Inflammatory (anterior uveitis)

66. A man, 39 years old, complained of redness, pain, blurred vision in his right eye. From the anamnesis it is known that I recently had an ARVI. Visual acuity OD = 0.6 n / k On examination: OD - pericorneal injection, ciliary pains on palpation, moisture in the anterior chamber opalescent, precipitates on the corneal endothelium, pupil of irregular shape, hypopion in the anterior chamber.

Iridocyclitis

67. On an ambulance call, a man, 64 years old, is worried about severe pain in his right eye radiating to the corresponding half of his head, nausea, and vomiting. The eye suddenly fell ill in the evening, after nervous stress. Objectively: OD - photophobia, lacrimation, stagnant injection, the cornea is swollen, rough, the anterior chamber is small; the pupil is wide, does not respond to light. Visual acuity OD = incorrect illumination. T n OD = +++

acute attack of glaucoma. 24 hours.

 

68. For which burn is MOST characteristic of the development of collicational necrosis?

Boiling water, steam, alkali.

69. At what stage of age-related cataract is MOST conservative treatment most appropriate?

Initial cataract

 

70

*! Which of the foreign fragments inside the eye is MOST likely to lead to the development of siderosis?

Iron

70. Patient M., 67 years old, who is in a hospital with appendicular infiltrate, who has throbbing pains in the right iliac region and fever up to 39.00С. An ultrasound of the abdominal cavity determines a cavity with a fluid level. What further treatment tactics are MOST appropriate?

* + surgical treatment in an emergency

 

71. A 37-year-old patient, six months after a cholecystectomy performed for chronic calculous cholecystitis, again began to experience pain in the right hypochondrium, periodically accompanied by yellowing of the sclera. Ultrasound examination of the abdominal cavity revealed no obvious pathology from the extrahepatic biliary tract.

Which of the following diagnostic methods in this case is the MOST informative?

* Choledochoscopy. BH blood test for bilirubin fractions. FGDS

72. A patient 56 years two years ago, an ultrasound revealed cholelithiasis. Upon admission to the hospital complains of colicky pain in the right hypochondrium, yellowness of the sclera and integument, skin itching, discoloration of feces and darkening of urine. Body temperature is within normal limits. In a biochemical blood test, the bilirubin level is 122.5 μmol / L.

Obstructive obstructive jaundice

 

73. Man S., 41 years old, comes with a sudden attack of severe pain in the upper abdomen. On palpation of the abdomen, pronounced muscle tension of the anterior abdominal wall is noted. Free gas revealed on abdominal x-ray

Pneumoperitoneum. Laparotomy

 

74. A 58-year-old man was admitted on an emergency basis with a clinic for ulcerative bleeding. A peptic ulcer history denies, 2 years ago he suffered a myocardial infarction, for which he receives cardiomagnyl for a long time. On FGDS, acute stomach ulcers were detected, there is no ongoing bleeding. What treatment tactics are MOST justified?

* + conservative treatment in a surgical hospital

 

75. An ambulance delivered a man with a restrained inguinal hernia. During transportation, the hernia spontaneously disengaged.

What further tactics of the surgeon is the most appropriate?

Patient monitoring

 

76. Woman A., 54 years old, complained of itching, sensation of a foreign body in the anus, and the release of red blood during bowel movements.

Which of the following is the MOST priority action in relation to the patient?

* + external examination of the perianal region

 

77. A 47-year-old man was diagnosed with acute subcutaneous paraproctitis.

Which of the following is the MOST priority treatment?

* + surgical treatment

78. A 35-year-old man was brought to the admission department of the hospital with complaints of sharp pain in the epigastric region. On examination, the position of the patient on the right side with legs brought to the stomach. On palpation, the abdomen is tense, hepatic dullness is not determined.

Which of the following is MOST probable?

* + perforated ulcer

 

79. Patient D., 25 years old, was discharged from the hospital after conservative treatment due to appendicular infiltrate. At the time of discharge, the patient does not complain, the condition is satisfactory, the abdomen is soft, the infiltrate is significantly reduced in size.

What further treatment tactics are MOST appropriate?

* + appendectomy 2 months after absorbable therapy

80. Mu zhchina 62 years old, entered the clinic of acute cholecystitis. In the blood test, leukocytosis up to 21.2x10 ⁹ / L is noted. On ultrasound, the gallbladder wall is layered, there is a fixed calculus at the neck.

What are the most appropriate patient management tactics?

* + emergency cholecystectomy

#1

*! P atsient M. 67 years old, is in hospital with appendicular infiltrate, which came throbbing pain in the right iliac fossa and fever up to 39.0 ⁰ C. In an abdominal ultrasound is determined by the cavity with the liquid level.

What further treatment tactics are MOST appropriate?

* + surgical treatment in an emergency

 

# 2

*! A patient 37 years old, six months after a cholecystectomy performed for chronic calculous cholecystitis, again began to experience pain in the right hypochondrium, periodically accompanied by yellowing of the sclera. Ultrasound examination of the abdominal cavity revealed no obvious pathology from the extrahepatic biliary tract.

