of the esophagus revealed its deformation in the form of beads, pseudo-diverticula, and a corkscrew. The diameter of the esophagus above and below the narrowing is not changed, the walls are elastic, the folds of the mucous membrane are longitudinal, the peristalsis is uneven and irregular. Diagnosed with esophagospasm. What is your surgical tactics? 104. A 47-year-old patient was operated on for bleeding with perforation 7 years ago, notes pain similar to the previous, ulcerative, but localized in the epigastric region on the left. Notes vomiting at the height of pain and weight loss. Conservative treatment is not effective. What disease should be suspected in the first place and your treatment tactics? 105. A 66-year-old patient was admitted to a surgical hospital with complaints of pain in the upper abdomen, nausea, vomiting mixed with bile, heartburn, regurgitation of food, weight loss. In the anamnesis it was established that the patient underwent gastric resection 2 years ago. After the instrumental examination, the diagnosis was made of the adductor loop syndrome, severe. Your treatment tactics: 106. A 49-year-old patient was operated on for bleeding with perforation 5 years ago, notes pain similar to the previous, ulcerative, but localized In the epigastric region on the left. Notes vomiting at the height of pain and weight loss. Conservative treatment is not effective. In feces, the Gregersen reaction (+++). What is your preliminary diagnosis? 107. A patient after selective proximal vagotomy for duodenal ulcer after 2 years developed intense epigastric pain on an empty stomach, nausea, vomiting, radiological signs of duodenostasis were revealed. Choose the most appropriate treatment method: 108. A 22-year-old patient has consulted a family doctor with complaints of general weakness, loose stools mixed with blood, general weakness, dizziness. A state of moderate severity. Tongue dryish, coated. The abdomen is painful in the lower regions. There are no symptoms of peritoneal irritation. Which of the additional research methods should be prescribed to establish a clinical diagnosis? 109. A 45-year-old patient was admitted to the hospital with complaints of non- discharge of stools and gases, nausea, vomiting, dry mouth, general weakness. From the anamnesis, the patient is ill for 1 day. I did not take medications on my own. The general condition of the patient is of moderate severity. Tongue dry, coated with white bloom. The abdomen is painful on palpation in all parts. Positive symptom of Shchetkin Blumberg. Diagnosed with acute intestinal obstruction. What is your treatment strategy? 110. A 86-year-old patient was taken by ambulance to the hospital with complaints of nausea, vomiting, non-discharge of stools and gases, general weakness, dry mouth. Objectively, the patient's condition is serious. Locally, the tongue is dry, coated. The abdomen is painful on palpation in all parts. Symptoms of peritoneal irritation. After a complete examination, the diagnosis was made - a tumor of the sigmoid colon, acute obstructive intestinal obstruction. What is your surgical tactics? 111. The patient consulted the surgeon with complaints of pain in the lower abdomen, general weakness, dry mouth. The patient has a history of intestinal diverticulosis. The patient's condition is moderate. Local status tongue dry, coated. The abdomen is painful on palpation in the lower parts. Symptom Shchetkin-Blumberg questionable. You assume the patient has developed pelvioperitonitis due to  perforation of the sigmoid diverticulum. What instrumental study do you prescribe to clarify the diagnosis? 112. Patient 60 years old, hospitalized in a surgical hospital with a diagnosis of acute abdomen. The patient was immediately taken to the operating room. During the operation, diverticulosis of the sigmoid colon was found. What is your surgical tactics? 113. An elderly patient 5 hours ago developed severe pains in the lower abdomen, nausea, vomiting. The patient's condition is moderate. Tongue dry. The abdomen is distended, painful and tense in the lower regions. Blood leukocytes 13000. Pulse 110 beats per minute, single extrasystoles. You suspect perforation of the sigmoid colon tumor in the patient. What additional measures will you take to clarify the diagnosis? 114. The patient was taken to a surgical hospital with complaints of cramping pains throughout the abdomen, non-discharge of stools and gases, general weakness. From the anamnesis, the patient is ill for 1 day. The patient's condition is moderate. Local status tongue dry, coated. The abdomen is swollen, painful on palpation in all parts. Shchetkin Blumberg's symptom is positive. Diagnosed with acute intestinal obstruction. What kind of surgical approach will you use for this patient? 115. The patient went to a surgical hospital with complaints of pain in the left side of the abdomen, general weakness, dry mouth. The patient's condition is moderate. Tongue dry, coated. The abdomen is painful on palpation in the lower parts, more in the left half of the abdomen. Positive symptom of Shchetkin Blumberg. With a diagnosis of peritonitis, the patient was taken to the operating room. Perforation of the sigmoid colon was found during the operation. What is your surgical tactics? 116. The patient came to the family medicine center with complaints of pain in the lower abdomen, loose stools, general weakness, loss of appetite, dry mouth. She has a history of sickness for a week. Locally, the tongue is dry, coated with white bloom. The abdomen is soft on palpation, moderately painful along the colon.  There are no symptoms of peritoneal irritation. A preliminary diagnosis of Crohn's disease has been made. What instrumental research method would you prescribe to clarify the diagnosis? 117. The patient came to the family medicine center with complaints of pain in the upper abdomen, nausea, vomiting, bringing temporary relief. The general condition of the patient is of moderate severity. Tongue dryish, coated. The abdomen is soft on palpation, painful in the upper abdomen. There are no symptoms of peritoneal irritation. Plain X-ray of the abdominal organs revealed the presence of two gas bubbles with fluid levels in the stomach and duodenum and a pronounced expansion of the intestinal lumen. What is your preliminary diagnosis? 118. A 37-year-old patient has applied to the family medicine center with complaints of pain in the upper abdomen, nausea, vomiting, which brings temporary relief. From the anamnesis, he has been sick for one month. The general condition is relatively satisfactory. Tongue dryish, coated. The abdomen is soft on palpation, moderately painful in the epigastrium. There are no symptoms of peritoneal irritation. A preliminary diagnosis of chronic duodenal obstruction was made. What instrumental study do you prescribe to confirm the diagnosis? 119. The patient came to the surgical hospital with complaints of pain in the upper abdomen, nausea, vomiting, bringing temporary relief. A history of these symptoms bothers for three months. After a complete examination, a diagnosis of duodenal obstruction was made. What is your surgical treatment strategy? 120. A 82-year-old patient went to the hospital with complaints of weight loss, difficulty in passing stool and gas, general weakness. From the anamnesis it was established that the patient suffers from ulcerative colitis in for 8 years. She is regularly treated on an outpatient and inpatient basis. What instrumental research method would you recommend for this patient? 