A 52-year-old man turned to the polyclinic, notes, according to him, frequent attacks of pancreatitis. From anamnesis: Suffers from duodenal ulcer for about 15 years. Objectively: Examined by a polyclinic surgeon, stomach X-ray is recommended. Which radiological sign is MOST characteristic of a penetrating ulcer? deep ulcerative niche snail-like stomach cascade stomach flat ulcerative niche pneumoperitoneum #4 !A 36-year-old man turned to the medical center with complaints of abdominal pain, weakness. From anamnesis: 1 hour ago there was an episode of «dagger pain». Objectively: On examination, the stomach is «plank-shaped». A review radiograph of the abdominal cavity was prescribed. Which radiological sign is MOST characteristic of a perforated ulcer? intestinal pneumatosis pneumoperitoneum Kloiber's cups pneumothorax intestinal arch #5 !A 38-year-old man turned to a local doctor and was admitted to a penetrating ulcer clinic. Which radiological sign is MOST characteristic of this complication? «snail-like» stomach flat ulcerative niche «cascade» stomach deep ulcerative niche pneumoperitoneum #6 !A 60-year-old man with a long ulcerative history went to the polyclinic with complaints of constant and difficult to stop pain in the epigastric region, while exacerbations of the disease «lost» specific frequency and seasonality, appetite is reduced. What complication of peptic ulcer disease are these signs indicative of? latent bleeding from the ulcer about the malignancy of the ulcer about covered ulcer perforation about the development of cicatricial stenosis about the regression of the disease #7 !A 36-year-old man turned to a polyclinic with a gastrointestinal bleeding clinic. Objectively: On examination, the skin is pale, covered with cold sweat. Blood pressure - 95/70mm. hg., pulse - 100 beats/min. What complication is MOST likely in this patient? hypovolemic shock hemorrhagic shock anaphylactic shock toxic shock septic shock #8 !A 22-year-old man who was admitted with a clinical picture of a perforated ulcer was assigned an overview radiography of the abdominal cavity. Which radiological sign is MOST characteristic of a perforated ulcer? intestinal pneumatosis Kloiber's cups pneumoperitoneum pneumothorax intestinal arch #9 !A man, 28 years old, was taken to the emergency department with complaints of pain in the epigastrium and the right half of the abdomen, nausea. From anamnesis: 10 hours ago there was an episode of sudden intense pain in the epigastrium, after taking an anesthetic, the pain decreased. Later, the pain began to spread throughout the abdomen, vomiting appeared, dry mouth. Objectively: On examination, tachycardia, the abdomen is moderately tense, painful in the epigastrium, in the right half, hypogastrium. Positive symptoms of Spizharny, Shchetkin-Blumberg. What is the MOST likely preliminary diagnosis? acute intestinal obstruction perforated ulcer acute pancreatitis acute cholecystitis acute appendicitis #10 !A 32-year-old woman was taken to the emergency department, she notes constant pain in hypogastrium more on the right, nausea, dry mouth. From anamnesis: 5 years ago I had an appendectomy. Objectively: During the examination, clinical signs of acute adhesive intestinal obstruction were revealed, an overview radiography of the abdominal cavity was prescribed. What is the MOST characteristic radiological sign for OCN? deep niche Kloiber's cups pneumoperitoneum pneumatization of the intestine gas bubble #11 !A 30-year-old man came to the clinic with complaints about the presence of a tumor-like formation on the scalp on the right. From the anamnesis: 3 years ago I noticed a painless formation in the above area, it does not bother me. Objectively: Body temperature is 36.6ºС. In the area of ​​the scalp on the right there is a tumor-like formation measuring 2.0x3.0 cm, the skin color is not changed, palpation is painless, there is no fluctuation, when pressed, a discharge with an unpleasant odor appears. MOST likely diagnosis? atheroma axillary phlegmon hygroma festering atheroma lipoma #12​ !A 48-year-old man turned to a GP with complaints of intense girdle pain, vomiting, flatulence. From the anamnesis: This attack is the second, appears after an error in nutrition and alcohol intake. Objectively: On examination, the face is «kallikreini» the abdomen is swollen, soft, sharply painful in the epigastrium, left hypochondrium. Which of the following diagnoses is MOST likely? duodenal ulcer, penetration acute pancreatitis duodenal ulcer, perforation acute mesenteric ischemia acute intestinal obstruction #13 !A 48-year-old woman came to the GP with acute pancreatitis. From the anamnesis: She turned to the GP 1 hour after the onset of the disease. After taking spicy food, there was a sudden intense pain in the epigastrium, nausea, and vomiting. Objectively: On examination, the skin is of marble color, covered with cold sweat. BP - 80/60 mm Hg, pulse - 100 beats / min. The abdomen is swollen, soft, resistant in the left half. Which of the following complications is MOST likely? hemorrhagic shock enzymatic peritonitis pancreatogenic shock omental bursa abscess septic shock #14 !A 49-year-old man came to the GP with complaints of epigastric pain, nausea, abdominal distention, high temperature (up to 38.5 ºС). From the anamnesis: 10 days ago he was discharged from the hospital, where he was treated with a diagnosis of acute pancreatitis. Objectively: On examination, the face is pale, the abdomen is swollen, soft, moderately painful in the epigastrium, where the formation is indistinctly palpated, there is no dullness on percussion in sloping areas. Shchetkin-Blumberg's symptom is negative. Which of the following complications is MOST likely? peritonitis enzymatic peritonitis pancreatogenic shock omental bursa abscess septic shock #15 !A 25-year-old man addressed a GP with complaints of abdominal pain. From the anamnesis: Sick for 5 hours. Objectively: Palpation shows muscle tension and pain in the right iliac region. Rovsing's sign is positive. Which of the following diagnoses is MOST likely? mesenteric thrombosis acute intestinal obstruction acute appendicitis acute pancreatitis acute cholecystitis #16 !A 60-year-old man turned to a GP with complaints of aching pain in the right side of the abdomen. From the anamnesis: He has been ill for 5-6 days, he did not go to the doctors. Objectively: On examination, the body temperature is 37.6ºС. Palpation in the right iliac region is determined by the formation of an oval shape, motionless, 7.0x5.0 cm in size, moderately painful. Which of the following diagnoses is MOST likely? appendicular infiltrate acute enterocolitis acute appendicitis tumor of the caecum peritonitis #17 !A 52-year-old female patient came to the GP with complaints of pain in the right iliac region. From the anamnesis: 10 days ago, she was worried about pain in the right iliac region, nausea, vomiting, which stopped after 3 days. For the last 2 days there has been an increase in body temperature up to 38.5ºС, increased pain in the right iliac region. Objectively: Body temperature is 38.5ºС. On palpation of the abdomen, a sharply painful infiltrate with a softening area is determined. Which of the following complications is MOST likely? colon cancer hepatic abscess pylephlebitis perforation of the caecum abscess formation of appendicular infiltrate #18 !An 18-year-old patient addressed a GP with complaints of throbbing pain in the 1st finger of the right hand. From the anamnesis: 2 days ago he removed a splinter from under the nail, after which a white spot formed under the nail and pain began to bother him. MOST likely diagnosis? paronychia purulent wound of the finger subungual panaritium infected finger wound stab wound to finger #19 !A patient came to the GP with complaints of swelling and pain in the area of ​​the 3rd finger of the left hand. From the anamnesis: I did a manicure in the salon, after 4 days the above complaints appeared. Objectively: The periungual ridge is hyperemic, edematous, painful on palpation, pus is released from under it when pressed. MOST likely diagnosis? subungual panaritium paronychia erysipeloid finger phlegmon pandactylitis #20 !A 30-year-old man came to the clinic with complaints about the presence of a tumor-like formation in the right iliac region. From the anamnesis: A year ago he underwent an appendectomy for acute gangrenous appendicitis. Objectively: In the right iliac region in the area of ​​the postoperative scar in the standing position, a soft-elastic tumor-like