Surgery

How many arteries supply the thyroid gland?

a) 2

b)3

c) 4 or 5

d)6

2. Which is the major structural element of the thyroid gland?

a) Colloid

b) Follicle

c) Triiodthyronine

d) Lobulus

e) Thyroxin

3. What is the main cause of endemic gaiter in some regions?

a) Family history

b) Iodine deficiency in soil, water and biosphere in some regions

c) High radioactivity levels in some regions

d) Chemical and heavy metal environmental pollution

4. Which are the major types of gaiter?

a) Nodular

b) Medullar

c) Mixed

d) Parenchymatous

e) Alveolar

1.Which are the complications in Grave's disease?

a) Portal vein thrombosis

b) Heart attack

c) Atrial fibrillation

d) Compression of the major neck structures

e) Discoordination of the active movements

2. What is the conservative treatment for Grave's disease?

a) Treatment of tachycardia and rhythm disorders

b) Thyrostatic therapy with inorganic iodine

c) Thyroxine therapy

3. What is the difference between benign and malignant turners of the thyroid gland?

a) High mitotic activity in benign turners

b) Smooth surface of the malignant turners

c) Presence of a capsule in benign tumors

d) Mature thyroid cells as a sign of malignisation

e) Lower hormonal activity in thyroid adenomas

4. Which of the following are considered precancerous conditions for thyroid gland carcinoma?

a) Thyroid gland adenoma

b) Thyrotoxic adenoma

c) Goiter

d) Ridl thyroiditis

e) Thyrotoxicosis

5. What are the major diagnostic tests for thyroid gland carcinoma?

a) Tumor markers

b) Neck X-ray

c) Thyroid gland ultrasound and biopsy

d) CT-scan of head and neck

e) Scintigraphy

Which of the following types are the most malignant tumors of the thyroid gland?

a) Small cell carcinoma

b) Follicular

c) Alveolar

d) Squamous

e) Gaint cell carcinoma

f) Papillary

2. Which are the possible complications after thyroid gland surgery?

a) Laryngeal nerve injury

b) Trigeminal nerve injury

c) Hemorrhage

d) Gas embolism

e) Heart attack

3. Which is the most common histological type of thyroid gland carcinoma?

a) Follicular

b) Papillary

c) Medullar

d) Non differentiated

4. What is the most appropriate therapeutical approach to a patient with a 2 cm "cold" nodule in the left thyroid lobe and histological result of malignant cells after fine needle aspiration biopsy?

a) Radioiodine ablation

b) Thyroidectomy

c) Lobectomy

d) Enucleoresection

What are the neuroprotective measures that should be taken towards laryngeal recurrent nerves during thyroid surgery?

a) lntraoperative CT-navigation

b) lntraoperative neuromonitoring

c) Express histological examination

d) Using magnifying glasses

2. What is the most dangerous complication of thyroid gland surgery? a) Acute intraoperative haemorrhage

b) Postoperative hypoparathyroidism

c) Dis- or aphonia

d) All of the above

3. What is the obligatory condition for considering a thyroid gland surgical procedure as minimally invasive one?

a) Using an endoscope

b) Incision to 3 cm

c) Preserving prethyroid muscles

d) All of the above

4. What does "near total thyroidectomy" mean?

a) Preserving 3-4g of the thyroid gland

b) Preserving small amount of thyroid tissue

c) lntracapsular blood vessel ligation

d) None of the above

What is the treatment of facial erysipelas?

a) Surgical

b) Antibiotic

2. Which is the microbiological agent that causes erysipelas?

a) Beta haemolytic streptococcus

b) E.coli

c) Pseudomonas aeruginosa

3. Is there a possibility for developing distant metastasis in melanoma?

a) Yes, the tumor has a metastatic potential

b) No, the tumor has only one localization

4. What is the origin of the midline cysts ofthe neck?

a) Thyroglossal duct

b) Thymus gland

c) lnfrahyoid muscles

1. What is the cause of torticollis (wry neck)?

a) Birth trauma

b) Embryogenesis disorders

c) Disorders o f the neck muscles innervations

2. What is the medical term for neck lymphadenitis in TB?

a) Tuberculum

b) Scrofulosis

c) Lipomatosis

3. Which of the following neck tumors is benign?

a) Haemangioma

b) Lymphosarcoma

c) Hodgkin lymphom

4. Which of the following conditions could develop in neck veins injury?

a) Air embolism

b) Haemorrhage shock

c) Infection

1. In which of the following congenital anomalies of the facial region the newborns have difficulties in eating?

a) Cleft palate

b) Coloboma

c) Microstomia

2. What is the most appropriate age for having a reconstructive surgical procedure of a cleft lip?

a) The first 6 months after birth

b) After the year of the baby

c) In puberty

3. What is the reason for developing cleft palate anomaly?

a) Birth trauma

b) Disorders in embryogenesis

c) Complications of facial tumors

4. What is the major and definitive treatment for congenital anomalies of the facial region?

a) Surgical

b) Conservative

Which of the following factors should be taken into consideration when forming a diagnostic algorithm for closed traumas ofthe facial region?

a) Psychological condition of the patient

b) Type and localization of the traumatic agent, general condition of the patient, type of surgical approach, extent of the traumatic injury

c) Trauma circumstances

What are the major characteristics of a gunshot injury?

a) Forming a wound canal

b) Presence of a projectile in the affected tissues

c) Loss of sight

d) Forming a haematoma

Which of the following neoplasms is malignant and has a metastatic potential?

a) Melanoma

b) Basocellular carcinoma

c) Atheroma

4. Which of the following is a complication of furuncle?

a) Abscess formation

b) Spontaneous drainage of the furuncle content

c) Venous vessels transmission to the cavernous sinus

Which are the atypical types of gaiter?

a) Retrosternal

b) Endothoracic

c) lntratracheal

d) Pulmonary

e) At the base of the tongue

f) Prescalene

2. What is the Grave's disease typical clinical triade?

a) Goiter

b) Hypothyroidism

c) Exophtalmos

d) Tachypnea

e) Hyperpirexia

f) Tachycardia

3. Which are the typical signs in the clinical manifestation of Grave's disease?

a) Higher cardiac minute volume

b) Dry skin

c) Sweating

d) High irritability

e) Mental and physical apathy

f) Tremor of the upper extremities

4.Which are the main eye symptoms in Grave's disease?

a) Rovsing symptom

b) Stellwag symptom

c) Kocher symptom

d) Bazedow symptom

e) Sitkovskiy symptom

f) Moebius symptom

g) Graefe symptom

1. What is the surgical treatment of the cleft lip?

a) Uraloplasty

b) Rhinoplasty

c) Cheiloplasty

In which of the following traumatic injuries ofthe facial region there is a haematoma in the shape of sunglasses?

a) Maxillar fracture

b) Gunshot injury

c) Puncture injury

3. Which is the most common complication in parotid gland injury?

a) Fistula

b) Haemorrhage

c) Paralysis of the facial muscles

4. What happens after traumatic injury of the facial nerve?

a) Paralysis of the facial muscles

b) Dysphagia

c) Motor aphasia

5. Which are the bronchiectasis types?

a) Congenital

b) Acquired

c) Hereditary

6. Which of the following statements is true for spontaneous pneumothorax?

a) Sudden beginning

b) There is a pathological communication between the lung and the pleural cavity

c) Lung parenchyma is intact

d) All of the above

7. What is the reason for perforation of emphysematous bullae?

a) Thin walls of the bullae

b) High intraalveolar pressure

c) High intrathoracic pressure

8. What is the clinical manifestation of spontaneous pneumothorax?

a) Pain

b) Cough

c) Dyspnea

d) Haemoptysis

9. Which of the following surgical procedures includes anastomosis between the stomach and the jejunum (gastrojejunal anastomosis)?

a) Meckel diverticulum resection

b) Total gastrectomy

c) Heineke-Mikulicz pyloroplasty

d) Billroth 1 resection

e) Billroth 2 resection

10. What is the position of the right vagus nerve in the distal part of the esophagus?

a) In front of the esophagus

b) Behind the esophagus

c) Left from the esophagus

d) Right from the esophagus

11. Which of the following are ulcer disease complications?

a) Perforation

b) Bleeding

c) Thrombosis

d) Penetration

e) Malignant transformation

f) Stomach dilation

g) Pyloric stenosis

h) Pyloric dilation

12. Which of the following inguinal hernia repair techniques includes continuous suture?

a) Bassini technique

b) Shouldice technique

c) Postemsky technique

d) McVay technique

13. What is the Cooper test purpose?

a) To distinguish indirect from direct type of inguinal hernia

b) To distinguish indirect type of inguinal hernia from femoral hernia

c) All of the above

d) Non of the above

14. Is it possible for the groin hernia sac to reach the scrotum?

a) It never reaches the scrotum

b) It always reaches the scrotum

c) It sometimes reaches the scrotum

d) None of the above

15. What is Whipple procedure?

a) Local tumor excision

b) Total pancreatectomy

c) Distal pancreatectomy

d) Proximal duodenopancreatic resection

16. How could bile duct derivation be performed in patients with jaundice due to pancreatic head carcinoma?

a) Stent insertion in the common bile duct

b) Cholecystogastric anastomosis

c) Choledochojejunal anastomosis

d) All of the above

Which of the following statements about pancreatic cancer is wrong?

