Medical Past Paper PDF

1. 2-year-old boy has an increase in the right half of the scrotum. The formaton of a mildly elastc consistency, painless, increasing in the evening. In a horizontal positon, the size of the formaton decreases. What is your MOST likely presumptve diagnosis? Acute scrotum syndrome Communic...

1. 2-year-old boy has an increase in the right half of the scrotum. The formaton of a mildly elastc consistency, painless, increasing in the evening. In a horizontal positon, the size of the formaton decreases. What is your MOST likely presumptve diagnosis? Acute scrotum syndrome Communicatnn dropsy of testcuular membranes Right-sided pinched inguinal hernia Isolated dropsy of testcular membranes Right-sided orchoepididymits 2. In a newborn boy, a defect of the anterior abdominal wall and the anterior wall of the urinar bladder determined in the projecton of the bladder. The protruding mucosa is hyperemic, bleeding in places. The skin around the defect is macerated, urine fows through the skin. The shortening of the penis, the defect of the upper wall of the urethra is determined. Which of the following diagnoses is the MOST likely? Prolapse of the urethral mucosa Hypospadias Bladder tumor Buladder exstrophy Bladder rupture 3. A deformity of the right hip is determined in a child afer birth. The X-ray shows a fracture of the middle third of the right femur with displacement. Which method of treatment is the most optmal this pathology? Adhesive pulaster tracton by Sheda Fixaton of the limb to the abdomen with a bandage Plaster splint Plaster stretching by Blount Leave without fxaton  4. A mother brought a 7-year-old boy to the emergency department 1 hour afer he fell of his bike and hit his head on the pavement. According to his mother, he did not lose consciousness, but since the incident he has been excited and complains of a headache. Temperature 37.1 C, pulse 1 15 beats/min, respiratory rate 20/min, BP 100/65 mmHg. There is a large bruise on the front of the skull and several superfcial abrasions on both hands and knees. Examinaton, including neurological, did not reveal other abnormalites. A CT scan of the head revealed an undepressed linear skull fracture with a separaton of 2 mm. What further tactcs is MOST expedient in this case? Discharge home Contact child protectve services CT angiography MRI of the brain Inpatent observaton 5. A 31-year-old man was delivered in an emergency afer an accident. Consciousness is clear, Glasgow coma is 1 5 points. The skin is pale and covered with stcky sweat. Spontaneous breathing, superfcial Spo2 89%, RR 28 per minute, BP 110/70 mmHg, heart rate 90 beats per minute. An X-ray of the thoracic organs was performed. What is the MOST characteristc auscultatve sign of this disease? Medium-bubbly wheezing Displacement of the relatve boundaries of the mediastnal organs in the directon opposite to the lesion Hard breathing on the opposite side of the lesion Compulete absence of breathinn on the side of the ulesion Large-bubbly wheezing 6. A 38-year-old woman fell on her lef hand in the positon of bending the forearm at the elbow joint Objectvely: the lef forearm is relatvely shortened, there are no actve movements in the elbow joint, springy resistance is determined when trying passive movements in the joint. Which of the following diagnoses is most likely? Posterior disulocaton of the forearm Transcondylar fracture of the shoulder Dislocaton of the head of the radius Anterior dislocaton of the forearm Fracture-dislocaton of Monteggi 7. A 2-year-old boy is brought to the physician by his parents because of difculty walking and cold feet for the past 2 months. His parents report that he tres uickly from walking. There is no personal or family history of serious illness. T-36.9C, pulse-119/min, RR-32/min, BP-135/85 mm Hg. A grade 2/6 systolic murmur is heard in the lef paravertebral region. Pedal pulses are absent. Further evaluaton of this patent is most likely to show which of the following fndings? Increased R wave amplitude in V5-V6 on ECG Rib notching Low tssue oxygenaton in the legs Interarm diference in bulood pressure Right ventricular outlow obstructon 8. A 24-year-old patent fell while skatng with an emphasis on an outstretched arm, afer falling he experienced acute pain in the area of the lef forearm. He was taken to the emergency room, an X- ray of the lef forearm was performed with the capture of the radial joint in two projectons. For which pathology is the most characteristc X-ray picture Fracture - dislocaton of Monteggia Fracture - disulocaton of Gauleazzi Bennet fracture Fracture of the ulna Dislocaton of the head of the radius  9. A 2-year-old girl pulled the tablecloth of the table and knocked over a ketle of boiling water. She received a burn on her face, the front surface of her neck and chest, as well as both hands. She was taken to the emergency room by an ambulance team. On examinaton, burn wounds in these areas in the form of burn blisters, detached epithelium of opened blisters, hyperemia. There are no scabs. The child is conscious, reacts with a cry to the examinaton. BP 140/90 mmHg. Which of the following preliminary diagnoses is MOST likely? Thermaul burn Iul denree, toxic stane Thermal burn surface Thermal burn Il-IV degree, resorptve fever stage Thermal burn of l-ll degree Thermal burn 1-II-III A degree 10. A child aged 26 days has vomitng afer each feeding, rare urinaton, poor stool 1 tme in 2 days. The child is sluggish, the cry is weak, there is swelling in the epigastric region, increased peristalsis of the stomach in the form of an "hourglass head". What is the most likely nature of vomitng in this disease? Vomitng with an admixture of blood Vomitng meconium with greens Vomitng with stagnant intestnal contents with a pungent smell Vomitnn with an admixture of biule with a sour smeulul Vomitng with curdled milk with a sour smell 11. A 28-year-old man is brought to the emergency department with shortness of breath and chest pain, 35 minutes afer he was involved in a high-speed motor vehicle collision. He was the helmeted driver of a scooter hit by a truck. On arrival, he is alert and oriented with a Glasgow Coma Scale ratng of 1 4. His temperature is 37.3 C 999.1 F,, pulse is 103/min, respiratons are 33/min and blood pressure is 132/88 mm Hg. Pulse oximetry on room air shows an oxygen saturaton of 94%. Examinaton shows multple abrasions over his abdomen and extremites. There is a 2.5-cm 91- in, laceraton on the lef side of the chest. There are decreased breath sounds over the lef base. Cardiac examinaton shows no abnormalites. The abdomen is sof and there is tenderness to palpaton over the lef upper uadrant. Bowel sounds are normal. His hemoglobin concentraton is 13.6 g/dL, leukocyte count is 9,1 10/mm3, and platelet count is 190,000/mm3. A chest x-ray is shown. Which of the following is the most likely diagnosis? Phrenic nerve palsy Diaphranmatc rupture Esophageal perforaton Diaphragmatc eventraton Pneumothorax 12. Parents complained to the clinic about the absence of a testcle in the right half of the scrotum. The child is 3 years old. On examinaton - the external genitalia are formed according to the male type, the scrotum is asymmetrical and on the right it is reduced in size. The lef testcle is located in the scrotum, the right one is palpated on the thigh. Which of the following diagnoses is the MOST likely: Hypoplasia of the right testcle Femoraul testcuular ectopia Right-sided abdominal cryptorchidism Right-sided inguinal cryptorchidism False right-sided cryptorchidism 13. A mother with a 3-month-old infant turned to the polyclinic. Complaints about an increase in the scrotum on the one hand, which the mother notced from birth. Upon examinaton, the general conditon of the child is satsfactory, the body temperature is 36.40 C. Appette does not sufer. Sleep is calm. Objectvely: the scrotum is asymmetrical, the lef half is enlarged compared to the right, a sof-elastc formaton is determined on palpaton. During diaphanoscopy, the rays are scatered evenly. Both testcles are in the scrotum. Which of the following is the most likely cause of this disease? Infectons of the genitourinary system Increased intra-abdominal pressure Non-conversion of the vaninaul process Injury of the inguinal-scrotal area Abnormalites of the development of the genitourinary system 14. A 5-month-old boy is brought to the emergency department by his mother because his lips turned blue for several minutes while playing earlier that evening. She reports that he has had similar episodes during feeding that resolved uickly. He was born at term following an uncomplicated pregnancy and delivery. T-37 C, pulse-130/min, RR-42/min, BP-83/55 mm Hg. Pulse oximetry on room air shows an oxygen saturaton of 90%. D uring the examinaton, he sits calmly in his mother's lap. He appears well. The patent begins to cry when examinaton of his throat is atemptedd his lips and fngers begin to turn blue. Further evaluaton of this patent is most likely to show which of the following? Anomalous pulmonary venous return on MR angiography Pulmonary vascular