Correct answer for all Question is A
51). A 27 year old man complains of pains in epigastrium which are relieved by food intake.
EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori.
Diagnosis is:
A. Gastritis of type B
B. Gastritis of type A
C. Reflux-gastritis
D. Menetrier’s gastritis
E. Rigid antral gastritis
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
52). A 75 year old man who has been suffering from diabetes for the last six months was found
to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6
months. Physical examination revealed a hard, globular, right upper quadrant mass that moves
during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling
defects in the liver. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas
B. Infectious hepatitis C. Haemolytic jaundice
D. Malignant biliary stricture
E. Metastatic disease of liver
Explanation: Elderly is risk factor. weight is alarm sign for cancer. On examination, hard, globular mass which move during respiration . CT scan shows enlargement of the head of the pancreas that indicate cancer.
53). A 22 year old woman complained of right subcostal aching pain, nausea, and decreased
appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in
an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the
subicteric sclerae, enlarged fi- rm liver. Your preliminary diagnosis:
A. Chronic viral hepatitis
B. Calculous cholecystitis
C. Gilbert’s disease
D. Acute viral hepatitis
E. Chronic cholangitis
Explanation:Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Many people have no symptoms, but some have vague symptoms, such as a general feeling of illness, poor appetite, fatigue and sign of jaundice.
54). A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and
weight loss since 4 months. Suggested diagnosis?
A. Cancer of the esophagus
B. Esophageal achalasia
C. Hanter’s disease
D. Esophagitis
E. Esophageal diverticulum
Explanation: Elderly, tabacco, alcoholism is risk factor of developing cancer, dysphasia and weight loss is alarm sigh of esophageal cancer.
55). A healthy 75 year old woman who leads a moderately active way of life went through a
preventive examination that revealed serum concentration of common cholesterol at the rate
of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG
reveals no pathology. What dietary recommendation is the most adequate?
A. Any dietary changes are necessary
B. Decrease of cholesterol consumption
C. Decrease of saturated fats consumption
D. Decrease of carbohydrates consumption
E. Increase of cellulose consumption
Explanation: Given condition everything is normal so Any dietary changes are necessary.
56). A 54 year old male patient complains about permanent dull pain in the mesogastral region,
weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In
blood: erythrocytes: 3, 5·1012/l, Hb- 87 g/l, leukocytes - 12, 6 · 109/l, stab neutrophil shift, ESR-
43 mm/h. What is the most probable diagnosis?
A. Cancer of transverse colon
B. Gastric ulcer
C. Chronic colitis
D. Chronic pancreatitis
E. Stomach cancer
Explanation: Mesogastral region is middle portion of stomach transverse colon located at that region. Weight loss and bleeding is alarm sign of cancer. elder patient more vulnerable to have cancer.
57). A 32 year old patient suffering from chronic viral hepatitis complains about dull pain in the
right subcostal area, nausea, dry mouth. Objectively: liver dimensions are 13-21-11 cm
(according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is 3,2
micromole/l·h, alanine aminotransferase - 4,8 millimole/l·h. Serological study revealed HBeAg,
high concentration of DNA HBV . What drug should be chosen for treatment of this patient?
A. α-interferon
B. Acyclovir
C. Remantadinum
D. Arabinoside monophosphate
E. Essentiale-forte
Explanation: α-interferon is used to treat chronic viral hepatitis.
58). A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On
rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous membrane. In blood: WBC- 9, 8 · 109/l, RBC- 3, 0 · 1012/l, ESR - 52
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfosalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for nonspecific Ulcerative colitis is sulfasalizine.
59). A patient suffering from gastroesophageal reflux has taken from time to time a certain
drug that "reduces acidity"for 5 years. This drug was recommended by a pharmaceutist. The
following side effects are observed: osteoporosis, muscle weakness, indisposition. What drug
has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. 2-blocker
D. Metoclopramide
E. Gastrozepin
Explanation: Antacid used to treat GERD. which neutralize gastric acid. osteoporosis, muscle asthenia, indisposition are side effect of Aluminium-bearing antacid.