a) Contrast CT-scan is a diagnostic method of choice

b) Abdominal ultrasound examination is a diagnostic method of choice

c) Resectability assessment of the tumor is made during the operation

d) Portal vein infiltration is a total contraindication for radical surgical treatment

e) Pancreatic carcinoma is sensitive to radio- and chemotherapy

18. Which parts of the GIT are affected in Crohn's disease?

a) Ileum

b) Colon

c) The whole GIT- from the mouth to the anus

19. Which sex is more affected in Crohn's disease?

a) Female

b) Male

c) Incidence is equal in both sexes

20. What is the etiology of Crohn's disease?

a) Viral infection

b) Mesenteric blood supply disorders

c) Allergy

d) Unclear etiology

e) All of the above

21. What is the clinical manifestation of Crohn's disease?

a) Alternation of constipation and diarrhea

b) Rectorrhagia, subfebrility

c) Abdominal pain

22. Which age group is most commonly affected in intestinal intussusception?

a) 0 - 6-7 months

b) 10 - 20 years

c) 40 - 50 years

d) 65- 75years

e) All of the above

23. Which is the most common localization of intestinal intussusception?

a) Small intestines

b) Sigmoid colon

c) Rectosigmoid segment

d) lleocecal segment

e) Transverse colon

24. What is the possible diagnosis of a restless 6-month-old baby with palpable mobile tumor mass in the right part ofthe abdomen?

a) Testicle torsion

b) Intestinal intussusception

c) Allergy

d) The baby is hungry

e) Non of the above

25. What are the medical terms for the intussusceptions parts?

a) lntussusceptum and intussuscipiens

b) ProximaI and distal segment

c) Ileum and cecum

d) All of the above

e) None of the above

26. Which are the 4 major arteries that supply the stomach?

a) Left gastric artery

b) Common hepatic artery

c) Right gastroepiploic artery

d) Left gastroepiploic artery

e) Superior mesenteric artery above

27. Which of the following statements about pancreatic fistulas is wrong?

a) They form after a traumatic injury or inflammation of the pancreatic tissue

b) The secretion contains amylase which exceeds many times plasma levels

c) The amount of secretion could be more than 1000ml

d) Somatostatin/Sandostatin reduces pancreatic secretion and helps the recovery

e) Chronic secretion doesn't lead to healing and has a higher mortality rate

Which of the following techniques is best for simultaneous treatment of both inguinal and femoral hernia?

a) Bassini technique

b) Martinov technique

c) Postemsky technique

d) McVay technique

5. How spontaneous pneumothorax could be diagnosed?

a) By patient's history

b) By percussion

c) By auscultation

d) By X-ray

e) By thoracoscopy

f) All of the above

4. What happens after traumatic injury of the facial nerve?

a) Paralysis of the facial muscles

b) Dysphagia

c) Motor aphasia

What does treatment of spontaneous pneumothorax include?

a) Antibiotic infusions

b) Single pleural puncture

c) Thoracocentesis

d) Thoracotomy

8. How many types of pleural empyema are there?

a) Total

b) Apical

c) Basal

d) Mediastinal

e) AII of the above

9. Chronic hypertrophic gastritis is the disease of:

a) Zollinger-Ellison

b) Menetrier

c) Peutz-Jeghers

d) Forrest

f) Heineke-Mikulicz

10. Which is the most common classification of upper GIT bleeding?

a) Zollinger-Ellison

b) Menetrier

c) Peutz-Jeghers

d) Forrest

e) Heinike-Mikulicz

11. Which stomach layers are affected in early stomach cancer?

a) Mucosa

b) Mucosa and submucosa

c) Mucosa, submucosa, muscular layer

d) Mucosa, submucosa, muscular layer, serosa

12. Which is the most common histological type of stomach carcinoma?

a) Squamous cell carcinoma

b) Adenosquamous carcinoma

c) Adenocarcinoma

d) Non differentiated

e) Neuroendocrine tumor

13. What is the definition of hernia taxis?

a) Type of surgical procedure

b) Manual reduction of strangulated hernia

c) All of the above

d) None of the above

14. What is the first method of choice in a baby with incarcerated inguinal hernia?

a) Hernia taxis

b) Urgent surgical treatment

c) Clinical observation

d) All of the above

e) Non ofthe above

15. In which cases surgical treatment of inguinal hernia is necessary in babies under 8 months?

a) Never

b) Always

c) If there are frequent incarcerations

d) All of the above

e) Non of the above

16. ls it possible to have a prevascular position of the hernia sac in a femoral hernia?

a) Never

b) Sometimes

c) Always

17. What is splenosis?

a) Caudate spleen

b) Big spleen

c) Ectopic spleen

d) Accessory spleen

e) Spleen with blood vessels abnormalities

18. What is the most dangerous complication of wandering spleen?

a) Infection and sepsis

b) Thoracic localization and dyspnea

c) Splenic torsion

d) Spontaneous rupture

e) Compression of the stomach and pancreas

19. What is the most common cause of spleen infarction?

a) Congenital anomalies of the spleen

b) Migrating embol from the left atrium of the heart

c) Pulmonary thromboembolism

d) Thalassemia major

e) Essential thrombocytopenia

20. Which are the typical clinical features of Crohn's disease?

a) Alternation of constipation and diarrhea

b) Abdominal pain, diarrhea, loss of weight

c) Loss of weight, anemia

d) Abdominal pain and distension, constipation, vomiting

21. Which layers of the intestinal wall are affected in Crohn's disease?

a) Serosa

b) Mucosa and serosa

c) All the layers

d) Only mucosa

22. What are the macroscopic changes of the intestinal wall in Crohn's disease?

a) Thick walls, narrowed lumen

b) Thin walls, widened lumen

c) There are no intestinal wall changes

23. Which are the complications of Crohn's disease?

a) Anal abscess and fistula formation

b) Intestinal fistulas

c) There are no complications

24. Which of the following arterial blood vessels is most commonly affected by embolism as a mesenteric blood flow disorder?

a) Superior mesenteric artery

b) Inferior mesenteric artery

c) Celiac trunk

d) Iliac artery

25. Which of the following diagnostic methods is useful in mesenteric thrombosis?

a) CT angiography

b) Doppler ultrasound

c) Seldinger technique catheter angiography

d) All of the above

26. Which are the risk factors for arterial mesenteric thrombosis?

a) Atherosclerosis

b) Atrial fibrillation

c) Acute pancreatitis

d) Bronchial asthma

e) Acute intestinal obstruction

27. The arc of Riolan connects branches of:

a) Superior mesenteric vein and inferior mesenteric vein

b) Internal iliac artery and external iliac artery

c) Superior mesenteric artery and inferior mesenteric artery

d) Common iliac artery and superior mesenteric artery

28. Which of the following are endocrine tumors of the pancreas?

a) Thymoma

b) Pheochromocytoma

c) lnsulinoma

d) Glucagonoma

e) Gastrinoma

5. Which of the following statements is true for treatment of pleural empyema?

a) It requires evacuation of the pus

b) It requires quick therapeutical measures for the inflammatory process

c) It aims lung expansion

d) Pleural puncture is a method of choice

6. What is mediastinitis?

a) Pleural inflammation

b) lnflammaton of surrounding tissues to the mediastinum

c) Inflammation of the mediastinal tissues

7. What is the medical term for a pus collection in the pleural space?

a) Chylothorax

b) Hydrothorax

c) Haemothorax

d) Pyothorax

What is the medical term for a lymph collection in the pleural space?

a) Chylothorax

b) Pneumothorax

c) Pyothorax

d) Hydrothorax

9. What is Laugier hernia?

a) Femoral hernia at a typical position

b) Prevascular type of femoral hernia

c) Femoral hernia passing through the lacunar ligament

d) All of the above

e) Non of the above

10. Is it possible the hernia sac in femoral hernia to pass through the muscular lacuna?

a) Never

b) Sometimes

c) Always

11. Where is the exact position of the intumescence in femoral hernia?

a) Below the inguinal ligament

b) Above the inguinal ligament

c) All of the above

d) Non of the above

12. ls it possible that men could have inguinal and femoral hernia at the same time?

