Orris

TICKET № 1. 1. Asepsis: concept, sources, and routes of infection penetration into a wound. Prevention methods. 2. Hemotransfusion shock: pathogenesis, clinical features, emergency care. 3. Classification of purulent diseases of the hand. Characteristics of the spread of pus on the hand. 4. Basic principles of conservative therapy for vascular pathology of the lower extremities, list the groups of medications. TICKET № 2. 1. Parenteral and enteral nutrition, classification, and indications. 2. Definition, goals, and stages of surgery (operation). Concept of surgical approach and basic techniques. 3. Types of rejection and methods of immunosuppression in organ and tissue transplantation. 4. Chronic arterial insufficiency of the lower extremities: causes, clinical features, diagnosis, and treatment. TICKET № 3. 1. Determination of blood grouping according to the ABO system using standard serums. Evaluation of results. 2. Local and general signs of inflammation. Principles of treating purulent wounds in the first phase of wound healing(process). 3. Chronic venous insufficiency: causes, clinical features, and diagnosis. Main types of lower extremity vein surgeries (operations). 4. Opisthorchiasis: clinical features, diagnosis, and treatment. TICKET № 4. 1. Types of sterilization. 2. Local and general signs of inflammation. Principles of treating purulent wounds in the second stage of the inflammatory process. 3. Osteomyelitis: classification, clinical features, diagnosis, and treatment. 4. Pulmonary embolism: causes, clinical features, diagnosis, and treatment. TICKET № 5. 1. Hand treating for surgeons before surgery (operation): rules and types. 2. Shock, classification. First aid for traumatic shock. 3. Pleural empyema, classification, clinical presentation, diagnosis, and treatment. 4. Aneurysm, clinical presentation of aortic dissection, diagnosis, and treatment. TICKET № 6. 1. Antiseptics, classification. 2. Drowning, clinical features, first aid. 3. Peritonitis, classification, clinical features, diagnosis, treatment. 4. Lymphostasis, clinical features, treatment. TICKET № 7. 1. Bleeding, classification. 2. Signs of biological death. 3. Prevention of postoperative thromboembolic complications. 4. Echinococcosis: clinical presentation, diagnosis, and treatment. TICKET № 8. 1. Indications for blood transfusion. 2. Collapse, causes, first aid. 3. Classification of specific surgical infections. Tetanus. 4. Alveococcosis: clinical features, diagnosis, treatment. TICKET № 9. 1. Blood transfusion complications. 2. Coma, clinical features, diagnosis, treatment. 3. Fast-track therapy. 4. Classification of congenital diseases. TICKET № 10. 1. Classification of blood components. 2. Mechanical and physical antisepsis. 3. Clinical groups of oncology patients. 4. Diagnosis of congenital diseases. TICKET №11. 1. Contraindications to blood donation. 2. Chemical and biological antisepsis. 3. Types of surgical procedures for malignant diseases. 4. Treatment of congenital diseases. TICKET №12. 1. Methods of blood component transfusion. 2. Wound classification. 3. Criteria for brain death. 4. Congenital esophageal stenosis: clinical features, diagnosis, and treatment. TICKET №13. 1. Contraindications to blood transfusion. 2. Wound healing, phases of wound healing. 3. Phlegmons of the hand: classification, diagnosis, treatment. 4. Congenital diaphragmatic hernia: clinical presentation, diagnosis, treatment. TICKET №14. 1. Algorithm before performing red blood cell transfusion. 2. Types of wound healing (proсess). 3. Рurulent arthritis: classification, clinical features, diagnosis, and treatment. 4. Congenital pyloric atresia: clinical features, diagnosis, and treatment. TICKET №15. 1. Individual selection before blood transfusion. 2. Frostbite, stages, and basic treatment principles. 3. Treatment methods for cancer patients. 4. Basic principles of plastic surgery. TICKET №16. 1. Rules for the use of medical masks. 2. Transfusion shock, diagnosis, and treatment. 3. Classification of purulent infections. 4. Congenital biliary atresia: clinical presentation, diagnosis, and treatment. TICKET №17. 1. Classification of blood products. 2. Basic principles of treating purulent infections. 3. Acute arterial obstruction: cause, clinical features, diagnosis, and treatment. 4. Congenital annular pancreas: clinical features, diagnosis, and treatment. TICKET №18. 1. Classification of blood substitutes and their use. 2. Terminal conditions. Signs of clinical death, first aid. 3. Classification of purulent diseases of the skin and subcutaneous tissue: clinical presentation, diagnosis, and treatment principles. 4. Congenital intestinal atresia: clinical presentation, diagnosis, and treatment. TICKET №19. 1. Indications for blood component transfusion, indications for use. 2. Ensuring surgical safety. 3. Classification of superficial forms of panaritiums (felon), clinical features, diagnosis, treatment principles, and pain management. 4. Congenital Hirschsprung's disease: clinical features, diagnosis, and treatment. TICKET №20. 1. Blood type and Rh factor determination, and procedure. 2. Hospital-acquired infections, prevention. 3. Classification of deep forms of panaritiums (felon), clinical presentation, diagnosis, treatment principles, and pain management. 4. Define the terms reconstructive, restorative, plastic surgery, and transplantation. TICKET №21. 1. Blood compatibility tests. 2. Electrical injury, clinical presentation, first aid. 3. Classification of hand phlegmons, clinical presentation, diagnosis, treatment principles, and pain management. 4. Transplantation, classification. TICKET №22. 1. Physician's actions before transfusing blood components. 2. Burn disease, periods, and treatment. 3. Patient assessment scales. 4. Brain death criteria. TICKET №23. 1. Local anesthesia, classification. Highest single dose of novocaine. Contraindications to local anesthesia. 2. Define each symbol: TNM in the International Classification of Malignant Diseases. 3. Acute venous insufficiency, clinical presentation, diagnosis, treatment. 4. Organ and tissue donor service, tasks. TICKET №24. 1. Classification of anesthesia. Conduction anesthesia, examples. 2. Principles of rational antibiotic therapy for purulent infections. 3. Differences between benign and malignant tumors. 4. Contraindications to organ harvesting. TICKET № 25 1. General anesthesia. Stages of anesthesia. 2. Initial patient examination. 3. Laparostomy: types and indications. 4. Tissue compatibility in organ transplantation, principles of organ selection, waiting list. Rejection, immunosuppression methods. TICKET №26. 1. Bleeding classification, clinical presentation, diagnosis, and treatment principles. 2. Hypothermia, stages, first aid. 3. Sepsis, etiology, pathogenesis, clinical presentation, diagnosis, and treatment principles. 4. Artificial organs, examples. TICKET №27. 1. Forest's endoscopic classification of ulcer bleeding. 2. Stages of patient examination. 3. Diagnostic methods in angiology. 4. Requirements for organ retrieval during transplantation. TICKET №28. 1. Hemorrhagic shock: stages, diagnosis, Algover index, treatment principles. 2. Methods for closing skin defects in burns. 3. Classification of malignant diseases by stage based on the international TNM classification. 4. Types of organ preservation during transplantation. TICKET №29. 1. Criteria for assessing the quality of medical care for blood loss. 2. Treatment options for deep burns. 3. Carcinogens, types, and effects. 4. Skin grafting, types. TICKET №30. 1. Sterile zones in the operating room. 2. Basic principles of burn treatment. 3. Precancerous conditions: optional and obligatory conditions, examples. 4. Legal and ethical issues of organ donation. TICKET №31. 1. Types of operating room cleaning. Medical waste classes. 2. Burns, classification by depth. 3. List the methods of body detoxification (hemosorption, hemodialysis, plasmapheresis) and their indications. 4. MARS - artificial liver, indications.

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Answer are too long, write little shorter answer again from starting

All 31 tickets are now answered. Here is a summary of what was covered:
All 31 Tickets Completed. Key topics covered across the answers:
  • Asepsis/Antiseptics (T1, T6, T10, T11): concepts, classification of antiseptics (mechanical, physical, chemical, biological), sterilization types
  • Blood Transfusion (T1, T2, T8, T9, T12-T17, T20-T22): indications, contraindications, compatibility testing, components, complications, hemotransfusion shock
  • Wound healing & Infections (T3, T4, T7, T13, T14, T16, T18, T19): phases, types of healing, purulent diseases of skin/hand, osteomyelitis, sepsis, peritonitis
  • Vascular (T1-T2, T3, T4, T5, T23, T26-T27): arterial/venous insufficiency, DVT, PE, aneurysm/dissection, diagnostic methods, angioplasty
  • Oncology (T10, T11, T15, T23, T28, T29, T30): TNM, clinical groups, tumor differences, carcinogens, precancerous conditions, treatment methods
  • Transplantation (T2, T21, T23-T25, T27-T28, T30): rejection types, immunosuppression, donor service, preservation, legal/ethical issues
  • Congenital diseases (T9-T14, T17-T19): classification, esophageal stenosis, diaphragmatic hernia, pyloric atresia, biliary atresia, annular pancreas, intestinal atresia, Hirschsprung's
  • Burns (T22, T28-T31): classification, burn disease periods, fluid resuscitation, treatment, grafting
  • Anesthesia (T5, T23-T25): hand scrub, local anesthesia types, conduction, general anesthesia stages
  • Emergency/Critical Care (T5, T6, T7, T8, T18, T26): shock, CPR, coma, drowning, hypothermia, collapse
  • Plastic/Reconstructive surgery (T15, T20, T21, T29): principles, skin grafting types
  • Parasitic infections (T3, T7, T8): opisthorchiasis, echinococcosis, alveococcosis
  • Extracorporeal detox (T31): hemodialysis, hemosorption, plasmapheresis, MARS

Rewrite the answer little more short, and don't write see ticket xx , write full answer again where it need to to written.

