vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side
of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is
the most likely diagnosis?
A. Perforative ulcer
B. Acute cholecystitis
C. Acute bowel obstruction
D. Acute appendicitis
E. Right-sided renal colic
Explanation: Correct answer is Acute cholecystitis but in krok base gives perforative ulcer.
12). A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from
heart ichemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition,
distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy:
some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable
diagnosis?
A. Mesenterial vessels thrombosis
B. Volvulus
C. Acute intestinal obstruction
D. Ichemic abdominal syndrome
E. Erysipelas
Explanation: Bowel loop dark blue due to ischemia which is caused by thrombosis because she had history of heart ischemia and diffuse cardiosclerosis.
13). A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive
girdle pain in the abdomen. Profuse nonformed stool 2- 3- times a day has appeared for the last
2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood
amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most
reasonable treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium
Explanation: Patient had history of alcoholism for 20 years. alcoholism is major cause of pancreatitis. since 20 year alcoholism history patient develop chronic pancreatitis so there is defficiency of pancreatitic 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. Thus, chronic pancreatitis is treated by pancreatic enzyme replacement (pancreatine).
14). A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On
rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous. In blood: WBC- 9, 8 ∗ 109/L, RBC- 3, 0 ∗ 1012/L, sedimentation rate- 52
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for Ulcerative colitis is sulfasalizine.
15). A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia,
following the semolina’s introduction (since 5 months). The child is adymanic, flabby, pale dry
skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on
percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color,
foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?
A. Celiakia (celiac disease)
B. Mucoviscidosis (cystic fibrosis)
C. Intestinal dysbacteriosis
D. Chronic enteritis
E. Disaccharidase insufficiency
Explanation: Semolina’s is purified wheat. In this case patient develop celiac disease which is an autoimmune disease caused by intolerance to gluten (protein found in wheat). which act as antigen and forms an immune complex in intestinal mucosa. Thus, cause malabsorption syndrome (loss of villi and proliferation of crypt cells). Coprocytogram show a lot of natural fat main feature of malabsorption.
16). A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the
gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to
medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal
area. Which complication development aggravated the patient’s state?
A. Malignisation
B. Penetration
C. Perforation
D. Haemorrhage
E. Stenosis
Explanation: Constant pain due to the stomach ulcer , increasing and resistant to medication is feature of penetration but in krok base Malignisation is correct answer. Malignisation is less common develop in younger age(25 year).
17). A male patient complains of heartburn which gest stronger while bending the body,
substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be
expected at gastroscopy?
A. Gastroesophageal reflux
B. Chronic gastritis
C. Gastric peptic ulcer
D. Acute erosive gastritis
E. Duodenal peptic ulcer
Explanation: Main feature of Gastroesophageal reflux is substernal pain during swallowing which is aggravated during bending forward. Heartburn due to acid reflux.
18). A 43 y.o. male complains of stomach pain, which relieves with defecation, and is
accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent
need for bowel movement, constipation or diarrhea in alternation. These symptoms have
lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Spastic colitisC. Colitis with hypertonic type dyskinesia
D. Chronic enterocolitis, exacerbation phase
E. Atonic colitis
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
19). A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems
with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses.
Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes
constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions,
smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged.
Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is
the preliminary diagnosis?
A. Cancer of esophagus
B. Diaphragmatic hernia
C. Diffuse constriction of esophagus
D. Myasthenia
E. Esophageal achalasia
Explanation : Elderly, Alcoholism, smokes is associated with esophageal squamous cell carcinoma . In esophageal carcinoma, there is progressive dysphasia i.e initially solid food later liquid also. Weight loss is one of the alarm sign of cancer.
20). A 38 y.o. man complains of having occasional problems with swallowing of both hard and
fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially
after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his
general condition is satisfactory, skin is of usual colour. Examination revealed no changes of
gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of
fluid in it. What is the preliminary diagnosis?
A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux
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.