a) Never

b) Rarely

c) Always

13. Which of the following surgical procedures are radical treatment for stomach cancer?

a) Tumor debulking

b) Subtotal gastrectomy

c) By-pass anastomosis

d) Total gastrectomy

e) Hepatectomy

14. In which cases stomach carcinoma is indicated for adjuvant chemotherapy?

a) In all patients

b) Depends on the histological type and the TNM stage

c) In young patients

d) In old patients

e) Depends on the localization of the tumor

15. According to the incidence of stomach cancer Bulgaria is one of the countries with:

a) Highest morbidity

b) High morbidity

c) Medium morbidity

d) Low morbidity

16. Which of the following statements about acute cholecystitis is false?

a) Nausea, vomiting

b) Positive Kerhr sign

c) Positive Murphy sing

d) Muscular defense in the right hypochondriac area and positive Blumberg sign

e) Positive Myussi-Georgievsky

17. Splenectomy in hereditary spherocytosis is indicated in which of the following age groups?

a) In newborns

b) In teenagers

c) 30-40-year-old

d) In mature age

e) Splenectomy is contraindicated

18. Splenectomy in thalassemkia minor is indicated in which of the following age groups?

a) In newborns

b) In teenagers

c) 30-40-year-old

d) In mature age

e) Splenectomy is contraindicated

19. Which of the blood cells are destroyed in the spleen in patients with Werlhof disease?

a) Erythrocytes

b) Leucocytes

c) Platelets

d) Lymphocytes

e) All of the above

20. Which of the following cells could be detected in patients with Hodgkin's disease after splenectomy?

a) Psammoma bodies

b) Sternberg cells

c) Hill cells

d) Foreign body cells

e) Defect erythrocytes

21. What is the differential diagnosis of Crohn's disease?

a) Chronic ulcerous colitis

b) Acute appendicitis

c) Diverticulosis

d) Intestinal obstruction

e) All of the above

22. Which diagnostic methods could be used in Crohn's disease?

a) Abdominal ultrasound examination

b) Patient's history and laparoscopy

c) Patient's history, colonoscopy with biopsy, contrast X-ray

d) lrigography

23. What is the treatment of Crohn's disease?

a) Conservative

b) Surgical

c) Conservative followed by surgical if there are complications

24. What does surgical treatment of Crohn's disease include?

a) lleostomy

b) Segmental resection

c) Colostomy

d) Colectomy

e) Biopsy and conservative treatment

25. Which parts of the intestines are affected in massive thrombosis of the superior mesenteric artery?

a) Duodenum

b) Jejunum and ileum

c) Cecum and ascending colon

d) Descending colon and sigmoid colon

e) Rectum

26. What is the normal amount of fluid in the abdominal cavity?

a) 20ml

b) 80ml

c) 120ml

d) 200ml

e) 220ml

27. Which of the following diseases does not lead to forming a hemorrhagic exudate in the abdominal cavity?

a) Acute pancreatitis

b) Acute cholecystitis

c) Mesenteric thrombosis

d) Mesenteric embolism

e) Acute intestinal obstruction

28. Abdominal pain as an initial symptom in acute peritonitis is present in:

a) 50% of the patients

b) 50- 75% of the patients

c) 75- 90% of the patients

d) 100% of the patients

5. What is the medical term for a blood collection in the mediastinum?

a) Mediastinitis

b) Haemomediastinum

c) Pneumomediastinum

d) Haemothorax

6. What is the definition of pneumomediastinum?

a) A blood collection in the mediastinum

b) An air collection in the mediastinum

c) A pus collection in the mediastinum

d) A lymph collection in the mediastinum

7. What is myasthenia gravis?

a) Neuromuscular disorder causing muscle weakness due to absence of acetylcholine receptors in the postsynaptic membrane

b) Electrolyte and enzyme transport disorder leading to muscle weakness

c) Neuromuscular disorder due to nutrient insufficiency

8. What is the clinical manifestation ofvena cava superior syndrome?

a) Oedema of the head, neck, upper extremities and the upper part of the thorax

b) Oedema of the chest and the abdomen

c) Oedema of the head, the chest and the abdomen

d) Oedema of the head, neck, upper and lower extremities

Cholecystostomy is indicated in acute destructive cholecystitis in:

a) Concomitant acute edematous pancreatitis

b) Concomitant obstructive jaundice

c) Poor general condition of the patient

d) Concomitant cholangitis

e) All of the above

10. What possible complications of the major disease have developed in a patient with acute phlegmonous cholecystitis, fever to 38, obstructive jaundice, no signs of acute peritonitis?

a) Stenosis of the papilla

b) Gallbladder empyema

c) Pylephlebitis

d) Subhepatic abscess

e) Purulent cholangitis

11. Which of the following is an indication for an emergency surgery in acute cholecystitis?

a) Intensity of the pain

b) Duration of the disease

c) Number of colic pain episodes in the past

d) Presence of acute peritonitis

e) Presence of stones

12. Which of the following cases is indicated for retrograde cholecystectomy? a) In old patients

b) If there are signs of acute cholangitis

c) If there is a gallbladder contraction

d) If there is an incarcerated gallstone in the gallbladder neck

e) If there are inflammatory changes of the gallbladder neck

13. Is it common for the femoral hernia to incarcerate?

a) Never

b) Sometimes

c) Often

14. Could femoral hernia become big in size?

a) Often

b) Never

c) Rarely

15. Which is the most common type of incarceration in femoral hernia?

a) Richter type

b) Litre type

c) All of the above

d) Non of the above

16. Could hernia taxis be performed in femoral hernia?

a) Always

b) Sometimes

c) Never

17. In which of the following conditions splenectomy is indicated?

a) Spleen abscess

b) Thalassemia minor

c) Splenic vein thrombosis

d) Splenitis

e) Wandering spleen

18. Which anatomical feature could lead to a dangerous complication after splenectomy?

a) Spleen position

b) Spleen haematoma during splenectomy

c) Short gastric arteries arising from the splenic artery

d) Enlargement of the spleen

e) Spleen's ligaments

19. Which of the following is a contraindication for splenectomy?

a) High levels of platelets

b) Low levels of leucocytes

c) Low levels o f neutrophils

d) High level of hemoglobin

e) Low level of platelets

20. Which of the following spleen tumors are benign?

a) Splenoma

b) Hemangioma

c) Fibrosarcoma

d) Angiosarcoma

e) Lymphangioma

21. Which of the following etiology factors are typical for diverticulosis?

a) Congenital tissue weakness

b) High intraluminal pressure

c) Discoordination in peristalsis

d) Hereditary risk factors

e) All of the above

22. Which of the following diagnostic methods could not be used in colon diverticulosis?

a) Colonoscopy

b) CT-scan

c) Upper endoscopy

d) lrigography

23. What does the conservative treatment of acute diverticulitis include?

a) Antibiotic therapy and dietary regime

b) Non steroid anti-inflammatory drugs

c) 5-ASA medications

d) Spasmolytics

24. What is megacolon?

a) Congenital/acquired disease of the colon which leads to dilation and enlargement of the colon and motility disorders

b) Congenital disease of the small intestines which leads to their dilation and enlargement,there are motility disorders\congenital/acquired disease of the colon and diarrhea

25. What is the therapeutic approach to a 14-year-old girl diagnosed with pneumococcal peritonitis who suffered from acute bronchitis for 3 days and after that developed diffuse abdominal pain, nausea, vomiting, diarrhea, circumoral cyanosis, HR 100 bpm, abdominal rigidity, leucocytosis to 38 000, elevated ESR level?

a) Emergency surgery

b) Antibiotic therapy

c) Detoxication therapy

26. 46-year-old patient is operated for acute gangrenous appendicitis and develops dull pain around the umbilicus, rectal tenesmus and increased body temperature to 37.8 - 38.5 5 days after surgery. What is the diagnosis?

a) Acute proctitis

b) Inflamed hemorrhoids

c) Diffuse peritonitis

d) Douglas pouch abscess

e) Acute cystitis

27. What is the most common cause for acute peritonitis?

a) Acute appendicitis

b) Perforated ulcer

c) Acute salpingitis

d) Small intestine strangulation

e) Stomach carcinoma

28. What is the duration of the reactive stage of acute peritonitis?

a) 4 - 6h

b) 24h

c) 48h

d) 72h

e) More than 72h

How many types of esophageal atresia are there depending on the communication between the esophagus and the trachea?

