Surgery New QB 2023/24 PDF

New QB in surgery - ED - 2023/2024 (NCA (tier 3 of surgery, december 2023) only got approx. 15 qs from the new QB, so it might be a good idea to also go through the Horesen quizlet and PP additionally, so you don't risk failing the theory… Questions I got were amongst others:...

New QB in surgery - ED - 2023/2024 (NCA (tier 3 of surgery, december 2023) only got approx. 15 qs from the new QB, so it might be a good idea to also go through the Horesen quizlet and PP additionally, so you don't risk failing the theory… Questions I got were amongst others: Caroli syndrome, fistula-in-ano + steps during gastric sleeve and Roux-en-Y Gastric Bypass, and complications after these. A lot of pancreas qs.) Add new qs to the document if they add new qs to the QB after tier 3 december 2023:)) New qs in december 2023 (added after november): 03D: What diseases are characterized by pain in the lower abdomen and left iliac fossa? (1) sigmoid diverticulosis; (2) mechanical obstruction of the small intestine; (3) urinary retention; (4) pancreatitis; (5) renal colic; (6) splenic infarction. The correct answer is: a. 3,4,6 b. 2,3,5 c. 1,3,5 d. 3,4,5 e. 4,5,6 11D: Typical symptoms of the upper gastrointestinal tract bleeding do NOT include - pick the most accurate answer: a. sudden weakness or fainting b. hemodynamic shock (fall in blood pressure, paleness, sweating) c. vomiting blood clots d. tarry stools (melena) e. fresh blood in the stool 12D: What are the signs of Beck’s triad associated with heart tamponade: (1) rise of the blood pressure; (2) drop of the blood pressure; (3) distention of external jugular veins; (4) muffled heart sound; (5) systolic murmur; (6) asystolic murmur. The correct answer is: a. 1,3,4 b. 1,4,5 c. 2,3,6 d. 2,3,4 e. 2,4,5 08D: Which scale is used to assess bleeding in gastroscopy: a. Ranson b. APACHE II c. Forrest d. Sengstaken e. Mallory 10D: A 29- year- old patient was admitted to the emergency room with increasing abdominal pain in the left part of the abdomen on the umbilical level and vomiting. The pain was radiating to the left groin. She associated the onset of the pain with lifting a heavy object from the ground. There were no abnormalities found in the imaging tests, leukocytosis - 9,6K, slight analgesic effect of metamizole, tramadol, or antispasmodics. The doctor decided to administer morphine subcutaneously which induced a strong pain attack. What do we suspect? a. Acute appendicitis b. Adnexitis c. Subcapsular rapture of the spleen d. Radiolucent ureteral stone e. Ovarian cyst torsion 04D: Mechanical jaundice is known by: a. dark urine, increased AST, increased indirect bilirubin b. dark urine, increased ALT, increased total bilirubin c. dark urine, discoloration of stool, increased ALP d. increased AST, increased ALT, decreased ALP e. increased AST, increased ALT, increased total bilirubin 02D: An ultrasound scan is performed to diagnose: (1) mechanical bowel obstruction, (2) cholecystolithiasis, (3) pneumonia. The correct answer is: a. 1 b. 2 c. 3 d. 1.2 e. 2.3 01D: Follow-up tests after colectomy, due to cancer, should include*: (1) abdominal ultrasound and chest x-ray, (2) colonoscopy, (3) CEA level control, (4) barium X-ray, (5) alkaline phosphatase level control. The correct answer is: a. 1,2,3 b. 1,3,4 c. 1,2,5 d. 1,4,5 e. 3,4,5 14D: The main symptoms of the cancer in the head of the pancreas are: (1) coffee ground vomitus; (2) painless obstructive jaundice; (3) enlargement of the gallbladder without its inflammation; (4) dilatation of the bile ducts; (5) splenomegaly. The correct answer is: a. 1,2,3 b. 2,3,4 c. 3,4,5 d. 2,4,5 e. 1,3,5 06D: A 56 year-old, female, obese, patient was admitted to the hospital because of the upper abdominal pain lasting for about 12 hours. Ultrasound scan showed signs of cholecystolithiasis, the retroperitoneal space could not be visualized. In laboratory findings there was a significant leukocytosis, raise in the CRP and amylase levels. What would be the correct management of this patient? a. urgent laparoscopic cholecystectomy b. open cholecystectomy with intraoperative cholangiogram c. endoscopic retrograde cholangiopancreatography d. transfer to the Intensive Care Unit and close monitoring of the patient e. fasting, intravenous fluids administration, antibiotic treatment and observation 05D: A 70-year-old, female patient was admitted to the surgical ER with abdominal pain and flatulence for 3 days, constipation ( last stool 4 days ago). No history of abdominal surgery. She reported a loss of about 5kg in the last 2 months. What would be the correct management of this patient: (1) to perform a laparotomy as soon as possible due to mechanical obstruction of the gastrointestinal tract; (2) radiological diagnostics (overview abdominal X-ray), in search of mechanical obstruction of the small intestine caused by adhesions, as the most likely cause of the symptoms; (3) radiological diagnostics (abdominal X-ray), in search of mechanical obstru1ction of the large intestine caused by cancer, as the most likely cause of the symptoms; (4) after confirming the presence of mechanical intestinal obstruction on an overview abdominal X-ray - urgent laparotomy; (5) after confirming the presence of mechanical obstruction of the large intestine on a plain abdominal X-ray - performing a rectal contrast enema to determine the level of obstruction and whether it is complete or partial. The decision on the mode of the surgery depends on the results of the rectal enema. The correct answer is: a. 1 b. 3,5 c. 2,4 d. 2,5 e. none of the above 09D: A 40-year- old, male patient was admitted to the hospital with symptoms of gastrointestinal bleeding. There were several episodes of bleeding from the upper gastrointestinal tract in the last year. The patient reports frequent, severe diarrhea for several months. What is the most common location of the pathology causing those symptoms? a. lungs b. right side of the colon c. lymph nodes d. pancreaticoduodenal region e. brain stem 13D: The main reason of reflux esophagitis is: a. premature contraction of upper esophageal sphincter b. The presence of the Schatzki ring c. The presence of Zenker's diverticulum d. The occurrence of prolonged relaxation time in the lower esophageal sphincter e. The presence of Barrett's esophagus 15D: What tests should be performed before paracentesis in a patient with liver cirrhosis? a. Blood morphology, Abdominal USG, PET, ALT, AST, Na, K, Cl b. Blood morphology, Abdominal USG, coagulation system parameters c. Blood morphology, CT of the abdomen, urea d. CT of the abdomen, urea, bilirubin e. Coagulation system parameters, ALT, AST, bilirubin, albumin 07D: The signs of acute abdomen include: (1) abdominal pain; (2) nausea and vomiting; (3) absence of passage of flatus and feces. a. 1 b. 2 c. 3 d. 1.2 e. 1,2,3 16D: Dukes classification is used to asses the staging of: a. pancreatic cancer b. colon cancer c. prostate cancer d. gastric cancer e. bile duct cancer Total: 83 qs in the new surgery QB for ED - november 2023 09W: If surgical treatment is possible, we can predict the best prognosis in metastases to liver from: a. gastric cancer b. melanoma malignum c. breast cancer d. colorectal cancer e. pancreatic cancer The Hinchey staging system is often used to describe the severity of complicated diverticulitis. Which of the stages are treated by IV antibiotics and aspiration? Choose the most appropriate answer: a. I b. II c. I, II d. III e. IV Severe abdominal pain out of proportion to examination, bloody diarrhea are the symptoms of: a. Appendicitis b. Intraabdominal abscess c. Bowel ischemia d. Diverticulitis e. Ulcerative colitis 27T: What is the most aggressive malignant tumor of the thyroid? a. Medullary thyroid carcinoma. b. Papillary thyroid carcinoma. c. Follicular thyroid carcinoma. d. Anaplastic thyroid carcinoma. e. Insular carcinoma. 05P: Open abdomen or laparotomy - repeated surgical interventions within open abdominal cavity and necrotic tissue removal is the most invasive procedure in the treatment of: a. Ileus b. Acute necrotic pancreatitis c. Chronic pancreatitis d. Acute appendicitis e. Pancreatic cancer 12S: The most common causes of gastrointestinal obstruction are: (1) Adhesions; (2) Small intestine cancer; (3) Colorectal cancer; (4) Incarcerated hernias; (5) Diverticula. The correct answer is: a. 1,2,3 b. 1,2,4 c. 1,3,4 d. 2,5 e. 5 39S: The most common cause of acute intestinal ischemia is: a. Atherosclerosis of the superior mesenteric artery b. Thrombosis of the mesenteric vein c. Portal vein thrombosis d. Embolism of the superior mesenteric artery e. Embolism of the inferior mesenteric artery 09H: The Mayo operation is: a. An operation for umbilical hernia involving the doubling of the fascia with single sutures b. Suturing the fundus of the stomach around the lower part of the esophagus c. A procedure for pancreatic resection without duodenectomy d. The resection of the head of the pancreas along with the duodenum and part of the stomach, with anastomosis of the pancreas to the distal small bowel, common bile duct to the side of the small bowel, and the stomach to a lifted loop of the small intestine e. The resection of a portion of the large intestine with the creation of an end stoma Which of the following is the most common non-obstetric surgical disease of the abdomen during pregnancy? a. Appendicitis b. Cholecystitis c. Pancreatitis d. Intestinal obstruction e. Acute fatty liver of pregnancy 17W: Which of the following are signs of acute cholangitis: a. acute pain in the right subcostal area, fever and jaundice b. acute pain in the right lower quadrant, vomiting and nausea, fever c. positive Murphy's sign, jaundice d. positive Blumberg's sign in left lower quadrant, tachycardia e. ileus paralyticus, fever, bloating 35H: Identify which statements correctly describe indirect inguinal hernia: (1) Indirect hernia has wide gates and rarely becomes incarcerated; (2) Indirect hernia can be congenital; (3) Indirect hernia is less common than direct hernia and accounts for about 25% of inguinal hernias; (4) Its prevalence increases with age; (5) Indirect hernia "pushes" through the weakened posterior wall of the inguinal canal directly into the external ring. Correct answers are: a. 1,2 b. 1,4 c. 2,3,4 d. 2 e. 4,5 18T: What is the indication for surgical treatment of tertiary hyperparathyroidism? a. Escalating hyperparathyroidism after kidney transplant, threatening graft function. b. Patients over 60 years of age with elevated PTH and calcium levels in the serum. c. Any patient with elevated PTH and calcium levels in the serum. d. Planned kidney transplant in the future. e. Tertiary hyperparathyroidism is not treated surgically. 05S: A patient presented to the emergency room with upper gastrointestinal bleeding. During gastroscopy, bleeding from the duodenal bulb was observed and treated. The patient stabilized with blood pressure and heart rate within the normal range. After 20 hours, there was a decrease in blood pressure to 100/60 mmHg and an increase in heart rate to 120/min. What is the initial management? a. Administer a proton pump inhibitor (PPI) b. Proceed with surgery c. Administer 2 units of packed red blood cells (PRBCs) d. Administer pressor amines e. Repeat gastroscopy 25T: Which of the following conditions is NOT an indication for splenectomy? a. Idiopathic thrombocytopenic purpura. b. Splenomegaly in lymphoma or chronic lymphocytic leukemia. c. Uncomplicated splenic infarction. d. Hereditary spherocytosis. e. Traumatic splenic rupture in polytrauma. 01H: A 45-year-old man presented to the emergency department with diffuse abdominal pain that had been increasing for several hours, radiating to the right groin, where it was most severe. Additionally, the patient has had vomiting reflexes, gas and stool retention, and difficulty urinating (small amounts). He underwent surgery years ago for a perforated duodenal ulcer. What is the most likely initial diagnosis? a. Gastric ulcer, duodenal ulcer, diverticulitis, urinary stones (urolithiasis), incarcerated hernia. b. Perforated duodenal or gastric ulcer, perforated diverticulum, testicular inflammation (orchitis), intestinal obstruction. c. Ruptured spleen, appendicitis, kidney colic, gallbladder colic. d. Gallbladder inflammation (cholecystitis), appendicitis (adnexitis? In the PD-Q at least), intestinal obstruction, appendicitis. e. Incarcerated hernia, appendicitis, urinary stone, Meckel's diverticulum. 