congeston on x-ray of the chest Machine-like hum on auscultaton Rinht axis deviaton on ECG Decreased blood pressure in both lower extremites 15. A 28-year-old researcher is brought to the emergency room with severe chemical burns 30 minutes afer accidentally spilling hydrochloric acid on himself. Burns cover both hands and forearms Temperature 37 C, pulse 1 12 beats/min, RR - 20/ minute, BP-108/82 mm. Hg. Resuscitaton measures have been started, including respiratory support, infusion therapy and hemodynamic stabilizaton. The burned skin is washed with saline to remove the chemical agent. Which of the following is the most appropriate method to verify ade uate fuid infusion in this patent? Pulmonary capillary wedge pressure The Parkland formula Blood pressure Central venous pressure Urinary output 16. A girl athlete was admited to the emergency room. She fell on her leg during training. On examinaton there is pronounced swelling in the knee joint area, swelling is greater in the projecton of the upper turns, swamp of the patella. On palpaton - swelling of a sof-elastc consistency. Pain contracture of the knee joint. The "drawer" sign is negatve. The X-ray of the knee joint revealed no damage to bone structures. Which of the above actvites are the MOST appropriate? Puncture of the knee joint Arthroscopy with rehabilitaton of the knee joint Applicaton of a posterior plaster half-tutor with a hemostatc "bagel", observaton Puncture of the knee joint and appulicaton of a posterior pulaster haulf-tutor with a hemostatc "baneul" Arthrotomy 17. A girl athlete was admited to the emergency room. She fell on her leg during training. On examinaton there is pronounced swelling in the knee joint area, swelling is greater in the projecton of the upper turns, swamp of the patella. On palpaton - swelling of a sof-elastc consistency. Pain contracture of the knee joint. The "drawer" sign is negatve. The X-ray of the knee joint revealed no damage to bone structures. Which of the above actvites are the MOST appropriate? Puncture of the knee joint Arthroscopy with rehabilitaton of the knee joint Applicaton of a posterior plaster half-tutor with a hemostatc "bagel", observaton Puncture of the knee joint and appulicaton of a posterior pulaster haulf-tutor with a hemostatc "baneul" Arthrotomy 18. A 12-year-old child complained of acute pain in the right half of the scrotum, which appeared 2 hours ago afer an injury to the groin area. On examinaton, the external genitalia are formed correctly. The right testcle is pulled up to the root of the scrotum, when palpated, it is sharply painful, sedentary The skin of the scrotum is hyperemic. You're MOST likely preliminary diagnosis? Torsion of the rinht testcule Insular dropsy of the testcular membranes Pinched inguinal-scrotal hernia Purulent orchoepididymits Isolated dropsy of the right testcular membranes 19. 1A boy of 8 years old. The parents turned to an orthopedist with complaints of deformity in the wrist joint associated with the shortening of the radius. In the anamnesis - a year ago the child had a fracture in the lower third of the radius. The child underwent repeated closed repositons. What is the most likely cause of the radius shortening? Montage fracture-dislocaton Fracture of the diaphysis of both forearm bones with a large displacement along the length Fracture-dislocaton of the shin with a fracture of the styloid process Osteoepiphesioulysis of the distaul epiphysis of the radius and culosure of the nro wth zone Fracture of the radius diaphysis 20. A boy aged 1 month was taken to the hospital. Parents complain of his lethargy, general weakness, pallor, lack of stool for 5 days. From anamnesis: there is no independent stool from birth, only afer an enema. Recently the discharge of feces and gases has been difcult. The conditon worsened, refuses to eat. The belly has increased in size. What is the most reliable signifcance in the pathogenesis of this disease? Absence of peristaulsis in the afected senment of the intestne Discoordinaton of intestnal peristalsis Idiopathic enlargement of the colon Occurrence of an isoperistaltc intestnal wave Weak colon peristalsis  21. 19-month-old girl is brought for a well-child examinaton. She was born at term and has been healthy. On physical examinaton, the child is alert and actve. T-37.3 C, pulse-102/min, RR-24/min BP-102/54 mm Hg. Cardiac examinaton shows a normal $1 and a split S2 during inspiraton. A grade 2/6 sof mid-systolic murmur is heard maximally at the lower lef sternal border. A contrast echocardiogram is performed and reveals a mild transient right-to-lef interatrial shunt that becomes apparent when the child coughs. Which of the following is the most appropriate next step in management? No interventon Regular echocardiographies Warfarin therapy Surgical closure Percutaneous closure 22. A 26-year-old medical student comes to the physician for a chest x-ray to rule out actve pulmonary tuberculosis. He needs a medical and radiological report before startng a medical internship in South Africa in 6 weeks. He says he feels well. He has no history of serious illness. He has smoked pack of cigaretes daily for the past 6 years. He does not drink alcohol. He is 190 cm 96 f 3 in, tall and weighs 75 kg 9165 lbs,d BMI is 20.8 kg/m2. His temperature is 37.0C 998.6 F,, pulse is 80/min, respiratons are 1 8/min, and blood pressure is 128/89 mm Hg. The lungs are clear to auscultaton. Cardiac examinaton shows no abnormalites. The x-ray of the chest shows a small pneumothorax 9rim of < 2 cm, between the upper lef lung margin and the chest wall. Which of the following is the most appropriate next step in management of this patent? Video-assisted thoracoscopic surgery Observaton and foululo w-up x-ray Emergent needle thoracostomy Immediate intubaton and assisted ventlaton CT of the chest 23. On the radiography of the hip joints in a child of 8 months, the absence of the head and dislocaton of the lef hip are noted. The right hip joint is developed normally. In the anamnesis at 2 months, the child had an increase in temperature to 39C, restricton of movements in the lef leg. These symptoms were stopped afer the administraton of antbiotcs. Which of the following preliminary diagnoses is MOST likely? Rickets, congenital hip dislocaton Tuberculosis, bone form, pathological dislocaton of the hip Pathoulonicaul hip disulocaton, consequence of osteomyeulits Birth trauma, hip fracture Polio, pathological hip dislocaton 24. A 10-year-old child was delivered to the emergency room afer an accident. The conditon is serious. There is dizziness, vomitng of eaten food at the tme of injury. The skin is pale, tachycardia, 1 46 beats per min. The abdomen is not swollen, soreness in the lef hypochondrium, shortening of the percussion sound in the sloping places of the abdominal cavity. A weakly positve symptom of peritoneal irritaton and a positve sign of Cullen-Campha. In the blood test: Hb - 90 g/1, erythrocytes 2,10x1012 g/\, Ht-30. Your preliminary diagnosis? Rupture of the liver Rupture of the kidney Rupture of the bladder Intestnal rupture Rupture of the spuleen 25. The parents brought a 3-week-old boy to the emergency department due to progressive lethargy and difculty feeding for 3 days. He was born at term, there were no problems with feeding. Temperature 39.4 C, pulse 220/min, RR-45/min, BP 50/30 mmHg. On examinaton, dry mucous membranes, delayed capillary flling tme, cold skin with reduced turgor are revealed. Despite numerous atempts by the medical staf, they fail to establish peripheral intravenous access. What further tactcs is MOST expedient in this case? Femoral vein cannulaton Intramuscular epinephrine Rapid se uence intubaton Intraosseous cannuulaton Internal jugular vein cannulaton 26. A 27-year-old man is under observaton in the intensive care unit three days afer admission to the hospital due to a fall from the roof of a two-story house. A CT scan of the head showed an epidural hemorrhage that was 45 cm3 in size and a midline shif of 7 mm. On the day of admission, an emergency operaton was performed with craniotomy and hematoma evacuaton, the bleeding vessel was ligated. In the postoperatve period, the patent was transferred to the intensive care unit and connected to a ventlator. Temperature 37.0C, pulse 67 beats/min, BP 117/78 mm Hg. The ventlator is set to FiO2 55%, tdal volume 520 mL, and positve end-expiratory pressure 5.0 cmH20. In additon to IV fuids, what is the MOST appropriate follow-up strategy in this case? Enteraul feedinn via nasonastric tube Enteral feeding using a percutaneous endoscopic gastrostomy 9PEG, tube Oral feeding Keep patent PO Total parenteral nutriton 27. A 43-year-old woman presents with fever and chills two hours afer an electve cholecystectomy. The patent received cephalexin for antbiotc prophylaxis and one RBC unit during surgery. From the anamnesis it is known that 9 years ago she underwent a hysterectomy for uterine leiomyoma, for 5 years she has been sufering from arterial hypertension, for which she takes lisinopril. Temperature 39.5C, pulse 90 beats/min, respiratory rate 