SURGICAL EXAM TICKETS — ANSWERS

TICKET № 1

1. Asepsis Asepsis is a system of measures preventing microorganisms from entering a wound. Sources: exogenous (air, staff, instruments, environment) and endogenous (patient's own skin, gut, chronic infection foci). Routes: airborne, contact, implantation, hematogenous. Prevention: sterilization of instruments, surgical hand scrub, sterile draping, antiseptic skin prep, laminar airflow in OR.
2. Hemotransfusion shock Caused by ABO incompatibility — donor RBCs hemolyzed by recipient antibodies → free hemoglobin release, DIC, renal tubular obstruction. Signs: agitation, chest/lumbar pain, fever, hypotension, hemoglobinuria (red-brown urine), jaundice, oliguria. Emergency care: stop transfusion immediately, keep IV line open with saline, furosemide, sodium bicarbonate IV, dopamine for BP support, treat DIC, hemodialysis if anuria develops.
3. Purulent diseases of the hand Classified as: panaritium (cutaneous, subcutaneous, periungual, subungual, tendinous, bony, articular, pandactylitis) and hand phlegmons (midpalmar, thenar, hypothenar, subaponeurotic, commissural, U-shaped). Pus spreads along tendon sheaths — thumb and little finger sheaths communicate, causing U-shaped (horseshoe) phlegmon. Dorsal edema often more visible despite palmar source.
4. Conservative therapy for lower extremity vascular pathology Drug groups: antiplatelet agents (aspirin, clopidogrel), anticoagulants (heparin, warfarin, NOACs), vasoactive drugs/vasodilators (pentoxifylline, cilostazol), venotonics (diosmin, troxerutin — for venous pathology), statins, prostaglandins (iloprost — critical ischemia), thrombolytics (alteplase — acute occlusion).

TICKET № 2

1. Parenteral and enteral nutrition Enteral nutrition: delivery via oral route, nasogastric/nasojejunal tube, or stoma (gastrostomy, jejunostomy). Used when GI tract functional but patient cannot eat (stroke, trauma, ICU). Parenteral nutrition: IV delivery of amino acids, lipids, glucose, electrolytes, vitamins — peripheral (short-term) or central via CVC (long-term, high-calorie). Indicated when gut is non-functional: ileus, bowel fistula, short bowel syndrome, severe pancreatitis.
2. Definition, goals, and stages of surgery Surgery is a planned sequence of manual and instrumental actions on tissues to treat disease. Goals: curative, palliative, or diagnostic. Stages: preoperative preparation → anesthesia → surgical approach → main operative step → wound closure → postoperative care. Surgical approach is the incision/route to reach the target organ (must be adequate, safe, and anatomically sound). Basic techniques: incision, dissection, hemostasis, ligation, suturing, anastomosis.
3. Rejection types and immunosuppression in transplantation Hyperacute: within minutes-hours, antibody-mediated (preformed antibodies), irreversible. Acute: days to weeks, T-cell mediated, reversible with treatment. Chronic: months to years, gradual fibrosis, poorly reversible. Immunosuppression: induction (anti-thymocyte globulin, IL-2 receptor blockers), maintenance (calcineurin inhibitors — tacrolimus/cyclosporine; mycophenolate; corticosteroids; mTOR inhibitors — sirolimus), acute rejection treatment (high-dose steroids, anti-CD3 antibody).
4. Chronic arterial insufficiency of lower extremities Causes: atherosclerosis (most common), Buerger's disease, diabetes. Fontaine stages: I — asymptomatic; IIa — claudication >200 m; IIb — claudication <200 m; III — rest pain; IV — trophic ulcers/gangrene. Diagnosis: ABI (<0.9 abnormal), duplex ultrasound, CT/MR angiography. Treatment: risk factor control, antiplatelet therapy, exercise; surgical: bypass grafting, endarterectomy, angioplasty/stenting, amputation for irreversible ischemia.

TICKET № 3

1. ABO blood grouping using standard serums Three standard serums (O, A, B groups) are placed in a row and mixed with test blood on a white plate. Read agglutination at 5 min at 15–25°C. Results: no agglutination = Group O(I); agglutination with O and B serums = Group A(II); agglutination with O and A serums = Group B(III); agglutination with all three = Group AB(IV). Confirmed by reverse grouping with standard red cells.
2. Signs of inflammation + treating purulent wounds phase 1 Local signs (Celsus-Galen): rubor, calor, tumor, dolor, functio laesa. General: fever, leukocytosis with left shift, elevated ESR/CRP, malaise, tachycardia. Phase 1 (inflammatory/exudative): goal is pus removal and bacterial reduction. Treatment: surgical incision and drainage, hypertonic (10% NaCl) dressings, antiseptic irrigation (chlorhexidine, povidone-iodine), proteolytic enzymes (trypsin), systemic antibiotics, analgesics.
3. Chronic venous insufficiency Causes: post-thrombotic syndrome (DVT), primary varicose veins, valvular incompetence. Features: heaviness, edema (worse in evenings), skin hyperpigmentation, lipodermatosclerosis, venous ulcers (medial malleolus). Diagnosis: duplex ultrasound (gold standard), phlebography. Operations: stripping (Babcock), crossectomy (high ligation of GSV), miniphlebectomy, endovenous laser/radiofrequency ablation, subfascial endoscopic perforator surgery (SEPS).
4. Opisthorchiasis Caused by Opisthorchis felineus from eating raw freshwater fish; affects bile and pancreatic ducts. Acute: fever, urticaria, eosinophilia, hepatomegaly, RUQ pain. Chronic: cholangitis, cholecystitis, pancreatitis, risk of cholangiocarcinoma. Diagnosis: stool microscopy (eggs), serology (ELISA), ultrasound/CT (dilated bile ducts), ERCP. Treatment: praziquantel, choleretics, antispasmodics; surgery for complications (strictures, stones).

TICKET № 4

1. Types of sterilization
  • Steam (autoclave): 121°C/30 min or 134°C/20 min — instruments, linen
  • Dry heat oven: 160°C/60 min or 180°C/30 min — glassware, oils, powders
  • Chemical (ethylene oxide, glutaraldehyde): heat-sensitive items (endoscopes, plastics)
  • Radiation (gamma): factory-sterilized disposables
  • Plasma (hydrogen peroxide): low-temperature, delicate instruments
  • Filtration: sterile liquids and gases
2. Signs of inflammation + treating purulent wounds phase 2 Local signs: rubor, calor, tumor, dolor, functio laesa. General: fever, leukocytosis, elevated CRP/ESR, tachycardia. Phase 2 (proliferative/regenerative): granulation tissue forms; goal is to protect granulations and stimulate healing. Treatment: gentle cleansing, ointment dressings (methyluracil, Vishnevsky balsam, hydrocolloids), secondary suture closure when granulations are healthy, skin grafting for large defects, physiotherapy (UVR, laser).
3. Osteomyelitis Classification: hematogenous (acute/chronic) vs. traumatic/postoperative; Cierny-Mader stages 1–4. Acute hematogenous: mainly children, long bones; high fever, bone pain, soft tissue swelling; X-ray changes appear at 10–14 days (periosteal reaction); MRI detects earlier. Chronic: sequestra, involucrum, fistulae. Treatment: IV antibiotics 4–6 weeks, surgical drainage of abscess, sequestrectomy, debridement; bone grafting/Ilizarov fixation for chronic forms.
4. Pulmonary embolism Causes: DVT (most common), immobility, surgery, cancer, thrombophilia. Features: sudden dyspnea, pleuritic chest pain, hemoptysis, tachycardia, hypoxia; massive PE causes hypotension, syncope, cardiac arrest. Diagnosis: D-dimer (screening), CT pulmonary angiography (gold standard), echo (right heart strain). Treatment: anticoagulation (LMWH → warfarin or NOAC), systemic thrombolysis for massive PE, surgical embolectomy, IVC filter if anticoagulation contraindicated.

TICKET № 5

1. Surgical hand scrub Goal: remove transient flora and reduce resident flora. Nails short, no jewelry; wash hands and forearms to elbows. Types: (1) Classic brush scrub + 70% alcohol/chlorhexidine; (2) Alcohol-based handrub — WHO standard, 1.5 min rubbing, 3–5 mL product, most widely used; (3) 0.5% chlorhexidine in 70% alcohol; (4) Spasokukotsky-Kochergin (historical, ammonia). Sterile gloves worn after any method.
2. Shock classification. First aid for traumatic shock Types: hypovolemic (hemorrhagic, dehydration), distributive (septic, anaphylactic, neurogenic), cardiogenic, obstructive (PE, tamponade). Traumatic shock = hypovolemic + pain component. First aid: stop bleeding (tourniquet/pressure), ensure airway, 2 large-bore IV lines, rapid crystalloid infusion, analgesia (morphine if no hypotension), immobilize fractures, oxygen, urgent transport; blood products for grade III–IV shock.
3. Pleural empyema Classification: acute (<3 months) vs. chronic; parapneumonic, postoperative, traumatic, tuberculous; free vs. encapsulated. Features: fever, chest pain, dyspnea, toxemia; dullness to percussion, absent breath sounds. Diagnosis: chest X-ray, ultrasound, CT, pleural fluid analysis (exudate, pH <7.2, bacteria). Treatment: antibiotics + tube thoracostomy, fibrinolytics for loculated empyema, VATS debridement, open decortication for chronic/organized empyema.
4. Aortic dissection Stanford: Type A (ascending aorta involved — surgical emergency), Type B (descending only — medical first). Aneurysm = localized aortic dilation >50% of normal diameter. Presents with sudden tearing chest/back pain, pulse differentials, aortic regurgitation, stroke/limb ischemia. Diagnosis: CT angiography (gold standard), TEE, MRI. Treatment: Type A — emergency surgical replacement of ascending aorta; Type B — IV beta-blockers + nitroprusside; endovascular stent-graft for complicated Type B.