14H: The posterior wall of the inguinal canal is formed by: a. The lower border of the internal oblique muscle. b. The lower border of the transversus abdominis muscle. c. The transversalis fascia. d. The inguinal ligament. e. The aponeurosis of the external oblique muscle. 32-year-old man with a 3-year history of ulcerative colitis (UC) presents for discussion for surgical intervention. The patient is otherwise healthy and does not have evidence of rectal dysplasia. Which of the following is the most appropriate elective operation for this patient? a. Total proctocolectomy with end ileostomy b. Total proctocolectomy with ileal pouch-anal anastomosis and diverting ileostomy c. Total proctocolectomy with ileal pouch-anal anastomosis, anal mucosectomy, and diverting ileostomy d. Total abdominal colectomy with ileal-rectal anastomosis e. Total abdominal colectomy with end ileostomy and very low Hartmann 17H: Identify the true statements regarding inguinal hernias: (1) Metabolic collagen disorder contributes to their development; (2) A defect in abdominal muscles contributes to their development; (3) The best treatment method is laparoscopic surgery; (4) Inguinal hernias are more common in men; (5) The lowest recurrence rates are seen after surgeries using synthetic mesh. The correct answer is: a. 1,3 b. 3,4 c. 2,5 d. 1,5 e. 2,4 01W: 60-year old female reported to ER due to severe colic pain radiating from right subcostal region to right scapula. Pain has started after a meal - Burger and Belgian fries with mayonnaise. She admitted that she already had a few similar episodes before. In physical examination right subcostal region was tender, peritoneal signs are negative: a. peptic ulcer perforation. b. superior mesenteric artery embolism. c. renal colic. d. cholecystitis. e. appendicitis. The indication for surgical treatment of gastric ulcer hemorrhage is: a. Orthostatic hypotension. b. Severe abdominal pain. c. Features of free perforation of the gastrointestinal tract on imaging studies. d. Necessity of transfusion of more than 4 units of CRT within 24 hours. e. Hemorrhage graded according to the Forrest scale as grade Ia. 02H: Which of the following surgical methods for inguinal hernias are tension-free methods (using synthetic meshes): (1) Lichtenstein method; (2) Halsted method; (3) Bassini method; (4) Rutkow method; (5) Shouldice method. The correct answer is: a. 1,2,3 b. 1,4 c. 2,3,4 d. 2,3,5 e. 4,5 What is medullary thyroid cancer and what are its characteristics? a. It is the most common type of thyroid cancer and develops in the thyroid tissue. b. It is a rare, malignant thyroid cancer that develops in the perifollicular cells of the thyroid gland and can produce calcitonin. c. It is a benign thyroid tumor that does not require treatment. d. It is a thyroid cancer that develops in the parathyroid glands. e. It is a type of cancer that has no characteristic features. An acute colitis characterized by formation of an adherent inflammatory exudate (pseudomembrane) overlying the site of mucosal injury is caused by: a. E. coli EPEC b. P. aeruginosa c. C. difficile d. C. perfringens e. C. albicans In a patient with a 10-year history of ulcerative colitis who has a sessile polyp 10 cm from the anal verge with high-grade dysplasia, the most appropriate planned surgical procedure will be: a. Low anterior rectal resection b. Abdominoperineal resection c. Subtotal colectomy with end ileostomy d. Total proctocolectomy with ileoanal J-pouch e. Sigmoid resection with end colostomy (Hartmann procedure) Which of the following is the best initial management strategy for anal cancer after diagnosis in a biopsy of bleeding 2.8 cm mass at the anus? a. Abdominoperineal resection b. Wide local resection with bilateral inguinal node dissection c. Local radiation therapy d. Systemic chemotherapy e. Combined radiation therapy and chemotherapy 23T: A patient, 3 days post-thyroidectomy for papillary thyroid carcinoma, reports tingling fingers, numbness around the mouth, agitation, and a tendency towards hyperventilation. What is the optimal management in this situation? a. Potassium chloride (KCl) i.v. b. Calcium gluconate. c. 5% glucose (glucose) i.v. d. Intravenous antibiotics. e. Intensive oxygen therapy. Indicate the true description of the Rockall scale: a. It is three graded (I-III) and is used to describe the signs of upper gastrointestinal bleeding. b. It is used to assess the preparation of the upper gastrointestinal tract for gastroscopy. c. It can be used to assess the risk of recurrent bleeding and the risk of death after upper gastrointestinal bleeding. d. The Rockall scale is used to assess polypoid lesions in the upper gastrointestinal tract. e. This scale is used to decide the amount of intravenous fluids given during fluid resuscitation for major upper gastrointestinal hemorrhage. 11T: Which of the following is not a complication of parathyroid surgery? a. Transient hypoparathyroidism. b. Permanent hypoparathyroidism. c. Recurrent hyperparathyroidism. d. Hypothyroidism. e. Injury to the recurrent laryngeal nerve. Which of the following is the first localization of ulcerative colitis? a. Ascending colon b. Transverse colon c. Sigmoid colon d. Rectum 32H: The Mayo method is performed for which type of hernia: a. Inguinal b. Esophageal c. Femoral d. Diaphragmatic e. Umbilical A 53-year-old man presents to the emergency room with left lower quadrant pain, fever, and vomiting. CT scan of the abdomen and pelvis reveals a thickened sigmoid colon with inflamed diverticula and a 7-cm by 8-cm rim-enhancing fluid collection in the pelvis. Which of the following is the most appropriate management in this patient? a. Sigmoid resection with end stomy b. Percutaneous drainage and antibiotic therapy c. Cystoscopy d. Sigmoid resection with primary anastomosis e. Loop stomy 20W: Which of the following could be an indication to TACE? a. Hepatocellular carcinoma b. Isolated metastasis to the liver from carcinoid tumors C. Isolated metastasis to the liver from colon cancer d. Isolated metastasis to the liver from breast cancer e. All of above are correct 06H: Tension-free methods for hernia surgery include: (1) Bassini's method; (2) Lichtenstein's method; (3) Shouldice's method; (4) Rutkow's method; (5) Halsted's method. The correct answer is: a. 1,2 b. 2,3 c. 2,4 d. 3,4 e. 4,5 29H: Surgical treatment of inguinal hernia using the Lichtenstein method: a. Signifies inguinal canal repair with a laparoscopic method. b. Involves suturing the internal ring of the inguinal hernia. c. Denotes open inguinal canal repair using a plastic mesh. d. Has been prohibited for a long time. e. This method of surgical treatment does not exist. Indicate the sentence that is TRUE about peptic ulcer disease and gastrointestinal erosions: a. Erosions are usually larger than ulcers and their diameter exceeds 10 mm b. Erosions are usually larger than ulcers and their diameter exceeds 5 mm c. Duodenal ulcers are usually located in the third (D3) and fourth (D4) parts of the duodenum d. Cameron's ulceration refers to confluent lesions in the duodenal bulb with the character of multiple erosions e. The most common cause of peptic ulcer disease is H. pylori infection 37T: Which of the following symptoms are typical for a pheochromocytoma of the adrenal gland: (1) Paroxysmal symptoms; (2) Sudden increase in systolic blood pressure with normal diastolic pressure; (3) Severe substernal pain and decreased blood pressure; (4) Headache, chest pain, and palpitations; (5) Between attacks, the patient may not experience significant symptoms but may have low blood pressure. a. 1,2,4 b. 1,4 c. 2,4,5 d. 1,2,5 e. 1,4,5 27H: Which method is not used in the surgical treatment of inguinal hernia: a. Bassini's. b. Halsted's. c. Littre's. d. Rutkow's. e. Shouldice's. 41S: In the case of bleeding from esophageal varices that cannot be stopped endoscopically or when urgent endoscopic treatment is not possible, the most effective hemostasis can be achieved by using: a. Total gastrectomy b. Intravenous administration of hemostatic drugs and a proton pump inhibitor c. Sengstaken-Blakemore tube d. Propranolol at a dose of 40 mg per day e. A Foley catheter inserted into the esophagus 38S: Which of the listed disorders or conditions is the most common cause of paralytic ileus? a. Intussusception and twisting of the intestine b. Narrowing after inflammation of colonic diverticula and in Crohn's disease c. Incarcerated hernias d. Intra-abdominal adhesions after previous surgeries e. Colorectal cancer 03S: A 70-year-old female patient has been complaining of constant pain in the left iliac fossa for 3 days. In the medical history, she has a history of chronic constipation. Today, the pain suddenly intensified. On physical examination, there is significant tenderness throughout the abdomen, abdominal guarding, tachycardia, and a temperature of 38°C. The most likely diagnosis is: a. Acute left-sided appendicitis. b. Perforation of a gastric or duodenal ulcer. c. Mechanical colonic obstruction. d. Urinary tract infection with left-sided pyelonephritis. e. Perforation of a sigmoid diverticulum. Who is at risk of diverticulum? People with low-fiber diets, chronic constipation, and a positive family history; incidence increases with age. Tänkte mechanical obstruction, typ fekalom menmen. 05H: Laparoscopic access is not the first-choice surgical approach for which of the following diagnoses? a. Unilateral inguinal hernia b. Gallbladder stone c. Acute appendicitis d. Gastroesophageal reflux unresponsive to pharmacological treatment e. Achalasia of the esophagus 08S: Mechanical intestinal obstruction is: (1) most commonly caused by colorectal cancer; (2) often starts with frequent urges to have a bowel movement; (3) due to decreased heart rate; (4) most commonly caused by adhesions; (5) most frequently involves the small intestine. The correct answer is: a. 1,2 b. 2,3 c. 4,5 d. 2,5 e. 3,5 06T: Calcitonin is a specific marker for: a. Papillary thyroid carcinoma. b. Medullary thyroid carcinoma. c. Anaplastic thyroid carcinoma. d. Follicular thyroid carcinoma. e. Parathyroid tumors. 10S: The most common cause of upper gastrointestinal bleeding is: a. Gastric ulcer b. Esophageal varices c. Duodenal ulcer d. Gastric cancer e. Mallory-Weiss syndrome 36T: Which of the following symptoms would suggest damage to one recurrent laryngeal nerve in a patient after thyroid surgery: (1) Hoarseness; (2) Difficulty pronouncing words like "Warszawa" and "Kraków"; (3) Difficulty pronouncing words like "Jan" and "Jakub"; (4) Change in voice quality and strength; (5) Laryngeal stridor. a. 1,2,3 b. 1,2,4 c. 3,4,5 d. 1,4,5 e. 1,3,5 10T: A patient, 3 days post-thyroidectomy for papillary thyroid carcinoma, reports tingling, numbness around the mouth, and anxiety. What should be done in this case? a. Administration of sedative drugs. b. Calcium preparations. c. Medications to improve circulation. d. Reoperation. e. Psychotherapy 08P: Jaundice and duodenal obstruction related to inoperable pancreatic hard (head eller?) cancer are indication to: a. Medical treatment b. Radiation c. Endoscopic bile duct stenting d. By-pass operation e. Endoscopic bile duct stenting and/or by-pass operation What is thyroid storm: a. Sudden thyroid shutdown. b. Effect of improper treatment of hyperthyroidism. c. Damage to the recurrent laryngeal nerve during thyroidectomy. d. Sudden deterioration of the condition of a patient with Hashimoto's disease. e. Infection of the thyroid gland. 21H: Identify the INCORRECT statement regarding diaphragmatic hernias: a. Paraesophageal hernias are more common than sliding hernias. b. The treatment of choice for paraesophageal hernias associated with reflux is fundoplication. c. Sliding hernias are associated with reflux esophagitis. d. Paraesophageal hernias can be associated with bleeding and incarceration. e. Congenital diaphragmatic hernias have two openings, Bochdalek's and Morgagni's foramen. 