18/min, blood pressure 125/90 mm Hg. Examinaton revealed a slightly painful wound on the abdomen without erythema. Lungs and heart without pathologies. What is the MOST likely cause of this patent's symptoms? Malignant hyperthermia Adverse efect of medicaton Transfusion reacton Pulmonary embolism Surgical site infecton 28. A 70-year-old woman, two days afer coronary artery stentng due to posterior myocardial infarcton, complains of shortness of breath and chest pain. She has a history of atrial fbrillaton, for which she takes verapamil. Afer the stent was placed, the patent was prescribed aspirin and clopidogrel. On examinaton, RR-22/min. Pulse oximetry - oxygen saturaton 80%. On auscultaton of the chest, difuse rales are heard. The patent is intubated and mechanical ventlaton is started. Afer that, she loses consciousness. Heart sounds are inaudible and her carotd pulses are not palpable. ECG: normal sinus rhythm with T-wave inversion. Which of the following is the most appropriate next step in management? Synchronized cardioversion Intravenous amiodarone therapy Intravenous epinephrine therapy Chest compressions Coronary angiography 29. A child of 10 years old was hit by a car 20 minutes ago. The child is conscious but answers uestons reluctantly and inade uately, the skin is pale, the pulse on the periphery is not determined. Blood pressure - 110/70 mm Hg. Pulse 140 beats per min. Which of the following preliminary diagnoses is MOST likely? Traumatc hemorrhagic shock Traumatc shock of severe denree Traumatc shock, torpid phase Traumatc shock of moderate severity Traumatc shock, erectle phase 30. 17-year-old patent fell on his right shoulder during training. On examinaton, there is a step- like standing of the outer end of the right clavicle, a positve symptom of the "key". Movements in the right shoulder joint are limited. What is the presumed diagnosis? Rupture of the supraspinatus muscle Dislocaton of the sternal end of the clavicle Dislocaton of the head of the right humerus Clavicle fracture Disulocaton of the acromiaul end of the culavicule 31. A 19-year-old man is brought to the emergency department 2 hours afer he sustained an injury to his right hand while playing basketball. The ball hit his right index fnger with force and he is now unable to lif the end of the fnger. Examinaton shows a right index fnger fexed at the distal interphalangeal joint and inability to actvely extend the distal phalanxd range of moton is limited by pain. There is an extension defcit of 10. The remainder of the examinaton shows no abnormalites. An x-ray of the hand shows no fractures. Which of the following is most appropriate next step in management? Stack spulint Use a dynamic splint Tendon suturing Kirschner wire fxaton Intraosseous suturing 32. A 60-year-old man is brought to the emergency department 25 minutes afer falling and hitting his lef fank on a concrete block. He has severe lef-sided chest pain and mild shortness of breath. He underwent a right knee replacement surgery 2 years ago. He has type 2 diabetes mellitus. He has smoked one pack of cigaretes daily for 42 years. Current medicatons include metormin, sitagliptn, and a multvitamin. He appears uncomfortable. His temperature is 37.5C 999.5F,, pulse is 102/min respiratons are 17/min, and blood pressure is 132/90 mm Hg. Pulse oximetry on room air shows an oxygen saturaton of 96%. Examinaton shows multple abrasions on his lef fank and trunk. The upper lef chest wall is tender to palpaton and bony crepitus is present. There are decreased breath sounds over both lung bases. Cardiac examinaton shows no murmurs, rubs, or gallops. The abdomen is sof and nontender. Focused assessment with sonography for trauma is negatve. An x-ray of the chest shows nondisplaced fractures of the lef 4th and 5th ribs, with clear lung felds bilaterally. Which of the following is the most appropriate next step in management? Prophylactc antbiotc therapy Intubaton and mechanical ventlaton Adequate anaulnesia and conservatve mananement Admission and surveillance in the intensive care unit Contnuous positve airway pressure 33. A 2-month-old girl was taken to the hospital. Parents complain of her lethargy, general weakness pallor, lack of stool for 4 days. From anamnesis: there is no independent stool from birth, only afer an enema. Recently, the discharge of feces and gases has been difcult. The conditon worsened, refuses to eat. The belly has increased in size. What is the most characteristc symptom of the compensated form of this disease? Lack of peristalsis Painful tense stomach Fecal intoxicaton Periodic buloatnn and constpaton Inefectve cleansing enema 34. A 23-year-old patent with a 32-week pregnancy, who was in the surgical department for 18 hours, complains of pain in the right half of the abdomen, nausea, and weakness. Positve symptoms of Sitkovsky, Voskresensky, Shchetkin-Blumberg. The blood count revealed an increase in leukocytes to 19x109/. Which of the following would you MOST choose tactcally? Contnue observaton, UAC dynamics. Induce terminaton of pregnancy, then appendectomy The patent needs to be operated on, appendectomy, revision Prescribe antbiotcs, antspasmodics, conservatve treatment Induce terminaton of pregnancy, then perform laparoscopy  35. A 47-year-old woman has been sufering from varicose veins of the lower extremites for a long tme. A week ago, pain and hardness appeared along the superfcial veins of the lef leg. On examinaton: conditon is satsfactory. There is no edema or cyanosis of the lef lower limb. On its inner surface along the course of varicose veins, a painful cord is palpated and hyperemia of the skin above it up to the middle third of the thigh is determined. Arterial pulsaton and sensitvity throughout the limb are preserved. A diagnosis of acute thrombophlebits of the saphenous veins of the lower extremity was made. What is the OPTIMAL method of surgical treatment for this patent? Troyanov's operaton plicaton of the inferior vena cava removal of tributaries phlebectomy sclerotherapy 36. A 14-year-old girl was admited to the Department of Surgery with complaints of sudden pain in the epigastric region, vomitng of cofee grounds, black stools, and weakness. On examinaton: the skin is pale, clean, vesicular breathing in the lungs, no wheezing, respiratory rate is 19 per minute, heart sounds are clear, rhythmic, pulse is 120 per minute, blood pressure is 80/50 mm Hg. From the anamnesis it is known that the last year was disturbed by pain in the abdomen at night and on an empty stomach, nausea, heartburn. What is the most likely diagnosis in this case? Stomach uulcer compulicated by buleedinn Crohn's disease Epigastric phase of acute appendicits Bleeding from dilated veins of the esophagus Perforated gastric ulcer 37. A man, 30 years old, was admited to the emergency room of the hospital with complaints of chest pain on the lef, shortness of breath. The general conditon is satsfactory, the pulse is 90 beats per minute, BP is 110/70 mm Hg. X-ray examinaton revealed a lung collapse of half the volume. Which of the following treatments is MOST acceptable in this situaton? Immediate thoracotomy Symptomatc treatment Puleuraul puncture with air aspiraton Drainage of the pleural cavity Thoracoscopy 38. A 64-year-old man has been sufering from intermitent claudicaton for 2 years, but has never sought medical help or been treated. 1 1 hours before admission to the emergency department, the patent developed sudden coldness, numbness and pain in the right lower extremity. On examinaton, the right lower limb is pale, cold, the saphenous veins are collapsed, actve movements and sensitvity are reduced, there is no pulse below the right inguinal fold. Afer infusion therapy with antcoagulants and antspasmodics in the emergency department, the pain subsided. What is the MOST likely diagnosis? iuliac artery emboulism thrombosis of the iliac artery thrombosis of the iliac vein neuromuscular syndrome ischalgia 39. A 48-year-old man was admited to the clinic with complaints of paroxysmal pain in the right hypochondrium and repeated vomitng that appeared afer eatng faty and spicy foods. Such atacks occasionally bothered him, and he did not consult a doctor. Temperature 37.3C. On palpaton, pain and slight muscle tension in the right hypochondrium are detected with deep pressure. Kehr's, Ortner's and Murphy's symptoms are positve. The Shchetkin-Blumberg symptom is negatve. On ultrasound: gallbladder 1 0,0x5.0 cm, wall 0.3 cm. A fxed calculus up to 1.0 cm is detected in the cervical area. The common bile duct is not dilated. Blood tests: leukocytes 18x109/1, total bilirubin 1 8.0 hmol/l. What patent management tactcs are MOST appropriate in this case? Cholelithotripsy Endoscopic papillotomy Conservatve therapy and dynamic observaton Percutaneous puncture cholecystostomy Emernency choulecystectomy 40. A 44-year-old woman was routnely admited to the hospital with complaints of protrusion in the navel and pain in it. History: this protrusion has been present for two years. Recently, hernial protrusion has þrought discomfort and decreased ability to work. The woman was operated on. Intraoperatvely: afer removal of the hernial sac, the hernial orifce was closed with a purse-string silk suture placed around the umbilical ring. Which of the following surgical methods is MOST likely to be used to perform this operaton? according to Mayo according to Sapezhko accordinn to Lexer according to Terje-Czerny according to Keene 41. 