a) 3 types

b) 4 types

c) 5 types

6. Esophageal perforation due to chemical burns of the esophagus requires:

a) Urgent surgical treatment of the mediastinitis

b) Prolonged clinical observation, surgical treatment in case of worsening

c) Elective surgical procedure after an informed consent of the patient

7. In which of the following conditions upper endoscopy is contraindicated?

a) Esophageal carcinoma

b) Esophageal perforation

c) Haemathemesis

d) Lung carcinoma

8. Which are the anatomical narrowings of the esophagus?

a) Thoracic and abdominal

b) Upper, middle and lower

c) Cervical, diaphragmatic and bowel

9. Which is the first diagnostic method of choice in 81-year-old patient with phlegmonous cholecystit is?

a) Abdominal ultrasound examination

b) Cholecystocholangiography

c) Laparoscopy

d) Retrograde cholangiopancreatography

e) Percutaneous transhepatic cholangiography

10. What kind of surgical procedure must be performed in 81-year-old patient with acute phlegmonous cholecystitis in a poor general condition?

a) Cholecystectomy

b) Cholecystostomy

c) Laparoscopic drainage of the subhepatic space

d) Cholecystolithotomy

11. What kind of procedure must be performed in a non complicated cholelithiasis which is an accidental finding?

a) Endoscopic retrograde cholangiopancreatography

b) Laparoscopy

c) Abdominal ultrasound examination

d) Percutaneous transhepatic cholangiography

12. Which of the following is not a complication of acute cholecystitis?

a) Obstructive jaundice

b) Portal hypertension

c) Purulent cholangitis

d) Subhepatic abscess

e) Incarcerated gallstone in the papilla

13. Which of the following conditions must be included in the differential diagnosis of femoral hernia?

a) Inguinal hernia

b) Incarcerated inguinal hernia

c) All of the above

d) Non of the above

14. Which of the following conditions must be included in the differential diagnosis of femoral hernia?

a) Great saphenous vein varicosis

b) Lymphadenitis

c) All of the above

d) Non of the above

15. Which of the following conditions must be included in the differential diagnosis of femoral hernia?

a) Lymphosarcoma

b) Femoral artery aneurysm

c) All of the above

d) Non of the above

16. What is the treatment of femoral hernia?

a) Surgical

b) Conservative

c) Non ofthe above

17. Which of the blood cells are destroyed in the spleen in patients with Felty syndrome?

a) Erythrocytes

b) Leucocytes

c) Platelets

d) Lymphocytes

e) All of the above

18. Which are the typical features of caudate spleen?

a) Enlargement of the spleen and compression of the stomach

b) Spleen is thin and long, could reach the pelvis

c) Could be located in the mesenterium or the great omentum

d) Could form after a traumatic injury of the spleen

e) It is commonly located in the right part of the abdominal cavity

19. Which are the major diagnostic methods for spleen echinococcosis?

a) Abdominal CT-scan

b) Abdominal ultrasound examination

c) Spleen scintigraphy

d) Abdominal X-ray

e) Laparoscopy and spleen biopsy

f) Upper endoscopy

20. What is spleen tuberculosis?

a) Acute nonspecific infection

b) Fulminant infection

c) Acute specific infection

d) Chronic specific infection

e) Chronic nonspecific infection

21. How many etiopathogenetic types of megacolon are there?

a) Congenital

b) ldiopatic

c) Symptomatic

d) All of the above

22. What is the incidence of Hirschhprung's disease?

a) 1:5 000

b) 1:10

c) 1:1 000 000

23. What is the clinical manifestation of Hirschprung's disease?

a) Loss of appetite, nausea, vomiting, constipation

b) Recurrent diarrhea, fever, abdominal pain

c) Constipation right after birth, defecation in 3-5 days after enemas

24. How many forms of Hirschprung's disease are there?

a) Compensated

b) Subcompensated

c) Decompensated

d) All of the above

25. What is the infection's spreading way in primary peritonitis?

a) From stomach ulcer perforation

b) From appendiceal perforation

c) From acute adnexitis

d) Hematogenous way

e) From intestinal trauma

26. Which of the following symptoms is not typical for acute peritonitis?

a) Muscular defense

b) Courvoisier sign

c) Tachycardia

d) Stop offlatulence

e) Vomiting

27. Which of the following symptoms is not typical for acute peritonitis?

a) Tachycardia

b) Dry tongue

c) Muscular defense

d) Absent peristalsis

e) Diarrhea

28. Which of the following is a major symptom of acute peritonitis?

a) Vomiting

b) Abdominal pain

c) Melaena

d) Stop offlatulence and defecation

e) Muscular defense

1. How many arteries supply the thyroid gland?

a) 2

b)3

c) 4 or 5

d)6

2. Which is the major structural element of the thyroid gland?

a) Colloid

b) Follicle

c) Triiodthyronine

d) Lobulus

e) Thyroxin

3. What is the main cause of endemic gaiter in some regions?

a) Family history

b) Iodine deficiency in soil, water and biosphere in some regions

c) High radioactivity levels in some regions

d) Chemical and heavy metal environmental pollution

4. Which are the major types of gaiter?

a) Nodular

b) Medullar

c) Mixed

d) Parenchymatous

e) Alveolar

5. How many types of esophageal diverticula are there depending on the localization?

a) Cervical, thoracic and stomach diverticula

b) Pharyngoesophageal, tracheal biffurcation, epiphrenic diverticula

c) Epiphrenic, Zenker's, Meckel's diverticula

6. Which is the most common type of esophageal atresia?

a) Blind end of the proximal part of the esophagus and communication between the distal part

b) of the esophagus and the trachea or the right bronchus

c) Proximal part of the esophagus communicates with the trachea, blind end of the distal part of the esophagus

d) Blind ends of both proximal and distal part of the esophagus, no communication with the trachea

e) Proximal and distal part of the esophagus communicate both with the trachea

7. What is Water syndrome?

a) Multiple congenital malformations - esophageal atresia, vertebral, renal, cardiac,ano-rectal anomalies

b) Abscense of a diaphragm dome and lung aplasia, GIT disorders

c) Cystic lung disease and recurrent respiratory infections

8. Which is the first symptom in esophageal atresia?

a) Acute cardiovascular insufficiency

b) Cyanosis

c) Abdominal distension

d) Hypersalivation, recurrent foamy secretions from the nose and the mouth after aspiration

9. What would be your therapeutic approach to a 67-year-old patient with acute gangrenous cholecystitis and local peritonitis?

a) Conservative therapy due to the age of the patient

b) Surgical treatment if conservative one is not effective

c) Depends on the stage of the disease

d) Delayed surgery

e) Emergency surgery

10. What is the treatment for a 77-year-old patient with destructive cholecystitis, acute peritonitis and decompensated heart failure?

a) Laparoscopic cholecystectomy

b) Conventional cholecystectomy

c) Cholecystostomy

d) Percutaneous transhepatic cholangiography

e) Conservative treatment

11. Which of the following symptoms is not a sign of purulent cholangitis?

a) High body temperature

b) Septic fever

c) Bowel paresis

d) Pain in the right hypochondriac area

e) Obstructive jaundice

12. Which is the best and the safest diagnostic method for asymptomatic choledocholithiasis and papillary stenosis?

a) Peroral cholecystography

b) Intravenous cholecystocholangiography

c) Laparoscopic cholecystocholangiography

d) Endoscopic retrograde cholangiopancreatography

e) Percutaneous transhepatic cholangiography

13. What does Ruggi-Parlavecchio femoral hernia repair technique include?

a) Elimination of the inguinal canal

b) Suturing the inguinal to the pectineal ligament

c) lnguinalisation of the femoral hernia and elimination of both inguinal and femoral canal

d) Non of the above

e) All of the above

14.Does surgicaI treatment of femoral hernia include using a mesh?

a) Yes

b) No

15. Could an abdominal approach be used in the surgical treatment of femoral hernia?

a) Yes

b) No

16. Could femoral hernia be treated laparoscopically?

a) Yes

b) No

17. Appendiceal artery is a direct branch of which of the following arteries?

a) Inferior mesenteric artery

b) Superior mesenteric artery

c) Descending branch of middle colic artery

d) lleocolic artery

18. What is the therapeutic approach to a 76-year-old patient who has acute myocardial infarction but there are suspicions for acute destructive appendicitis?

a) Emergency surgery

b) Clinical observation and emergency surgery if there are signs of acute peritonitis

c) Administration of high doses of broad spectrum antibiotics and surgical treatment if there is no good effect of the conservative therapy

d) All the answers are wrong

19. What does the right therapeutic behavior include if you are suspicious for acute appendicitis in a patient?

a) Urgent hospitalization

b) Administration of spasmolytic medications and another physical examination in 4-6h

c) Control total blood count test and measuring the body temperature in the next 12-24h

d) Antiinflammatory medications and control physical examination the next day

e) Observation in ambulatory care-sensitive conditions and hospitalization if the general condition worsens