TICKET № 6

1. Antiseptics classification
  • Mechanical: debridement, wound irrigation, drainage
  • Physical: hypertonic dressings, UV light, laser, ultrasonic cavitation
  • Chemical: halogens (iodine, chlorhexidine), oxidizers (H₂O₂, KMnO₄), alcohols, aldehydes (formaldehyde), detergents (benzalkonium chloride), dyes (brilliant green), heavy metals (silver sulfadiazine), nitrofurans (furacilin)
  • Biological: antibiotics, bacteriophages, proteolytic enzymes, immunoglobulins
2. Drowning Types: true (water aspiration), asphyxial (laryngospasm without aspiration), syncopal (cardiac arrest from cold/shock). Features: cyanosis, foaming from mouth, hypoxia, confusion, pulmonary edema, arrhythmia. First aid: remove safely from water, check responsiveness, CPR if no pulse/breathing (30:2), clear airway, recovery position if breathing, call EMS, oxygen, warmth (hypothermia common), hospitalize even if "recovered" — secondary drowning risk within 24h.
3. Peritonitis Classification: primary (spontaneous bacterial peritonitis), secondary (bowel perforation, appendicitis — most common), tertiary (persistent, hospital-acquired). By spread: local, diffuse, generalized. Features: abdominal pain, guarding/rigidity, rebound tenderness, absent bowel sounds, fever, tachycardia; septic shock in late stages. Diagnosis: clinical exam, WBC, abdominal X-ray (free air), CT. Treatment: emergency surgery (source control, peritoneal lavage, drains), broad-spectrum IV antibiotics, fluid resuscitation, ICU support.
4. Lymphostasis (Lymphedema) Primary (congenital, Milroy disease) or secondary (infection, tumor, surgery, radiation). Features: painless non-pitting edema of limb, skin thickening and fibrosis, "orange peel" appearance, recurrent erysipelas, elephantiasis in advanced stages. Treatment: conservative — compression stockings/bandaging, manual lymphatic drainage, skin care, antibiotics for infections; surgical — lymphovenous anastomosis, liposuction, Charles procedure (radical excision) for severe cases.

TICKET № 7

1. Bleeding classification By vessel: arterial (bright red, pulsatile), venous (dark red, continuous), capillary (oozing), parenchymal (mixed). By direction: external, internal (into cavity — hemothorax, hemoperitoneum), interstitial (into tissue). By timing: primary (at injury), secondary early (<3 days, clot dislodgement), secondary late (>3 days, arrosion by infection). By volume: Class I (<15%), II (15–30%), III (30–40%), IV (>40% blood volume).
2. Signs of biological death Early (1–4 h): livor mortis (dependent purplish discoloration), algor mortis (body cools ~1°C/h), corneal desiccation. Late: rigor mortis (begins 2–4 h, maximum 6–12 h, resolves by 48–72 h), putrefaction (green abdominal discoloration begins 24–48 h), Larcher spots (triangular scleral desiccation). Absolute sign: absence of cardiac activity on ECG for >30 min, fixed dilated pupils, no respiration.
3. Prevention of postoperative thromboembolic complications Non-pharmacological: early mobilization, compression stockings, intermittent pneumatic compression, adequate hydration. Pharmacological: LMWH (enoxaparin 40 mg/day) starting 12 h pre-op or 6–12 h post-op; UFH for renal impairment; NOACs (rivaroxaban, apixaban) for orthopedic surgery. Duration: 10–14 days (general surgery), 35 days (hip/knee arthroplasty). Risk stratified by Caprini or Rogers score.
4. Echinococcosis Caused by Echinococcus granulosus (cystic form). Liver most common, then lung. Slow-growing cyst; RUQ mass, hepatomegaly, biliary obstruction; rupture causes anaphylaxis and dissemination. Diagnosis: ultrasound/CT (cyst with daughter cysts, calcification), serology (ELISA, indirect hemagglutination). Treatment: surgery (pericystectomy) or PAIR (puncture-aspiration-injection-reaspiration) + albendazole pre/postoperatively; albendazole alone for inoperable cases.

TICKET № 8

1. Indications for blood transfusion
  • Acute hemorrhagic anemia: Hb <70 g/L (stable) or <100 g/L with ongoing bleeding/cardiovascular disease
  • Surgical blood loss >20–25% blood volume
  • Pre-operative: Hb <80 g/L before major surgery
  • Coagulopathy with active bleeding (FFP, platelets)
  • Exchange transfusion (hemolytic disease of newborn) Transfusion should be based on clinical signs, not Hb value alone.
2. Collapse Acute vascular insufficiency with sudden BP drop without loss of consciousness. Causes: massive hemorrhage, MI, severe infection/toxemia, adrenal insufficiency, vasovagal. Features: pallor, cold sweats, weak rapid pulse, hypotension, nausea, confusion. First aid: lay flat with legs elevated, IV access, crystalloid infusion, vasopressors (norepinephrine) if BP unresponsive, treat underlying cause, oxygen, ECG monitoring.
3. Specific surgical infections — Tetanus Specific infections include: tetanus, gas gangrene (C. perfringens), anthrax, erysipelas. Tetanus: caused by C. tetani neurotoxin (tetanospasmin) blocking glycine/GABA → spastic paralysis. Incubation 3–21 days. Signs: trismus (lockjaw), risus sardonicus, opisthotonus, tonic spasms triggered by stimuli, autonomic instability. Treatment: wound debridement, TIG 3000–6000 IU, metronidazole/penicillin, diazepam/muscle relaxants, mechanical ventilation. Prevention: DTP vaccination; active-passive immunization post-injury.
4. Alveococcosis Caused by Echinococcus multilocularis (fox tapeworm). Behaves like a malignant tumor — infiltrative growth, no capsule. Mainly liver; metastasizes to brain and lungs. Symptoms: hepatomegaly, jaundice, portal hypertension, biliary cirrhosis; late presentation common. Diagnosis: CT/MRI (irregular, densely calcified infiltrative mass), serology (Em2/Em18 ELISA), PET. Treatment: radical resection when possible; albendazole long-term (often lifelong) for inoperable cases; liver transplantation in select patients.

TICKET № 9

1. Blood transfusion complications
  • Immunological: hemolytic reaction (ABO/Rh incompatibility), febrile non-hemolytic reaction (most common), allergic/anaphylactic, TRALI, transfusion-associated GvHD
  • Infectious: HIV, hepatitis B/C, CMV, syphilis, malaria
  • Metabolic: hyperkalemia, hypocalcemia (citrate toxicity), hypothermia, acidosis
  • Circulatory: TACO (volume overload), air embolism
  • Massive transfusion: dilutional coagulopathy, hypothermia, acidosis triad
2. Coma Unarousable unresponsiveness; GCS <8. Causes: metabolic (hypoglycemia, hepatic, uremic, DKA), structural (stroke, TBI, tumor, meningitis). Features: no eye opening, no verbal/motor response, absent protective reflexes. Diagnosis: blood glucose first, ABG, electrolytes, toxicology screen, CT head, LP if infection suspected. Treatment: ABCDE, correct hypoglycemia (50% dextrose), naloxone (opioids), thiamine (alcoholism), intubate if GCS <8, treat underlying cause.
3. Fast-track (ERAS) therapy Multimodal perioperative protocol to reduce surgical stress and speed recovery. Preoperative: carbohydrate loading, no prolonged fasting, prehabilitation. Intraoperative: minimally invasive approach, goal-directed fluid therapy, normothermia, short-acting anesthetics. Postoperative: early oral feeding and mobilization, multimodal non-opioid analgesia, early removal of drains/catheters. Benefits: shorter hospital stay, fewer complications, lower costs.
4. Classification of congenital diseases By etiology: genetic (chromosomal — Down syndrome; monogenic — PKU; multifactorial — cleft palate), environmental (teratogens), combined. By timing: embryopathies (1st trimester — major structural defects), fetopathies (2nd–3rd trimester — functional/growth disorders). By severity: lethal, severe (urgent correction needed), moderate, minor. By number: isolated vs. multiple malformations (syndromes).

TICKET № 10

1. Classification of blood components
  • Red cell components: packed RBCs, leukoreduced RBCs, washed RBCs, irradiated RBCs, frozen RBCs
  • Platelet components: random donor platelets, apheresis (single-donor) platelets
  • Plasma components: fresh frozen plasma (FFP), cryoprecipitate (fibrinogen, FVIII, vWF), single-donor plasma
  • Granulocyte concentrates (rare indications) Whole blood is rarely used; component therapy is standard.
2. Mechanical and physical antisepsis Mechanical: removal of microorganisms by physical means — primary surgical debridement, wound irrigation, drainage (passive/active), dressing changes, pus evacuation. Physical: drying effect of hypertonic solutions, UV irradiation (germicidal wavelength 253.7 nm), laser therapy, ultrasonic cavitation, sorption dressings (activated charcoal, silica gel).
3. Clinical groups of oncology patients
  • Group Ia: patients with precancerous conditions
  • Group Ib: under examination with suspected cancer
  • Group II: malignant tumor potentially curable by radical treatment
  • Group IIa: subject to radical treatment
  • Group III: practical recovery after radical treatment (remission/observation)
  • Group IV: advanced cancer not amenable to radical treatment; palliative/symptomatic care only
4. Diagnosis of congenital diseases Prenatal: ultrasound (structural anomalies from 18–20 weeks), maternal serum screening (AFP, hCG, estriol), amniocentesis (chromosomal analysis), CVS (10–12 weeks), NIPT (cell-free fetal DNA). Postnatal: neonatal screening (PKU, hypothyroidism, cystic fibrosis), clinical examination, imaging (X-ray, US, CT, MRI), karyotyping, enzyme assays, molecular genetic testing.

