27yer old mn complined of ching epigstric pin just fter mel hertburn nd nuse
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1. A 27-year old man complained of aching epigastric pain just after meal, heartburn, and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Establish the diagnosis?
+Chronic type A gastritis
Chronic type B gastritis
Peptic ulcer of the stomach
Chronic type C gastritis
Menetrier’s desease
2. A 60-year-old woman, mother of 6 children, developed sudden onset of upper abdominal pain radiating to the back, associated with nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temperature of 38,9C, along with right upper quadrant tenderness. Most likely diagnosis?
Benign biliary structure
+Choledocholithiasis
Malibnant biliary stricture
Carcinoma of the head of the pancreas
Choledochal cyst
3. Patient with 48 years of age ,complains of intensive skin itching, jaundice and bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrarum. The liver is +6sm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/l per hour, AST-2,1 mmol/l, ALT-1,8 mmol/l, alkaline phosphotase 4,6 mmol/l per hour, cholesterol -9,2 mmol/l, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
Alcoholic liver cirrhosis
Primary liver cancer
Chronic viral hepatitis B
Acute viral hepatitis B
+Primary biliary liver cirrhosis
4. The man of 25 years old complains of periodic epigastric pain. At inspection the chronic gastritis with the increased acidity is revealed. The patient is treated. What preparation is expedient for using for primary preventive maintenance of a stomach ulcer?
Vicalinum
Cerucal
+Famotidin
Maalox
Gastrophan
5. A sick man who is 43, started to complain to his therapist about the heaviness in the stomach after a meal, bad belching, vomiting the food he had eaten the day before. He has suffered from ulcer of duodenum for 10 years. He has applied to the doctor 2 times but he began to feel worse from the last month. What pathology must it be?
Achalasia of the gullet
Gullet cancer
Stomach cancer
+Ulcerous stenosis of the exit part of the gullet
Reactive pancreatitis
6. A patient 33 years old was admitted to the hospital. Patient is pale, at an attempt to stand up complains about strong dizziness. There was approximately hour ago vomiting like coffe- grounds. BP-90/60 mm hg, pulse -120b/min. It is known from anamnesis that patient since 4 years suffering with ulcerous illness of the stomach, painless form. An ulcer was exposed at fibrogastroscopy. Your diagnosis?
Ulcerous illness of duodenum, complicated with bleeding.
+Ulcerous illness of stomach, complicated with bleeding
Erosive gastritis
Acute pleurisy
Acute myocardial infarction, abdominal form
7. Patient, 48 years old. complains about the decline of appetite, heaviness in an epigastric region after a meal, pain in right hypohondrium, aching character, increasing after meal, especially fat .Experinces nausea, flatulence, disorders of stool and loss of weight. At examination –jaundice of skin, vascular spiders, gynecomastia, ascities, “caput medusea” were revealed. The liver at palpation is painless, dense, an edge is sharp and the spleen is enlarged. Your preliminary diagnosis.
Acute hepatitis A
Chronic active hepatitis
+Liver cirrhosis
Acute cholecystitis
Acute pancreatitis
8. A 5 years old teacher consulted a department therapist about a corresponding diet. Complains: frequent constipations( defecation once in 2-3 days), flatulence and unpleasant aftertaste; blunt pain occurs in the lower half of abdomen after intake of ice cream or soda drinks. At 17-20 she was treated for duodenal ulcer. Objective data: height 164cm, weight 62 kg, abdomen is oval, palpation doesn’t detect pathological changes. What diet is necessary into acute priod?
Table 9 by Pevzner
Table 4a by Pevzner
General Table
Table 2 by Pevzner
+Table 4 by Pevzner
9. Patient, 45 years old, was delivered by an ambulance with complains of pain in the epigastrium, vomit occurs at the height of pain with impurity of blood; heartburn, weakness, dizziness, “black stool” in the morning. He has been ill for 10 years, nutrition is irregular. What complication has developed in the patient?