10W: Charcot Triad is a: a. Blumberg sign, Rovsing sign, Chełmoński sign in the same time b. Right Upper Quadrant pain, jaundice, bilirubinuria c. RUQ pain, jaundice, ileus d. RUQ pain, jaundice, fever e. RUQ pain, ileus, fever Pseudodiverticula most often occur in: a. Sigmoid colon b. Ascending colon c. Transverse colon d. The entire large intestine 31S: In order to stop bleeding from the upper gastrointestinal tract presenting as bloody vomiting, the primary (method of choice) intervention would be: a. Surgical treatment b. Conservative treatment c. Endoscopic treatment d. Patient observation e. None of the above 01S: A 28-year-old patient was admitted to the emergency room (ER) with a blood pressure of 80 mmHg and a heart rate of 110 beats per minute, without any pain complaints. In the medical history, the patient reports vomiting with black content, feeling weak but not fainting. The most likely diagnosis is: a. Gastric ulcer perforation. b. Duodenal ulcer perforation. c. Splenic rupture. d. Episode of lower gastrointestinal bleeding. e. Episode of upper gastrointestinal bleeding. 26H: Which statement about sliding hernia is correct: (1) It is characterized by the contents of the hernia sac being an abdominal organ located retroperitoneally (or a part of it); (2) The organ that most frequently "slides" into the inguinal canal is the bladder, bladder diverticulum, or cecum; (3) This anomaly is most commonly diagnosed before surgery; (4) The presence of such a hernia can be suspected intraoperatively when the dissected hernia sac has one (or part of one) unnaturally thick wall; (5) Surgical treatment is the same as in a typical hernia - cutting off the hernia sac and reinforcing the inguinal canal wall (hernia repair). Correct answers are: a. 1,2,3 b. 2,4 c. 5 d. 2,3,5 e. 1,2,4 13S: Non-blanching redness that does not resolve after releasing pressure, indicating microcirculation disorders, is a bedsore (according to the Torrance scale): a. Grade I b. Grade II c. Grade III d. Grade IV e. Grade V 20H: Choose the correct statement regarding abdominal hernias: a. Sliding inguinal hernias, in contrast to direct hernias, rarely become incarcerated due to the wide hernia gates. b. Femoral hernias are a typical acquired hernia and are more common in men. c. A specific form of hernia is Richter's hernia, in which the intestines in the hernia sac are arranged in a characteristic W shape. d. Direct inguinal hernia is exclusively an acquired hernia, and the hernia sac never descends into the scrotum. e. All of the above statements are false. The recommended type of surgical treatment for ulcerative colitis is: a. Ileostomy b. Proctocolectomy with ileoanal anastomosis with J-pouch c. Colectomy with end-to-end ileoanal anastomosis d. Local excision of the affected segment of the colon 01P: 40 years old male was admitted to emergency with slight abdominal pain and palpable painless, not mobile tumor in epigastrium. He underwent 2 months before hospital treatment related to acute pancreatitis. On ultrasound a 20 cm diameter cyst was found. Optimum treatment would be: a. Incision and fluid evacuation b. Incision and drainage c. Endoscopic drainage d. Tumor resection e. Pancreatic resection with tumor 04S: A 71-year-old male patient has presented to the emergency department with massive vomiting of bloody content. Over the past week, the patient has been taking large amounts of non-steroidal anti-inflammatory drugs. Additionally, he has been chronically taking acetylsalicylic acid. Given the most probable cause of bleeding, routine management of this patient should include: (1) administration of recombinant factor VII clotting factor; (2) performing a gastroscopy; (3) laparotomy with surgical management of the bleeding site; (4) transfusion of a platelet concentrate. The correct answer is: a. 2 b. 1,2 c. 2,3 d. 2,4 e. 4 33T: In preparation for splenectomy due to idiopathic thrombocytopenic purpura, the following tests or procedures should be performed, EXCEPT for: a. Doppler ultrasound to assess possible portal vein thrombosis. b. Vaccination against pneumococcus, Haemophilus influenzae, and hepatitis B. c. Scintigraphic study of platelet uptake by the spleen and liver. d. Perioperative antibiotic prophylaxis. e. Preparation of 2 units of packed red blood cells. Non-traumatic hemorrhage into the peritoneal cavity - indicate a FALSE sentence: a. Should be treated conservatively, surgical treatment is contraindicated due to the difficulty of identifying the source of such hemorrhage. b. One of the causes may be a ruptured ectopic pregnancy. c. A splenic artery aneurysm that is a complication of an episode of pancreatitis can cause massive hemorrhages into the free peritoneal cavity. d. In some selected cases, laparoscopic access can be used to control bleeding. e. Liver tumors can cause hemorrhage into the free peritoneal cavity. 23W: Mechanical jaundice and common bile duct dilatation is characteristic for: (1) carcinoma of pancreatic tail; (2) carcinoma of Vater`s papilla; (3) carcinoma of pancreatic head; (4) carcinoma of distal CBD; (5) primary hepatocellular carcinoma. a. 1,2,3 b. 2,3,4 c. 3,4,5 d. 2,4,5 e. 1,3,5 44T: Identify correct statements regarding the treatment of Graves' disease: (1) Treatment is primarily surgical; (2) Surgical treatment is indicated for large goiters compressing the trachea; (3) Surgical treatment is indicated if malignancy is excluded; (4) In surgical treatment, complete thyroidectomy is currently the standard; (5) Treatment with radioactive iodine, which damages the gland and causes fibrosis, is possible. a. 1,3,5 b. 2,3,4 c. 2,4,5 d. 1,4,5 e. 1,2,4 04W: Klatskin tumor: a. recurrent inflammatory pseudomas around gallbladder b. cholangiocarcinoma of the liver hilum c. palpable, painless gallbladder - as a symptom of pancreatic head tumor d. hepatocellular adenocarcinoma e. Gastric cancer metastasis to subclavian region 21W: In routine histopathology of gallbladder, after laparoscopic cholecystectomy due to symptomatic cholecystolithiasis, T2NxMx adenocarcinoma of gallbladder was found. What diagnostic / therapeutic protocol should be considered: a. Observation and USG examination every 6m-o b. Reoperation - hepatoduodenal ligament lymphadenectomy and resection of gallbladder bed from liver c. Right subcostal region teleradiotherapy and afterwards second look operation d. Only chemotherapy with intention to treat e. Only palliative chemotherapy 02S: A 62-year-old female patient presents with moderate abdominal pain. In her medical history, there is a tendency for constipation, periodic blood in the stool, and a weight loss of approximately 4 kg. For the past 3 days, there has been a lack of gas and stool passage. She has not vomited. On physical examination, her condition is good, the abdomen is distended, and there is tenderness throughout the abdomen. Per rectum examination reveals no stool in the rectal ampulla. The most likely diagnosis is: a. Acute diverticulitis. b. Colonic stenosis due to diverticulosis. c. Aggravation of chronic constipation. d. Colonic obstruction, probably due to a neoplasm. e. Colonic obstruction, likely due to a fecal stone. 15S: Strangulation obstruction is the most common cause of bowel necrosis. Which part of the intestine quickly undergoes necrosis? a. Mucosa b. Submucosa c. Muscular layer d. Entire intestinal wall e. Serosa Diverticulosis is: a. A presence of true diverticula b. A presence of Meckel's diverticulum c. A presence of numerous pseudodiverticula d. A presence of true and pseudodiverticula 03P: Pancreatic pseudocyst symptoms are: (1) fever; (2) epigastric pain; (3) fluctuance tumor in epigastrium. a. 1 b. 2 c. 3 d. 1,3 e. 1,2,3 03T: Which of the following is NOT a typical complication of thyroidectomy? a. Hemorrhage. b. Hypocalcemia. c. Unilateral recurrent laryngeal nerve injury. d. Bilateral recurrent laryngeal nerve injury. e. Thyroid storm 16H: In paraesophageal hernia, there is displacement of: a. The entire stomach along with the cardia into the mediastinum. b. The fundus and greater curvature of the stomach without the cardia. c. The small intestine. d. The stomach with the cardia and liver. e. The cardia and upper part of the stomach. 40S: Paralytic ileus can be caused by: a. Hypokalemia b. Uremia c. Acute porphyria d. Uncontrolled diabetes e. All of the above 32S: In cases of intestinal necrosis caused by occlusion of the superior mesenteric artery, the appropriate treatment is: (1) Embolectomy; (2) Intraoperative thrombolytic therapy; (3) Resection of the necrotic intestine; (4) Revision 24-48 hours after the initial laparotomy; (5) Anticoagulant treatment with low molecular weight heparin. The correct answer is: a. 1,2,3 b. 1,3,4 c. 1,3,5 d. 2,3,5 e. 3,4,5 16W: The tumor marker for HCC is: a. CEA b. Ca-19.9 c. AFP d. Ca125 e. NSE 14T: In the case of traumatic splenic rupture, what is the correct approach? a. Leave the rupture alone, as a hematoma will form around the spleen, leading to spontaneous cessation of bleeding. b. Attempt to control bleeding (spray coagulation, hemostatic material). c. Perform splenectomy if bleeding cannot be stopped. d. Leave small fragments of the spleen in place. e. All of the above. 19T: What is the indication for splenectomy? a. Splenic cyst larger than 5 cm. b. Splenic abscess. c. Uncomplicated splenic infarction. d. Hereditary spherocytosis. e. Traumatic splenic rupture in polytrauma. 28W: The Bismuth-Corlette classification is a classification system for perihilar cholangiocarcinomas, which is based on the extent of ductal infiltration. Bismuth I is described by: a. Limited to the common hepatic duct, below the level of the confluence of the right and left hepatic ducts b. Involves the confluence of the right and left hepatic ducts c. Larger than T2 according to 9th edition of AJCC d. Smaller than T2 according to 9th edition of AJCC e. None of the above Colorectal cancer most often occurs in: a. Ascending colon b. Rectum c. Sigmoid colon d. Transverse colon 40T: Which of the following symptoms does not belong to the clinical picture of toxic nodular goiter? a. Cardiac disturbances (tachycardia, arrhythmias). b. Increased excitability, sleep disturbances, easy fatigue, increased sweating. c. Enophthalmos. d. Weight loss, diarrhea tendency. e. Trophic changes - warm, moist skin, hair loss, brittle nails. 08T: A patient previously treated for a pheochromocytoma presents with hyperparathyroidism and an elevated calcitonin level. What is the most appropriate initial step? a. Radiochemotherapy. b. Thyroidectomy. c. Radioiodine ablation. d. Thyroid ultrasound and lymph node assessment. e. Dialysis therapy 17T: In traumatic splenic rupture: a. Splenectomy is always necessary. b. It is possible to spare part of the spleen. c. Laparoscopic technique can be used. d. Hemorrhage into the peritoneal cavity is always present. e. Subcapsular hematoma frequently occurs. Which of the following is true: (1) The incidence of appendicitis in pregnant women is comparable with that in nonpregnant women matched for age; (2) Appendicitis is the most prevalent extrauterine indication for laparotomy in pregnancy; (3) Pregnancy should delay surgery if appendicitis is suspected; (4) Appendiceal perforation greatly increases the chance of premature labor and fetal mortality; (5) Cholecystitis is the most common non-obstetric surgical disease of the abdomen during pregnancy. a. 1,2 b. 1,3,4,5 c. 1,2,4 d. 2,3,4 e. 4,5 22T: Failure to normalize platelet count after splenectomy for idiopathic thrombocytopenic purpura can be caused by: a. Prolonged preoperative steroid therapy. b. Low spleen-liver ratio. c. Portal vein thrombosis. d. Preservation of an accessory spleen. e. Preoperative immunosuppressive therapy. POLISH DIVISION LEK-QB 2023/2024: (This is where they took the new ED QB surgery-questions 2023 from) Ulcerative colitis is characterized by inflammation involving: 1) The mucosa; 2) Submucosa; 3) Muscular membrane; 4) Serous membrane; 5) The entire wall of the large intestine. a. 1 b. 1,2 c. 1,2,4,5 d. 3,4,5 e. 4,5 Indicate the FALSE statement regarding secondary hyperparathyroidism: 1) it is always an indication for surgery; 2) surgery is performed when symptoms of calciphylaxis occur; 3) parathyroid adenoma is surgically removed - the most common cause; 4) subtotal removal of the parathyroid glands or removal of all of them and autotransplantation of one of them; 5) we do not