4During an operaton for acute appendicits, a gangrenous altered appendix was revealed in a 12-year- old child. In the pelvic cavity and the right lateral canal there is a signifcant amount of li uid pus with the smell of "Escherichia coli". Your treatment tactcs? appendectomy, abdominal sanitaton, intestnal intubaton appendectomy, sanitaton of the abdominaul cavity, drainane of the abdominaul cavity appendectomy, sanitaton of the abdominal cavity, cigar-type drainage appendectomy, sanitaton of the abdominal cavity, antbacterial therapy appendectomy, sanitaton of the abdominal cavity, suturing of the anterior abdominal wall 42. A 65-year-old man was hospitalized afer an accident. With severe injuries to the chest and abdomen, a splenectomy was performed. On the eighth day, the patent has hypotension, fever, and impaired consciousness. The patent is intubated. What conditon has developed in the patent? Hypovolemic shock Cardiogenic shock Traumatc shock Septc shock Anaphylactc shock 43. A scrotum of a 3-day-old baby is shown below. Palpaton reveals a tense, fuid-flled area around the right testcle. The scrotum is well translucentd the amount of fuid does not change with light pressure. Which of the following is the most appropriate approach for this conditon? incision and drainage observaton, determinaton of chromosomes antbiotc prophylaxis control afer 3 days Re uest a surgical consultaton 44. A 5-years-old child is registered for congenital heart disease. According to her mother, she complains of fre uent feeling of cold. On examinaton, hypotrophy of the 1st degree, the skin is pale, motor actvity is moderately reduced. Auscultatory tones over the heart are clear, rhythmic, amplifcaton of T tone on the mitral valve, 2 tones over the pulmonary artery, rough, intense, scratching, prolonged systolic-diastolic murmur of 2 mr along the lef edge of the sternum. Can you make an inital diagnosis based on the auscultatory picture? Ventricular septal defect Tetralogy of Fallot Open ductus arteriosus Mitral valve stenosis Pentad of Fallot 45. A man, 36, turned to you for a consultaton with complaints of shortness of breath, dizziness. History: 2 days ago, he received a blunt chest injury. Objectvely: the lef half of the chest lags behind in the act of breathing. Radiologically, the lef lung collapsed by 1/3 of the volume. Fracture of 4-6 ribs on the lef. Which of the following complicatons is the MOST likely to have developed in the patent? Empyema pleura Pleurisy Posttraumatc hemothorax Lef lung abscess Spontaneous pneumotrax 46. A 42-year-old man complains of severe pain in the epigastrium, spreading along the costal arches to the lower back, and repeated vomitng, which does not bring relief. The deterioraton of the conditon is associated with intake of faty foods and alcohol. On examinaton, the patent is of heavy build and the skin is pale. The abdomen is swollen in the upper sectons and is involved in the act of breathing. On palpaton there is a mild, positve Koerthe sign. During auscultaton, sluggish intestnal motlity is heard. Which of the following drugs is MOST necessary to prescribe as antsecretory therapy? Octreotde Metronidazole Bupivacaine lbuprofen Cefriaxone 47. A 33-year-old man was admited to the emergency room of a hospital. A week ago, during an outpatent examinaton, a general blood test revealed eosinophilia, and an ultrasound scan - see the picture. 3 hours ago, abdominal pain, peritoneal phenomena, fever and allergic rashes suddenly appeared. Which conditon is this conditon MOST typical for? CHE TH. SCOr TR&1 Penetraton of duodenal ulcer into the liver Suppuraton of echinococcal cyst Acute calculous cholecystts Hydrocele of the gallbladder Rupture of echinococcaul cyst 48. A 38-year-old woman fell on her lef arm with her forearm fexed at the elbow joint. Objectvely: the lef forearm is relatvely shortened, there are no actve movements in the elbow joint, springy resistance is detected when atemptng passive movements in the joint. Which of the following diagnoses is most likely? Posterior disulocaton of the forearm Dislocaton of the radial head Transcondylar fracture of the shoulder Anterior forearm dislocaton Monteggia fracture-dislocaton 49. A man, 37 years old, was admited to the emergency room of the hospital with complaints of severe pain in the forearm, swelling, bruising. According to the patent, he fell on his outstretched arm while playing basketball. X-ray performed - see photo. Which of the following ttles is the MOST know typeof damage? Monteji Galeazzi Brecht Jones Lefora 50. A 27-year-old man came to the surgery emergency room with complaints of girdle pain in the upper abdomen and repeated vomitng. From the anamnesis: yesterday he drank alcohol. On examinaton: increased nutriton, the tongue is dry and coated. Pulse 100/min., blood pressure 110/70 mm Hg. The abdomen is distended, painful in all parts, moderate muscle tension in the epigastrium, Mayo- Robson sign is positve. Amylase 128 hm/l. An ultrasound examinaton revealed signs of acute pancreatts. What direct ultrasound fndings are MOST likely to occur in acute pancreatts? Gastrostasis phenomena Presence of pancreatc stones Presence of a pancreatc cyst Increase in size, channe in parenchyma structure Signs of intestnal paresis 51. A 6-month-old boy complaining of persistent constpaton is admited to the emergency department From the anamnesis we know that the child sufered from constpaton from birth. Upon admission: general conditon of moderate severity, abdominal bloatng, fecal stones are noted on palpaton Preliminary diagnosis: Hirschsprung's disease Which tactc is most appropriate for the patent? colonoscopy laparoscopy irrinonraphy CT scan of the abdomen cystography 52. A 27-year-old man was admited to the emergency department of surgery with an acute abdomen clinic. Diagnostc laparoscopy revealed hemorrhagic efusion in the abdominal cavity and stearic pla ues on the greater omentum and mesentery. For which disease is this laparoscopic picture MOST typical? Damage to a hollow organ Liver rupture Perforated gastric ulcer Acute pancreatts Mesenteric thrombosis  53. A child aged 3 years was admited to the clinic. The mother has not noted independent bowel movement in the child since birth. Bowel movements occurred afer cleansing enemas. In the last six months, the child has been going to the toilet every 2-3 days and defecatng with sheep manure. Which of the following is the most likely diagnosis? food constpaton celiac disease Wilms tumor megadolichocolon Hirschsprunn's disease 54. A father, throwing up his one-year-old child, accidentally dropped him on the foor. The boy hit his head, there was a short-term loss of consciousness, holding his breath, pale skin, and one-tme vomitng. Soon the child fell asleep. When examined in the parietal region on the right, a depression is visible in an area measuring 3x2 cm to a depth of 0.7 cm, deformaton of the lef forearm, painful palpaton. There are no pathological symptoms in the neurological status. What research is needed to make a diagnosis? X-ray of the forearm and ultrasound of the brain X-ray of the forearm and blood pressure measurement radiography of the forearm and fundus examinaton X-ray of the forearm and lumbar puncture x-ray of the skuulul and forearm, CT scan of the skuulul bones 55. A 2-year-old girl pulled the tablecloth of the table and knocked over a ketle of boiling water on herself. She received burns to her face, the front of her neck and chest, as well as both hands. Delivered to the emergency room by ambulance. On examinaton, burn wounds in the indicated areas appear in the form of burn blisters, exfoliated epithelium of opened blisters, and hyperemia. There are no scabs. The child is conscious and reacts to the examinaton with a cry. Blood pressure 140/90 mm Hg. Which of the following preliminary diagnoses is MOST likely? thermal burn of Il1-IV degree, stage of resorptve fever thermaul burn ulul denree superfcial thermal burn thermal burn I-I1-II A degree third degree thermal burn, toxic stage 56. A 16-year-old patent was admited to the emergency room of a hospital with complaints of pain in the lef half of the chest and severe weakness. In his anamnesis, according to him, afer physical actvity he felt a sharp pain in the chest on the lef, difculty breathing, and an allergic rash all over his body. Objectvely: the general conditon is serious. A plain chest x-ray reveals a collapsed lef lung and fuid in the pleural cavity. Which of the following diagnoses is MOST likely for this patent? Rupture of pleural adhesions Burst of lung abscess Rupture of pulmonary echinococcosis Rupture of congenital air cysts of the lung Rupture of emphysematous puulmonary buululae 