Thrombocytopenia
Intestinal bleeding
Bleeding from esophageal veins
Bleeding from hemorrhoidal veins
+Gastric bleeding
10. A 39y.o. woman complains of squeezed epigastric pain occurring 1 hour after meal and heartburn. She has been ill for 2 years. On palpation, there was moderate tenderness in pyloroduodenal area. Antral gastritis was revealed on gastroscopy. What study can establish genesis of the disease?
Examination of motor function of stomach
Examination of secretion of stomach
+Revealing of Helicobacter infection in gastric mucosa
Gastirn level in Blood
Detection of autoantibodies in the serum
11. A patient with hepatic cirrhosis drank some spirit that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of hepatic cirrhosis is meant?
+Hepatocellular insufficiency
Hemorrhage from varicosely dilatated veins of esophagus
Acute stomach ulcer
Thrombosis of mesenteric vessels
Portal hypertension
2. A 45 y.o. man complains of having intensive pain in the epigastric region occurs 1,5-2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively : temperature 36,5C, RR- 16/min, Ps- 70 bpm, AP-120/80 mm hg. On palation local painfulness in the right epigastric region is revealed. What parameters of intragastric PH-meter in the region of stomach body are the most typical for this patient’s disease?
pH = 6,0-7,0
pH = 5,0-6,0
pH = 3,0 -4,0
pH = 4,0 -5,0
+pH = 1,0 –,0
13. A 50 y.o. woman for complained of attacks from 1 year of right subcostal pain after fatty meal. Last week the attacks have repeated every day and became more painful. What diagnosis study would you recommend?
X-ray examination of the gastrointestinal tract
+Ultrasound examination of the gallbladder
Ultrasound study of the pancreas
Blood cell count
Liver function tests
14. A 56 y.o. man, who has been taking alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen, profuse non formed stool 2-3 times a day have appeared for the last 2 years and also has lost weight about 8 kg in 2 years. On examination: abdomen is soft, painless. Blood amylase –g/l. Feces examination – neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?
Contrykal
+Pankreatin
Imodium
Levomicytine
Aminocapron acid
15. A 27 y.o. patient complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter pylori. What can be diagnosed in this case?
Reflux-gastritis
Rigid antral gastritis
Gastritis of A type
Menetrier’s disease
+Gastritis type B
16. A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liquid foamy feces with sour smell following the dairy products consumption. What is the correct name of this syndrome?
Malabsorption syndrome
Syndrome of decayed dyspepsia
Dyskinesia of fermentative dyspepsia
+Syndrome of fermentative dyspepsia
Syndrome of fatty dyspepsia
17. A man, 42 years old, died in a road accident on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?
+10-14%
-20%
-30%
-9%
-50%
18. Classical X-ray image of intestinal obstruction is:
+Gas and horizontal levels
Filling defect
High positioned diaphragm
Reactive pleuritis
Pneumatosis
19. A 45-year-old man from 1 month has complains of epigastric and right subcostal aching pain, pruritus, indigestion, dark colored urine and acholic stool, fever, and significant weight loss. On exam: jaundice, presence of Courvoisier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?
+Cancer of the pancreas head
Gallbladder stones
Chronic pancreatitis
Chronic cholangitis
Chronic hepatitis
20. A 62 years old woman complains of severe constant pain in the right hypochondrium, jaundice, discoloration of stool and dark urine, mild fever up to 37,5оС. Above mentioned complaints were appeared after an attack of severe abdomen pain connected with fatty food intake. On clinical examination the abdomen is soft. A painful enlarged gall bladder is palpated. The Ortner, Kerr’s symptoms are positive. What is the probable diagnosis?
+Acute cholecystitis, choledochus calculi and obstructive jaundice
Infectious hepatitis
Liver cancer
Liver abscess
Liver cirrhosis
21. A 75 year old man who had developed diabetes within last 6 months was found to be jaundiced. He has remained asymptomatic ,expect for weight loss about 10 pounds in 6 months. On physical examination he is found to have a non- tender ,globular ,right upper quadrant mass that moves with respiration. The CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. Suspect the diagnosis:
+Carcinoma of the head of the pancreas
Metastatic disease of the liver
Pancreatitis
Choledocholithiasis
Hemolytic jaundice
22. The patient has peptic ulcer of stomach with frequent recurrences. Course of anti-recurrent therapy must be:
+Once in 3 months
Twice a year
Each year
Each month
After each recurrence
23. A 34 years old patient has been admitted to clinic with complaints of heaviness in the right subcostal area, nausea and emesis after intake of fried pork; dark urine and light feces. He was ill with viral hepatitis half a year ago, but wasn’t on a diet. Objectively: Scleras are subicteric. Abdomen is with continent inflation. Liver is +2cm of costal arc margin on right midclavicular line. Its surface is smooth and it has an elastic consistence. What disease would you think about?