operate, we just keep Ca and vitamin D within normal limits, and PTH 2.9x above the upper limit of normal. The correct answers are: a. 2,4,5 b. 1,4,5 c. 1,3 d. 2,3 e. They are all false Chronic kidney failure is the most common cause of secondary hyperparathyroidism Angiodysplasia is a common cause of lower gastrointestinal bleeding in older people. The most common location of angiodysplasia is: a. Jejunum b. Ileum c. Right half of the large intestine d. Left half of the large intestine e. Rectum Angiodysplasia: Swollen, fragile blood vessels in the colon In the treatment of anal fissure, the following are used: 1) Beta-blockers; 2) Calcium channel blockers; 3) Botulinum toxin; 4) Alpha-blockers; 5) Nitroglycerin; 6) Adrenaline. a. 1,2,3 b. 2,3,4 c. 2,3,5 d. 3,4,6 e. 1,2,3,4,5 The classification of hemorrhoidal disease is: a. Parks - not fistulas and anal abscesses b. CDAI c. Banova d. TNM A 50-year-old man presented after the second episode of bleeding from diverticula of the large intestine. The recommended procedure is: a. Surgical treatment - Hartmann procedure b. Surgical treatment - sigmoidectomy with descending-anal anastomosis c. Surgical treatment - colectomy with ileum-rectal anastomosis d. Endoscopy e. Pharmacotherapy 45O: A set of symptoms lasting about 30 minutes, caused by a meal, alcohol consumption, excessive physical exercise, including vasomotor disorders such as reddening of the skin of the face and upper torso, diarrhea, asthmatic shortness of breath and arterial hypertension, is typical of the syndrome: a. Zollinger-Ellison syndrome b. Mallory Weiss syndrome c. Lynch syndrome d. Gardner syndrome e. Carcinoid 57B: Identify FALSE statements regarding erysipelas (rose): a. It is an infectious disease caused by staphylococci. b. Infection can spread through the lymphatic system (so-called wandering rose). c. The onset of the disease is sudden, and the course is rapid. d. The treatment of choice is large doses of penicillin. e. Lesions are usually located on the lower limbs or face, sometimes leading to necrosis or gangrene of the skin. Mc by: β-haemolytic streptococcus and Staph. aureus. Gram-negative or anaerobic bacteria may cause infection in immunocompromised people and those with diabetes. 08PP: What complications can a colon polyp cause? 1) colon cancer; 2) sigmoid volvulus; 3) bleeding; 4) ulcerative colitis; 5) perianal fistulas. Correct answer: a.1,5 b.2,3 c.1,3 d.3,4 e.3.5 54B: McBurney’s point is: a. the place marking the attachment of the inguinal ligament to the pubic bone - an important landmark in hernia surgery. b.the place of greatest pain in the case of acute cholecystitis. c.the place where the small intestine connects with the large intestine. d. a place on the line between the anterior superior iliac spine and the umbilicus, usually located above the base of the appendix. e.place of branching of the celiac trunk from the abdominal aorta. Familial adenomatous polyposis (FAP) is an autosomal dominant disease. One of the recommended therapeutic methods is prophylactic colectomy with mucosectomy of the rectum. a.Truth-truth, there is a cause-and-effect relationship. b.Truth-truth, there is no cause-and-effect relationship. c.True-false. d.False-true. e.False-false. 19O: Breast-sparing surgery for breast cancer: a. Is performed in cases of small cancerous tumors. b. It involves local excision of a segment of the gland along with the tumor. c. It is necessary to simultaneously remove the axillary lymph nodes. d. After surgery, radiotherapy is necessary. e. All statements are true. 45PP: Indicate the correct sentences relating to Hartmann's operation: 1) Hartmann's operation is performed only on the large intestine (colon); 2) No intestinal anastomoses are performed in this type of surgery; 3) After this operation, the patient always has an artificial anus in the form of a loop colostomy; 4) After this operation, the patient always has an artificial anus in the form of a colostomy or end ileostomy; 5) In this operation, the proximal part of the intestine is closed silently. The correct answers are: a. 1,2,3 b. 2,4 c. 3,4,5 d. 1,2,4 e. 2,4,5 18O: Symptoms suggestive of rectal cancer are: 1) tarry stools; 2) blood in the stool during defecation; 3) change in bowel habits; 4) itching; 5) leukocytosis; 6) pencil-shaped stools. The correct answer is: a. 1, 5, 6 b. 2, 3, 4 c. 1, 3, 6 d. 2, 3, 6 e. 1, 2, 3 53D: A patient with a head injury after a car accident is diagnosed with: anisocoria; opening the eyes only to a strong pain stimulus; the patient makes incomprehensible sounds; when establishing intravenous access, the patient withdraws his hand. Indicate GCS score and whether the patient requires endotracheal intubation. Correct answer: a. GCS 8, patient requires intubation. b. GCS 9, the patient does not require intubation. c. GCS 9, too little clinical data to indicate indications for intubation. d. GCS 8, the patient does not require intubation. e. GCS 9, patient requires intubation. 38V: Mark the FALSE nutritional treatment route: a. oral b. intravenous c. jejunostomy d. transversostomia e. all listed routes are suitable 10B: Soft tissue infection limited to the subcutaneous tissue, most often limited to one phalanx, and if the proximal phalanx is affected, it tends to spread to the hand. Initially in the form of an inflammatory infiltrate, later a collection containing purulent contents. The presented characteristics may correspond to: a. zanakcicy. b. empyema. c. brace. d. seroma. e. fibroma. 35V: In a patient complaining of cyclical, regular, long-term lower abdominal pain and monthly rectal bleeding, the following should be suspected: a. Meckel's diverticulum b. hyperthyroidism c. gastrointestinal endometriosis d. bleeding disorder e. None of the above 24H: Which of the following statements regarding the treatment of an incarcerated inguinal hernia are completely true: 1) If no more than 6 hours have passed since the incarceration, the hernia can be removed; 2) It is always an indication for surgical treatment; 3) If more than 6 hours have passed since the entrapment, the hernia should be operated on urgently (on the same day); 4) If more than 6 hours have passed since the incarceration, the hernia can be operated on as scheduled (the next day); 5) The operation is best performed using the tension-free method (e.g. Lichtenstein), regardless of the situation. The correct answers are: a. odp. 1,3 b. odp. 1,3,5 c. odp. 2,3,5 d. odp. 3,4,5 e. odp. 1,4 16B: Which of the following statements about acute appendicitis is true? a. is the most common inflammatory disease of the abdominal cavity, occurring mainly in older people. b. occurs more often in men than in women, and urinary tract diseases are most often taken into account in the differential diagnosis. c. typically begins with pain in the right iliac fossa, and the leukocytosis test is one of the most important factors determining the diagnosis. d. Abdominal ultrasound is the imaging test that determines the diagnosis, and appendectomy is the only treatment for the established diagnosis. e. the diagnosis is based primarily on the interview and physical examination, and urinary and gynecological diseases in women are most often taken into account in the differential diagnosis. 41D: Mechanical jaundice may be caused by: 1) deposits in the bile ducts 2) portal hypertension 3) cancer of the pancreatic body 4) penetrating duodenal ulcer 5) cancer of the head of the pancreas Correct answer: a. 1,2 b. 1,3 c. 2,3 d. 4,5 e. 1.5 01V: A 35-year-old patient complains of a palpable mass located in the lower outer quadrant of the right breast. The formation is painful and the skin above it is red and excessively warm. The patient has a fever. The ultrasound examination described a regular hypoechoic lesion with a diameter of 7 cm. The appropriate course of action will be: a. incision and drainage of the breast abscess, additional antibiotic therapy. b. excising the lesion in its entirety and sending it for histopathological examination. c. treatment with Rivanolum compresses and antibiotics empirically. d. fine needle biopsy of the lesion under antibiotic protection. e. none of the answers listed are correct. 29O: Cancer of the peripapillary area may be called: 1) cancer of the bile ducts; 2) pancreatic head cancer; 3) cancer around the greater ampulla of the duodenum (Vater) a. 1 b. 2 c. 3 d. 1 and 2 e. 1, 2 and 3 07T: INCORRECT statement regarding the treatment of thyroid crisis: a. May require treatment in the ICU. b. Thiamazole should be administered. c. May require plasmapheresis. d. Requires thyroidectomy. e. Anticoagulant treatment should be initiated. 06PP: What type of gastric resection is used in the surgical treatment of morbid obesity? a. Subtotal gastrectomy b. Proximal gastrectomy c. Hemigastrectomy d. Wedge gastrectomy e. Sleeve gastrectomy The most common cause of non-varicose hemorrhages from the upper gastrointestinal tract is: a. Gastric adenocarcinoma b. Gastropatia wrostna c. Mallory-Weiss syndrome d. Cameron's ulcers e. Peptic ulcer disease of the stomach and duodenum. 18H: Indicate the true sentences regarding the incarceration of a ventral hernia: 1) the inguinal hernia is most often incarcerated; 2) in some cases, only the intestinal wall is trapped; 3) incarcerated hernia always leads to mechanical intestinal obstruction; 4) entrapment most often occurs at night, during sleep. Correct answer: a. all mentioned. b. 1, 2, 4. c. 2, 4. d. 1, 2. e. 1, 2, 3. The following substances have the effect of inhibiting the motility of the large intestine: 1) Insulin; 2) Glucagon; 3) Leptin; 4) Somatostatin; 5) Gastrin. a. 1,2 b. 1,2,4,5 c. 3,4,5 d. 4,5 e. 2.4 43D: A 58-year-old obese patient came to the primary care physician with pain in the right hypochondrium, fever and yellowing of the sclera. She was referred to the Emergency Department, where she developed consciousness disorders. The most likely diagnosis is: a. Intra-abdominal abscess b. Acute cholangitis c. Exacerbation of viral hepatitis d. Viral meningitis e. Neuroborreliosis 19W: A 58-year-old patient treated at the Department of Hepatology for liver cirrhosis developed symptoms of bleeding from the upper gastrointestinal tract. The patient's blood pressure was 170-80mmHg, heart rate was 118. What diagnosis and treatment is most likely? a. esophageal varices – gastroscopy. b. esophageal varices – laparotomy. c. bleeding duodenal ulcer - panendoscopy. d. bleeding duodenal ulcer - laparotomy. e. none of the answers are correct. 02V: Total parenteral nutrition (TPN) should be carried out at home after surgery: a. almost complete resection of the small intestine due to mesenteric embolism. b. complete removal of the large intestine due to ulcerative colitis. c. uncomplicated total gastrectomy due to cancer. d. duodenectomy due to a benign lesion. e. each of the above. 24S: The intestinal wall becomes necrotic as a result of: 1) hernia incarceration; 2) portal hypertension; 3) intestinal strangulation around peritoneal adhesions; 4) embolism of the mesenteric artery or its branches; 5) diverticula of the small intestine. The correct answer is: a. 1,2,3 b. 2,3,4 c. 1,3,5 d. 1,3,4 e. 1,2,4 04W: Drainage using the Kerh-T drain is used to drain: a. pleural cavity. b. peritoneal cavity. c. ureters. d. bile ducts. e. no correct answer. 28B: During the operation in which the rectum was resected, the intestinal lumen was opened on the perforated tumor and fecal contents leaked into the peritoneal cavity. How is such a wound classified? a. the wound is clean. b. clean-contaminated wound. c. contaminated wound. d. dirty wound. e. surgical wound. The least common anal abscess is: a. Subcutaneous b. Ischiorectal c. Intersphincteric d. Supralevator e. Submucosal 53O: The most common stomach cancer is: a. adenocarcinoma. b. lymphoma. c.stromal tumor. d. squamous cell carcinoma. e. all of the above occur comparably often. 04H: Which of the following statements about the treatment of an incarcerated abdominal hernia are true? 1) an incarcerated hernia can be attempted to be removed within the first few hours; 2) an attempt to remove an incarcerated hernia can always be made, regardless of the time that has passed since the incarceration; 3) an incarcerated hernia should always be treated surgically; 4) hernia removal may involve the risk of damaging the contents of the sac. The correct answer is: a. 1,4. b. 2,4. c. 3,4. d. only 3. e. only 4. 