TICKET № 11

1. Contraindications to blood donation Absolute: HIV/AIDS, hepatitis B/C, syphilis, active TB, malignancy, serious cardiac/renal/hepatic disease, blood disorders, CJD history. Temporary deferral: recent infection/fever (4 weeks), recent surgery, pregnancy/lactation (6 months), recent vaccination (2–4 weeks), travel to malaria-endemic areas, recent tattoo/piercing (4–6 months), low Hb (<120 g/L women, <130 g/L men).
2. Chemical and biological antisepsis Chemical: halogens (iodine 5%, povidone-iodine, chlorhexidine), oxidizers (H₂O₂ 3%, KMnO₄), alcohols (70% ethanol, isopropanol), aldehydes (glutaraldehyde), detergents (benzalkonium chloride), heavy metals (silver nitrate), nitrofurans (furacilin 1:5000), dyes (brilliant green, methylene blue). Biological: antibiotics, bacteriophages, proteolytic enzymes (trypsin, chymotrypsin — break down necrosis), immune sera, immunoglobulins, interferons.
3. Types of surgical procedures for malignant diseases
  • Radical: complete tumor removal with regional lymph nodes (R0 resection) — curative intent
  • Extended radical: resection of adjacent involved organs
  • Palliative: tumor bulk reduction to improve quality of life or enable other therapy
  • Symptomatic: relieves complications (colostomy for obstructing cancer, biliary bypass)
  • Cytoreductive + HIPEC (peritoneal malignancies)
  • Diagnostic/staging: biopsy, exploratory laparotomy, sentinel node biopsy
4. Treatment of congenital diseases Conservative: medications (enzyme replacement, hormone therapy, dietary restriction), physiotherapy, orthoses. Surgical: timing by severity (emergency — intestinal atresia; elective — cleft palate at 6–12 months). Genetic: gene therapy (developing), bone marrow transplant for SCID/thalassemia. Prenatal interventions: fetal surgery for spina bifida, hydronephrosis. Multidisciplinary team approach required.

TICKET № 12

1. Methods of blood component transfusion
  • Intravenous: peripheral or central venous catheter (standard)
  • Intraosseous: emergency when IV impossible (children, field conditions)
  • Intra-arterial: historical, rarely used for severe peripheral spasm
  • Autologous: preoperative donation, intraoperative cell salvage (Cell Saver), acute normovolemic hemodilution
  • Exchange transfusion: hemolytic disease of newborn, severe toxicology
2. Wound classification By mechanism: incised, lacerated, contused, stab, gunshot, bite, avulsion. By depth: superficial, deep, penetrating (into body cavity). By contamination: clean (surgical), clean-contaminated, contaminated, dirty/infected. By timing: fresh (<6 h), stale (6–24 h), old (>24 h). Surgical wound classes: I (clean), II (clean-contaminated), III (contaminated), IV (dirty/infected).
3. Criteria for brain death Preconditions: known irreversible cause, normothermia, no drug intoxication or metabolic disturbance. Clinical: deep coma (GCS 3), absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough reflex), apnea test (no breathing at pCO₂ >60 mmHg). Confirmatory tests: EEG (isoelectric), cerebral angiography (no intracranial blood flow), TCD. Two independent physicians certify; observation period varies by jurisdiction.
4. Congenital esophageal stenosis Rare narrowing due to fibromuscular thickening, cartilaginous (tracheobronchial) remnants, or membranous web. Presents when solids are introduced: dysphagia, regurgitation, choking, failure to thrive, recurrent aspiration pneumonia. Diagnosis: barium swallow (smooth fusiform narrowing), esophagoscopy with biopsy. Treatment: endoscopic balloon dilation (first-line, multiple sessions); surgical resection with anastomosis for long-segment or refractory stenosis; cartilaginous type usually requires surgery.

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1. Contraindications to blood transfusion Absolute: decompensated heart failure with pulmonary edema, severe hypertension, thromboembolism, acute glomerulonephritis, hepatic failure. Relative: compensated heart failure, hepatic/renal disease, allergic conditions, bronchial asthma, polyvalent allergy. In life-threatening hemorrhage with no alternative, there are no absolute contraindications — use leukoreduced/washed products in sensitized patients.
2. Wound healing phases Phase 1 — Inflammatory (days 1–4): hemostasis, neutrophil infiltration, debridement of necrotic tissue, exudation. Phase 2 — Proliferation (days 4–21): fibroblast migration, collagen synthesis, granulation tissue formation, angiogenesis, wound contraction by myofibroblasts. Phase 3 — Remodeling (3 weeks to 2 years): collagen reorganization (Type III → Type I), scar maturation, tensile strength increases to ~80% of normal. Disrupted by infection, ischemia, diabetes, malnutrition.
3. Phlegmons of the hand Diffuse purulent inflammation of cellular spaces. Types: subcutaneous (dorsal/palmar), subfascial, midpalmar space, thenar space, hypothenar, subaponeurotic, commissural ("collar-button"), U-shaped (horseshoe — communicating thumb/little finger tendon sheaths). Diagnosis: throbbing pain, tense edema, finger held in flexion, fever. Treatment: urgent surgical drainage via adequate incisions (counter-incisions where needed), antistaphylococcal antibiotics, hand elevation, splinting.
4. Congenital diaphragmatic hernia Herniation of abdominal organs into thorax (90% left-sided, Bochdalek type). Pulmonary hypoplasia is the main cause of mortality. Neonatal presentation: respiratory distress, cyanosis, scaphoid abdomen, bowel sounds in chest, mediastinal shift. Diagnosis: prenatal ultrasound (stomach in thorax), chest X-ray (bowel loops in chest, mediastinal shift). Treatment: stabilize first, intubate, NG tube decompression; delayed surgical repair (primary closure or patch) after physiological stabilization; ECMO for severe pulmonary hypertension.

TICKET № 14

1. Algorithm before red blood cell transfusion
  1. Verify indication and obtain written consent
  2. Check patient identity (name, DOB, medical record) against blood unit label
  3. Inspect blood bag (expiry, integrity, color — no brown/black discoloration or clots)
  4. Confirm ABO/Rh of unit matches patient's group
  5. Perform bedside ABO compatibility test (patient serum + donor cells)
  6. Biological test: infuse 10–15 mL slowly, observe 3 min × 3 cycles
  7. Transfuse at correct rate (RBCs: 1–4 h); monitor patient continuously
  8. Document lot number, volume, time, and any reactions in medical record
2. Types of wound healing Primary intention (per primam): clean wound edges surgically approximated, minimal granulation, thin scar — requires no infection, good blood supply, adequate apposition. Secondary intention (per secundam): wound left open, heals by granulation, contraction, and re-epithelialization — larger scar; for infected or contaminated wounds. Tertiary intention (delayed primary closure): wound debrided and left open 3–5 days, then surgically closed once infection controlled — combines benefits of both methods.
3. Purulent arthritis Classification: by cause (hematogenous, post-traumatic, iatrogenic), by stage (serous → seropurulent → purulent → putrid), by joint. Features: severe joint pain, swelling, redness, warmth, restricted movement, fever, joint held in position of comfort. Diagnosis: joint aspiration (turbid fluid, WBC >50,000/μL, bacteria on culture), ultrasound/X-ray, MRI. Treatment: joint drainage (aspiration with irrigation, arthroscopic washout, or open arthrotomy for severe cases), IV antistaphylococcal antibiotics, immobilization.
4. Congenital pyloric atresia Very rare complete pyloric obstruction (membranous, solid cord, or gap defect). Neonatal presentation: non-bilious vomiting from birth, visible gastric peristalsis, upper abdominal distension, dehydration. Associated with epidermolysis bullosa (EB-PA syndrome). Diagnosis: abdominal X-ray (single "bubble" — gastric dilation, no distal gas), upper GI contrast (obstruction at pylorus), ultrasound. Treatment: surgical correction after resuscitation — pyloroplasty or gastroduodenostomy; excellent prognosis if isolated.