20. Which of the following conditions requires abdominal cavity tamponade in acute appendicitis?

a) Diffuse capillary bleeding from the appendiceal area

b) 3d stage obesity

c) Gangrenous appendicitis

d) Periappendiceal abscess

e) Local peritonitis

21. Which of the following conditions are complications of Hirschprung's disease?

a) Intestinal obstruction

b) Rectorrhagia

c) Acute peritonitis

d) Intestinal fistulas

22. What does treatment of Hirschprung's disease include?

a) Conservative therapy with cristaloid solutions and spasmolytic medications

b) Surgical treatment including resection of the aganglionic part and the dilated part of the sigmoid colon

c) Diet and enemas

23. Which of the following diagnostic methods are not used in Hirschprung's disease?

a) Colonoscopy

b) lrigography

c) Swenson's procedure

d) Manometry of the anal sphincter's tonus

e) Barium sulphate x-ray

24. What does treatment of chronic ulcerous colitis include?

a) Total parenteral nutrition

b) Total colectomy and ileostomy

c) Subtotal colectomy and ileostomy

d) All of the above

e) Non of the above

25. Which of the following conditions could not lead to acute peritonitis?

a) Meckel's diverticulum perforation

b) Crohn's disease

c) Papilla Vater stenosis

d) Richter's type incarceration

e) Acute intestinal obstruction

26. Which of the following symptoms is not typical for subdiaphragmatic abscess?

a) lnspiratory pain in the upper part of the abdomen and the right thoracic half

b) Pain in compression of the lower ribs

c) Septic fever

d) Kloiber glasses

e) Extended liver dullness

27. Which of the following symptoms is not typical for a subdiaphragmatic abscess?

a) Limited respiratory movements of the affected chest half

b) Elevated diaphragm

c) Reactive pleural effusion in the affected chest half

d) Pain irradiating to the supraclavicular space

e) Diarrhea

28. What is the treatment of subdiaphragmatic abscesses?

a) Conservative

b) Extraperitoneal drainage

c) Laparotomy and tamponade of the abdominal cavity

d) Abscess puncture under ultrasound control

1. Which are the atypical types of gaiter?

a) Retrosternal

b) Endothoracic

c) lntratracheal

d) Pulmonary

e) At the base ofthe tongue

f) Prescalene

2. What is the Grave's disease typical clinical triade?

a) Goiter

b) Hypothyroidism

c) Exophtalmos

d) Tachypnea

e) Hyperpirexia

f) Tachycardia

3. Which are the typical signs in the clinical manifestation of Grave's disease?

a) Higher cardiac minute volume

b) Dry skin

c) Sweating

d) High irritability

e) Mental and physical apathy

f) Tremor of the upper extremities

4.Which are the main eye symptoms in Grave's disease?

a) Rovsing symptom

b) Stellwag symptom

c) Kocher symptom

d) Bazedow symptom

e) Sitkovskiy symptom

f) Moebius symptom

g) Graefe symptom

5. How could esophageal atresia be diagnosed?

a) Barium sulfate X-ray

b) Water-soluble contrast material X-ray

c) CT-scan

d) MRI

e) Nasogastral tube

6. What is the treatment of esophageal atresia in a newborn?

a) Elective surgery

b) Emergency surgery

c) Emergency surgery in a specialized hospital

d) Conservative treatment

7. What is the surgical treatment of esophageal atresia?

a) One-stage surgery

b) Two-stage surgery

c) All of the above

8. In which cases two-stage surgical procedures are indicated in esophageal atresia?

a) If there is a esophagotracheal fistula

b) If the distance between the proximal and the distal part of the esophagus is more than 2 cm

c) If there is a delay in the diagnosis

9. What kind of surgical procedure is indicated in a patient operated for cholelithiasis, common bile duct lithiasis and purulent cholangitis?

a) Cholecystectomy and drainage of the subhepatic space

b) Cholecystostomy

c) Cholecystectomy and drainage of the common bile duct through the cystic duct stump

d) Cholecystectomy, choledochotomy and drainage of the common bile duct by a T-tube drain

e) All of the above

10. What is the right therapeutic approach to a patient with acute phlegmonous cholecystitis and 48h of non effective conservative therapy?

a) Laparoscopy

b) Intensifying of the conservative therapy

c) Emergency surgery

d) Antibiotic therapy

e) Percutaneous transhepatic drainage of the common bile duct

11. Which of the following is not a type of common bile duct drainage?

a) T-tube drainage

b) Vishnevsky drainage

c) Spasokukotsky drainage

d) Halsted drainage

e) Non of the above

12. Which of the following is not a cholelithiasis complication?

a) Acute pancreatitis

b) Obstructive jaundice

c) Duodenal stasis

d) Small bowel obstruction

e) Purulent cholangitis

13. In which of the following groups femoral hernia happens more often?

a) In men

b) In children

c) In men and children

d) Non of the above

14. What could happen after a femoral hernia incarceration?

a) Incarceration of the antimesenteric part of the bowel wall

b) Bowel wall necrosis

c) Peritonitis

d) All of the above

e) Non of the above

15. Is it possible not to have an intestinal obstruction as a clinical sign of incarcerated femoral hernia?

a) Yes

b) No

16. Could femoral hernias become big in size?

a) Yes

b) No

17. In which of the following cases appendectomy is contraindicated in acute appendicitis?

a) If there is appendiceal infiltrate

b) Acute myocardial infarction

c) Pregnancy in 30-40 gestational week

d) Novocain allergy

e) Coagulation status disorders

18. How could acute appendicitis be differentiated from kidney colic pain?

a) Administration of spasmolytics

b) Administration of opioid analgesics

c) Urine analysis

d) Chromocystography or excretory urography

e) Angiography of the renal vessels

19. Which of the following symptoms are typical for perforation of the appendix?

a) Free gas in the abdominal cavity

b) Reduction of the circulatory blood volume

c) Sudden intensification of the abdominal pain

d) Muscular defense of the abdominal wall

e) Positive Blumberg sign

20. What is the primary cause of gangrenous appendicitis?

a) Thrombosis of the inferior mesenteric artery

b) Stenosis of the ileocolic artery

c) Non specific arteriitis of the visceral branches of the aorta

d) Bacterial infection

e) Thrombosis of the appendiceal artery

21. Which of the intestinal layers is affected in chronic ulcerous colitis?

a) Serosa

b) Muscular layer

c) Mucosa

d) All of the above

22. Which are the most common complications of chronic ulcerous colitis?

a) Hemorrhage and abscess formation

b) Perforation

c) Intestinal obstruction

d) All of the above

23. Conservative treatment of chronic ulcerous colitis includes:

a) Non steroid anti-inflammatory drugs

b) 5-ASA medications

c) Antibiotics

d) Pain-killers

24. Which of the following complications of chronic ulcerous colitis does not require surgical treatment?

a) Hemorrhage

b) Perforation

c) Malignancy

d) Toxic megacolon

e) Electrolyte imbalance

25. What kind of peritonitis do tuberculosis and abdominal typhus cause?

a) Primary

b) Secondary

c) Tertiary

26. What kind of peritonitis does hallow organs perforation cause?

a) Primary

b) Secondary

c) Tertiary

27. Diffuse peritonitis affects:

a) One abdominal area

b) Two abdominal areas

c) Three abdominal areas

28. When does the toxic stage of the acute peritonitis start?

a) Until the 24th hour

b) 24th - 72 hours

c) After 72 hours

1.Which are the complications in Grave's disease?

a) Portal vein thrombosis

b) Heart attack

c) Atrial fibrillation

d) Compression of the major neck structures

e) Discoordination of the active movements

2. What is the conservative treatment for Grave's disease?

a) Treatment of tachycardia and rhythm disorders

b) Thyrostatic therapy with inorganic iodine

c) Thyroxine therapy

3. What is the difference between benign and malignant turners of the thyroid gland?

a) High mitotic activity in benign turners

b) Smooth surface of the malignant turners

c) Presence of a capsule in benign tumors

d) Mature thyroid cells as a sign of malignisation

e) Lower hormonal activity in thyroid adenomas

4. Which of the following are considered precancerous conditions for thyroid gland carcinoma?

a) Thyroid gland adenoma

b) Thyrotoxic adenoma

c) Goiter

d) Ridl thyroiditis

e) Thyrotoxicosis

5. What are the major diagnostic tests for thyroid gland carcinoma?

a) Tumor markers

b) Neck X-ray

c) Thyroid gland ultrasound and biopsy

d) CT-scan of head and neck

e) Scintigraphy

6. What is the origin of Zenker's diverticula?

a) Cervical part of the esophagus

b) Middle third of the esophagus

c) Distal third of the esophagus

7. Which are the most common symptoms in Zenker's diverticula?

a) Dysphagia and regurgitation

b) Heartburn and pain in the epigastrium

c) Heaviness and pain in the chest

8. Chest pain and stenocardia complaints are typical for:

a) Cervical diverticula

b) Biffurcation diverticula

c) Epiphrenic diverticula

d) All of the above

9. What is the definition of esophageal achalasia?

a) Esophageal neoplastic disease with liver metastasis

b) Neuromuscular esophageal disease with disfunction of the lower esophageal sphincter

c) Neuromuscular disease of the pylorus and the stomach wall

10. Which of the following is a determining factor of the therapeutic approach in a patient with acute phlegmonous cholecystitis?