25D: The most valuable and accurate method of locating the parathyroid glands before surgery is: a. CT b. MRI c. USG d. Scintigraphy using MIBI labeled with the isotope of technetium 99mTc e. Catheterization of jugular veins and determination of PTH concentration 14O: The most common complication after surgical treatment of esophageal cancer is: 1) complete narrowing of the anastomotic area; 2) cardiac arrhythmias; 3) stroke; 4) pulmonary complications (atelectasis, pleural effusion) a. 1 b. 2 c. 3 d. 4 e. 2 and ??? Maybe Q about borders of the inguinal canal -> aka anterior wall? a. Aponeurosis of the external oblique muscle b. Aponeurosis of the internal oblique muscle c. Transverse fascia d. White line e. Inguinal ligament 38T: Indicate which of the following symptoms are typical of nodular goiter: 1) enlargement of the thyroid gland; 2) palpable enlarged cervical lymph nodes; 3) shortness of breath, hoarseness and swallowing disorders (in case of large goiter); 4) exophthalmos; 5) the disease may be asymptomatic for a long time. The correct answers are: a. 1,2,3 b. 2,3,4 c. 3,4,5 d. 1,3,5 e. 2,3,5 13PP: The patient was admitted as part of the emergency service to the Department of Surgery with suspected appendicitis. Additional tests (ultrasound) allowed for the detection of periappendiceal infiltration. The patient was treated conservatively, and after the symptoms disappeared and the number of leukocytes in peripheral blood decreased, he was discharged home on the sixth day. The next day, the patient returned to the emergency room of the same hospital, complaining of increased body temperature, a feeling of general weakness and mild pain in the right iliac fossa. Indicate the appropriate conclusions and actions: a. the patient should undergo an abdominal ultrasound. b. the patient may undergo a CT scan of the abdominal cavity. c. the patient will likely require emergency invasive treatment. d. it will be possible to recognize the presence of an intra-abdominal abscess. e. all answers are correct. 40H: A 45-year-old man who reports periodic burning sensation in the groin area, indicate the appropriate course of action: a. Based on a physical examination and possibly an ultrasound examination, the patient should be referred for planned surgical treatment of inguinal hernia. b. Herniography should be performed to confirm the diagnosis of hernia. c. It is necessary to perform an MRI examination to assess the size of the hernia. d. The patient qualifies for urgent surgical treatment due to symptoms of incarcerated inguinal hernia. e. It is recommended to perform an abdominal X-ray in a standing and lying position. 10PP: A 20-year-old man came to the emergency room with typical migratory lower abdominal pain and nausea. In the Emergency Department, physical examination showed tenderness in the area of ​the right iliac fossa. WBC 14 thousand The most appropriate course of action is: a. laparoscopy with appendectomy – urgent. b. laparotomy with appendectomy – urgent. c. conservative treatment. d. urgent laparoscopic surgery or laparotomy with appendectomy, depending on the facility's capabilities. e. None of the above. Operative access with a McBurney incision is used in the following surgeries: a. removal of the appendix b. pylorus perforation notebook c. mechanical obstruction of the gastrointestinal tract d. acute pancreatitis e. inflammation of the sigmoid colon 26O: An example of reconstructive surgery in oncology is: a. installation of a fecal fistula in the case of mechanical obstruction caused by an inoperable tumor of the large intestine. b. performing a tracheostomy in a patient suffering from shortness of breath due to laryngeal cancer. c. restoring the continuity of the gastrointestinal tract after removal of the large intestine tumor causing obstruction. d. removal of moles on the skin which, if left untreated, may turn into a malignant tumor. e. resection of the stomach along with the tumor, lymph nodes, greater omentum and spleen. 09S: The method of choice for the treatment of upper gastrointestinal bleeding is: a. surgical treatment using laparoscopic access. b. treatment with blood and blood products. c. surgical treatment using a classic approach. d. endoscopic treatment. e. none of the mentioned methods. 39H: The etiopathogenesis of hernias includes: 1) collagen metabolism disorders; 2) smoking; 3) male gender; 4) increased activity of metalloproteinases (e.g. in Marfan syndrome) 5) working in a sitting position. The correct answers are: a. answer 2.5 b. odp. 1,2,3,4 c. answer: all answers are correct d. answer 1,3,4,5 e. answer 1 21PP: Indicate the true statement regarding Zenker's pharyngoesophageal diverticulum: 1) it is the most common esophageal diverticulum; 2) occurs as a result of impaired relaxation of the upper esophageal sphincter; 3) may cause esophageal obstruction; 4) may cause Mendelson's syndrome; 5) a large diverticulum may cause hoarseness. The correct answers are: a. 1,2,4 b. 2,3,5 c. 1,2,3 d. 1,2,5 e. all correct Which of the following symptoms distinguish acute appendicitis from pyelonephritis? 1) onset of illness with chills; 2) body temperature above 39 degrees C; 3) marked peritoneal symptoms; 4) undisturbed urination rhythm; 5) positive Rowsing's sign. The correct answer is: a. all mentioned b. 1,2,3 c. 3,4,5 ? - reply from wnl - this is also the case on another exchange d. 3.5 -> and not when the appendix touches the bladder there is frequent urination, could someone verify? e. 1.2 Stage 3 hemorrhoidal disease is characterized by: a. Nodules visible only under anoscopy b. The lumps fall out but go away on their own c. Necrotic nodules d. Thrombosis of hemorrhoidal plexuses e. The nodules fall out and require removal by the patient 05T: What medications are used before surgery in pheochromocytoma? a. alpha blockers. b. proton pump inhibitors. c. H2- blockers. d. inhibitory steroidogenezy. e. angiotensin-converting enzyme inhibitors (ACE-I). 02O: A 65-year-old man presented to a surgeon due to the presence of fresh blood in the stool, weight loss and narrow stools. During rectal examination, the doctor found infiltration of the anal canal. Ultrasound showed transrectal infiltration of the entire intestinal wall, without involvement of the anal sphincters. In the perianal tissues, cancerous infiltration was found in two lymph nodes. Adenocarcinoma was found in the samples taken. Further proceeding: a. radical radiochemotherapy. b. preoperative radiotherapy followed by surgery. c. preoperative chemotherapy followed by surgery. d. operation. e. brachytherapy with chemotherapy. The cause of mortality in the acute phase of severe acute pancreatitis IS NOT: a. Diabetes due to destruction of the pancreatic parenchyma b. Multiple organ failure c. Complications of septic shock d. Extreme pancreatic exocrine insufficiency e. Correct A and D 49B: To perform laparoscopic surgery, it is necessary to introduce gas into the peritoneal cavity (create pneumoperitoneum), which is: a. Whole b. Carbon dioxide c. Air d. Oxygen e. Nitrous oxide Damage Control Surgery (DCS) to: a. A treatment strategy for trauma patients involving complete and definitive treatment of all intra-abdominal injuries. b. A treatment strategy for trauma patients involving the control of bleeding and intra-abdominal contamination using temporary packing. c. Treatment strategy for trauma patients with isolated CNS injuries to prevent cerebral edema. d. A treatment strategy for trauma patients with isolated lower limb injuries aimed at complete repositioning of bone fragments. e. No correct answer. 38D: In acute, uncomplicated appendicitis, there is no evidence of: a.leukocytosis with a shift of the smear to the left. b. pressure pain in the right iliac fossa in the so-called McBurney point. c.significantly increased body temperature (above 39C). d.pain initially located in the upper abdomen. e.intensification of pain when coughing. 24D: Male, tenderness in the right lower abdomen, temperature above 37.5C, positive Blumberg's sign, pain during digital rectal examination, increased tension of abdominal muscles. These are typical symptoms for: a. inflammation of the gallbladder. b. acute pancreatitis. c. adnexitis. d. perforation of a stomach or duodenal ulcer. e. appendicitis. 43T: Select the correct sentences referring to pheochromocytoma: 1) it develops in the adrenal medulla and cortex; 2) it is a tumor that secretes mainly norepinephrine; 3) usually occurs bilaterally; 4) 90% of cases are malignant; 5) is part of the MENI type endocrine adenomatosis syndrome. a. 2,3,5 b. 2,3,4 c. 2,5 d. 5 e. none of the above. 17O: The most common clinical symptom in patients after surgery for esophageal cancer is/are: a. dysphagia. b. vomiting and burping. c. pain behind the sternum when swallowing. d. joint and muscle pain. e. regurgitation of food contents. 19T: Indications for splenectomy are: 1) splenic cyst larger than 5 cm; 2) splenic abscesses; 3) spleen tumors; 4) chronic thrombocytopenia; 5) splenic artery aneurysm larger than 1.5 cm. Correct answer: a. 1,2,3 -> most likely b. 1,3,4 c. 2,3,4 ?? - in another exchange it is d. 3,4,5 - e. all correct. 39V: A flat, sharply demarcated lesion, brown in color and uneven pigmentation, located on the skin of the face and neck, growing slowly, is: a. pigmented birthmark b. senile keratosis c. lentigines d. atheroma e. common wart 52B: The most common place for arterial embolic material to form is: a. Left ventricle of the heart. b. Ascending aorta. c. Right atrium of the heart. d. Descending aorta. e. Left atrium of the heart. 17W: Contraindications to liver transplantation are: a. HCV infection. b. HIV infection. c. hepatocellular carcinoma. d. fulminant liver failure. e. neither answer is correct. 51B: Over recent years, the incidence of surgical complications of gastric and duodenal ulcers has decreased. What is the main cause of this? a. surgical performance of trunk vagotomy. b. use of selective vagotomy. c. use of highly selective vagotomy. d. improvement of conservative treatment methods. e. surgical trunk vagotomy with anthrectomy. 13B: 40-year-old woman after two deliveries, body weight 104 kg and height 172 cm - a patient prone to: a. stomach and duodenal ulcer. b. urolithiasis. c. gallstones. d.duodenal ulcer. e.kidney stones. 07B: A 21-year-old man comes to the surgical clinic with a cut wound to his hand. The injury occurred while gardening. The patient's documentation shows that he received all vaccinations provided for in the mandatory Protective Vaccination Program (the last dose of the Td vaccine was 3 years ago). Indicate the correct course of action for tetanus prevention: a. the patient does not require vaccination or antitoxin. b. 1 dose of Td or T vaccine should be administered. c. 1 dose of Td or T vaccine should be administered, and then the dates for the next two doses should be scheduled (in 1 month and 6 months). d. 1 dose of Td or T vaccine and 1 dose of specific immunoglobulin should be administered. e. 1 dose of Td or T vaccine and 1 dose of specific immunoglobulin should be administered, and then the dates for the administration of two further doses should be set (in 1 month and 6 months). Symptoms of hyperparathyroidism include, except: a. desire b. weak bones c. abdominal pain d. kidney stones e. hypotension 60D: Indicate the appropriate elements of the procedure in the case of a patient with yellow skin who came to the surgical clinic: 1) laboratory tests of bilirubin, alkaline phosphatase, ALAT, ASPAT, GGTP; 2) abdominal ultrasound; 3) referral to hospital for endoscopic retrograde cholangiopancreatography; 4) referral to an imaging laboratory for cholangio-NMR. The correct answers are: a. 1,2 b. 1,3 c. 1,4 d. 2,3 e. 1,2,3 21O: A 57-year-old patient with a histologically confirmed adenocarinoma tumor in the splenic flexure of the colon. No other changes were detected in the CT scan apart from the primary tumor. Anesthetically, the patient was classified as ASA-2. The surgical procedure of choice in such a case will be: a. prawostronna hemicolectomy b. left-sided extended hemicolectomy c. colectomy d. segmental resection of the colon e. resection of the transverse colon extended to include the splenic flexure 09P: Identify the true statement regarding acute pancreatitis: 1) the most common causes of acute pancreatitis include gallstones and alcohol 2) the treatment of choice is surgery 3) septic complications are the most common cause of death in necrotizing acute pancreatitis 4) to combat the symptoms morphine is administered for pain 5) there are two clinical forms of acute pancreatitis; edematous and necrotic Correct answer: a. 1,2,3 b. 2,3,5 c. 1,3,5 d. 1,2,4 e. 1,3,4 09B: A 4-year-old child fell and hit her left lower costal arch. Immediately after the accident, he was taken to the emergency room pale, with hypotension and tachycardia. What should you suspect? a. rupture of the mesentery of the small intestine. b. diaphragm injury. c. liver injury and rupture. d. rupture of the spleen. e. bleeding from the gastrointestinal tract. 