formation is determined, which, in the prone position, is reduced into the abdominal cavity through a defect in the aponeurosis 2x3 cm in size. MOST likely diagnosis? irreducible hernia strangulated hernia postoperative ventral hernia suppuration of the postoperative wound abdominal abscess #21 !A 43-year-old woman. Complains of a feeling of heaviness, pain, fatigue in the legs when walking, swelling of the shins by the end of the working day, varicose veins. From anamnesis: She has been ill since she was 23. Objectively: In the vertical position of the patient, varicose veins in the form of nodes of various sizes are visible on the inner surface of the shins and thighs, the skin above them is not changed, palpation is painful. Which of the following is the MOST likely preliminary diagnosis? varicose veins of the lower extremities with an ulcer varicose veins of the lower extremities with inflammation varicose veins of the lower extremities without ulcers and inflammation varicose veins of the lower extremities with ulcers and inflammation varicose veins of the lower extremities without ulcers #22 !The man is 62 years old. Complains of intermittent chromaticity, pain in the left lower limb, chilliness of the left foot. From anamnesis: Ill for 10 years. Smokes. At first, the patient could walk 500 m without pain in the left shin, then he could walk less than 200 m before the pain appeared. Recently, pain occurs when walking up to 25 m. Objectively: The skin of the left foot and lower leg are pale, cool to the touch, active movements in full. The pulsation of the femoral artery on the left is distinct, above the popliteal, posterior tibial arteries is not determined. Which of the listed preliminary diagnoses is MOST likely? obliterating atherosclerosis of the arteries of the left lower limb. Ischemia 2A art . obliterating atherosclerosis of the arteries of the left lower limb. Ischemia of 1 art. obliterating atherosclerosis of the arteries of the left lower limb. Ischemia 3 art . obliterating atherosclerosis of the arteries of the left lower limb. Ischemia 4 art . obliterating atherosclerosis of the arteries of the left lower limb. Ischemia 2B art . #23 !A 34-year-old woman. I went to a general practitioner with complaints of pain on the medial surface of the left shin in the lower and middle thirds of the thigh. From anamnesis: The pain appeared 3 days ago in the shin area and subsequently spread to the thigh. Body temperature rose to 37.5ºС, walking became difficult. Objectively: When examined along the course of the varicose-altered left large subcutaneous vein of the lower leg and thigh, there is hyperemia of the skin, palpation in this area determines a painful weight. Palpation in the groin area is painful. There is no swelling of the foot and lower leg. Which of the listed preliminary diagnoses is MOST likely? acute deep vein thrombophlebitis acute thrombophlebitis of superficial veins​ obliterating atherosclerosis obliterating endarteritis post-phlebitic syndrome #24 !The man is 45 years old. I went to the doctor with complaints of unpleasant sensations after the act of defecation, itching in the anal canal, bleeding with the release of scarlet blood unmixed with feces. Objectively: With an objective examination during straining below the Hilton line, in the projection of «7 o'clock», an oblong tumor-like formation with ulceration in the apex area and traces of hemorrhage is determined. What is the MOST likely preliminary diagnosis? chronic external hemorrhoids acute paraproctitis chronic paraproctitis rectal polyp rectal prolapse #25 !The young man is 18 years old. I turned to a general practitioner with complaints of an increase in body temperature to 39.0ºС, chills, general weakness, intense, acute pain in the perineum area, which increases with straining, the act of defecation. Objectively: When examining the anal area, there is hyperemia of the skin to the right of the anus, swelling and swelling of tissues, with palpation, sharp soreness and fluctuation. What is the MOST likely preliminary diagnosis? acute submucosal paraproctitis acute subcutaneous paraproctitis acute sciorectal paraproctitis acute pelviorectal paraproctitis acute retroectal paraproctitis

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