60). A 20-year old woman has a 3-4 month history of bloody diarrhoea; stool examination
proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter
and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and
sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:
A. Ulcerative colitis
B. Gastroenteritis
C. Carcinoid syndrome
D. Zollinger-Ellison syndrome
E. Granulomatous colitis
Explanation: ulcerative colitis is a chronic inflammatory disease of the colon and rectum , which develops starting from the rectum. Symptoms include bloody diarrhoea, pain during defication , rectal and sigmoid colon ulceration.
61). A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal
pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently,
she noticed yellow discoloration of her sclera and skin. On physical examination the patient was
found to be febrile with temp. of 38, 9oC, along with right upper quadrant tenderness. The
most likely diagnosis is:
A. Choledocholithiasis
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
Explanation:
5F are to risk factors for the development of cholelithiasis in an event of upper abdominal pain:
Fair: more prevalent in Caucasian population(fair)
Fat: BMI >30
Female gender
Fertile: one or more children
Forty: age ≥40
62). In which of the following disorders does the pathophysiology of portal hypertension involve
presinusoidal intrahepatic obstruction?
A. Congenital hepatic fibrosis
B. Alcoholic cirrhosis
C. Hemochromatosis
D. Budd-Chiari syndrome
E. Cavernomatous transformation of the portal vein
63). A 50-year-old man comes to the emergency room with a history of vomiting of 3 days’
duration. His past history examination reveals that for about 20 years he has been suffering
from epigasric pain lasting for 2 to 3 weeks, during early spring and autumn. He remembers
getting relief from pain by taking milk and antacids. Physical examination showed a fullness in
the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel
sounds. The most likely diagnosis is:
A. Gastric outlet obstruction
B. Small bowel obstruction
C. Volvulus of the colon
D. Incarcerated umbilical hernia
E. Cholecystitis
Explanation: Obstruction of gastric out cause fullness in epigastric region with visible peristalsis. Obstruction is one of the complication of duodenal ulcer (environmental risk factor spring and autumn).
64). A 24-year-old law student is brought to the emergency room complaining of severe
abdominal pain of 6-8 hours duration. He had been to a party the night before. The pain is in
the epigastrium radiating to the back and is accompanied by nausea. The patient had vomited
twice prior to coming to the emergency room. Clinical examination revealed that the young
man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of
100/68 mm Hg, and body temperature of 38, 1oC. The most likely diagnosis is:
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Acute diverticulitis
E. Mesenteric adenitis
Explanation : Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal. Acute pancreatitis is associated with alcoholism.
65). A 45-year-old woman, mother of four children, comes to the emergency room complaining
of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back,
accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant,
bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of
amylase, lipase, and bilirubin. The most likely diagnosis is:
A. Acute cholecystitis
B. Perforated peptic ulcer disease
C. Myocardial infarction
D. Sigmoid diverticulitis
E. Acute pancreatitis
66). A female patient has been suffering from pain in the right subcostal area, bitter taste in the
mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the
evening is 37, 6oC. Sonography revealed that bile bladder was 5,5Ñ…2,7 cm large, its wall - 0,4
cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic
formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations
are up to 0,3 cm thick. What is the most likely diagnosis?
A. Alveolar echinococcus of liver
B. Liver cancer
C. Liver abscess
D. Cystous liver cancer
E. Paravesical liver abscesses
Explanation: Echinococcosis, also called hydatid disease, It is a parasitic disease of tapeworms of the Echinococcus type. The two main types of the disease are alveolar echinococcosisand cystic echinococcosis . USG show multiple hypo-echoic cyst like formation.
67). In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after
having meals and at night. He complains about pyrosis and constipation. The pain is getting
worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-
water bag. The patient has been suffering from this disease for a year. Objectively: furred moist
tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal
muscles in the same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose 1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.
68). 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, light-colored 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
69). A patient suffering from gastroesophageal reflux has taken from time to time a certain
drug that "reduces acidity"over 5 years. This drug was recommended by a pharmaceutist. The
following side effects are observed: osteoporosis, muscle asthenia, indisposition. What drug
has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. H2-blocker
D. Metoclopramide
E. Gastrozepin
Explanation: Antacid used to treat GERD. which neutralize gastric acid. osteoporosis, muscle asthenia, indisposition are side effect of Aluminium-bearing antacid.