121. A 42-year-old patient was taken by ambulance to a surgical hospital with complaints of pain throughout the abdomen, nausea, vomiting, dry mouth, and general weakness. The patient's condition is moderate. Tongue dry, coated. The abdomen is painful in all parts. Shchetkin Blumberg's symptom is positive. The patient was urgently taken for surgery. During the operation, perforation of the sigmoid colon and diffuse purulent peritonitis were found. What is your surgical tactics? 122. A 48-year-old patient was admitted to a surgical hospital for planned surgical treatment for a labial fistula of the small intestine. What is your surgical treatment strategy? 123. A 38-year-old patient has had colon resection for volvulus against the background of diffuse purulent peritonitis. What must be done during the operation from the following activities? 124. A 46-year-old patient was hospitalized with a diagnosis of “tubular fecal fistula of the splenic angle of the colon”, which arose after a gunshot wound to the colon. What are your instrumental research tactics? 125. A 30-year-old patient was operated on 6 months ago for injury to the transverse colon. The transverse colon was transected with the proximal end being excreted in the form of a single-barreled complete labial fistula. The peripheral end was sutured tightly. What is your treatment strategy? 126. Patient 78 years old. She is undergoing inpatient treatment in a hospital with an external colonic fistula. What means do you use from the methods treatment of intestinal fistulas allows you to successfully fight dermatitis and ensures the passage of the contents through the intestine? 127. A 40-year-old patient has turned to the family medicine center with complaints of skin redness and pain in the area of the external small intestinal fistula. From the anamnesis the patient was discharged from the hospital after treatment of intestinal obstruction a month ago. The patient's condition is relatively satisfactory. Locally,  on the anterior abdominal wall there is an external labial fistula, the skin around the fistula is hyperemic, there is maceration. What remedy should be used in this patient for the treatment of maceration? 128. Patient 45 years old, turned to the clinic with complaints of pain in the right hypochondrium, yellowness of the skin. From the anamnesis the patient has been ill for 4 days. On examination, the skin is icteric, on palpation, the abdomen is painful in the right hypochondrium. Ortner's symptom is positive. Ultrasound revealed choledocholithiasis. What are the treatment tactics? 129. Patient 38 years old, accountant. went to the surgeon with complaints of paroxysmal pain in the right hypochondrium, nausea, bitterness in the mouth, general weakness. From the anamnesis, he is sick for 1 day, after an error in the diet, there was a intake of fatty and fried foods. What instrumental method of treatment will you use to establish the diagnosis of this patient? 130. Patient, 40 years old after a complete examination in a surgical hospital. According to esophagogastroduodenoscopy, varicose veins of the esophagus and signs of splenomegaly with ultrasound were revealed, a history of repeated bleeding, and hypersplenism. What surgery is aimed at reducing portal hypertension and eliminating hypersplenism? 131. A patient, 21 years old. I went to the family medicine center with complaints of heaviness in the right hypochondrium, nausea, black stools. He has a history of cirrhosis of the liver for 4 years. On ultrasound, hepatomegaly, splenomegaly and moderate ascites. History of bleeding episode from esophageal varices. What more effective treatment should be applied to prepare for liver transplantation? 132. The patient is 70 years old. Delivered to the hospital by relatives. Complaints of the patient of nausea, vomiting with blood, an increase in the abdomen in volume, edema in the legs, yellowness of the skin. The patient suffers from cirrhosis of the liver for a long time, is regularly treated in a hospital for bleeding from varicose  veins of the esophagus. What kind of surgery is indicated for prophylactic purposes? 133. A 18-year-old patient who recently underwent amoebic dysentery and underwent a course of treatment followed by recovery developed rather intense pains in the right hypochondrium, aggravated by breathing. The temperature rose and became intermittent. There were debilitating chills. The patient began to progressively lose weight. Examination reveals a painful, significantly enlarged liver. Stool and urination are normal. Leukocytes in the blood 17.0 x 109 / l. What is your diagnosis? 134. A 60-year-old patient, the cook turned to the surgeon with complaints of nausea, vomiting with blood, dizziness, heaviness in the right hypochondrium. The patient has been suffering from cirrhosis of the liver for 3 years. The patient had a history of bleeding two years ago. Diagnosed with liver cirrhosis. Portal hypertension. Varicose veins of the esophagus complicated by bleeding. What kind of surgery is indicated for prophylactic purposes? 135. A 36-year-old patient, a football player, turned to a surgeon with complaints of nausea, vomiting with blood, dizziness, heaviness in the right hypochondrium. The patient has been suffering from cirrhosis of the liver for 6 years. Gastroscopy revealed varicose veins of the esophagus complicated by bleeding. What is your treatment strategy? 136. Patient 38 years old. She went to the hospital with complaints of heaviness in the right hypochondrium, an increase in the volume of the abdomen due to ascites. In anamnesis, the patient suffers from cirrhosis of the liver, complicated by portal hypertension for one year. Instrumental examination revealed the presence of fluid in the abdominal cavity, pathological enlargement of the spleen in size. What is your tactic of surgical treatment? 137. In a 30-year-old patient in a hospital, endoscopic examination revealed bleeding from varicose veins of the esophagus. The gastric mucosa is not changed. Which of the listed methods of hemostasis can be applied in any medical institution? 138. A 50-year-old patient was admitted to the hospital with complaints of weakness, vomiting mixed with blood and black stools. When viewed on the anterior abdominal wall, pronounced venous pattern, palmar erythema. What is the research method to determine the source of bleeding? 139. The patient is 22 years old, came to the family medicine center with complaints of pain in the right hypochondrium, fever up to 38C, nausea, vomiting, weakness. After a complete examination, the patient was diagnosed with liver abscess. What is your surgical tactics? 140. A patient, 40 years old, consulted a family doctor with complaints of a feeling of fullness in the upper abdomen. On physical examination, abdominal asymmetry is noted due to bulging of the left upper quadrant, and an enlarged spleen is palpable. A spleen cyst was suspected. What method of instrumental research should be used to confirm the diagnosis? 141. Patient 19 years old. He was admitted to the hospital with complaints of pain in the left hypochondrium, dizziness, darkening of the eyes and general weakness. From the anamnesis, the patient fell 1 hour before admission while cycling. Ultrasound examination revealed rupture of the spleen, intra-abdominal bleeding. What is your surgical strategy? 