42O: From the following sentences, choose those that correctly characterize hereditary nonpolyposis CRC - HNPCC (Lynch I syndrome): 1) occurs in the 4th-5th decade of life; 2) brain tumors coexist; 3) most often develops in the right half of the colon; 4) it most often develops on the basis of polypoid lesions; 5) accounts for approximately 20% of all colorectal cancers. The correct answer is: a. 1,3,4 - then no b. 2,5 c. 2,3,4 d. 1,3 e. 1,2,3,4 Medullary thyroid cancer – indicate false: a. It often requires extended removal of the neck lymph nodes b. Can be inherited c. After diagnosis, radiomodem treatment is necessary d. May require assessment of adrenal hormonal activity 20PP: Identify the true statement regarding acute appendicitis: 1) laparoscopic surgery should not be performed; 2) most often occurs at a young age; 3) begins with pain that moves from the upper abdomen to the right lower abdomen; 4) does not occur in people over 50 years of age; 5) often accompanies Crohn's disease. The correct answer is: a. 1,2 b. 3,4 c. 4,5 d. 2,3 e. 2.4 06T: Calcitonin is a specific marker for: a. papillary thyroid cancer. b.medullary thyroid cancer. c. anaplastic thyroid cancer. d.follicular thyroid cancer. e.parathyroid gland cancer. Goodsall's rule applies to: a.Crohn's disease b.Ulcerative colitis c. Hemorrhoidal diseases d.Anal fissures e.Anal fistulas 47B: Compartment syndrome is caused by all of the following except: a.acute pancreatitis. b.acute pyelonephritis. c.ascites. d.bleeding into the peritoneal cavity. e.resuscitation. Which of the following bariatric surgeries uses mainly the restrictive mechanism (A) and which mainly uses the malabsorption mechanism (B)? Select the correct pair: (1) Roux-en-Y Gastric Bypass; (2) Gastric Banding; (3) Sleeve gastrectomy; (4) Biliopancreatic diversion – Scopinaro operation. a.A1-B3-MI b.A4-B2 c.A3-B1 d.A2-B4 e.No suitable pair 41H: Inguinal hernias, choose the correct sentence: a. constitute approximately 75% of abdominal hernias. b. women get sick more often than men. c. only patients whose hernia size exceeds 5 cm should be operated on. d. in the case of bilateral inguinal hernia, only the anterior (classic) approach should be used. e. the contents of the Amyand's hernia sac are the sigmoid colon. 56O: Colorectal cancer is most often located in: a. cecum. former ascendants. c. transverse colon. d. descendants.proviso e. sigmoid colon and rectum. 23D: The method of choice in the initial diagnosis of mechanical jaundice is: a. Abdominal ultrasound. b. endoscopic retrograde cholangio-pancreatography (ERCP). c. CT scan of the abdominal cavity. d. percutaneous, transhepatic cholangiography. e. Abdominal X-ray. 53B: A patient taking one of the vitamin K antagonists permanently requires urgent surgery. In this situation, the patient should be given: (1) fresh frozen plasma; (2) albumin; (3) platelet concentrate; (4) vitamin K intravenously. a. 1,2 b. 2,3 c. 3,4 d. 1,4 e. 1,3,4 31T: Complications after thyroid removal may include: a. hyperparathyroidism. b. hearing loss. c. ślinotok. d. facial nerve palsy. e. hypoparathyroidism 05PP: Short bowel syndrome may be caused by: a. resection of a significant part of the small intestine. b. fistulas between loops of the small intestine. c. fistula between the stomach and large intestine. d. enterocutaneous fistula. e. all mentioned above. 54D: In the diagnosis of cancer and monitoring the effectiveness of their treatment, increasing the concentration of certain markers is important. In the case of colorectal cancer, the concentration of: a. CA 19.9 b. CEA c. a-FP d. CA 125 e. CA 15-3 The recommended type of surgical treatment for ulcerative colitis is: a. creating an ileostomy b. proctocolectomy with enteroanal anastomosis creating a J-type reservoir c. colectomy with end-to-end enteroanal anastomosis d. local excision of the section with the largest changes. An 83-year-old nursing home resident with Alzheimer's disease presents symptoms of abdominal distension without severe pain. An abdominal X-ray revealed a dilated right half of the colon filled with air, with no signs of gastrointestinal perforation. What treatment will you suggest first? (Ogilvie syndrome) a. Surgical treatment b. Endoscopic decompression of the colon c. Radiotherapy d. Atropine drug therapy e. Discontinuation of medications used for Alzheimer's disease 17D: A 56-year-old woman was admitted to hospital after a craniocerebral injury. It opens its eyes in response to a pain stimulus, to which there is a flexion reaction (the arm runs away). She is so confused that the interview with her is unreliable. What is his GCS score? a. 5 b. 7 c. 9 d. 11 e. 13 Obstruction due to volvulus of the large intestine most often occurs in: a. Cornice b. Ascendants c. Crosswalkers d.Descendants e. Esicy * sigmoid Retrosternal goiter is: a. Enlarged thyroid gland located entirely below the sternal notch b. Enlarged thyroid gland extending partially below the sternal notch c. An enlarged thyroid gland located entirely in the neck pressing on the trachea d. Enlarged thyroid gland causing symptoms of hyperthyroxemia 62B: Indicate which of the following factors is not considered to contribute to the development of varicose veins in the lower limbs. a. hereditary factor (familial laxity of connective tissue). b. staying in a standing or sitting position for a long time. c. obesity. d. previous pregnancies. e. age. 06W: What size gallbladder polyp is an indication for cholecystectomy? a. 3mm b. 5mm c. 1cm d. 2cm e. 3cm 25H: Which of the following sentences correctly characterize a femoral hernia. : 1) In this hernia, the sac "presses" into the femoral canal through the femoral ring and passes under the skin, bulging in the groin above the inguinal ligament; 2) Femoral hernias are as common as inguinal hernias; 3) It occurs primarily in women; 4) It has a relatively wide gate and rarely becomes trapped; 5) The hernia gate is the femoral ring in the lower pole of the inguinal ligament. The correct answers are: a. answer 1,2,3 b. answer 1.4 c. answer 2,3,4 d. answer: 3.5 e. answer 4.5 What is it? ○ Hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels (Think: FM radio, or Femoral hernia = Medial) What are the boundaries of the femoral canal? ○ 1. Cooper's Ligament Posteriorly ○ 2. Inguinal Ligament Anteriorly ○ 3. Femoral Vein Laterally 4. Lacunar Ligament Medially What factors are associated with femoral hernias? ○ Women, pregnancy, and exertion What percentage of all hernias are femoral? ○ 5% What percentage of patients with a femoral hernia are female? ○ 85%! What are the complications? ○ Approximately one third incarcerate (due to narrow, unforgiving neck) What is the most common hernia in women? ○ Indirect inguinal hernia What is the repair of a femoral hernia? ○ McVay (Cooper’s ligament repair), mesh plug repair 25S: The three most common causes of upper gastrointestinal bleeding are: 1) stomach cancer; 2) hemorrhagic gastritis; 3) peptic ulcer disease; 4) Mallory-Weiss syndrome; 5) esophageal varices. The correct answer is: a. 1,2,3 b. 2,3,4 c. 3,4,5 d. 1,3,4 e. 2,3,5 36O: In esophageal cancer, in order to restore the continuity of the digestive tract, the following methods are used: a. transplant from the stomach or large intestine. b. small intestine transplant. c. colon transplant only. d. esophageal intubation with stent insertion. e. transplant from the stomach or large or small intestine. 24D: Male, tenderness in the right lower abdomen, temperature above 37.5C, positive Blumberg's sign, pain during digital rectal examination, increased tension of abdominal muscles. These are typical symptoms for: a. inflammation of the gallbladder. b. acute pancreatitis. c. adnexitis. d. perforation of a stomach or duodenal ulcer. e. appendicitis. 55D: In case of persistent vomiting, the following may occur: a. hyperchloremia, hyperkalemia, metabolic alkalosis. b. hypochloremia, hyperkalemia, metabolic alkalosis. c. hypochloremia, hypokalemia, metabolic alkalosis d. hyperchloremia, hyperkalemia, metabolic acidosis. e. hypochloremia, hyperkalemia, metabolic acidosis. 14B: Which disease is not associated with the occurrence of colon polyps? a. Gardner's syndrome. b. Puetz-Jeghers syndrome. c. HNPCC – Lynch syndrome d. familial adenomatous polyposis. e. Juvenile polyposis A 43-year-old woman came to the clinic with the results of a chest computed tomography. A 4 cm tumor was described in the right adrenal gland. What should be the next course of action? a. referral to the surgical department for right open adrenalectomy. b. go to the surgical department for right laparoscopic adrenalectomy. c. referring the patient for a core needle biopsy. d. In performing multiphase computed tomography of the adrenal glands. e. A 1-year follow-up period is indicated In the physical examination of the patient, the lack of hepatic suppression indicates: a. b. hiatal hernia c. mechanical jaundice d. splenomegaly e. sigmoid twist no suppression → gas in the peritoneal cavity 26S: The three most common causes of mechanical intestinal obstruction are: 1) postoperative adhesions; 2) colorectal cancer; 3) Meckel's diverticulum; 4) intussusception; 5) hernia incarceration. The correct answer is: a. 1,2,5 b. 2,3,5 c. 1,3,4 d. 1,2,4 e. 1,3,5 What is the treatment of acute pancreatitis in the early phase of the disease? Indicate the incorrect answer. a. surgical removal of the inflamed part of the pancreas b. fluid resuscitation c. nutritional treatment d. pain management 40S: Paralytic obstruction may be caused by: a. hypokalemia. b. uraemia. c. oyster porphyria. d. decompensated diabetes. e. all of the above. 22B: Symptoms of diffuse peritonitis include: 1) severe abdominal pain; 2) gas and stool retention; 3) high blood pressure; 4) increased intestinal peristalsis; 5) pale face with sharp features. The correct answer is: a. 1,2,3 b. 1,3,4 c. 1,2,3,4,5 d. 1,2 4,5 e. 1,2,5 10H: Oblique inguinal hernia: a. it is always acquired b. it occurs less frequently than simple inguinal hernia c. it is more often incarcerated than a simple hernia d. it never goes down to the scrotum e. it is diagnosed if the hernia sac is visible in an ultrasound examination during coughing medial to the lower epigastric vessels 15S: Stroke ileus is the most common cause of intestinal necrosis. Which part of the intestine undergoes necrosis the fastest? a. mucous membrane. b. submucosa. c. muscle membrane. d. the entire intestinal wall. e. serosal membrane. 35S: Select the correct statements about stomach ulcers: 1) the most common cause is Zollinger-Ellison syndrome; 2) the most common location is the gastric angle and the prepyloric area; 3) all gastric ulcers should be treated surgically; 4) the most frequently performed operations in treatment are Billroth I and II, vagotomy; 5) perforation of the ulcer causes symptoms of an acute abdomen. Correct answer: a. 1, 2, 3 b. all correct c. 1, 4, 5 d. 3, 4, 5 e. 2, 4, 5 06O: What procedure seems to be optimal in the case of simultaneous detection of three tumors of the large intestine located in the ascending colon, transverse colon and descending colon, respectively, assuming that they are adenocarcinomas and the stage of the disease does not exceed T3NXM0 for any of them? a. endoscopic polypectomy. b. Transanal Endoscopic Microsurgery (TEM). c. colectomy. d. endoscopic insertion e. palliative treatment. 