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1. Individual selection (compatibility testing) before transfusion Steps: (1) ABO/Rh grouping of patient and donor unit. (2) Antibody screen (indirect Coombs) for irregular antibodies in patient's serum. (3) Crossmatch: major crossmatch (patient serum + donor RBCs) — most important; tests at room temperature, 37°C, and Coombs phase. Electronic crossmatch acceptable if ≥2 previous negative antibody screens. All results documented before blood issued.
2. Frostbite — stages and treatment Degrees: I — erythema/edema, no blisters; II — clear fluid blisters, superficial necrosis; III — hemorrhagic blisters, full-thickness skin necrosis; IV — necrosis of all tissues including bone. Treatment: remove from cold, remove wet clothing; rapid rewarming in 38–42°C water bath; analgesia (ibuprofen, opioids); antiplatelet therapy (aspirin, iloprost); aspirate clear blisters, leave hemorrhagic ones intact; antibiotics for grade III–IV; surgical amputation delayed until clear demarcation (weeks).
3. Treatment methods for cancer patients Surgical (radical, palliative, symptomatic), radiation therapy (external beam, brachytherapy, stereotactic), chemotherapy (alkylating agents, antimetabolites, taxanes, anthracyclines), targeted therapy (TKIs, monoclonal antibodies — trastuzumab, imatinib), immunotherapy (checkpoint inhibitors PD-1/PD-L1, CTLA-4; CAR-T cells), hormone therapy (breast, prostate), radiofrequency/cryoablation. Multimodal combination is standard.
4. Basic principles of plastic surgery Goal: restoration of form and function. Principles: adequate blood supply to tissues, minimal tension on closure, atraumatic technique, replace like tissue with like. Methods: primary closure, split-thickness skin graft (STSG), full-thickness graft (FTSG), local flaps (rotation, transposition, advancement), pedicled flaps (TRAM, latissimus dorsi), free flaps (microsurgical anastomosis — DIEP, ALT), tissue expanders, implants.

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1. Rules for use of medical masks Must cover nose and mouth completely with no gaps. Change every 2 hours or sooner if moist; do not touch front surface; remove by ear loops only; never reuse disposable masks. Surgical masks protect against droplets; FFP2/N95 respirators protect against aerosols. Hand hygiene before and after mask removal. Must be combined with hand hygiene, gloves, and eye protection for high-risk procedures.
2. Transfusion shock — diagnosis and treatment Occurs during or immediately after transfusion due to ABO incompatibility. Diagnosis: agitation → chest/lumbar pain → hypotension (BP drop >20 mmHg), tachycardia, fever, hemoglobinuria (red-brown urine), oliguria. Lab: free hemoglobin in plasma/urine, positive direct Coombs, rising bilirubin, DIC markers. Treatment: stop transfusion immediately, keep IV line open with saline, furosemide IV, sodium bicarbonate IV, dopamine/norepinephrine for BP, corticosteroids, maintain urine output >100 mL/h, hemodialysis if anuria, treat DIC with FFP/platelets.
3. Classification of purulent infections By location: skin/subcutaneous (furuncle, carbuncle, abscess, phlegmon, erysipelas, hidradenitis), tendon sheaths/joints/bones (tenosynovitis, arthritis, osteomyelitis), body cavities (empyema, peritonitis), organs (mastitis, liver abscess). By pathogen: staphylococcal, streptococcal, gram-negative, anaerobic (putrid), mixed. By extent: local vs. generalized (sepsis). By course: acute vs. chronic.
4. Congenital biliary atresia Progressive fibro-obliterative cholangiopathy of extrahepatic bile ducts. Presents at 2–8 weeks: prolonged conjugated jaundice, acholic (pale clay) stools, dark urine, hepatomegaly; progresses to biliary cirrhosis and liver failure. Diagnosis: ultrasound (absent/small gallbladder), hepatobiliary scintigraphy (no excretion into bowel), liver biopsy (bile duct proliferation, fibrosis), intraoperative cholangiography (gold standard). Treatment: Kasai portoenterojejunostomy (best results before 60 days of age); liver transplantation for failed Kasai or advanced liver disease.

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1. Classification of blood products
  • Whole blood (rarely used)
  • Cellular: packed RBCs, leukoreduced RBCs, washed RBCs, platelets, granulocytes
  • Plasma: FFP, cryoprecipitate, albumin (5%, 20%, 25%)
  • Coagulation factor concentrates: Factor VIII, Factor IX, prothrombin complex concentrate (PCC), fibrinogen concentrate, recombinant FVIIa
  • Immunoglobulins: IVIG, specific immunoglobulins (anti-D, anti-tetanus)
2. Basic principles of treating purulent infections
  1. Surgical: timely incision and drainage, excision of necrotic tissue, adequate drainage
  2. Antimicrobial: empirical → culture-guided antibiotics (antistaphylococcal + broad-spectrum for polymicrobial)
  3. Local wound care: phase-appropriate antiseptic dressings
  4. Detoxification: IV fluids; extracorporeal methods in severe cases
  5. Immunostimulation: immunoglobulins, vitamins, specific sera
  6. Supportive: analgesia, nutritional support, treatment of comorbidities
3. Acute arterial obstruction Causes: embolism (cardiac source — AF, MI, valvular disease — 80%) vs. thrombosis (on atherosclerotic plaque). Signs — "6 Ps": Pain (sudden, severe), Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (cold). Muscle necrosis begins at 4–6 h. Diagnosis: Doppler ultrasound, CT angiography. Treatment: immediate heparin bolus, surgical embolectomy (Fogarty catheter, up to 6 h), catheter-directed thrombolysis (>6 h or distal vessels), bypass for thrombotic origin, fasciotomy for compartment syndrome.
4. Congenital annular pancreas Ring of pancreatic tissue encircles and obstructs the second part of the duodenum. Associated with Down syndrome (20–30%). Neonates: bilious vomiting, duodenal obstruction (double bubble on X-ray). Adults: upper abdominal pain, peptic ulcer (30%), pancreatitis. Diagnosis: X-ray (double bubble), upper GI series, CT, MRCP. Treatment: surgical bypass — duodenoduodenostomy or duodenojejunostomy; never attempt to divide the annular tissue; excellent prognosis.

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1. Classification of blood substitutes
  • Volume expanders (colloids): albumin, dextrans (dextran-40), hydroxyethyl starch (HES), gelatins — for hypovolemia
  • Crystalloids: saline, Ringer's, PlasmaLyte — fluid resuscitation
  • Oxygen carriers: perfluorocarbon emulsions (Perftoran), hemoglobin-based carriers (HBOC) — experimental
  • Detoxification solutions: hemodez (povidone), reopolyglucin — improve microcirculation, bind toxins
  • Parenteral nutrition solutions: amino acid mixtures, lipid emulsions, glucose
2. Terminal conditions — clinical death, first aid Terminal states: predagony → agony → clinical death → biological death. Clinical death: cessation of circulation and respiration, reversible for 4–6 min (longer in hypothermia). Signs: absent carotid pulse, absent breathing, unconsciousness, dilated pupils (after 1–2 min). CPR: firm surface, compressions 30:2 (rate 100–120/min, depth 5–6 cm), AED as soon as available, epinephrine 1 mg IV every 3–5 min; continue until ROSC or 30+ min without response (except hypothermia).
3. Purulent skin/subcutaneous diseases
  • Furuncle: single hair follicle/sebaceous gland (S. aureus); painful nodule → pustule → necrotic core. Tx: drainage when fluctuant, antibiotics if systemic signs
  • Carbuncle: multiple follicles, wide necrosis, severe systemic signs; surgical debridement + IV antibiotics
  • Abscess: walled-off pus collection; fluctuance, fever. Tx: incision and drainage
  • Phlegmon: diffuse spreading, no clear border. Tx: multiple incisions + drainage + antibiotics
  • Erysipelas: β-hemolytic Streptococcus, sharp-bordered skin inflammation. Tx: penicillin
  • Hidradenitis: sweat gland (axillae/groin), recurrent. Tx: drainage, excision
4. Congenital intestinal atresia Duodenal (50%), jejunal/ileal (40%), colonic (10%). Neonatal signs: bilious (below Vater's) or non-bilious vomiting, abdominal distension (distal type), failure to pass meconium. Diagnosis: prenatal ultrasound (polyhydramnios), plain X-ray (double bubble for duodenal; multiple air-fluid levels for ileal), contrast enema (microcolon). Treatment: surgical anastomosis (primary or tapering) after stabilization; stoma if contaminated; TPN postoperatively.

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1. Indications for blood component transfusion
  • RBCs: Hb <70 g/L (stable) or <100 g/L (cardiac disease/active bleeding); acute hemorrhage >30% blood volume
  • Platelets: <10×10⁹/L (prophylactic), <50×10⁹/L (active bleeding/surgery), <100×10⁹/L (neurosurgery)
  • FFP: coagulopathy with active bleeding, INR >1.5 before invasive procedure, DIC, warfarin reversal
  • Cryoprecipitate: fibrinogen <1.5 g/L, hemophilia A, vWD
  • Granulocytes: neutropenia <0.5×10⁹/L with life-threatening infection not responding to antibiotics
2. Ensuring surgical safety WHO Surgical Safety Checklist — 3 pauses: (1) Sign In (before anesthesia): patient identity, consent, site marking, anesthesia/equipment check. (2) Time Out (before incision): confirm patient/procedure/site, antibiotics given, team introductions, critical steps reviewed. (3) Sign Out (before leaving OR): procedure confirmed, specimens labeled, instrument/sponge count correct, key recovery concerns communicated. Reduces surgical mortality and complications by ~50%.
3. Superficial panaritiums Types: (1) Cutaneous — pus under epidermis; (2) Subcutaneous — most common, painful pulp abscess; (3) Periungual (paronychia) — nail fold infection; (4) Subungual — under nail plate. Features: throbbing pain, redness, swelling at fingertip. Treatment: incision and drainage (fishmouth or hockey-stick incision); nail removal for subungual type. Anesthesia: ring block (metacarpal nerve block) with 1% lidocaine without epinephrine at base of finger.
4. Congenital Hirschsprung's disease Absence of ganglion cells (Meissner's and Auerbach's plexuses) in rectum ± sigmoid → functional obstruction. Neonates: failure to pass meconium within 48 h, bilious vomiting, abdominal distension. Older children: chronic constipation, distension, failure to thrive. Enterocolitis is a life-threatening complication. Diagnosis: rectal biopsy (absent ganglion cells — gold standard), barium enema (transition zone, no evacuation at 24 h), anorectal manometry (absent rectoanal inhibitory reflex). Treatment: Swenson/Duhamel/Soave pull-through operation; initial colostomy in sick neonates.