142. A 94-year-old patient was admitted to the surgical department with complaints of recurrent pain in the left hypochondrium with an increase in body temperature to subfebrile numbers in the evenings. History 2 months ago injury to the left half of the body. On physical examination, there is a significant increase in the spleen. Ultrasound reveals a fluid formation of 15x10 cm with structural heterogeneity in the projection of the spleen. Diagnosed with spleen abscess. What is your treatment tactics? 143. Patient 82 years old, taken to the hospital by ambulance. The patient's complaints of pain in the left hypochondrium, nausea, dizziness. From the anamnesis, the patient fell in the toilet and hit the sink with his left side. Ultrasound examination revealed a ruptured spleen. What is your surgical tactics? 144. A 40-year-old patient came to a surgical hospital with complaints of dull pain in the epigastrium, nausea, vomiting, weight loss, general weakness. She has a history of the disease for 1 month. He did not seek medical help anywhere. Objectively, the patient's condition is moderate. After a complete examination, a pancreatic cyst was diagnosed. What is your surgical strategy? 145. A 64-year-old patient consulted a family doctor with complaints of fluid discharge from a postoperative wound. In anamnesis, the patient underwent surgery on the pancreas. A preliminary diagnosis of pancreatic fistula was made. What research method would you prescribe to confirm the diagnosis? 146. A 48-year-old patient consulted a family doctor with complaints of epigastric pain of a surrounding nature, nausea, repeated vomiting, dry mouth. A preliminary diagnosis of pancreatitis was made. What laboratory biochemical analysis and instrumental research method do you prescribe to clarify the diagnosis? 147. An 80-year-old patient turned to a surgeon at the family medicine center with complaints of epigastric pain of a surrounding nature, nausea, repeated vomiting, dry mouth. Diagnosed with acute pancreatitis. What is your treatment strategy? 148. A 64-year-old patient consulted a surgeon with complaints of epigastric pain of a surrounding nature, nausea, repeated vomiting, dry mouth. After the examination, she was diagnosed with a pancreatic cyst. Your surgical tactics. 149. A patient with chronic pancreatitis has moderate pain syndrome in the absence of blockade of the duct system. Choose appropriate treatments. 150. In a patient who underwent pancreatic necrosis a month ago, in the upper abdomen, a volumetric formation is determined, moderately painful with fluctuations in the center. The abdomen is soft without peritoneal symptoms.  Temperature and blood count are within normal limits. A preliminary diagnosis was made - a pancreatic cyst. What instrumental study should you assign to this patient? 151. A 40-year-old patient complained of dull aching pains in the upper abdomen, dyspepsia, weakness, weight loss, and the presence of a tumor-like formation in the abdomen. The patient's condition is relatively satisfactory. Locally, the tongue is clean and moist. The abdomen on palpation is moderately painful in the epigastric. There are no symptoms of peritoneal irritation. Ultrasonography revealed an anechoic oval-shaped lesion with smooth, clear contours. A preliminary diagnosis of pancreatic cyst was made. What instrumental research method would you prescribe to clarify the diagnosis? 152. A 50-year-old patient was operated on for acute gangrenous appendicitis complicated by peritonitis. What method of intraoperative gastrointestinal decompression should be used in this patient? 153. A 40-year-old patient is diagnosed with peritonitis. After preoperative preparation, the patient was taken to the operating room. What kind of operative access would you use for this patient? 154. A 90-year-old patient was admitted to a surgical hospital by relatives in a serious condition. Complaints of pain in all parts of the abdomen, nausea, vomiting, dry mouth. Locally, the tongue is dry, coated. The abdomen is painful on palpation in all parts. Positive symptom of Shchetkin Blumberg. On an ultrasound examination of the abdominal cavity, there is fluid in all sections. With a diagnosis of peritonitis, the patient was taken for surgery. Operational finding - diffuse purulent peritonitis caused by a perforated duodenal ulcer. What is your surgical strategy? 155. A 20-year-old patient applied to a surgical hospital. After a complete examination, the patient was diagnosed with acute destructive appendicitis, complicated by widespread peritonitis. What kind of operative access should you use for this patient? 156. A 55-year-old patient came to the admission department of a surgical hospital 14 days after the disease, with complaints of pain in the epigastric region, then the pain moved to the right iliac region, accompanied by nausea, dry mouth, and vomiting. She did not seek medical help, she self-medicated. Local status: tongue dry, coated. The belly is swollen. On palpation, painful in all parts. Positive symptoms of peritoneal irritation. Blood leukocytes - 12.0 × 109 / l, shift of the leukocyte formula to the left. What is your diagnosis and treatment strategy? 157. A 43-year-old patient suffering from duodenal ulcer, felt intense pain in the upper abdomen. Seek medical help. Tongue dry. The belly is swollen. Does not take part in the act of breathing. On palpation, painful and tense in all parts. The Shchetkin- Blumberg symptom is positive. Percussion hepatic dullness is absent, tympanitis is determined. What method of instrumental examination should you use in this patient? 158. Patient T. 30 years old, taken by ambulance to the emergency surgery. Complaints of pain throughout the abdomen, nausea, vomiting, dry mouth. From the anamnesis, the patient is ill for a day. serious condition, tachycardia 118 beats per minute, blood pressure 100/60 mm Hg. Locally, the tongue is dry, coated. the abdomen is painful on palpation in all parts. Positive symptom of Shchetkin Blumberg. Diagnosed with peritonitis. What is your treatment strategy? 159. Patient 40 years old. He was taken to the hospital in an ambulance with complaints of pain in all parts of the abdomen, nausea, vomiting, dry mouth. The patient's condition is grave. Locally, the tongue is dry, coated with white bloom. On palpation, the abdomen is painful in all parts. Positive symptom of Shchetkin Blumberg. Diagnosed with peritonitis. What operational do you use access in this patient? 160. A 40-year-old patient was admitted to the surgical department, 3 days after the onset of the disease. On admission, the patient complains of pain in the right iliac region. From the anamnesis it is known that the pain began in the epigastrium and  after a few hours migrated to the right iliac region. The general condition of the patient is severe, conscious, the skin is of low humidity, the tongue is dry. The abdomen is moderately distended and tense in the lower regions. Due to the tension of the muscles of the anterior abdominal wall, the study is difficult, palpation in the lower sections is sharply painful, positive symptoms of peritoneal irritation are determined. What is your surgical tactics? 