+Chronic hepatitis
Cirrhosis of liver
Active hepatitis
Chronic cholecystitis
Chronic pancreatitis
24. A 60 year old woman was admitted in the hospital with abdominal cramps, watery diarrhea and flushing with episodes of wheezing. Select the appropriate diagnosis:
+Carcinoid syndrome
Gastroenteritis
Uclerative colitis
Lactose intolerance
Short gut syndrome
25. A 20- year old woman with 3-4 months history of bloody diarrhea ,stool examination negative for a ova and parasites,stool culutre negative for Clostridium,Campylobacter and Yersinia,normal bowel series edema,hypermia and ulceration of rectum and sigmoid colon seen on sigmoidoscopic examination .what is your diagnosis?
+Ulcerative colitis
Gastroenteritis
Carcinoid syndrome
Granulomatous colitis
Lactose intolerance
26. Which of the diseases doesn’t trigger cancer of the rectum:
+Amebiasis
Diffusive family polyposis
Crohn's disease
Ulcerative colitis
Immunodeficiency
27. Rectoromanoscopy showed a 1 cm polyp in the patient. On histological examination there was found an adenomatous polyp. The further reasonable step in treating this patient can be?
+Irrigoscopy
Rectum resection
Endoscopy polypectomy
Repeated analysis of the occult blood in feces
Repeated rectoromanoscopy
28. The complications of acute cholecystitis which require surgical intervention are as follows except:
+Jaundice
Empyema of the gall-bladder
Emphysematous gall-bladder
Gall-bladder perforation
Cholangitis conditioned by the presence of stones in the bile tract
29. The serologic profile of the patient having been inoculated with recombinant vaccine against hepatitis B HBV includes the positive result of the test for:
+anti-НВс
HBsAg
anti-HBe
anti--HBs
anti - HBc and anti -HBs
30. Which of the following substances (drugs) can cause granulomatous hepatitis?
+allopurinolum
alchohol
paracetamol
methyldopha
cordaron
31. The patient is 36 years old. For a few years he has complained of heaviness and a dull ache in the abdomen. The liver is enlarged, hard and has an uneven surface. CT (computer tomography) has shown multiple pathological changes in the organs of abdominal cavity. The correct diagnosis is:
+polycystosis of the liver;
cirrhosis of the liver;
multiple metastases of liver cancer;
echinococcosis of the liver;
acute hepatitis.
32. Splenomegaly, the low RBC (red blood cells) count, the high content of urobilinogen in feces of the patient with jaundice are the symptoms of:
+hemolytic jaundice
extrahepatic cholestasia
intrahepatic cholestasia
sepsis
mechanical jaundise
33. A boy 15 years old periodically has been complaining of the epigastric pain, nausea and heartburn. Gastroduodenoscopy revealed the signs of gastroduodenitis and ulceration of the duodenal mucous membrane. What drug will be the most effective in the treatment of this patient?