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1. Blood type and Rh factor determination ABO: apply 2 drops each of anti-A, anti-B, anti-AB monoclonal serums on white tile + 1 drop of test blood; read agglutination at 5 min at 15–25°C. Rh factor: anti-D serum + test blood on heated slide (37°C); agglutination = Rh+. Confirmed with standard Rh+ and Rh- cells. Must be performed in 2 independent blood samples from the patient; confirmed in the laboratory.
2. Hospital-acquired (nosocomial) infections — prevention Definition: infection acquired ≥48 h after admission, not present on entry. Pathogens: MRSA, VRE, ESBL gram-negatives, C. difficile, Candida. Transmission: contact (hands — most common), droplet, airborne. Prevention: hand hygiene (#1 measure), standard/contact/airborne precautions, aseptic technique, surgical site infection bundles (prophylactic antibiotics, skin prep, normothermia), catheter/line care bundles, environmental disinfection, antibiotic stewardship.
3. Deep panaritiums Types: (1) Tendinous (tenosynovitis) — Kanavel's 4 signs: finger held in flexion, fusiform swelling, tenderness along sheath, pain on passive extension (most important); (2) Bony — phalanx necrosis, X-ray changes; (3) Articular — joint swollen and boggy; (4) Pandactylitis — all structures involved. Treatment: urgent drainage of tendon sheath (Brunner incisions + continuous irrigation), IV antistaphylococcal antibiotics; debridement ± amputation for bony/articular types. Anesthesia: wrist block or general anesthesia.
4. Definitions: reconstructive, restorative, plastic surgery, transplantation
  • Reconstructive surgery: correction of anatomical defects caused by disease, trauma, or congenital anomalies (e.g., post-mastectomy breast reconstruction)
  • Restorative surgery: restoration of normal function lost due to injury or disease (e.g., nerve repair, tendon repair)
  • Plastic surgery: operations altering shape/appearance of body structures; includes cosmetic (aesthetic) and reconstructive components
  • Transplantation: transfer of cells, tissues, or organs from donor to recipient to replace lost/failed function (autologous, allogeneic, xenogeneic)

TICKET № 21

1. Blood compatibility tests (1) ABO compatibility: patient serum + donor RBCs on slide — agglutination = incompatible. (2) Rh compatibility: same with anti-globulin serum at 37°C. (3) Indirect Coombs (antibody screen): detects irregular alloantibodies in patient serum. (4) Full crossmatch: major (patient serum + donor cells at room temp, 37°C, Coombs phase) + minor (donor serum + patient cells). (5) Electronic crossmatch: computer verification if ≥2 historical negative screens. (6) Bedside biological test: infuse 10 mL slowly × 3, observe for reaction.
2. Electrical injury Severity depends on voltage, current type (AC > DC), path through body, duration. Local: entry/exit burns (deep, charred), deep muscle necrosis along current path. Systemic: ventricular fibrillation (leading cause of death), respiratory arrest, CNS seizures/unconsciousness, rhabdomyolysis → myoglobinuria → renal failure. First aid: disconnect power safely, CPR if cardiac arrest, do not touch victim until safe; IV fluids (prevent myoglobin-induced renal failure), ECG monitoring, burn treatment, hospitalize all significant exposures.
3. Hand phlegmons Diffuse purulent inflammation of hand fascial spaces. Types: midpalmar (most common deep space), thenar (thumb/index), hypothenar, subaponeurotic, subfascial dorsal, commissural (collar-button between fingers), U-shaped/horseshoe (communicating sheaths thumb–little finger). Diagnosis: severe throbbing pain, fingers in forced flexion, massive edema (dorsal often more prominent), fever/sepsis. Treatment: urgent drainage through adequate incisions, tendon sheath irrigation, IV antistaphylococcal antibiotics. Anesthesia: brachial plexus block (axillary/infraclavicular) or general anesthesia.
4. Transplantation classification By donor-recipient relationship:
  • Autotransplantation: same individual (e.g., skin graft, saphenous vein bypass)
  • Isotransplantation (syngeneic): identical twins — no rejection
  • Allotransplantation: same species, different individual — most common clinical transplants
  • Xenotransplantation: across species (pig → human — experimental)
By organ/tissue: solid organs (kidney, liver, heart, lung, pancreas), composite tissue (hand, face), cells (bone marrow, islet cells), tissues (cornea, heart valves, bone). By technique: orthotopic (native organ removed, e.g., heart) vs. heterotopic (native retained, e.g., kidney placed in iliac fossa).

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1. Physician's actions before transfusing blood components
  1. Verify indication and obtain informed consent
  2. Confirm patient identity against blood unit label (name, DOB, medical record)
  3. Inspect unit: expiry date, integrity, color (RBCs must not be brown/black), no clots
  4. Confirm ABO/Rh of unit matches patient
  5. Review transfusion history and antibody screen
  6. Perform bedside compatibility and biological tests
  7. Set correct infusion rate (RBCs: 1–4 h; platelets: 20–30 min; FFP: 30 min)
  8. Monitor patient throughout; document lot number, volume, time, and any reactions
2. Burn disease — periods and treatment Occurs with burns >10–15% BSA. Periods: (1) Burn shock (first 1–3 days): massive fluid shifts, hypovolemia — Parkland formula: 4 mL × kg × %BSA; half in first 8 h, half in next 16 h. (2) Acute burn toxemia (3–10 days): toxin absorption, fever, organ dysfunction. (3) Septicotoxemia (2 weeks to months): wound infection, sepsis, multi-organ failure. (4) Convalescence: wound healing, rehabilitation. Treatment: analgesia, fluid resuscitation, wound care (silver sulfadiazine), early excision and grafting, nutritional support, physiotherapy.
3. Patient assessment scales
  • GCS (Glasgow Coma Scale): eye (1–4) + verbal (1–5) + motor (1–6) = 3–15; <8 = intubate
  • APACHE II/III: ICU severity scoring
  • SOFA/qSOFA: organ dysfunction in sepsis; qSOFA ≥2 (RR ≥22, altered mentation, SBP ≤100) = suspected sepsis
  • Braden scale: pressure ulcer risk
  • Wells score: DVT/PE pre-test probability
  • Caprini score: VTE risk in surgical patients
  • NRS-2002 / MUST: nutritional risk screening
  • ASA physical status: anesthetic risk (I–VI)
  • VAS: pain intensity (0–10)
4. Criteria for brain death Preconditions: known irreversible cause, normothermia, no drug intoxication or metabolic disturbance. Clinical criteria: coma (GCS 3, no response to pain), absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough), apnea (no breathing when pCO₂ >60 mmHg). Confirmatory tests (when needed): isoelectric EEG, cerebral angiography/TCD (no intracranial flow), somatosensory evoked potentials. Two independent physicians certify; required waiting period varies by jurisdiction.

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1. Local anesthesia — classification, max novocaine dose, contraindications Types: (1) Topical/surface (lidocaine spray, cocaine on mucosa); (2) Infiltration (injection into tissues, Vishnevsky "creeping infiltrate"); (3) Conduction/regional (nerve block, plexus block, epidural, spinal); (4) IV regional (Bier block). Max single dose of novocaine (procaine): 0.25% — up to 500 mL; 0.5% — up to 150 mL; 1% — up to 75 mL; 2% — up to 25 mL. Dose increases by 1/3 with epinephrine. Contraindications: allergy to ester-class anesthetics, coagulopathy (spinal/epidural), infection at injection site, severe hypovolemia (spinal), patient refusal.
2. TNM classification
  • T (Tumor): Tx — not assessed; T0 — no evidence; Tis — in situ; T1–T4 — increasing size/local invasion
  • N (Nodes): Nx — not assessed; N0 — no regional nodes; N1–N3 — increasing nodal involvement
  • M (Metastasis): M0 — no distant metastasis; M1 — distant metastasis present Stage groupings (0, I, II, III, IV) derived from T+N+M combinations; determine treatment choice and prognosis.
3. Acute venous insufficiency Caused by DVT, superficial thrombophlebitis, or iatrogenic venous injury. DVT: calf/thigh pain, edema, warmth, redness. Phlegmasia alba dolens (iliac thrombosis): pale, painful, swollen leg. Phlegmasia cerulea dolens (massive outflow obstruction): blue, severely edematous leg → venous gangrene. Diagnosis: duplex ultrasound (gold standard), D-dimer. Treatment: anticoagulation (LMWH, NOACs), leg elevation, compression; catheter-directed thrombolysis or thrombectomy for massive/phlegmasia cases; IVC filter if anticoagulation contraindicated.
4. Organ and tissue donor service — tasks Tasks: (1) Identification and referral of potential brain-dead donors; (2) Medical suitability evaluation (infectious disease screening, tissue typing); (3) Family communication and consent; (4) Coordination with transplant centers and procurement organizations; (5) Organ preservation and procurement surgery; (6) Allocation by national registry (matching, waiting list, urgency, cold ischemia time); (7) Quality assurance and outcome tracking; (8) Public education and donation awareness programs.