161. In the surgical department is patient K., 30 years old, who underwent an operation 8 days ago - appendectomy for gangrenous perforated appendicitis. The postoperative period was satisfactory. On the 3-4th day, the drains were removed from the abdominal cavity. By the 8th day of the postoperative period, the body temperature increased to 38.5, bloating appeared. In the mesogastrium, a volumetric mass is indistinctly palpable, painful. There are no symptoms of peritoneal irritation. An interintestinal abscess is suspected. What instrumental research method prescribe to confirm the diagnosis? 162. An 18-year-old patient is being treated in the surgical department, who underwent an operation - appendectomy - for gangrenous appendicitis 5 days ago. The stump of the appendix could not be reliably immersed due to symptoms of typhlitis. After the operation, the body temperature began to rise to 39.5C. There were pains in the lower abdomen. When examining per vaginum: overhang of the posterior fornix of the vagina, sharp soreness with displacement of the uterus. A preliminary diagnosis was made of an abscess of the Douglas space. 163. What instrumental research method prescribes to confirm the diagnosis? 164. A 45-year-old patient was admitted to the emergency department 4 days after the onset of the disease with complaints of diffuse, persistent pain in all parts of the abdomen, repeated vomiting. Sick 4 days ago, when there was intense pain in the epigastrium (as from a dagger strike). He did not seek medical help. The condition is extremely serious. The patient is inhibited. Facial features are pointed. The abdomen is evenly swollen and tense in all parts. With superficial palpation,  symptoms of irritation of the peritoneum in all departments are determined. Diagnosed with peritonitis, sepsis. What is your surgical tactics? 165. A 24-year-old patient was admitted to the emergency department 2 days after the onset of the disease, with complaints of pain in the lower abdomen, which then spread to the right iliac region. The tongue is coated. The abdomen is swollen in the lower sections, participates in the act of breathing. On palpation, there is a moderate muscle tension in the lower sections, positive symptoms of irritation of the peritoneum in the same place. Appendicular symptoms are questionable. What is your diagnosis and what surgical tactics would you use in this patient? 166. A 42-year-old patient underwent a planned gastric ulcer resection according to Hofmeister-Finsterer. On the 3rd day after the operation, the patient's condition deteriorated sharply. There were sharp pains in the epigastric region, which spread throughout the abdomen. Breathing is shallow. The abdomen is swollen, painful in the epigastric region, right hypochondrium, tense. Peristalsis is not audible. Shchetkin-Blumberg's symptom is positive. Diagnosed with peritonitis. What is your surgical tactics? 167. Patient 45 years old. She was taken to the surgical hospital with complaints of chest pain on the right, chills, fever up to 37C, weakness. Sick for 1 month. Locally, the chest is cylindrical, in the act of breathing it lags behind on the right. Voice trembling is weakened in the lower sections on the right. Percussion on the right dullness of pulmonary sound. What research will appoint for establishment of the diagnosis? 168. A 30-year-old patient applied to a family doctor with complaints of general weakness, loose stools with blood, general weakness, dizziness. Moderate condition. The tongue is dry, coated. The abdomen is painful in the lower parts. There are no symptoms of peritoneal irritation. Which of the additional research methods should be prescribed to establish a clinical diagnosis? 169. A 78-year-old patient was brought to the hospital by her relatives with complaints of nausea, vomiting, non-passing of stools and flatus, general weakness, dry mouth. Objectively, the patient's condition is severe. Locally, the tongue is dry, furred. The abdomen is painful on palpation in all departments. Symptoms of peritoneal irritation. After a complete examination, a diagnosis was made - a tumor of the sigmoid colon, acute obstructive intestinal obstruction. What is your surgical strategy? 170. A 28-year-old patient applied to a surgical hospital with complaints of pain in the upper abdomen, nausea, and vomiting that brought temporary relief. In history, these symptoms are disturbing for three months. After a complete examination, a diagnosis of duodenal obstruction was made. What is your surgical treatment strategy? 171. Patient, 26 years old. He turned to the surgical hospital with complaints of pain in the left hypochondrium, dizziness, darkening of the eyes, general weakness. From the anamnesis, the patient fell down while cycling 1 hour before admission. Ultrasound examination revealed rupture of the spleen, intra-abdominal bleeding. What is your surgical approach? 172. A 55-year-old patient was delivered to a surgical hospital by ambulance with complaints of dull epigastric pain, nausea, vomiting, weight loss, and general weakness. She has been ill for 1 month. He did not go anywhere for medical help. Objectively, the patient's condition is moderate. After a complete examination, a diagnosis of a pancreatic cyst was made. What is your surgical approach? 173. A 37-year-old patient applied to the emergency surgery. Complaints at admission to pain throughout the abdomen, nausea, vomiting, dry mouth. From the anamnesis he is ill for a day. Severe condition, tachycardia 118 beats per minute, blood pressure 100/60 mm Hg. Locally, the tongue is dry, furred. The abdomen is painful on palpation in all departments. Positive symptom of Shchetkin Blumberg. A diagnosis of peritonitis was made; scheduled for emergency surgery.  Operational finding extensive mixed pancreatic necrosis, diffuse peritonitis. What is your surgical treatment strategy? 174. A 28-year-old patient was brought to the emergency hospital by his relatives with complaints of constant pain in the umbilical region, watery diarrhea up to 10-12 times a day, weight loss, thirst, dizziness, headaches and general weakness. According to the anamnesis, diarrhea has been bothering him for 6 months. He took loperamide on his own. The effect was temporary. Over time, the stool became more frequent and pain appeared. He was consulted by an infectious disease specialist and infectious pathology was excluded. Taking into account the anamnesis of the disease, the doctor suspects Crohn's disease and recommended performing a colonoscopy with biopsy. Determination of which morphological feature is a key aspect of the biopsy to confirm the diagnosis? 175. A 35-year-old patient came to the FMC with complaints of pallor, chilliness, a crawling sensation and coldness of the right shin. During the examination, the doctor asked the patient to lie down on a couch with his legs raised and to bend and straighten his ankle joints. After performing 5 movements, the patient felt weakness in his right foot. What test did the doctor perform? 176. A patient underwent excision of a mediastinal cyst in the posterior mediastinum behind the right bronchus. It looked like a thin-walled formation containing transparent fluid. Further histological examination revealed that the cyst was lined with ciliated epithelium from the inside. What type of mediastinal cyst was detected? 177. Which of the following types of pancreatic cysts develops with stricture of the excretory ducts or persistent blockage of their lumen by stones? 