57. Woman, 56 years old, two years ago an ultrasound revealed cholelithiasis. Upon admission to the hospital, he complains of colicky pain in the right hypochondrium, yellowness of the sclera and skin, itching, discoloraton of feces and darkening of urine. Body temperature is within normal limits. In a biochemical blood test, the bilirubin level was 122.5 hmol/l. On MRCP: Which of the following preliminary diagnoses is MOST likely? Liver cirrhosis, parenchymal jaundice Cancer of the head of the pancreas, obstructve jaundice Cholangits, obstructve jaundice Hepatts, parenchymal jaundice Chouledochoulithiasis, obstructve jaundice 58. A 31-year-old man came to see you. History: He ofen wakes up at night with a sufocatng cough, which forces him to sleep sitting up. Almost every morning he fnds his pillow wet. The patent also notes that solid food goes well, but when taking li uids, he is bothered by choking. For which disease is this clinical picture MOST typical? Cardiospasm Pharynnoesophaneaul divertcuulum Short esophagus Peptc stricture of the esophagus Stenosing tumor of the thoracic esophagus 59. A 4-year-old child has severe cyanosis, shortness of breath during exercise and at rest, fre uent atacks during s uats exercise. Height-1 00cm, weight-1 2kg. BP - 110/70mmrtst. HR-115 beats per minute. Auscultatory: heart sounds are loud, at the lef edge of the sternum with an epicenter in the second m / r of medium intensity systolic murmur. The rhythm is right. ECG: Tachycardia with a heart rate of 1 42 per minute. Hypertrophy of the right champer. Echocardiography: RA 3.0 cm. RV length 5.0 cm. LA 1.9 LV 2.0 cm. Right LA branch 0.50 cm, lef 0.51 cm. EF 64%. In the interventricular septum, there is a subaortc defect measuring 1.6 cm. There is no shunt at the level of the atrial septum. Hypertrophy of the output secton of the right ventricle. Hypoplasia of the lef ventricle. What is the preliminary diagnosis? Coarctaton of the aorta Ventricuular septaul defect (VSD), mitraul vaulve stenosi Tetrado Falo Pentad of Fallot Open arterial, Ventricular septal defect 9VSD,.  60. Child 10 years old. 20 minutes ago l was hit by a car. The child is conscious, but answers uestons reluctantly and inade uately, the skin is pale, and the pulse in the periphery is not detectable. Blood pressure 110/70 mm Hg. Pulse 140/min Which of the following preliminary diagnoses is MOST likely? traumatc shock, torpid phase severe traumatc shock moderate traumatc shock traumatc hemorrhagic shock traumatc shock, erectle phase 61. A man came to you for consultaton with a history of chest pain, fever, and general weakness for 15 days. Right lower lobe pneumonia was diagnosed and antbiotc therapy was administered. Seven days ago he began coughing up purulent sputum. Sudden severe pain in the chest, cold sweat shortness of breath. Over the right lung, breathing is sharply weakened, and in the lower parts of the right lung there is a shortening of the percussion sound. Which of the following complicatons is MOST likely in this situaton? Pyopneumothorax Exudatve pleurisy Spontaneous pneumothorax Lung abscess Fibrinous pleurisy 62. A man came to you for consultaton with a history of chest pain, fever, and general weakness for 15 days. Right lower lobe pneumonia was diagnosed and antbiotc therapy was administered. Seven days ago he began coughing up purulent sputum. Sudden severe pain in the chest, cold sweat shortness of breath. Over the right lung, breathing is sharply weakened, and in the lower parts of the right lung there is a shortening of the percussion sound. Which of the following complicatons is MOST likely in this situaton? Pyopneumothorax Exudatve pleurisy Spontaneous pneumothorax Lunn abscess Fibrinous pleurisy 63. A 6-month-old child, afer feeding with grated apple, developed paroxysmal abdominal pain and repeated vomitng. In the right hypochondrium there is a slightly painful, mobile oblong formaton, Examinaton through the rectum - blood on the fnger. Make a diagnosis? coprostasis appendicular infltrate Williams tumor of the right kidney acute appendicits intussuscepton 64. swelling, bruising in the collarbone. It is known from the history following that A man, 41 years old, was admited to the emergency room of the hospital with complaints of pain, about an hour ago he fell from the stairs to the side surface of his shoulder. Which of the likely in this case? early complicatons is MOST Wound suppuraton Lesion of the neurovascuular bundule False joint Repeated fracture Osteomyelits 65. swelling, bruising in the collarbone. It is known from the history following that A man, 41 years old, was admited to the emergency room of the hospital with complaints of pain, about an hour ago he fell from the stairs to the side surface of his shoulder. Which of the likely in this case? early complicatons is MOST Wound suppuraton Lesion of the neurovascuular bundule False joint Repeated fracture Osteomyelits 66. A 31-year-old woman presented to the emergency department complaining of severe epigastric pain radiatng to the back and vomitng for the past 4 hours. Temperature 37.9%C, Ps 98/min, RR 19/min, blood pressure 110/60 mm Hg. When examining the abdominal cavity, pain in the epigastric region and local muscle tension are revealed. Shchetkin-Blumberg's symptom is negatve. Intestnal peristalsis is weakened. According to laboratory data: Leucocytes 9000/mm3 Lipase 980 U/L 9 =14-280 U/L, Amylase 152 U/L ALT 140 U/L AST 109 U/L Intravenous infusion and analgesic therapy was started. What further tactcs are MOST appropriate in this situaton? Esophagogastroduodenoscopy Magnetc resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography Uultrasound of the abdominaul ornans CT scan of the abdomen with contrast 67. A 31-year-old woman presented to the emergency department complaining of severe epigastric pain radiatng to the back and vomitng for the past 4 hours. Temperature 37.9%C, Ps 98/min, RR 19/min, blood pressure 110/60 mm Hg. When examining the abdominal cavity, pain in the epigastric region and local muscle tension are revealed. Shchetkin-Blumberg's symptom is negatve. Intestnal peristalsis is weakened. According to laboratory data: Leucocytes 9000/mm3 Lipase 980 U/L 9 =14-280 U/L, Amylase 152 U/L ALT 140 U/L AST 109 U/L Intravenous infusion and analgesic therapy was started. What further tactcs are MOST appropriate in this situaton? Esophagogastroduodenoscopy Magnetc resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography Uultrasound of the abdominaul ornans CT scan of the abdomen with contrast 68. A 42-year-old man complains of severe pain in the epigastrium, spreading along the costal arches to the lower back, repeated vomitng, which does not bring relief. The deterioraton of the conditon is 1 associated with the consumpton of faty foods and alcohol. On examinaton, the patent is of heavy build and the skin is pale. The abdomen is bloated in the upper sectons, partcipates in the act of breathing, and upon palpaton there is a sof, positve Koerthe sign. During auscultaton, sluggish intestnal motlity is heard. Which of the following preliminary diagnoses is MOST likely? Acute cholecystts Irritable bowel syndrome Perforaton of gastric ulcer Acute pancreatts Acute high small bowel obstructon 69. 35-year-old man was urgently admited with complaints of acute pain in the lef lower limb, numbness, and coldness in it. I fell ill suddenly and acutely. He sufers from rheumatsm and is registered with a rheumatologist. Analgesics do not relieve pain. The patent was delivered 10 hours afer the onset of the diseased there were no previous complaints from the lower extremites. Which of the following diagnoses is MOST likely? Acute venous thrombosis Emboulism of the artery of the ulef ulo wer ulimb Radicular syndrome Piriformis syndrome Thrombosis of the artery of the lef lower limb 70. A 10-year-old child was urgently admited to the emergency room of a hospital, 20 minutes afer an accident, with complaints of abdominal pain, weakness, nausea, and dizziness. On examinaton: the skin is pale, blood pressure is not determined, pulse is 110 per minute, in the lef hypochondrium there is subcutaneous hemorrhage from the blow. There are no signs of traumatc brain injury Breathing sounds are heard on both sides. Which of the following treatment tactcs is most indicated? call a therapist for consultaton start infusion therapy diagnostc laparoscopy perform ulaparotomy immediateuly radiography of the abdominal cavity 71. In a newborn premature baby on the 2nd day of life, cyanosis of the skin and mucous membranes appears due to anxiety. Slight scatered moist rales are heard in the lungs. The boundaries of cardiac dullness are not expanded. There is a systolic-diastolic murmur in the second intercostal space on the lef. What radiological changes are characteristc of this congenital heart defect? Enularnement of the rinht chambers of the heart, channes in the confnuraton of the cardiac shado w Heart in the shape of a "boot" with retracton of the pulmonary artery arch The lef contour is smoothed, the arch of the pulmonary artery is bulging