TICKET № 24

1. Classification of anesthesia — conduction anesthesia By method: local (topical, infiltration, conduction), regional (spinal, epidural, nerve blocks), general (inhalational, IV, combined). By route: inhalational (isoflurane, sevoflurane, desflurane), IV (propofol, ketamine, thiopental), combined (most common). Conduction anesthesia — local anesthetic deposited near specific nerves: brachial plexus (axillary, supraclavicular, interscalene blocks), femoral nerve block, sciatic nerve block, intercostal block, paravertebral block, pudendal block, dental nerve blocks. Spinal and epidural = central neuraxial conduction blocks.
2. Principles of rational antibiotic therapy for purulent infections
  1. Culture before starting antibiotics when possible
  2. Empirical coverage for likely pathogens (antistaphylococcal for skin/soft tissue; broad-spectrum for polymicrobial)
  3. Correct dose, route (IV for severe infections), and duration
  4. De-escalate based on culture/sensitivity results
  5. Combine agents for synergy or resistance prevention where indicated
  6. Surgical source control is mandatory — antibiotics alone insufficient for abscess/empyema
  7. Limit surgical prophylaxis to ≤24 h
3. Differences between benign and malignant tumors
FeatureBenignMalignant
GrowthSlow, expansiveFast, invasive
CapsuleUsually presentAbsent
BordersClearIrregular, infiltrative
MetastasisNoYes
RecurrenceRareCommon
Cell atypiaMinimalMarked
NecrosisRareCommon
Systemic effectLocal compressionCachexia, paraneoplasia
4. Contraindications to organ harvesting Absolute: HIV infection (except HIV+ → HIV+ in some countries), active malignancy (except primary CNS tumors/some skin cancers), prion diseases (CJD), uncontrolled sepsis with multi-organ failure. Relative: prolonged warm ischemia, hepatitis B/C with active replication (usable for specific recipients), advanced donor age, severe organ dysfunction, prolonged hypotension before death. High-risk social history (IV drug use) requires additional infectious disease screening.

TICKET № 25

1. General anesthesia — stages Guedel's stages (described for ether; referenced clinically): Stage I (Analgesia) — conscious, responsive, pain reduced. Stage II (Excitement/Delirium) — unconscious but agitated, irregular breathing, vomiting risk — dangerous, pass through quickly. Stage III (Surgical anesthesia) — 4 planes: regular breathing, progressive reflex loss and muscle relaxation; planes 2–3 = optimal surgical level. Stage IV (Overdose) — respiratory and circulatory center depression → death. With modern agents: induction (propofol/thiopental) → maintenance (inhalational agent + opioid + muscle relaxant, monitored by BIS, end-tidal agent) → emergence.
2. Initial patient examination History: chief complaint, history of present illness, past medical/surgical history, medications, allergies, family and social history, review of systems. Physical examination: general appearance, vital signs (HR, BP, RR, temperature, SpO₂), then systematic — head/neck, chest (inspection, palpation, percussion, auscultation), abdomen, extremities, neurological assessment. Document findings in medical record. For surgical patients: assess ASA risk and determine if additional investigations are needed.
3. Laparostomy — types and indications Laparostomy = intentional temporary open abdomen. Types: (1) Bogota bag (sterile saline bag sewn to fascia); (2) VAC (vacuum-assisted closure — negative pressure dressing); (3) Wittmann patch (Velcro-type fascial closure for planned re-operations); (4) Mesh/zipper closure. Indications: damage control surgery (severe trauma with uncontrolled hemorrhage + coagulopathy), generalized peritonitis with severe contamination, abdominal compartment syndrome (ACS), planned second-look for ischemic bowel, fascial dehiscence.
4. Tissue compatibility in transplantation — organ selection, rejection, immunosuppression HLA matching (HLA-A, -B, -DR most important); ABO compatibility required; PRA (panel reactive antibody) measures sensitization. Crossmatch: donor lymphocytes + recipient serum — agglutination = positive crossmatch (contraindication to transplant). Waiting list criteria: medical urgency, time on list, HLA compatibility, geographic proximity. Rejection types: hyperacute (preformed antibodies, minutes-hours, irreversible), acute (T-cell mediated, days-weeks, reversible with treatment), chronic (fibrosis, months-years, poorly reversible). Immunosuppression: induction (ATG, IL-2 blockers), maintenance (tacrolimus + mycophenolate + corticosteroids), rejection treatment (high-dose steroids, anti-CD3).

TICKET № 26

1. Bleeding — classification, clinical presentation, diagnosis, treatment By vessel: arterial (bright red, pulsatile), venous (dark red, continuous), capillary/parenchymal. By direction: external, internal (hemothorax, hemoperitoneum), interstitial. Hemorrhagic shock classes: I (<750 mL, HR <100), II (750–1500 mL, HR 100–120, narrow pulse pressure), III (1500–2000 mL, HR >120, hypotension, confusion), IV (>2000 mL, life-threatening). Diagnosis: vitals + FAST ultrasound + CT. Treatment: ABCDE, direct pressure/tourniquet, 2 large-bore IVs, crystalloids + blood products (1:1:1 ratio for massive hemorrhage), tranexamic acid within 3 h, surgical source control.
2. Hypothermia — stages, first aid Mild (32–35°C): shivering, confusion, ataxia. Moderate (28–32°C): shivering stops, severe confusion, bradycardia, atrial arrhythmias. Severe (<28°C): unconscious, fixed dilated pupils, VF/asystole — "no one is dead until warm and dead." First aid: prevent further heat loss, remove wet clothing, handle gently (avoid triggering VF), horizontal position. Rewarming: passive (insulation), active external (warm blankets, warm IV fluids), active core (warmed humidified O₂, peritoneal lavage, ECMO for severe cases); continuous cardiac monitoring; CPR if arrested until rewarmed to >35°C.
3. Sepsis Sepsis-3: life-threatening organ dysfunction (SOFA increase ≥2) caused by dysregulated host response to infection. Sources: lung, abdomen, urinary tract, soft tissue, vascular access. Pathogens: gram-negatives (E. coli, Klebsiella, Pseudomonas), gram-positives (Staph, Strep). Pathogenesis: PAMPs → TLR activation → cytokine storm → endothelial dysfunction, coagulopathy, vasoplegia, organ failure. qSOFA ≥2 (RR ≥22, altered mentation, SBP ≤100) = suspected sepsis. Treatment (Surviving Sepsis bundle): blood cultures → broad-spectrum antibiotics within 1 h, 30 mL/kg IV crystalloids, norepinephrine for MAP <65, surgical source control, glucose control, VTE prophylaxis.
4. Artificial organs — examples
  • Heart: total artificial heart (SynCardia), ventricular assist devices (LVAD — HeartMate, HeartWare)
  • Kidney: hemodialysis/CVVHDF machines (extracorporeal); wearable artificial kidney in development
  • Liver: MARS, Prometheus systems (extracorporeal support)
  • Lung: ECMO (veno-venous for respiratory failure, veno-arterial for cardiac failure)
  • Pancreas: closed-loop artificial pancreas (insulin pump + continuous glucose monitor)
  • Ear: cochlear implant
  • Joints: hip, knee, shoulder endoprostheses

TICKET № 27

1. Forrest's endoscopic classification of ulcer bleeding
ClassDescriptionRebleeding risk
IaActive arterial spurting~90%
IbActive oozing~50%
IIaNon-bleeding visible vessel~40–50%
IIbAdherent clot~25–30%
IIcFlat pigmented spot~5–10%
IIIClean base<2%
Forrest Ia/Ib/IIa require endoscopic hemostasis (injection + thermal/clips); IIb usually treated; IIc/III managed medically (high-dose PPI).
2. Stages of patient examination
  1. Chief complaint
  2. Medical history (present illness — onset, character, duration; past history; family/social history; medications; allergies)
  3. Physical examination (general → systemic by body system)
  4. Laboratory investigations (CBC, biochemistry, coagulation, urinalysis)
  5. Instrumental investigations (ECG, X-ray, ultrasound, CT, endoscopy, biopsy)
  6. Clinical diagnosis formulation (preliminary → confirmed)
  7. Treatment planning and ongoing monitoring/reassessment
3. Diagnostic methods in angiology Non-invasive: pulse examination, skin temperature, ABI (ankle-brachial index — normal ≥0.9), duplex ultrasound (gold standard non-invasive), transcutaneous oximetry, CT angiography (CTA), MR angiography (MRA), photoplethysmography, segmental limb pressures. Functional: treadmill test (claudication distance), reactive hyperemia. Invasive: digital subtraction angiography (DSA — gold standard for intervention planning), intra-arterial pressure measurement, IVUS.
4. Requirements for organ retrieval during transplantation Legal: brain death certified by ≥2 independent physicians (not from transplant team); informed family consent or documented donor card. Medical: donor hemodynamic stability, absence of absolute contraindications. Technical: multi-organ procurement team, preservation solutions ready (UW, Custodiol, Celsior), transplant centers notified. Procedure: aortic cannulation + cold flush, en bloc removal, minimize warm ischemia time. Cold ischemia limits: kidney 24–36 h, liver 12–24 h, heart/lung 4–6 h, pancreas 12–18 h. Organ viability assessed; tissue biopsies taken; full documentation required.