178. A 35-year-old patient came to the emergency room complaining of pain in the right iliac region, nausea, and a single episode of vomiting. Objectively: t -37.5 C. The skin and visible mucous membranes are of normal color. Vesicular breathing, no wheezing. RR 18 per min. Heart sounds are clear and rhythmic. HR 92 per min.  BP 110/70 mmHg. The abdomen is painful in the right iliac region. Shchetkin- Blumberg symptom is positive. CBC: Hb 125 g/l, Er. 3.8x10 12/l, CI 0.9, Leukocytes 13.0x109/l, Platelets 280x109/l, ESR 17 mm/h. Urine analysis: color is straw-yellow, transparency is complete, density is 1012, leukocytes are 3-5 in the field of view. The doctor determined that the peritonitis is of moderate severity. On the basis of how many signs did the doctor determine the severity? 179. What role does increased venous pressure play in the pathogenesis of trophic leg ulcers in varicose veins of the lower extremity?. 180. Why is 100–120 ml of 0.25% Novocaine solution injected into the root of the mesentery of the small intestine during surgery? 181. What type of exudate peritonitis occurs after unintentional damage to the large intestine during colonoscopy? 182. When a loop of the intestine is strangulated in hernias, the greatest pathological changes occur? 183. A 54-year-old female patient complains in the emergency department of frequent episodes of pain in the right hypochondrium, which has been increasing for the last 2 days, nausea, and flatulence. From the anamnesis: she underwent laparoscopic cholecystectomy 7 months ago. The doctor diagnoses postcholecystectomy syndrome. Objectively: Body temperature is 36.8 C. The skin and visible mucous membranes are of normal color. Breathing is harsh, no wheezing. Heart sounds are clear, rhythmic. Complete blood count: Hb 110 g / l, Er. 3.7x1012 / l, CP 0.9, Leukocytes 7.0x109 / l, Platelets 290x109 / l, ESR 14 mm / h. Amylase 170 U / l. What complication arose with this condition? 184. During morning rounds on the third day after choledochoduodenostomosis, bile in the amount of 100.0 ml began to flow through the drainage from the right hypochondrium. What type of fistula most likely developed in this patient as a result of a complication of the postoperative period? 185. A 20-year-old female patient presented to the doctor with complaints of dysphagia, especially when eating solid and dry food, regurgitation of food after meals, rapid fatigue, and weight loss over the past 6 months. Objectively: Height 170 cm, Weight 50 kg. The abdomen is soft and painless on palpation. Shchetkin- Blumberg symptom is negative. Barium X-ray revealed esophageal dilation and retention of contrast agent. EGDS: distended esophagus, lower esophageal sphincter does not relax, passage of the endoscope is difficult. The mucous membrane is hyperemic and edematous. Esophageal manometry: increased pressure in the lower esophageal sphincter and lack of normal relaxation. Which of the following surgical treatments is most appropriate for this patient? 186. A 57-year-old patient is admitted to the surgical department complaining of difficulty swallowing and intermittent episodes of severe chest pain. From the medical history, he notes that in recent months he has been experiencing belching and discomfort after eating. Objectively: The skin and visible mucous membranes are of normal color, breathing is harsh, no wheezing, heart sounds are clear and rhythmic. Locally: The tongue is moist and clean. The abdomen is soft and painless. Shchetkin-Blumberg's symptom is negative. EGDS: the esophagus is passable, there is a protrusion of the mucous membrane, around which the mucous membrane is hyperemic and edematous. Radiography with contrast in two projections: a protrusion on the posterior wall of the esophagus. Which treatment method would be most appropriate for this patient? 187. A 50-year-old female patient complains of swelling and nagging pain in the right lower limb, and cramps in the calf muscles at night. The patient's medical history includes conservative treatment for acute deep vein thrombophlebitis 4 months ago. Objectively: Breathing is harsh, no wheezing. Heart sounds are clear and rhythmic. Locally: The skin in the right lower limb is pale and edematous. There is pain on palpation of the calf muscle. Duplex scanning reveals heterogeneous  thrombotic masses of varying degrees of organization. What complication has developed in the patient? 188. A 38-year-old patient, an active fitness enthusiast, presented with severe pain in the left shoulder, swelling of the left arm, and cyanosis of the skin on the hand. He noted that the symptoms developed after a recent weight training session. On examination, the subcutaneous veins in the left arm were tense and dilated, and there was firm swelling that did not leave a pit when pressed. What surgical treatment should be used to treat this condition? 189. A 32-year-old male athlete was admitted to the department complaining of swelling of the right upper limb, shoulder pain, and heaviness in the right arm. The symptoms appeared several hours after training with heavy weights. Swelling and cyanosis of the right hand are visually noticeable, as well as increased venous pattern on the right. Palpation reveals pain in the right shoulder area. RR - 22 beats per minute, HR - 110 beats per minute, BP 110/70 mm Hg. Doppler examination in the subclavian vein area reveals no blood flow, the vein is dilated, there is a hypoechoic formation in the lumen, and there is no vein collapse during the Valsalva maneuver. What treatment is indicated for the patient? 190. A 29-year-old patient was admitted to the surgical department with complaints of stabbing pains in the epigastric region, single episodes of vomiting, and gas and stool retention. Medical history: the illness developed acutely about 5 hours ago, when acute pains in the epigastrium appeared after drinking alcohol. Objectively: The patient's condition is severe. The skin is pale. Breathing is harsh, no wheezing. Respiratory rate is 20 per minute. Heart sounds are clear and rhythmic. HR is 110 sec min. Blood pressure is 95/60 mm Hg. The tongue is dry, coated with a white coating. The abdomen does not participate in the act of breathing, is board-shaped, sharply painful in all areas, Shchetkin-Blumberg symptoms are positive. Intestinal sounds are sharply weakened. What surgical treatment is necessary to eliminate the cause of peritonitis? 191. A 57-year-old patient was delivered by ambulance in a serious condition. The patient is inhibited, answers questions late, lethargic, adynamic. According to his wife, he has been ill for 3 days. He took ketoprofen on his own. Complaints of pain throughout the abdomen, repeated vomiting, nausea, dizziness and headache. Objectively: t - 39.8 ° C, Hippocratic face. Breathing is harsh, weakened in the lower sections, RR - 22 per min. Heart sounds are muffled, rhythmic HR 120 beats / min., BP 90/55 mm Hg. Tongue is dry, coated with a brown coating. The abdomen is sharply and diffusely swollen, painful in all areas. Shchetkin- Blumberg symptom is positive. Ultrasound of the abdominal cavity reveals free fluid. What will be your tactics? 