07H: The most common type of hiatal hernia is the hernia of: a. sliding b. of mixed type c. periesophageal d. Morgagni e. Bochdaleka 08T: Patient previously treated for pheochromocytoma. Currently, follow-up tests have shown hyperparathyroidism and an increase in calcitonin levels. The most correct first step will be: a. radio-chemotherapy. b. removal of the thyroid gland. c. radioiodine ablation. d. ultrasound of the thyroid and lymph nodes. e. dialysis therapy. 45V: Which of the following body injuries may be an indication for immediate emergency thoracotomy? a. blunt chest trauma. b. blunt abdominal trauma. c. blunt pelvic trauma. d. penetrating chest trauma leading to cardiac arrest. e. penetrating abdominal injury. 42T: Indicate the correct opinions regarding the indications for surgical treatment of accidentally detected adrenal tumor (so-called Incidentaloma): 1) malignant nature confirmed by biopsy; 2) confirmed hormonal activity; 3) diameter greater than 4cm; 4) diameter greater than 2cm; 5) each adrenal tumor is an indication for surgical treatment. The correct answers are: a. 1,2,3 -> not this b. 2.3 - most likely, biopsy contraindicated in case of malignant lesions c. 2.4 - this is also wrong d. 1,2,4 - shows me that it is fading e. 5 38S: Which of the following diseases or conditions is the most common cause of mechanical intestinal obstruction? a. intussusception and intestinal volvulus. b. strictures after diverticulitis and Crohn's disease. c. incarcerated hernias. d. intra-abdominal adhesions after previous operations. rather this, on questions from the drug this e. colon cancer. probably -> then no, confirmed by a test The most common complication of hemorrhoidal disease treatment using the banding method is: a. infection b. necrosis c. Fournier's gangrene d. anal abscess e. bleeding Open hemorrhoidectomy is hemorrhoidectomy using: a. Milligana-Morgana b. Banova c. Parks d. As Ferguson e. Jurasza According to the "step-up approach" protocol, the first choice in the treatment of patients with infected pancreatic necrosis is: a. drainage under ultrasound control. b. surgical excision. c. conservative treatment. d. antibiotic therapy. e. none of the above. The most serious long-term side effect of sleeve gastrectomy requiring revision bariatric surgery is: a. Have severe gastroesophageal reflux that is resistant to conservative treatment! b. Weight gain of 20 kg since the surgery c. Postoperative weight loss approximately 10% d. Correct A and B e. A, B and C correct 60O: In the case of sigmoid adenocarcinoma, the following procedures are performed: a. laparoscopic sigmoid resection. b. laparotomy and resection of the sigmoid colon. c. Hartmann procedure laparoscopically. d.laparotomy and Hartmann's procedure. e. all mentioned. Chemical inflammation of the peritoneal cavity appears in the first hours: a. in appendicitis b. in a perforation of the stomach wall c. in cholecystitis d. in perforation of the large intestine e. in splenic infarction 06V: For total parenteral nutrition (using a high osmolarity mixture), venipuncture is recommended: a. ulna. b. subclavicular. c. radial. d. main lower. e. saphenous. 03T: Typical complications of thyroidectomy do not include: a. hemorrhage. b. hypocalcemia. c. unilateral damage to the recurrent laryngeal nerve. d. bilateral damage to the recurrent laryngeal nerves. e. thyroid storm. 38PP: Indicate a disease that is not likely to be a complication of sigmoid diverticulitis: 1) Bleeding from the lower gastrointestinal tract; 2) Perforation of the diverticulum; 3) Enterovesical fistula; 4) Peri-diverticular abscess; 5) Post-inflammatory sigmoid stenosis. The correct answers are: a. 1,2,3 b. 1,2,4 c. 1,2,5 d. 1,2,4,5 e. All of the above are possible complications of sigmoid diverticulitis. 35PP: The most common colonic diverticula in the population are: a. acquired cecal diverticula. b. congenital sigmoid diverticula. c. congenital cecal diverticula. d. congenital diverticula of the transverse colon. e. acquired sigmoid diverticula. What are the indications for surgical treatment of acute pancreatitis? a.infected pancreatic necrosis b.perforation of the digestive tract c.stomach retention d.true A, B, C e.true A and B 46PP: Identify the true statement regarding Meckel's diverticulum: a.is a true diverticulum. b. is the most common developmental defect of the digestive tract. c.consists of all layers of the intestinal wall. d.its structure may contain elements of pancreatic tissue. e.all mentioned. 32T: The patient underwent thyroid ultrasound - a hypoechoic lesion with a diameter of 15 mm, higher than wide, was detected in the right lobe. No change is palpable. What will be the most appropriate course of action? a. Ultrasound-guided biopsy. b. Total thyroidectomy. c. Radioiodine treatment. d. Inspection in 6 months. e. No need to conduct further diagnosis of the lesion. Performing total pancreatectomy in the treatment of pancreatic cancer results in: a.the death of the patient in approximately 30 days if pancreas transplantation is not performed within this time b.the need for total parenteral nutrition for the rest of life c.the need to treat type 3 diabetes for approximately 4 weeks d.the need for treatment of type 3 diabetes and pancreatic enzyme supplementation for the rest of life e. following a low-protein diet and supplementing pancreatic enzymes for the rest of life The most common complication of diverticulitis is: a.Perforation b.Peri-intestinal abscess c. Bleeding from the large intestine d.Enterovesical fistula e.Narrowing of the large intestine 24PP: Diverticulitis of the large intestine most often manifests itself with: 1) pain in the left lower abdomen; 2) an admixture of blood in the stool; 3) painful resistance over the left iliac plate; 4) stopping wind and vomiting; 5) narrow stools. The correct answer is: a.1,2 b.2,3 c.3,4 d.1,3 e.1.5 33S: Select the true sentences: 1) perforation of a gastric ulcer is an indication for urgent surgical treatment; 2) the most common symptom of a perforated gastric ulcer is sudden, severe pain in the upper abdomen; 3) the basic additional examination enabling the diagnosis of gastric ulcer perforation is an abdominal X-ray; 4) a typical symptom of a perforated gastric ulcer on an X-ray is the presence of free air in the peritoneal cavity. The correct answer is: a.1,3 b.1,2,3 c.1,3,4 d.2,3,4 e.all mentioned 01B: A 45-year-old patient came to the Emergency Department with a boil in the right submandibular area. The place is red, painful, with a whitening of the top. Patient after implantation of an artificial aortic valve in the course of RA (inactive). During physical examination, there was a murmur consistent with an artificial valve in the 2nd intercostal space, on the right side of the sternum. Apart from that, the physical examination showed no changes. What should be the correct course of action in such a case? a. incision and drainage b.evacuation of the necrotic plug and serous content c. incision, drainage and anticoagulants d.oral antibiotic therapy and local antiseptics e.evacuation of the necrotic plug and purulent contents and oral antibiotic therapy 34W: Patient undergoing emergency surgery. The surgeon wants to perform the Pringle maneuver. What structures does it oppress? 1) splenic volume; 2) proper hepatic volume; 3) gastric volume; 4) f. right hepatic; 5) f. portal; 6) f. common hepatic; 7) common bile duct. a.1,2,3 b.1,2,3,4,5 c.2,6,7 d.2,5,7 e.2,5,6,7 24B: A 25-year-old patient came to the emergency room due to pain when sitting and defecation (for 3 days). Physical examination showed a nodular lesion on the buttock, located 3 cm from the anus, the skin over the lesion was unchanged. Rectal examination impossible to perform due to severe pain. What will be the correct, ad hoc procedure: a.antibiotic therapy. b. USG transrectal. c. incision and drainage. d.drainage under ultrasound guidance. e. rectal examination under anesthesia. Iatrogenic damage to the bile ducts most often occurs as a result of: a. the inflammatory process of the hepatoduodenal ligament b.developmental anomalies of the bile ducts c.lack of identification of the elements of Calot's triangle - d.anatomical variations of the vascularization of the liver and bile ducts e.lack of surgical skills of the surgeon f.all true A cystic lesion detected accidentally in the pancreas of a 30-year-old woman is most likely to be: a.pancreatic cancer b. pseudocyst c.IPMN type 1 d.mucous adenoma e.neuroendocrine tumor 49D: The method of choice in the diagnostic procedure leading to the confirmation of mechanical jaundice is: a. Abdominal ultrasound - not this b.endoscopic retrograde cholangio-pancreatography (ECRP) → I guess that's it c.CT of the abdominal cavity. d.percutaneous, transhepatic cholangiography. e.X-ray of the abdominal cavity. Diagnosis is done with MRCP but hey who knows.. Which of the following statements is false for Meckel's diverticulum? a.It is usually diagnosed incidentally. b.May present with pain, bleeding or inflammation. c.Located on the mesenteric edge of the small intestine. d.Often contains ectopic gastric mucosa. e.Meckel's diverticulumitis is treated surgically. What is the usual location? ○ Within ≈2 feet of the ileocecal valve on the antimesenteric border of the bowe ○ l What is the major differential diagnosis? ○ Appendicitis Is it a true diverticulum? ○ Yes; all layers of the intestine are found in the wall What is the incidence? ≈2% of the population at autopsy What is the gender ratio? ○ Twice as common in men What is the average age at onset of symptoms? ○ Most frequently in the first 2 years of life, but can occur at any age What are the possible complications? ○ Intestinal hemorrhage (painless)—50%; accounts for half of all lower GI bleeding in patients younger than 2 years ○ Bleeding results from ectopic gastric mucosa secreting acid → ulcer → bleeding Intestinal obstruction—25%; most common complication in adults; includes volvulus and intussusception ○ Inflammation (± perforations)—20% What are the signs/symptoms? Lower GI bleeding, abdominal pain, SBO What is the most common complication of Meckel’s diverticulum in adults? ○ Intestinal obstruction In what percentage of cases is heterotopic tissue found in the diverticulum? ○ >50% What heterotopic tissue type is most often found? ○ Gastric mucosa (60%), but duodenal, pancreatic, and colonic mucosa are also found What is the “rule of 2s”? ○ 2% of patients are symptomatic ○ Found ≈2 feet from the ileocecal valve ○ Found in 2% of the population ○ Most symptoms occur before age 2 years ○ Ectopic tissue found in 1 of 2 patients ○ Most diverticula are ≈2 inches long ○ 2:1 male-to-female ratio What is the role of incidental Meckel’s diverticulectomy (surgical removal upon finding asymptomatic diverticulum)? ○ 1. Most woul removing children ○ 2. Adults: Ectopic tissue (fullness) or Mesodiverticular band What is a Meckel’s scan? ○ Scan for ectopic gastric mucosa in Meckel’s diverticulum; uses technetium pertechnetate IV, which is preferentially taken up by gastric mucosa What is the treatment of a Meckel’s diverticulum that is causing bleeding and obstruction? ○ Surgical resection, with small bowel resection as the actual ulcer is usually on the mesenteric wall opposite the diverticulum! 10P: According to the "step-up approach" protocol, the first choice in the treatment of patients with infected pancreatic necrosis is: a.drainage under ultrasound control. b.surgical excision.NO c.conservative treatment. d.antibiotic therapy. e.none of the above. 33T: The following tests or procedures should be performed in preparation for splenectomy for essential thrombocytopenia, except: a. Doppler ultrasound to assess possible thrombosis in the portal vein. b. Vaccinations against pneumococci, Haemophilus influenza and hepatitis B. c. Scintigraphic examination of the uptake of labeled platelets by the spleen and liver. d. Perioperative antibiotic prophylaxis. e. Preparation of 2 RBC units. 