81). 4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences
stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation
lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic
region. The amylase rate in blood is stable. X-ray reveals some calcifications
navel. What is the most likely diagnosis?
A. Chronic pancreatitis
B. Chronic gastroduodenitis
C. Duodenal ulcer
D. Zollinger-Ellison syndrome
E. Chronic calculous cholecystitis
Explanation: Chronic pancreatitis leads to Deficiency of pancreatic enzyme (lipase) which is essential for conversion of triglyceride to monoglycerides and free fatty acids which is absorbed. Due to lipase deficiency cause natural fat in stool i.e steatorrhea. X-ray reveals calcifications above naval is pathognomonic sign.
82). A 51-year-old female patient complains of frequent defecation and liquid blood-streaked
stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over
the previous month. Objectively: body temperature - 37, 4oC, malnutrition, skin is pale and dry.
Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense,
painful, extends 3 cm below the costal margin. What is the most likely diagnosis?
A. Non-specific ulcerative colitis
B. Bacillary dysentery
C. Sprue
D. Intestinal enzymopathy
E. Helminthic invasion
Explanation: Nonspecific ulcerative colitis is a chronic inflammatory disease of the colon and rectum , which develops starting from the rectum. Usually, the periods of exacerbation of ulcerative colitis alternate with the absence of its evident symptoms.
83). A 50-year-old patient complains about having pain attacks in the right subcostal area for
about a year. He pain arises mainly after taking fattening food. Over the last week the attacks
occurred daily and became more painful. On the 3rd day of hospitalization the patient
presented with icteritiousness of skin and scleras, lightcolored feces and dark urine. In blood:
neutrophilic leukocytosis - 13, 1 · 109/l, ESR- 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
Explanation: lightcolored feces and dark urine indicate obstructive jaundice(icteritiousness of skin and scleras). Increase ESR and leucocytosis indicate inflammation. Right subcostal pain for one year it means chronic.
84). A 6-year-old child has duodenal ulcer. What antibacterial drug should be coadministered
together with metronidazole and De-Nol in order to eradicate Helicobacter pylori infection?
A. Amoxicillin
B. Tetracycline
C. Oleandomycin
D. Biseptol
E. Sulfadimethoxinum
Explanation: Triple therapy = PPI, Amoxycillin, clarithromysin.
Quadraple therapy: Bismuth(De-nol), ppI, metronidazole, tetracycline.
Note: Amoxicillin is given with metronidazole and denol along with PPI.
85). A 35-year-old patient complains of heartburn, sour eructation, burning, compressing
retrosternal pain and pain along the esophagus rising during forward bending of body. The
patient hasn’t been examined, takes Almagel on his own initiative, claims to feel better after its
taking. Make a provisional diagnosis:
A. Gastroesophageal reflux disease
B. Functional dyspepsia
C. Cardiospasm
D. Gastric ulcer
E. Duodenal ulcer
Explanation: Main feature of Gastroesophageal reflux is substernal pain during swallowing which is aggravated during bending forward. Heartburn due to acid reflux.
86). A patient complains of retrosternal pain, difficult swallowing, over 10 kg weight loss within
three months, general weakness. In blood: hypochromic anaemia, neutrophilic leukocytosis. In
feces: weakly positive Gregersen’s reaction. On esophagram a filling defect with ill-defined
serrated edges shows up along a large portion of the esophagus. What is the most likely
diagnosis?
A. Esophageal carcinoma
B. Benign tumour
C. Esophageal achalasia
D. Peptic ulcer
E. Sideropenic dysphagia
Explanation: sudden weight loss is alarm sign of cancer and patient have difficult in swallowing, esophagram show ill defined edge indicate esophageal cancer.
87).A 13-year-old girl has a 5-year history of pain in the right hypochondrium irradiating to the right
shoulder blade. The pain attacks are usually associated with diet violations, they are short and can be
easily relieved by antispasmodic drugs. During a pain attack, palpation of the abdomen is painful, the
pain is most intensive in the projection of the gallbladder. What is the most likely diagnosis?
A.Biliary dyskinesia
B.Chronic cholecystitis
C.Chronic gastroduodenitis
D.Chronic pancreatitis
E.Duodenal ulcer
Explanation: Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi. The motility disorder of the gallbladder is called gallbladder dyskinesia. antispasmodic drug relief the pain.
88).A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left, that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis. Blood amylase is 4 g/h·l. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6,0 mmol/l. What treatment is indicated forth is patient?
A.Panzinorm forte
B.Insulin
C.Gastrozepin
D.Contrycal
E.No-spa
Explanation :This patient suspect to have chronic pancreatitis because history of acute pancreatitis and coprogram show steatorrhea so pancreatic enzyme(panzinorm forte) should be replaced.
89).A 24-year-old female patient complains of pain in the right hypochondrium that is getting worse after taking meals; nausea, fever up to37,7oC, icteric skin, pain in the large joints. These presentations have been observed for 8 months. Objectively: hepatosplenomegaly. Blood test results: ESR- 47 mm/h, total bilirubin - 86,1 mmol/l, direct bilirubin - 42,3 mmol/l. Total protein - 62 g/l, albumins - 40%, globulins - 60%, gamma globulins - 38%. Viral hepatitis markers were not detected. The antibodies to smooth muscle cells are present. On ultrasound the portal vein diameter was of 1 cm. What is the most likely diagnosis?
A.Autoimmune hepatitis
B.Primary biliary cirrhosis
C.Gilbert’s syndrome
D.Cholangiogenic hepatitis
E.Hemachromatosis
Explanation: Antibodies to smooth muscle cells specific for Autoimmune hepatitis.
90). A 57-year-old female complains of having a sensation of esophageal compresion, palpitation, difficult breathing during eating solid food, occasional vomiting with a full mouth, "wet pillow"sign at night for the last 6 months. Objectively: body tempearture -39 oC, height - 168 cm, weight - 72 kg, Ps- 76/min, АP- 120/80 mm Hg. X-ray revealed a considerable dilation of esophagus and its constriction in the cardial part. What pathology is most likely to have caused dysphagia in this patient?
A.Achalasia cardiae
B.Primary esophagism
C.Hiatal hernia
D.Esophageal carcinoma
E.Reflux esophagitis
Explanation: Achalasia is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing solid and liquid food from passing into the stomach. Bird beak or rat tail (esophageal dilatation with level of fluid ) radiological sign is specific for achalasia.
part 10