+De-nol
Nos-pa
Papaverin
Atropin
Almagel
34. The 52 years old patient has been admitted to the hospital. He complains of vomiting, soft black repeated stools (melena) during the day. Such cases have never been seen before. The pulse rate is 96 beats per minute, the blood pressure 100/70 mm Hg. On finger examination of the rectum black feces was found. The appropriate examining is:
+Esophagogastroduodenoscopy
rectoromanoscopy
irrigoscopy
roentgenoscopy of the stomach
laparoscopy
35. The patient 48 years old, complains about the decrease in appetite, heaviness in an epigastric region after meal, pain in right hypochondrium, aching character, increasing after meal, especially fat, nausea, flatulence, disorders of stool, loss of weight. At examination –pallor skin, vascular spiders, gynecomastia, ascites, “caput medusae”. The liver at palpation is painless, dense, an edge is sharp, the spleen is enlarged. Your preliminary diagnosis:
+Liver cirrhosis
Chronic active hepatitis
Acute hepatitis A
Acute cholecystitis
Acute pancreatitis
36. The patient 38 years old, complains about dull, aching pain in the area of right hypochondrium, permanent or arising up in 1-3 hours after the reception of abundant and especially fat food and fried dishes. Pain radiates upwards, in the region of right shoulder and neck. In addition, often disturbs feeling of bitter taste and metallic taste into the mouth, belch with air, flatulence. At palpation of abdomen, tenderness in the area of projection of gall bladder is found. The liver is not enlarged and spleen is not palpable. Your preliminary diagnosis:
+Chronic cholecystitis
Cirrhosis of liver
Acute hepatitis
Chronic hepatitis
Acute cholecystitis
37. A patient is 65 y.o. He has been smoking from last 40 years. Now he has lost 10kg during the last 3 months. He complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogen reaction. Where is the initial process that caused these changes?
In gallbladder
+In pancreas
In duodenum
In common bile duct
In liver
38. A 40 y.o. patient was admitted to the gastroenterology with the complaints of skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is pale, traces of stratches, liver is +5sm, spleen is 6x8cm. In blood: alkaline phosphatase -2,0mmol/l, general bilirubin - 60 mkmol/l, cholesterol -8,0 mmol/l. What is leading syndrome in the patient?
Mesenchymal inflammatory
Cystolic
Asthenic
Liver-cells insufficiency
+Cholestatic
39. A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, especially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?
+Esophagus achalasia
Myastenia
Cancer of esophagus
Esophagus candidosis
Gastroesophageal reflux
40. A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day; stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?
+Irritable bowels syndrome
Celiac disease
Crohn's disease
Pseudomembranous colitis
Dispancreatism
41. A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin. He had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?
+Liver cirrhosis
Cancer of the liver
Cancer of the head of pancreas
Gallstones
Viral hepatitis B
42. In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and at night. He complains of pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food; it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue.
Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles the same region. What is the most likely diagnosis?
+Duodenal ulcer
Chronic cholecystitis
Diaphragmatic hernia
Stomach ulcer
Chronic pancreatitis
43. A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation. There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?
+Esophagogastroduodenoscopy with biopsy
Ultrasound examination of abdomen
pH-metry
Ureatic test
Stomach X-ray
44. A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?
+Ultrasonic
Roentgenological
Radionuclid
Magnetic-resonance
Thermographic
45. 4 hours after having meals a patient with signs of malnutrition and steatorrhea experience stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?
+Chronic pancreatitis
Chronic gastroduodenitis
Duodenal ulcer
Zollinger-Ellison syndrome
Chronic calculous cholecystitis
46. A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?
+Irritable colon syndrome
Chronic enteritis
Chronic pancreatitis
Chronic atrophic gastritis
Colorectal cancer
47. A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale; the patient is of thin build. Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb - 110 g/l, RBCs - 3,4*1012/l, WBC count is normal. ESR - 16 mm/h. What is the most informative study that will allow making a diagnosis?
+Esophageal gastroduodenoscopy
X-ray of digestion organs
Study of gastric juice
pH-metry
Duodenal probing
48. A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged. What study is required to make a diagnosis?
+Esophagogastroduodenoscopy along with biopsy
Clinical blood test
X-ray of digestive tract organs
X-ray in Trendelenburg's position
Study of gastric secretion
49. A 40-year-old man is ill with autoimmune hepatitis. Blood test: А/G ratio 0,8, bilirubin – 42 mmol/L, transaminase : ALT- 2,3 mmol g/L, АSТ - 1,8 mmol g/L. What is the most effective means in treatment from the given below?
+Glucocorticoids, cytostatics
Antibacterial medication
Hepatoprotectors
Antiviral medications
Hemosorbtion, vitamin therapy
50. A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis - 13,1*109/l, ESR- 28 mm/h. What is the most likely diagnosis?