70). In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having
meals and at night. He complains of pyrosis and constipation. The pain is getting worse after
consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag.
The patient has been suffering from this disease for a year. Objectively: furred moist tongue.
Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the
same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose 1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.
71). 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 located above
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 :steato
72). A 43-year-old female patient complains of unstable defecation with frequent constipations,
abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are
these clinical presentations typical for?
A. Irritable colon syndrome
B. Chronic enteritis
C. Chronic pancreatitis
D. Chronic atrophic gastritis
E. Colorectal cancer
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.
73). A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the
epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach
nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on
palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood:
Hb - 110 g/l, RBCs - 3, 4 · 1012/l, WBC count is normal. ESR - 16 mm/h. What is the most
informative study that will allow make a diagnosis?
A. Esophageal gastroduodenoscopy
B. X-ray of digestion organs
C. Study of gastric juice
D. pH-metry
E. Duodenal probing
74). A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups,
voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months).
Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart
sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation.
Liver is not enlarged. What study is required to make a diagnosis?
A. Esophageal duodenoscopy along with biopsy
B. Clinical blood test
C. X-ray of digestive tract organs
D. X-ray in Trendelenburg’s position
E. Study of gastric secretion
Explanation :- There is loss of weight, deglutition problem with solid food thus, patient is suspected to have cancer and the best method of investigation in this case is Esophagogastroduodenoscopy with biopsy.
75) . A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the
right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two
days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are
icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner’s,
Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s symptoms are positive. Which method should be
applied for diagnosis in the first place?
A. USI of gallbladder and biliary duct
B. Fibrogastroduodenoscopy
C. X-ray of abdominal organs
D. Radionuclide scanning of liver and gallbladder
E. Diagnostic laparotomy
Explanation: Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s sign are positive in acute cholecystitis. USG is gold-standard for hepatobiliary disorder.
To be continued.. part 4
51). A 27 year old man complains of pains in epigastrium which are relieved by food intake.
EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori.
Diagnosis is:
A. Gastritis of type B
B. Gastritis of type A
C. Reflux-gastritis
D. Menetrier’s gastritis
E. Rigid antral gastritis
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
52). A 75 year old man who has been suffering from diabetes for the last six months was found
to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6
months. Physical examination revealed a hard, globular, right upper quadrant mass that moves
during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling
defects in the liver. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas
B. Infectious hepatitis C. Haemolytic jaundice
D. Malignant biliary stricture
E. Metastatic disease of liver
Explanation: Elderly is risk factor. weight is alarm sign for cancer. On examination, hard, globular mass which move during respiration . CT scan shows enlargement of the head of the pancreas that indicate cancer.
53). A 22 year old woman complained of right subcostal aching pain, nausea, and decreased
appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in
an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the
subicteric sclerae, enlarged fi- rm liver. Your preliminary diagnosis:
A. Chronic viral hepatitis
B. Calculous cholecystitis
C. Gilbert’s disease
D. Acute viral hepatitis
E. Chronic cholangitis
Explanation:Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Many people have no symptoms, but some have vague symptoms, such as a general feeling of illness, poor appetite, fatigue and sign of jaundice.
54). A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and
weight loss since 4 months. Suggested diagnosis?
A. Cancer of the esophagus
B. Esophageal achalasia
C. Hanter’s disease
D. Esophagitis
E. Esophageal diverticulum
Explanation: Elderly, tabacco, alcoholism is risk factor of developing cancer, dysphasia and weight loss is alarm sigh of esophageal cancer.
55). A healthy 75 year old woman who leads a moderately active way of life went through a
preventive examination that revealed serum concentration of common cholesterol at the rate
of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG
reveals no pathology. What dietary recommendation is the most adequate?
A. Any dietary changes are necessary
B. Decrease of cholesterol consumption
C. Decrease of saturated fats consumption
D. Decrease of carbohydrates consumption
E. Increase of cellulose consumption
Explanation: Given condition everything is normal so Any dietary changes are necessary.