192. A 38-year-old patient with a history of malaria hit his left hypochondrium while falling, after which he felt a sharp pain in the left half of the abdomen, weakness, dizziness, and a short-term loss of consciousness. Objectively: the patient is in a moderate condition, consciousness is preserved. The skin and mucous membranes are pale. The tongue is coated, dryish, heart rate is 110 beats per minute, blood pressure is 80/60 mm Hg. The abdomen is moderately distended, there is diffuse pain throughout the abdomen. Percussion reveals a shortened sound in sloping areas of the abdominal cavity. Shchetkin-Blumberg's symptom is positive. Ultrasound: free fluid in the abdominal cavity. What treatment does the patient need? 193. Patient M., 68 years old, was admitted to the emergency department with complaints of dull pain in the right hypochondrium, dry mouth, yellowness of the skin and sclera. From the anamnesis: 2 years ago, he underwent cholecystectomy. Objectively: the skin and visible mucous membranes are yellowish in color. The abdomen is enlarged due to subcutaneous fat, painful in the right hypochondrium. Ultrasound of the abdominal organs showed dilation of the common bile duct to 12 mm, as well as the presence of a slight dilation of the pancreatic duct. According to magnetic resonance cholangiopancreatography, a narrowing was  detected in the area of the large duodenal papilla at the level of the ampulla of Vater. What operation should be performed? 194. A 45-year-old patient was admitted to the surgical department with complaints of fever, chills, pain in the right hypochondrium and shortness of breath. A week ago he underwent surgery for a perforated gastric ulcer. At the time of examination: t - 39.1 ° C, pain on palpation in the right hypochondrium and decreased respiratory excursion in the right lung are noted. An ultrasound scan of the abdominal organs revealed a subdiaphragmatic formation in the right hypochondrium with signs of fluid. What treatment method is optimal for the patient? 195. A 24-year-old female patient complains of constant pain, heaviness in the lower abdomen, tenesmus, loose stools with mucus, and frequent urge to urinate. History: received outpatient treatment for salpingo-oophoritis 2 weeks ago. Objectively: The tongue is dry. The abdomen is painful in the lower parts of the abdomen, the Shchetkin-Blumberg symptom is questionable. Examination of the per rectum reveals: gaping of the anus, overhanging and soreness of the anterior wall of the rectum. Per vaginum: overhanging of the posterior fornix of the vagina, sharp pain when the uterus is displaced. Diagnosis: Abscess of the Douglas space. What treatment method will be used? 196. A 34-year-old female patient presented with complaints of difficulty swallowing, a lump in the throat and chest pain, belching, and nausea. History: symptoms appeared about a year ago and gradually worsened, especially when eating solid food. Barium X-ray revealed significant dilation of the esophagus and narrowing in the cardia. Esophageal manometry revealed no relaxation of the lower esophageal sphincter during swallowing. What treatment method would you use? 197. A 60-year-old patient was admitted to the emergency department with complaints of severe abdominal pain, nausea, vomiting, and constipation. The symptoms developed suddenly about 24 hours ago. On examination: the patient's condition is severe, the abdomen is distended, painful to palpation, especially in the left iliac  region, the Shchetkin-Blumberg symptom is positive, peristalsis is not heard. t - 39 ° C, heart rate - 120 beats / min. An urgent laparotomy was performed, during which a volvulus of the sigmoid colon with signs of diffuse purulent peritonitis was detected. The cecum is necrotic, which required its resection. What else should be done during the operation? 198. A 32-year-old female patient has been suffering from ulcerative colitis for several years. Despite constant drug therapy, the disease is accompanied by frequent exacerbations, expressed as intense abdominal pain, bloody diarrhea up to 10 times a day, weakness and significant weight loss. The patient has been hospitalized several times due to complications and posthemorrhagic anemia caused by frequent blood loss. Colonoscopy revealed diffuse damage to the colon, especially pronounced in the sigmoid and descending colon. The rectum is affected to a lesser extent. What surgical treatment method is optimal for this patient? 199. A 65-year-old female patient, presents with complaints of severe chest pain, shortness of breath, difficulty swallowing, and nausea. She also reports experiencing intermittent heartburn for several months but thought it was just acid reflux. The pain is worse after meals and is not relieved by over-the-counter antacids. On physical examination, you notice she has mild tachycardia (HR 104 bpm), low blood pressure (98/60 mmHg), and she appears mildly anxious. You also observe that she is mildly dyspneic on exertion. The CT scan confirms a large paraesophageal hernia/ Paraesophageal hernia is dangerous due to: 200. In the treatment of pancreatic cysts, anastomoses with the gastrointestinal tract are often practiced. The best of them are Understanding 201. A 38-year-old female patient complains of intense intermittent claudication that occurs after walking 200 meters. The skin of the feet and legs has lost elasticity, is dry, flakes, the nails are thickened, brittle. Pulsation on the arteries of the foot  is not detected. What stage of obliterating endarteritis is this symptom complex typical for? 202. What operation is indicated for obliterating endarteritis during the development of wet foot gangrene, accompanied by edema, lymphangitis and lymphadenitis? 203. A 34-year-old man, a 10-year-old smoker, came to the clinic with complaints of intermittent claudication: after 100 meters he had to stop because of pain in the calf muscles. Considers himself ill for six months, when intermittent claudication appeared after 400m. The patient's legs are marbled, the distal parts of the feet are purple-cyanotic. Dry and brittle nails. Pulse on the arteries of the foot is absent, on the popliteal arteries is weakened. Determine the stage of the disease? 204. Patient 54 years old, suffering from varicose veins of the lower extremities for ten years. He complained of pain along the varicose vein of the left leg, moderate swelling of the foot, increasing in the evening. Objectively: there are varicose veins due to v. saphena magna in the shins and thighs. On the inner surface of the left thigh in the lower third, hyperemia along the great saphenous vein up to 5 cm is determined. On palpation, there is a sharp pain in the region of the lower third of the left leg, infiltration. Your diagnosis 205. A 39-year-old patient has a sharp edema of the entire right upper limb after a sharp increase in weight, pain of a bursting character, he cannot clench his fingers into a fist. Movement, sensitivity are preserved. The upper limb is increased in volume throughout, the edema spreads to the subclavian region and the anterior lateral surface of the chest. What is your preliminary diagnosis? 206. A 42-year-old patient, after sclerotherapy of varicose veins, developed a bursting pain in the calf muscles of the left leg, edema of the foot and leg, t = 37.8 ° C. Positive Moses symptom. What complication has developed? 207. When examined at home, you diagnosed a patient with acute thrombophlebitis of the great saphenous vein with a spread of up to the middle third of the thigh. What is your treatment strategy? 