+Chronic calculous cholecystitis
Chronic recurrent pancreatitis
Fatty degeneration of liver
Chronic cholangitis, exacerbation stage
Hypertensive dyskinesia of gallbladder
51. A male patient complains of heartburn which gets stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disorder should be expected at gastroscopy?
+Gastroesophageal reflux
Chronic gastritis
Gastric peptic ulcer
Acute erosive gastritis
Duodenal peptic ulcer
52. A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
+Irritable bowel syndrome
Spastic colitis
Colitis with hypertonic type dyskinesia
Chronic enterocolitis, exacerbation phase
Atonic colitis
53. A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous month. Objectively: body temperature - 37,4oC, malnutrition, skin is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3 cm below the costal margin. What is the most likely diagnosis?
+Non-specific ulcerative colitis.
Bacillary dysentery.
Sprue.
Intestinal enzymopathy.
Helminthic invasion.
54. Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?
+Chronic type A gastritis.
Chronic type B gastritis.
Chronic type C gastritis.
Menetrier disease.
Stomach cancer.
55. A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomiting without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?
+Perforative ulcer.
Acute cholecystitis.
Acute bowel obstruction.
Acute appendicitis.
Right-sided renal colic.
56. A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left, that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis. Blood amylase is 4 g/h*l. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated for this patient?
+Panzinorm forte.
Insulin.
Gastrozepin.
Contrycal.
No-spa.
57. A 28-year-old patient has been hospitalized for the pain in the epigastric region. He has a 10-year history of duodenal ulcer (DU). Recently, the pain character has changed: it became permanent, persistent, irradiating to the back. There are general weakness, dizziness, fatigue. The patient has put off weight. Objectively: HR- 68/min, AP- 120/80 mm Hg. What is most likely cause of deterioration?
+Penetration.
Hemorrhage.
Perforation of duodenal wall.
Exacerbation of duodenal ulcer.
Stenosis development.
58. A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated: she developed convulsions, mental confusion, progressing jaundice. What study may give reasons for such aggravation?
+Determination of serum ammonia.
Determination of cholesterol ethers.
Determination of alpha-phetoprotein.
Determination of ALAT and ASAT.
Determination of alkaline phosphatase.
59. A 35-year-old patient complains of heartburn, sour eructation, burning, compressing retrosternal pain and pain along the esophagus rising during forward bending of body. The patient hasn't been examined, takes Almagel on his own initiative, claims to feel better after its taking. Make a provisional diagnosis:
+Gastroesophageal reflux disease.
Functional dyspepsia.
Cardiospasm.
Gastric ulcer.
Duodenal ulcer.
60. A patient complains of retrosternal pain, difficult swallowing, over 10 kg weight loss within three months, general weakness. In blood: hypochromic anemia, neutrohilic leukocytosis. In feces: weakly positive Gregersen's reaction. On esophagram a filling defect with ill-defined serrated edges shows up along a large portion of the esophagus. What is the most likely diagnosis?
+Esophageal carcinoma.
Benign tumor.
Esophageal achalasia.
Peptic ulcer.
Sideropenic dysphagia.
61. A 60-year-old patient complains of nearly permanent sensation of heaviness and fullness in the epigastrium, that increases after eating, foul-smelling eructation, occasional vomiting with food consumed 1-2 days ago, weight loss. 12 years ago he was found to have an ulcer of pyloric channel. The patient has taken ranitidine for periodic hunger pain. The patient's condition has been deteriorating over the last 3 months. Objectively: splashing sound in the epigastrium is present. What kind of complication is it?
+Pyloric stenosis.
Penetration of gastric ulcer.
Functional pyloric spasm.
Foreign body in the stomach (bezoar).
Malignization of gastric ulcer.
62. Patient with intestinal dysbiosis intended therapy. Which of these drugs do not have to be assigned?
+Prednisone
Baktysubtil
Hilak
Laktobatsylys atsydofylys
Linex
63. A 20-year-old woman has a 3-4 month history of bloody diarrhea; stool examination proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:
Zollinger-Ellison syndrome
Gastroenteritis
Carcinoid syndrome
+Ulcerative colitis
Granulomatous colitis
64. A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC- 9,8*109/l, RBC- 3,0*1012/l, ESR - 52 mm/hour. What medication provides pathogenetic treatment of this patient?