a) Presence of acute peritonitis

b) Presence ofconcomitant diseases

c) Age of the patient

d) Surgeon's qualification

e) Presence of stones in the gallbladder

11. What is the therapeutic approach to a 53-year-old patient with obstructive jaundice due to a stone in the common bile duct and acute liver insufficiency?

a) Emergency surgery and external drainage of the bile ducts

b) Emergency surgery and hemosorption in the postoperative period

c) Emergency surgery and external drainage of the thoracic duct

d) Emergency surgery after hemosorption

e) Emergency endoscopic papillosphincterotomy and hemosorption and surgical treatment after jaundice reduction

12. What is the therapeutic approach to a 69-year-old patient with acute phlegmonous cholecystitis in a fair general condition, heart rate 90bpm, soft abdominal walls upon palpation, pain in the right hypochondriac area and negative Blumberg sign?

a) Emergency surgery

b) Conservative treatment including antibiotics

c) Conservative treatment and emergency surgery after 24h if there is no effect of the therapy

d) Cholecystectomy after preoperative preparation

e) It depends on the presence of stoned in the gallbladder and the bile ducts

13. Patients with biliary colic pain due to stones in the gallbladder are indicated for?

a) Emergency cholecystectomy

b) Conservative treatment

c) Antienzymatic therapy

d) Emergency surgery after colic pain reduction

e) Laparoscopic cholecystectomy

14. What is the definition of omphalocele?

a) Congenital umbilical hernia

b) Non obliterated omphaloenteric duct

c) Non obliterated urachus

15. What is the treatment for congenital umbilical hernias?

a) Conservative

b) Elective surgery

c) Emergency surgery

16. What is the treatment for a congenital umbilical hernia with a small defect of the abdominal wall?

a) One stage surgery

b) Multiple stage surgery

c) Conservative treatment

17. What is the treatment for a congenital umbilical hernia with a big defect of the abdominal wall?

a) Two stage surgery

b) One stage surgery

c) Conservative treatment

18. Which of the following symptoms are typical for phlegmonous appendicitis?

a) Blumberg sign

b) Bartomier-Michelson sign

c) Kocher-Volkovich sign

d) Rovsing sign

e) Murphy sign

19. How could acute appendicitis be differentiated from perforated duodenal ulcer?

a) Upper endoscopy

b) Abdominal X-ray

c) Abdominal ultrasound examination

d) Laparoscopy

e) Barium sulphate image study of the stomach

20. Acute appendicitis is an inflammatory processes affecting:

a) Caecum

b) Terminal ileum

c) lleocecal valve

d) Vermiform process

21. What does ileocecal bowel segment include?

a) Terminal ileum

b) Caecum and the appendix

c) lleocecal valve

d) All of the above

22. Which are the indicationsfor surgical treatment ofchronic ulcerous colitis?

a) Toxic megacolon

b) Perforation

c) Hemorrhage

d) Non effective conservative therapy

e) All of the above

23. Which of the following microorganisms causes pseudomembranous colitis?

a) Enterococcus fecalis

b) Bacteroides spp.

c) Clostridium perfringens

d) Clostridium difficile

e) E.coli

24. Which are the most complications of diverticulosis?

a) Diverticulitis

b) Hemorrhage

c) Perforation

d) Intestinal obstruction

e) Fistulas

25. Which of the following diagnostic methods could be used in colon polyps?

a) Colonoscopy

b) Virtual colonoscopy

c)MRI

d) All of the above

26. After leakage of which of the following contents the patient could develop aseptic peritonitis?

a) Bile juice

b) Stools

c) Pancreatic juice

d) Urine

27. Which of the following symptoms are typical for diffuse peritonitis?

a) Muscular defense

b) Positive Courvoisier sign

c) Positive renal sucussion

d) Positive Blumberg sign

28. Which of the following diagnostic methods is most informative in determining the T and N status in patients with rectal carcinoma?

a) CT- scan

b) Rectoscopy

c) MRI

d) Digital rectal examination

e) Transanal ultrasound examination

1. Which of the following types are the most malignant tumors of the thyroid gland?

a) Small cell carcinoma

b) Follicular

c) Alveolar

d) Squamous

e) Gaint cell carcinoma

f) Papillary

2. Which are the possible complications after thyroid gland surgery?

a) Laryngeal nerve injury

b) Trigeminal nerve injury

c) Hemorrhage

d) Gas embolism

e) Heart attack

3. Which is the most common histological type of thyroid gland carcinoma?

a) Follicular

b) Papillary

c) Medullar

d) Non differentiated

4. What is the most appropriate therapeutical approach to a patient with a 2 cm "cold" nodule in the left thyroid lobe and histological result of malignant cells after fine needle aspiration biopsy?

a) Radioiodine ablation

b) Thyroidectomy

c) Lobectomy

d) Enucleoresection

5. What is the first method of choice for treatment of a 76-year-old patient with histological verification of esophageal carcinoma, 27cm away from the oral cavity, liver metastasis, dysphagia and total obstruction ofthe esophageal lumen?

a) Esophageal resection by two surgical approaches

b) Feeding gastrostomy

c) Self-dilating tube insertion

d) Adjuvant chemotherapy

6. Assessment of respectability of esophageal carcinoma depends on:

a) The histological verification

b) The histological verification and staging

c) The type ofthe tumor and the age of the patient

7. What is Trousseau syndrome?

a) Purple spots around the umbilicus

b) Migratingthrombophlebitis

c) Thrombophlebitis of the lateral thoracic vein

d) Enlarged non painful gallbladder

8. Which is the upper border of the anterior abdominal wall?

a) Xiphoid process

b) Left costal margin

c) Right costal margin

d) All of the above

e) None of the above

9. Which of the following diagnostic methods is not a method of cgoice in obstructive jaundice?

a) Liver enzymes test

b) Infusion cholangiography

c) Laparoscopy

d) Endoscopic retrograde cholangiopancreatography

e) Percutaneous transhepatic cholangiography

10. Which is the first symptom of acute cholecystitis?

a)Fever

b)Vomiting

c) Pain in the right hypochondriac area

d) Diarrhea

e) Discomfort in the epigastrium

11. Biliary colic pain beginning is:

a) Sudden and sharp

b) Gradual

c) After long period of starving

d) After hypothermia

12. Which of the following drug is contraindicated in acute and chronic cholecystitis?

a) Papaverin

b) Morphine hydrochloride

c) Drotaverine

d) Atropine sulphate

e) Spasmalgon

13. What is the treatment for an umbilical hernia in children?

a) Conservative

b) Surgical

c) Surgical after unsuccessful conservative treatment after the 1st year of the child

14. Which are the clinical features of an umbilical hernia in adults?

a) Small in size, no signs of incarceration, spontaneous recovery b) Big in size, frequent incarcerations, surgical treatment

c) Big in size, rare incarcerations, surgical treatment

15. What is the name of the surgical procedure in which the hernia ring of an umbilical hernia is sutured?

a) Mayo technique

b) Sapozhko-Piccoli technique

c) Mesh hernia repair

16. What is the non obliterated omphaloenteric duct?

a) Fistula between the small intestine and the umbilicus

b) Meckel diverticulum

c) Fistula between the urine bladder and the umbilicus

17. Appendix is a rudimentary organ and is formed by:

a) Terminal ileum wall

b) lleocecal valve

c) Caecum wall

d) Transverse colon wall

18. What is the function ofthe appendix?

a) Secretory

b) Contractile

c) Lymphocytic

d) All of the above

e) It has no functions

19. Which are infection's spreading ways in acute appendicitis? a) Haematogenous and contact

b) Lymphogenous

c) Enterogenous

d) All of the above

20. Which of the following organs is also known as abdominal tonsil?

a) Terminal ileum

b) Caecum

c) lleocecal valve

d) Appendix

21. Which is the golden standard in the treatment of colon polyps?

a) Conservative

b) Endoscopic polypectomy

c) Surgical polypectomy

d) Segmental resection of the affected part of the colon

22. What is the metastatic way of colorectal cancer?

a) Lymphogenous

b) Hematogenous

c) Local invasion

d) Implantation

e) All of the above

23. Which of the following conditions is the most common precancerosis for colorectal cancer?

a) Skin nevus

b) Lynch syndrome

c) Colon polyposis

d) Peutz-Jeghers syndrome

24. Which is the most common symptom in left-sided colorectal cancer?

a) Constipation/ intestinal obstruction

b) Anemia

c) Headache

d) Pain

25. Which of the following is a contraindication for rectal resection in patients with cTl status?

a) cN+

b) High grade earcinoma

c) Infiltration of the deepest submucosal layer

d) All of the above

26. Which is the most minimally invasive surgical procedure that could be used in a 82-year-old patient with colic abdominal pain, nausea and vomiting, stop offlatulence and defecation for three days, abdominal distension with hypersonic sound upon percussion, decreased peristalsis, empty rectal ampulla upon digital rectal examination. Concomitant diseases - myocardial infarction and coronary stent insertion, chronic obstructive pulmonary diasease. Anesthesiologist consultation -ASA 4 . CT - scan data for tumor of the proximal rectum, dilated small and large bowel loops, hydroaeric levels.