208. Patient J., 69 years old, complained of sudden pain in the right lower limb, cooling of the skin of the limb in the area of the foot and lower leg, decreased sensitivity. Considers himself ill for 2 days when the above complaints first developed. On examination: the right lower limb is cool to the touch, the pulsation of the common femoral artery is determined, the distal pulsation (in the area of the popliteal artery and arteries of the lower leg) is not detected. Active and passive movements in the ankle and knee joints are preserved. Deep sensitivity is not impaired, superficial sensitivity is reduced. What examination does the patient need to clarify the diagnosis? 209. A 33-year-old patient was admitted to the department of vascular surgery, complaining of swelling of the entire right lower limb, a feeling of heaviness and distention in it, aching pains that worsen with the vertical position of the body, shortness of breath. Pain appeared two days ago. Examination by the surgeon revealed the smoothness of the groin and gluteal folds, soreness in the right groin area on palpation. Choose a research method. 210. Patient 38 years old. He was admitted to a surgical hospital with complaints of chest pain, shortness of breath during exertion, cough, restriction of physical activity, fever up to 38C, dry mouth, general weakness. From the anamnesis it was found that the above complaints were disturbing for 3 weeks. The patient took painkillers at home on his own, due to lack of time he did not seek medical help anywhere. Over time, the patient's condition worsened, shortness of breath began to bother even at rest. In the hospital, a survey radiograph of the chest organs was made - the conclusion of a lung abscess complicated by pleural empyema. What is your treatment strategy? 211. At fluoroscopy of the lungs in a 53-year-old patient, infiltration of the middle and lower lobes of the right lung was revealed, against which there were multiple areas of tissue rarefaction with horizontal levels and shadows of sequesters. What is your preliminary diagnosis? 212. Patient V., 19 years old, has been undergoing treatment for 13 days at the therapeutic department for left-sided lower lobe pneumonia. From day 10, the temperature increased to 39 ° C, pain in the left side of the chest, shortness of breath. On the chest X-ray, homogeneous darkening of the lower and middle pulmonary fields is noted, the mediastinum is displaced to the right. What's your diagnosis? 213. Patient 40, turned to the surgeon with complaints of sharp pains in the chest, shortness of breath, fever, chills. An overview X-ray of the chest organs revealed a collapse of the right lung, a wide horizontal fluid level, and a sharp shift of the mediastinal shadow to the left. What's your diagnosis? 214. Patient 25 years old. I went to the family medicine center with complaints of chest pain on the right, fever, dry cough, general weakness. The patient has a history of pulmonary tuberculosis for 6 months. Locally, the rib cage is cylindrical; in the act of breathing it lags behind on the right. Vocal tremor is weakened in the lower parts of the right. Percussion on the right is dullness of the pulmonary sound. Plain X-ray of the chest organs revealed omission of the diaphragm on the right. What complication has developed in a patient with pulmonary tuberculosis? 215. A 38-year-old patient has consulted a surgeon with complaints of sharp pains in the chest, cough, dry mouth, general weakness, fever. Has been ill for 1 week. Locally, the rib cage is cylindrical; in the act of breathing it lags behind on the left. Vocal tremor is weakened in the lower regions on the left. Percussion on the left is dullness of the pulmonary sound. In the general analysis of blood, leukocytosis. The plain chest X-ray shows a horizontal fluid level. What complication has developed in the patient against the background of exudative pleurisy? 216. What determines the outcome of purulent mediastinitis? 217. A 59-year-old patient, during blind bougie of the esophagus with bougie No. 32 about his post-burn stricture, developed sharp pains behind the sternum, increased  body temperature, and crepitus in the neck. What complication of bougienage did this patient have? 218. Patient 40 years old, turned to the family medicine center with complaints of chest pain, tremendous chills, cough. From the anamnesis she has been ill for a week. An overview X-ray of the chest organs revealed an increase in the posterior esophageal space, the presence of fluid in this area, and anterior displacement of the trachea. What is your preliminary diagnosis? 219. The patient turned to the surgeon with complaints of pain behind the breastbone, tremendous chills, pain in the neck. From the anamnesis, he is ill 2 weeks ago and was operated on for a stab wound in the neck. Computed tomography of the chest organs revealed an increase in the retrocervical space, the presence of edema in this area, and posterior displacement of the trachea. What complication did this patient develop? 220. A 85-year-old patient is hospitalized after a thoracotomy operation. On the 10th day, the patient's condition worsened, increasing pain in the wound area, displacement of the edges of the dissected sternum when coughing or on palpation, increased body temperature, shortness of breath, redness and swelling of the edges of the wound began to disturb. In laboratory tests, leukocytosis. What complication did this patient develop? 221. A man of 29 years old. No complaints. With prophylactic fluorographic research in the mediastinum found additional education. Objectively: the condition is satisfactory. On organs - no peculiarities. On X-ray of the chest: organs in frontal and lateral projections, in the middle of the anterior mediastinum of an oval shape, a formation in the thickness of which denser inclusions are revealed, its outer contours are clear, smooth. The adjacent parts of the lung are not changed. CT scan shows a tumor with clear contours in the middle floor of the anterior mediastinum. What is your presumptive diagnosis? 222. A 53-year-old patient complains of chest pain, heartburn, which intensify after eating and in the supine position. In a standing position, the pain decreases. Blood tests show moderate hypochromic anemia. What disease are you thinking about? 223. A 40-year-old patient has heartburn for 5 years. Three months ago, the condition worsened, at night food from the stomach began to flow into the oral cavity, from which the patient was forced to sleep half-sitting. Spitting up in the slope appeared. What is your preliminary diagnosis? 224. A 26-year-old female patient consulted a surgeon complaining of severe pain after the breastbone, sharply increasing after eating, weight loss, general weakness, malaise, heartburn, belching, regurgitation. Computed tomography of the thoracic organs revealed that most of the stomach is in the thoracic cavity. What is your preliminary diagnosis? 225. A 26-year-old patient fell down a ladder while working. Complaints about the feeling of rumbling, transfusion in the left side of the chest, the patient began to feel short of breath, shortness of breath. During the examination, a fracture of the ribs was revealed. Above the left half of the chest, peristaltic noises are heard. On chest x-ray, intestinal loops were found. Your preliminary diagnosis: 226. A 30-year-old patient consulted a surgeon complaining of pain of varying intensity behind the breastbone during the passage of food through the esophagus, swallowing disorder. Sometimes pain occurs outside of meals. Has a history of sickness for 1 year. Not treated, did not apply to anywhere. An X-ray examination of the esophagus reveals its deformation in the form of a rosary, pseudodiverticula, and a corkscrew. The diameter of the esophagus above and below the narrowing is not changed. What is your preliminary diagnosis? 