Vikasolum
Motilium
+Sulfosalasine
Linex
Kreon
65. Plan radiography of the patient's abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
+Intestinal obstruction
Perforative ulcer
Meteorism
Cancer of large intestine
Price's disease
66. A patient complains of feeling heaviness behind his breast bone, periodical sensation of food stoppage, dysphagy. During the X-ray examination barium contrast revealed a single saccular outpouching of anteriodextral esophagus wall with regular contours and rigidly outlined neck. What is the most probable diagnosis?
+Esophageal diverticulum
Cancer of esophagus
Hiatal hernia
Varix dilatation of esophageal veins
Esophageal polyp
67. 46 y.o. woman complaines of regurgitation and heartburn. She had been ill for 2 years. On palpation there was absent of tenderness in pyloroduodenal area. Nothing was revealed on gastroscopy. What study can establish diagnosis of the disease?
Revealing of Helicobacter infection in gastric mucosa
+24H pH-monitoring
Gastrin level in blood
Examination of stomach secretion
Examination of stomach motor function
68. A patient suffering from gastroesophageal reflux has taken from time to time a certain drug that "reduces acidity" for 5 years. This drug was recommended by a pharmaceutist. The following side effects are observed: osteoporosis, muscle weakness, and indisposition. What drug has such following effects?
Gastrozepin
Metoclopramide
+Inhibitor of proton pump
H2-blocker
Aluminium-bearing antacid
69. A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphasia and weight loss since 4 months. Suggested diagnosis?
Esophagitis
Esophageal diverticulum
Esophageal achalasia
+Cancer of the esophagus
Hanter's disease
70. «Gold triad» in diagnostics of Cholangitis is:
Biliary colic, jaundice and leukocytosis
+Biliary colic, jaundice and fever
Biliary colic, fever and leukocytosis
Fever, jaundice and leukocytosis
Fever, jaundice and diarrhea
71. What treatment is prescribed for the patient of 63 years of age with an attack of biliary colic, caused by gall-bladder stones?
+Conservative treatment
Emergency operation
Urgent operation after cupping an attack
Antienzyme therapy
Laparoscopic cholecystotomy
72. «Gold triad » in diagnostics of Cholecystitis is:
Biliary colic, jaundice and leukocytosis
Biliary colic, jaundice and fever
+Biliary colic, fever and leukocytosis
Fever, jaundice and leukocytosis
Fever, jaundice and biliary colic
73. The Unconjugated Hyperbilirubinemia develops in:
Dubin-Johnson syndrome
+Gilbert syndrome
Rotor's syndrome
Hepatitis
Common bile duct stone or pancreatic cancer
74. The informative symptom in differentiation of Gallstone disease and Acalculous Cholecystitis is:
+Presenting of gallstones
Biliary colic
Kerr’s sign
Fever
Increasing temperature
75. The typical symptoms of Cholecystitis are all next symptoms, except:
Increasing temperature
Biliary colic
Jaundice
Kerr’s sign
+Diarrhea
76. Differential diagnostics of Cholecystitis should be with:
Pancreatitis
Gastritis
Diskinesia of the biliary tract
Cholangitis
+All variants.
77. A 39 y.o. woman complains of squeezed epigastric pain 1 hour after meal and heartburn. She had been ill for 2 years. On palpation, there was moderate tenderness in pyloroduodenal area. Antral gastritis was revealed on gastroscopy. What study can establish genesis of the disease?
Examination of stomach secretion
Detection of autoantibodies in the serum
Gastrin level in blood
+Revealing of Helicobacter infection in gastric mucosa
Examination of stomach motor function
78. A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
+Gastritis of type B
Gastritis of type A
Reflux-gastritis
Menetrier's gastritis
Rigid antral gastritis
79. A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Esophagogastroduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?