TICKET № 28

1. Hemorrhagic shock — stages, Algover index, treatment Stages (ATLS): I (<15% BV, <750 mL) — normal vitals; II (15–30%, 750–1500 mL) — HR 100–120, narrow pulse pressure, anxiety; III (30–40%, 1500–2000 mL) — HR >120, hypotension, confusion; IV (>40%, >2000 mL) — HR >140, severely low BP, lethargy, imminent death. Algover Shock Index = HR/systolic BP: normal <1.0; 1.0–1.5 = moderate (20–40% loss); >1.5 = severe (>40%). Treatment: stop bleeding, 2 large-bore IVs, crystalloids + 1:1:1 blood products, permissive hypotension (MAP 50–65 in penetrating trauma), tranexamic acid within 3 h, surgical/radiological hemorrhage control.
2. Methods for closing skin defects in burns
  1. Split-thickness skin graft (STSG): most common; donor site heals spontaneously; meshing (1.5:1 to 3:1) expands coverage
  2. Full-thickness graft (FTSG): better cosmesis; for face/hands; donor site requires primary closure
  3. Cultured epidermal autograft (CEA): grown from small biopsy; for massive burns with limited donor sites
  4. Temporary biological cover: cadaveric allograft, porcine xenograft, amnion, synthetic substitutes (Integra, Biobrane) — bridge until autograft available
  5. Local flaps: for small specialized defects (exposed bone/tendons)
3. TNM staging Stage 0: Tis, N0, M0 (carcinoma in situ). Stage I: T1–2, N0, M0 (localized). Stage II: T3–4, N0, M0 or T1–2, N1, M0 (locally advanced). Stage III: any T, N2–3, M0 (extensive node involvement). Stage IV: any T, any N, M1 (distant metastasis). Specific cutoffs vary by tumor type; stage determines resectability, treatment choice, and prognosis.
4. Types of organ preservation during transplantation
  • Cold static storage: flush with cold solution at 4°C, store in ice; simplest, most used. Solutions: UW (University of Wisconsin) for liver/kidney, Custodiol (HTK), Celsior.
  • Hypothermic machine perfusion (HMP): reduces delayed graft function in kidneys; increasingly used.
  • Normothermic machine perfusion (NMP, 37°C): assesses and reconditions marginal/DCD organs; allows viability testing before transplant.
  • Ex-vivo normothermic perfusion (EVNP): targeted organ treatment and assessment before implantation.

TICKET № 29

1. Criteria for assessing quality of care for blood loss Key indicators: (1) Time to hemorrhage recognition; (2) Time to IV access and first fluid bolus; (3) Activation of massive transfusion protocol (MTP); (4) Tranexamic acid given within 3 h; (5) Blood product ratio achieved (1:1:1 RBC:FFP:platelets); (6) Time to surgical/angiographic hemorrhage control; (7) Hemostatic endpoints achieved (temperature >35°C, pH >7.35, Ca²⁺ >1.1 mmol/L, fibrinogen >1.5 g/L); (8) 24-hour and 30-day mortality; (9) Avoidance of unnecessary transfusion (adherence to Hb triggers).
2. Treatment options for deep burns
  1. Early tangential excision (within 48–72 h): shave to viable tissue, reduces sepsis risk
  2. Fascial excision: down to fascia for very deep burns
  3. Biological temporary cover: allograft, xenograft, Integra, Biobrane — while awaiting autograft
  4. Autologous STSG: definitive closure of excised areas
  5. Cultured skin for massive burns with limited donor sites
  6. Full-thickness grafts for hands/face
  7. Escharotomy: for circumferential deep burns causing compartment syndrome (chest/extremities)
  8. Flap reconstruction: for exposed bone/tendon defects
3. Carcinogens — types and effects Chemical: polycyclic aromatic hydrocarbons (tobacco), nitrosamines, aflatoxin B1, asbestos, benzene, vinyl chloride, aromatic amines → cause DNA mutations and adducts. Physical: ionizing radiation (X-ray, gamma, radon → DNA double-strand breaks), UV-B radiation → pyrimidine dimers → skin cancer. Biological: oncogenic viruses (HPV → cervical/oropharyngeal cancer; HBV/HCV → hepatocellular carcinoma; EBV → lymphoma; H. pylori → gastric cancer). Mechanisms: direct DNA mutation, epigenetic changes, chronic inflammation, immunosuppression.
4. Skin grafting — types (1) Split-thickness (STSG): epidermis + partial dermis; donor site heals; for large/burn wounds. (2) Full-thickness (FTSG): epidermis + full dermis; better cosmesis, less contraction; for face, hands, eyelids. (3) Composite graft: skin + cartilage or fat; for ear/nose. (4) Pedicled flap: retains blood supply through pedicle — rotation, transposition, advancement, island flap. (5) Free flap: completely detached, vessels anastomosed microsurgically (DIEP, ALT, latissimus dorsi). (6) Cultured epithelial autograft (CEA): laboratory-grown epithelial sheets for massive burns.

TICKET № 30

1. Sterile zones in the operating room
  • Zone 1 (Sterile): surgical field, instrument tables, scrub team (sterile gloves, gown sterile from chest to waist-level and cuff to elbow); only sterile items contact this zone
  • Zone 2 (Clean): circulating nurse area, anesthetist station; scrubs and mask; non-sterile
  • Zone 3 (Semi-clean): OR corridor, changing rooms
  • Zone 4 (Unclean): general hospital corridors Sterile field rules: items are sterile only on top surface, gown is sterile only front chest-to-table and sleeve to elbow; any contamination requires replacement.
2. Basic principles of burn treatment
  1. First aid: cool with running water 15–20 min (not ice); cover with clean dressing
  2. Calculate %BSA: Rule of Nines (adults) or Lund-Browder chart (children)
  3. Fluid resuscitation: Parkland formula (4 mL × kg × %BSA; half in first 8 h/half in next 16 h)
  4. Analgesia and sedation
  5. Wound care: debridement, silver sulfadiazine, non-adherent dressings; early excision + grafting for deep burns
  6. Nutritional support: high-protein, high-calorie; early enteral feeding
  7. Infection control: surveillance cultures, antibiotics only for documented infection
  8. Physiotherapy: prevent contractures, restore function
3. Precancerous conditions — obligatory and optional Optional (facultative): occasionally transform, low risk — examples: chronic atrophic gastritis, gastric ulcer, cervical ectopia, actinic keratosis, hyperplastic colon polyps, chronic inflammatory bowel disease. Obligatory: almost always progress to cancer if untreated, high risk — examples: familial adenomatous polyposis (FAP), Barrett's esophagus with high-grade dysplasia, carcinoma in situ (any site), erythroplasia of Queyrat, leukoplakia with dysplasia, Paget's disease of nipple.
4. Legal and ethical issues of organ donation (1) Informed consent: opt-in (most countries) vs. opt-out/presumed consent (Spain, France — higher rates). (2) Dead donor rule: organs only from dead donors (brain dead or DCD — donation after circulatory death). (3) No organ commercialization (WHO principle). (4) Equitable allocation: based on medical urgency and compatibility, not wealth. (5) Family rights: family informed/consulted even in opt-out systems. (6) Confidentiality: donor/recipient anonymity. (7) No conflict of interest: treating physicians must not be on transplant team. (8) Living donors (kidney, liver lobe) require independent ethics committee approval.

TICKET № 31

1. Types of OR cleaning — Medical waste classes OR cleaning: (1) Preliminary (morning, before first operation); (2) Current (between cases — surfaces wiped, used materials removed); (3) Post-operation (after each case — full surface disinfection); (4) Final (end of workday — thorough cleaning of all surfaces + UV irradiation); (5) General (weekly — deep clean including walls, ceiling, ventilation ducts). Medical waste classes: A — non-hazardous (household equivalent); B — potentially hazardous (sharps, biological waste); C — hazardous (cytotoxic, chemical waste); D — radioactive; E — highly contagious (Class III–IV pathogens).
2. Burns — classification by depth
  • Grade I: epidermis only; erythema, pain, no blisters; heals 3–5 days
  • Grade IIa (superficial partial thickness): epidermis + superficial dermis; blisters, moist, pink, very painful; heals 10–14 days spontaneously
  • Grade IIb (deep partial thickness): deep dermis; pale/mottled, less painful (nerve destruction), blisters; heals >21 days with scarring; often requires grafting
  • Grade III (full thickness): entire dermis destroyed; white/brown/charred, leathery, painless; requires grafting
  • Grade IV: deep structures (fat, muscle, bone, tendons); requires flap reconstruction or amputation
3. Body detoxification methods
  • Hemodialysis: blood through semi-permeable membrane; removes small/medium solutes (urea, creatinine, K⁺, drugs) and excess water. Indications: acute/chronic renal failure, severe electrolyte/acid-base disturbance, dialyzable drug overdose.
  • Hemosorption (hemoperfusion): blood passed through activated charcoal or resin; removes large hydrophobic toxins (barbiturates, cardiac glycosides, bilirubin). Indications: exogenous poisoning, hepatic failure.
  • Plasmapheresis: plasma separated and removed (replaced with albumin or FFP); removes large-molecule toxins, antibodies, immune complexes. Indications: TTP, Guillain-Barré, myasthenia gravis, Goodpasture's, hyperviscosity, severe autoimmune disease.
4. MARS (artificial liver) — indications MARS (Molecular Adsorbent Recirculating System) is an extracorporeal liver support system removing albumin-bound toxins (bilirubin, bile acids, aromatic amino acids, fatty acids, cytokines) and water-soluble toxins via albumin dialysate + activated charcoal + anion exchanger columns. It mimics detoxification but does not replace synthetic liver function. Indications: acute liver failure (bridge to transplantation), acute-on-chronic liver failure (ACLF), grade III–IV hepatic encephalopathy, drug-induced liver injury, primary graft non-function post-transplant, refractory cholestatic pruritus.
All 31 tickets completed — 124 questions answered.
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