56). A 54 year old male patient complains about permanent dull pain in the mesogastral region,
weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In
blood: erythrocytes: 3, 5·1012/l, Hb- 87 g/l, leukocytes - 12, 6 · 109/l, stab neutrophil shift, ESR-
43 mm/h. What is the most probable diagnosis?
A. Cancer of transverse colon
B. Gastric ulcer
C. Chronic colitis
D. Chronic pancreatitis
E. Stomach cancer
Explanation: Mesogastral region is middle portion of stomach transverse colon located at that region. Weight loss and bleeding is alarm sign of cancer. elder patient more vulnerable to have cancer.
57). A 32 year old patient suffering from chronic viral hepatitis complains about dull pain in the
right subcostal area, nausea, dry mouth. Objectively: liver dimensions are 13-21-11 cm
(according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is 3,2
micromole/l·h, alanine aminotransferase - 4,8 millimole/l·h. Serological study revealed HBeAg,
high concentration of DNA HBV . What drug should be chosen for treatment of this patient?
A. α-interferon
B. Acyclovir
C. Remantadinum
D. Arabinoside monophosphate
E. Essentiale-forte
Explanation: α-interferon is used to treat chronic viral hepatitis.
58). A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On
rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous membrane. In blood: WBC- 9, 8 · 109/l, RBC- 3, 0 · 1012/l, ESR - 52
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfosalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for nonspecific Ulcerative colitis is sulfasalizine.
59). A patient suffering from gastroesophageal reflux has taken from time to time a certain
drug that "reduces acidity"for 5 years. This drug was recommended by a pharmaceutist. The
following side effects are observed: osteoporosis, muscle weakness, indisposition. What drug
has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. 2-blocker
D. Metoclopramide
E. Gastrozepin
Explanation: Antacid used to treat GERD. which neutralize gastric acid. osteoporosis, muscle asthenia, indisposition are side effect of Aluminium-bearing antacid.
60). A 20-year old woman has a 3-4 month history of bloody diarrhoea; stool examination
proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter
and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and
sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:
A. Ulcerative colitis
B. Gastroenteritis
C. Carcinoid syndrome
D. Zollinger-Ellison syndrome
E. Granulomatous colitis
Explanation: ulcerative colitis is a chronic inflammatory disease of the colon and rectum , which develops starting from the rectum. Symptoms include bloody diarrhoea, pain during defication , rectal and sigmoid colon ulceration.
61). A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal
pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently,
she noticed yellow discoloration of her sclera and skin. On physical examination the patient was
found to be febrile with temp. of 38, 9oC, along with right upper quadrant tenderness. The
most likely diagnosis is:
A. Choledocholithiasis
B. Benign biliary stricture
C. Malignant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
Explanation:
5F are to risk factors for the development of cholelithiasis in an event of upper abdominal pain:
Fair: more prevalent in Caucasian population(fair)
Fat: BMI >30
Female gender
Fertile: one or more children
Forty: age ≥40
62). In which of the following disorders does the pathophysiology of portal hypertension involve
presinusoidal intrahepatic obstruction?
A. Congenital hepatic fibrosis
B. Alcoholic cirrhosis
C. Hemochromatosis
D. Budd-Chiari syndrome
E. Cavernomatous transformation of the portal vein
duration. His past history examination reveals that for about 20 years he has been suffering
from epigasric pain lasting for 2 to 3 weeks, during early spring and autumn. He remembers
getting relief from pain by taking milk and antacids. Physical examination showed a fullness in
the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel
sounds. The most likely diagnosis is:
A. Gastric outlet obstruction
B. Small bowel obstruction
C. Volvulus of the colon
D. Incarcerated umbilical hernia
E. Cholecystitis
Explanation: Obstruction of gastric out cause fullness in epigastric region with visible peristalsis. Obstruction is one of the complication of duodenal ulcer (environmental risk factor spring and autumn).
64). A 24-year-old law student is brought to the emergency room complaining of severe
abdominal pain of 6-8 hours duration. He had been to a party the night before. The pain is in
the epigastrium radiating to the back and is accompanied by nausea. The patient had vomited
twice prior to coming to the emergency room. Clinical examination revealed that the young
man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of
100/68 mm Hg, and body temperature of 38, 1oC. The most likely diagnosis is:
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Acute diverticulitis
E. Mesenteric adenitis
Explanation : Acute abdominal pain irradiating to the spine is hallmark for pancreatitis. pancreas location retroperitoneal. Acute pancreatitis is associated with alcoholism.