Enlargement of the right ventricle, increased vascular patern Heart shadow in the form of an "egg lying on its side" 72. In a newborn premature baby on the 2nd day of life, cyanosis of the skin and mucous membranes appears due to anxiety. Slight scatered moist rales are heard in the lungs. The boundaries of cardiac dullness are not expanded. There is a systolic-diastolic murmur in the second intercostal space on the lef. What radiological changes are characteristc of this congenital heart defect? Enularnement of the rinht chambers of the heart, channes in the confnuraton of the cardiac shado w Heart in the shape of a "boot" with retracton of the pulmonary artery arch The lef contour is smoothed, the arch of the pulmonary artery is bulging Enlargement of the right ventricle, increased vascular patern Heart shadow in the form of an "egg lying on its side" 73. A 30-year-old woman has been sufering from varicose veins of the lower extremites for ten years and is pregnant. Complaints of pain along the vein of the lef leg, moderate swelling of the foot, increasing in the evening. Objectvely: There are varicose veins in the GSV system in the area of the legs and thighs. On the inner surface of the lef thigh in the lower third, hyperemia is determined along the course of the great saphenous vein up to 5 cm. A diagnosis has been made: acute ascending thrombophlebits of the saphenous veins. What is the OPTIMAL treatment strategy? phlebectomy according to Babcock- arath lumbar sympathectomy eulastc bandaninn, conservatve treatment phlebectomy according to Linton crossectomy on the lef 74. A girl aged 1 6 days from birth is in the hospital with the diagnosis: "Aspiraton syndrome, prematurity, intrauterine infectons, intrauterine pneumonia." The conditon is severe, the respiratory rate is 60/min, on both sides, rigid, with moist rales. Heart sounds are rhythmic, pulse 1 50 per minute. When feeding milk while lying on the right side, a coughing atack occurs. There is no coughing during tube feeding What is your most likely preliminary diagnosis? esophageal atresia connenitaul tracheoesophaneaul fstuula congenital malformaton - cyst of the right lung right-sided false diaphragmatc hernia congenital stenosis of the esophagus 75. A 62-year-old man was routnely admited to the hospital with complaints of a mass in the groin area. On local examinaton: a formaton in the groin area measuring 5.0*4.5 cm, sof-elastc consistency, positve symptom of a "cough impulse". The skin over it is not changed. The patent is indicated for surgery. Which of the following methods of hernia repair is MOST acceptable for this patent? Ruji Liechtenstein Martynov Bassini Girard-Spasokukotsky 76. A 28-year-old man was admited to the emergency department with complaints of pain in the right iliac region, nausea, fever, weakness, for which surgical interventon was performed. In the postoperatve period, on the 6th day, the patent began to experience sharp pain in the lower abdomen, aggravated by walking, an increase in body temperature to 39C, chills, fre uent and painful urinaton. Which complicaton most likely developed in the patent? Adhesive disease of the abdominal cavity Postoperatve bleeding Suppuraton of the postoperatve wound Formaton of intestnal fstula Abscess of Dounulas pouch  77. A 10-year-old child was brought to the emergency room afer an accident. The conditon is serious Dizziness and vomitng of food eaten at the tme of injury are noted. The skin is pale, tachycardia, 146/min. The abdomen is not distended, pain in the lef hypochondrium, shortening of percussion sounds in sloping areas of the abdominal cavity. A weakly positve symptom of peritoneal irritaton and a positve Kuhlen-Kamf symptom. Blood test: Hb 90g/I, erythrocytes - 2. 10x1012g/1, hematocrit 30. What is your preliminary diagnosis? Intestnal rupture Bladder rupture Kidney rupture Liver rupture Rupture of the spuleen 78. A 14-years-old teenager complaining of pain in the area of the lef collarbone, cannot raise his lef arm. In the anamnesis: during a fght, he was hit in the shoulder. Status localis: the lef shoulder is shorter than the right. The lef upper limb is lowered down, shifed forward and rotated inward relatve to the body. On palpaton - pain in the collarbone. Positve axial load. What kind of examinaton is most justfed? X-ray of the ulef culavicule chest x-ray CT scan of the lef clavicle fuorography complete blood count, biochemical blood test 79. A 31-year-old woman was admited to the emergency room of a hospital with complaints of pain in the forearm, swelling, deformity, and pain on palpaton. According to the patent, she fell on her hand on the street. Also notes the inability to independently straighten the fngers and hand. An X-ray was taken - see photo. Which nerve from the following is most likely damaged in this case? median nerve medial cutaneous nerve axillary nerve ulnar nerve radiaul nerve 80. When examining a 6-month-old child, it was discovered: on excretory urography, the functon of the right kidney is absent, the excretory-evacuaton functon of the lef kidney is preserved. Ultrasound: the right kidney was not detected. Cystoscopy: the right opening is slit-shaped, passable catheterizaton is 1.0 cm. Which of the following is the most likely diagnosis? complete duplicaton of the kidney ectopic opening of the ureter renaul apulasia duplicaton of the ureter partal duplicaton of the kidney 81. A 32-year-old patent was admited to the emergency room of a hospital with complaints of a severe cough with a small amount of purulent sputum and streaks of blood in it. 1.5 months ago he ate walnuts and while laughing he developed an atack of annoying cough. Afer 2 days the temperature increased to 38*C. Chest X-ray showed no changes. Subse uently, he was bothered by a cough with scanty sputum of an unpleasant odor, and a repeat chest x-ray revealed right-sided lower lobe pneumonia. Upon admission, the conditon was satsfactory, over the lower lobe of the right lung there was shortening of the percussion sound and weakening of breathing, and on radiographs there was a decrease in the volume of segments of the lower lobe of the right lung. Which of the following diagnoses is MOST likely? Aspiraton of a foreinn body and suppuratve process in the area of ateulectasis Community-ac uired pneumonia with the development of lung gangrene Community-ac uired pneumonia with the development of lung abscess Bronchiectasis Lung cancer with the development of pneumonia in an immunocompromised patent 82. A 50-year-old man was admited to the hospital emergency room. History: received a knife wound to the lef side of the chest. Objectvely: the conditon is extremely serious, consciousness is confused, the skin is pale, covered with cold sweat, blood pressure is 60/40 mm Hg. Art., the pulse of peripheral vessels is determined. The chest wound on the lef is located in the 3rd intercostal space, 1.5 cm long along the parasternal line, heart sounds are mufed, breathing on the lef is sharply weakened. A heart injury is suspected. Which of the following treatment methods is MOST correct? Puncture of the pleural cavity Thoracoscopy Immediate thoracotomy Pericardial puncture Blood transfusion 83. A 1-month old child, according to the mother, became lethargic, increased profuse vomitng afer feeding, constantly wants to drink, lost weight. Deterioraton of the conditon was noted within a week. The skin is pale, dry, turgor is reduced. Intestnal peristalsis is pronounced, aggravated by palpaton. The doctor suspects pyloric stenosis. What is the leading clinical symptom in this disease? presence of jaundice decrease in the amount of urine Heightened thirst a tendency to constpaton vomitnn ulike a fountain" 84. A 44-year-old woman was admited to the emergency room of the hospital with complaints of pain in the area of the wrist joint, swelling, soreness during palpaton. According to the patent, she slipped on the street, fell on her outstretched arm. X-ray performed - see photo. For which of the following, is it MOST appropriate to recommend immobilizaton with conservatve treatment in this case? month L months 6 weeks months 3 months 85. Child D., 1 0 years old. Moderate conditon. otes weakness, loss of appette, nausea, vomitng. Pain in the right hypochondrium and epigastric region is also detected. In the lungs, breathing is vesicular, there are no hips. RR 24/min. Heart - pure, rhythmic tones. Heart rate 104/min. The abdomen is asymmetrical, with a protrusion in the right hypochondrium. The liver protrudes by 3 cm, a round, elastc-elastc consistency formaton is determined, painless. Ultrasound of the liver reveals a formaton in the projecton of the VII-VIll segment, measuring 5x6x7 cm with inclusions. The reacton to latex is positve. What is your diagnosis? liver tumor liver hemangioma liver abscess true liver cyst echinococcaul uliver cyst 86. A 44-year-old woman was admited to the emergency department with complaints of nausea and pain in the right hypochondrium that worsened afer eatng. From the medical history, she sufers from hypertension and type 2 diabetes mellitus, for