Which of the following diagnostic methods in this case is the MOST informative?

* + endoscopic retrograde pancreatocholangiography

 

# 3

*! A patient 56 years two years ago, an ultrasound revealed gallstone disease. Upon admission to the hospital complains of colicky pain in the right hypochondrium, yellowness of the sclera and skin, itching, discoloration of feces and darkening of urine. Body temperature is within normal limits. In a biochemical blood test, the bilirubin level is 122.5 μmol / L.

Which of the following preliminary diagnoses is MOST probable?

* + choledocholithiasis, obstructive jaundice

 

#4

*! Male S., 41 years old, comes with a sudden attack of severe pain in the upper abdomen. On palpation of the abdomen, pronounced muscle tension of the anterior abdominal wall is noted. On the survey roentgenogram of the abdominal cavity revealed free gas.

What is the most appropriate treatment tactic in this case?

* + emergency operation

 

#5

*! A 58-year-old man was admitted on an emergency basis with a clinic for ulcerative bleeding. A peptic ulcer history denies, 2 years ago he suffered a myocardial infarction, for which he receives cardiomagnyl for a long time. On FGDS, acute stomach ulcers were detected, there is no ongoing bleeding.

What treatment tactics are MOST justified?

* + conservative treatment in a surgical hospital

 

# 6

*! An ambulance delivered a man with a restrained inguinal hernia. During transportation, the hernia spontaneously disengaged.

What further tactics of the surgeon is the most appropriate?

* + observation in a hospital

 

# 7

*! Woman A., 54 years old, complained of itching, sensation of a foreign body in the anus, secretion of red blood during defecation.

Which of the following is the MOST priority action in relation to the patient?

* + external examination of the perianal region

 

#8

*! A 47-year-old man is diagnosed with acute subcutaneous paraproctitis.

Which of the following is the MOST priority treatment?

* + surgical treatment

 

#9

*! A 35-year-old man with complaints of sharp pains in the epigastric region was delivered to the admission department of the hospital. On examination, the position of the patient on the right side with legs brought to the stomach. On palpation, the abdomen is tense, hepatic dullness is not determined.

Which of the following is MOST probable?

* + perforated ulcer

 

#10

*! Patient D., 25 years old, was discharged from the hospital after conservative treatment, which was due to appendicular infiltrate. At the time of discharge, the patient does not complain, the condition is satisfactory, the abdomen is soft, the infiltrate is significantly reduced in size.

What further treatment tactics are MOST appropriate?

* + appendectomy 2 months after absorbable therapy

 

#eleven

*! A man, 62 years old, was admitted to the clinic of acute cholecystitis. In the blood test, leukocytosis up to 21.2x10 ⁹ / L is noted. On ultrasound, the gallbladder wall is layered, there is a fixed calculus at the neck.

What is the most appropriate patient management tactic?

* + emergency cholecystectomy

 

# 12

*! A 49-year-old patient complains of pain in the right hypochondrium, yellowness of the skin and sclera, itching, light stool, dark urine, body temperature in the evening to 38 ⁰ C, chills. It is sick 5 days. The onset of the disease is associated with physical activity. The abdomen is soft, moderately painful in the right hypochondrium. The liver and spleen are enlarged.

Which of the following preliminary diagnoses is MOST probable?

+ Choledocholithiasis, obstructive jaundice?

# 13

! A 39-year-old woman undergoing treatment at a neuropsychiatric clinic swallowed a metal object, presumably a pin. On esophagography, a foreign body is found in the lower third of the esophagus.

Which of the following is the MOST important treatment event?

+ At The pressure of a foreign body

# 14

*! A 28-year-old patient was admitted to the clinic complaining of difficult passage of rough food, weakness and bad breath. For 6 years suffers from reflux esophagitis. When an X-ray contrast study revealed a narrowing of the lower third of the esophagus, then the contrast mass enters the stomach in a narrow stream.

Which treatment is most acceptable?

* + b allon dilatation of the esophagus

# 15

*! During an X-ray examination of the stomach, a deep ulcerative "niche" was found with uneven edges protruding above the mucosa, while the stomach itself acquired a cascading shape.

What complication of peptic ulcer is MOST likely?

* + about penetration of ulcers in the left lobe of the liver

# 16

*! Patient 57 years old, is in hospital with a diagnosis of " Chronic lung abscess". In radiography revealed round formation in the lower lobe of the lung, comprising liquid and gas.

What tactics of patient management are I MOST expedient?

* + lobectomy

# 17

*! A man, 62 years old, was admitted to the clinic of acute cholecystitis. In the blood test, leukocytosis of up to 25.4x10 ⁹ / L is noted. On ultrasound, the gallbladder wall is layered, there is a fixed calculus at the neck.

What is the most appropriate patient management tactic?

Emergency cholecystectomy

 

# 18

*! Male 52, located in the surgical room, on the 6th day after surgery appeared and camping in pain after the surgical wound, increase in body temperature to 38.5 ⁰ C. When viewed in the area of a postoperative wound is marked hyperemia, painful with palpation. Which of the following complications is MOST probable in this case?