65). A 45-year-old woman, mother of four children, comes to the emergency room complaining
of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back,
accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant,
bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of
amylase, lipase, and bilirubin. The most likely diagnosis is:
A. Acute cholecystitis
B. Perforated peptic ulcer disease
C. Myocardial infarction
D. Sigmoid diverticulitis
E. Acute pancreatitis
66). A female patient has been suffering from pain in the right subcostal area, bitter taste in the
mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the
evening is 37, 6oC. Sonography revealed that bile bladder was 5,5Ñ…2,7 cm large, its wall - 0,4
cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic
formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations
are up to 0,3 cm thick. What is the most likely diagnosis?
A. Alveolar echinococcus of liver
B. Liver cancer
C. Liver abscess
D. Cystous liver cancer
E. Paravesical liver abscesses
Explanation: Echinococcosis, also called hydatid disease, It is a parasitic disease of tapeworms of the Echinococcus type. The two main types of the disease are alveolar echinococcosisand cystic echinococcosis . USG show multiple hypo-echoic cyst like formation.
67). In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after
having meals and at night. He complains about pyrosis and constipation. The pain is getting
worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-
water bag. The patient has been suffering from this disease for a year. Objectively: furred moist
tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal
muscles in the same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose 1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.
68). 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, light-colored 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
69). A patient suffering from gastroesophageal reflux has taken from time to time a certain
drug that "reduces acidity"over 5 years. This drug was recommended by a pharmaceutist. The
following side effects are observed: osteoporosis, muscle asthenia, indisposition. What drug
has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. H2-blocker
D. Metoclopramide
E. Gastrozepin
Explanation: Antacid used to treat GERD. which neutralize gastric acid. osteoporosis, muscle asthenia, indisposition are side effect of Aluminium-bearing antacid.
70). In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having
meals and at night. He complains of pyrosis and constipation. The pain is getting worse after
consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag.
The patient has been suffering from this disease for a year. Objectively: furred moist tongue.
Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the
same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Explanation: Duodenal ulcer is associated stomach pain that arose 1.5-2.5 hours after having meal and get relief by meal. Spring and autumn are environmental risk factor for duodenal ulcer.
71). 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 located above
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 :steato
72). A 43-year-old female patient complains of unstable defecation with frequent constipations,
abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are
these clinical presentations typical for?
A. Irritable colon syndrome
B. Chronic enteritis
C. Chronic pancreatitis
D. Chronic atrophic gastritis
E. Colorectal cancer
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.
73). A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the
epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach
nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on
palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood:
Hb - 110 g/l, RBCs - 3, 4 · 1012/l, WBC count is normal. ESR - 16 mm/h. What is the most
informative study that will allow make a diagnosis?
A. Esophageal gastroduodenoscopy
B. X-ray of digestion organs
C. Study of gastric juice
D. pH-metry
E. Duodenal probing
74). A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups,
voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2,5 months).
Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart
sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation.
Liver is not enlarged. What study is required to make a diagnosis?
A. Esophageal duodenoscopy along with biopsy
B. Clinical blood test
C. X-ray of digestive tract organs
D. X-ray in Trendelenburg’s position
E. Study of gastric secretion
Explanation :- There is loss of weight, deglutition problem with solid food thus, patient is suspected to have cancer and the best method of investigation in this case is Esophagogastroduodenoscopy with biopsy.
75) . A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the
right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two
days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are
icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner’s,
Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s symptoms are positive. Which method should be
applied for diagnosis in the first place?
A. USI of gallbladder and biliary duct
B. Fibrogastroduodenoscopy
C. X-ray of abdominal organs
D. Radionuclide scanning of liver and gallbladder
E. Diagnostic laparotomy
Explanation: Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s sign are positive in acute cholecystitis. USG is gold-standard for hepatobiliary disorder.
To be continued.. part 4
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