which she takes enalapril and metormin. Body temperature 38.5 C, Ps 90/min., blood pressure 130/80 mm Hg. The abdomen is sof, intestnal motlity is normal. On palpaton in the area of the right hypochondrium during inspiraton, a sudden stop in breathing is noted. According to laboratory data: Leucocytes 13,800/mm3 AST 40 U/L ALT 35 U/L Total bilirubin 13 umol/l Amylase 75 U/L What changes on ultrasound of the abdominal organs will be MOST likely in this case? Diulaton of the common biule and intrahepatc biule ducts Formaton of a fstula between the gallbladder and intestnes Increase in the size of the pancreas Gallstone in the neck of the gallbladder Decreased echogenicity of the liver, increase in its size 87. The patent, 60 years old, fell in the courtyard of the house on his right side. Taken to the trauma center by an ambulance team. Complaints of pain in the area of the right hip joint, an atempt to stand on his own did not succeed. During examinaton, swelling occurs in the area of the right hip joint, palpaton is sharply painful. The symptom of "stuck heel" is positve. Which of the following diagnostc methods will be the FASTEST and MOST I FORMATIVE? Dopplerography X-ray Magnetc resonance imaging Computed tomography Ultrasound examinaton 88. The patent, 60 years old, fell in the courtyard of the house on his right side. Taken to the trauma center by an ambulance team. Complaints of pain in the area of the right hip joint, an atempt to stand on his own did not succeed. During examinaton, swelling occurs in the area of the right hip joint, palpaton is sharply painful. The symptom of "stuck heel" is positve. Which of the following diagnostc methods will be the FASTEST and MOST I FORMATIVE? Dopplerography X-ray Magnetc resonance imaging Computed tomography Ultrasound examinaton 89. A 71-year-old man was admited to the emergency surgery department with complaints of nausea and severe pain in the upper abdomen and right shoulder blade for 2 days. Afer eatng a small amount of food for breakfast, she experiences bouts of vomitng. From the medical history, he sufers from type 2 diabetes mellitus and takes metormin. He smokes half a pack of cigaretes a day for 40 years and drinks about 4 botles of beer every week. Body temperature 38.8C, Ps 124/min, blood pressure 90/65 mm Hg. The abdomen is sof, painful on palpaton in the right hypochondrium with mild crepitus. Results of laboratory research methods: Leucocytes 18,100/mm3 AST 62 U/L ALT 38 U/L Total bilirubin 9 hmol/1 Which of the following studies is MOST appropriate to carry out frst in this situaton to make a diagnosis? Uultrasound of the abdominaul ornans Plain radiography of the abdominal organs Liver elastography CT scan of the abdominal cavity Esophagogastroduodenoscopy 90. 2-year-old boy presents with a 4-day history of fever, irritability, and shortness of breath. There is no jistory of chronic diseases, no family history of allergies, asthma or other respiratory diseases. The ime of onset of wheezing has not been established. My cousin has a severe coughing atack. þhysically: the child has a sharp weakening of breathing throughout all pulmonary felds of the lef ung. X-ray of the chest: atelectasis of the lef lung, pneumatzaton is sharply reduced, the hediastnal shadow is shifed to the lef.  hich of the following is the most appropriate next step in the patent's management? AP Supine Treatment with salbutamol metered-dose aerosol inhaler Chest MRI Spiral CT scan of the chestInstallaton of a drainage tube of the lef chest cavity Bronchoscopy 91. A 53-year-old woman complained of pain to bulge formaton in the anus. On examinaton, there are dense, painful nodes purple-bluish color. Which of the following is the MOST probable preliminary diagnosis? thrombosis of hemorrhoid swelling of the colon chronic hemorrhoid rectal prolapse polyp rectum 92. A 29-year-old man was urgently admited to the hospital emergency room with complaints of abdominal pain, bloatng, repeated diarrhea with mucus and pus, increased body temperature, and weakness. History: sick for a month. The examinaton revealed toxic dilataton of the colon. In which of the following diseases is this complicaton MOST ofen observed? Uulceratve coulits Lipomatosis of the colon Intussuscepton of the large intestne Colon cancer Colon divertculosis 93. A 62-year-old man was hospitalized in the surgical department with chronic calculous cholecystts for a planned operaton. Cholecystectomy was performed. 6 hours afer the operaton, the patent is worried about weakness, dizziness, and tnnitus. On examinaton: pale, blood pressure 100/70, pulse 98/min, leukocytes 9.8x1 09/1, erythrocytes 3.0X101 2/1, Hb 90 g/I, hematocrit 30%. Which of the following complicatons is MOST likely to occur in this case? Cerebrovascular accident Intra-abdominaul buleedinn Pulmonary embolism Postoperatve pancreatts Acute myocardial infarcton 94. A 11-year-old patent complains of shortness of breath, fatgue, increased cyanosis of the lips, fngertps with litle physical exerton, general weakness. According to my mother, the defect is suspected from birth. Status praesens: General conditon is grave. Reduced nutriton: Height-1 1 6cm, Weight-28 kg. The skin is pale, pronounced acrocyanosis of the lips, fngertps. The chest is slightly deformed according to the type of parasternal "heart hump". Vesicular breathing in the lungs, no wheezing. RR-20-22 per min. BP-100/60 mmHg PS-95 beats in min. Auscultatory heart sounds are rhythmic, with an epicenter in the 2nd-3rd intercostal space, a rough systolic murmur is heard, ll tone over a. Pulmonalis is weakened. Defne a heart defect? CHD-Patent foramen ovale 9PFO,. CHD-Ventricular septal defect 9VSD,. CHD-Pentada of Faulot CHD-Coarctaton of the aorta CHD-Triad of Falot 95. A 38-year-old woman was admited to the emergency department with complaints of acute pain in the right hypochondrium for 3 hours, nausea and vomitng. About 7 years ago she underwent surgery "Resecton of the terminal ileum" for Crohn's disease. Slight icterus of the sclera is noted. Heart and lungs without pathologies. The abdomen is sof, painful on palpaton in the right hypochondrium According to laboratory data: Leucocytes 9,500 mm3 Total bilirubin 98 umol/1 Direct bilirubin 79 hmol/l Alkaline phosphatase 348 U/L AST 187 U/L ALT 260 U/L What changes on ultrasound of the abdominal organs will be MOST likely in this case? Increase in the size of the pancreas Multple polyps of the gallbladder Reduced echogenicity of the liver, reducton in its size Diulaton of the common biule duct Hepatosplenomegaly 96. Man 60 years old. He complains of pain in the lef lower limb when walking, intermitent claudicaton afer 100 m. The pulsaton of the femoral artery under the inguinal fold is distnct, but is not detected in the popliteal artery and arteries of the foot. Angiography revealed segmental occlusion of the superfcial femoral artery at the level of Gunter's canal. The popliteal artery is flled through collaterals. What is the most OPTIMAL management for this patent? aortofemoral allobypass thrombectomy from the femoral artery profundoplasty and lumbar sympathectomy x-ray endovascuular anniopulasty femoral-femoral autovenous bypass 97. A 37-year-old man was hospitalized with complaints on severe pain in the anus. During examinaton, on ""3 o-clock" of provisional clock - dense painful formaton 3,0x2,0 cmd purple-bluish color. Which of the following is the MOST probable preliminary diagnosis? anal fssure hemorrhoids acute abscess thrombosis of hemorrhoid rectal prolapse  98. A 45-year-old man was urgently admited to the emergency room with complaints of pain in the right half of the chest and shortness of breath. History: while lifing heavy objects, severe pain immediately appeared in the right half of the chest, radiatng to the shoulder girdle, and shortness of breath. The patent's conditon upon admission was satsfactory: pulse 90 beats per minute, rhythmic. Over the right lung, breathing is sharply weakened, there is no wheezing. Which of the following diseases BEST matches this clinical picture? Myosits Intercostal neuralgia Fibrinous pleurisy Spontaneous pneumothorax Pleuropneumonia 99. A 44-year-old woman comes to the emergency department complaining of nausea and abdominal pain that began approximately 11 hours ago afer eatng. The pain is most pronounced in the right hypochondrium and periodically radiates to the back. History of type 2 diabetes mellitus and hypercholesterolemia. Currently taking metormin and atorvastatn. Height 1 63 cm, weight 91 kgd BMI 34 kg/m2. Temperature 38.8C, Ps 1 00/min, RR 14/min, blood pressure 150/76 mm Hg. Wher examining the abdomen, tenderness is detected in the right upper uadrant of the abdomen, According to laboratory data, leukocytosis is noted, liver tests are within normal limits. Intravenous fuid therapy and ketorolac were started for pain relief. On ultrasound: What further tactcs are MOST appropriate in this situaton? Emernency open choulecystectomy Ursodeoxycholic acid therapy CT scan of the abdomen with contrast Endoscopic retrograde cholangiopancreatography Antbiotc