63O: Indicate the correct sentences referring to carcinoid tumor: (1) it is usually a benign tumor, only about 10% of tumors show signs of malignancy; (2) typical clinical symptoms include flushing, tachycardia, and diarrhea; (3) is most often located in the appendix; (4) has the property of producing adrenaline; (5) small tumors with a diameter of less than 2 cm are relatively non-malignant. a. 1, 2, 3 b. 1, 3, 4 c. 2, 3, 5 d. 3, 4, 5 e. 1, 2, 5 Carcinoid triad ○ Diarrea ○ RSHF ○ Flushing What is carcinoid syndrome? ○ Syndrome of symptoms caused by release of substances from a carcinoid tumor What are the symptoms of carcinoid syndrome? ○ Bronchospasm ○ Flushing (skin) ○ Diarrhea ○ Right-sided heart failure (from valve failure) -> Tricuspid Insufficiency, Pulmonary Stenosis What is the most common appendiceal tumor? ○ Carcinoid tumor -> also in Ileum,. Rectum, Bronchus ○ What is the treatment of appendiceal carcinoid 1.5 cm? ○ Right hemicolectomy What percentage of appendiceal carcinoids are malignant?  ○ 5 cm) of the rectus abdominis muscles and involves suturing the sheaths of both muscles The prognostic factor in acute pancreatitis is not: a. presence of effusion in the left pleural cavity. b. occurrence of Cullen and Grey-Turner symptoms. c. serum lipase and amylase activity. d. BMI. e. percentage of necrosis in the pancreatic parenchyma. Thyroid storm can be caused by: a. improper treatment of hyperthyroidism. b. stress in patients with hyperthyroidism. c. when euthyroidism was not achieved before surgery. d. in case of sudden discontinuation of thyrostatic drugs. e. all answers correct. The Billroth I operation is a surgical procedure consisting of, among others: performing the anastomosis: a. esophagus - jejunum. b. esophagus - ileum. c. stomach - jejunum. d. stomach – duodenum. e. stomach - ileum. Inguinal hernias: 1) are several times more common in men than in women; 2) only large hernias extending into the scrotum should be operated on; 3) the best results are achieved by operations using plastic mesh; 4) always threaten with imprisonment; 5) surgery is most often performed laparoscopically. The correct answer is: a. 1,2,3. b. 1,3,4. c. 2,4,5. d. 1,2,5. e. 2,3,4. Is cholecystectomy indicated in asymptomatic patients with a gallbladder with a non-thickened wall filled with numerous small deposits described in ultrasound examination? 1) yes, with polyps larger than 1 cm; 2) never; 3) yes, in the case of patients awaiting cardiac surgery; 4) yes, in patients requiring immunosuppressive treatment. The correct answer is: a. only 2 b. 1,3 c. 1,3,4 d. 3,4 e. only 1 Indicate which of the following diseases is not an indication for surgical treatment in the case of thyroid inflammatory diseases: a. formation of an abscess within the gland. b. symptoms of pressure on adjacent organs. c. loss of thyroid gland tissue. d. formation of an external fistula as a result of an abscess penetrating the inflamed parenchyma. e. suspicion of cancer. On the second day of treatment for acute pancreatitis in the intensive care unit, the patient reports tingling around the mouth, paresthesia of the fingers of both hands and cramps in the lower limbs. ECG shows sinus bradycardia and QT prolongation. The treatment of choice is: a. calcium salt intravenously. b. changing antibiotic therapy. c. dialysis therapy. d. antiarrhythmic drugs. e. tlenoterapia. To decompress the bile ducts, the following are used: a. Hegar probe. b. dren Kehra. c. dren Redona d. Tiemann catheter. e. Pezzer catheter. Familial adenomatous polyposis of the large intestine is characterized by: 1) the presence of very numerous hyperplastic polyps in the large intestine; 2) the presence of up to 100 adenomatous polyps in the large intestine; 3) presence of more than 100 adenomatous polyps in the large intestine; 4) the risk of developing colorectal cancer in the 3rd or 4th decade of life in almost 100% of patients; 5) the presence of discoloration on the lips, face and cheek mucosa. The correct answer is: a. 1,4,5 b. 2,4,5 c. 3,4,5 d. 1,4 e. 3,4 22V: The burn on the front surface of the torso and both upper limbs is a part of the total body surface area (according to the "rule of nines") of approximately: a. 10%. b. 18%. c. 27%. -> tror denna, står inget om backsidan torso… d. 36%. e. 45%. 18D: Which of the following tests is the least useful in the diagnosis of mechanical gastrointestinal obstruction - assessment in terms of verification, nature, location, and passage of food content: a. Abdominal X-ray. b. contrast rectal enema. c. auscultation of the abdomen (the nature of peristalsis sounds). d. CT scan of the abdominal cavity without contrast. - strange, but that's what the database says e. passage of the digestive tract. Detta svaret är fakking weird 11H: Hernia in the postoperative scar: 1) is a common consequence of postoperative wound suppuration; 2) treated with an abdominal hernia belt; 3) may be a site of intestinal entrapment; 4) treated with voltage-free methods; 5) is a common cause of bleeding into the peritoneal cavity. Correct answer: a. odp 1,2,5 b. odp 1,3,4 c. odp 1,4,5 d. odp 1,3,5 e. odp 1,2,3 The recurrent laryngeal nerve crosses: a. Inferior thyroid artery b. Superior thyroid artery c. Inferior thyroid vein d. Facial artery The hormonal transmitter secreted by glands located at the bottom of the stomach, the activity of which is responsible for the feeling of hunger, is: a. Insulin b. Ghrelin and Pankreozymina (cholecystokinin (CCK): secreted from duodenum) c. Ghrelin - wrong (?) d. Glucagon-like peptide 1 (GLP-1) - no e. Glucagon-like peptide 2 (GLP-2) 25O: Correct statement regarding breast cancer: 1) one of the most common malignant tumors in European women 2) most often it develops on the basis of fibroadenoma 3) prognosis depends on the stage of advancement 4) the risk of developing the disease increases with genetic predisposition 5) it never occurs in men Correct answer: a. 1,2,3 b. 2,3,4 c. 3,4,5 d. 1,3,4 e. 1,4,5 Indications for surgical treatment in chronic pancreatitis are: a. dilatation of the pancreatic duct, no pain, diabetes b. lack of dilatation of the pancreatic duct, diabetes c. widening of the pancreatic duct, pain d. autoimmune pancreatitis, no pain e. autoimmune pancreatitis, pain A 75-year-old man underwent right hemicolectomy for stage 3 colon cancer. A history of COPD requiring chronic steroid use, diabetes, and coronary artery disease. On the 2nd postoperative day, serous-bloody discharge from the wound appeared, with no signs of wound infection. Which of the following factors likely caused this complication? a. Sewing the postoperative wound with a continuous suture. b. Coronary artery disease. c. Early mobilization of the patient on the 1st postoperative day. d. Injury during aggressive physical examination on postoperative day 1. e. COPD. 11T: A complication after parathyroid surgery is not: a. temporary hypoparathyroidism. b. permanent hypoparathyroidism. c. recurrence of hyperparathyroidism. d. Hypothyroidism. e. damage to the recurrent laryngeal nerve. Select the true statements: 1) CT scan is the gold standard in the diagnosis of diverticulitis; 2) In the diagnosis of diverticulitis, the gold standard is colonoscopy; 3) Each patient after an episode of diverticulitis should be qualified for surgical treatment; 4) In the treatment of diverticulosis of the large intestine, surgical treatment is recommended; 5) The procedure of choice in the treatment of diverticulitis is the Hartmann procedure. a. 1 b. 1,2 c. 1,2,4,5 d. 3,4,5 e. 4,5 02B: A 20-year-old patient came to the Emergency Department due to the diagnosis of a boil in the right parietal area. What should be the correct course of action in such a case? a. incision and drainage. b. evacuation of the necrotic plug and evacuation of purulent contents. c. excision of the lesion with local skinplasty. d. oral antibiotic therapy and local antiseptics. e. evacuation of the necrotic plug and purulent contents and antibiotic therapy. 11B: What anesthesia for partial removal of the nail of the first toe of the right foot in paronychia: a. conduction anesthesia (Oberst method). b. local infiltration anesthesia. c. soaking with ethyl chloride. d. local infiltration anesthesia or ethyl chloride infiltration. e. no anesthesia is necessary. 22D: Mechanical intestinal obstruction is characterized by: 1) constant abdominal pain; 2) wave-like abdominal pain; 3) gas and stool retention; 4) hyperkalemia; 5) bradycardia. The correct answer is: a. 2,3 b. 2,4 c. 3,4 d. 1,4 e. 2,5 31B: Prevention of thromboembolic complications consists of: a. early launch. b. administration of low molecular weight heparin. c. use of intermittent pneumatic compression. d. using compression stockings. e. all answers are correct. 16S: Symptoms of mechanical intestinal obstruction include: 1) increased white blood cell count; 2) wave-like abdominal pain; 3) gas and stool retention; 4) hyperkalemia; 5) bradycardia. The correct answer is: a. 2,3 b. 2,4 c. 3,4 d. 1,3 e. 2,5 A 75-year-old man underwent right hemicolectomy for stage 3 colon cancer. A history of COPD requiring chronic steroid use, diabetes, and coronary artery disease. On the 2nd postoperative day, serous-bloody discharge from the wound appeared, with no signs of wound infection. You suspect that the patient has: a. Paralytic obstruction - NO b. Seroma in the wound - NO c. Gangrene of the wound d. Eventration e. Hernia in the postoperative wound - NO In the treatment of anal fissure, the following are used: 1) Beta-blockers; 2) Calcium channel blockrey; 3) Botulinum toxin; 4) Alpha-blockers; 5) Nitroglycerin; 6) Adrenaline. a. 1,2,3 b. 2,3,4 c. 2,3,5 d. 3,4,6 e. 1,2,3,4,5 32PP: The recommended minimum BMI value qualifying for surgical treatment of obesity without comorbidities is: a. 50 b. 45 c. 40 d. 35 e. 30 Indicate the completely correct sentence about the treatment of diffuse peritonitis. Diffuse peritonitis is an indication for: a. Urgent surgical treatment, because untreated diffuse peritonitis almost always ends in death. b. Surgical treatment only if gas is found under the dome of the diaphragm. c. Conservative treatment if there is no gas under the dome of the diaphragm and leukocytosis is less than 10G. d. Surgical treatment if the clinical condition does not improve after 24 hours of observation e. Conservative treatment if the concentration of pancreatic amylase in urine exceeds 5000 IU and leukocytosis exceeds 20 G. 06H: Tension-free hernia surgery methods include: 1) Bassini; 2) Lichtenstein; 3) Shouldice; 4) Rutkowa; 5) Halsett. Correct answer: a. odp 1,2 b. odp 2,3 c. odp 2,4 d. odp 3,4 e. odp 4,5 23PP: Select a set of features characterizing Crohn's disease: 1) lesions may occur in any section of the digestive tract; 2) changes are limited to the mucosa and submucosa; 3) they are often accompanied by perianal fistulas; 4) in the case of this disease, the principle of sparing procedures applies; 5) in the case of this disease, extensive resection procedures are indicated. The correct answer is: a. 1,2,4 b. 2,3,4 c. 2,3,5 d. 1,3,4 e. 1,2,3,4 A complication after liver transplantation is not: a. infection with opportunistic microorganisms. b. acute and chronic rejection. c. graft-versus-host disease d. inflammation of the gallbladder. e. recurrence of the underlying disease. 45D: A quite common cause of non-specific abdominal pain are functional disorders of the gastrointestinal tract resulting from a dietary error. Which of the following statements represents the most reasonable management of the patient in such cases? a. Clinical examination and - if no significant pathologies are found - discharge with a prescription for metamizole (Pyralgina) and drotaverine (No-spa). It does not b. Testing biochemical parameters of inflammation (leukocyte count, CRP), symptomatic treatment (analgesic and antispasmodic). If there are no changes in the tests and the symptoms disappear, discharge home. c. Overview X-ray and abdominal ultrasound, symptomatic treatment (analgesic and antispasmodic). If there are no changes in the tests and the symptoms disappear, discharge home. d. CT scan of the abdominal cavity, symptomatic treatment (analgesic and antispasmodic). If there are no changes in the examination and the symptoms disappear, discharge home. e. Admission to hospital to the internal ward and implementation of full diagnostics for possible abdominal diseases. An 8-year-old patient was admitted to the Emergency Department, BP 80mmHg, HR 110min, no pain. In the interview, the patient reports that he vomited black content, became weak, bu