227. During the examination by the surgeon of the polyclinic of a 26-year-old woman, complaints of difficulty in swallowing liquid food, periodic regurgitation were noted. Esophagomanometry revealed a decrease in the relaxation of the esophageal sphincter during swallowing. What is your preliminary diagnosis? 228. A 53-year-old patient complained of intense bursting pain in the epigastric region after eating, daily vomiting with an admixture of bile, bringing relief. History of gastric resection according to Billroth II for duodenal ulcer. Weight deficit of more than 15 kg. Your preliminary diagnosis: 229. A 47-year-old patient was admitted to the hospital by relatives with complaints of weakness after taking sweet and dairy foods, sweating, dizziness, and a desire to lie down to rest. When questioning the patient, the surgeon found out that three months ago the patient underwent gastric resection. What is your preliminary diagnosis? 230. A 20-year-old patient was admitted to the hospital with complaints of loose stools mixed with blood and mucus up to 4-6 times a day, general weakness, weight loss, pain in the knee and ankle joints. Considers herself sick for about 2 months, when she began to notice blood clots on the surface of the formed feces. 2 weeks before admission to the hospital, she developed loose stools mixed with blood and mucus, and took antibiotics and loperamide for 10 days. Objectively: the state of moderate severity, the skin and visible mucous membranes are of normal color, the tongue is moist, coated with white bloom; percussion borders of the lungs within normal limits, clear pulmonary sound; during auscultation, vesicular breathing, no wheezing. Your provisional diagnosis. 231. A 66-year-old patient suddenly fell ill: pain in the left iliac region, fever. On examination, some muscle tension and soreness in the left iliac region. From the anamnesis 3 years ago, at a colonoscopy, sigmoid diverticulosis was established. What is your preliminary diagnosis? 232. A patient suffering from ulcerative colitis developed asymmetric abdominal distention, sharply weakened intestinal peristalsis, stool retention, increased body temperature. Your diagnosis. 233. The patient complains of bleeding from the rectum, diarrhea, cramping abdominal pain, fever up to 38 degrees, tenesmus, recurrent vomiting, as well as deterioration in general condition and weight loss. What is your presumptive diagnosis? 234. A 34-year-old patient was admitted to the clinic with complaints of pain in the right iliac region, nausea, body temperature 37.4˚C. On palpation of the abdomen - pain and tension in the right iliac region. There are no symptoms of peritoneal irritation. In the analysis of blood - neutrophilia, accelerated ESR. An hour after admission, he was operated on with suspected acute appendicitis. During revision - hyperemia, edema, thickening and rigidity of the walls of the small intestine for 50 cm proximal to the ileocecal angle, the appendix was changed for the second time. What disease does this patient have? 235. A 65-year-old patient was admitted with pain in the left side of the abdomen, increasing within 2 days. For the last 10 years he has been suffering from constipation. On examination, febrile condition, tachycardia, pain in the left lower quadrant of the abdomen; here are moderately expressed peritoneal symptoms. There are no free gas and liquid levels on plain abdominal fluoroscopy. What is your diagnosis? 236. Patient 58 years old, consulted a doctor in connection with the appearance of pain in the lower abdomen and unstable stools (more than a month notes the alternation of constipation and diarrhea). The appetite is saved. The tongue is moist and clean. The abdomen is not distended, soft, painful on deep palpation in the left iliac region. Body temperature 37.3˚С. With a digital examination of the rectum, there is no pathology. On irrigoscopy, diverticula of the sigmoid colon were found. What complication of the diverticulum has developed in the patient? 237. A patient of 80 years old applied to the polyclinic with complaints of difficulty in defecation, traces of dark blood in the feces. 3 days before admission to the clinic, cramping pains in the abdomen appeared, gas stopped, and there was no stool. Tongue dry, coated with white bloom. Tachycardia up to 90 per minute, pulse of  weak filling, single extrasystoles. The abdomen is uniformly distended, palpation of the abdomen is soft, moderately painful. There are no symptoms of peritoneal irritation. On digital examination of the rectum, an empty, gaping ampoule. What is your diagnosis? 238. A 60-year-old patient consulted a surgeon with complaints of cramping pain around the navel, no gas and stool discharge, nausea, vomiting, dry mouth. 239. From the anamnesis, the patient is ill for 1 day. Objectively: the patient's condition is moderate. Heart rate 98 beats per minute. Locally, the tongue is dry, coated. The abdomen is painful on palpation around the navel. Symptoms of peritoneal irritation. The symptom of "splash noise" is positive. What is your preliminary diagnosis? 240. Patient 90 years old. I went to the surgeon with complaints of cramping pains around the navel, nausea, general weakness, dry mouth, stool and flatulence. From the anamnesis, she has been ill for more than a day. On the plain X-ray of the abdominal organs, a sharply enlarged sigmoid colon with two fluid levels is visualized. What's your diagnosis? 241. Patient 20 years old. I went to the family medicine center with complaints of pain in the left side of the abdomen, constipation, general weakness. From the anamnesis, the patient is sick for about 1 month. The patient's condition is moderate. The skin is normal. The cardiovascular system was normal. Locally: the tongue is wet. The abdomen participates in the act of breathing, on palpation it is moderately painful in the left half of the abdomen. There are no symptoms of peritoneal irritation. What is your preliminary diagnosis? 242. A 34-year-old patient consulted a surgeon complaining of bloody stools, general weakness, dry mouth. From the anamnesis she is ill during those days. The patient's condition is moderate, the patient is conscious, adequate, pulse and blood pressure are normal. Locally, the tongue is dry. The abdomen is of a normal shape, participates in the act of breathing evenly, on palpation it is moderately painful in  the course of the large intestine. There are no symptoms of peritoneal irritation. During colonoscopy, the mucous membrane is in the form of "cobblestones". What is your preliminary diagnosis? 243. Patient 40 years old, taken by ambulance to a surgical hospital with complaints of pain in the lower abdomen, dry mouth, general weakness. The anamnesis has established that the patient has been suffering from Crohn's disease for a long time. Locally, the tongue is dry, coated with white bloom. The abdomen is painful on palpation in all parts. Shchetkin Blumberg's symptom is positive. What complication did this patient develop? 244. A 40-year-old patient was operated on for a gunshot wound to the abdominal cavity with d