a) Emergency surgery, Hartmann procedure

b) Laparoscopy, double barrel proximal colostomy

c) Endoscopic stent insertion

27. Which of the following statements is false?

a) Short- and long-term oncology results in laparoscopic rectal resection in rectal carcinoma are equal to those after conventional open surgery

b) Conversion to open surgery after laparoscopic rectal resection is more often that conversion to open surgery after laparoscopic colon cancer resection

c) Resectable carcinoma of the distal third of the rectum is a contraindication for laparoscopic resection

d) Previous abdominal surgery is not a contraindication for laparoscopi rectal resection

28 Transanal minimally invasive surgery is a method of choice in: a) Rectal polyps

b) Rectal carcinoma

c) All of the above

1. What are the neuroprotective measures that should be taken towards laryngeal recurrent nerves during thyroid surgery?

a) lntraoperative CT-navigation

b) lntraoperative neuromonitoring

c) Express histological examination

d) Using magnifying glasses

2. What is the most dangerous complication of thyroid gland surgery?

a) Acute intraoperative haemorrhage

b) Postoperative hypoparathyroidism

c) Dis- or aphonia

d) All of the above

3. What is the obligatory condition for considering a thyroid gland surgical procedure as minimally invasive one?

a) Using an endoscope

b) Incision to 3 cm

c) Preserving prethyroid muscles

d) All of the above

4. What does "near total thyroidectomy" mean?

a) Preserving 3-4g of the thyroid gland

b) Preserving small amount of thyroid tissue

c) lntracapsular blood vessel ligation

d) None of the above

5. Which areas does epigastrium include?

a) Left and right hypochondriac area, epigastric area

b) Right hypochondriac area, epigastric area, left lumbar area

c) Right lumbar area, epigastric area, left lumbar area

d) Right and left hypochondriac area, umbilical area

e) None of the above

6. Which areas does mesogastrium include?

a) Right and left hypochondriac area, epigastric area

b) Right hypochondriac area, epigastric area, left lumbar area

c) Right and left lumbar area, umbilical area

d) Right and left hypochondriac area, umbilical area

e) None of the above

7. Which areas does hypogastrium include?

a) Right and left hypochondriac area, suprapubic area

b) Right and left iliac area, suprapubic area

c) Right and left lumbar area, supra pubic area

d) Right and left hypochondriac area, umbilical area

e) None of the above

8. Anterior abdominal wall consists of which of the following muscles?

a) External oblique muscle, transverse abdominal muscle, rectus abdominis muscle

b) Internal oblique muscle, transverse abdominal muscle, rectus abdominis muscle

c) External oblique muscle, internal oblique muscle, transverse abdominal muscle

d) External oblique muscle, Internal oblique muscle, rectus abdominis muscle

e) None of the above

9. Which of the following procedures is not used in extrahepatic bile ducts examination?

a) Palpation of the common bile duct

b) Choledochoscopy

c) lntraoperative cholangiography

d) Catheter probe examination of the common bile duct

e) Intravenous cholangiography

10. What is the treatment for a patient with obstructive jaundice due to choledoholithiasis?

a) Emergency surgery

b) Conservative treatment

c) Delayed surgery after preoperative preparation

d) Celiac trunk catheterization

e) Plasmapheresis

11. Which of the following is indicated in acute calculous cholecystitis?

a) Emergency surgery

b) Delayed surgery

c) Conservative therapy followed by elective surgery

d) Conservative treatment

e) All of the above

12. Courvoisier symptom is not typical for?

a) Acute calculous cholecystitis

b) Pancreatic head carcinoma

c) lndurative pancreatitis

d) Papillary tumor

e) Common bile duct tumor

13. What is the clinical manifestation of an non obliterated urachus?

a) Fistula between the urine bladder and the umbilicus

b) Fistula between the small intestine and the umbilicus

c) Fistula between the colon and the umbilicus

14. What is the definition of a Meckel diverticulum?

a) Partially non obliterated omphaloenteric duct

b) Partially non obliterated urachus

15. Where is the localization of a Meckel diverticulum?

a) Ileum

b) Jejunum

c) Ascending colon

d) Transverse colon

e) Sigmoid colon

16. How many types of diaphragmatic hernias are there?

a) Traumatic

b) Non traumatic

c) Traumatic and non traumatic

17. How many types of acute appendicitis are there?

a) Superficial (catarrhal)

b) Destructive

c) Complicated

d) All of the above

18. What does destructive appendicitis mean?

a) Catarrhal

b) Appendiceal colic

c) Phlegmonous

d) Phlegmonous, gangrenous and perforated appendicitis

19. Which are the complications of acute appendicitis?

a) Periappendiceal infiltrate and abscess formation

b) Pylephlebitis and sepsis

c) lntrabdominal pus collections and peritonitis

d) All of the above

20. Which of the following factors determine the clinical manifestation of acute appendicitis?

a) Age, sex, general condition

b) Pathological changes in the appendix and other abdominal organs

c) Macroorganism resistance to infections and presence of any complications of the disease

d) All of the above

21. Which is the most common symptom in righ-sided colorectal cancer?

a) Constipation/intestinal obstruction

b) Anemia

c) Headache

d) Pain

22. Which of the following procedures is a golden standard in the surgical treatment of rectal cancer?

a) Rectotomy

b) PartiaI rectal resection

c) Total mesorectal excision

d) Rectal resection

23. What are the first therapeutic measures in metastatic colorectal cancer?

a) Adjuvant chemotherapy

b) Surgical treatment

c) Neoadjuvant chemotherapy

d) Radiotherapy

24. Which is the surgical method of choice in treatment of cecal carcinoma?

a) Left hemicolectomy

b) Right hemicolectomy

c) lntermedium hemicolectomy

d) Subtotal colectomy

25. Which IBD does not affect the rectum?

a) Crohn's disease

b) Chronic ulcerative colitis

26. Where is the typical localization of hemorrhoids in a gynecological position?

a) 3 o'clock

b) 5 o'clock

c) 7 o'clock

d) 9 o'clock

e) 11 o'clock

27. Which anatomical feature is the border between internal and external hemorrhoids?

a) Dentate line

b) Anal orifice

c) Recto-sigmoid junction

d) Proximal rectal third

e) Anal levator muscle

28. Which of the following is a typical symptom in hemorrhoids? a) Pain

b) Anal bleeding after defecation

c) Anal bleeding before defecation

d) Diarrhea

e) Anal itching

1. What is the criteria according to which we divide chest traumas to open and closed?

a) Whether there is a chest bones injury

b) Whether there is a skin injury

c) Whether there is a pulmonary or pleural injury

2. What is the definition of penetrating chest trauma?

a) Skin injury

b) Thoracic fascia injury

c) Pleural injury

d) Pulmonary injury

3. What is the medical term for the presence of blood and air in the pleural cavity and shifting of the mediastinum to the non affected side of the chest?