Disorder of gastric motor activity
Dietary allergy
Autoantibody production
Reduced prostaglandin synthesis
+Helicobacterial infection
80. A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft, there are no symptoms of peritoneum irritation, "splashing sounds" in epigastrium. Defecation - once in 3 days. What complication corresponds with the patient's state and described clinical presentations?
Concealed ulcer perforation
+Ulcerative pyloric stenosis
Stomach cancer
Ulcer penetration
E Chronic pancreatitis
81. A 63 y.o. woman complains of motiveless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature - 37,50С, BR- 20/min, Ps- 96/min, AP- 110/75 mm Hg. On palpation in epigastrium - pain and muscle tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a diagnosis?
+Cytologic
Radiography
Endoscopy
Stomach content examination
Coprology
82. A 45 yr. old man is admitted with his 3rd episode of upper gastrointestinal haemorrhage. He had 2 prior ulcer operation. Zollinger-Ellison syndrome is suspected. All the following would support your suspicions EXCEPT:
+Suppression of hypergastrinaemia by secretin given I\V
A fasting gastrin level of 450pg/ml.
Post operative notes detailing ulcers in the duodenum and jejunum
Liver metastasis on CT scan
A history of diarrhoea
83. A 22 year old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:
+Chronic viral hepatitis
Calculous cholecystitis
Gilbert's disease Acute viral hepatitis
Chronic cholangitis
84. A man with liver cirrhosis complained of nasal bleedings, right subcostal pain, weakness, and nausea. On physical examination: jaundice, hemorrhagic rash, enlarged liver span (of 14 cm), liver edge irregular. What is the cause of hemorrhagic syndrome in this patient?
As a result of portal hypertension
As a consequence of DIC
Thrombocytopenia
+Decreased liver production of procoagulants
K and C hypovitaminosis
85. A 10-year-old boy suffers from chronic viral hepatitis type B with maximal activity. What laboratory test can give the most precise characteristic of cytolysis degree?
Test for whole protein
+Transaminase test
Prothrombin test
Weltman's coagulation test
Takata-Ara test
86. A 32-year-old patient suffering from chronic viral hepatitis complains about dull pain in the right subcostal area, nausea, and dry mouth. Objectively: liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is 3,2 micromole/l*h, alanine aminotransferase - 4,8 millimole/1*h. Serological study revealed HBeAg, high concentration of DNA HBV. What drug should be chosen for treatment of this patient?
Arabinoside monophosphate
Remantadinum
+Acyclovir, α-interferon
α-interferon
Essentiale-forte
87. A 42 yr. old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Examination reveals asterixes on the hands, ankle clonus, and spider angiomas on the face and chest. Blood ammonia level is twice its baseline. Precipitating factors of this condition include all of the following EXCEPT:
Bleeding esophageal
+Insufficient protein ingestion
Excessive diuretic therapy
Non compliance with lactulose therapy
Spontaneous bacterial peritonitis
88. A 22 year old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:
+Chronic viral hepatitis
Calculous cholecystitis
Gilbert's disease
Acute viral hepatitis
Chronic cholangitis
89. A 10-year-old boy suffers from chronic viral hepatitis type B with maximal activity. What laboratory test can give the most precise characteristic of cytolysis degree?
Test for whole protein
+Transaminase test
Prothrombin test
Weltman's coagulation test
Takata-Ara test
90. A 32-year-old patient suffering from chronic viral hepatitis complains about dull pain in the right subcostal area, nausea, and dry mouth. Objectively: liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is 3,2 micromole/l*h, alanine aminotransferase - 4,8 millimole/1*h. Serological study revealed HBeAg, high concentration of DNA HBV. What drug should be chosen for treatment of this patient?
Arabinoside monophosphate
Remantadinu
+Acyclovir, α-interferon
α-interferon
Essentiale-forte
91. A 42 yr. old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Examination reveals asterixes on the hands, ankle clonus, and spider angiomas on the face and chest. Blood ammonia level is twice its baseline. Precipitating factors of this condition include all of the following EXCEPT:
Bleeding esophageal
+Insufficient protein ingestion
Excessive diuretic therapy
Non compliance with lactulose therapy
Spontaneous bacterial peritonitis
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