months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical
examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like.
Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and
glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and
negative urobilinogene reaction. Where is the initial process that caused these changes?
A. In pancreas
B. In common bile duct
C. In liver
D. In duodenum
E. In gallbladder
Explanation: Feces is light color it means patient has obstructive jaundice that is caused by cancer developed on pancreatic head. Gallbladder enlarged due to bile flow obstruction by pancreatic head cancer. Elderly, smoking is risk factor. weight is alarm sign for cancer.
32). A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and
feeling of abdominal swelling in approximately 30 minutes after meals. He lost 10 kg during the
last months because he doesn’t eat in order to avoid pain. Abdomen examination reveals no
changes in the periods between pain attacks. Above the right femoral artery a murmur can be
auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of stomach
and colonoscopy reealed no changes. What is the leading factor of this pathogenesis?
A. Ischemia
B. Psychogenic changes
C. Neoplastic process
D. Inflammation
E. Transient obstruction
Explanation :Elderly patients most viable to develop atherosclerosis and it causes blockade of artery resulting ischemia. in above situation,murmur was due to blockade of right femoral artery,and weak peripheral pulse.
33). A 38 y.o. woman was hospitalized to the surgical unit with acute abdominal pain irradiating
to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is
suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforative gastric ulcer
E. Acute appendicitis
Explanation : Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal. Acute pancreatitis is associated with alcoholism. Diagnosis- hemorrhagic pancreatitis.
34). A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to
38, 50, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and
mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed.
What is the most probable diagnosis?
A. Acute dysentery
B. Amebiasis
C. Colibacillosis
D. Nonspecific ulcerative colitis
E. Malignant tumors of large intestine
Explanation:Dysentery is an intestinal inflammation, especially in the colon, that can lead to severe diarrhea with mucus or blood in the feces. Patients typically experience mild to severe abdominal pain or stomach cramps.
35). A 50 y.o. woman for 1 year complained of attacks of right subcostal pain after fatty meal.
Last week the attacks have repeated every day and become more painful. What diagnostic
study would you recommend?
A. Ultrasound examination of the gallbladder
B. Liver function tests
C. X-ray examination of the gastrointestinal tract
D. Ultrasound study of the pancreas
E. Blood cell count
Explanation: patient suspected to have cholecystitis so gold standard is USG of gallbladder .
36). A 39 y.o. woman complaines of squeezed epigastric pain 1 hour after meal and heartburn.
She had been ill for 2 years. On palpation, there was moderate tenderness in pyloroduodenal
area. Antral gastritis was revealed on gastroscopy. What study can establish genesis of the
disease?
A. Revealing of Helicobacter infection in gastric mucosa
B. Detection of autoantibodies in the serum
C. Gastrin level in blood
D. Examination of stomach secretion
E. Examination of stomach motor function
Explanation: Helicobacter is most prevalence in antrum area and leads to antral gastritis.
37). A patient complains of feeling heaviness behind his breast bone, periodical sensation of
food stoppage, dysphagy. During the X-ray examination barium contrast revealed a single
saccular outpouching of anterodextral esophagus wall with regular contours and rigidly
outlined neck. What is the most probable diagnosis?
A. Esophageal diverticulum
B. Cancer of esophagus
C. Hiatal hernia
D. Varix dilatation of esophageal veins
E. Esophageal polyp
Explanation:X-ray barium contrast revealed a single saccular outpouching of anterodextral esophagus wall which indicates esophageal diverticulum.
38). A patient suffers from chronic recurrent pancreatitis with evident disturbance of
exocrinous function. After intake of rich spicy food and spirits his stool becomes fatty. Reduced
production of what factor is the most probable cause of steatorrhea?
A. Lipase
B. Tripsin
C. Acidity of gastric juice
D. Amylase
E. Alkaline phosphatase
Explanation: Pancreatic enzyme (lipase) which is essential for conversion of triglyceride to monoglycerides and free fatty acids which is absorbed. Due to lipase deficiency cause fatty stool. Thus, chronic pancreatitis is treated by pancreatic enzyme replacement (pancreatine).
39). A 45 y.o. man complains of having intensive pain in the epigastric region 1,5- 2 hours later
after food intake. He has been suffering from ulcer for 11 years. Objectively: t 0- 36, 50, RR-
16/min, Ps- 70 bpm, AP- 120/80 mm Hg. On palpation: local painfulness in the right epigastric
region. What parameters of intragastric Ph-meter in the region of stomach body are the most
typical for this patient’s disease?
A. рН = 1,0-2,0
B. рН = 3,0-4,0
C. рН = 4,0-5,0
D. рН = 5,0-6,0
E. рН = 6,0-7,0
Explanation:As Ph( 1,0-2,0) value decrease means more acidity and intensive pain indicate high acidity.
40). A patient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting,
aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of
hepatic cirrhosis is meant?
A. Hepatocellular insufficiency
B. Hemorrhage from varicosely dilatated veins of esophagus
C. Portal hypertension
D. Acute stomach ulcer
E. Thrombosis of mesenteric vessels
Explanation: Hepatic insufficiency is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology.
Fetor hepaticus also known as breath of the dead or hepatic foetor, is a condition seen in portal hypertension where portosystemic shunting allows thiols(sulfur containing analogue of alcohols) to pass directly into the lungs.
In this patient have headache, insomnia due to accumulation of nitrogenous compound.
part 5