a) Tension chylopneumothorax

b) Haemothorax

c) Tension haemopneumothorax

4. What is the medical term for the presence of blood in the pleural cavity?

a) Pyothorax

b) Chylothorax

c) Haemothorax

d) Haemascos

5. How many walls does the inguinal canal have?

a) 1

b) 2

c) 3

d) 5

e) None of the above

6. Which is the inferior border of the inguinal canal?

a) Inguinal ligament

b) Pectineal ligament

c) Transverse fascia

d) Internal oblique muscle

e) None of the above

7. Which of the following elements forms the anterior wall of the inguinal canal?

a) Internal oblique muscle aponeurosis

b) Transverse abdominal muscle aponeurosis

c) A and B

d) Rectus abdominis muscle aponeurosis

e) Non of the above

8. Which of the following elements forms the superior wall of the inguinal canal?

a) Lower parts of the internal oblique muscle

b) Lower parts of the transverse abdominal muscle

c) A and B

d) Lower parts of the rectus abdominis muscle e) All of the above

9. Which of the following is not typical in obstructive jaundice due to choledocholithiasis?

a) Hyperthermia

b) Increased levels of direct bilirubin

c) Increased levels of alkaline phosphatase

d) Increased levels of liver transaminases

e) Absence of stercobilin in the stools

10. Which of the following procedures is not used for diagnosing obstructive jaundice?

a) CT-scan

b) Intravenous cholecystocholangiography

c) Percutaneous transhepatic cholangiography

d) Endoscopic retrograde cholangiopancreatography

e) Abdominal ultrasound examination

11. Which of the following is not typical for acute obstructive cholangitis?

a) Jaundice

b) Fever

c) Small size of the liver

d) Leucocytosis

e) Liver enlargement

12. Which of the following is not typical for acute cholangitis?

a) Fever

b) Pain in the right hypochondriac area

c) Jaundice

d) Leucocytosis

e) Diarrhea

13. What is the localization of non traumatic diaphragmatic hernias?

a) Esophageal hiatus

b) Larrey and Morgagni space, Bochdalek's foramen

c) All of the above

14. Where does hiatal hernia pass through?

a) Esophageal hiatus of the diaphragm

b) Larrey and Morgagni space

c) Bochdalek's foramen

15. Where does parasternal diaphtragmatic hernia pass through?

a) Larrey and Morgagni space

b) Bochdalek's foramen

c)Esophageal h~tus

16. Where do posterolateral diaphragmatic hernias pass through? a) Larrey and Morgagni space

b) Bochdalek's foramen

c)Esophageal h~tus

17. Which of the following is the major symptom of acute appendicitis?

a) Nausea and vomiting

b) Fever and increased heart rate

c) Diarrhea

d) Abdominal pain

18. What is the first localization of the pain in acute appendicitis?

a) In the epigastrium

b) Diffuse abdominal pain

c) In the ileocecal area

d) Around the umbilicus

e) Above the pubic symphysis

19. Which of the following signs are typical for acute appendicitis?

a) Kocher-Volkovich sign

b) Courvoisier sign

c) Rovsing sign

d) Murphy sign

e) Obraztsov sign (Psoas sign)

20. What is important for diagnosing acute appendicitis?

a) Localization of the pain in the beginning of the disease

b) Final localization of the pain

c) First and final localization of the pain

d) Pain localization is not related to the diagnosis

21. Which is the surgical method of choice in treatment of descending colon cancer?

a) Left hemicolectomy

b) Right hemicolectomy

c) lntermedium hemicolectomy

d) Subtotal colectomy

22. What is a combined trauma?

a) Traumatic injury of many organs in one anatomical cavity

b) Traumatic injury caused by a few traumatic agents at the same time

c) Traumatic injury of organs in different anatomical cavities (thoracic and abdominal, central nervous system and thoracic cavity)

d) Trauma to an organ with previous pathological changes

23. Which of the following conditions is a predisposing factor for a rupture of a hollow abdominal organ in closed trauma?

a) If the organ is empty

b) If the organ is full

c) If the organ is mobile

d) If the organ is in a fixed position

e) If the organ is atonic

24. Which of the following diagnostic methods is most informative in liver rupture?

a) ERCP

b) Upper endoscopy

c) Native abdominal X-ray

d) Contrast abdominal X-ray

e) Laparoscopy

25. Which of the following are typical complications of hemorrhoids?

a) Thrombosis and inflammation

b) Massive hemorrhage

c) Abscess and fissure formation, intoxication

d) Rectal carcinoma

e) Anal and rectal prolapse

26. What does surgical treatment of hemorrhoids include?

a) Ultrasound ligation

b) Morgan's procedure

c) Alcoholization

d) Whitehead's procedure

e) Liquid nitrogen therapy

27. What is the typical localization of anal fissure in gynecological position?

a) 3 o'clock

b) 6 o'clock

c) 7 o'clock

d) 9 o'clock

e) 11 o'clock

28. Which are the symptoms of anal fissure?

a) Pain during and after defecation

b) Mucus and pus anal discharge

c) Bleeding

d) Anal sphincter spasms

e) Diarrhea

1. What is the definition of flail chest?

a) Three or more consecutive ribs or costal cartilages are fractured in two or more places and this segment has an independent mobility

b) Three or more consecutive ribs or costal cartilages are fractured in two or more places and this segment doesn't have an independent mobility

c) Shoulder complex paradoxal mobility

2. Which type of pneumothorax requires prehospital emergency care?

a) Open subtotal pneumothorax

b) Partial pneumothorax

c) Tension pneumothorax

d) Total pneumothorax without shifting of the mediastinum

3. What is the most common fracture in chest trauma?

a) Rib fracture

b) Clavicular fracture

c) Sternal fracture

d) Scapular fracture

4. What are the clinical and X-ray signs of tension pneumothorax?

a) Shadow on the affected chest half

b) Total collapse of the affected lung and shifting of the mediastinum to the contra lateral sideof the chest

c) Dull percussion sound of the affected side

d) No breathing sounds of the affected side

5. Which of the following elements forms the posterior wall of the ingunal canal?

a) Transverse fascia

b) Transverse abdominal muscle

c) Rectus abdominis muscle

d) Internal oblique muscle

e) External oblique muscle

6. How many rings does inguinal canal have?

a) Internal (deep)

b) Medium

c) External (superficial)

d) A and C

e) All of the above

7. Which artery is the medial border of the deep inguinal ring?

a) Inferior epigastric artery

b) Superficial epigastric artery

c) Superior epigastric artery

d) Internal iliac artery

e) Internal pudenda I artery

8. Is there a femoral canal if there is no hernial sac in it?

a) Yes

b) No

9. What is the cause of intermittent obstructive jaundice?

a) Incarcerated stone in the terminal part of the common bile duct

b) Common bile duct tumor

c) Stone in the cystic duct

d) Stone in the common bile duct causing ventil type of obstruction

e) Stricture of the common bile duct

10. In which of the following cases an emergency surgery for choledocholithiasis is indicated?

a) In cystic duct occlusion

b) In biliopancreatitis

c) In perforative cholecystitis

d) In mechanical jaundice

11. Which of the following conditions is a choledocholithiasis complication?

a) Hydropsofthe gallbladder

b) Empyema of the gallbladder

c) Obstructive jaundice and cholangitis

d) Chronic exacerbated hepatitis

e) Perforative cholecystitis and peritonitis

12. Which of the following is a method of choice in the therapeutic approach to a patient with chronic calculous cholecystitis?

a) Litholytic medications intake

b) Microcholecystostomy

c) Lithotripsy

d) Cholecystectomy

e) Complex conservative treatment

13. What is the most important and constant symptom in congenital diaphragmatic hernias?

a) Cyanosis

b)Vomits

c) Abdominal distension

14. What organs disorders are typical for diaphragmatic hernias? a) Abdominal organs

b) Thoracic organs

c) Abdominal and thoracic organ

15. What are the physical examination findings in incarcerated diaphragmatic hernia?

a) Tympanic sound in the affected half of the chest

b) Decreased or absent breathe sounds and presence of peristalsys in the affected half of the chest

c) All of the above

16. What is the treatment for incarcerated diaphragmatic hernia? a) Elective surgery

b) Emergency surgery

c) Conservative treatment

17. Which are the cardinal symptoms of acute appendicitis?

a) Pain upon palpation

b) Muscular defense

c) Positive Blumberg sign

d) All of the above

18. Which of the following symptoms is always present in acute appendicitis?

a) Muscular defense

b) Positive Blumberg sign

c) Spontaneous and palpation-induced pain

d) Increased heart rate

19. High leucocyte rate in acute appendicitis is:

a) Determinant factor the diagnosis

b) Important factor for the diagnosis

c) It is not related to the diagnosis

d) Additional factor for the diagnosis

20. Muscular defense and positive Blumberg sign in acute appendicitis are:

a) Constant symptoms in all the types of acute appendicitis

b) Always observed in the catarrhal forms

c) Always observed in the destructive forms

d) Rarely observed in catarrhal and observed in 70-92% of the destructive forms

21. Which of the following diagnostic methods is most informative in urine bladder rupture?

a) Laparoscopy

b) Abdominal ultrasound

c) Transrectal ultrasound

d) Retrograde contrast cystography

e) Urine analysis

22. In which of the following cases abdominal ultrasound examination is an informative diagnostic method?

a) Stomach rupture

b) Small bowel rupture

c) Urine bladder rupture

d) Rupture of parenchymatous abdominal organs

23. What is the clinical manifestation of hemobilia?

a) Positive Blumberg sign

b) Pain in the right hypochondriac area

c) GIT bleeding

d) Intermittent hyperbilirubinemia

e) Positive Cullen's sign