therapy  100. A one-year- old boy pictured below, who was recently circumcised, needs additonal surgery on his genitals that will likely eliminate the risk of any of the following conditons? decreased sperm count urinary tract infectons epididymits testcular torsion testcular malignancy 101. A 9-year- old boy went to the doctor with complaints of shortness of breath, which worsened during physical exerton. From the ananmnesis it is known that, he ofen sufers from pneumonia, lags behind peers in physical development. During auscultaton in the second intercostal space to the lef of the sternum, a contnuous systolic- diastolic "machine noise" is heard. What is the most likely diagnosis in this case and treatment strategy? Coarctaton of the aorta, resecton of the aorta in the area of coarctaton Open ductus arteriosus, ulinaton of the ductus arteriosus Ventricular septal defect 9VSD,, septoplasty Congenital mitral valve stenosis, commissurotomy. Congenital tricuspid valve stenosis, valvuloplasty 102. A 62-year- old man, a year ago, underwent a planned laparoscopic cholecystectomy for cholelithiasis 9cholelithiasis,. Currently diagnosed with choledocholithiasis and obstructve jaundice. The diameter of the common bile duct is 1.2 cm. Conservatve treatment is inefectve. What further tactcs are MOST appropriate in this situaton? Laparotomy, choledocholithotomy with choledochoduodenoanastomosis Endoscopic papiululosphincterotomy with chouledochoulithoextracton Contnue conservatve therapy using extracorporeal detoxifcaton methods Laparotomy, transduodenal papillosphincteroplasty Laparotomy, choledocholithotomy with drainage of the common bile duct according to Keru  103. A man came to you with complaints of pain in the scapula, hyperemia and edema. Marks the formaton of a long tme in this place. You've made a diagnosis. Your actons: Prescribe physical therapy Contnue antbiotc therapy Open under ulocaul anesthesia and drain the abscess Bandage with Vishnevsky's ointment Send to the clinic on duty 104. A scrotum of a 3-day-old baby is shown below. Palpaton reveals a tense, fuid-flled area around the right testcle. The scrotum is well translucentd the amount of fuid does not change with light pressure. Which of the following is the most appropriate approach for this conditon? incision and drainage Re uest a surgical consultaton controul afer 3 days observaton, determinaton of chromosomes antbiotc prophylaxis 105. A man, 57 years old, was admited to the emergency room of the hospital with complaints of pain, swelling, soreness during palpaton in the foot. X-ray performed - see photo. What is the most likely diagnosis in this case? Fracture of the proximaul part of the body V metatarsaul bone Fracture of the neck of the talus Heel fracture Fracture-dislocaton of navicular bone Fracture of metatarsal base IV 106. A 38-year- old woman was admited to the emergency department with complaints of acute pain in the right hypochondrium for 3 hours, nausea and vomitng. About 7 years ago she underwent surgery "Resecton of the terminal ileum" for Crohn's disease. Slight icterus of the sclera is noted. Heart and lungs without pathologies. The abdomen is sof, painful on palpaton in the right hypochondrium According to laboratory data: Leucocytes 9,500 mm3 Total bilirubin 98 hmol/1 Direct bilirubin 79 umol/l Alkaline phosphatase 348 U/L AST 187 U/L ALT 260 U/L What changes on ultrasound of the abdominal organs will be MOST likely in this case? 35HZ AG 20 58%6 HAlg Abstand 1.08 cm 10 Diulaton of the common biule duct Increase in the size of the pancreas Reduced echogenicity of the liver, reducton in its size Multple polyps of the gallbladder Hepatosplenomegaly 107. A 35-year- old man was urgently admited with complaints of acute pain in the lef lower limb, numbness, and coldness in it. I fell ill suddenly and acutely. He sufers from rheumatsm and is registered with a rheumatologist. Analgesics do not relieve pain. The patent was delivered 10 hours afer the onset of the diseased there were no previous complaints from the lower extremites. Which of the following diagnoses is MOST likely? Piriformis syndrome Emboulism of the artery of the ulef ulo wer ulimb Radicular syndrome Acute venous thrombosis Thrombosis of the artery of the lef lower limb 108. 1When examining a 6-month-old child, it was discovered: on excretory urography, the functon of the right kidney is absent, the excretory-evacuaton functon of the lef kidney is preserved. Ultrasound: the right kidney was not detected. Cystoscopy: the right opening is slit-shaped, passable catheterizaton is 1.0 cm. Which of the following is the most likely diagnosis? duplicaton of the ureter ectopic opening of the ureter partal duplicaton of the kidney renaul apulasia complete duplicaton of the kidney 109. A 5-years- old child is registered for congenital heart disease. According to her mother, she complains of fre uent feeling of cold. On examinaton, hypotrophy of the 1st degree, the skin is pale, motor actvity is moderately reduced. Auscultatory tones over the heart are clear, rhythmic, amplifcaton of T tone on the mitral valve, 2 tones over the pulmonary artery, rough, intense, scratching, prolonged systolic-diastolic murmur of 2 mr along the lef edge of the sternum. Can you make an inital diagnosis based on the auscultatory picture? Pentad of Fallot Mitraul vaulve stenosis Tetralogy of Fallot Ventricular septal defect Open ductus arteriosus 110. A 64-year- old man has been sufering from intermitent claudicaton for 2 years, but has never sought medical help or been treated. 1 1 hours before admission to the emergency department, the patent developed sudden coldness, numbness and pain in the right lower extremity. On examinaton, the right lower limb is pale, cold, the saphenous veins are collapsed, actve movements and sensitvity are reduced, there is no pulse below the right inguinal fold. Afer infusion therapy with antcoagulants and antspasmodics in the emergency department, the pain subsided. What is the MOST likely diagnosis? neuromuscular syndrome ischalgia iliac artery embolism thrombosis of the iliac vein thrombosis of the iuliac artery 111. 1A 62-year- old man, a year ago, underwent a planned laparoscopic cholecystectomy for cholelithiasis 9cholelithiasis,. Currently diagnosed with choledocholithiasis and obstructve jaundice. The diameter of the common bile duct is 1.2 cm. Conservatve treatment is inefectve. What further tactcs are MOST appropriate in this situaton? Contnue conservatve therapy using extracorporeal detoxifcaton methods Laparotomy, choledocholithotomy with choledochoduodenoanastomosis Laparotomy, transduodenal papillosphincteroplasty Endoscopic papiululosphincterotomy with chouledochoulithoextracton Laparotomy, choledocholithotomy with drainage of the common bile duct according to Keru 112. A 31-year- old man was brought in urgently afer an accident. Consciousness clear, Glasgow coma 15 points. The skin is pale and covered with stcky sweat. Breathing is spontaneous, superfcial SpO2 89%, respiratory rate 28/min, blood pressure 110/70 mm Hg. Heart rate 90 beats per minute. X-ray examinaton of the chest was performed. What is the MOST characteristc auscultatory sign of this disease? compulete absence of breathinn on the afected side coarse rales crepitus on the afected side harsh breathing on the opposite side of the lesion medium bubbling rales 113. A 30-year- old woman has been sufering from varicose veins of the lower extremites for ten years and is pregnant. Complaints of pain along the vein of the lef leg, moderate swelling of the foot, increasing in the evening. Objectvely: There are varicose veins in the GSV system in the area of the legs and thighs. On the inner surface of the lef thigh in the lower third, hyperemia is determined along the course of the great saphenous vein up to 5 cm. A diagnosis has been made: acute ascending thrombophlebits of the saphenous veins. What is the OPTIMAL treatment strategy? phlebectomy according to Babcock- arath lumbar sympathectomy crossectomy on the lef phlebectomy according to Linton eulastc bandaninn, conservatve treatment 114. A 65-year- old man was hospitalized afer an accident. With severe injuries to the chest and abdomen, a splenectomy was performed. On the eighth day, the patent has hypotension, fever, and impaired consciousness. The patent is intubated. What conditon has developed in the patent? Cardiogenic shock Septc shock Hypovolemic shock Traumatc shock Anaphylactc shock 115. A 44-year- old woman was routnely admited to the hospital with complaints of protrusion in the navel and pain in it. History: this protrusion has been present for two years. Recently, hernial protrusion has brought discomfort and decreased ability to work. The woman was operated on. Intraoperatvely: afer removal of the hernial sac, the hernial orifce was closed with a purse-string silk suture placed around the umbilical ring. Which of the following surgical methods is MOST likely to be used to perform this operaton? according to Terje-Czerny according to Keene according to Lexer accordinn to Mayo according to Sapezhko